What is attention-deficit/hyperactivity disorder (ADHD)?

The core feature of ADHD is an ongoing pattern of inattention and/or impulsivity-hyperactivity, which interferes with functioning (see Table 2).

Inattention refers to difficulties sustaining attention to tasks that are not frequently rewarding or highly stimulating, distractibility, and difficulties with organisation.
Impulsivity refers to acting in response to immediate stimuli, without consideration of the outcome.
Hyperactivity refers to excessive motor activity and difficulties remaining still, typically evident in situations that require behavioural self-control.

Many people experience periods of distraction and have difficulty concentrating. Similarly, many people experience periods of excitability or zealousness, which can sometimes be described as ‘hyperactive’. ADHD is distinct from relatively short periods of over-excitability or distraction in that it involves severe and persistent symptoms that are present in more than one setting (e.g., home and work). The extent of inattention and hyperactivity-impulsivity is also outside what would be expected given a person’s age and level of intellectual functioning.

A case study example of how a person experiencing co-occurring ADHD and AOD use disorder may present is illustrated in Box 1.

Table 2: Attention-deficit/hyperactivity disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD)
ADHD is characterised by a persistent and debilitating pattern of inattention and/or hyperactivity-impulsivity where at least five inattention or hyperactivity-impulsivity symptoms are present. Symptoms need to have been experienced for at least six months, and several need to have been present prior to age 12:
Inattention: Lacking attention to detail. Difficulty maintaining focus during work, study, or conversation. Appearing not to listen when spoken to. Difficulty following instructions and completing housework, work, or study. Difficulty organising time and materials. Avoiding tasks that involve constant mental energy. Losing material possessions. Easily distracted. Forgetting to return calls, pay bills, keep appointments.
Hyperactivity and impulsivity: Fidgeting, tapping hands or feet, wriggling in seat. Leaving seat in inappropriate situations. Inappropriately restless. Unable to relax or engage in activities quietly. Unable to keep still for extended periods. Talking excessively. Interrupting conversations. Difficulty waiting in line or for their turn. Intruding on or taking over from others.

Box 1: Case study A: What does co-occurring ADHD and AOD use look like? Sam’s story

Case study A: Sam's story

Sam, a 25-year-old who identified as female, was referred to her local AOD service by her GP. Her presentation followed a routine visit to her GP, during which she mentioned that her alcohol use had increased during the COVID-19 lockdowns. She also occasionally used methamphetamines. Sam has been living with her partner for the past two years, but there has been recent strain in their relationship, exacerbated by the ongoing pandemic lockdowns, that has contributed to her increase in drinking, putting further strain on their relationship. Although Sam's partner accompanied her to her appointment with the AOD service, they remained in the waiting room for the duration of the session. Sam had been working in the hospitality industry but has been out of work for the past 12-months or so, due in part to the impact of COVID-19 on the hospitality industry, but also due to Sam's unreliability as an employee leading to her dismissal from numerous jobs.

Sam first began drinking alcohol while at high school, though she never considered herself to have a ‘drinking problem'. During the assessment, Sam also mentioned that she had experimented with other substances while in high school, including taking one of her friend's Ritalin on a few occasions, but did not experience a ‘high' like her other friends seemed to. When asked about her use of methamphetamines, Sam described feelings of relaxation following their use. Sam also mentioned that she sometimes used cannabis to help her get to sleep but found that sometimes her use of cannabis led to outbursts of anger. Sam had difficulties at school and left at the end of year 10. Her teachers described her as intelligent, but her concentration and attention were poor, and she therefore frequently failed to complete her homework and her teachers noted that she ‘under-performed' in her exams. Sam later reported that she had great difficulty revising and her attention to revision was often impaired because her ‘thoughts strayed all over the place'. Sam was often irritable with her siblings and lost many friends because she was notoriously unreliable at meeting them as arranged. Sam also spoke of difficulties she had getting to sleep during her childhood, and of sometimes feeling incredibly tired. Sam enrolled in a design course at TAFE after leaving school but was not able to complete the course.

Key Points

What are the primary concerns for Sam?
Where to from here?

Case study A continues in Chapter B7.