Focus on Inattentive ADHD: The Under-Diagnosed, Under-Treated Subtype (with Mary Solanto, Ph.D.)

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.
In this hour-long webinar, learn about the signs, symptoms, and unique features of Inattentive ADHD from Mary Solanto, Ph.D.
Download the slides associated with this webinar here:
www.additudemag.com/webinar/i...
4:56 ADHD Historical Timeline
9:10 ADHD in the DSM-V
18:49:10 Impairment Associated with Inattention vs Hyperactivity-Impulsivity
20:30 Sluggish Cognitive Tempo
21:47 Prevalence: Gender X Subtype
27:23 Comorbidity
29:25 Comparisons between PI and CB
30:01 Cognitive/Executive Functions
33:02 Social Characteristics
35:19 Social Skills Rating Scale Teacher
37:22 Heritability/Familial Genetics
40:47 Assessment and Diagnosis for Adults
54:58 Response to Medication
47:07 Response to Psychological Treatment
48:12 The Two Most Helpful Strategies
50:29 Summary
52:21 Q&A
Related Resources:
1. Read: What Is Inattentive ADHD? Symptoms, Characteristics, Diagnostic Considerations
www.additudemag.com/add-inatt...
2. Free Download: Your Guide to Inattentive ADHD
www.additudemag.com/download/...
3. eBook: "How the ADHD Brain Works"
www.additudemag.com/product/h...
Subscribe to the ADDitude KZbin Channel: / @additudemag
Visit the ADDitude web site: www.additudemag.com

[@leilap2495]

I find this to be so true, that those who are predominantly inattentive are often overlooked. I am seeing this happen currently for my son, who is also predominantly inattentive. As long as they are “smart enough” and “not disruptive,” teachers and many healthcare providers think nothing needs to be done to support them.

[@mutazah]

What prompted you to evaluate your son for ADD?

[@jdxx59]

My son is 37 and slipped through the school system with his inattentive ADHD (formally diagnosed at age 30). He wasn’t disruptive and was just a daydreamer. He was ‘forgotten’ about until report time when teachers would realise he hadn’t produced any work and them complained about it to us. His school years were exasperating! The only education system that would suit ADHD kids is Montessori as it’s based around the child’s interests and strengths.

[@katiepouliot5225]

This was very helpful to me. The psych dept. in my healthcare network did not take the time to get to know me or explore comprehensive treatment options with me when I discussed my symptoms. They were quick to recommend medication, and when I refused they suggested an emotional well-being class (I'm doing fine emotionally) and to try meditating. Meditating is helping so far, but I have a need for being understood and for being well-informed. I can relate to everything that Dr. Solanto said about PI. I thought that my slow information processing was some kind of rare learning disorder. It's nice to know that it's part of my PI ADHD. The comment at the end about inflection points was highly relatable. My symptoms became more apparent as the demands in my life increased, but until a few months ago, I thought these were just "me" problems that I simply had to struggle through. The more I learn about ADHD, the freer I become. Knowledge truly is power.

[@cleanzumba8670]

Indeed it is... Gives me a sense of peace as it answers many of my life concerns 💙

[@DK-zu6tt]

This presentation was mislabled. It was not focused on Inattentive, but rather a comparison of Inattentive ADD to Combined presentation. The one slide at the end which listed the "2 most helpful strategies" was the only thing useful for me. And I have Combined. But, as a 52 y.o. woman, I had already developed physical calendar (planner) management since my mid 20's (1990's), long before I was diagnosed. So, this was mostly a waste of time. What I think the ADHD medical community should focus on, concerning the under-diagnosis of women, is the interaction of starting a girl's period (estrogen) and symptoms. After researching ADHD and perimenopause, it has been proven that fluctuating estrogen in perimeno, exacerbates ADHD in women. So, why couldn't or wouldn't a girl starting menses also affect or exacerbate ADHD? It seemed my ADHD really started to show most prominately in high school. I started my period at 14, during my freshman year, which also puts me outside of the age of diagnosis. How many other women are like me (is this why many women are missed at a younger age)? The age of diagnosis for older women is ageist and sexist, because when I turned 12 in 1982, there had only been one single study done (according to Stephen P. Hinshaw) which asked the question: "can girls even have ADHD?" It was not even settled science then, and she never even mentioned that fact in her first slide showing the history of ADHD. But I am not surprised. As a woman she should know better---the medical community has largely pushed women aside and continues to do so in the research of ADHD.

[@littlejenng3]

would also be interested to see studies on how postpartum exacerbates symptoms. i feel like mine got much worse after i became a mother, especialy having to deal with the comorbid things like anxiety and depression, ocd on top of it

[@diabloakland]

I started puberty very early, it had the opposite effect on me as well- it exacerbated symptoms of adhd for sure but people attributed it to puberty. Here i am 15 years later.

[@VooDooSue]

So well stated. I'm the poster child of your post. ❤ Working on seeing my doctor for a diagnosis which explains so much!! I had no idea of inattentive ADHD and, yesterday, I had a project due that required focus I didn't have in me. My go to? Cleaning my bathroom while thinking of the project allowed me to then focus on the project...got it done only when my focus got split up and distracting. It's exhausting yet seen as a positive: clean house and done projects....at what cost? I'm really tired and learned last week that this is not everyone.

[@DarrenGedye]

I'm a male diagnosed with inattentive adhd at age 53 and I found this very interesting. As the speaker said, I didn't disrupt the class by bouncing off the walls so I was mostly overlooked. (The sole exception was my beloved chemistry teacher who made me turn off my bunsen burner while she was talking because she noticed I didn't pay attention to her while it was on!)

[@haint7709]

If your like me, you can skip the intro and get right to it at 5:00 mark.

[@eileencita]

"Focus on inattentive" sounds just funny 😂. Thank you for all your videos!!! 🎉

[@mooncatandberyl5372]

word juxtaposition is the best explanation I can immediatedly think of.

[@salparadise1220]

1798 is the first mention of a "disease of the attention", by Scottish physician Sir Alexander Crichton. He wrote a three volume series of books on mental illness. Chapter Two of Book Two is entitled, "On Attention and its Diseases.

[@gypsypath1]

Really looking forward to the webinar on perfectionism. Hopefully, I’ll be able to make myself follow at least one tip and stop procrastinating so much!

[@LillithLeonard]

That middle school thing... The elementary school teachers saw that I was smart and so they didn't make me turn in my work. Junior high (yes, I'm that old) came along, and I did my work but didn't turn it in. Nearly failed Social Studies and had to endure an hour-long lecture from my parents.

[@jonathanberry1111]

🎯 Key Takeaways for quick navigation: 00:18 🧐 *Understanding Inattentive ADHD* - Inattentive ADHD is characterized by symptoms of inattention rather than hyperactivity or impulsivity. - The DSM-5 distinguishes between three presentations of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and combined. - The symptoms for each presentation type are outlined and discussed, highlighting the importance of recognizing inattention as a significant component of ADHD. 05:16 🕰️ *Historical Overview of ADHD* - ADHD has a long history, with descriptions dating back to 1900. - Changes in terminology and understanding of ADHD have evolved over the years. - The diagnostic criteria for ADHD have been refined, leading to the current recognition of three presentations in the DSM-5. 09:13 🔄 *Stability of ADHD and Subtypes Over Time* - Research shows that ADHD can persist into adulthood, but the specific subtype may change. - Predominantly inattentive type ADHD is more stable over time compared to predominantly hyperactive-impulsive type. - The DSM-5 uses the term "presentations" instead of "subtypes" to acknowledge the potential for changes in symptom profiles over time. 15:16 ⚖️ *Inattentive vs. Hyperactive-Impulsive Symptoms* - Inattentive symptoms are associated with executive function difficulties and academic underachievement. - Hyperactive-impulsive symptoms can lead to social difficulties and disruptive behavior. - Sluggish Cognitive Tempo (SCT) is a related concept that may co-occur with ADHD and respond to stimulant medication. 22:02 👫 *Gender and ADHD Subtypes* - The prevalence of ADHD subtypes varies by gender, with the inattentive type being more common. - For children, the combined type has a higher male-to-female ratio, while the inattentive type is more evenly distributed. - In clinical settings, both males and females seek help for ADHD, but the combined type may be slightly more prevalent among males. 25:18 🧠 *Understanding Gender Differences in ADHD Subtypes* - Women are more likely to have the inattentive subtype of ADHD compared to men. - In childhood, the diagnosis of ADHD often shows a significant gender imbalance, but in adulthood, the gender ratio becomes closer to one-to-one due to self-referral for evaluation. 27:25 📚 *Comorbidity in ADHD Subtypes* - The combined subtype of ADHD is more likely to be associated with comorbid conditions like oppositional defiant disorder, conduct disorder, and substance abuse. - The predominantly inattentive subtype is less likely to have these comorbidities. 30:13 🧠 *Cognitive and Executive Function Differences* - The combined subtype of ADHD tends to have greater deficits in inhibitory control and emotional regulation. - The predominantly inattentive subtype may struggle more with processing speed and visual-motor tasks. 33:13 🧒 *Social Functioning Differences* - The predominantly inattentive subtype may appear slow to respond interpersonally, with deficits in social knowledge. - The combined subtype may struggle with aggression and impulsivity in social situations. 35:21 🗂️ *Social Skills Interventions* - Tailored social skills interventions are needed for different ADHD subtypes, considering their unique social challenges. - Existing interventions should be more widely disseminated and adapted for specific subtype-related difficulties. 37:37 🧬 *Heritability and Family Genetics* - ADHD has a strong genetic component, with heritability estimated at 70-80%. - While ADHD tends to run in families, specific subtypes may not necessarily be inherited in the same way, suggesting variable expression of subtypes within families. 42:14 🧐 *Assessing ADHD in Adults* - Assessing ADHD in adults requires a comprehensive evaluation, including a detailed developmental history. - Symptoms may manifest differently in males and females, depending on the context and roles they juggle in life. 46:07 💊 *Response to Treatment* - Response to stimulant medication may vary between subtypes, with some studies suggesting different optimal doses. - Behavioral therapy programs should be tailored to subtype-specific challenges, but both subtypes can benefit from behavior therapy. 48:55 📅 *Most Helpful Strategies in Treatment* - Planner use and chunking are two highly effective strategies for managing time and organization, beneficial for individuals with ADHD and without. - These strategies can significantly improve daily functioning and task management. 50:05 📚 *Characteristics of the Pi Subtype of Inattentive ADHD* - The Pi subtype doesn't have difficulties associated with inhibitory control or emotional dysregulation. - They exhibit core inattention symptoms with less difficulty in behavioral inhibition and self-control. - Pi subtype individuals may have slower processing speed and unique social difficulties. 52:37 🧠 *Stereotypes and Lack of Diagnosis in Women and Older Adults* - Stereotypes about ADHD, such as blaming parents or thinking it's a children-only condition, can discourage diagnosis. - Women and older adults may not have been identified with ADHD in childhood due to atypical symptoms. - There's a misconception that nothing can be done about ADHD in adulthood, which is untrue. 56:14 ⏰ *Inflection Points and Challenges in ADHD Symptoms* - Situational demands change as individuals transition from grade school to middle school, high school, and adulthood. - Middle school, high school, and parenthood bring increased challenges for executive function. - Symptoms may become more apparent during these inflection points, leading to referrals for evaluation and treatment. Made with HARPA AI

[@ConstanceCamus]

Thank you for posting the breakdown. Signed, PI 😎

[@capselj]

This was an excellent presentation. I learned a lot and definitely recommend this webinar.

[@jonathanberry1111]

🎯 Key Takeaways for quick navigation: 05:01 📜 *Historical Overview of ADHD Nomenclature* - ADHD subtypes have evolved over time, reflecting changes in our understanding. - From the first description in 1900 to the DSM-5's three presentations in 2013, the terminology has adapted. 09:13 🔄 *Evolution of ADHD Subtypes Stability Over Time* - Stability of ADHD subtypes changes over time. - Predominantly Inattentive (PI) subtype tends to be less stable than the Combined (CB) subtype. - The shift from subtype to subtype is not uncommon, acknowledging the instability recognized in DSM-5. 18:58 🚸 *Impact of Inattention vs. Hyperactivity-Impulsivity* - Inattention is associated with difficulties in executive function, academic underachievement, and shyness. - Hyperactivity-impulsivity relates more to social challenges and disruptive behaviors. - Understanding the different types of impairment helps tailor interventions for individuals with ADHD. 22:02 👫 *Gender Disparities in ADHD Subtypes* - Inattentive subtype is more prevalent in both children and adults. - The male-to-female ratio is lower for the inattentive subtype, challenging the stereotype of ADHD primarily as a hyperactive condition. - Examining clinic presentations shows a more balanced gender distribution than often assumed. 25:18 🧠 *Gender Differences in ADHD Subtypes* - Women are more likely to have the inattentive subtype of ADHD. - In clinical studies of children, the inattentive subtype is less prevalent, but in adulthood, women are more likely to seek evaluation for ADHD. - Factors such as referral patterns, social behavior, and presentation contribute to the observed gender distribution. 27:25 🔄 *Comorbidity in ADHD Subtypes* - ADHD is associated with disruptive behavior disorders, with oppositional defiant disorder and conduct disorder more common in the combined subtype. - The combined subtype shows higher rates of alcohol/substance abuse, while depression and anxiety occur at similar frequencies in both subtypes. - Longitudinal studies indicate that girls with ADHD are at greater risk for depression, anxiety, eating disorders, and even suicidal behavior. 29:30 🧩 *Research on ADHD Subtypes* - Ongoing research compares ADHD subtypes in dimensions like cognitive function, executive function, social behavior, heritability, and response to treatment. - Cognitive and executive function differences are noted, with inhibitory control deficits more pronounced in the combined subtype and processing speed difficulties in the inattentive subtype. - Social characteristics, heritability, and treatment responses are being explored to understand if the predominantly inattentive subtype represents a distinct disorder. 33:13 🤝 *Social Functioning in ADHD Subtypes* - The predominantly inattentive (PI) type tends to be slow to respond interpersonally, showing deficits in social knowledge and being more socially neglected. - The combined subtype may know social norms but struggles with impulse control, resulting in more aggressive behavior, leading to social rejection. - Differentiated social skills interventions may be needed for each subtype based on their unique challenges. 37:23 🧬 *Heritability of ADHD* - ADHD has a strong genetic component, with a heritability rate of 70-80%. - Twin studies show a high concordance rate in identical twins, indicating genetic vulnerability. - While ADHD is heritable, the specific subtype may vary within families, suggesting variability in the inherited expression of the disorder. 41:32 💼 *Assessment and Diagnosis of ADHD in Adults* - Screening tools like the WHO instrument provide likelihood, but diagnosis involves careful history, symptom evaluation, and exploration of daily functioning. - Age of onset, impairment assessment, and consideration of contextual manifestations in gender are crucial in diagnosing ADHD in adults. - Identifying the predominantly inattentive subtype (PI) requires distinguishing attention issues from other potential disorders like anxiety, depression, or learning difficulties. 46:07 ⚖️ *Response to Treatment in ADHD Subtypes* - Response to stimulant medication may vary, with some studies suggesting the PI subtype responds better at lower doses. - Psychological treatment, especially behavior therapy, shows promise for both subtypes, with some unique programs designed for the predominantly inattentive type. - Individualized and carefully titrated medication, combined with behavioral interventions, is emphasized for optimal treatment outcomes. 50:05 🚀 *Overcoming Procrastination and Task Aversion* - When facing difficulty getting started, the mantra is to recognize that the first step might be too big. - Strategies include breaking tasks down by time spent or by manageable amounts. - The PI subtype in ADHD lacks inhibitory control or emotional dysregulation, distinguishing it from other subtypes. 52:37 🧠 *Stereotypes and ADHD Diagnosis Challenges* - Stereotypes, such as associating ADHD with unruly behavior or blaming parents, hinder proper evaluation. - Older women may avoid seeking a diagnosis due to misconceptions about ADHD being a childhood condition. - Stigma and beliefs about limited treatment options contribute to the underdiagnosis of ADHD in adults. 56:00 🔄 *Inflection Points and Escalation of Inattentive Symptoms* - Inflection points, like transitioning to middle school or adulthood responsibilities, can exacerbate inattentive symptoms. - Increased demands for executive functions in various life stages often reveal existing ADHD challenges. - Even if symptoms were less noticeable before age 12, they can become more apparent during key life transitions. 58:20 🕰️ *Signs of ADHD Before Age 12 and the Importance of Evaluation* - Symptoms of ADHD may be easy to ignore before age 12, requiring a careful evaluator to identify subtle signs. - The absence of noticeable symptoms in childhood does not rule out ADHD, as manifestations can be more subtle. - Specific inquiries about organizational skills and procrastination tendencies help unveil potential ADHD precursors. 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[@georgemaier6094]

excellent!

[@VindicatorMike]

There's a lot of unnecessary setup for an ADHD video, I wanted to give up on this many times during the introduction. Painful.

[@mnelson9057]

This was very helpful, thank you! Could you put the link to the menopause video in the description? I can’t find it on your channel. Thank you

[@david.petrey]

Seems that this would mostly be interesting to medical professionals, maybe to some parents or an adult who is new to adhd. As an inattentive adult this was not helpful for me. One slide at the end had some helpful ideas.

[@quadcom]

With regards to the social interaction differences between ADD and ADHD, has there been any research or study on the relevance of the personality types? Could being introverted or extroverted have any impact on the type of ADHD, or could it be the other way around? The type of ADHD drives the personality type? I am very much introverted, always have been. And now at 50, have been diagnosed with ADD type. Looking back on my life, it is pretty clear I've been this way ever sine I was a child. Oh how life might have been different if this was a know thing when I was in school!!

[@diabloakland]

Interesting, I’m a true extrovert and also deal with inattentive adhd. I think your second opinion though has lots of merit, too. Adhd untreated made me feel inadequate even though I’m naturally extroverted

[@paulcreedon5730]

Just out of interest - did anyone find the WHO brief screener mentioned at 40:48? I searched and couldn't find it.

[@catchnowsortlater]

Adult ADHD Self-Report Scale (ASRS)

[@FrancisFjordCupola]

"Focus on Inattentive ADHD" sounds like a good pun to me. I expect the matter can use some light-heartedness upfront given the "under-treated" a bit later in the title.

[@lisawhitehall1870]

Been trying for years to get help..but my state refuses the federal awards 😒 not allowed help...supports and services NOTHING...HELP

[@brandipiecora7640]

Because of my ADHD - I couldn’t make it through the intro 😢

[@taoist32]

I stopped after 2 minutes, realizing I was fidgeting and playing with my phone instead of watching this video.

[@kor6bigtime592]

Bro these adhd seminars are not suited for adhd people are they? Morale of the story is what the fucks going on?

[@user-jm5jt9ud4p]

Hi guys, I'm literally not good at anything. This makes it hard to choose a career. Any advice?

[@kor6bigtime592]

"Any monkey can slap on paint" - said from a NZ monkey looking folk. I typically have a love hate for digging holes in the ground but I do genuinely like fencing. Maybe something that's outdoors and a little physical will suit? Trial and error really.

[@LoveLife-gv8jg]

Sluggish cognitive tempo!! THATS IT...FIRST TIME SOMEONE NAMED IT

[@thetransferaccount4586]

I wonder who's the audience for these videos.. certainly not the targeted audience

[@hollisbabybeats]

11:30 minutes in I’m lost

[@lindsayheyes925]

"Focus on Inattentive ADHD"... That title is the best example of an oxymoron since "Military Intelligence".

[@LS87B3]

That intro wasted her 5 minutes of her life. Also mine too :) Start the video at 5 minutes before loosing your attention! :)

[@lizzieboredom92]

I found myself getting upset the longer I watched this presentation. For one, the data shows men display PI more than women. No duh. Women are grossly underdiagnosed and I did not hear the presenter mention it once. And I feel like it fuels the bad stereotype that women can't have ADHD or it's rare. Maybe I got distracted when they did? Regardless, I just found this upsetting. Two, I thought I had understood this presentation to be a focus on Inattentive ADHD in a way that would give me a better understanding of how it affects my life; not data that confirms it can be a diagnosis. I fail to understand how showing raw numbers from two SMALL studies is actually a beneficial to the scientific community. Don't you need many studies that confirm the results again and again to verify the finding is accurate? I also do not find small sample sizes helpful because it can misrepresent the actual population. IDK, maybe I'm just being too critical but I'm mad and think this was a bad presentation.

[@Abbi_Lovely]

I definitely heard her mention women are under diagnosed. She didn’t make it a slide point but it was said.

[@va_yer6831]

Check 26:00

[@Azzy_Mazzy]

She did mention it, did you even reach half point of the video before going on this rant? Most major studies show that it does happen more in men. Yes women are under-diagnosed (adults in general but women more specifically) but lets not be confused about actual prevalence.

[@SamShank175]

One thing I've learned is that there's not a whole lot of black and white when it comes to ADHD or really anything affecting the brain. You're not likely to find many large definitive studies on ADHD. She's presenting the differences so you can see how inattentive type varies. Expecting a presentation to give you everything you want it to is pretty unrealistic and being mad about it is kind of dumb.