At OTogether, we understand that behind every diagnosis or label is a unique child trying to navigate a world that doesn’t always fit their nervous system. We aren’t here to just look at a checklist of symptoms; we are here to look at your whole child.
Today, I want to clear up the confusion between ADD and ADHD, explain how we see these differences through the lens of Occupational Therapy (OT), and share how we can support your child’s unique journey.
The Elephant in the Room: Is “ADD” Still a Thing?
Let’s start with the most common question we hear from parents: “My child isn’t hyperactive – they just can’t focus. So, it’s ADD, not ADHD, right?”
Here is the medical reality: ADD (Attention Deficit Disorder) is technically an outdated term.
The medical community officially retired the term “ADD” in 1987 and further refined the definitions in 1994. Today, under the current diagnostic guidelines (the DSM-5), everyone receives the diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD), regardless of whether they are bouncing off the walls or quietly daydreaming in the back of the class.
However, just because the umbrella term is the same doesn’t mean the children are the same. We now look at ADHD in three distinct “presentations”:
1. Predominantly Inattentive Presentation: This is what we used to call ADD.
2. Predominantly Hyperactive-Impulsive Presentation: This is the stereotypical “motor-driven” presentation.
3. Combined Presentation: A mix of both.
While the medical books have changed, we know that the term “ADD” still resonates with many families because it perfectly describes that quiet, dreamy, unfocused struggle.
Breaking Down the “Types”: It’s Not One-Size-Fits-All
To help your child, we first have to understand what their nervous system is doing. In our OT sessions, we generally see two very different profiles, and understanding which one fits your child is the key to unlocking their potential.
The “Inattentive” Child (Formerly ADD)
These children are often misunderstood. They aren’t disrupting the class, so they often fly under the radar. You might notice:
- The “Space Cadet” Phenomenon: They seem to be in a fog, daydreaming, or staring out the window.
- Disorganization: Their backpack is a black hole of crumpled papers, and they frequently lose lunchboxes, jackets, or homework.
- Careless Mistakes: They might rush through work or miss details, not because they don’t know the answer, but because their attention drifted.
- Avoidance: They may resist tasks that require sustained mental effort because it feels physically exhausting to them.
The “Hyperactive-Impulsive” Child
This presentation is usually easier to spot because it’s external and visible. You might notice:
- The Motor That Won’t Stop: They act as if “driven by a motor,” constantly running, climbing, or fidgeting.
- Impulsivity: They blurt out answers, interrupt conversations, or have trouble waiting their turn.
- Physicality: They may have trouble playing quietly or staying in their seat when expected.
The OT Perspective: How We Look at It Differently
While a doctor looks at symptoms to make a diagnosis, as Occupational Therapists, we look at function and sensory processing.
We don’t ask, “What is wrong with this child?” We ask, “What does this child’s nervous system need to be successful?”
The Sensory Connection
From an OT perspective, ADHD behaviors are often linked to how a child processes sensory information.
The Inattentive Child often has a “low registration” or “under-responsive” sensory system. Their brain isn’t getting enough input to stay alert. They aren’t ignoring you on purpose; their brain literally hasn’t registered that you are speaking.
The Hyperactive Child is often a “sensory seeker.” Their body is craving movement (proprioception and vestibular input) to feel regulated. They wiggle and crash into things because their body is shouting for feedback.
Tailoring Treatment: Why One Approach Doesn’t Fix All
Because the underlying sensory and executive function needs are different, we treat “ADD” and Hyperactive ADHD very differently in the clinic.
Treatment for the Inattentive Child (The Daydreamer)
For these children, our goal is to “wake up” the nervous system and build external structures for internal chaos.
- Alerting Sensory Strategies: We might use fast swinging, cold water play, or crunchy snacks to increase alertness before homework time.
- Visual Anchors: Since verbal instructions often “float away,” we create visual schedules and checklists.
- Executive Function Training: We teach them how to break a big project into tiny, manageable steps so they don’t freeze up.
- Sluggish Cognitive Tempo Support: For some kids who seem particularly lethargic or slow to process, we focus on pacing and energy management.
Treatment for the Hyperactive Child (The Mover)
For these children, our goal is to “ground” the nervous system and improve self-regulation.
- Heavy Work: We use activities that push and pull against resistance (like carrying heavy books, wall push-ups, or animal walks). This provides proprioceptive input, which is naturally calming and organizing for the brain.
- Active Seating: We don’t force them to sit still. We use wobble stools or therapy balls to allow movement that helps focus rather than distracts from it.
- Impulse Control Games: We play games like “Red Light, Green Light” with twists to help them practice putting the brakes on their motor system.
What You As a Parent Must Know
If you take nothing else away from this post, please hear this: Your child is not giving you a hard time; your child is having a hard time.
Here are three things we want every parent to know:
- Girls are Different: ADHD is often missed in girls because they are more likely to have the inattentive presentation. They are often labeled as “shy,” “daydreamy,” or “anxious” rather than ADHD. They are masters of “masking” – hiding their struggles to fit in – which can lead to burnout later.
- It’s Not About Intelligence: Many children with ADHD are incredibly bright. Their struggles with focus or organization have nothing to do with their IQ. In fact, many are “2e” (twice-exceptional) – gifted, but with ADHD.
- There is Hope Beyond Medication: While medication is a valid tool for many families, it is not the only tool. OT provides the practical skills, sensory strategies, and environmental changes that help children thrive long-term.
At OTogether, we believe in a neurodiversity-affirming approach. We aren’t trying to “fix” your child’s brain. We are trying to give them the manual for how it works.
If you are ready to explore a way forward that honors your child’s unique makeup, we are here to help.
Frequently Asked Questions:
My child can focus on video games for hours. How can they have ADHD/ADD?
This is actually very common! ADHD is not a deficit of attention, but rather a difficulty regulating attention. The ADHD brain is fueled by interest and dopamine. Video games provide constant, immediate feedback and dopamine hits, allowing the child to “hyperfocus.” The struggle comes when they have to focus on something that is not immediately rewarding, like math homework or cleaning their room.
Did the term “ADD” just disappear?
Medically, yes. It was removed from the diagnostic manual (DSM) in 1987 and replaced with ADHD. However, many people (including adults who were diagnosed years ago) still use “ADD” because it feels like a better description for inattentive symptoms without hyperactivity.
Can a child have both inattentive and hyperactive symptoms?
Yes, this is called the Combined Presentation, and it is actually the most common type of ADHD. These children might be physically restless and struggle with organization and forgetfulness.
Is “Sluggish Cognitive Tempo” the same as inattentive ADHD?
Not exactly, though they look similar. Sluggish Cognitive Tempo (SCT) is characterized by daydreaming, mental fogginess, and slow processing speed. While many kids with Inattentive ADHD have these traits, SCT is often linked more to internal distraction and social withdrawal, whereas ADHD is more about distractibility and executive dysfunction. Some researchers believe they are distinct but overlapping conditions.
Will my child outgrow this?
It was once thought that children outgrew ADHD, but we now know that about 60% of children continue to experience symptoms into adulthood. However, the presentation often changes. Hyperactivity in a child often turns into an internal feeling of restlessness in an adult. With the right OT strategies, children learn to manage their symptoms so they can succeed as adults.