What Is the Difference Between ADD and ADHD?

What do you call the neurodevelopmental disorder characterized by quickly losing focus, acting impulsively, and constant fidgeting? Your answer to that question might depend on your age.

Before and After 1994

Before 1994, the term for this illness was attention deficit disorder, or ADD. At the time, patients — mostly school-age children — were diagnosed with ADD if they suffered from inattentiveness and found it challenging to focus. At the time, fidgeting, constant movement, or hyperactivity, weren’t included in the diagnosis of attention deficit disorder.

However, in 1994, physicians created the term, attention deficit hyperactivity disorder, or ADHD, to encompass all attention deficit diagnoses. This term includes diagnoses that didn’t include hyperactivity. Today, the condition formerly known as ADD is a type of ADHD, and ADD has become an outdated term that is no longer recognized by the medical community or the American Psychiatric Association (APA). However, adults who became familiar with attention deficit disorders before 1994 may still use the older acronym.

More Misconceptions

In addition to the confusion in terminology and primary symptoms, many people misunderstand what causes ADHD and who it affects. Some believe family conflict, bad parenting, or too much sugar or TV causes ADHD because of its disruptive symptoms and impact on a child’s behavior. Most research suggests ADHD is caused by genetics. However, some environmental factors may contribute to a child’s chances of developing ADHD symptoms. These factors include environmental toxins like lead or pesticides, a mother’s alcohol, tobacco, or drug use during pregnancy, and even some food additives.

Although the illness is one of the most common conditions among children and adolescents, affecting about 6.4% of the under-18 population, ADHD also can be diagnosed in adulthood. According to the National Institute of Mental Health (NIMH), about 4.4% of adults in the United States currently suffer from this medical condition.

The APA estimates that about half of patients diagnosed in childhood will carry ADHD symptoms into adulthood. Also, the lifetime prevalence rate is about 8.1%, meaning an estimated 8.1% of adults will be diagnosed with adult ADHD during their lifetimes. However, some adult ADHD patients will never be diagnosed at all.

The symptoms of ADHD will present a little differently in adults than in young children because of the level of maturity of adults and their physical differences. While many parents may be alerted to their children’s symptoms by a teacher following disruptions or problematic behaviors at school, adults may become aware of their ADHD symptoms when they affect their performance in the workplace. Both adults and children will find that their ADHD symptoms also interfere with their functioning in social situations, and have a significant impact on their daily life. 

The primary symptoms of the different types of ADHD — inattentiveness, hyperactivity, and impulsivity — span all age groups and appear in varying levels of severity.

Three Types of ADHD

When most people think about ADHD, they most likely picture an always-in-motion, easily distracted person. There are three types of ADHD, each with unique diagnostic criteria.

Primarily inattentive ADHD: This is the subtype of ADHD that was formerly known as ADD. Primarily inattentive ADHD is ADHD without the “H.” It includes symptoms like forgetfulness, disorganization, and poor listening skills, but not hyperactivity.

According to the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), children must often demonstrate six of the following symptoms (five in adults) over at least six months to warrant a diagnosis of inattentive ADHD:

• Failing to pay close attention to details
• Making careless mistakes
• Having difficulty maintaining attention
• Seeming not to listen when spoken to
• Not following through on instructions, meeting deadlines, or finishing schoolwork or chores
• Having a hard time organizing tasks or activities
• Avoiding or disliking tasks that require mental effort
• Being easily distracted
• Being forgetful in daily life
• Misplacing things necessary for tasks, including backpacks, cell phones, paperwork, tools, wallets, keys, or eyeglasses

Hyperactive-impulsive ADHD: The second subtype of ADHD, hyperactive-impulsive ADHD, is the least-diagnosed in both children and adults. As the name implies, the symptoms of this type of ADHD include different types of hyperactivity and impulsive behavior.

The DSM-5 criteria for a childhood/adolescence diagnosis of hyperactive-impulsive ADHD include six of the following symptoms (or five in adults) persisting for at least six months:

• Restlessness or fidgeting
• Difficulting staying seated when remaining seated is expected
• Interrupting or intruding on others, or finishing other people’s sentences
• Talking excessively
• Difficulty waiting your turn
• Running or climbing excessively
• Blurting out answers
• Appearing always “on the go.”
• Difficulty playing or engaging in leisure activity quietly.

Combined type ADHD: The last ADHD subtype is characterized by both impulsive symptoms and inattentive ADHD symptoms. 

Is it ADHD or something else?

One of the criteria of most DSM-5 diagnoses is that another mental health condition can’t explain the symptoms of the particular psychological disorder better. The same is true, with a diagnosis of ADHD. According to the Mayo Clinic, symptoms and signs of ADHD may be similar to learning disabilities, mood disorders, vision or hearing problems, seizure disorders, sleep disorders, or brain injury.

However, the Centers for Disease Control (CDC) finds that six in 10 children with ADHD have at least one additional mental, emotional, or behavioral disorder. According to the CDC, about five in 10 children with ADHD have behavior problems or conduct disorder, and three in 10 have anxiety. Others suffering from childhood ADHD may have depression, autism spectrum disorder, oppositional defiant disorder (ODD), or Tourette Syndrome. Your child’s doctor or a psychiatrist, psychologist, or other mental health professional can help to sort out the symptoms of ADHD and make a conclusive diagnosis.

Although ADHD is not a learning disability, it can be classified as a disability under the Individuals with Disabilities Education Act (IDEA). This determination makes a student eligible for special education services.

Effective Treatments for ADHD

Symptoms of ADHD may evolve as a person enters adulthood, but they won’t disappear. Unfortunately, ADHD can’t be cured. However, more and more options are becoming available for the treatment of ADHD.

Currently, ADHD treatment options include stimulant medications, behavior therapy, and psychotherapy, or a combination of these.

Stimulant drugs improve symptoms of inattention and hyperactivity by boosting and balancing levels of brain chemicals. ADHD medications include amphetamines like Adderall or Vyvanse and methylphenidates like Ritalin. If someone can’t take stimulants because of side effects or other health problems, antidepressants may be an option.

Behavior therapy includes behavior-changing strategies like setting and following routines, giving plenty of praise, creating quiet spaces, or offering rewards or timeouts under challenging situations. Parents, teachers, school counselors, and family members can learn behavior therapy techniques as well as provide social skills training for children with ADHD.

Psychotherapy, or talk therapy, offers older children and adults with ADHD the opportunity to talk about their ADHD symptoms and how they impact their daily life. Cognitive-behavioral therapy, a typical and effective type of psychotherapy, helps patients identify and explore negative thoughts and behaviors associated with their condition and replace them with more positive ones.

In 2019, the Food and Drug Administration (FDA) permitted marketing of the first medical device for the treatment of childhood ADHD. The device called the Monarch external Trigeminal Nerve Stimulation (eTNS) system generates a low-level electrical stimulation to increase activity in brain regions that help to regulate attention, emotion, and behavior. The eTNS system is recommended for use on patients seven to 12 years old who aren’t currently taking prescription stimulant drugs for their ADHD symptoms.

Do you or your child have symptoms of ADHD?

If you believe you or your child may be suffering from attention deficit hyperactivity disorder, don’t hesitate to make an appointment with your pediatrician or general practitioner to discuss your symptoms. Once your doctor has ruled out other possible causes, and you receive a diagnosis of ADHD, consider making psychotherapy or counseling a part of your treatment plan. Parents of children with ADHD can also benefit from psychotherapy, counseling, or joining a support group.

The mental health clinicians at Therapy Group of NYC can help you learn to deal with your symptoms of inattention, hyperactivity, or both, healthily. Our patients have found great success in improving their overall wellbeing and maintaining healthy lifestyles. Reach out to the Therapy Group of NYC today and schedule your first teletherapy session with one of the best therapists in New York City.