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The inattentive subtype poses different challenges
Many professionals and lay people alike may be unaware of a subtype of attention deficit hyperactivity disorder (ADHD) in which the individual is not hyperactive, restless, or even impulsive, but rather has problems primarily in the maintenance of focused and sustained attention. This predominantly inattentive (IN) subtype of ADHD was first recognized in DSM-IV, in which IN is listed with the two other currently recognized subtypes-the predominantly hyperactive-impulsive (HI) subtype and the most widely recognized form of ADHD, the combined (CB) subtype, which encompasses the full spectrum of ADHD symptoms.1
Prevalence
Early epidemiologic studies, conducted on the basis of teacher ratings of attention and behavior, suggested that the IN subtype was at least as common as the CB subtype, although children with IN were less likely to be referred for treatment because the symptoms are not disruptive in the classroom.2 More recent research identifying those cases in which parents and teachers agreed on the presence of the primary symptoms reported a higher rate of IN (1.6%) than CB (0.6%) among 1,275 school-age children in Australia.3 Several studies have found the male-to-female gender ratio for IN to be closer to 1:1 than for CB (approximately 4:1). These studies also showed that if a girl has ADHD, it is more likely to be of the IN than the CB subtype.
Symptoms
Children with IN, like those with CB, have difficulty with focused and sustained attention and are, as a result, distractible, less likely to complete tasks, and more likely to have problems with organization and planning.1 More than 75% of children with the IN and CB subtypes are rated by teachers as "academically impaired."4 However, important qualitative differences exist between the IN and CB subtypes. Whereas children with CB typically are fast-moving and hyper-reactive, teachers and parents describe children with IN as daydreamy, sluggish, and hypoactive.5 Other children may view them as "space cadets" and may become impatient with their slow response style and their lack of initiation. Whereas children with CB are more likely to be rejected by peers because of their unpredictable, intrusive behavior, children with IN are more likely to be socially neglected.6 Thus, children with IN typically have more difficulty initiating friendships, whereas children with CB...