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Three key features define attention-deficit hyperactivity disorder (ADHD)1 or hyperkinetic disorder (HKD):2

  • Inattention
  • Hyperactivity
  • Impulsivity.

The contribution of each to an individual’s presentation of ADHD varies from patient to patient.1 In some individuals, two or more features may contribute in equal measure; in others, one feature may predominate.1

How do the symptoms of ADHD change across the lifespan? | Dr David Coghill | Royal Children’s Hospital, Melbourne, Australia


As different features of ADHD can impair functioning and quality of life in different ways,3-8 it is important to accurately evaluate each patient’s unique symptomatic characteristics, using medical classification systems such as the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5TM) or the International Classification of Mental and Behavioural Disorders 10th revision (ICD-10).1,2 Whereas the ICD-10 characterises HKD by its ‘cardinal features’ of impaired inattention and overactivity,2 the DSM-5TM categorises patients with ADHD by three main presentations: combined type, predominantly inattentive type and predominantly hyperactive-impulsive type.1

Inattention

Inattention is characterised as an individual moving between tasks without completing any one activity, seemingly losing interest in one task because they become diverted to another.1,2 Individuals with inattention are often easily distracted and forgetful, and experience difficulties when organising activities1,2 (Figure).

Typical symptoms of inattention1,2

Typical symptoms of inattention

Hyperactivity

Hyperactivity refers to excessive motor activity,1,2 and may present differently depending on the patient’s age (Figure).1

Typical symptoms of hyperactivity1,2

Typical symptoms of hyperactivity

Impulsivity

Individuals with impulsive tendencies can be reckless and appear impatient, and are often disinhibited in social situations. They may find it difficult to wait their turn, intruding on or interrupting others’ activities or blurting out answers to a question before it has been completed (Figure).1,2

Typical symptoms of impulsivity1,2

Typical symptoms of impulsivity

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
  2. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Available at: www.who.int/entity/classifications/icd/en/bluebook.pdf. Last updated 1993; 1: 1-263. Accessed 04 January 2017.
  3. Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.
  4. Cussen A, Sciberras E, Ukoumunne OC, et al. Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr 2012; 171: 271-280.
  5. Caci H, Doepfner M, Asherson P, et al. Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: results from the European Lifetime Impairment Survey. Eur Psychiatry 2014; 29: 316-323.
  6. Grenwald-Mayes G. Relationship between current quality of life and family of origin dynamics for college students with attention-deficit/hyperactivity disorder. J Atten Disord 2002; 5: 211-222.
  7. Gudjonsson GH, Sigurdsson JF, Eyjolfsdottir GA, et al. The relationship between satisfaction with life, ADHD symptoms, and associated problems among university students. J Atten Disord 2009; 12: 507-515.
  8. O’Callaghan P, Sharma D. Severity of symptoms and quality of life in medical students with ADHD. J Atten Disord 2014; 18: 654-658.
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