ADD vs. ADHD

What is ADD (Attention Deficit Disorder)? What is ADHD (Attention Deficit Hyperactivity Disorder)? Are they different?  Actually, both terms refer to exactly the same disorder of attention, arousal regulation and impulse control in children and adults.  ADD is simply an older term used by the American Psychiatric Association for the disorder. Whereas ADHD is the current nomenclature used for the disorder.  

Over the past 120 years, the neurodevelopmental disorder known as ADHD has been called by various names.  A syndrome defining the broad outlines of the disorder was first noted in 1902. The father of British Pediatrics, Sir George Fredrick Sill presented a series of 3 lectures to the Royal College of Physicians in London outlining “abnormal psychical conditions in children.”  In his lectures he described 43 children “who had serious problems with sustained attention and self-regulation, who were often aggressive, defiant and resistant to discipline, excessively emotional or passionate, who showed little inhibitory volition, had serious problems with sustained attention and could not learn from the consequences of their action; though their intellect was normal.” These lectures were also published in The Lancet (the premier medical journal of British medicine) in 1902. 

Other names for ADHD have included Hyperkinetic Impulse Disorder, Hyperexcitable Syndrome, Hyperactive Child Syndrome, Hyperkinetic Reaction of Childhood, and Minimal Brain Dysfunction.  

The American Psychiatric Association only first noted the syndrome as Hyperkinetic Impulse Disorder in the second Diagnostic and Statistical Manual (DSM) published in 1968.  In 1980 the disorder was renamed ADD or (Attention Deficit Disorder) with specifiers related to the disorder either being with or without hyperactivity. In 1987 a revised edition of the Diagnostic and Statistical Manual renamed the disorder ADHD (Attention Deficit Hyperactivity Disorder) without any subtypes or specifiers suggested.  In 2000 the DSM IV was published. This iteration of the manual designated a combined type of ADHD, a predominantly inattentive type ADHD or a predominantly hyperactive-impulsive type ADHD. Finally, in 2013, the DSM 5 was published continuing with the name ADHD and preserving the specifiers of a combined presentation, a predominantly inattentive presentation, and a predominantly hyperactive/impulsive presentation. 

Regardless of the name given the disorder, ADHD or ADD remains a diagnosis of problems of inattention, impulsivity, and arousal regulation that can present with varying degrees of impairment related to each or all of these symptoms in any particular individual.  Each person struggling with this collection of symptoms should be evaluated individually. Subsequently, appropriate treatment decisions should be made based on the presenting person’s specific set of symptoms and impairment. 

At its core, ADHD is a diagnosis that brings with it a primary impairment of production.  The symptoms in all shades and variations of presentation lead to difficulties accomplishing or finishing tasks, projects, commitments, etc.  The individual affected by the symptoms of ADHD has trouble getting anything done to completion. Treatment and accommodations related to the diagnosis, regardless of a symptom presentation of primarily inattentiveness or impulsivity/hyperactivity or a combination of both, should be geared toward improving production or assisting in furthering production so that tasks, projects, commitments, etc. are accomplished. Those interventions may vary based on the primary symptom presentation but generally will include psychopharmacological intervention, modification of the production requirements necessary to accomplish a particular goal and/or direct assistance with administration of executive function to accomplish the production goal.  These interventions can in large part remediate the impairments of the individual with ADHD experiences and lead to a successful and productive outcome.

In the end, it is not the name given the difficulties that make the biggest difference it is how the symptoms are addressed based on the needs of the individual.  The common struggle is to find the appropriate intervention recipe for each individual’s unique presentation to engender success.    

References
Some abnormal psychical conditions in children: the Goulstonian lectures”. The Lancet’, 1902;1:1008-1012
The combined Diagnostic and Statistical Manuals, published by the American Psychiatric Association.

 

Learn about the author. Who is Dr. Roy Sanders?

Dr. Sanders received his medical degree from the University of South Alabama College of Medicine. He completed an internship in Pediatrics at Children’s Hospital National Medical Center, Washington, DC. He continued with adult and child and adolescent psychiatric residencies at Vanderbilt University in Nashville, Tennessee. After training, Dr. Sanders continued on faculty with Vanderbilt University.

In 1993, Dr. Sanders became the medical director for the Mental Health Cooperative in Nashville. He was instrumental in leading the effort to create a comprehensive system of care for chronically mentally ill adults and children that included outpatient, in-patient, and mobile crisis care for the city. He continued as adjunct faculty at Vanderbilt and was involved in research and teaching at Vanderbilt as well as Meharry Medical School, East Tennessee College of Medicine, and the University of Tennessee School of Social Work.

In 1999 Dr. Sanders and his family moved to Cooperstown New York where he continued to work with children and adults with developmental disabilities through the Upstate Home for Children and Adults, Pathfinder Village for people living with Down Syndrome, and the Herkimer County Board of Cooperative Educational Services. He also ran a child psychiatric clinic at Bassett Healthcare, a comprehensive healthcare facility affiliated with Columbia University Medical School. He continued to lecture and teach colleagues, medical students and residents from Columbia as well as the New England School of Osteopathic Medicine.

Dr. Sanders served as the Medical Director of the Marcus Autism Center, an Affiliate of Children’s Healthcare of Atlanta from 2008 to 2013. He is currently in private practice in Decatur, Georgia.

Dr. Sanders is devoted to developing a comprehensive and humane system of care for children and adults with developmental disabilities. He is active in several community organizations aimed at making full inclusion a reality in our community. He is also the father of a son with Pervasive Developmental Disorder and Intellectual Disabilities.  He is the author of “How to Talk to Parents About Autism” published by WWNorton Professional Books, 2008.

Dr. Sanders is also happy to be a part of the SOAR family over the past decade.  In addition to being part of the professional advisory board, he has been a facilitator for the SOAR family weekend every spring.  He is always in awe of the dedication every parent we meet has for his or her children.  He is honored to be part of the process of learning and growing with the participating families, and is thrilled by the growth he sees over the course of one weekend.  “That is the magic power of SOAR, fueled by the deep love and commitment each family has for their children and the SOAR staff has for each and every child and family.” Dr. Roy Sanders

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