ADHD is often mistaken for indiscipline, but it is a neurodevelopmental condition that impacts attention, behaviour, and relationships across life stages, says Dr Mohan Roy, professor of psychiatry at Government Medical College, Thiruvananthapuram, in an interview with Unnikrishnan S. Edited exceprts:
How do you differentiate ADHD from normal childhood restlessness or adult stress?
Normal restlessness in children is usually situation-specific — a child may be excited at an event but can settle down with structure or instruction. They can focus when interested, and their behaviour does not significantly impair functioning. ADHD, on the other hand, affects academics, behaviour and relationships. The child struggles to sustain attention even in engaging situations and may show impulsivity, poor time management and emotional dysregulation.
In adults, stress-related attention problems typically begin after a clear trigger like work pressure, fluctuate, and improve when the stress reduces. ADHD is long-standing, often beginning in childhood, and persists across settings.
Can ADHD present differently in women compared to men?
Yes. In men, hyperactivity and externalising behaviours are more common, so the condition is often identified early. In women, ADHD is frequently missed because it presents as inattention — disorganisation, anxiety and low self-esteem — without disruptive behaviour.
What are the key diagnostic criteria? Are online self-tests reliable?
Diagnosis is based on standard criteria. There must be persistent symptoms of inattention and/or hyperactivity-impulsivity — at least six in children and five in adults — along with onset before age 12, presence in multiple settings, and clear functional impairment. Online self-tests can help with screening, but they are not diagnostic and may sometimes cause unnecessary anxiety. A clinical evaluation is essential.
What are the most effective non-medication strategies?
Structure is key — using calendars, reminders and clear schedules. Tasks should be broken into smaller steps and progress monitored. Behavioural strategies like reward systems help reinforce positive behaviour. Equally important are reducing distractions, ensuring good sleep, regular physical activity and, where needed, cognitive behavioural therapy.
When is medication necessary? Is long-term use safe?
Medication is considered when symptoms are moderate to severe and interfere with school, work or relationships. Both stimulant and non-stimulant medications are used. They are generally safe under medical supervision, but require regular follow-up. The duration varies depending on improvement and individual needs.