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The diagnosis of ADD is not based upon the presence of the main symptoms of inattention, impulsivity and hyperactivity.  In fact, most people do experience these traits at times.  Diagnosis is based upon the intensity and duration of the symptoms and the extent to which they interfere in everyday life.  Importantly, the DSM-IV qualifies that the ADD symptoms must be met for the last six months and must be present by seven years of age.  It also states that some impairment from symptoms must be present in two or more settings (e.g. School, work, home).  Problems with the DSM-IV criteria include its inappropriateness to all ages.  In that regard, more items are needed that relate to the adult stage of the disorder.

 

The following screening tool is an example of a more complete listing of possible symptoms and behaviors that relate more specifically to the adult individual.  In reviewing these six ADD types, it is helpful to recognize that client presentation is often a blending of the criteria from the different types.

 

THE SIX ADD TYPES

 

TYPE 1: CLASSIC ADD

 

This is the most familiar type of ADD and is usually evident early in life.  In infancy they may present as colicky, very active and difficult to sooth.  In childhood, they are restless, physically active, noisy, talkative and demanding and rely on excitement.  In adulthood, they often have low self esteem related to the hyperactivity, conflict-driven behavior and impulsivity which results in frequent conflict with others.

 

The main presenting symptoms include:

 

distractible

difficulty sustaining attention for task completion

poor listening skills

procrastination

disorganized

poor time management

loses items

poor attention to detail (careless mistakes)

forgetful

restless or hyperactive

fidgety (trouble sitting still)

noisy (difficulty being quiet)

acts as if “driven by a motor”

talks excessively

impulsivity (making comments)

difficulty waiting their turn

interrupts others (e.g. Conversations or games)

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TYPE 2:  INATTENTIVE ADD

 

Individuals tend to be quiet and distracted and described as slow, lazy or spacey.  They are often labeled as couch potatoes who are uninterested or unmotivated in their lives.  This type is more frequently found in females.

 

The main presenting symptoms include:

 

distractibility

difficulty sustaining attention for task completion

poor listening skills

procrastination

disorganized

poor time management

loses items

careless mistakes with poor attention to detail

forgetful

daydreams excessively

complains of being bored

appears apathetic or unmotivated

tired, sluggish or slow moving

spacey or seems preoccupied

 

TYPE 3:  OVERFOCUSED ADD

 

Individuals possess all core ADD symptoms.  In addition, they experience significant difficulty shifting attention and tend to remain stuck in negative thought patterns or behaviors.  This type is frequently found in substance abusers and in children and grandchildren of alcoholics.

 

The main presenting symptoms include:

 

excessive worrying

oppositional and argumentative

becomes locked in negative repetitive thoughts

compulsive behaviors

holds grudges

difficulty shifting attention

difficulty seeing options in situations

opinionated and unable to listen to alternative viewpoints

becomes locked into a course of action regardless of outcome

inflexible routines

 

 

TYPE 4: TEMPORAL LOBE ADD

 

Individuals experience problems with temper, mood instability, learning disabilities and memory problems.  This type is associated with domestic violence and suicide.

 

The main presenting symptoms include:

 

unprovoked temper or rage

misinterprets comments as negative

cyclical periods of irritability escalating into rage and receding in fatigue

periods of spaciness or confusion

episodic panic for no specific reason

imagines visual changes such as seeing shadows or objects change shape

frequent periods of déjà vu 

sensitive or mild paranoia

headaches or abdominal pain of uncertain origin

history of head injury or family violence 

dark thoughts including suicidal or homicidal ideas

periods of forgetfulness or memory problems

short fuse or periods of extreme irritability

 

TYPE 5:  LIMBIC ADD

 

Individuals experience the core symptoms of ADD and in addition, they demonstrate negativity, moodiness, sadness, low energy and decreased interest in life.

 

The main presenting symptoms include:

 

moodiness, negativity, low energy and frequent irritability

tendency to be socially isolated

frequent feelings of hopelessness, helplessness or excessive guilt

lack of interest in “fun” activities

sleep problems

chronic low self-esteem

 

TYPE 6:  “RING OF FIRE” ADD

 

Individuals possess the core ADD characteristic and are disinhibitted and hyperactive.

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The main presenting symptoms include:

 

anger or aggression

sensitivity to noise, light, clothes or touch

frequent cyclic mood changes

inflexibility or rigid thinking

insists on having own way regardless of being told “no”

periodic meanness, nastiness, or insensitivity

periodic excessive talkativeness

unpredictable behavior

grandiose thoughts

fast talking

sensation of thoughts moving fast

anxious or fearful