Tuesday, February 9, 2010

The Basics--A class on why it's not "ADD"

General Election - Education

Okay class, today we're going to talk about a confusing topic--we're going to talk about the different subtypes of ADHD. Take good notes. You'll be expected to turn them in at the end of class for credit.

So, here's the breakdown. ADHD is a disorder with three basic subtypes. First, there's the hyperactive subtype (ADHD-H). Then, there's the inattentive subtype (ADHD-I). Finally, there's a combined subtype where someone has features of both disorders at the same time. (This is probably the suckiest subtype, I would think, and it's abbreviated as ADHD-C).

*Susy raises her hand*

Yes, Susy?

Susy: But teacher, I always thought that ADHD meant someone was hyperactive, and that ADD means the disorder you're writing this blog about--you know, the one without hyperactivity. Isn't that why ADD has no "H"?

Teacher: Great question Susy. Lots of people get confused on this point, and there is a good reason why. It's kind of technical, but it is interesting. Here it goes: the DSM, or the Diagnostic and Statistical Manual of Mental Disorders (don't ask me how they distilled that to three letters), is the manual put out by the American Psychiatric Association that provides diagnostic criteria for (surprise) mental disorders. It's what clinicians use to assess a client and say "hey, your symptoms mean that you have Generalized Anxiety Disorder" or "hey, the reason you can't pay attention in class is because you meet the criteria for one of the subtypes of ADHD" or "hey, your flat affect and strange symptoms mean you have Antisocial Personality Disorder, which basically means you're a sociopath and might kill me without remorse. I am now afraid of you--please get out of my office." (Just kidding about that last one.)

Anyway, Susy, to answer your question, there have been four versions of the DSM since it was created. We are now on the DSM-IV. In this version, the disorder is broken down like I described above (ADHD-H, ADHD-I, and ADHD-C). However, in the DSM-III, the version of the DSM that was used from 1987-1994 (i.e. the time period when a lot of us first heard of this disorder), it was differentiated as ADHD being the equivalent to ADHD-H, and ADD being the equivalent to ADHD-I.

Am I making sense?

Susy: I think so. So, in other words, when I tell somebody who says they have the inattentive subtype of ADHD that what they actually have is ADD, instead of looking knowledgeable, I actually look like I'm stuck in the mid-90's?

Teacher: Well, I suppose so. But it's an easy mistake to make when you haven't actually looked at the DSM-IV breakdown.

*Billy raises his hand*

Yes Billy?

Billy: So what you're saying is that the term "ADD" kind of doesn't even exist anymore? So nobody should be using it to describe any subtype of ADHD?

Teacher: That's right Billy. Except in studies published in journals over 15 years ago, the term won't be found in any research. It is outdated and no longer used by clinicians (unless those clinicians haven't cracked open their DSM-IV in a while.) So, we as the general public should follow their lead and use the correct terminology.

Billy: But it seems like such a large number of people know the disorder as "ADD" that it would be impossible to expect them to change.

Teacher: You make a good point. A lot of people use the blanket term "ADD" to refer to all subtypes of the disorder. In this sense, because it's common parlance, "ADD" might be an acceptable thing to say. But for the purposes of this blog, errr, classroom, I'll probably always refer to it as its specific subtype to avoid confusion and to be more accurate.

Billy: What about when they come out with the DSM-V? What will happen then? What if it's different??

Teacher: Well, Billy, we'll just see what happens when that time comes. The new version of the DSM is slated to appear in 2013, so for at least the next three years you're safe using the terminology described above. It's possible they change it. Heck, I'd love to see ADHD-I taken out of the ADHD family--I feel that it's a totally different disorder worthy of its own title--but we have to work with a common language, and so following whatever the DSM proffers is one's best bet.

Billy: Oh, okay. That makes sense.

Teacher: Any other questions? No? All right, well, everybody go ahead and pass in your notes so you get credit for today's class.

*the class passes in their notes*

Teacher: Hey, wait a minute. Jason, I see I didn't get any notes from you. Did you forget to turn them in?

Jason (sheepishly): Uh, I didn't take any notes...

Teacher: You didn't? Well, then what were you doing during our class discussion?

Jason: Uhhh, I was mapping out the entire blue-print of the giant snow fort I'd build if I were dropped off alone by plane in Antarctica.

Teacher: So you didn't hear anything I was saying, yet you sat pleasantly looking as if you were taking notes?

Jason: I didn't mean to. I'm really sorry... it was a really big snow fort. *Jason bows his head in shame*

Teacher: It's okay! Don't be embarrassed. You've helped us out a lot. You've actually just demonstrated one of the main symptoms of a kid with ADHD-I. Good work, Jason. We'll talk more about your snow fort and what it tells us next time we meet.


  1. These are really interesting posts, Josh. If you are going to be doing this regularly, I'd be interested in hearing about strategies for managing ADHD-I.

    I'm sure type of discussion always brings people out of the woodworks saying "I must have ADHD too!" But your "Jason" character describes me from elementary school through grad school.

    I have a million questions, so maybe I'll just use this as a classroom on the subject.

  2. Hey Brad. Thanks a lot for letting me know what you'd be interested in hearing--I'll definitely do some writing on strategies for managing ADHD-I.

    Also, as far as you being like "Jason," I'll do a post on the criteria for the disorder soon, but I wanted to tell you that you being able to remember yourself that way early on is actually one of the indicators that you might have ADHD-I. If that's the case, a lot of this stuff should be sounding eerily familiar.

    Thanks for reading!

  3. I know the whole DSM lingo mix-up thing, and the fact that there are strands of ADHD and such, but in the teaching world (or at least in my program...and everyone we talked about or read about) referred to the inattentive kids as ADD. Acronyms in education change about every 9 months, so it gets super confusing...and since everything in education happens to be an acronym, you get lost pretty quick. So, long story short....I think ADD works just fine. Especially when it comes to the application of it...such as discussing a students behavior with parents. They will understand ADD as being inattentive, rather than hyperactive, better than trying to explain ADHD-1 to them. Know what I mean? Ok, I just discovered your blog...so I'm going to continue reading now. Sorry to hear about the violin story. At least you were attentive and brilliant enough to become a great violinist! People with ADD/ADHD often find great ways to work around (or with) their weaknesses...and it looks like you have done just that.


  4. That's interesting, Kayla. Perhaps that's why the whole "ADD" label persists even though it died so long ago--it's all education's fault! ;-)

    I totally know what you mean about the acronym thing. When I was teaching middle school it didn't seem like such a big deal. But in my actual education classes? Oh boy. Everyone was trying to re-invent the wheel, attempting to pneumonically overtake the planet. The acronyms were out of control.

    I can definitely see value in speaking a common language that parents will understand. However, I still have the feeling (based on my own subjective experiences, of course) that most parents, and most people for that matter, think of hyperactivity when they hear "ADD." But the thing that excites me is the idea that teachers are even talking to the parents about it at all! That is an awesome step in the right direction, and didn't happen when I was a kid.

  5. Oh yeah people definitely still think of the hyperactive kid who can't sit in his chair...even when you say ADHD. It's sad. And everyone thinks that they only way to help a student with ADHD is to give them drugs, which isn't always the case. It gets a bad rep, no matter what you do or how you present it. Note: Teachers obviously don't talk about ADHD or ADD unless the student has been diagnosed....otherwise, that would be a bad deal.