"[T]he predominantly inattentive type is the most common subtype..."

[Conman]

i think the Hyperactivity-Impulsivity type is probably the least common.

maybe Predominantly Inattentive type being the most common yet least referred to clinical things is due to PI coming off as mainly forgetfulness or lack of awareness to most NT's. people generally assume ADD and ADHD mean "you cant focus and youre hyper bouncing off the walls", so PI sort of flies under the radar

[JOHNCG]

Originally Posted by namazu

Both combined and PI can and do create adult problems.

If you were to take a big sample of the whole population and screen them all for ADHD, more people would meet the criteria for ADHD-PI than for ADHD-C.

However, more people with ADHD-C end up seeing a mental health professional.



(At least, that's how I understand Retro's summary/excerpt of this paper that I haven't actually read yet. If I have a chance to read it I'll try to report back with some more nuanced analysis...there are lots of issues here about how you define the subtypes and diagnose people that probably make it more complicated.)

I think that ADHD-PI is an issue well worth looking at for a number of reasons.

The first is that it demonstrates one of the processes (i.e. insufficiently rigorous/injudicious diagnosis) by which adult ADHD (comb and pI), in general, is currently over-diagnosed.

With regard to this particular forum ADHD-PI seems something of a vexed issue. It periodically ignites some quite intense debate, and if the anecdotal evidence is anything to go by, ADHD-PI seems to quite a common diagnosis among posters on ADDF (?)

There is also a lot of confusion about ADHD-PI -or ADD as it is usually called in North America- on this forum.

So here's my take on the science of the matter...

Of all the patients who roll up to a GP's or psychiatrist's office for an ADHD evaluation, those who present primarily with complaints of inattention, but who do not offer a history of poor self-control and overactivity (i.e. hyperactivity; verbal and/or behavioural impulsivity;behavioural disinhibition; etc)

Why?

Because even though early-appearing, chronic, and pervasive behavioural disinhibition is associated by definition (and almost uniquely) with ADHD, the same cannot be said of inattention when it occurs outside the context of poor self-control ( i.e.adequate behavioural inhibition).

"Inattention", besides being a core symptom of (DSM-IV) ADHD, is also a "core symptom" of human nature. Especially human nature when it is under any kind of stress. Equally, inattention is typical, not only of normal behaviour, but the full ranges of psychiatric abnormalities. It is so universal a symptom of mental illness, that in isolation, it provides hardly any diagnostic direction. If anything, it is a global marker for distress, regardless of origin.

This means that the only way a diagnosis of ADHD - PI can be properly justified is where convincing evidence is presented to rule out the full range of other psychiatric possibilities!

For instance, clearly distinguished here are those patients with a clear history of ADHD- combined type, who, by virtue of marked and typical declines in hyperactivity that we know occur with age, no longer have enough symptoms to meet the full DSM-IV criteria for that type in adulthood. These persons would be re-classified in the DSM as having the Predominantly Inattentive type, thought really clinicians should (logically) continue to conceptualise them as the Combined Type. These patients have not actually CHanged types of ADHD so much as they have moved to having borderline or subthreashold Combined Type, merely as a consequence of declines in hyperactivity.

If we put these cases aside, then diagnosing ADHD-PI correctly must be basically a process of elimination.

So, if a person presents with symptoms that fall ALMOST ENTIRELY into a COGNITIVE REALM: ( inattention, poor concentration, lack of focus, distractibility) the very first thing that needs to be done is rule out the possibility of any other psychiatric issues at play.


To be continued below

[JOHNCG]

Johncg's post continued....


In particular, those related to Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, and various different forms of depression and schizophrenia.

If these explanations prove inappropriate, next, learning problems, such as intellectual limitations, specific LDs or a poor match between abilities and the patient's educational program or occupation.

If learning problems fail to account for the patient's presenting complaints, only then MIGHT ADHD-PI be indicated as a diagnosis.

BUT... and here's the rub...

There still needs to be evidence that the patient's ability to attend is limited to such a degree that it causes CLINICALLY SIGNIFICANT IMPAIRMENT.

Bearing in mind, again, that inattention is a common outcropping of human nature, PATHOLOGICAL inattention requires an UNCOMMON DEGREE of underperformance and poor adjustment.

That is, in short, the inattentive-only variety of ADHD should (logically) be a RELATIVELY RARE PHENOMENON, contrary to the relatively high numbers/proportions of adults who seem to have been given this diagnostic label in recent years!!!

My verdict??

A simple case of OVER-DAIGNOSIS.

That is, ADHD-PI is NOT the most common subtype of ADHD - quite the opposite.

[Fortune]

Originally Posted by JOHNCG

My verdict??

A simple case of OVER-DAIGNOSIS.

That is, ADHD-PI is NOT the most common subtype of ADHD - quite the opposite.

I don't know whether this study is accurate or not, and I am actually skeptical of the conclusions. However, one cannot conclude from this study that overdiagnosis is the cause of said conclusion. This argument strikes me as a matter of begging the question.

[namazu]

Originally Posted by JOHNCG

For instance, clearly distinguished here are those patients with a clear history of ADHD- combined type, who, by virtue of marked and typical declines in hyperactivity that we know occur with age, no longer have enough symptoms to meet the full DSM-IV criteria for that type in adulthood. These persons would be re-classified in the DSM as having the Predominantly Inattentive type, thought really clinicians should (logically) continue to conceptualise them as the Combined Type. These patients have not actually CHanged types of ADHD so much as they have moved to having borderline or subthreashold Combined Type, merely as a consequence of declines in hyperactivity.

If we put these cases aside, then diagnosing ADHD-PI correctly must be basically a process of elimination.

I agree with you that the more recent literature does not support a categorical distinction between "partly-remitted" or "slightly-subthreshold" ADHD-C and full ADHD-C, and it appears that this will be taken into account in DSM-5.

However, the fact remains that if you use the "by-the-book" criteria according to DSM-IV, as I believe the researchers did in this case, such cases could well be "correctly" (again, per DSM-IV, flawed though it may be) classified as "ADHD-PI". So I don't think we can simply "put these cases aside" and yet go on to claim massive overdiagnosis, though we can discuss whether or not the "PI" label really fits most of those to whom it has been applied.

In addition, I'm not sure it is possible to accurately infer the population distribution of diagnoses (let alone "true" subtypes) from ADDF; there may be factors (including the existence of a separate "Inattentive" section, but not a "Combined Type" or "Hyperactive/Impulsive" section) that make the PI subtype appear more common than it really is, in terms of the absolute numbers of diagnoses given in the population.

I agree that the ADHD-PI diagnosis is one that requires a lot of ruling-out, perhaps more so than ruling-in, and that there's a lot that remains poorly-understood about the nature of inattentive symptoms in the absence of overt self-control problems or other clearly-defined disorders or circumstances.