By Rev. Carlene Appel, MDiv., PC, SC, CERC, CISM, CTP, CDCS, CCFP, CGP
Today, I want to bring attention to a problem that affects mainly girls, and impacts their ability to learn in classroom settings. With the help of the editors of ADDITUDE, the on-line and printed journal of “Strategies and Support for ADHD & LD,” let's talk about Inattentive ADHD.
If I mention the word ADHD in regard to children (and actually adults too), how would you describe them?
The usual understanding is a kid who is hyper, and these kids are most often the first to be evaluated and diagnosed with ADHD. However, there are actually 3 types. INATTENTIVE ADHD is the second type. Those will be mainly the girls in the class quietly staring out the window at the Monarch butterfly that just
landed on a tall milkweed in the schoolyard. Meanwhile their schoolwork is on their desk in front of them not done.
The National Institutes of Mental Health says the symptoms in these kids have a greater likelihood of going unrecognized by parents, teachers, and medical professionals. I suspect it may be because they are the quiet ones. Let’s face it, what parent, especially those with other children who are bouncing off the walls with with energy, doesn’t appreciate having a kid who’s calmer. And what teacher doesn’t appreciate having a few kids in class that they don’t have to focus as much attention to. Pediatricians rely on parents input when assessing their patients. So if nothing is mentioned as a concern by the parent, then something is likely to be missed. As a result, the kids rarely get diagnosed or treated in the beginning as they are starting to struggle with the unrecognized symptoms. That struggle turns into frustration with schoolwork, apathy, and undeserved shame that can last for somebody’s whole life.
That’s not right to have these kids fall through the cracks. So I am hoping that parents, teachers, pediatricians who are listening out there, will think about your kids, your students, your patients who might be fit the profile of those who are silently suffering because of Inattentive ADHD. Let me stress that not all kids who appear to have vast amounts of energy or are shy and quiet have some form of ADHD.
There are perfectly normal kids just being kids. Some are loud some are not. Some are noisy, some are quiet. Let’s resist the urge to pathologize every single behavior. For example, a lot of renowned therapists including David Kessler, the world's foremost authority on grief as well as a grieving parent himself, are raising concerns about the DSM6 pathologizing what is really just normal grief and rightly objecting. There is a big difference between ADHD and normal kid behavior. ADHD interferes with a child’s ability to learn and retain learning and carry out activities of daily living also called Executive Functioning. ADHD can carry into adulthood. In fact, as I’ve done formal assessments for my adolescent clients, I recognized myself and it’s been helping me to understand why there are some executive tasks like time management that I have struggled with for as long as I can remember.
Here's the 3 ways that ADHD presents itself:
1. Predominantly Hyperactive/Impulsive: this is the stereotypical “hyper”person. Can’t sit still, won’t shut up, & are like an IndyCar motor when the driver floors it.
2. Predominantly Inattentive: Marked inability to focus or pay attention, not hyperactive.
3. Combined: The person has both problems paying attention and impulsiveness.
DIAGNOSING INATTENTIVE ADHD
Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
o Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
o Often has trouble holding attention on tasks or play activities.
o Often does not seem to listen when spoken to directly.
o Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
o Often has trouble organizing tasks and activities.
o Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
o Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile tele
o Is often easily distracted
o Is often forgetful in daily activities.
Diagnosing ADHD in Adults
ADHD often lasts into adulthood. Unfortunately, it’s often mistaken for anxiety or depression. To diagnose ADHD in adults and adolescents age 17 years or older, only 5 symptoms are needed instead of the 6 needed for younger children. Symptoms might
look different at older ages. For example, in adults, hyperactivity may appear as extreme restlessness or wearing others out with their activity.
Here's how the 9 symptoms might look “in the wild” as the ADDitude editors call it.
1. Careless mistakes-Children rush through quizzes missing questions she or he knows the answers to or skipping whole sections just to finish. Adults might not proofread documents or emails, causing unwanted attention & embarrassment. If you tell yourself to slow down & pay attention, it’s mentally painful & physically uncomfortable to do. Your brain aches to jump to the next thing and it wins.
2. Short attention spans- Children have unfinished classwork, half-done art projects, incomplete reading assignments.. Adults hate boring work meetings 10x more than their co-workers. They need to chew gum, sip coffee, stand during the meeting just to keep paying attention. Unable to make it through long documents, stay focused, or complete projects.
3. Poor listening skills- Students understand only half or less of verbal instructions given to them. Notebooks filled with more doodles than notes, may need to record and listen several times to lectures to absorb all the info. Adults at parties interrupt others stories to tell one of their own, don’t remember names, zone out halfway through a conversation. Someone may ask “weren’t you listening?”
4. No follow-through- what's common to children and adults alike is they start projects and just never complete them
5. Disorganization- Does your kid's room, or/and your home, your ride, or your office look like the Tasmanian Devil paid a visit? There's a lot of chores that the average person has to tend to as it is with all the demands on our time. For the inattentive adult, normal ADLs (Activities of Daily Living) frequently overwhelm them and they may just give up trying. The shame can be paralyzing as they often compare their homes and lives to others.
6. “Laziness” or “Apathy” "She could focus if she just tried harder." "She's irresponsible, always late for meetings and paying out the invoices." Inattentive symptoms make us look lazy or not caring, particularly if ADHD is either undiagnosed or no one knows due to our feelings of shame. Untreated we end up often losing jobs and friends or becoming bitter as a defense mechanism. If people have called you lazy for as long as you remember, it can become a self-fulfilling prophecy if we end up believing them.
7. Bermuda Triangle Syndrome- We all misplace things from time to time like glasses, keys, cellphones, and notebooks. People with inattentive ADHD misplace those things and more of those essentials needed every day. Do you need a "launch pad" by the door so that you don't forget your keys or laptop and need a locator device on your phone or key ring? If so, it may be an indicator.
8. Distractibility- Adults who have Inattentive ADHD are dreamers-you'll find doodling in our notes at a big meeting, or our minds wander when people are talking to us or asking about something important. Sometimes we're labeled "Space Cadets"because it's difficult to focus or we quickly lose interest in what is being said--people lose patience with us because we can't pay attention, especially if it's something urgent and important.
9. Forgetfulness- Adults with Inattentive ADHD frequently miss things like doctor appointm''ents,, or don't show up for a lunch date with a friend, or join a conference call 45 min. late. All because they forgot about it. Paying bills, returning calls, sending out birthday cards, and filing taxes on time is a struggle for us. People might judge us as being irresponsible, rude, or lazy, but 99.9% of the time we're not intentionally doing it.
If you are recognizing yourself in the above characteristics, help is available
For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHDexternal icon and the National Institutes of Mental Healthexternal icon.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
Content source: National Center on Birth Defects and Developmental Disabilities
It was during my doing formal assessments for my adolescent clients that I recognized myself. It was with mixed feelings I accepted it. More so in some ways it felt like the dam broke and flooded me with relief. Suddenly I was understanding why time management, constant tardiness, and sloppy handwriting are things I have struggled with for as long as I can remember. Now, I am slowly incorporating accommodations and Medication is one route. There are also numerous non-medicated accommodation strategies are available on ADDitude.com online journal and I've found a ton of resources on Instagram.
Perhaps the best part for me is knowing I'm not alone in the struggle and that we're not doomed to continue doing it for the rest of our lives. My hope is that if Inattentive ADHD is something you are struggling along with like me, this blog has been encouraging and birthed a sense of hope in you. Please leave comments in the space below if so.
Remember God Loves You and so do I.