As with all psychological disorders, in order to be diagnosed with ADHD, a psychiatrist seeks to identify clusters of symptoms as detailed in the Diagnostic and Statistical Manual (commonly referred to as ‘DSM’).
They must have an impact on your day-to-day life and symptoms of ADHD must have been present since childhood.
The core traits of ADHD will often present themselves in childhood in the following ways:
- Inattention: Easily distracted, poor concentration skills, difficulty organising themselves
- Impulsivity: Impatient, risk-taking, disproportionately emotional responses
- Hyperactivity: Overly energetic, talkative, excessive fidgeting, difficulty staying on task
Everyone is different, so it isn’t uncommon for two people to experience ADHD in different ways. These behaviours often differ between the sexes, with males displaying high levels of obvious physical hyperactivity while often females may appear to be the opposite, quiet and inattentive due to mental hyperactivity resulting in excessive daydreaming.
ADHD is broadly characterised by inattention and hyperactive-impulsive behaviour but the diagnosis will also contain a sub-type, each tied to one or more of the core characteristics.
Types of ADHD
Type 1 – Inattentive-type (I-ADHD or PI-ADHD)
If you have this type of ADHD, you may experience more symptoms of inattention than those of impulsivity and hyperactivity. You may struggle with impulse control or hyperactivity at times but these aren’t the main characteristics of the inattentive type.
People who experience inattentive behaviour often:
- Miss details and are distracted easily
- Get bored quickly
- Have trouble focusing on a single task
- Have difficulty organising thoughts and learning new information
- Lose pencils, papers, or other items needed to complete a task
- Don’t seem to listen
- Move slowly and appear as if they’re daydreaming
- Process information slower and less accurately than others
- Have trouble following directions
Type 2 – Hyperactive/Impulsive-type
This type of ADHD is characterised by symptoms of impulsivity and hyperactivity. People with this type can display signs of inattention, but it’s not as marked as the other symptoms.
People who are impulsive or hyperactive often:
- Squirm, fidget, or feel restless
- Have difficulty sitting still
- Talk constantly
- Touch and play with objects, even when inappropriate to the task at hand
- Have trouble engaging in quiet activities
- Are constantly “on the go”
- Are impatient
- Act out of turn and don’t think about consequences of actions
- Blurt out answers and inappropriate comments
Type 3 – Combined-type ADHD
This is the most common type of ADHD. Combined-type ADHD means that your symptoms cover both inattention and hyperactive-impulsive behaviour.
ADHD symptoms can change in severity, visibility and impact over a lifetime, meaning someone can move between combined-type ADHD, inattentive-type ADHD, hyperactive/impulsive-type ADHD and ‘sub-clinical’ ADHD (sub-clinical ADHD refers to someone who has too few medical symptoms to meet diagnostic criteria). Diagnosis of a sub-type of ADHD can be important for understanding but, equally, it may just reflect which traits of ADHD are easy to observe as having a negative impact. All types of ADHD share the same brain and nervous system changes in development, though no two brains are the same.
Most people, with or without ADHD, experience some degree of inattentive or hyperactive/impulsive behaviour. These symptoms are far more severe in people with ADHD, with symptoms often interfering with the ability to function properly at home, school, work, and in social situations.
Emotions and ADHD
Many people with ADHD experience emotions differently to others, with many reporting:
- fast-building, high-intensity and short-lived emotions
- difficulties recognising emotions in themselves and others
- extremes of empathising completely with others or reacting without emotions to others
- experiencing many more emotions simultaneously than a typical person might
Experiencing multiple contradictory emotions at the same time can be difficult for people with and without ADHD to understand. For example, it is not uncommon for someone with ADHD to say they feel excited, happy, frustrated and nervous all at once in a situation where someone neurotypical is likely to only be experiencing one or two emotions.
Differences in emotions in people with ADHD can lead to ‘shutdowns’, where someone is so overwhelmed with emotions that they space out, may find it hard to speak or move and may struggle to articulate what they are feeling until they can process their emotions.
Similarly, people with ADHD can also experience ‘meltdowns’ more commonly than others, which is where emotions build up so extremely that someone acts out, often crying, angering, laughing, yelling and moving all at once, driven by many different emotions at once – this essentially resembles a child tantrum and can continue throughout adulthood. Meltdowns can be an important way to self-regulate and can actually bring great lasting relief to adults afterwards.
Differences in emotions as well as experiencing meltdowns and shutdowns are also common in autism.
These differences in emotions are often referred to as ’emotional dysregulation’. There is ongoing debate in the medical field as to the role of ADHD in symptoms of emotional dysregulation.
Is emotional dysregulation part of ADHD?
Emotional dysregulation used to be considered a core part of ADHD and was always included in descriptions of ADHD. There have been many name changes to ADHD, with medical literature from the 19th and 20th century referring to ‘minimal brain dysfunction’, ‘defect in moral control’, ‘mental restlessness’, ‘hyperactive child syndrome’ and ‘hyperkinetic impulse disorder’ before the term ADHD became centralised. In all of these early conceptualisations, emotional dysregulation was considered a key part of ADHD and physicians sought to treat patients and mediate the impact emotional dysregulation had on someone’s life.
In the 1970s, ADHD research became more formalised so that ADHD could be incorporated into the DSM (Diagnostic and Statistics Manual – the key psychiatry book). Emotional dysregulation was repeatedly observed during research, but researchers chose to focus on inattention, hyperactivity and impulsivity since these traits were far more easy to measure and develop treatments for in a laboratory or clinical setting. Measuring emotional dysregulation was more challenging and, as such, it was phased out of medical descriptions of ADHD.
What is known about emotional dysregulation and ADHD now?
Despite being left out of the DSM, emotional dysregulation continued to show up in ADHD research, and researchers today are unanimous in agreement that ADHD and emotional dysregulation are strongly connected.
There are debates over how emotional dysregulation relates to ADHD, however. The opposing models are:
- Emotional dysregulation is a core trait of ADHD and comes from the same brain and nervous system changes to features like impulse control, executive function and working memory – like how inattention, hyperactivity and impulsivity are traits that arise from these changes.
- Emotional dysregulation is a separate condition from ADHD and comes from different but overlapping brain and nervous system changes, meaning people with ADHD are much more likely to develop emotional dysregulation – like how people with ADHD are also likely to develop dyslexia.
- Emotional dysregulation and ADHD together comprise a new condition distinct from ADHD altogether.
Some people also believe that emotional dysregulation in ADHD is strictly due to other mental health conditions that can co-occur with ADHD. Whilst co-occuring conditions can create a research challenge and weaken data, this idea has been disproven.
Emotional dysregulation is thought to affect around 1 in 3 children with ADHD and 1 in 2 adults with ADHD, meaning it is likely to be a big part of adult ADHD.
Alongside the core traits and emotional dysregulation, people with ADHD can also have other co-occuring neurodiverse conditions as well as mental health conditions.