What is the difference between ADD and ADHD?
Over the years, the name for ADHD has changed, which has added to a lot of confusion about what the correct name for this disorder is. The official name currently is Attention-Deficit/ Hyperactivity Disorder or ADHD for short. This term is derived from the Diagnostic and Statistical Manual of Mental Disorders (or DSM), which is now in its 4th edition. In the DSM-IV, ADHD is divided into 3 subtypes:
- ADHD – Predominantly Inattentive Type
- ADHD – Predominantly Hyperactive/Impulsive Type
- ADHD – Combined Type (a combination of inattentive and hyperactive/impulsive)
Prior to the release of the DSM-IV in 1994, the DSM-III referred to this disorder as ADD, with or without the Hyperactivity. So, many people first became familiar with the disorder as “ADD,” and this term, although technically outdated, is still widely used. Individuals with ADHD – Predominantly Inattentive type are not hyperactive as the name implies. When such individuals are referred to as having “ADHD,” they often say, “I’m not ADHD, just ADD!” This is probably because the term ADHD still conjures up images of children (or adults) who are “bouncing off the walls.” In sum, “ADHD” is the more technically correct term, and “ADD” really refers to the Predominantly Inattentive Type of ADHD. Although the term “ADD” is outdated in a technical sense, it is still so widely used that it is probably here to stay.
What causes ADD/ADHD?
The causes of ADD/ADHD remain relatively unknown. However, researchers have discovered that the biological factors are major contributors to the disorder. ADD/ADHD tends to run in families, thereby indicating a strong genetic origin. Moreover, neuroimaging research shows that brains of individuals with ADD/ADHD differ fairly consistently from those without the disorder. The brain areas that control attention (i.e., pre-frontal cortex, basal ganglia, and cerebellum) have been found to be slightly smaller and demonstrate less activity in individuals with ADD/ADHD. Although researchers have been unable to pinpoint the exact genetic or biological origins of ADD/ADHD, they have been able to rule out most environmental causes. ADD/ADHD is NOT caused by poor parenting, family problems, ineffective teachers or schools, or food allergies, though environmental factors can interact with an individual’s genetic/biological propensity to develop the disorder.
Some have argued, and point to supporting research, that technology has encroached upon our lives so much that many of us are showing symptoms of ADHD (or, ADD, if you prefer). For instance, we are tethered to computers and cell phones such that we are frequently responding to one attempt or another to connect with us (e.g., push notifications, email alerts, tweets, Facebook notifications, text messages). Also, we have grown accustomed to fast-paced gaming and highly stimulating forms of entertainment (e.g., 3-D movies). In a sense, our brains are increasingly wired for shallow levels of thinking because deep, uninterrupted thinking is a rare commodity these days. We are, in a manner of speaking, an “ADD Society”, and it isn’t going to get easier as technology evolves, and we are all continuously connected. While technology cannot be said to be the cause of ADD/ADHD, it certainly poses challenges for all of us, but particular for those who truly have the disorder.
Is ADD/ADHD more common in boys than in girls?
It is a common belief that ADD/ADHD is far more prevalent in boys than in girls. Research suggests that close to 10% of school-aged children in the United States will be diagnosed with ADD/ADHD, and boys are three or four times more likely to be diagnosed than girls. However, recent research indicates that ADD/ADHD is under-diagnosed in girls. Boys are more likely to display the hyperactive/impulsive symptoms of ADD/ADHD, whereas girls are more likely to experience only the inattentive symptoms. Hyperactive and impulsive behaviors (e.g., fidgeting, getting out of their seats in school, blurting out answers) typically make the disorder more noticeable at home and in the classroom and lead to a far greater referral rate for boys. However, the inattentive symptoms (e.g., poor attention to details, forgetfulness, distractibility) can be just as detrimental to educational success, self-esteem, and social relationships. Often ADD/ADHD in females goes unrecognized until school work becomes more difficult (4th grade to middle school).
Is there a specific test to diagnose ADD/ADHD?
ADD/ADHD is a clinical diagnosis, and there is not one specific test that determines whether an individual has ADD/ADHD. The best method of assessing for ADD/ADHD is to have a qualified mental health professional, such as a Licensed Psychologist, conduct a comprehensive assessment. A comprehensive assessment is important given that many problems and disorders (e.g., depression, anxiety, dyslexia, sleep deprivation, working memory deficits) can cause attention deficits. Such an evaluation typically includes a thorough review of history, behavioral observations, interviews, behavioral checklists from multiple informants (parents, teachers, self), a computerized test of attention, and standardized testing of cognitive abilities and academic skills. A more thorough evaluation can lead to a more accurate diagnosis, a better understanding of strengths and resources, individualized treatment recommendations, and access to important educational accommodations at both school and college level (e.g., extended time on standardized tests).
Are there treatment options other than medication?
Yes! There are a variety of treatment options for treatment besides medication. Various types of therapy have been shown to be helpful. Specifically, cognitive-behavioral therapy (CBT) can be effective. A main focus in CBT is to decrease impulsivity and to practice skills that help you or your child stop and think before acting. Individual therapy can also be beneficial in addressing secondary emotional problems, such as anxiety and depression, that have arisen because of the problems caused by ADHD. Family therapy and parent training/coaching are also common treatment options for children and teens with ADD/ADHD. These techniques can address family dynamics, introduce effective behavioral modification methods, and concentrate on creating a structured and supportive environment. In addition, you or your child may benefit from ADHD coaching, in which you learn to improve time management, organization, and motivation. Many individuals are able to sufficiently manage their symptoms of ADD/ADHD through ADHD coaching so that medication is not necessary. For others, a combination of therapy or ADHD coaching and medication can prove to be quite effective. Although the stimulant medications that are commonly prescribed for ADD/ADHD (e.g., Ritalin, Adderall) are fairly well tolerated, individual responses to medication vary, and some people prefer not to pursue medication due to side effects or personal reasons.
I’m an adult and can’t concentrate or focus anymore. What’s wrong?
Numerous problems other than ADD/ADHD can cause concentration and focus problems. If the lack of concentration and focus is a new difficulty for you, it is unlikely that you have ADD/ADHD. ADD/ADHD is a neurological condition that begins in childhood, though it not always diagnosed during that time period. Difficulty with concentration and focus can be caused by a number of other factors including day-to-day stress, anxiety, depression, sleep deprivation, grieving, overuse of technology, as well as medical conditions and the side effects of medications. Receiving a full physical from you medical doctor can be helpful in ruling out problems of a medical nature. Consulting directly with a trained professional, such as a psychologist, regarding your symptoms can ensure that you receive the correct diagnosis and treatment.
What does sleep have to do with ADHD?
As a nation, we are fairly sleep deprived. On average, American adults are getting about two hours less sleep per night than we did 100 years ago. Sleep deprivation contributes to a host of physiological and psychological problems, such as diminished attention and concentration, fatigue, irritability, and mood fluctuations. Chronic sleep deprivation is also linked to a number of medical conditions including heart disease, obesity, and certain types of cancers. Restorative sleep forms a bedrock of mental and physical well-being (along with exercise, positive social relationships, and nutrition). Certainly, if you or your child is chronically sleep-deprived, you will experience some of the same symptoms as someone with ADD/ADHD.
In recent study, Australian researchers found that children with ADHD often suffer from sleep problems, which has implications for both the children and their caregivers. Researchers found moderate to severe sleep problems affected over 70% of the children. Specific problems included difficulty falling asleep, fatigue when waking up, and resisting going to bed. According to the study’s authors, sleep problems of this nature impact a child’s “psychosocial quality of life and daily life functioning,” often because these children miss school more frequently than children without sleep problems. Furthermore, the caregivers of children with ADHD and sleep problems tend to have poorer mental health and are more often late for work. Sleep problems are also associated with poorer overall family functioning.
Importantly, sleep deprivation in and of itself is not thought to be a true cause ADHD. It is just that sleep deprivation can cause many of the same symptoms or, in people who have ADHD, sleep deprivation can exacerbate the symptoms. Thus, before pursuing a diagnosis and treatment for ADD/ADHD, we recommend that you first ensure that you are getting a proper amount of sleep (which tends to be around 7-9 hours for most adults and around 10-12 for most school-aged kids). If attention-related difficulties persist, then we recommend consulting with a mental health specialist to consider options for treatment.
How do I know my son’s high activity level isn’t just “normal” behavior?
One of the ways that psychologists determine if a child’s activity level is “normal” is by giving standardized tests. Standardized tests are those that have been given to a group of hundreds of boys and girls of different ages, grades, socioeconomic backgrounds, and ethnicities. Psychologists then use the group’s results to determine what scores most children get on a particular test. The range of scores that has been obtained by a majority of the children in the group is then considered to be the “normal” or “average” range of scores for a particular test. When evaluating your child’s activity level, your clinician will give you and/or your child many standardized tests that measure activity level, attention, and other attributes. The clinician will then compare these scores to the average range of scores for that test. From this comparison the clinician can determine if the scores indicate that you or your child’s activity level is above that of peers.
I recently read that most children outgrow ADHD. Is that true and if so, is it possible to determine whether my child will simply grow out of his ADHD?
Recent research by Shaw and colleagues (2007) found that maturation of the cortex was delayed in many children with ADHD compared to those without ADHD. Further, the research indicated that approximately half of children with ADHD had “better” outcomes and their brains eventually matured to a level similar to those without ADHD. In the remaining group of children with ADHD who had poorer outcomes, brain differences (specifically, a thinner cortex in regions important to attention control) were maintained over time.
Unfortunately, it is not yet possible to determine whether an individual child will be in the improved group based on an individual brain scan (as the current research looks at accumulated group differences rather than individual differences). It is encouraging that some children demonstrate significant improvement in their attention functioning over time, particularly in response to appropriate intervention. Since the brain can grow and change based on experience, it seems likely that children who are identified and treated are more likely to experience changes in their brains than children who continue to struggle and experience frustration as a result of their attention problems. Ultimately, it is important to address each child’s needs in the present, with an emphasis on providing opportunities to learn new skills. For some children, classroom accommodations are sufficient in promoting the adoption of compensatory skills, whereas other children benefit from more intensive cognitive/behavioral training and/or treatment with medication. At the ApaCenter, our professionals are dedicated to helping determine an individual’s strengths and weaknesses and developing appropriate recommendations for home and school to optimize a child’s opportunities and success.
But my child is really smart; he can’t have ADD/ADHD too, can he?
Many smart and/or gifted children have ADD/ADHD. The disorder is not related to intelligence, but it does affect other cognitive skills such as planning and organization, focus, working memory, and inhibition of impulses. Sometimes, gifted children with ADD/ADHD appear to be underachieving and/or not working up to their potential. When ADD/ADHD symptoms are addressed, these children’s achievement in school is likely to improve since they are better able to concentrate and use their strong intellectual ability. Alternatively, some children who are bright intellectually might not be recognized as having ADD/ADHD because they do “good enough” in school with relatively little effort. This is especially true in elementary school. Gifted children with ADD/ADHD are sometimes referred to as “twice-exceptional,” which is abbreviated as “2e.”
Does poor parenting cause ADD/ADHD?
Poor parenting cannot and does not cause ADD/ADHD. ADD/ADHD is a neurological condition. However, parents with strong behavior management skills can help children with ADD/ADHD better manage their symptoms so that they have more control over their own behavior. When appropriate behavior management skills are lacking, even a child without ADD/ADHD may demonstrate significant problems with attention and impulse control that are not neurologically based. For this reason, a comprehensive assessment and thorough review of history are important in determining a correct diagnosis and appropriate treatment plan.