ADHD symptoms – updated checklist

If your child has ADHD they may display some of the following behaviors:

Have you noticed the following Attention Deficit Hyperactivity Disorder (ADHD) symptoms in your child? If the symptoms persist for at least six months to a degree that is disruptive to your life, you may be dealing with ADHD.

The list below expands on a checklist for medical professionals published by the Canadian ADHD Resource Alliance (CADDRA). You can find it here: https://www.caddra.ca/pdfs/caddraGuidelines2011ADHDChecklist.pdf. If six or more areas on the original CADDRA checklist are present, then this points to an ADHD diagnosis, but those symptoms should be observed and acknowledged by an expert.

Here is our version of the CADDRA list with examples of the symptoms to be aware of.

If you suspect that your child has ADHD, contact your medical healthcare professional for a proper diagnosis.

• Fidgets with hands or feet and squirms in chair
  • cannot seem to sit still
  • sometimes the whole body shakes
  • tapping the fingers, glass, the side of a table constantly (with object or fingers)
  • getting into a purse to take keys or other items
  • snapping fingers when they have nothing to hold
  • shaking one or both legs constantly
• Excessively runs around and climbs
  • running around just to move (“full of energy”)
  • needs activities to wear them out before bed
  • climbs through open doors and windows
  • climbs onto high and dangerous places, such as the roof, cars, and bookshelves
  • climbing on chairs and sofas various times during the day
• Loses focus, gets sidetracked
  • constantly reminding them to brush their teeth in one night (more than three reminders)
  • leaves the room and says that they forgot what they were doing (in a matter of seconds)
  • cannot remember tasks
• Does not appear to listen (observed in the first three years of life)
  • when learning how to read, they cannot recollect the sounds of letters
  • seems like they are not listening, looking around when you talk to them
  • needs a physical task to listen (keep hands busy)
• Loses things
  • losing five different things on the same day
  • having to make a daily checklist of everything they need
  • sets things down and cannot remember where the items are five minutes later

• Is forgetful in daily activities
  • sending them to do a task, which they do, just not exactly what you asked
  • forgets their coat because they forgot it was cold
  • loses focus, distracted easily (as listed above)
  • needs something to refer to (list or written schedule)
• Often has trouble waiting for one’s turn.
  • waiting in line for food at school and moves out of line (does not get food at all)
  • seems bored or impatient
  • fear that they will miss their turn at something
  • bounces when having to stand in place or wait
• Avoids, dislikes, or does not want to do things that take a lot of mental effort for a long period (such as schoolwork or homework)
  • helping them with their homework, you turn around, and they are gone
  • leaves the dinner table
  • cannot do puzzles (unable to complete)
  • seems impossible for them to complete tasks (small or big)
  • cannot stay for an entire day of school
• Has trouble keeping attention on tasks or play activities
  • does not play video games for too long
  • skips between activities quickly, usually unfinished
  • loses interest very quickly (similar to examples above)
  • seems obstinate or disrespectful
• Has difficulty with organization
  • does activities out of order (brushing teeth, getting dressed, doing homework)
  • unable to retrieve the things they need for an activity or task
• Often does not seem to listen when spoken to directly
  • repeating yourself more than three times
  • they do something about the instruction, but the wrong thing
  • does not make eye contact
  • needs to repeat things back, so you know they heard and understood

• Is easily distracted
  • when you ring a bell, they turn around immediately
  • doesn’t pay attention to things enough and can be distracted by everything.
  • similar to the dogs in the movie “UP” (Disney)
• Has trouble playing quietly
  • closes doors loudly
  • makes loud sounds while playing with a quiet toy, like a book
• Interrupts or intrudes on others
  • lacks social skills to care about the needs of others
  • needs you the minute you get on the phone
  • bursts into a conversation with loud noises or needing something
• Does not seem to understand or follow instructions
  • when given a task, does it their way (opposite to what they were told to do)
  • Seems obstinate (similar to descriptions above)
• Fails to give close attention to details or makes careless mistakes
  • given pictures and cannot find simple details that are missing (like a nose on a face)
  • when setting the table, misses something important, like the plates or utensils
  • seems to be on “hurry” mode
  • asked to grab a red cup, but they grab a blue cup (color does not seem to matter)
• Talks excessively
  • seems to be on “hurry” mode constantly
  • talks twice as much as other children
  • seems to have a “motor mouth”
  • are bullied at school for what they say

If you suspect that your child has ADD or ADHD, contact your medical healthcare professional for a proper diagnosis.

Parents who have implemented Sensory Enrichment Therapy™ at home with their children have reported improvements in the areas of concentration, staying on task, hyperactivity, staying organized, learning and sleep.
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1. When kids just cannot seem to sit still, they suffer from a dysfunction of dopamine receptors. Dopamine is a key neurotransmitter for several brain functions including locomotor control and reward systems, meaning that dopamine controls movement. Kids with a dysfunction of dopamine receptors have to move themselves around.
   1. Gizer, I. R., Ficks, C., & Waldman, I. D. (2009). Candidate gene studies of ADHD: a meta-analytic review. Human Genetics, 126(1), 51–90.
   2. McHugh, P. C., & Buckley, D. A. (2015). The structure and function of the dopamine transporter and its role in CNS diseases. Vitamins and Hormones, 98, 339–369.
   3. Retz, W., Wolfgang, R., & Freitag, C. M. (2009). Molecular Genetics of Attention-Deficit Hyperactivity Disorder. In Key Issues in Mental Health (pp. 58–77).
   4. Shaw, P., Gornick, M., Lerch, J., Addington, A., Seal, J., Greenstein, D., … Rapoport, J. L. (2007). Polymorphisms of the dopamine D4 receptor, clinical outcome, and cortical structure in attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 64(8), 921–931.
2. Tendencies to be distracted is attributed to anomalies of the decision centers. Studies suggest that kids with ADHD cannot recognize priorities, leaving adults to make decisions. Due to the low-frequency vibrations of intrinsic connectivity networks, children with ADHD do not know what to prioritize and thus, lose focus on activities, situations, tasks, etc.
   1. Wang, X.-H., & Li, L. (2015). Altered temporal features of intrinsic connectivity networks in boys with combined type of attention deficit hyperactivity disorder. European Journal of Radiology, 84(5), 947–954.
3. Poor listening skills are often connected to slower brain growth. Studies suggest intrinsic connectivity networks (ICNs), important units of functional brain organization, have been reliably related to attention performance. Kids who do not listen may have slower brain growth, which produces attention-deficit/hyperactivity. 
   1. Kessler, D., Angstadt, M., & Sripada, C. (2016). Growth Charting of Brain Connectivity Networks and the Identification of Attention Impairment in Youth. JAMA Psychiatry , 73(5), 481–489.
4. Losing things can be accredited to having a smaller brain. “The children with ADHD in this category demonstrated significantly smaller total cerebral volume. Studies found that maturational lag (specifically in connections within and between these networks) suggests a developmental diagnosis for the deficits proposed in these models.”
   1. Qiu, M.-G., Ye, Z., Li, Q.-Y., Liu, G.-J., Xie, B., & Wang, J. (2011). Changes of brain structure and function in ADHD children. Brain Topography, 24(3-4), 243–252.
   2. Sripada, C. S., Daniel, K., & Mike, A. (2014). Lag in maturation of the brain’s intrinsic functional architecture in attention-deficit/hyperactivity disorder. Proceedings of the National Academy of Sciences, 111(39), 14259–14264.
5. Forgetfulness may be attributed to having a thinner cortex, and less gray matter. Studies found that ADHD is characterized by a delayed maturation of prefrontal cortical thickness. With a thinner cortex, our brains have fewer cells to carry information. As our cerebral cortex thins, our memory faculties weaken, thus producing more forgetfulness.
   1. Shaw, P., Malek, M., Watson, B., Sharp, W., Evans, A., & Greenstein, D. (2012). Development of cortical surface area and gyrification in attention-deficit/hyperactivity disorder. Biological Psychiatry, 72(3), 191–197.
6. Such impatience is connected to a deficit in the learning centers. Dysfunction of the learning centers is a consistent finding in childhood and adulthood ADHD, which reflects an impairment in the frontostriatal circuitry (the neural pathways that connect the frontal lobe with the basal ganglia). Frontostriatal circuitry mediates motor, cognitive, and behavioral functions within the brain. The main brain areas dealing with learning and functional activity are severely affected with defects and poor communication between them.
   1. Emond, V., Joyal, C., & Poissant, H. (2009). [Structural and functional neuroanatomy of attention-deficit hyperactivity disorder (ADHD)]. L’Encephale, 35(2), 107–114.
7. If kids have a dysfunction of the reward system, they have difficulties liking certain objects, events, or activities. Our reward system is responsible for incentive salience (the “wanting or “desire” attribute given by the brain). Our data suggests that neurophysiological (ERPs) models are useful to assess subclinical decision-making processes in patients with ADHD and BD. Such models also link the cingulate cortex with action monitoring systems. “Patients with ADHD presented a neural pattern characteristic of insufficient valence electrons (fERN) and reward magnitude learning (P3). This pattern was associated with clinical evaluations of impulsivity, hyperactivity and inattention as well as impairments in executive function and working memory. Our data is consistent with the clinical features of ADHD with regard to decision-making.”
   1. Ibanez, A., Agustin, I., Marcelo, C., Agustin, P., Hugo, U., Sandra, B., … Facundo, M. (2012). The Neural Basis of Decision-Making and Reward Processing in Adults with Euthymic Bipolar Disorder or Attention-Deficit/Hyperactivity Disorder (ADHD). PloS One, 7(5), e37306.
   2. Mizuno, K., Takiguchi, S., Yamazaki, M., Asano, M., Kato, S., Kuriyama, K., … Tomoda, A. (2015). Impaired neural reward processing in children and adolescents with reactive attachment disorder: A pilot study. Asian Journal of Psychiatry, 17, 89–93.
8. Inattention may be attributed to deficits in the prefrontal cortex and cerebellum. “The cerebellum, and its role in affect and cognition, is also persistently implicated in the study of ADHD.” Studies show that the cerebellum is important for motor and cognitive functions and such deficits leave kids not being able to focus. Impairments in implicit sequence learning and executive control may reflect distinct deficits in bottom-up and top-down frontalstriatal-cerebellar (motor, cognitive, and behavioral functions within the brain) signaling.
   1. Diamond, A. (2000). Close interrelation of motor development and cognitive development and of the cerebellum and prefrontal cortex. Child Development, 71(1), 44–56.
9. Being disorganized. Deficits in the development of the corpus callosum prevent different parts of the brain from communicating with each other. Our brains are wired in ways that enable us, often unconsciously, to make decisions with the information we’re given. Without communication inside the brain, we have difficulties making decisions, such as when we are organizing. “Studies suggest that the corpus callosum integrates information across cerebral hemispheres and thus serves an energy causing function in interhemispheric communication.” “Morphometric analysis revealed that ADHD children had a smaller corpus callosum, particularly in the region of the genu and splenium, and in the area just anterior to the splenium.”
   1. Bloom, J. S., & Hynd, G. W. (2005). The Role of the Corpus Callosum in Interhemispheric Transfer of Information: Excitation or Inhibition? Neuropsychology Review, 15(2), 59–71.
   2. Gilliam, M., Stockman, M., Malek, M., Sharp, W., Greenstein, D., Lalonde, F., … Shaw, P. (2011). Developmental trajectories of the corpus callosum in attention-deficit/hyperactivity disorder. Biological Psychiatry, 69(9), 839–846.
   3. Hynd, G. W., Semrud-Clikeman, M., Lorys, A. R., Novey, E. S., Eliopulos, D., & Lyytinen, H. (1991). Corpus callosum morphology in attention deficit-hyperactivity disorder: morphometric analysis of MRI. Journal of Learning Disabilities, 24(3), 141–146.
10. Interrupting. Your child may lack Serotonin. Serotonin is connected to behavioral responding and in modulating motor behavior. Studies show that serotonin in behavioral suppression may be important in social behavior involving aggression and anxiety. When a child does not listen, plays loudly, or interrupts, they have no concept of personal space or social cues.
    1. Kent, L., Doerry, U., Hardy, E., Parmar, R., Gingell, K., Hawi, Z., … Craddock, N. (2002). Evidence that variation at the serotonin transporter gene influences susceptibility to attention deficit hyperactivity disorder (ADHD): analysis and pooled analysis. Molecular Psychiatry, 7(8), 908–912.
    2. Lucki, I. (1998). The spectrum of behaviors influenced by serotonin. Biological Psychiatry, 44(3), 151–162.
    3. Seeger, G., Schloss, P., & Schmidt, M. H. (2001). Functional polymorphism within the promotor of the serotonin transporter gene is associated with severe hyperkinetic disorders. Molecular Psychiatry, 6(2), 235–238.
11. Not following instructions. In children with ADHD, response inhibition appears to be a primary deficit that is observed even when executive function demands of tasks are minimal. There is a physiological deficit in the brain of children with ADHD which disables the child when they are supposed to answer questions, even if the questions are simple.
    1. Wodka, E. L., Mark Mahone, E., Blankner, J. G., Gidley Larson, J. C., Sunaina, F., Denckla, M. B., & Mostofsky, S. H. (2007). Evidence that response inhibition is a primary deficit in ADHD. Journal of Clinical and Experimental Neuropsychology, 29(4), 345–356.
12. Lack of attention to detail. We do not know why the majority of individuals with ADHD make mistakes and fail to notice details. A possible explanation could be that they have a lack of connections between certain brain areas caused by a lag in the maturation of brain pathways. Below are studies that briefly address this concept. Studies suggest that ADHD is a consequence of delay in brain maturation.
    1. Shaw, P., Malek, M., Watson, B., Sharp, W., Evans, A., & Greenstein, D. (2012). Development of cortical surface area and gyrification in attention-deficit/hyperactivity disorder. Biological Psychiatry, 72(3), 191–197.
13. Excessive talking. We do not know why the majority of individuals with ADHD talk excessively. A possible explanation could be abnormal activity of the brain during rest. Below are studies that briefly address this concept.
    1. Cao, X., Cao, Q., Long, X., Sun, L., Sui, M., Zhu, C., … Wang, Y. (2009). Abnormal resting-state functional connectivity patterns of the putamen in medication-naïve children with attention deficit hyperactivity disorder. Brain Research, 1303, 195–206.
    2. Ghanizadeh, A. (2009). Excessive Talking Triggered by Methylphenidate in a Boy with ADHD. Pharmacopsychiatry, 42(01), 35–36.

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