Don't throw Inattentive ADHD Out with the Bath Water


The American Psychiatric Association (APA) is furiously working to improve the ADHD diagnosis in the DSM, the Diagnostic and Statistical Manual of Mental Disorders. As the February 2013 date for the publication of the fifth edition approaches, questions regarding what they will do with the definition of Inattentive ADHD abound. An article in the Journal of Abnormal Psychology offers a simple solution.

The authors of the paper suggest that people in the subclasses of ADHD, that is, the Predominantly Inattentive type, Combined type and Hyperactive type, all have the core symptoms of ADHD, namely inattention, impulsive behavior and hyperactivity. These core symptoms cause impairments in social, academic, adaptive and occupational functions but the disease for everyone with this diagnosis is a just a matter of the degree or amount of each of these symptoms that they suffer from. The authors state, "Nearly all differences among the... subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes."

This is close to what Russell Barkley, PhD has lectured about in the past. People with Inattentive ADHD, he has said, are mostly people with Combined type ADHD with low levels of hyperactivity and impulsive behavior. There is no Inattentive ADHD, the people that are inattentive and sluggish have a different diagnosis that will be called, in the DSM-V, Sluggish Cognitive Tempo.

I have argued in the past that there are people with normal levels of activity (not sluggish or hyperactive) and normal levels of impulsive behavior that are predominantly inattentive and that the focus, in the psychiatric community, on mainly treating the hyperactivity and impulsive symptoms of ADHD detracts funds, scientific research and focus from research into the causes and treatment of inattention.

There is plenty of research that indicates that people with Inattentive ADHD have different challenges from people with combined type ADHD. I have stated before that, I believe, the inattention of ADHD-PI is not a distracted inattention but rather an internal '"lost in your own private Idaho" spaciness.

The Combined type of inattention is different. That inattention is what I describe as a "too distracted to pay attention" inattention. I believe that people with Inattentive ADHD (ADHD-PI) lapse inappropriately into the Brain's Default Mode (BDM). This is the same area of the brain that makes the elderly forgetful and gets them in trouble. Neurologist are only now learning more about the BDM and what in our inattentive brains makes this area more active than is good for us.

I do not see how changing the DSM to define ADHD as people on a continuum of abnormal levels of hyperactivity, impulsive behavior and inattention does much to improve our understanding and treatment of inattention. The solution offered to improving the DSM-V ADHD definition in this Journal of Abnormal Psychology article is simple but, in my opinion, that is about the only good thing that you can say about it.

Validity of DSM-IV Attention Deficit/Hyperactivity Disorder Symptom Dimensions and Subtypes.

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