ADHD 101: Missing DSM-5 Symptoms of ADHD
- Mudita Psychological
- Jun 13
- 7 min read
The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM5) is the most commonly used criteria for diagnosing mental disorders in North America. While the DSM5 is a useful tool to aid clinicians in diagnosing a variety of mental disorders, the DSM has its flaws. The criteria for ADHD in the DSM5 has been widely criticized for lacking many common ADHD symptoms, and not being standardized for many different populations.
As a practitioner with ADHD who specializes in working with clients who have ADHD, I think it is imperative that anyone who is impacted by ADHD is aware of the symptoms that are missing in the DSM5 so they can work on developing a well-rounded approach to manage those symptoms.
This blog post will go through 10 common missing symptoms. Please note this list is not extensive. For more information on the current criteria in the DSM5 for ADHD see this blog post.
Symptom 1: Emotional Dysregulation Symptoms

Often individuals with ADHD will feel emotions very strongly compared to those without ADHD: physically and mentally. In addition to the intensity, emotions can increase and decrease quite quickly, which can be jarring experience. It is important to note that the intensity of emotions and quick activation/deactivation does not just apply to negative feelings: it can apply to positive ones as well.
For example, when I was a child I remember telling my Mom that we had to cancel Christmas because I was SO excited that it felt like my body was going to burst apart. I remember it physically feeling so intense that I thought I would explode: it was not a comfortable feeling.

Symptom 2: Rejection Sensitive Dysphoria
The ADHD brain experiences a symptom called Rejection Sensitive Dysphoria (RSD). RSD is an increased sensitivity to real or perceived rejection. This was discovered by many researchers who realized that ADHD individuals will interpret neutral faces as being negative. Dr William Dodson, an ADHD practitioner and researcher estimates that 99% of people with ADHD experience RSD. Making it a significant symptom that individuals need to recognize and learn to cope with.
This symptom can significantly impact relationships. For example, someone with ADHD may interpret their partner's neutral face as them being mad and be less likely to set boundaries or bring up concerns. The intense feeling of rejection can also be experienced when people are not involved. If we are not good at something or are make a mistake, that can feel like rejection. For example, I was doing a presentation a few months ago and the timings on my slides were messed up. It felt as though the computer was trying to tell me I was talking too much and I should move on. It wasn’t: it’s a computer and it can’t do that. Regardless of knowing this is ridiculous I felt the rejection feeling in my body.
Symptom 3: Motivational Impulsivity
The ADHD brain lacks dopamine, a neurotransmitter that is responsible for regulating many systems, including the reward system and the system that contributes to regulating impulsivity. The lack of dopamine in the ADHD brain results in Motivational Impulsivity, which is the inability to motivate oneself for things that are not immediately rewarding, or things that there are no immediate consequences for. My favorite quote from Dr Russell Barkley that I think describes ADHD in a nutshell perfectly is:
“ADHD is not a disorder of not knowing what to do, it is a disorder of not being able to do what you know”.
It is imperative that folks with ADHD and loved ones of folks with ADHD understand that ADHD individuals are NOT LAZY: they are unmotivated. They can’t “Just do the thing”: instead they need to learn strategies for how to motivate themselves by understanding how their brain works.
Symptom 4: Cognitive Impulsivity and Poor decision Making

The impulsive nature of the ADHD brain due to lack of neurotransmitters that regulate impulsivity, results in ADHD individuals engaging in Cognitive Impulsivity. Cognitive impulsivity is poor contemplation of options and hasty decision making. Individuals with ADHD might feel there is only one option for a situation, and have difficulty even recognizing that there is more than one option.
For example, let’s say a student with ADHD has realized they have 24 hours before an assignment is due that they have not started. They may automatically think there is only one option: that they screwed up and they will have to take a zero on the assignment and not hand it in. They may not consider that there are other possibilities such asking for an extension or writing something up that isn’t perfect. Another example is purchasing items. Rather than researching and looking at all the options available, folks with ADHD may feel overwhelmed by all the choices and just buy the first thing that looks good enough, which may or may not be the best option.

Symptom 5: Sensory Overload
High sensitivity to light, sounds, textures, smells, and taste are common with ADHD individuals. Sound sensitivity and sensitivity to certain food or clothing textures are the most common sensory overload types that my clients report. For example, if someone is talking while the tv is on, there is music playing, and there is background noise like traffic: All this sensory sound information coming in at once can be overwhelming.
Certain food textures or clothing textures may just “feel icky” and result in the individual being uncomfortable with certain fabrics or food. For myself I relate to sensory overload, especially in the area of certain fabrics or things touching my skin such as tags on the back of a shirt or certain squeaky fabrics/textiles like ones made from acrylic yarn.
Symptom 6: Hyper focus & Hyper fixation

Individuals with ADHD will often get hyper focused or hyper fixated on something they enjoy (for a short period of time). Hyperfocus is when someone is very focused on a certain task or activity. Hyper fixation involves prolonged attachment to hobbies or interests.
If someone with ADHD is hyper focused on something they enjoy it can be very difficult to tear themselves away from that thing and turn their attention elsewhere. I get hyper focused on video games a lot, and it can be difficult to stop playing and do boring paperwork instead.
Hyper fixations can impact money management and cause clutter in the household. Cognitive and motivational impulsivity and emotional dysregulation symptoms exacerbate hyper fixation, because the intensity of emotions create a sense of urgency which makes it less likely for individuals to think through their decisions. For example, if you have just discovered the joy of LEGO, suddenly it may seem IMPERITIVE that you buy ALL the LEGO and that you do it right NOW!
Hyper focus and Hyper fixations can have negative impacts but they can also be used positively to help manage ADHD symptoms for example to motivate and learn to concentrate on one thing at a time.

Symptom 7: Time Blindness
People with ADHD experience time very differently than those without ADHD. For us with ADHD there is “now’ and “not now”. Something that is an hour away can feel like a lifetime. This results in folks overestimating or underestimating how long it will take to do something. This contributes to some ADHD individuals being chronically late to things or why they will delay getting started on tasks.
This inability to measure time can be paralyzing and impact the ability to start or complete tasks. For example, I used to have trouble motivating myself to take out the garbage because it felt like it was going to take sooooo long and really interrupt my day. Once I timed myself and realized it would only take 36 seconds to do, I was able to recognize the time blindness and do the task without a giant debate in my head.
The experience of time also extends to what I call Time Paralysis which is the experience of being paralyzed on other tasks if there is something scheduled later in the day. If you have an appointment scheduled at 4 pm, it may feel like you cannot do anything else all day until that appointment is over and you are stuck waiting for the appointment to start.
Symptom 8: Self-esteem Issues

ADHD children are told thousands more negative messages about themselves compared to non-ADHD children. Messages like “you are lazy”, “you talk to much”, “you can’t wait your turn”, etc. These negative messages get compounded over the lifetime and internalized so they become negative beliefs about one’s capabilities and value as a person. This results in self-esteem issues, which can impact the ability to be assertive, set boundaries, and form/maintain social relationships.
Symptom 9: Internal Hyperactivity Symptoms
The DSM5 criteria for ADHD includes external hyperactivity symptoms such as leaving your seat when it’s expected for you to sit down, or just having a lot of physical energy to expend. However, it misses the internal hyperactivity that many ADHD folks feel. Internal hyperactivity that does not manifest as outwards behaviors includes rushing of thoughts in the ADHD brain, feeling physically full of energy or on edge. I often describe my brain as having 25 lanes of traffic in it at the same time, as there are many things that my brain is trying to focus on at once. The internal hyperactivity for me feels like an internal buzzing or like I could run a mile, (even though I abhor running and know that I would not actually run a mile even if you paid me).

Symptom 10: Difficulty with Transitions
Individuals with ADHD have a hard time transitioning from one thing to another, especially if it is something they are really engaged in. For students it may be hard to transition between classes, for those in the workforce it may be hard for people to transition from “work brain” to “home brain”. Often individuals with ADHD need a lot of time to make the mental shift to be prepare to fill a different role. Common impacts may include: bringing problems from work home or from home to work, disruption in sleep schedules as individuals have difficulty stopping what they are doing to get ready for bed, and in general difficulty stopping a pleasurable task for a less pleasurable one.
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