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 “Hyperkinetic Disorder” or “Hyperactive 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 “Minimal 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.
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