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In order to diagnose ADHD, the child needs to present with significant symptoms of inattention, impulsivity/hyperactivity or both. The dimension impulsivity/hyperactivity is often referred as disinhibition.

More than 60% of the children with ADHD have the combined type (both inattention and disinhibition), 30-35% have the inattentive type  (inattention without significant disinhibition) while 5-10 % of the children have the hyperactive type (disinhibition without inattention).


ADHD is fairly common

·         4.2% – 6.3% (up to 7-8% total) frequency among children

·         In US, 4-5% adults (12 million) likely have ADHD

·         males : females = 3:1


Risk Factors for ADHD

·         One parent has ADHD                                     x8

·         Mom smoked during pregnancy                    x2-3

·         Mom used alcohol during pregnancy             x2-3

·         Low Birth Weight                                              x3


Types of Attention


There are several types of attention (see below). The more you go down the list the more difficult the type of attention is. Few people can actually do well on divided attention tasks.

1.    Focused attention:

ability to respond to one thing

2.    Sustained attention:

ability to maintain focus on what matters

3.    Selective attention:

ability to resist distractions and stay with what matters

4.    Alternating attention:

ability to shift between two activities that matter

5.    Divided attention:

ability to respond simultaneously to multiple tasks


Children with ADHD may do alright focusing on one thing if the circumstances are optimal (1:1 work, little distractions, the task is exciting or pleasant, the mood is OK etc.) but will have a hard time sustaining that focus over time and persist with what is required. They are also more sensitive to distractions than most of the other children.


The symptoms of inattention seen as the result of an impaired working memory. The working memory is the part of our memory where we are holding pieces of information where they can be manipulated. Holding in mind a list of items I need to get from the grocery store or remembering the steps I need to go trough to get something done are examples of working memory tasks.


Inattention in ADHD increases the risk for impairment in academic achievement and school performance.


Symptoms of Inattention in ADHD


About the child

  • difficulty sustaining attention

  • easily distracted

  • loses things

  • forgetful

  • difficulty organizing tasks and activities


The child appears to the adult like he….

  • avoids tasks that require sustained mental effort

  • does not seem to listen /fails to give close attention to details

  • makes careless mistakes  /does not follow through



Behavioral Control


Behavioral control in essence means having the right behavior for the situation. There is a time for running and a time for sitting still, a time for quick reactions and a time for patience. When the behavior is not properly regulated for the situation this creates problems.

Children with ADHD have a hard time inhibiting their first impulse to do something (inhibition of prepotent responses). They are more prone to get into action quicker, without thinking through consequences and once they are about to do something they cannot just stop. There is a reason why one of the most common commands from parents becomes: “Stop!” or “No!”.

Disinhibition in ADHD increases the risk for oppositional behaviors, conduct disorder and substance use and abuse.


Symptoms of Hyperactivity/Impulsivity (Disinhibition) in ADHD


Physical behaviors

  • fidgets

  • leaves seat (when remaining seated is expected)

  • “on the go” / “driven by a motor”

  • runs / climbs excessively & inappropriately

  • not awaiting turn


Verbal behaviors

  • talks excessively

  • even during leisure activities is not quiet

  • answers before questions have been completed

  • interrupts / intrudes


 Developmental Course



  • The average onset of ADHD is in preschool years (ages 3–4), more likely with symptoms of hyperactivity/impulsivity.


School years

  • During the first few grades of primary school (ages 5-8) the symptoms of inattention become apparent while the hyperactive / impulsive behavior is likely to continue.


Transition into adolescence (ages 12-17)

  • All symptoms tend to decline by adolescence, especially the hyperactivity and impulsivity.
  • A majority, 50-80% of the children treated in clinics continue to meet the criteria.


Persistence into Adulthood

  • Up to 60% do not meet full criteria for ADHD by adulthood but only 30% will no longer meet any symptoms. Even fewer, 10-15% will present no functional impairment associated with ADHD.

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