SYMPTOMS: What signs and symptoms point to ADHD in adults?

A: If you have adult ADHD, you may find it hard to remember information, organize tasks, finish work on time… | Keep reading on WebMD »

SUBTYPES: What are the key differences between inattentive, hyperactive, and combined-type ADHD in adults?

A: The three types of ADHD are primarily hyperactive and impulsive, primarily inattentive, and combined. Each presentation is… | Keep reading on ADDitude »

INATTENTIVE: What signs of inattentive ADHD in adults are commonly overlooked or mistaken?

A: The first overlooked sign of inattentive ADHD is difficulty completing tasks. People with inattentive ADHD are… | Keep reading on ADDitude »

THE ADHD BRAIN: What should I understand about how the ADHD brain is wired?

A: The ADHD nervous system regulates attention and emotions in different ways than the nervous system in those without… | Keep reading on ADDitude »

EXECUTIVE FUNCTIONS: What should I know about executive dysfunction and its relationship to ADHD?

A: The cognitive skills that help us plan, prioritize, and execute complex tasks are commonly tied to ADHD… | Keep reading on ADDitude »

NEUROSCIENCE: How does the neurology of ADHD help explain my challenges?

A: The ADHD nervous system is rarely at rest. It always wants to be engaged in something interesting and…” | Keep reading on ADDitude »

FIRST-PERSON: “I Branded Myself a Misunderstood Freak. But It Was ADHD All Along.”

“The psychologist listened as I spoke about my life. He then gave me that look people often give when I talk at 200 mph and asked, ‘What do you do when you’re calm?’ ‘I’m never calm!’ I told him, genuinely dumbfounded by this revelation.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: ADHD IN ADULTS

Could your disorganization, poor memory, hypersensitivity, and financial struggles be due to ADHD? | Take the self-test on ADDitude »

SYMPTOM TEST: INATTENTIVE ADHD

Symptoms can show up as procrastination and difficulty sustaining attention. | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults, from WebMD x ADDitude:

> DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to my doctor?
DECISION 3: How can I improve my odds of an accurate ADHD evaluation?
DECISION 4: How can I find a professional to diagnose and treat my ADHD?
DECISION 5: What should a thorough evaluation for adult ADHD include and exclude?
DECISION 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
DECISION 8: Should I also be screened for the sleep, eating, or other disorders?

“Growing up, being undiagnosed in the ‘70s meant I learned to fidget in place. Getting up and moving wasn’t allowed. Disrupting a meeting wasn’t allowed. People say I’m not hyperactive, but if they watch me for five minutes they’ll see my feet wiggling or bouncing, my hands fiddling with something, and me changing positions constantly. I cannot be still. Ever. It’s exhausting sometimes.” — An ADDitude Reader

“As a child, my symptoms were talking loud, talking a lot, coming alive at night, and needing very little rest. At about 18, my ADHD turned inward and now it feels like this constant knot in my stomach, like I have stage fright every day. I still talk loud, and a lot, but I need a lot of rest these days.” — Emma, Australia

“The activity in my head is constant, so my body jumps from one task to another, adding more tasks to the list as I go. As I’ve gotten older, I force myself to sit down in the evenings with my husband and watch television. When he’s not around, I continue on doing — keeping busy until I drop at bedtime. Then I’m dead to the world and nothing can wake me.” — Anna, Ireland

“As a child the hyperactivity manifested mostly through impatience, the inability to sit still, and fidgeting with everything around me. I often had this ‘excited’ type of feeling inside my chest. I just couldn’t contain it and it was impossible to not move. Once I transitioned to adulthood, the hyperactivity definitely got more subtle. At times, I still have that excited feeling in my chest that forces me to abruptly walk away mid-conversation.” — An ADDitude Reader

[Free Download: Secrets of the ADHD Brain]

“ADHD feels like energy. It affects my mind, thoughts, actions, and activity level all at once. It has urgency and makes me feel anxious. I need to do things right away. It is sporadic and unorganized at the same time. I’ve always had a very active mind, and I am easily excitable. I need to do things very quickly, in bursts. The energy will fade out once I’ve hit a wall or have to go to bed. Sometimes I wish I didn’t have to sleep.” — Amy, North Carolina

“For me, hyperactivity impacts both my actions and thoughts. The morning can be a double-edged sword because I have boundless energy and intentions to get everything done, but I find it hard to settle myself down to do the things that have to be done. Much of the time that causes anxiety.” — Toni, Canada

“My hyperactivity feels like I had too much caffeine — racing heart, alertness, and an inability to say no when presented with any opportunity. I feel like I just have this internal tank that never runs out of gas. I am constantly needing to go somewhere or do something.” — An ADDitude Reader

“I want to sprint. I want to do all the things and so I do. I chat. I worry. I run. I smash out a boxing bag. I take on too much, which helps me keep all the balls in the air until I drop them all at once and need a holiday.” — An ADDitude Reader

“I was extremely hyperactive as both a child and an adult. A brain injury stopped much of my physical activity for years, and my hyperactivity became much more mental after that — I have a mind that literally never shuts off. I need to do something like reading or crosswords even while watching a TV show. Doing two things at once is a necessity.” — An ADDitude Reader

ADHD Hyperactivity in Women: Next Steps

• Read: What Happens When Hyperactivity is Trapped Inside
• Watch: How ADHD Shapes Your Perceptions, Emotions, and Motivation
• Download: Get a Grip on Tough ADHD Emotions

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What Is Maladaptive Daydreaming?

People with maladaptive daydreaming have intentional, vivid, all-consuming daydreams that interfere with their daily functioning. Individuals with inattentive ADHD have trouble sustaining focus; they are easily distracted and forgetful. Because symptoms of inattentive ADHD and maladaptive daydreaming overlap, some patients may receive incorrect diagnoses, according to a study published in the Journal of Clinical Psychology.¹

The study found that 21% of 83 participants with ADHD diagnoses also met the diagnostic criteria for MD. “In some cases [of people] presenting with ADHD symptoms, maladaptive daydreaming may better explain the clinical picture” than would an ADHD diagnosis, the study suggested, adding that improper diagnosis may have serious treatment implications.¹

Maladaptive Daydreaming vs. Inattentive ADHD

People with inattentive ADHD and MD share these symptoms:

• They get disproportionately upset by interruptions.
• They are easily distracted and seem unaware of their surroundings.
• They have trouble sleeping.

Below are more key similarities — and differences — between inattentive ADHD and maladaptive daydreaming.

Controlled Fantasy vs. Wandering Thoughts

Maladaptive Daydreaming: By engaging in purposeful, consuming daydreaming that lasts for hours on end, some individuals choose to become immersed and lost in their inner fantasy worlds. Many maladaptive daydreamers become addicted to the alternative realities they’ve created.

[Self-Test: Do I Have Adult Inattentive ADHD?]

Inattentive ADHD: Mind wandering with ADHD is unintentional, scattered, and often allows for jumping from one idea or scenario to another.

Dissociation vs. Hyperfocus

Maladaptive Daydreaming: Dissociation means deliberately detaching from one’s surroundings and body to avoid experiencing them. The dissociative nature of MD can result in neglecting short- and long-term responsibilities.

Inattentive ADHD: In hyperfocus, individuals with ADHD become intensely focused on an interest or activity for hours at a time. This can look like dissociation and cause detachment from one’s surroundings. However, hyperfocus is usually prompted by external stimuli, such as a computer game or a new interest, and it is usually spontaneous and uncontrolled.

Maladaptive Daydreaming Treatment vs. ADHD Treatment

Maladaptive Daydreaming: Some maladaptive daydreamers in the study reported their condition worsened with stimulant medications due to “enhanced focus” on the fantasies.

“The notion that maladaptive daydreaming causes ADHD-like symptoms, as a secondary effect, leads to the conclusion that addressing the addiction to daydream first would be reasonable,” wrote study co-author Nirit Soffer-Dudek, Ph.D., a senior psychology lecturer at Ben-Gurion University of the Negev, in Israel. She called for future studies to explore whether MD should be considered a mental health disorder.

[eBook: Inattentive ADHD in Adults – An Essential Guide to the Underdiagnosed, Undertreated Subtype]

Inattentive ADHD: ADHD-related mind wandering is manageable with stimulants and other medications that target focus and attention.

Overlapping Symptoms of Depression, Loneliness, and Low Self-Esteem

Maladaptive Daydreaming: Emotional distress may underlie MD, according to the research. “We do not yet have long-term longitudinal data on risk factors for maladaptive daydreaming, but there are definitely correlations with social anxiety. Many people with maladaptive daydreaming have described how it helps them escape from a harsh reality, [such as] trauma, depression, anxiety, and social anxiety,” wrote Soffer-Dudek.

Inattentive ADHD: People with both ADHD and MD were more likely to suffer from depression, loneliness, and low self-esteem, the study found. ADHD is more commonly a genetic condition and is not thought to be a direct result of trauma.

The study describes maladaptive daydreaming as an “independent mental phenomenon,” which often creates an attention deficit as a side effect. “This causes some MDers to meet the criteria for ADHD, but not necessarily vice versa.”

Maladaptive Daydreaming vs. Inattentive ADHD: Next Steps

• Read: Maladaptive Daydreaming Should Be a Diagnosis Distinct from ADHD
• Free Download: How to Pay Attention (When You’d Rather Be Daydreaming)
• Read: Why Even Parents Miss the Signs of Inattentive ADHD In Their Quiet Daydreamers

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Theodor-Katz, N., Somer E., Hesseg R.M., Soffer-Dudek, N. (2022). Could immersive daydreaming underlie a deficit in attention? The prevalence and characteristics of maladaptive daydreaming in individuals with attention-deficit/hyperactivity disorder. Journal of Clinical Psychology. 1002/jclp.23355

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists nine core symptoms of ADHD, predominantly inattentive presentation. In my practice, I have found that the following five signs are the most commonly overlooked.

5 Overlooked Signs of Inattentive ADHD

Sign #1: Difficulty Completing Tasks

The first overlooked sign of inattentive ADHD is difficulty completing tasks. People with inattentive ADHD are not lazy, stupid, unwilling, or oppositional. They are creative, outside-the-box thinkers whose minds stray from uninteresting tasks. They have a biologically based challenge with attending to an uninteresting task, maintaining their focus, and sticking with it until finished. All too often, their brains tire more quickly.

Sometimes a lack of focus doesn’t indicate a lack of interest, but it could reflect a learning disorder, a lack of clarity on what to do, or a preoccupation with something else. Sadly, it’s commonly confused with lower intelligence and general capabilities when it really reflects challenges with working memory or how someone processes information.

Inattentive ADHD Strategy

Break each task into smaller chunks to help you sustain focus. The aim is to make a task seem approachable and manageable. So, the smaller the task, the better. Before sitting down to do something – whether it’s homework, work, or chores — consider how long you (or your child) can concentrate before losing focus. Set that amount of time as your goal. Then decide how many work periods are reasonable to expect in one period. Add five-minute body, bathroom, water, or snack breaks between these work blocks. Decide on a pre-planned incentive you can earn after completing the period.

[Could You Have Inattentive ADHD? Take This Self-Test]

Sign #2: Easily Distracted

People with ADHD inattentive type are often pulled away to think about something other than the task at hand; their brains just naturally stray. I call it “Going to Bermuda.” You could be sitting in class or at your computer working. Suddenly, you drift — maybe you think about lunch, or something captures your attention, like the snowfall outside.

Many people with inattentive ADHD judge themselves negatively for this freewheeling thinking. The problem isn’t that you gaze off, but rather that, when you come back from drifting, you feel disorganized, lost, and confused. Then panic sets in, and you wonder what you missed and how to catch up.

Inattentive ADHD Strategy

If you get easily distracted and space out, identify an ally to come to your aid. Do you have someone who can share their notes or take notes for you in a class or meeting so you can just listen and not worry that you missed writing down something important? Many students with ADHD are legally entitled to a notetaker, so inquire about this for your child. If you are an adult student with this challenge, talk to the student disabilities office about possible support.

In work or social situations, identify a colleague or friend who understands ADHD and doesn’t judge you for it. Create a plan for communicating with them when you’ve gotten distracted or missed something. How can they quietly bring you up to speed? Help your child find a similar person who can help at recess or the lunch table.

[Think Your Child May Have Inattentive ADHD? Take This Symptom Test]

Sign #3: Forgetfulness

The third overlooked sign of inattentive ADHD is forgetfulness. This may be due to a deficit in working memory, which is a common challenge for people with all ADHD subtypes (inattentive, hyperactive, and combined). Working memory is a crucial executive functioning skill that acts like the computational space in your brain. It helps you retain information and perform an action on it. When something has emotional salience, it sends material into long-term memory. It also pulls up past experiences and applies them to our current situation to guide actions and thoughts.

Inattentive ADHD Strategies

We’re lucky to live in a time with a lot of available technology, alarms, sticky notes, and so on. I keep notes on my phone. Some people prefer voice memos. Technology (such as apps or gadgets) can help you remember important dates, events, and items. Use an accordion file if you tend to lose important papers because you forget where you put them. Don’t label each section all at once, but as you use it.

If you have a child with inattentive ADHD, rely on preparation. Use cues and lists that explain what needs to get done and the steps to get there. If you just tell a child to clean their room, they may not understand what that entails. If you ask a child to do multiple things at once, such as get your backpack, put on your boots, and meet me at the door, your child may only remember to put on the boots.

You want to set up children for success. To keep your child from forgetting to bring things to school, create a laminated list of items that need to go in their backpack. They can check the list before they zip up and go. Using family calendars, a daily responsibility list, or a chart is also handy. These items will trigger their memories and improve their organization and prioritization skills.

Sign #4: Trouble Listening or Following Directions

The fourth overlooked sign of inattentive ADHD is having trouble listening or following directions. What often appears to the outside world like carelessness or laziness is actually a neurological nuance of the ADHD brain.

Many people with inattentive ADHD have a slower processing speed; they get overwhelmed quickly and shut down. It takes them longer to sort through and digest information, which may look like poor listening or follow-through skills. Again, this has nothing to do with intelligence.

Inattentive ADHD Strategies

Use visual cues, banners, app notifications, a vibrating watch, or other captivating tools to re-set your focus if you drift off. For children, school accommodations such as having a notetaker or getting copies of teachers’ notes will decrease the pressure they feel about writing down everything. Giving direction with my Rule of Three technique builds working memory and improves cooperation.

1. Make eye contact (or close to it).
2. State your request.
3. Ask your child or teen to repeat your request two times.

Missing directions or social cues can be especially embarrassing. (Ever answer “Yes” to a question that was never asked?) This is when you need that buddy who understands your ADHD and can help you seamlessly re-enter the conversation or share the instructions for the class assignment. For important meetings, ask if you can record them to review any important nuggets later and write them down at your own pace. It’s often tough for adults with inattentive ADHD to take notes, follow directions and listen during meetings. Instead of fighting the disorder, work with it and figure out what will help your best.

Sign #5 Disorganization

The final overlooked sign of inattentive ADHD is disorganization. Disorganization often causes people with inattentive ADHD to feel overwhelmed. They have no idea where to begin organizing or how to engage in a productive process. Reaching the end may seem impossible. Plus, it can be very challenging for people with inattentive ADHD to keep track of stuff and they, like so many others, probably lose or misplace items more than they care to admit. Creating practical organization systems and breaking old habits that lead to piles, messes, and overwhelm can be daunting.

Inattentive ADHD Strategies

Designate a specific place for things. Where do items live? For example, I put my keys in the same purse pocket every day. Otherwise, I’ll spend ten frantic minutes each morning looking for them. What type of places — shelves, baskets, boxes, hooks — can live as “home” for your most essential items such as your phone, wallet, and backpack, or briefcase?

Second, use a self-smart system of organization. In other words, create a system that makes sense to you or your child — not according to someone else’s advice. Really consider what makes the most sense to you. For example, do you want to organize your closet by color or garment type? Do you want to hang your coat in a hallway closet or mudroom? Where should shoes, gloves, and hats live? These systems should be simple, straightforward, and logical to your ADHD brain. They may seem kooky to someone else. Don’t worry! Focus on what works for you!

Honor your efforts. It takes time, repetition and practice to build these key skills related to living with inattentive ADHD. Remember to notice and validate your completed tasks, and the effort you put forth along the way. This acknowledgment encourages kids and adults to try different strategies, regroup along the way, and feel good about themselves for their engagement.

ADHD Inattentive Type: Next Steps

• Free Download: Inattentive ADHD, Explained
• Read: What Is Inattentive ADHD? Symptoms, Characteristics, Diagnostic Considerations
• Read: Inattention and the ADHD Brain

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Attention deficit disorder (ADD) is no longer a standalone diagnosis; its telltale symptoms of disorganization, poor time management, faulty working memory, and lack of focus, among others, are now categorized as attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation, in the DSM-5. In other words, inattentive type ADHD is the not-so-new name for ADD.

Individuals with inattentive type ADHD do not exhibit the stereotypical symptoms of ADHD — namely physical hyperactivity and impulsivity. Their executive dysfunction is easily blamed on carelessness or laziness, and their social struggles may be attributed to growing pains or character idiosyncrasies. All of this contributes to a chronic problem of underdiagnosis and inadequate treatment for inattentive type ADHD, particularly in girls and women.

Inattentive ADHD: Symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists nine core symptoms of ADHD, predominantly inattentive presentation:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate
• Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
• Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
• Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
• Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
• Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
• Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

A child must exhibit at least six of these symptoms (and fewer than six symptoms of hyperactivity and/or impulsivity) to receive a diagnosis of inattentive ADHD. Adults and late adolescents must exhibit only five of the above symptoms (and fewer than five symptoms of hyperactivity and/or impulsivity). Symptoms of ADHD, predominantly hyperactive/impulsive type, include fidgeting, interrupting others, and acting “on the go,” among several others. (Click here to read about symptoms that are present in ADHD-combined presentation.)

[Could You Have Inattentive ADHD? Take This Self-Test]
[Think Your Child May Have Inattentive ADHD? Take This Symptom Test]

Inattentive ADHD: Prevalence and Gender Disparities

Some research using population-based samples indicate that inattentive type ADHD is the most prevalent presentation of ADHD. According to a meta-analysis of 86 studies of children and adolescents, and 11 studies of adults, inattentive ADHD constitutes 21% of preschool ADHD cases, 45% of elementary school cases, and 72% of adolescent cases.¹ It is also the most common presentation type in adults, making up about half of all ADHD cases across all demographics.¹

The predominantly hyperactive/impulsive presentation of ADHD is relatively rare in clinical settings, especially after preschool. Hyperactive ADHD typically converts to the combined type over time, as attentional demands become more salient. The inattentive and combined presentations, while also subject to fluctuations, do not vary to the same degree.²

Missed or misdiagnosed symptoms of inattentive ADHD are an ongoing and well-documented problem for girls and women, in particular. Though females are more likely than males to be diagnosed with inattentive ADHD,³ men still outnumber women across all presentation types. The ratio gap, however, becomes smaller in adulthood⁴, possibly pointing to increased awareness of ADHD symptoms historically overlooked in girls.

Inattentive ADHD: Distinctive Characteristics and Presentation

The impairments and challenges associated with inattentive ADHD differ from those associated with other ADHD presentation types. The following distinctive characteristics exist across multiple domains, and they are confirmed by research and clinical observations.

[Read: What It’s Like Living with Inattentive ADHD]

Inattentive ADHD, Cognition, and Executive Function

• Slower processing speed. Inattentive ADHD is associated with relatively greater deficits in processing speed, as shown in research involving visual-motor and visual-search tasks such as matching a letter to a number or comparing symbols.⁵ This association is in line with research on sluggish cognitive tempo – a combination of characteristics and symptoms that include hypoactivity, “daydreaminess,” lethargy, and apathy – which has been linked to predominantly inattentive ADHD.⁶
• Greater inhibitory control. Compared to inattentive type ADHD, combined-type ADHD is associated with greater deficits in situation and on tasks that require inhibitory control – or the ability to stop before carrying out an action.⁵
• Stronger emotional regulation. Individuals with combined-type ADHD are at greater risk for disruptive outbursts, meltdowns, excessive reactions, and intense emotions than are individuals with inattentive ADHD alone.⁵

Inattentive ADHD and Social Characteristics

• Children with inattentive ADHD are more likely to be socially shy, passive, or withdrawn than are their combined-type counterparts, who are often described as impulsive, intrusive, and aggressive.^{3 7} Inattentive children also appear slower to respond to cognitive and social stimuli, while children with a combined presentation rapidly orient to stimuli.⁶
• Social knowledge vs. social performance: Individuals with inattentive ADHD are more likely to exhibit deficits in social knowledge (e.g., how to introduce themselves to strangers, make friends, join a group conversation, etc.) compared to individuals with combined-type ADHD. On the other hand, individuals with combined-type ADHD may exhibit greater deficits in social behavioral self-regulation (even if they know how they should behave), which impairs their ability to navigate through social settings.⁸
• Socially neglected vs. socially rejected: Sociometric studies in children suggest that inattentive ADHD is associated with social neglect and combined-type ADHD with social rejection.⁸ That is, children may be more likely to ignore their inattentive peers, possibly because of their perceived unresponsiveness or shyness; they may avoid interacting with combined-type peers who struggle to “play nicely” and follow rules or directions.

Inattentive ADHD and Comorbidities

• Inattentive ADHD is highly comorbid with internalizing disorders such as anxiety and mood disorders, and with learning disorders.³
• Disruptive behavior disorders such as oppositional defiant disorder (ODD) and conduct disorder (CD), as well as alcohol and substance abuse issues, are relatively more prevalent in individuals with combined-type ADHD.³

Inattentive ADHD: Diagnostic and Treatment Considerations

Inattentive ADHD Evaluation

Inattentive ADHD is challenging to identify in practice for a few reasons.

• Symptoms of inattention are rarely as “obvious” as the more visible symptoms of hyperactivity or impulsivity.
• Attention problems may present across various disorders, including anxiety, autism, mood disorders, and learning disorders. What’s more, these conditions often co-occur with ADHD.³
• Perceived gender differences bias evaluations. While the core symptoms of inattentive ADHD are the same across genders, symptom manifestations depend heavily on context, which often differs for females and males.

A comprehensive diagnostic evaluation for ADHD should include:

• A questionnaire rating an individual’s ADHD symptoms: The Conners’ Adult ADHD Rating Scale (CAARS) is a self-reported scale that yields a score with respect to how a patient compares to others in their gender and age group.
• Careful assessment of a patient’s current functioning and impairment across educational, social, occupational, and other spheres: Clinicians should consider the various ways difficulties may be expressed across males and females. (The gendered division of domestic labor, for example, continues to disproportionately affect women.⁹ Women with inattentive ADHD, therefore, may exhibit difficulties with household management that may not manifest in male patients.)
• An appreciation for how changes in responsibilities and expectations may reveal previously hidden ADHD symptoms: Clinicians should consider “inflection points,” or significant life events and changes, that may exacerbate and reveal ADHD symptoms not obvious before age 12, the latest age of onset indicated in the DSM-5. Many individuals develop coping mechanisms that help them function well until a major change, like college, marriage, or parenthood, stresses their executive functions to the breaking point. Beyond basic questions of inattention, clinicians should use specific manifestations as examples such as, “Do you/does your child tend to do things at the last minute?” and “Did you/your child always have a messy desk?”
• Differential diagnosis to consider comorbid conditions: It takes careful inquiry to identify the presence and boundaries of co-occurring disorders.

Inattentive ADHD and Medication Response

How do children with inattentive ADHD respond to stimulant medications? The research is inconclusive. In one study, children with inattentive ADHD were more likely than those with combined-type ADHD to respond optimally to lower doses of stimulant medication.¹⁰ Another report found no difference in response across the groups,¹¹ and a more recent study showed that children with inattentive ADHD see smaller medication effect sizes than do children with combined-type ADHD across all doses.¹² Parallel studies comparing medication response of the ADHD subtypes in adults have generally not been conducted.

Sluggish cognitive tempo, which is strongly associated with inattentive ADHD, also responds well to stimulant medication, according to a study on adults with ADHD.¹³

With all patients, prescribers must carefully titrate ADHD medication to achieve the greatest symptom improvement with the fewest side effects – a process that involves identifying and quantifying improvements and side effects over time.

Psychological Treatment for Inattentive ADHD

• Behavioral training (BT). There are no differences in response to typical BT programs across ADHD presentation types. The Child Life and Attention Skills (CLAS) Program, however, is a behavioral treatment specifically developed for children with inattentive ADHD.¹⁴
• Cognitive behavior therapy (CBT): Similarly, research shows no differences in response to CBT for executive dysfunction across ADHD presentation types in adults. The treatment, which imparts skills and strategies for planning, organization, time management, and more, improves ADHD symptoms.¹⁵ The program’s most helpful strategies include planner use and task chunking (breaking down large jobs into smaller steps) to help individuals overcome procrastination.

Inattentive ADHD: Conclusions

Though inattentive type ADHD is the most prevalent presentation type, it remains under-studied and undertreated — especially in women. Research has uncovered several key characteristics — namely, sluggish cognitive tempo, deficits in social knowledge, related comorbidities, and stimulant medication response in children — that can help clinicians better identify and treat inattentive ADHD in patients of all ages.

Inattentive ADHD: Next Steps

• Free Download: Inattentive ADHD, Explained
• Read: Inattention and the ADHD Brain
• Read: After the ADHD Diagnosis – Experts Answer Your Top 10 Questions

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “Focus on Inattentive ADHD: The Under-Diagnosed and Under-Treated Subtype” [Video Replay & Podcast #384] with Mary V. Solanto, Ph.D., which was broadcast live on January 10, 2022.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Willcutt E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 9(3), 490–499. https://doi.org/10.1007/s13311-012-0135-8

² Lahey, B. B., Pelham, W. E., Loney, J., Lee, S. S., & Willcutt, E. (2005). Instability of the DSM-IV Subtypes of ADHD from preschool through elementary school. Archives of General Psychiatry, 62(8), 896–902. https://doi.org/10.1001/archpsyc.62.8.896

³ de la Peña, I. C., Pan, M. C., Thai, C. G., & Alisso, T. (2020). Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Subtype/Presentation: Research Progress and Translational Studies. Brain Sciences, 10(5), 292. https://doi.org/10.3390/brainsci10050292

⁴ Solanto, M. V. (2019). The Prevalence of “Late-Onset” ADHD in a Clinically Referred Adult Sample. Journal of Attention Disorders, 23(9), 1026–1034. https://doi.org/10.1177/1087054718765672

⁵ Solanto, M. V., Gilbert, S. N., Raj, A., Zhu, J., Pope-Boyd, S., Stepak, B., Vail, L., & Newcorn, J. H. (2007). Neurocognitive functioning in AD/HD, predominantly inattentive and combined subtypes. Journal of Abnormal Child Psychology, 35(5), 729–744. https://doi.org/10.1007/s10802-007-9123-6

⁶ Jacobson, L. A., Geist, M., & Mahone, E. M. (2018). Sluggish Cognitive Tempo, Processing Speed, and Internalizing Symptoms: the Moderating Effect of Age. Journal of Abnormal Child Psychology, 46(1), 127–135. https://doi.org/10.1007/s10802-017-0281-x

⁷ Solanto, M. V., Pope-Boyd, S. A., Tryon, W. W., & Stepak, B. (2009). Social functioning in predominantly inattentive and combined subtypes of children with ADHD. Journal of Attention Disorders, 13(1), 27–35. https://doi.org/10.1177/1087054708320403

⁸ Maedgen, J. W., & Carlson, C. L. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29(1), 30–42. https://doi.org/10.1207/S15374424jccp2901_4

⁹ Glynn, S. (May 2018) An unequal division of labor: How equitable workplace policies would benefit working mothers. Center for American Progress. https://www.americanprogress.org/article/unequal-division-labor/

¹⁰ Stein, M. A., Sarampote, C. S., Waldman, I. D., Robb, A. S., Conlon, C., Pearl, P. L., Black, D. O., Seymour, K. E., & Newcorn, J. H. (2003). A dose-response study of OROS methylphenidate in children with attention-deficit/hyperactivity disorder. Pediatrics, 112(5), e404. https://doi.org/10.1542/peds.112.5.e404

¹¹ Solanto, M., Newcorn, J., Vail, L., Gilbert, S., Ivanov, I., & Lara, R. (2009). Stimulant drug response in the predominantly inattentive and combined subtypes of attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 19(6), 663–671. https://doi.org/10.1089/cap.2009.0033

¹² Beery, S. H., Quay, H. C., & Pelham, W. E., Jr (2017). Differential Response to Methylphenidate in Inattentive and Combined Subtype ADHD. Journal of Attention Disorders, 21(1), 62–70. https://doi.org/10.1177/1087054712469256

¹³ Adler, L. A., Leon, T. L., Sardoff, T. M., Krone, B., Faraone, S. V., Silverstein, M. J., & Newcorn, J. H. (2021). A Placebo-Controlled Trial of Lisdexamfetamine in the Treatment of Comorbid Sluggish Cognitive Tempo and Adult ADHD. The Journal of Clinical Psychiatry, 82(4), 20m13687. https://doi.org/10.4088/JCP.20m13687

¹³ Pfiffner, LJ, Hinshaw, SP, Owens, EB, Zalecki, C, Kaiser, NM, Villodas, M, & McBurnett, K (2014). A two-site randomized clinical trial of integrated psychosocial treatment for ADHD-inattentive type. Journal of Consulting and Clinical Psychology. http://doi.org/10.1037/a0036887

¹⁴ Solanto, M. V., Marks, D. J., Wasserstein, J., Mitchell, K., Abikoff, H., Alvir, J. M., & Kofman, M. D. (2010). Efficacy of meta-cognitive therapy for adult ADHD. The American Journal of Psychiatry, 167(8), 958–968. https://doi.org/10.1176/appi.ajp.2009.09081123

“Daydreamer”

“Forgetful”

“Unmotivated”

“Lazy”

Take your pick — the misconstrued labels for children with inattentive ADHD (once called ADD) are as vast and varied as the symptoms they manifest. Often misunderstood — or worse, neglected — at school, children with ADHD face unique challenges complicated by outdated ADHD stereotypes.

Here, ADDitude readers share the biggest challenges their children with inattentive ADHD face at school and home. What struggles does your child with predominantly inattentive ADHD encounter? Share your stories in the Comments section below.

“Mind-wandering is a challenge for my daughter when she needs to complete schoolwork, especially reading. She has a hard time focusing and will fixate on sounds around her (ticking clock, hallway conversation, foot-tapping classmate, etc.) rather than the one sound she needs to hear: Her teacher’s voice. However, her inattentiveness and mind-wandering are a total asset when she’s drawing, writing, or creating because it allows her to be fluid, make connections, and find flow.” — Anonymous

“Often our 5th grader doesn’t hear us, and it can be very frustrating. He is very gifted, but the inattentiveness has caught up to him. I see him wrapping his computer cord around his hand or doodling absentmindedly instead of completing his assignments.” — Anonymous

“The biggest challenge is my 16-year-old daughter’s room. I’m tempted to call it her ‘swamp’ because it is absolutely a mess of everything you can imagine — dirty clothes, clean clothes, wet bath towels, food and drink containers, jewelry, school supplies, make-up, unfinished crafts, papers that should have been signed and returned to school — scattered on the floor. We’ve tried everything from kindly reminding her to tidy up her room to doing it ourselves when we can’t take it anymore. It’s really exhausting and sucks so much energy from us.” — Anonymous

[Take This Test: Could Your Child Have ADD?]

“My son misses verbal instructions at school, or if he hears them, he doesn’t remember them. He doesn’t want to call attention to himself by writing them down.” — Anonymous

“The biggest challenge for my daughter is accessing appropriate support at school. My daughter is quiet and intelligent so teachers assume she doesn’t need support. They do not see the hours of additional study and near panic and frustration that happens at home. The amount of time she spends on organizing and building routines so she can manage are mind-blowing. It is so difficult to watch her needlessly struggle. Also, her budding independence means she wants no interference from her parents. This desire for independence is mismatched with her not-yet-there social, money, and time-management skills. I see students with ‘extra energy’ receive a lot of attention and help, and the inattentive kids — especially girls — are left with messages that they are ‘lazy,’ ‘unmotivated,’ and just need to ‘try harder’.” — Anonymous

“My son’s bedroom, locker, and backpack all look like the aftermath of a tornado. I don’t usually make a big deal about it, but it affects his ability to keep track of schoolwork, 4H club projects, etc. His executive functioning skills are much weaker than his peers, and he rarely remembers any assignments. Middle school has been an incredibly challenging transition for him. He thrived in elementary school. Now his grades are in the 60s instead of 80s and 90s. He is bright, but he is lost.” — Anonymous

“Remembering important school meetings and not putting projects off until the night before they are due seems nearly impossible for my teen! They are very smart, but frequently lose points on work for turning it in late, and as a parent with the same issues, I find it difficult to remember for them (or to call them out) when I forget, too.” — Anonymous

[Download This: Your Free In-Depth Guide to Inattentive ADHD?]

“My daughter struggles to complete a task. Even when we ask her to do one job, like, put on socks, it takes ages, and she usually returns with a couple of toys — and sometimes the socks. It also takes her a long time to sit and eat a meal. The table could be clear of all distracting items, and she will think of something she ‘has to do’ and then leaves the table forgetting about her food.” — Anonymous

“’What am I supposed to do right now?’ I ask my son every hour, as it is impossible for him to complete simple tasks such as brushing his teeth or clearing the kitchen table after we eat. We’ll sit down for dinner, and despite multiple reminders, my son is off elsewhere, lost doing something completely irrelevant. At school, staying on task is impossible and worsens if the task is boring for him, even though he can do it with ease. My younger one is better organized and over enthusiastic with every task, which in turn increases sibling rivalry and makes things worse for us.” — Anonymous

“Starting and completing tasks: I can’t focus on my own tasks because I’m busy monitoring hers.” — Anonymous

“My son is verbally advanced by a couple years, and his inattention is most obvious in his conversations. He can bounce between a dozen topics a minute recalling what he’s read, taught, or heard. It distracts him from getting ready in the mornings, so we gave him a checklist. I still verbally remind him and ask ‘is the list done?’ At least he doesn’t need reminders at each step.” — Anonymous

“My son hates, hates, hates school. Although he’s in an accelerated program, he struggles with writing and timed tests. His teacher seems unwilling or unable to make accommodations for him, citing a lack of ‘personal responsibility’ and the need for a ‘growth mindset.’ At home, he struggles with pretty intense emotional dysregulation, (particularly stemming from his frustration at being asked to perform onerous tasks such as homework and chores).” — Anonymous

“Teachers don’t notice that a student has lost focus. Eye contact and even body language may give the impression of focus, yet the student is not listening. Their thoughts are elsewhere. This is equally as stressful to the students because they know they were present, and therefore, think they just forgot what was taught not realizing they had intermittent moments of inattentiveness. An inattentive ADHD student is often neglected, and IEP classroom accommodations are not as easily put into play as they are for a student with hyperactive ADHD. A student who is actively disruptive receives nearly immediate re-direction. This is not the case for the inattentive student. As a parent of both inattentive and hyperactive children with ADHD, it is more difficult to teach the inattentive children strategies than the hyperactive one.” — Anonymous

“Test taking is a challenge. He is brilliant orally, but he can’t concentrate on written exams.” — Anonymous

“My 10-year-old daughter assumes her homework ‘won’t take long.’ She does not plan the appropriate amount of time for it and pushes back every step of the way.” — Anonymous

“Teachers take the inattention personally and then are overly punitive. At home, before we understood that she couldn’t process more than one task at a time we would get frustrated. Now we know to only ask her to do one thing at a time.” — Anonymous

“My son struggles keeping up with class discussions, and he needs instructions repeated and reminders to complete routine activities.” — Anonymous

“Two of my children have predominantly inattentive ADHD. Both tend to lack follow through. While my daughter writes things down and uses planners, my son does not — so I always need to remind him. But with my predominantly inattentive ADHD, it’s hard to remember to remind him. When he’s fully engaged, he gets the job done, often going above and beyond what was required. The challenge is getting him to that point of engagement. My daughter worries that she’ll ‘forget something’ or and won’t get things done ‘perfectly.’ This perfectionism is both a blessing and a curse. It’s a blessing because she’s developed coping strategies, and she’s more self-contained and self-motivated because of it, but it turns simple things into jousting matches with her psyche. Many times, she’s afraid to start something because she fears she’ll fail at it, or worries that she’ll miss an important bit of information. Then she spends a good amount of time spinning her wheels before getting started.” — Anonymous

Inattentive ADHD in Children: Next Steps

• Self-Test: The ADHD Symptom Test for Girls
• Read This: “Inattentive ADHD, According to a 12-Year-Old Boy”
• Read This: Are You Listening? What Inattentive ADHD Looks Like — And Responds To

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Lots of adults write lots of essays about their childhoods with ADHD. I remember spacing out, forgetting work, and losing shoes — as does my husband. But my childhood during the 1990s doesn’t match any childhood today — complete with smartphones, 24/7 streaming, social media, and a global pandemic.

What is it like for a child to live with inattentive ADHD today? I don’t have a clue, really.

So I asked my 12-year-old — now a lanky, eye-rolling tween who tortures us with groan-inducing puns — to perch on the arm of my writing couch and tell me about his ADHD.

Inattentive ADHD and Hyperfocus

“Hyperfocusing can be very hard,” Blaise said immediately. “But it’s very useful if you want to research something.”

The kid’s not wrong — I often call him for dinner several times only to find him curled up with a book. (He devours everything from graphic novels to Archeology.)

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

“I didn’t hear you,” he’ll say, and I believe him.

Hyperfocus, a distinctive trait of ADHD, involves direct, intense attention to a singular task. When it’s directed at something “useful,” like reading, writing, or, as Blaise says, “researching,” it’s almost a superpower.

But when hyperfocus lasers in on something less than useful — like Star Wars: Battlefront II — it can become a burden. Kids with inattentive ADHD don’t consciously choose what grabs their attention. So, while Blaise’s hyperfocused research into cryptozoology has him beating adults in trivia contests, he often forgets dinner because he’s programming Roblox.

Inattentive ADHD and Big Emotions

Every mother will say their baby is the sweetest child alive and a monster in the same breath — and my characterization of Blaise isn’t any different. However, Blaise is beginning to understand that his sometimes-vicious temper is not just a symptom of his tweenhood, but of his inattentive ADHD, too.

“I get really mad,” he told me. “I tell other kids it helps to yell into pillows when no one else is around.”

[Read: “Why Are We Still Failing Kids with Inattentive ADHD?”]

Kids with inattentive ADHD can be dreamy and spacey, but they can also have the same big feelings and emotional dysregulation as kids with the hyperactive subtype of ADHD. We continue to work on coping skills.

Inattentive ADHD and Working Memory

“I forget small stuff, like where my library books are,” Blaise sighed. “I also forget really big stuff, like bringing a tablet cord when we go on vacation. I forget things a lot.”

It’s a hallmark of kids with inattentive ADHD: They forget things. They lose things. And from the sadness in his voice, Blaise knows it.

We homeschool Blaise, along with his two younger brothers, so, he misses some of the social embarrassment over losing papers and forgetting his lunch. But he knows that when it’s time to round up library books, I get exasperated when he’s missing three. I try verbal reminders. I try baskets. The books still disappear. So, too, do his shoes, despite dedicated shoe depositories.

Whenever it happens, I take a deep breath, and I remember my own shame and self-blame. Kids with inattentive ADHD will forget things. They will lose things. But they need support to overcome a cycle of self-blame. When Blaise sighed, my heart broke a little bit. I forget things, too. I need to be kinder.

Inattentive ADHD and Cleaning (What’s That?)

When the topic of his room came up, Blaise seemed at a loss. He groaned. “Cleaning is just hard to do, okay?” he said. “Cleaning up after dinner, cleaning my room — it’s just hard.”

Kids with inattentive ADHD struggle with cleaning. Blaise often says he just doesn’t see a mess. I sympathize. As an adult with inattentive ADHD, I can open an Amazon package, drop the box, and walk away. I don’t think, I should pick up that box. 

It shouldn’t come as a surprise that kids with inattentive ADHD don’t know where to begin. Blaise’s floor may contain sedimentary layers by now and saying, “Clean your room,” will only end in tears.

He needs nonjudgmental reminders, and he needs them frequently. We say, “Can you pick up your plate?” after dinner, rather than, “You didn’t pick up your plate!” once he leaves the table. It’s easier, and he needs that grace. Why not give it to him? I wish a good fairy would pop up and remind me to pick up my Amazon boxes.

“I hope this helps other kids,” Blaise said, before running off. “Parents need to understand it’s not easy, having ADHD.”

As much as I recall my own childhood with inattentive ADHD, it helps being reminded how kids with inattentive ADHD actually feel. It hurts to hear that he blames himself for losing things. But I’m glad that he recognizes how his hyperfocus helps him. Blaise isn’t ashamed of his diagnosis. Its symptoms annoy him sometimes. But being non-neurotypical doesn’t.

Some days, I understand him. Some days, I’m baffled. But talking about his ADHD gave me more insight into his life. I’ll parent a little more kindly. Like he said, “it’s not easy having ADHD.” I already knew that. But add in being 12 years old — that sounds pretty tough on anyone.

Inattentive ADHD in Tweens: Next Steps

• Free Download: Inattentive ADHD Explained
• Read: How ADD (Inattentive Type ADHD) Looks a Lot Like Learning Disabilities
• Read: How Teachers Can Help Inattentive Children

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ADHD’s three distinct subtypes were first recognized in the 1994 update to the DSM (Diagnostic and Statistical Manual), however confusion over the subtypes’ differences persists even today. This appears particularly true of the “Predominantly Inattentive” (PI) subtype, which is characterized by symptoms of distractibility, failure to complete work, forgetfulness, and disorganization. People with the predominantly inattentive ADHD — many of them women diagnosed later in life — experience the same problems paying attention that are typical of ADHD, but they face fewer of the difficulties related to impulse control seen in the Combined subtype.

Because inattentive children exhibit fewer behavior-management problems, PI is not always recognized and diagnosed in childhood, and this under-recognition can persist into adulthood. This is particularly true for girls with ADHD, who are more likely than boys to have the PI subtype. Research and clinical experience show clearly, however, that difficulties with attention — even when not accompanied by impulsivity or hyperactivity — can lead to significant functional impairment and distress in higher education, the workplace, and in social interactions. When PI is diagnosed and treated early, individuals can work to manage symptoms and take better control of the condition.

In this webinar, you will learn about:

• The prevalence of predominantly inattentive ADHD in children and adults
• The most common symptoms and distinctive features of inattentive ADHD
• How predominantly inattentive ADHD is recognized and diagnosed
• The daily-life difficulties of people with PI
• Effective treatments for predominantly inattentive ADHD

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More on Inattentive ADHD

• Free Download: Inattentive ADHD, Explained
• Self-Test for Adults: Do I Have Inattentive ADHD?
• Self-Test: Could Your Child Have Inattentive ADHD?

Obtain a Certificate of Attendance

If you attended the live webinar on January 10, 2022, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Dr. Mary Solanto is professor of pediatrics and psychiatry at the Hofstra/Northwell School of Medicine (Long Island, N.Y.). Prior to joining Hofstra, she was Director of the ADHD Center at the Mount Sinai School of Medicine and Associate Professor of Psychiatry at NYU. In 2017-2018, Dr. Solanto was a Fulbright U.S. Scholar in the Netherlands, where she conducted research on treatment of ADHD in college students. Dr. Solanto’s research on the cognitive and behavioral functioning of children and adults with ADHD, the effects of psychostimulants, and the characteristics of subtypes of ADHD has been supported by grants from NIMH, NICHD, and NINDS. She developed a novel cognitive-behavioral intervention for adults with ADHD, which was the focus of an NIMH-sponsored efficacy study (American Journal of Psychiatry, 2010). The manual for therapists, Cognitive-Behavioral Treatment of Adult ADHD: Targeting Executive Dysfunction was published by Guilford Press (2011). The program was recognized as the Innovative Program of the Year by CHADD (2011). Dr. Solanto has served on study section/grant review panels for NIMH. Currently, she is a member of the editorial boards of the Journal of Attention Disorders, and the ADHD Report (Guilford Press), and serves on the professional advisory boards of CHADD and APSARD.

Listener Testimonials

“Dr. Solanto was excellent! Good pacing, presentation, and lots of helpful and well-researched information.”

“Really appreciated Dr. Solanto’s precision of language while still being clear and accessible for a non-expert! A great talk.”

“Solanto is a knowledgeable speaker who breaks down complicated research and makes it easier to understand for the lay person. She is also at the vanguard of the field, bringing awareness to the latest discoveries.”

“I listened to this and it described me! It has given me insight as to why I struggled when I moved from primary to secondary education. I feel like someone has opened the curtains and allowed me to see through the windows.”

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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

• Free Download: Inattentive ADHD Explained
• Read: How ADD (Inattentive Type ADHD) Looks a Lot Like Learning Disabilities
• Read: How Teachers Can Help Inattentive Children

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Visual and auditory information are processed differently by children with ADHD, depending on their diagnosed ADHD subtype and the presence of comorbid conditions, according to a new Journal of Attention Disorders study exploring cognitive distinctions between the ADHD sub-types and between children with and without ADHD comorbidities.¹  Notably, the research found that children with combined-type ADHD respond best to visual information, though children without ADHD outperform those with inattentive- or combined-type ADHD on Continuous Performance Tests measuring attention, inhibition, and working memory.

One hundred fifty participants, aged 7 to 10, were grouped according to ADHD presentation (combined or inattentive) or comorbid diagnosis (anxiety, ODD, both, or neither). Their performance on the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was compared to a control group of 60 children without ADHD. Diffusion decision modelling was used to break down performance into cognitive components.

Children with combined- or inattentive-type ADHD had slower and less accurate visual and auditory processing than did controls. Those with combined-type ADHD were more sensitive to changes in presentation modality than those with inattentive-type and controls; they reacted more favorably to visual information than they did to auditory information, overall. “These results could be important for educational strategies regarding the most useful modality for presentation of educational materials: in a context with frequent targets (go stimuli), presenting them visually rather than auditorily helped particularly children with ADHD-C to achieve faster and more accurate processing,” the study reported.

Children with comorbid ADHD, ODD, and anxiety disorders demonstrated an increased tendency toward making premature decisions than did the children with ADHD and anxiety only, ODD only, or no comorbidity. Researchers suggest that additional biases may occur in cognitive processing with double comorbidity due to the confounding effect of “comorbidity load.”

These findings highlight the need for cognitive tests with multiple conditions because clinical associations appear when changes in cognitive components are examined across conditions. Identifying underlying cognitive components of types of ADHD and co-morbid diagnoses could help tailor treatments to the needs of different individuals with ADHD, and improve educational interventions.

Sources

¹ Ging-Jehli NR, Arnold LE, Roley-Roberts ME, deBeus R. Characterizing Underlying Cognitive Components of ADHD Presentations and Co-morbid Diagnoses: A Diffusion Decision Model Analysis. Journal of Attention Disorders. June 2021. doi:10.1177/10870547211020087

Some people think that a diagnosis of inattentive ADHD (formerly known as ADD) means not being able to pay attention to anything. Wrong! Everyone can pay attention to at least a few activities or tasks that really interest them — like playing a sport they enjoy or playing favorite video games. Inattentive type ADHD actually means not being able to focus and sustain attention adequately on important non-preferred tasks, like schoolwork or assignments at work.

This webinar will explain how inattentive type ADHD is diagnosed and how to effectively treat it. It will also correct common misunderstandings about medications for ADHD and why they need to be “fine-tuned” to be effective.

In this webinar, you will learn:

• Why inattentive ADHD symptoms usually last longer in adulthood than does hyperactivity
• Why IQ has nothing to do with inattentive ADHD
• Why inattentive symptoms may not be noticed until adolescence
• Why some middle-aged women develop inattentive ADHD
• How inattentive can be effectively diagnosed
• How medications work in the brain to help improve ADHD symptoms
• Why medications for ADHD need to be carefully “fine-tuned”

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; iHeartRADIO.

Read More on Inattentive ADHD

What Is ADD? Inattentive ADHD Explained

Inattentive ADHD and Me

Obtain a Certificate of Attendance

If you attended the live webinar on July 8, 2021, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Thomas E. Brown is a clinical psychologist who earned his Ph.D. at Yale University and served on the clinical faculty for the Dept. of Psychiatry at the Yale School of Medicine for 20 years while also operating a clinic for children and adults with ADHD and related problems. He served as Adjunct Clinical Associate Professor of Psychiatry & Behavioral Sciences at the Keck School of Medicine of USC. Dr. Brown’s most recent books are Smart but Stuck: Emotions in Teens and Adults with ADHD (2014); Outside the Box: Rethinking ADD/ADHD in Children and Adults (2017); ADHD and Asperger Syndrome in Smart Kids and Adults: 12 Stories of Struggle, Support and Treatment (2021). | See expert’s full bio »

Ryan J. Kennedy is a Nurse Practitioner who earned his Doctor of Nursing Practice at Quinnipiac University. For ten years he has collaborated with Dr. Brown for research, publications, and in clinical practice. He is Associate Director of the Brown Clinic for Attention and Related Disorders where he specializes in assessment, behavioral, and psychopharmacological treatments for children and adults.  The clinic website is: www.BrownADHDClinic.com. | See expert’s full bio »

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share.

Listener Testimonials

“The information about fine tuning medication and the relationship between menopause and ADHD was very helpful. No wonder my symptoms have gotten worse in the past few years!”

“Outstanding. It is so useful how specific these talks get, especially the case studies that are used.”

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ADDitude recently asked adults with ADD these questions: “What are your biggest challenges and how do your inattentive ADD symptoms affect your daily life? How would you explain your presentation of ADHD as opposed to ADHD with a strong hyperactivity component?” Below are their stories of daily struggles to conjure motivation, to finish tasks, to pay attention in conversations, to overcome time blindness, and more. Share your experience with inattentive ADHD in the Comments section bellow.

Commonly Misinterpreted ADD Symptoms in Adults

“The long periods of time that I sit still might have the appearance of laziness, but I am actually just overwhelmed by the rapid-fire making and changing of plans going on inside my head. I think my intelligence and ability to act under pressure is often underestimated. I actually thrive when it counts and the pressure is on – it gets me out of the endless loop of thoughts.” – Anonymous

“My biggest challenges are staying on task, procrastinating, socializing, and remembering that I’m not lazy. My symptoms make it easy to get behind, get overwhelmed, and then get burned out. My relationships are impacted because I forget things, I become very quiet when I’m drained, and I overreact because I can’t regulate my emotions. I am diagnosed with inattentive type, but like all people with ADHD, I have a hyperactive mind. While I may look like I’m doing nothing, my brain is at work.” – Anonymous

“My biggest challenge is finding my internal drive to move from where I am to whatever my next task is. Sometimes it feels like a Herculean effort. I’ve put off making appointments until I can’t handle the tooth pain anymore or my car is about to break down without repairs. This has limited my career since I’ve avoided multi-stepped projects. It can be physically painful to sit down and work on the minutiae.” – Erica

[Do I Have ADD? Take This Symptom Test]

“My thoughts are constantly jumping from one thing to another, and I can’t stay focused on reading and writing tasks. I’m chronically late, extremely messy, and I’ll frequently forget what I’m doing, walk into a room and say, ‘Why am I here?’ This is mostly a problem while I’m working, but I also have trouble staying mentally present in social situations, most frustratingly in my sex life!” – Anonymous

“My biggest challenge is managing the physical and emotional exhaustion that comes from my mental hyperactivity. My mind is a whirl of worries, ‘what ifs,’ and ‘should haves.’ Others would never guess my inner turmoil based on my calm, albeit slightly distracted, exterior.” – Anonymous

“I am quiet and withdrawn, but there is plenty of hyperactivity in my head. I have social anxiety and I’m easily distracted during conversations, which make me miss important information. This is especially painful with a spouse or child interaction – they feel like I don’t care about what they have to say. My brain feels like a cloudy input mechanism that doesn’t store data coming in with appropriate priority.” – Anonymous

“My biggest struggle is with expressing my thoughts in a way that other people understand. It feels like I am able to say every third thought: my lips move too slowly. I also struggle to pay attention to what others are saying, which is terrible at work. I feel ashamed when I constantly have to ask them to repeat themselves.” – Anonymous

[How Inattentive ADHD Looks a Lot Like Learning Disabilities]

“I’m 36 years old and the biggest challenge for me is my lack of social skills. It’s frustrating because I feel like they are skills I should already know, or should have learned when I was younger, but I just can’t figure out how to function around other people. I always feel like a burden.” – Anonymous

“Completing projects, time blindness, and short-term memory are my biggest problems. My inattentive ADHD affects work and personal life – people don’t understand that I have ADHD because I am not hyperactive. I present as calm, but I am actually anxious and over-compensating.” – Anonymous

“For me, inattentive ADHD presents as excessive absentmindedness at work and in relationships. I get distracted by memories of shame, excitement, and other emotions. It’s as if I am living in my head instead of living in my life.” – Anonymous

“As a girl, I never had problems in school, but in university and self-employed work, I struggled with time management and meeting deadlines. Procrastination and emotional impulsivity are the main symptoms of my inattentive ADHD. Upbringing and social expectations led to suppressing my urges to externalize stress, which led to depressive symptoms. Only through therapy was I able to learn that it is okay to experience feelings deeply and live them in healthy ways.” – Christine

“My brain often feels like it is in a different place than wherever my body is. It is like I have to climb a mountain just to think through an idea that is longer than a sentence.” – Katie

“I have trouble being present. I am also hearing impaired, so people usually think that I did not hear them. I am forgetful and frequently succumb to anxious thoughts. Medication has improved my focus, my ability to be present, and my emotional regulation.”  – Glenda

“I struggle to stay focused in conversations and pay attention to things I’m watching or reading. Unlike people with the hyperactive or impulsive presentations of ADHD, I don’t often get the urge to interrupt others. Instead, I tend to go off into my own little world and stop listening, so then I lose track of the conversation and contribute too little rather than too much.” – Anonymous

“Time blindness has made me late to weddings, funerals, and most appointments. I’m a 55-year-old female and was just recently diagnosed with inattentive ADHD. So many people, myself included, thought my tardiness was careless or rude. Now I finally have an explanation. I’ve worked out a method where I write down my arrival time and work backwards to determine how long it will take for each task up to leaving somewhere.” – Anonymous

“I have extreme difficulty paying attention. I obsess about something absolutely irrelevant and ridiculous, like how someone pronounced a word. Or, mid conversation, I completely forget what we are talking about.” – Holly

“My biggest challenge is getting proper help. When I was younger, I was always called lazy or irresponsible, and that still affects me as an adult.”  – Megan

“I’ll listen to someone explain something and understand every word they said, and even respond to questions, but as soon as anyone finishes saying something to me, it vanishes from my mind. I could stare at the wall or floor for hours without feeling the passing of time.” – Anonymous

ADD in Adults: Next Steps

• Download: Your Free In-Depth Guide to Inattentive ADHD
• Learn: Why Even Parents Miss the Signs of Inattentive ADHD
• Read: Inattentive ADHD and Me

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Sleep deprivation causes greater impairment in attentional regulation and emotional control among adults with subclinical ADHD symptoms than it does among those with low ADHD symptoms, according to a study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.¹ “Subclinical” refers to symptoms of ADHD not severe, numerous, prevalent, or debilitating enough to merit a diagnosis, according to the DSM-5.

The study included 180 participants ages 17-45 without an ADHD diagnosis who were assessed for inattentiveness and emotional instability, and then randomly assigned to receive a night of normal sleep or total sleep deprivation. The subjects then performed a computerized Stroop task that measured executive function and emotional control.

Researchers found that sleep deprivation caused impairment on all tasks. Subjects with higher levels of baseline inattention demonstrated increased cognitive conflict reaction after sleep deprivation but not after normal sleep. This relationship persisted after controlling for baseline cognitive conflict reaction time and emotional instability. In other words, participants with symptoms of inattention were more vulnerable to sleep deprivation and exhibited greater executive function impairment than did those with low ADHD traits.

Researcher Predrag Petrovic, M.D., Ph.D., of the Karolinska Institute in Stockholm, Sweden, explained the importance of these findings: “We know that young people are getting much less sleep than they did just 10 years ago. If young people with high ADHD traits regularly get too little sleep, they will perform worse cognitively and, what’s more, their symptoms might even end up at a clinically significant level.”

Sources

¹Floros O, Axelsson J, Almeida R, et al. Vulnerability in executive functions to sleep deprivation is predicted by subclinical attention-deficit/hyperactivity disorder symptoms. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. (Oct. 2020) https://www.sciencedirect.com/science/article/pii/S2451902220303086?via%3Dihub

Jump to… What Is ADHD? | What Are the 3 Types of ADHD? | What Are the Symptoms of ADHD? | ADHD Tests | What Causes ADHD? | ADHD Diagnosis Information | ADHD in Children | ADHD in Adults | ADHD Treatment Options | How to Find ADHD Doctors

What Is ADHD? Definition & Meaning

Attention deficit hyperactivity disorder (ADHD or ADD) is a complex brain disorder that impacts approximately 11 percent of children aged 4-17 and almost 5 percent of adults in the United States.¹ ADHD is not a behavior disorder. It is a developmental impairment of the brain’s self-management system and executive functions.

“ADHD is not a breakdown of the brain in one spot. It’s a breakdown in the connectivity, the communication networks, and an immaturity in these networks,” says Joel Nigg, Ph.D., professor of psychiatry at Oregon Health & Science University. “These brain networks are interrelated around emotion, attention, behavior, and arousal. People with ADHD have trouble with global self-regulation, not just regulation of attention, which is why there are attentional and emotional issues.”²

Learn more about ADHD here.

What Are the 3 Types of ADHD?

There are three distinct subtypes of ADHD:

• Hyperactive-Impulsive ADHD
• Inattentive ADHD (formerly called ADD)
• Combined ADHD

People with hyperactive-impulsive ADHD act “as if driven by a motor” with little impulse control — moving, squirming impatiently, and interrupting others. People with inattentive ADHD are easily distracted and forgetful. They may be daydreamers who lose track of homework, cell phones, and conversations with regularity.

Learn more about the 3 types of ADHD here.

ADD vs. ADHD: What Is the Difference in Symptoms?

Traditionally, inattentive symptoms like trouble listening or managing time were diagnosed as “ADD.” Hyperactive and impulsive symptoms were associated with the term “ADHD.” Today, there is no ADD vs. ADHD; according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), there is just one diagnosis of ADHD — with 3 subtypes.

What Are the Symptoms of ADHD?

Common symptoms of ADHD include inattention, lack of focus, poor time management, weak impulse control, exaggerated emotions, hyperfocus, hyperactivity, and executive dysfunction.

Doctors diagnose ADHD using symptom criteria from the (DSM-V), which lists nine symptoms that suggest Inattentive ADHD and nine that suggest Hyperactive-Impulsive ADHD. A child may be diagnosed with ADHD only if he or she exhibits at least six of nine symptoms from these ADHD symptom checklists, and if the symptoms have been noticeable for at least six months in two or more settings — for example, at home and at school. What’s more, the symptoms must interfere with the child’s functioning or development, and at least some of the symptoms must have been apparent before age 12³. Older teens and adults may need to consistently demonstrate just five of these symptoms in multiple settings.

View the full checklist of ADHD symptoms here.

ADHD Symptoms in Children

Common Symptoms of Hyperactive-Impulsive ADHD in Children

• Talks excessively and blurts out answers
• Acts as if “driven by a motor”
• Fidgets and squirms in seat constantly
• More symptoms of Hyperactive-Impulsive ADHD in children

Common Symptoms of Inattentive ADHD in Children

• Distracted or short attention span
• Struggles to organize tasks and activities
• Often loses things and is forgetful
• More symptoms of Inattentive ADHD in children

See the full list of ADHD symptoms in children.

ADHD Symptoms in Adults

Roughly two-thirds of people who experienced ADHD symptoms as a child will continue to experience ADHD symptoms as an adult, though its manifestations change with age.⁴ What’s more, many people with attention deficit were undiagnosed or misdiagnosed as children. They may suffer serious psychological consequences after a lifetime of blaming themselves for ADHD symptoms such as:

• Forgetting names and dates
• Missing deadlines and leaving projects unfinished
• Extreme emotionality and rejection sensitivity
• Becoming easily distracted and disorganized
• Suffering anxiety and depression

See the full list of ADHD symptoms in adults.

ADHD Tests

Does My Child Have ADHD?

Does your child struggle to stay focused on homework and chores? Does he or she forget things even with frequent reminders? Is he or she constantly fidgeting? Take the ADHD symptom test for children.

Do I Have ADHD?

Do you struggle to finish the projects that you start? Are you easily distracted by noises and activity around you? Do you often forget appointments and obligations? Do you feel rejection more intensely than others? Take the ADHD symptom test for adults.

Take the ADHD symptom test for women and girls.

What Causes ADHD?

ADHD a brain-based, biological disorder. It is not caused by bad parenting, too much sugar, or too many video games. Scientists are investigating whether certain genes, especially ones linked to the neurotransmitter dopamine, play a role in developing ADHD.⁵ Additional research suggests that exposure to toxins and chemicals may increase a child’s risk of having ADHD.

Learn more about the causes of ADHD here.

ADHD Diagnosis Information

Any good ADHD diagnosis is based on the criteria defined in the DSM-V. A clinical interview is performed to gather the patient’s medical history, and is often supplemented with neuropsychological ADHD tests, which offer greater insight into strengths and weaknesses, and helps identify comorbid (or co-existing) conditions. It can take several hours of talking, test taking, and analysis by an ADHD specialist to diagnose symptoms.

Learn more about the ADHD diagnosis process here.

ADHD in Children: Symptoms and Diagnosis

ADHD diagnoses have skyrocketed nearly 50 percent since 2003, bringing the total number of American children with ADHD to nearly 6 million, according to 2015 statistics from the Center for Disease Control and Prevention (CDC).⁶
Learn more about ADHD in children, including common symptoms, treatment options, and parenting advice.

ADHD in Adults: Symptoms and Diagnosis

ADHD symptoms do not magically disappear with puberty. In fact, roughly two-thirds of all children with ADHD grow up to be adults with ADHD. But many still don’t know it. Because the medical community’s understanding of inattentive vs. hyperactive attention deficit, and the unique manifestation of symptoms in girls vs. boys, has improved so markedly in the last few decades, many adults are recognizing their ADHD symptoms for the first time in their 30s, 40s, 50s and even 60s.
Learn more about ADHD in adults, including common symptoms, treatment options, and parenting advice.

ADHD Treatment Options

The best ADHD treatment strategies are multimodal ones — combinations of several different, complementary approaches that work together to reduce symptoms. Most ADHD treatment plans include one or more of the following:

• ADHD medication — including a stimulant like Adderall (amphetamine) or Ritalin (methylphenidate), or a non-stimulant like Strattera or Intuniv
• An ADHD diet low in sugar and carbohydrates, and high in protein, greens, and omega-3 fatty acids
• ADHD vitamins and supplements — particularly zinc, iron, Vitamin C, Vitamin B, and magnesium, which are critical to healthy brain function.
• Behavioral Therapy for ADHD, which works best in improving ADHD-associated oppositional behaviors in children, as well as other areas of functioning, like interactions with parents and school, when combined with medication.
• ADHD therapies that run the gamut from cognitive behavioral therapy (CBT) and occupational therapy to art or music therapy to play therapy and beyond
• Natural remedies for ADHD like mindfulness meditation, brain training, or exercise

How to Find ADHD Doctors

“ADHD is generally ignored in medical education,” says William Dodson, M.D., an ADHD specialist and author. “Just 5 years ago, 93 percent of adult psychiatry residencies didn’t mention ADHD in four years of training and, amazingly, half of pediatric residencies didn’t mention ADHD.”

Finding a medical professional who understands ADHD and its comorbid conditions is not easy, but it is vital if you hope to secure an accurate diagnosis and proactive treatment plan. Use these criteria to find an ADHD doctor or other specialist near you.

Footnotes

¹ “Data & Statistics.” Centers for Disease Control and Prevention. Ed. Center for Disease Control. Centers for Disease Control and Prevention, 14 Feb. 2017. Web. 14 Mar. 2017.
² Brown, Thomas E., PhD. “What Is ADHD? (And What Is It Not?).” Additude. New Hope Media, 14 Mar. 2017. Web. 14 Mar. 2017.
³ Association, American Psychiatric, ed. Diagnostic and Statistical Manual of Mental Disorders: DSM-V. Washington: American Psychiatric, 2014.
⁴ Brown, Thomas E et al. “Persisting Psychosocial Impairments in Adults Being Treated with Medication for Attention Deficit/Hyperactivity Disorder.” Psychopharmacology bulletin (2017).
⁵ Blum, Kenneth et al. “Attention-deficit-hyperactivity disorder and reward deficiency syndrome.” Neuropsychiatric disease and treatment (Oct. 2008). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626918/
⁶ “Data & Statistics.” Centers for Disease Control and Prevention. Ed. Center for Disease Control. Centers for Disease Control and Prevention, 14 Feb. 2017. Web. 14 Mar. 2017.