ADHD predominantly inattentive

Overview
ADHD predominantly inattentive (ADHD-I or ADHD-PI) is one of the three subtypes of Attention-Deficit Hyperactivity Disorder (ADHD). While ADHD-PI is commonly referred to as Attention Deficit Disorder (ADD) without hyperactivity, the terms "ADD" and "attention-deficit disorder" are no longer recognized in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

Differences from traditional ADHD
ADHD-I is different from the other subtypes of ADHD in that it is characterized by inattention, daydreaming and lethargy, but with little to none of the hyperactivity, impulsiveness or conduct disorders typical of the other three ADHD subtypes ("ADHD predominantly hyperactive/impulsive", "ADHD combined", and "ADHD not otherwise specified."). It is less studied and less understood than ADHD with hyperactivity because those with ADHD-I are not as disruptive or active as those with "standard" ADHD and are less likely to be diagnosed.

There has been some debate as to whether all adults who meet the ADHD-I criteria should in fact receive that diagnosis. It has been noted frequently that hyperactive children will lose some or all of their hyperactive symptoms as they get older while retaining inattentive and impulsive symptoms. Some researchers have suggested that these former hyperactive children should receive the ADHD-combined diagnosis. Hallowell and Ratey (2005) suggest 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-I were found to have these symptoms, this only occurred with the absence of hyperactive symptoms. These distinct symptoms were described as sluggish cognitive tempo (SCT). There is some debate if those with SCT symptoms may be a homogeneous grouping. It has been estimated that approximately half of those with ADHD-I can be better described as having SCT symptoms.

Some experts, such as Dr. Russell Barkley, argue that ADHD-I is so different from "traditional" ADHD that it should be regarded as a distinct disorder. Barkley cites different symptoms among those with ADHD-I -- particularly the almost complete lack of conduct disorders and high-risk, thrill-seeking behavior -- and markedly different responses to stimulant medication.

DSM-IV criteria
The DSM-IV allows for diagnosis of the predominantly inattentive subtype of ADHD 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:


 * 1) Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
 * 2) Often has trouble keeping attention on tasks or play activities.
 * 3) Often does not seem to listen when spoken to directly.
 * 4) Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
 * 5) Often has trouble organizing activities.
 * 6) Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
 * 7) Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
 * 8) Is often easily distracted.
 * 9) Is often forgetful in daily activities.

A requirement for an ADHD-I diagnosis is that of the symptoms that cause impairment must have been present before seven years of age, and symptoms 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.)

Examples of observed symptoms
Children


 * Failing to pay close attention to details or making careless mistakes when doing schoolwork or other activities
 * Trouble keeping attention focused during play or tasks
 * Appearing not to listen when spoken to
 * 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


 * Often making careless mistakes when having to work on uninteresting or difficult projects
 * Often having difficulty keeping attention during work
 * 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
 * Often distracted by activity or noise
 * Often having problems remembering appointments or obligations