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Symptom development in children by age and frequency

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Symptom development in children by age and frequency

1. Symptom development of ADHD-HI (with hyperactivity) by age

1.1. Infancy

One study was able to distinguish those with high genetic ADHD risk (older siblings or parents with ADHD) from those without genetic ADHD risk on the basis of behavior (primarily increased activity and impulsivity and more frequently reported behavioral and temperament problems) in children 1 month of age.1

  • Restlessness, hypermotor activity
    • About 60 % of the children show extreme restlessness2
    • Continuous urge to move2
    • Inexhaustible energy3
    • Crawling eliminated, early walking4
    • Restless, unbalanced4
    • Game endurance shortened4
    • Difficulty in establishing even a calm waking state3
  • Sleep
    • Unstable waking and sleeping rhythm2
    • Superficial sleep, wide awake4
    • Short sleeper3
  • Crying, screaming
    • Particularly frequent persistent and shrill screaming23
    • Unquenchable crying at times4
  • Food intake
    • Drinking problems43
    • Heathy eater3
    • Frequent colics3
  • Cleanliness education often delayed2
  • Language development often delayed2
  • Stroking is not enjoyed4
  • Often skin allergies4

1.2. Toddler age (1 - 3 years)

  • Distractibility3
  • Chaotic and destructive, little goal-oriented play behavior2
  • Sleep problems
    • Sleep-through problems in toddlers 1 to 3 years of age were a stronger predictor of later ADHD than sleep duration.5
    • Sleep disorders3
  • Gross motor problems
    • Often falls over its own legs6
    • Mouth motor activity conspicuous6
      • Mouth is often open
      • Drools easily
    • Desire for violent movements3
    • Constantly on the move3
    • Motor sometimes very skillful3
  • Game endurance shortens6
    • Often changes employment
    • Does not finish game
  • Learning problems
    • No learning gain from negative experiences2
    • Learns hard to dress6
    • Language development delayed67
    • Conversion problems6
    • Adaptation problems6
  • Can’t wait6
    • Until the turn
  • Sensitivity changes
    • Highly sensitive or hyposensitive to external stimuli6
  • Novelty Seeking
    • Stimulation hunger3
    • Enormously curious3
    • Daring, increased risk of accidents3
  • ADHD-HI-specific
    • Group incompetence and disruptive behavior, outsider role2
    • Constant fidgeting and talking in between in the chair circle2
    • Strong urge to move leads to danger to self and others2
    • No awareness of danger2
    • Impulsivity
      • Impulsivity at age 2 correlated with ADHD symptoms at age 3.8
    • Emotional dysregulation
      • Aggression
        • Increased aggression2
        • Little tyrant3
        • Destruction of games and toys3
      • Anger
        • Frequent / uncontrollable tantrums23
      • Affect spasms3
      • Affect labile, mostly pronounced defiant phase3
  • ADHD-I specific
    • Remarkably calm and well-behaved6
    • Overprotective, clingy, very affectionate6

1.3. Preschool age (4 - 6 years)

1.3.1. ADHD-I in preschool age (without hyperactivity)

  • Often anxious6
  • Often unsafe6
  • Learning Difficulties
    • Problems listening6
    • Slow comprehension6
    • Often believes task cannot be accomplished6
    • Slow language acquisition, confuses letters6
  • Gross motor skills
    • Conspicuous mouth motor activity6
    • Speaks indistinctly6
    • Does not like to paint and tinker6
    • Motor problems6
    • Difficulty learning to swim6
    • Difficulty learning to ride a bike
    • Balance problems
    • Activities slowed down or over-fast6
  • Withdrawn social behavior
    • Often plays alone6
    • Little contact with children of the same age6
    • Withdrawal tendencies in groups6
      • Kindergarten
      • Chair circle
    • Gets bored quickly6
  • Often loses and forgets things6

1.3.2. AHDS in preschool age (with hyperactivity)

  • Motor hyperactivity
    • Agitation6
    • Always on the move6
  • Impulsivity
    • Gets excited quickly and strongly6
    • Reacts spontaneously and rashly6
    • Asks a lot6
      • Often does not wait for answers6
    • Does not follow rules6
      • Often forgets rules again9
    • Grumbles quickly6
  • Attention problems
    • Often only become apparent at a later age (school years)
    • Can not listen for long6
    • Forgets quickly6
    • Loses a lot6
  • Aggression
    • Often as a comorbidity
    • Especially with uncertainty6
  • Gross motor skills
    • Conspicuous mouth motor activity10
    • Language problems
      • Speaks indistinctly6
      • Stammer6
      • Difficulties with some consonants
    • Does not like to paint and tinker10
    • Holds pens cramped6
    • Presses too hard on6
    • Coloring or cutting out shapes more difficult6
    • Difficulty learning to swim
    • Difficulties in learning to ride a bike
    • Balance problems
  • Social behavior
    • Strong sense of justice6
    • High ambition in sports and games6
    • Often wants to determine6
    • Eager at social services6
    • Quickly offended11
      • Rejection Sensitivity
  • Impatience
    • With itself6
    • With others6
  • Wets more often still a6
    • More often during the day than at night
  • Sleep
    • Often fall asleep late6
    • Needs little sleep6

1.4. School time (6 to 15 years)

ADHD symptoms now become fully apparent.2

1.4.1. ADHD-I at school age (without hyperactivity)

  • Emotional problems
    • Often anxious6
    • Often unsafe6
    • Does not dare to do anything6
    • Rejection Sensitivity
      • Easily offended6
      • Cries quickly6
      • Emotionally sensitive6
      • Takes criticism badly6
      • Feels unloved6
      • Feels misunderstood6
  • Attention and learning difficulties
    • Problems listening6
    • Easily distractible6
    • Forgets a lot6
    • Overheard much6
    • Unfocused6
      • Unless something is of particular interest
    • Dreamy6
    • Slow6
    • Inflexible thinking6
    • Takes a very long time to do homework6
    • Can not do homework alone6
  • Gross and fine motor problems
    • Writing problems
    • Messy coloring6
    • Speaks indistinctly6
  • Social behavior
    • Is easily annoyed6
    • Can resist badly6
    • Delayed development of social maturity6
    • Gets bored quickly6
  • Often loses and forgets things
  • Somatization tendencies
    • Frequent headaches6
    • Frequent abdominal pain6

1.4.2. ADHD-HI in school age (with hyperactivity)

  • Social behavior
    • Fitting in with the rest of the class very difficult2
  • Aggression
    • Hits frequently, is often hit by others2
  • Risk behavior
    • Can assess dangers poorly6
    • 85 % of accidents on the way to school2
  • Attention problems become apparent for the first time
    • Earliest at the age of 7 years
    • Until the age of 14, 15
  • Motor hyperactivity
    • Agitation6
    • Always on the move6
    • Fidgets a lot6
  • Gross motor skills
    • Poor force dosage6
  • Impulsivity
    • Gets excited quickly and strongly6
    • Reacts spontaneously and rashly6
    • Interrupts others
    • Answers before question is finished6
    • Is often loud6
  • High sensitivity
    • Is often sensitive to noise itself9
  • Attention problems
    • Often only become apparent at a later age (school years)
    • Can not listen for long6
    • Forgets quickly6
    • Loses a lot6
    • Concentration span limited
      • Frequently switches back and forth between tasks / activities6
    • Often paints on the side
    • Difficulty starting homework6
    • Frequently interrupts homework6
    • Good observation skills6
      • Notices many things6
      • Can see through others well6
  • Learning problems
    • Makes mistakes again and again
    • Does not learn from mistakes6
  • Gross motor skills
    • Conspicuous mouth motor activity10
    • Language problems
      • Speaks indistinctly6
      • Stammer6
      • Difficulties with some consonants
    • Does not like to paint and tinker10
    • Holds pens cramped6
    • Presses too hard on6
    • Coloring or cutting out shapes more difficult6
    • Difficulty learning to swim
    • Difficulties in learning to ride a bike
    • Balance problems
  • Emotional dysregulation
    • Rejection Sensitivity
      • Feels quickly treated unfairly6
  • Social behavior
    • Strong sense of justice6
      • Altruistic behavior
    • Often wants to determine6
    • Gets along worse with peers than with younger or older people6
  • Collects useless things6
  • Sleep
    • Often fall asleep late

1.5. Adolescence (from 15 years)

  • Motor hyperactivity decreases2
  • Inner and outer restlessness6
  • Impulsivity and decreased attention remain2
  • Orientation towards marginalized social groups2
  • Risk of developing a propensity for addiction2
  • Willingness to engage in high-risk behavior2
  • Frequent accidents2
  • Performance drop under stress6
  • Organization problems6
  • Low determination6
  • Crackled handwriting6

1.6. Adulthood

  • Hardly any motor hyperactivity, instead inner restlessness, being driven12
  • Attention problems subside somewhat
  • Emotional problems / affective comorbidities increase
    • Depression
    • Anxiety disorders
  • Increased risk of addiction, disturbances in social behavior13
  • Anxiety symptoms, alcohol problems14
  • Criminal history 15
  • Increased accident proneness16
  • Worse professional position17

2. Symptom frequency and symptom intensity in ADHD

The diagnosis of ADHD is not made by having a specific type of symptom that is exclusive to ADHD (categorical), but by the set of symptoms that may originate from ADHD and their intensity (dimensional).1819

  • In a collection of symptoms presented by Barkley20
    • Non-affected persons on average 1 to 2 of the 18 symptoms often, i.e. about 5 %
    • ADHD sufferers often have on average 12 of the 18 symptoms mentioned, i.e. about 66%.20
  • In the online test we designed ourselves ADHD online tests
    have
    • Subjects not affected according to their own assessment, on average just under 8 out of 32 possible symptoms (25 %)
    • Subjects with a confirmed ADHD diagnosis around 24 of the 32 possible symptoms (75 %)
  • Hardly any affected person has all symptoms “often”, and it is hardly typifiable which symptoms occur together in clusters.

The symptoms must occur over a long period of time and in several areas of life. In most cases, they first become apparent before the age of 12. However, more and more cases of Late Onset ADHD are being recognized, in which there were no sufficiently severe symptoms in adolescence to warrant a diagnosis. This mainly affects women in their late 30s and older.
The fact that symptoms must persist for a longer period of time and in different areas of life serves to distinguish ADHD as a permanent disorder from symptoms of merely temporary (stress) exposure to stressors that exist for a limited period of time.

3. Ethnic and cultural differences

When adults diagnose ADHD in children, the different ethnic and cultural backgrounds should be taken into account.21


  1. Miller, Iosif, Bell, Farquhar-Leicester, Hatch, Hill, Hill, Solis, Young, Ozonoff (2020): Can Familial Risk for ADHD Be Detected in the First Two Years of Life? J Clin Child Adolesc Psychol. 2020 Jan 17;1-13. doi: 10.1080/15374416.2019.1709196. PMID: 31951755.

  2. www.sonderpaedagogik-k.uni-wuerzburg.de/fileadmin/06040400/downloads/sopaed2_ws0304_ads-adhs.pdf

  3. Brandau (2004): Das ADHS-Puzzle; Systemisch-evolutionäre Aspekte, Unfallrisiko und klinische Perspektiven. Seite 39

  4. Simchen (2015): Die vielen Gesichter des ADS, 4. Aufl., S. 11

  5. Carpena, Munhoz, Xavier, Rohde, Santos, Del-Ponte, Barros, Matijasevich, Tovo-Rodrigues (2019): The Role of Sleep Duration and Sleep Problems During Childhood in the Development of ADHD in Adolescence: Findings From a Population-Based Birth Cohort. J Atten Disord. 2019 Oct 16:1087054719879500. doi: 10.1177/1087054719879500.

  6. Simchen (2015): 1.1. Viele fragen: “Woran erkenne ich ADS?” In: Die vielen Gesichter des ADS, 4. Aufl.

  7. Goh, Yang, Tsotsi, Qiu, Chong, Tan, Pei-Chi, Broekman, Rifkin-Graboi (2020): Mitigation of a Prospective Association Between Early Language Delay at Toddlerhood and ADHD Among Bilingual Preschoolers: Evidence from the GUSTO Cohort. J Abnorm Child Psychol. 2020 Jan 3. doi: 10.1007/s10802-019-00607-5.

  8. Gagne, Asherson, Saudino (2020): A Twin Study of Inhibitory Control at Age Two and ADHD Behavior Problems at Age Three. Behav Genet. 2020 Jul;50(4):289-300. doi: 10.1007/s10519-020-09997-5. PMID: 32162153.

  9. Simchen (2015): 1.1. Viele fragen: “Woran erkenne ich ADS?” In: Die vielen Gesichter des ADS, 4. Aufl.

  10. Simchen (2015): Die vielen Gesichter des ADS, 4. Aufl., S. 13

  11. [Simchen (2015): 1.1. Viele fragen: “Woran erkenne ich ADS?” In: Die vielen Gesichter des ADS, 4. Aufl.](https://www.kohlhammer.de/wms/instances/KOB/appDE/E-Books/Die-vielen-Gesichter-des-ADS-978-3-17-026957-6

  12. Barkley: Das große Handbuch für Erwachsene mit ADHS, 2010, Huber

  13. www.sonderpaedagogik-k.uni-wuerzburg.de/fileadmin/06040400/downloads/sopaed2_ws0304_ads-adhs.pdf unter Verweis auf New York-Studie 1985 -1991

  14. www.sonderpaedagogik-k.uni-wuerzburg.de/fileadmin/06040400/downloads/sopaed2_ws0304_ads-adhs.pdf unter Verweis auf Shekim et al. 1990

  15. www.sonderpaedagogik-k.uni-wuerzburg.de/fileadmin/06040400/downloads/sopaed2_ws0304_ads-adhs.pdf unter Verweis auf Iowa-Studie 1983

  16. www.sonderpaedagogik-k.uni-wuerzburg.de/fileadmin/06040400/downloads/sopaed2_ws0304_ads-adhs.pdf unter Verweis auf Beck et al. 1996

  17. www.sonderpaedagogik-k.uni-wuerzburg.de/fileadmin/06040400/downloads/sopaed2_ws0304_ads-adhs.pdf unter Verweis auf Warnke & Remschmidt 1990

  18. Edel, Vollmoeller (2006): Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen, Springer, Seite 52

  19. so auch Barkley, Steinhausen, Krause und viele andere

  20. Barkley: Das große Handbuch für Erwachsene mit ADHS, 2010, Huber, Seite 46; n = 252

  21. DuPaul (2020): Adult Ratings of Child ADHD Symptoms: Importance of Race, Role, and Context. J Abnorm Child Psychol. 2020 Jan 3. doi: 10.1007/s10802-019-00615-5.

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