ADD vs ADHD: What Are The Differences?

There has been a massive increase in the types of developmental conditions diagnosed in childhood. One of the most prevalent developmental conditions, attention deficit hyperactivity disorder (ADHD), is often confused with attention deficit disorder (ADD). How are the two conditions similar? What are the recommended treatment approaches today? Let’s take a deeper look at ADD vs. ADHD.

Key takeaways:

How common is ADHD?

According to the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), attention-deficit/hyperactivity disorder (ADHD) features “a persistent pattern of inattention and hyperactivity-impulsivity that interferes with functioning or development.” This interference must be present in various settings, such as work or school.

One of the most common mental health conditions of childhood, ADHD is at least three times as common in boys compared to girls and twice as high among men than women in adulthood.

The prevalence of ADHD varies widely from 8 to 15 percent among children and adolescents and decreases to about 2.5-5 percent in adulthood. Approximately 5.4 million children have been diagnosed with ADHD in the U.S., and the median age at diagnosis is 7 years. Almost two-thirds of all children and adolescents are on ADHD medication, and half have received behavioral treatment within the prior year. Around 25 percent had never been treated for ADHD.

Genetics is thought to play a role in ADHD risk, but other factors are likely also involved, such as childhood trauma, prematurity, low birth weight, nutrition, sleep, stress, and obesity.

What causes ADHD?

The frontal lobe of the brain, located behind the forehead, directs planning and paying attention, making decisions, and moderating behaviors. It is thought that the frontal lobe matures more slowly in people with ADHD than in those who are “neurotypical.”

For people with ADHD, focusing is difficult unless there is substantial interest in the activity or task. “Automatic attention” requires little effort because the activity is inherently interesting or stimulating. “Directed attention,” on the other hand, requires great effort. The delayed maturation of the frontal lobe may make it more difficult for someone with ADHD to stay on task.

However, with good coaching and strategies to increase executive function, people with ADHD can improve their ability to focus.

The ADHD brain may be hyper-connected

Another way to look at the “wiring” of the brain is through the lens of nerve signals traveling through the brain. When in “default mode,” the automatic attention network of nerves is dominant. To focus on a task or activity, the “task-positive mode” must be activated by switching to the directed attention network. Researchers believe that the switching mechanisms are different in people with ADHD.

Neuromodulators, such as dopamine and serotonin, may play a role in the brain wiring of people with ADHD. Unlike neurotransmitters, which affect the messaging between specific neurons, neuromodulators carry signals related to risk and reward, effort, novelty, and social cooperation.

The neural networks influence attention, emotion, goal-directed behaviors, and decision-making. A recent global brain function study found that children with ADHD tended to switch into a hyper-connected state, both within and across subnetworks, and stay there longer than their neurotypical peers. This finding may explain why people with ADHD can struggle with distractibility as their brains are very efficient at picking up on and processing stimuli.

Types of ADHD

The two types of ADHD are predominantly inattentive and predominantly hyperactive/impulsive. People can have symptoms consistent with either or both of these presentations.

Inattentive Type

Signs of inattentiveness may include not paying close attention to details, making careless mistakes, an inability to focus attention for long periods on tasks like preparing reports or reviewing papers, difficulty paying attention to instructions or finishing tasks in a work or school setting (such as paying bills or returning calls or emails), organizing time, losing one’s keys, wallet, or phone, being distracted, and being interrupted by unrelated thoughts or stimuli.

Hyperactive/Impulsive Type

Signs of hyperactivity include extreme restlessness, fidgeting or tapping hands or feet while seated, having difficulty waiting in line, interrupting during conversation, the inability to engage in quiet leisure activities, excessive talking, and jumping in to answer questions before they are completely asked.

An expert qualified to assess the presence of these symptoms in a range of contexts must make the diagnosis of ADHD.

At least six persistent symptoms of hyperactivity or inattentiveness (or both) must be present in and interfere with functioning in at least two settings, such as home, work, social life, or school.

Combined Type

The most common type of ADHD is combined inattentive-hyperactive/impulsive. According to the American Attention Deficit Disorder Association, the combined type is approximately twice as common as the inattentive type and eight times more prevalent than the hyperactive/impulsive type.

People with symptoms fitting both categories for at least six months may be diagnosed with the combined type. The intensity of ADHD can be categorized as mild, with little impairment, moderate, or severe, causing significant challenges in at least two settings.

As children age into adolescence, their hyperactive and impulsive behaviors tend to decrease while symptoms of inattentiveness linger. Boys may be more likely to have other psychiatric disorders related to externalizing their frustrations, such as conduct disorder or oppositional defiant disorder. Girls, on the other hand, may have internalized their struggles and tend to have anxiety or depression.

Unspecified Type

In unspecified type ADHD, the child has clear dysfunction, but the symptoms do not meet the criteria for a diagnosis of ADHD. To establish a complete assessment of symptoms and their severity, these children should be thoroughly assessed by a number of caregivers, educators, and medical professionals in a variety of settings.

How are ADHD and ADD different?

The history of attention deficit as a mental health struggle dates back to 1994. The inattentive type of ADHD was once called attention deficit disorder (ADD), but this subtype has been included under the umbrella of ADHD for decades, and ADD is considered an outdated term.

6 out of the 9 symptoms from the hyperactive/impulsive criteria or the inattentive criteria must be present for a diagnosis of ADHD. These characteristics can manifest in various ways, depending on the situation and the age of the person. For instance, two-thirds of adolescents have the combined subtype (hyperactive/impulsive and inattentive), while most adults (90%) have the inattentive subtype.

Gender also plays a role; boys tend to have the hyperactive/impulsive subtype, while girls tend to have the inattentive subtype.

Treatments for ADHD

Parent training in behavior management (PTBM) is the first line of treatment for preschool-aged children, ages four through six. This training helps parents learn what behaviors should be expected at various ages and developmental stages. Parents also learn how to strengthen the parent-child relationship and manage specific problems. In a large, multi-site study, PTBM alone improved symptoms among preschoolers. New research suggests that all children should start with parent coaching in behavior management, yet most receive medication only.

Classroom supports and individualized learning plans (IEPs) or other accommodations, such as a 504 plan, can be put in place at school to help the child function optimally. These environmental supports include additional time to complete tests, a reduced homework load, a place to leave supplies in the classroom, and more opportunities to ask questions.

Healthcare professionals may advise older children, adolescents, and adults to take stimulant medications in addition to behavioral and environmental support. While the benefits of a stimulant medication wear off immediately, the effects of behavioral modifications continue as long as the habits are maintained.

Thriving with ADHD

Healthcare professionals recommend a multi-faceted approach to ADHD management, including behavioral approaches to modifying habits and sometimes medication. Watch what captures the child’s strengths and look for ways to tailor tedious tasks and environments to help the frontal lobe engage. Working with a therapist or coach can help the child develop new habits that support executive function skills like organization and focus.

With appropriate behavioral therapy and/or medication, ADHD symptoms can be managed successfully. As the frontal lobe matures, people often gain a greater ability to direct their attention, even when tasks are not fulfilling. People with ADHD are intelligent, creative, divergent thinkers with great energy.

Bottomline, adults living with ADHD are highly intelligent and creative. Yet, they may harbor much frustration about their perceived lack of productivity, change jobs often, or struggle to maintain relationships. In such cases where life is severely disrupted, stimulant medications can help by increasing brain neuromodulators which help with network switching, such as dopamine, serotonin, and norepinephrine.

Medication should be layered on top of other approaches such as behavioral therapy, adequate sleep, nutrition, exercise, and reduced screen time. As effective coping strategies are built, the individual may be able to taper off medication under the supervision of a healthcare professional.

Adopting a strengths-focused mindset instead of dwelling on deficits can help people with ADHD learn to embrace their unique abilities and savor their wins. This frame of mind can help minimize the frustrations and self-doubt that can sabotage the joy of life.

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