8 Essential Things to Know About ADHD-Primarily Inattentive Type

NASET ADHD SERIES

By Cynthia Hammer

Special Education Teachers:

Test Your Knowledge of ADHD (of the Inattentive Type).

Then read the article to learn which ones you got right.

1.         Medication for ADHD should be taken only as a last resort              True    False

2.         Boys always have the hyperactive type of ADHD                             True    False

3.         We all have a bit of ADHD so it is not a serious problem.                True    False

4.         Too many children are unnecessarily diagnosed with ADHD           True    False

5.         ADHD results from poor parenting                                                   True    False

6.         Children with ADHD are rarely outstanding students                       True    False

7.         Most children outgrow their ADHD symptoms by 18.                       True     False

8.         To Identify students with learning challenges and to provide           

appropriate accommodations is not a school’s responsibility.                     True      False

Often people form opinions that are not based on facts.  This article includes only facts, information based on research, which might challenge opinions you have about ADHD, its causes, manifestations, and treatments.  If you read something that differs from what you believe, I hope you will reconsider your beliefs.

ADHD is a chronic neurodevelopmental condition that is largely genetic in nature.  Although each child’s brain is as unique as his fingerprints, children with ADHD have small variations in their brain chemistry and structure that differ from neuro typical children. Most children are born with ADHD and continue to have it throughout their lives. It does not result from poor parenting although environmental factors can lessen or exacerbate its symptoms. 

There are two common types of ADHD—Combined and Inattentive. With the Combined Type, a child is hyperactive, impulsive and distractible.  Children with the Combined Type are typically diagnosed by age seven as disruptive children are noticed and get help. 

Children with the Inattentive Type are usually introverted, shy and dreamy, not paying attention in class, but not causing a disturbance.  If the child is committed to being a good student, he or she may never come to your attention. 

If the child is quiet and gets good grades, is his inattentive ADHD still a problem?   Why be concerned if children with inattentive ADHD have been, and continue to be, under-diagnosed?

The answers to these questions comes from adults, who discover at age 25, 45, 65 or even 85, when finally diagnosed with inattentive ADHD, that they lived, unnecessarily, greatly diminished lives. They were hampered in using their full range of abilities, and they experienced more failure than their peers.  Fewer of them graduate from college, and if they do, it often took additional years. They have less successful professional lives and earn significantly less income. More of them have failed relationships.  Their low self-esteem leads them to pair with anyone willing to be with them or their procrastination, forgetfulness, and tardiness drives their partners and friends away. 

Studies show that an ADHD diagnosis is associated with poor health outcomes including obesity, accidental injuries of all types, substance use, and comorbid psychiatric disorders. The diagnosis increases the risk of exposure to traumatic events and victimization and suicide attempts and completions. Their lifespan, on average, is twelve years less than those without ADHD. Early diagnosis and treatment of ADHD mitigates these dire outcomes.  CHADD-Health-Outcomes-White-Paper_8-5-21-FINAL.pdf

Someone with inattentive ADHD tends to be:

•           Easily pulled off course, forgetful, and inattentive.

•           Disorganized mentally and physically, making careless mistakes, and not paying close attention to detail.

•           Forgetful of one or more items when an assignment requires multiple items.

•           Resistant to undertake tasks that are boring or require significant mental energy.

They have:

•           Difficulty organizing their work, setting priorities, planning out a strategy, and remembering to complete all required tasks.

•           Difficulty organizing their things and are often sloppy.

•           Trouble keeping track of their belongings and forgetting where they put them, in part because they rarely put things away.

•           Trouble holding multiple things in mind, which can make arithmetic calculation, reading, or abstract problem solving difficult.

www.ncbi.nlm.nih.gov/pmc/articles/PMC1474811/;

Think how a child’s or adult’s life is impacted by these behaviors which occur all day, every day. Ponder how these behaviors reduce their opportunities for success. 

Children with undiagnosed inattentive ADHD grow up with frequent criticism by parents and others who don’t understand the child’s behaviors and get frustrated or angry. Here are some examples:

“I’ve told you “X” times already. How do you not remember? It’s like you don’t care.”

“You’re just being lazy. You need to do better. You aren’t trying!”

“You never listen to me. You should have planned this out better.”

“You lost XYZ again? Why can’t you just remember where you put it?”

“Anything that starts with “You should’ve…” or “If you had…”or “Why don’t you…..”

Dr. William Dodson, a psychiatrist who has treated adults with ADHD for over 30 years, says, “It’s common for those of us with ADHD, from childhood to adulthood, to feel like failures for not meeting the expectations of our parents, friends, teachers, and others. When children hear and sense these negative comments, they start to internalize them. They begin to view themselves and the world through these hurtful and harmful comments.”

Professor Philip Asherson of the Institute of Psychiatry Psychology and Neuroscience, Kings College London, states, “With younger children it is really important to think about their self-esteem. Difficult children often get difficult reactions from parents and teachers. They’re being told off all the time. This can instill a very negative self-view of life. Then, when older, for example, they’re much more likely to become an anxious or a depressed adult. Being very positive and supporting somebody in a positive way is really important to instilling a positive, long-term outcome for [children with ADHD].”

When the child with undiagnosed inattentive ADHD becomes an adult, she brings her challenging behaviors to the workplace.  How valued an employee will she be when she is frequently late for work or when she submits her work late and with numerous errors or she doesn’t understand the assignment and spends time on irrelevant activities or she doesn’t listen when spoken to?

Meanwhile, the belittling comments or the rolled eyes of coworkers, friends and family continue.  The child or adult feels different without understanding why or how. Her low self-esteem and self-confidence continue to suffer and often metastasize into the comorbid conditions of depression and anxiety.  Whatever dreams she had for her life slowly erode as, time after time, she under-performs. 

Some, however, go in the other direction and accept nothing less than perfection. They expend significant energy masking their deficits. They believe being perfect is the only way they will be accepted. They exhaust themselves, struggling to keep their personal challenges and failures hidden from the world. 

They make a good impression but lose touch with themselves and feel like a fraud. No one can see or know who they really are. Successful undiagnosed adults suffer from their striving, expending twice the effort to obtain a similar result.  Their low self-esteem makes them believe they are worth less than others.

“I have a very high IQ that was tested when I was in school, and I can compensate but, as a consequence, I am burnt out, exhausted, tense and snappish. It’s like being a sprinter with a piano tied to my back who still competes in the race. Sure, I can do it, but I’m wrecked after I get to the finish line in a way that the other participants aren’t.”

“I sometimes wonder how much faster I would be without the weights holding me down. I do my best not to think that way, but it is difficult not to wonder sometimes.”

“I am at the point where I am trying not to be angry at how unfair it is that I have to have the metaphorical piano tied to me. It’s hard. My peers don’t see how hard I have to work to compensate and I hear all the time that everything “comes so easily” to me. Oh. Buddy. If you only knew.”

Believing they have abilities they aren’t using, without understanding why, is the tragedy of undiagnosed inattentive ADHD.  Getting diagnosed is a relief, “Now I understand and can work to improve my life”—and a sorrow, “Now I understand and am sad my life has been less than it could have been.”  Many say that having ADHD isn’t the problem. Not knowing they had ADHD was the problem. Like any medical condition, until you understand what you are dealing with, you flounder; but once your condition is known and understood, you can set a course correction.  

Following a diagnosis of inattentive ADHD, the course correction for adults includes medication and developing new habits and behaviors.  For elementary and middle school–aged children the American Academy of Pediatrics recommends FDA–approved medications along with parent training and behavioral classroom interventions.

A large-scale treatment study by the National Institute of Mental Health (NIMH) study assessed the safety and effectiveness of ADHD medications.  It provides evidence that stimulant medication reduces hyperactivity and impulsivity, improves attention, and increases the ability to get along with others. For this reason, stimulant medications remain the medications of first choice for treating individuals with ADHD.

Professor Philip Asherson says, “When you get the medication correct–the right medication and the right dose– what it’s actually doing is boosting the function of the brain. That’s why the medications are called stimulants. They enhance brain function. It seems that parts of the brain are not functioning as efficiently as they should and the medications enhance the efficiency of the brain. Medications enable those with ADHD to be better at doing things, and they give the child or adult more control and regulation.”

According to Dr. Russell Barkley, numerous studies indicate that not only are stimulant medications safe for children, but that they are beneficial (neuro-protective) if started at an early age. Evidence based on 30+ studies supports the notion that stimulant medications appear to promote brain development and that the ADHD brain may proximate that of neuro-typical children with early and continued intake of stimulant medication.  https://www.youtube.com/watch?v=HYq571cycqg

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There is likely one or more children in a typical classroom with probable inattentive ADHD.  By identifying these children and initiating help for them, you will change the course of their lives. 

Teachers are well positioned for this detective work because you see children in a structured environment where the inattentive ADHD is more apparent. You are trained in normal child development and know what behaviors aren’t age-appropriate. You can spot behaviors that are outside the norm.

In addition, you are empowered by the Child Find mandate of national Individuals with Disabilities Education Act that “requires all school districts to identify, locate and evaluate all children with suspected disabilities, regardless of their severity. This includes children who earn passing grades.”  www.wrightslaw.com/info/child.find.mandate.htm

Perhaps your school has used the Connor’s Rating scale and believe that is an adequate tool for identifying these children, but for too many years these children have gone undiagnosed.  That is why we created the Child Questionnaire as it provides more guidance on what behaviors to watch for. The hyperactive type of ADHD maybe over-diagnosed; but the inattentive type has been under-diagnosed. Until teachers learn what to look for, they won’t “see” the children in their classrooms with inattentive ADHD.  By distributing the Child Questionnaire and explaining its importance to the teachers in your school, you will help them “see” these children in their classrooms and get them the help they deserve.

Now, back to the eight statements that began this article and to find out how well you scored.  The correct answer to each item is False. 

About the Author

Cynthia Hammer was diagnosed in 1992 when she was 49 years old. To educate other adults about ADHD, she founded and ran the non-profit ADD Resources for 15 years. During Covid isolation she wrote a memoir about living with Inattentive ADHD and spent time relearning information about ADHD.  She was dismayed to learn that children with inattentive ADHD continued to be under-diagnosed.  In March, 2021 she founded the Inattentive ADHD Coalition. (www.iadhd.org)  As a small non-profit the Board decided we should focus on one thing, educating elementary school personnel about inattentive ADHD.  By sharing this article and questionnaire you will help us. 

CHILD’S NAME____________________________TEACHER__________________________DATE_____________

Check all behaviors that occur to a more severe degree and/or greater frequency than for other children. If a child has checkmarks in five or more areas, suggest the parents talk with their child’s pediatrician. 

Fails to give close attention to details.    ? Has careless mistakes in schoolwork  ? Makes mistakes from not reading questions properly  ? Leaves questions unanswered   ? Overlooks or misses details  ? Work is often inaccurate  ? Leaves the reverse side of a test unanswered  ? Not checking the answers in homework  ? Too much time is needed to complete tasks    Has trouble maintaining attention on tasks.   ? Easily distracted  ? Needs structure to avoid being distracted  ? Difficulty staying focused during instruction or conversations  ? Difficulty keeping attention on schoolwork*  ? Difficulty concentrating* ? Easily bored*       *Unless the subject is really interesting     Does not seem to listen when spoken to directly.   ? Not knowing what teacher said  ? Often has to be addressed a second time  ? Questions have to be repeated  ? Only listens during eye contact or when a voice is  ? Mind seems elsewhere, even without obvious distractions   ? Dreamy or preoccupied    Loses items necessary for tasks and activities.  ? Loses school materials, pencils, books, or other items  ? Mislays homework  ? Spends a lot of time searching for things  ? Gets in a panic if other people move things around    Is frequently distracted.  ? In the classroom, often looks outside  ? Easily distracted by noises or events  ? After being distracted, has difficultly returning to work

Avoids/dislikes tasks requiring sustained mental effort.   ? Avoids schoolwork or dislikes it  ? Avoids subjects that require concentration ? Avoids tasks that require concentration  ? Often postpones boring or difficult tasks.  ? Reads few books or doesn’t like to read    Has trouble organizing for tasks and activities.  ? Difficulty being ready on time  ? Arrives late to activities  ? Poor sense of time  ? Fails to meet deadlines  ? Does things in a muddled way  ? Difficulty planning tasks or homework  ? Difficulty keeping materials and belongings in order  ? Messy desk   ? Difficulty playing alone  ? Difficulty keeping himself/herself entertained    Is forgetful in daily activities.  ? Forgets instructions  ? Forgets to do assigned tasks  ? Has to be frequently reminded of things  ? Part-way through a task, forgets what to do  ? Forgets to bring necessary items to school  ? Leaves items needed for homework behind at school   ~~~~~~~~~~~~    This questionnaire is provided as a public service by the    non-profit organization, the Inattentive ADHD Coalition,    and alone is responsible for its contents.   Additional free copies available at  www.iadhd.org/child     Books that feature a child with inattentive ADHD Andrew’s Awesome Adventures with his ADHD Brain              by Kirsten Wilcox, Ph.D. Focused (about a girl)             by Alyson Gerber

Download a PDF Version of this Issue of the NASET ADHD SERIES –CLICK HERE

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