ADHD predominantly inattentive (ADHD-PI or ADHD-I) is one of the three subtypes of Attention-deficit hyperactivity disorder (ADHD). While ADHD-PI is sometimes still called attention deficit disorder or ADD by the general public, these older terms were formally changed in 1994 in the new Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).
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ADHD-PI is different from the other subtypes of ADHD in that it is characterized primarily by inattention, easy distractibility, disorganization, procrastination, forgetfulness, and lethargy (fatigue), but with less or none of the symptoms of hyperactivity or impulsiveness typical of the other ADHD subtypes.[1] These children are at greater risk of academic failures and early withdrawal from school.[2] Teachers and parents may make incorrect assumptions about the behaviours and attitudes of a child with undiagnosed ADHD-PI, and may provide them with frequent and erroneous negative feedback (e.g. "you're irresponsible", "you're lazy", "you don't care/show any effort", "you just aren't trying", etc.).[3]
The more intelligent inattentive children may realize on some level that they are somehow different internally from their peers; however, they are unfortunately also likely to accept and internalize the continuous negative feedback, creating a negative self-image that becomes self-reinforcing. If these children progress into adulthood undiagnosed or untreated, their inattentiveness, ongoing frustrations, and poor self-image frequently create numerous and severe problems maintaining healthy relationships, succeeding in postsecondary schooling, or succeeding in the workplace. These problems can compound frustrations and low self-esteem, and will often lead to the development of secondary pathologies including anxiety disorders, mood disorders, and substance abuse.[2]
It has been suggested by Patricia Quinn,[1] among others, that some of the symptoms of ADHD present in childhood appear to be less overt in adulthood. This is likely due to an adult's ability to make cognitive adjustments and develop coping skills minimizing the frequency of inattentive or hyperactive behaviors. However, the core problems of ADHD do not disappear with age.[2] Some researchers have suggested that individuals with reduced or less overt hyperactivity symptoms should receive the ADHD-combined diagnosis. Hallowell and Ratey (2005) suggest[4] that the manifestation of hyperactivity simply changes with adolescence and adulthood, becoming a more generalized restlessness or tendency to fidget.
In the DSM-III, sluggishness, drowsiness, and daydreaming were listed as characteristics of ADHD. The symptoms were removed from the ADHD criteria in DSM-IV because, although those with ADHD-PI were found to have these symptoms, this only occurred with the absence of hyperactive symptoms. These distinct symptoms were erroneously described as sluggish cognitive tempo (SCT).
Some experts, such as Dr. Russell Barkley,[5] argue that ADHD-PI is so different from the other ADHD subtypes that it should be regarded as a distinct disorder. Barkley cites different symptoms among those with ADHD-PI—particularly the almost complete lack of conduct disorders and high-risk, thrill-seeking behavior—and markedly different responses to stimulant medication.
The DSM-IV allows for diagnosis of the predominantly inattentive subtype of ADHD (under code 314.00) if the individual presents six or more of the following symptoms of inattention for at least six months to a point that is disruptive and inappropriate for developmental level:
A requirement for an ADHD-PI diagnosis is that of the symptoms that cause impairment must be present in two or more settings (e.g., at school or work and at home). There must also be clear evidence of clinically significant impairment in social, academic, or occupational functioning. Lastly, the symptoms must not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder).
| Life Period | Example |
|---|---|
| Children[6] | Failing to pay close attention to details or making careless mistakes when doing school-work or other activities |
| Trouble keeping attention focused during play or tasks | |
| Appearing not to listen when spoken to (often being accused of "daydreaming") | |
| Failing to follow instructions or finish tasks | |
| Avoiding tasks that require a high amount of mental effort and organization, such as school projects | |
| Frequently losing items required to facilitate tasks or activities, such as school supplies | |
| Excessive distractibility | |
| Forgetfulness | |
| Procrastination, inability to begin an activity | |
| Difficulties completing household chores | |
| Adults[7] | Often making careless mistakes when having to work on uninteresting or difficult projects |
| Often having difficulty keeping attention during work, or holding down a job for a significant amount of time | |
| Often having difficulty concentrating on conversations | |
| Having trouble finishing projects that have already been started | |
| Often having difficulty organizing for the completion of tasks | |
| Avoiding or delaying in starting projects that require a lot of thought | |
| Often misplacing or having difficulty finding things at home or at work | |
| Disorganized personal items (sometimes old and useless to the individual) causing excessive "clutter" (in the home, car, etc.) | |
| Often distracted by activity or noise | |
| Often having problems remembering appointments or obligations, or inconveniently changing plans on a regular basis |
Recent studies indicate that medications approved by the FDA in the treatment of ADHD tend to work well in individuals with the predominantly inattentive type. These medications include two classes of drugs, stimulants and non-stimulants. Stimulants are divided in first-line medication and second-line medications. The former with a lower response rate and lower effect size and the latter with a higher response rate.[8] Some of the most common stimulants are Methylphenidate (Ritalin), Adderall and Vyvanse.
Although medication can help improve concentration, it does not cure ADHD-I and the symptoms will come back once the medication stops. Moreover, medication works better for some patients while it barely works for others.[9]
Also, behavioral therapy is recommended together with medications to improve organizational skills, study techniques or social functioning.
There has been anecdotal evidence that dietary changes such as reducing food additives, colorings and sugars may be a useful treatment, however, there is no evidence from trials to support this information.[10]
Many people report excellent results using medical cannabis for treating ADHD and some research supports this treatment. [11][12]
A recently funded study at the Mount Sinai AD/HD Center, supported by grants from the National Institutes of Health (NIH) will examine the use of functional Magnetic Resonance Imaging in identifying unique patterns of brain activation in children with ADHD-PI.[13]
Parents are recommended to learn about this disorder in order to first be able to help themselves and then their children.
Behavioral strategies are of great help and they include creating routines, getting organized, avoiding distractions (television, video and computer games especially on weekdays during homework), limiting choices, using goals and rewards, ignoring behaviors.[14]
Since ADHD kids are extremely disorganized, parents should have specific places for everything and teach kids to use calendars and schedules. Parents are also advised to get children into sports to help them build discipline, confidence, and improve their social skills. Physical activity boosts the brain’s dopamine, norepinephrine, and serotonin levels and all these substances affect focus and attention. However, some sports may be too challenging and would add frustration. Parents should talk to their children about what kinds of sports or exercise most stimulate and satisfy them before signing them up for classes or enrolling them in a given team sport.[15]
It is very important to establish close communication with the school[16] in order to develop an educational plan to address your child’s needs. Accommodations in school such as extended time for tests or more frequent feedback from teachers are also beneficial for these individuals.[17]
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