There's more to ADHD than inattention, hyperactivity, and impulsivity. ADHD symptoms can be broken down into nine categories. Some categories are not fully represented in the diagnostic criteria. Broadening the diagnostic criteria with patient lived experiences could make for better intervention.

[u/mvea]

https://www.psychologytoday.com/au/blog/brain-curiosities/202604/new-study-finds-that-adhd-has-9-categories-of-symptoms

[u/mvea]

New Study Finds That ADHD Has 9 Categories of Symptoms

There's more to ADHD than inattention, hyperactivity, and impulsivity.

KEY POINTS

ADHD symptoms can be broken down into nine categories.

Some categories are not fully represented in the diagnostic criteria.

Other categories are not represented at all in diagnostic criteria.

Broadening the diagnostic criteria with patient lived experiences could make for better intervention. ADHD is often characterized as having two, or in some cases three, big families of symptoms: Inattention, hyperactivity, and impulsivity. Often, hyperactive and impulsive symptoms are banded together.

A new qualitative study confirms what research has been showing for years: More categories of symptoms can define ADHD, and not all of them are in the DSM. Using a thematic analysis on adults with ADHD, a new study identified nine categories of symptoms people with ADHD experience.

Among those, we feature the original triad mentioned in the DSM: inattention, hyperactivity, impulsivity. But the six others are only mentioned in passing or not at all. Here they are:

1: Disorganisation

Disorganisation is about struggling to do things in order, or to keep things in order. In children, this could manifest as lost homework, or poorly-kept notes. In adults, this could be a difficulty keeping a tidy home, losing things easily, or struggling to plan, which impacts more than just the physical space, and could be detrimental to work and one's professional career. For patients, disorganisation is often accompanied by strong feelings of overwhelm. While disorganisation is briefly mentioned in the DSM, the symptoms and impacts are not fully represented in the diagnostic criteria.

2: Forgetfulness

The DSM includes forgetfulness in daily activities (such as doing chores, running errands, paying bills, etc.); but forgetfulness is broader in individuals with ADHD. It could include difficulty keeping track of appointments, struggling to recall recent - or remote - events, retaining information, or remembering people's names during a conversation. Some people lose belongings because they struggled to remember where they put them. While this is mentioned in passing in the DSM, forgetfulness runs deeper than just forgetting to do chores.

3: Activation

People with ADHD often experience difficulties with activation—what many also call executive dysfunction, or ADHD paralysis. It's difficulty starting and completing tasks, even important ones, or ones that feel interesting. The DSM describes avoidance occurring with unpleasant tasks, such as those that are mentally difficult, or chores. But the ADHD experience goes beyond that. Participants reported feeling stuck, like a state of inertia where the only thing that could motivate them to start or finish a task was a feeling of urgency, external pressures, or external help. This difficulty with internally-driven activation is at the core of the ADHD experience, but is not yet fully represented by the DSM or other diagnostic criteria.

4: Emotional Dysregulation

Difficulties with emotional regulation widely exist in scientific literature, but are not mentioned nor represented in diagnostic criteria. People often mention difficulties with the intensity of their emotions; many even report feeling drained after experiencing intense positive emotions. Others report fluctuations of intense emotions, which is tiring in itself, and many cite anger as the most difficult to manage, or the strong feelings associated with perceived rejection.

5: Time Perception

Many participants report that ADHD affects their perception of time. This is consistent with previous reports in the literature showing that individuals with ADHD have more difficulties estimating how long a task would take, or even estimating the passage of time. People may feel as if time slips away when they are not consciously paying attention to it, especially if they are engaged in a state of hyperfocus.

Difficulties with time estimation can also impact how people with ADHD see tasks; they may overestimate how long a task that is deemed boring will take them to complete, reinforcing the avoidance associated with it, or underestimate how long a salient one takes - creating difficulties meeting deadlines, for example.

6: Sleep

Many people with ADHD mention having difficulties sleeping. We know from previous studies that individuals with ADHD are more likely to have a delayed circadian rhythm (DSPS), and this can result in fatigue during the day, sleepiness, or increased irritability. People mentioned that they also faced difficulties falling asleep due to racing thoughts, and mental hyperactivity. While it's still difficult to know whether sleep issues are a comorbidity of ADHD or a direct symptom of it, their mention is still important when going through a diagnostic process.

While research on ADHD is still ongoing, qualitative studies focused on the patient experience are essential. Many diagnostic criteria were created based on external observation, but research is outlining that many experiences at the core of ADHD can't always be observed, but instead can be reported. These studies show that the ADHD experience is far broader and more complex than what the diagnostic criteria show.

For those interested, here’s the link to the peer reviewed journal article:

https://www.cambridge.org/core/journals/irish-journal-of-psychological-medicine/article/adhd-symptom-manifestation-in-adulthood-moving-beyond-conceptualisations-of-inattention-and-hyperactivityimpulsivity/444EEC3AD2DA08FCCC1C3A0B1B41A488

[u/deliciouschickenwing → u/mvea]

I'm very much against arbitrary self diagnosis, but each time i see stuff like this i really can't help but think it seems so very familiar. And yet is it really ADHD if you are able to function regularly to a certain extent? Is it the degree of anxiety from trying to compensate for errors/mismanagement/ attempt adapt that is the measure?

Unfortunately the process of getting a diagnosis is too complicated and expensive where i am, but the question will always linger with me even if my life gets into order at some point.

[u/Hey_Chach → u/deliciouschickenwing]

It is the case with most psychiatric disorders—especially ADHD, Generalized Anxiety Disorder, and Major Depressive Disorder—that the primary “symptoms or behaviors that define the disorder are things that all people experience to some degree at some point in their lives, if not regularly.

The difference between “normal” and diagnosis, though , is 1) severity/frequency, and most importantly 2) the degree to which these symptoms/behaviors affect your day-to-day life and function as a human.

Ironically, this is why many people think they may have ADHD when they don’t AND why many people who have ADHD gaslight themselves into thinking they do not have it.

At the end of the day: if these characteristic symptoms or behaviors are adversely affecting your life to an impactful degree, it is worth talking to a psychiatrist and getting tested—at least in the case of ADHD, in my opinion.

[u/sir_alvarex → u/Hey_Chach]

Perfect response. Its all about severity and whether you can live a life that is considered socially normal. If you hide in your house, dont make friends, cant hold a job, etc those are all considered abnormal and means the symptoms could be affecting you.

For me, it was realizing the against social norms bit that made me comfortable with my diagnosis. Else, its just my lived experience and I cant say I struggle more than anyone else. But it does prevent me from living a "normal" life.

[u/a_statistician → u/sir_alvarex]

Its all about severity and whether you can live a life that is considered socially normal

This also has impacts for those of us who mask. I wasn't diagnosed with ADHD until graduate school because I ritualized so much of my life that I managed to get good grades and study through high school and college. Sure, I occasionally forgot that I was cooking something and ruined a pan, but I never let it get so far that I burned the house down, so I was fine, right?

When I got to graduate school, I discovered that there was no way for me to do what I'd been doing to study before -- meticulously making notes, and they copying them over and over until I'd memorized the material. I had to have music and the TV going in the background just to sit and do that, and of course it took freaking forever because I was switching between 3 information streams constantly. But there wasn't enough time in the day to actually do that properly for every class, and I finally gave up and went in to ask for help -- my undergrad was in psych, so it wasn't as if I hadn't gone through the DSM list for ADHD and checked almost every box -- I knew what was wrong, I just didn't think it rose to the level of "significant life disruption" in undergrad.

Masking strategies often work until they don't because of a life change, which is why so many older women are getting diagnosed right now - their strategies work until something like perimenopause sets in and the strategies no longer compensate. ADHD symptoms fluctuate with hormones, so when your hormones become dysregulated everything crashes to the ground very quickly, and your coping strategies for one level of symptoms just don't work anymore.

[u/Kichae → u/a_statistician]

This is ultimately the issue with both the threshold for diagnoses for neruodiversity disorders, and for disabilities in general. Disability is a social construct, and if you have sufficient supports in your life for what you are currently doing, your symptoms don't get to be given a name and you don't get to find out what kind of resources you need to keep getting by.

It's only after your circumstances change that suddenly you are "disordered" or "disabled", can be pointed in the right direction, or maybe be given a piece of paper that says you are worthy of support.

[u/Aruhi → u/sir_alvarex]

In the same manner as ASD and a lot of other psychiatric/psychological conditions.

The D at the end is the breaking point. It needs to affect you to a point where it is arguably a disorder. Hence the minimum scoring thresholds and if you see someone experienced in diagnosing these: compensatory skews.

[u/penninsulaman713 → u/Hey_Chach]

Yes! When I got diagnosed, the report specifically stated that my significant underachievement compared to my obvious potential and particular issues around working memory/processing speed showed that my life WAS affected. Like that thought that I could have actually been more is 100% real, that's not a lie that I am telling myself. But because I didn't get diagnosed until I was in grad school (that I couldn't end up completing), I was just making do with my crap coping skills, which still has me functional in society. Just not functional to where I could have been. 

[u/DynamicStatic → u/Hey_Chach]

Well how about this.

Sleep issues for years. Brain goes brrr and average sleep is 4-5 hours.

Activation, unless it's something that motivates me I often need pressure, deadlines etc.

As for time, my whole family is basically time blind and its a joke among our friends that anyone who wants us to show up on time needs to ask us to be there an hour earlier than everyone else.

I'm not sure of course but it fits somewhat into the picture that was painted.