Symptoms and signs

Not all these symptoms are always present, and can appear in different combinations. Sometimes these behaviours can be confused with particularities in the child's personality. It is important to keep in mind that a disorder can be considered only when the child's manifestations occur more frequently than in most children of the same age and with the same level of development. They must also be taken into account if they affect the person's work or social or family life.  

Some of the warning signs that can help identify this disorder are:  

• Being described as "lazy" or "rude".  
• Parents feel overwhelmed, due to requiring excessive supervision.  
• Low academic performance, the comment "could do more" by teachers is frequent.  
• Receives many warnings for not turning in assignments when due.  
• Is often disorganised in writing and has problems with presentation.
• He is often punished at school.  
• He has frequent conflicts with classmates.  

Symptoms may seem less intense in girls, but are widespread, harmful and become more evident in times of social or educational transition (for example, when entering secondary school or new extracurricular activities). 

These symptoms are not consistent, but vary and can combine with, or be replaced by, each other depending on the stage of life. Some examples are:  

• As infants, children with ADHD are more aggressive in games and have more tantrums.
• At school, they tend to talk excessively, interrupt others or submit incomplete homework.  
• In adolescence, they may have low self-esteem, be disorganised or internally restless, with physical hyperactivity symptoms being reduced.

More frequently than others, people with ADHD also have other mental disorders. Some associations observed are:  

• Depressive disorder: This disorder is present with ADHD in 10-40% of cases.
• Anxiety disorder: This disorder is present with ADHD in 34% of cases, rising to 40% in the adult population. The most frequent anxiety disorders in people with ADHD are: separation anxiety, panic disorder, obsessive-compulsive disorder (OCD) and general anxiety.
• Autism Spectrum Disorder (ASD): Of children with ASD, inattentive type ADHD symptoms are observed in 33% and combined type ADHD symptoms in 26%.
• Substance Abuse Disorder (SAD): approximately 23% of subjects with SAD have symptoms of ADHD. In some investigations that include all kinds of toxins and alcohol, 52% of patients diagnosed with ADHD are identified with substance use disorder.
• Tic disorders and Tourette Syndrome: Most children with this syndrome have associated ADHD; while, a minority of children with ADHD also have tics.
• Oppositional Defiant disorder: This disorder occurs in 2-16% of the general child population but 20-40% of children with ADHD.

Symptoms may be less evident and less serious, but are generalised. However, they can be aggravated by hormonal changes during the menstrual cycle.  

Some of the most common symptoms are: 

• Behavioural changes. Developing compensatory strategies, e.g., dedicating long hours to study, mimicking peer behaviour.  
• Difficulties with attention and organisation, which occur more frequently.  
• Internalising symptoms, such as anxiety or depression. These are the most frequent symptoms and can overshadow the main problem, thus masking the diagnosis of ADHD. A key phrase is: "Anxiety, emotional lability or sadness can eclipse ADHD in young and adolescent girls" As such, the absence of overt behavioural issues should not rule out its diagnosis.  
• Lack of emotional control, which tends to be more common and serious than in boys, and must be treated to prevent a greater impact on adulthood. 
• Social problems which can be especially harmful, since they are more vulnerable to physical, social and online harassment. 

Parents and teachers often underestimate ADHD symptoms in girls, so they end up receiving less medical care. Also, current diagnostic criteria often fail to account for sex differences across developmental stages.