Dear Readers,
If you’ve been navigating the world of ADHD for a while, you may remember when “ADD” and “ADHD” were considered two different conditions. Perhaps you’ve wondered why we now use “ADHD” for everything, or why your child’s evaluation report says they have “ADHD, predominantly inattentive presentation” even though they’re not hyperactive at all. This week, we’re diving into the history of how this diagnostic language evolved, what science revealed about symptom presentations, and why these changes matter.
đź“š The Historical Split: When ADD and ADHD Were Separate
Back in 1980, the DSM-III introduced a diagnosis called “Attention Deficit Disorder,” which came in two varieties: “ADD with hyperactivity” and “ADD without hyperactivity.” This framework suggested these were fundamentally different conditions—one with attention challenges plus physical restlessness, the other with attention difficulties alone.
Then in 1987, the DSM-III-R shifted to a single diagnosis: “Attention-Deficit Hyperactivity Disorder” (ADHD). This reflected growing recognition that the distinction between “with” and “without” hyperactivity might not be as clear-cut as once thought.
However, many people continued using “ADD” colloquially and the terminology confusion has persisted ever since.
🔬 What Research Revealed: It’s More Fluid Than We Thought
The real turning point came with longitudinal studies—research that follows the same individuals over time. These studies demonstrated something fascinating: most people with ADHD don’t neatly fit into just one category forever. Instead, symptom profiles shift and change across development and life circumstances.
Here’s what the research showed:
Combined symptoms are more common than “pure” presentations. The majority of individuals with ADHD actually experience symptoms in both the inattention category and the hyperactivity/impulsivity category, rather than having symptoms in just one domain.
Presentations change over time. A child diagnosed with predominantly hyperactive/impulsive presentation at age 6 might look more like combined presentation at age 10, and then predominantly inattentive as a teenager or adult. Hyperactivity often becomes less visible with age, morphing into internal restlessness, while inattention symptoms may become more impairing as demands increase.
Treatment approach is the same. Whether someone’s current symptoms lean more toward inattention, hyperactivity/impulsivity, or both, the evidence-based treatment approaches remain consistent: behavioral interventions, medication options, skills training, and environmental accommodations all work across presentations.
🎯 The Modern Framework: Presentations, Not Types
The current DSM-5 reflects this more nuanced understanding. Today, everything falls under the ADHD umbrella, but individuals receive a presentation specifier that describes which symptoms are most prominent at this time:
- ADHD, predominantly inattentive presentation
- ADHD, predominantly hyperactive/impulsive presentation
- ADHD, combined presentation
Notice the word “presentation”—not “type” or “subtype.” This language is intentional and meaningful. A “type” suggests something fixed and permanent, like your blood type. A “presentation” describes how something appears right now, acknowledging that this can shift. It’s a modifier that captures the current clinical picture, recognizing ADHD is dynamic rather than static.
This is especially important to understand. If your child was diagnosed with predominantly hyperactive/impulsive presentation at age 5, but their report card at age 12 highlights attention and organization challenges, that’s not a new diagnosis—it’s the same ADHD brain presenting differently as developmental demands change. Similarly adults who were once the “bouncing off the walls” kid, may now experience their hyperactivity as racing thoughts, difficulty relaxing, or constantly feeling like they need to be doing something.
đź’ What This Means for You
Understanding this evolution in diagnostic language helps in several important ways:
It normalizes symptom changes over time. If you or your child’s ADHD looks different now than it did five years ago, that’s expected and doesn’t mean the original diagnosis was wrong.
It validates diverse ADHD experiences. Not everyone with ADHD is hyperactive, and not everyone is purely inattentive. Most people experience a blend, and that blend can shift.
It reinforces treatment principles are broadly applicable. The specific presentation doesn’t dramatically change the treatment approach. Whether inattention or impulsivity is more prominent, the core executive functioning challenges benefit from similar supports.
🌟 Final Thoughts
The journey from “ADD versus ADHD” to our current understanding, reflects the evolution of clinical science. We’ve moved from seeing these as separate, fixed conditions to recognizing ADHD as a dynamic neurodevelopmental difference that expresses itself in varied and changing ways across the lifespan.
Whether you’re supporting a child who seems to be in constant motion, an adult who can’t stop their mind from racing, or someone who appears to daydream through life while struggling with follow-through, know that these are all valid expressions of the ADHD brain. The specific presentation matters less than understanding the underlying executive functioning challenges and building a support system that honors the whole person—challenges, strengths, and all.
As always, if you have questions about your own or your child’s ADHD presentation, or if you’re wondering whether an evaluation might provide clarity, we’re here to help.
Warmly,
Dr. Liz Adams
Neuropsychologist
Founder & CEO
Minnesota Neuropsychology
