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“Why Are We Still Failing Kids with Inattentive ADHD?”

“We are still relying on research done years ago on white, hyperactive boys. There are few studies and fewer insights on girls and women. Likewise, children with inattentive ADHD (formerly called ADD) continue to fly under the radar. Why?”

I left the world of ADHD, where I had been the founder and director of the now-defunct non-profit organization ADD Resources, more than 15 years ago. Then, during the pandemic, I began writing a memoir about living with ADD and so dove into updating my knowledge. What I learned dismayed me.

We are still relying on research done years ago on white, hyperactive boys. There are few studies and fewer insights on girls and women. Likewise, boys and girls with inattentive ADHD (formerly called ADD) continue to fly under the radar.

Why? Recent articles offer the same old explanation from decades ago: Children with inattentive ADHD are under-diagnosed because they are not disruptive in the classroom. In 15 years, we haven’t progressed. We still provide the same unacceptable explanation for failing to help these children. Some clinicians have sounded the alarm, but their clarion calls haven’t penetrated the public or teachers’ understanding that ADHD presents in two distinct ways — with and without hyperactivity.

To prevent from children from falling through the cracks, the public, parents and teachers need to realize that both ADHD presentations require urgent diagnosis and treatment.

I have a few suggestions that might help.

[Could Your Child Have ADD (aka Inattentive ADHD)? Take This Test]

1. Elevate Inattentive ADHD: Whenever someone writes or talks about ADHD, they should first talk about the inattentive symptoms, stressing how this form of ADHD is under-diagnosed and how this needs to change because undiagnosed ADHD negatively impacts young lives. They should describe how inattentive ADHD symptoms may be recognized by parents and teachers. When I asked Dr. Hallowell if inattentive ADHD could be identified in children, he readily said, “Yes. You just need to question them about how they spent their time in school, how their day went, what they learned.”

2. Children with Inattentive ADHD are typically not aggressive; they are not bullies; and they usually aren’t disrespectful of authority or overly stubborn. In describing ADHD behaviors, speakers and writers should clearly delineate hyperactive symptoms from inattentive symptoms. When the behaviors are combined or confounded, parents or teachers of a child with inattentive ADHD may say, “That doesn’t describe my child or student.”

3. In describing inattentive symptoms, speakers and authors often say this presentation is more commonly observed in girls. To increase awareness, we need to stress that inattentive ADHD exists in boys as well as girls. I know because I have a son with inattentive ADHD.

4. We need research that separates hyperactive-impulsive or combination ADHD from inattentive ADHD. Most research lumps all forms of ADHD together, though they are not the same.

[Read: “Are You Listening?” What Inattentive ADHD Looks Like — and Responds To]

5. Knowledge and understanding about the differences is improving, but more progress is needed. If you share my concern about the under-diagnosis of children with inattentive ADHD, visit iadhd.org, the website of the non-profit organization, the Inattentive ADHD Coalition. Together, we will find ways to make a lasting difference.

ADD Symptoms: Next Steps


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3 Comments & Reviews

  1. I would love to see some additional information regarding Inattentive ADHD and Giftedness. My daughter was identified gifted at age 7 and experience significant problems once she started high school. She was ultimately diagnosed with Inattentive ADHD at age 30 after struggling for years to understand why she couldn’t preform at the same level as her peers. As parents we could have done so much more to support her if we had known. She was very good at masking her struggles as a teenager and it was only as an adult that she decided to address her challenges due to debilitating anxiety attacks and self-esteem issues.

  2. Cynthia, with all due respect, and this is also coming from lives experience of ADHD (diagnosed as inattentive), I am firm in my belief that there is no such thing as ADHD without hyperactivity – and in fact I think that the current DSM-V division into ‘predominant presentations’ instead of ‘types’ goes a small way to addressing that, but in an insubstantial and inadequate way.
    So, I am diagnosed ‘inattentive presentation’ but I am FAR from ‘not hyperactive’, and every other adult with ADHD that I have met, all of whom are also ‘inattentive presentation’ have a road to Damascus moment of realisation when I explain my observation.
    I’ll explain myself, and also why I see a complete change of the DSM categorisation as important – because there is harm being done by it.
    So here it is: cognitive hyperactivity, hyperactivity of thought is endemic in ADHD. It’s invisible though, so difficult for third parties to verify, and not as awkward as physical hyperactivity for third parties… not ‘in your face’… but it is where much of the torment of ADHD ends up coming from.
    If we think about it – intense activity provides upwards regulation of our dopamine neurotransmitter circuits, and that includes mental activity just as much as physical activity. We hear simplistic expressions of that as the ‘dopamine hit’ from running or playing… or gaming or listening to loud, exciting music. Physical and cognitive activity provides regulation of dopamine, and consequently norepinephrine neurotransmitter circuits.
    That provides a really elegant explanation for our ’hyper’ activity – it is our body’s systems attempting to self-regulate those neurotransmitter circuits, but we aren’t capable of doing that by activity alone, so it is unceasing hyperactivity, like a hamster on a wheel, intense activity but getting nowhere.
    SO – for me there is no distinction between physical and cognitive hyperactivity, but for others looking on at ADHD there is, they can’t see most of the hyperactivity, they can only see where some ADHD individuals, mostly young, mostly males have BOTH presentations.
    This is why ADHD medications address the level of uncontrollable, intrusive cognitive activity. It is why the right drug quietens our minds.
    Sometimes the simplest constructs are the best.
    So, why is this important?
    Like you said – underdiagnosis. Awareness that intrusive, repeated thoughts about tangible, real things that are actual or predicted IS NOT anxiety (Generalised Anxiety Disorder) to be treated with ‘anxiety medication’ like an SSRI, it is likely to be hyperactivity… and ADHD should be investigated.
    Also – outcomes for children. I met a parent that described her 6 year old son and his ADHD diagnosis the other day, and she stated he had been diagnosed ‘inattentive type’ (‘type’ is 2013 obsolete DSM-IV description, so wtf doctor?) so he is ADD and not hyperactive. I listened and asked her to describe him, and I asked some more questions about things he does, like how he appears to think, his patterns. When I described my construct above she had a lightbulb moment – she identified many of his behaviours and how he articulates his thoughts as hyperactive, and then she realised that HE CAN’T CHOOSE NOT TO HAVE THAT HYPERACTIVITY so many of those things, which he has been told not to do, punished and disciplined for, now need to be placed under the umbrella of his medical condition and supported, not punished, and treated with medication just as much as his inattentive traits. That mother-child relationship abd that lad’s relationship with himself and the world just improved a whole lot! Win.
    We absolutely need to change the narrative.

  3. It’s not just ADD/ADHD – it’s also kids with other intellectual issues. My Long Island school district gets lots of funding for special ed – yet the education special ed kids there get is a joke. District super told parents one night that it’s OK if your kids get to high school unable to read or write. Summer school for catching up was not allowed. Some teachers simply did not believe in the idea of special ed – no, those kids were bad kids, not kids needing properly trained teachers and more effort.

    I only learned, like so many others, that I had ADD because my kids were diagnosed. Because I didn’t get help with it, it caused me lots of problems. So I wanted to do better by my kids. But our school district didn’t care.

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