ADD vs. ADHD

Though some people still use the term attention deficit disorder interchangeably with attention-deficit/hyperactivity disorder, ADD no longer appears in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition. The term ADD was initially used to describe those with inattentiveness without presentations of hyperactivity.

The DSM-5, which is the current edition of the APA’s diagnostic tool, outlines ADHD as a neurological disorder with three presentations. People with ADHD can present with inattention, hyperactivity and impulsivity or a combination of symptoms in what is termed a “combined presentation.”

Descriptions of what we now call ADHD first appeared in the DSM in 1968. Attention Deficit Disorder (with and without hyperactivity) was used in 1980’s DSM-3. ADHD was introduced in 1987’s revision with both ADD and ADHD appearing until 2013 when the DSM-5 was released and the use of the term ADD was no longer included.

The APA also changed the description of ADHD types from the DSM-4 to ADHD presentations in the DSM-5. As authors J.N. Epstein and Richard E. A. Loren in Neuropsychiatry explained regarding the DSM-5, “The retention of the ADHD symptom domains and 18 core symptoms likely reflects a judgment that the DSM-4 definition of ADHD has largely withstood the test of time. DSM-4 ADHD criteria have proven to be quite effective at reliably identifying a population of individuals who have significant impairments across a wide range of outcomes.”

Today, an ADHD diagnosis requires a persistent pattern of inattention and/or hyperactivity-impulsivity. Children 16 years old and younger must present with six or more symptoms of inattention or six or more symptoms of hyperactivity-impulsivity for six months or longer. Adults ages 17 years and older must present with five or more symptoms.

The most recent long-range study of ADHD diagnoses shows an increase from 6.1% in 1997-98 to 10.2% in 2015-16 in kids ages 6 to 17. This increase is considered significant, but more data is needed to definitively identify a cause.

Contributing factors may include greater awareness of the disorder, clear diagnostic tools, expanded healthcare access and increased testing. Changes in health insurance coverage under the Affordable Care Act, for example, may have afforded more people with opportunities for discussions of their ADHD symptoms with their primary care providers.

Increased ADHD awareness among educators, parents and childcare workers may also play a role in increased discussions with doctors, leading to an increase in diagnoses. Destigmatizing mental health care has helped encourage more people to seek ADHD treatment.

Inattentive ADHD was initially called ADD. This presentation of ADHD includes symptoms related to attention and focus. People with inattentive ADHD experience more frequent patterns of distraction and can find focusing on some tasks challenging.

To be diagnosed with inattentive ADHD, the following conditions must be met: Several inattentive or hyperactive-impulsive symptoms of ADHD presenting before age 12 years and appearing in more than one setting, like school and home.

Symptoms must also be inappropriate for the developmental level, cause clinically significant impairment and negatively affect social, academic or occupational functioning. Additionally, the symptoms are not attributed to other mental or personality disorders.

Inattentive ADHD vs. Hyperactive-Impulsive ADHD

The hyperactive-impulsive presentation of ADHD includes symptoms related to impulse control. People who present with hyperactive and impulsive symptoms often have challenges keeping still and sometimes blurt out answers or interrupt others when speaking.

Some people can present with both inattentive ADHD and the hyperactive-impulsive presentation, which is classified as a combined presentation. Combined presentation means they have symptoms of both inattention and hyperactivity/impulsivity presentations.

The DSM-5 exclusively uses the term ADHD. Academic institutions and publications from medical journals to science reviews use the term ADHD. The Associated Press, for example, advises writers in its AP Stylebook, “Do not use the outdated terms attention-deficit disorder or ADD.”

Some doctors, parents and people diagnosed with ADHD still use the term ADD. There are some people who prefer the term ADD to describe inattentive presentations without hyperactive and impulsive symptoms, but ADHD encompasses this presentation.