General Election - Education

Okay class, today we’re going to talk about a confusing topic–we’re going to talk about the different subtypes of ADHD. Take good notes. You’ll be expected to turn them in at the end of class for credit.

So, here’s the breakdown. ADHD is a disorder with three basic subtypes. First, there’s the hyperactive subtype (ADHD-H). Then, there’s the inattentive subtype (ADHD-I). Finally, there’s a combined subtype where someone has features of both disorders at the same time. (This is probably the suckiest subtype, I would think, and it’s abbreviated as ADHD-C).

*Susy raises her hand*

Yes, Susy?

Susy: But teacher, I always thought that ADHD meant someone was hyperactive, and that ADD means the disorder you’re writing this blog about–you know, the one without hyperactivity. Isn’t that why ADD has no “H”?

Teacher: Great question Susy. Lots of people get confused on this point, and there is a good reason why. It’s kind of technical, but it is interesting. Here it goes: the DSM, or the Diagnostic and Statistical Manual of Mental Disorders (don’t ask me how they distilled that to three letters), is the manual put out by the American Psychiatric Association that provides diagnostic criteria for (surprise) mental disorders. It’s what clinicians use to assess a client and say “hey, your symptoms mean that you have Generalized Anxiety Disorder” or “hey, the reason you can’t pay attention in class is because you meet the criteria for one of the subtypes of ADHD” or “hey, your flat affect and strange symptoms mean you have Antisocial Personality Disorder, which basically means you’re a sociopath and might kill me without remorse. I am now afraid of you–please get out of my office.” (Just kidding about that last one.)

Anyway, Susy, to answer your question, there have been four versions of the DSM since it was created. We are now on the DSM-IV. In this version, the disorder is broken down like I described above (ADHD-H, ADHD-I, and ADHD-C). However, in the DSM-III, the version of the DSM that was used from 1987-1994 (i.e. the time period when a lot of us first heard of this disorder), it was differentiated as ADHD being the equivalent to ADHD-H, and ADD being the equivalent to ADHD-I.

Am I making sense?

Susy: I think so. So, in other words, when I tell somebody who says they have the inattentive subtype of ADHD that what they actually have is ADD, instead of looking knowledgeable, I actually look like I’m stuck in the mid-90’s?

Teacher: Well, I suppose so. But it’s an easy mistake to make when you haven’t actually looked at the DSM-IV breakdown.

*Billy raises his hand*

Yes Billy?

Billy: So what you’re saying is that the term “ADD” kind of doesn’t even exist anymore? So nobody should be using it to describe any subtype of ADHD?

Teacher: That’s right Billy. Except in studies published in journals over 15 years ago, the term won’t be found in any research. It is outdated and no longer used by clinicians (unless those clinicians haven’t cracked open their DSM-IV in a while.) So, we as the general public should follow their lead and use the correct terminology.

Billy: But it seems like such a large number of people know the disorder as “ADD” that it would be impossible to expect them to change.

Teacher: You make a good point. A lot of people use the blanket term “ADD” to refer to all subtypes of the disorder. In this sense, because it’s common parlance, “ADD” might be an acceptable thing to say. But for the purposes of this blog, errr, classroom, I’ll probably always refer to it as its specific subtype to avoid confusion and to be more accurate.

Billy: What about when they come out with the DSM-V? What will happen then? What if it’s different??

Teacher: Well, Billy, we’ll just see what happens when that time comes. The new version of the DSM is slated to appear in 2013, so for at least the next three years you’re safe using the terminology described above. It’s possible they change it. Heck, I’d love to see ADHD-I taken out of the ADHD family–I feel that it’s a totally different disorder worthy of its own title–but we have to work with a common language, and so following whatever the DSM proffers is one’s best bet.

Billy: Oh, okay. That makes sense.

Teacher: Any other questions? No? All right, well, everybody go ahead and pass in your notes so you get credit for today’s class.

*the class passes in their notes*

Teacher: Hey, wait a minute. Jason, I see I didn’t get any notes from you. Did you forget to turn them in?

Jason (sheepishly): Uh, I didn’t take any notes…

Teacher: You didn’t? Well, then what were you doing during our class discussion?

Jason: Uhhh, I was mapping out the entire blue-print of the giant snow fort I’d build if I were dropped off alone by plane in Antarctica.

Teacher: So you didn’t hear anything I was saying, yet you sat pleasantly looking as if you were taking notes?

Jason: I didn’t mean to. I’m really sorry… it was a really big snow fort. *Jason bows his head in shame*

Teacher: It’s okay! Don’t be embarrassed. You’ve helped us out a lot. You’ve actually just demonstrated one of the main symptoms of a kid with ADHD-I. Good work, Jason. We’ll talk more about your snow fort and what it tells us next time we meet.