ADD vs. ADHD: Why the Name Changed and What the Difference Is

In the ADD vs. ADHD question, the difference is mostly history. ADD (attention deficit disorder) was the official name from 1980 until 1987, when the American Psychiatric Association introduced the term attention-deficit/hyperactivity disorder and dropped ADD without hyperactivity as a diagnosis^[1].

Today, what people call ADD is ADHD, predominantly inattentive presentation. It is one of three ways the same disorder can present, alongside predominantly hyperactive-impulsive and combined^[2].

The practical difference between the two labels is hyperactivity. A person described as having ADD finds it hard to organize or finish tasks, pay attention to details, or follow instructions and conversations, and is easily distracted^[2]. The fidgeting, restlessness and interrupting of the hyperactive-impulsive presentation are not prominent.

Because symptoms can change over time, a person's presentation can change too^[2]. Many children diagnosed with the combined presentation later shift to the predominantly inattentive one as hyperactivity fades^[1].

The diagnosis first appeared in the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) in 1968 as hyperkinetic reaction of childhood, a label focused on excess motor activity^[1]. The 1968 manual described overactivity, restlessness, distractibility and short attention span, and said the behavior usually diminishes by adolescence^[6].

The DSM-III in 1980 reframed the condition around attention, impulsivity and hyperactivity and renamed it attention deficit disorder, with and without hyperactivity^[1]. That edition is the origin of ADD as a name, and of the idea that attention problems can occur with no hyperactivity at all.

The revised DSM-III-R in 1987 introduced the term ADHD and eliminated ADD without hyperactivity, a change Epstein and Loren describe as controversial^[1]. At the time it was unclear whether attention problems without hyperactivity were the same disorder or a separate one, and those cases were moved to a residual category called undifferentiated ADD^[6].

The DSM-IV in 1994 kept the ADHD name and introduced three subtypes: predominantly inattentive, predominantly hyperactive-impulsive and combined^[1]. That is why the H stays in the name even for people who are not hyperactive.

DSM-5 in 2013 kept the same 18 core symptoms and renamed the subtypes presentations^[1]. It also moved the age-of-onset cutoff from 7 to 12, lowered the threshold for people 17 and older from six symptoms to five in either domain, and stopped treating autism spectrum disorder as an exclusion^[1].

The CDC describes three presentations of ADHD, defined by which symptom group dominates^[2]:

• Predominantly inattentive (often called ADD): difficulty organizing or finishing tasks, paying attention to details, and following instructions or conversations; easily distracted; forgets details of daily routines.
• Predominantly hyperactive-impulsive: fidgeting and talking a lot, trouble sitting still, restlessness, interrupting, and trouble waiting a turn.
• Combined: symptoms of both types are equally present.

The DSM-5 lists nine inattention symptoms and nine hyperactivity-impulsivity symptoms^[7]. Children up to age 16 need six or more symptoms in a domain, and people 17 or older need five or more^[8]. The full item-by-item list is in our ADHD symptoms checklist.

The remaining criteria apply to every presentation. Symptoms must have lasted at least 6 months, several must have been present before age 12, several must appear in two or more settings such as home, school or work, and they must interfere with or reduce the quality of functioning^[8].

Which symptoms stand out depends on age. Hyperactivity is usually most noticeable in preschool and elementary school, while inattention comes to the fore late in elementary and middle school^[7]. Diagnosis rates for kids are tracked on the ADHD in children page.

Inattention is the part of ADHD most likely to persist. Hyperactivity-impulsivity symptoms decline significantly from early childhood through adolescence, while inattention symptoms decline only minimally with age^[3].

As a result, most adults with ADHD struggle mainly with inattention: disorganization, forgetfulness, unreliability, and trouble with planning, finishing tasks and managing time^[7]. In adolescents, hyperactivity may shrink to fidgeting and feelings of jitteriness or impatience^[7].

That pattern is what many adults call adult ADD. In 2023, an estimated 15.5 million U.S. adults, or 6.0%, had a current ADHD diagnosis, and 55.9% of them received it at age 18 or older^[4]. More adult figures are on the ADHD in adults page and in how many people have ADHD.

Late diagnosis fits the inattentive pattern. People with predominantly inattentive symptoms may not show significant impairment until demands for self-management rise in late elementary or middle school, and adults diagnosed late often have trouble recalling when symptoms began^[1].

ADHD is diagnosed nearly twice as often in boys. In 2024, 13% of U.S. boys had a current ADHD diagnosis, compared with 7% of girls, according to a national survey of parents of children aged 3 to 17^[9].

Girls and women who do have ADHD are more likely to have the inattentive presentation. In the 2012 meta-analysis, 42% of females with ADHD met criteria for the inattentive type vs. 36% of males based on parent ratings, and 55% vs. 49% in studies of adults^[3]. Males were more likely to have the combined type^[3].

A 2020 expert consensus statement in BMC Psychiatry found that less overt symptoms are less likely to lead to referral, so inattentive girls are more often missed^[5]. In girls and women, inattention may look like being easily distracted, disorganized, overwhelmed or lacking in motivation, and symptoms may become more obvious during periods of social or educational transition^[5].

Sex-specific data are on the ADHD in women and ADHD in men pages.

No. Since 1994 there has been one diagnosis, ADHD, with the inattentive pattern recorded as a subtype under DSM-IV and a presentation under DSM-5^[1].

Diagnosis

No single test diagnoses ADHD, and sleep disorders, anxiety, depression and some learning disabilities can cause similar symptoms^[2]. A psychologist, psychiatrist or primary care provider such as a pediatrician can make the diagnosis^[2]. How screening tools and evaluations work is covered in ADHD test: how screening and diagnosis work.

Medication and therapy

NIMH does not list separate treatments by presentation. Standard ADHD treatments include medication and psychosocial interventions such as cognitive behavioral therapy, parent training and school interventions^[10].

Medications include stimulants such as methylphenidate and amphetamine products and nonstimulants such as atomoxetine; for adults, adding cognitive behavioral therapy to medication can be an effective strategy^[7]. Trial results by drug class are summarized in ADHD meds: stimulants vs. non-stimulants.

ADD, ADHD and autism

DSM-5 removed autism spectrum disorder from the list of conditions that rule out ADHD, so a person can now be diagnosed with both^[1]. The change reflected research showing that children with autism can also have ADHD^[1]. Data on the condition itself are on the autism page.