What’s the difference between ADD vs. ADHD?
The diagnostic landscape is constantly evolving. One change happened in 1994 when the term ADD was discontinued by the American Psychiatric Association’s published manual, the DSM-4.
Before 1994, ADD (Attention Deficit Disorder) was used to describe what we now call the “inattentive subtype” of ADHD (Attention-Deficit/Hyperactivity Disorder).
Today, ADHD encompasses three subtypes, Predominantly Inattentive Presentation (the former ADD), Predominantly Hyperactive-Impulsive Presentation, and Combined Presentation (Inattention, Hyperactivity, and Impulsivity). The term “ADHD” now covers multiple subtypes of the disorder that differ in their diagnostic criteria. [i]
For years, the Drake Institute has used advanced treatment technologies to create customized treatment protocols for patients with ADHD, autism, and other brain-based conditions. Brain map-guided neurofeedback and neurostimulation help our ADHD and ASD patients reduce and/or resolve their symptoms.
ADHD is a neurodevelopmental disorder that can significantly impact a child’s day-to-day experience. This condition arises due to deviations in brain development, leading to a range of challenges related to maintaining attention, sustaining focus, and controlling impulses. Despite appearances that individuals with ADHD might not be “trying hard enough” to concentrate on a task or sit quietly, it’s important to know that these individuals can’t necessarily control those actions as much as a neurotypical individual may be able to do.
There are multiple factors that can lead to the development of ADHD, including genetic and environmental. [ii]
The history of ADD and ADHD dates to the late 18th century when a Scottish doctor named Sir Alexander Crichton observed individuals who struggled with distraction and a lack of focus from an early age. His observations align with what we now understand to be ADHD.
In 1902, Sir George Frederic Still delivered lectures highlighting the presence of mental conditions in otherwise healthy children with normal intelligence. These children displayed impulsivity, attention difficulties, and self-control issues, while still noting a higher incidence in boys than girls.
Thirty years later, two German doctors described a condition they called hyperkinetic disease, a condition characterized by restlessness, difficulty following rules, and problems in social interactions among young children. They noted that this condition often improved with age, like how ADHD symptoms of impulsivity and hyperactivity may lesson by adulthood. The 1968 second edition of the DSM included hyperkinetic reaction of childhood as a disorder.
DSM’s third edition, published in 1980, identified ADD, with two variations: with hyperactivity and without. The name changed again in 1987 to ADHD. The 1994 release of the DSM-IV categorized ADHD into three main subtypes. In 2013, DSM-IV ADHD “sub-types” were recategorized as “presentations”. [iii]
ADHD encompasses several distinct subtypes or presentations. They are characterized by specific patterns of symptoms and behaviors. These types include Predominantly Hyperactive-Impulsive Presentation, Predominantly Inattentive Presentation, and Combined Presentation. [iv] [v]
This presentation is marked by pronounced impulsivity and hyperactivity. Individuals with this type may often act impulsively or spontaneously without considering the consequences.
Individuals with this presentation of ADHD struggle primarily with sustained focus. They may have challenges completing non-preferred tasks and may appear lazy or unmotivated to others.
Those with this type of ADHD experience a combination of symptoms from the previous two types. They struggle with focus as well as impulsivity and hyperactivity.
Are ADD and ADHD the same thing? Not quite.
Attention Deficit Disorder, widely known as ADD, is no longer an official diagnosis. What used to be referred to as ADD without hyperactivity is now categorized as ADHD Inattentive Presentation. This subtype of ADHD does not include symptoms of hyperactivity or impulsivity.
Inattentive Presentation of ADHD (formerly ADD) specifically refers to difficulties related to attention and focus. Individuals with this presentation may struggle to maintain attention during non-preferred tasks, become easily distracted, have trouble following instructions, and can be excessively forgetful.
On the other hand, Hyperactive-Impulsive Presentation is related to external behaviors. These individuals may appear excessively fidgety and impulsive, often having difficulty remaining seated or waiting their turn. They often appear restless and at times “on the go”.
ADHD may present differently in boys and girls.
For instance, boys often exhibit symptoms of hyperactivity or impulsivity. Their symptoms are external and more disruptive and noticeable by peers, parents, teachers, and others. As a result, boys are often diagnosed earlier than girls. They may also receive intervention and treatment earlier than girls because their external behaviors lead to an earlier evaluation.
ADHD in girls, with exceptions, is more likely to manifest inwardly, with focusing difficulties, academic struggles, and challenges in executive functioning, such as planning and organization. Girls with ADHD may also display internalizing behaviors like anxiety, depression, or withdrawal. They are less likely to exhibit hyperactive symptoms and are more frequently diagnosed with the inattentive subtype of ADHD.
However, it’s important to remember that while these distinctions exist, both boys and girls with ADHD can display a range of symptoms, and individual experiences may vary. [vi]
To establish an ADHD diagnosis, individuals must consistently exhibit a pattern of inattention and/or hyperactivity-impulsivity that significantly disrupts their daily functioning or development, typically spanning a minimum of six months. Symptoms should also show up in multiple settings, such as home, school, work, or social environments.
Following these criteria set out by the DSM-5, a clinician conducting a comprehensive clinical history with standardized ADHD rating scales, and ruling out other conditions, can make an appropriate diagnosis. [vii]
The Drake Institute also includes a qEEG brain map to identify any regions or networks in the brain that are dysregulated linked to symptoms. This is used not only to support a neurophysiologic basis for the symptoms but also to develop the most appropriate treatment plan.
While symptoms can lessen over time, some individuals may actually outgrow the disorder, but most children with ADHD will struggle with symptoms into adulthood.
At the Drake Institute, we have treated patients with ADHD who no longer meet the criteria for diagnosis following completion of treatment.
However, with early diagnosis and proper support and treatment, children can maximize their opportunities for a successful life.
ADHD symptoms may pose greater challenges over time due to increased responsibilities and challenges. In addition, for example, an adolescent with ADHD may not only be under increased complex demands, but also may not have developed an effective foundation in executive functioning and learning skills that put him or her at increased disadvantage.
Physiological changes can disrupt attention and impulse control. Hormonal changes and poor sleep patterns can exacerbate symptoms. Anxiety and/or depression can make ADHD symptoms worse. In addition, ADHD individuals are more likely to develop anxiety or depression so it can become a vicious cycle. [viii]
The cause of ADHD or ADD can be multi-factorial, including genetic and environmental factors.
In fact, scientists have identified up to 27 common genetic variants that may influence ADHD. These variants have been found in genes expressed in the frontal cortex, which is involved in memory and attention, and the midbrain dopaminergic neurons, which are involved in voluntary movement and reward processing. [ix]
A genetic predisposition in itself may not result in ADHD, but combined with other factors can increase the possibility of developing ADHD.
Over the last 40 years, the Drake Institute has clinically pioneered the use of advanced treatment technologies to treat a variety of brain-based medical disorders such as ADHD, Autism Spectrum Disorder, PTSD, anxiety, panic disorder, depression, insomnia, and more. Using a combination of brain map-guided neurofeedback and sometimes neurostimulation, our Medical Director creates customized treatment protocols to address each patient's needs.
To develop our individualized treatment plans, we first complete a qEEG brain map analysis for each patient. Brain mapping helps us identify which specific regions or networks of the brain are dysregulated linked to symptoms.
To collect this data, 19 sensors are placed around the scalp in areas of the brain responsible for language, focus, memory, executive functioning, social/emotional understanding and behavioral/emotional regulation. The 19 sensors measure and record brainwave activity that is processed through a normative database of neurotypical individuals.
When we compare the patient's results with those of neurotypical individuals, we can identify regions or networks of the brain that are dysregulated and causing symptoms. This information also allows us to determine how these areas are dysregulated so that we can develop specific treatment protocols that help improve brain functioning and reduce symptoms.
During neurofeedback training/treatment, sensors are once again placed on the scalp. The sensors record and display instantaneous brainwave activity visually in real-time on a computer screen with simultaneous auditory feedback as well.
During neurofeedback sessions, the patient is seeing the results of how their brain is working and with this information, they learn to improve their brainwave activity by guiding it toward healthier, more appropriately functional brainwave patterns.
We do not administer any drugs or perform invasive procedures during this process. Instead, the patient is improving their own brain functioning, guided by visual and auditory feedback.
As an adjunct to neurofeedback, we may also use neurostimulation guided by qEEG brain map findings to gently stimulate the brain into healthier functional patterns. In our experience, some patients may benefit even more from neurofeedback if we also use neurostimulation. We have found this particularly helpful for lower-functioning children on the Autism Spectrum.
In the last forty years, Drake has helped thousands of patients with various disorders such as autism, ADHD, PTSD, anxiety, panic disorder, depression, insomnia, migraine headaches, irritable bowel syndrome, and hypertension reduce or resolve their symptoms and thereby achieve a better quality of life. Call us at 1-800-700-4233 or fill out the free consultation form to get started.
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Interview with Dr. David Velkoff
Interview with Dr. David Velkoff
Spanish News Feature
“David F. Velkoff, M.D., our Medical Director and co-founder, supervises all evaluation procedures and treatment programs. He is recognized as a physician pioneer in using biofeedback, qEEG brain mapping, neurofeedback, and neuromodulation in the treatment of ADHD, Autism Spectrum Disorders, and stress related illnesses including anxiety, depression, insomnia, and high blood pressure. Dr. David Velkoff earned his Master’s degree in Psychology from the California State University at Los Angeles in 1975, and his Doctor of Medicine degree from Emory University School of Medicine in Atlanta in 1976. This was followed by Dr. Velkoff completing his internship in Obstetrics and Gynecology with an elective in Neurology at the University of California Medical Center in Irvine. He then shifted his specialty to Neurophysical Medicine and received his initial training in biofeedback/neurofeedback in Neurophysical Medicine from the leading doctors in the world in biofeedback at the renown Menninger Clinic in Topeka, Kansas. In 1980, he co-founded the Drake Institute of Neurophysical Medicine. Seeking to better understand the link between illness and the mind, Dr. Velkoff served as the clinical director of an international research study on psychoneuroimmunology with the UCLA School of Medicine, Department of Microbiology and Immunology, and the Pasteur Institute in Paris. This was a follow-up study to an earlier clinical collaborative effort with UCLA School of Medicine demonstrating how the Drake Institute's stress treatment resulted in improved immune functioning of natural killer cell activity. Dr. Velkoff served as one of the founding associate editors of the scientific publication, Journal of Neurotherapy. He has been an invited guest lecturer at Los Angeles Children's Hospital, UCLA, Cedars Sinai Medical Center-Thalians Mental Health Center, St. John's Hospital in Santa Monica, California, and CHADD. He has been a medical consultant in Neurophysical Medicine to CNN, National Geographic Channel, Discovery Channel, Univision, and PBS.”