Is it ADHD? Is it ADD?

Paul made an appointment with me and arrived with a concern: “My wife keeps telling me I have ADHD because I am always misplacing things, forgetting what she says, and running late - even to work. But I have never been hyperactive, so can she still be right?”

A week later, I met Jennifer upset with what her doctor had told her. “He said I have ADHD, but I know I don’t! I am very low energy, and my biggest problem is procrastination. I have ADD, not ADHD.”

Is it ADHD? Is it ADD? What’s the difference? Both Paul and Jennifer share a very common confusion about ADHD: What are the symptoms of ADHD? What is the difference betwee
ADHD and ADD? How do I know which one I have?

To help in answering this, it’s important to know that The American Psychological Association (APA) has recently published a new guide detailing what a person must be experiencing or have experienced for the diagnosis of ADHD. In this manual, the Association uses the term “ADHD” as an umbrella term to include both ADD (inattentive symptoms) and ADHD (hyperactive/impulsive symptoms).

In other words, instead of two separate ADD or ADHD diagnoses, as in the past, the American Psychological Association now simply identifies three “presentations” or types of ADHD:

• Predominantly Inattentive Presentation
• Predominantly Hyperactive-Impulsive Presentation, and
• Combined Presentation, which includes symptoms of inattentive and hyperactive-impulsive.

“Predominately Inattentive” ADHD is the new terminology for what was previously simply called ADD. Symptoms for Predominately Inattentive ADHD are the same as what were previously called ADD symptoms and include the following, however, not all need to be present for a diagnosis:
• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
• Often has trouble holding attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
• Often has trouble organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
• Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
• Is often easily distracted
• Is often forgetful in daily activities.

“Predominantly Hyperactive-Impulsive Presentation” is the current term for individuals who primarily have the hyperactive and impulsive symptoms associated with ADHD. Again, someone doesn’t need to be experiencing all of the symptoms to have this type of ADHD:

• Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
• Often unable to play or take part in leisure activities quietly.
• Is often "on the go" acting as if "driven by a motor".
• Often talks excessively.
• Often blurts out an answer before a question has been completed.
• Often has trouble waiting his/her turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games)

The “Combined Presentation” is when an individual has symptoms of both inattentive and hyperactive-impulsive types of ADHD.

So, when I met with Paul, I explained the difference between the “Predominantly Inattentive” and the “Hyperactive-Impulsive” presentations, or subtypes, of ADHD. I suggested that, if his wife were correct in guessing that he has ADHD, his symptoms might be those of the “Predominantly Inattentive” subtype:

• Often does not seem to listen when spoken to directly.
• Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
• Often has trouble organizing tasks and activities and
• Is often easily distracted (both of which can lead to running late).

In looking at the symptoms for “Predominantly Inattentive” ADHD, Paul recognized a few others in himself:

• Often fails to give close attention to details or makes careless mistakes.
• Is often forgetful in daily activities.
Paul recognized that he has a number of symptoms of the ADHD “Predominantly Inattentive” subtype. However, for Paul to have the correct diagnosis, he needs to go to a doctor, preferably one who has experience in treating ADHD, for an exam, history, and perhaps testing, if he wants to have a definite diagnosis. The checklist is helpful in becoming aware of the symptoms that might indicate a diagnosis of ADHD, but a doctor or other health provider with a specialty in mental health needs to make the official diagnosis.

With Jennifer, I assured her that she and her doctor are probably both correct. For some time, she’s known that she has symptoms of what used to be called ADD. Her symptoms haven’t changed, only the terminology has. Due to the recent change in terms used to describe ADD and ADHD, her pattern of symptoms—similar to that which Paul has—is now called the “Predominantly Inattentive” presentation of ADHD. She can check at her next medical appointment, but it’s likely that her doctor is just using the newer terminology for ADHD—terms which includes symptoms of inattentive, hyperactive-impulsive, and combined manifestations together under one broad, umbrella term: ADHD.

Is it ADHD or ADD? According to the new criteria and language used in the diagnosis, ADHD. To distinguish between the different types of ADHD, using the new diagnostic terms it would be ADHD “predominantly inattentive” if you lack the restlessness or hyperactivity, ADHD “predominantly hyperactive” if you notice you have the restlessness or fidgetiness, and ADHD “predominantly combined type”, if you have a combination of the two.

What type of ADHD are you? Let me know by replying to this blog…I’d love to hear from you!

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

http://www.cdc.gov/ncbddd/adhd/diagnosis.html