ADHD symptom manifestation in adulthood: moving beyond conceptualisations of inattention and hyperactivity/impulsivity

Abstract

Objectives: Screening tools for attention-deficit/hyperactivity disorder (ADHD) help to identify individuals likely to have ADHD. Several screening scales are used for identifying adults with ADHD, based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The ADHD symptoms described in the DSM were originally developed to describe the behaviours of children, not adults, and focus on the triad of symptoms of inattention, hyperactivity, and impulsivity. Clinical research and experience, however, have revealed additional dimensions of adult ADHD, such as hyperfocus, racing thoughts, emotional lability, impaired sleep, and differences in time perception. Commensurate with the conditions’ growing recognition, the adult ADHD presentation requires rethinking. Methods: To understand better the ADHD symptomatology experienced by adults, qualitative interviews were conducted with 11 diagnosed adults. Results: Using thematic analysis, nine themes of adult ADHD symptoms were identified. The first three themes map to the original triad of symptoms-attentional difficulties, hyperactivity, and impulsivity. A further three themes identified are briefly mentioned in the DSM-disorganisation, forgetfulness, and reduced activation. The final three themes are covered to some degree in the current rating scales but are absent from the DSM 5-emotional lability, sleep difficulties, and time perception difficulties. Conclusions: This study highlights nine themes relevant to adult ADHD, six of which are absent from the DSM 5’s triad. This research highlights gaps in current assessment tools and suggests symptoms that are more reflective of the adult experience of having ADHD.