ADHD- Primarily Inattentive

[Tokyomarie]

I'm interested in stories of older teens & young adults who have ADHD, with mainly inattentive & possibly milder symptoms of impulsivity, without a major hyperactivity component.

 

What were the tipoffs that a non-hyper teen does indeed have ADHD, even though they don't look like it to an outsider? What about a young person who as an older teen or young adult has a strong set of morals and is on the whole a fairly quiet person who doesn't engage in illegal or some of the major socially unacceptable behaviors?

 

My son, as an older teen, has lost a lot of the obviously impulsive behaviors, such as getting up and walking away while I'm mid-sentence during a school lesson. He has lost the obvious oppositional defiant stuff that he engaged in when he was younger- which I now know was probably related to anxiety &/or perfectionism in a dyslexic child who has struggled with reading & writing. In fact, today, more than he ever did, he really looks much more like a typical teen.

 

But, but, but- I still see the inattention in major ways- remembering things he's read, making many errors in math due to failing to notice details, his sense of time (which, thankfully!, is finally developing- going from zero sense a year ago to actually asking what time & day something is scheduled to happen), having difficulty engaging in repetitive tasks, easily bored & having difficulty with tasks that are not high interest, having difficulty with getting started on projects & knowing how to break down a project into managable pieces, hyperfocusing on high interest tasks (which mainly include gaming & other computer based activities- has been at the level of addiction, though current activity is more on the high moderate side), and so on.

 

I also see impulsivity in such areas as starting a task without confirming all the directions, starting a task in some random way without a cognitive strategy for tackling it (though he is often excellent at developing a strategy if he slows down), sometimes still talking over me when I'm trying to instruct him (and he sometimes does this with other adults), side conversations in the classroom, etc.

 

And of course, as I have posted before, the ability to fall asleep at a reasonable hour, which is common in people with ADHD, has been a major issue for years.

 

At this point, it appears that the professionals are divided in their opinion as to whether ADHD is at play. The current folks seem to intimate that ds's issues are driven by poor parenting strategies. I tend to trust our first neuropsych's assessment more, but he didn't make a definitive diagnosis due to lack of input by people outside the family.

 

I'm actually on the fence again as to whether meds are the best way to go. After observing some differences in him since we started using magnesium, I'm kind of inclined to wait again on meds, and try some of the other supplements that often have positive effects in these kids as well as to try more coaching. He is much more cognitively ready for a coaching approach than he was even one year ago.

 

Anyway, I guess I'm wondering about other teens who look like really "good kids" and can get average to slightly above average grades but the parent knows they still aren't anywhere close to meeting their potential.

[Misty]

For us, it's the executive dysfunction that is the big tip off. My daughter (14) has ADHD-predominantly inattentive. Not hyper at all, but she does have some issues with impulse control (both with her actions and her mouth). Her main issue remains the executive dysfunction and working memory issues (extremely forgetful and messy!)

[Beth in OH]

For us, it's the executive dysfunction that is the big tip off. My daughter (14) has ADHD-predominantly inattentive. Not hyper at all, but she does have some issues with impulse control (both with her actions and her mouth). Her main issue remains the executive dysfunction and working memory issues (extremely forgetful and messy!)

 

:iagree: When my dd turned 16, began driving, taking a couple classes outside of homeschool, etc. her executive dysfunction and impulse control issues skyrocketed. She was not amenable to getting help until she was 19, at which time she was able to describe to her thoughts/feelings to her pdoc. He prescribed a trial course of medicine which proved to be extremely helpful.

 

I'm not sure this post gives you much insight into your ds's situation. We had more symptoms than just inattention in academics, and the fact that dd was an adult made her dr. relationship different than if she were a child.

[PeterPan]

Can I just ask a little question? Are you saying ADHD without a major hyperactivity component because there *is* the hyper-activity side, or are you saying that it's ADD? I just wanted to know, because these diagnosis things and the way they get handled seems to vary. So whatever, I was just trying to understand.

 

A lot of what you're describing as causing problems right now is actually do to executive function, and, because that's a specific portion of the brain, it can be worked on. I just got the books from Linguisystems that Michele has been talking about. Even our VT, ironically enough, did some good for her executive function. Like she went from NEVER remembering to feed the dog to GENERALLY remembering to feed the dog. That's still not a normal level or even as good as my 2 yo ds could do, but it's 80% better than she was. And all that from doing some activities that incorporated EF skills into the VT, kwim? Lots of bang for a little effort!

 

So I'm excited to see where those worksheets will get us. There are also books on EF. "No Mind Left Behind" was really good. There are plenty more. But seriously, look at the EF training books from linguisystems. I haven't had a chance to look at them in person yet, but even just the samples flabbergasted me. Take a look. They had these checklists that were like HOW DID THEY KNOW THAT'S WHAT MY KID DOESN'T DO!!!!! Huge lightbulbs. :)

[rafiki]

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[Tokyomarie]

Can I just ask a little question? Are you saying ADHD without a major hyperactivity component because there *is* the hyper-activity side, or are you saying that it's ADD? I just wanted to know, because these diagnosis things and the way they get handled seems to vary. So whatever, I was just trying to understand.

 

I'm talking about ADHD without hyperactivity (ADD): ADHD- Predominantly Inattentive is the DSM-IV designation.

 

My son has clearly exhibited executive function issues- which are present in kids with ADHD as well as kids on the spectrum. As Michele says, people can also have executive function issues apart from ADHD, though I've seen a lot less written about that.

 

Ds looked a *lot* more ADHD when he was younger & I have viewed him in that light. This has been helpful as far as handling his behaviors. Since some of the academic issues are improved w/tutoring, and he has developed coping skills for managing frustration, his ADHD-type behaviors are overall reduced. General cognitive maturity has helped, too. Over the summer, the signs of inattention were showing most prominently. However, since ds started at his new school, we are seeing far fewer symptoms of any kind, apart from those associated with dyslexia.

 

This afternoon, we had an appt. with the clinic concerning a possible med trial. The surveys from his teachers show some inattention, but not at a clinically significant level which would prompt a med trial. I agree that, at the moment, ds has a good fit for school & level of extra support and is doing amazingly well with his attempts to stay engaged and keep up with the demands. Of course, we're still in that phase where things are novel, and we know that novelty & good support both bump up the level of engagement. We'll see what things look like by the end of the semester.

 

Meanwhile, I'm currently in agreement to not do meds; I'm feeling differently than I did in the summer. I'm also of the mind to add some more supplements & see if that is enough to improve what we are still seeing.

[Tokyomarie]

ADD/ADHD always involve executive functioning issues, but one can have executive dysfunction without having ADD or ADHD.

 

Do you have any good references which discuss this? I have heard this elsewhere but all the references I have are focused on executive dysfunction as a feature of ADHD.

[PeterPan]

Maria, thanks for explaining all that! Now I've missed something. What is his middle college program?

[Running the race]

I have a 15yo son with this diagnosis. He has been on medication for a little over a year. I'd be interested in knowing what supplements you are using.

 

I'd be happy to discuss this with you.

[rafiki]

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[Tokyomarie]

Marie, our psychotherapist was the one who explained this to dh and I.

 

Here's the best link I've found -

http://www.schoolbehavior.com/disorders/executive-dysfunction/overview-of-executive-dysfunction/

 

I have this one bookmarked as well for additional resources -

http://www.challengingkids.com/?page_id=14

 

Thanks, Michele. This summer, I picked up some of the resources listed in the second link & have been perusing them. I'm not sure if it makes much difference whether the executive function difficulties are associated with ADHD, ASDs, or not any other particular diagnosis with respect to remediating & accommodating them. I'm just concerned about getting them recognized for official accommodation as necessary.

 

I was hopeful to find something that specifically discusses how executive dysfunction can occur apart from ADHD or ASDs- especially now that certain professionals feel that ds is not ADHD. I have this niggling thought that perhaps he really does have shadows of an ASD, without having a full-blown syndrome. There are certain things about him that have often given me pause, but his ability to connect with his peers & his testing related to theory of mind is too high for an obvious in-your-face, no denying it diagnosis.

[PeterPan]

Marie, I just googled and found quite a bit using executive dysfunction autism. I'm too tired to read them now, but I'll try later. The articles do look very interesting. The one was talking about how you could have executive dysfunction *without* the frontal lobe damage (common to both AD(H)D and spectrum kids) and then trying to see if therefore the executive function is what's actually causing those symptoms.

[Tokyomarie]

I have a 15yo son with this diagnosis. He has been on medication for a little over a year. I'd be interested in knowing what supplements you are using.

 

I'd be happy to discuss this with you.

 

I have only started to investigate supplements for my son. There are a number of threads here that discuss diet, lifestyle, and supplements for ADHD & Autism Spectrum Disorders & I've been learning from them.

 

The main supplements that are frequently mentioned are Omega 3 Fatty Acids, B-6, magnesium, zinc, L-carnitine. So far, I only have my son on magnesium because I was trying it to see if it helped his sleep.

 

Of this list, I personally take Omega 3s, Bs, magnesium, and zinc. I have waxing & waning executive dysfunction (self diagnosed- I've never had neuropsych testing) and can get into a mild depression related to a long term health condition. I find that these supplements help my neuro functioning, so I have decided to try to get my son on them, too. Highly resistant teens are not so easy to work with sometimes, so it's going to be a bit slow, I think.

 

Misty on this board (who posted upthread) has a lot of experience with biomedical treatments. Look for her posts for some good information.

[wendylee]

I'm coming into this thread late, but I've gotten a lot of help for ADHD Teen questions at this forum: http://connect.additudemag.com/groups/group/Parents_of_ADHD_Teens_and_Young_Adults. It's specifically for parents of teens and young adults with ADHD.

[Misty]

So far, I only have my son on magnesium because I was trying it to see if it helped his sleep.

 

Marie,

Does he have trouble falling asleep or staying asleep? Or both? If he has trouble falling asleep, you might try melatonin. Two of my Aspies have a very hard time falling asleep. Melatonin puts them to sleep within 30 minutes. We use the GNC brand.. 1mg sublingual cherry-flavored. We use GNC because it is soy free. There are other brands that work just as well.. I would get sublingual, just 1mg to start and then add more, if needed. Be careful to always give the lowest effective dose. Too much melatonin can cause nightmares and/or very vivid dreams. Melatonin tastes good so most kids willingly take it. I try to only use it when occasionally necessary because I don't want to give them too much of anything, even though most research will tell you that melatonin is completely safe. Usually it's when I know we have to get up early the next morning for something and I need them to go to bed earlier.. Or when they are on a screwy sleep schedule that needs corrected. My 8yr old requires it more than anyone. She is extremely hyperactive, has restless leg syndrome (which magnesium also is great for), high anxiety, etc. Very difficult to get her to sleep at night. She thinks about all the wrong things at bedtime (long ago dead pets, etc.) and then she starts crying and carrying on. This happens routinely. I don't know what I would do without melatonin!

[Tokyomarie]

Marie,

Does he have trouble falling asleep or staying asleep? Or both? If he has trouble falling asleep, you might try melatonin.

 

About a year ago, I took my son to a behavioral sleep specialist. She diagnosd him with Delayed Sleep Phase Syndrome. His whole sleep cycle is shifted, so he falls asleep in the middle of the night & wakes up late morning without any outside interference. Otherwise, it appears that his sleep pattern is likely to be normal (I say likely, because he hasn't had a sleep study done). Her solution was a combination of low dose melatonin & early morning light therapy.

 

At that time, ds (who was not very receptive to the whole thing), complained that the melatonin made him wake up with a headache in the morning. It did help him fall asleep a bit earlier & might have worked if he could have continued. He shot down the bright lights idea, complaining of light sensitivity. Fortunately, I had not gone out and bought a light box. I simply opened his shades & let the morning sun in, which made him grumpy & combative.

 

Currently, he has to get up at 7am to get ready for school, because as of this fall, he is attending a charter school that transitions high school students into community college. With this morning schedule, he is regularly falling asleep at 1-1:30am. It is still much too late, but better than the 3-4am that was common in the past.

 

I would like to suggest to him that he try melatonin again, but I'm not sure how he'll respond.

[Tokyomarie]

Maria, thanks for explaining all that! Now I've missed something. What is his middle college program?

 

I see that I never answered this question. My son's new school is a charter school high school on the campus of our local community college. Students may enroll in the school if they are entering 10th or 11th grade & can spend 3 years in the program. Those who would be entering 11th get reclassified as 10th graders when they begin, so they maintain eligibility to participate for the full three years.

 

Students spend the first semester in self-contained high school classes that integrate the teaching of "soft skills"- formal study skills & proper interaction with professors/instructors- with consolidation of basic academic skills in four areas: science, English, math, and critical thinking. After the first semester, if students are soft skill "credentialed" & have received an A or B in the subject area course, they can begin taking community college courses. In addition to the soft skills curriculum, another non-traditional aspect of the program is that all students go through a process of doing learning & interest inventories, learning about the programs offered at the community college, and using that information to create an Educational Development Plan (EDP). The EDP includes their chosen technical certificate or associates degree program & a tentative course plan for the entire time of enrollment. At the end of the program, students receive a high school diploma from the charter school & their chosen technical certificate or associates degree.

 

We chose this school for three main advantages: 1) the intentional soft skill teaching & coaching for choosing an educational path, which we felt would be a good bridge from homeschool to community college with his particular learning needs 2) the ability for him to take CC classes full time as a high school student, rather than be limited to the 7 hours that dual enrollment students are permitted and 3) he can complete an associates degree and still maintain eligibility to apply to 4 year universities under freshman status.

 

So far we are mostly happy with what's happening. We are seeing new motivation in our son, and some maturity that we were not seeing while he was still home last year. There are some things that could be different, but overall I think it was a good move for ds.

[PeterPan]

Very interesting, thanks for sharing!