Child Development

ADD vs. ADHD: What's the Difference?

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Despite the prevalence of ADHD, not everyone understands what it is or the different ways that it can look symptomatically. There’s a lot of misinformation out there about ADD and ADHD.

This article provides an opportunity to learn more about the different presentations of ADHD, as well as the diagnosis and treatment, based on the current information we have on ADHD as a condition. So, what exactly is ADHD, and what are the different ways it can manifest or affect a person’s life? 

What is ADHD?

ADHD stands for attention-deficit/hyperactivity disorder. 11% of children and teenagers in the United States have been diagnosed with ADHD, but some sources say that the actual prevalence of ADHD might be even higher. ADHD can affect anyone, and it is a common disorder in people of all ages across the globe. It's a condition that's characterized by persistent patterns of inattention and/or hyperactivity-impulsivity symptoms.

A person may present with primarily hyperactive-impulsive symptoms, primarily inattentive symptoms, or both. This, as well as other factors, such as a person's age, can affect the way a person experiences life with ADHD, and it might also impact whether or not ADHD is detected in some cases.

What is ADD?

We talked a little bit about what it means to have ADHD. But, what about ADD? ADD, which stands for "Attention Deficit Disorder," is no longer a diagnosis. That does not mean that individuals who were once diagnosed with ADD no longer have a disorder.

Nowadays, it's probable that someone who would’ve been diagnosed with ADD in the past would meet the criteria for a diagnosis of ADHD, regardless of whether or not they experience a high number of hyperactivity and/or impulsivity symptoms. 

How does this work? There are now "subtypes" of ADHD that indicate the various ways ADHD can present. The presentations of ADHD include primarily inattentive ADHD, primarily hyperactive ADHD, and ADHD with a combined presentation. Accordingly, what was once called ADD would now, most likely, be diagnosed as primarily inattentive ADHD. 

Differences & Symptoms

While ADHD impacts people of all ages, there are some differences that can occur based on age. Here are some of the dissimilarities you may notice:

ADHD in Kids 

ADHD symptoms in children differ for a range of reasons. First, kids don't know what is and is not seen as socially acceptable yet. Of course, development itself is also noted. Where ADHD symptoms often affect adults in other parts of life, such as the workplace and romantic relationships, symptoms in kids often show up or cause concern in K-12 education and afterschool activities.

Though teachers can't formally diagnose ADHD, they may pick up on certain signs or symptoms, such as if a child gets up and runs across the room during class when they are supposed to remain seated, or a child who is unable to focus, interrupts other children during games, and so on. Treatment may be a little bit different for kids and adults. For example, though medication can help and is approved for kids over 6+, the dosage may vary based on age and other factors.

Kids with ADHD may have an IEP and other forms of support or accommodation to help them in school alongside age-appropriate behavioral therapy or other interventions. Parent support or intervention is often very important for children.

ADHD in Adults 

Conversations that surround ADHD - and even ADD, in situations where the term is still brought up - often surround children, but adults can also have ADHD. Among those between the ages of 18 and 44 in the United States, the estimated lifetime prevalence of ADHD is said to be around 8.1%.

Though signs of ADHD start in childhood, adults who live with ADHD are often no less affected. The manifestation of symptoms can change over time, but this doesn't mean that an adult won't experience symptoms just as much. ADHD symptoms can impact work, but they can also affect interpersonal relationships, daily tasks or obligations, self-esteem, and other areas of life.

An example of how symptoms can differ is actually seen in the criteria for ADHD. Whereas kids may climb or run excessively in inappropriate settings if they experience hyperactivity symptoms, an adult is more likely to know that this is not socially appropriate or acceptable, so for them, it might manifest as restlessness. Diagnosis, including diagnostic requirements, may also vary among kids and adults.

Just as children can benefit from behavioral therapy, many adults who live with ADHD find therapy incredibly helpful. However, the process will look quite a bit different, as it will center around improved functioning in one's adult life. 

Diagnosis

For a diagnosis of ADHD to occur in someone below the age of 17, the diagnostic standards in the diagnostic and statistical manual of mental disorders (DSM) for ADHD require that six or more symptoms of either hyperactivity, inattention, or both, persist in an individual for six months or more. For those aged 17 or above, a person must experience five or more symptoms of either hyperactivity, attention, or both. 

With that in mind, you might wonder, what are the symptoms that a professional will look for when diagnosing ADHD?

Inattention symptoms include:

  • Frequent failure to give close attention to details or making careless mistakes at school, in the workplace, and/or during other activities.
  • Trouble following through on instructions and failure to finish schoolwork, chores, or duties in the workplace, not due to oppositional behavior or difficulty understanding instructions.
  • Appearing as though one is not listening when spoken to.
  • Difficulty sustaining attention in tasks or play activities.
  • Trouble organizing tasks and activities.
  • Losing things necessary for tasks and activities. 
  • Being easily distracted by external stimuli.
  • Difficulty with tasks that require sustained mental efforts, such as work tasks or school assignments.
  • Forgetfulness.

Hyperactivity/impulsivity symptoms include:

  • Fidgeting or squirming.
  • Running or climbing excessively in situations where it's inappropriate to do so (or, in adolescents or adults, subjective feelings of restlessness).
  • Difficulty remaining seated in situations where one is expected to do so.
  • Trouble playing or engaging in leisure activities quietly.
  • Always being "on the go" or acting as though one is "driven by a motor." 
  • Difficulty waiting for one's turn.
  • Blurting out answers before someone finishes asking a question.
  • Interrupting or intruding on others.
  • Excessive speech. 

These symptoms must start before the age of 12 and must not be better attributed to another disorder. Some other disorders, such as anxiety disorders, can have symptoms that overlap with ADHD, which is one of the reasons as to why professional assessment is necessary.

The difference between a primarily inattentive presentation of ADHD, a primarily hyperactive presentation of ADHD, and ADHD with a combined presentation is reflected in the category of symptoms above.

If someone displays six or more symptoms of inattention but not hyperactivity/impulsivity, the specifier "primarily inattentive type" would be used for that person. If someone displays six or more symptoms of both, the specifier "combined type" would be used. However, all of these individuals would be able to say, "I have ADHD." 

Though the removal of ADD from the DSM was a controversial choice to some, many individuals once thought of ADD as "less severe" than ADHD, when in reality, this was not the case. Seeing ADD or primarily inattentive ADHD as less severe can be quite damaging, as ADHD can range in severity regardless of the type and a person's struggles, both internal and external, should not be overlooked or diminished.

Instead, the distinct symptoms that someone experiences based on the subtype of ADHD they present with mean that they face specific potential challenges that someone with another subtype may or may not face. Treatment for ADHD is available for people who live with any of the three primary subtypes or presentations, and it can help someone improve their quality of life. 

Treatment for ADHD

Treatment for ADHD is something a patient or caregiver and their provider will decide on together. There are a number of different treatments for ADHD, and regardless of the specific presentation of ADHD a person experiences, treatment may be the same or similar. Treatments we use for ADHD in the medical field can include but are not restricted to: 

  • Stimulant medication. Stimulant medication is known to reduce ADHD symptoms by somewhere from 70% to 80%. 
  • Mental health therapy. Mental health or behavioral therapy can help kids and adults with emotional dysregulation, self-esteem or confidence, behavior, and more. There are therapists who specialize in ADHD, and some therapists also specialize in working with specific age groups. 
  • Lifestyle modification. For kids and adults alike, lifestyle modifications such as changes in diet or taking supplements may be advantageous for symptom management. 
  • Other tools. Various tools can be used to aid the treatment of ADHD, such as games or gaming devices designed to help with ADHD symptoms. 

Want to learn more about games that can support symptom management in those with ADHD? Joon works with occupational therapists and child psychologists who specialize in ADHD. Joon is meant to minimize screen-time usage while maximizing time spent engaging in important, real-life activities, which is highly beneficial for individuals who live with ADHD and may be at a higher risk for concerns such as technology addiction. Click here to get started.

Accommodations for ADHD could be considered a part of treatment, and they may be necessary for the workplace or at school. These accommodations are there to help adults and children with ADHD succeed. In cases where ADHD is severe, a person may qualify for disability benefits.

If an individual lives with multiple diagnoses or conditions, such as ADHD and an anxiety disorder, they may receive care for both. For kids and adults alike, it is very common for individuals who live with ADHD to experience another disorder. These can include but are not limited to Autism Spectrum Disorder (ASD), eating disorders, anxiety disorders, substance use disorders, sleep disorders, learning disorders, and depression.

It is crucial that a person with ADHD receives care that is tailored to them and their unique health needs as an individual. Alongside age and the type of ADHD a person has, these co-occurring conditions can inform what care looks like.

Conclusion

Although ADD was once a well-known and widespread diagnosis, it is no longer used in medical or mental health settings. Some individuals who are diagnosed with ADD before its removal may still use the term or acronym. There are many differences in how ADHD can present, whether that's related to the type of ADHD a person lives with or their age and other factors.

There's no way to prevent ADHD, but some people do experience partial remission from symptoms as they age. This is not the case for everyone. It's common for ADHD to run in families, and many of those who live with ADHD are also diagnosed with one or more comorbid or co-occurring disorders. With the right care, people who live with ADHD can thrive.

Frequently Asked Questions (FAQs) 

What Is Inattentive ADHD? 

Inattentive ADHD is a presentation of ADHD where an individual primarily experiences symptoms of inattention. A minor aged 17 or below with a primarily inattentive presentation of ADHD will experience six or more symptoms of inattention, but they won't experience enough symptoms of hyperactivity or impulsivity to meet the criteria for combined-type ADHD. Similarly, those aged 17+ with a primarily inattentive presentation will experience five or more symptoms of inattention, but they won't experience enough symptoms of hyperactivity/impulsivity to meet the criteria for combined-type ADHD.

What Is Hyperactive-Impulsive ADHD?

Hyperactive-impulsive ADHD is a presentation of ADHD where an individual experiences symptoms that are primarily hyperactive/impulsive. A minor aged 17 or below with a primarily hyperactive-impulsive presentation of ADHD will experience six or more symptoms of hyperactivity/impulsivity, but they won't experience enough symptoms of inattention to meet the criteria for combined-type ADHD. Similarly, those aged 17+ with a primarily hyperactive-impulsive presentation will experience five or more symptoms of hyperactivity/impulsivity, but they won't experience enough symptoms of inattention to meet the criteria for combined-type ADHD.

What Is Combined Type ADHD?

Combined type ADHD is a presentation of ADHD where a person experiences both a clinically significant quantity of inattention symptoms and hyperactivity/impulsivity symptoms. In those aged 17 or below, this would mean that they experience at least six symptoms of both inattention and hyperactivity or impulsivity. In those aged 17 or above, this would mean that they experience at least five symptoms of both inattention and hyperactivity or impulsivity. Teens and adults sometimes work to "mask" or hide certain symptoms, which may mean that they internalize the struggles they face. Treatment can help.