Attention-Deficit/Hyperactivity Disorder, or AD/HD, is generally diagnosed as one of three types, each with its own symptoms and way of developing. However, the most commonly diagnosed type is the combined hyperactive-impulsive and inattentive type of AD/HD.
Hyperactivity
Symptoms of hyperactivity typically are observed by 4 years of age and increase for the next three to four years, reaching their most severe when the child is 7 to 8 years old, then steadily decline. By the adolescent years, hyperactive symptoms are barely discernible. Behavior may include:
- excessive fidgetiness;
- excessive talking;
- difficulty remaining seated when required to do so;
- excessive running or climbing in inappropriate situations;
- difficulty playing quietly; and
- frequent restlessness or being always "on the go."
Impulsivity
Similar to symptoms of hyperactivity, impulsivity typically appears by age 4 and peaks when the child is 7 to 8 years old. In younger children, it almost always occurs in conjunction with hyperactivity. However, impulsive symptoms usually remain a problem throughout life. Behavior may include:
- difficulty waiting turns;
- blurting out answers too quickly;
- disruptive classroom behavior;
- intruding or interrupting other's activities; and
- unintentional injury.
Inattention
Children with the inattentive type of AD/HD usually are diagnosed at the age of 7 or 8, when the symptoms become noticeable. As with impulsivity, symptoms of inattention usually are a life-long problem. Behavior may include:
- forgetfulness;
- not listening to instructions;
- being easily distracted;
- losing or misplacing things;
- disorganization;
- avoiding tasks that require sustained mental effort;
- poor follow-through with assignments or tasks;
- poor concentration; and
- poor attention to detail.
Pattern of symptoms
In the younger ages, children often have combined hyperactive-impulsive symptoms. These symptoms often occur simultaneously with attention problems. However, roughly half of the children with AD/HD only have attention problems without significant hyperactive-impulsive behavior.
In addition to having a significant number of symptoms, children with AD/HD display persistent problems in multiple settings. Symptoms are always present prior to seven years of age, though the diagnosis may not occur until later. Finally, the symptoms of AD/HD must have a clear and significant impact in the child’s social or academic functioning.
As many as one-third of children with AD/HD have one or more comorbid conditions, such as conduct disorders, depression, anxiety disorder, and learning disabilities, which must be treated separately.
“Because the diagnosis of AD/HD is extensive and because comorbidity is a common finding, children should be reevaluated whenever the symptoms worsen or new symptoms emerge,” says Dr. Kevin Krull, head of the Child Neuropsychology Program and associate director at Texas Children’s Learning Support Center for Child Psychology.
