I see this question a lot, in my social media arenas and just around the Internet: “ADD vs. ADHD – what’s the difference?”.
I think it’s a really good question, and truthfully before my diagnosis and this blog, I had no clue! I vaguely knew ADD was more of an old-school term, but beyond that I had nothing.
Stepping Back in Classification History
To get the answer to this, you’d have to actually go back to 1980 – when the Diagnostic and Statistical Manual of Mental Disorders Third Edition (DSM-III) was published.
Thanks to the work of Virginia Douglas in the 1970s, hyperkinetic impulse disorder, or Hyperkinetic Reaction of Childhood, was reclassified in the DSM-III as “Attention-Deficit Disorder with or without hyperactivity”. This is the origin story of the term ADD, and it was at this moment that the American Psychiatric Association determined that hyperactivity was no longer the single key identifier of the condition.
This was an important step forward for classification because as we know, what we today call Inattentive Type ADHD doesn’t present with hyperactivity – and labelling the condition in the prevailing diagnostic manual as with or without hyperactivity could ensure that those with Inattentive Type might not get overlooked.
The 1987 DSM-III Revision
But through the 1980s, debate continued on the manifestations of ADD, and whether the type without hyperactivity was actually the same condition – and in 1987, a revised edition of the DSM-III was released, and the name was changed again.
This time, the manual was published to include “Attention Deficit-Hyperactivity Disorder (ADHD)”, and the subtype of ADD without hyperactivity was renamed “undifferentiated ADD”.
This new name was troublesome for two reasons.
For one, “attention deficit” is misleading. The condition doesn’t present with a lack of attention. It’s more specifically a difficulty with placing and maintaining attention. Many with ADHD have attention in spades – but they struggle to harness it.
And second, putting hyperactivity in the name of the condition forever marked it as “the wild child” disorder. For decades, ADHD has been over-identified in children who squirm and move and fidget frequently, and under-identified in children who daydream quietly in the corner.
Continuing ADD vs. ADHD Classification Debate
In the late 1980s and early 1990s, several more studies were done to understand what were the key manifestations of the condition, and to determine whether the current classification was actually relevant. New neuroimaging techniques allowed researchers to better understand brain structure differentiations, and the concept of a “deficit of attention” came into question.
Then, in 1994, the DSM-IV came out, and ADHD was redefined into the classification we know today – Attention-Deficit Hyperactivity Disorder (ADHD), with three presentations: Inattentive Type, Hyperactive Type and Combined Type. At this time, ADHD was also reclassified as a condition that could affect both children and adults.
So, ADD isn’t a different condition than ADHD – it’s essentially a precursor. But technically, it is an outdated clinical term – it could be more correct today to call it ADHD Inattentive Type, if that’s what you’re referring to.
However, there’s a preference amongst many to continue to use ADD, because ADHD itself is misleading, as not all with ADHD present with hyperactivity – despite it being right there in the name!
Think you could name it better? Tell me what you would call ADHD if you could rename it today!