What’s the Difference Between ADD and ADHD?

By Dr. Mary Rooney, Ph.D.

As an ADHD clinician and researcher, one of the most common questions that I’m asked is, “What’s the difference between ADD and ADHD?” Both terms come up regularly in conversation and in the media, making it hard to know which one should be used to describe your child or your students. So, if you’ve been wondering this yourself, here is the definitive answer to the question.

The term ADD was used in the 1980s and early 1990s as a diagnostic label to describe individuals with impairing symptoms of inattention without any related hyperactivity or impulsivity. However, in 1994, the field of psychiatry dropped the ADD label and instead began using ADHD as an umbrella term that described everyone with ADHD, including those previously described as having ADD.

They also added ‘subtypes’ or ‘presentations’ to the disorder label. Today, a child with only symptoms of inattention (without significant hyperactivity or impulsivity) would receive a diagnosis of ‘ADHD – predominantly inattentive presentation.’  Relatedly, if a child has symptoms of hyperactivity and/or impulsivity with few inattention symptoms, then they would be diagnosed with ‘ADHD - predominantly hyperactive/impulsive presentation.’ And a child who is experiencing symptoms of both inattention and hyperactivity/impulsivity would receive a diagnosis of ‘ADHD – combined presentation.’  

The shift to the use of ADHD as an umbrella label for the disorder and the use of ‘presentation’ to describe the predominant symptom clusters was based on decades of research showing that ADHD symptoms often change over time. Hyperactive/impulsive symptoms may be extreme and impairing in young children, but they typically become less severe over time. By adolescence, these symptoms may appear primarily as restlessness, excessive talkativeness, and sometimes as impulsive decision-making.

Inattentive symptoms, in contrast, may not be apparent in younger children but often become more pronounced in the late elementary school, middle school, or high school grades. Therefore, the ADHD presentation that matches an individual’s symptoms in childhood may be different from the one that fits them best as an adolescent.

The shift to a single diagnostic label has also helped alter the misconception that ADHD is a disorder that only affects boys. ADHD is diagnosed more often in boys than in girls, but that doesn’t necessarily mean that girls are less likely to have ADHD. However, girls are less likely to have impairing symptoms of hyperactivity and impulsivity and are more likely to be diagnosed with the predominantly inattentive presentation than boys.

As a result, their ADHD is more likely to be overlooked or diagnosed later in adolescence or adulthood. These missed and delayed diagnoses have a negative impact on girls, who find themselves struggling to focus, stay organized, meet academic milestones, and maintain healthy friendships without access to the treatments that could help.

Evidence-based treatments for ADHD do not differ based on diagnostic presentations. Behavioral interventions delivered by parents and teachers, organizational skills and social skills programs, and medication are evidence-supported treatments for managing symptoms and impairments related to inattention, hyperactivity, and impulsivity. The intensity of treatments and the focus of the interventions may shift over time as a child’s symptoms change and as they encounter more challenging social and academic situations. With that in mind, it can be helpful to have your child’s doctor reassess their symptoms and impairments periodically to make sure that the focus of their ongoing treatments are matched to their current needs.  


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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