


ADHD - ADD
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)
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.
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
