By Sybrand Hagan

Clinical Psychologist
Rivonia, Gauteng
[email protected]

THE DIFFERENCE BETWEEN CHILD

F
or many years the diagnosis WHAT IS ADHD? how ADHD affects a person differently
of Attention-Deficit/ ADHD is a neurodevelopmental at different points in their life. Based
Hyperactivity Disorder (ADHD) disorder that affects children and on how many symptoms of ADHD
was reserved for children, adults. It’s an on-going pattern of a person has and how challenging
and not adolescents or adults. This inattention and/or hyperactivity- those symptoms are, a person can
means adolescents and adults with impulsivity that impacts on an be diagnosed with mild, moderate or
symptoms of the disorder, who might individual’s typical development or severe ADHD.
have been struggling for many years, disrupts their daily life. People with
not exactly knowing what they’re ADHD may also have difficulties ADHD ACROSS DEVELOPMENT
struggling with, couldn’t officially be with working memory, maintaining There are three main components
diagnosed with ADHD. This changed attention and executive function (our that make up ADHD, namely:
in the fifth edition of the Diagnostic brain’s ability to begin an activity, • Hyperactivity,
and Statistical Manual of Mental organise itself and manage tasks). • Inattention,
Disorders (DSM-5). Adolescents • Impulsiveness
and adults can now officially be PRESENTATIONS OF ADHD
diagnosed with ADHD. The diagnostic There are three different presentations These three primary symptoms that
criteria in the DSM-5 mentions and of ADHD, namely: define ADHD can be seen in both
gives examples of how the disorder • Predominantly inattentive children and adults, but differ in how
presents in adolescents and adults • Predominantly hyperactive/ they present between these two. As
(aged 17 and older). impulsive an individual moves through different
When diagnosing an adult with • Combined inattentive and stages of life, you will see a difference
ADHD, clinicians now look at the hyperactive/impulsive in how the symptoms manifest. With
individual’s middle childhood (age 12) children the symptoms appear more
and their teen years, instead of going It’s important to note that a person obvious and apparent, whereas with
all the way back to their childhood can change presentations during the adults they might be more difficult
(age 7). course of their life. This speaks to to spot. As adults have had to live
with these symptoms for a much • Hyperactivity in children can and feeling as if they are being
longer time, they’re more likely to present itself as a constant driven by a motor. This can be
have found ways to cover up their climbing on things, squirming seen in difficulty to sit still for
symptoms or make excuses for them. in the classroom or when in a long periods of time (through
So it’s extremely important to be able chair, running, finding it difficult meals, meetings or movies),
to recognise and understand the to sit down or constantly feeling fidgety, talking excessively,
differences in the ways symptoms of fidgeting with their hands or becoming easily bored once a
ADHD appear in children and adults. feet. Children with ADHD are task has been mastered. They are
often described as ‘on the go’ always on the go and generally
EARLY LIFE AND SCHOOL AGE or as being driven by a motor. don’t respond well to frustrating
ADHD is most typically diagnosed Despite the child’s best efforts, situations.
during school years, but recently this constant motion does not • Inattentive symptoms in adults
there has been a tendency to seem to be something they are more present in their work
identify symptoms in preschool have control over. or with daily activities of living,
children. It’s quite normal for • Inattention in children can and presents itself as making
healthy preschool children to have most easily be noticed with careless mistakes, losing things,
some behavioural manifestations regards to their schoolwork, not paying attention to detail, not
of ADHD, such as poor inhibitory but can also be seen when being able to follow-through with
control, high activity levels and a doing chores or other projects. instructions, having difficulty with
short attention span. However in They may also lose or organisation, being forgetful in
clinical cases, these manifestations misplace things, have difficulty daily life or they try to multi-task
are more prominent and result sustaining attention, avoid or without actually completing any
in poor performance at school, dislike tasks where they have of the tasks.
higher rates of physical injury, to do a lot of thinking and don’t • Impulsiveness can manifest itself
risky behaviour and unmanageable appear to listen when being at work, for example blurting
conduct across a variety of spoken to. It’s important to out answers at a meeting,
settings. note that inattention in ADHD but can also be seen in their
They also often suffer from is not due to defiance or lack of spending patterns, engaging
comorbid conditions, including comprehension. in risky behaviour, interrupting
anxiety disorders, Oppositional • Impulsiveness can most often other people’s conversations,
Defiant Disorder (ODD) and be seen at school, for example making inappropriate comments,
difficulty in communication. A skipping lines or queues, intruding upon others or even
combination of ADHD and any of blurting out answers, acting monopolising a conversation.
these comorbid condition leads to without thinking about the
more impairment than children only consequences of their actions, When making a diagnosis of ADHD,
diagnosed with ADHD. Preschool not waiting their turn and it’s vital to look at the person/
children mostly suffer from the intruding on personal space or child holistically, as a lot of the
combined ADHD presentation. The interrupting others. symptoms are things most people
hyperactive/impulsive subtype is do every once in a while. For it to
also more common in preschool ADULTHOOD be considered as a symptom of
children than with older children, About one in three children with ADHD, they have to have these
as hyperactivity tends to decrease ADHD show remission by adulthood. symptoms all the time and can’t
with age, whereas the inattentive Inattention symptoms have a greater help themselves from doing them.
subtype is rarer with preschool persistence into adulthood and show The symptoms also have to impact
children, as inattention becomes a slower decline than hyperactivity their ability to function in two or
more apparent as children grow and impulsivity symptoms. For adults, more areas of their life, for example
older. hyperactivity symptoms become at work and home, or school and
In the school-age years, felt more internally than observed home. Symptoms also worsen
symptoms are usually picked outwardly. Adults with ADHD have during times of stress.
up due to academic difficulties shown to struggle with occupational Clinical practices for ADHD in
and/or disruptiveness in the rank, academic achievement, and job childhood depend heavily on the
classroom. School-aged children performance. They also engage in developmental stage of a child
with ADHD tend to be impaired risky sexual behaviour, are more likely and may include optimal prenatal
with regards to peer relationships, to have early unwanted pregnancies, practices, pharmacological or
academic achievements and traffic violations, car accidents and multimodal treatment, and parent
family interactions, as well as marital or relationship distress and training for parents with children
having elevated rates of psychiatric psychiatric comorbidities. Studies that have been diagnosed with
comorbidity. The most common have shown elevated rates of ODD, ADHD. In adulthood a combination
comorbidities include ODD, learning conduct disorder and Antisocial of medication and therapy (often
disorders and anxiety disorders. Personality Disorder with adults that CBT) is recommended. ADHD is a
The prevalence of hyperactivity suffer from ADHD. Adults having lifelong condition and may require
symptoms tends to decrease grown up with ADHD also have higher ongoing treatment to promote
during the school-age years and rates of criminal behaviour optimal long-term outcome.
inattention symptoms tend to • Adults experience hyperactivity
increase. more as a general restlessness References available upon request