ADD vs ADHD

Your child daydreams a lot at school and is easily distracted when he’s doing homework or chores. Maybe he fidgets constantly. You might wonder if he has attention-deficit/hyperactivity disorder (ADHD). Or is it attention deficit disorder (ADD)?

Is there a difference?

Many people use the terms to mean the same thing — and that’s sometimes correct. But not always.

ADD is a type of ADHD that doesn’t involve constant movement and fidgeting. But it’s a blurry distinction. The confusion dates to 1994. That’s when doctors decided all forms of attention-deficit disorder would be called “attention-deficit/hyperactivity disorder,” even if the person wasn’t hyperactive.

Which term is right for your family to use depends on your child’s specific symptoms and diagnosis. It’s important to talk with an experienced mental health provider to make sure your child gets the right diagnosis.

Daydreamer or Fidgeter?

ADHD is a brain-based disorder. It can interfere with your child’s everyday activities at home and at school. Kids who have it have trouble paying attention and controlling their behavior, and are sometimes hyperactive.

Before she’s diagnosed, you will want to note your child’s symptoms. The CDC offers an ADHD checklist for children that may help you keep track of them.

Here are the signs to look for:

  • Inattention: Includes disorganization, problems staying on task, constant daydreaming, and not paying attention when spoken to directly.
  • Impulsivity: Includes spur-of-the-moment decisions without thinking about the chance of harm or long-term effects. She acts quickly to get an immediate reward. She may regularly interrupt teachers, friends, and family.
  • Hyperactivity: Involves squirming, fidgeting, tapping, talking, and constant movement, especially in situations where it’s not appropriate.

Mental health professionals in the United States use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose all psychiatric conditions, including ADHD. The latest version divides it into three types:

  • ADHD predominantly inattentive presentation (what used to be called ADD)
  • ADHD predominantly hyperactive-impulsive presentation
  • ADHD combined presentation

Your child’s diagnosis will depend on her specific symptoms.

ADHD Predominantly Inattentive Presentation (ADD)

Kids with this condition aren’t hyperactive. They don’t have the high energy level seen in others with ADHD. In fact, children with this form may seem shy or “in their own world.”

ADD is diagnosed if a child under age 16 has 6 or more symptoms of inattention (5 or more for older teens) for at least 6 consecutive months but no signs of hyperactivity/impulsivity.

The symptoms include:

  • Trouble paying attention (easily sidetracked)
  • Doesn’t like or avoids long mental tasks (such as homework)
  • Trouble staying on task during school, at home, or even at play
  • Disorganized and seems forgetful
  • Doesn’t appear to listen when directly spoken to
  • Doesn’t pay close attention to details
  • Loses things often
  • Makes careless mistakes
  • Struggles to follow through with instructions

Children with this subtype of ADHD may go undiagnosed because the symptoms may be chalked up to daydreaming.

ADHD Predominantly Hyperactive-Impulsive Presentation

Children with this form of ADHD have tons of energy and are constantly moving in a way that causes problems. It’s diagnosed if a child under age 16 has 6 or more hyperactive/impulsive symptoms for at least 6 months (5 or more for older teens). This form is more noticeable than the inattentive type.

Symptoms include:

  • Blurting out answers before a question is finished
  • Constantly interrupting others
  • Trouble waiting his turn
  • Talks too much
  • Fidgeting, tapping, and squirming
  • Gets up when it’s not appropriate (such as when the teacher is talking or in the middle of dinner)
  • Running or climbing in inappropriate situations
  • Unable to play quietly

How is ADHD Treated?

The symptoms of ADHD can be managed and associated impairment can be meaningfully reduced.

For preschool-aged children (4-5 years old):

First Line Treatments

Evidence-based parent- and/or teacher-administered behaviour therapy, implemented under the guidance of a behaviour therapist, should be prescribed as the first-line treatment.

Behavioural approaches, including behavioural parent training, classroom management, and peer interventions, and organizational interventions currently have the most research evidence for the treatment of children and adolescents with ADHD and are considered well-established treatments. In evidence-based behavioural approaches, professionally trained behaviour therapists work directly with the parents and/or teachers to implement behaviour interventions in the home and/or school settings. For children and adolescents with ADHD, Combined Presentation, these interventions focus on reducing impulsive and disruptive behaviours (e.g., interrupting, getting out of their seat at inappropriate times, blurting out) as well as improving planning, materials organization, time management, and homework management skills.

Second Line Treatments

  • Methylphenidate may be prescribed if the behaviour interventions do not yield significant improvement and there is continued moderate-to-severe disturbance in the child’s functioning.
  • In areas in which evidence-based behavioural treatments are not available, the risks of starting medication at an early age must be weighed against the harm of delaying diagnosis and treatment.

For school-aged children and adolescents (6-18 years old):

First Line Treatments

  • Treatment guidelines generally recommend the use of both FDA-approved medications for ADHD and evidence-based parent- and/or teacher-administered behavior therapy under the guidance of a behavior therapist.
  • Stimulant medications have been demonstrated to reduce symptoms of ADHD, combined presentation, such as disruptive and noisy behavior, and improve impulse control, attention span, focus, and task completion. Specific first-line medications for ADHD, combined presentation, in school-aged children and adolescents include:
    • Methylphenidate
      • dexmethylphenidate
      • extended release dexmethylphenidate
      • extended release methylphenidate
      • methylphenidate hydrochloride

Second Line Treatments

In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:

  • Atomoxetine
  • Extended release guanfacine
  • Extended release clonidine
    • The school environment, program, or placement should be part of any treatment plan.

Additional Treatments to Consider

Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments listed above, might be considered:

  • Neurofeedback training
  • Cognitive training

Healthcare professionals are encouraged to stress the value of a balanced diet, good nutrition, and regular exercise for children and adolescents with ADHD.

For more information about helping your child with ADD, contact Anel Annandale at 083 711 5267 or via email at  anel@childpsych.co.za.

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