As an ADHD expert one of the questions that I’m asked most often is, “What is the difference between ADD and ADHD?” Sometimes people share with me that they were diagnosed with ADD is as a kid and wonder how the ADHD that they hear about today is different from the diagnosis they received in childhood. With both terms being so prevalent, people are often surprised to learn that ADD is actually an outdated term. Today healthcare providers only refer to ADHD and no longer use ADD as a diagnostic label. Labels like ADD and ADHD originate from the Diagnostic and Statistical Manual of Mental Disorders (the DSM), which is the healthcare “manual” for all recognized mental disorders. The DSM is used by healthcare professionals as a reference guide for the symptoms, impairments, and diagnostic criteria associated with ADHD as well as other disorders, like depression and anxiety.
In 1980, the term Attention Deficit Disorder (ADD) was included in the DSM for the first time. Two types of ADD were described: ADD with hyperactivity and ADD without hyperactivity. Overtime, healthcare professions became concerned that the term “ADD” didn’t place enough emphasis on hyperactive and impulsive symptoms that so many people with the disorder experience. So, in 1987 the name was changed to Attention Deficit Hyperactivity Disorder (ADHD) and has stayed the same ever since. Today ADHD is described in the DSM-5 as having 3 possible presentations (or subtypes):
Predominantly Inattentive Presentation: This presentation is assigned to children and adults who experience challenges that are solely related to inattention symptoms. These symptoms reflect difficulty sustaining attention, persisting at tasks or play activities, following through on instructions, giving close attention to details, organizing tasks and activities, and keeping track of belongings.
Predominantly Hyperactive Impulsive Presentation: This presentation is assigned to children, and occasionally to adults, who experience challenges solely related to the hyperactive/impulsive symptoms. These symptoms reflect excessive movement, including difficulty remaining seated, often fidgeting, and constantly being on-the-go as if “driven by a motor,” as well as excessive talkativeness, and impulsive behavior such as blurting out answers, difficulty waiting, and frequently interrupting others.
Combined Presentation: This presentation is assigned to children and adults who experience symptoms in both the inattentive and hyperactive/impulsive clusters. It’s the most common presentation diagnosed in children and adolescents.
Often, when someone has received a diagnosis of the Predominantly Inattentive Presentation of ADHD, they will refer to themselves as having ADD rather than ADHD. It’s an easy way to describe the fact that they struggle with focus and concentration, but aren’t necessarily hyperactive or impulsive. It is much easier to day “ADD” than it is to say “ADHD-Predominantly Inattentive Presentation” whenever you’re talking about your diagnosis! And these patients aren’t alone. There is discussion among many clinicians and researchers about whether the term ADHD should be changed to better reflect the symptoms and challenges that come with the disorder. For example, the majority of children and adults with ADHD struggle with organization, time management and following multi-step instructions. None of these challenges are clearly captured by the ADHD label. In addition, for children and adults who have the inattentive presentation of ADHD, it doesn’t necessarily make sense to have the term “hyperactivity” included the diagnosis. Some psychologists have suggested that Executive Function Deficit Disorder may be a better term for ADHD, especially for the inattentive presentation.
Over the next decade, as scientists learn more about ADHD and the biological underpinnings of the disorder, we can expect to see changes in the way healthcare professionals think about and label the disorder. With so many possible presentations and combinations of ADHD symptoms, clear descriptions and labels will make it easier for people with ADHD to communicate about their experiences and will create pathways for the development of more targeted and personalized treatments.
Mary Rooney, Ph.D., is a licensed clinical psychologist in the Department of Psychiatry at the University of California San Francisco. Dr Rooney is a researcher and clinician specializing in the evaluation and treatment of ADHD and co-occurring behavioral, anxiety, and mood disorders. A strong advocate for those with attention and behavior problems, Dr. Rooney is committed to developing and providing comprehensive, cutting edge treatments tailored to meet the unique needs of each child and adolescent. Dr. Rooney's clinical interventions and research avenues emphasize working closely with parents and teachers to create supportive, structured home and school environments that enable children and adolescents to reach their full potential. In addition, Dr. Rooney serves as a consultant and ADHD expert to Huntington Learning Centers.
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