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May 13
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by Jess

Spotting people with Inattentive ADHD (ADHD-I) can be as difficult as finding Waldo in those busy picture books. People with ADHD-I do not stand out, blend into the setting they are in, and are perfectly happy if they are never found. Trevor is a good example.

Trevor is a quiet, well behaved, seventh grader who always sits in the back of the classroom. He rarely listens to a word that his biology teacher says, instead, he spends his time thinking about the science fiction book that he is reading. There will be a biology test in five days and he will barely pass it.

Trevor standardized test scores indicate that his intelligence is above average. His parents have long wondered how it is that this smart, shy, pleasant, 12 year old can be failing so many of his classes. His parents know that Trevor does not like school much, he has few friends and he is not especially good at sports. His only bright spot in school is English. His teachers report that he is a good writer and an excellent reader.

Predominantly Inattentive ADHD (ADHD-I) is sometimes referred to as just ADD. It was once thought to be more common in girls than in boys but researchers have come to understand that the Inattentive type of ADHD is often a missed diagnosis in both girls and boys. The Inattentive type of ADHD is a less common condition than the Combined type of ADHD (ADHD-C) and the symptoms of this type of ADHD are more ‘internal’ and less obvious than the symptoms ADHD-C.

Where people with ADHD-C are likely to be impulsive, hyperactive, extroverted, aggressive, oppositional and distracted, people with ADHD-I are, in many ways, just the opposite. They are cautious, slow, introverted, passive, obedient and spacey. Both ADHD types are inattentive but the inattentiveness of the Combined type appears to stem from distraction while the inattentiveness of ADHD-I appears to be a more “lost in their own world” type of mental fog.

People diagnosed with ADHD all under perform academically but some studies show that the inattentiveness of ADHD-I may have a particularly negative effect on academic success .Trevor’s had gone through six grades with no one giving much thought to his school underperformance but his biology teacher noticed and asked his parents to have Trevor evaluated. Trevor’s pediatrician diagnosed him as having ADHD Inattentive type in November and started him on Focalin 10mgs a day.

Unfortunately, the Focalin made Trevor feel sad and depressed. His mother brought him back to the doctor and asked if they might try some non-medication interventions. Some people with the Inattentive type of ADHD will react poorly to standard stimulant therapy and a lower dose of stimulant therapy or non-stimulant interventions sometimes improve symptoms more successfully.

The doctor asked the family to stop the Focalin and started Trevor on a regimen of Exercise, Multivitamins, Fish Oil tablets and Melatonin for sleep (Trevor’s parents reported that Trevor frequently stayed up until 1:00am). The doctor also suggested that his parents speak to the school about an Individualized Education Program (IEP). As part of his IEP, Trevor was moved to the front of the classroom and he started using a weekly planner to keep up with assignments. Trevor mom had heard that a computerized cognitive training program might help and with the doctor’s approval, he started that as well.

Executive Function problems such as disorganization, time management issues and emotional control problems commonly coexist with ADHD as do sleep problems. Melatonin, exercise, diet interventions, Fish Oil and cognitive training can sometimes help these coexisting conditions and in the process help the mental fogginess and sluggishness seen in patients with ADHD-I symptoms.

After two months, Trevor’s symptoms and grades had improved. He reported that he was more engaged in school but that he was still having focus problems in math, his least favorite class. His pediatrician started Trevor on Adderall SR 10mg and by March of his seventh grade year, Trevor had an A average in all his classes.

The diagnosis of Inattentive ADHD is often missed because the symptoms are less apparent to teachers and parents than the symptoms of the hyperactive types of ADHD. The management of ADHD-I is slightly different as ADHD and stimulants do not always work as effectively.

People with ADHD-I can get lost in the scenery and knowledgeable parents and teachers are often the first to recognize the subtle symptoms of ADHD-I. Spotting and treating these symptoms promptly is important as getting the correct diagnosis and treatment can make the difference between success and failure for children with Inattentive ADHD.

Tess Messer is the founder and editor of the award winning website Primarily Inattentive ADD. She is a practicing Physician Assistant with a Master's degree in Public Health who has written articles for ADDitude magazine, Livestrong and many other publications. Tess is the author of the book, Ten Tips to Help Inattentive ADHD Students Succeed at School and of the soon to be published, Commanding Attention, Affordable and Effective Non-Drug Help for ADHD. She and her spouse of 24 year live in Atlanta. When she is not seeing patients, she can be found fishing with her two boys on Florida's Forgotten Coast. Visit Tess at www.primarilyinattentiveadd.com


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6 Responses to “Spotting Inattentive ADHD”

  1. I can identify with this story because this is my son’s story. He also takes adderall for his ADHD-I which has helped him. I often wonder if there will be a day when he no longer has to take medicine for this? I don’t like medicating my son but I have seen great improvement in his grades and interactions socially with family and other children. I will definitely try supplementing with vitamins and minerals. I currently use melatonin on occassion but for his sister and her restlessness because I read that when giving it to a child for sleep the brain stops producing it naturally.

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  2. As a former elementary school principal, I am quite aware that attention difficulties are just the tip of the iceberg. ADHD children can’t filter out distractions, finish tasks on-time, use their memory optimally, etc.

    My wife and I can empathize with this story because our son, Alex, was diagnosed. We opted to use cognitive training for our son, Alex. We used Play Attention (www.playattention.com) and ADHD Nanny (www.adhdnanny.com). We’ve been very successful with these approaches. We also changed our parenting skills with great success. He’s a teen now and while making good grades, he also works at McDonalds.

    It’s just important to know that medicine teaches nothing. Parents and teachers must actively participate to help change a child’s life.

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    • I too have a son called Alex who is identified as ADD. Over the years we have tried numerous therapies and have seen slow improvements. We have just completed a course of neurotherapy which didn’t prove as successful as we had hoped. Will look at the websites you mention. However I am most intrigued to learn how you changed your parenting skills. I feel this is the area which would most benefit the whole family. What did you do?


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  3. This sounds exactly like my daughter. She was tested and they ruled out ADHD, but I believe she has the Inattentive ADHD. I have tried everything and just don’t know how to help her or get someone to listen.

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  4. im too ADD to finish this article

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