How ADHD Can Look Differently in Different Settings

Attention Deficit Hyperactivity Disorder is a developmental disorder most well known for its stereotypical presentations: young children (typically boys) struggling to sit still in school, refusing to do homework, and having boundless energy that can’t be contained or controlled. Because of this perception, it can be hard to understand the presentations ADHD can have in different contexts and environments. 

While hyperactivity is common in a large portion of presentations of ADHD, the way hyperactivity actually functions can vary far beyond running around and struggling to sit still. In children who are naturally more reserved, things like fear of judgment, shyness, or discomfort will prevent the behaviors typically associated with hyperactivity. This means that in large groups, performance-based settings, social situations, etc, some children will not present as hyper, but quiet. Their hyperactivity is often turned inwards, resulting instead in racing thoughts, pressured speech when talking, or an overall heightened emotional state– like anxiety. The presentation of the symptoms are highly dependent on both the natural temperment of the person and the setting they’re experiencing at the times. 

Understanding how setting can shift ADHD’s expression can be helpful to understanding ADHD as a whole. For many parents, it feels frustrating or even deliberate that their children may struggle with sitting still or paying attention at school, but at home or during fun events they don’t experience the same struggles. For example, a child who struggles to pay attention at school may be able to sit still for hours at a time watching their favorite movies, playing a video game, or at a sporting event. This can be due to a number of factors. One of the most important and powerful factors is interest level. Many people with ADHD are capable of hyperfocus– a very narrow, long-lasting focus on one specific activity or event for abnormal amounts of time, something that is essentially the opposite of typical ADHD presentation. For things that they find particularly interesting or engaging, the brain releases floods of dopamine, the chemical that ADHD brains are constantly seeking out, and it results in the capacity to focus for long periods of time. Another factor is expectation. When situations demand a certain level of focus, stillness, or attention for long periods of time, the restriction these environments create can exacerbate inattentive and hyperactive symptoms of ADHD. The brain becomes understimulated more quickly in these situations, and struggles to find other stimulation, causing acting out.

So why does ADHD look so different in these different settings? 

This is ultimately because of what ADHD actually is at its most simple– a difficulty manually distributing attention and a lack of control over what the brain focuses on. The ADHD brain takes in everything with equal importance, from the flickering of lights to the sound of cars outside to what a teacher is saying, and then uses the level of dopamine (triggered by enjoyment and interest or by something being new and unusual) to determine what things it should focus on. Because of this, ADHD presentations are highly dependent on the surroundings of the person affected, and by that person’s own personality and interests, what they find gratifying or fun, and what the expectations of the environment are.