Inattentive or Distracted??

I found this recently published article out of the Chinese Medical Journals interesting. The findings show that children with Inattentive ADHD (ADHD-I) had the largest discrepancy between their verbal IQ and their performance IQ when they were compared to children with the Combined type (ADHD-C) or the Hyperactive/Impulsive type of ADHD (ADHD-HI). The ADHD-I children also had greatest learning impairments.

What blows me away about this study is that the Predominantly Inattentive children were the most likely to fail at school. Would it not seem more likely that if you suffered for hyperactivity, impulsiveness AND inattentiveness, as kids with ADHD combined type do, that you would be the subtype most likely to fail in school?

Do the findings of this study imply that being hyperactive and impulsive somehow gives you an advantage when it comes to school performance? Is this advantage because kids with ADHD-I are just ignored? Is this disadvantage related to the fact that the lack of attention in ADHD-I is different? Could it be that the inattentiveness in the combined type of ADHD is related to the fact that you can't attend because you are running at the mouth and running on foot and jumping into this and that and that the inattentiveness of ADHD-I is more deep seeded?

I have been thinking a lot about attention. Is inattention the same as being distracted? I think that people with ADHD-C and ADHD-HI are often distracted by their activities while people with ADHD-I are off in their own world and the word 'distracted' does not really capture what is happening to their attention.

Robert Eme, Ph.D. an ADHD researcher has described the inattentiveness of ADHD-I like this; "In ADHD-PI, the distractibility is external in that there is a failure to inhibit or block out irrelevant external stimuli." He describes the distractibility in Sluggish Cognitive Tempo (SCT) and internal and says this about the inattentiveness in SCT; "In SCT, the distractibility is internal as the mind drifts from thought to thought rather than focusing on the task."

I find Dr. Eme's insight fascinating but I would describe the inattentiveness of ADHD-C as external and the inattentiveness of ADHD-I and SCT as internal. I think that Dr Eme has described a difference in inattentiveness between two groups of people with ADHD which researchers must study as it appears, from this study, that perhaps this ‘internal’ type of inattention is more severely impairing, when it comes to learning, than the ‘external’ type of inattention.

I would love to have your comments regarding what you make of the notion of ‘internal’ vs. ‘external’ attention. Please leave a comment and let me know your thoughts.

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Clinical features of various subtypes of attention deficit hyperactivity disorders in children.

Department of Pediatrics, Shenzhen People's Hospital, Second Medical College of Jinan University, Shenzhen, Guangdong 518020, China. feiqiuwen16@hotmail.com.
Chen YZ, Wen FQ, Zhou KY, Yang CH, Zhang W, Li N.

CONCLUSIONS: The children with ADHD-C or ADHD-HI have higher incidences of comorbidities with ODD and TD than those with ADHD-I who the learning difficulties and the imbalance between VIQ and PIQ are more severe.

16 comments:

  1. My son is ADHD-I, and I would definitely describe his inattention as internal. He is quiet and reserved and often gets 'lost in his own thoughts'. I think that ADHD-I children may be most likely to fail in school because they may tend to get diagnosed later. It took me over a year of school meetings, etc. to finally accept that there was an issue because the inattention never posed much of a problem at home. It is the classroom setting that brings out the worst in ADHD-I children, and I think they often times go unnoticed or teachers may dismiss them as the child who doesn't want to try.

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  2. I think that you are absolutely right on all counts. Thanks for your comments!!

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  3. You could test this, right? You could do a task for sustained attention like a number or letter cancellation task in a room with no distractions. Then do a similar task with increasing amounts of distraction. I think the rub would be eliminating all distractions.

    I think my son is definitely a combination of internal and external distractions. Sometimes, He can have something to do but be found minutes later staring at his toenail or playing with a loop on the carpet. Is he searching for something to distract himself or did he really get distracted by an external oabject?

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  4. I do not think that anyone has done this type of study but you are absolutely right. It is probably something that could be tested! I think it probably should be as from a treatement standpoint we need to know if minimizing distractions is the issue of if the many things (that do not relate to what is going on in the here and now) that are going on in the heads of people with ADHD-PI is the issue.

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  5. I tend to agree with your assessment that a better distinction would be between people with ADHD-C being more primarily distracted by exterraneous stimuli, and both PI and SCG being more distracted by internal forces.

    I know that for myself, external distractions are only part of the larger schematic of distraction going on in my brain. I'll never forget this time I tried to study for a stats test--I locked myself in the bathroom and turned on the fan for white noise, yet had accomplished nothing--literally not a page read--when I exited a few hours later. At the same time, if there's a conversation going on within my vecinity while I'm trying to concentrate, my mind is immediately distracted by it.

    I guess it's distinction that doesn't seem to allow for clean breaks and clear lines. It's interesting to think about, though.

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  6. Did you hear about that recent study that reported that white noise is supposed to help those of us with ADHD? I like white noise but I am not sure that it makes me more attentive. Thanks for writing in!!

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  7. For most of my life I've needed the continuous hum of a fan or an air-conditioner in order to sleep. I use a fan all year round, even in the dead of winter.

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  8. It is getting cold here but I still have my fan running as well. My significant other is convinced that hot flashes must be a terrible thing.

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  9. Is needing to sleep with the bathroom fan on a sign of ADHD-PI? My 8yo daughter just got a prelim diagnosis of this, and I need the fan on to sleep! I can't have any light in the room. I'm very disorganized, late everywhere, miss appointments, yet pulled it together for Bar exams, law school finals, etc. (Even doing well, but had to clean up completely in order to focus and study.) Her ped. thought (in gathering family history) that I might have executive function issues...it's sounding quite similar to me!

    As for distraction, I can easily get distracted in my own head. I used to take notes during classes just so I would be paying attention.

    Beth

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  10. I, like you daughter, find the white noise of the fan to be comforting and do not find it to be 'externally' distracting.

    It seems that you have managed your distractions and that is fantastic. Since you have lived and succeeded managing your inattentiveness ,you will be much better able to help your daughter.

    Thanks for your comments and for reading! Tess

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  11. I wouldn't go so far as to say that I've succeeded in managing it all, lol. It's easier in some ways to be an at-home mom than working in a law firm. (I never even knew what to ask my secretary to do.) Yet, I always carry around the feeling that I'm missing something that I should be doing or that I'm late for something.

    Oh--and I'm the white noise needer! Not the kid. She can sleep anywhere!

    Both husband and I are concerned that we're too disorganized to give her what she needs, and hope the neuropsych appointment gives us specific strategies of what to do for her.

    Beth

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  12. Oddly, I'm able to sleep when there is abundant light, as when the over-head lights are on, or in broad daylight; but if it's mostly dark and there happens to be a small amount of light emanating from an electrical device in the room, I have to cover it up with a piece of clothing otherwise it will annoy me from sleeping.

    Also, a full moon gives me ferocious insomnia.

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  13. I'm with Mizmar. Can sleep in abundant light, but not with a tiny amount of light. And the full moon is also problematic.

    Beth

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  14. I sleep with the covers over my head blocking out whatever might be out there. I do not suffocate and the dark cocoon is cozy. Weird, I know.

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  15. I can sleep both with white noice and without and with or without light. But my daydreams become blurry when there is no light, so I prefer to keep it on. As for the study, I think hyperactive people can make use of their energy to do their schoolwork (if they can block the distractions). Also, they are mostly extravert. School results don't just depend on learning stuff, but also on presenting it and being able to work in teams.

    Paul

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  16. Thanks for weighing in on this. Interesting about the blurry daydreams.

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