It’s weird looking at my childhood photos. I seem so happy, so full of life. But I don’t remember feeling happy. Mostly, I remember feeling ashamed that I could never meet my teachers’ and my parents’ expectations.

Why Am I So Angry?

I tried to be the good kid, the good student, the good friend. Nothing ever went according to plan. Report cards pointed out the many ways in which I failed as a student. I was too late, too messy, too much. I was also not enough. I didn’t apply enough effort. I didn’t have enough willpower.

“Jesse is too emotional,” teachers said, and it was hard to argue with this. I felt emotions intensely and expressed them with the same ferocity. My classmates were quick to notice. No child wants to be labeled a crybaby, so I learned to hide inside the one emotion that seemed acceptable for boys: anger.

[Read: Crashing Out? How to Calm Down When You’re Angry]

Anger wasn’t weak, right? Anger felt strong. I could ball up my fists and fight in anger. When I got angry, no one called me a crybaby.

How Blame Becomes Shame

My frequent angry outbursts got me into trouble. It was clear that something was wrong. But instead of investigating the root of my behavior, teachers and administrators made me out to be the troublemaker. That blame became shame. And I carried it around with me like a heavy backpack. Each time I did or said the wrong thing, or forgot about another important task, or didn’t meet expectations, the backpack grew heavier. It weighed me down.

That shame didn’t diminish with age. Any time my actions didn’t line up with expectations, more shame was shoveled into the backpack. My bosses would tell me, “You’re the only person I’ve ever had trouble with. I just don’t know what to do with you.”

[Read: ADHD and the Epidemic of Shame]

I didn’t know what to do with me either. I tried to cover my faults by working harder, working longer, working later. I continued to fall short and burn out.

A Clarifying Diagnosis

When I was finally diagnosed with ADHD as an adult, it all made sense. I finally understood why my actions and intentions rarely synced up. But I couldn’t shrug off the heavy shame. The backpack was still there, weighing me down.

Yet trying to remove and unpack it didn’t feel like an option. After so many years, it felt like a part of me.
Then I realized the truth: The shame in my backpack never should have been mine. It was created by people who just didn’t understand ADHD.

Toxic Shame and ADHD: Next Steps

• Read: Life Is Too Short for Shame
• Download: Rein In Intense ADHD Emotions
• Read: Neutralize Chronic Shame by Understanding Its Source

Jesse J. Anderson is the author of Extra Focus: The Quick Start Guide to Adult ADHD. He is the host of the podcast ADHD Nerds.

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April 29, 2026

The distinct symptom profiles of ADHD — namely, inattention and hyperactivity-impulsivity — follow their own unique behavioral and developmental pathways, and they may benefit from targeted interventions and treatment, suggests a new study published in Frontiers in Psychology.¹

Findings from the study show that ADHD symptoms arise not from a single deficit, but from different underlying brain systems involved in attention, behavioral control, emotional regulation, and sleep.

The research team found that symptoms of hyperactivity and impulsivity typically decrease as children age and are more commonly observed in boys, whereas inattention remains stable throughout development and affects boys and girls at similar rates. Overall, symptoms of inattention were found to be more severe than symptoms of hyperactivity and/or impulsivity.

Learning challenges appeared to be the strongest predictor of inattention, according to the study. Children with more severe inattentive symptoms showed greater difficulty sustaining focus, filtering out distractions, and managing mental effort. “These deficits directly impact classroom learning and explain the strong association [of inattention] with academic difficulties,” the researchers wrote.

The researchers also found strong associations between symptoms of hyperactivity-impulsivity and oppositional or conduct-related behaviors, emotional dysregulation, as well as specific sleep disruptions, such as restless sleep, nightmares, or unusual nighttime movements.

Sleep emerged as an important factor across both symptom clusters, but in different ways. While general sleep difficulties were loosely connected to inattention, disturbances in sleep–wake transitions, specifically restless sleep, nightmares, or sleep talking were a significant predictor of hyperactivity-impulsivity.

“Poor sleep may impair brain regulation systems, especially those tied to impulse control and emotional reactivity,” the researchers wrote.

“Sleep problems in youth with ADHD are associated with several negative outcomes,” said Stephen P. Becker, Ph.D., in the ADDitude webinar “Why Am I Always So Tired? The Latest Science on Improving Sleep in Children and Teens with ADHD.” “They impact functioning during the day, be it at school or at home, and they are associated with mental health problems over time. Sleep problems in adolescents with ADHD are tied to poorer quality of life, as well as poor academic performance and lower grades.”

Low-Anxiety, High-Impulsivity Subtype

Interestingly, children with lower levels of anxiety tended to show higher levels of hyperactivity and impulsivity, leading researchers to infer that anxious behaviors may suppress overt hyperactive behaviors. Children with anxiety may be more cautious, self-aware, or responsive to consequences, while children with low anxiety may be more prone to risk-taking and impulsive actions and less responsive to threat cues.

This finding points to a possible “low-anxiety, high-impulsivity” subtype of ADHD.

The recognition that different ADHD symptom profiles are driven by different neurological mechanisms could reshape how clinicians diagnose and treat the condition and its many subtypes.

For example, children with primarily inattentive symptoms may benefit most from academic support, cognitive interventions, and strategies that strengthen attention and information processing. Children with more pronounced hyperactivity and impulsivity may respond best to behavioral therapy, emotional regulation support, and interventions that address sleep quality.

This cross-sectional study was conducted at the outpatient Cognitive Center of Guangxi Zhuang Autonomous Region People’s Hospital, between December 2020 and December 2022. It included a sample of 331 children aged 6 to 12 years with ADHD.

Source

¹Fu Y, Qin Z, Qin L, Zhang H, Liu H, Huang S and Li D (2025) Multidimensional factors associated with ADHD core symptoms in children: cognition, sleep, behavior, and demographics. Front. Psychiatry. https://doi.org/10.3389/fpsyt.2025.1658202