What Is Inattentive ADHD?

Formerly called ADD, inattentive ADHD is characterized by symptoms of disorganization, poor time management, faulty working memory, and a lack of focus — all signs commonly dismissed or misdiagnosed, particularly in girls and women. Here, learn about the distinctive characteristics that should guide clinicians’ diagnostic and treatment practices for inattentive ADHD.

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.

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
• Often has difficulty sustaining attention in tasks or play activities
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
• Often has difficulty organizing tasks and activities
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
• Often loses things necessary for tasks or activities
• Is often forgetful in daily activities

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.)

Prevalence and Gender Disparities

Some research using population-based samples indicates 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. It is also the most common presentation type in adults, making up about half of all ADHD cases across all demographics.

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.

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, men still outnumber women across all presentation types. The ratio gap, however, becomes smaller in adulthood, possibly pointing to increased awareness of ADHD symptoms historically overlooked in girls.

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.

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. 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.

Greater inhibitory control. Compared to inattentive type ADHD, combined-type ADHD is associated with greater deficits in situations and on tasks that require inhibitory control – or the ability to stop before carrying out an action.

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.

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. Inattentive children also appear slower to respond to cognitive and social stimuli, while children with a combined presentation rapidly orient to stimuli.

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.

Ongoing Research into Inattentive-type ADHD

Though inattentive type ADHD is the most prevalent presentation type, it remains understudied 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.

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Full article originally published in ADDitude Mag.