WWK08 ADHD Predominantly Inattentive Type

8/14/2019 WWK08 ADHD Predominantly Inattentive Type

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www.help4adhd.org 1-800-233-4050

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W H A T W E K N O W

AD/HD PedoinantInattentive Tpe

For more than 100 years, extremely hyperactive

children have been recognized as having behavioral

problems. In the 1970s, doctors recognized that those

hyperactive children also had serious problems with

paying attention. Researchers in the 1980s ound that some children had severe

problems in paying attention, but little or no problem with hyperactivity at all.

Tats when they started talking about two types o Attention Decit Disorder:

with or without hyperactivity.1

CONfusINg lAbEls fOr AD/HD

In 1994 the name o the disorder got changed in a way that is conusing or many

people. Since that time all orms o attention decit disorder are ocially called

Attention-Decit/Hyperactivity Disorder aer which a comma appears. Aer

the comma, a subtype is specied:

Predominantly Inattentive ype or someone with serious inattention

problems, but not much problem with hyperactivity/impulsive symptoms;

Combined ype or someone with serious inattention problems and serious

problems with hyperactivity and impulsivity; or,

Predominantly Hyperactive/Impulsive ype or someone with serious

problems with hyperactivity/impulsivity, but not much problem with

inattention.

Even though these are the ocial labels, a lot o proessionals and lay people use

both terms: ADD and AD/HD. Some use those terms to designate the old

subtypes; others use ADD just as a shorter way to reer to any subtype.


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What We KnoW 8 ad/hd predominantly inattentive type

INATTENTION symPTOms

In the DSM-IV, the diagnostic manual o the American

Psychiatric Association, there is a list o nine symptoms

o inattention problems.2 Almost everybody has some

diculty with some o these sometimes. Persons who

qualiy or a diagnosis o AD/HD have at least six o

these nine symptoms and suer signicant impairment

as a result. Tis means that daily unctioning in two or

more o the ollowing areas is signicantly disrupted:

school, work, amily or social interaction.

Oen ails to give close attention to details or makes

careless mistakes in schoolwork, work, or other

activities

Oen has diculty sustaining attention in tasks or

play activities

Oen does not seem to listen when spoken to directly

Oen does not ollow through on instructions and

ails to nish schoolwork, chores, or duties in the

workplace (not due to oppositional behavior or ailureto understand instructions)

Oen has diculty organizing tasks and activities

Oen avoids, dislikes, or is reluctant to engage in

tasks that require sustained mental eort (such as

schoolwork or homework)

Oen loses things necessary or tasks or activities

(e.g., toys, school assignments, pencils, books, or

tools)

Is oen easily distracted by extraneous stimuli

Is oen orgetul in daily activities

Because the DSM-IV diagnostic criteria were originallydesigned or children, the ollowing questions have

been developed rom those criteria by the World Health

Organization3 to ask adults about whether they suer

rom AD/HD inattention symptoms:

1. Do you oen make careless mistakes when you have

to work on a boring and dicult project?

2. Do you oen have diculty keeping your attention

when you are doing boring or repetitive work?

3. Do you oen have diculty concentrating on what

people say to you, even when they are speaking to you

directly?4. Do you oen have trouble wrapping up the nal

details o a project, once the challenging parts have been

done?

5. Do you oen have diculty getting things in order

when you have to do a task that requires organization?

6. When you have a task that requires a lot o thought,

do you oen avoid or delay getting started?

7. Do you oen misplace or have diculty nding

things at home or at work?

8. Are you oen distracted by activity or noise around

you?

9. Do you oen have problems remembering

appointments or obligations?

Individuals who have signicant chronic impairmentrom six or more o these symptoms are likely to have

AD/HD i they also meet certain other criteria or

diagnosis that are specied in the DSM-IV.

ds b bs w s

ss ss?

Yes, these symptoms o inattention are characteristic o

everyone sometimes. Only persons who have signicant

impairment most o the time rom these symptoms

warrant a diagnosis o AD/HD. I someone currently

has signicant impairment rom at least six o these

inattention symptoms and little or no hyperactive or

impulsive symptoms o AD/HD, they are likely toqualiy or diagnosis as having AD/HD, predominantly

inattentive type. An individual can have little or

no impairment rom any hyperactive or impulsive

symptoms and still ully meet DSM-IV diagnostic

criteria or AD/HD.4

W s ws c c, bu

s ss w?

I someone is currently impaired by at least six o these

inattention symptoms and at least six o the hyperactive/

impulsive symptoms, they are likely to qualiy or the

diagnosis o AD/HD, combined type. I they experienced

sucient impairment rom hyperactive and/or impulsive

symptoms when they were younger, but now are

impaired by inattention symptoms o AD/HD with little

or no problem with hyperactivity, the current diagnosis

would be AD/HD, predominantly inattentive type. It

is common or hyperactive children to become less

hyperactive as they get older; or those with AD/HD, the

some children [have] severe

problems in paying attention,

but little or no problem with

hyperactivity at all.


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inattentive symptoms tend to persist and may become

more impairing as the person encounters the challenges

o adolescence and adulthood.5,6

a ss ad/hd cs?

a s ss g ?

No, though the inattention symptoms must be

chronically impairing or a diagnosis o AD/HD, thisdoes not mean that they are constant in everything the

person does. Everyone with AD/HD has a ew types

o activity in which they are able to unction quite well

without much trouble rom their usual inattention

symptoms. Tey might be able to concentrate very well

when playing a avorite sport or video game. Tey might

be good at maintaining ocus or a long time when

watching V shows they like, doing art or building Lego

models.

When asked why they can pay attention so well or these

avored activities and not or other important activities,

such as school or work, they oen explain that they

can pay attention easily on activities that are interesting

to them, but cannot make themselves pay attention to

tasks that do not really interest them, even when they

know it is important. Tis makes it look like AD/HD is a

willpower problem, but that is not the case.4

C s b s s ad/hd?

Yes, AD/HD has nothing to do with how smart a person

is. Some individuals with AD/HD have very high IQ

scores, others score in the average range, and others

score much lower. Oen individuals with AD/HD who

are very bright are not recognized as being impaired with

AD/HD symptoms. eachers and parents and clinicians

oen think they are just being lazy or unmotivated or

bored.7

W c s w

ad/hd b cgz gs?

Children who have AD/HD with hyperactivity are

usually recognized and diagnosed in preschool or

early elementary school grades, especially i they are

disruptive and dicult to manage. Most individuals

with AD/HD, predominantly inattentive type are not

recognized until later when parents or teachers noticethat they are having a lot o diculty staying ocused

on tasks, or remembering what they have read, or in

keeping up with their work in school, homework or tasks

at home. Sometimes these inattention symptoms are not

noticed until a student gets into middle school or high

school where they must deal with multiple teachers and

many dierent classes and assignments daily.8,4

C s ad/hd,

b gs u

scs us cg wk

sg ?Yes, sometimes a persons AD/HD impairments have

been blamed on laziness or lack o motivation or many

years. Until recently, very ew teachers, psychologists or

other doctors had been taught to recognize symptoms o

AD/HD, predominantly inattentive type. Oen parents

recognize their own AD/HD impairments only aer they

become more amiliar with the disorder as their child

has been diagnosed with AD/HD. o qualiy or AD/

HD diagnosis, at least some o the AD/HD symptoms

should have been present sometime in childhood or

adolescence, even though they may not have been

recognized at the time.9,5

C gs w ad/hd, s jus

b s?

Studies show that or every three boys diagnosed with

AD/HD there is at least one girl who has the disorder. In

adult samples the ratio o males to emales is almost one

to one. It appears that girls are oen overlooked because

they tend to have AD/HD, predominantly inattentive

type more oen than the combined type. Tis means

that girls with AD/HD are less likely to be recognized

as having AD/HD because oen they are not being

disruptive enough to call attention to themselves.10,11

hw s ad/hd,

gs?

Tere is no one blood test, psychological test,

computer test nor brain imaging test that can make the

diagnosis o AD/HD o any type. Adequate evaluation

requires a comprehensive clinical assessment done

AD/HD has nothing to do with how

smart a person is. Some individuals

have very high IQ scores, others

score in the average range, and

others score much lower.


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by a psychologist, psychiatrist, pediatrician or other

proessional trained to recognize AD/HD and other

learning or psychiatric disorders that may mimic or

accompany AD/HD. Te evaluation should include

an intensive clinical interview with the child or adult

suspected o having AD/HD. For children or adolescents,

parents should be included in the interview and

inormation rom past and present teachers should bereviewed. In addition, or all ages, a medical examination

is important to rule out possible medical causes or

AD/HD symptoms.7,12,13

For adults, it is usually helpul to include a spouse,

riend or someone else who knows the individual

well. In addition to the interviews, standardized rating

scales or AD/HD and DSM-IV diagnostic criteria or

AD/HD should be utilized; there should also be careul

screening or other possible disorders, especially learning

disorders, anxiety and depression. As with children,

there should be a medical examination to rule outpossible medical causes or AD/HD symptoms. Tis

is especially important or adults who may have more

medical problems and may be taking more prescriptions

that might cause AD/HD-like symptoms.7,5

W s usu u c

us w

ad/hd?

Until recently, most o the research on AD/HD

treatments was done only on children or adults with

combined type AD/HD. More recent studies that

included predominantly inattentive type indicatethat medications approved by the U.S. Federal Drug

Administration (FDA) or treatment o AD/HD tend

to work well or a substantial majority o those with

predominantly inattentive type.14,15 Details about these

medications and the careul medical management

they require are included in the What We Know #3,

Managing Medication or Children and Adolescents

with AD/HD and What We Know #10, Managing

Medication or Adults with AD/HD.

In addition to medication, anyone with AD/HD

also needs education or themselves and their amily

about AD/HD and its treatment. Some individuals

with predominantly inattentive type also benet rom

accommodations in school such as extended time

or tests or more requent eedback rom teachers.

Behavioral interventions to improve organizational skills,

study techniques or social unctioning are also helpul

or some. For others, careully managed medication

and education about AD/HD may be sucient. Most

individuals with AD/HD, predominantly inattentive type

unction quite well when they are receiving appropriate

treatment.16,17,18

rEfErENCEs

1. Lahey, B.B., & Carlson, C.L. (1991). Validity o the

diagnostic category attention decit disorder withouthyperactivity: a review o the literature.J. Learning Disabilities24 (3), 110-120.

2. American Psychiatric Association (2001). Diagnostic andStatistical Manual o Mental Disorders, Fourth Edition, extRevision. Washington, DC, American Psychiatric Press.

3. World Health Organization (2003). Adult Sel-Report Scaleor ADHD. www.-int/en/.

4. Brown, . E. (2000). Emerging Understandings o AttentionDecit Disorders and Comorbidities. In Attention DecitDisorders and Comorbidities in Children, Adolescents andAdults. . E. Brown, Ed. Washington, D.C., American

Psychiatric Press: 3-55.5. Weiss, M, Hechtman, L.., & Weiss, G. (1999): ADHDin Adulthood: A Guide to Current Teory, Diagnosis andreatment. Baltimore, Johns Hopkins University Press.

6. Biederman, J., & Mick, E., et al. (2000). Age-Dependent

Decline o Symptoms o Attention Decit HyperactivityDisorder: Impact o Remission Denition and Symptom ype.American Journal o Psychiatry 157(5), 8-15-818.

7. Barkley, R.A. (1998): Attention-Decit HyperactivityDisorder: Handbook or Diagnosis and reatment. New York,Guilord Press.

8. Brown, . E. (1995). Dierential Diagnosis o ADD vs.ADHD in Adults. In A Comprehensive Guide to Attention

Decit Disorder in Adults. K. G. Nadeau, Ed. New York,Brunner/Mazel: 93-108.

9. Millstein, R. B., & Wilens, .E., et al. (1997). PresentingADHD symptoms and subtypes in clinically reerred adultswith ADHD.J. Attention Disorders 2(3), 159-166.

10. Nadeau, K. G., & Littman, E.B., et al. (1999). UnderstandingGirls With AD/HD. Silver Spring, MD, Advantage Press.

11. Biederman, J., & Mick, E., et al. (2002). Infuence oGender on Attention Decit Hyperactivity Disorder inChildren Reerred to a Psychiatric Clinic.American Journal oPsychiatry 159(1), 36-42.

12. American Academy Child Adolescent Psychiatry (1997):

Practice Parameters or the Assessment and reatment oChildren, Adolescents and Adults With Attention-Decit/Hyperactivity Disorder.Journal o the American Academy ChildAdolescent Psychiatry ; 36(10 Supplement):085S-121S

13. American Academy o Pediatrics (2000): ClinicalPractice Guideline: Diagnosis and Evaluation o the ChildWith Attention-Decit/Hyperactivity Disorder. Pediatrics;

105(5):1158-1170


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14. American Academy o Child & Adolescent Psychiatry(2002): Practice Parameter or the Use o StimulantMedications in the reatment o Children, Adolescents and

Adults.Journal o American Academy o Child and Adolescent

Psychiatry; 41(2 Supplement):26S-49S

15. American Academy o Pediatrics (2001): ClinicalPractice Guideline: reatment o the School-Aged ChildWith Attention-Decit/Hyperactivity Disorder. Pediatrics;

108(4):1033-1044

16. Dendy, C. A. Z. (1995). eenagers With ADD: A ParentsGuide. Bethesda, Woodbine House, Inc.

17. Brown, .E. (2000).Attention-decit Disorders andComorbidities in Children, Adolescents, and Adults. Washington,D.C.: American Psychiatric Press.: 537-568.

18. Pner, L. (2003). Psychosocial reatment or ADHD-Inattentive ype.ADHD Report11, 1-8.

Te inormation provided in this sheet was supported by Grant/Cooperative Agreement Number R04/CCR321831-01 rom theCenters or Disease Control and Prevention (CDC). Te contentsare solely the responsibility o the authors and do not necessarily

represent the ofcial views o CDC.

Tis sheet was approved by CHADDs Proessional AdvisoryBoard in September 2004.

2004 Children and Adults with Attention-Decit/Hyperactivity Disorder (CHADD).

For urther inormation about AD/HD or CHADD,

please contact:

n rsuc C ad/hd

C aus w

a-dfc/hc ds

8181 Prfssil Plc, Sui 150

Ldvr, MD 20785

800-233-4050

www.4.g

Pls ls visi ChaDD Wb si

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WWK08 ADHD Predominantly Inattentive Type