Ask Away Blog: The Distinct Characteristics of ADD and ADHD

Children with this type of ADHD have symptoms from the inattentive and hyperactive/impulsive categories. They may fidget, have excess energy, talk excessively and cannot wait their turn.

Providers use the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5) to determine whether children meet the criteria for ADHD inattentive, hyperactive/impulsive or combined type.

Inattentive

For children and adults with the inattentive presentation of ADHD, it is hard for them to stay focused on schoolwork, work tasks, leisure activities, or household chores. Inattentive symptoms include daydreaming, getting easily distracted by extraneous stimuli, and having trouble following instructions. These individuals must remember things frequently, leading to misplaced keys or unpaid bills.

They may rush through assignments or projects and make careless mistakes. Children with inattentive ADHD often have difficulty keeping track of their belongings, such as books and homework.

In contrast, those with Predominantly Hyperactive/Impulsive ADHD align more closely with the stereotypical view of attention deficit disorder: a child who fidgets and can't sit still and seems to have an endless supply of energy. They may be impulsive, blurting out answers before questions have been asked or interrupting others in conversation. This type of ADHD typically causes a significant impact on social and family life, as well as professional life, for the affected individual.

Combined type ADHD, which includes inattentive and hyperactive/impulsive presentation symptoms, is the most common disorder. To be diagnosed with this, a child or adult must show six or more symptoms of inattentive and hyperactive/impulsive ADHD. Men and boys are more likely to be diagnosed with hyperactive/impulsive ADHD, while women and girls are likelier to have inattentive presentations.

Unspecified

If an individual shows ADD symptoms but doesn't exhibit the hyperactivity/impulsivity of Predominantly Hyperactive-Impulsive ADHD, they're considered to have a combined type presentation of ADHD. People with this presentation may show some signs of hyperactivity/impulsivity, but they're often seen as daydreamers who struggle to follow directions and lose track of their work. They can't sit still for long periods but usually don't fidget or constantly move around.

To diagnose how are ADD and ADHD different, an individual must have six or more symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders. These symptoms must be present in multiple settings, appear before age 12, and interfere with life functioning. They must also not be explained by another condition, like mood or personality disorders.

In addition to learning and behavioral problems, many individuals with ADHD have co-existing conditions that can cause various complications. These include oppositional defiant and conduct disorders, depression, anxiety, tics or Tourette syndrome, substance abuse and sleep issues. In addition, some have difficulties with executive function, which is important for school and career success. It includes planning, prioritizing, organizing, and managing thoughts and actions. This can lead to failure at work and in personal relationships. Moreover, these problems can lead to feelings of frustration, guilt or blame.

Hyperactive/Impulsive

Adults with hyperactive/impulsive ADHD struggle to control their emotions, which can manifest as low frustration tolerance, impulsivity, and dramatic mood swings. They can have trouble with self-control, which can affect how they interact with others and even lead to relationship problems or car accidents if the person is driving. They may have trouble waiting in line or sitting for a meeting and often forget to pay bills or return calls, making it difficult to meet deadlines and stay organized.

Hyperactive/impulsive ADHD in children and teens may manifest as fidgeting, squirming in their seats, tapping their feet, or playing with everything they see. They might have trouble focusing on homework or sports and feel compelled to act without thinking. They are often talkative and tend to interrupt others during conversations.

Sometimes, a child might have inattentive ADHD with no hyperactive/impulsive symptoms. These children may go undiagnosed because their behavior is mistaken for daydreaming or getting bored. They might miss out on the best opportunities in school because they can't listen or follow instructions.

Psychiatrists can also identify the seven ADD types using functional neuroimaging techniques like SPECT scanning to measure brain activity. These tools show psychiatrists whether the brain is working well or too hard and help them decide on the most appropriate treatment plan.

Combined

A child or adult with inattentive ADHD is often disorganized and finds it difficult to concentrate on tasks. They tend to procrastinate, fail to complete assignments, and lose things frequently. They need help organizing their work and household chores and often need help finding misplaced keys, cell phones, or school materials. People with inattentive ADHD are easily distracted, frequently forget important details, and make careless mistakes at school or work.

Children and adults with inattentive ADHD aren't as obvious as the hyperactive kids who scribble on their notes during class or climb up the slide at recess. Instead, they might seem "spacey" or apathetic—like the child staring out the window at a bird while their homework is unfinished. Adults with inattentive ADHD might have difficulty keeping their jobs, be forgetful and struggle to follow through on commitments or be moody and anxious.

The American Psychiatric Association changed the name of ADHD to include all three subtypes in 1994. However, many professionals and parents still use the old terms—or at least the word ADD—because it is more familiar to them. However, using ADD for symptoms that don't involve hyperactivity or impulsivity can confuse since the condition now has different presentation and treatment options. At the Drake Institute of Neurophysical Medicine, we use a drug-free approach to help individuals with ADD or ADHD heal their brains and regain control of their lives.