Inattentive ADHD is Different

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Inattentive ADHD is Different

Those of us who have Inattentive ADD or have children with Inattentive ADD know that we and our kids behave fundamentally differently from people who have Hyperactive or Combined type ADHD.  To me, ADHD Inattentive feels different to the core but until fairly recently not everyone even believed the symptoms of Inattentive ADHD were different from the symptoms of Combined Type or Hyperactive Type ADHD.

Fifteen years ago Russell Barkley was the first ADHD researcher to speak of  the difference between the three types of ADHD and in the last few years other ADHD researchers have taken a deeper look.  Scientists are finding biological, even cellular differences between the ADHD types.

The researchers of a new study that was published last month in the Journal Frontiers in Molecular Neuroscience found chromosomal differences between ADHD children of different types.  The researchers performed a study where they looked at a piece of genetic material called a telomere in nine year old kids with ADHD.  What they found was that the length of the telomere was shortened in the Combined type kids but not in the Inattentive kids. 

You have maybe heard of telomeres.  What are they?  In short, telomeres are chromosomal "caps".  Like a the plastic cap at the end of our shoe laces, our telomeres keep our DNA filled chromosomes from unraveling. .

To further the biology lesson...  Our DNA contains the codes that make our bodies work. Our Chromosomes are made of DNA molecules that are wrapped  with proteins and then capped  with telomeres to keep the DNA from unraveling.  The cap or telomere is important because unraveled DNA does not work properly. Telomeres shorten as we age but stress, depression, illness, poor nutrition, lack of exercise and other life style factors  (drug and alcohol use, smoking), speed up their shortening. 

I always wonder when I read studies such as this one about the "chicken and the egg" questions.  Do kids with Combined type ADHD have shortened telomeres because they were born that way or does the stress of having Combined type ADHD (and all the co-conditions that go along with that diagnosis such as depression, etc) cause their telomeres to shorten?

I also wonder about nutrition and exercise.  Lots of studies have shown that we can protect the length of our telomeres by eating better, being at a normal weight and exercising. Might this be the reason that diet and exercise have been found to be beneficial for the treatment of ADHD?

Genetics plays a huge role in ADHD.  We know that ADHD is very inheritable and that other genetic components also contribute to the condition.  I have written a post on one of these components, Epigenes, that gives further insight on the importance of genetics and the environment as it relates to ADHD symptoms.

There is much more to learn about the differences between the ADHD types.  Any study or research work that furthers our knowledge of this condition is helpful to our overall understanding.  It is exciting to me that the pace of research into this topic appears to be quickening!

Telomere length is highly inherited and associated with hyperactivity-impulsivity in children with attention deficit/hyperactivity disorder.


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I receive emails from parents regularly. I often get emails regarding inattentive symptoms in very young school age children.  The parents of these 4-6 year old children are writing to ask if the fact that their child does not pay attention when he/she is sitting "criss-cross applesauce" during story time, while writing his/her alphabet letters endlessly on a worksheet or while doing various math or reading drills is normal.

I want to scream at my computer. 'YOUR CHILD DOES NOT HAVE INATTENTIVE ADHD, YOUR CHILD IS FIVE YEARS OLD', but I do not.  The sad fact is that many of these spaced out five year olds, will be space out 4th graders and the parents that are writing me are doing so because they know their child and they know that the child's level of spaciness goes beyond an inability to write the letter 'C' on lined paper, 30 times.

I could go on an on about the stupid demands that most school's place on Kindergartners but instead I want to address the fact that most parents know well before there is an official diagnosis, that their child's inattention is a problem and that. as a parent, once you become concerned about your child's inability to focus, it is time to:

A. Figure out how out of the normal range your child's lack of attention is.

B. Alert the child that focus an attention are skills that take practice but that can be learned (before a teacher or anyone else decides that they are nothing but an inattentive mess).

C. Forge a plan to teach attention skills.

D. Be your child's biggest fan and love them for all the other great skills and talents that make them who they are.

To give you an example of what might happen to an inattentive five year old once they get to a kindergarten classroom, I would like to post part of a letter I received (the writer has granted me permission to do so), and my response.

"My five year old son just started Kindergarten. He went to a small preschool where there were only 10 kids to a classroom and though he was shy and quiet, he was a favorite of the teachers as he just loved to quietly observe everything around him and they found him easy and smart. He learned to read, in preschool, when he was four and he now reads better than most first graders...  

He is a dawdler and it often takes him 3 hours to complete a chore that could have been done in 5 minutes.  He is obedient at home and at school and despite the fact that he is slow, spacey and a procrastinator, he is otherwise a creative, funny, insightful and delightful kid.

I am writing because my problem is his new school. Since he started Kindergarten his teacher has been calling me almost weekly to report that he does not pay attention, that he wonders around the classroom when he should be sitting "criss-cross applesauce", that he is slow to complete assignments and that they are worried about him socially because, for example, when he is on the playground he does not play, he just sits and watches the older kids play and the teachers talk...

I have started using a timer to make him aware of his dawdling and I have started to try to make him understand the 'new rules of Kindergarten'...

I am concerned with all the teacher calls, can you give me some advise as to what else I might do?"

I get a variation of this letter at least once a month. My response:

Thanks for your email. Your son sounds like a sweetheart and it sounds as though you are doing all the right things. With your continued support and guidance his procrastination, dawdling, organization and attention will improve. 

My suggestions would include having him start walking or doing some kind of daily exercise, having him set some of his own goals to accomplish something HE wants and show him how the steps of that goal get performed in a timely way.

 He is only 5, at this point you have to teach timeliness. I used timers a lot because my son had no internal clock and needed an external one to help him.

He will continue to need lots of organizational support and charts, cues, routines, etc will be more and more important as he ages. 

His classrooms and teachers will need to have in place written and accessible assignments and deadlines. Many schools are using Schoology a program that keeps students and parents abreast of upcoming projects and homework. Some system, such as that, will be helpful so that you can help him help himself.

He will do great. Ages 5 to 7 are tough as are the start of middle school and high school. The good news is that once they reach middle school you will have been coaching him so long, the two of you as a team will be seasoned pros and will know exactly how to tackle the rising challenges.

Keep the faith and keep me posted.

Have a great summer, Please keep your letters coming! I love hearing from you. 

BTW, I wanted my readers to know that I have two articles in the Summer edition of Additude Magazine which I hope you will read and enjoy!