Child A.D.H.D. Assessment

Attention-Deficit/Hyperactivity Disorder (A.D.H.D.) is a neurodevelopmental difference that is an inherent part of an individual's identity and many prefer to be called "A.D.H.D. individuals" or "ADHDers" to affirm their identity. ADHDers have unique ways of thinking, processing information, and engaging with the world.

A.D.H.D. tends to run in families. Additionally, brain function differences might be associated with A.D.H.D. Unfortunately, it is still crucial to note that A.D.H.D. is not caused by parenting practices (e.g., permissive parenting).

Prevalence rates of A.D.H.D. vary by region and population but it is estimated 9.8% of people have been identified as A.D.H.D. A.D.H.D. is a common and naturally occurring difference that transcends racial, ethnic, and socio-economic backgrounds. It is a unique way of experiencing the world that comes with strengths and challenges.

Inattention: “ADHDers” often have difficulty sustaining attention and following through on tasks. They may struggle to stay organised, and they may be easily distracted.

Hyperactivity: Some “ADHDers” experience hyperactive behaviour—this can include restlessness, fidgeting, and difficulty remaining still or seated.

Impulsivity: Impulsivity is another common indicator. “ADHDers” may act before thinking about potential consequences, have trouble knowing when it is their turn to talk in conversations, or have difficulty waiting their turn in activities.

Difficulties Across Multiple Settings: indicators of A.D.H.D. should be present across multiple settings—such as at home and in school or work. This differentiates A.D.H.D. from situational presentations.

Difficulties Present From Early Childhood: Indicators of A.D.H.D. should have been present since early childhood. It is a neuro-developmental difference that becomes apparent in early childhood.

Difficulties with Daily Activities: To receive a formal diagnosis of A.D.H.D., these traits must have a significant impact on the child’s daily functioning.

Here are some strengths associated with A.D.H.D., backed by research:

Creativity: ADHDers often display high levels of creativity, which can lead to innovative thinking and problem-solving (Kyaga et al., 2013).

Hyperfocus: While also considered a challenge, hyperfocus, or the ability to intensely concentrate on a task or interest, can be a positive quality as well. Research has discussed hyperfocus in A.D.H.D., as seen in "A.D.H.D. and Hyperfocus: The Flip Side of the Same Coin?" by Tucha et al. (2015).

Enthusiasm and Passion: ADHDers often approach their interests with enthusiasm and passion, which can lead to dedication and success in areas that align with their passions. This positive trait has been discussed in various publications on A.D.H.D. and personal strengths.

Quick Thinking: ADHDers tend to think quickly and adapt to changing situations, which can be advantageous in dynamic and fast-paced environments. Research has explored the cognitive flexibility and quick thinking associated with A.D.H.D. (Alderson et al., 2008).

High Energy Levels: The surplus of energy in A.D.H.D. can lead to increased productivity and motivation in tasks and activities.

Empathy: Some research suggests that ADHDers may have heightened empathy and sensitivity to the emotions of others. While more research is needed in this area, some studies have explored the social and emotional aspects of A.D.H.D., such as "Emotion Recognition in Adults with Attention-Deficit/Hyperactivity Disorder" by Corbett et al. (2009).

It is, of course, important to remember that the strengths associated with A.D.H.D. vary among individuals. ADHDers also experience challenges as a neuro-minority group.

It is important to recognise that “ADHDers” have unique experiences regardless of gender. However, research has shown that there can be differences in how AD.H.D. presents in cisgender girls compared to cisgender boys. These differences reflect the diverse ways A.D.H.D. can manifest.

Underdiagnosis and Misdiagnosis: Research has highlighted that cisgender A.D.H.D. girls are often underdiagnosed or misdiagnosed compared to cisgender boys. This may be due to differences in presentation and the tendency for girls to display less overtly disruptive behaviors, which can lead to their challenges being overlooked or attributed to other things (Quinn, P. O. , 2008).

Inattentive Type: Cisgender A.D.H.D. girls are more likely to exhibit the predominantly inattentive presentation of A.D.H.D. or A.D.H.D.-P.I., which is characterised by difficulties with focus, organisation, and attention to detail—rather than the hyperactive-impulsive presentation often associated with cisgender boys (Rucklidge, J. J., 2010).

Social Coping Strategies: Some research suggests that cisgender A.D.H.D. girls may develop compensatory social coping strategies to “mask” their difficulties, making it less apparent that they are struggling with inattention and impulsivity (Hinshaw, S. P., 2002).

Internalising Symptoms: Cisgender A.D.H.D. girls may be more likely to experience internalising difficulties, such as anxiety and depression, which can complicate the presentation and diagnosis (Owens, J. S., et. al., 2007).

Academic Struggles: Cisgender A.D.H.D. girls may face challenges in academics, but these difficulties may manifest differently, such as in disorganisation, inconsistent performance, and difficulty staying on task (Gaub, M., & Carlson, C. L., 1997).

Rejection sensitivity dysphoria (R.S.D.) is a concept that refers to the heightened emotional response individuals may experience when they perceive or anticipate rejection, criticism, or disapproval from others.

ADHDers often have unique neurocognitive profiles that make them highly sensitive to social interactions and cues. While it is important to note that not all ADHDers experience rejection sensitivity, some may be more prone to it due to social and systemic adversity related to being neurodivergent.

Rejection sensitivity in ADHDers means that they may be acutely attuned to social dynamics and are more likely to interpret ambiguous or neutral social cues as rejection or criticism. This heightened sensitivity can lead to emotional distress and anxiety in social situations.

Recognising rejection sensitivity in ADHDers may include creating safe and inclusive environments, providing consistent co-regulation, modelling and teaching emotional regulation skills, and promoting self-acceptance.

A.D.H.D. can sometimes be mistaken for or co-occur with other neurodivergent and mental health presentations. Here are some common differential presentations for A.D.H.D.:

Adverse Childhood Experiences (ACEs): ACEs, which include traumatic experiences in early life, such as abuse, neglect, and household dysfunction, can have profound effects on a child's development. The difficulties associated with high ACEs or trauma can, in some cases, closely resemble difficulties associated with A.D.H.D., leading to potential misdiagnoses or misunderstandings.

Key Differences: The onset of trauma symptoms arise after exposure to traumatic or adverse events and can be triggered by reminders of the trauma. Indicators of A.D.H.D. appear in the early developmental period and are not reactions to specific events. While both can involve inattention, in trauma, this might manifest as dissociation or avoidance—while in A.D.H.D., it is more about difficulty sustaining attention due to neurological differences. Lastly, trauma responses often involve intense emotional reactions tied to memories or reminders of traumatic events. Whereas emotional dysregulation in A.D.H.D. is not typically linked to specific traumatic memories. References: Ford, J. D., et. al. (2000) and Steinberg, A. M., et. al. (2004).

Anxiety Presentations: Anxiety presentations, such as generalised anxiety disorder or social anxiety disorder, can sometimes share similarities with A.D.H.D., such as restlessness or difficulty concentrating.

Sensory Processing Differences: Some individuals may have sensory processing differences that resemble A.D.H.D. traits. However, these differences do not include the hallmark symptoms of inattention and hyperactivity associated with A.D.H.D (Dunn, W., 2014). Additionally, some A.D.H.D. individuals can have sensory processing differences.

Specific Learning Differences: Specific Learning Differences, such as dyslexia or dyscalculia, can also have an impact on attention and academic performance. They should be considered and ruled-out when considering A.D.H.D. (Shaywitz, S. E., & Shaywitz, B. A., 2008).

Mood Presentations: Difficulties related to mood presentations, like depression or bipolar disorder, share similarities with A.D.H.D., such as difficulty concentrating and impulsivity (Source: N.I.M.H.).

Executive Functioning Challenges: Executive functioning difficulties, which are often present with A.D.H.D., may also occur in other neurodivergent presentations (Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L., 2000).

Specifically, autism and A.D.H.D., can share overlapping traits and characteristics, such as:

Executive Functioning Challenges: Both autistic individuals and ADHDers may experience difficulties with executive functions, which include skills like planning, organising, initiating tasks, and maintaining attention. These challenges can impact daily life and academic or work performance (Zalewska, A., 2019). Executive functioning difficulties in ADHDers arise primarily from difficulties related to inhibitory control, working memory, task initiation, and attention regulation. Organisational difficulties, leading to challenges in structuring tasks or activities and often resulting in misplaced items or last-minute rushes, can occur. There can also be difficulty with time management, estimating how long a task will take, or perceiving the passage of time accurately.

Executive functioning challenges in autism are diverse, affecting processes such as cognitive flexibility, planning, and initiating actions. They can also be intertwined with social communication differences. Difficulties in switching between tasks or adapting to changes in routine are common. While some autistic individuals may excel at detailed planning, others might struggle with organising tasks, foreseeing consequences, or sequencing actions. Challenges in starting tasks or activities, especially if they are not aligned with personal interests, can occur. Some autistic individuals may have difficulty holding and processing multiple pieces of information simultaneously, especially in dynamic social situations. A preference for routines or familiar environments may be associated with difficulties adapting to unexpected changes. Lastly, autistic individuals might focus on details rather than the overall context or “bigger picture.”

Sensory Processing Differences: Many autistic individuals and and ADHDers have sensory processing differences—but sensory processing is associated more strongly with autism. Sensory processing difficulties are a core feature of autism and are included in its diagnostic criteria for autism. In A.D.H.D., while these difficulties are prevalent, they are not a central diagnostic feature. Also, the range and depth of sensory sensitivities might be more diverse in autism, encompassing all sensory modalities. Individuals with sensory processing differences can be hypersensitive and then seek to avoid certain sensory inputs, such as sound, light, or textures, and/or hyposensitive (i.e., they may seek out certain stimuli). Sensory sensitivities can influence individuals comfort in and response to various environments (Ben-Sasson, A. et.al., 2007).

Social Interaction Differences: Social challenges in ADHDers primarily stem from impulsivity, inattention, and hyperactivity. ADHDers might interrupt others, act without thinking, or struggle to wait their turn, leading to unintentional social faux pas amongst neurotypical peers. They might miss social cues because they are distracted or not paying close attention to social interactions. This can make them appear as if they're not listening or are not interested in others. Also, restlessness or fidgeting can be perceived by neurotypical people as disruptive in group settings. There is often a desire to engage socially and make friends, the A.D.H.D. child’s difficulties can make sustained positive interactions more challenging—especially with neurotypical peers. ADHDers often recognise and feel hurt when rejected or left out, but they might not always understand why their actions lead to these outcomes.

By contrast, social challenges for autistic children are related to inherent differences in understanding and interpreting social information. Autistic children might have difficulty interpreting body language, facial expressions, or tone of voice, and might use fewer non-verbal cues themselves. Predicting and understanding the behaviours, thoughts, or feelings of neurotypical peers can be challenging—and vice versa. (See the double empathy problem.) While some autistic children might be less aware of or concerned about peer perceptions, many recognise their social differences from neurotypical peers. These differences can land do lead to social misunderstandings with neurotypical peers (Johnston, K., et.al., 2015).

To summarise: The root of social difficulties for ADHDers is more tied to impulsivity, inattention, and hyperactivity—while, for autistic children, it is related to differences in understanding and navigating social interactions with neurotypical peers. The type of social miscues differs: Miscues for ADHDers might involve interrupting or not listening—whereas for autistic children, this might manifest as missing the nuances of a conversation with neurotypical peers or not understanding neurotypical social expectations. Awareness and desire for social connection might differ: ADHDers often actively seek peer connections despite challenges—while autistic children might have variable social motivation.

Emotional Regulation: Both autistic individuals and ADHDers can struggle with emotional regulation. Individuals may experience difficulties in managing their emotions, leading to emotional meltdowns, burnout, etc. (Yerys, B. E., et. al., 2017). In A.D.H.D. children, emotion regulation difficulties are often linked to impulsivity and the challenges of inhibitory control. ADHDers might have rapid and strong emotional reactions to stimuli, often appearing to act without thinking. They might become frustrated, impatient, or irritated more quickly than others, often due to difficulties with waiting or experiencing setbacks. Emotional reactions can be intense, leading to difficulties regulating strong feelings of disappointment, excitement, or frustration. ifficulty calming down after becoming upset.ADHDers can experience challenges in shifting attention away from a distressing event or stimulus, which can prolong difficult emotional states.

For autistic children, emotion regulation difficulties are multifaceted, stemming from sensory sensitivities and social communication differences. Over-or-under-responsiveness to sensory input can trigger strong emotional responses. For instance, an unexpected loud noise might result in an intense fear or distress response. Difficulties being understood by neurotypical peers can lead to misinterpretations, potentially resulting in seemingly unexpected emotional responses in the autistic young person. Lastly, difficulties adapting to change or unexpected outcomes can cause anxiety or distress.

Hyperfocus vs Monotropic Interest Pursuit: A.D.H.D. is characterised by variable attention regulation. While distractibility is common, the opposite can also occur, leading to hyperfocus. Hyperfocus in ADHDers refers to an intense concentration on a specific task or activity, often to the exclusion of everything else. ADHDers might hyperfocus on various activities, from video games to work tasks. The subject of hyperfocus might change frequently. Hyperfocus in ADHDers often occurs when the individual is particularly interested or engaged in an activity; this contrasts with day-to-day tasks that might be difficult to focus on due to inattention. Many ADHDers describe using hyperfocus productively, especially in creative or work-related tasks, though it can also lead to imbalance when other responsibilities are neglected.

The term "hyperfocus" is less frequently used in the context of autism, but individuals with autism can exhibit intense concentration on specific interests or activities—and this is known as a monotropic approach to interests. Many people with autism have specific topics or activities, that they are passionate about; this can range from academic subjects to hobbies or even specific items or phenomena. Unlike the more variable nature of A.D.H.D. hyperfocus, the topics of intense concentration in autism tend to be more consistent over time. The focus on a passionately held interest or activity is not necessarily driven by external rewards but seems to be intrinsically motivating. Engaging in an interest can be comforting and a way to manage anxiety or overwhelming sensory input. Deep dives into these interests can lead to high levels of expertise or knowledge in specific areas (Tani, P., et. al., 2006).

Movement: Fidgeting for ADHDers refers to small and often restless movements, especially with the hands and feet. These can include tapping, bouncing, or shifting position frequently. ADHDers may fidget to help maintain attention. Fidgeting can act as a self-regulation mechanism to help them stay engaged in a task or situation. Fidgeting might increase during tasks requiring sustained attention or in situations where the ADHDers needs to stay still for extended periods.

By contrast, “repetitive behaviours,” often referred to as "stimming" (short for self-stimulatory behaviours), are behaviours or body movements that are done repeatedly. They can include hand-flapping, rocking, spinning, humming, flicking, etc. Like fidgeting in ADHDers, stimming can be a self-regulation mechanism. It can help manage overstimulation or understimulation, and help the autistic individual cope with anxiety or other emotions. Stimming can also provide pleasing sensory input or help modulate overwhelming sensory experiences. Stimming is often more consistent for the autistic individual compared to the variable fidgeting seen in ADHDers. Both fidgeting and stimming can be misinterpreted by neurotypical individuals, and it is important that neurodivergent children should not be deterred from fidgeting or stimming—unless, of course, the behaviour is causing harm.

Here are just some notable A.D.H.D. individuals:

Michael Phelps: The legendary Olympic swimmer, with 23 Olympic gold medals, has spoken openly about his A.D.H.D. diagnosis and how it has influenced his life.

Will Smith: The actor and rapper Will Smith has discussed his A.D.H.D. diagnosis.

Justin Timberlake: The musician and actor Justin Timberlake has revealed his A.D.H.D. diagnosis and how it has shaped his creativity.

Simone Biles: The gymnastics superstar and multiple Olympic gold medalist has shared her A.D.H.D. diagnosis and advocated for mental health awareness in sports.

Sir Richard Branson: The entrepreneur and founder of the Virgin Group has spoken about his A.D.H.D. diagnosis and how it has contributed to his success.

Cher: The iconic singer and actress Cher has talked about her A.D.H.D. diagnosis and how it has influenced her life and career.

David Neeleman: The founder of JetBlue Airways and other successful ventures has shared his A.D.H.D. diagnosis and has advocated for neurodiversity in the workplace.

Solange Knowles: The singer, songwriter, and actress Solange Knowles has revealed her A.D.H.D. diagnosis.

These individuals have achieved remarkable success in their respective fields, thus demonstrating that neurodiversity can be a source of strength. Their openness about their experiences has contributed to reducing stigma and increasing understanding of A.D.H.D.