ADD versus ADHD

Today there is more awareness of the diagnosis of ADD and ADHD, which is a wonderful step forward in human compassion and knowledge. Many of our Pathfinders families have been touched by this diagnosis. However, you may have wondered what the difference that “H” makes in between the two terms. For those of you with little spare time, the short answer is ADD is the antiquated term for ADHD, which is the currently diagnosable disorder in the DSM-V, the Diagnostic and Statistical Manual (fifth edition) used by healthcare professionals to classify and diagnose mental disorders. For those of you with more time on your hands, let’s dive into this transition of terminology.

History of ADHD

Professionals have observed the behaviors associated with ADHD for over two hundred years, though “ADHD” is a very modern term for it. A diagnosis of what is now known as ADHD was first seen as early as the late 1700’s. In 1798, Dr. Alexander Crichton used the term “mental restlessness” to describe a child with what we now call poor selective attention skills – the ability to select or focus your attention on one object or goal in the midst of distractions. The most well-known case of early ADHD diagnosis occurred in 1902 when Sir George Still famously – or perhaps infamously – described “an abnormal defect in moral control in children.” He used this definition to label children who behaved contrary to what was expected of them by their peers, parents and greater society. This definition implies that the children were intentionally behaving selfishly by purposefully displeasing others and ignoring the greater good. Today, we have a better understanding of the complications ADHD adds to someone’s life, though many still incorrectly interpret behavior caused by ADHD as carelessness and tactlessness.

How the term changed to ADHD

The American Psychiatric Association, who curates the Diagnostic and Statistical Manual, did not formally recognize ADHD until the second edition of the DSM (1968), in which the diagnosis was labeled “hyperkinetic impulse disorder.” Upon the publication of the third edition (1980), the term was changed to Attention Deficit Disorder (ADD). In this classification, the APA specified two subtypes describing the presence or absence of hyperactivity. In the revised third edition of the DSM (1987), we finally see the term ADHD. In this version, the inattentive and hyperactive aspects of ADHD were grouped together. Only in the fourth edition (2000) did the APA separate ADHD into its current subtypes: inattentive, hyperactive-compulsive and combined ADHD. Let’s talk a bit more about those subtypes.

The current types of ADHD

Currently, ADHD is divided into three subtypes. The DSM lists two groups of symptoms used to diagnose the disorder. One group lists traits of inattentive ADHD, and the other lists traits of hyperactive-compulsive ADHD. For a diagnosis of either inattentive or hyperactive-compulsive ADHD to occur, a person needs to exhibit at least 5-or-6 traits (depending on age) that inhibit daily life for at least the last six months. The only difference between these subtypes and combined ADHD is that a person with combined ADHD will present at least 5-or-6 traits from each list, with a total of at least 10-to-12 traits. Here are some examples of those traits:

Inattentive ADHD is characterized by the following traits:
- overlooks details, is easily distractible and forgetful
- struggles with selective attention for prolonged periods of time and avoids/dislikes activities that require this skill
- appears not to listen when directly spoken to, has trouble organizing, keeping track of materials for and fully completing tasks

Hyperactive-compulsive ADHD is characterized by the following traits:
- is fidgety when seated and cannot remain seated for prolonged periods of time
- has difficulty quietly participating in leisure activities, and runs or climbs at inappropriate times or feels restless
- talks excessively, interrupts when others are speaking and has difficulty waiting their turn

Combined ADHD is characterized by a combination of the traits described above.

We, here at Pathfinders, hope you’ve learned a bit more about ADHD, even if it’s only to remember the “H”.

ADD versus ADHD

History of ADHD

How the term changed to ADHD

The current types of ADHD

References