ADHD-PI is not really ADHD, but something else? Really? Here's what a so-called expert on ADHD--Russell Barkley--has to say about it:

From: http--www.schwablearning.org-pdfs-2200_7-barktran.pdfdate=4-12-05 (http://www.addforums.com/forums/http--www.schwablearning.org-pdfs-2200_7-barktran.pdfdate=4-12-05)

...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.
------------------------------------------------------------

How do you rest of you with ADHD-PI feel about being excluded from the overall ADHD category?

I read the rest of Barkley's 40 page lecture and if I can be honest, to me he almost comes across as implying that ADHD-PI kids are "less intelligent" overall than the other two classic types of ADHD. Basically I felt there was a tacit implication that there is an actual deficit in intelligence with ADHD-PI.

i can tell you, from reading these forums, that hyperactivity or not - we are all having the same struggles. most of us get what the others are talking about, subtype or not.

i think that is silly, but i'm glad it's being looked into. any/all AD/HD research is an attempt at progress and understanding, no matter the bias.

I think he qualifies this a bit further in another part of this document (though, to be honest, it was a few months ago that I read the quoted article -- I might have read this in something else he wrote).

He believes a majority of people who are currently diagnosed ADHD-PI usually meet at least some of the criteria that would contribute to a ADHD-C diagnosis. That is, most ADHD-PI have some hyperactive or impulsive behaviours as well as the predominant inattentive behaviours, just not enough to actually tick over into the Combined category. For example, I am diagnosed ADHD-PI, but I had almost enough symptoms to be ADHD-C. Does that mean I am actually ADHD-PI and one half ADHD-C? The categories are really just arbitrary divisions to help make diagnosis and treatment a bit easier. It makes more sense to think about ADHD as a spectrum like this:

[Hyperactive/Impulsive}----{Combined}----{Inattentive]<COMBINED><INATTENTIVE p ]<>

Barkley's overarching theory is that ADHD is primarily an inherited disorder that delays development of the brain's executive (planning/inhibiting/internalising) functions. Thus, if ADHD is in fact a fundamental delay in the development of certain behvaiour, diagnosis of ADHD would only make sense in relation to the individual's expected behaviour for their age.

So, what happens to a typical non-ADHD child as they age? They become less physically active, less impulsive and more inhibited -- they develop executive function (well, you could say children don't become less physically active, but are less impulsive about their activity). According to Barkley's theory, the same can be assumed for individuals with ADHD, but this development of executive function happens at a slower rate.

What would you expect if the above were true? The main thing you would expect is that as people with ADHD age, their diagnosis would actually shift further towards the Inattentive end of the spectrum above. Continuing this thinking, you could say that someone like myself who was recently diagnosed as ADHD-PI, may have been ADHD-C previously but has developed past enough of the hyperactive/impulsive symptoms to fit neatly into the ADHD-PI camp.

Extending this thinking further, what about those who never ever had any hyperactive/impulsive symptoms? In Barkley's model, they can't have ADHD, because their executive function seems to have developed normally. This is the group that he's talking about -- individuals who have trouble paying attention, but don't seem to have any other difficulty controlling their behavior.

So, to summarise, my interpretation of what he's saying is, those diagnosed as ADHD-PI who have also never met any of the hyperactive or impulsive criteria probably have some other disorder, such as Slow Cognitive Tempo. I guess it would make a bit more sense to say, he's referring to a small sub-group of ADHD-PI as having a separate disorder. He doesn't make that very clear though.

When I read the quoted document, I remember thinking that there were a few things that seemed ambiguous, or he seemed to be refering to some other information that wasn't directly referenced. I believe the document is a transcription of a speech he gave, where he also had PowerPoint slideshow going on in the background that he referred to. Thus, when read as just text without the slides, some of the context is missing.

My opinion is that most of Barkley's theory of ADHD makes a great deal of sense. A lot of what he talks about in that linked article resonated a great deal with me, and has changed the way I think of how ADHD is affecting me. I would be very interested to hear other peoples' thoughts about the linked article.

the generalization that boys tend to be (H) and girls to be (-In)

- indicates a gender bias which wll lead us to see that just as men and women have physical differences

- so also do -

men and women have a 'mental gender'

physical male may be mental male or mental female
physical female may be mental male or mental female

Generally
physical male may be mental male or mental female
physical female may be mental male or mental female
hence the
generalization
above

however only a generalization since the physical and mental abstraction layers are independent.

This is the basis to homosexuality -
- of course homosexuality as completely normal -

simply the product of

physical same sex + mental male and female individuals being attracted to one another.

Good posts. Very interesting subject.

I have some opinions on this but they are just that opinions.

If you define ADHD as primarily hereditary defects in executive functions as described by Barkley, and if there are several genes involved and several parts of the brain in a complex relationship (as is being well supported in the research) then one can make the case that there is only one disorder with different manifestations. All could be considered the combined type with different presentations. Some will present with the classic inattention-hyperactivity in roughly equal amounts. Some would have few signs of hyperactivity but a number of signs of inattention. One could be mostly hyperactive/impulsive and able to sustain a reasonable level of attention under many circumstances. All could be considered to be ADHD if they stem from the same basic genetic/neurological causes.

We read and I saw often kids who are, in my opinion, combined type but are a few criteria short of enough symptoms to be classified so. The DSM would have us diagnose these kid as inattentive type which totally misses the dynamics involved. Once the child is classified based on the inattentive diagnosis alone then work on impulsiveness and other manifestations of ADHD could be missed and the prognosis would not be as good. I feel that a more accurate description would be ADHD combined type with primarily symptoms of inattention. I often put this on my reports.

There is a lot of work going to restructure ADHD to conform better with current research and understanding of the disorder for the DSM-V. Barkley seems to be hot and heavy in the middle of this which bodes well. Others forum members will probably chime in with more detailed information.

SCT (Sluggish Cognitive Tempo-Inattention)
It is looking very good for SCT to be named as a separate disorder in the new DSM. It almost made the DSM-IV. Whereas ADHD is considered to be an output disorder.( The kids know what to do but they have a hard time doing what they know). SCT seems to be a true input disorder. There are problems with processing the data coming in. ADHD kids do not have this problem. They process fine, they just don't use what they process very well. I suspect very much that it will be found to have different genetic and neurological origins. I also suspect they can be quite bright but often appear to be, if you would, "sluggish" in their thinking. One problem is that these kids are not often referred for assessment and the schools do not see a problem only a "dreamy" kid and they get missed.

The research goes on. I suspect that in the new DSM there will be two disorders, ADHD by whatever name they give it and SCT by whatever name. That is still quite open.

Also please note that the Schwab transcript is from 2000. It is still very good and has held up very well but there has been quite a lot of new research and data since then. It is, however, still one of the best easily accessible primers on ADHD available.

These are some thoughts. I hope there will be others posting with more detailed knowledge.

I bet, however, that when the new DSM comes out, I will not be too far off the mark.

Keep plugging. Dealing with ADHD is a journey not a destination. You never get there but you can go a long ways on the trip, usually one step at at time.

Dizfriz

maybe there's sense to a separate name -
- if it helps -Inattentives to be taken seriously

- in the UK ADHD is all about the H

- but I'd be opposed if it lead to the suggestion that the aetiologies are different
- because it's important that we see the passage of

ADHD
..+.......-> combined type at balance
ADD-In

The balance of H and -In reducing in apparence with age (the basis behind the false belief that ADHD corrects itself in adulthood
- which has given way more recently to the more accurate notion of switch from

H ->-to->- - combined type with {age, mind, education}

is what I'm getting at here.

Just to put some distance between -H and -In, so that Inattentive ADDers are helped to gain access to medication.
By the very nature of the -Inattentive ADDer
- I'm guessing that this is one group (especially when young) which won't rock the boat -
and so will themselves in and of themselves -suffer- accordingly.

My question: what is the relevance of Barkeley's distinctions for treatment? Would the treatment of us inattentive types change? If not, I don't see the importance or relevance of this new "sub" diagnosis.

I don't see the importance or relevance of this new "sub" diagnosis.

just a short term fix to help parents and teachers to get over the stigma of their children having ADHD without H -

- in the UK ADHD with H
isn't really considered a disease
- just a condition in association with either bad parenting or bad kids

- only the extreme H's are catered for

and ADD-Inattentive -
- not too sure that it exists

~ by the way ~
All of the above are on a National level -
- there are a couple of clued up medics in the country -
though funnily enough I've heard most sense (on a personal level) from a neurologist and not psychiatrist.

Institutional malaise ?

We've 1 state and 1 private centre for treating ADHD in the country
- psychs who'd rather give bipolar meds than acknowledge ADHD
and
a fear of stimulant medication (due to its chemical character).

My question: what is the relevance of Barkeley's distinctions for treatment? Would the treatment of us inattentive types change? If not, I don't see the importance or relevance of this new "sub" diagnosis.

The primary thing is that a separate diagnosis can drive research. That is one of the primary purposes of research and theory building; to point at new directions to explore. From that can come more effective treatment. The inattentive type of ADHD and, if you would separate them, SCT have had almost no research in comparison to combined ADHD.

The work to differentiate them could hopefully result in more research interest.

Another consideration is that if you treat them the same, it will not work if the disorder indeed is truly different with different origins and dynamics. From a clinical point of view; the more accurate the diagnosis, the better the plan of treatment. As an example, if you can successfully differentiate pediatric bipolar from ADHD then you have a much better chance of developing a successful treatment for the bipolar child and you can be much more sure of your direction with the ADHD child.

Dizfriz

I think he qualifies this a bit further in another part of this document (though, to be honest, it was a few months ago that I read the quoted article -- I might have read this in something else he wrote).

He believes a majority of people who are currently diagnosed ADHD-PI usually meet at least some of the criteria that would contribute to a ADHD-C diagnosis. That is, most ADHD-PI have some hyperactive or impulsive behaviours as well as the predominant inattentive behaviours, just not enough to actually tick over into the Combined category. For example, I am diagnosed ADHD-PI, but I had almost enough symptoms to be ADHD-C. Does that mean I am actually ADHD-PI and one half ADHD-C? The categories are really just arbitrary divisions to help make diagnosis and treatment a bit easier...

It's interesting that you should mention this idea of "formerly being ADHD-C." Indeed, my recollection of my own childhood shows a certain concentration of behaviors that would belong more on the "hyperactive/impulsive" side of ADHD. But the last time you could have observed any hyperactive behavior in me would have been around 5th grade.

Anyhow, you seem to think that he's talking about a small subgroup of ADHD-PI who never had any hyperactive or impulsive behavior? The way I read it, in that case, may have been incorrect.

I seemed to think that he meant any child who has much more difficulty with selective attention/information processing, and who exhibits little-to-no difficulty with the other traits, had "another disorder that isn't ADHD." And this would describe me. While I've had a little bit of hyperactivity in my childhood, and I've always had some impulsive tendencies (addictive personality, etc), that's really NOT my problem... my problem is not really with behavioural inhibition. The problem is with paying attention, distractibility, working memory, commitment/motivation, passivity, slow processing speed, etc.

How about just asking...

Do you guys--personally--feel there's different etiology, origin, dynamics for ADHD-PI than for the other subtypes?

Or, do you guys tend to think it's all under the same umbrella?

Forgive me, but I tend to understand things better when presented in black-and-white terms, rather than seeing things in abstraction as it tends to be the case in this forum.

How about just asking...

Do you guys--personally--feel there's different etiology, origin, dynamics for ADHD-PI than for the other subtypes?

Or, do you guys tend to think it's all under the same umbrella?

Forgive me, but I tend to understand things better when presented in black-and-white terms, rather than seeing things in abstraction as it tends to be the case in this forum.

Batman55

The problem you may run into is that the jury is out on that one.

My opinion? I very much suspect that there will be a separate diagnosis for what is currently being termed SCT. The research will decide.

I wish I could give you something more definite but alas I cannot. Unfortunately, my opinion and seventy five cents will buy you a coke some places but not others.

Dizfriz

ADHD-PI, according to Barkley and others is not a developmental stage of ADHD. ie you start hyper then go combo and then end up inattentive. Barkley is talking about SCT which is a term of use...until they find something better to call it. Check wikipedia if you are interested....information is scarce. It's a subtype of ADHD that is not ADHD at all. Never hyper...in fact hypo...daydreamers...space cadets...in their own world. The hyper kids are rejected in social situations...the SCT kids ignored. They are polar opposites of ADHD and have the true attention deficit. There are a number of other differences.

How about just asking...

Do you guys--personally--feel there's different etiology, origin, dynamics for ADHD-PI than for the other subtypes?

No. I think there genuinely is such a thing as ADHD-PI, and it is definitely ADHD. But that's just my opinion -- I'm no expert, I can only form conclusions based on what I've read around the internet.

Or, do you guys tend to think it's all under the same umbrella?

My personal opinion is that the group of people who are currently diagnosed ADHD-PI can be split into two groups. Those who actually have ADHD-PI; and those who have something else, possibly SCT. According to Barkley, something like 30-40% of ADHD-PI seem to have this "something else", read: http://knol.google.com/k/russell-barkley/attention-deficit-hyperactivity/l2_SXavv/ZKHmPA

In your case, I think you sound like you have ADHD. Things like addictive personality, poor working memory, and commitment and motivational issues are pretty standard ADHD symptoms. The SCT group wouldn't really have these symptoms -- they supposedly don't have addictive personality issues or commitment and motivation issues, they just process everything slower would come across as a bit spacey.

The difference is, those of us with ADHD don't have any trouble interpreting what we see, it's just hard for us to act on it properly. The other SCT group have a hard time interpreting what they see, but no problem acting on it once they've got it.

If it exists, it is important to identify and separate this "something-else/SCT" from ADHD, because it might have a different cause. If it has a different cause, then different treatments could be more effective for SCT than ADHD proper.

He's NOT a so-called expert.

He's among the most widely, if not THE most widely, respected ADHD researcher/scientist on earth.

And He HAS NOT excluded ADHD-PI.

Science HAS already accepted SCT as a legitimate SUBGROUP within ADHD-PI (but not as a different disorder).

Barkley postulates that WITHIN the ADHD-PI type, there exists a "qualitatively different" disorder,comprising 30-50% of that population.

That is his theory of SCT.

I believe he's right btw.

Either way, he hasn't excluded ADHD-PI type in the least.

tc

mctavish23

(Robert)

I am waiting for the day that that a "meta" category of Executive Function Disorders is created with "classic" ADHD, ADD -- PI, SCT etc.[!] listed as distinct disorders under that heading. Until then I will continue to muddle through. As far as I am concerned you can label my collection of malfunctions as "SNAFU Disorder". :D

As a "consumer" my interest is getting the information and assistance I need. Theoretical rigor is not exactly a priority for me.

Do I need to repeat that the map is not the territory?

To thine own self be true. You can't really do that if you don't know who you are. The map is important. It puts things in scale, allows you to see globally, and indicates direction.

Sigh. I am not advocating tossing the "map" to the side. What I am saying is recognize that it is a provisional document that merely attempts to model the reality -- it is not the reality itself.

Not so long ago the phrase "attention deficit disorder" did not exist. (Look up "minimal brain dysfunction"). It's quite possible that it will be retired in the future -- its place taken by a new phrase with a new conceptual framework behind it...

To thine own self be true. You can't really do that if you don't know who you are. The map is important. It puts things in scale, allows you to see globally, and indicates direction.

He's NOT a so-called expert.

He's among the most widely, if not THE most widely, respected ADHD researcher/scientist on earth.

And He HAS NOT excluded ADHD-PI.

Science HAS already accepted SCT as a legitimate SUBGROUP within ADHD-PI (but not as a different disorder).

Barkley postulates that WITHIN the ADHD-PI type, there exists a "qualitatively different" disorder,comprising 30-50% of that population.

That is his theory of SCT.

I believe he's right btw.

Either way, he hasn't excluded ADHD-PI type in the least.

tc

mctavish23

(Robert)

Forgive me, as I was acting on impulse and perhaps had not mentally processed the entire document before posting here.

I have the problem of interpreting what I see (the input problem), as well as the output problem (acting on what I know.)

Sigh. I am not advocating tossing the "map" to the side. What I am saying is recognize that it is a provisional document that merely attempts to model the reality -- it is not the reality itself.

Not so long ago the phrase "attention deficit disorder" did not exist. (Look up "minimal brain dysfunction"). It's quite possible that it will be retired in the future -- its place taken by a new phrase with a new conceptual framework behind it...

Using the metaphor some more. The map has existed for almost 50 years...some would claim longer. The name of the map has changed several times and the detail is getting much finer. The map title may yet change again but you will still have a very usable map. :)

As a "consumer" my interest is getting the information and assistance I need. Theoretical rigor is not exactly a priority for me.

Do I need to repeat that the map is not the territory?


Thank you Retromancer - common sense isn't very common so you are a breath of fresh air.

If their theories or what ever does not equate into real time life improvement then why do I need to have my life confused by them - what having ADD isn't enough to deal with???

Apparently we got to have ADD research and "experts" who can't freaking agree on what to even call it - wtf?????

I quit looking at ADD research specifically back ohh about 2005. I am vaguely aware of it but clinical theory and practical application is about as far apart as watching Star Trek episodes is to actual space travel - with many of the same functional problems.


From a clinical point of view; the more accurate the diagnosis, the better the plan of treatment. As an example, if you can successfully differentiate pediatric bipolar from ADHD then you have a much better chance of developing a successful treatment for the bipolar child and you can be much more sure of your direction with the ADHD child.

If the child is bipolar and ADD then what???? Is there left open this possibility - the fact that these two conditions together may look very different than either presenting separately.

Clinical views and practical application are miles apart please lets not forget that one small detail.


small subgroup of ADHD-PI who never had any hyperactive or impulsive behavior?

This is correct - it is Barkley's theory and possibly a few others as well. . .


How about just asking...

Do you guys--personally--feel there's different etiology, origin, dynamics for ADHD-PI than for the other subtypes?



No Too many cross over symptoms and they all deal with selective attention and the inability will ones brain to filter some stimuli out in order to focus on other stimuli -


Or, do you guys tend to think it's all under the same umbrella?

I think some individuals have been misdiagnosed ADD-PI simply because they have attention problems that do not fit into other diagnostic categories.

Clinical types like categories it allows life to make more sense - very concrete world with a major problem being life comes in shades of grey


Forgive me, but I tend to understand things better when presented in black-and-white terms, rather than seeing things in abstraction as it tends to be the case in this forum.

Most people do understand in terms of black and white easier than shades of gray however most things in life are perspective defined and there are many different perspectives because there are so many variations in people.

Forgive me, as I was acting on impulse and perhaps had not mentally processed the entire document before posting here.


No need to be forgiven for having an opinion or writing out what is on your mind.You didn't violate any guidelines or treat any one badly.

My opinion of Barkley makes yours look like a compliment. . . . so chin up and don't allow intimidation to set in because some members hold this researcher up on a pedestal -

Barkley is well known however like most people who are well known opinions of him vary and last I checked according to the guidelines (http://www.addforums.com/forums/showthread.php?t=15843) that is allowed here . . . .

Please be respectful to one another. People come from all different backgrounds and many have different ideas and views on different issues.

Yep we are all still allowed to have different opinions. Barkley isn't on the banned topic list unless we are going to consider worshiping him as a god If this becomes the case then he would be considered a religion which is restricted :D

maybe there's sense to a separate name -
- if it helps -Inattentives to be taken seriously

- in the UK ADHD is all about the H

- but I'd be opposed if it lead to the suggestion that the aetiologies are different



The answer over here from the US is yes and no

Science HAS already accepted SCT as a legitimate SUBGROUP within ADHD-PI (but not as a different disorder).

Barkley postulates that WITHIN the ADHD-PI type, there exists a "qualitatively different" disorder,comprising 30-50% of that population.


Please note McT exact quote above -underlining mine Do you really think that is going to clear any thing up??? LAMO - PLUS PLUS they are going to change the freaking names again??????

I am glad diabetes was already on the books - type one diabetes and type two diabetes are very different but once they picked a name they freaking stuck with that name - jeminey cricket new ADD diagnostic criteria - If you can remember what they call it now you don't have it and if you still care your defiantly neurotypical so no worries.


Using the metaphor some more. The map has existed for almost 50 years.

The territory was still there first I don’t care how long you have had the map –no territory no map. . . .no map well ya still got territory

Point if you make the map too detailed it won’t be of much use to people who want to go from point a to point b – Change the name of the area along with the view fifty zillion times and people will quit buying your maps . . .


To the average ADDer they want practical helpful solutions Most really couldn’t care less what you call the disorder – call it the late for breakfast dysfunction what is important is what can be done so I can still eat lunch

You can't really do that if you don't know who you are. The map is important. It puts things in scale, allows you to see globally, and indicates direction.


What in the name of logic does the new name for ADD in the next issue of the DSMV have to do with who I am ?????

Call ADD what ever you want my symptoms are still going to be my symptoms hence my over all annoyance at all this intellectual masturbation in the name of science. . . . Address the problems with conscious selective attention - the bombardment of stimuli {internal external depends upon the subtype} that distracts and/or over loads my ability to selectively filter out un-necessary stimuli so I can pay attention to the necessary no matter how under stimulating and you will help not only the inattentive but those whom you call impulsive. Geez making it hard must be a specialty of some sort. . . .:mad:

I think I was more patent with this scientific stuff when I was primarily hyperactive . . . . now that I qualify for combined ADD I find most of it silly. For some reason inattention has decreased my patience???? That sucks I wasn't very patent to begin with

My major beef

What are we doing about ADD and menopause, puberty, hormonal fluctuation, anxiety, depression ,Learning disorders, how about ADD and bipolar????

The well known supposed experts answer - nothing but we are adding a new ADD subgroup we are calling SCT in the next DSMV -

WTF?????

Subtly another one of my wonderful qualities

ADHD never felt right as a diagnosis for me...in fact one was never made until recently at almost 50! Then one day I read Barkley's piece and it all fell together in my mind beautifully. Meadd, for someone who has this form of ADHD...this is huge for me...get a grip.

It clears up something that should have been cleared up a long time ago. They will simply create a subgroup of a subgroup...that is it..and I don't care what they name it, as long as they acknowledge it.

To: meadd823
I often enjoy your posts but this one I had to respond to.

Me:
Begin quote:

"From a clinical point of view; the more accurate the diagnosis, the better the plan of treatment. As an example, if you can successfully differentiate pediatric bipolar from ADHD then you have a much better chance of developing a successful treatment for the bipolar child and you can be much more sure of your direction with the ADHD child.

end quote

Start quote form mead823

"If the child is bipolar and ADD then what???? Is there left open this possibility - the fact that these two conditions together may look very different than either presenting separately.

Clinical views and practical application are miles apart please lets not forget that one small detail."

end quote from mead823

Since this was in relation to a post by me, I guess I need to comment.

I was giving an example to illustrate a point. I was not trying to give a treatise on differential diagnosis. You seem to be taking me to task for not covering all possibilities. I am afraid that pediatric ADHD/bipolar is much too complex a subject to give a sentence or so description. For all readers, if you are interested in the subject then I might recommend "The Bipolar Child" by Papolos and Papolos. It is considered to be one of the best books on the subject out there and is written to be assessable to both professionals and parents.

Be aware that clinical views and practical applications are very much not miles apart for those dealing with these conditions. The most important factor in dealing with both ADHD, bipolar, and if you would the combination, is knowledge. The parents need to be come as close as they can to becoming experts on the subject. This is the primary tool. Knowledge and understanding the disorders is the key. All else follows.



There was too much in your post for me to attempt to deal with. I do not wish to be argumentative and will only comment on the last remarks since they struck a strong chord in me.

Start quote from mead823

"My major beef

What are we doing about ADD and menopause, puberty, hormonal fluctuation, anxiety,
depression ,Learning disorders, how about ADD and bipolar????

The well known supposed experts answer - nothing but we are adding a new ADD subgroup we
are calling SCT in the next DSMV -

WTF?????"
end quote from mead823

Doing nothing? I will use my experience for an example. My eldest is pushing 40 and is ADHD. When he was a child we were desperate for any information on ADHD so we could help him. There was so little out there then. We had only ritalin as a medication. There was no Barkley out her to help me understand. There were few resources available to help parents. There were very few professionals who had any good ideas on how to help the parents help their children. We were struggling and pretty much lost. I have mentioned to my son one day that if I knew then what I know now both his and my life would have been a whole lot easier. He indicated hardy agreement. I would have given anything for even a small portion of what I know today.

Now there is so much more available, more knowledge, understanding, medications and all else involved. Now there are huge collections of resources. There has been an unbelievable amount of research and there is more ongoing and planned. There are much better medications. There is now a good theory (Barkley) to help work with the disorder and to drive research. All indications are that you haven't seen anything yet, a lot more is coming. The amount of knowledge available now and in the pipelines is awe inspiring from one with my prospective. I think it is wonderful, I can see in the future the chance of really being able to deal with ADHD. Not now but perhaps soon.

I am sorry, but to hear that nothing is being done boggles my mind. I really do not think you meant it this way but it is the way I saw it and felt I needed to comment.

Yours respectfully,

Dizfriz

I don't know if SCT will be added to the DSM-V.

However, I do know that the empirically (research) supported characteristics found to accurately distinguish one group form the other (Pediatric Bipolar Disorder from ADHD);assuming of course there is a documented family history are :


1) elevated & expansive mood swings ( the lenght of which helps determine the type); as opposed to temper tantrums,

2) flight of ideas/racing thoughts

3) decreased need for sleep ( these kids can get by on only a few hrs sleep and wake up alert and ready to get going);

4) grandiose behavior, as in "I'm the world's greatest expert on whatever, even if I have no clue( for younger children that might present as bossy)" and

5) hypersexual behavior (doesn't seem to be as common).

It s more like self stimulation or rubbing on furniture.It can also be lewd coments; the key being the very young age of the child.

Without a family history of BPD, all those points are null & void.

The inappropriate statements would also have to be something other than picking up on whats said in the environment,etc.


tc


mctavish23

(Robert)

Robert (mctavish23)

As usual, a good post but I do wish to point out that sometimes the family history of BPD is really hard to establish. Often the response is that someone in the immediate family had some problems but there was no diagnosis and it could be like pulling teeth to try get usable behavior descriptions of those family members. For foster and adopted children, there was often no information whatsoever available on family history and the work had to be solely based on observed symptoms.

Other than that, we seem to agree on all points.

For the main, neither myself and the docs I worked with would normally put a diagnosis of bipolar on young children. This could stay with them for life. We did treat as bipolar however and were able to often show some real progress.

Dizfriz

Thanks.

I agree with that as well.

What I often do (diagnostically) in such cases,where there's more going on than just ADHD,and where some or all of the above characteristics apply , is use :

296.90 MOOD DISORDER NOS, with possible features of (Pediatric) Bipolar Disorder.

I usually list that as my primary Axis I dx.

ADHD (whatever type ) is secondary.

We have an excellent Pediatric Psychiatrist and a Master's level RN/Clinical Nurse Specialist (of which there are only a few in the state) on our clinic staff.

There is also a Pediatric Neurologist about an hour away as well.

For being in a rural setting, which this definately is, we have access to excellent health care.

For example, our town is less than 10k, yet the hospital has a Sleep Lab.

There's also another Sleep Lab in a hospital about 30mins from here.

I feel truly blessed to have all of these things at my disposal.

Anyway,excellent point.

Well taken.

tc

mctavish23

(Robert)


PS

In keeping more to the original thread, I've certainly added " with features of Sluggish Cognitive Tempo (SCT)" to some diagnoses of 314.00 ADHD-PI type, as well.

I'm really wondering about just what's happening to my ability to retain information correctly... this is confusing, again, to me. Anyone else's cognitive functions declining lately.. cuz mine sure are.

I think perhaps what I'm getting at is I can't *quite* see the point of creating a subgroup for ADHD-PI called "SCT." Because I can't see how the treatment would be significantly different for SCT, vs. ADHD-PI.

So please let me get this straight for my own sanity. The principal difference between SCT and ADHD-PI is, generally, the following:

- ADHD-PI patients tend to exhibit a few symptoms of impulsivity and/or hyperactivity (or at least did for a short while in childhood, before inattention became the primary symptom); SCT patients rarely, if ever, exhibit these behaviors

If I am wrong and there's some other differences I've not included here, please feel free to correct me.

I'll try and explain why it's important to differate the two, lets start with diagnosis, when I first discovered I have ADD no one would believe me, ADD in general is associated with hyperactivity and as I'm the exact opposite so it's a problem.

Now how does SCT manifest itself in me, as I see it, imagine hearing everything a person says in a slurred way, you just hear and process stuff slower then other people, by the time I understand what someone has said he has moved on to the next subject, It's just that I get lost in thought about this one subject that has been brought up, sometimes I just have to force myself to stop thinking about what was said and just listen, my mind has adapted in a way and I just piece together words and through intuition I understand what the other person meant, and ask a question to varify it.

It's quite common for me to just ask "what?", just so I will have more time to process what the other person said, I do have many symptoms of ADHD it just takes too much effort to concentrate on certain things so I don't and just get lost in thought, when reading a book I can just get sucked into thinking about a word or a sentance and completely get out of the train of thought that I was in and my attention has a tendency to drift to outside stimulants such as noises and such.

I can come up with brilliant ideas, because eventhough my mind works slowly, it works very effectivly and I can connect things fantasticly. (over time for effective communication I need to piece together words into a sentance) but in certain situations I just can't follow, especially during class, when the teacher speaks too fast, it just becomes a big blur as I get lost in trying to understand the first few sentances.

When I take Ritalin it feels horrible mainly because I'm so used to thinking slowly and moving slowly, and it just speeds me up to uncomfortable levels, I can't settle down and I stop feeling like myself, I'm just not built to cope with such a burst of energy and I become agitated, eventhough I can suddenly follow people so much better and understand every word people tell me.

A couple of days ago while chatting, a friend here asked me if I really have ADD, and later clarified that what I write just doesn't resonate ADD,
I was confused at the time but now I understand that when I have enough time to process what was said, I sound quite normal even fairly intelligent, on the otherhand my contribution to disscussions once a few more people join the chat dissapates quickly and I sit there mute unable to follow what is being said.

I think the best example was given by george costanza in seinfield in "the comeback" (I think that is what it was called), he was antagonized by someone and everytime he couldn't come up with a good reply, later he thought of the perfect reply but it was to late, because the time had come and past, that is how it is with me, I only understand what people mean when it's to late to reply and eventhough I've thought of the perfect reply, I can't give it and just stay silent.

I think perhaps what I'm getting at is I can't *quite* see the point of creating a subgroup for ADHD-PI called "SCT." Because I can't see how the treatment would be significantly different for SCT, vs. ADHD-PI.


Batman
I understand your question. It is a very good one and needs to be addressed. Perhaps I can shed a little light.


A scenario: This is not meant to be accurate but just to give a simplified basis to explore the question.

First:
Let us assume that ADHD-PI is a variation on ADHD combined type. In otherwords, it has the same basic genetic basis and generally effects the same parts of the brain but the hyperactive impulsive component is subdued and one sees primarily inattention.

Let us assume there is a different disorder called SCT that is not a variation of the combined type and has a different genetic basis and effects different parts of the brain.

Now,
Let us also assume that the methods used to treat the combined type of ADHD works fairly well on the ADHD-PI population but not on the SCT one. If SCT has a different causation then it would be logical that the classic ADHD treatments will not work very well. Right now, assume no effective tools to help SCT.

We have to figure out how to help the individuals dealing with SCT. The medications used on ADHD are not effective. These individuals are left out in the treatment cold.


Next:
To study this population, we have to figure out how to define them so we can accurately differentiate them from the much larger ADHD group. Once we have defined them and can correctly identify, then we can design research to help find ways to treat this specific disorder.

First we have to do the research to define, then we can begin to develop the research to help.

In my own wordy way, I hope this is of some help. It really is a good question.

Dizfriz

We have an excellent Pediatric Psychiatrist and a Master's level RN/Clinical Nurse Specialist (of which there are only a few in the state) on our clinic staff.

There is also a Pediatric Neurologist about an hour away as well.

For being in a rural setting, which this definately is, we have access to excellent health care.



Ah, you were indeed truly blessed. Child Psychiatrists are really quite rare today as well as Pediatric Neurologists. To find any that would take Medicaid was even more rare and in some specialties, non existent.

Dizfriz

Since this was in relation to a post by me, I guess I need to comment.

I was giving an example to illustrate a point. I was not trying to give a treatise on differential diagnosis. You seem to be taking me to task for not covering all possibilities.

No I am obviously some one with a different perspective on this subject - I have a child with both ADD and bipolar as well as a sister with both conditions - You speak as if this research stuff has made differentiating the two is easy in children when in fact it isn't easy even in adults -

you writing about family history and bipolar - those people back then know less than you do now yet you are depending upon a family history to be able to diagnosis bipolar in children and help distinguish it from ADD

However, I do know that the empirically (research) supported characteristics found to accurately distinguish one group form the other (Pediatric Bipolar Disorder from ADHD);assuming of course there is a documented family history are :

The non-technical version along the lines of
research clearly indicates there are certain traits that enable a practitioner to tell the difference - but only if there is a documented family history of it !!!!

Without a family history of BPD, all those points are null & void

My dad was a loon - that is all the family history I have and I am not even sure if he was a bipolar loon - documentation LMAO not even close Hence there is a difference between the clinical ideas in your office and and practical application in my real life - I am not being argumentative I am sharing your example from my point of view. . . .

Nothing more . . . . why am I doing this because

My sister suffered a great many years due to lack of a diagnosis You make it sound like it is cut and dry. It isn't and much of the diagnostic process is subjective in nature.

Until the coexisting conditions that accompany ADD in some thing like 75% of us are accounted for how are you even going to be able to determine what subtype you are dealing with - ADD PI could be an SCT with a bipolar element how are you going to know the difference if you can't even know for sure when ADD and bipolar occur together with out years of missed diagnoses and patent suffering.

I see more confusion in the world of ADD than what we already have at a time when we do not need it - inattentive ADDers want to be taken more seriously so their point of view I understand - adding a subgroup in inattentive PI just the notion is confusing the people here and they know more about ADD than most non-medical people.


Why is wrong with addressing the issues of inattention and impulsiveness as they are seeing that most ADDers have symptoms of both?

To what end is all this focus in a SCT sub-type ???? If inattentive ADD in it self isn't even taken as serious by some how is adding to this sub-group going to help those who have inattentive ADD now? Changing the name is going to make it look like we are all a bunch of loons - including those experts you yelled at batman over -


He's NOT a so-called expert.

He's among the most widely, if not THE most widely, respected ADHD researcher/scientist on earth.


Forgive me, as I was acting on impulse and perhaps had not mentally processed the entire document before posting here.

I have the problem of interpreting what I see (the input problem), as well as the output problem (acting on what I know.)

He shouldn't have felt like he needed to apologize he didn't do any thing wrong - :(

All he is looking for is some answers.

If you just got to go off on some one then yell at me I am used to it - I don't even take in personally any more. Hence my strong approach loss of humor. . . becoming the target of frustration been doing it for years now. . . . and most just thought I was being impulsive and argumentative.

There is a difference between star trek the move and actual space travel -

I'll try and explain why it's important to differate the two, lets start with diagnosis, when I first discovered I have ADD no one would believe me, ADD in general is associated with hyperactivity and as I'm the exact opposite so it's a problem.

Now how does SCT manifest itself in me, as I see it, imagine hearing everything a person says in a slurred way, you just hear and process stuff slower then other people, by the time I understand what someone has said he has moved on to the next subject, It's just that I get lost in thought about this one subject that has been brought up, sometimes I just have to force myself to stop thinking about what was said and just listen, my mind has adapted in a way and I just piece together words and through intuition I understand what the other person meant, and ask a question to varify it.

It's quite common for me to just ask "what?", just so I will have more time to process what the other person said, I do have many symptoms of ADHD it just takes too much effort to concentrate on certain things so I don't and just get lost in thought, when reading a book I can just get sucked into thinking about a word or a sentance and completely get out of the train of thought that I was in and my attention has a tendency to drift to outside stimulants such as noises and such.

I can come up with brilliant ideas, because eventhough my mind works slowly, it works very effectivly and I can connect things fantasticly. (over time for effective communication I need to piece together words into a sentance) but in certain situations I just can't follow, especially during class, when the teacher speaks too fast, it just becomes a big blur as I get lost in trying to understand the first few sentances.

When I take Ritalin it feels horrible mainly because I'm so used to thinking slowly and moving slowly, and it just speeds me up to uncomfortable levels, I can't settle down and I stop feeling like myself, I'm just not built to cope with such a burst of energy and I become agitated, eventhough I can suddenly follow people so much better and understand every word people tell me.

A couple of days ago while chatting, a friend here asked me if I really have ADD, and later clarified that what I write just doesn't resonate ADD,
I was confused at the time but now I understand that when I have enough time to process what was said, I sound quite normal even fairly intelligent, on the otherhand my contribution to disscussions once a few more people join the chat dissapates quickly and I sit there mute unable to follow what is being said.

I think the best example was given by george costanza in seinfield in "the comeback" (I think that is what it was called), he was antagonized by someone and everytime he couldn't come up with a good reply, later he thought of the perfect reply but it was to late, because the time had come and past, that is how it is with me, I only understand what people mean when it's to late to reply and eventhough I've thought of the perfect reply, I can't give it and just stay silent.

A lot of this is VERY familiar to me, but I still don't see why any of these symptoms you talk about would be strange for anyone with ADHD-PI, as I imagine inconsistent processing speed, high distractibility by the surroundings, and greater trouble with input than output is common among this group.

So I am still not swayed into thinking that what you are talking about is definitively different from ADHD-PI.

He shouldn't have felt like he needed to apologize he didn't do any thing wrong - :(

All he is looking for is some answers.

If you just got to go off on some one then yell at me I am used to it - I don't even take in personally any more. Hence my strong approach loss of humor. . . becoming the target of frustration been doing it for years now. . . . and most just thought I was being impulsive and argumentative.

There is a difference between star trek the move and actual space travel -

Ah, yes, one of my issues with ADD forums is that a lot of you folks are sticklers for accuracy. That is the extent of the problem I had with McTavish and a couple other members in other threads.

However, while I appreciate mead's defense in this case, I think we can consider this matter closed as I don't think McTavish was all that offensive to begin with, and he's sent me a note clarifying things anyway.

Batman, I actually agree with you, I don't see much difference between SCT and ADD-PI, I do think they are the same, but I think that ADD-PI and ADHD are two distinct conditions that can lead to similar problems (with attention).

I just noticed that most examples (videos and such) of what it means to have AD/HD just don't fit me at all, I don't have a hundred thoughts at once, I just have one that just takes much longer to come to frutition, I don't hear and see everything around me but instead focus on one thing but this thought process is a long and branching one that allows me to see all directions of that one subject, but while working things out I will miss other more important things such as the rest of the sentance and such. :)

As I see it the two conditions are actually polar opposites one of the other and most people are in the middle, I believe that every person who has ADD in whatever form, fits one of these two scenerios, or he processes things slower then normal leading to overlapping thoughts, or he processes things faster then normal so his thoughts jump from one thing to the other and it all becomes a mess.

Both of these scenerios lead to similar symptoms but they are completely different in essence and I'm sure the treatments that are commonly used for ADD have completely different effects on both groups. (so both deserve to be studied seperately.)

A different way to look at it is that people with ADHD don't think enough about things and move on too quickly which leads to impulsivity and people with ADD-PI think too much about things and have a problem moving on, which leads to obssesive thinking and anxiety. :D

Of course this is just a theory and I'll probably change my mind tommorow,

A different way to look at it is that people with ADHD don't think enough about things and move on too quickly which leads to impulsivity and people with ADD-PI think too much about things and have a problem moving on, which leads to obssesive thinking and anxiety. :D


The thing with me, though, is I exhibit *both* of these behaviors, but in different scenarios. For example, in the majority of social situations I'll think too much about everything and get anxiety to the point where I don't say or do anything; but if I have time to myself I don't even think of the consequences of what I do (the only thing that matters is "now, now, now") whether that be too much computer time or other kinds of addictions I have.

Could it be that I'm somewhere in between the two ADHD types? But then that doesn't explain my strange response to stimulants (which is similar to yours, I tend to get sped up and anxious.)

Very interesting thread!

Forgive me, but I tend to understand things better when presented in black-and-white terms, rather than seeing things in abstraction as it tends to be the case in this forum.


LOL! In a forum full of adders, abstraction may be all you get.:) LOL! But I know personally, I'm a bottom-line kinda guy too, yet I'm ALWAYS explaining things from the abstract.

But it's great! While I always want to know the bottom-line, it never makes sense to me until I know WHY. These posts have been GREAT at explaining the WHY!

LOL! In a forum full of adders, abstraction may be all you get.:) LOL! But I know personally, I'm a bottom-line kinda guy too, yet I'm ALWAYS explaining things from the abstract.


Try having Asperger's.... black and white thinking is pretty much the rule.

jeminey cricket new ADD diagnostic criteria - If you can remember what they call it now you don't have it and if you still care your defiantly neurotypical so no worries.

Ah, no.

A different way to look at it is that people with ADHD don't think enough about things and move on too quickly which leads to impulsivity and people with ADD-PI think too much about things and have a problem moving on, which leads to obssesive thinking and anxiety. :D

Of course this is just a theory and I'll probably change my mind tommorow,

Nope. My anxiety is caused by my Tourettes/ADHD combo with "Obsessive-Compulsive behaviours" this is my anxiety... it presents as fear of all stimulus in my environment, only my head being safe, or not even... but I've got that worked out now... havent had a panic attack since last september. Although my anxiety is often off the charts... made worse by stimulants... I have to really work hard to have my mind semi-clear when the stimulants kick in, if this is the case, I am rewarded to a slow quiet mind for a couple hours... if not I am inundated by rapider thoughts and not being able to focus on any of them... obviously I need more dexedrine as it always used to work and now I'm tolerant of it... when I take more than I'm supposed to it works like that (quieting and slowing) and its great... I hate being used to the cognitive effects of a dose but not the side effects.

When I mentally work through my social anxiety and ****, then the stimulants work great... sigh.

Anyway, your whole theory is flawed from my personal experience. As a child I would have agreed, but not since Im suffering from PTSD and all forms of anxiety and depression myself.

Sometimes I'm sick of this brain and I just want to put a bullet into it.. all day long every day dealing with this and having every ****ing person look at me like im some spoiled, ungrateful, brat/deliqiuent on disability, when I just want to be normal and ****...

Your "not thinking enough about things" does lead to anxiety! You cant come to any conclusions about whether or not the stimulus is threatening and so you go with your ADHD built up intuition... mine being everyone wants to hurt me and ****. Id rather think a lot about stuff and come to hte right conclusions.

Nope. My anxiety is caused by my Tourettes/ADHD combo with "Obsessive-Compulsive behaviours" this is my anxiety... it presents as fear of all stimulus in my environment, only my head being safe, or not even... but I've got that worked out now... havent had a panic attack since last september. Although my anxiety is often off the charts... made worse by stimulants... I have to really work hard to have my mind semi-clear when the stimulants kick in, if this is the case, I am rewarded to a slow quiet mind for a couple hours... if not I am inundated by rapider thoughts and not being able to focus on any of them... obviously I need more dexedrine as it always used to work and now I'm tolerant of it... when I take more than I'm supposed to it works like that (quieting and slowing) and its great... I hate being used to the cognitive effects of a dose but not the side effects.

When I mentally work through my social anxiety and ****, then the stimulants work great... sigh.

Anyway, your whole theory is flawed from my personal experience. As a child I would have agreed, but not since Im suffering from PTSD and all forms of anxiety and depression myself.

Sometimes I'm sick of this brain and I just want to put a bullet into it.. all day long every day dealing with this and having every ****ing person look at me like im some spoiled, ungrateful, brat/deliqiuent on disability, when I just want to be normal and ****...

Your "not thinking enough about things" does lead to anxiety! You cant come to any conclusions about whether or not the stimulus is threatening and so you go with your ADHD built up intuition... mine being everyone wants to hurt me and ****. Id rather think a lot about stuff and come to hte right conclusions.

This has been a very interesting post. I'm definitely ADHD-PI, as I have a very mild history of hyperactivity in childhood (went away quickly in adolescence), and yet I relate to this "fear of everything in the environment." I'm diagnosed GAD but the bigger problem underneath that DX's umbrella is social anxiety.

I wonder, then, if the anxiety problem I have (manifests as being generally nervous and "over-alert" to everything, social phobic, a general sense of paranoia) is a direct result of ADHD. Possible?

I notice that while stimulants allow me to "attend" better to whatever I'm doing, and are therefore helpful with motivation, I don't really get the paradoxical ADHD effect from amphetamines... Ritalin made me a paranoid psychotic and Dexedrine, while more effective, also caused paranoia and anxiety.

This really is a confusing mess. Could it be possible that stimulants would work as they should for an ADHD person (me in this case), if I could just get the social anxiety "figured out"?

....

How do you rest of you with ADHD-PI feel about being excluded from the overall ADHD category?

I read the rest of Barkley's 40 page lecture and if I can be honest, to me he almost comes across as implying that ADHD-PI kids are "less intelligent" overall than the other two classic types of ADHD. Basically I felt there was a tacit implication that there is an actual deficit in intelligence with ADHD-PI.


I don't agree with that ADHD-PI / SCT should make one less intelligent. At primary school, I was tested as gifted (iq > 144) but the SCT profile still fits me completely.

The thing is, it is a lot harder for us to actually put our intelligence to use. That is because of the input problem: the processing of incoming information is slow .. I think that is linked to a smaller 'working memory' than normal. I *feels* like that, too. When someone explains something to me verbally, I have to close my eyes and desperately hang on to their words and try to process them as quickly as possible, like someone is handing you items that you have to put on shelves but they go FIVE TIMES as fast as you can put 'm away and in the end you have items in every hand, hold on to another with your teeth, keep one between your shoulder and your left cheek, clutch one between your right elbow and your side, and another one between your knees.

And then they hand you yet another one, and the whole business comes clattering down.

It just does not work. So I have to ask to repeat it, or, better to show me visually.
But I have never felt anything wrong with juggling the information once it's inside my head. I can sometimes amaze myself in that respect.

(in the Netherlands they usually use ADD for ADHD-PI .. and I don't like the term SCT, it sounds much more like a handicap ...)

To me, ADD / SCT feels like: (starting with the things that I think every ADHD type is familiar with)

brain fog: sidetrack all the time, associative thinking
motivational problem .. even though I want to do something and intend to do it *now* ... *NOW* .. *NOWWW!!!* .. I still don't get off my chair and do it .. this can be soo annoying :(
a very selective memory .. I remember things that interest me or that motivate me (even in a negative way, like if they scare me) .. but the rest :eek:
a very active imagination, weird (according to some) sense of humor
tend to let chaos arise at home: "piles"
aversion of groups / group behaviour.. this has, at one time, made me wonder if I maybe had asperger or something. But when I looked into that I missed the characteristics: I am actually very social and empathic, as long as it concerns individuals. I am very sensitive to social clues. And I don't seem to have any of the typical aspergian traits like dislike for change (I love changes) or the preoccupations.
I have the idea that this of me - the social hierarchy / status part - is just not developed. I have no trouble respecting authority as long as I can understand the sense in it - like traffic rules. But I don't if it is a matter of status.
I experience strong emotions, but it's very hard to express them in words, especially on the moment itself. It is like my tongue refuses service.
an I/O problem: I process especially auditive information slowly. Learning by 'doing things myself' seems to work fine, if I am interested enough.
physically usually slow / sluggish (I have learnt to mask it a bit)
being a bit like a child in some respects. I love and value simple things like hugs, feeling home somewhere, nature, songs, friendliness etc. above all else. I feel ill at ease with trends, partying, fashion, TV hypes and the like. I see no value in those things. That does not mean that I despise everything this culture has brought forth though.
Also: I never grow tired of things that I love. I can read books and watch movies that I love time and again.
Oh also: if I do not restrict it, I have a tendency to feel empathy for even inanimate things (my ex GF could reduce me to tears with something like: oh look, they've made that poor bus 23 depart as last from the station .. again!).
I loathe violence, intolerance and hate. That does not imply that I never feel anger. I do: usually not towards persons though, but towards abstractions like, well, 'violence' or 'injustice'. Of course someone displaying this behaviour is to be held responsible, but I consider "what one does" not the same as "who one is".



although undoubtably some of these are not ADD-related, but just personal traits.

Extending this thinking further, what about those who never ever had any hyperactive/impulsive symptoms? In Barkley's model, they can't have ADHD, because their executive function seems to have developed normally. This is the group that he's talking about -- individuals who have trouble paying attention, but don't seem to have any other difficulty controlling their behavior.
Well, even though we don't have any hyperactivity/impulsivity, there is still the motivational problem which is seen by the outside world as laziness: it is also behaviour, be it more a lack of behaviour :p.

To get yourself to do things, to get organised, to finish tasks: those are all executive functions that are impaired by SCT and I think that there is not so much difference in these aspects between ADHD-C and SCT.

I've met quite some people with ADHD-C, -PI and maybe 1 or 2 other that could fit the SCT profile.
As someone else here also says, ADHD-PI is a very wide category, covering everything between SCT and "almost" ADHD-C. And I think that is the reason Barkley, Diamond etc. want to change the definitions a bit .. treatment and medication seems to work differently on different ends of the spectrum, too.

There are a lot of similarities and recognition in issues we encounter in life. The 'jumping around' or 'associative' way of thinking seems similar, too. I find meeting others, be they -C or -PI, very relaxing and fun.

But you get a good feel for the differences too when you meet people IRL. People that are on the ADHD-C side of PI can be much more nervous or restless, both physical and mental. I can sit and space out for hours, and talk very little in groups (with just one other person, I open up much more). They would never do that. They seem to like 'busy' situations (lots of noise, traffic, people) more, I avoid it like the plague because it totally jams my input.

i was confused/concerned since i read this and i couldt get the link in the OP to work, ive not managed to read much of these posts so far. but i just found this:-

Barkley cites different symptoms among those with ADHD-I -- particularly the almost complete lack of conduct disorders and high-risk, thrill-seeking behavior -- and markedly different responses to stimulant medication.


I think i have inatentive type , although i get confused thinking about what type ive got, as im sort of hyperactive too, but not thats observable as such. exept for where i wore the carpet out with my fidgety feet.

however I gues I havnt got any conduct disorder at all, and my thrill seeking is limited as i get scared easily.

however I have no clue as to what the marked diference response means, i respond wel to stimulant medication, but is he saying the diferenmce means people dont respond to it or do respond to it ?

sometimes i read stuff and things become clearer, sometimes things sudelnly seemed more confusing. i gues im gaining more, by reading though.

PS ive just read a bit more of this thread, its interesting and i didnt have problems with anxiety, but realise it might be a problem now due to the battle of trying to get treatment for the last 13 years.

Barkley cites different symptoms among those with ADHD-I -- particularly the almost complete lack of conduct disorders and high-risk, thrill-seeking behavior -- and markedly different responses to stimulant medication.


however I have no clue as to what the marked diference response means, i respond wel to stimulant medication, but is he saying the diferenmce means people dont respond to it or do respond to it ?

I don't know what Barkley says about medication. Adele Diamond mentions that we (I mean, the ones without hyperactivity) respond less well to methylphenidate (Ritalin, Concerta) but if it helps, it does so usually on lower doses then with the ones with hyperactivity.
She says we seem to be helped more with the amphetamines like Adderall, Dexedrine etc.

Which is true with me, anyway.

A lot of this is VERY familiar to me, but I still don't see why any of these symptoms you talk about would be strange for anyone with ADHD-PI, as I imagine inconsistent processing speed, high distractibility by the surroundings, and greater trouble with input than output is common among this group.

So I am still not swayed into thinking that what you are talking about is definitively different from ADHD-PI.

From the horses mouth
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 long-term 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.

-----
-----


Keep in mind the talk was in 2000, and that Barkely isn't the only researcher interested in this group, and that what we know is still in the infancy stage of knowledge compared to say hyperactive-ADHD.

Here are my observations on the subject. It's not inconsistent processing speed but a marked and consistent slower processing speed...and a processing that is prone to error. You hear them referred to as day dreamers...space cadets. That may be kind, at times they looked stunned...oblivious...so far gone they could be on another planet. Their brain seems to be floating in molasses. It's not that they are, "highly distracted by their surroundings"...although they can be, rather you could put them in a in a white room and they would be totally distracted by their own mind. This group would be the model prisoners. The outside world disappears from their mind and they get lost, WAY LOST... in a thought which unfolds into more thoughts down a deep rabbit hole. Barkley calls this group the only group with the true attention deficit disorder. They are NOT PAYING attention in any way. With ADHD you find they are paying attention but choose to ignore you. They focus in with the start of something new, and their mind goes BORING...and they tune you out. With SCT...that initial burst of attention is not a given. Their mind is focusing in and focusing out...more like the waves of the ocean. You can get their attention but you will have to do it with more effort then probably any other kid in the class...especially if it is from the front of the classroom and not one on one.

Here are some more observations. These kids are often thought to be depressed by the casual observer. They are so listless ...meek...without life. Probably in school they are more often thought to be mildly retarded...that blank look. But what I can tell you from personal experience is that they are rarely if ever depressed as children...they are rarely if ever mildly retarded. These are the type of kids who go with the flow, if you place them in a slow class, that life path will destroy potential. They are slow developers. They are in the deepest fog say around 10 and it doesn't start to lift until high school...may be later...may be never.

There is much more to this...especially on the behavioural and LD front...but I'll stop here for now. Could SCT be the far end of the inattentive ADHD spectrum? Possibly...if this was all cut and dry this all would have been codified by now.

aversion of groups / group behaviour.. this has, at one time, made me wonder if I maybe had asperger or something. But when I looked into that I missed the characteristics: I am actually very social and empathic, as long as it concerns individuals. I am very sensitive to social clues. And I don't seem to have any of the typical aspergian traits like dislike for change (I love changes) or the preoccupations.


I haven't just wondered if I have it, I have actually gone ahead and self-dxed myself with it, but I notice a lot of people find this to be improper, unscientific, or even "vain" (as in a cry for attention, an excuse for immaturity, or a way to "feel unique by setting oneself apart from the norm") so now I just explain it by saying, "I have some Asperger traits." Professional diagnosis is not an option for me at this time.

Reasons why I may have it include aversion of group behavior, difficulty with social cues/comprehension, weak central coherence, literal-mindedness, difficulty with making changes which thus manifests as high need for routine, low empathy, an impaired imagination (sp. in regards to socializing), and executive dysfunction.

Some things that are missing: obvious stimming, math gifts/gifted IQ, "expert knowledge" in a special interest, strong logical thinking, etc.


As someone else here also says, ADHD-PI is a very wide category, covering everything between SCT and "almost" ADHD-C. And I think that is the reason Barkley, Diamond etc. want to change the definitions a bit .. treatment and medication seems to work differently on different ends of the spectrum, too.


I consider myself ADHD-PI. And yet, most (if not all) stimulants give me an "upper" kind of effect and often cause anxiety. Strangely enough, I also find stimulants addictive.


But you get a good feel for the differences too when you meet people IRL. People that are on the ADHD-C side of PI can be much more nervous or restless, both physical and mental. I can sit and space out for hours, and talk very little in groups (with just one other person, I open up much more). They would never do that. They seem to like 'busy' situations (lots of noise, traffic, people) more, I avoid it like the plague because it totally jams my input.

RE the bolded print: That's me, alright.

Here are my observations on the subject. It's not inconsistent processing speed but a marked and consistent slower processing speed...and a processing that is prone to error. You hear them referred to as day dreamers...space cadets. That may be kind, at times they looked stunned...oblivious...so far gone they could be on another planet. Their brain seems to be floating in molasses. It's not that they are, "highly distracted by their surroundings"...although they can be, rather you could put them in a in a white room and they would be totally distracted by their own mind. This group would be the model prisoners. The outside world disappears from their mind and they get lost, WAY LOST... in a thought which unfolds into more thoughts down a deep rabbit hole. Barkley calls this group the only group with the true attention deficit disorder. They are NOT PAYING attention in any way. With ADHD you find they are paying attention but choose to ignore you. They focus in with the start of something new, and their mind goes BORING...and they tune you out. With SCT...that initial burst of attention is not a given. Their mind is focusing in and focusing out...more like the waves of the ocean. You can get their attention but you will have to do it with more effort then probably any other kid in the class...especially if it is from the front of the classroom and not one on one.

Here are some more observations. These kids are often thought to be depressed by the casual observer. They are so listless ...meek...without life. Probably in school they are more often thought to be mildly retarded...that blank look. But what I can tell you from personal experience is that they are rarely if ever depressed as children...they are rarely if ever mildly retarded. These are the type of kids who go with the flow, if you place them in a slow class, that life path will destroy potential. They are slow developers. They are in the deepest fog say around 10 and it doesn't start to lift until high school...may be later...may be never.

There is much more to this...especially on the behavioural and LD front...but I'll stop here for now. Could SCT be the far end of the inattentive ADHD spectrum? Possibly...if this was all cut and dry this all would have been codified by now.

I totally relate to most everything you've written of here. I was that "space cadet" you're talking about, and I still am.

The thing with me is, however, if you take me out of a group atmosphere or an atmosphere with people I'm not personally familiar with (where I will remain extremely rigid and quiet) I can exhibit hyperactivity and impulsivity. I have an addictive personality as well and this seemed to manifest at an early age--it's like a craving for a "controlled" sensory stimulation. It started in innocence and ended up with drug addiction.

A random thought, though: this talk of ADHD-PI/SCT kids being slow developers and being "lost in their own world." Is it just me, or does this subtype have an interesting overlap/similarity to high functioning Asperger's?

I totally relate to most everything you've written of here. I was that "space cadet" you're talking about, and I still am.

The thing with me is, however, if you take me out of a group atmosphere or an atmosphere with people I'm not personally familiar with (where I will remain extremely rigid and quiet) I can exhibit hyperactivity and impulsivity. I have an addictive personality as well and this seemed to manifest at an early age--it's like a craving for a "controlled" sensory stimulation. It started in innocence and ended up with drug addiction.

A random thought, though: this talk of ADHD-PI/SCT kids being slow developers and being "lost in their own world." Is it just me, or does this subtype have an interesting overlap/similarity to high functioning Asperger's?

Again, personal observations...when younger there were times when I would be relatively more hyper. The key term is "relatively". In school, in a controlled environment...I was ALWAYS spacey. Bring in the supply teacher and I would perk right up...but that would be relatively speaking. I was not the most hyper kid with the supply teacher, I was just one of several disruptive kids. Someone suggested having SCT is like a computer always trying to put itself in sleep mode, that was interesting way of seeing it for me. Supply teachers and outdoor activities could perk me right up as kid. I still get energized by the outdoors. Perhaps it is as you suggest, that the brain is trying to pull itself out of sleep mode by sensory stimulation. Seeking the same stimulus could lead to addiction. I would probably come pretty close to meeting the definition of computer addiction.

I dealt weed for a while...smoking for free. In the end I didn't want to be more spacey then I already was, and gravitated towards alcohol which took away that social awkwardness that I, and it seems most in this group, have towards strangers. Alcohol also seems to give you more energy. In the end I gave up weed completely, never tried other drugs, drank a lot....but slowly reduced my intake to the point where I drink normally now. I finally did try Adderall. It was no magic pill for me. The dose I use is small. I see small improvements with impulsive traits, I mainly use it because it pulls me out of sleep mode. I don't drag my *** around work like I used to.

Finally, I agree that about impulsive traits. No hyper traits...my wife sometimes calls me sarcastically, "Mr. Outgoing". But impulsive traits...especially with decision making. Self censoring has always been an issue...saying things I probably shouldn't say...letting my emotions get into the equation. I have the hardest time finishing things around the house. Especially large projects that require several steps.

Aspergers...I read somewhere that the target genes are similar for the two disorders. The differences I see at work is that Asbergers/ HF kids easily sensory overload and then completely overreact. They totally need routines and again freak out if they are changed. The self stimming is way beyond anything that ADHDers need to do.

I totally relate to most everything you've written of here. I was that "space cadet" you're talking about, and I still am.

The thing with me is, however, if you take me out of a group atmosphere or an atmosphere with people I'm not personally familiar with (where I will remain extremely rigid and quiet) I can exhibit hyperactivity and impulsivity. I have an addictive personality as well and this seemed to manifest at an early age--it's like a craving for a "controlled" sensory stimulation. It started in innocence and ended up with drug addiction.

A random thought, though: this talk of ADHD-PI/SCT kids being slow developers and being "lost in their own world." Is it just me, or does this subtype have an interesting overlap/similarity to high functioning Asperger's?

I don't know enhough about autism to comment on the overlap between it and Inattentive ADHD but as someone who suspects they are Inattentive ADHD ( I am in the UK where diagnosis can be a prolonged and frustrating process ) there have been times when people have thought and hinted to me that I am autistic based probably on my lack of response /attention both of which can be variable .However I can be quite emphathetic with others but I am often not very good a picking up hints and other social cues .I might be aware that something significant was said or done but only later when I review a situation might I realise what occured .

There is below details of a genetic study which suggests that the overlap between Inattentive ADHD and autism might be based upoon a gene involved in attentional processes .

X-linked ichthyosis (XLI) (steroid sulfatase deficiency) is<SUP> </SUP>caused by deletions or point mutations of the steroid sulfatase<SUP> </SUP>(STS) gene on chromosome Xp22.32. Deletions of this region can<SUP> </SUP>be associated with cognitive behavioural difficulties including<SUP> </SUP>autism. Animal work suggests the STS gene may be involved in<SUP> </SUP>attentional processes. We have therefore undertaken a systematic<SUP> </SUP>study of autism and attention deficit hyperactivity disorder<SUP> </SUP>(ADHD) in boys with XLI.<SUP> </SUP>
<SUP></SUP>
http://jmg.bmj.com/cgi/content/abstract/45/8/519

Meanwhile:

"...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..."

It's now 2008. Has there been any any progess on this subject? Or are we atypical adults left to muddle through any way we can?

Life is what happens while the diagnosis is being debated...

This has been a fantastic thread.

Being undiagnosed, I sit here in confusion wondering where I may be placed in the AD/HD to SCT spectrum. I don't know. Somewhere in the middle, maybe, somewhere a little closer to SCT. (There's no way for me to know if I conditioned myself to be a certain way due to neglect and lack of treatment, or if ADD/SCT has done these things.) I act far more SCT, but feel that for most of my life I have surpressed many things, including some of the "H".

I don't like the term "SCT". Sluggish cognitive tempo. It sounds like an insult. What is a name? A name will change anyone's idea of something, but NEVER what it actually is. It's only going to give more reason to call one "sluggish" and lazy and unmotivated.

Look at poor Pluto, he's not any different than he was hundreds of years ago. But he's not a "planet" anymore. Now people THINK it's just a big rock, and kids won't be learning much about him in astronomy lessons.


If you neglect SCT from the AD/HD spectrum, then you're going to end up neglecting SCT when the term "ADD" is thrown out there.


We have seen from this forum alone that the two are harmonious. Just as Pluto is harmonious with the other planets to the gravitational forces of the sun.

SCT and AD/HD just go about things a little differently. Like Pluto has the slowest route around the sun, Mercury the fastest, Saturn has rings, Jupiter has a billion gazillion moons, and Uranus' axis is on it's side. But they all have a similar disposition: they can't stop going in circles. :P

I have this thing with metaphors, sometimes they're the only way I can explain things.

Hmm, the AD[H]D spectrum. What a useful -- albeit heretical-- concept. (I would however suggest renaming it the "executive function disorder" spectrum...)

... If you neglect SCT from the AD/HD spectrum, then you're going to end up neglecting SCT when the term "ADD" is thrown out there.

Look at poor Pluto, he's not any different than he was hundreds of years ago. But he's not a "planet" anymore. Now people THINK it's just a big rock, and kids won't be learning much about him in astronomy lessons.

Aw! I feel bad for that old snowball ... :(

but what a wonderful metaphor!

And yes, I don't like the term SCT either. It's much more 'disorder' sounding then ADD. We'll need a better word .. maybe we could come up with a better one?

- brainstorm session -
first some loose words ...

surprise - wonder - nth rock from the sun - earth angel - urban spaceman / girl - creative uncommon - mystery - fractal mind - the long way round - side trip - traveling mind - gentle & fuzzy - someplace else - something else - lost in space - non-locality - input invariant fast processing - hey, we just have a streamlined instruction set! - economic I/O -

SCT beats "Minimal Brain Damage" all to hell = my diagnosis

SCT is accepted as a part of ADHD-PI

I'm not sure where the research is with that subject right now.

The ADHD Report hasn't mentioned it in a while

But that doesn't necessarily mean anything

I'll see what I can find though

tc

mctavish23

(Robert)

Meanwhile:

"...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..."

It's now 2008. Has there been any any progess on this subject? Or are we atypical adults left to muddle through any way we can?

Life is what happens while the diagnosis is being debated...


In a word, no one is really thinking SCT...in fact they are even missing a lot ADHD-PI in schools. It's a term that helps define a group a kids within the ADHD-PI subgroup that could be different...and that is about it. I did have the chance to hear Barkley about 2 years ago and went up to him to talk about this at break time. I had about a minute and asked where I could find more info. He suggested some of his publications had some info on it, and I told him I wanted a book. He smiled and then told me that book has yet to be written. Don't hold your breath folks. Try doing a google news search on ADHD and then SCT. Zip on SCT, plenty on ADHD. We are speculating. Simply anyone with SCT characteristics is ADHD-PI as far as the real world is concerned. I'd hazard to guess that many who make the diagnosis wouldn't really know the key characteristics of SCT, if they knew the term at all. The enlightened ones know the term and the phrase is useful for communication.

There have a been a few more studies done. One recently pointed out that it appears only those with SCT characteristics have a true selective attention problem...ie the ADHD kid listens to your first few words and then chooses to ignore you. The SCT is spaced out from the get go.

We adults must muddle for now, and probably a fair time yet. If anyone finds a Dr. who has there finger on the pulse of SCT, let me know. I'd take a plane to see him.

I've diagnosed 2 kids in the last few years

Without knowing about SCT,

there's no way anyone would think to look

however, one young man had ( literally) failed the same grade twice

and was in the process of # 3

when I did the eval

He got an IEP

but it was an SLD

which really burned me

why hadn't they looked sooner

at any rate

he got meds & an IEP

so that was cool

tc

mctavish23

(Robert)

I haven't just wondered if I have it, I have actually gone ahead and self-dxed myself with it, but I notice a lot of people find this to be improper, unscientific, or even "vain" (as in a cry for attention, an excuse for immaturity, or a way to "feel unique by setting oneself apart from the norm") so now I just explain it by saying, "I have some Asperger traits." Professional diagnosis is not an option for me at this time.

well, self-diagnosis is tricky, since it is easy to get it wrong. That goes for ADD, but I suppose also for other things, like Asperger.
But I wouldn't use the moral judgements.


Reasons why I may have it include aversion of group behavior, difficulty with social cues/comprehension, weak central coherence, literal-mindedness, difficulty with making changes which thus manifests as high need for routine, low empathy, an impaired imagination (sp. in regards to socializing), and executive dysfunction.

Some things that are missing: obvious stimming, math gifts/gifted IQ, "expert knowledge" in a special interest, strong logical thinking, etc.

I can only do what anyone could do: compare this to a DSM symptom list. But that is not a diagnosis, just a "hmm, yes, it could .. and then again, could be something different" .. but I can't tell, because I know very little of you; I am not a psych/expert; I read only what you let me read and maybe a host of other reasons.

I consider myself ADHD-PI. And yet, most (if not all) stimulants give me an "upper" kind of effect and often cause anxiety. Strangely enough, I also find stimulants addictive.

About the stims effect: I hear contradicting opinions about whether ADD ppl react different to them as non-ADD people. Still, I react by internally quieting down .. they act like a tranquilizer. Not sedative, usually, although I can sleep very well on them, especially in the latter half of the night. A high dose of caffeine (like fout very strong cups of coffee - I hardly do that though) does make me very sleepy. And I don't feel addicted. I usually forget to take one dose, especially now I have had to go back to short acting here in the Netherlands (I loved the spansules, only twice a day. Also, the rebounding is much more harsh with the IR tablets. Gosh, it sucks that they do not sell them here).

But you get a good feel for the differences too when you meet people IRL. People that are on the ADHD-C side of PI can be much more nervous or restless, both physical and mental. I can sit and space out for hours, and talk very little in groups (with just one other person, I open up much more). They would never do that. They seem to like 'busy' situations (lots of noise, traffic, people) more, I avoid it like the plague because it totally jams my input.

RE the bolded print: That's me, alright.
ok, but that can still have very different causes.

A person with Asperger does not like groups because s/he has difficulties with social interaction / reciprocity and reading social cues.
THe ADD people of whom I know have the same thing do not like groups for another reason: because they seem to miss the point of social hierarchies. I see very clearly what happens with people when they interact in groups and to my "feeling of authenticity" it is an incredibly fake sort of behaviour. I know it is "just human", but I miss that part. Even if I could bring myself to "act" like that, I would refuse, because I find it dishonest and off-putting, even unworthy. The reason that I feel so strongly about it is because contrasts so painfully with the real 1-to-1 social contact that touches my heart so much.
In meetings with other ADD people, this is very noticeable. There is no group dynamics. No-one 'acts'. It is very odd at first. And also, very hard to decide on 'what to do next'.

It is confusing that both this one-to-one interaction, and the group behaviour are both labeled "social". I can hardly think of a starker contrast.


I would try to get a proper diagnosis. The danger of these DIY things is not only that you are very limited re. treatment options, but you will probably keep on questioning yourself, returning to the same point over and over. And you need to move on after a while I think :)

scuro

You are hitting it on the head with the lack of research on SCT or Inattentive ADHD. Barkley, in a workshop tape a number of years ago, mentioned that the ratio of studies combined ADHD/inattentive was about 100 to 1. There were thousands of studies on the combined type and only a handful on the inattentive type.

My line was that I did know much about the inattentive type. I did not feel bad about it because no one else did either.

That seems to be changing but there is a very long way to go on getting a handle on this specific disorder.

Thanks for the post, it was a good one.


Dizfriz

Dizfriz thanks for the compliments, even before your post I've thought your insights to be good. :)

About the stims effect: I hear contradicting opinions about whether ADD ppl react different to them as non-ADD people. Still, I react by internally quieting down .. they act like a tranquilizer. Not sedative, usually, although I can sleep very well on them, especially in the latter half of the night. A high dose of caffeine (like fout very strong cups of coffee - I hardly do that though) does make me very sleepy. And I don't feel addicted. I usually forget to take one dose, especially now I have had to go back to short acting here in the Netherlands (I loved the spansules, only twice a day. Also, the rebounding is much more harsh with the IR tablets. Gosh, it sucks that they do not sell them here).


For me, all stimulants act as stimulants. There are some calming effects, but usually they are not consistent; the calming effects change into nervous energy after a while, etc. The conclusion I come to is I have a sensitive peripheral nervous system.

About group behavior, I feel the same way. It's an incredibly fake thing for me that I want absolutely no part of. But here's the deal: I seem to know WHY it is done, but I do not understand the mechanics of how it is done, for example, HOW can someone graduate to become a part of a group... that is a mystery for me.

I also do not understand the meaning of social cues. I can often recognize that SOMETHING is being said with a nonverbal cue, but I don't know the meaning of it, and I don't know HOW to respond to it...

About group behavior, I feel the same way. It's an incredibly fake thing for me that I want absolutely no part of. But here's the deal: I seem to know WHY it is done, but I do not understand the mechanics of how it is done, for example, HOW can someone graduate to become a part of a group... that is a mystery for me.

oh that's funny ... I would say it the other way around: I can see HOW it is done: for instance, by acting sycophantic to someone in the group who is higher in status. The changes in facial expression and other body language is obvious.

It is the WHY that I can't understand for the life of me, except in very general terms like "to become a member of that group". But why someone would forego their pride and identity to achieve that is a mystery to me.

I have observed a marked difference between men and women here. With women it is acted out more subtle and 'under-the-skin', but it is nevertheless very obvious. I have, on occasion, been astonished by how some girls behave: one day you have a great contact with someone, verging on friendship. And the next day, you meet her in the presence of other people, among which are members of a group she wants to belong to ... and then she totally ignores me.
I was initially very hurt by that, until I understood that she just acted according to her priorities. Acting friendly to a non-member of the group she aspired to become a member of, would be unfitting .. at least, for this group. It was not so that she suddenly decided she did not like me anymore .. it was just "not fitting".

Men act more direct, it seems.

Strange folk, those humans, if you ask me ...


I also do not understand the meaning of social cues. I can often recognize that SOMETHING is being said with a nonverbal cue, but I don't know the meaning of it, and I don't know HOW to respond to it...

You mean that as in one-to-one social contacts as well?

That's indeed a difference .. I do get those cues very well and also know how I should react to them. But if the desired reaction goes against my feeling of what is right, I may not want to.

wow this is all so interesting yet i find it al so hard to take in.
I thought I was inactive type, but i feel resltess and have fidety feet, but most people probably see me as in atentive, and my hyperfocus is not noticeble as it probably does not disturb other people.

its interesting reading ad/hd responds well to moderate to high does of stumulants, wich i certainly do, but then again i have little of the other disruptive bahavours.

I think its realy good if they can distinguish wich treatment is likly to work the best for a given score for each of the spectrum of symptoms, wich i think this has actualy acheived as its identifed a considerable diference in response, however I feel its pointless trying to start debating names, it just confuses people like me when they say oh its maybe not ad/hd but this other thing.

I also hope they recognise that people are diferent and while the statistical critera is good to use as the quickest route to finding the right treatment that it isnt used to limit the available treatment. I say this becuase I was considered for narcolepsy, but despite ritalin was fantastic it was discontinued becuase I didnt fit the exact criterea.

I think the important thing is to look at yourself as you were as a child. Our subjective recollections of ourselves cloud objectivity of on that matter. Look at report cards...talk to your parents. Any hyperactivity in the past and you would be combo or inattentive. ADHD inattentive can have a few hyperactive symptoms, not so for the SCT grouping. Symptoms for the SCT grouping would be difficulties at school with learning at a young age...say past kindergarten...quiet...spacey/daydreamy and lethargic/sloth like, points to the SCT grouping. It is this group where lower doses of stimulants seem to work better. Unlike the the combos where stimulants like Ritalin can make a remarkable difference and clinically works for a vast majority of that population...Adderall works better for the SCT crowd but shows a clinically improvement only for about a 1/4 of that population, typically at a lower dose.

thanks, that helps a bit, I still wasnt clear as my mind is so sleepy, but I cant help but be drawn to this, as a child i think i was probably hyperactive as my mum said the teachers said I was never in my chair when I was suposed to be but that is before i can remember.

In 2000 Barkley had insisted that the SCT group be free of hyperactivity at all stages of life. It doesn't look with time, that this theory is supported widely. He was arguing that the SCT group was a unique disorder with a unique etiology and symptoms. I think that is because he was trying to differentiate the SCT group from any form of ADHD. I understand the reasoning behind that point of view. These kids are the polar opposites of Hyper kids....but is it another disorder? Since there is so little research here it will take years to sort out. They do seem to have unique characteristics but this could just be a more pronounced form of inattentive ADHD...time will tell.

He was also strongly advocating that the combos and hypers who "became" inattentive with age because of brain maturity and the loss of hyperactivity symptoms, don't belong in the inattentive( SCT grouping ). If they get a diagnosis later in life it should be combo. If they have a diagnosis of hyper or combo it shouldn't change because their symptoms change. But that is not a widely understood practice by those who diagnosis. This idea makes sense and has wider support. The combos and hypers who look inattentive in later years should get a diagnosis of combo. They still respond excellently to Ritalin even after the hyperactivity disappears. That is not true for the SCT group and possibly the inattentives.

At least that is my take on all of this. :)

He was also strongly advocating that the combos and hypers who "became" inattentive with age because of brain maturity and the loss of hyperactivity symptoms, don't belong in the inattentive( SCT grouping ). If they get a diagnosis later in life it should be combo. If they have a diagnosis of hyper or combo it shouldn't change because their symptoms change. But that is not a widely understood practice by those who diagnosis.I wonder if this is the reason we are seeing a lot of people on the forums who are just recently diagnosed with Inattentive ADD?

I wonder if this is the reason we are seeing a lot of people on the forums who are just recently diagnosed with Inattentive ADD?

Good question . . . . .



If they have a diagnosis of hyper or combo it shouldn't change because their symptoms change. But that is not a widely understood practice by those who diagnosis. This idea makes sense and has wider support.

Makes me wonder about who is doing the diagnosing

My diagnosis didn't change even though I have a lot more inattentive symptoms that I did even as recently as when I joined here . . . . but I am still PH - primarily hyperactive.



The combos and hypers who look inattentive in later years should get a diagnosis of combo. They still respond excellently to Ritalin even after the hyperactivity disappears. That is not true for the SCT group and possibly the inattentives.


I have never responded well with ritalin however I responded very well to Adderall

I understood Adderall to more effective with adult ADDers as a group regardless of subtype . .. ..

It is the WHY that I can't understand for the life of me, except in very general terms like "to become a member of that group". But why someone would forego their pride and identity to achieve that is a mystery to me.


You know, I should have clarified. Pretty much my understanding of WHY it is done is the same as yours... it doesn't go much beyond that.

And a feeling of belonging, and so on.

Why are there more inattentives on this board...or more ADHD-PI's recently? Most everything I write here will be subjective generalized interpretations: I love text, my hyper friend loves the phone and skype. Could it be that inattentives are more reflective while hypers and combos want more immediate communication? The hypers and combos are more outgoing while the inattentives more inwards. This medium suits reflection.

Are there more inattentive diagnosis's recently? I wouldn't know. Generally the Hyper and Combo diagnosis is a lot easier. Their symptoms are more outwards, you can see it if you spend any time with them. Others can also easily observe the behaviour. Their symptoms are more unique as far as behaviour goes. It becomes more a question