Inattention, hyperactivity (restlessness in adults), disruptive behavior, and impulsivity are common in ADHD. Academic difficulties are frequent as are problems with relationships. The symptoms can be difficult to define, as it is hard to draw a line at where normal levels of inattention, hyperactivity, and impulsivity end and significant levels requiring interventions begin. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms must be present for six months or more to a degree that is much greater than others of the same age. This requires at least 6 symptoms of either inattention or hyperactivity/impulsivity for those under 17 and at least 5 for those 17 years or older. The symptoms must interfere with or reduce quality of functioning in at least two settings (e.g., social, school, work, or home). Additionally, several symptoms must have been present before age twelve. Subtypes ADHD is divided into three primary presentations: predominantly inattentive (ADHD-PI or ADHD-I), predominantly hyperactive-impulsive (ADHD-PH or ADHD-HI), and combined type (ADHD-C). The table "DSM-5 symptoms" lists the symptoms for ADHD-I and ADHD-HI. Symptoms which can be better explained by another psychiatric or medical condition which an individual has are not considered to be a symptom of ADHD for that person. +DSM-5 symptoms Presentations Symptoms Inattentive 6 or more of the following symptoms in children, and 5 or more in adults, excluding situations where these symptoms are better explained by another psychiatric or medical condition: * Frequently overlooks details or makes careless mistakes * Often has difficulty maintaining focus on one task or play activity * Often appears not to be listening when spoken to, including when there is no obvious distraction * Frequently does not finish following instructions, failing to complete tasks * Often struggles to organise tasks and activities, to meet deadlines, and to keep belongings in order * Is frequently reluctant to engage in tasks which require sustained attention * Frequently loses items, including those required for tasks * Is frequently easily distracted by irrelevant things, including thoughts in adults and teenagers * Often forgets daily activities, or is forgetful while completing them Hyperactive-Impulsive 6 or more of the following symptoms in children, and 5 or more in adults, excluding situations where these symptoms are better explained by another psychiatric or medical condition: * Is often fidgeting or squirming in seat * Frequently has trouble sitting still during dinner, homework, at work, etc. * Frequently runs around in inappropriate situations. In adults and teenagers, this may be present as restlessness. * Often cannot quietly engage in leisure activities or play. * Frequently seems to be in constant motion, or uncomfortable when not in motion. * Often talks too much. * Often answers a question before it is finished, or finishes people's sentences. * Often struggles to wait their turn, including waiting in lines. * Frequently interrupts or intrudes, including into others' conversations or activities, or by using people's things without asking. Combined Meet the criteria for both inattentive and hyperactive-impulsive ADHD. Girls and women with ADHD tend to display fewer hyperactivity and impulsivity symptoms but more symptoms of inattention and distractibility. Symptoms of hyperactivity tend to go away with age and turn into inner restlessness in teens and adults with ADHD. Although not listed as an official symptom for this condition, emotional dysregulation is generally understood to be a common symptom of ADHD. People with ADHD of all ages are more likely to have problems with social skills, such as social interaction and forming and maintaining friendships. This is true for all presentations. About half of children and adolescents with ADHD experience social rejection by their peers compared to 10–15% of non-ADHD children and adolescents. People with attention deficits are prone to having difficulty processing verbal and nonverbal language which can negatively affect social interaction. They also may drift off during conversations, miss social cues, and have trouble learning social skills. Difficulties managing anger are more common in children with ADHD as are poor handwriting and delays in speech, language and motor development. Although it causes significant difficulty, many children with ADHD have an attention span equal to or greater than that of other children for tasks and subjects they find interesting. Comorbidities Psychiatric In children, ADHD occurs with other disorders about two-thirds of the time. Other neurodevelopmental conditions are common comorbidities. Autism spectrum disorder (ASD) co-occurring at a rate of 21%, affects social skills, ability to communicate, behaviour, and interests. As of 2013, the DSM-5 allows for an individual to be diagnosed with both ASD and ADHD. Learning disabilities have been found to occur in about 20–30% of children with ADHD. Learning disabilities can include developmental speech and language disorders, and academic skills disorders. ADHD, however, is not considered a learning disability, but it very frequently causes academic difficulties. Intellectual disabilities and Tourette's<unk>  are also common. ADHD is often comorbid with disruptive, impulse control, and conduct disorders. Oppositional defiant disorder (ODD) occurs in about 25% of children with an inattentive presentation and 50% of those with a combined presentation. It is characterized by angry or irritable mood, argumentative or defiant behaviour and vindictiveness which are age-inappropriate. Conduct disorder (CD) occurs in about 25% of adolescents with ADHD. It is characterized by aggression, destruction of property, deceitfulness, theft and violations of rules. Adolescents with ADHD who also have CD are more likely to develop antisocial personality disorder in adulthood. Brain imaging supports that CD and ADHD are separate conditions, wherein conduct disorder was shown to reduce the size one's temporal lobe and limbic system, and increase the size of one's orbitofrontal cortex whereas ADHD was shown to reduce connections in the cerebellum and prefrontal cortex more broadly. Conduct disorder involves more impairment in motivation control than ADHD. Intermittent explosive disorder is characterized by sudden and disproportionate outbursts of anger, and commonly co-occurs with ADHD. Anxiety and mood disorders are frequent comorbidities. Anxiety disorders have been found to occur more commonly in the ADHD population. This is also true of mood disorders (especially bipolar disorder and major depressive disorder). Boys diagnosed with the combined ADHD subtype are more likely to have a mood disorder. Adults and children with ADHD sometimes also have bipolar disorder, which requires careful assessment to accurately diagnose and treat both conditions. Sleep disorders and ADHD commonly co-exist. They can also occur as a side effect of medications used to treat ADHD. In children with ADHD, insomnia is the most common sleep disorder with behavioral therapy the preferred treatment. Problems with sleep initiation are common among individuals with ADHD but often they will be deep sleepers and have significant difficulty getting up in the morning. Melatonin is sometimes used in children who have sleep onset insomnia. Specifically, the sleep disorder restless legs<unk>  has been found to be more common in those with ADHD and is often due to iron deficiency anemia. However, restless legs can simply be a part of ADHD and requires careful assessment to differentiate between the two disorders. Delayed sleep phase disorder is also quite a common comorbidity of those with ADHD. There are other psychiatric conditions which are often co-morbid with ADHD, such as substance use disorders. Individuals with ADHD are at increased risk of substance abuse. This is most commonly seen with alcohol or cannabis. The reason for this may be an altered reward pathway in the brains of ADHD individuals. This makes the evaluation and treatment of ADHD more difficult, with serious substance misuse problems usually treated first due to their greater risks. Other psychiatric conditions include reactive attachment disorder, characterized by a severe inability to appropriately relate socially, and sluggish cognitive tempo, a cluster of symptoms that potentially comprises another attention disorder and may occur in 30–50% of ADHD cases, regardless of the subtype. ADHD and trauma are also highly comorbid, which could be in part potentially be explained by the similarity in presentation between different diagnoses. The symptoms of ADHD and PTSD can have significant behavioral overlap - in particular, motor restlessness, difficulty concentrating, distractibility, irritability/anger, emotional constriction or dysregulation, poor impulse control, and forgetfulness are present in both populations. Given this overlap, there is an attempt in the existing literature to distinguish if there is a relationship between the two, and if so, what the nature of that relationship is. Hypotheses include that symptoms of ADHD may mask underlying trauma-related distress (and therefore the primary diagnosis is trauma-related), that traumatic events in childhood lead to structural brain changes or the development of behaviors that are the same as those in ADHD (and therefore trauma leads to a concrete diagnosis of ADHD), and that the behavioral consequences of ADHD symptoms such as hyperactivity and impulsivity cause those with the condition to have a higher chance of experiencing something traumatizing (and therefore ADHD leads to a concrete diagnosis of a trauma-related disorder). Additionally, it is simply possible that the lack of an appropriate understanding of the particular individual's history can lead to an incorrect diagnosis of one as opposed to
complications of XYY syndrome
complications of Turner syndrome
complications of Klinefelter syndrome
complications of Kallmann syndrome
onset of Kallmann syndrome
medical cause of Hyperdontia
medical cause of Precocious puberty
symptom of XYY syndrome