Misunderstanding of Inattentive ADD by Everyday Health Expert

An expert at the website Everyday Health has misunderstood and misrepresented the diagnosis of Inattentive ADD.  This website recently asked a panel of ADHD experts to answer the questions that were most frequently asked of their ADHD health editors.  

The experts largely did a superb job of clearing up the myths and misunderstandings of ADHD but one expert's answer to a question regarding the Inattentive subtype of ADD was so wrong that it made me want to scream at my computer.

Let me first say that the Everyday Health question and answers were, overall, a good read.  It was interesting to read how the experts responded to several questions regarding stimulant use. They were pretty much in agreement that the stimulants were safe but they were divided on the question of whether stimulants were over prescribed. I totally agree with 95% of the answers that were given and even agree with the experts that the stimulants are over prescribed to certain populations and under prescribed to others who may benefit from stimulant therapy.

The question, however, that interested me the most was a question about Inattentive ADD. Most of the experts when asked the question of why some kids with ADHD had no hyperactivity simply gave a definition of the Inattentive type of ADD or they explained how historically the subtypes came to be defined. One respondent, however, set out to explain why, in his opinion, a distinction between the Inattentive subtype of ADHD and the Hyperactive/impulsive subtype of ADHD was diagnostically and
therapeutically not important.

This is what Dr. F. Allen Walker had to say about the Inattentive subtype of ADD, "I find almost all of my (ADHD) patients have varying levels of hyperactivity, depending on how one perceives hyperactivity. Hyperactivity can be expressed both internally and externally. " Dr. Walker goes on to say, "Girls have the tendency to express their hyperactivity more internally through hair twirling, fidgeting with buttons on their shirt, tapping their feet or pencil... Boys express their hyperactivity with less self-discipline. In other words, they struggle to stay seated in their chairs. Quite frankly, I don't feel
the differentiation is diagnostically or therapeutically important."

His response is incorrect in several respects. Lets starts with, 'all my patients have varying levels of hyperactivity' and 'hyperactivity can be internal and external'. I suppose that if you redefine hyperactivity as being whatever the heck you want it to be then yes, everyone will have varying degrees of it.

ADHD hyperactivity and Impulsive behavior are clearly defined in the DSM IV, the psychiatric diagnostic manual, and people with symptoms of Inattentive ADD do not have varying degrees of those symptoms. Inattentive ADD is seen in boys and girls, and in men and women who are, according to the DSM-V, not internally, externally, metaphysically, metaphorically, existentially or in any other way, hyperactive.

On a completely different (but no less off base) note, the notion that the hyperactivity of ADHD is a self discipline issue is ridiculous. Hyperactive people with ADHD, whether they are boys or girls, men or
women, do not get out of their chairs because of a lack of self discipline, they get out of their chairs because their condition makes them biologically incapable of remaining seated.

A distinction must be made between Inattentive ADD and the other subtypes of ADHD because people with Inattentive ADD:

  • Respond differently to medication treatment and can, on occasion, become more sluggish and hypo-active when treated with stimulants and because patients with the Inattentive subtype of ADHD may require a lower dose of stimulant medication to achieve an optimal treatment response.
  • Have good symptom improvement (compared to the marginal improvement seen in the other subtypes of ADHD) from non-pharmaceutical interventions such as Cognitive Behavioral Therapy (CBT) and brain training programs such as neuro bio-feedback. The reason for this may be that these programs better address the working memory and motivational deficits that are more problematic for people with Inattentive ADD.
  • Do not develop and do not need remediation for the adverse life outcomes (substance abuse and law enforcement problems) that are more often seen in people with the other subtypes of ADHD because people with Inattentive ADD are less likely to have a co-existing conditions conduct or oppositional disorder.
Inattentive ADD is diagnostically and therapeutically different from the other subtypes or ADHD and, with all due respect to Dr. Walker, differentiating between these subtypes is essential for an appropriate
ADHD diagnosis and treatment.

Everyday Health has, overall, done a great job of compiling commonly asked ADHD questions and soliciting respected experts for answers. If you get a chance you should check out all the questions and answers at the Everyday Health website.  The response to the Inattentive ADD question can be found at this link.

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