Symptom development in children by age and frequency

• 1. Symptom development of ADHD-HI (with hyperactivity) by age
  • 1.1. Infancy
  • 1.2. Toddler age (1 - 3 years)
  • 1.3. Preschool age (4 - 6 years)
    • 1.3.1. ADHD-I in preschool age (without hyperactivity)
    • 1.3.2. AHDS in preschool age (with hyperactivity)
  • 1.4. School time (6 to 15 years)
    • 1.4.1. ADHD-I at school age (without hyperactivity)
    • 1.4.2. ADHD-HI in school age (with hyperactivity)
  • 1.5. Adolescence (from 15 years)
  • 1.6. Adulthood
• 2. Symptom frequency and symptom intensity in ADHD
• 3. Ethnic and cultural differences

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