ADD stands for Attention Deficit Disorder which is now considered as an outdated term. The updated term is ADHD which stands for Attention Deficit Hyperactivity Disorder (1). However, there still remains some confusion regarding the use of the term ADD. Some people use ADD and ADHD as synonymous terms while others consider ADD a subtype of ADHD.
The term ADD is used to describe people with traits of impulsiveness and inattention without hyperactivity. At the same time, ADHD includes inattention, impulsive behavior, and hyperactivity. Without proper care and management, people with ADHD and ADD have a hard time focusing on tasks at hand, keeping up with assignments, and following instructions.
History of Term ADD
The term ADD was first added to the third edition of “The Diagnostic and Statistical Manual of Mental Disorders (DSM)”. The condition was separated into two subtypes
- ADD without hyperactivity
- ADD with hyperactivity
In 1987, the two conditions were combined under the same term ADHD in the revised fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
What is ADHD?
Attention Deficit Hyperactivity Disorder is a psychiatric condition that affects the normal functioning ability of children. Children suffering from ADHD have developmentally abnormal patterns of inattentiveness, hyperactivity, and impulsivity. ADHD is also seen in adults. According to a review done in 2021, almost 2.6 percent of adults have had ADHD since childhood, and 6.7 percent of adults develop ADHD later (1).
Types of ADHD
Based on the symptoms of the patient, ADHD can be classified into three subtypes
- Inattentive type
- Impulsive type or Hyperactive type
- Combination of inattentive and impulsive type
- Inattentive Type (ADD):
Originally inattentive type ADHD was known as ADD which was replaced by ADHD later. So, previously a person with symptoms of inattentive type was diagnosed with ADD. Now, the diagnosis becomes ADHD (inattentive type).
A person suffering from the inattentive type of ADHD has problems concentrating and focusing on a particular thing for an extended period. Some characteristic symptoms of the inattention subtype include (3):
- Easy distractibility
- A problem in following directions and instructions
- Difficulty in staying on task
- A problem in concentrating when someone else is speaking
- Difficulty in completing tasks as asked
- Tendency to get sidetracked and lose focus
- Forgetfulness
- Making careless mistakes and inability to take care of personal items like keys.
- Problems in being organized
- Difficulty in paying attention to details
- Tendency to delay tasks that require mental effort
- Daydreaming and avoiding the task
- Decreased attention span and executive function
- Learning disabilities
- Problems in time management
These symptoms of inattention become evident in schoolwork, job, leisure activities, or any other organized or focused activity.
- Hyperactive Type
This type is also known as Hyperactive-Impulsive ADHD with the major symptoms of hyperactivity and impulsivity as follows:
- Inability to sit quietly
- Excessive talking
- Difficulty in waiting patiently
- Fidgeting, tapping, and squirming hands and feet
- Feelings of restlessness
- The person blurts out responses
- Problems in taking part in quiet activities
- Excessive running
- Problems with staying seated
- A problem in taking turns
- A habit of interrupting when someone else is talking
- The habit of completing other people’s sentences
- Combined Type or Inattentive-hyperactive Type:
This form of ADHD involves both inattentive and hyperactive symptoms. If a person displays six or more inattention symptoms and six or more hyperactive-impulsive symptoms, he is diagnosed with a combined type of ADHD. The Combined type of ADHD is more common than the other two types. In one 2010 study, 62 percent of older people had a combined type of ADHD while 31 percent had a predominantly inattentive presentation and 7 percent had a predominantly hyperactive type (4). However, a study done in 2020 concluded that the combined type is the least common (5).
Diagnosis of ADHD
ADHD is diagnosed by pediatricians, psychologists, and psychiatrists. It does not have any medical testing.
To be diagnosed with ADHD children should have had at least six symptoms for at least the previous six months and adults above 17 should have had at least 5 symptoms for the past six months. Depending upon the type of symptoms, the patient is diagnosed as predominantly inattentive, predominantly hyperactive, or combined type ADHD. Additional criteria for diagnosis include
- Children should have some symptoms before age 12.
- Symptoms should be present in at least two settings like school, home, playground, etc.
- The symptoms are strong enough to interfere with the normal functioning of life.
While looking for ADHD, the mental health professional also keeps in mind the following disorders to rule them out as he moves forward:
- Anxiety and mood disorders
- Substance abuse disorder
- Personality disorders
- Dissociative disorders
Method of Diagnosis:
Healthcare professionals take different approaches when trying to form the diagnosis of ADHD. It may include:
- Assessment or evaluation
- Conversation sessions
- Information from parents
- Observations during an office setting
- Information from teachers and classmates
- Medical testing to rule out medical causes of symptoms
- Information from the family doctor or primary health provider
ADHD in Adults
ADHD remains undiagnosed in some cases especially when the symptoms do not interfere with the flow of life for others. A 2020 study established that ADHD symptoms, especially inattentive ones go undiagnosed in girls because they do not cause any obvious disruption (6). These children seem distant and dreamy. They may appear focused on classwork while being completely zoned out and daydreaming.
When a person starts having problems in school or work, or relationships with family, friends, and romantic partners, he seeks help. For many people, the symptoms of ADHD improve with age. But, if the diagnosis is not established, the symptoms might appear to get worse because the person does not know how to cope with them.
In adult life, stressors like finances, and relationships also affect the symptoms. Characteristically, the symptoms of a child and an adult ADHD are similar but the adult responsibilities can have an impact. For example, being careless or unfocused does not harm the child as such. But for an adult, it causes problems at work and home.
Treatment of ADHD
ADHD treatment can be done in the following ways
- Skill training of the patient
- Psychotherapy or talk therapy
- Cognitive Behavioral Therapy
- Medications
- Education services
- A combination of the above-mentioned treatments
Children less than six years of age are preferred to have non-medical treatment first. While people older than six years are treated with medications and other options (7).
Therapy:
Therapy for ADHD includes interventions for the patient, his family, and his surroundings.
- The health care professional might recommend family therapy to ensure that parents and other family members understand how to support the person with ADHD.
- It is also necessary that parents understand how to deal with and communicate with a child suffering from ADHD. the parents are educated and counseled. They are also taught play therapy and talk therapy to allow their child to openly express his emotions and learn healthy coping mechanisms.
- If the child meets the criteria for the Individuals with Disabilities Education Act of Rehabilitation Act, the school will arrange extra accommodations for the child. It includes frequent breaks, positive reinforcements, assignments that are personalized for the child, and a healthy environment.
- A therapist or psychologist can also arrange a peer support group where the child will learn how to interact with other children of his age.
Medications:
Medications can be stimulants or non-stimulants.
- Psychostimulants affect the neurotransmitters in the brain and boost the energy levels. Psychostimulants include amphetamines such as Adderall and Methylphenidates such as Ritalin.
- If stimulant drugs produce side effects in a patient, they are switched to non-stimulant drugs. These drugs have an effect on norepinephrine which helps in alleviating the symptoms.
- In some patients, antidepressants are also useful.
Conclusion
ADHD is one of the mental health conditions that affects children. Although previously known as ADD, ADHD has three ranges of symptoms which include inattention, impulsivity, and hyperactivity. Diagnosis and management in childhood help in relieving symptoms in adulthood. The treatment of ADHD varies for different people depending upon their symptoms and choice.
The National Resource Center on ADHD is a program for Children and Adults with ADHD (CHADD) supported by the Centers for Disease Control and Prevention (CDC) and has resources and information. You can reach it at 1-866-200-8098 or online
References:
- Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention deficit hyperactivity disorder. Attention deficit and hyperactivity disorders, 2(4), 241–255. https://doi.org/10.1007/s12402-010-0045-8
- Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health, 11, 04009. https://doi.org/10.7189/jogh.11.04009
- Cabral MDI, Liu S, Soares N. Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Transl Pediatr. 2020;9(Suppl 1): S104-S113. doi:10.21037/tp.2019.09.08
- Wilens, T. E., Biederman, J., Faraone, S. V., Martel, M., Westerberg, D., & Spencer, T. J. (2009). Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD. The Journal of Clinical Psychiatry, 70(11), 1557–1562. https://doi.org/10.4088/JCP.08m04785pur
- Ayano, G., Yohannes, K., & Abraha, M. (2020). Epidemiology of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in Africa: a systematic review and meta-analysis. Annals of General Psychiatry, 19, 21. https://doi.org/10.1186/s12991-020-00271-w
- Young, S., Adamo, N., Ásgeirsdóttir, B.B. et al. Females with ADHD: An expert consensus statement taking a lifespan approach guiding the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry 20, 404 (2020). https://doi.org/10.1186/s12888-020-02707-9
- Wolraich ML, Hagan JF, Allan C, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144(4):e20192528. doi:10.1542/peds.2019-2528