Complete list of ADHD symptoms by manifestation

Review: Dipl.-Psych. Waldemar Zdero

This chapter describes the totality of ADHD symptoms, i.e. the subjective or observable effects of ADHD in the areas of behavior, perception and sensation.
We have collected around 45 symptoms that can be directly triggered by ADHD.
⇒ List of symptoms according to manifestations.

DSM 5 is limited to 8 particularly diagnosis-relevant symptoms.
ADHD has no clear symptoms or biomarkers and is diagnosed based on the number and intensity of symptoms.
ADHD symptoms in adults are different from those in children and differ according to different forms of presentation.
ADHD symptoms coincide with functional stress symptoms. Nevertheless, ADHD and severe chronic stress are different things. A differential diagnosis between ADHD and chronic stress is easy in adults due to the long time that can be assessed, but is naturally much more difficult in children.

The diagnosis-relevant symptoms according to DSM or ICD must be distinguished from the 45 ADHD symptoms as a whole. DSM 5 only mentions 8 symptoms:

Inattention (distractibility and concentration problems, but not task switching problems)
Forgetfulness
Disorganization
Hyperactivity
Impulsiveness
Impatience
Inner drivenness
Excessive talking

These 8 symptoms distinguish ADHD particularly well from non-affected people and from other disorders. They are not the most common ADHD symptoms (according to our data, adults with ADHD report procrastination more frequently than hyperactivity in ADHD-HI or inattention in ADHD-I), nor are they all symptoms that are relevant for the treatment of ADHD (these are all 45 symptoms)
It is undisputed that DSM 5 and ICD 10 do not cover all symptoms of ADHD. For example, emotional dysregulation and learning problems are not mentioned.
Until DSM IV, the criteria catalogs were tailored exclusively to children, although it had long been known that the symptoms change in adults (hyperactivity decreases or disappears, Inner drivenness comes to the fore).
⇒ ADHD in adults

Which symptoms are particularly prominent in ADHD and are therefore particularly suitable for diagnosis is a matter of debate, even among experts.¹

ADHD does not have clear symptoms that occur exclusively with ADHD. All ADHD symptoms can also result from other disorders. Furthermore, no ADHD symptom occurs in all people with ADHD. There is ADHD without attention problems (children: ADHD-HI with predominant hyperactivity; adults: ADHD-HI with predominant inner restlessness and inability to relax) and there is ADHD without hyperactivity (ADHD-I with predominant inattention). ADHD-C (inattention and hyperactivity / inner restlessness) is the most common. In our opinion, the presentation forms (formerly: subtypes) represent different phenotypic stress reactions. The ADHD-HI subtype reacts stress (impulsively) more outwardly, the ADHD-I subtype eats stress more internally²
All forms of presentation (subtypes) have the same underlying causes and are generally treated and medicated in the same way.

In the past, ADHD in adults was often misjudged because ADHD-C hyperactivity fades into the background in adults with ADHD-HI. Instead, inner restlessness and inability to relax become more prominent.

Due to the lack of ADHD-exclusive symptoms, ADHD is not diagnosed by identifying a specific symptom (categorical), but by the set of symptoms that apply and their intensity (dimensional).³⁴ In other words, ADHD is diagnosed based on the number of symptoms from the ADHD cluster that frequently occur in a person with ADHD.
Using the example of a collection of symptoms by Barkley:

Non-affected people often have 1 to 2 of 18 symptoms on average (around 5%)⁵
On average, people with ADHD often have 12 of these 18 symptoms (around 66%)⁵

Using the example of the 42 symptoms listed in the ADxS.org online symptom test version 3:

On average, non-affected people often had 12 of the 42 symptoms mentioned, i.e. around 28%.
On average, people with ADHD often had 30 of the 42 symptoms mentioned, i.e. around 72%.

With ADHD, a normal day at the office is like having a desk in the middle of the busiest pedestrian zone, with a streetcar passing right next to it every three minutes.
Although this sounds drastic, it is not easy to find out whether this could affect you. What should you compare it to if you don’t know any other life?
ADHD is more than just a disorder of the stimulus filter, as is also discussed in schizophrenia, mania or autism spectrum disorders, among others. In addition to the increased sensitivity (always present in ADHD) (which can be understood as a stimulus filter disorder), information processing (especially working memory in the dlPFC, which controls executive functions (planned tasks) and the reinforcement system in the striatum, which regulates motivation, drive and inhibition - and thus also hyperactivity) and stress regulation are also impaired.

ADHD and stress - similar but not identical

All ADHD symptoms are also functional symptoms of “mere” severe acute stress, while in other disorders some of these stress symptoms have become dysfunctional (e.g. functional: increased need for caution during stress / dysfunctional: anxiety disorder; functional: increased need for security during stress / dysfunctional: obsessive-compulsive disorder; functional: dysphoria only during inactivity / dysfunctional: depression). While all ADHD symptoms are also stress symptoms, not all stress symptoms are also ADHD symptoms. More on this at ⇒ ADHD symptoms are stress symptoms.
We refer to the advantages of functional stress symptoms as “stress benefits”. ⇒ Stress benefits - the survival-promoting purpose of stress symptoms

Nevertheless, ADHD and severe chronic stress are different things. ADHD is something fundamentally different than a mere reaction to existing stressors.
While the symptoms caused by “merely” severe acute stress disappear again once the stressors (the stress triggers) have disappeared, the symptoms of ADHD persist even without an adequate stressor.

In our opinion, ADHD can be caused by a chronic overreactivity (triggered genetically or by gene-environment interactions) or a deficient shutdown of the stress regulation systems. However, this only affects a subgroup of people with ADHD.
For ADHD as a whole, ADHD and severe chronic stress mediate their symptoms neurophysiologically in the same way **** (dopamine and noradrenaline deficiency) and therefore show similar symptoms. However, the causes of the dopamine and noradrenaline deficiency differ.

Due to the similarity of symptoms, ADHD and chronic stress are not always easy to distinguish. The confusability of symptoms is the reason why a diagnosis of ADHD requires the symptoms to occur over a longer period of time and in several areas of life. However, we doubt whether the 6 months required by the ICD is sufficient. Someone who has been in a severe life crisis for some time, i.e. who has had severe self-esteem or existence-threatening (= cortisolergic) stress for one or two years, will typically have stress symptoms during this entire long period of time with a severity and frequency that can be confused with ADHD. On the other hand, stimulants are also likely to help these people with ADHD to compensate for reduced dopamine levels. We think it is quite plausible that stimulants will be used in a few years as an acute medication for severe stress states - as a kind of painkiller for the soul.

In order to distinguish ADHD from symptoms of severe chronic stress, it helps to look at the respective life history. The similarity between the symptoms of ADHD and severe chronic stress and the neurophysiological mediation of these symptoms must be distinguished from the fact that ADHD can be caused by early childhood stress if this activates/manifests a genetic ADHD disposition. If the person with ADHD already had the (then still childhood) typical symptoms of massive cortisolergic stress in childhood/school, without corresponding stressors being present the entire time, ADHD can be assumed with some probability. However, if the symptoms were not recognizable in the first 12 years of life, and if they first appeared in the last 6 to 12 months, since a certain stressor existed, a “mere” acute stress overload is more likely.

Late-onset ADHD, which appears for the first time in adulthood, is particularly common in women. More on this under Gender differences in ADHD.
It is also conceivable that a latent ADHD exists, which the person with ADHD normally copes with “on board”. However, if a chronic stressor is added, even less drastic stress experiences together with the mild (subclinical) ADHD can lead to an overall burden that requires treatment, as their influences on the dopamine and noradrenaline balance add up. This is consistent with long-term studies that have shown that adults initially clearly diagnosed with ADHD (or unstable PS) have not been diagnosed for several years. This also explains why it makes sense to try to discontinue medication every year.

In children, it is much more difficult to distinguish whether they suffer from ADHD or chronic severe stress (which can come from the school environment or from the home), because you cannot look back on a complete school career and other years. ⇒ ADHD diagnostic methods.

Other frequently occurring symptoms do not stem from ADHD itself, but from disorders that often occur together with ADHD, so-called typical comorbidities.
More information on this can be found at ⇒ ADHD - Comorbidity and the subpages on individual comorbidities.
In order to determine whether a symptom results from ADHD or another Disorder, a differential diagnosis is required
More information on this can be found at ⇒ Differential diagnosis of ADHD And the subpages on individual differential diagnoses.

This chapter describes all the symptoms that can be caused by ADHD. Knowledge of all possible ADHD symptoms is of particular importance for people with ADHD and those treating them.
The following overall collection classifies ADHD symptoms according to their perceptibility from the outside, not according to their neurophysiological correlates. For some symptoms, there is a reference to the description of the causative neurophysiological mechanisms.
Symptoms

Complete list of ADHD symptoms

Wonderfully entertaining and sympathetic collections of reports by people with ADHD about typical ADHD behavior can be found on the net.

German-speaking:

English-speaking:

Additude Mag - ADHD Humor: You Know You Have ADHD When..

Schneider, Schöttle, Hottenrott, Gallinat, Moritz (2019): Assessment of Adult ADHD in Clinical Practice: Four Letters-40 Opinions. J Atten Disord. 2019 Oct 18:1087054719879498. doi: 10.1177/1087054719879498. ↥
Ramos, Arnsten (2007): Adrenergic pharmacology and cognition: focus on the prefrontal cortex. Pharmacol Ther. 2007 Mar; 113(3):523-36., Kapitel 6 ↥
Edel, Vollmoeller (2006): Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen, Springer, Seite 52 ↥
so auch Barkley, Steinhausen, Krause und viele andere ↥
Barkley, Benton (2010): Das große Handbuch für Erwachsene mit ADHS, Huber, Seite 46; n = 252 ↥ ↥

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Complete list of ADHD symptoms by manifestation