Inattentive adhd may be it's own disorder and when I recently saw Russell Barkley he indicated in all likelihood it will be identified as a unique disorder. The current term being used is SCT or sluggish cognitive tempo. People with "true" SCT are born with this temperament and don't change into it from combined or hyper adhd. SCT are supposed to have more difficulties processing information and are more prone to making mistakes then ADHDers. There is very little info on SCT.


Here are two bits of further reading. Would love to read more if anyone has an online source.
From Barkley-> "As noted earlier, evidence is mounting that the predominantly inattentive type of ADHD (ADHD-PI) may be comprised of a rather heterogeneous mix of children, a subset of whom have a qualitatively different disorder of attention and cognitive processing (Milich et al., 2001). This subset is probably not a subtype of ADHD but may represent a separate disorder (Barkley, 1998, 2001; Milich et al., 2001), manifesting a sluggish cognitive style and selective attention deficit, having less comorbidity with oppositional and conduct disorder, demonstrating a more passive style of social relationship, having memory retrieval problems, and, owing to their lower level of impulsiveness, probably having a different, more benign, developmental course".
http://www.continuingedcourses.net/active/courses/course003.php

and....

"however, there is some research in support of a higher rate of learning disabilities in children with ADHD,IA".

From ->http://www.kidsource.com/LDA-CA/ADD_WO.html

I don't think anyone is suggesting that ADD-I is a separate disorder, rather, that SCT is a separate disorder. In other words, SCT is a similar disorder in its manifestations and executive deficits, but has it's own defining characteristics, which may have important implications for treatment and course.

The research suggests that SCT is a small percentage of actual ADHD diagnoses. Just a little clarification ;)

I don't think anyone is suggesting that ADD-I is a separate disorder, rather, that SCT is a separate disorder. In other words, SCT is a similar disorder in its manifestations and executive deficits, but has it's own defining characteristics, which may have important implications for treatment and course.

The research suggests that SCT is a small percentage of actual ADHD diagnoses. Just a little clarification ;)

SCT = ADHD innattentive subtype (who were always that way and who don't fall into the innattentive subtype later in life. They are not combo or hyperactive ADHDers whose symptoms decrease and who consequently now fit the DSM-IV critera of innattenive). SCT's are seen as being mentally "foggy" or daydreamers and who often lose their attention because they can't process information fast enough. I believe I am one as my report card clearly indicates :p although I don't know if "not owning the deed", is a symptom. :D

Are we on the same page?

Comparing SCT to non-SCT inattentiveness:

http://www.m-net.co.il/english/lifestyle/health/adhd.html

I am a bit skeptical about SCT, at least how it's currently defined. From the link posted above: http://www.m-net.co.il/english/lifestyle/health/adhd.html

Subtype C: Sluggish cognitive type (or SCT)
http://www.m-net.co.il/english/lifestyle/life_images/spacer.gif
Day-dreamy, foggy, easily confused, has trouble focusing. Can’t discern what’s important. Information-processing problems.
http://www.m-net.co.il/english/lifestyle/life_images/spacer.gif
Passive, lethargic, hypoactive, not at all impulsive. Shy, withdrawn, passive, uninvolved.

Productivity is okay but problems with accuracy.
http://www.m-net.co.il/english/lifestyle/life_images/spacer.gif
Does not respond well to stimulant medication; may respond to social skills training and cognitive therapy.

Out of all the Inattentive subtypes, this one seems to fit me the best, I've always had it, I've never had hyperactivity as far as I can recall (back to age 3). However, some parts don't quite fit, for instance, I'm not easily confused or 'foggy'. 'Can't discern what's important' - I have difficulty acting on whats important, however I can discern it. 'Productivity is okay but problems with accuracy.' - again, it's the opposite for me. Accuracy is ok, but I have problems with productivity. And as for 'does not respond well to stimulant medication' - I've had some success with stimulants, still in the 'trying to get the dose right' stage.

Maybe there is an undiscovered inattentive subtype 'E' not on that list?

Nope, no undiscovered subtype E :p.

That article looks to be inaccurate although for the most part factual. Four subtypes? Also these symptoms also seem exaggerated or wrong; "easily confused, can’t discern what’s important, good productivity, and does not respond well to stimulant medication".

Remember that SCT is not a true designation. It has not been recognized as such and really the acronym is just a heck of a lot shorter then saying..."ADHD inattentive subtype (who were always that way and who don't fall into the inattentive subtype later in life. They are not combo or hyperactive ADHDers whose symptoms decrease and who consequently now fit the DSM-IV criteria of inattentive)" :p

There are also not two types of SCT since it is only a designation at this point. So no SCT and non-SCT inattentiveness:

But the 'ADHD inattentive' description fits me perfectly, but when you break inattentive down into four subtypes, suddenly those subtypes don't quite fit me right.
:(

I have SCT traits, but other inattentive subtype traits as well. Since this classification is so new, I have to wonder if it's not completely accurate yet (as previous classifications weren't). Hey, nobody studied me in order to come up with these classifications :D

There are also not two types of SCT since it is only a designation at this point. So no SCT and non-SCT inattentiveness:

I was only discerning SCT from anything else that featured inattentiveness, including ADHD combined.

I thought this was an interesting question and needed its own thread.


From a talk by Barkley in 2000:
http://www.schwablearning.org/pdfs/2200_7-barktran.pdf?date=4-12-05

First of all, in that group are the true Inattentive kids. But also in that group are AD/HD children who came in one symptom short of being in the Combined group, right? They’ve got six inattention and five hyperactive symptoms, and according to the DSM, if they don’t have six, they’re not in the Combined type. Well, yes they are, and you should think of them as being Combined type children, even if they come up one symptom short. Don’t put those kids into the Inattentive group. The Inattentive group in our clinic is for kids with three symptoms or fewer off of that Hyperactive-Impulsive list. Any more than three and you’re better off thinking of them as what we call sub-threshold Combined type children.
There’s another group, the group that starts out being in the Combined type and by adolescence or adulthood are no longer so hyperactive, but they meet the criteria on the Hyperactive list. Now you would flip them over into the Inattentive type. Don’t do it. You always think of them as Combined type. So, bottom line is this: If any point in your history there was a whiff of problems with inhibition and impulse control, you’re a traditional AD/HD Combined type kid. . .

And you reserve this Inattentive group for kids who have never in their lives had trouble with inhibition. Those are the spacey, daydreamy, confused, in a fog, sluggish, hypoactive . . .
Here Barkley suggests that there's not four types, but three and Inattentive is a separate disorder.

There are only two pages in my parents’ book, Taking Charge of ADHD, on this group, and it tells you . . . [t]his is a different disorder. Stay tuned. We don’t know what to do with them. It’s up to you. You’re just going to have to cobble together some help any way you can and hope that it works, because there is no science beyond what I just told you.

I buy that, Stan.


It sucks to be on the cutting edge of Science. The regular Adhders have had a good med for 50 years!

3,5,...10 years down the road I'm sure they will have a better SCT drug. I'm 44....dang....how long do I have wait?

Ouch! :eek: Watch that cutting edge, Scuro.

Better to be behind the edge than in front of it, eh?;)


I like this Barkley. He's seems to be asking the interesting questions.

But the 'ADHD inattentive' description fits me perfectly, but when you break inattentive down into four subtypes, suddenly those subtypes don't quite fit me right.
:(

I have SCT traits, but other inattentive subtype traits as well. Since this classification is so new, I have to wonder if it's not completely accurate yet (as previous classifications weren't). Hey, nobody studied me in order to come up with these classifications :D
that would be me, too. although i have had impulsive moments .... few and far between, but enough to get me in trouble...

I was dxed as ADHD-primarily inattentive, and none of the SCT symptoms quite fit. On the contrary, my way of processing information seems to outstrip others more often than not (e.g. I think of something and it takes a while for others to catch on). I'm not 'sluggish', really, or too dreamy for that matter.

But at the same time, I also have my hyperactive moments and it's entirely too easy for me to hyperfocus on things that may matter to me, but aren't critical at the moment. And impulse control has always been a problem for me (case in point: deciding to put a very hot pan with oil in it under a stream of cold water). Methylphenidate has worked quite well for me, so I think that not all primarily inattentive ADHDers have SCT. There are still ADHDers who are mostly inattentive but would qualify for the ADHD label more so than the SCT one.

that would be me, too. although i have had impulsive moments .... few and far between, but enough to get me in trouble...
Yeah, I went back and looked at the diagnostic criteria for combined/hyperactive/impulsive. I see you need to meet 6 of the criteria to be diagnosed with those types. I meet maybe 3. Hyperactive? never, fidgety and squirmy? yes. Impulsive? occasionally. I had a roommate in college who was probably the poster boy for impulsive ADD, I was nothing like that.

So I think it might be some years of revision before they get this these subtypes nailed down right :D

I was dxed as ADHD-primarily inattentive, and none of the SCT symptoms quite fit. On the contrary, my way of processing information seems to outstrip others more often than not (e.g. I think of something and it takes a while for others to catch on). I'm not 'sluggish', really, or too dreamy for that matter.
I'm the same way when it comes to processing information, but I was very daydreamy in school or even in boring meetings. So while there may be such a thing as SCT that is distinct from ADHD, I worry that the critera isn't defined completely right, and may put real adhd people into the SCT group, and they might not receive medications that can help them.

SCT seems to be a good way of describing myself. I have been known to be hypoactive, lethargic, and slow to think. Yet I do swing between both sides of the attentional spectrum (long hyperfocus) and stimulants have a dramatic effect on me. At times, I am more like Dr. Amen's Overfocused type (ruminating on bad thoughts, being angry when interrupted, becoming "antsy" (nearly hyperactive) coming down off of focus)


Methylphenidate has worked quite well for me, so I think that not all primarily inattentive ADHDers have SCT. There are still ADHDers who are mostly inattentive but would qualify for the ADHD label more so than the SCT one.

I agree.

I wonder if it would be possible to have both SCT and ADHD?

It's very important for you to remember that the oldest subject in the sample population used to develop the DSM criteria was 16. In addition, the sample was heavily weighted towards boys.

It's therefore necessary to "age reference" the symptoms so that they are more applicable to adults.In other words, more atune to the adults stage of development; as ADHD is a developmental disability.
In the process, you end up needing fewer & fewer symptoms to meet the criteria as a person gets older.

My reference here are my notes from Russ Barkley's Door County 2003 presentation.They're at the office but I'd be glad to look for the notes that deal with this.

At this point in time, I don't know if he has actually come out and said he has conclusively proven SCT to be a separate disorder. He's too much of a "pure scientist" not do it any other way.Until then, I'll view as a "theoretical construct."

If you know Barkley or have seen him in person, then you know that he is truly devoted to his craft. I therefore expect him to finally resolve the question one way or the other.

Thanks for the excellent posts and for raising the issue in the first place.

Another purely Inattentive-ADDer here.

These symptoms also seem exaggerated or wrong; "easily confused, can’t discern what’s important, good productivity, and does not respond well to stimulant medication". I feel the same, even though I indeed don't get much help from stimulants. "Easily confused?" Ironically, I'm confused about what leads them to say this. Sure, I easily end up having trouble deciding how to follow through a command properly, but just as a result of swift forgetfulness or a broader interpretation of words, and little like what I would imagine in such a "foggy, easily confused" person.

"Can’t discern what’s important"? Whaddaya mean? I've hardly had troubles with- oh wait, why am I typing this reply at 1AM when I should be sleeping :p? But really, that's just a matter of being wrapped up in things. In truth I always appear to have a better grasp on what's important than the average kid my age. Not that it's easy to self-evaluate a thing like that…

'Can't discern what's important' - I have difficulty acting on whats important, however I can discern it. 'Productivity is okay but problems with accuracy.' - again, it's the opposite for me. Accuracy is ok, but I have problems with productivity.
Well said. I'm quite the skilled writer when it comes to spelling and grammar, as well as other related things. Not that I'm not also a good creative, expressive writer, but that can require rediculous amounts of time if I fail to really get myself into the assignment.

that would be me, too. although i have had impulsive moments .... few and far between, but enough to get me in trouble...I second that. Few and far between, but has terribly bugged me when it slipped out.


All in all, this SCT feels like something that I'm tempted to see as being my problem, but (feels as if it) ends up just being a misguided idea that doesn't align with reality. Even if it does turn out to have merit, it's even more in need of a name change than "Attention Deficit Disorder".

MCT, if you have the time, I would love a post from your reference notes. I'd look the information up myself but there ISN'T ANY. On the web most links are basic, on the DSM designation, or or about the D4(?) receptor, many links anyways.

I did to talk to Dr. Barkley briefly on this topic asking him where to go for more info. He suggested his handbook which I believe is for diagnositic purposes. I said I was a teacher and I can't remember exactly what he said but basically he said that the concept of SCT is cutting edge with new discoveries happening right now. He also mentioned that at some point a book would probably come out and shed more light on the subject for laymen like us.

I went back to Stan's link and found lots more. Barkley is quoted verbatim and he is much easier to understand.

Now I want to come back to this group that we call Inattentive AD/HD. We used to call them ADD without Hyperactivity. These days some people are just using the term ADD for them. I don’t like that. Part of the problem with using that term is that that was the old term for AD/HD over 10 years ago, so it creates a lot of labeling confusion.

ADD and AD/HD are the same thing. ADD is the earlier, 1987 term—goes all the way back to 1980, in fact, whereas AD/HD is the more recent label.

So let’s talk about this Inattentive type: the kids who come to see us who don’t show problems with hyperactivity, who aren’t impulsive. What do we know about that subtype? We know enough that several of us in the research community have taken to arguing that this is a different disorder. This does not belong in AD/HD. This is not AD/HD. This is a real attention disorder with real information processing deficits, and it has little in common with the other two kinds of AD/HD.

The Hyperactive type of AD/HD and the Combined type of AD/HD are the same disorder. You’re just catching it at different developmental stages. Kids start out with Hyperactivity; the attention deficits come within a few years after that, and then they move into being the Combined type. But these children, on the other hand, are a different story all together. Why do I think this is a different disorder? Why do some of my colleagues agree with it? Why do the rest of my scientific colleagues certainly agree that this is a qualitatively different group of children? Whether you view them as a different subtype or as an entirely different disorder is less of concern to me than that you understand these are not the same kids. They do not have the same risk, the same co-morbidities, the same causes and the same outcome, and it is likely that they do not respond to the same treatments the same way.

But we will not know any more about treatment if we don’t view them differently, because everyone will assume as you may do, quite naively, that the treatments for one apply to all the subtypes, and they don’t. We have discovered a new disorder and it does not belong here. It needs its own name and its own criteria and it needs to get out of this category known as the disruptive behavior disorders, because it has no affinity for them. So let me show you why many of my colleagues are now slowly coming around to an idea that 10 years ago I argued for. This is a different disorder. Why do I think it’s a different disorder? Because these children come in with the opposite symptoms. Instead of being hyperactive, intrusive, distractable, they’re lethargic, slow-moving, hypoactive, spacey, daydreamy, quiet, passive, withdrawn, confused, in a fog. They are the polar opposite of the AD/HD child in their clinical presentation. This is not an impulsive, disruptive, intrusive, aggressive, emotional, naive child. This is a kid who is staring, daydreaming, confused, and not processing information accurately. This is a real attention deficit, if attention means information processing. These kids have a processing deficit. AD/HD children do not. Do not confuse these two groups. They do not have the same problems with paying attention.

Other things we see in these children: when we bring them into the clinic, and we run them through a battery of neuropsychological tests, they have deficits in an area we call selective attention. Selective attention is how quickly you can deduce what’s important from unimportant in a spatial array of information, how fast you accurately process information coming at you. AD/HD children have no trouble with selective attention. And by the way, let’s put an end then, to this metaphor for AD/HD that it’s a filtering problem. Because it isn’t. Real AD/HD has no trouble with filtering, selecting information. AD/HD children perceive the world exactly as everybody else does. These children don’t. These kids have a selective attention problem, which by the way explains something that we have found in about six different studies. These kids make more mistakes in academic work than AD/HD children do, many more mistakes. The problem that AD/HD children have is with productivity; number of problems attempted. The problem with these kids is accuracy: the number of errors made. These kids have a real problem with input coming into the brain, how quickly they can handle it, how accurately they can select it out, and deal with it. These children have memory problems. AD/HD children do not. These children have trouble with getting information out of short-term and longterm memory and doing it correctly. It’s especially so for long-term memory, so that they show a very erratic recall of information. AD/HD children, if they have a memory problem, it’s going to be in a very unusual form of memory we’re going to talk about later today. But this is traditional long-term storage, and these children have some trouble with that, probably for the same reason. They’re not getting information out of memory any more accurately than they’re processing information coming into the brain.

There are problems with selection, with filtering, with focusing their attention. These children have a very different social profile. The traditional AD/HD child is often a rejected child, because they’re immature and emotional and hotheaded and demanding and controlling and impulsive and often aggressive, so that when we compute a social profile of the AD/HD children they often wind up as being the least liked, the least popular and most likely to fight. That is their peer group profile. That is what Ken Dodge and his profile of peer acceptance views as the rejected child. And 50 percent or more of AD/HD children are utterly rejected by their peer group; these [inattentive] children, very different picture. These children are overlooked. In Ken Dodge’s taxonomy of social problems, they’re neglected. Why? Because they’re passive, uninvolved. They’re staring, daydreaming, hypoactive, absent-minded, passive. Unengaged is a better term for them. They’re not disliked by the other kids. They’re not rejected by them. The other kids just don’t know them. They’re not engaging. They’re not out there participating. They’re just kind of passive kids. They have more friends than AD/HD children have, actually. These kids tend to be neglected, not rejected. It’s a very different social profile.

Other differences: there is no affinity of this disorder for Oppositional (Defiant) or Conduct Disorder that we can tell. They basically have the same base rates as the normal population. But many AD/HD children are likely to go on to develop Oppositional Disorder and Conduct Disorder. Forty-five to 55 percent of AD/HD children develop Oppositional Disorder by age 7, and another 25-45 percent move up to Conduct Disorder by ages 8 to 12. AD/HD goes with Oppositional and Conduct Disorder. The inattentive group does not.

You see another reason why they don’t belong in this group? Those three disorders—AD/HD, ODD, and CD—are all part of a larger category we call the disruptive disorders. The inattentive group isn’t and it shouldn’t be there. Other differences that we see: by definition, of course, these kids are not impulsive. They don’t have any difficulties with inhibition. These children do not respond to stimulants anywhere near as well as AD/HD hyperactive, impulsive children do. Only about one in five of these children will show a sufficiently therapeutic response to maintain them on medication after an initial period of titration. Oh, you’ll find that about two-thirds of them show mild improvement, but those improvements are not enough to justify calling them clinical responders, therapeutic responders. Ninety-two percent of AD/HD children respond to stimulants. Twenty percent of these children respond to stimulants. And the dosing is different. AD/HD children tend to be better on moderate to high doses. Inattentive children, if they’re going to respond at all, it’s at very light doses, small doses. So the drug response is different. And that’s all we know.

[At this time] there are no other studies of treatment of this group—none. The only studies are five involving medication and mine was the only one that tested multiple doses with a placebo control. There are only two pages in my parents’ book, Taking Charge of ADHD, on this group, and it tells you what I just told you. This is what we know. These are different kids. This is a different disorder. Stay tuned. We don’t know what to do with them. It’s up to you. You’re just going to have to cobble together some help any way you can and hope that it works, because there is no science beyond what I just told you.

They may have different causes. They certainly have different family histories. Those children tend to come from families where there are more anxiety disorders and learning disabilities. AD/HD children come from families where there’s more AD/HD, Conduct Disorder, antisocial behavior, and substance abuse. The family histories of these two groups are not the same. Now, we have to be careful here, because the Inattentive group, it turns out, is rather a wastebasket group of kids. First of all, in that group are the true Inattentive kids. But also in that group are AD/HD children who came in one symptom short of being in the Combined group, right? They’ve got six inattention and five hyperactive symptoms, and according to the DSM, if they don’t have six, they’re not in the Combined type. Well, yes they are, and you should think of them as being Combined type children, even if they come up one symptom short. Don’t put those kids into the Inattentive group.

The Inattentive group in our clinic is for kids with three symptoms or fewer off of that HyperactiveImpulsive list. Any more than three and you’re better off thinking of them as what we call subthreshold Combined type children. There’s another group, the group that starts out being in the Combined type and by adolescence or adulthood are no longer so hyperactive, but they meet the criteria on the Hyperactive list. Now you would flip them over into the Inattentive type. Don’t do it. You always think of them as Combined type.

So, bottom line is this: If any point in your history there was a whiff of problems with inhibition and impulse control, you’re a traditional AD/HD Combined type kid, and it shouldn’t matter what the DSM is telling you about cut-off scores. Clinically that’s how you would approach that child. That’s a Combined type kid. And you reserve this Inattentive group for kids who have never in their lives had trouble with inhibition. Those are the spacey, daydreamy, confused, in a fog, sluggish, hypoactive, slow-moving group. And as long as you conceptualize them that way, you won’t make any clinical mistakes. But if you follow the DSM as it’s written—perhaps you have OCD and you just have to follow all those criteria, just as they’re written—then you’re going to get yourself into some trouble.

Because remember, the DSM was not chiseled in stone in Israel. It’s a set of guidelines developed to help make clinical decisions, but it’s to be used with clinical judgment and understanding of the criteria. Okay, that’s just to resolve some confusion.

And by the way, I said the Inattentive group was a wastebasket. Why did I say that? Inattention is nonspecific. Inattention is unhelpful in defining what disorder you have, because most mental disorders produce inattention. So if somebody walks into your clinic and says, you know, I’m having a lot of trouble concentrating, can’t pay attention, can’t finish work, you have no idea what they have. You don’t automatically say, oh, that’s AD/HD, I’ve heard about that. This could be a psychotic. This person could be a substance abuser. This person could have a generalized anxiety disorder or panic attacks or major depression or bipolar illness. How the hell do you know what they have? For now, just know that the Inattentive type of AD/HD is a real wastebasket category of really inattentive children, along with children who have other disorders that are producing their inattention. There really is an Inattentive group out there, but they have a different disorder, and it’s not AD/HD.




....and a little more from my original link, also from Barkley.

Likewise, controversy continues to swirl around the place of a subtype composed primarily of inattention within the larger condition of ADHD (see Clinical Psychology: Science and Practice, 2001, Vol. 8 (4) for a debate on this issue), with some arguing for it being a new, unique disorder from ADHD (Barkley, 2001; Milich et al., 2001) and others arguing that this distinction may be premature (Hinshaw, 2001; Lahey, 2001) or not especially important to treatment planning (Pelham, 2001). Relatively consistent across viewpoints, however, is the opinion that a subset of children having only high levels of inattention probably represents a qualitatively different problem in attention (deficient selective attention and sluggish cognitive processing) than is seen in ADHD (poor persistence, inhibition, and resistance to distraction).

SCT = ADHD innattentive subtype (who were always that way and who don't fall into the innattentive subtype later in life. They are not combo or hyperactive ADHDers whose symptoms decrease and who consequently now fit the DSM-IV critera of innattenive). SCT's are seen as being mentally "foggy" or daydreamers and who often lose their attention because they can't process information fast enough. I believe I am one as my report card clearly indicates :p although I don't know if "not owning the deed", is a symptom. :D

Are we on the same page? More or less. The problem with your statement is that ADD-I happens all the time in people who are not hyperactive, and never have been. Hence the DSM nosology. ADD-I seems to be especially common in females. When you look at the research, you find that ADD-I is highly correlated with other subtypes (H- and combined), it's just a different manifestation. SCT, on the other hand is considered a satellite. It is a designation, still being formulated, that implies a very different set of problems, course, comorbity, and treatment response. It has many of the same executive deficits, but there are enough distinctions to warrant separately defined disorder.

Alot of this is overly simplified when you look only at nosology. All kinds of disorders manifest deficits in the same systems as the ADHDer. Systems that regulate arousal, executive functions (working memory, inhibition/activation balance, selective/attention shifting), attention, and task salience. Bipolarity is correlated with executive deficits, as is depression, autistic spectrum, panic-agoraphobic, and of course ADHD. Autistic spectrum and ADHD especially overlap, not only in decicits, but also in many of the brain regions involved, but there are differences. And that is the key.

Although SCT has not been extensively characterized, via epidemiological, imaging, or in the basic sense of defining traits, it may very well involve many of the same pathways as ADHD subtypes.

The main reason ADD-H, ADD-I, and combined are all considered "ADHD", is because they all hover around each other, and stick together well in studies of treatment response, genetics, course, etc. Of course they involve different pathways, but those pathways don't effect how they are treated. This is bound to change, as any disorder is better researched and characterized, treatments get more specific, and nosology changes.

Studies so far basically say this: SCT may present similar to ADD-I, and has many commonalities, but involves more comorbitity, treatments are less effective, and involves a different course. That is why people are pushing to characterize SCT. Once it's characterized, anectdotes on treatment response will emerge. Models will pop up in animals. Imaging studies will appear. Theories will abound. And eventually, the disorder will be defined in common psychiatry and treatment "standards" will emerge.

Don't expect any of this to happen anytime soon, however. Because SCT studies so far have estimated a small population, SCT represents more of a scientific curiosity, that anything likely to attract real research dollars, or interest from pharmaceutical companies. Much of the info SCT will trickle down from ADHD research as ADHD continues to gain moment in the "mainstream".

-Brian

Take a look at the post above yours, tons of great information about a new concept with not much literature to support it. Barkley states it very well and the points that he makes don't mesh entirely with what you have said.


Here is one snippet. "Whether you view them as a different subtype or as an entirely different disorder is less of concern to me than that you understand these are not the same kids. They do not have the same risk, the same co-morbidities, the same causes and the same outcome, and it is likely that they do not respond to the same treatments the same way".


So...ADHD inattentive Subtype(SCT) most likely is not classic ADHD, what we now have is apples and oranges. This is not just different varities of the same fruit; say Red Delicious, MacIntosh, and Granny Smith.

And I couldn't be more please to find that extensive quote from Barkley above so that I can finally share this information with people, it will be nice to fully explain who I am.

Those were great posts.When I get a chance I'll look at the powerpoint notes form the March teleconferences on kids & adults. They're essentially the same, with a few exceptions. Both address SCT in passing.

I would love to be back in Door County this week, as Russ is back again presenting on ADHD. At least I got to hear him in March.

In corresponding with him, he talked about the update on his ADHD Handbook being completed sometime this month. This would be the third revision. I'll have to check that out at Guilford Press to see.

Thanks again.Those are excellent posts.

Take a look at the post above yours, tons of great information about a new concept with not much literature to support it. Barkley states it very well and the points that he makes don't mesh entirely with what you have said.


Here is one snippet. "Whether you view them as a different subtype or as an entirely different disorder is less of concern to me than that you understand these are not the same kids. They do not have the same risk, the same co-morbidities, the same causes and the same outcome, and it is likely that they do not respond to the same treatments the same way".


So...ADHD inattentive Subtype(SCT) most likely is not classic ADHD, what we now have is apples and oranges. This is not just different varities of the same fruit; say Red Delicious, MacIntosh, and Granny Smith.

And I couldn't be more please to find that extensive quote from Barkley above so that I can finally share this information with people, it will be nice to fully explain who I am. I see what you're saying, and I think we are both trying to say the same thing. What you are not getting from barkley, is that most people ADD-I are either girls, or guys that have occasional problems with the very same symptoms of combined. They are primarily inattentive, but every now and then they get impulsive, angry, and have problems with inhibition, but many times they inhibit too much because they can't properly formulate thier ideas. There are alot of personalities as well as comorbid conditions that influence how ADHD presents itself. These people may not be considered by any around them to have ADHD with hyperimpulsive symtpoms, but measure higher than most, and have the same constellation of cognitive deficits as ADHDers.

Sub-threshold is a great way to describe it. In fact many disorders are being looked at increasingly in the context of spectrums, where some of the main symptoms are not visible, some are subthreshold, and others are fully expressed. These have been called "forme frustes" in psychiatry for a long time, but spectrum theories are being used increasingly. Look at bipolar disorder I and II. Bipolar II is just like BPI, but because it is so much less intense it is associated with more chronic problems rather than the immediate destruction of BPI. But even BPII is being looked at increasingly as a spectrum called "soft bipolarity", which include risk factors associated with BPII development and include forme frustes and subthreshold traits. Even temperaments. Some things associated quantitively are a family history of bipolar, hypomanic response to antidepressants, temperamental profiles characterized by "hyperthymia", dysthymia, as well as atypical depressions. Even borderline personality shows features that strongly co-exist in bipolar.

This not only covers more ground, but it gets to the heart of the matter. Our brains are so complex with so many systems interconnecting and overlapping. Physical processes within a system that may produce BPII in one patient, may produce hyperthymia or atypical depression in another.

And so it is with ADHD, and how it presents itself so heterogeneously.

What is important, and barkley does a good job of stating this, is that SCT is pure inattentive, that it has similarities to ADHD-I, but that it is qualitively different. In other words, it is not just a different presentation of the classic underlying abnormalities that exsist in ADHD (that might produce something like a lethargic, inattentive true ADHDer), but that it is a different disorder altogether.

I just wanted to make this clear, not so much to you, but to the people who read these forums. You may look a hell of lot like SCT, but actually have ADHD-I. Everyone is unique, and until the features of SCT are properly defined, think of this first. Most likely you are not SCT, but a particular arrangement of factors has predisposed or formed you into a more passive, avoidant, lethargic, or primarily inattentive individual.

Scuro, that was some excellent information, and I think we all appreciate your contribution. Good luck! :D

-Brian

No no no...,not "inattentive has the same constellation of symptoms as combined". Sure they share somethings but mainly they are very different disorders. We have apple and oranges here. You can't mix the two together anymore. It's like the Adam and Eve metaphor, Barkley has taken that bite and we have new knowledge. Classic ADHD and ADHD inattentive subtype(SCT) are fundamentally different disorders. While you can say that they are both fruits, they are very different fruits with unique characteristics. They are so different that we could even start a new message board called SCT. I would never do that though because I have the deepest respect for Andrew. :cool:

Here is Barkley strongly making the point above. "This is a different disorder. Why do I think it’s a different disorder? Because these children come in with the opposite symptoms. Instead of being hyperactive, intrusive, distractible, they’re lethargic, slow-moving, hypoactive, spacey, daydreamy, quiet, passive, withdrawn, confused, in a fog. They are the polar opposite of the AD/HD child in their clinical presentation. This is not an impulsive, disruptive, intrusive, aggressive, emotional, naive child. This is a kid who is staring, daydreaming, confused, and not processing information accurately. This is a real attention deficit, if attention means information processing. These kids have a processing deficit. AD/HD children do not. Do not confuse these two groups. They do not have the same problems with paying attention".

As of right now SCT and ADHD inattentive subtype mean the same thing. SCT is just a descriptor used to easily classify this unique group and exclude classic ADHDers ( who sometimes used to fall under this label as they aged and their hyperactive symptoms decreased ). Please don't talk of two acronyms as being two separate entities, it's not accurate and will really confuse people. I say this with the utmost respect and hope you don't take offense.

Chris

Scuro, now you're just being oppositional! :D

My point above was not that SCT or the "true" ADHD-I is the same as ADHD whether combined or ADHD-I as it commonly presents itself, rather that ADHD-I as it commonly presents itself is NOT SCT! This is simple fact, and barkley is observing tendancies he's seen clinically, backed up by a few preliminary studies. Don't start making conclusions yet about what is SCT or what is ADHD-I. ADHD itself has not been characterized very well in comparison to some other mental disorders, let alone SCT.

The point I was making is that ADHD-I as it commonly presents itself is simply ADHD as a forme fruste, or with subclinical symptoms from the hyper-impulsive branch. Not even Barkley would disagree with this, I assure you.

Imagine that you know child A who is mostly characterized by daydreaming, inhibition, confusion, and is very abstract and vague. He has a really hard time paying attention, is disorganized so his backpack and room are always chaos. But, really he seems pretty calm and dreamy most of the time. What you really notice is his anxiety. The kid will get hyper every now and then, or he will get frustrated and act out severly, but nothing like child B who is constantly bouncing off the walls. Child A, doesn't seem at all like child B (who is constantly in trouble), but child A does have some of the same problems. Both are disorganized and get frustrated easily, and can't pay attention unless something is very exciting. Both have problems maintaining or acquiring friends. I guess the real thing you can say that differentiates them is that child B simply can't stop moving, while child A only gets that way occasionally, when his inhibitions are low.

As child A grows up he is diagnosed with social anxiety disorder, and eventually depression. He knows that he is naturally a more reclusive and anxious person, but that inside his head there is a constant chaos and confusing fog that seems to make things really hard to focus on. He can't make friends not just because he is naturally anxious, but also because things don't come out of his mouth right. He always seems to say the wrong thing at the wrong time, and is considered rude or shy and "wierd" by many. For some reason, he just can't seem to say what he wants to, can't pay attention the way he knows he needs to, and suffers the consequences.

Child B on the other hand has a similar course. He can go from super happy to depressed or anxious really quick, and he's never even. He goes from one thing to another, but as he grows this means he never is able to keep anything meaningful or constant in his life. His peers think he is funny, but he is never really "with it". He changes subjects and interupts too much, and he can go from being witty and funny, to being rude. It gets annoying. He just doesn't seem to play by the social rules. He can't seem to stay at any one job for long, and he knows there is something wrong, but he can't say what. The world constantly feels like it's closing in on him, so he keeps moving.

.......

Child A has many of the thought processes and problems that child B does. He can't pay attention, can't observe social rules, and gets bored and distracted easily. But he is too anxious and naturally withdrawn to let out alot of the chaos that is within him, so he appears alot different. Indeed he is. Sometimes he gets very impulsive, like when he's upset or angry, or when he finds something new and novel the he enjoys. But mostly he is just impulsive and hyperactive within his mind. He deals with it with withdrawal and introspection, which has always been his way. But things keep leaking out, and he doesn't make progress. He KNOWS what's wrong for the most part, he just can't get it together.

Child B deals with his problems by moving fast. If he slows down for a minute all his anxieties will crash in upon him. But no matter what he tries and what he gets into, he can't seem to get it together. He gets into a new job or a new relationship, and he can function well, but it never lasts long. Soon he is bored and starts to worry, get distracted and makes the mistakes he always has. So he moves on. Eventually he TOO gets depressed, but it takes alot more beat down. Child A is naturally geared towards depression.

Child A and child B are both diagnosed finally with ADHD, and both respond well to treatment with Ritalin.

Child A can finally formulate his thoughts and gains communication efficacy, which improves his social interactions. He also is able to seek out a job he is geared towards and stay with it long enough to make advancements, which improves his confidence. Child A is not outgoing and happy all of a sudden. He remains generally quiet and a bit stand-offish, true to his nature. But he does find that he can now seek out people and achieve goals that reflect his nature temperament, and so finds a measure of happiness. It's not perfect. Sometimes he gets overwhelmed and very anxious, but at least he can manage now. The medication calms the chaos in his head long enough for him to make sense of the world and interact with it effectively.

Child B on the other hand finds that medication really slows him down and allows him to think clearly. All of a sudden (just like child A) the world is not about to cave in. He is able to think things through before he does them, and does not get overly excited, or frustrated interacting with people. Finally he can listen and actually enjoy a decent conversation. That doesn't mean he wants to sit still with a small group like Child A. He still loves the excitement and adventure of meeting tons of new people, finding new things, and going new places. He still gets bored. But he finds that he can slow down long enough to get what he wants, and keep it for an extended period. His circle of friends stabilizes, and he finds a career that will allow him to move and interact the way he needs. Now that he can stick with it, and deal with all the details involved, he thrives, and his self-image improves. His depression lifts, and he regains the natural spunk he had before life beat him down.

--------

Scuro, these people are everywhere, and they are the types that present for treatment. Child B is classic ADHD-combined, while child A has an underlying temperament that predisposes him to anxiety, withdrawal, and familiar things. Both are anxious, but child A's anxiety pervades his whole personality and style. Everything he is and wants to associate with reflects what makes him happy. Which are things that don't make him scared. Child A has several subthreshold traits of hyper-impulsivity. He gets frustrated and blurts out cynical remarks, or will get in fights. This happens less often than child B, who seems to act on everything he comes in contact with, good or bad. But it happens enough. Child A has problems communicating, because he's got a million things flying through his head all at once. He can't select the proper things, and he doesn't realize it until life beats him down, and he is finally diagnosed with ADHD (after depression, probably depression refractory to standard treatments). When child A is in a situation that's familiar and is very comfortable, he can act more like child B, but still never to that extent.

The two probably share many of the same neural networks involved in classical ADHD. But because they are very different temperamentally, the problems present different. This disposition means they interact with thier environment different, which reinforces certain tendancies. They end up being two very different people, with many of the same problems.

-----------------------

This is just an easy, down to earth example, I created. The truth is on a physiological level, ADHD is not produced by the EXACT same genes, in the EXACT same brain regions. There are regions that are CORE to ADHD, but many regions are involved that interact with and influence the disorder's presentation. Some regions may be hypo-active in one and hyper- in another, but the core regions have enough similarities, that they have the same course, respond to the same treatments. They may be two VERY DIFFERENT indivduals. People can be bipolar, or autistic, or borderline, or "normal", or unusually sociable or unusually passive, and still have the same core problem of ADHD. It happens everywhere and it is MUCH better characterized in the literature than barkley's SCT. Once again, I think barkley would whole-heartedly agree.

To reiterate, my point was that ADHD-I in it's most "pure" form, may actually in SOME CASES be a wholly different disorder, now being called "SCT". Much of the ADHD-I is just ADHD-C with either a forme fruste effect, or subthreshold symptoms. This can happen because of brain regional differences, temperament overlap, etc. The reason people with ADHD-C sometimes become more ADHD-I (even extreme cases of hyperactivity), is because certain brain regions mature and ameliorate much of the hyperactivity. And yet, an adult who has outgrown ADHD and is now average in activity, or even hypo- active, is still considered ADHD if he meets the inattentive symptoms. Who says that whatever has changed to amleriorate his hyper-activity cannot be there in some children from the start? And studies suggest that this is indeed the case.

Don't think this is black and white for a second. In a few years, ADHD itself may be subdivided further, if this means more individualized identification that carries over to course and treatment and comorbidity. That's the way this stuff works man.

SCT is probably very different in a collection of brain regions, and so is not amenable to ADHD treatments. It may share enough in common with ADHD to allow it to present similar, which is probably the case considering it is an attention disturbance, but enough is different to warrant a new more specific characterization. Specificity, prediction, and explanation of phenomena is, of course the battle of science, is it not? :)

Take care,
-Brian

My head hasn't spun so much since Stabile was posting :faint: :faint: lol. I disagree with fair bit of what your saying and I'll leave it at that.

relvinnian, great post! It's kind of what I was thinking, that while SCT may indeed be a different disorder, it doesn't necessarily mean that all ADHD-I cases that didn't feature hyperactivity or impulsivity are SCT. There are ADHD-I people here who've received benefit from ADD medication even though that's not supposed to happen according to SCT theory.

OK, I think I was so excited reading this, I of course just skimmed!
I think some of this may help me with my many questions about my son.

He was diagnosed w/ADHD as was I but we could not be more different.

Upon further testing we found he was a stinking genius with a way below average processing speed. All the other areas tested above average or higher (working memory, perceptual reasoning etc) as a result school is brutal for him, he is barely at grade level…

When I then took him to an OT for testing we learned he has "difficulties with sensory modulation... appears to be under aroused with a decrease alertness level.....also has a shortened Postrotary Nystagmus and therefore requires increased amounts of movement in order for his nervous system to feel the effects of it....

This all went down about a year and a half ago, and I have always been so puzzled that even with the sub groups, my son and I could possibly have the same diagnoses.

I am having a hard time articulating this so bear with me. I always looked at the big picture as yes; he obliviously has a problem with paying attention hence the ADHD diagnosis, but it seemed to me the slow processing and the inability to get his energy level where it needs to be for whatever task was at hand seemed to “create” the ADHD symptoms. I seem to have “simple old ADHD” so I know how that works…

Child A has many of the thought processes and problems that child B does. He can't pay attention, can't observe social rules, and gets bored and distracted easily. But he is too anxious and naturally withdrawn to let out alot of the chaos that is within him, so he appears alot different. Indeed he is. Sometimes he gets very impulsive, like when he's upset or angry, or when he finds something new and novel the he enjoys. But mostly he is just impulsive and hyperactive within his mind. He deals with it with withdrawal and introspection, which has always been his way. But things keep leaking out, and he doesn't make progress. He KNOWS what's wrong for the most part, he just can't get it together.


Exactly! Behavior is not static. Behavior operates more like a "state-machine"; the symptoms displayed are related to the state one is in. If one gets angry after being interrupted (in a dead-switch fashion) while in hyperfocus, it does not imply that the person is "overfocused" all of the time. This is a characteristic of the state transition. The anger may not be highly expressed externally if inhibition is in place, but the irritability is still present.

Wouldn't it be safe to say that most people are impulsive when they are excited? Most people are not aroused enough beyond their base state most of the time, so they learn to inhibit themselves in this state, giving an truely inhibited appearance. Again, it is the state that matters.

VickiS-

How old/what grade is your son?

I spent my first three years of school doing 4-6 hours of homework EVERY night and reading with the "remedial" group. 3rd Grade teacher bumped me to the "fast" group after I tested higher than anyone else in 3rd grade for reading comprehension. By 4th grade I never really did homework again. Made mostly A's, some B's, rare C's. (its hard to make an "A" in science when you fall asleep on the book after 1 or 2 paragraphs). College however was pure hell.

I still struggle with new material, but once it sets in, my brain processes much faster than the average person on subjects that interest me. I don't make many mistakes either.

Guess what I'm saying is hopefully after the initial learning curve of basics is over with, your son may be able to "slide" a bit and not struggle so much. My nephew appears to have an even more pronounced LD than I had, but even he is finding things easier now that he's in 6th grade.

Hope this helps a bit.

The point I was making is that ADHD-I as it commonly presents itself is simply ADHD as a forme fruste, or with subclinical symptoms from the hyper-impulsive branch. Not even Barkley would disagree with this, I assure you. Barkley is saying, indirectly, that there's no such thing as ADHD-I. Many children and adults diagnosed as I should be considered Combined Type (with subclinical symptoms or with symptoms that have changed with age), as you suggest:


The Inattentive group in our clinic is for kids with three symptoms or fewer off of that HyperactiveImpulsive list. Any more than three and you’re better off thinking of them as what we call subthreshold Combined type children. There’s another group, the group that starts out being in the Combined type and by adolescence or adulthood are no longer so hyperactive, but they meet the criteria on the Hyperactive list. Now you would flip them over into the Inattentive type. Don’t do it. You always think of them as Combined type.
Barkley is shifting terms about. First there is a mountain, then there is no mountain. . . Then there is no ADHD-I, but there is I, but then they're really C. So why not keep the ADHD-I designation, or call them all C?

Then there's Barkley's left-behind group-- truly inattentive, who theoretically aren't ADHD and need their own disorder and treatment, since they don't respond well to the drugs known to work for ADHD. (this non-response presumably adds weight to the existance of separate disorder).


This begs for a new diagnostic criteria centered around SCT for people with SCT without ADHD criteria to muddy it up.

What are the numbers? Are half ADHD-I really SCT? One-quarter? If you're diagnosed as I and don't respond well to stims, are you actually SCT-- goddess forbid. Some hyperactives don't respond either, what does that make them?

This is a general problem with criteria for psychological and psychiatric spectrum disorders. Here's where the anti-psychiatric community make their most forceful attack. Where do you draw the line?

Well, you know a schitzophrenic when you see one, and a kids whose totally withdrawn, non-verbal, spinning plates, will likely be diagnosed as autistic. And an extremely hyperactive kid who has no impuse control, etc. is a prime candidate to enlist in the newest drug trial.

But does Stan have a learning disorder or is he just lazy?

Barkley is saying that ADHD - I Does exist and that within that group, there is a select subtype effecting 30-50% of ADHD-I's that constitutes a "qualitatively different disorder."

That's from the March teleconference and is straight off his power points.

The Inattentive group in our clinic is for kids with three symptoms or fewer off of that HyperactiveImpulsive list. Any more than three and you’re better off thinking of them as what we call subthreshold Combined type children. There’s another group, the group that starts out being in the Combined type and by adolescence or adulthood are no longer so hyperactive, but they meet the criteria on the Hyperactive list. Now you would flip them over into the Inattentive type. Don’t do it. You always think of them as Combined type.
One problem is that list can be subjective. For instance, I might qualify for more than 3 on that list, or I might not, depending on how you measure it, so that still doesn't tell me if I'm ADD or SCT:

· often fidgets with hands or squirms in seat; -yes, I do that.
· often leaves seat in classroom or in other situations in which remaining seated is expected; -No, never


· often runs about or climbs excessively in which it is inappropriate (in adolescents and adults, may be limited to subjective feelings of restlessness; -No


· often has difficulty playing or engaging in leisure activities quietly; Define 'quietly'?!?


· is often "on the go" or often acts as if "driven by a motor" - This is another tough one, I always have raging thoughts, and I always feel like I need to be working on something, I have trouble sitting around doing nothing, but it doesn't manifest as hyperactivity or impulsivity. (I could be quiet and still as a child if needed, even if I didn't want to)


· often talks excessively; -no


· often blurts out answers before questions have been completed; - I do/did this at times, but how often is 'often'?


· often has difficulty awaiting turn; - I hate waiting in lines, and get aggrivated if I have to wait long, but don't most people?


· often interrupts or intrudes on others (e.g. butts into conversations or games) - again, at times, but how often is 'often'?

Thanks for the clarification, mctavish. Barkley created his own scales, he ought to be able to distinguish a new group.


Did a quick Medline search. Hartman found an association of SCT measures and both Inattentive and Combined ADHD.

http://www.findarticles.com/p/articles/mi_m0902/is_5_32/ai_n6234463

The relation between sluggish cognitive tempo and DSM-IV ADHD
Hartman

Confirmatory factor analyses revealed that five putative SCT symptoms loaded on a third factor separate from DSM-IV inattention and hyperactivity-impulsivity symptoms. Teacher ratings of SCT were most strongly associated with the inattentive type, whereas parent ratings indicated that both the combined and inattentive subtypes exhibited significant SCT. In summary, these results suggest that SCT is an internally consistent construct that is significantly associated with DSM-IV inattention.

Showing an association (and factor loading) is different than identifing a new, underlying disorder. ADHD diagostic scales were used to create the three groups in this study, its not surprising that the additional SCT scales would load on their own, separate dimension. Interesting that teacher ratings of SCT correlate with both Combined and Inattentive types.

One problem is that list can be subjective. For instance, I might qualify for more than 3 on that list, or I might not, depending on how you measure it, so that still doesn't tell me if I'm ADD or SCT

Yes, subjective. And the scales were validated on kids and teens (someone mentioned, R?). But there are SCT scales, as well. Take them and what will that tell you?

Syphillis started out being clumped with general venerial disease or viewed as different diseases depending on the symptoms, or the stage. Then mercury preparations were used to subdue the infection. Response to mercury was used to further distinguish Syphillis as its own unique disease. Then the spirochette was identified and shown to be associated with the physical illness. Now we have antibotics that work against the spirochette and prevent the enduring and well known outcomes of this illness. We know what the disease is and what causes it. A tidy package, but it took hundreds of years to figure out--forgive me for my historical sloppiness here, I cut corners, but you get the idea.

Psych disorders are not a tidy package, yet. Maybe 50 to 100 years?

Yes, subjective. And the scales were validated on kids and teens (someone mentioned, R?). But there are SCT scales, as well. Take them and what will that tell you?
I haven't been able to find any yet for SCT, got a link?

Syphillis started out being clumped with general venerial disease or viewed as different diseases depending on the symptoms, or the stage. Then mercury preparations were used to subdue the infection. Response to mercury was used to further distinguish Syphillis as its own unique disease. Then the spirochette was identified and shown to be associated with the physical illness. Now we have antibotics that work against the spirochette and prevent the enduring and well known outcomes of this illness. We know what the disease is and what causes it. A tidy package, but it took hundreds of years to figure out--forgive me for my historical sloppiness here, I cut corners, but you get the idea.

Psych disorders are not a tidy package, yet. Maybe 50 to 100 years?
completely agree. That's why I'm bothered by some comments that seem to say if I'm inattentive, then I really have SCT, even if it doesn't quite fit me. I don't think we've got all the distinctions totally defined yet.

...walks around dazed and confused....mutters;"this is like an exploding filing cabinet". :faint:

Back to the basic premise. Think of SCT like a nick name, say like four eyes. So I can be identified as four eyes or Scuro and I am still the same person. SCT = ADHD inattentive subtype and the opposite also holds true. ADHD inattentive subtype is the formal name. No one gets a formal diagnosis of SCT...it’s a nick name.

Barkley changes what he states as he learns more through Science and new discoveries. He now strongly states to keep ADHD inattentive subtype pure for the true SCT kids. Don’t put any of those Combo people in who fit the criteria of inattentive subtype because their symptoms change with time. They stay Combo type. Because there has been new discoveries about this group the criteria for the diagnosis will continue to change with time.


The second premise. Yes, there is a change of names, and even symptoms but the changes have been made based on Science. This happens all the time in Science so this criticism that there is too much change doesn't wash. Think of our view of the Universe. At one point we thought that the earth was flat and that there was a ceiling above us. Over thousands of years we have changed our views on this subject. I don't here anyone say that Astronomy is a bogus field because it keeps on changing.

I could go on and on here but I'll leave it at these two points which irked me the most. I think posts get too opaque if you try to say too much at once.

Now Barkley has strongly stated to keep ADHD inattentive subtype pure for the true SCT kids. Don’t put any of those Combo people in who fit the criteria of inattentive subtype because their symptoms change with time. Because there has been new discoveries about this group the criteria for the diagnosis is also changing.
But it sounds like he unilaterally changed the definition of the combined type, instead of creating clarity, it's creating confusion,

but the changes have been made based on Science

true, but science is often not exact, and it's likely this will ultimately be further revised.

..and Barkley on drug response for Innattentive subtype;"Ninety-two percent of AD/HD children respond to stimulants. Twenty percent of these children respond to stimulants. And the dosing is different. AD/HD children tend to be better on moderate to high doses. Inattentive children, if they’re going to respond at all, it’s at very light doses, small doses. So the drug response is different. And that’s all we know".

...and more Barkley. I really don't think he is saying that you have innattentives and then you have this other sluggish new group.

"The Inattentive group in our clinic is for kids with three symptoms or fewer off of that HyperactiveImpulsive list. Any more than three and you’re better off thinking of them as what we call subthreshold Combined type children. There’s another group, the group that starts out being in the Combined type and by adolescence or adulthood are no longer so hyperactive, but they meet the criteria on the Hyperactive list. Now you would flip them over into the Inattentive type. Don’t do it. You always think of them as Combined type.

So, bottom line is this: If any point in your history there was a whiff of problems with inhibition and impulse control, you’re a traditional AD/HD Combined type kid, and it shouldn’t matter what the DSM is telling you about cut-off scores. Clinically that’s how you would approach that child. That’s a Combined type kid. And you reserve this Inattentive group for kids who have never in their lives had trouble with inhibition. Those are the spacey, daydreamy, confused, in a fog, sluggish, hypoactive, slow-moving group. And as long as you conceptualize them that way, you won’t make any clinical mistakes. But if you follow the DSM as it’s written—perhaps you have OCD and you just have to follow all those criteria, just as they’re written—then you’re going to get yourself into some trouble.

Because remember, the DSM was not chiseled in stone in Israel. It’s a set of guidelines developed to help make clinical decisions, but it’s to be used with clinical judgment and understanding of the criteria. Okay, that’s just to resolve some confusion".

But it sounds like he unilaterally changed the definition of the combined type, instead of creating clarity, it's creating confusion,

but the changes have been made based on Science

true, but science is often not exact, and it's likely this will ultimately be further revised.

Not changing the defintion but rather seeing it more as a changing with the age of the subject...ADHD is a developmental disorder.

Yes, there is confusion but in time people will adjust..and yes there will probably be more changes in the future. The whole concept of ADHD although over 50 years old, is still relatively new.

"The Inattentive group in our clinic is for kids with three symptoms or fewer off of that HyperactiveImpulsive list. Any more than three and you’re better off thinking of them as what we call subthreshold Combined type children. There’s another group, the group that starts out being in the Combined type and by adolescence or adulthood are no longer so hyperactive, but they meet the criteria on the Hyperactive list. Now you would flip them over into the Inattentive type. Don’t do it. You always think of them as Combined type.
That's exactly what I'm saying, he changed the definition of what it means to be 'combined'. Under standard definitions, I would be purely inattentive. However under Barkley's new definition, I probably would be combined (or subthreshold combined). That's why I say he is creating confusion.

It would be better if he kept the definitions as they were, and created a test to differentiate between true ADHD-I and SCT (since it is supposed to not be ADHD at all).

I disagree...new terms/definitions for new thinking. Didn't the old term for ADHD make reference to mild brain damage? Should we all go around thinking of ourselves as brian damaged because thats the way it always was?

Thanks for posting the Hartman research article. Its incredibly long so I only skimmed it.
One thing I did notice is that they used a behavior rating scale (Disruptive Behavior Scale) for the parent & teacher comparison's (as opposed to an ADHD scale). The correlation between parents and teachers on behavior scales is much stronger than on ADHD scales;which is only a 3% match.

I disagree...new terms/definitions for new thinking. Didn't the old term for ADHD make reference to mild brain damage? Should we all go around thinking of ourselves as brian damaged because thats the way it always was?
But Is 'sluggish cognitive tempo' really much of an improvement over 'minimal brain damage'?

It would be one thing if the new terms were generally accepted, but Barkley has created his own definition of 'combined type' that is different than the official one. He then goes on to say that all 'inattentive type' have SCT. But what isn't clear to the layman reading that is what he is really saying is 'all inattentive type according to Barkley's criteria' have SCT. That creates alot of confusion. I'm all for new terms if they help clear things up, not when they muddle things even more.

In his presentation in March,as well as at Door County 2 years ago, what he said was that within the Inattentive type, up to 30-50% have a "different disorder."

He was on the committee that drew up the DSM-IV diagnostic criteria/symptom list.What I believe he's trying to do, is to highlight how significantly different the non-hyperactive group is from the hyperactive-impulsive & combined types.

In the process, I also believe that he's trying to draw attention to the fact that in all his many years of researching and treating ADHD (his 1977 Milwaukee Study is still ongoing and is the longest running ADHD research study to date), he is seeing some subtle differences within the ADHD-I group that needs a separate category.

If you've ever read or tried to read his 1997 work.....ADHD and the Nature of Self-Control....., then you know how complicated this is.

One thing is for certain, Dr.Barkley is a "pure scientist" in that he won't present something that isn't evidenced based.

I can not discuss this using the vocabulary of some of you experts so stick with me here.
What we have in our house is both ends of the hyper/non-hyper spectrum. Let’s just be crude and call me a “spaz” and my 8 year old son a “slug”
Since we both have trouble with attention and self regulation we both get the diagnosis of ADHD.
My question is could I have been born a “slug” and somehow figured out at a very young age that moving around (a lot) kept my arousal level up and kept me stimulated, thus developing habits/strategies (bouncing in my saucer, interrupting, getting excited, being impulsive) that seem to help keep me alert?
After all of the testing we did on my son I discovered movement is the key to getting him fired up (well fired up for him) Not letting him sit too long, lots of little tasks his teacher asks him to do gets him up and moving around helps keep him from sinking into darkness…
Anyway perhaps we share the ADHD gene, which includes the inability to self regulate (up or down) but perhaps there is an X factor (not related to ADHD?) that determines how we deal with it….hence whether it manifests into hyper vs non-hyper.

Since we both have trouble with attention and self regulation we both get the diagnosis of ADHD.
Well, if he is innattentive he would be having more trouble with selective attention, memory, and processing of information and you are having more trouble with self regulation, ...according to the latest research. The Innattentive subtype kids may be the ones with the true attention problem.



My question is could I have been born a “slug” and somehow figured out at a very young age that moving around (a lot) kept my arousal level up and kept me stimulated, thus developing habits/strategies (bouncing in my saucer, interrupting, getting excited, being impulsive) that seem to help keep me alert?
Nope, once a "slug" always a "slug".


Anyway perhaps we share the ADHD gene...
There is the possiblity that there are two different gene expressions for two very different disorders. Thats what I'm starting to believe.

I haven't read the SCT research article so this comment is strictly off the top of my head and may well be offbase.

Keep in mind too that I'm one of the "least likely to ever become a researcher " psychologist's you'll meet. I simply don't have the patience (or the inclination).My point is that this is definately not my area, so take this with a grain of salt .

It occurred to me after briefly looking it over that there may be a methodilogical flaw.

The key word is "may."

In using a scale that measure's... disruptive behavior... to compare and contrast parent & teacher responses for SCT (or even just Inattentive kids in general), they're measuring something that is rarely if ever demonstrated by Inattentive kids.

For years, the research has consistenly shown how Inattentive kids are less like to present with behavior problems (as opposed to their ADHD-Hyperative-Impulsive & Combined type counterparts).

Therefore, using a measure of a set of behavior's seldom exhibited in the first place makes little or no sense to me. I think that it would only serve to confound the issue instead of clarifying it.


My references, again off the top of my head, would be The ADHD Book of Lists and ADHD and the Nature of Self-Control. Basically, any text that deals with the differences between the types of ADHD would say the same thing.

I spent my first three years of school doing 4-6 hours of homework EVERY night and reading with the "remedial" group. 3rd Grade teacher bumped me to the "fast" group after I tested higher than anyone else in 3rd grade for reading comprehension. By 4th grade I never really did homework again. Made mostly A's, some B's, rare C's. (its hard to make an "A" in science when you fall asleep on the book after 1 or 2 paragraphs). College however was pure hell.
Garsh, that sounds familiar. I remember in the second grade, when all the kids would break into reading groups I would go with the other "special" kids to a room in the basement with a kindly old nun... Then in 3rd grade I was in the "gold" reading group ... then in 4th grade did my reading group with the top 5th grade group ... then by high school was within a hair of flunking out.

My son got a kind of slow start in first grade as well, but he's a lot like me (lord help him), and from my history I wasn't too worried. Iwas more getting geared up to tackle slackitude in the upper grades.

However, my son's school doesn't have a basement -- they recommend the kids who aren't keeping up be held back instead.

So I had to start trying to get him studying. This led to the realization that he likely has ADD, then to the realization that I likely do too... and here I am. :)

Both of us are "inattentive" although we both enjoy sports.

Uminchu,

Teach him good habits early. Wish I had done that with my daughter so that she wouldn't have known any better. You can't have them turn on the jets later in High School because there are no jets. lol

Teach him good habits early. We are trying to now. Actually it's going a lot better than I thought. We have all kinds of tricks. The biggest is a colorful checklist of tasks on the fridge, with rewards for peformance that get progressively bigger, and using timed tests whenever possible. Like, how many flashcards can you read in 1 minute?

You can't have them turn on the jets later in High School because there are no jets. lol I don't know. I found my "jets" but it wasn't until college -- and that was with 5 years in the military in between. Maybe the military taught me those good habits I never had before. Before I knew anything about ADD-I or whatever we want to call it, my goal was to get my son to make his breakthrough without the need for the military.

This is nuts :faint:

You guys are going way off on a tangent (although I could hardly expect otherwise, right?) Many of Barkley's statements on SCT and it's relation with ADHD, are not empirically supported. I'm not denying that Barkley is a "pure scientist", but science is very open to interpretation. That's why quantification is so important. But SCT has not even come close to being quantified OR defined! These are people who have observed tendancies, and are trying to define those tendancies in such a way that holds up to statistical scrutiny, and peer review.

Scuro is spouting Barkley as if his words just came down from Mt. Sinai! It's a mistake, I'm telling you.
Exactly! Behavior is not static. Behavior operates more like a "state-machine"; the symptoms displayed are related to the state one is in. If one gets angry after being interrupted (in a dead-switch fashion) while in hyperfocus, it does not imply that the person is "overfocused" all of the time. This is a characteristic of the state transition. The anger may not be highly expressed externally if inhibition is in place, but the irritability is still present.

Wouldn't it be safe to say that most people are impulsive when they are excited? Most people are not aroused enough beyond their base state most of the time, so they learn to inhibit themselves in this state, giving an truely inhibited appearance. Again, it is the state that matters. Very good point HF. People do get more impulsive when they get excited, but they have natural mechanisms to inhibit this. As arousal builds in most people, the volume is turned up in certain inhibitory regions, like the frontal cortex as it modulates the limbic system. This tension between systems is mediated by the specific strength of the connections between individual regions, the regions natural strength, and the type of arousal (such that different types of arousal engage different regions selectively).

Here's a thought experiment though, to get you guys thinking: Let's say for simplicity's sake the ratio of frontal strength to limbic strength determines ADHD if they are, say, 1:2, whereas normal is 1:1. Person A is classic ADHD with regional deficits in frontal strength, but normal limbic strength. He is 1:2 in ratio, but not because his limbic strength is greater. Person B on the other hand has a very strong frontal region, but unfortunately, his limbic region is stronger still. He is also 1:2 in ratio.

What consequences would this have in terms of presentation? Now think that it's not as simple as frontal strength to limbic strength. Although this is part of it, frontal areas connect to many regions and involve many specific structures, all which have variability, and orchestrate different functions. Each one plays a role in reasoning, and usually select regions perform many functions! The limbic system, again, has many interactions and structures, each one contributing something to behavior and emotion. Which structures and systems produce the specific symptoms that characterize ADHD? Frontal structures that involve serotonin, or glycine, or gaba? Maybe. Structures that involve dopamine, norepinephrine, and glutamate? Definately, the evidence is strong here. What about cholinergic systems? Probably.

What does it mean when a specific receptor, say, D4DR, has a polymorphism? How does this change the functionality of the dopamine system, as a whole, and regionally? Sure, receptors play a role, and genetic polymorphisms may affect specific regions, but surely a certain polymorphism doesn't produce ADHD in everyone who gets it. What about the genetics that determine the construction of the brain, from prenatal to maturity, as well as the pronounced influence of environment? Some people grow out of ADHD, even the inattention. What makes them different? Adults who outgrow ADHD, have "normal" brains? Many may function at a superior level, but I doubt their brains are "normal".

In ADHD the balance is tipped because of structural deficits. This can be true of any disorder, however. What counts is that statistically, ADHD can be characterized by certain select regional abnormalities, and can be defined by certain behavioral standards (DSM-IV) that predict outcome and response. Really, the later is all that matters to us, but those damned scientists just gotta know why ;)! Not all people with ADHD have the same brains. Some may have brains that look normal or supra-normal, but behave funny. But on the whole these differences exist.

As far as SCT, what makes it different in terms of physiology? No one knows. Some propose that SCT is just a manifestation of certain mood disorders or temperamental profiles interacting with the ADHD physiology. Once again, many mood disorders involve ADHD regions and circuitry, and ADHD is highly comorbid with many disorders. People with bipolar or autism don't just appear like ADHD. They meet the criteria, meaning they have many of the same problems with impulse control, attention, and executive deficits. There is emotional disregulation. Why does this happen so frequently? I've said it before, because other disorders involve much of the same circuitry.

All this arguing about SCT is so pointless. The available literature on SCT shows that it is a curiosity whose tendancies, population presence, course, and physiology are at this point just mere hypothesis! Barkley speaks of anectdotes and a FEW studies. There have been studies on subtype differences, and differences in ADHD w/ and w/o various comorbidities, etc. Far more than anything on SCT. These imply interactions that must be studied further, and they shed some light on the complexity of neuroscience and its impact on clinical psychiatry.

I really hope this sinks in because, I have not heard a single compelling arguement in this thread. My guess is it won't because people think they can read a couple articles, and all of a sudden make reasonable judgements about poorly defined constructs. I'll tell you what, Scuro, you're Barkley's biggest cheerleader!

It's not black and white, people :confused:

Cheers
-Brian

Many of Barkley's statements on SCT and it's relation with ADHD, are not empirically supported.

Riiiight. Which ones? This guy bases all of his theories on Science.




But SCT has not even come close to being quantified OR defined! These are people who have observed tendancies, and are trying to define those tendancies in such a way that holds up to statistical scrutiny, and peer review.

I think we are there already. Barkley has helped with the underpainting and he has been at it for a while. Now others are supporting the original findings. We are at the point where they are starting to paint in details.




Scuro is spouting Barkley as if his words just came down from Mt. Sinai! It's a mistake, I'm telling you.

Because his findings are peer reviewed they are solid. The guy doesn't come up with any theory that I don't see everyday at work in ADHD children. What's more he is the undisputed leader in the field and uses the discoveries of others liberally in his findings and formation of new theories.

You can come to this board on any given day and someone is expounding a personal theory on ADHD. At best, they make a few interesting subjective observations. The flip side of that coin is that they can get caught up in their words and ideas and be very wrong. Worse still, is if others follow, think Scientology or Dr. Peter Breggin.

If there is one thing I know about ADHD, it's that there are far too many drifting, listing, and sinking lives of people who have this disorder. Everyday I can come onto this board and read several new threads of people or families in crisis. Barkley has shed much light in the field and leads the way forward. Yeah...I got no problem if you want to call him the Moses of ADHD.

I don't know. I found my "jets" but it wasn't until college -- and that was with 5 years in the military in between. Maybe the military taught me those good habits I never had before. Before I knew anything about ADD-I or whatever we want to call it, my goal was to get my son to make his breakthrough without the need for the military.

I actually found my jets in grade 11. My daughter is going into grade 12 and is still looking for the ignition switch. Finding your personal motivation is a maturity thing and that is one place where ADHD people lag behind. Prop them up until they find an interest that will carry them forward or until they mature.

I never said that anything had been empirically validated. To the best of my knowledge it hasn't.However, that doesnt mean there's not something in the pipeline.The bottom line is this is just a theory right now.

What I said was that until it is emperically confirmed SCT reamins a "theoretical construct." Because he is a "pure scientist," he won't proclaim SCT to be anything more that that, until the theory has been validated and found to be reliable.

Lets play nice, guys. Please avoid personal attacks, especially mixed with obscure (OMG!) religious references-- Mt. Sinai, tisk, tisk.

I find this whole line of discussion useful. I'm interested in the emerging hypotheses about ADHD for both intellectual and personal reasons.

SCT research (whether it pans out or is just a fluke of multiplying scales) may be a harbinger for the parsing of ADHD into a number of different disorders based on neurobiology, and not just symptoms. Or not; ADHD will be deemed a spectrum of behaviors produced by atypical wiring (or--fill in the blank with your favorite hypothesis or methaphor).

I, like Scuro, would like to see better, more appropriate treaments developed and less controversy as to ADHD's existance. Identifying a mis-diagnosed disorder (if it exists) nestled within ADHD will help achieve the goal of better treatment.

I find this whole line of discussion useful. I'm interested in the emerging hypotheses about ADHD for both intellectual and personal reasons.

SCT research (whether it pans out or is just a fluke of multiplying scales) may be a harbinger for the parsing of ADHD into a number of different disorders based on neurobiology, and not just symptoms. Or not; ADHD will be deemed a spectrum of behaviors produced by atypical wiring (or--fill in the blank with your favorite hypothesis or methaphor).

I, like Scuro, would like to see better, more appropriate treaments developed and less controversy as to ADHD's existance. Identifying a mis-diagnosed disorder (if it exists) nestled within ADHD will help achieve the goal of better treatment.
And I think we all would.

And discussing the latest thinking and theories is fine and all, but please make it clear you are talking about leading-edge theories!

For example, when I came here I was learning alot about ADHD. I've only recently been diagnosed, and according to the currently accepted criteria, I would be ADHD-Inattentive. So I come here and start reading posts that say that all ADHD-I are really a different disorder known as SCT. This SCT supposedly doesn't respond well to medication, and they really don't know how to treat it. So I had just started Concerta with mixed results, and already I was getting the feeling I should give up on it.

Then I ask questions about it here and get responses from other ADHD-I people who tell me that medication helps them alot. :confused: So at that point I was really confused. Finally, I see this thread, and get to read Barkley's actual words, and now it makes sense-- The reason he says all his ADHD-I patients are SCT is because he is usind a different criteria for what ADHD-I and ADHD-C are. Under Barkley, I would probably be ADHD-C.

So the proponents of Barkley's research have ignored those little important details in other threads, even the title of this thread reflects that problem. So please make sure when you talk about leading edge research and theories that haven't been widely yet, you make that clear, it can confuse the newbies. Also don't try to make something black and white that isn't (if you are ADHD-I, then you are automatically SCT)

I find this whole line of discussion useful. I'm interested in the emerging hypotheses about ADHD for both intellectual and personal reasons.

SCT research (whether it pans out or is just a fluke of multiplying scales) may be a harbinger for the parsing of ADHD into a number of different disorders based on neurobiology, and not just symptoms. Or not; ADHD will be deemed a spectrum of behaviors produced by atypical wiring (or--fill in the blank with your favorite hypothesis or methaphor). I wholeheartedly agree with you! My motivation in arguing the SCT vs. ADHD thing here was not to bash the research, or be cynical in any way. In fact, with my references to other disorders and spectrum theories, as well as the influence of multiple factors on how a disorder presents itself, it should be clear where I stand. From a theoretical perspective, I have alot of respect for Barkley's findings (although I think he has been partially mis-represented in this thread).

My real motivation here was to clarify to people who may fall along the inattentive end of the spectrum, that SCT has no real solid implications for them in terms of treatment right now. As of now, there is not enough solid evidence about SCT to make decisions on even the most basic things, like what it feels like, or how best to get help and treatment. This is practical information I'm talking about here, not theory. In order to have practical information that makes its way into mainstream consciousness, you have to prove something in large double-blind studies, that are then replicated. From population presence, to clearly defined symptoms that make the disorder distinct, to treatment approaches. This hasn't occured yet, and I fear that people will get caught up in this SCT thing long before anything solid is found.

As far as theory, SCT is a step in the right direction. It takes information that has been accumlating since the '80s on subtype differences, and attempts to create strict definition and derive solid principles from it. There is still a long road ahead of SCT, and also for ADHD, but that road looks very promising. It's amazing to have someone like Barkley fighting in our corner, because we absolutely need it!:cool: Modern models of mood and temperament, cognitive function, and disorder in the brain, involve the broad applicability of spectrum tendancies, as well as the specificity of detailed characterizations of disorder. These combine in ways that can benefit us all. Scientists from very different areas of research now combine to tie very important gaps together.

I think I'll agree to disagree with Scuro on certain aspects of this discussion. I appreciate the input.

-Brian

And I think we all would.

And discussing the latest thinking and theories is fine and all, but please make it clear you are talking about leading-edge theories!

For example, when I came here I was learning alot about ADHD. I've only recently been diagnosed, and according to the currently accepted criteria, I would be ADHD-Inattentive. So I come here and start reading posts that say that all ADHD-I are really a different disorder known as SCT. This SCT supposedly doesn't respond well to medication, and they really don't know how to treat it. So I had just started Concerta with mixed results, and already I was getting the feeling I should give up on it.

Then I ask questions about it here and get responses from other ADHD-I people who tell me that medication helps them alot. :confused: So at that point I was really confused. Finally, I see this thread, and get to read Barkley's actual words, and now it makes sense-- The reason he says all his ADHD-I patients are SCT is because he is usind a different criteria for what ADHD-I and ADHD-C are. Under Barkley, I would probably be ADHD-C.

So the proponents of Barkley's research have ignored those little important details in other threads, even the title of this thread reflects that problem. So please make sure when you talk about leading edge research and theories that haven't been widely yet, you make that clear, it can confuse the newbies. Also don't try to make something black and white that isn't (if you are ADHD-I, then you are automatically SCT) HAHA! It's so funny you say this right as I get done typing my response. What better way to buffer my point! :D

If you look at most of my responses in this thread, I try to be practical, like when I made examples of "child A and B". I always make a point to do this here on ADHD forums, because that's what most people will identify with. I could go on forever citing multiple studies that give support to my argument, and spouting dense jargon, but it just confuses people. Even in my 2nd to last post, when I started talking specifics, I never made statements, but asked questions for people to ponder.

This forum is not a theoretical debate forum. It affects alot of people who have had problems their entire lives and desparately need a solid base to start from.

Once again, thank you Hound :D

Take care,
-Brian

Somehow, my last post didn't show up, although it shows up in my posting history. Spoooky! :D

Edit: Nevermind there it is!:eyebrow::foot:

Who knows where the truth lies, but...I don't think Barkley would make any statement without having supporting evidence. Hang your hat on that one.

So what did he say about meds? Well, he said that it works for roughly a 1/4 of SCT's and he also said that the dose is usually significantly lower. What would that tell me if I were SCT? It would tell me that I may have to do a lot of trial and error to find a drug that will work for me, and even if I do this, I may be wasting my time.

When talking about meds you should always ask yourself, "how significant the impairment is currently"? Is your life good? Are you generally happy? Do you have a job you like, and are you happy to come home? If you answer yes to most of these questions then I would suggest trying coffee first. You might just need an added boost here and there.

On the other hand, if you life is a mess, well then, it might be worth your time to really investigate the whole medication option.

BUT if....

...as a child, you were hyper or a combo... then you should really give meds a trial run because what do you have to lose? If you are the classic ADHD type then try meds because it makes a big difference for the vast majority of classic ADHDers.


just my two cents worth...

I dunno, I look at my child and realize that this SCT thing hit pretty close to home, I don't care if it gets its own web site and specialists or keeps company with the rest of the ADD subtypes as long as they are working towards understanding the kids/adults that have this special groups of symptoms...
These kids are low maintenance in so many ways it too easy to let them fall through the cracks.

BTW Straterra did nothing for my son ( I finally asked his Doc why on earth she thought something that was advertised as a non-stimulant would help ) Adderall made him a social outcast (too intense) a little whiff of Concerta seems to be what works. That and a little bit of Coke or Pepsi with caffeine does wonders if the timing is right.

I apologize if this seems elitist but I also think the posters on this topic made it pretty clear that this is new info and a work in progress. I’d hate to have to limit discussions of this sort to protect the few who don’t get it or would try to diagnose themselves by what they read in this forum.

I dunno, I look at my child and realize that this SCT thing hit pretty close to home, I don't care if it gets its own web site and specialists or keeps company with the rest of the ADD subtypes as long as they are working towards understanding the kids/adults that have this special groups of symptoms...
These kids are low maintenance in so many ways it too easy to let them fall through the cracks.

I apologize if this seems elitist but I also think the posters on this topic made it pretty clear that this is new info and a work in progress. I’d hate to have to limit discussions of this sort to protect the few who don’t get it or would try to diagnose themselves by what they read in this forum.
Yes, in this thread. In previous threads about SCT, the message came across like this:
1) Latest reseach says that ADHD-Inattentive is really SCT
2) SCT is really something completely different than ADHD
3) SCT doesn't respond will to ADHD meds, and we don't know how to treat it.

In fact, in some of those threads, SCT was treated more as established fact than theory.

So to someone trying to learn about their ADHD-I, the message I got from that, is I don't really have ADHD, All of the existing research, books and medicine on ADHD aren't going to do me any good. There isn't much good information on how to deal with it other than dense research literature. And worst of all, it has a name that's sounds nearly as bad as "Minimum Brain Damage", the original term for ADHD.


BUT if....

...as a child, you were hyper or a combo... then you should really give meds a trial run because what do you have to lose? If you are the classic ADHD type then try meds because it makes a big difference for the vast majority of classic ADHDers.
again you seem to be missing the point that the widely accepted definition of 'combo' is not what Barkley is using when talking about SCT, and that leads to confusion. Probably the best thing to say about SCT right now is 'don't even think about it unless you are interested in following the latest research. The SCT label isn't going to help you much in treatment right now otherwise'

oK, you all sparked my interest in this topic. So I did a bit of reading (not extensive research obviously, but I read a small handfull of articles). Here's what I learned...

First of all, some of the SCT symptoms were originally included in the feild trials for the DSM-IV. But they were deleted because they had poor predictive validity. That is, while these symptoms did predict inattentiveness thier absence does not predict an absence of inattention.

The problem is that the feild trial research included both the innattentive type and the combined type when testing the SCT symptoms. So now researchers are taking another look at those SCT symptoms as a way to discriminate subtypes.

Here's something I found intersting. Combined type has greater severity of hyperactive symptoms than the hyperactive-impulsive type. And the combined type also has a greater severity of inattention symptoms than the inattentive type. But the inattentive type exceeds the combined type for SCT symptoms.

In an article by Carlson and Mann (2002), they found that a group of inattentive ADHD children could be divided into a high SCT group (28%) and a low SCT group (72%). Only 8% of combined typed and 3% of no-ADHD children obtained the high SCT score. They argued that this suggests ADHD-inattentive type can be divided into two subtypes. They found that those with high SCT scores had lower levels of externalizing behaviours and higher levels of aniety/depression, withdrawn behaviour, social dysfunction, and unhappiness. While the inattentive group that was low in SCT symptoms had fewer internalizing and more externalizing behaviours, which is more like the combined group but with lower levels of impairment. So they suggest that the low SCT group of inattentive ADHD are really subthreshold cases of ADHD-Combined type, which is alot like what it sounds like Barkley is saying.

Theres some studies that use factor analysis to look at SCT. I'm not really well schooled on factor analysis but I think they look at how well a bunch of items (or symptoms in this case) correlate with each other and figure out which ones group together best. (Let me know if I'm way off on this). From what I've read the results look kind of muddy.

In an article by Hartman et al (2004), which I think Stanzen already mentioned, they found that when they put in all the DSM-IV ADHD symptoms plus the SCT symptoms, they best fit into three groups (or factors). I think there was a group of hyperactivity-impulsivity symptoms, a group of inattention symptoms, and then the group of SCT symptoms. This would support the idea that SCT is a seperate construct from inattention.

In a another study (Burnett et al 2001), they found that when they put in all the ADHD symptoms and two of the SCT items ('daydreams a lot" and "often is sluggish or drowsy") that they formed two groups - inattention and hyeractivity-impulsivity, with the SCT items loading onto the inattention factor. But when they put in just the inattention symptoms and the SCT syptoms, then the daydreams, sluggish/drowsy, and forgetful items formed a separate factor.

Another group of researchers (Richard et al, 2004) found that the SCT symptoms formed a seperate factor for boys, but for girls the SCT symptoms loaded onto the inattention symptoms. So what would this mean, it's a separate construct for boys but not girls?

So I guess the SCT symptoms might be illustrating a seperate group of inattentive ADHD, or they might be symptoms of another disorder. But I think a lot more research needs to be done before anything can be decided.

3) SCT doesn't respond will to ADHD meds, and we don't know how to treat it.

Barkley states; "Only about one in five of these children will show a sufficiently therapeutic response to maintain them on medication after an initial period of titration. Oh, you’ll find that about two-thirds of them show mild improvement, but those improvements are not enough to justify calling them clinical responders, therapeutic responders. Ninety-two percent of AD/HD children respond to stimulants. Twenty percent of these children respond to stimulants".



In fact, in some of those threads, SCT was treated more as established fact than theory.

The evidence is there. We know that there is a group within ADHD that is measurably different then classic ADHD. That as Barkley has stated, they are like the polar opposite of ADHD in many regards. This fact should not be questioned. The question now is, do they belong as a subtype of ADHD or should it get it's own unique designation as a disorder? ...and will there be better treatment options in the future.


again you seem to be missing the point that the widely accepted definition of 'combo' is not what Barkley is using when talking about SCT, and that leads to confusion. Probably the best thing to say about SCT right now is 'don't even think about it unless you are interested in following the latest research. The SCT label isn't going to help you much in treatment right now otherwise'

Yup, Barkley is advocating that we change the rules of what combo is but is this any reason to get your knickers in a knot? This is called progress. As he said, treatment will not improve until the diagnosis is done properly. Barkley on the changing rules;"But if you follow the DSM as it’s written—perhaps you have OCD and you just have to follow all those criteria, just as they’re written—then you’re going to get yourself into some trouble because remember, the DSM was not chiseled in stone in Israel. It’s a set of guidelines developed to help make clinical decisions, but it’s to be used with clinical judgment and understanding of the criteria".

..and please don't write off the whole SCT "thing". I agree with you, SCT kids have no great drug like there is for classic ADHD. BUT as an educator I can tell you that the information from studies about this group of children is very valuable. Now when I see an SCT kid I know that there a good chance there there will be; processing issues, memory issues, selective attention issues, and that these kids will also make more mental mistakes then a classic ADHD kid. I will know that typically there shouldn't be disruptive behaviours and if there are then we should take a closer look at these kids. Most importantly, the accommodations for a SCT kids can be more tailored to meet SCT needs.

In both of the March teleconferences on ADHD in Adults and one on ADHD in Children Russ posted his powerpoints and then used them for the 1hr presentation(s). In both of those he has the same schematic for the types of ADHD which features SCT as an offshoot of the Inattentive type. It then lists SCT as comprising 30-50% of that group.

In ADHD and the Nature of Self-Control and again at Door County 2003, he puts forth the idea of a new way of looking at ADHD .He then goes into great detail to distinguish his remarks about "ADHD" and its impact on kids, as excluding the Inattentive type.

I 'm not sure if they're tapes available of this years Door Co.Summer Institute that just finished,but I think I'll check it out. They have some fantastic speakers come in all throughout the Summer.

I really appreciate your post, as I've not had the time to look at any existing SCT research. It pleases me that it is beginning to show up more frequently in the literature.

I apologize if this seems elitist but I also think the posters on this topic made it pretty clear that this is new info and a work in progress. I’d hate to have to limit discussions of this sort to protect the few who don’t get it or would try to diagnose themselves by what they read in this forum. Limiting discussion is always a mistake. Nevertheless, some people come across as if they they are stating facts, even when talking about poorly understood concepts. It spreads mis-information, which may affect how people proceed with treatment. Case in point: Unleashthehound. The solution is not to limit discussion, it's to request that people be more sensitive about what they proclaim, and to have people on the other side of the fence willing to take the time to debate. People will then decide, and at least they will stop and think for a moment.

For alot of people the concepts that are being teased out in SCT research may provide a piece of the puzzle they have felt was missing with basic ADHD concepts. That's why the research is so great. But to me, how that information is presented is important. I'd hate to condemn people to a poorer prognosis just because of a lapse in subtlety, by stating preliminary data as if it were well-established fact backed up by large studies from many perspectives.

Take care
-Brian

The evidence is there. We know that there is a group within ADHD that is measurably different then classic ADHD. That as Barkley has stated, they are like the polar opposite of ADHD in many regards. This fact should not be questioned.
Evidence isn't the same as established fact. Look at the post Outside posted above. Sounds like researchers are still struggling to define what SCT is vs true ADHD-inattentive.

Yup, Barkley is advocating that we change the rules of what combo is but is this any reason to get your knickers in a knot? This is called progress. As he said, treatment will not improve until the diagnosis is done properly. Barkley on the changing rules;"But if you follow the DSM as it’s written—perhaps you have OCD and you just have to follow all those criteria, just as they’re written—then you’re going to get yourself into some trouble because remember, the DSM was not chiseled in stone in Israel. It’s a set of guidelines developed to help make clinical decisions, but it’s to be used with clinical judgment and understanding of the criteria".
It's fine that he wants to change the rules, but keep in mind were still stuck with the rules we've got, and those rules say I'm ADHD-I. If Barkley gets his rule change, I may well be ADHD-C, but today, no doctor is going to call me that. So when you post a statement that says that ADHD-I is really SCT, do you not see the confusion that can cause?

..and please don't write off the whole SCT "thing". I agree with you, SCT kids have no great drug like there is for classic ADHD. BUT as an educator I can tell you that the information from studies about this group of children is very valuable.
I'm not writing it off, I don't doubt that it probably exists. I just want to see a little more qualification when discussing it so others don't get dragged down the wrong road like I did.

Limiting discussion is always a mistake. Nevertheless, some people come across as if they they are stating facts, even when talking about poorly understood concepts. It spreads mis-information, which may affect how people proceed with treatment. Case in point: Unleashthehound. The solution is not to limit discussion, it's to request that people be more sensitive about what they proclaim, and to have people on the other side of the fence willing to take the time to debate. People will then decide, and at least they will stop and think for a moment.
I agree, discuss it freely in the research, news and those types of areas, but please be careful in the "coping with ADHD" areas, put a disclaimer or something saying it's not part of the DSM yet, and it is bleeding edge research.

Evidence isn't the same as established fact. Look at the post Outside posted above. Sounds like researchers are still struggling to define what SCT is vs true ADHD-inattentive.

No one is "struggling to see the difference between SCT and inattentive subtype". They use these terms interchangeably in the same sentence. SCT is like a nick name.

What is established fact, but a whole lot of evidence pointing in the same direction. We are there. Many Scientists have observed this difference for a while between the inattentive type and classic ADHD. Studies looking at these differences occurred as far back as 1984. At least that is the earliest one that I could find. Will there be further differences discovered in the future? Sure...but then again we are also learning more about ADHD everyday also. Do we question ADHD's existence because we don't know everything about it?

What Scientists are struggling with, is determining if this is a different disorder.



It's fine that he wants to change the rules, but keep in mind were still stuck with the rules we've got, and those rules say I'm ADHD-I. If Barkley gets his rule change, I may well be ADHD-C, but today, no doctor is going to call me that. So when you post a statement that says that ADHD-I is