ADD, ADHD and the DSM
The difference between ADD and ADHD is clear in that one encompasses hyperactivity and the other does not, but in general usage, the definitions are blurred. Both terms are used by the public to refer to the attention deficit condition that may or may not include hyperactivity. The acronyms are used so often these days that it’s easy to forget they refer to actual psychiatric conditions, the definitions of which are carefully considered.
The terms ADD and ADHD come from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM is periodically revised and updated, the last major revision resulting in the DSM-IV in 1994, with a text revision (DSM-IV-TR) in 2000. Work is underway on the DSM-V, to be published in 2013.
Attention Deficit Disorder: ADD
The DSM was published by the American Psychiatric Association in 1952 and had its first major revision in 1968. That year, a disorder named “hyperkinetic reaction of childhood” was added to the DSM. The symptoms included restlessness, hyperactivity and short attention span. In 1980, the DSM-III changed the name of the disorder to “attention deficit disorder” to reflect the idea that the disorder was predominantly inattentive in nature and that a child could have attention difficulties, without hyperactivity or impulsivity. Therefore, a child could be diagnosed as having ADD with hyperactivity or ADD without hyperactivity.
Attention Deficit Hyperactivity Disorder: ADHD
The idea that one could have inattention without hyperactivity sparked debate, and when the DSM was revised in 1987 (DSM-IIIR), all symptoms were consolidated into one disorder named “attention deficit hyperactivity disorder.” Now, a child could not be diagnosed with attention deficit if he or she was not also hyperactive/impulsive. But by 1994, when the DSM-IV was published, enough research had been done to support a diagnosis of attention deficit without hyperactivity. The name of the disorder remained “attention deficit hyperactivity disorder,” but the symptoms were split into categories of “inattention” (nine symptoms) “hyperactivity” (six symptoms), and “impulsivity” (three symptoms). The combination of these symptoms could lead to a diagnosis of one of three subtypes: ADHD, Predominantly Inattentive; ADHD, Predominantly Hyperactive/Impulsive; or ADHD, Combined Type.
According to the most recent edition of the DSM (DSM-IV-TR), to be diagnosed a person must have at least six of the inattentive symptoms and six of the hyperactive and impulsive symptoms. The symptoms must have been present for at least six months and some symptoms must have been present before the age of seven years. Clear impairment due to the symptoms must be present in two or more settings (for example, at home and at school), and the symptoms must not be due to some other disorder.
Change on the Horizon
The DSM is again undergoing revision, and along with it, the entry for ADHD. Suggestions range from treating ADD and ADHD as two distinct disorders to adding new criteria to better represent the impulsivity characteristic. As of May 2010, the proposed revision changes the age of onset from before seven years old to before twelve years old. It groups together the hyperactive/impulsive symptoms and adds four new symptoms for impulsivity. In the proposed revision, the name of the disorder will remain “attention deficit hyperactivity disorder” but will have four presentations: Combined, Predominantly Inattentive, Predominantly Hyperactive/Impulsive, and Inattentive (Restrictive). To be diagnosed with Inattentive Presentation (Restrictive), no more than two symptoms of hyperactivity/impulsivity may be present.
The Difference Between ADD and ADHD
Technically, attention deficit disorder, ADD, does not exist as a diagnosis in the current edition of the DSM. Whether it will be added to the DSM-V as a disorder separate from ADHD remains to be seen. For the moment, for the public, the difference between ADD and ADHD is not an obvious one, and the two terms will likely to continue to be used interchangeably.