Attention deficit hyperactivity disorder predominantly inattentive

ADHD-PI is an attention-concentration deficit that has everything in common with other forms of ADHD except that it has fewer hyperactivity or impulsivity symptoms and has more directed attention fatigue symptoms.{{cite book | last = Quinn | first = Patricia | title = ADD and the College Student: A Guide for High School and College Students with Attention Deficit Disorder | publisher = Magination Press | year = 1994 | location = New York, NY | pages = 2–3 | url = http://www.maginationpress.com/4416630.html | isbn = 1-55798-663-0}}

The DSM-5 allows for diagnosis of the predominantly inattentive presentations of ADHD (ICD-10 code F90.0) if the individual presents six or more (five for adults) of the following symptoms of inattention for at least six months to a point that is disruptive and inappropriate for developmental level:

• Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
• Often has trouble keeping attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
• Often has trouble organizing activities.
• Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period (such as schoolwork or homework).
• Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
• Is often easily distracted.
• Is often forgetful in daily activities.{{cite web |url=http://behavenet.com/attention-deficithyperactivity-disorder |title=Attention-Deficit/Hyperactivity Disorder |website=BehaveNet |access-date=17 April 2013}}

An ADHD diagnosis is contingent upon the symptoms of impairment presenting themselves in two or more settings (e.g., at school or work and at home). There must also be clear evidence of clinically significant impairment in social, academic, or occupational functioning. Lastly, the symptoms must not occur exclusively during the course of schizophrenia or another psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder).{{Cite journal |last1=Drechsler |first1=Renate |last2=Brem |first2=Silvia |last3=Brandeis |first3=Daniel |last4=Grünblatt |first4=Edna |last5=Berger |first5=Gregor |last6=Walitza |first6=Susanne |date=October 2020 |title=ADHD: Current Concepts and Treatments in Children and Adolescents |journal=Neuropediatrics |volume=51 |issue=5 |pages=315–335 |doi=10.1055/s-0040-1701658 |issn=0174-304X |pmc=7508636 |pmid=32559806}}

{{main|Attention deficit hyperactivity disorder management}}

Although ADHD has most often been treated with medication, medications do not cure ADHD. They are used solely to treat the symptoms associated with this disorder and the symptoms will come back once the medication stops.{{cite web|title=Attention deficit hyperactivity disorder |date=2008 |url=http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml |publisher=National Institute of Mental health |access-date=9 January 2013 |archive-date=19 January 2013 |archive-url=https://web.archive.org/web/20130119030917/http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml |url-status=live |df=dmy }}

Stimulants are typically formulated in fast and slow-acting as well as short and long-acting formulations. The fast-acting amphetamine mixed salts (Adderall) and its derivatives, with short and long-acting formulations bind to the trace amine associated receptor and triggers the release of dopamine into the synaptic cleft.{{cite journal |vauthors=Retz W, Retz-Junginger P, Thome J, Rösler M |title=Pharmacological treatment of adult ADHD in Europe |journal=The World Journal of Biological Psychiatry |volume=12 |issue=Suppl 1 |pages=89–94 | date=September 2011 |pmid=21906003 |doi=10.3109/15622975.2011.603229|s2cid=34871481 }} They may have a better cardiovascular disease profile than methylphenidate and potentially better tolerated.{{cite journal |vauthors=Kolar D, Keller A, Golfinopoulos M, Cumyn L, Syer C, Hechtman L |title=Treatment of adults with attention-deficit/hyperactivity disorder |journal=Neuropsychiatric Disease and Treatment |volume=4 |issue=2 |pages=389–403 | date=April 2008 |pmid=18728745 |pmc=2518387 |url=|doi=10.2147/ndt.s6985 |doi-access=free }}

The fast-acting methylphenidate (well known under the trade name Ritalin) is a dopamine reuptake inhibitor.{{Cite journal|last1=Volkow|first1=N. D.|last2=Fowler|first2=J. S.|last3=Wang|first3=G.|last4=Ding|first4=Y.|last5=Gatley|first5=S. J.|date=1 January 2002|title=Mechanism of action of methylphenidate: insights from PET imaging studies|journal=Journal of Attention Disorders|volume=6|issue=Suppl 1 |pages=S31–43|issn=1087-0547|pmid=12685517|doi=10.1177/070674370200601s05|s2cid=9132302}} In the short term, methylphenidate is well tolerated. However, long-term studies have not been conducted in adults, and concerns about long-term effects like increases in blood pressure have not been established.{{cite journal |author=Godfrey J |title=Safety of therapeutic methylphenidate in adults: a systematic review of the evidence |journal=Journal of Psychopharmacology |volume=23 |issue=2 |pages=194–205 | date=March 2009 |pmid=18515459 |doi=10.1177/0269881108089809|s2cid=5390805 }}

The slow and long-acting nonstimulant atomoxetine (Strattera), is primarily a norepinephrine reuptake inhibitor and, to a lesser extent, a dopamine reuptake inhibitor.{{cite journal |vauthors=Simpson D, Plosker GL |title=Spotlight on atomoxetine in adults with attention-deficit hyperactivity disorder |journal=CNS Drugs |volume=18 |issue=6 |pages=397–401 |year=2004 |pmid=15089111 |doi=10.2165/00023210-200418060-00011|s2cid=23171429 }} It is sometimes prescribed in adults who do not get enough vigilant concentration response from mixed amphetamine salts (Adderall) or get too many side effects.{{cite web |last=Messer |first=Tess |date=December 2009 |url=http://www.primarilyinattentiveadd.com/2009/12/best-medicine-for-inattentive-adhd.html |title=The Best Medicine for Inattentive ADHD |website=Primarily Inattentive ADHD (blog) |access-date=25 December 2013}}{{Unreliable medical source|sure=y|date=October 2016}} It is also approved for ADHD by the US Food and Drug Administration.

The use of cholinergic adjunctive medications is uncommon and their clinical effects are poorly researched;{{cite journal |vauthors=Wilens TE, Decker MW |title=Neuronal nicotinic receptor agonists for the treatment of attention-deficit/hyperactivity disorder: focus on cognition |journal=Biochemical Pharmacology |volume=74 |issue=8 |pages=1212–23 | date=October 2007 |pmid=17689498 |pmc=2974320 |doi=10.1016/j.bcp.2007.07.002}}{{cite journal |vauthors=Sarter M, Givens B, Bruno JP |title=The cognitive neuroscience of sustained attention: where top-down meets bottom-up |journal=Brain Research Reviews |volume=35 |issue=2 |pages=146–60 | date=April 2001 |pmid=11336780 |doi=10.1016/S0165-0173(01)00044-3|s2cid=7338299 }}{{cite journal |vauthors=Levin ED, Simon BB |title=Nicotinic acetylcholine involvement in cognitive function in animals |journal=Psychopharmacology |volume=138 |issue=3–4 |pages=217–30 | date=August 1998 |pmid=9725745 |doi=10.1007/s002130050667|s2cid=12099416 }}{{Unreliable medical source|sure=y|date=October 2016}}{{cite journal |vauthors=Demeter E, Sarter M |title=Leveraging the cortical cholinergic system to enhance attention |journal=Neuropharmacology |volume=64 |pages=294–304 | date=January 2013 |issue=1 |pmid=22796110 |pmc=3445745 |doi=10.1016/j.neuropharm.2012.06.060}} consequently, cholinergics such as galantamine or varenicline would be off label use for ADHD.{{cite journal |last=Lehmann |first=Christine |date=21 November 2003 |title=ADHD Symptoms Respond To Cholinergic Drugs |journal=Psychiatric News |volume=38 |issue=22 |page=25 |doi=10.1176/pn.38.22.0025 }}{{cite web |last=Snyder |first=Bill |date=11 December 2009 |title=Genetics may explain three types of ADHD |website=Reporter: Vanderbilt University Medical Center's Weekly Newspaper |url=http://www.mc.vanderbilt.edu:8080/reporter/index.html?ID=7947 }}{{cite journal |vauthors=Potter AS, Newhouse PA, Bucci DJ |title=Central nicotinic cholinergic systems: a role in the cognitive dysfunction in attention-deficit/hyperactivity disorder? |journal=Behavioural Brain Research |volume=175 |issue=2 |pages=201–11 | date=December 2006 |pmid=17081628 |doi=10.1016/j.bbr.2006.09.015|s2cid=9994841 }} New nicotinic cholinergic medications in development for ADHD are pozanicline,{{cite journal |vauthors=Apostol G, Abi-Saab W, Kratochvil CJ, Adler LA, Robieson WZ, Gault LM, Pritchett YL, Feifel D, Collins MA, Saltarelli MD |title=Efficacy and safety of the novel α₄β₂ neuronal nicotinic receptor partial agonist ABT-089 in adults with attention-deficit/hyperactivity disorder: a randomized, double-blind, placebo-controlled crossover study |journal=Psychopharmacology |volume=219 |issue=3 |pages=715–25 | date=February 2012 |pmid=21748252 |doi=10.1007/s00213-011-2393-2|s2cid=18882095 }}{{Primary source inline|reason=Source reports on primary research. Several reviews cite this study, one of those may be more appropriate.|date=October 2016}}{{cite journal |vauthors=Rueter LE, Anderson DJ, Briggs CA, Donnelly-Roberts DL, Gintant GA, Gopalakrishnan M, Lin NH, Osinski MA, Reinhart GA, Buckley MJ, Martin RL, McDermott JS, Preusser LC, Seifert TR, Su Z, Cox BF, Decker MW, Sullivan JP |title=ABT-089: pharmacological properties of a neuronal nicotinic acetylcholine receptor agonist for the potential treatment of cognitive disorders |journal=CNS Drug Reviews |volume=10 |issue=2 |pages=167–82 |year=2004 |pmid=15179445 |pmc=6741767 |doi=10.1111/j.1527-3458.2004.tb00011.x}} ABT-418,{{cite journal |vauthors=Wilens TE, Biederman J, Spencer TJ, Bostic J, Prince J, Monuteaux MC, Soriano J, Fine C, Abrams A, Rater M, Polisner D |title=A pilot controlled clinical trial of ABT-418, a cholinergic agonist, in the treatment of adults with attention deficit hyperactivity disorder |journal=The American Journal of Psychiatry |volume=156 |issue=12 |pages=1931–7 | date=December 1999 |pmid=10588407 |url=http://ajp.psychiatryonline.org/article.aspx?volume=156&page=1931 |doi=10.1176/ajp.156.12.1931 |s2cid=20375475 }}{{Primary source inline|reason=Source reports on primary research. Several reviews cite this study, one of those may be more appropriate.|date=October 2016|citation=Childress, A., & Sallee, F. R. (2014). Pozanicline for the treatment of attention-deficit/hyperactivity disorder. Expert opinion on investigational drugs, 23(11), 1585-1593.}}{{Cite journal|last1=Childress|first1=Ann|last2=Sallee|first2=Floyd R|date=2014-09-06|title=Pozanicline for the treatment of attention-deficit/hyperactivity disorder|url=http://dx.doi.org/10.1517/13543784.2014.956078|journal=Expert Opinion on Investigational Drugs|volume=23|issue=11|pages=1585–1593|doi=10.1517/13543784.2014.956078|pmid=25196198|s2cid=22019342|issn=1354-3784}} and ABT-894.{{cite journal |vauthors=Bain EE, Robieson W, Pritchett Y, Garimella T, Abi-Saab W, Apostol G, McGough JJ, Saltarelli MD |title=A randomized, double-blind, placebo-controlled phase 2 study of α4β2 agonist ABT-894 in adults with ADHD |journal=Neuropsychopharmacology |volume=38 |issue=3 |pages=405–13 | date=February 2013 |pmid=23032073 |pmc=3547191 |doi=10.1038/npp.2012.194}}{{Primary source inline|reason=Source reports on primary research. Several reviews cite this study, one of those may be more appropriate.|date=October 2016}}

In some cases, children who enjoy learning may develop a sense of fear when faced with structured or planned work, especially long or group-based assignments that require extended focus, even if they thoroughly understand the topic. Children with ADHD-PI may be at greater risk of academic failures and early withdrawal from school.{{cite book | last = Triolo | first = Santo | title = Attention Deficit Hyperactivity Disorder in Adulthood: A Practitioner's Handbook | publisher = Brunner-Routledge | year = 1998 | location = Philadelphia, PA | pages = 65–69 | isbn = 0-87630-890-6}} Teachers and parents may make incorrect assumptions about the behaviors and attitudes of a child with ADHD-PI, and may provide them with frequent and erroneous negative feedback (e.g. "careless", "you're irresponsible", "you're immature", "you're lazy", "you don't care/show any effort", "you just aren't trying", etc.).{{cite book | last1 = Kelly | first1 = Kate | first2 = Peggy |last2 = Ramundo | title = You Mean I'm Not Lazy, Stupid or Crazy?! The Classic Self-Help Book For Adults with Attention Deficit Disorder | publisher = Scribner | year = 2006 | location = New York, NY | pages = 11–12 | url = http://www.simonsays.com/content/book.cfm?tab=1&pid=506364 | isbn = 0-7432-6448-7}}

The inattentive children may realize on some level that they are somehow different internally from their peers. However, they are also likely to accept and internalize the continuous negative feedback, creating a negative self-image that becomes self-reinforcing. If these children progress into adulthood undiagnosed or untreated, their inattentiveness, ongoing frustrations, and poor self-image frequently create numerous and severe problems maintaining healthy relationships, succeeding in postsecondary schooling, or succeeding in the workplace. These problems can compound frustrations and low self-esteem, and will often lead to the development of secondary pathologies including anxiety disorders, mood disorders, and substance abuse.

It has been suggested that some of the symptoms of ADHD present in childhood appear to be less overt in adulthood. This is likely due to an adult's ability to make cognitive adjustments and develop compensating or coping skills to minimize the impact of inattentive or hyperactive symptoms. However, the core problems of ADHD do not disappear with age. Some researchers have suggested that individuals with reduced or less overt hyperactivity symptoms should receive the ADHD-combined diagnosis. Hallowell and Ratey (2005) suggest{{cite book |last1=Hallowell |first1=Edward M. |title=Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder |year=2005 |publisher=Ballantine Books|location=New York|isbn=0-345-44231-8 |pages=[https://archive.org/details/deliveredfromdis00edwa/page/253 253–5] |author-link=Edward Hallowell (psychiatrist) |author-link2=John Ratey |first2=John J. |last2=Ratey|title-link=Delivered from Distraction }} that the manifestation of hyperactivity simply changes with adolescence and adulthood, becoming a more generalized restlessness or tendency to fidget.

A meta-analysis of 37 studies on cognitive differences between those presenting ADHD-Predominantly Inattentive presentations and ADHD-Combined type found that "the ADHD-C presenting performed better than the ADHD-PI presenting in the areas of processing speed, attention, performance IQ, memory, and fluency. The ADHD-PI presenting performed better than the ADHD-C group on measures of flexibility, working memory, visual/spatial ability, non-verbal IQ, motor ability, and language. Both the ADHD-C and ADHD-PI groups were found to perform more poorly than the control group on measures of inhibition, however, there was no difference found between the two groups. Furthermore, the ADHD-C and ADHD-PI presenting did not differ on measures of sustained attention."{{cite book |last=Lane |first=Brittany Ann |year=2003 |title=The differential neuropsychological/cognitive profiles of ADHD presentations: A meta-analysis |type=PhD Thesis |publisher=University of Northern Colorado |oclc=56479200}}{{page needed|date=September 2014}}

It is difficult to say exactly how many children or adults worldwide have ADHD because different countries have used different ways of diagnosing it, while some do not diagnose it at all. In the UK, diagnosis is based on quite a narrow set of symptoms, and about 0.5–1% of children are thought to have attention or hyperactivity problems. In comparison, professionals in the U.S. used a much broader definition of the term ADHD until recently.{{Cite journal |last1=Lange |first1=Klaus W. |last2=Reichl |first2=Susanne |last3=Lange |first3=Katharina M. |last4=Tucha |first4=Lara |last5=Tucha |first5=Oliver |date=2010 |title=The history of attention deficit hyperactivity disorder |journal=Attention Deficit and Hyperactivity Disorders |volume=2 |issue=4 |pages=241–255 |doi=10.1007/s12402-010-0045-8 |issn=1866-6116 |pmc=3000907 |pmid=21258430}} This meant up to 10% of children in the U.S. were described as having ADHD. Current estimates suggest that ADHD is present internationally in about 7.2% of children.{{Cite journal|title = Prevalence of Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis|url = http://pediatrics.aappublications.org/content/135/4/e994|journal = Pediatrics|date = 2015-04-01|issn = 0031-4005|pmid = 25733754|pages = e994–e1001|volume = 135|issue = 4|doi = 10.1542/peds.2014-3482|first1 = Rae|last1 = Thomas|first2 = Sharon|last2 = Sanders|first3 = Jenny|last3 = Doust|first4 = Elaine|last4 = Beller|first5 = Paul|last5 = Glasziou|s2cid = 2457397|doi-access = free}} ADHD is diagnosed around 5 times more often in boys than girls. Reasons for this disparity are debated, but likely involve both biological and social/diagnostic factors.{{cite journal |vauthors=Bruchmüller K, Margraf J, Schneider S |title=Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis |journal=Journal of Consulting and Clinical Psychology |volume=80 |issue=1 |pages=128–38 | date=February 2012 |pmid=22201328 |doi=10.1037/a0026582|s2cid=6436414 }}{{Primary source inline|reason=Survey research by the authors.|date=October 2016}} Some theorize this may be because of the particular ways they express their difficulties. Boys and girls both have attention problems, but due to differences in gender and symptoms, boys may come off as more active in their symptoms and therefore seem harder to manage.{{Cite journal|last1=Skogli|first1=Erik Winther|last2=Teicher|first2=Martin H|last3=Andersen|first3=Per Normann|last4=Hovik|first4=Kjell Tore|last5=Øie|first5=Merete|date=2013-11-09|title=ADHD in girls and boys – gender differences in co-existing symptoms and executive function measures|journal=BMC Psychiatry|volume=13|issue=1|page=298|doi=10.1186/1471-244x-13-298|pmid=24206839|pmc=3827008|issn=1471-244X |doi-access=free }} Children from all cultures and social groups are diagnosed with ADHD. However, children from certain backgrounds may be particularly likely to be diagnosed with ADHD, due to different expectations about how they should behave.{{citation needed|date = October 2013}} It is, therefore, important to ensure that a child's cultural background is understood and taken into account as part of the assessment.

In 1980, the DSM-III changed the name of the condition from "hyperkinetic reaction of childhood" to "attention deficit disorder" (ADD), as research by Virginia Douglas had suggested deficits in attention and impulse control were more important than hyperactive behavior for understanding the disorder. The new label also reflected the observation of clinicians that attention deficits could also exist without hyperactivity. Deficits in sustained attention or vigilance could separate the disorder from other psychiatric disorders.

For the first time, two subtypes were introduced: ADD with hyperactivity (ADD+H) and ADD without hyperactivity (ADD-H). While the ADD+H category was fairly consistent with previous definitions, the latter subtype represented essentially a new category. Thus, almost everything that is known about the predominantly inattentive subtype is based on research conducted since 1980. Those diagnosed with ADD-H were distinguished as more prone to daydreaming and developing lethargic and hypoactive behaviors in academic settings. In 1987, revisions to DSM renamed the disorder to "attention deficit hyperactivity disorder" (ADHD). The DSM combined the symptoms lists for inattentive, impulsivity, and hyperactivity into a single list.{{Cite book |title=Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment |date=2015 |publisher=The Guilford Press |isbn=978-1-4625-1772-5 |editor-last=Barkley |editor-first=Russell A. |edition=Fourth |location=New York}}{{cite web |url=http://www.kidsource.com/LDA-CA/ADD_WO.html |first1=Jennifer |last1=Wheeler |first2=Caryn |last2=Carlson |date=3 July 1996 |title=Attention Deficit Disorder without Hyperactivity (ADHD, Predominantly Inattentive Type) |website=KidSource Online |access-date=30 June 2016 |archive-url=https://web.archive.org/web/20160706111707/http://www.kidsource.com/LDA-CA/ADD_WO.html |archive-date=6 July 2016 |url-status=dead |df=dmy-all }}

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{{wiktionary|ADHD-PI|ADHD}}

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Category:Attention deficit hyperactivity disorder

Category:Amphetamine