ADHD predominantly inattentive
(ADHD-I) is one of the three subtypes of Attention-deficit hyperactivity disorder
While ADHD-I is sometimes still called Attention Deficit Disorder or 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).
Differences from other ADHD subtypes
ADHD-I is different from the other subtypes of ADHD in that it is characterized primarily by inattention, easy distractibility, disorganization, procrastination, forgetfulness, and lethargy
, but with less or none of the symptoms of hyperactivity
or impulsiveness typical of the other ADHD subtypes. Children with ADHD-I are usually not diagnosed nearly as early as children with other ADHD subtypes, possibly because their lack of hyperactivity symptoms may make their condition less obvious to observers. These children are at greater risk of academic failures and early withdrawal from school. Teachers and parents may make incorrect assumptions about the behaviors and attitudes of a child with undiagnosed ADHD-I, and may provide them with frequent and erroneous negative feedback
(e.g. "you're irresponsible", "you're lazy", "you just aren't trying", etc.). The more intelligent inattentive children may realize on some level that they are somehow different internally from their peers; however, they are unfortunately 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 and 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
, 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-I were found to have these symptoms, this only occurred with the absence of hyperactive symptoms. These distinct symptoms were erroneously described as sluggish cognitive tempo (SCT).
Some experts, such as Dr. Russell Barkley, argue that ADHD-I is so different from the other ADHD subtypes that it should be regarded as a distinct disorder. Barkley cites different symptoms among those with ADHD-I -- particularly the almost complete lack of conduct disorders and high-risk, thrill-seeking behavior -- and markedly different responses to stimulant medication.
allows for diagnosis of the predominantly inattentive
subtype of ADHD 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 of time (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.
A requirement for an ADHD-I diagnosis is that of the symptoms that cause impairment must have been present before seven years of age and symptoms must be present 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.)
Examples of observed symptoms
- Failing to pay close attention to details or making careless mistakes when doing schoolwork or other activities
- Trouble keeping attention focused during play or tasks
- Appearing not to listen when spoken to
- 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
- Procrastination, inability to begin an activity
- Difficulties completing household chores
- Often making careless mistakes when having to work on uninteresting or difficult projects
- Often having difficulty keeping attention during work
- 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
- Often distracted by activity or noise
- Often having problems remembering appointments or obligations