Understanding the symptoms of hyperactive/impulsive type ADHD can be difficult, even more so in adults than children. It is tempting for us as nurses to armchair-diagnose the disorder in our coworkers, our neighbors, celebrities, even in our patients. However, ADHD symptoms aren’t widely understood and the condition is often stigmatized. This article is the second in a series that I hope will shatter some misconceptions and bring the facts of ADHD out into the open.
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Children often fiddle with pencils/crayons in class, fidget, tap their fingers or their toes, take overshirts or jackets off and put them back on, toy with their clothing or with fasteners, click pens, etc.
Teens and adults tend to bounce their knees, doodle, take excessive notes, pass notes in class, flip through textbooks, read and reread agendas or other meeting documents, flip through reports, twirl pens, tap pens, change positions frequently, and so forth.
Children will get up frequently in class, ask to use the bathroom frequently, find excuses to get up and look out the windows, get up while eating, get on the floor while supposed to be sitting, and get up for frequent snacks and bathroom breaks while doing homework.
Teens and adults will offer to do tasks that require standing or walking, claim that sitting hurts their back and stand against the wall, shift position frequently, leave to get beverages or snacks. They may also take frequent bathroom breaks, get up and down for extras during dinner, clean or do several other tasks while watching television, and stand or walk around while talking on the telephone.
Children will often display these behaviors while participating in sports or other structured activities; to the child with ADHD, the world is often a fascinating obstacle course.
Teens and adults have usually learned to stop doing this, but are often restless. This behavior can be exaggerated in situations where it is appropriate, such as while participating in sports or outdoor activities. Patients will often search out opportunities to be physically active, like participating in martial arts, taking self-defense classes, running obstacle courses and marathons, or sports.
Children can be loud, argumentative, and confrontational during structured quiet time.
Teens and adults often show this while watching sports or television by talking to or yelling at the screen, as well as by becoming overly competitive and loud while playing board or card games.
Children may be unable to stop themselves from an enjoyable activity, or may complete one activity and dive straight into the next; this is characterized as acting as though they are "driven by a motor."
Teens and adults may display "driven" behaviors towards school, work, or leisure activities. This can be mistaken for commitment, but is similar to short-term obsession. The teen and adult with ADHD are frequently enthusiastic to the extreme about a new project, video game, garage band, concept for entrepreneurship, and so on. Teens may stay up all night playing music or games even though they have class the next day. Adults may be unable to stop work in the middle of a task and continue on to finish it even though it takes hours and affects sleep patterns. Artists and craftspeople may work without sleeping until exhausted or until a project is complete. In teens and adults, this symptom can be mistaken for mania. Another term for this symptom is hyperfocus.
Children may talk excessively in class or during activities, tell stories constantly, socialize during class time, and may be characterized as a "motormouth."
Teens and adults may dominate conversations, especially when excited, or talk over others.
Children do not wait to be called on and shout out answers in class or at home even before the question is finished, say whatever they are thinking without thought to the consequences, and change subjects in the middle of sentences.
Teens and adults answer questions before they are finished, make uncensored comments, say hurtful things without meaning to, and have trouble staying on topic.
Children have a hard time waiting for their turn, preferring for it to be their turn all the time. They may become frustrated and tearful when it is another child's turn.
Teens and adults may lose interest in long games and look for a more exciting activity, break in line, or get frustrated while waiting in line and leave.
ADHDers often miss social cues that indicate an intrusion is not welcome and will do things such as interrupt speakers, interject during movies, walk through a photo op, barge into rooms, and break into other's conversations. These patients may be labeled as a "busy-body."
For ADHD children, action is often synonymous with thought; an affected child will chase after something it sees that it wants, change direction mid-stride, break into running, slide to a stop, grab for things without being careful, snatch toys, hit other children, scream suddenly, or throw things when frustrated.
Teens and adults often make poorly thought out decisions, such as choosing a college because their friend got in, taking the first job offered, spontaneous road trips, sudden turns while driving, making expensive purchases on a whim. These patients may be described as "flighty."
"Only boys are hyperactive." Females are diagnosed with hyperactive/impulsive type ADHD, as well as combined type. In females, the trait displays more as excessive talking and hyper-social behavior.
"There's nothing wrong with that child except a lack of discipline." While discipline and structure can help a child mitigate behavioral symptoms, the underlying ADHD is not cured.
"Boys will be boys!" The often out-of-control behavior that is typical of males with hyperactive/impulsive symptoms is not a normal manifestation of maleness. These children often need help to learn how to regulate their behavior.
"There's nothing wrong with that girl except too much pent-up energy." While getting enough exercise is an important element in treating ADHD, it is only part of a complete treatment plan.
"That's just a bad kid." Children with ADHD are not inherently bad. With proper treatment, they can be very successful.
First article in the series: Stupid, lazy, or ADHD?
References
American Psychiatric Association (APA), "What is ADHD?"
National Institute of Mental Health (NIMH), "Attention Deficit Hyperactivity Disorder"
NIMH >> Attention Deficit Hyperactivity Disorder
The Centers for Disease Control and Prevention (CDC), "Symptoms and Diagnosis"
Symptoms and Diagnosis | ADHD | NCBDDD | CDC
Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) The National Resource on ADHD, "About ADHD:
this article is me to a T..every single observation. Add to being extremely introverted & low self esteem made my childhood very lonely until I hit high school and stopped caring so much. I've found that as an adult I handle my ADHD better than I did as a child, but navigating a pretend organized life can be stressful.
nice to see a well written article on the matter, thanks!
I asked for medication at one point because I was having trouble focusing.I was told it wasn't possible because of depression.
I take Wellbutrin which is one of two FDA approved non-stimulants (Strattera being the other), last time I checked at least. Wellbutrin, of course, is primarily used as an antidepressant but ADHD is a secondary use, as well as smoking cessation. I was diagnosed in 7th grade and went through the adderall thing until Strattera came out in 2002. That got me through high school and some college. I ended up switching to Wellbutrin after maxing out the strattera dose.
I take Wellbutrin which is one of two FDA approved non-stimulants (Strattera being the other), last time I checked at least. Wellbutrin, of course, is primarily used as an antidepressant but ADHD is a secondary use, as well as smoking cessation. I was diagnosed in 7th grade and went through the adderall thing until Strattera came out in 2002. That got me through high school and some college. I ended up switching to Wellbutrin after maxing out the strattera dose.
OMG JMURSE!!! That is my miracle pill. I had already heard of it, and was planning on switching to it in a few months when my new insurance kicks in.
I had heard it didn't have some of the side effects certraline does. Which is why I was considering it.
It is supposed to have mild side effects while still being effective. So I will definitely be talking about it soon.
Thanks.
Can I ask an ignorant question?If you're inclined to be distracted, start too many projects etc but are able to stay focused if you are determined to and make effort, versus your natural MO, would that be considered a mild form of ADHD or personality/habit?
I don't understand what you mean.
The ADHDer's natural MO is the two extremes. Most neuronormal people have balance and are able to maintain a consistent level of attention.
We literally can't be consistent. We are super obsessed and enthusiastic at the beginning of something new. We outperform our own expectations (which are ridiculously high) when we're in the groove. Once the lure of a new experience has worn off, whether or not the project is finished, we're done. It takes high stakes to get back into performance mode.
For example, I can't do a paper until the night before it's due. I need the adrenaline rush of possibly failing to raise the stakes high enough for my brain to take notice. A neuronormal person can plan the paper out and work on it a little bit at a time. I literally can't.
It is incredibly frustrating and demoralizing to find yourself doing laundry when you are on deadline for the biggest paper of the semester. It's even worse when you realize that you finished it but forgot to submit it.
I love my creativity. I love my tunnel vision. I love bouncing from great idea to great idea.
I hate my inability to control when any of it happens.
nurse8019, LPN
19 Posts
Thanks so much for sharing! I tend to gravitate toward the tough but fair educators/trainers as well-they seem to be less likely to lose patience or have complete meltdowns over the questions and interrupting. I am so glad you shared your tip about the questions, though. I really do have a hard time w/it, but not as hard as everyone around me. I will try your suggestion. The only other thing I've really struggled with as a nurse with ADHD (which is not a minor deal at all, really) is being a hundred percent competent at work, but having a hard time with other nurses and staff being extremely reluctant(despite no cause) to trust or believe that I don't 'just play one on tv' and I really am safe to let on the floor without a 'monitor'. It's not a good feeling.