How ADD (Inattentive Type ADHD) Looks a Lot Like Learning Disabilities
Problems with organization, focus, and time management often point to inattentive-type ADHD (aka ADD). But learning disabilities can be easily overlooked. Here’s how to tell what’s behind the symptoms.
A child or adult with attention deficit hyperactivity disorder may be diagnosed with one of three types of ADHD:
- ADHD – Combined Type means that the individual is hyperactive, inattentive, and impulsive
- ADHD – Hyperactive-Impulsive Type means that the individual is hyperactive and impulsive
- ADHD – Inattentive Type (aka ADD) means that the individual is only inattentive.
It is not difficult to understand what behaviors go with being hyperactive or impulsive. But what does inattentive mean?
ADHD Inattentive Type: What Does ADD Look Like?
The guidelines listed in the Diagnostic and Statistical Manual of Mental Disorders-V — used to establish whether a child or adult has inattentive ADHD — requires the clinician to identify at least six behaviors out of nine.
One of the nine behaviors listed refers to being distracted by external stimuli (sounds or visual stimuli). Another refers to difficulty sustaining attention. The remaining seven describe difficulties related to the concept of executive function — the ability to conceptualize a task, plan how to carry it out, and complete it in a timely way. (These problems can also be thought of as difficulties with organization and planning your time.) Thus, a child or adult who had difficulties with executive function alone could meet the criteria to be identified as having inattention.
When ADHD Medication Doesn’t Work
Sometimes difficulties with inattention significantly improve when an ADHD stimulant is used.
Often, though, medication does not fully address these organization and time-management problems, and additional help is needed: special-education tutoring for the child or, for an adult, working with an ADHD coach who specializes in organization.
It is important for the parent of a child with inattention, as well as for an adult who is experiencing the same problem, to understand the potential causes and how they dictate the most effective treatment.
Parents must understand the ways that symptoms of inattentive ADHD may impact their child. For instance, organization and time-planning problems might also cause academic difficulties — in retaining what is read and organizing one’s thoughts to write a paper.
Inattentive ADD: Case Studies
When I asked Jane, a mother of three children, who suspected she had ADHD, to talk about her symptoms, she told me the following story. “I go upstairs to collect the laundry,” she said. “At the top of the steps, I look into a bedroom and see something that needs to be done. I do it. Then, I remember the laundry, but I notice something else and stop to do that. The laundry never gets collected.”
After further questioning, Jane described a history of inattention. She was distracted by anything she saw or heard. She couldn’t manage household chores and her three children. She was never on time, and she often forgot what needed to be done each day.
I confirmed a diagnosis of inattentive-type ADHD, and I placed Jane on a stimulant. Her life changed. On medication, she could complete tasks without being distracted by other activities. Her life was organized.
Jessica, a tenth grader, was a more complicated case. She had struggled in school since eighth grade, and she was now in serious academic trouble. After a psycho-educational evaluation at school, it was found that she had above-average intellectual ability, but her processing-speed and working-memory scores were below average.
The school suspected she had inattentive-type ADHD. Jessica saw her pediatrician, and was started on a stimulant. Her focus improved, but her academic performance did not. That is when Jessica’s parents asked me to evaluate her.
I discovered that Jessica had been a good student until seventh grade. She had more difficulty keeping up with assignments and completing her work each year. While she comprehended the material, she didn’t retain what she read. She appeared to understand lectures, but she couldn’t organize her thoughts well enough to write them down in a paper.
“I just stare at the page and nothing comes out,” she said. Adding to these difficulties was the fact that she often forgot to write assignments down.
I re-read Jessica’s psycho-educational evaluation. Her educational difficulties were not addressed at the school conference. Instead, most professionals concluded that she had ADHD. Yet educational testing showed her trouble with retaining what she read and organizing her thoughts. It was not clear to me that she had ADHD. It was clear that she had learning disabilities. I suggested special-education tutoring, and encouraged the school to provide accommodations. The medication was stopped. Her grades slowly and steadily improved.
What do these two stories show? Both women had organization and time-planning problems. Jane’s problems were secondary to inattentive-type ADHD. She responded beautifully to a stimulant medication. Jessica, on the other hand, had organizational problems that resulted from learning disabilities. She needed special-education interventions. Some children or adults have both problems, and require medication and coaching or special education services.
The Right Help for ADD or LD
Some school professionals are too quick to interpret symptoms of inattention and problems with executive function (specifically, organization and time planning) as ADHD.
In fact, many school evaluation teams focus on the findings that support an ADHD diagnosis. Your family physician might use these results as evidence for prescribing medication. This is well and good if the medication significantly improves the child’s inattentive symptoms. But what if it doesn’t? Be aware that symptoms might stem from learning disabilities, which require a different treatment plan.
What about adults? Say, you’ve been diagnosed with inattentive-type ADHD, take a stimulant, and work with an organizational coach. If these don’t help, chances are, you have a learning disability. Think back to your school days: Did you struggle with academics? Do certain “academic” tasks — math on an expense report, say — complicate your career and life? If so, you may benefit from a special education-focused intervention. It is never too late to get help.
What Are the Symptoms of Inattentive ADHD?
- Often fails to give close attention to details, or makes careless mistakes in school or at work
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish school work or chores
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (homework or filing paperwork)
- Often loses things necessary for tasks or activities
- Often easily distracted by extraneous stimuli
- Often forgetful in daily activities
Larry Silver, M.D., is a member of ADDitude’s ADHD Medical Review Panel.