Types of ADHD

ADHD is classified into three presentations based on the DSM-5 diagnostic criteria:

  • Predominantly Inattentive Type: Characterized by difficulty sustaining attention, following instructions, organizing tasks, and maintaining focus on details. May appear as "daydreaming" or being easily distracted.
  • Predominantly Hyperactive-Impulsive Type: Characterized by excessive fidgeting, difficulty staying seated, excessive talking, interrupting others, and acting without thinking.
  • Combined Type: Meets criteria for both inattention and hyperactivity-impulsivity. This is the most common presentation.

Symptoms in Children

Inattention

  • Difficulty paying attention to details or making careless mistakes
  • Difficulty sustaining attention in tasks or play
  • Appears not to listen when spoken to directly
  • Difficulty following through on instructions or finishing tasks
  • Difficulty organizing tasks and activities
  • Avoids tasks requiring sustained mental effort
  • Loses things necessary for tasks
  • Easily distracted by unrelated thoughts or stimuli
  • Forgetful in daily activities

Hyperactivity and Impulsivity

  • Fidgets, taps hands or feet, squirms in seat
  • Leaves seat when expected to remain seated
  • Runs or climbs in inappropriate situations
  • Unable to play quietly
  • "On the go" as if driven by a motor
  • Talks excessively
  • Blurts out answers before questions are completed
  • Difficulty waiting turns
  • Interrupts or intrudes on others

Symptoms in Adults

Approximately 60% of children with ADHD continue to experience symptoms into adulthood. Adult ADHD may present differently:

  • Chronic procrastination and difficulty meeting deadlines
  • Poor time management and difficulty estimating time
  • Difficulty maintaining focus in meetings or during long conversations
  • Impulsivity in decision-making, spending, or relationships
  • Emotional dysregulation and low frustration tolerance
  • Difficulty with organization and task completion
  • Restlessness (may be internal rather than physical)
  • Low self-esteem and underperformance relative to potential

Diagnosis

ADHD diagnosis is made by a qualified healthcare provider (psychiatrist, pediatrician, neurologist, or psychologist) based on:

  • Clinical interview and detailed history
  • Symptom criteria from the DSM-5
  • Symptoms present in two or more settings (home, school, work)
  • Symptoms that interfere with or reduce quality of functioning
  • Rating scales from parents, teachers, or partners
  • Rule out of other conditions that may mimic ADHD (anxiety, depression, sleep disorders, thyroid problems)

Stimulant Medications

Stimulant medications are the first-line treatment for ADHD, with response rates of 70–80%:

  • Methylphenidate-based: Ritalin, Concerta, Focalin, Methylin. Available in immediate-release and extended-release formulations.
  • Amphetamine-based: Adderall, Vyvanse (lisdexamfetamine), Dexedrine. Vyvanse is a prodrug activated in the body, providing a smoother onset.

Common side effects include decreased appetite, weight loss, difficulty sleeping, headache, and stomach upset. Stimulants are Schedule II controlled medications, requiring a written prescription and periodic monitoring. Many states require an initial in-person evaluation before prescribing stimulants via telehealth.

Non-Stimulant Medications

When stimulants are not effective, not tolerated, or not preferred:

  • Atomoxetine (Strattera): SNRI that takes 4–6 weeks to reach full effect. Not a controlled substance.
  • Guanfacine ER (Intuniv): Alpha-2 adrenergic agonist. May be used alone or with stimulants.
  • Clonidine ER (Kapvay): Alpha-2 adrenergic agonist. May help with ADHD and sleep difficulties.
  • Vyvanse (also a stimulant): Sometimes categorized separately due to its prodrug mechanism.

Behavioral Therapy

  • For children under 6: The AAP recommends parent training in behavior management as the first-line treatment before medication.
  • For children 6+: Medication combined with behavioral therapy is more effective than either alone.
  • For adults: CBT adapted for ADHD helps with organization, time management, and emotional regulation.
  • School accommodations: 504 plans and IEPs can provide accommodations like extended time, preferential seating, and reduced distractions.

Resources

  • NIMH - ADHD — National Institute of Mental Health
  • CHADD — Children and Adults with Attention-Deficit/Hyperactivity Disorder
  • ADDitude Magazine — Resources and support for ADHD
  • AAP - ADHD — American Academy of Pediatrics
Important: This guide is for educational purposes only. ADHD requires diagnosis and treatment by a qualified healthcare provider. Stimulant medications are controlled medications with risks of dependence and abuse. Never share ADHD medications or take them without a prescription. In case of a medical emergency, call 911.