THE BASICS
What is ADHD?
ADHD is a common neurodevelopmental condition that affects how a person regulates attention, activity, and impulses. It is best understood as a difference in self-regulation and executive functioning, the skills that help us plan, get started, stay organized, manage time, and manage emotions. A child with ADHD usually knows what to do. The difficulty is doing it consistently, at the right moment.
ADHD is strongly influenced by genetics and brain development, and a person with ADHD is not lazy or unmotivated. Many people with ADHD are creative, energetic, curious, and able to focus intensely on things that capture their interest.
Predominantly inattentive
Difficulty sustaining attention, careless mistakes, losing things, forgetfulness, and trouble following through.
Predominantly hyperactive-impulsive
Fidgeting, restlessness, talking a lot, blurting out answers, interrupting, and difficulty waiting.
Combined
Significant features of both. A person's presentation can change as they grow.
DAY TO DAY
What ADHD can look like
ADHD shows up differently at every age. Hyperactivity often becomes less visible with time, while difficulties with attention and organization tend to continue into adolescence and young adulthood.
01
Starting is the hardest part
Knowing what to do, but struggling to begin, especially with long or repetitive tasks.
02
Losing track of time
Underestimating how long things take, running late, and last-minute rushes.
03
Forgetting and misplacing
Homework left at home, lost belongings, and instructions that slip away.
04
Restless body or restless mind
Constant movement in young children, often becoming inner restlessness in teens.
05
Big feelings, quickly
Frustration and emotional ups and downs that rise fast and are hard to settle.
06
Focus that comes and goes
Difficulty with boring tasks, but intense focus on things that are interesting.
Girls with ADHD are often first identified with anxiety or low mood, and the ADHD underneath is missed.
Young et al., 2020
OFTEN MISSED
ADHD in girls
ADHD is diagnosed more often in boys, but girls are frequently overlooked. In clinic referrals, boys outnumber girls by anywhere from 3 to 1 to as much as 16 to 1, while community studies find a smaller gap, which suggests that many girls are never referred.
Quieter symptoms: girls are more likely to have the inattentive presentation, which is less disruptive in class.
Misread as personality: described as daydreamy, chatty, disorganized, or anxious.
Working twice as hard: staying up late or over-preparing to compensate and hide difficulties.
Visible at transitions: symptoms often become clearer when starting high school or post-secondary studies.
Age in the classroom matters too
A Canadian study of nearly one million children found that those born in December, the youngest in their grade, were more likely to be diagnosed with ADHD than those born in January. A careful assessment considers developmental context.
DIFFERENTIAL DIAGNOSIS
What else could it be?
Difficulty paying attention has many possible causes, and ADHD often occurs alongside other conditions. A good assessment asks not only whether attention is a struggle, but why.
Condition
How it can look like ADHD
What helps tell them apart
Learning disability
Avoiding schoolwork, not finishing tasks, seeming not to listen during lessons
Difficulties are concentrated in reading, writing, or math. Attention is often fine in activities that do not rely on the weak skill. Both often occur together.
Anxiety
Restlessness, difficulty concentrating, avoidance, irritability
Attention problems come and go with worry and stressful situations, rather than being present across most tasks since early childhood.
Depression
Poor concentration, low motivation, unfinished work
Depression is a change from the person's usual self, with low mood or loss of enjoyment. ADHD difficulties are longstanding.
Autism
Distractibility or overfocus, interrupting, executive functioning difficulties
In autism, social expectations often stay confusing even when explained. Intense interests and sensory differences point toward autism. Both often occur together.
Language or hearing difficulties
Not following instructions, seeming not to listen
Difficulty understanding spoken language, rather than staying focused. Hearing should always be checked.
Sleep difficulties
Inattention, irritability, hyperactivity
Short or poor-quality sleep can mimic ADHD in children. Sleep history is an essential part of assessment.
Trauma or significant stress
Hypervigilance, distractibility, emotional reactivity
Difficulties begin or worsen after adverse experiences and are linked to feeling unsafe.
Giftedness
Boredom, daydreaming, off-task behaviour
Attention improves when work is appropriately challenging. Giftedness and ADHD can also occur together.
Relative immaturity
Higher activity and impulsivity than classmates
The youngest children in a grade are more often diagnosed. Comparing a child to same-age expectations helps.
OUR APPROACH
How a careful assessment helps
01
A developmental and background interview
Early childhood, school history, sleep, and family history.
02
Rating scales from more than one setting
Home, school, and, when age appropriate, the young person.
03
Direct assessment
Attention, working memory, processing speed, and executive functioning.
04
Other explanations considered
Learning disabilities, anxiety, mood, and autism, so recommendations fit the whole child.
Meet the assessment team
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