ADHD: What’s in a Name?

October is ADHD Awareness Month, a time when those of us in the ADHD community reach out to educate the public, share facts not myths and to support individuals and families who are struggling. When I first started coaching, the term used was ADD for Attention Deficit Disorder. The DSM 3 and 4 listed different types – predominantly inattentive, predominantly hyperactive and combined type.  The “H” was always there but not part of the commonly used acronym.  In 1997, research was done on the difference between DSM-III and DSM-IV diagnoses of ADHD and the results showed minimal changes in case identification.

  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
  • Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

In the years following, I encountered many parents who were insistent that I use the term ADD because their child was not hyperactive and they did not want their child to be confused with children who were hyperactive.  Sad to know that there was so much additional fear for parents and stigma for children with hyperactivity at that time.  At the same time, children who did not exhibit hyperactivity, the inattentive type, were often misdiagnosed or undiagnosed.  In 2013, the DSM-V was published. The diagnostic criteria have changed slightly, mostly in terminology and details of the disorder. Here is a link to an easy-to-read reference. We have learned so much in the past 20 years!

Inattentive ADHD has the same symptoms that center around distractedness minus the external hyperactivity component. Most individuals diagnosed with inattentive ADHD report that they have internal hyperactivity – restlessness of thought and a sense of jitteriness or “itchiness” as a few of my clients have explained. Children and adults finds it difficult to process information, which distracts them from thinking and understanding. They may also find that other action around them prevents them from focusing on the task at hand. The symptoms of inattentive ADHD are largely related to distractedness. For instance, at school, a child may be focused on activities they can see out the window of the classroom, instead of what the teacher is saying. A child that looks to be “daydreaming” from the outside does not compete for a teacher’s attention like a child that has trouble sitting in their seat will. Therefore, they often fly under the radar without someone looking closer at what is truly going on with this “daydreamer”. The hyperactivity, or “H” factor, adds extreme high-energy that makes a child or adult seem as if a motor drives them.

It is critical to remind you that multiple factors that go into a diagnosis of ADHD, as it is far more complex than simple hyperactivity or inattentiveness and involves varying co-morbid (co-existing) conditions such as executive dysfunction, learning disabilities, anxiety or depression.. This translates into ADHD looking different for every person that you meet, especially when based on what can be seen on the surface by a casual observer.

Although we reference children and parents in this article, we would be remiss in not clarifying that the diagnostic criteria are similar for adolescents and adults… Adults face different challenges than children, and they may have learned coping skills along the way, so their hyperactivity or inattentiveness may not be as evident. It is valuable to learn as much as possible about your or your student’s diagnosis to set them up for success in whatever path that they choose. I leave it to you, our readers, to take a closer look for your own edification, and hope you find this information helpful.