Understanding ADHD and Its Different Presentations
Not long ago my husband and I were having a discussion about our two children, currently young adult men at 18 years and 19 years old. Both were diagnosed at a young age with ADHD so it’s not unusual for us to touch base as parents, even now, about how we can best support them at every age and stage. As I jokingly made a comment about my son Gabriel’s ADHD brain and, what’s referred to in our house as “The Gabriel Check” (i.e. the uncanny ability to look for something and not find it even when it’s right in front of you.), my husband remarked, “Well, ya, he doesn’t have ADHD, just ADD”. A bit taken aback by his comment, I corrected him about the distinction, explaining that ADD isn’t actually a term that’s used anymore, leading to a moment of bewilderment on his part. This sparked a realization that, despite living with a psychotherapist, there are still basic unknown elements about ADHD that a lot of people may not know.
So, let’s shed light on this commonly misunderstood aspect.
The ADHD/ADD Conundrum
Distinguishing ADHD and ADD: When and Why the Change?
One of the first hurdles in understanding ADHD lies in distinguishing between ADHD and ADD. The terminology seems to have shifted at some point, leaving many puzzled about the reasons behind this change. Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) are terms often used interchangeably, leading to confusion regarding their differences. It's important to recognize that ADHD and ADD are related but distinct conditions, and the evolution of these terms has contributed to our current understanding of attention disorders.
Historical Background:
The concept of attention disorders dates back to the early 20th century, when attention-related symptoms were first recognized. However, it wasn't until the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published that attention disorders gained more comprehensive recognition.
DSM-II (1968):
The second edition of the DSM, DSM-II, introduced the term "Hyperkinetic Reaction of Childhood" to describe what we now recognize as ADHD. This term emphasized hyperactivity as a core feature of the disorder.
DSM-III (1980):
With the publication of DSM-III, the diagnostic criteria evolved, and the term "Attention Deficit Disorder" (ADD) was introduced. The criteria outlined two subtypes: ADD with hyperactivity and ADD without hyperactivity. This revision acknowledged that attention issues could manifest without the presence of hyperactivity.
DSM-IV (1994):
The DSM-IV retained the ADD terminology but added a distinction between three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined presentation. This acknowledged the assortment of symptoms within the disorder.
DSM-5 (2013):
The most recent edition of the DSM reintroduced the term "ADHD" as the umbrella term, incorporating all three subtypes previously identified. ADHD is now categorized into two presentations: Inattentive Presentation and Hyperactive-Impulsive Presentation. There is also Combined Presentation, where both inattentive and hyperactive-impulsive symptoms are present.
Key Differences:
1. ADHD is the Umbrella Term:
ADHD is the current overarching term that encompasses the different presentations.
Inattentive presentation refers to difficulties sustaining attention and organizing tasks.
Hyperactive-impulsive presentation involves hyperactivity and impulsive behavior.
2. ADD was a Previous Subtype:
ADD was used in earlier editions of the DSM to describe attention disorders but was eventually replaced by ADHD.
The term "ADD" is no longer used in official diagnostic criteria, but still used interchangeably outside of an assessment setting.
3. Recognition of Subtypes:
ADHD recognizes and categorizes presentations based on the predominant symptoms.
Inattentive presentation, hyperactive-impulsive presentation, and combined presentation allow for a more nuanced understanding of the disorder.
As mentioned, the terms are still used interchangeably and, no, there are no ADHD (or ADD?) police (although my husband would probably say otherwise); however, what IS important, is that the evolution from ADD to ADHD reflects our growing understanding of attention disorders. The change in terminology has not only eliminated confusion but also highlighted the diversity of symptoms within the disorder. Recognizing ADHD as an umbrella term acknowledges that attention issues may present differently in individuals, allowing for more accurate diagnoses and targeted interventions.
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