View Full Version : Fascinating article - ADHD inattentive do not response as well to med.


Tisha
02-16-10, 11:48 AM
I have just begun reading the 2000 Dr. Barkley lecture excerpts and found the following paragraph fascinatint. I'd love to know what updated research there is on this. This fits my own son perfectly, recently diagnosed with Inattentive. I took him off his meds two weeks ago as his personality was completely changed. Stimulants did help his schoolwork somewhat, but at what cost (he was on 60 mg of Vyvanse) so we will address this issue at the appt. I wonder if there is any new science out there (that the doc refers to 10 years ago), does anyone know? What has your experience been with meds for these types of kids (small doses, etc).

"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 two-thirds of them show mild improvement, but those improvements are not enought to justify calling them clinical responders, therapeutic responders. 92% of AD/HD children response to stimulants. 20% 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.

.....These are different kids. This is a different disorder. Stay tuned. We don't know what to do w ith 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."

meridian
02-16-10, 11:52 AM
Well of course that's 10 years old now, so things may have changed.

I posted a Barkley video from 18 months go and was chastised for posting something so "old" but you may still wish to watch it on you Tube.

here's that thread

http://www.addforums.com/forums/showthread.php?t=77219

Tisha
02-16-10, 12:45 PM
Well, it was posted in the "front office" prefaced that even though it was 10 years old, much of the information is still relevant. I've printed it off and have been reading it and yes...much of it is still relevant and you find the same information as current. That was why I was wondering what other's experiences have been and if there is any new info. But thanks for the warning.....

meridian
02-16-10, 02:00 PM
Sorry I didn't mean it as a warning. And if the info is still relevant that's good to know. So much seems to change so rapidly these days! :)

Dizfriz
02-16-10, 02:04 PM
Basically it remains fairly current.

Inattentive type (Sluggish Cognitive Tempo (SCT) seems to be a different but related disorder from ADHD.

Current thinking is tending toward having one diagnosis of ADHD with different presentations and another separate one of SCT. The Attentive type may disappear altogether in the next DSM. The jury is still out on this but this seems to be the general trend in thinking. We shall see in the new DSM currently scheduled for 2013 (if it not delayed some more).

SCT does seem to gain less benefit from the medications than ADHD. There is evidence that they respond better to lower doses and may do better with the Amphetamine (Adderol) type medications but we really do not know an awful lot about this disorder. There is a good bit of research going on so hopefully this was get better in time.

Also keep in mind that with the current DSM IV criteria, a child can be a symptom or so short of combined type and be classified as Inattentive type but they will still be primarily in the combined type category and will respond as Combined Type ADHD.

You read the 2000 transcript. Here is a more recent video of a Barkley workshop that may be of help. I would suggest that the 6:00 session may have more of the information you are are looking for.
http://www.ucdmc.ucdavis.edu/mindinstitute/events/dls_recorded_events.html#dls10

Look for the guy with the gray beard and not a lot of hair.

Keep on plugging.

Dizfriz

Dizfriz
02-16-10, 02:10 PM
Well of course that's 10 years old now, so things may have changed.

I posted a Barkley video from 18 months go and was chastised for posting something so "old" but you may still wish to watch it on you Tube.

here's that thread

http://www.addforums.com/forums/showthread.php?t=77219

I think that Retromancer was off base a little with this criticism. There is almost nothing that has changed from the videos and little from the basic ideas presented in the 2000 transcript.

I am glad you posted it. It suspect it has helped a number of people.

Dizfriz

Tisha
02-17-10, 06:13 AM
Thank you for all this information. MY pc keeps freezing when I try to play the video. I'm fairly new to all of this and trying to get my hands on anything useful. I printed off the 40 page synopsis and slowly getting thru that. It really does explain things in a no-nonsense way, no sugar coating. I think I've shed a few too many tears yesterday reading thru it, grieving the loss of my normal child, who was "normal" the first 13 years of his life. Somehow that's harder to bear than my younger one, where i knew since first grade he had reading issues and something was amiss.

Someday I feel so up for this challenge and some day very defeated and don't want to deal with it. I know that's normal, too. My brother has ADHD and dyslexia, he's 42. They had him tested for dyslexia, but didn't really know much about ADHD 35 years ago and I think has been with no meds for most of this time. His life is a mess...... can't hold a job more than 2 months. When he does take drugs, it's for depression. They are on welfare. I see my brother and panic, but then remember my paretns didn't have the tools or knowledge to help..I do. I have seen this side of ADHD/LD that didn't turn out good and it frightens me so much. It's good to be able to vent here and find info and support.

tessmesser
02-17-10, 05:06 PM
Tisha,

Adele Diamond is another great source of information of Inattentive ADHD. She has a 2005 article titled" Attention-deficit disorder (Attention-deficit disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity).

She believes that Inattentive ADHD is better described as ADHD without hyperactivity and that sometimes but not alway this disorder is accompanied by slow cognitive tempo. She also does not believe that all truly Inattentive ADHD types are sub-clinical combined types. She believes that the main problem with the inattentive subtype is in working memory as opposed to a problem with response inhibition.

The good news is that this subtype has very different risk factors and sometimes responds much better to cognitive, executive function, and working memory training.

Tess http://Primarilyinattentiveadd.com

Tisha
02-18-10, 09:40 AM
Thank you. I'm going to look into Cogmed and see what I find. I also ready your blog a little, especially about the weekend issue. Ugh. For my oldest son, I actually have woke him up at 8 to take his pill. More so for his personality..he is very sluggish and so lethargic acting it's, awful. He needs that stimulant...and goes back to sleep after taking it. I almost want to give it to him because he will sleep until noon if I let him.

I didn't like giving my younger DS it at all...he didn't need it that way, and I think his ADHD is 'lighter'. I agree...I wish there were a shorter acting one, instead of just not giving it to themon the weekend.

Tisha

tessmesser
02-18-10, 04:12 PM
As the DSM V is written, it will be interesting to see what they do with the ADHD-I bag of worms. There is disagreement regarding applying the 'subclinical combined type' hypothesis to ADHD-I, and to applying the Sluggish Cognitive Tempo hypothesis to most folks with ADHD-I.

Do you think that males with ADHD-I kind of look like subclinical combined types and females tend to look more sluggish?? I had the same symptoms of ADHD-I that my son now has but he looks more like a sub clinical combined type (which, by the way, would make him have the activity level of a normal kid, right?????) and I had more of a SCT picture though my cognition was not sluggish (my actions were).

Someone is going to figure this out!!

Retromancer
02-18-10, 06:41 PM
The intent wasn't to 'chastise' you for posting something "old". Actually thanks is in order for posting something relevant and current.

I doubt I am the only person on this forum who has expressed frustration at the apparent lack of progress in the AD(H)D field.

Well of course that's 10 years old now, so things may have changed.

I posted a Barkley video from 18 months go and was chastised for posting something so "old" but you may still wish to watch it on you Tube.

here's that thread

http://www.addforums.com/forums/showthread.php?t=77219

Dizfriz
02-18-10, 07:46 PM
I doubt I am the only person on this forum who has expressed frustration at the apparent
lack of progress in the AD(H)D field.


I can see what you are saying. Perhaps it is a difference in prospective but, on my part, I see rather dramatic progress in dealing with this disorder.

The real significant movement on understanding ADHD began with the publishing of Barkley's book "ADHD and the nature of self control" in 1997. Here is where he presented his theory of ADHD being a function of deficits in the executive functions (self control/regulation). This had a major impact on how ADHD was seen and was and still is a significant influence on directing the thrust of research on the disorder.

From my viewpoint I am amazed at how much has been done in so little time. Most of the significant work has been done in the last 13 years or so.

My ADHD son will be 40 this year and the differences of we have available to deal with ADHD are of a night and day order of magnitude compared to what he had growing up.

Working from a different prospective.

Dizfriz

ADDMagnet
02-18-10, 09:25 PM
[quote=Dizfriz;841661]Basically it remains fairly current.

Inattentive type (Sluggish Cognitive Tempo (SCT) seems to be a different but related disorder from ADHD.

Current thinking is tending toward having one diagnosis of ADHD with different presentations and another separate one of SCT. The Attentive type may disappear altogether in the next DSM. The jury is still out on this but this seems to be the general trend in thinking. We shall see in the new DSM currently scheduled for 2013 (if it not delayed some more).

SCT does seem to gain less benefit from the medications than ADHD. There is evidence that they respond better to lower doses and may do better with the Amphetamine (Adderol) type medications but we really do not know an awful lot about this disorder. There is a good bit of research going on so hopefully this was get better in time.

Also keep in mind that with the current DSM IV criteria, a child can be a symptom or so short of combined type and be classified as Inattentive type but they will still be primarily in the combined type category and will respond as Combined Type ADHD.

You read the 2000 transcript. Here is a more recent video of a Barkley workshop that may be of help. I would suggest that the 6:00 session may have more of the information you are are looking for.
http://www.ucdmc.ucdavis.edu/mindinstitute/events/dls_recorded_events.html#dls10

Look for the guy with the gray beard and not a lot of hair.

Keep on plugging.

Dizfriz[/quot


I can not speak for everyone with inattentive ADHD symptoms but my son, daughter and I all have the primarily inattentive ADHD (not anywhere close to being a subclinical form of combined type for the three of us) and we have all responded well to medication. My son had taken 72 mg. of Concerta, supplements of Focalin when he needed coverage in the late afternoon or evening, and now at age 18 is currently taking Vyvanse. Not only did his academics improve, but my son has played baseball for many years and he was a great pitcher. His focus while on the meds (usually the Focalin since games were in the evenings or weekends) was incredible. The coaches could tell whether he took his meds or not. Even my son, who loved to pitch, told the coach once that he probably shouldn't pitch this particular game since he had forgotten his medicine. This was at the age of 15.

I most definitely fit the SCT model and I have been taking 140 mg. of Vyvanse. I am thrilled with the difference the medication makes for me. It has considerably improved my working memory and my writing skills! I am able to organize the thoughts in my mind more coherently. I had always hated writing papers in school because I struggled so much with what to say, how to say it, how to organize it, etc. It wasn't that I didn't know the subject matter but I felt overwhelmed by it all. Mind you, I graduated high school with a 3.9 (and this was before knowing I had ADHD) and went on to get a college degree in Accounting! I avoided writing papers whenever I could and knowing I would have to write a thesis if I pursued a Master's was a strong deterrent to furthering my education.

I feel smarter and more confident when I am taking my medication. I don't get confused so easily and I catch on much more quickly. I don't have to reread difficult textbooks three times anymore to comprehend and remember what I read. I also don't have to write everything down step by step in order to remember it like I used to.

In my case, I am on a "high" dose of medicine and it has helped me tremendously. I do not have any of the impulsive or hyperactive symptoms and I have at least 90% of the sluggish, cognitive symptoms. My daughter is inattentive and takes 60 mg. of Adderall XR, my sister also takes Adderall XR for her inattentive ADHD, and they both have had good results as well.

There needs to be a lot more research in this area as I think there are some faulty assumptions being made regarding those of us with inattentive or SCT symptoms. I read of one research study done on children with SCT symptoms where the researcher commented that perhaps the SCT symptoms were simply a sign of low intelligence!! He obviously never met my neighbor whose IQ is over 180 but who has some rather severe SCT symptoms along with his ADHD.

The best information I have read on inattentive ADHD so far has been the work done by Adele Diamond. See the following: www.devcogneuro.com/Publications/ADD.pdf (http://www.devcogneuro.com/Publications/ADD.pdf)

ginniebean
02-19-10, 01:02 AM
As the DSM V is written, it will be interesting to see what they do with the ADHD-I bag of worms. There is disagreement regarding applying the 'subclinical combined type' hypothesis to ADHD-I, and to applying the Sluggish Cognitive Tempo hypothesis to most folks with ADHD-I.

Do you think that males with ADHD-I kind of look like subclinical combined types and females tend to look more sluggish?? I had the same symptoms of ADHD-I that my son now has but he looks more like a sub clinical combined type (which, by the way, would make him have the activity level of a normal kid, right?????) and I had more of a SCT picture though my cognition was not sluggish (my actions were).

Someone is going to figure this out!!

The general concensus is that about 30% of people with ADHD PI have SCT. It is these people with purely inattentive traits and none of they hyperactive or impulsive traits that may be considered another disorder.

Do I think males are more often the subclinical ADHD-C? No, I don't. First they said that ADHD affected predominantly males, then they noticed females have the symptoms only they express differently due to gender conditioning and perhaps gender biology. They are now starting to see that girls are underdiagnosed mainly over not having as many behaviour problems, or the problems they have aren't as disruptive to others.

Just as many females as males are diagnosed as adults, there's no disparity in the numbers which makes identifying girls much more important as we are now aware that early treatment can reduce or eliminate co-morbid conditions like depression and anxiety.

I was just reading about adult diagnosis and how it's mostly relied on research from young children. at 5 you need to know your colours your shapes, how to count to ten and such now, if you used this same criteria to test a much older child or even an adult the criteria you're using wouldn't reflect much about the adult. With ADHD the big three are hyperactivity, impulsiveness and inattention.

Russell Barkley points out that for adults, the amount of questions asked about hyperactivity are inappropriate since hyperactivity becomes much more subtle or 'normalizes' as children grow older (around the teen years) the inattentive symptoms don't show up until later.


This means a child could be diagnosed at 3 with extreme hyperactivity but little to inattentive symptoms and few impulsive symptoms.. later at 7 or 8 the child moves into combined type as hyperactivity lessens but impulsivity increases and inattention starts showing up as more demands are made on working memory.

One of the biases that the researchers are looking at in the criteria for adult adhd is reducing the items in the hyperactivity set of questions, increasing the amount in the impulsive set and decreasing the amount in the inattentive list to provide adults with more accurate diagnosis.

There's also the possibility of 'types' being disposed of. If SCT is removed from the ADHD heading then researchers see no reason to have types of ADHD as they are artificial and basically are the same disorder with varying degrees of symptomology.

kamk2k8
03-20-10, 02:50 PM
I am ADHD-PI but definitely do not have SCT...

Regardless the maximum dose of IR adderall has done wonders for me, and in fact, it is the only thing that has worked at all (not even double the max of vyvanse)