Ryan S. Sultan, MD
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ADD (Attention Deficit Disorder) is an outdated term. Modern DSM-5 uses ADHD with three presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined type. |
By Ryan S. Sultan, MD
Assistant Professor of Clinical Psychiatry, Columbia University
February 13, 2026
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Quick Answer: There is no difference between ADD and ADHD anymore. "ADD" (Attention Deficit Disorder) is an outdated term from the 1980s. Since 1994, the official diagnosis is "ADHD" (Attention-Deficit/Hyperactivity Disorder), which includes three presentations: Predominantly Inattentive (what used to be called ADD), Predominantly Hyperactive-Impulsive, and Combined Type. |
If you're looking for a quick takeaway:
But there's much more to this story. Understanding why the terminology changed—and what the research revealed—provides important insights into how we understand and treat ADHD today.
In 1980, the DSM-III (Diagnostic and Statistical Manual of Mental Disorders, Third Edition) introduced two distinct diagnoses:
This was revolutionary at the time. Previously, the condition had been called "Hyperkinetic Reaction of Childhood" (1968 DSM-II), which only recognized hyperactive children. The 1980 DSM-III finally acknowledged that some children struggled with attention without being hyperactive.
Just seven years later, DSM-III-R (Revised) changed course. The diagnosis became "Attention-Deficit Hyperactivity Disorder" as a single condition, eliminating the subtypes.
Why the change? Research showed that attention problems and hyperactivity often occurred together, and the boundaries between "with" and "without" hyperactivity were less clear than initially thought.
However, this created a problem: children who were inattentive but NOT hyperactive no longer had a specific diagnostic category. The pendulum had swung too far.
DSM-IV (1994) introduced the system we largely still use today: One diagnosis (ADHD) with three subtypes:
The current DSM-5 (2013) kept the three-category system but made an important language change: from "subtypes" to "presentations."
Why does this matter? The term "presentation" acknowledges that ADHD symptoms can change over time. A child might have Combined Presentation, but as an adult might only meet criteria for Inattentive Presentation (hyperactivity often decreases with age, while inattention persists).
Despite the official change in 1994, many people still say "ADD" today. Why?
1. The Term Is More Intuitive
If someone struggles with attention but ISN'T hyperactive, calling it "Attention Deficit Disorder" makes sense. Calling it "Attention-Deficit/Hyperactivity Disorder" when there's no hyperactivity feels contradictory.
2. Generational Language Persistence
People diagnosed before 1994 were told they had "ADD." They've used that term for decades. It became part of their identity.
3. Easier to Say
"ADD" is one syllable. "ADHD, Predominantly Inattentive Presentation" is a mouthful.
4. Media and Pop Culture
Movies, TV shows, books, and articles often still use "ADD," reinforcing the outdated terminology.
5. Stigma Avoidance
Some people (particularly girls and women) prefer saying "ADD" because they don't identify with the stereotypical image of a hyperactive boy bouncing off walls. "ADD" feels less stigmatizing.
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Clinical Note: While "ADD" is technically outdated, if a patient uses that term, I don't correct them immediately. What matters is that they're seeking help for attention difficulties. The official terminology is less important than getting proper evaluation and treatment. — Dr. Ryan Sultan |
Diagnostic Criteria: Must have 6 or more inattention symptoms (5 for people 17+), but fewer than 6 hyperactive-impulsive symptoms.
Common Symptoms:
What It Looks Like:
Sarah, 32, was diagnosed with ADHD, Inattentive Presentation in her late twenties. She's never been hyperactive—in fact, teachers used to describe her as "spacey" or a "daydreamer." She struggles to focus during meetings, frequently zones out during conversations, and has trouble completing paperwork. Her apartment has piles of unfinished projects. She's intelligent and capable, but executive function challenges make daily life exhausting.
Demographics:
Diagnostic Criteria: Must have 6 or more hyperactive-impulsive symptoms (5 for people 17+), but fewer than 6 inattention symptoms.
Common Symptoms:
Hyperactivity:
Impulsivity:
What It Looks Like:
Jake, 8, cannot sit still during class. He's constantly tapping his pencil, getting up to sharpen it repeatedly, and talking out of turn. At home, he runs everywhere instead of walking. He interrupts family conversations and has difficulty waiting for his turn in games. Interestingly, his attention span is fine when doing activities he enjoys—his challenges are primarily with physical restlessness and impulse control.
Demographics:
Diagnostic Criteria: Meets criteria for BOTH inattention (6+ symptoms) AND hyperactivity-impulsivity (6+ symptoms).
What It Looks Like:
Marcus, 14, struggles with attention during homework (inattention) AND can't sit still at the dinner table (hyperactivity). He forgets to turn in completed assignments (inattention) AND interrupts conversations constantly (impulsivity). He loses his belongings regularly (inattention) AND feels like he's "driven by a motor" (hyperactivity). He has the full constellation of ADHD symptoms.
Demographics:
| Aspect | "ADD" (Outdated Term) | ADHD, Inattentive (Current Term) |
| Official Status | Not recognized since 1994 | Current DSM-5 diagnosis |
| Hyperactivity | Little to none | Little to none (fewer than 6 symptoms) |
| Primary Symptoms | Inattention, disorganization, forgetfulness | Inattention, disorganization, forgetfulness |
| Common Demographics | More common in girls/women | More common in girls/women |
| Age at Diagnosis | Often diagnosed later | Often diagnosed later |
| Treatment | Stimulant medication, therapy | Stimulant medication, therapy |
| Insurance Billing | Would use ADHD code anyway | F90.0 (ICD-10) |
Bottom Line: ADD and ADHD Inattentive Presentation describe the same condition. The only difference is the name—and the name changed over 30 years ago.
From a clinical standpoint, yes—but perhaps less than you'd think.
1. Understanding Symptom Profile
Knowing whether someone's primary challenge is inattention vs. hyperactivity helps target interventions:
2. Predicting Comorbidities
3. Educational Accommodations
4. Social and Emotional Impact
1. Treatment Is Similar
Stimulant medications work for ALL presentations. Methylphenidate (Ritalin, Concerta) and amphetamines (Adderall, Vyvanse) are first-line regardless of presentation. Response rates are comparable across presentations.
2. Presentations Can Change Over Time
Many children with Combined Presentation become Inattentive Presentation as adults when hyperactivity decreases but inattention persists. The underlying neurobiology is the same.
3. Shared Core Deficits
All ADHD presentations share common neurobiological features:
4. Symptom Overlap Is Common
Many people have 5 inattention symptoms and 5 hyperactive symptoms—just barely missing criteria for Combined. The boundaries between presentations are somewhat arbitrary.
❌ Misconception #1: "ADHD means you're hyperactive; ADD means you're not"
✅ Reality: Everyone with attention difficulties now has "ADHD" as the diagnosis, regardless of hyperactivity. Hyperactivity determines the PRESENTATION (Inattentive vs. Hyperactive vs. Combined), not whether it's ADHD.
❌ Misconception #2: "ADD is less severe than ADHD"
✅ Reality: Inattentive presentation can be equally or more impairing than other presentations. Just because it's less obvious doesn't mean it's less serious. In fact, Inattentive ADHD often goes undiagnosed longer, leading to years of untreated impairment.
❌ Misconception #3: "Girls have ADD; boys have ADHD"
✅ Reality: While girls are more likely to have Inattentive presentation and boys are more likely to have Hyperactive or Combined presentations, ALL genders can have any presentation. The stereotype that "ADHD is a boy's diagnosis" has led to massive underdiagnosis of girls.
❌ Misconception #4: "ADD doesn't require medication because it's milder"
✅ Reality: ADHD Inattentive Presentation responds equally well to stimulant medication. Medication can be life-changing regardless of presentation type.
❌ Misconception #5: "You can have both ADD and ADHD"
✅ Reality: You can't have both because "ADD" doesn't exist as a separate diagnosis. If you have both inattention AND hyperactivity symptoms, you have "ADHD, Combined Presentation."
❌ Misconception #6: "Adults grow out of hyperactivity, so they have ADD now"
✅ Reality: Adults who had hyperactivity as children often still have ADHD, but the hyperactivity manifests as internal restlessness, mind racing, or inability to relax rather than running around. The diagnosis might change to "ADHD, Inattentive Presentation" if hyperactivity symptoms drop below threshold, but it's still ADHD.
In Medical/Professional Settings:
Use "ADHD" with the specific presentation:
In Casual Conversation:
Say whatever feels comfortable and is understood:
If someone says "I have ADD," you know what they mean - they have ADHD with primarily inattentive symptoms. No need to correct them unless it's causing confusion.
For Insurance and Documentation:
Official diagnosis codes (ICD-10):
There is no diagnosis code for "ADD" - it would be coded as F90.0 (Inattentive).
Stimulant Medications:
Research shows comparable response rates (70-80%) across all three presentations. Your presentation doesn't determine which medication will work—individual brain chemistry does.
Non-Stimulant Medications:
Cognitive Behavioral Therapy (CBT) for ADHD:
ADHD Coaching:
For Inattentive Presentation:
For Hyperactive-Impulsive Presentation:
For All Presentations:
Complete ADHD Treatment Guide →
When seeking evaluation, it doesn't matter which term you use. What matters is describing your symptoms:
Questions your evaluator will ask:
A comprehensive evaluation includes:
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Seeking ADHD Evaluation in NYC? Dr. Ryan Sultan is a board-certified psychiatrist specializing in ADHD diagnosis and treatment at Columbia University. He provides comprehensive evaluations for all ADHD presentations, with expertise in adult ADHD and the inattentive presentation often missed in women. |
ADD vs ADHD: The simple truth
If you've been saying "ADD" your whole life, you don't need to change. Just know that officially, you have ADHD with predominantly inattentive symptoms. And if you're seeking diagnosis or treatment, describing your actual symptoms matters far more than which acronym you use.
The most important thing: Whether you call it ADD or ADHD, if attention difficulties are impairing your life, evidence-based treatment can help. Don't let confusion about terminology delay getting support.
Learn more about ADHD: