Have you ever found yourself wondering whether your daily distractions might cross over into a clinical level of adult onset attention-deficit hyperactivity disorder (ADHD)? What are the signs that differentiate normal attention difficulties from ADHD?
ADHD or Normal Inattention?
Before describing some of the key symptoms of ADHD, it may be worthwhile to consider all of the different reasons people might want to know if they have ADHD. These reasons may include one or all of the following:
- wanting to be more productive
- wanting to obtain educational or legal accommodations in work or school
- wanting to receive personalized feedback and help for treating the problem if one exists.
Figuring out the “why?” question may better direct you to the appropriate referral because assessment and treatment for ADHD often involves a multidisciplinary team of neuropsychologists, therapists, educators, psychiatrists, and primary care doctors.
With the recent immense media coverage of ADHD and widespread prescribing of stimulants, it is easy to look up the clinical criteria and “self-diagnose” clinical ADHD. Remember to not fall victim to the reverse inference fallacy—just because you’ve taken stimulants and been much more productive doesn’t mean you have ADHD; everyone does better on stimulants!
Like with any mental health condition, symptoms exist on a continuum. With ADHD in particular, I usually caution patients to not immediately pathologize because everyone is different. Even if you have some real attention or distractibility deficits, the brain is extremely flexible and capable of compensating in extraordinary ways. In addition, ADHD is a disorder that is especially important to consider from a developmental context because the symptoms have to be more severe relative to one’s age group.
It is also the case that severe hyperactivity symptoms that emerge in childhood often resolve on their own in adulthood, so noticing individual patterns in attention, impulsivity, and strategies that help with academic and work performance, and how all of these change over time, are important to observe. Another thing to keep in mind is that clinical levels of ADHD are relatively low, compared to rates of clinical depression and anxiety, occurring in approximately 3.0-7.7% of children and 4-5% of adults. It is possible that you may have some subclinical symptoms, but the vast majority of people do not meet full criteria.
When clinical ADHD is present, it can be extremely impairing, usually appears before age 12, and is often associated with another learning disability and less educational attainment than same-age peers.
In the recent changes to the Diagnostic and Statistical Manual (DSM) fifth edition, which clinicians use to diagnose various clinical disorders, the criteria for ADHD were modified to better capture symptoms that occur in adulthood.
To meet criteria, one must display SIX OR MORE of the following inattention symptoms:
- Often overlooks details or makes careless mistakes
- Often has difficulty sustaining attention in tasks or conversations
- Often not seeming to listen when spoken to directly
- Often not following through on instructions or finishing tasks
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or reluctant to engage in tasks requiring sustained mental effort
- Often loses things necessary for tasks or activities (glasses, keys, wallet, phone)
- Often forgetful in daily activities
Individuals must also display SIX OR MORE of the following hyperactivity/impulsivity symptoms:
- Often fidgets with or taps hands or feet or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is inappropriate
- Often unable to play or engage in leisure activities quietly
- Often “on the go,” acting as if “driven by a motor"
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has difficulty waiting his or her turn
- Often interrupts or intrudes on others
To meet criteria, one must also: display several of these symptoms before age 12, and have difficulties across two or more settings (home, school/work, with friends/family, etc.).
Proper assessment of ADHD is done by obtaining a neuropsychological assessment, in which standardized measures of intelligence, attention, and memory are conducted, along with patient and informant-based self-report measures, to determine whether the profile is consistent with ADHD. More than half of cases of ADHD involve the combined inattention and hyperactivity type. Although it is typically identified in childhood, most cases have developed symptoms by age 14-16, and a percentage (15-30%) of children outgrow these problems. When making a diagnosis of ADHD, it’s important to rule out other potential sources of inattention, including depression, anxiety, adjustment-related stress, sleep disorders, and eating disorders.
Good cognitive-behavioral therapy for ADHD involves skill-based practice with organizing and planning, managing distractions, adaptive thinking, and confronting procrastination.
ADHD or Not: Ways to Stay Focused
Here are some recommendations for everyone, with or without ADHD, to help you focus:
- If you are someone who is frequently losing important things like your ID, wallet, credit cards, phone, glasses, etc., practice keeping everything together in one place (basket near the door. At the least, decide where each of these things belong and practice putting things back where they belong as soon as you notice it is out of place. For sunglasses, I personally find that keeping them in the case is extremely helpful!
- Loose papers always get lost. My husband now scans every important document into Evernote (which is free!)… if you are technologically savvy, this might do the trick!
- If you have trouble remembering important material, rehearse! This is a tip from the cognitive science literature on improving long-term memory. Take notes actively when reading and use paper/pencil/notebooks rather than laptops when attending lectures.
- A ton of research has shown that good sleep habits improve memory. Get used to a regular sleep schedule, even on weekends, and avoid taking long naps. It’s more important to wake up the same time everyday rather than going to bed the same time.
- Minimize distractions: turn off email/social media/TV when you’re working on something that takes a lot of effort (I need to do this when I’m reading dense material).
- Sit in the front of the room for important lectures or talks.
- Delegate tasks to others so that the work you do each week matches up with the unique skills that you have to complete the task at hand.
- Break down large tasks into smaller (realistic and reasonable) tasks and schedule them into your calendar.
- This is an old school tip but is effective for a reason- keep a consistent calendar book and daily to do/task list.
- The best time to do annoying things like paying your bills is now. You may think you are saving time or money by waiting for more money in your bank, but this strategy only risks that you miss the deadline and end up paying more.
- Set reminders! Put them in your phone, put them on post-it notes in your home, ask for doctors to send you appointment reminders.
- Know the limits of your attention span. Test your attention span by working on something requiring sustained mental effort and start a timer. As soon as you get an urge to stop and do something else, stop the timer. Once you know this number, you can schedule tasks accordingly (For example, it is amazing how much writing you can do when you allow yourself to just work on the writing for even twenty minutes at a time).
Don’t be discouraged if these tips don’t work right away! Improving your attention is a form of mindfulness and takes practice, just like building a muscle.
 American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Washington D.C., American Psychiatric Association.
By Angela Fang, Ph.D. - Expert Psychologist