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ADHD & ADD Different Disorders

ADHD (Attention Deficit Hyperactivity Disorder) and ADD (Attention Deficit Disorder) are frequently written about in the mainstream media, but unfortunately the same oversimplified pictures are presented repeatedly in different words. The complexity of the condition is given a two dimensional treatment, making the ADHD problem appear clear and simple. This could not be further from the truth.

Within the scientific literature over the last decade there are a number of key articles, which indicate that Attention Deficit disorder is not 3 types of one disorder, but four or five (or six) separate disorders. ADD and ADHD are 2 conditions, they were considered so until a few years ago, and might be considered so again in a few year's time, in 2012, when the next version of the DSM-V (Diagnostic and Statistical Manual) is published. The other 2 or 3 or 4 “disorders” are neither ADD nor ADHD, but share certain behavior patterns.

These share common symptoms, which is partly why there is confusion. In science a mechanism has to be propose to explain a theory. This has not been done in the case of ADHD. The causes and the mechanisms of this condition are not yet well defined by neurology, biology, or genetics. There are indications that the different forms of ADD and ADHD have different mechanisms behind them.

ADHD and ADD are highly controversial conditions. On the one side is the “medication is the only way to go” lobby, and on the other side is the “ADHD does not exist” lobby. In between lies a spectrum of opinions. When equally qualified scientists and doctors hold such varied and even opposite opinions, then the underlying problem is both complex and misunderstood. If the different sides would deflate their egos for a moment and reflect, they would see the paradoxes in their respective paradigms.

The diagnoses for ADHD and ADD are based on the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) list of behavioral patterns. Nothing in the official diagnosis refers to anything biochemically or physiologically disordered. There is no medical test for ADHD; the diagnosis is inferred from subjective reports by parents and teachers.

The DSM-IV manual makes this clear:

"There are no laboratory tests, neurological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Attention-Deficit/Hyperactivity Disorder."

(DSM-IV, page 88)

When scientists refer to biological disorder or dysfunction, they refer mainly to speculative research papers, and conclusions based on preconceived assumptions. These are opinions and not scientific facts. The facts are facts, as in verifiable neurological differences, many of which are undisputed by both sides of the ADHD controversy. How these facts are interpreted is where there is a  difference of opinion.

This site ( has as a goal to unravel the knots diverging scientific groups have tied themselves in, and present the different options we ADHD/ADD people have, in normal English. Only by understanding the causes and the different solutions to our personal difficulties, will we have an idea how to proceed to a successful normal fulfilling life.

The behavior problem is very real. Anyone coming into contact with a child with full-blown ADHD is left in no doubt it is a real condition. What is dangerous with the present increase of diagnosed cases is that misdiagnoses are easily made. If the medication suppresses the symptoms, then the underlying cause is left untreated.

There are over 100 disorders, both emotional and physiological that can cause or result in attention deficit and hyperactive behavior. These are mostly treatable conditions, where after treatment, the bad behavior disappears. A child behaving badly because of emotional trauma, such as sexual abuse, will not be helped by being medicated with stimulants.

Medication does have an important role to play, but not as a universal cure-all. Since medication does not cure, merely suppresses symptoms, the long-term solution is some form of coaching or therapy. The children need to learn to understand themselves, their emotions and learn coping skills that prepare them for life. The parents need to be taught how to coach their children. It is a challenge.

There is a range of behaviors and intensities in ADHD. When the children are unable to benefit from coaching or therapy because they are too hyperactive or have unsustained focus, then medication is justified. The goal should still be to get the children off the medication.

Every year there are hundreds of scientific papers published on ADHD. New insights are continually emerging and deeper understanding of the condition should lead to more flexible and variable treatments and solutions.

The historical names over the last 100 years, of what is today called ADHD, shows the attitude towards this condition:

  • Morbid Defect of Moral Control
  • Volitional Inhibition Disorder
  • Morbid Moral Defect
  • Minimal Brain Damage
  • Minimal Brain Dysfunction
  • Hyperactive Child Syndrome
  • Hyperkinetic Reaction of Childhood
  • Attention Deficit Disorder with or without Hyperactivity
  • Attention Deficit/Hyperactivity Disorder

These fashions have an average lifespan of about 11 years before the next trend catches on.

How much is science and how much is opinion? Up until the time of the second last term for ADHD, homosexuality was considered a mental disorder. That was 1974. The present terminology is influenced by the previous paradigms.

Until a few hundred years ago it was scientifically proven that the Sun orbits the Earth every 24 hours. It is now time for an ADHD paradigm shift.

For a start, the DSM-IV diagnosis is outdated. There are three types of Attention Deficit Disorder defined by it:

  • Attention Deficit predominantly Hyperactive-Impulsive Type.
  • Attention Deficit predominantly Inattentive Type.
  • Attention Deficit Combined Type. (The first and second types together)

There is evidence that the ADD (Attention Deficit Disorder) or predominantly Inattentive Type has a different mechanism to the inattentiveness of the Hyperactive-Inattentive Type. This suggests that these are not different types of the same disorder, but two distinct disorders.

These two groups also differ in their response to stimulant medication and to therapy or coaching. The predominantly Inattentive Type responds better to therapy and coaching and less to stimulants than the Hyperactive and Combined Types. This also indicates a different mechanism behind the behavior.

The hyperactive, impulsive and combined type child has a difficulty keeping attention on a subject and is unable to resist distraction, due to impulsivity. The inattentive type has more of a focusing problem. There is a qualitative difference between the two. The ADD child is generally better behaved than the ADHD child, and they do not have defiant oppositional or conduct disorders.

Impulsive behavior such as not waiting turns, interrupting and blurting out comments can have different mechanisms, but similar symptoms. After all the behavior is not the “disorder” it is the symptom. Impulsive behavior can be a result of impulsivity or lack of self-control. Anxiety can cause irritability, frustration and impatience, which can be interpreted as impulsivity. The focus needs to be on the cause and not on the behavior if we are to find the best solution for our child, our spouse or ourselves.

Something to keep in mind, especially with diagnosing pre-school kids is that children at this age are not able to internalize their emotions. This means that a child with depression, unlike an adult, will act hyperactively or hyperkinetically. An adult internalizes the emotions from depression and then feels a lack of energy. Very confusing.

This brings us to another phrase used in connection with ADHD, a developmental disorder. About a third of the children diagnosed as having ADHD will grow out of this condition by their late teens or early twenties. Did they have ADHD, or did they develop later than average? In one research project brain scans of hyperactive children showed slightly thinner areas in the cortex associated with attention control. In the follow-up a few years later, some of those children had average thickness. This is not a disorder; this is later development.

Looking at the problem as different types of the same disorder, mixes two different groups and confuses the issue. An alternative, more dimensional paradigm is needed to replace the present categorical diagnostic model for ADD and ADHD.

This will hopefully come in 2012, with the next DSM, the DSM-V. Until then we are left with an outdated “science” so called,

This is why alternative ADHD treatments can be so effective. They meet the practical need as opposed to a search for a theoretical explanation. ADD Coaching is an example, where the treatment is focussed on the cause, rather than supressing symptoms.

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