Oftentimes, there can be some confusion over the use of the terms Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). How do they differ? Are they the same thing? Can I have ADHD if I am not hyperactive? Why does ADHD sometimes have a slash -- AD/HD? What is the correct term to describe what I (or my child, spouse, friend, etc.) have?
ADD or ADHD?
Part of the confusion that many people have over the name comes from the large number and variety of terms and subtypes that have been used to describe the condition over the years -- including Hyperkinetic Reaction of Childhood; Attention Deficit Disorder with Hyperactivity (ADDH); Attention Deficit Disorder without Hyperactivity (ADD), Attention Deficit Disorder, Residual Type (ADD-RT); Attention-Deficit Hyperactivity Disorder (ADHD); Undifferentiated Attention-Deficit Disorder (UADD) -- to name a few.
Another factor that contributes to these questions is the varied way this cluster of symptoms -- inattention, impulsivity, and hyperactivity -- can present in people. For some people, impairments in inattention may be the predominate feature. For others, there may be a combination of the core symptoms.
In the United States, we use the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, as our standard guideline for assessing and diagnosing ADHD. The official diagnostic label or term we use to identify this pattern of symptoms comes from the DSM, and the current edition of the DSM (fourth edition, text revision) uses Attention Deficit/Hyperactivity Disorder (with the slash) or AD/HD. (On the ADD.About.com site, I most frequently use the term ADHD.)
The use of the label ADHD is often confusing because some people with ADHD, including many adults and girls, may not have significant hyperactive symptoms (or if they do, these symptoms may present differently as internal restlessness or hypersocial behavior, for example) -- yet the diagnosis is called attention deficit hyperactivity disorder. To address this, ADHD diagnoses in the current edition of the DSM are accompanied by a subtyping distinction.
Three Major Subtypes of ADHD
- ADHD, Combined Type
- ADHD, Predominately Inattentive Type
- ADHD, Predominately Hyperactive-Impulsive Type
As the names of these subtypes imply, people with the combined type of ADHD experience difficulties with attention, along with some combination of hyperactive and impulsive impairments. Those with the predominately inattentive type mainly experience problems with inattention, and those with the predominately hyperactive-impulsive type of ADHD exhibit impairments mostly related to hyperactive-impulsive symptoms.
What About ADD?
Though AD/HD is the official clinical term, ADD (without the "H") is frequently used by the general public. ADD is also a generic name that is often used to describe those who have the predominately inattentive type of ADHD. Interestingly, older editions of the DSM used the diagnostic label Attention Deficit Disorder without Hyperactivity or ADD.
To add further to the confusion about the terms, if you are a parent of a child with ADHD, you may find that your child's school uses both the ADD and ADHD labels. This is because federal education law refers to those students with hyperactivity and impulsivity as having ADHD and students who are predominantly inattentive as having ADD.
In general, most people use the terms ADD, ADHD, and AD/HD interchangeably for both those who do and those who do not have symptoms of hyperactivity and impulsiveness. Release of the next revision of the DSM (DSM-5) is expected in May 2012. Soon we'll see what changes -- maybe even name changes -- this edition may bring. Revisions will reflect our ever-changing and updated understanding of ADHD.
Arthur D. Anastopoulos and Terri L. Shelton, Assessing Attention-Deficit/Hyperactivity Disorder. Kluwer Academic/Plenum Publishers, 2001.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, (Fourth Edition, Text Revision). Washington, D.C. 2000.