Editing Attention deficit hyperactivity disorder (section)

=== {{anchor|ADHD-PH}} Presentations ===
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ADHD is divided into three primary presentations:<ref name=DSM5TR/><ref name="Ramsay_2007" />
* [[Attention deficit hyperactivity disorder predominantly inattentive|predominantly inattentive]] (ADHD-PI or ADHD-I)
* predominantly hyperactive-impulsive (ADHD-PH or ADHD-HI)
* combined presentation (ADHD-C).

The table "Symptoms" lists the symptoms for ADHD-I and ADHD-HI from two major classification systems. Symptoms which can be better explained by another psychiatric or medical condition which an individual has are not considered to be a symptom of ADHD for that person. In DSM-5, subtypes were discarded and reclassified as presentations of the disorder that change over time.
{| class="wikitable"
|+Symptoms
!Presentations
!width=45%|{{abbr|DSM-5|Diagnostic and Statistical Manual, 5th Edition}} and {{abbr|DSM-5-TR|Diagnostic and Statistical Manual, 5th Edition, Text Revision}} symptoms<ref name=DSM5/><ref name=DSM5TR/>
!width=45%|{{abbr|ICD-11|International Classification of Diseases |edition=11th}} symptoms<ref name="ICD-11" />
|-
|Inattention
|<!-- DSM-5 -->Six or more of the following symptoms in children, and five or more in adults, excluding situations where these symptoms are better explained by another psychiatric or medical condition:
* Frequently overlooks details or makes careless mistakes
* Often has difficulty maintaining focus on one task or play activity
* Often appears not to be listening when spoken to, including when there is no obvious distraction
* Frequently does not finish following instructions, failing to complete tasks
* Often struggles to organise tasks and activities, to meet deadlines, and to keep belongings in order
* Is frequently reluctant to engage in tasks which require sustained attention
* Frequently loses items required for tasks and activities
* Is frequently easily distracted by extraneous stimuli, including thoughts in adults and older teenagers
* Often forgets daily activities, or is forgetful while completing them.
|<!-- ICD-11 -->Multiple symptoms of inattention that directly negatively impact occupational, academic or social functioning. Symptoms may not be present when engaged in highly stimulating tasks with frequent rewards. Symptoms are generally from the following clusters:
* Struggles to maintain focus on tasks that are not highly stimulating/rewarding or that require continuous effort; details are often missed, and careless mistakes are frequent in school and work tasks; tasks are often abruptly abandoned in favour of another before they are completed.
* Easily distracted (including by own thoughts); may not listen when spoken to; frequently appears to be lost in thought
* Often loses things; is forgetful and disorganised in daily activities.

The individual may also meet the criteria for hyperactivity-impulsivity, but the inattentive symptoms are predominant.
|-
|Hyperactivity-Impulsivity
|<!-- DSM-5 -->Six or more of the following symptoms in children, and five or more in adults, excluding situations where these symptoms are better explained by another psychiatric or medical condition:
* Is often fidgeting or squirming in seat
* Frequently has trouble sitting still during dinner, class, in meetings, etc.
* Frequently runs around or climbs in inappropriate situations. In adults and teenagers, this may be present only as restlessness.
* Often cannot quietly engage in leisure activities or play
* Frequently seems to be "on the go" or appears uncomfortable when not in motion
* Often talks excessively
* Often answers a question before it is finished, or finishes people's sentences
* Often struggles to wait their turn, including waiting in lines
* Frequently interrupts or intrudes, including into others' conversations or activities, or by using people's things without asking.
|<!-- ICD-11 -->Multiple symptoms of hyperactivity/impulsivity that directly negatively impact occupational, academic or social functioning. Typically, these tend to be most apparent in environments with structure or which require self-control. Symptoms are generally from the following clusters:
* Excessive motor activity; struggles to sit still, often leaving their seat; prefers to run about; in younger children, will fidget when attempting to sit still; in adolescents and adults, a sense of physical restlessness or discomfort with being quiet and still.
* Talks too much; struggles to quietly engage in activities.
* Blurts out answers or comments; struggles to wait their turn in conversation, games, or activities; will interrupt or intrude on conversations or games.
* A lack of forethought or consideration of consequences when making decisions or taking action, instead tending to act immediately (e.g., physically dangerous behaviours including reckless driving; impulsive decisions).

The individual may also meet the criteria for inattention, but the hyperactive-impulsive symptoms are predominant.
|-
|Combined
|<!-- DSM-5 -->Meet the criteria for both inattentive and hyperactive-impulsive ADHD.
|<!-- ICD-11 -->Criteria are met for both inattentive and hyperactive-impulsive ADHD, with neither clearly predominating.
|}

Girls and women with ADHD tend to display fewer hyperactivity and impulsivity symptoms but more symptoms of inattention and distractibility.<ref>{{cite journal |vauthors=Gershon J |title=A meta-analytic review of gender differences in ADHD |journal=[[Journal of Attention Disorders]] |volume=5 |issue=3 |pages=143–154 |date=January 2002 |pmid=11911007 |doi=10.1177/108705470200500302 |s2cid=8076914}}</ref>

Symptoms are expressed differently and more subtly as the individual ages.<ref name="Kooij_2010">{{cite journal |vauthors=Kooij SJ, Bejerot S, Blackwell A, Caci H, Casas-Brugué M, Carpentier PJ, Edvinsson D, Fayyad J, Foeken K, Fitzgerald M, Gaillac V, Ginsberg Y, Henry C, Krause J, Lensing MB, Manor I, Niederhofer H, Nunes-Filipe C, Ohlmeier MD, Oswald P, Pallanti S, Pehlivanidis A, Ramos-Quiroga JA, Rastam M, Ryffel-Rawak D, Stes S, Asherson P |title=European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD |journal=[[BMC Psychiatry]] |volume=10 |issue=67 |page=67 |date=September 2010 |pmid=20815868 |pmc=2942810 |doi=10.1186/1471-244X-10-67 |doi-access=free}}</ref>{{rp|6|quote=Whereas the core symptoms of hyperactivity, impulsivity and inattention, are well characterised in children, these symptoms may have different and more subtle expressions in adult life.}} Hyperactivity tends to become less overt with age and turns into inner restlessness, difficulty relaxing or remaining still, talkativeness or constant mental activity in teens and adults with ADHD.<ref name="Kooij_2010"/>{{rp|pp=6–7 |quote=For instance, where children with ADHD may run and climb excessively, or have difficulty in playing or engaging quietly in leisure activities, adults with ADHD are more likely to experience inner restlessness, inability to relax, or over talkativeness. Hyperactivity may also be expressed as excessive fidgeting, the inability to sit still for long in situations when sitting is expected (at the table, in the movie, in church or at symposia), or being on the go all the time. ... For example, physical overactivity in children could be replaced in adulthood by constant mental activity, feelings of restlessness and difficulty engaging in sedentary activities.}} Impulsivity in adulthood may appear as thoughtless behaviour, impatience, irresponsible spending and sensation-seeking behaviours,<ref name="Kooij_2010"/>{{rp|6|quote=Impulsivity may be expressed as impatience, acting without thinking, spending impulsively, starting new jobs and relationships on impulse, and sensation seeking behaviours.}} while inattention may appear as becoming easily bored, difficulty with organisation, remaining on task and making decisions, and sensitivity to stress.<ref name="Kooij_2010"/>{{rp|6|quote=Inattention often presents as distractibility, disorganization, being late, being bored, need for variation, difficulty making decisions, lack of overview, and sensitivity to stress.}}

====Characteristics in childhood====
Difficulties managing anger are more common in children with ADHD,<ref>{{cite web |title=ADHD Anger Management Directory |publisher=Webmd.com |url=http://www.webmd.com/add-adhd/adhd-anger-management-directory |access-date=17 January 2014 |url-status=live |archive-date=5 November 2013 |archive-url=https://web.archive.org/web/20131105032151/http://www.webmd.com/add-adhd/adhd-anger-management-directory}}</ref> as are delays in [[communication disorder|speech, language]] and motor development.<ref name="ICD10"/><ref name="pmid22201208">{{cite journal |vauthors=Bellani M, Moretti A, Perlini C, Brambilla P |title=Language disturbances in ADHD |journal=Epidemiology and Psychiatric Sciences |volume=20 |issue=4 |pages=311–315 |date=December 2011 |pmid=22201208 |doi=10.1017/S2045796011000527 |doi-access=free}}</ref> Poorer [[handwriting]] is more common in children with ADHD.<ref name="Racine_2008">{{cite journal |vauthors=Racine MB, Majnemer A, Shevell M, Snider L |title=Handwriting performance in children with attention deficit hyperactivity disorder (ADHD) |journal=[[Journal of Child Neurology]] |volume=23 |issue=4 |pages=399–406 |date=April 2008 |pmid=18401033 |doi=10.1177/0883073807309244 |s2cid=206546871}}</ref> Poor handwriting can be a symptom of ADHD in itself due to decreased attentiveness. When this is a pervasive problem, it may also be attributable to [[dyslexic|dyslexia]]<ref>{{cite journal |vauthors=Peterson RL, Pennington BF |title=Developmental dyslexia |journal=[[The Lancet]] |volume=379 |issue=9830 |pages=1997–2007 |date=May 2012 |pmid=22513218 |pmc=3465717 |doi=10.1016/S0140-6736(12)60198-6}}</ref><ref>{{cite journal |vauthors=Sexton CC, Gelhorn HL, Bell JA, Classi PM |title=The co-occurrence of reading disorder and ADHD: epidemiology, treatment, psychosocial impact, and economic burden |journal=[[Journal of Learning Disabilities]] |volume=45 |issue=6 |pages=538–564 |date=November 2012 |pmid=21757683 |doi=10.1177/0022219411407772 |s2cid=385238}}</ref> or [[dysgraphia]]. There is significant overlap in the symptomatologies of ADHD, dyslexia, and dysgraphia,<ref name="Nicolson_2011">{{cite journal |vauthors=Nicolson RI, Fawcett AJ |title=Dyslexia, dysgraphia, procedural learning and the cerebellum |journal=Cortex; A Journal Devoted to the Study of the Nervous System and Behavior |volume=47 |issue=1 |pages=117–127 |date=January 2011 |pmid=19818437 |doi=10.1016/j.cortex.2009.08.016 |s2cid=32228208}}</ref> and 3 in 10 people diagnosed with dyslexia experience co-occurring ADHD.<ref>{{cite web |url=https://www.webmd.com/add-adhd/adhd-dyslexia-tell-apart |title=Dyslexia and ADHD |access-date=19 May 2022 |archive-date=21 February 2023 |archive-url=https://web.archive.org/web/20230221112159/https://www.webmd.com/add-adhd/adhd-dyslexia-tell-apart |url-status=live}}</ref> Although it causes significant difficulty, many children with ADHD have an attention span equal to or greater than that of other children for tasks and subjects they find interesting.<ref name="Walitza_2012">{{cite journal |vauthors=Walitza S, Drechsler R, Ball J |title= [The school child with ADHD] |language=de |journal=Therapeutische Umschau |volume=69 |issue=8 |pages=467–473 |date=August 2012 |pmid=22851461 |doi=10.1024/0040-5930/a000316 |trans-title=The school child with ADHD}}</ref>