Inattention, Hyperactivity. Impulsivity. Everyone knows the three main traits of a person with ADHD. However, this brain condition is complex, everyone is unique and some people experience symptoms that are less known, yet are closely related to ADHD. Let’s review in this article these ADHD signs and symptoms that are often overlooked.
While hyperactivity is classically described in the medical test books, only 25 % of the children and even fewer adults experience visible hyperactivity. Instead, the majority of people have so-called emotional hyperarousal. This hyperarousal creates quick, intense mood swings because a person with ADHD has stronger, more intense emotions than those without ADHD. For this reason, ADHD is often misdiagnosed as anxiety or depression. Many people, especially adults initially receive antidepressants before the diagnosis of ADHD becomes clear and the treatment is adjusted to ADHD.
How do you recognize the difference? This is how Dr. William Dodson explains to NeuroHealth: mood changes seen in mood disorders often last more than two weeks, and are separate from events for a person’s life. On the other hand, mood changes related to ADHD are often triggered by perceptions and events that quickly resolve. Simply put, these are normal, day-to-day moods that are felt more intense by a person with ADHD. A person with ADHD may get upset, but quickly feel better. Someone with depression feels low for longer periods of time. Having a good support system from family, friends, teachers, or co-workers is important to help an individual cope with the mood swings which often are associated with low self-esteem and feeling shame. Research shows that this state of hyperarousal can also lead to insomnia and other sleeping problems- which many people with ADHD do experience.
Rejection sensitive dysphoria (RSD)
Closely related to emotional hyperarousal, rejection sensitive dysphoria (RSD) is experienced by up to 99% of teenagers and adults with ADHD. RSD means that a person is more sensitive than usual to rejection or criticism. Many people affected by RSD also believe this is the hardest part of living and coping with ADHD. Some may choose to work harder to feel more admired by peers and partners, becoming people pleasers. Others may prefer to isolate themselves- to the point of getting social phobia, in order to not get hurt or feel embarrassed. Other signs of RSD include getting angry quickly when felt rejected, setting high standards and feeling like a failure when they aren’t met, low self-esteem, feeling anxious in social settings, and at times contemplating hurting themselves.
Just like emotional hyperarousal, RSD can be misdiagnosed as depression, social phobia, borderline personality disorder, or obsessive-compulsive disorder (OCD). One way to differentiate ADHD from these conditions is to look at the duration of the signs and symptoms. RSD episodes resolve quickly, where the emotions and thoughts related to the other conditions tend to last longer. Drugs like guanfacine, clonidine, and older generation antidepressants may be recommended for RSD. Seeking a psychotherapist or psychologist and practicing stress management strategies can further help this condition.
Laser focus (Hyperfocus)
ADHD is mostly known to cause inattention and getting easily distracted. Yet, some adults with ADHD often experience episodes of highly focused attention. These episodes can be long-lasting or short-lived. The same people who are hyper-focused on specific tasks and projects may lack attention, while completely ignoring or “tuning out” everything else. This phenomenon of hyperfocus has been described not only in cases of ADHD, but also in autism and schizophrenia, yet more research is needed to fully understand it. It seems that the nervous system is stimulated by interest, rather than priority or importance. Being hyper-focused at work may seem an ideal situation, as it makes a person more productive, efficient, and successful. On the flip side, however, relationships and other areas of life may become neglected. Long, intense hours of focusing on one task can also lead to burnout. In other cases, there is a lot of focus on a relationship. It happens early when the partners meet and start dating. The relationship seems perfect, very romantic, with intense passion. Yet, things can change quickly to the exact opposite, making the partner feel ignored and unloved. It is important to note that certain ADHD medications also act as “nootropics” or smart drugs and make a person more focused and productive.
There are other important signs and symptoms related to ADHD that do not get enough attention but interfere with day-to-day life. Sleeping problems, fatigue and exhaustion, the distorted feeling of time (one minute may feel like an hour for someone with ADHD), low tolerance to boredom and constantly looking for stimulation or challenge, impulse shopping, and addictions. ADHD is often associated with headaches/migraines, anxiety, depression, OCD, and other conditions. Adults with ADHD are more likely than children to have anxiety, substance abuse/addiction, personality disorders, and social phobia. On the other hand, children are more likely to have separation anxiety or oppositional disorder. It is important to work with experienced, healthcare professionals who specialize in ADHD and understand this condition beyond the ADHD criteria described in the DSM-5 medical textbook.