Differentiating ADHD, with and without Hyperactivity: Diagnosis, Symptoms and Treatment

Health Writer

Throughout the past several decades, there has been a great deal of information on what is called attention deficit hyperactivity disorder, or ADHD. Often, this information references a young boy, bouncing off walls and unable to contain his energy.  There are, however, three distinct types of ADHD, according to the Diagnostic and Statistical Manual V (DSM V):

That means ADHD - Predominantly Inattentive Type is still called ADHD even though hyperactivity might not be present. This can be confusing for those who can't pay attention but are quite able to sit still and is why it is often referred to as simply ADD.  While there is no official diagnosis of ADD, for the purposes of explanation, we will use ADHD to describe attention deficit disorder - Predominantly Hyperactive-Impulsive type and ADD to describe Predominantly Inattentive Type.

ADD and ADHD share a number of symptoms.  Both types of the disorder can create problems with forgetfulness and becoming easily distracted.  Both types cause difficulties in school, in completing assignments and in paying attention.  Individuals with both types often lose or misplace items and may have problems keeping track of time.  Both may create low self-esteem issues.

There are, however, some distinct differences:


With ADHD, parents often seek medical help in early education, although it can be in the toddler years.  ADHD is more recognizable once a child begins school, with behaviors such as disrupting the class, difficulty sitting still or getting out of their seat at inappropriate times.  ADD may go undetected until later, possibly in middle school or high school.  Children with ADD can be labeled as underachievers or severely shy.  They can be seen as unmotivated in school.  As they get older and must deal with more classes and moving in between classes, organization becomes a must.  Children with ADD often have great difficulty with organization.  Symptoms such as inattention show up in failing grades or forgetting homework assignments.  Parents may be signaled by a continuation of issues that there is a problem.


While hyperactivity is normally constant, inattention is not always consistent.  A child with hyperactivity always seems to have endless energy, even in sleep.  Hyperactivity is often easy to recognize.  Inattention, however, is more difficult to diagnose.  A child may be able to pay attention when something holds their interest.  They may be able to watch a television show or play video games.  They may be able to participate in sports or other activities with high stimulus levels to keep them interested.  When faced with activities that do not hold their interest, such as studying, they may not be able to focus and pay attention for an extended period of time.  They may become distracted easily or daydream constantly.  This inconsistency is very confusing for parents, who may not understand why their children can focus one moment, but are unable to the next. It can also lead to labels such as "defiant" or "lazy" because they are seen as choosing not to pay attention.

Social Interactions

For children or adults with ADHD, energy abounds.  They can be socially outgoing and consistently attract people to them.  But they also may have more difficulty creating emotional bonds.  They may have many acquaintances, but few friends.  People with ADD, on the other hand, find it easier to develop friendships, but seem to have more of a problem in attracting other people.  They, therefore, might have only a couple friends.  Both ADD and ADHD can cause social difficulties because of the inability to follow conversations.  They may miss parts of the discussion or forget what has been said.

Energy Levels

For those with ADHD, energy levels are consistently high.  They seem to never sit still and can talk non-stop.  Other words often used to describe someone with ADHD would include overactive, easily excitable, and hyperactive.  People with ADD frequently have low energy levels.  They are seen as daydreamers, sluggish or lethargic.  They can be considered to be painfully shy.


Treatment for ADHD and ADD is the same.  Both react well to traditional medications, Ritalin, Concerta, Adderall and Strattera.  All of these medications help to decrease symptoms.  In addition, behavior modification programs can be set up to target specific symptoms.  These would be beneficial for both ADHD and ADD.

More on symptoms of ADHD:

Common Symptoms of ADHD in Women

Comparing Symptoms of ADHD in Children and Adults

How ADHD Symptoms in Children Appear in "Real-Life"

How ADHD Symptoms Manifest in Adults


(2004). AD/HD Predominantly Inattentive Type (WWK8). from National Resource Center on AD/HD Web site: http://www.help4adhd.org/en/about/what/WWK8

Strock, Margaret (2006). Attention Deficit Hyperactivity Disorder. Retrieved May 15, 2007, from National Institute of Mental Health Web site: http://www.nimh.nih.gov/publicat/adhd.cfm