ADD vs. ADHD: What They Mean

Attention-deficient/hyperactivity disorder (ADHD) affects more than 7 million children worldwide, and it’s being diagnosed in adults more than ever before.

It’s one of the most common neurodevelopmental disorders. But you may remember a time when ADD (attention-deficit disorder) was on the rise and wonder why no one seems to talk about it these days.

That’s because ADD is an outdated term for what is now called ADHD. The change represents a shift in language and understanding. Not a separate condition.

We asked developmental pediatrician Carrie Cuffman, MD, to explain the evolution from ADD to ADHD.

What was ADD?

ADD is no longer an official medical diagnosis. But it was once used to describe what is now recognized as ADHD inattentive type. ADD was a diagnosis that described symptoms like:

• Trouble focusing
• Forgetfulness
• Difficulty staying organized or completing tasks

Let’s take a look at the history.

Medical professionals use a reference book called the Diagnostic and Statistical Manual of Mental Disorders (DSM). It lays out definitions and lists the criteria needed to diagnose every known condition related to mental health and brain health.

The most current edition of the book is called the DSM-5-TR® (as in fifth edition, text revision). It was published in 2022. It does not include ADD as a diagnosis. But earlier versions of the DSM did.

ADD was made an official diagnosis in the DSM-III, which was published in 1980. At that time, ADD was categorized into two types:

• With hyperactivity
• Without hyperactivity

“People who describe themselves as having ADD typically were diagnosed in the 1980s as ADD without hyperactivity,” Dr. Cuffman says.

Splitting ADD into those two types was based on the best scientific understanding at that time, which assumed that hyperactivity wasn’t a defining or common symptom.

But times change. And the more experts learned, the more they understood hyperactivity to often be an important feature of the condition.

What is ADHD?

In 1987, the DMS-III was updated to become the DSM-III-R (with the “R” standing for revision). In that edition, ADD and its subtypes were redefined as ADHD.

Today, the DSM-5-TR defines three subtypes of ADHD:

• Predominantly inattentive: This describes people for whom ADHD causes difficulty focusing or staying on task. They may appear forgetful, easily distracted or disorganized.
• Predominantly hyperactive-impulsive: This type involves having an abundance of energy and difficulty sitting still. People with this type may appear restless and fidgety. They may also be extra talkative.
• Combined type: This describes people with ADHD who have features of both types. It’s the most diagnosed type.

“The update better reflected what clinicians were seeing — that hyperactivity and impulsivity are common features and that the condition presents differently in different people,” Dr. Cuffman explains.

The types are also fluid, meaning that you may be diagnosed as one type, but that can change with time. For example, as children mature, hyperactivity tends to decrease, which may shift a diagnosis toward inattentive type.

“Preschoolers often present with more hyperactive symptoms, but as they age, the inattentive symptoms become clearer,” she continues. “Inattention typically becomes more noticeable as kids go to school and take on more responsibility and autonomy.”

What’s the difference between ADD and ADHD?

The difference between ADD and ADHD is simply a change in terminology reflecting what we’ve come to learn about the condition.

“It’s the same condition it’s always been — we just use updated criteria and terminology,” Dr. Cuffman clarifies.

But language matters. And the change from ADD to ADHD may have also improved awareness and diagnosis.

“In the past, providers were primarily focused on inattention as the hallmark of ADD,” she notes. “Now, our understanding of ADHD recognizes hyperactivity as part of the picture.”

That distinction may help to identify more children who might have been missed under the old definition. And that’s important because accurate diagnoses help to ensure people with ADHD can have access to appropriate treatment and support.

“It’s not that the disorder changed — our understanding did," Dr. Cuffman confirms. “The terminology just helps us describe it more precisely and better reflect real-world symptoms.”