Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood but is also prevalent in adulthood. ADHD is characterized by dysregulated attention and can impact behaviors, emotions, and the ability to learn new things.
People with ADHD may seem restless, have trouble concentrating, and may act impulsively.
The Centers for Disease Control and Prevention (CDC) suggest that about 9.4% of children and adolescents in the U.S have ADHD.
In This Article
ADD & ADHD in the DSM
The term attention deficit disorder (ADD) is now an outdated term. It is no longer a diagnostic term in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, it is often still used to refer to a subset of symptoms that fall under the umbrella of ADHD.
The term ADD first appeared in the third edition of the DSM, with experts separating the condition into two subtypes:
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ADD with hyperactivity
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ADD without hyperactivity
When the American Psychological Association (APA) released a revised edition of the DSM in 1987, they combined these two subtypes into one condition: ADHD. The latest version of the DSM (5th edition) divides ADHD into three types:
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ADHD Predominantly Inattentive Presentation (what was previously known as ADD).
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ADHD Predominantly Hyperactive-Impulsive Presentation
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ADHD Combined Presentation (both Inattentive and Hyperactive-Impulsive symptoms).
ADHD has had several name changes in the last few decades. This is because as more research is carried out, understanding grows, so the name has been changed to reflect that knowledge.
Is ADD the same as ADHD?
Some people may be frustrated that ADD is now known as ADHD. They can feel that the ‘H,’ which stands for hyperactivity, does not accurately describe them or their child.
Often, when people hear the term ‘ADHD,’ they may think of hyperactivity as being the main symptom, when a lot of the time, people with ADHD may not have this symptom.
It may be helpful for some people with ADHD to specify to others that they have inattentive ADHD to clarify that inattention is their main symptom.
Differences
Many may have used the terms ADD and ADHD interchangeably, but they are different. ADD refers to one particular type of ADHD – Predominantly Inattentive Type, whereas ADHD is the neurological disorder under which the Inattentive Type falls.
Since 1994, professionals have been using the term ADHD to describe both the Hyperactive-Impulsive and Inattentive subtypes of ADHD.
A key difference between ADD and ADHD is the element of hyperactivity. Those with ADHD are typically very energetic and may resemble more stereotypical behaviors when considering ADHD, such as a child who cannot keep still and excessively climbs about.
They may be very impulsive and demonstrate behavior problems. People with ADD, however, often lack the hyperactivity component, which is a prominent symptom of ADHD.
ADD means that a person shows enough symptoms of inattention but is not thought to be hyperactive or impulsive. Those with ADD are considered to be daydreamers or appear disinterested and disorganized in the classroom or workplace.
They can be prone to forgetfulness, often losing items, and may struggle to follow instructions. Likewise, someone with ADD may be easily distracted, have problems sustaining attention on tasks, and may procrastinate on starting tasks that require considerable mental effort.
ADD has been thought of as the ‘less severe’ form of ADHD.
In reality, none of the types of ADHD are any more or less severe than the others. The so-called ‘milder’ symptoms of ADD can still have a big impact on individuals.
The symptoms may not affect conduct or behavior at school or work in obvious ways. However, those with ADD may still face difficulties focusing, staying organized, and completing tasks correctly or on time.
Predominantly Inattentive ADHD (Formerly ADD)
Below are some of the common traits of those who have the Inattentive Type of ADHD:
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Issues with paying attention on tasks that are difficult or boring
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Poor working memory
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Distractibility
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Poor executive functioning
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Poor focus
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Low organizational skills
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Poor listening skills
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Dislikes or avoids long mental tasks
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Trouble staying on task
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May miss important details
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Loses things often
In children, the Inattentive Type of ADHD can be seen as the child being spacey and coming across as having apathetic behavior, particularly in girls. In adults, Inattentive ADHD may resemble a mood disorder such as depression.
Those with this type may not focus on things that are not intrinsically interesting to them, especially for long periods.
Diagnostic criteria for Predominantly Inattentive ADHD (Formerly ADD)
According to the DSM-5 criteria, at least six of the following symptoms must be present to warrant a diagnosis of ADHD, Predominantly Inattentive Type:
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Often fails to give close attention to details or makes careless mistakes
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Often have difficulty sustaining attention
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Often does not seem to listen when spoken to
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Often does not follow through on instructions and fails to finish projects
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Often has difficulty organizing tasks and activities
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Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
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Often loses things necessary for tasks/activities
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Is often easily distracted
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Is often forgetful in daily activities
Hyperactive-Impulsive ADHD
The traits associated with the Hyperactive-Impulsive type align more closely with the stereotypical understanding of ADHD:
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A squirmy individual (usually in children)
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Bursting with energy
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Struggles to wait their turn
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Talks excessively
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Has nervous energy
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Taps and fidgets
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Unable to engage in an activity quietly
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A habit of finishing others’ sentences and interrupting others
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Impulsive
This subtype encompasses many of ADHD’s stereotypical traits and can be easier to spot in children as teachers and parents may have difficulty managing their behavior.
In reality, a small portion of children and adults meet the symptom criteria for this type.
What is hyperactivity?
When considering hyperactivity, people may often think of a child who cannot sit still and is physically active.
As an adolescent or adult, hyperactivity may present in less obvious ways, such as being talkative, overworking, or having many thoughts which jump from one topic to another.
What is impulsivity?
Impulsivity in ADHD is seen as spur-of-the-moment decisions without thinking about the consequences or long-term effects. Someone impulsive may:
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Act quickly to get an immediate reward
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Regularly interrupt others
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Gamble or spend recklessly
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Have emotional outbursts or find it hard to manage extreme or intense emotions
Diagnostic criteria for Predominantly Hyperactive-Impulsive Type
According to the DSM-5 criteria, at least six of the following symptoms must be present to warrant a diagnosis of ADHD, Predominantly Hyperactive-Impulsive Type:
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Fidgets with hands or feet or squirms in seat
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Leaves seat in classroom or in other situations in which remaining seated is expected
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Runs about or climbs excessively in situations in which it is inappropriate. Feelings of restlessness in teens and adults
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Has difficulty playing or engaging in leisure activities quietly
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Appears ‘on the go’ or acts as if ‘driven by a motor’
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Talks excessively
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Blurts out answers
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Has difficulty waiting for their turn
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Interrupts or intrudes on others
How does Hyperactive-Impulsive ADHD Look Different from Inattentive ADHD (Formerly ADD) in Everyday Life?
Trouble sustaining attention
A child with Inattentive ADHD may find it difficult to pay attention at school, or they may have trouble focusing on activities or hobbies such as sports and games. An adult may struggle to maintain attention at work, in meetings, or during lengthy conversations.
They may even have trouble paying attention when doing things that interest them, such as reading books.
Problems with following instructions
Many children, adolescents, and adults with Inattentive ADHD may struggle to follow instructions and finish schoolwork, chores, or other work duties.
In many cases, it may be better for them to see the instructions written down or to be verbally told the steps one by one to help them follow through.
Failing to listen
When spoken to directly, those with Inattentive ADHD may seem to be absent-minded even without any distraction.
Adults may not listen when their partner or boss speaks to them, which can cause many issues. They may need others to repeat themselves multiple times before comprehending what is being said to them.
Making careless mistakes
A child with Inattentive ADHD may rush through their homework or schoolwork, skipping over sections or giving incorrect answers due to not reading the questions properly.
As an adult, they may fail to carefully proofread a document or email at work, which can lead to problems. Those with Inattentive ADHD may also make ‘social mistakes’ such as misinterpreting social cues, which could lead to relationship issues.
Being unorganized
Organization can be challenging at any age for those with Inattentive ADHD. A child may struggle with keeping their room organized, an adolescent may find it hard to organize their study times, and adults can feel overwhelmed by work emails, paying bills on time, and doing their taxes.
Poor organization skills can often go together with unfinished work, poor time management, and a failure to stick to deadlines.
Losing items
A child with Inattentive ADHD may always find that they lose their homework or school supplies, whereas an adult may often misplace their phone or keys.
They may forget where they have placed items in a room, causing them to be late for school, work, or other events if they spend extra time finding what they have lost.
Procrastinating
Since difficult tasks require a lot of attention and concentration, those with Inattentive ADHD may avoid these tasks as long as possible, often until the deadline is imminent.
They may often have difficulty completing projects, schoolwork, workplace tasks, essay assignments, and filling out forms.
Easily distracted
Children with Inattentive ADHD may become easily distracted by any environmental stimuli in the classroom, which is why they may often be labeled as ‘daydreamers.’
Adults may drift off into their thoughts, switch rapidly from one topic to another, and lose focus on the task at hand.
Forgetfulness
Those with Inattentive ADHD may forget to do their homework, forget appointments, and important tasks, pay bills, return emails, and keep track of special dates such as birthdays and anniversaries.
They may even forget to perform tasks to take care of themselves, such as eating and showering.
ADHD in Girls and Women
ADHD has long been thought of as a condition that affects males due to the diagnostic criteria being based on hyperactive boys. More girls and women have gained a diagnosis as the understanding of ADHD has deepened.
It is believed that more women and girls are thought to have Inattentive ADHD than Hyperactive-Impulsive presentation. Girls are more likely to have Inattentive ADHD, in which daydreaming and shyness are common, whereas it is more typical for boys to have Hyperactive-Impulsive ADHD or the combined type.
This is not to say that girls cannot also be hyperactive. It is suggested that many girls present with hyperactivity differently – they may be chattier and more rebellious, but this may not be picked up as anything out of the ordinary.
Girls who struggle with inattentive issues are often overshadowed by hyperactive boys, who are more likely to demonstrate more stereotypical hyperactive ADHD behavior.
Girls and women are also more likely to mask their symptoms of ADHD. A reason for this may be that girls are often expected to be more social than boys, and so they learn to present in ways that are deemed more acceptable, which can make it harder for girls to get a diagnosis.
Often, girls and women who have undiagnosed ADHD get diagnosed as having a mood disorder. This may be because their undetected symptoms can lead to complications such as anxiety and depression, which can be flagged up more easily by professionals.
A lot of the time, girls and women do not seek help for their ADHD until they have developed comorbid conditions.
Presentation in Adults
ADHD is often diagnosed in childhood and can persist into adulthood.
The average age that someone receives a diagnosis of ADHD is around seven years of age.
It is thought that as many as 11% of school-aged children are believed to have ADHD.
The condition is often more diagnosed in males than females, to a ratio of approximately 3:1. According to the Diagnostic and Statistical Manual and Mental Disorders (DSM-5), symptoms of ADHD must have been prevalent before the age of 12 for a diagnosis to be made.
ADHD can present differently in children and adults. In children, the symptoms of ADHD typically cause issues at school, such as being disruptive, not being able to pay attention, difficulties concentrating on a task, and they may be unable to sit still for extended periods.
Likewise, children with ADHD may have a lower threshold for frustration and difficulty controlling their emotions, and they may experience mood swings.
In adults with ADHD, the symptoms can change to some extent. The hyperactive symptoms can become less visible, finding they can relatively sit still; instead, the hyperactivity can come from internal restlessness, such as rapid and changing thoughts and ideas.
The inattentive symptoms of ADHD usually remain consistent. However, adults usually have more control over their environments than children, so while children are expected to sit still at a desk most of the day, some adults can choose a job where they can move around more.
While the symptoms may change as they become adults, ADHD can still interfere with an adult’s functioning, specifically in their work life, relationships, family life, and finances.
ADHD is often thought of as a condition for children that they grow out of once they become adults. However, a 2021 review found that nearly 2.6% of the global adult population has had persistent ADHD from childhood, while about 6.7% of adults have adult ADHD (Song et al., 2021).
In some cases, ADHD is not recognized or diagnosed until the person reaches adulthood, with many people never being diagnosed. Many people may find that their symptoms improve with age, although if a diagnosis or treatment is missed, they may find their symptoms difficult to cope with.
Adult ADHD may not be as clear as ADHD symptoms in children. In adults, hyperactivity may decrease, but impulsiveness, restlessness, and difficulty paying attention may persist. Their hyperactivity may present in different ways, such as being talkative, fidgety, and having nervous energy.
Other symptoms which may persist into adulthood include trouble focusing on tasks, easily losing track of time, struggling with executive functions, and finding it hard to sustain attention for extended periods.
Problems that adults with ADHD face
As an adult, there are usually more responsibilities, such as caring for children, having a job, and managing a household. An adult with ADHD may find these tasks exceedingly difficult, leading to further problems.
In childhood ADHD, it might matter less if things are misplaced or forgotten, especially if the child has a family member to help them out. As an adult, forgetting to pay bills, being late with the rent, and losing their wallet can have more serious consequences.
Adults with ADHD may also experience a lot of difficulties in relationships.
If the person is not attending to their partner or friends, is constantly asking for repetition, and forgets important events, this can put a strain on these relationships.
A romantic partner of an adult with ADHD may become frustrated that their partner never appears to listen to them, remember to do important household tasks, or pay them attention.
Finally, comorbid conditions are very common in adults with ADHD. It is thought that 80% of adults with ADHD have a comorbid condition, including depression, anxiety, bipolar disorder, substance use disorders, and personality disorders (Katzman et al., 2017).
Further Reading
References
Advokat, C. D., & Scheithauer, M. (2013). Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers. Frontiers in neuroscience, 7, 82.
Children and Adults with Attention-Deficit/Hyperactivity Disorder. (n.d.). Women and Girls. Retrieved 2022, January 25, from: https://chadd.org/for-adults/women-and-girls/
Chronis‐Tuscano, A. (2022). ADHD in girls and women: a call to action–reflections on Hinshaw et al.(2021). Journal of Child Psychology and Psychiatry .
Gershon, J., & Gershon, J. (2002). A meta-analytic review of gender differences in ADHD. Journal of attention disorders, 5 (3), 143-154.
Gurian, A. (2014). Girls with ADHD: overlooked, underdiagnosed, and underserved. NYU Child Study Center About Our Kids .
Hinshaw, S. P. (2002). Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive and social functioning, and parenting practices. Journal of consulting and clinical psychology, 70 (5), 1086.
Hinshaw, S. P., Nguyen, P. T., O’Grady, S. M., & Rosenthal, E. A. (2021). Annual Research Review: Attention‐deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry.
Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of consulting and clinical psychology, 80 (6), 1041.
Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17 (1), 1-15.
Meza, J. I., Owens, E. B., & Hinshaw, S. P. (2021). Childhood predictors and moderators of lifetime risk of self-harm in girls with and without attention-deficit/hyperactivity disorder. Development and psychopathology, 33 (4), 1351-1367.
Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders, 16 (3).
Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of global health, 11.
