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Inattentive ADHD

Pure "inattentive"ADHD does not exist!

When I started psychiatry and the first time learnt about ADD, I thought it is a condition of adults with ADHD in their childhood who grown out of hyperactivity or were able to control it as grown ups. So I thought this group of adults since they still have attention deficit, they are labelled ADD or Attention Deficit Disorder. But later on when studies more about the subject then and read DSM III, then and later on IV and now 5, I learnt that the bible of psychiatry has recognized ADD without hyperactivity or “purely” or “predominantly” inattentive.
The history of ADHD before DSM-III in 1980 started recognizing this condition as a €œHyperkinetic Disorder € or €œHyperactive Disorder €, but later on some experts focussed on the attention deficit in the subjects and insisted that ADHD is primarily a cognitive or attention deficit disorder and kept pressing on their views to the point of labelling it as €œMinimal Brain Dysfunction Syndrome €!  Then APA(American Psychiatric Association) published its DSM-III and legalized ADD or ADHD purely or predominantly inattentive!  Here as in my writings elsewhere, I will argue against such subtype and if it exist it does not belong to ADHD.
As I discussed elsewhere and here on other postings and discussions at this website, the original ADHD that includes hyperactivity and impulsivity possesses a very intelligent brain (read other members discussion in the gifted ADHD group).  These subjects are intelligent, because they have a “hyper-attentive” and “dynamic” brain.  These subjects are very good in alternative or switching attention, divided attention and selective attention.  But if they are tested for sustained attention that most current IQ tests or other cognitive tests are based on, they may show being inattentive as they get bored easily and selectively they are not interested in slow paced and boring subjects. This has been shown in my writings with sufficient scientific evidence from neuroscience and elsewhere in other researchers studies and writings. There are also strong opinions by me and a few other scientists that inattentive and hyperactive/impulsive subtypes of ADHD have different aetiologies and pathophysiology and are in fact heterogenous than homogenous, even genetically and have different neuroanatomic pathways. 
in brief, “inattentive” subtype if exist alone without hyperactivity and impulsivity, it must be a different condition out of ADHD. Then if a bit of hyperactivity and impulsivity since childhood exist with the inattention, then that is not purely or predominantly inattentive.  if this contention hold true, then the combined subtype does not exist as these two conditions could not exist together, as they have two heterogenic causes and pathophysiology. If ADHD hyperactive/impulsive that is the only genuine group of ADHD has some inattention, this must be in “sustained attention” obviously that these subjects are not good at due to their hyperactivity and impulsivity and due their getting bored easily with passive and slow paced tasks, but they are very good in fast paced tasks requiring dynamic attention as discussed above.
i have seen patients in my practice diagnosed with purely or predominantly inattentive subtype of ADHD who do not respond to stimulant medications, but show side-effects of irritability, anger, restlessness and insomnia, etc.  This is another practical proof that the inattentive subtype has a different pathophysiology and are not deficient in brain dopamine to require stimulants that increase the level of dopamine in the brain.
So I would suggest inattentive ADHD do not take stimulant medications as they will not work for them, but will cause side-effects as their brains seem not to need extra dose of dopamine.  Lastly I need to list some psychiatric conditions that can cause “inattention”, “distractibility”, ” poor concentration” etc. Depression, anxiety, or any anxiety disorders, substance use, even some medical conditions, such as thyroid dysfunctions, anaemias, sleep disorders specially sleep apnea, diabetes, hypertensions, cardiac disorders, even smoking may cause some cognitive difficulties, inattention, distractibility , poor concentration, etc.

Replies

I’m not sure where you are going with this ADHD, Combined type individuals have a more “intelligent brain” than ADHD, predominantly Inattentive Type or why you are writing all this on a forum.  Frankly, it is rather insulting, particularly since many women are often diagnosed with ADHD, predominantly Inattentive Type.  My husband is diagnosed ADHD, Combined Type.  Our son is diagnosed ADHD, predominantly Inattentive Type.  Our son is an honor roll student.  He takes stimulant medication that helps him immensely.  I just do not see in our own experience how any of what you are saying is true.

Posted by debhib on May 17, 2014 at 8:56pm

I have had ADD all my life (I was diagnosed by a Psychiatrist when I was 42yo with ADD, and he told me I did not fit the criteria of hyperactivity)  and hyperactivity other than my brain always being in race mode was not a problem for me. I had and have a bad memory, and was and still do have a short attention span.
To be quite honest I did not finish you very long post because I lost interest in it. My question to you is, are you ADHD?

Posted by Rancher John on May 17, 2014 at 10:32pm

dehib & Rancher John:
I know what I posted here could be shocking and perhaps insulting.  But I do not mean to insult anyone specially patients, as all my professional life, I have tried to understand and help patients who are suffering. My argument is not with the patients, but with the psychiatry institutions, mostly with APA and their DSM that all your diagnosis and labelling come from there.  If your son is smart and he has been diagnosed with inattentive type, they made a mistake, he could not be inattentive.  That is not your problem or your son, dear, it is theirs that have to fix. Ask your son and go back and see if he had any element of hyperactivity &/or impulsivity that can present in different forms.  If he was not restless and could not sit still, maybe he was talking too much, or similar symptoms that i described well in my writings elsewhere and shown with many scientific data to back up.  I cannot detail all these here as there is not much space and could be too technical and boring for this website readers.  What i am saying and writing and elsewhere, are all based on scientific data and facts and we cannot close our eyes to it. and John, your racing brain is a sign that you have some hyperactivity and if smart too, proves my points.  You’re right and your psychiatrist was wrong!

Posted by Dr.Showraki on May 18, 2014 at 1:18am

I would appreciate it if you would not call me “dear.”  Your defensiveness suggests to me that you are unwilling to consider any opinion other than your own pet theory, which is not shared by many other professionals in the field.  From what I have read, there is no definitive evidence that Inattentive ADHD is a distinct and separate disorder from ADHD.  So to recommend on a forum that anyone with that diagnosis NOT take stimulant medications is unprofessional to say the least.  By the way, I am familiar with the DSM as I used it frequently in my job as a vocational rehabilitation counselor working primarily with a mental health agency.

In addition, this emphasis on people with ADHD, Combined Type being somehow more “intelligent” bears no weight with me.  I recently read a post from a woman who said her eldest son was diagnosed with predominantly Inattentive Type and his IQ was 148. 

I can assure you that my son is quite smart and definitely is not in the least impulsive or hyperactive.  I have had 11 years to observe his behaviors and development and can say without hesitation that his diagnosis is correct.  Four professionals (a private psychologist, child psychiatrist, our pediatrician, and the school psychologist) are all in agreement as to his diagnosis, although there HAS been some question as to whether or not he also is on the autistic spectrum.

In any event, I would just like to say that I think this whole interest in “giftedness” is overrated.  I was identified as “gifted” in elementary school and went into a gifted program through the school.  Other than being an excellent student, I cannot say it has brought me particular fame or fortune.  I think it is far more important to emphasize diligence, self discipline, persistence, kindness, and compassion.  Helping your child to develop those traits will get them much farther in life than being gifted will.

Posted by debhib on May 18, 2014 at 6:27am

“Inattention” could be a feature of Autism or other autistic spectrum disorders as there such association studies in the literature.  But autism is a quite different disorder with different symptomatology and pathophysiology that I will describe briefly here.

Autism is a disorder of neural development characterized by impaired social interaction, verbal and non-verbal communication,  and by restricted, repetitive or stereotyped behavior. The symptoms of Autism appear before age three. Autism affects information processing in the brain by an under-connectivity and disturbed synchronization between neurons and their synapses. Autism is a pervasive developmental disorder (PDS) in the Autism Spectrum Disorders (ASDs) group along with Asperger Syndrome and Pervasive Developmental Disorder, not otherwise specified according to DSM classification. Autism has a strong, but complex genetic basis, perhaps caused before conception by rare mutations or rare combinations of common genetic variants. Just after birth, the brains of autistic children tend to grow faster than usual, followed by normal or relatively slower growth in childhood. This overgrowth in early stage of life, seems to be related to over-metabolism of Glutamate, the main excitatory and most abundant neurotransmitter in the brain and influential in communication between different parts of the brain. This overgrowth seems to happen more in the frontal cortex in early stages of life at the cost of undergrowth in other areas of the brain and poor connectivity or association between the frontal cortex and other regions. That is why some autistic subjects, specially Asperger’s may appear to have “gifted” intelligence in specific areas such as math. (as in the movie, “Rain man”), but poor in other skills and aptitudes mostly social interactions and behaving odd.

My point of contention is that ADD (Attention Deficit Disorder) without hyperactivity or/& impulsivity if exists alone, that seems to be rare without any association with any other primary disorder, is very rare and does not belong to ADHD as both have quite different etiology and pathophysiology and could not be mixed together.
Finally, I agree that the term “giftedness” is very ambiguous and could be easily found in Autism where one can find specific talent in some aspects such as math but poor in other aspects.

Posted by Dr.Showraki on May 19, 2014 at 3:51pm

Dr. Showraki, I would suggest that the medical profession, especially those working in mental health, stop messing around with the DSM and start paying better attention to their patients.  I am not sure that I understand why you would post your long comment in any forum outside of the professional ones. 

While some of what you wrote makes sense, it is a far cry from how medicine has been practiced to date.  While not everyone came through treatment with their high expectations intact, most did learn a few things that provide significant help in their daily lives.

Statistics have their place in medicine, but not at the patient treatment level.  At that point, doctors and others treating the patients had better be keeping their attention on the patient.  Too many so-called professionals are more interested in their checkbooks than in patient outcomes. 

I do not care what it is called MBD or ADD/ADHD.  I have been told that I have Inattentive ADD based on an earlier diagnosis of Minimal Brain Dysfunction, made when I was in fifth grade, age 10.  The diagnosis was given to me when I was 50 years of age as “Inattentive Attention Deficit Disorder”.  Now at age 67, I figure that the last prescribing doctor must have been right because his treatment and the therapy that I had in conjunction with his treatment has made all the difference.

If you are going to beat this matter to death, then I would suggest that you take it up with your medical peers.  Frankly, I believe that if in the nearly 60 years since my first diagnosis no one else has tried to separate Inattentive ADD from the other types of ADD that there was a very good reason not to do so.

Going further, the DSM does nothing more than provide a numerical diagnostic code that allows the doctors (and others) to bill for their services to insurance companies and government agencies who have no ability or willingness to deal with words they cannot pronounce, thus requiring a numerical basis on which to “lean”.

While “giftedness” may well exist in conjunction with ADD/ADHD, I do not believe that one has to be diagnosed with one to be the other.

There is no need to respond to this missive.

Posted by Dianne in the Desert on May 19, 2014 at 6:59pm

Because I am an adult and must act like one, I will not say what I would like to say.  I agree with the last post.  I believe you would be better served by hashing this out in the ADHD Professionals group.  You don’t need to respond to this post either.

Posted by debhib on May 19, 2014 at 8:46pm

If predominantly inattentive is a separate disorder than the combined type why, if I am diagnosed as ADHD-I, and no, I have never been hyperactive or impulsive, is my daughter diagnosed as ADHD-combined type? ADHD is highly hereditary, and she shares all of my symptoms and has a handful of her own that I have never had. This is not a coincidence. I think your theory is flawed.

Posted by nicklepickle on May 25, 2014 at 7:03am

Dr. Shoraki,

Besides the many un-scientific and logically-flawed statements that I have noticed in your posts here, it is pretty hard to take you seriously when you state “...that I will describe briefly here”, and immediately follow that with text copied verbatim from Wikipedia without citation.

Posted by AverySays on Jun 08, 2014 at 8:36am

Dr. Showraki,

It would be illogical for any of us to reject the DSM V’s conclusion on this matter based only on the above, because other doctors would argue just as strenuously and more persuasively in support of the DSM’s listing. I for one would be willing to reconsider, but only through a review of studies found in multiple sources. Can you direct us to these studies?

Glen

Posted by ReadReadWrite on Jun 08, 2014 at 10:33pm

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