The difference between ADHD and ADD

ADD is ADHD without the hyperactivity.
That’s a simple way to explain the difference between the two.
However, if you want to go into more depth, it is a little more complicated than that.
“One patient explained what it feels like to live with the diagnosis as ‘it’s like everyone else is playing pool while I’m playing pinball,’ and that probably gives a pretty good picture of how it can feel,” says Louise Frödell, licensed psychologist and unit manager at Aleris Neuropsychiatry.
Here she describes the most common symptoms, explains how an assessment is carried out, and debunks several myths.

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Who hasn’t experienced difficulty concentrating, losing focus, being easily distracted, and sometimes forgetting scheduled meetings or where they put their keys? Most people can probably relate to this—and there’s not always a reason to be concerned about it. At the same time, these are also common symptoms of ADHD and ADD.

The difference between ADHD and ADD

ADHD stands for Attention Deficit Hyperactivity Disorder, and there are different variants of the diagnosis depending on whether you only have difficulties with inattention or whether it also involves hyperactivity and impulsivity. Most people have difficulties in both areas.

“If you remove the H from ADHD, you get ADD, which means that you mainly have problems with inattention and concentration, not hyperactivity. ADD is the same diagnosis as ADHD but belongs to a different subgroup,” says Louise Frödell, licensed psychologist and unit manager at Aleris Neuropsychiatry.

She continues:

However, the idea that the diagnosis is only about having problems with attention and, for example, not being able to read a book or always being distracted is something that needs to be problematized. It is not always the case that a person with ADHD or ADD has difficulty maintaining concentration and attention in all situations.

Many people with the diagnosis can, for example, become hyperfocused when they are doing something they are interested in. In such cases, they find it difficult to shift their attention, which can create major problems in everyday life.

“I would therefore like to emphasize that it is a matter of varying attention span in different situations.”

“A serious diagnosis”

Since it is not possible to see who has ADHD/ADD, and how hard they often have to work to make their lives function, it is sometimes difficult for outsiders to take the diagnosis seriously.

According to Louise Frödell, there are many myths circulating.

“Most of them are about ADHD/ADD looking a certain way. People may say, ‘You’re so smart, you can’t have that diagnosis. There are also those who view the medication as drugs, but that is not the case. The medication is about helping the person reach the same level of functioning as everyone else.

Some go so far as to say that ADD/ADHD does not exist and is just a fabrication, even though there is a great deal of research behind the diagnosis and the consequences of living with it.

“It’s really important to emphasize that this is a serious diagnosis that involves difficulties and challenges throughout life. The consequences of living with ADHD involve a reduced quality of life in many different ways. People have problems with housework, finances, parenting, studies, sick leave, unemployment, and social relationships.”

She continues:

“One patient explained how it feels to live with the diagnosis as ‘it’s like everyone else is playing pool while I’m playing pinball,’ and that probably gives a pretty good picture of how it can feel.

At the same time, she wants to emphasize that ADHD is not something you suffer from—it is not an illness.

“It’s just a different way of functioning.”

Symptoms of ADD

To go into more detail about the most common symptoms, first and foremost, many people find it very difficult to work carefully and easily miss things. It is difficult to concentrate over time, especially when it comes to things that are difficult, things that you are not very interested in.

“This diagnosis is about having problems with internal control and the functions in the brain that deal with the reward system, and it can be very frustrating for relatives. If you are interested in something, it often flows smoothly, but doing something monotonous like taking out the trash can be very exhausting. However, this does not mean that you should blame it, but rather work actively to find strategies and adaptations, says Louise Frödell.

Concentration difficulties and difficulties maintaining focus in conversations are common symptoms in both the ADHD and ADD subgroups. This can mean that you often interrupt others, either because you have difficulties with working memory or because you have problems with impulse control.

“And this thing about following through on things can be very difficult. You follow through 99 percent of the way, but then you let go, because you’re almost there. You have no motivation left at that point,” says Louise Frödell.

She continues:

“Many people only function when they have a knife to their throat, which makes life very stressful. It’s common to end up exhausted because you work flat out during the week and then collapse at the weekend. 

Difficulties with planning and structuring are also common among people with ADD and ADHD.

“Many people double-book themselves or arrive late. They also often put things off until the last minute or don’t do them at all because they miss them. Losing and misplacing things is also common, as is having an irregular daily rhythm.

Do the symptoms differ between children and adults?

The challenges are in the same sphere, but they manifest themselves differently and change over time. Research has shown that approximately 5-7 percent of all children have ADHD, but only around 3 percent of adults. 

One theory that may explain this is that many people manage to work through their symptoms, their brains mature, and they find an environment that suits them—their disability is no longer an obstacle.

ADHD is a diagnosis that is more common among boys, while girls are more likely to be diagnosed with ADD. This is often due to the environment’s perception of how ADHD/ADD manifests itself. Studies show that teachers do not identify the difficulties in girls. Instead, it is the parents who discover and report the symptoms, but the girls are diagnosed later in life.

This is partly because girls have different symptoms. As a result, their problems are not noticed in the same way. Hyperactivity in girls manifests itself in them being “hyper talkative” or “hyper reactive,” or more fidgety and fussy. They are better able to channel their restlessness and “keep it together” at school, only to collapse during their free time. Louise Frödell explains this by saying that it is not socially acceptable for girls to behave in the same way. Many girls also learn to channel their hyperactivity in socially acceptable ways. In the classroom, they often become quiet and invisible.

Girls are also more likely to be diagnosed with anxiety and depression.

Risk factors for ADD and ADHD

Why people develop ADHD/ADD is still a mystery. About 75 percent of cases can be explained by genetics, but the causal relationship is unknown.

“But there is talk of risk factors such as pregnancy and childbirth complications and psychosocial risk factors – how you grew up. The problem is expressed in terms of a stress and vulnerability model. If you had a tough childhood without structure, the symptoms can become more pronounced,” says Louise Frödell.

She continues:

“We can say that those who come in late for assessment often had a stable and secure upbringing with a supportive family that helped them for a very long time. It is natural that they are then able to compensate to a greater extent. It is only when they move away from home and have to take responsibility for their home and household and have children that the difficulties become unmanageable. 

Treatment and medication for ADD

When it comes to children with ADHD/ADD, the treatment that is primarily offered is parental support and adapting the school situation.

“But because the symptoms vary greatly from person to person, the interventions must be tailored to different needs. Some have great difficulties, while others have fewer. There is a grading system—mild, moderate, and severe—and sometimes medication is also required.

When it comes to medication for ADHD/ADD, there are various misconceptions, including a fear among people that it will cause personality changes. Louise Frödell wants to reassure people about this. 

“Medication is just a way to get up to a functional level and make it a little easier with stamina, concentration, and inhibiting impulses in different situations. It can help you achieve a more consistent level of activity. Some people experience limited or no effect from the medication, while others find it crucial to their ability to cope with school and/or work. 

For many adults, basic education about what the diagnosis entails and an understanding of how the brain works is sufficient.

“But in many cases, people want both medication and psychoeducation, education about the diagnosis and what society has to offer. That combination often gives the best results,” says Louise Frödell.

She explains that it is also important to highlight people’s strengths and resources and refers to the many self-help books available on the market today. 

“But it’s important to have a nuanced view of what is written and not just buy into the idea that the diagnosis is a superpower. Many people see it as an insult because we are actually talking about a disability, something that people really struggle with. It is very important to know the difference between ADHD and ADD.