ADD is NOT the same as Hyperactivity

image via Flickr, Carolyn Tiry

image via Flickr, Carolyn Tiry

Hyperactivity is one of the many labels that have been used over the years to describe individuals who demonstrate the characteristics of ADD. Other labels that have been applied to this same grouping of individuals include hyperkinesis, Minimal Brain Dysfunction (MBD), dyslexia, and learning disability.

The use of so many diverse terms to describe the same or similar behaviors has contributed to much of the confusion that surrounds ADD.

In fact, today many use the term ADHD or Attention Deficit Hyperactivity Disorder to describe all ADD individuals. They go on to break ADHD into several subtypes: primarily hyperactive, primarily inattentive, and combined type. I don’t embrace these labels and distinctions for several important reasons.

Don’t Perpetuate the Hyperactive Myth

First, holding onto the ‘hyperactive’ label perpetuates the myth in the minds of many lay and professional people that one must be hyperactive in order to have ADD. Clearly, this is not the case, since the majority of individuals with ADD demonstrate either a normal or a low activity level!

Hyperactivity is NOT a Core Characteristic of Attention Deficit Disorder!

Secondly, I don’t believe that hyperactivity is a core characteristic of the ADD syndrome. My observations over the years are that individuals with ADD show “hyperactive” behavior for two reasons, both grounded in underlying attention difficulties.

image via Flickr, Dana

image via Flickr, Dana

Some individuals with ADD demonstrate fidgetiness and motoric overactivity because they have underlying problems with low arousal and need extra movement such as squirming in their chair, bouncing their leg, or tapping their fingers to keep them awake.  Interestingly, these unconscious attempts to maintain arousal frequently disappear quickly when these individuals take one of the ADD medications that wakes them up.

Other ADD individuals appear to be “hyperactive” because their attentional weaknesses preclude efficient self-control of a temperamentally-based high activity level.

I have seen this in my own family. My older son got his mother’s weak attention and my high activity level. His impulsivity, distractibility, and poor self-monitoring coupled with his high activity level lead to his bouncing off the wall, numerous careless accidents, and disturbing out of his seat behavior. On the other hand, my high activity level has never been as problem for me. When it is coupled with my strong attention, I have been able to “put a method to my madness” to accomplish many things.

Real World People Don’t Fit Into Neat Little Boxes

I appreciate that categorization systems like DSM (Diagnostic and Statistic Manual) that split ADD into various subtypes (e.g., Hyperactive) may serve a purpose in defining a pool of research subjects or to clarify communication between professional. However, my experience in the real world is that individuals don’t fit into such neat little boxes defined by narrow criteria.

When all is said and done, what matters most when it comes to ADD are the five key characteristics of inattention. After this, every individual with ADD is unique: some hyperactive, some underactive, some intense, some very sensitive, some gifted, some retarded. What we see on the outside is the result of how the core characteristics mix with other traits, abilities, and characteristics.

Craig B. Liden, MD  is an internationally recognized expert in the diagnosis and treatment of ADD/ADHD.  Since the 1980’s, Dr. Liden has been in private practice evaluating and treating behavior and developmental issues across the life span.   He has treated more than 10,000 patients with ADD/ADHD and related co-morbidities.  Dr. Liden  has written and lectured extensively about ADD/ADHD, education, individual differences and a variety of health problems, most recently publishingAccommodations for Success: A Guide and Workbook for Creating 504 Agreements and IEP’s for Children with ADD/ADHD and ADD/ADHD Basics 101: How to Be A Good Consumer of Diagnostic and Treatment Services for ADD/ADHD.   Dr. Liden is the Founder and Medical Director of The Being Well Center located in Pittsburgh, PA.  He is available for speaking engagements, workshops, and interviews.


About cblmd

medical director of the being well center, ADHD expert, speaker, and author

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