A child who is constantly on the move and an adult who quietly struggles to keep track of daily responsibilities may appear to have very little in common.
Yet both may be experiencing ADHD. Understanding the different ways it can present helps us look beyond the most noticeable behaviour.
ADHD is a neurodevelopmental condition involving persistent difficulties with attention, hyperactivity or impulsivity. These difficulties begin in childhood, although they may not be recognised until later. The impact varies from person to person, and the same person may manage well in one situation while needing considerable support in another.
With a predominantly inattentive presentation, difficulties may include following instructions, remembering everyday tasks, or maintaining attention during activities that require sustained effort. A child may seem to listen but miss an important part of what was said. An adult may start several jobs and find that none reaches completion. These experiences can be easy to overlook when someone is quiet or outwardly appears to be managing.
With a predominantly hyperactive and impulsive presentation, movement, restlessness or acting before thinking may be more prominent. A child may find waiting particularly difficult or interrupt without intending to be rude. In adulthood, hyperactivity may feel more like restlessness than obvious running or climbing. Someone may struggle to settle into a quiet activity even when they want to rest.
A combined presentation involves difficulties in both areas. However, this does not mean that every person with combined ADHD will behave in the same way. Age, the demands of a situation and the support available all influence what others see. A label describes a pattern of symptoms; it cannot describe the whole person.
It can help to notice the tasks that repeatedly cause difficulty rather than comparing someone with a familiar image of ADHD. Are instructions being lost? Is getting started harder than understanding the work? Does waiting lead to repeated problems? Concrete examples give a more useful picture than describing someone as distracted or lively.
Occasional forgetfulness or high energy alone does not establish ADHD. Assessment considers the history, persistence and impact of difficulties across settings. The purpose is to understand the person's needs and identify appropriate support, while recognising the interests, relationships and abilities that are also part of their life.
Elaine Kelly
