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.
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