Q&A with William Shryer, MSW, LCSW

What’s the difference between Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) ?

The difference between the two has to do with the behaviors a child may exhibit.  For example, boys are more likely to show signs of being hyperactive (ADHD), while girls are more like to have trouble paying attention and staying focused (ADD). While both boys and girls can exhibit the same behaviors it is just more common that hyperactivity is seen in boys.

And because a girl’s ADD symptoms may be less noticeable and less disruptive in the classroom, they are more likely to get missed; the squeaky wheel gets the grease!

The main factor that gets missed when children are diagnosed is inattention and short term memory. Many people think that hyperactivity and attention deficit are the same thing; they are not.

Why does misdiagnosis happen?  

The majority of patients referred to my office have been misdiagnosed. The main reason for this is a poor or inadequate history. Many therapists don’t take the time to delve into the family history.  ADHD is highly genetic and it tends to be sex-linked; it is more likely to go from mother to daughter and father to son than mother to son, etc.

It’s also important to discern between deficits of attention and attention deficit disorder. Children and teens with deficits of attention can exhibit the same behaviors as a person with ADD or ADHD when they actually have a type of obsessive compulsive disorder (OCD). These children are too busy thinking or obsessing about things rather than their school work, for example.

Also, a depressed child might not be able to pay attention and a person with Asperger’s often cannot pay attention due to thinking about dinosaurs, vacuum cleaners or quantum physics.

Children with mood disorders such as bipolar disorder often have co-occurring attention issues, often due to the speed at which thoughts are flying through their brain. It’s so important to not just treat the tip of the iceberg; you have to dig deeper.

How are the two conditions different in adults?  What behaviors are typical for each?  

In adults the difference between ADHD and ADD is often hard to spot due to the fact that the hyperactivity of childhood gives way to more of a sense in internal restlessness. For many women poorly treated or untreated ADHD, can lead to depressive symptoms. Often we find that when properly treated for their ADHD, their depression is resolved.

Untreated or poorly treated ADHD in adults is a huge problem. There are still many clinicians that believe that this disorder goes away at puberty.  Some of the symptoms of adult ADHD are memory problems, poor follow through, going off topic during a conversation, interrupting, social skills difficulties, and more.

How is each treated?  

The medications used to treat inattention work very well. Stimulants are still the gold standard, while other medications such as atomoxitine are second tier approaches.  Food, diet, therapy, supplements seem to do very little other than having some placebo effects.  A highly structured learning environment can assist the student, but not directly impact the ADHD.

Both conditions are treated the same with attention being paid to any co-occurring conditions.  The gold standard is still psychostimulants such as mixed amphetamine salts also known as Adderall, methylphenidate preparations also known as Ritalin. There are many variations of these and the old fashioned and generic such as dexadrine tablets and longer acting dexadrine spansuls work just as well as the far more expensive preparations.

Learn More

• Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
• Adult attention-deficit/hyperactivity disorder (ADHD) – Mayo Clinic

William Shryer, LCSW, received his MSW from the University of California at Berkeley specializing in children and families. Mr. Shryer has been in private practice since 1981 specializing in autistic spectrum disorders, mood disorders, and the anxiety spectrum in children, adults and their families. He has lectured frequently to college classes and professionals in the areas of ADD and autistic spectrum disorders and their implications in the educational setting.