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Attention Deficit Hyperactivity Disorder - Predominantly Inattentive Type A Diagnostic Dilemma - by Dr. Deane G. Baldwin

Attention Deficit Hyperactivity Disorder (ADHD) is a common mental disorder in children that adversely affects adequate attention, acceptable levels of activity and imposes an impulsive behaviorial style. For children the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), a publication of the American Psychiatric Association, breaks ADHD into four categories:

ADHD - Predominantly Inattentive Type

ADHD - Predominantly Hyperactive/Impulsive Type

ADHD - Combined Type

ADHD - Not Otherwise Specified

For the most part, ADHD Hyperactive/Impulsive and Combined types have highly visible characteristics that bring the child to the attention of medical providers at an early age. On the other hand, ADHD Inattentive Type (ADD) may be overlooked until the affected child is found to be struggling in school or showing signs of a mood or anxiety disorder.

At this point the picture may be less clear and many questions will arise. Is the academic underachievement due to the under focused behavioral style of ADD? Perhaps it is confused with internalized and over focused behaviors seen in children with a compulsive or pervasive developmental disorder? Might it be because the child has a learning or language disorder (LDD)? Maybe, for many reasons, the child is depressed or anxious and cannot concentrate.

The answer is that ADD can be confused with or be associated with any or all of the above. This is the reason for the dilemma that many mental health care providers face when evaluating the child for problems that have not been recognized in the early grades or when there are coexisting conditions in the same child.

Inconsistency of early academic performance is the key to early detection of simple or isolated ADD. Generally speaking, when a child performs well in all phases of academics some of the time but struggles the rest of the time, ADD should be a prime diagnostic consideration. Once ADD has been diagnosed and properly treated, the erratic learning style will be corrected and the child with the disorder should progress at or near full ability. This is especially true when the diagnosis is made before academically imposed stressors come into play.

A real diagnostic puzzle for the caregiver is to identify conditions that are frequently coentities with ADD or those same conditions that can, of themselves, cause inattention. One should always consider evaluating a child for LDD when a child with ADD continues to have academic difficulty after appropriate management has been in place. By the same token, children who are clearly learning disabled but struggle with productivity should be highly suspect for ADD. (About 50% of children with LDD have ADD and about 30% of children with ADHD have LDD).

Another puzzle is the over focused child who is often misdiagnosed as ADD. A key difficulty for this child is one of dealing with transition. The over focused child finds it difficult to leave one school subject and turn attention to another. This problem is often thought to be an attention deficit, when, in reality, it is quite the opposite. This problem requires very different strategies for behavioral and academic intervention.

Other mental disorders can interfere with attention: juvenile mania, depression and anxiety, to name a few. Each and every condition that is seen with ADHD should be considered and ruled out. So too, should environmental, familial, health, behavioral and other risk factors be inventoried and evaluated for potential problems that could alter attention.

Again, early intervention and treatment of ADD can be very rewarding as there are behavioral and educational strategies as well as medications that, when used appropriately, can prevent the problems seen in chronic school failure often associated with ADD.

For more information about the conditions or terms used, visit and the ABLE Glossary.

Dr. Deane G. Baldwin, M.D., FAAP, is a Board Certified Pediatrician in private practice for 39 years. Specializing in developmental disorders and school health. For more information go to www. ABLEDEV.COM

How Well Do You Know Your Child? - By Marie Magdala Roker


Do you think you really know your child? I don`t mean know what he/she likes and doesn`t like, but to know him/her well enough to understand his/her challenges, to appreciate his/her strengths and weaknesses and to help him/her develop his talents. Knowing your child can help increase their chance for success in the future and improve your relationship.

As parents, we are constantly looking for ways to improve out relationship with our children, discipline our children and provide proper guidance. How many of us take the time to get to really know our child? Some of us believe that our children are extensions of us and don`t have their own thoughts, dreams and goals. When was the last time you sat down with your child to find out what they are thinking? The answers may surprise you. Children, especially during puberty, start to discover and develop their identity. They go through an emotional and psychological identity crisis and question and challenge their parents. At this point, children start to crave support and direction from their parents, but are not always compelled to ask for it. But how can you help your child, if you do not know their needs? Simple, ask them!

You are not a mind reader and your child probably will not voluntarily share his/her personal information with you. When you start to offer unsolicited advice, they feel that you are being intrusive or nosy and get defensive. There are two simple steps to getting to know your child. The first step is to listen more and speak less. Let your child direct the conversation and when they ask for your advice, offer it without being judgmental or critical. Lecturing and berating your child for poor judgment or unhealthy decisions will not help you to understand him/her more because you will not be getting to the core reason for the behavior. If you do not have the proper information, how can you give your child the support that he/she needs? By listening, you will be able to help your child understand how their choices and decisions affect their lives and direct them to making healthier and more responsible decisions. By being an active listener, you learn to acknowledge what your child is feeling and give your chil d the information and advice that he/she needs.

The second step is to ask the questions that will create meaningful conversation. The typical responses to ?How was your day?? are ?Good? or ?Fine.? Ask open ended questions instead of closed ended questions that result in one word responses. Ask specific rather than general questions that will stimulate your child to think. Show your child that you have a genuine interest in what is going on in his/her life. Don`t force this process, let it come naturally and soon your child will respond. Ask casually and soon your child will start to volunteer the information. Find out who influences your child. Even ask tough questions such as, "How do you feel about our family?" The point is not to judge your child`s responses, but to know what he/she is thinking or how he/she is feeling. Ask your child if he/she has any resolutions for this year. What was his/her biggest challenge or setback last year? Ask the questions without interrogating. Don`t bombard them with questions or you may face resistance. Resolve today to spend a few minutes each day getting to know your child better. This is one of the most valuable gifts you can give to your child.

Recommended Further Reading:

Get Close to Your Teen Ebook

How to Have Fun With Your Child Anywhere

Teen and Child Personality Test for Parents

How Well Do You Know Your Child Survey

Marie Magdala Roker is an Academic and Personal Development Coach and Certified Breakthrough Parenting Instructor who works with parents to help them unlock and nurture the personal and academic potential in their children and motivate their children to success. You can find her on the web at or

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