What Is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity, and impulsivity that are inconsistent with developmental level, present across multiple settings, and cause significant functional impairment.
ADHD is not a disorder of attention per se — people with ADHD can often focus intensely on activities they find stimulating or rewarding (a phenomenon known as hyperfocus). Rather, ADHD is better understood as a disorder of executive function and self-regulation — the ability to direct and sustain attention, manage impulses, regulate emotions, plan, organise, and initiate tasks.
ADHD is one of the most extensively researched conditions in psychiatry. It affects approximately 5–7% of children and 2–5% of adults globally. In South Africa, estimates suggest that ADHD affects approximately 5–8% of school-aged children, though many cases remain undiagnosed due to limited access to assessment services.
Types of ADHD
The DSM-5 recognises three presentations of ADHD:
Predominantly Inattentive Presentation
This presentation (previously called ADD) is characterised primarily by difficulties with attention, organisation, and follow-through, without prominent hyperactivity or impulsivity. It is more common in girls and adults and is more likely to go unrecognised because it does not produce the disruptive behaviour associated with hyperactivity.
Predominantly Hyperactive-Impulsive Presentation
This presentation is characterised primarily by hyperactivity and impulsivity, without prominent inattention. It is more common in younger children and tends to become less prominent with age as hyperactivity diminishes.
Combined Presentation
The combined presentation involves significant symptoms of both inattention and hyperactivity-impulsivity. This is the most common presentation in clinical settings.
Symptoms of ADHD
Inattention Symptoms
- Often fails to give close attention to details or makes careless mistakes
- Often has difficulty sustaining attention in tasks or activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish tasks
- Often has difficulty organising tasks and activities
- Often avoids or is reluctant to engage in tasks requiring sustained mental effort
- Often loses things necessary for tasks or activities
- Often easily distracted by extraneous stimuli
- Often forgetful in daily activities
Hyperactivity-Impulsivity Symptoms
- Often fidgets with or taps hands or feet, or squirms in seat
- Often leaves seat in situations where remaining seated is expected
- Often runs about or climbs in situations where it is inappropriate (in adolescents and adults, may be limited to feeling restless)
- Often unable to play or engage in leisure activities quietly
- Often "on the go," acting as if "driven by a motor"
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has difficulty waiting their turn
- Often interrupts or intrudes on others
How Symptoms Present in Adults
In adults, ADHD often presents differently from childhood. Overt hyperactivity typically diminishes, replaced by inner restlessness. Adults with ADHD commonly experience difficulties with time management, organisation, prioritisation, completing projects, managing finances, and maintaining relationships. Emotional dysregulation — intense emotional reactions, low frustration tolerance, and sensitivity to criticism — is also a prominent feature in many adults with ADHD.
Causes and Risk Factors
Neurobiological Factors
ADHD is associated with differences in brain development and function, particularly in the prefrontal cortex (involved in executive function) and its connections with the striatum and cerebellum. Neuroimaging studies have found that brain maturation is delayed by approximately three years in children with ADHD compared to neurotypical peers. Dopamine and norepinephrine neurotransmitter systems play central roles in ADHD.
Genetic Factors
ADHD is highly heritable — twin studies estimate heritability at approximately 70–80%. Having a first-degree relative with ADHD substantially increases risk. Multiple genes have been implicated, each contributing a small effect, and the genetic architecture is complex.
Environmental Risk Factors
Prenatal exposure to alcohol, tobacco, or certain toxins (particularly lead) increases ADHD risk. Premature birth and low birth weight are associated with higher rates of ADHD. Severe early deprivation or neglect can produce ADHD-like symptoms. However, ADHD is not caused by poor parenting, diet, screen time, or social factors — though these can influence the severity and management of symptoms.
ADHD in the South African Context
Access to Assessment
Formal ADHD assessment in South Africa typically requires access to a psychiatrist, paediatrician, or psychologist — specialists who are in short supply in the public health system. The cost of private assessment is prohibitive for many families. As a result, a significant proportion of South Africans with ADHD remain undiagnosed and unsupported.
Educational Impact
Undiagnosed and unsupported ADHD has significant educational consequences. Children with ADHD are at elevated risk of academic underachievement, grade repetition, school dropout, and disciplinary problems. In a country where educational outcomes are already severely unequal, unaddressed ADHD can compound existing disadvantage.
Stigma and Misunderstanding
ADHD is frequently misunderstood in South Africa. Children with ADHD may be labelled as naughty, lazy, or disrespectful. Adults may internalise these messages, developing low self-esteem and shame. Cultural attitudes toward mental health and neurodevelopmental conditions can create barriers to seeking assessment and support.
When to Seek Professional Assessment
Consider seeking a professional assessment if:
- You or your child have persistent difficulties with attention, organisation, or impulse control that began in childhood
- Symptoms are present across multiple settings (home, school, work)
- Difficulties are causing significant functional impairment in academic, occupational, or social functioning
- Standard strategies for managing attention or behaviour have not been effective
A GP is a good first point of contact and can provide an initial assessment and referral. Under the National Health Act (Section 6), you have the right to be informed about your condition and to participate in decisions about your care.