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The full toll
of living with
ADHD

See how diagnostic symptoms, associated symptoms, and comorbidities may impact patients.

Even when the diagnostic symptoms of ADHD are managed, associated symptoms and comorbidities may leave patients with unmet needs.¹

The full clinical presentation of ADHD may include not only diagnostic symptoms, but ADHD-associated symptoms as well, which can be a continuing source of struggle for patients.^1-3

In addition, comorbidities such as anxiety and depression can further add to the full burden of ADHD.^4,5 Patients may be left wondering: Is it me or my ADHD?

Jump to diagnostic symptoms

Jump to associated symptoms

Jump to comorbidities

^*Clinic-based studies in children ages 4–18 with ADHD have reported emotional dysregulation prevalence estimates of 24%–45%.

Difficulties with associated symptoms of ADHD can show up in many ways, including:

Low self-esteem⁷

Educational difficulties^8,9

Social problems¹⁰

Employment problems^11-13

Financial problems^8,14,15

In addition, comorbidities, such as anxiety and depression, have overlapping symptoms that can blur the line between ADHD and other mental health disorders, complicating the lives of patients and the ability of providers to fully treat ADHD.^4,5

Get the whole picture

Even when treated, ADHD leads to chronic social, occupational, interpersonal, and health challenges that cause a ripple effect within families and communities.¹

A patient’s diagnostic symptoms may seem under control, but it’s important to ask patients if they’re struggling with associated symptoms as well.

The diagnostic criteria for ADHD¹⁶

Healthcare providers use the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, 5th edition, text revision (DSM-5-TR), to help diagnose ADHD. While the symptoms listed in the diagnostic criteria are inattention and hyperactivity/impulsivity, the DSM-5-TR notes that associated symptoms also have an impact on patients.¹⁶

A minimum number of diagnostic
symptoms must be met

6 or more symptoms of inattention and/‌or hyperactivity/‌impulsivity for children up to age 16 years

5 or more symptoms of inattention and/‌or hyperactivity/‌impulsivity for adolescents aged 17 years and older and adults

Diagnostic symptoms are categorized into 2 buckets

Inattention

Difficulty sustaining attention on tasks or activities
Frequent careless mistakes due to inattention
Seeming not to listen when spoken to directly
Failure to follow through on instructions and tasks
Trouble organizing tasks and activities
Avoidance or dislike of sustained mental effort tasks
Losing items necessary for tasks or activities
Easily distracted by external stimuli
Forgetfulness in daily activities

Hyperactivity/‌impulsivity

Fidgeting or tapping hands/feet
Inability to stay seated
Running or climbing inappropriately (or restlessness in adults)
Inability to play or engage in activities quietly
Acting as if “driven by a motor”; difficulty remaining still
Excessive talking
Blurting out answers or interrupting conversations
Difficulty waiting their turn
Interrupting or intruding on others’ activities or conversations

Additional conditions must be met

Several inattentive or hyperactive-impulsive symptoms were present before age 12 years
Several symptoms are present in 2 or more settings (such as at home, school or work; with friends or relatives; in other activities)
There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning
The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder

An ADHD diagnosis could fall into 1 of these 3 presentations

Predominantly inattentive presentation (e.g., challenges with staying on task, focusing, and organization)

Predominantly hyperactive-impulsive presentation (e.g. excessive movement and energy, being talkative, decisions or actions taken without thinking through the consequences)

Combined presentation (ADHD with symptoms that fall into both categories)

Associated symptoms can also disrupt patients’ lives¹⁶

While diagnostic symptoms may be the most discernable symptoms of ADHD, associated symptoms are common and are listed in the DSM-5-TR to provide context and to support a clinical classification of ADHD. They may come up when a patient describes their experience. While they are separate from the diagnostic symptoms, they can exacerbate the impairment patients with ADHD already face.^10,16

Emotional dysregulation

Mood swings
Irritability or frustration intolerance
Difficulty managing stress

Executive dysfunction

Problems with planning, prioritizing, and time management
Poor working memory

Social challenges

Difficulty maintaining relationships
Misinterpreting social cues
Low self-esteem due to repeated academic, social, or occupational struggles

Sleep disturbances^17,18

Trouble falling or staying asleep
Irregular sleep patterns

Patients may struggle with long-term impacts of associated symptoms.

Especially over the course of a patient’s life, difficulties with executive functioning, emotional dysregulation, and sleep disturbance can manifest in many ways.

Studies have shown that anxiety exacerbates difficulties in inhibitory control and emotional regulation in children and adults.¹⁹

In addition, emotional regulation is dependent on sufficient cognitive resources, and heightened negative emotions can diminish executive function.²⁰

In children with ADHD, sleep difficulties worsen ADHD symptom severity and neurocognitive deficits. In adults with ADHD, evidence suggests disturbed sleep is related to poorer collegiate academic functioning and a lower employment rate.^21,22

†Studies in adults with ADHD have reported executive function prevalence estimates of 30%-73%.

ADULTS WITH ADHD ARE

3X more likely

to develop major depressive disorder^7,23

ADULTS WITH ADHD ARE

4X more likely

to have a mood disorder^7,23

Up to 80%

of adults with ADHD have at least 1 comorbid psychiatric disorder⁷

64% of children

with ADHD have at least 1 comorbid condition²⁴

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get curious about ASSOCIATED SYMPTOMS

Explore resources to help better understand the impact of associated symptoms

Check out the ADHD toolbox

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1.
Brown TE, et al. Unmet treatment needs in adults with attention-deficit/hyperactivity disorder. Prim Care Companion CNS Discord. 2019;21(3):18m02397.
2.
Lenzi F, et al. Pharmacotherapy of emotional dysregulation in adults with ADHD: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2018;84:359-367.
3.
Moukhtarian TR, et al. Effects of stimulants and atomoxetine on emotional lability in adults: a systematic review and meta-analysis. Eur Psychiatry. 2017;44:198-207.
4.
Centers for Disease Control and Prevention. Data and Statistics on ADHD. Published November 19, 2024. Accessed April 24, 2025.
5.
Jain R, et al. Addressing diagnosis and treatment gaps in adults with attention-deficit/hyperactivity disorder. Prim Care Companion CNS Disord. 2017;19:17nr02153.
6.
Shaw P, et al. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry. 2014;171(3):276-293.
7.
Katzman MA, et al. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17(1):302.
8.
Holst Y, Thorell LB. Functional impairments among adults with ADHD: a comparison with adults with other psychiatric disorders and links to executive deﬁcits. Appl Neuropsychol Adult. 2020;27(3):243-255.
9.
Arnold LE, et al. Long-term outcomes of ADHD: academic achievement and performance. J Atten Disord. 2020;24(1):73-85.
10.
Kosheleff AR, et al. Functional impairments associated with ADHD in adulthood and the impact of pharmacological treatment. J Atten Disord. 2023;27(7):669-697.
11.
Adler L, et al. The structure of adult ADHD. Int J Methods Psychiatr Res. 2017;26(1):e1555.
12.
Biederman J, et al. The effects of attention-deficit/hyperactivity disorder on employment and household income. Med Gen Med. 2006;8(3):12.
13.
Verheul I, et al. The association between attention-deficit/hyperactivity (ADHD) symptoms and self-employment. Eur J Epidemiol. 2016;31(8):793-801.
14.
Biederman J, et al. Impact of psychometrically defined deficits of executive functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry. 2006;163:1730-1738.
15.
Volkow ND, Swanson J. Clinical practice: adult attention deficit–hyperactivity disorder. N Engl J Med. 2013;369(20):1935-1944.
16.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition, Text Revision. DSM-5-TR™. American Psychiatric Publishing; 2022.
17.
Brevik EJ, et al. Prevalence and clinical correlates of insomnia in adults with attention-deﬁcit hyperactivity disorder. Acta Psychiatr Scand. 2017;136(2):220-227.
18.
Díaz-Román A, et al. Sleep in adults with ADHD: systematic review and meta-analysis of subjective and objective studies. Neurosci Biobehav Rev. 2018;89:61-71.
19.
Manoli A, et al. The differential effect of anxiety and ADHD symptoms on inhibitory control and sustained attention for threat stimuli: a go/no-go eye-movement study. J Atten Disord. 2021;25(13):1919-1930.
20.
Koay JM, Meter AV. The effect of emotion regulation on executive function. J Cogn Psychol (Hove). 2023;35(3):315-329.
21.
Lunsford-Avery JR, et al. Sleep disturbances in adolescents with ADHD: a systematic review and framework for future research. Clin Psychol Rev. 2016;50:159-174.
22.
Schein J, et al. Symptoms associated with ADHD/treatment-related adverse side eﬀects and their impact on quality of life and work productivity in adults with ADHD. Curr Med Res Opin. 2023;39(1):149-159.
23.
Kessler RC, et al. The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry. 2006;163(4):716-723.
24.
Danielson ML, et al. Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. J Clin Child Adolesc Psychol. 2018;47(2):199-212.

The full toll
of living with
ADHD