Decoding Attention Deficit Disorder: ADD or ADHD?

ADHD, or attention deficit hyperactivity disorder, is a condition whose definition and name have changed as mental health researchers have learned more about it. For a certain period of time, it was known as ADD, or attention deficit disorder. You may still find older sources of information that refer to it as ADD, but what’s really meant is ADHD.

ADHD is now the umbrella term for the many subtypes of the illness, and ADD has come to mean the subtype defined as the predominantly inattentive type, says ADHD expert Richard Gilman, PhD, director of psychology in the division of developmental and behavioral pediatrics at the Cincinnati Children’s Hospital Medical Center in Ohio.

There are three subtypes of ADHD:

• Predominantly hyperactive-impulsive, with six or more ADHD symptoms in the hyperactive/impulsive description.
• Predominantly inattentive, with six or more ADHD symptoms related to inattention and few hyperactive or impulsive symptoms.
• Combined hyperactive-impulsive and inattentive, with six or more ADHD symptoms in the hyperactive/impulsive description and six or more ADHD symptoms of inattention. Most children have this subtype.

What This Means for Your Child

Children who fall into the predominantly inattentive type of ADHD are the ones who have to be told multiple times what to do and how to do it. Often they are diagnosed later than children with other subtypes of ADHD, because instead of acting out, they will probably seem quiet and withdrawn. They may even seem to get along well with other children, especially compared to kids with hyperactive or impulsive symptoms. In fact, while ADHD can be diagnosed in early childhood, those who are primarily inattentive could reach adolescence without a diagnosis or treatment .

Because all children and teens may at some point seem to be unable to pay attention or follow directions, a diagnosis requires that at least six inattentive subtype symptoms be present for at least six months and be worse than the same behaviors in a child’s peers . This is why daycare providers and teachers, who see a lot of the same-age children, are often among the first to identify problematic inattention in a child .

Symptoms of inattentive ADHD can include these behaviors:

• Has difficulty focusing on one thing
• May get bored easily and move onto something else
• Forgets things (homework, instructions) easily
• Seems distracted
• Overlooks details
• Daydreams frequently
• Loses objects, such as pencils or instructions, that are important to completing a project
• Seems not to be listening
• May seem to be quietly working, but in fact is not
• Has a hard time following instructions
• Seems confused or slow to figure things out
• Needs more repetition and explanation to “get” instructions or ideas

Gilman explains that researchers are still trying to understand why ADHD symptoms manifest the way they do in any given child. For instance, one of the big unknowns is why girls tend to fall into the predominantly inattentive subtype, while boys generally have more hyperactive or impulsive symptoms.

Children with predominantly inattentive ADHD symptoms may require a different approach to treatment, but the goal of all ADHD treatment, says Gilman, is to find ways to help kids adapt to their situation and succeed in life as young people and as adults.

“It used to be assumed that ADHD was just a childhood issue,” Gilman says. But a sizable percent of adolescents will always have the condition. “You don’t develop this — you’re born with these characteristics,” he says. “What you want to do is help the child cope with these behaviors and adapt to them.”