Shy, Autistic, Anxious, or Inattentive ADHD. The Confusion.

 When you look at this DSM-IV list of symptoms of Inattentive ADHD it is easy to see how confusing it can be to diagnose a person with this subtype of ADHD.

A person must have six or more of the following symptoms of inattention have been present for at least 6 months, in at least two settings, to a point that is disruptive and inappropriate for developmental level:

1) Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

2) Often has trouble keeping attention on tasks or play activities.

3) Often does not seem to listen when spoken to directly.

4) 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).

5) Often has trouble organizing activities.

6) 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).

7) Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).

8) Is often easily distracted.

9) Is often forgetful in daily activities

The problem with this list is that it may be useful for diagnosing adults but it is almost worthless for diagnosing children.  The reason is that the above list describes 90% of children.  Children, by the simple nature of being children, are distracted and inattentive. 

The equation is further complicated by the fact that parents and teachers have to agree.  Russell Barkley has reported that parents and teachers only agree that there is a hyperactivity, impulsivity, or inattentiveness problem in about 30-50% of all cases of ADHD.  I can guarantee you that for inattentive ADHD the incidence of agreement is even less.   The demands that are placed on children and at home are so different that a child that may be considered totally impaired by inattention by a teacher, may only seem mildly distracted to a parent.

The diagnosis becomes more complicated when you factor in the internalizing comorbidities that can accompany Inattentive ADHD such as anxiety and depression.  We all know that we can be disorganized, scattered, and off in our own world when we are depressed or anxious.  So is this anxiety or is this ADHD??  The truth is that the inattentive, anxious child is often still inattentive even when their anxiety is under control.  Yes they are more likely to be depressed or anxious but even after controlling for those symptoms, the inattention remains.

Inattentives can also appear shy or socially awkward.  The inattentive child is labeled as 'just shy' but in fact in situations when they are socially comfortable the Inattentive subtype is still distracted and spacey, in fact more so.  

There is also a considerable overlap between the symptoms of inattentive ADHD and Asberger's syndrome.  The Inattentive ADHD person sometime fails to make eye contact and is sometime socially inappropriate.  The difference is that the inattentive ADHD person is aware of the social norm and is distracted or disinterested in adhering to it, whereas the Asberger's person is unaware of the social norm.

People with Inattentive ADHD and slow cognitive tempo (SCT) may appear learning disabled and may be thought to be of low IQ.  A person who is dyslexic and inattentive may also be labeled as having a low IQ.  Striking a bull’s-eye on the diagnosis can be complicated when there are other mood, learning or cognitive issues mixed in with the inattentive ADHD.

The way I see inattentive ADHD is like this.  The person with Inattentive ADHD is most comfortable, and gains energy from being in the world going on in their mind.  That very interesting world, in their head,  can be distracting.  When I am thinking about something in my head, I am often disinterested and un-engaged with what is happening in the world outside my head.  

I see two treatment goals for those of us with inattentive ADHD.  The first is to find a way to make the inattentive's outside world interesting enough to stay in for a while, and second is to devise a set of treatment strategies, (medical and behavioral),  that will keep you on task and organized in the real world.


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  2. Some good points on inattentive ADHD. There is so much diversity and interesting variety to the ADHD condition, and the better we understand it, the better those who have it lives will be (hopefully!) =)

  3. Misty and David, Thanks for your comments. I just found your site today when I was researching writing a post on Ritalin vs Adderall. Enjoyed reading it!!


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