ADHD predominantly inattentive
Encyclopedia
ADHD predominantly inattentive (ADHD-PI or ADHD-I) is one of the three subtypes of Attention-deficit hyperactivity disorder
(ADHD). While ADHD-PI is sometimes still called "attention deficit disorder" (ADD) by the general public, these older terms were formally changed in 1994 in the new Diagnostic and Statistical Manual of Mental Disorders, fourth edition
(DSM-IV).
(e.g. "you're irresponsible", "you're immature", "you're lazy", "you don't care/show any effort", "you just aren't trying", etc.).
The inattentive children may realize on some level that they are somehow different internally from their peers. However, they are also likely to accept and internalize the continuous negative feedback, creating a negative self-image that becomes self-reinforcing. If these children progress into adulthood undiagnosed or untreated, their inattentiveness, ongoing frustrations, and poor self-image frequently create numerous and severe problems maintaining healthy relationships, succeeding in postsecondary schooling, or succeeding in the workplace. These problems can compound frustrations and low self-esteem
, and will often lead to the development of secondary pathologies including anxiety disorders, sexual promiscuity, mood disorders, and substance abuse
.
It has been suggested that some of the symptoms of ADHD present in childhood appear to be less overt in adulthood. This is likely due to an adult's ability to make cognitive adjustments and develop coping skills minimizing the frequency of inattentive or hyperactive behaviors. However, the core problems of ADHD do not disappear with age. Some researchers have suggested that individuals with reduced or less overt hyperactivity symptoms should receive the ADHD-combined diagnosis. Hallowell and Ratey (2005) suggest that the manifestation of hyperactivity simply changes with adolescence and adulthood, becoming a more generalized restlessness or tendency to fidget.
In the DSM-III, sluggishness, drowsiness, and daydreaming were listed as characteristics of ADHD. The symptoms were removed from the ADHD criteria in DSM-IV because, although those with ADHD-PI were found to have these symptoms, this only occurred with the absence of hyperactive symptoms. These distinct symptoms were described as sluggish cognitive tempo
(SCT).
A meta-analysis of 37 studies on cognitive differences between those with ADHD-Inattentive type and ADHD-Combined type found that "the ADHD/C subtype performed better than the ADHD/I subtype in the areas of processing speed, attention, performance IQ, memory, and fluency. The ADHD/I subtype performed better than the ADHD/C group on measures of flexibility, working memory, visual/spatial ability, motor ability, and language. Both the ADHD/C and ADHD/I groups were found to perform more poorly than the control group on measures of inhibition, however, there was no difference found between the two groups. Furthermore the ADHD/C and ADHD/I subtypes did not differ on measures of sustained attention."
Some experts, such as Dr. Russell Barkley
, argue that ADHD-PI is so different from the other ADHD subtypes that it should be regarded as a distinct disorder. ADHD-PI is noted for the almost complete lack of conduct disorder
s and high-risk, thrill-seeking behavior, and additionally have higher rates of anxiety. Further research needs to be done to discover differences among those with attention disorders.
allows for diagnosis of the predominantly inattentive subtype of ADHD (under code 314.00) if the individual presents six or more of the following symptoms of inattention for at least six months to a point that is disruptive and inappropriate for developmental level:
An ADHD-PI diagnosis is contingent upon the symptoms of impairment presenting themselves in two or more settings (e.g., at school or work and at home). There must also be clear evidence of clinically significant impairment in social, academic, or occupational functioning. Lastly, the symptoms must not occur exclusively during the course of a pervasive developmental disorder
, schizophrenia
, or other psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder
, anxiety disorder
, dissociative disorder, personality disorder
).
As a result, up to 10% of children in the USA were described as having ADHD. Current estimates suggest that ADHD is present throughout the world in about 1–5% of the population. About five times more boys than girls are diagnosed with ADHD. This may be partly because of the particular ways they express their difficulties. Boys and girls both have attention problems, but boys are more likely to be overactive and difficult to manage. Children from all cultures and social groups are diagnosed with ADHD. However, children from certain backgrounds may be particularly likely to be diagnosed with ADHD, because of different expectations about how they should behave. It is therefore important to ensure that a child's cultural background is understood and taken into account as part of the assessment.
(FDA) in the treatment of ADHD tend to work well in individuals with the predominantly inattentive type. These medications include two classes of drugs, stimulants and non-stimulants. Drugs for ADHD are divided into first-line medications and second-line medications. First-line medications include several of the stimulants, and tend to have a higher response rate and effect size than second-line medications. Some of the most common stimulants are Methylphenidate
(Ritalin), Adderall
and Vyvanse. Second-line medications are usually anti-depressant medications such as Zoloft, Prozac, and Wellbutrin. These medications can help with fidgeting, inattentiveness, irritability, and trouble sleeping. Some of the symptoms the medications target are also found with ADHD-PI patients.
Although medication can help improve concentration, it does not cure ADHD-I and the symptoms will come back once the medication stops. Moreover, medication works better for some patients while it barely works for others.
Also, along with medication, behavioral therapy is recommended to improve organizational skills, study techniques or social functioning.
AD/HD Center, supported by grants from the National Institutes of Health
(NIH) will examine the use of functional Magnetic Resonance Imaging
in identifying unique patterns of brain activation in children with ADHD-PI.
Behavioral strategies are of great help and they include creating routines, getting organized, avoiding distractions (television
, video and computer games
especially on weekdays during homework), limiting choices, using goals and rewards, ignoring behaviors.
Since children with ADHD can be extremely disorganized, parents should work with children to find specific places for everything and teach kids to use calendars and schedules. Parents are also advised to get children into sports to help them build discipline, confidence
, and improve their social skills. Physical activity boosts the brain’s dopamine
, norepinephrine
, and serotonin
levels and all these neurotransmitters affect focus and attention. However, some sports may be too challenging and would add frustration. Parents should talk to their children about what kinds of sports or exercise most stimulate and satisfy them before signing them up for classes or enrolling them in a given team sport.
It is very important to establish close communication with the school in order to develop an educational plan to address the child’s needs. Accommodations in school such as extended time for tests or more frequent feedback from teachers are also beneficial for these individuals.
Attention-deficit hyperactivity disorder
Attention deficit hyperactivity disorder is a developmental disorder. It is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting before seven years of age.ADHD is the most commonly studied and...
(ADHD). While ADHD-PI is sometimes still called "attention deficit disorder" (ADD) by the general public, these older terms were formally changed in 1994 in the new Diagnostic and Statistical Manual of Mental Disorders, fourth edition
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
(DSM-IV).
Differences from other ADHD subtypes
ADHD-PI is similar to the other subtypes of ADHD in that it is characterized primarily by inattention, easy distractibility, disorganization, procrastination, and forgetfulness; where it differs is in lethargy - fatigue, and having fewer or no symptoms of hyperactivity or impulsiveness typical of the other ADHD subtypes. In some cases, children who enjoy learning may develop a sense of fear when faced with structured or planned work, especially long or group-based that requires extended focus, even if they thoroughly understand the topic. Children with ADHD-PI may be at greater risk of academic failures and early withdrawal from school. Teachers and parents may make incorrect assumptions about the behaviours and attitudes of a child with ADHD-PI, and may provide them with frequent and erroneous negative feedbackNegative feedback
Negative feedback occurs when the output of a system acts to oppose changes to the input of the system, with the result that the changes are attenuated. If the overall feedback of the system is negative, then the system will tend to be stable.- Overview :...
(e.g. "you're irresponsible", "you're immature", "you're lazy", "you don't care/show any effort", "you just aren't trying", etc.).
The inattentive children may realize on some level that they are somehow different internally from their peers. However, they are also likely to accept and internalize the continuous negative feedback, creating a negative self-image that becomes self-reinforcing. If these children progress into adulthood undiagnosed or untreated, their inattentiveness, ongoing frustrations, and poor self-image frequently create numerous and severe problems maintaining healthy relationships, succeeding in postsecondary schooling, or succeeding in the workplace. These problems can compound frustrations and low self-esteem
Self-esteem
Self-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...
, and will often lead to the development of secondary pathologies including anxiety disorders, sexual promiscuity, mood disorders, and substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
.
It has been suggested that some of the symptoms of ADHD present in childhood appear to be less overt in adulthood. This is likely due to an adult's ability to make cognitive adjustments and develop coping skills minimizing the frequency of inattentive or hyperactive behaviors. However, the core problems of ADHD do not disappear with age. Some researchers have suggested that individuals with reduced or less overt hyperactivity symptoms should receive the ADHD-combined diagnosis. Hallowell and Ratey (2005) suggest that the manifestation of hyperactivity simply changes with adolescence and adulthood, becoming a more generalized restlessness or tendency to fidget.
In the DSM-III, sluggishness, drowsiness, and daydreaming were listed as characteristics of ADHD. The symptoms were removed from the ADHD criteria in DSM-IV because, although those with ADHD-PI were found to have these symptoms, this only occurred with the absence of hyperactive symptoms. These distinct symptoms were described as sluggish cognitive tempo
Sluggish cognitive tempo
Sluggish Cognitive Tempo is an unformalized descriptive term which is used to better identify what appears to be a homogeneous sub-subgroup within the formal subgroup "ADHD predominantly inattentive"...
(SCT).
A meta-analysis of 37 studies on cognitive differences between those with ADHD-Inattentive type and ADHD-Combined type found that "the ADHD/C subtype performed better than the ADHD/I subtype in the areas of processing speed, attention, performance IQ, memory, and fluency. The ADHD/I subtype performed better than the ADHD/C group on measures of flexibility, working memory, visual/spatial ability, motor ability, and language. Both the ADHD/C and ADHD/I groups were found to perform more poorly than the control group on measures of inhibition, however, there was no difference found between the two groups. Furthermore the ADHD/C and ADHD/I subtypes did not differ on measures of sustained attention."
Some experts, such as Dr. Russell Barkley
Russell Barkley
Russell A. Barkley, Ph.D., is a Research Professor in the Department of Psychiatry at the State University of New York Upstate Medical University...
, argue that ADHD-PI is so different from the other ADHD subtypes that it should be regarded as a distinct disorder. ADHD-PI is noted for the almost complete lack of conduct disorder
Conduct disorder
Conduct disorder is psychological disorder diagnosed in childhood that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated...
s and high-risk, thrill-seeking behavior, and additionally have higher rates of anxiety. Further research needs to be done to discover differences among those with attention disorders.
DSM-IV criteria
The DSM-IVDiagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
allows for diagnosis of the predominantly inattentive subtype of ADHD (under code 314.00) if the individual presents six or more of the following symptoms of inattention for at least six months to a point that is disruptive and inappropriate for developmental level:
- Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- Often has trouble keeping attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
- Often has trouble organizing activities.
- Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period (such as schoolwork or homework).
- Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
- Is often easily distracted.
- Is often forgetful in daily activities.
- Often mixes up peoples' names or forgets them for short periods of time.
An ADHD-PI diagnosis is contingent upon the symptoms of impairment presenting themselves in two or more settings (e.g., at school or work and at home). There must also be clear evidence of clinically significant impairment in social, academic, or occupational functioning. Lastly, the symptoms must not occur exclusively during the course of a pervasive developmental disorder
Pervasive developmental disorder
Pervasive developmental disorders is a diagnostic category refers to a group of disorders characterized by delays or impairments in communication, social behaviors, and cognitive development.Pervasive developmental disorders include Autism, Asperger's syndrome, Rett's syndrome, Childhood...
, schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, or other psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder
Mood disorder
Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature...
, anxiety disorder
Anxiety disorder
Anxiety disorder is a blanket term covering several different forms of abnormal and pathological fear and anxiety. Conditions now considered anxiety disorders only came under the aegis of psychiatry at the end of the 19th century. Gelder, Mayou & Geddes explains that anxiety disorders are...
, dissociative disorder, personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...
).
| Life Period | Example |
|---|---|
| Children | Failing to pay close attention to details or making careless mistakes when doing school-work or other activities |
| Trouble keeping attention focused during play or tasks | |
| Appearing not to listen when spoken to (often being accused of "daydreaming") | |
| Failing to follow instructions or finish tasks | |
| Avoiding tasks that require a high amount of mental effort and organization, such as school projects | |
| Frequently losing items required to facilitate tasks or activities, such as school supplies | |
| Excessive distractibility | |
| Forgetfulness | |
| Procrastination Procrastination In psychology, procrastination refers to the act of replacing high-priority actions with tasks of low-priority, and thus putting off important tasks to a later time... , inability to begin an activity |
|
| Adults | Often making careless mistakes when having to work on uninteresting or difficult projects |
| Often having difficulty keeping attention during work, or holding down a job for a significant amount of time | |
| Often having difficulty concentrating on conversations | |
| Having trouble finishing projects that have already been started | |
| Often having difficulty organizing for the completion of tasks | |
| Avoiding or delaying in starting projects that require a lot of thought | |
| Often misplacing or having difficulty finding things at home or at work | |
| Disorganized personal items (sometimes old and useless to the individual) causing excessive "clutter" (in the home, car, etc.) | |
| Often distracted by activity or noise | |
| Often having problems remembering appointments or obligations, or inconveniently changing plans on a regular basis | |
Prevalence in children
It is difficult to say exactly how many children worldwide have ADHD because different countries have used different ways of diagnosing it, while some do not diagnose it at all. In the UK, diagnosis is based on quite a narrow set of symptoms, and about 0.5–1% of children are thought to have attention or hyperactivity problems. In comparison, until recently, professionals in the USA used a much broader definition of the term ADHD.As a result, up to 10% of children in the USA were described as having ADHD. Current estimates suggest that ADHD is present throughout the world in about 1–5% of the population. About five times more boys than girls are diagnosed with ADHD. This may be partly because of the particular ways they express their difficulties. Boys and girls both have attention problems, but boys are more likely to be overactive and difficult to manage. Children from all cultures and social groups are diagnosed with ADHD. However, children from certain backgrounds may be particularly likely to be diagnosed with ADHD, because of different expectations about how they should behave. It is therefore important to ensure that a child's cultural background is understood and taken into account as part of the assessment.
Treatment
Recent studies indicate that medications approved by the U.S. Food and Drug AdministrationFood and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
(FDA) in the treatment of ADHD tend to work well in individuals with the predominantly inattentive type. These medications include two classes of drugs, stimulants and non-stimulants. Drugs for ADHD are divided into first-line medications and second-line medications. First-line medications include several of the stimulants, and tend to have a higher response rate and effect size than second-line medications. Some of the most common stimulants are Methylphenidate
Methylphenidate
Methylphenidate is a psychostimulant drug approved for treatment of attention-deficit hyperactivity disorder, postural orthostatic tachycardia syndrome and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neural insult and obesity...
(Ritalin), Adderall
Adderall
Adderall is a brand name of amphetamine salts–based medication used for attention-deficit hyperactivity disorder and narcolepsy. It is a brand-name psychostimulant medication composed of racemic amphetamine aspartate monohydrate, racemic amphetamine sulfate, dextroamphetamine saccharide, and...
and Vyvanse. Second-line medications are usually anti-depressant medications such as Zoloft, Prozac, and Wellbutrin. These medications can help with fidgeting, inattentiveness, irritability, and trouble sleeping. Some of the symptoms the medications target are also found with ADHD-PI patients.
Although medication can help improve concentration, it does not cure ADHD-I and the symptoms will come back once the medication stops. Moreover, medication works better for some patients while it barely works for others.
Also, along with medication, behavioral therapy is recommended to improve organizational skills, study techniques or social functioning.
Research
A recently funded study at the Mount SinaiMount Sinai Hospital, New York
Mount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States. In 2011-2012, Mount Sinai Hospital was ranked as one of America's best hospitals by U.S...
AD/HD Center, supported by grants from the National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
(NIH) will examine the use of functional Magnetic Resonance Imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
in identifying unique patterns of brain activation in children with ADHD-PI.
Strategies for Parents of Afflicted Children
Parents are recommended to learn about this disorder in order to first be able to help themselves and then their children.Behavioral strategies are of great help and they include creating routines, getting organized, avoiding distractions (television
Television
Television is a telecommunication medium for transmitting and receiving moving images that can be monochrome or colored, with accompanying sound...
, video and computer games
Personal computer game
A PC game, also known as a computer game, is a video game played on a personal computer, rather than on a video game console or arcade machine...
especially on weekdays during homework), limiting choices, using goals and rewards, ignoring behaviors.
Since children with ADHD can be extremely disorganized, parents should work with children to find specific places for everything and teach kids to use calendars and schedules. Parents are also advised to get children into sports to help them build discipline, confidence
Confidence
Confidence is generally described as a state of being certain either that a hypothesis or prediction is correct or that a chosen course of action is the best or most effective. Self-confidence is having confidence in oneself. Arrogance or hubris in this comparison, is having unmerited...
, and improve their social skills. Physical activity boosts the brain’s dopamine
Dopamine
Dopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...
, norepinephrine
Norepinephrine
Norepinephrine is the US name for noradrenaline , a catecholamine with multiple roles including as a hormone and a neurotransmitter...
, and serotonin
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
levels and all these neurotransmitters affect focus and attention. However, some sports may be too challenging and would add frustration. Parents should talk to their children about what kinds of sports or exercise most stimulate and satisfy them before signing them up for classes or enrolling them in a given team sport.
It is very important to establish close communication with the school in order to develop an educational plan to address the child’s needs. Accommodations in school such as extended time for tests or more frequent feedback from teachers are also beneficial for these individuals.
See also
- Attention-deficit hyperactivity disorderAttention-deficit hyperactivity disorderAttention deficit hyperactivity disorder is a developmental disorder. It is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting before seven years of age.ADHD is the most commonly studied and...
for main article - Adult attention-deficit disorderAdult attention-deficit disorderAdult attention deficit hyperactivity disorder is the common term used to describe the neuropsychiatric condition attention-deficit hyperactivity disorder when it is present in adults. Up to 60% of children diagnosed with ADHD in early childhood continue to demonstrate notable ADHD symptoms as...
- Auditory processing disorderAuditory processing disorderAuditory Processing Disorder , also known as Central Auditory Processing Disorder is an umbrella term for a variety of disorders that affect the way the brain processes auditory information. It is not a peripheral hearing disorder as individuals with APD usually have normal peripheral hearing...
- Chemical imbalance theory
- Educational psychologyEducational psychologyEducational psychology is the study of how humans learn in educational settings, the effectiveness of educational interventions, the psychology of teaching, and the social psychology of schools as organizations. Educational psychology is concerned with how students learn and develop, often focusing...
- Pediatric Attention Disorders Diagnostic ScreenerPediatric Attention Disorders Diagnostic ScreenerThe Pediatric Attention Disorders Diagnostic Screener , created by Dr. Thomas K. Pedigo and Kenneth L. Pedigo, is a suite of computer administered neuropsychological tests of attention and executive functioning. The PADDS is used in the diagnosis of Attention Deficit Hyperactivity Disorder in...
- School psychologySchool psychologySchool psychology is a field that applies principles of clinical psychology and educational psychology to the diagnosis and treatment of children's and adolescents' behavioral and learning problems...
- Sensory integration disorder
- Sluggish cognitive tempoSluggish cognitive tempoSluggish Cognitive Tempo is an unformalized descriptive term which is used to better identify what appears to be a homogeneous sub-subgroup within the formal subgroup "ADHD predominantly inattentive"...
- Wilson's syndromeWilson's syndromeWilson’s syndrome, also called Wilson’s thyroid syndrome or WTS, is an alternative medical diagnosis consisting of various common and non-specific symptoms that are attributed to a below-median body temperature and impaired conversion of thyroxine to triiodothyronine , despite normal thyroid...
External links
- http://whatisadd.net
- http://www.adda-sr.org/reading/Articles/mooreinattentive.htm
- http://www.addresources.org/?q=reading_material
- http://www.child-1st.com/new_site/index.html Educational materials specifically designed for children with ADD
- http://www.psychnet-uk.com/readers_articles/adhd_general.htm