ADD or ADHD Without Hyperactivity

It is increasingly common to hear about ADD or ADHD without hyperactivity or attention deficit without hyperactivity.

But is ADD a different disorder than ADHD?

In order to obtain an answer to this question, we went to the Malibu based adolescent treatment center, Centered Health and spoke with its experts.

Attention Deficit Hyperactivity Disorder is a neuro-developmental disorder in which the adolescent presents in different levels of restless behaviors, difficulties to maintain attention as well as impulsive behaviors.

According to Centered Health psychologists, depending on which symptom is more predominant, three subgroups are defined:

• ·         Combined presentation
• ·         Predominant presentation with attention deficit
• ·         Predominant hyperactive impulsive presentation

Let's see the meaning of the initials:

• ADD: Attention Deficit Disorder.
• ADHD: Attention Deficit and Hyperactivity Disorder.

How is the disorder recognized?

The diagnosis of Attention Deficit Hyperactivity Disorder requires the presentation of a specific type of behavior in the adolescent and there are two classification systems that have been established by the World Health Organization (WHO) and the American Psychiatric Association (APA).

The Centered Health experts share in their research publications that the DSM is the diagnostic and statistical manual of mental disorders, designed by the APA. It is the most used system. The "hyperkinetic reaction of childhood" is defined from the DSM-II version. In the DSM-III version the attentional component is highlighted, changing its name to "Attention Deficit Disorder", with or without hyperactivity. From the DSM III R version the disorder is defined with the term we know today.

The ICD is the classification and description of mental disorders according to WHO. ICD-9 defines the term "hyperkinetic syndrome" characterized by short duration of attention. The disorder of activity and attention is included in the hyperkinetic disorders in the ICD-10.

ADD or ADHD without hyperactivity

Why does the need to talk about ADD arise?

According to one of the Centered Health psychologists, initially the first descriptions of children with ADHD referred to those who, without presenting any type of intellectual deficit, presented very restless behaviors, with little modulated response to the stimuli and / or with difficulties to focus on tasks that required concentration. As these children grew impulsive and hyperactive traits were diluted in most cases, but the attentional difficulties persisted as well as the difficulty in task organization.

However, over the years it was observed that there was a subgroup of children in whom, despite of not showing such a marked concern and impulsivity, they did have significant attention and focus difficulties, along with difficulties in time management as well as task organizing. Since the alteration of the quality of the attention is predominant, this type of children was diagnosed with ADHD, but included in the inattentive subtype, with what many doctors summarize as ADD.

If ADD stands for attention deficit then ADHD have attention deficit hyperactivity disorder? And what happens with those who are only hyperactive? Are they HD?

“As we have seen before, Attention Deficit Hyperactivity Disorder has gone through different nominations in the international classification systems. Currently the acronym ADHD refers to the disorder, without specifying the subtype” says one of the Centered Health specialists, who is a member of the Prevention Institute.

“Although, correctly speaking, it should be put in the diagnosis of ADHD and specify the subtype, many times in the reports the doctor makes a "summary" diagnosis” continues the specialist.

And so:

• ·         The initials ADD in many cases are used referring to the inattentive subtype
• ·         The letters HD usually refer to the impulsive-hyperactive predominance subtype.

In this way, many Centered Health doctors when reading ADD and /or HD, already know that it is a "Attention Deficit Hyperactivity Disorder" and with the subtype. It must be borne in mind that patients, whether they are in the subtype or not, present symptoms of inattention, hyperactivity and / or impulsivity to a greater or lesser degree. But the symptom/s that they present in a more marked manner will define the subtype.

Are they different disorders or the same disorder with different denominations?

At present, it is considered to be the same disorder. Some patients present more clinical inattention, and others more impulsive hyperactivity, but some inattentive feature is always present. Despite this diversity, the medication used is the same for subtype with a predominance of attention deficit and for the hyperactive subtype. According to Centered Health statistics, both types of patients had a good response to the treatment.

Is it correct to differentiate between ADD and ADHD as if they were two independent disorders?

“At present, this differentiation is not necessary. The DSM-5, the latest version of this classification, recognizes "Attention Deficit Disorder and Hyperactivity" with three subtypes: combined presentation, predominant presentation with lack of attention and predominant hyperactive / impulsive presentation. It is important that professionals homogenize the "diagnostic labels" since unspecific diagnostic definitions can lead to confusion” states one the Centered Health psychologists.

Centered Health specialists warn that in ADHD remains not treated, it could lead to substance addiction in teens.