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There are three types of attention deficit disorder. Know what they are and their differences.
The spectrum of attention deficit disorders with or without hyperactivity, popularly known by the acronym ADD / ADHD, are neurodevelopmental disorders. This means they are a problem with neurological bases, affecting the psychosocial development of those who suffer from it. Other common neurodevelopmental disorders, especially in the classroom, are those of the autism spectrum and learning, such as dyslexia or specific learning and intellectual disability.
Previously, the ADHD / ADHD complex was considered a behavioral disorder; however, in recent years, the neurobiological, genetic, and environmental bases that contribute to the expression of these disorders have been described. According to CDC data, from 1997 to 2010, the prevalence has increased by 4%, from 6% to 11%. This increase has raised doubts regarding the existence of overdiagnosis of these disorders.
What is ADD / ADHD?
According to the Diagnostic and Statistical Manual of Mental Disorders, in its fifth edition (DSM-V), there are three types of Attention Deficit Disorder:
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With a predominance of attention deficit
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With a predominance of hyperactivity/impulsivity
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Combined
And although there are different types, it is generally included as Attention Deficit Hyperactivity Disorder (ADHD). In fact, since 1994, only Attention Deficit Hyperactivity Disorder (ADHD) has been used, not Attention Deficit Disorder (ADD).
Possible causes of ADHD are genetic, biochemical, sensorimotor, physiological, and behavioral factors. Some risk factors are birth weight <1,500 g, head trauma, iron deficiency, obstructive sleep apnea, and lead exposure, as well as prenatal exposure to alcohol, tobacco, and cocaine.
It commonly begins before the age of twelve and is diagnosed on average between eight and ten. Still, it is sometimes not diagnosed until after adolescence, even as the person is an adult.
The main symptoms of ADD / ADHD are:
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Lack of attention
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Impulsiveness
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Hyperactivity
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Inattention typically presents with the following symptoms:
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Ignores details, making mistakes on homework or other activities
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Has difficulty maintaining attention, not only when doing homework but also when playing
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Does not seem to listen when spoken to directly
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Doesn’t follow directions or finish tasks
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Has difficulty organizing
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Dislikes doing activities that require mental effort for a long time
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Lose things frequently
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Easily distracted
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Is forgetful
However, the DSM-V lists characteristics of impulsivity and hyperactivity as a whole without distinguishing between one condition and another.
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Has trouble staying still, moves hands, feet, or squirms
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He gets up, followed by his seat
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It is difficult for him to play quietly
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Is always doing something
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Talk excessively
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Often runs or climbs places when it shouldn’t
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Answer before questions are completed
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Don’t wait for it to be their turn
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Interrupts others
Identifying some type of ADHD is based on a thorough evaluation of children’s developmental, educational, psychological, and medical aspects. It is diagnosed based on the DSM-V criteria considering these nine signs and symptoms of inattention and of hyperactivity and impulsivity. These characteristics need to be present often for six months or less, be more visible than expected based on their level of development, occur in at least two settings, such as at home and school, present before the age of twelve, and interfere with the child’s behavior whether at home or school.
To meet the diagnostic criteria for attention deficit, depending on the age of diagnosis, at least six symptoms of those already described are needed, persistently present for at least six months, and affecting the person in more than one situation. The attention-deficit of the hyperactive-impulsive type demands the same but fulfills the specific hyperactivity and impulsivity symptoms. When criteria for attention and impulsivity or hyperactivity are met, it’s a combined type. It is difficult to differentiate between the types of ADHD, so the manual asks not to overdiagnose and accurately identify if there are no symptoms of other developmental disorders such as autism, or learning, anxiety, depression, or behavior that better explain the identified symptoms.
As the child grows, the signs of ADHD become more evident from a qualitative point of view because those with the hyperactive-impulsive type or the combined type tend to be more restless, moving their hands or legs continuously, talking impulsively, or are not aware of their surroundings. However, those with ADD are more difficult to identify as they have no physical symptoms.
The medical evaluation seeks to identify a history of prenatal exposure to drugs, alcohol, or tobacco, perinatal complications or infections in the central nervous system, traumatic brain injury, heart disease, sleep-disordered breathing, and a family history of ADHD. The developmental assessment seeks to determine the onset and evaluation of signs and symptoms by checking developmental milestones, especially language milestones, and the use of ADHD-specific rating scales.
The educational evaluation focuses on documenting the main signs and symptoms; it involves reviewing academic records, rating scales, or checklists. However, these two often do not distinguish whether the child has ADHD or another type of developmental disorder.
On the other hand, boys are three times more likely to be diagnosed than girls because they have more subtle symptoms. Sometimes their only symptoms are that they are inattentive and are labeled as dreamy or groggy. If they have symptoms of
hyperactivity-impulsivity, they are more likely to be considered aggressive, hyperactive, or overly emotional.
ADHD in adults
Although it is considered a childhood disorder since it begins during childhood, it persists into adulthood, and in some cases, the behavioral symptoms remain evident even into adulthood.
In adults, ADHD symptoms include:
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Difficult to focus
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It is difficult for them to finish tasks
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Humor changes
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Impatience
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Difficulty maintaining relationships
Hyperactivity manifests as restlessness and restlessness, unlike motor hyperactivity in children. These are at greater risk of being unemployed, having less academic achievement, substance abuse, and criminality.
It is more difficult to diagnose in adults as symptoms can confuse mood disorder, anxiety, or substance use symptoms. Doctors review school records and interview the patient and relatives to confirm that symptoms have manifested before 12. Since self-report of childhood symptoms can be unreliable, clinicians may have to review school or family interview records to ensure manifestations before 12 years.
There are two types of treatment: drug or behavioral therapy. Still, the American Psychiatric Association clarifies that behavioral therapy alone is not as effective as stimulant drugs in school-age children but is recommended as monotherapy, that is, alone in younger children. Pharmacotherapy does not correct the neurophysiological differences in ADHD. Still, it does help alleviate symptoms and allow them to participate in activities that they could not previously do due to their poor attention or their impulsivity and hyperactivity. However, they can present side effects such as lack of sleep, depression, upset stomach, and rapid heartbeat.
ADHD overdiagnosis
In the research “Overdiagnosis of Attention-Deficit / Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review,” the authors reviewed 12,267 publications from January 1, 1979, to August 21, 2020. The study found evidence of overdiagnosis and ADHD overtreatment, confirming that the rates are rising. A large proportion of new cases that have been diagnosed are with mild symptoms. They even found a growing number of adults diagnosed with ADHD who may have other disorders, such as autism.
These findings imply that overdiagnosed people may be harmed by the effects of medications during childhood, adolescence, and even adulthood. More extensive studies are needed to confirm whether cases with mild symptoms can harm the person. For the authors, research should focus on the needs of young people with more severe symptoms and who are more likely to benefit.
They recommend that doctors, teachers, and parents think about the benefits and harms that can come from diagnosing and treating ADHD, especially if they have mild symptoms.
ADHD in education
Educators are sometimes unaware that there are different types of attention deficit, especially since the characteristics of each can be fickle and unpredictable and can be confused with other learning or behavior disorders.
The “Foro infancia y adolescencia Los Millares” gives recommendations for the management of attention disorders in the classroom:
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Be sure that the student has ADD / ADHD: if you suspect that the student has an attention deficit, approach the family of experts to find out if an evaluation has been carried out or recommend that it be done.
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Ensure that the teacher has the support of the school, family, and an expert.
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That the educator knows her limitations and when to ask for help.
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Ask the student how to help him.
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Children with ADD / ADHD need structure, so they need lists, limits, reminders, and forecasts.
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When setting rules in the classroom, have them write them down and understand them.
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Repeat instructions.
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Remember the emotional part of learning: be aware of the emotions involved in your learning process.
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Make frequent eye contact: This serves to keep the student on track if he is distracted, reassure him to ask something, or convey confidence.
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Sit the ADHD child near the desk or where she can constantly see him.
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Establish limits within the classroom, let the teacher take control.
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Make an activity schedule as predictable as possible.
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Try to help the children make their activity calendars.
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Eliminate or reduce the frequency of tests or evaluations with time limits.
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Focus on the quality of tasks rather than quantity.
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Divide long activities into several short activities.
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Go unconventional, introduce daily innovations and jokes. However, be careful not to overstimulate.
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Express yourself clearly and decisively.
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A bonus system with points is a possibility as part of a behavior modification or a reward system for the little ones.
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Lean on games when explaining a topic.
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The educator should insist on having a home-school-home communication notebook.
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Encourage a structure for self-monitoring, make them self-observers.
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These children need to know in advance what is to come so that they can prepare internally.
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Memory is often a problem in children with ADD / ADHD; having them write notes for themselves will help them remember their responsibilities and doubts.
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Promote reading aloud at home.
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One of the best treatments for ADHD, both in children and adults, is exercise, preferably vigorous.
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The prizes and/or rewards should be applied immediately to what needs to be reinforced.
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Try to avoid situations that the child can
not control. -
Place students who are appropriate role models next to the child with ADD: attentive, orderly, and usually follow orders.
It is important to remember that just because a student has trouble concentrating or is hyperactive, it does not mean that she has ADD / ADHD. Moreover, it was difficult to identify students with attention deficit without hyperactivity for a long time because they tend to be slow and calm.
Although the family should take their child for diagnosis, educators sometimes realize that the child needs to go to an expert. Being detected from an early age can ensure that the child has the support she needs, be it therapy or medication, and helps her not feel less because she has a different learning pace.
Did you know the different types of attention deficit? Did you know that you can have it without hyperactivity? Have you dealt with someone with ADD / ADHD? Please leave us your answers in the comments.
Translation by Daniel Wetta.
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This article from Observatory of the Institute for the Future of Education may be shared under the terms of the license CC BY-NC-SA 4.0 
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