ADHD across the lifespan

ADHD isn't just "hyper kids who grow out of it." It's a lifespan condition that changes costume as a person ages — the hyperactivity that's obvious in a squirming second-grader often morphs into inner restlessness and disorganization in the adult. Examiners test whether you know it persists and how it looks at different ages.

ADHD has three presentations, defined by which symptom domain dominates: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Inattentive symptoms — careless mistakes, difficulty sustaining attention, not listening, poor follow-through, disorganization, losing things, distractibility, forgetfulness. Hyperactive-impulsive symptoms — fidgeting, leaving seat, restlessness, talking excessively, blurting, difficulty waiting turns, interrupting.

Two DSM criteria worth remembering: several symptoms must be present before age 12 (it's a neurodevelopmental disorder, not adult-onset), and symptoms must appear in two or more settings (e.g., home and school/work).

Across the lifespan: In young children, hyperactivity is loud and physical — running, climbing, can't sit. In adolescence, overt hyperactivity often fades while inattention, disorganization, and impulsivity persist, hitting academics and risk-taking. In adults, hyperactivity is typically internalized as restlessness rather than visible motor activity; the presenting problems are inattention, disorganization, poor time management, forgetfulness, procrastination, and emotional dysregulation, often surfacing at work or in relationships. ADHD frequently persists into adulthood rather than being outgrown.

Clinical Pearl: ADHD is a neurodevelopmental disorder — symptoms must begin before age 12 and appear in >=2 settings. It doesn't vanish with age; the hyperactivity dampens into inner restlessness while inattention and disorganization become the dominant adult complaints.