Part of the reason ADHD is often missed is that people expect the symptoms to be loud and in-your-face. The stereotypical ADHDer is a little boy who’s running all over the place. An actual ADHDer, of course, can be any age or gender and have any temperament.
Why do people think that someone with ADHD will have symptoms that are overtly disruptive and impossible to ignore? The “H” part of ADHD definitely plays a role. If someone has ADHD, they have hyperactivity, and if they have hyperactivity it’ll be obvious, right?
But what I want to talk about today is that even if someone does have the H in ADHD, they aren’t necessarily going to be climbing up walls. It can still require being observant to know what’s going on.
For starters, not everyone with the hyperactive side of ADHD is loud and talkative. While talking non-stop is part of ADHD for some people, there are many other ways hyperactivity can express itself. Someone who’s an introvert can have an aversion to sitting still, fidget a lot, think better when they’re moving, and be impatient.
Then there’s the fact that comorbid conditions come into play. If an ADHDer has another condition like anxiety or depression, which is common, that can make hyperactive symptoms harder to spot. On the other hand, conditions like anxiety or bipolar disorder can also exacerbate hyperactive symptoms, so a mental health professional might initially attribute hyperactivity to those other disorders before realizing that ADHD is a factor.
It’s worth recognizing that hyperactivity isn’t just about excessive activity, and the terminology used in the DSM’s diagnostic guidelines has evolved to reflect that fact. In particular, “hyperactive” symptoms are now known as “hyperactive-impulsive” symptoms. As an example of what this means, consider that interrupting people or answering questions before someone is done asking them has more to do with an inability to inhibit impulses rather than excessive activity.
To be sure, there are ADHDers who you can tell clearly have hyperactive symptoms within seconds of meeting them. But in many cases, you have to know what to look for to know if someone has the H. It’s certainly not a given that hyperactive symptoms are obvious enough to necessarily be identified in childhood and then diagnosed.