ADD Vs. ADHD: Symptoms And Terminology For The Presentations Of An ADHD Diagnosis
You may have heard the terms ADD and ADHD used interchangeably. The obvious difference between these two is the “H,” which stands for “hyperactivity.” Here, we’ll explore which of these acronyms is the correct one to use today as well as the history of hyperactivity as a recognized symptom of ADHD, how it can affect a person's life and functioning, and how to get support for ADHD symptoms.
Exploring the terminology: ADD vs. ADHD
Previously, attention-deficit/hyperactivity disorder was called “attention-deficit disorder,” with hyperactivity not yet being listed as an official symptom. This changed when an updated version of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) was released in 1987. It listed the modern term: attention-deficit/hyperactivity disorder (ADHD), making “attention-deficit disorder” and “ADD” outdated terms.
Does the distinction between ADD vs. ADHD still matter for adults or children?
All that said, distinctions between symptoms of inattention and hyperactivity are still relevant, since not everyone with ADHD experiences both. In 2000, a new version of the DSM was released listing three subtypes, or presentations, of ADHD that a person could have: primarily inattentive, primarily hyperactive/impulsive, or a combined type. We’ll explore these more in depth below.
Today, children will typically be diagnosed with ADHD and one of these subtypes. Adults who were diagnosed before the year 2000 may have originally been diagnosed with ADD, which would now be referred to as ADHD with a particular subtype.
ADHD: the basics of this condition that affects children and adults
ADHD is a neurodevelopmental disorder that tends to first appear in childhood and typically lasts throughout a person’s life. People living with ADHD can experience restlessness, trouble paying attention, difficulty following instructions, and/or a variety of other symptoms that may impact their well-being, relationships, and academic/professional life. It’s estimated that around 6% of adults in the US currently have an ADHD diagnosis.
ADHD symptoms for each subtype
Again, the three primary presentations of ADHD per the most recent version of the DSM are:
Primarily inattentive
Primarily hyperactive/impulsive
A combined type
See below for a brief overview of the inattentive and hyperactive/impulsive types.
Primarily inattentive attention-deficit/hyperactivity disorder symptoms
Individuals with primarily inattentive symptoms of ADHD often have trouble paying attention, listening, organizing, and completing tasks. They may experience forgetfulness, difficulty with time management, trouble following instructions, and several other symptoms that impact their social, academic, or professional lives. The Diagnostic and Statistical Manual of Mental Disorders states that—as with hyperactive-impulsive type ADHD—symptoms must be present for six months for inattentive type ADHD to be diagnosed.
The signs of ADHD in adults can be different from children because an adult may have learned to keep some of their behaviors in check. This means they probably aren’t going to get up in the middle of a board meeting and run around the room— yet they may still feel like doing that. Hyperactivity in adults may present as a general restlessness or impulsivity, meaning a person may act on ideas or things without thinking them through all the way. ADHD can also make it hard for adults to respond appropriately to certain emotions.
Primarily hyperactive/impulsive ADHD symptoms
For people who experience primarily hyperactive/impulsive symptoms of ADHD, hyperactivity may make them feel uncomfortable remaining still. Hyperactivity can be easier to spot in a young child, who may have tendencies to run, jump, squirm, or even get up in school (such symptoms are often first identified in a classroom setting). Additionally, individuals with ADHD are thought to display symptoms of hyperactivity less frequently and severely as they age. Because of the challenges associated with these symptoms, children with ADHD may be provided with accommodations in some circumstances, including extended time on assignments, alterations to the classroom environment, and personalized instructions.
Hyperactive and impulsive behaviors could include tapping fingers, wiggling feet, fidgets, and even talking excessively. According to the APA, difficulty with hyperactivity and impulse control can cause a young child to interrupt frequently, run or climb at inappropriate times, and experience “difficulty waiting his or her turn”.
Treatment options for trouble paying attention, hyperactivity, or impulsive behaviors
If you believe you’re living with ADHD, a healthcare professional can provide you with psychological testing and medical evaluations (to find out whether any medical conditions are present). After these tests, they can determine whether further assessments, an ADHD diagnosis, and treatment are necessary.
There are different treatment options available that can help manage the symptoms of ADHD. If you’d like more information about ADHD, consider visiting the National Resource Center on ADHD’s website or reading articles and studies from the National Library of Medicine. That said, according to the American Psychiatric Association, some of the most common forms of treatment include the following.
Prescription medication to help with paying attention
Prescription medication is a popular form of treatment for ADHD. Many children that are diagnosed with the disorder may end up on medication to stay focused in the classroom and pay attention to their studies. Parents often speak with a primary care provider or consult a psychiatrist to discuss potential prescription medication treatment options for their children. Likewise, adults can get prescription drugs to manage their symptoms at any age.
While medication can be beneficial for those with ADHD, being diagnosed with a disorder does not automatically mean that a person needs to take prescription medication. Many people can cope with their symptoms by making lifestyle changes and picking up healthy coping mechanisms. Some people experience more serious cases of ADHD than others, making their need for medication more urgent. If you’re unsure about taking prescription medication yourself or getting it for your child, speak with a medical professional to ease your concerns.
Therapy sessions
Some people with ADHD may struggle with their interpersonal relationships because of the symptoms and behaviors that come along with the disorder. Therapists can help clients connect with their partners, friends, or family by using skills that maintain healthy relationships. Additionally, they can equip their clients with healthy coping mechanisms and tools to deal with disruptive behaviors, such as restlessness and hyperactivity. ADHD can be disruptive to an individual’s everyday life, but therapy can allow them to manage their symptoms more effectively.
These are just a few of the ways that a therapist can support you in your treatment. When choosing a therapist, check to see if they have experience with treating ADHD in the past. The more they’ve been exposed to clients with ADHD, the more success you might find in pursuing therapy with them.
Support groups
You may also find it beneficial to join a support group for people living with ADHD. It can be helpful to hear advice from a different perspective, including what’s worked for them and what has made it harder to manage their symptoms. It can make a difference to be supported by others who understand what you’re going through from personal, firsthand experience.
About hyperactivity in particular
In a discussion of how “ADD” became “ADHD,” speaking more in depth about the symptom of hyperactivity can be important. This symptom can affect a person's daily functioning, work or school life, and interpersonal functioning in a variety of ways. It can cause fidgeting, high energy levels, trouble waiting one’s turn, frequent interrupting, rash or risky decisions, chronic restlessness, disorganization, procrastination, and forgetfulness. In many cases, a person can learn to more effectively manage symptoms like these with the right support, the options for which we’ll outline below.
There’s also a long and complex history of how hyperactivity in those with ADHD has been viewed by the medical and psychological community. Even today, this symptom may be linked to disparities in ADHD diagnoses. For example, girls and women are diagnosed and treated for ADHD at lower rates than boys and men, despite ADHD affecting people of all genders. Many experts suggest it could be partly because, in terms of socialization, girls are often taught to “behave” and not be disruptive, which could lead symptoms to manifest in a different, less recognizable way and/or cause girls to consistently “mask” their symptoms.
There’s a lot of information out there about the challenges of living with ADHD. While the treatment options listed above can help you address many of those challenges, it may be helpful to remember that certain symptoms can sometimes also lend unique advantages—particularly when you’re receiving treatment to effectively manage them. Here are a few examples for those who experience the primarily hyperactive/impulsive ADHD type or the combined type of ADHD.
High energy levels as a result of an ADHD diagnosis
As the Diagnostic and Statistical Manual of Mental Disorders states, hyperactivity can make individuals feel like they’re being “driven by a motor”. The high energy level that your hyperactivity brings can be viewed as an asset if you learn how to manage it. When others are getting burnt out or experiencing low energy at work, you may use your energy to get organized or check off the to-do lists that you’ve set. When others are ready to sit on the couch and binge Netflix shows after a stressful day, you may still have the energy to take on a project or get something productive done. If you find that you’re starting to lose focus because of your restlessness, take a moment to engage in an activity that will release some of your energy so you can refocus.
Creativeness and innovation
Many people find that adults with attention deficit hyperactivity disorder tend to be more creative than those without the disorder. If you find that you’re continually coming up with new ideas or ways to do things, you may have your ADHD to thank for it. You might consider looking for careers and activities that allow you to put your creativity to use.
While it’s true that inattention can be challenging for some—causing them to be easily distracted—others with adult ADHD may enjoy having the ability to hyper-focus on specific areas and tasks. This can benefit you in multiple areas, including your personal and work life, and may help you accomplish the goals that you’re working toward with more success.
Living a lifestyle that’s supportive to physical and mental health
The extra energy that you may gain from ADHD can be harnessed to support positive physical and mental health. For instance, while many people struggle to get motivated for a workout during the day, you may not have as much of a struggle in this area. Moreover, the time you spend exercising can help to expel some of your energy, which may allow you to stay more focused throughout the day.
A qualified therapist can screen for and diagnose ADHD. Once you have a diagnosis, working with a therapist can also help you learn to manage the symptoms of ADHD as well as any co-occurring mental health conditions. They may support you in managing your time better, making wiser behavioral choices, and dealing with the anxiety that you might experience because of your ADHD. You can connect with a therapist who specializes in ADHD through BetterHelp, an online counseling platform. Many people turn to internet-based therapy because of its convenience and usability. Since there is no requirement to commute to an in-person appointment, it’s often more convenient, even for the busiest individual.
The efficacy of online therapy for mental health
Online therapy can be a viable option for treating a variety of neurodevelopmental and mental health disorders. In a 2022 study, online therapy was shown to be “more effective than a waiting list in improving attention deficit and social function of adults and children with ADHD.” Researchers found that non-pharmaceutical approaches, such as online therapy, tended to produce more effective long-term results, and had fewer side effects for those participating.
Takeaway
You can overcome the symptoms commonly associated with ADHD by developing helpful coping strategies, seeking support, and getting treatment. You can also learn how to put ADHD to work for you, using it to your advantage in many cases. Getting connected with an online mental health professional can help you explore your symptoms and begin to learn how to live productively with them. You don’t have to navigate ADHD on your own.
Hyperactive ADD is no longer a diagnosable condition. In the past, attention deficit disorder (ADD) was diagnosed when a child struggled to focus, concentrate, and pay attention. ADD could be diagnosed with or without hyperactivity. Since the 1990s, the term ADD has been replaced by attention-deficit hyperactivity disorder (ADHD) and its three subtypes: predominantly inattentive, predominantly hyperactive, or combined. ADD with hyperactivity would today refer to the predominantly hyperactive type of ADHD, while ADD would refer to the predominantly inattentive type.
Hyperactivity and ADHD are not the same thing. The predominantly hyperactive subtype of ADHD is diagnosed when a person has sustained patterns of hyperactive behavior, such as struggling to remain seated, being “driven by a motor,” and having problems with impulse control. The behavior must occur consistently across settings and make it hard for the child to function. In contrast, typical hyperactivity is not typically consistent and usually resolves independently.
Many children display signs of hyperactivity occasionally, but fewer meet the criteria for ADHD. Evidence suggests that 4% to 12% of children have ADHD, but nearly every child will display hyperactive or impulsive behaviors, especially when they are very young. It is important to have hyperactive behaviors evaluated by a professional, especially if the behavior is consistent and interferes with the child’s ability to function at home or school.
All children display developmentally appropriate hyperactive behaviors occasionally. If your child’s behavior is sustained and interferes with their ability to function, it may be worth having them evaluated for ADHD. Behaviors common to the hyperactive subtype of ADHD include:
- Fidgets excessively
- Unable to remain seated when required
- Cannot play quietly
- Always “on the go” or “driven by a motor”
- Talks excessively, interrupts, or blurts out answers to questions
- They cannot wait their turn
If your child regularly demonstrates some or all of the behaviors listed above, it is likely worthwhile to speak to a professional to see if they may be challenged by ADHD. Many begin the process by consulting with the child’s pediatrician, who can provide appropriate referrals if necessary.
Is hyperactivity a form of autism?
Hyperactivity is not a form of autism, but autism spectrum disorder (ASD) is closely linked to ADHD. Evidence suggests that 50% to 70% of people diagnosed with ASD also present with ADHD. The high rate of comorbidity between the two conditions may make it seem like hyperactivity is a feature of autism when it is more likely that the person has the hyperactive subtype of ADHD.
How do you calm a child with ADHD?
One of the best ways to help a child with ADHD find calm is to teach and model self-soothing activities. Relaxation techniques such as progressive muscle relaxation can be helpful when a child is struggling with hyperactivity, impulsivity, or frustration. It is likely also beneficial to teach mindfulness and meditation techniques, which kids can use to help understand their feelings and enforce emotional control.
Finally, it is also likely helpful to give the child a designated “cooling off” space where they can take time to relax and self-soothe. It is important to remember that telling a child to go to their cooling-off space is not the same as a timeout, nor is it a punishment. The space should be welcoming and comfortable and have quiet toys or books to help keep them occupied. Giving the child a dedicated space to calm helps them associate the space with soothing activities, making it easier to calm down the more it is used.
If your child is occasionally hyperactive, it’s likely not a cause for concern, especially if hyperactivity occurs after certain types of stimulation, like eating a lot of sugar. Usually, children return to a low-energy state once they tire themselves out. However, if your child is constantly hyperactive, struggles to control themselves in a developmentally appropriate way, and seems very hyper for their age, it may be worth having them evaluated for ADHD. A mental health professional can help you sort possible ADHD symptoms from those of other conditions, like oppositional defiant disorder.
Evidence suggests that about half of all children diagnosed with ADHD will grow out of the condition by early adulthood. In typical development, most children should be able to control their behavior most of the time by around age 7. However, even at that age and older, children sometimes still have moments of hyperactive or impulsive behavior. It is not unusual for older children to struggle to control their behavior due to some environmental factors, such as a stressful day or not getting enough sleep.
The root cause of ADHD has not been completely determined, but researchers continue to identify new risk factors and underlying reasons for the disorder. ADHD is hereditary, and genetic risk factors have been identified that may one day allow diagnosis of ADHD through genetic testing. Environmental risk factors include poverty, adverse childhood experiences, lead exposure, and exposure to organophosphate pesticides. Evidence also suggests that rates of ADHD are higher in children born to mothers who smoked cigarettes, drank alcohol, or experienced excessive stress during pregnancy.
ADHD evaluations are comprehensive psychological testing processes that often last hours and span multiple sessions. A mental health professional will take a detailed history of your child’s behavior and speak to your child about their actions in a developmentally appropriate way. They will look for signs of ADHD and other conditions that may be contributing to your child’s inattention or hyperactivity. Your child may also be referred for a complete medical examination to rule out underlying medical causes.
After obtaining a history and a thorough clinical interview, the clinician will likely utilize rating scales and other diagnostic tools to get more information about your child’s behavior. They will likely ask you to fill out rating forms and may give you some to give to your child’s teacher. If your child is old enough, they will also likely complete one or more rating scales.
Other common tools include cognitive assessments, tests of ability, and computerized testing. Once all details are collated, the clinician will use their experience and expertise to analyze everything and determine if ADHD is the most probable diagnosis. It is possible that they will give a diagnosis other than ADHD or give no diagnosis if your child’s symptoms do not reach clinical levels.
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