The Big Three of ADD & ADHD

Inattention, Impulsivity and Hyperactivity.

Aug 18, 2006 Darcy Andries

A brief introduction to the major symptoms of attention deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD).

When making an official diagnosis of attention deficit hyperactivity disorder, a doctor will generally refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the only definition of ADHD. The DSM-IV places symptoms in one of three major categories: inattention, impulsivity, and hyperactivity.

If a person shows symptoms of inattention but not hyperactivity and impulsivity, they are said to have predominantly inattentive attention deficit hyperactivity disorder, although many people mistakenly call this attention deficit disorder, or ADD. (More information on this subject can be found in my article ADHD or ADD?

If a person shows symptoms of hyperactivity and impulsivity but not inattention, they are said to have predominantly hyperactive-impulsive ADHD. And if a person shows enough symptoms of all three categories, they are said to have a combined type of ADHD.

Everyone has symptoms of attention deficit hyperactivity disorder and occasionally people will have "ADHD moments," but this does not mean they have ADHD.

Three things need to occur to get an official diagnosis. First, the doctor needs to rule out any medical disorders that can cause symptoms similar to ADHD. Second, they must determine that the symptoms have been present before age seven, continue for at least six months, and occur in more than one situation. In other words, a person can't be ADHD at school but not at home. Finally, the symptoms must be disruptive and impair the person's life, plus they must occur more frequently in the person than in his or her peers. Most little boys are hyperactive and not ADHD.

One of my favorite lines from South Park refers to this issue. One parent is talking about how her son Kyle must have ADD because "he runs around like a little 8-year-old." Kyle immediately responds, "But I am eight." Later in the episode it is discovered that Kyle does not have ADD.

The DSM-IV Criteria for ADHD is as follows:

Inattention:

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.

Hyperactivity:

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.

Impulsivity

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

(From the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.)

More information about NIMH's definition of ADHD can be found on their website.

Although, these are the major symptoms of ADHD, there are multitudes of secondary symptoms that I will discuss in a future article.

The copyright of the article The Big Three of ADD & ADHD in ADD/ADHD is owned by Darcy Andries. Permission to republish The Big Three of ADD & ADHD in print or online must be granted by the author in writing.