A diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) is made when a person has experienced long-standing and significant difficulties maintaining focus, following through on instructions or tasks, or utilizing planning and organizational skills in order to reach longer term goals. While the name of this disorder has changed over time, it is currently held that there are three diagnostic categories of ADHD: inattentive type (i.e., without significant impulsivity or motor activity), hyperactive/impulsive type (i.e., involving frequent fidgeting, restlessness, impatience, and extraneous motor activity), and combined type (i.e., involving both inattention/distractibility and hyperactivity/impulsivity). ADHD without significant hyperactivity is also commonly referred to Attention Deficit Disorder or "ADD".
People frequently wonder about the differences between ADHD with and without hyperactivity (i.e., ADHD versus ADD), given that individuals with such diagnoses often present as decidedly different people with markedly different functional concerns. Moreover, many wonder why the diagnosis should be assigned at all, given that people with ADHD are frequently known to have little difficulty focusing, and are often "hyper focused," when they are immersed in preferred or pleasurable activities (e.g., consider the adolescent with ADHD who is capable of maintaining attention and concentration for hours as they play very challenging video games). While these observations are true, people with both ADHD and ADD share a tendency to experience considerable difficulties tolerating frustration and maintaining task persistence during "non-preferred" activities.
When the diagnosis is rendered in children, it is crucially important to make the distinction between a "normal" (i.e., conventionally expected or typical) level of inattention, distractibility, and activity in children versus a significant developmental concern. Thus, an ADHD diagnosis should not be assigned unless the symptoms have been present before the age of 12 and have been experienced for more than 6 months. Moreover, symptoms related to the diagnosis must exert a significant impact to functioning in two or more life settings (e.g., home, school, work, relationships, etc.) and should not be attributable to other factors or variables (e.g., other psychological or psychiatric disorders, major life loss, drug or alcohol usage, etc.). Finally, it should be noted that longitudinal studies have shown that a large percentage (i.e., 50 to 75%) of individuals diagnosed with ADHD as children no longer meet criteria for this disorder as adults.
While it is generally agreed that there are genetic and neurobiological underpinnings of ADHD, it is also known that there are many socio-cultural factors that contribute to its diagnosis. Thus, the diagnostic rates of ADHD vary depending upon variables such as race and country of origin, socioeconomics, and gender. Given this, clinicians and families should be particularly sensitive to such factors in rendering the diagnosis and initiating treatment.
Behavioral Therapy (e.g., using functional analysis and behavioral intervention plans, etc.) and Cognitive Behavioral Therapy (CBT) approaches are regarded to be highly efficacious in treating the behavioral symptoms (e.g., poor concentration and task persistence, avoidance responsibilities, etc.) and functional impairments (e.g., "executive functioning" difficulties such as problems weighing rules and consequences, delaying gratification, planning and organizing in the service of reaching long-term goals, etc.). In addition, while it is not indicated that "poor parenting" is a primary cause of ADHD, parent training and family training therapy are regarded as the "best practice" or recommended mode treatment for preschool and early elementary-age children. For older children, teenagers, and adults, these techniques are often used in concert with medications, such as psychostimulants, as part of a multidisciplinary approach.