Attention deficit hyperactivity disorder, commonly known as ADHD, is a neurodevelopmental condition that affects attention, activity levels, impulse control and self regulation.
ADHD begins during childhood, although some people are not diagnosed until adolescence or adulthood. It can influence learning, relationships, employment, emotional wellbeing and the ability to manage everyday responsibilities.
ADHD is not caused by laziness, poor parenting or a lack of intelligence. It reflects differences in how the brain develops and manages important functions such as attention, motivation, planning, working memory and emotional regulation.
Approximately one in twenty Australians has ADHD, although many people remain unidentified. Girls, women and people with primarily inattentive characteristics may be diagnosed later because their difficulties are often less outwardly noticeable.
ADHD Is More Than Difficulty Paying Attention
The name ADHD can be misleading because people with the condition do not necessarily have a complete lack of attention.
Many people with ADHD can focus intensely on activities that are interesting, urgent or personally meaningful. This is sometimes described as hyperfocus. However, they may find it much harder to direct or maintain attention when a task is repetitive, unclear or provides little immediate reward.
The difficulty is often with regulating attention rather than simply having too little attention.
ADHD may also affect executive functioning. These are the mental processes that help a person:
- Begin and complete tasks
- Organise time and belongings
- Remember instructions
- Decide what to prioritise
- Move attention between activities
- Control impulses
- Monitor emotions
- Work towards a future goal
A person may understand exactly what they need to do but still find it difficult to begin, organise or complete the task consistently.
The Three Presentations of ADHD
ADHD is commonly described through three presentations. A person’s presentation can change over time as their circumstances and support needs change.
1. Predominantly inattentive presentation
A person with inattentive characteristics may:
- Become distracted easily
- Forget appointments, tasks or instructions
- Lose belongings regularly
- Find organisation and time management difficult
- Make mistakes through missed details
- Appear not to listen
- Begin tasks but struggle to complete them
- Avoid activities requiring sustained mental effort
- Daydream or mentally drift away
This presentation can be overlooked because the person may not appear disruptive. A quiet child who looks out of the window, forgets instructions or submits incomplete work may be experiencing significant difficulties even if they are not disturbing the class.
2. Predominantly hyperactive and impulsive presentation
A person with hyperactive or impulsive characteristics may:
- Move, fidget or talk frequently
- Find it difficult to remain seated
- Feel internally restless
- Interrupt conversations
- Call out answers
- Act before considering the consequences
- Find waiting difficult
- Seek stimulation or excitement
- Make quick decisions
Hyperactivity can look different in adults. Instead of running or climbing, an adult may experience constant internal restlessness, speak rapidly, take on many activities or find quiet situations uncomfortable.
3. Combined presentation
A person with combined presentation experiences enough inattentive and hyperactive or impulsive characteristics to meet the diagnostic criteria for both groups.
The way these characteristics affect daily life can vary considerably. One person may struggle most with learning and organisation, while another may experience greater difficulties with emotional regulation, relationships or impulsive decisions.
What Causes ADHD?
There is no single cause of ADHD. Research indicates that genetics play a strong role, and ADHD often occurs in more than one member of a family.
Differences in brain development and function are also associated with the condition. Certain environmental and developmental factors may contribute to a person’s likelihood of developing ADHD, but these factors do not provide a simple explanation for an individual diagnosis.
ADHD is not caused by too much screen time, eating sugar, poor discipline or parents failing to set boundaries. These factors may affect behaviour or concentration in some situations, but they do not create ADHD.
How Is ADHD Diagnosed?
There is no single medical test, blood test or brain scan that can confirm ADHD.
In Australia, an assessment may be completed by an appropriately qualified paediatrician, psychiatrist or psychologist, depending on the person’s age, location and circumstances.
A comprehensive assessment usually considers:
- Developmental, medical and family history
- Current difficulties and strengths
- Information from home, school, work or other settings
- Standardised questionnaires
- The effect of the characteristics on daily functioning
- Other conditions that could produce similar experiences
For an ADHD diagnosis, the characteristics must have been present before twelve years of age, continued for at least six months and affected functioning in more than one setting. They must also be inconsistent with the person’s developmental stage and cause meaningful difficulty in daily life.
Everyone experiences distraction, forgetfulness or restlessness occasionally. ADHD is diagnosed when these patterns are persistent, occur across settings and significantly affect functioning.
Clinicians must also consider alternative explanations such as anxiety, depression, trauma, sleep difficulties, learning disorders, autism, medical conditions or environmental stress. ADHD can also occur alongside these conditions.
ADHD in Girls and Women
ADHD has historically been identified more often in boys. Girls and women may be overlooked because they are more likely to show inattentive characteristics or direct their difficulties inward.
They may appear quiet, anxious, disorganised or emotionally overwhelmed rather than visibly hyperactive. Some work extremely hard to hide their difficulties, which can lead to exhaustion, reduced confidence and delayed diagnosis.
Greater awareness is helping more girls and women receive assessments that consider how ADHD can present across different people.
How Is ADHD Supported?
ADHD support should be individualised. Depending on the person’s age and needs, it may include:
- Education about ADHD
- Positive parenting strategies
- Psychological support
- Organisational and time management strategies
- Environmental adjustments
- Support at school, university or work
- ADHD coaching
- Assistance with sleep, exercise and daily routines
- Medication prescribed and monitored by an authorised doctor
Australian clinical guidance recommends a multimodal approach, meaning that different forms of support may be combined. Medication can be effective for many people, but decisions should be made with a qualified health professional after considering potential benefits, risks and personal circumstances.
Recognising Strengths as Well as Challenges
ADHD can create genuine difficulties, but a diagnosis should not be treated as a description of everything a person can or cannot do.
People with ADHD may also demonstrate creativity, curiosity, energy, humour, spontaneity, determination and the ability to become deeply engaged in meaningful interests. These qualities vary between individuals and should not be used to minimise real support needs.
The goal of support is not to remove a person’s individuality. It is to reduce barriers, build practical skills and create conditions in which the person can function well.
The Most Important Message
ADHD is a recognised neurodevelopmental condition, not a character flaw or an excuse for poor behaviour.
With appropriate assessment, understanding and individualised support, children and adults with ADHD can develop effective strategies, build on their strengths and participate meaningfully in education, work, relationships and community life.
If ADHD characteristics are affecting your child’s or your own daily functioning, a general practitioner is a suitable first point of contact.
Sources
Healthdirect Australia: Attention Deficit Hyperactivity Disorder
Australian Evidence Based Clinical Practice Guideline for ADHD
