ADD predominantly inattentive

[IndigoBell]

Does anyone here know about ADD predominantly inattentive?

My DD is doing really badly at school and has extremely slow processing. Could this be ADD?

She is not at all hyper-active.

How does ADD get diagnosed? A referral to a pead?

Thanks, and Merry Christmas.

Our ds has add primarily inattentive also asd/asperger's and possible auditory processing disorder. The slow processing and difficulty concentrating can I think be symptoms of all or any of these. I think it can be difficult in some cases to distinguish between different possiblediagnoses. With add primarily inattentive don't have to have any hyperactive symptoms but inattentive symptoms need to be present in two settings eg home and school. Diagnosis can be via paed or camhs child psychologist. I would list likely symptoms and ask gp for referral to either.

hth

Thanks

She doesn't have any other problems like ASD. Her only problem is a total inability to learn.

She is in Year 3 but she is doing reception level work, despite having daily 1:1 since reception.

So she has some 'learning problem' but I just can't work out what it was. Till I saw today 'ADD inattentive'

None of the learn to read methods which are designed for dyslexics help her. In fact in 3 years of trying we have found nothing that helps her learn.

But she is a perfectly normal, bright, young lady. If you met her outside the classroom you would never guess she has any kind of learning difficulty.

Thanks leonie.

She has been tested for APD and doesn't have that. Nor do I feel she has any other sensory issues. ( her brothers do so I feel I know more or less what to look for)

I've been researching ADD all morning and really feels it describes her far more than anything else - and I've been trying to find out why she is so slow for the last 2 years - so we are talking a lot of research.

Now I guess just have a long waiting game to play before getting to see a paed.

Hi, DD1 has this and it took 4 years of assessments to work it out because she didn't fit the "classic" ADHD profile. In fact, girls with inattentive type ADD are the most underdiagnosed group with this condition because they don't tend to cause a problem in the classroom, they just wander off in a dream at the back of the class and "click" back in to find they've missed 20 minutes of the lesson.
I'd thoroughly recommend Dr Christopher Green's book on ADHD (he of Toddler Taming fame) as it is one of the most user friendly texts I've read on the subject.
We made the decision to trial DD1 on ritalin. After googling and seeing all the horror stories, it was not a decision taken lightly. It was the absolute best thing we have ever done. Six months after going on the medication, she received her first ever "normal" school report. After four years of inexplicable underachievement and angst, this was utterly mindblowing to us. I think I sobbed for a whole day!!!
A diagnosis has to be made by a suitably qualified paediatrician or educational psychologist. Waiting for your local health authority or school to organise this for you is pretty futile, much as it pains me to say so. If your daughter isn't smashing up the classroom, she isn't a priority. If you're at all in the position to do so, find someone who specialises in ADHD in children and pay to see them privately if you have to.
Don't go in and expect them to see what you see. Tell them explicitly your concerns and opinions. Above all, don't be afraid of a diagnosis. It has been for DD1 the very best thing that could happen for her. Good luck to you all.

Thank you very much. That is all very reassuring to hear.

She is already down to see the school EP as she is doing so badly academically in class - so I will specifically ask them to look for this. And I'll ask the GP to refer us to a paed. The initial referral for my son didn't take long, so I'm hoping that will still be the case for DD.

I can see why this condition is hard to diagnose. Everyone has just been writing off all her problems as dyslexia. Although her first school just thought she was slow :(

A normal school report! I can't even imagine getting one of those...

Well, I never got a "normal" school report. But mind you, I was 43 when I was diagnosed with ADHD-I so probably a leeetle too late for me!

The diagnosis process for ADHD - ime - is fairly strong; there are a lot of questionnaires and they spend a lot of time differentiating it from other conditions. So I think it's definitely worth a bash, from my diagnosis experience it seems very hard to get a "false positive". It's a very different game here to in the USA.

Your issue, I think, will be if she turns out to have a bit of one thing and a bit of another and not quite enough of any of them for diagnosis though the overall picture explains her problems at school. So if/when you do get to talk to the experts, explore the whole picture carefully and make sure all the symptoms are explained. "No she doesn't quite have ADHD" is not going to be a good enough answer.

If she does have it, you need to know before she gets much older. Otherwise you'll spend as much time repairing her confidence as treating the underlying problem.

Make a huge fuss to the school EP and ensure they consider it properly (also ask how much experience they have of predominantly inattentive ADHD, and adhd in girls... if not much, ask them to research it before seeing her). Given that EPs reluctance to support diagnoses cos of resources, it might be worth stating that you want a diagnosis as you want to consider medication 'so she won't need so much 1-1 support'.

My dd has this and is exactly as you describe your dd. She was referred to her paed in Y3 and diagnosis was very thorough and took two years. We have tried medication, but dd really didn't like taking it - she had unwanted side-effects and she also didn't like the feeling that it (in her own words) controlled her mind (which of course, it didn't, just helped her to concentrate, but we didn't want to coearse her in any way when she is able to think for herself iyswim - hard to explain really)! Her concentration improved for sure, but her levels stayed static. She is 10 now and in year six and her self esteem is a major issue. Earlier diagnosis may have helped, but we are now fighting for SA as she has awful difficulty with reading, but is not deemed dyslexic! There is a good book here which could have been written for dd.

There is no doubt in my mind that this is a very real condition, but is seriously hard to pick up on and diagnose because dd really doesn't stand out in a crowd, but the symptoms have developed more as she has grown older and can no longer be written off as her age etc and the gap between her and her peers is widening, yet like you say, if you met her out of the classroom, you really would never think there was a problem. She is bright, articulate in her speech and has good common sense etc. She certainly has a few traits of ASD, but not enough for a diagnosis. ADD predominently inattentive dx describes her symptoms exactly. I have come across very few people who are in the same boat as us, so for me reading your post has gone some way to helping me feel it's not all in my head as I have felt at various times over the last few years despite my intinct telling me otherwise!! Feel free to contact me if you want to chat.

Thanks Aero - that's reallly interesting / hopeful / depressing.

2 years for a dx! I hope it doesn't take that long - although I was expecting 1 year, because I think the paed will have to see her 6 months apart.

I'll pm you for more details.

I think it is harder for girls. And the brighter they are, in one way the harder it is because if you are bright enough then periods of hyperfocus will be enough to pull it off and they are perceived as "lazy" and "can concentrate fine when they want to". I think most of the self-esteem issues are down to that sort of thing: it's a very irritating condition to live and work with and people can't help venting a bit; you have to teach your child they are criticising the condition not them.

The up side is that with enough help to organise yourself, you can do very well. I have 4 science A-levels, 2 degrees, and had a fairly whizzy career before DD1 (though I had to retake the A levels, got thrown out of uni 3 times, and managed to find myself a really really stressful job where flying by the seat of my pants was an advantage). My personal theory is that not only are people with ADHD very creative, they have to develop extra skills to cope.

Indigo,
Diagnosis needn't take as long as a year. You could ask your gp which would be quicker in your area - referral to a child paed or child psych via child and adolescent mental health service. Although local camhs often have waiting lists, once you see a child psychologist, the process needn't take longer than a couple of weeks in theory. I know they need to have evidence of inattention in more than one setting eg home and school. In our case someone from cahms came to observe ds in school plus class teacher filled out connor's questionnaire. We filled out home version of connor's questionnaire and gave detailed history in an initial interview followed by another long interview and observation with child psych who then gave on the spot diagnosis.

I don't think an ed psych can give an official diagnosis but will be able to provide useful evidence of your dd's difficulties in class.

www.adders.org/ has useful info.

Good luck.

I found a SpLD (dyslexia) report done on her 6 months ago:

Classroom Observation

I observed DD for the start of her maths lesson. She came into the room sucking her thumb. The teacher started to get the attention of the class by giving simple instructions e.g. put your hands on your head. DD was the only student in the class who did not follow the instructions. She then needed a further prompt from the teaching assistant at her table to get her whiteboard out.

Views of the child

DD identified her strengths in school as maths, although she said she was qutie slow. When I asked if there was anything she found difficult she replied that she does not always understand what to do and admitted that she does not always listen. At home she enjoys imagining things.

Screams out ADD-PI to me (now I know what it is :) ) Hopefully the paed will accept this as evidence that she has had this for at least 6 months.

And if the EP assesment done this term looks for at, then by the time we see the paed we will have 2 diff reports, 6 months apart, saying the same thing.

I can't believe the SpLD team didn't spot it. They have been particularly rubbish.
(Given they also said she was a bright, articulate girl, and they couldn't explain why she couldn't read)

I honestly don't know why nobody has picked up on this before. She does not cover it up. She does not have periods of hyper focus. She basically just sits at the back of the class and daydreams. She has made no progress at all in school. She is in Y3 but is doing Reception level work....

Anyway, now I know what's happening. I can start to try different things with her even without a dx.

Thanks for all your help.

Hi Indigo

just out of interest where was your daughter "tested" for APD, currently there are only two recognised APD diagnostic centres.
there are also quite a few dubious professionals who claim to be able to diagnose APD but who are not qualified to interpret the result of the tests of an APD assessment. This includes some Behavioral Optometrists, who have no understanding of APD what so ever. The only professionals qualified to diagnose APD are Audiologists and one or two APD qualified Speech and Language Pathologists.
An APD assessment at Great Ormond Street Hospital (GOSH) is most recommended as they have the facilities to assess and diagnose for any other related issue if APD is not the problem.

It takes about 12 weeks from a GP referral to see a consultant at GOSH.
Unless the diagnosis consultant is aware of the similarities displayed by those who have APD and ADD, and able to understand the diagnostic differences between APD and ADHD then you may not get the correct diagnosis.

What we know as ADD is now included as ADHD spectrum of issues.

Does she have TA support in her work Indigo? she should reall have someone on her table to keep her on task. Dd has a habit of slumping over her desk when things get too much, so there are clear indications for adults working with her to spot. She also does not cover up her condition as what she does is natural for her. With clear observations from school, a dx shouldn't take as long as ours did - there was a lapse of communication between school and the paed on the observation front, so the evidence took longer in coming, but once the paed got the hold of school's observations and ASD was ruled out in the main, (her ASD traits can also be attributed to ADD-PA), then dx was prety clear. Our appts were 4-6 months apart and in that time a few appts were changed and the wait was longer, but the paed wanted to be very sure and a dx was helpful to dd in her own understanding of her barriers to learning. It's definitely not all bad, as r3 points out, but support at this stage is crucial imo and dd has largely missed the primary school boat becasue no-one knew what they were dealing with until a year ago.

Hi Dolfrog,

She was tested for APD by our local NHS audiologist ábout a year ago, who we specifically asked to check for APD and not hearing problems. They said they could see no evidence of it, but that they would refer us to GOSH if we really wanted to....

But I really don't think this is a problem with auditory processing - for example she loses competitive races because she starts daydreaming half way through...

Also she has all the ADD symptoms of being unable to organise herself. She frequently doesn't hand her homework in, or bring it home, she is always losing her PE kit etc.

Her symptoms would not be explained by APD. And in fact she never 'misunderstands' what is being said. She is just daydreaming and totally misses what she should have been listening to....

Hi Indigo

Auditory Processing Disorder (APD) is a listening disability, or not being able to process what you hear. This includes having problems processing conversations and verbal instructions.
Many who have APD are able to conceal the true nature their APD problems in many everyday situations, as we become very good at developing coping strategies for the mot frequent daily events, it is new events and tasks which pose the biggest problems especially when the instructions do not best suite our way of thinking normally very visual or very kineasthetic.

Specific Learning Disability is just another way of talking about Dyslexia which is about having problems with a man made communication system the Visual Notation of speech which in our culture we call the written word. So SpLD are only interested in your daughter having a problem with the written word, and are not qualified nor interested in the various medical, issues which can cause this type of learning disability.

A Learning Disability, should not be confused with a medical cognitive disability. dyslexia would not exist if we did not use a visual notation of speech. But the Auditory Processing, Visual Processing and Attentional cognitive problems would still exist. This happens in cultures where they do not yet use written language, dyslexic does not exist, but the underlying cognitive problems do exist, so they do have APD or listening problems, they do have Visual processing problems understanding what you see, and attention problems.
The development of our education system over the last 150 years or so has just brought these problems into a new light, as being the cause of learning problem when using a man made communication system to teach children in mass learning centres we call schools. If the teacher were qualified enough to be able to teach all children according to their learning needs these problems would not be so common. Children have different learning needs based on their cognitive strengths and weaknesses or disabilities.
Unfortunately too many of our teachers do not understand the full range of our childrens learning needs, and only know how to use some of the teaching programs which our children may need to use to learn. They are more instructor than teachers.

Aero - she doesn't have any TA support at the moment. But it is now clear to me she is going to need it...

She had a TA assigned to her table all last year - and this is the amount of progress she has made with that level of support. :(
(However a rubbish teacher, a rubbish TA, and no dx didn't help)

Have to wait till school goes back to talk to the SENCO and find out what we can arrange...

We moved school last term (for obvious reasons) and this new school have managed to get a TA for my older son (who has ASD) without a statement - so we'll see what they can do for DD.

This is all so crap. I was talking to the SENCO last week and asking when they thought she'd be able to come off the SEN register ( ie when they thought she'd catch up with her peers...) And now just a week later I know I'm going to have to apply for a statement :(

In my area a diagnosis is made by a multi disciplinary team usual led by CAMHS. My son was diagnosed by a psychiatrist pre CAMHS

mrz - as SENCO, what support would you arrange for someone who was diagnosed with ADD-PI?????? (And working at the levels / making the kind progress that DD is?)

Do you have any kids with this dx in your school?

As ASD was diagnosed by a paed at the child develpoment centre, I'm hoping that ADD will be diagnosed the same way - but I guess I'll find out as the months progress... :)

We don't have CAMHS here - we have CFAC - and they refused to see my son while he was being investigated for ASD.

Hi Indigo

Over the last year most NHS centre audiologists have yet to participate in the additional APD training required to carry out a full APD assessment and diagnosis, they centre you visited may have been participating in the Diagnostic test trials run by the Medical Research Council as part of the Required Ethics procedure which all new diagnostic tests need to pass.
I think you should follow up on the option for the GOSH referral where the new diagnostic test were developed, and where the leading UK APD consultants work. GOSH also have the facilities to provide a multi-discipline assessment, so if it is not APD they have access to the professional teams who can provide the correct diagnosis.

There is a difference between misunderstanding or not understanding, and not being able to listen.
APD is about having a listening problem, not neccessarily about not understanding. I may not process what some one has said even though I would have no problem understanding the words they have used. I may not process the words when they say them, as if I had never heard them in the first place.

Those who have APD have poor auditory memories especially for remembering verbal instructions, we also tend to have poor sequencing skills so getting things in the right order can be a problem and we tend lack a sense of time.
Having as poor working memory is usually due to having to run coping strategies to work around issues such as APD and not necessarily due to ADHD, which is about poor concentration skills over any task.

So those who have APD are just as you have described your daughter, who may also have some additional attentional issues. It is possible to have co-morbid conditions.

Dolfrog - I have previously researched APD and now I have also researched ADD - and I really think it sounds far more like ADD then APD.

However of course I'm not qualified to dx anything...

Hi Indigo

The real problem here may be similar to the situation described by Prof. David Moore director of the Medical Research Councils Institute of Hearing Research in a 2006 research paper.
From identical symptoms it is possible to obtain at least 4 different diagnosis depending on the diagnostic professional you are referred to see.
In his paper Prof, Moore mentioned audiologists diagnosing APD, psychologists diagnosing dyslexia, psychiatrists diagnosing Autism, and Speech and Language Pathologists diagnosing speech and language problems. All could be correct, what is needed is a multi-discipline team of all these professionals working together to provide thew best overall diagnosis which is now beginning to happen at GOSH.

None of them should provide a diagnosis without the consulting other types of professional who specialise in the related areas of cognition

We only have one child with an official diagnosis (other issues means he also has a statement )He benefits from many of the same strategies and resources we use with ASD pupils visual and audio prompts as well as a nudge from staff.
Breaking tasks down to small manageable steps with single instructions.
Make sure that all equipment needed is available we use visual equipment menues and visual prompts for each step the child can remove as each is completed.

mrz - thanks. They sound like useful strategies to try.