New Study Finds That ADHD Has 9 Categories of Symptoms |
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ADHD symptoms can be broken down into 9 categories.
Some categories are not fully represented in the diagnostic criteria.
Other categories are not represented at all in diagnostic criteria.
Broadening the diagnostic criteria with patient lived experiences could make for better intervention.
ADHD is often characterized as having two, or in some cases three, big families of symptoms: Inattention, hyperactivity, and impulsivity. Often, hyperactive and impulsive symptoms are banded together.
A new qualitative study confirms what research has been showing for years: More categories of symptoms can define ADHD, and not all of them are in the DSM. Using a thematic analysis on adults with ADHD, a new study identified nine categories of symptoms people with ADHD experience. Among those, we feature the original triad mentioned in the DSM: inattention, hyperactivity, impulsivity. But the six others are only mentioned in passing or not at all. Here they are:
Disorganisation is about struggling to do things in order, or to keep things in order. In children, this could manifest as lost homework, or poorly-kept notes. In adults, this could be a difficulty keeping a tidy home, losing things easily, or struggling to plan, which impacts more than just the physical space, and could be detrimental to work and one's professional career. For patients, disorganisation is often accompanied by strong feelings of overwhelm. While disorganisation is briefly mentioned in the DSM, the symptoms and impacts are not fully represented in the diagnostic criteria.
The DSM includes forgetfulness in daily activities (such as doing chores, running errands, paying bills, etc.); but forgetfulness is broader in individuals with ADHD. It could include difficulty keeping track of appointments, struggling to recall recent - or remote - events, retaining information, or remembering people's names during a conversation. Some people lose belongings because they struggled to remember where they put them. While this is mentioned in passing in the DSM, forgetfulness runs deeper than just forgetting to do chores.
People with ADHD often experience difficulties with activation—what many also call executive dysfunction, or ADHD paralysis. It's difficulty starting and completing tasks, even important ones, or ones that feel interesting. The DSM describes avoidance occurring with unpleasant tasks, such as those that are mentally difficult, or chores. But the ADHD experience goes beyond that. Participants reported feeling stuck, like a state of inertia where the only thing that could motivate them to start or finish a task was a feeling of urgency, external pressures, or external help. This difficulty with internally-driven activation is at the core of the ADHD experience, but is not yet fully represented by the DSM or other diagnostic criteria.
4: Emotional Dysregulation
Difficulties with emotional regulation widely exist in scientific literature, but are not mentioned nor represented in diagnostic criteria. People often mention difficulties with the intensity of their emotions; many even report feeling drained after experiencing intense positive emotions. Others report fluctuations of intense emotions, which is tiring in itself, and many cite anger as the most difficult to manage, or the strong feelings associated with perceived rejection.
Many participants report that ADHD affects their perception of time. This is consistent with previous reports in the literature showing that individuals with ADHD have more difficulties estimating how long a task would take, or even estimating the passage of time. People may feel as if time slips away when they are not consciously paying attention to it, especially if they are engaged in a state of hyperfocus.
Difficulties with time estimation can also impact how people with ADHD see tasks; they may overestimate how long a task that is deemed boring will take them to complete, reinforcing the avoidance associated with it, or underestimate how long a salient one takes - creating difficulties meeting deadlines, for example.
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Many people with ADHD mention having difficulties sleeping. We know from previous studies that individuals with ADHD are more likely to have a delayed circadian rhythm (DSPS), and this can result in fatigue during the day, sleepiness, or increased irritability. People mentioned that they also faced difficulties falling asleep due to racing thoughts, and mental hyperactivity. While it's still difficult to know whether sleep issues are a comorbidity of ADHD or a direct symptom of it, their mention is still important when going through a diagnostic process.
While research on ADHD is still ongoing, qualitative studies focused on the patient experience are essential. Many diagnostic criteria were created based on external observation, but research is outlining that many experiences at the core of ADHD can't always be observed, but instead can be reported. These studies show that the ADHD experience is far broader and more complex than what the diagnostic criteria show.
Adding elements reported by patients themselves could broaden the understanding of ADHD, and lead to better diagnostic processes. Since studies show that ADHD is still underdiagnosed, broadening the scope of the DSM criteria could be a good first step to give more people the help they need.
Chua IJJ, Salmon C, Vinnicombe J, Bowen J, McNicholas F, Adamis D, Jayasooriya T, Das S, Johnson K. "ADHD symptom manifestation in adulthood: moving beyond conceptualisations of inattention and hyperactivity/impulsivity." Ir J Psychol Med. 2026 Feb 5:1-8. doi: 10.1017/ipm.2026.10175. Epub ahead of print. PMID: 41640011.
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