Need help with inattention!!

If his inattention stems from anxiety, neither IM, VT, nor stimulant medication will help. There are medications for anxiety, but you might also consider cognitive behavioral therapy, which has a good track record alone or combined with medication. Is your son receiving any kind of therapy to help with his anxiety? What kinds of thoughts are distracting him? Is it anxiety over his learning issues or are other fears distracting him? Has anyone considered the possibility of childhood depression? It can present as an inability to focus. I saw that in my own child when he was depressed.

The original neuropsych. eval (2 years ago) concluded that alot of his inattention was due to anxiety. And I think it is a factor. But having now put him in a school where he feels safe (I think!) and having the psychiatrist conclude that his anxiety doesn’t merit any more therapy kind of makes me think there is more to it than that. It probably is compounded by many things. I would have been very willing to do a medication trial prior to his having tics. But ironicaly noone thought we needed to - that therapy, a special school etc would do the trick. Its so frustrating!!

His thoughts are usually “stories” he makes up, fantasies, plots to video games he would like to create. only rarely do his thoughts seem to be about something he is worried about. He is not a fearful child, despite being a worrier. And the stuff he worries about is not irrational. None of the emotional testing indicated any depression, and as I said, he just concluded overa year’s worth of psychotherapy so I feel pretty comfortable that he’s OK in that regard.

Perhaps he really does have ADHD. I do, the inattentive kind,and what you say your son thinks about is what it feels like to me. Tics aren’t necessarily a reason not to use stimulants, per the latest research, but perhaps Strattera would be a better first choice, if he does have ADHD. Biofeedback also has some interesting prospects although it seems to benefit most when the family feels confident about the treatment.

Karen,

My son does some of the same things but not to the extent you describe. I too have struggled with what to do. I had one neurologist tell me that most kids who are severely LD are ADD too. A blanket statement. My son significantly improved doing IM but there still are issues. When we took him to Read America, the therapist told me he zoned out and she had to redirect him a lot. She also said he got better when his reading improved. Another therapist, who I trust a lot, has told me she thinks it is processing.

One question is whether his zoning out is related to him doing something that is difficult. If, for example, he is doing math does he zone out as much as in reading. It is only natural to want to escape things that are hard, I think.

If he is zoning out regularly, regardless of subject, and he is unhappy about it, and you can not come up with any other explanation for his inattentiveness (I agree anxiety doesn’t seem to be a likely diagnosis), I’d consider medication. I mean you already have him in the most optimal setting and have done some of the therapies that others have found have improved attention. Clearly, there are other conditions that appear like ADD—in other other causes for inattention—but it seems to me you have investigated those and they haven’t had a big impact.
ADD is in some ways a residual diagnosis—an explanation for inattentiveness that doesn’t have any other explanation.

Beth

Beth,
That’s the reluctant conclusion I have come to . We just didn’t see gains in attention from either IM or VT. We did think he seemed more “with it” in the fall, when his anxiety was at an all time low. I noticed he’s been more spaced out since mid-november, which is exactly when the tics started. I think the initial relief of being at his new school wore off, and the normal stresses of school and other social things have kicked back in. Its disappointing.

These analysis become circular too - maybe school would be less stressful, and he’s do better socially if he were more attentive.

His math teacher was the only one who hasn’t mentioned attention as a problem. But just b/c he can focus on his favorite subject for 1 period a day doesn’t mean he doesn’t have ADD. And honestly, he’s a space cadet at home too. We just automatically give him all instructions twice. Its the slow slow processing - but isn’t that an indicator for ADD?

Have you considered Audiblox? It is a very strong focusing, concentration program that works on processing as well as memory. I have seen good results with someone who had trouble staying on task. She is now very excited about learning.

I have considered audioblox as something we might do once vision therapy is over (in a week!) . Thanks for reminding me…

What about asking the school or your private psychologist for a Functional Behavioral Assessment and plan? THere is more to a behavioral plan than teacher redirecting(which is teaching the student no skills of his own). Clearly this is a big commitment of time, both at home and at school, but may well be worth it in the end. This type of assessment is often available where kids with ADHD, and autistic spectrum disorders are served.

SAR, I have our psychiatrist getting in touch with the school, but I don’t know how to tell if they are putting an appropriate plan together, or if anyone involved knows what to do! There is a school psychologist too of course. Is a Functional Behavioral Assessment a standard type of document /plan that a private school would be familiar with ? (Its a special school, but he’s not operating under an IEP)

Thanks for the tip, I’ll suggest this to our psych. …

Karen,

I agree that just because he can focus on his favorite subject for one period a day doesn’t mean he isn’t ADD. It does suggest to me though that the difficulty of learning may be contributing to his inattentiveness. On the other hand, if he can’t pay attention, he can’t learn. It may be though that if you deal with the inattentiveness medically, the learning may follow more easily and in the long run he may not require medication.

My son is a space cadet at home too. He insists that we write down what he has to do…so he won’t forget. So I give him a list of chores…it does help. Maybe some of these compensation mechanisms would help your son too.

Audioblox is supposed to help with attention. I guess the question only you can answer is whether he is functioning well enough to wait for results.

One advantage you have is that the teachers can compare him to other kids with LD. My son’s teacher this year told me he was spacing out. When I told her about him being diagosed with ADD but that we never followed the medication route after IM (she is familiar with it because they do it at the school), she told me she didn’t think he was severe enough for medication. Now is he not severe enough or is her perception of severe enough a kid bouncing off the wall rather than a well behaved zoning child???

I would be interested in learning about any type of behavioral interventions you develop.

Beth

I will happily share anything good that comes out of this!

I think even in an LD setting they are more used to dealing with problem behavior, than a child like mine. His highest grades in the fall were for behavior in the classroom! Its hard to know how zoned out he really is - sometimes he looks inattentive but is still getting it. But if they tell us its interfering with his learning in such a small classroom, and with teachers that theoretically are attuned to these things then we do need to take it seriously. I agree, and hope, that if we do turn to medication it will be to allow the learning to take place and so that he can develop self confidence and some compensatory skills.

Keep ya posted.

Karen,

I am working with several boys who sound like your son. It is such an internal struggle for them. I have listened to one as he told me…”I am really trying to listen, to the teacher, I hear what the teacher is saying but I just can’t control where my thoughts go. When she gives us a worksheet to fill out I am totally lost as I missed all the directions she just told me.” This kid is what I call one of the “lost boys” and it isn’t like the ones in Peter Pan. He has progressively gotten more inattentive as time has worn on and he doesn’t know what to do. I am trying different behavioral strategies but I fear they will not give him the “internal” monitoring that he needs.

My other lost boy, just zones in his class, …he just can’t focus for the life of him…then he gets worried when he comes out of the fog because he missed out on crucial information and is overwhelmed and gets more anxious…unless someone is there to walk him through it.

I am pro medication because I have seen first hand the amazing changes in my own childf from being one of the inattentive lost girls in 5th grade to being a successful high school student. She has even been peer tutoring kids, which just amazes me considering she was so inattentive and failing her 5th grade level prior to medication.

But if you don’t want to try meds the only other resolution I can see is to use an assistive listening device to help him focus in the classroom. This may help, it helped me during college. You have nothing to lose in trying either of these solutions, meds or an assistive listening device. If anything else it will help you rule out just one more thing.

Take care and good luck.

Patti, where did your behavioral strategies come from? Is there a source you can recommend or was it just from your years of experience? Right now the school is trying to work with his psychiatrist on behavior cues etc, but I suspect there will be limited success there. We’ll see, his classes are quite small so maybe it will be adequate for now.

The reason I am reluctant to try meds is b/c of other neurological issues including anxiety, and not because I am anti meds in philosophy. And yes, I could see that he would feel anxious because he is aware that he isn’t focusing… I can relate to your lost boys. And even if we can get him functioning at an acceptable level in his special school the goal is to mainstream him when his dyslexia is sufficiently remediated - but then the issues of class size and attention become more critical. I just wish I could get a handle on this one… thanks for your input.

Karen,

I get referrals from a Neuropsyche to treat kids with ADD. Sometime ago I was tutoring one of her patients and she decided to refer kids to me that she knows need an ADD coach.

In regards to personal experience…We spent $1,000’s before we realized to get a handle on our child’s dyslexia we had to get a handle on her attention… :shock: sSe went from scraping the bottom of the barrel to fast forward 4 years later…at our last IEP the teachers said over and over again…She is a Teacher’s Dream, she tutors other kids in the class, she is the Team Captain of her Waterpolo team etc.. :D . All we wanted for her was to be able to read and overcome the dyslexia, depression and anxiety when she was drowning…and giving up in grammar school. What she has accomplished with the help of meds…has surpassed our wildest dreams.

and the Anxiety…I have seen that time and time again as a by-product of being overwhelmed due to the extent of the ADD. I liken it to knowing something is wrong but the person mired in the inattention just can’t get a handle on it.. kind of like being stuck in quiksand and the harder one tries to get out the deeper the child with inattention sinks…

I have a whole library of books on ADD and Behavioral Intervention. Many of the kids I work with have Executive Functioning deficits. Until they reach the age of maturity where I can logically reason with them and get them to have some semblance of emotional intelligence they won’t be able to realize, let alone take responsibility for how their inattentive behavior is impacting their learning and acquisition of essential life skills. They haven’t a clue, literally how to stop the imagination and focus on the real world around them. :?

Several books I like: one is a book for medical professionals by Arthur L. Robin ADHD in Adolescents Diagnosis and Treatment by The Guilford Press; Another one is 50 activities for Teaching Emotional Intelligence by Innerchoice publishing.

You have heard my song and dance many times before….I am getting off the soap box now.. :oops:

Hi Patti,

I don’t feel like you are on a soapbox at all - just a great resource for us parents on this board!

Thanks for the information and references.

karen,

If other methods don’t help, you might look into Strattera. I understand it does not exacerbate anxiety like the stimulants may do. No head to head studies of the effectiveness of Strattera vs. stimulants has been completed (several are underway) but there are studies showing that it is effective in reducing symptoms of inattentiveness and mental impulsivity such as your son displays.

KarenN, you are right that Patti is one of our most valuable posters! When I was struggling with these issues about 3 years ago, she was one of the ones who gave me enough confidence to buck the school psych’s opinion and go with my gut (also backed by my family doctor, btw!). Patti’s clear descriptions of herself and her child, especially some of her child’s symptoms and opinions of her own symptoms, showed me that I was correct in perceiving a difference between HER and HER child and ME and MY child.

Of course, at the time I was still terrified that I’d be wrong — but 3 years later, I KNOW I am right. It is a fine line, but essential that each of us places our kiddo on the right side of it. Since making my decision, I have continued to research and participate in this forum because, if I was wrong, I wanted to know at the earliest possible moment — again, my participation has enriched my ability to make decisions for my kiddo, and ALSO to support friends (a couple of very close ‘real-life’ ones!) who have made the decision to use meds, in an entirely appropriate and equally successful manner.

My son and I are not, as far as I can tell, ‘ADD’ in the way Patti describes it in her post above. We’re dreamers…artists…poets…’storythinkers’. And we are stubbornly self-directed, and we DON’T particularly like academics. WE don’t care about gold stars, provided we don’t get in trouble for not earning them!

While my son is quite visually dyslexic (resolved for reading but still struggling with spelling and written expression) and I suspect suffered from a developmental vision problem that seems to have largely resolved itself with maturity, he DID respond to appropriate tutoring — and how! He also responds to appropriate teaching methods — and how! And if he LIKES the teacher — even better! Again, this says he is NOT like Patti’s daughter, for whom extensive remediation did not work well.

However, he is NOT getting high marks — B- is a huge triumph, and last year we had D- and many ‘R’ marks with a non-sympathetic teacher! But we survived, and made progress overall. I took a long hard look at him and my goals for him, and the developing goals he seems to have for himself — and decided that academic ‘success’ was not essential — self esteem and PASSING marks were, plus adult-level literacy and numeracy skills on HS graduation. I can protect him from ‘failure’ until HS, but it seems entirely appropriate that he face repeating a course in HS if he can’t get it — my uncle ‘the lawyer’ loves to tell how it took him seven years to get thru HS — longer than thru university & law school!

We also have a literacy test in 10th grade that MUST be passed — but my niece took it, and it is entirely passable for David by that stage, even if we have to write it more than once (which I doubt, even at this early stage). In second grade, the school told me NO WAY he’d be able to do it — that is when I stopped taking their advice, again a course that worked for me and my kid, but might be suicide for anyone else.

So that is what we are working for, long term. He is not a kid who cares to be the top of the class — unlike some of his ADHD buddies (we seem to have a big population in our Cub group!) he does not CARE about his report card, provided I am ok with it and the teacher is happy with him — luckily we have a teacher who agrees with my easygoing long-range plan, and so this year is the best in school since Nursery School.

But somewhere between Patti and her kid, and me and my kid…is your kid! Only YOU can decide where he sits, and plan your next move(s). ANd I guess the point of this long post is that I want to affirm that it is OK to tell the teachers ”I’m still not ready”! Even if he is not having ‘success’. And maybe the redirecting is a problem also — I think you should look at that. It may be that it actually heightens his anxiety — perhaps the ‘school/academic’ phobia needs to be resolved somewhat before he will settle in — and maybe the teachers need to give him some time also. If he is NOT the usual ‘type’, it is natural for teachers, who MUST work with categories and slot kids into slots, even in an LD school, to keep trying to fit him into that slot…

I guess I am also saying that maybe he needs the performance pressure taken off. For my son, I have taken the stand since 2nd grade that ‘marks do not define you — they simply tell us where you are, and where you need to go’. But that is not a path for everyone — those R’s still kept me up at night! (R = an ‘F’ ‘remediation required’!) However, one of the reasons my plan is working is, I believe, because the R’s DON’T keep my son up at night — for some kids, this would not be appropriate. LindaF and I think alike, but she has done much more formal remediation with her son — BECAUSE he was the type of kid who cared, and wanted to improve. My son has a certain tolerance for home-schooling which we do on nights and weekends only, since I work, and I wasn’t going to sacrifice our relationship or sell our home to push an agenda that was mine alone. This decision is not for everyone!

Only you can assess the damage being done by each deficency or problem — follow your gut, backed up by plenty of research and then never rest until you are sure. (Requires hindsight!) But don’t let anyone push you or even make you doubt yourself!

I thank all of you for your well thought out advice. I think Elizabeth is onto something in her post.

Its not always black and white- I’m sure my son ‘s attentional issues do interfere with learning - the question is how much and how much interference is enough interference to warrant medical intervention. That is a tough question….

i’m sure anxiety could be making the problem worse, however it doesn’t explain the whole problem. he was more attentive at the beginning of the year (at a new school). My guess is the novelty captured his attention and now that it is routine he’s having trouble staying focused. Plus he zones out at home, in very unstressful settings. He zones out while playing sports. He doesnt’ lose focus when he’s doing something he enjoys, or on a playdate .

The other catch-22 of the thing is that his growing awareness of being lost makes him anxious. Its possible that giving him medical assistance might be the way to remove the anxiety barrier.

Anyway, I just spoke to his psychiatrist, who had spoken to the school, and his take on it is if DS’s learning is compromised in a small very structured class then perhaps we should consider medication. First he’s going to work with the school on behavioral methods and we’ll see what that yields. he didn’t mention it by name but he referred to “new medications” that should n’t exacerbate the tics. I assume he means straterra.

The good news (i guess) is that my son is not a behavior problem. So the school’s motivation to push us to medicate is less than it would be if he were disruptive. The only one who gets hurt by his “add” is him.
This will all unfold over the next few weeks so thanks for being my support group.

It’s interesting and one I’ve not heard before. Is there any theme or repetition to his internal distracting thoughts? Is it a Walter Mitty kind of thing who lapsed into fantasies of heroic behavior when bored?

Does this happen only in school? When he watches television, does he zone out overcome by his internal distracting thoughts or is he watching? I’m tempted to say many of us zone out and lapse into our internal thoughts when bored. I do it often at faculty meetings. Does it happen at the dinner table and when you visit an amusement park? When he plays soccer?

If this happens everywhere with your son, that’s one thing. If it only happens in school, that’s another and I’d ask what kind of special school is this? Are there no teachers whose classes and presentations are compelling in any way?

Your son might be very bright and very bored in his school. What is he given to do in this school? Just because a school is deemed ‘special’ doesn’t mean that it is.

In any case, without knowing a bit more, it’s hard to say what’s best to do but if you’d be willing to tell us more about your son, I’d be interested to know it.

Sara,
He is in school for bright dyslexic children, and I’m sure the work is repetitive out of necessity. He may zone out when bored, frustrated or tired. He does space out at home, sometimes at times that would indicate a lack of control over it. Like at the dinner table. His own internal fantasy world is very interesting to him, he’s quite creative and would love to be an inventor.

He doesn’t lose focus on a tv show, video game or playdate that he’s enjoying, so its not like a seizure or something that is completely unrelated to what’s going on around him. But its more like an executive function problem - the gate keeper to his fantasy world is not regulating him properly.

I do think its a regulation problem for lack of a better way of describing him. We all would like to stop paying attention during a boring meeting, but most of the time we control ourselves.

my 12 yr old son is dx’d with ADDinattentive only and sounds much like your son. He is old enough to readily admit he is ‘daydreaming’ and cannot “help it’ at times. He seems to have the fantasy type Walter Mitty stuff going on from his descriptions

One of the best fitting explanations Ive heard for ADHD is that it is the inability to control impulses-period.

We are most familiar with kids whose impulse is to run or shout out an answer, but the impulse to daydream is an impulse too!!! He just doesn’t seem to be able to regulate it.

My favorite example IS the dinner table. We will be talking about renting a movie and then we move on to two or three other subjects. He will have been quiet and then suddenly pipes up with “you know what movie Id like to rent tonight?”

We’re like “Uh, Blake, that was 3 conversations ago!” He’s clueless. I assume thinking of movies set off remembering an old movie which set off a fantasy about SWAT which……

AdderallXR helped but we switched to Strattera a few months ago and I am happier with it. I am homeschooling this year(first time)and I notice a huge difference in his learning. The focus improved with Adderall too, but this is ‘different’-I wish I could put my finger on it-more consistent??? less frustrated when he doesnt get a concept immediately?

He also sleeps extremely well now. I honestly wonder how much of his learning issues were due to lack of sleep. I know from older siblings roaming the house at night that he was up chatting with them at all hours. I don’t think he was being naughty;I think he woke up at 2am and the mind went off into fantasyland and he lost several hours of sleep. This just isnt happening now. HE goes to bed an hour earlier than he did on AdderallXR(by choice)and sleeps right through.

His psych thought anxiety at first too. Like someone mentioned(perhaps the OP)there is going to be anxiety for a child who is struggling in school. It’s hard to sort out but I think Strattera makes the need to sort it out less worrisome

Good luck! If you decide to do the Strattera, BE patient. It WILL have side effects for a few weeks. They do go away for almost every kid I’ve read about on the boards. At least every kid who has stuck with it!

You might want to aim for Spring Break! A lot of kids are extremely tired the first 2 weeks on the medication-that time at home would help a bit. Although you have a pretty special school-I imagine they will understand better if he falls asleep in class ;)

Marycas,

I never thought of the desire to follow your own thoughts as involving impulse control. My son is more in tune to what is going on around him than your son but I do see some of this. Makes me really think that we are talking about a continuum here. And the real question is where on the continuum do you medicate.

No easy answers because it isn’t black and white.

Beth

Exactly Beth. Its a continuum, like all of these conditions. EVen like my son’s dyslexia - which is a fairly straight forward disability. There are kids in the mainstream for whom reading is difficult and there kids that cannot stay in the mainstream and ever achieve literacy. Its a question of threshhold. Actually, articulating this makes me feel a little better about where we are at.

For those of you with inattentive children I’m wondering if there was anything noticeable about their attention when they were little. Early evaluations of my son usually noted his good attention span. He could focus on his games, trains, books that were read to him for a long time. In fact we used to joke that we knew at least he wasn’t ADHD. (no H, which is still true!)

If this developed later, it seems to me that the ability to attend could be learned with the right techniques. Have you looked into David Stein’s book - Ritalin is not the Answer?

When I think back my daughter had signs when she was little of something not being right but it really wasn’t obvious to us what it was. However, to be honest I knew relatively very little about ad/hd compared to now. She is also inattentive and comes across as being dyslexic but is not diagnosed dyslexic. Her ad/hd very much affects her memory, visual and auditory processing. I do know she was very sensitive to her surroundings and was easily overstimulated as a baby. Loud sounds bothered her and she never did well with crowds. For example, this is a kid who hated the circus and said she never wanted to go back. Said it was too loud, too crowded and made her tummy hurt. We didn’t realize she was on constant overload. She is incredibly better on meds.

Her anxiety was something that was also always a part of our lives. I honestly didn’t realize that as a parent I was avoiding situations and heading off her anxiety wherever and whenever I could. I don’t know how I didn’t realize it wasn’t how other kids were. We just kind of all got used to it and did things to make sure she didn’t lose it. This has also been much better since meds. There are still incidents but not as many. The doctor told me she felt the anxiety was caused by her not feeling in control of her surroundings her whole life and because she is bright and was frustrated by her academic struggles.

My older child is not diagnosed ad/hd but knowing what I know now I have no doubt she has it also. In fact, she is more the classic chatty ad/hd girl. It does not affect her as severely. However, I am bringing her up because she is having trouble with overfocusing. She has silent reading time at school and is an avid reader. When the teacher comes in to start the class my daughter isn’t aware of it. She keeps reading and misses half the class before she realizes it. Like your son she is also very imaginative only she writes her stories down. This is wonderful since she wants to be a writer. The problem is she comes home from school with a 12 page story she’s written in school. I always have to ask her when she did it and I suspect some of it is when she should be doing something else. A teacher did tell me once that when she was supposed to be participating in class she would be writing in a notebook instead. I guess what I’m getting at is when children are younger there is less for them to worry about as far as focusing. School adds a whole new dimension. So, maybe some of what is seen as super good focusing or attention could be the other extreme with hyperfocusing?

I plan to look at David Stein’s book, as well as Dr. Amen’s work and some of the other great resources out there. This is not going to be an uninformed or hasty decision.

JenM- My son also was coming home in 3rd grade with drawings that illustrated a story he was composing in his head, when he should have been paying attention in school I suspect. He too was not formally dx as dyslexic by our neuropsych, although other people working with him felt he probably was. (It would be almost tragic if it turns out the root problem is ADD causing the reading issue, and not dyslexia causing anxietythat looks like ADD. If you know what I mean. )

But your post where you said ” The doctor told me she felt the anxiety was caused by her not feeling in control of her surroundings her whole life and because she is bright and was frustrated by her academic struggles. ” really rang a bell. I think for a child who perceives the world differently there can be a need for control, and subsequently anxiety when the control isn’t there. My son has always beena child that responds well to routine, predictability. When he was little we also did parent to meet that need. Fortunately as he has matured and received therapy we are able to go with the flow more. But it doesn’ t come naturally.

I also want to ask you about processing speed. My son is a slow processor - you can see that even when he has heard an instruction his response time is slower than normal. This was one piece of feedback we did get even when he was in nursery school. Transitions to new activities were slow for him - he didn’t tantrum or anything. It just takes him longer . Sometimes I think this looks like inattention - b/c his responses to questions are delayed as well. And yet , I know PattiM has posted that slow processing speed is an indicator for ADD. Is slow processing speed a component of ADD, or is it just a comorbid condition? (I’m going to search old posts, but if anyone here can comment….)

The following is excerpted from a Medline article I just found.
http://www.medscape.com/viewarticle/463181

In case you can’t access it:

Oct. 17, 2003 — Editor’s Note: Attention deficit-hyperactivity disorder (ADHD) has become an important area in child and adolescent psychiatry. Much of the new research has delved into the various diagnostic subtypes, response to treatment, and cognitive styles of both children and adults diagnosed with ADHD.

To discuss this new research, Medscape spoke with Mary Solanto, PhD, an associate professor of psychiatry in the Division of Child and Adolescent Psychiatry at Mt. Sinai School of Medicine and director of ADHD Clinic at Mt. Sinai Medical Center in New York City.

Medscape caught up with Dr. Solanto at the annual meeting of the American Academy of Child & Adolescent Psychiatry in Miami Beach, Florida.

Medscape: You presented a poster here in Miami on ADHD subtypes. Can you tell us about it?
Dr. Solanto: We are doing a lot of research trying to understand what may be critical differences between the two most recognized types of ADHD. There are kids who are predominantly inattentive, who’ve only been recognized recently in the DSM-IV, and then there is the more commonly recognized child with ADHD that is also hyperactive and impulsive. There seem to be many differences in the behavioral functioning of these children and possibly in the kinds of deficits they’re likely to experience. We’re evaluating these children on a whole array of neuropsychological measures. What we reported on were some differences on the WISC [Weschler Intelligence Scale for Children] and we looked at whether there were differences on measures of processing speed, which is how quickly a child can respond to a task and complete it, as well as measures of distractibility.

Parents and teachers often report that kids with this inattentive type are very sluggish, they’re very slow to accomplish many things, homework among them. And other kids often observe that they are very slow to respond interpersonally. You ask them a question and you don’t even know if they heard you, and they are looking around and daydreaming. [Their peers] may not have patience for that kind of behavior. These kids can suffer socially as well.

What we showed on the WISC was that there was a much higher proportion of kids with this inattentive type who did very poorly on the processing speed index. They were more likely to have a big discrepancy between their verbal functioning and their processing speed. They were also more likely to have a big discrepancy between their verbal functioning and their freedom from distractibility index on that test. That seems to verify the kinds of behaviors that we observed interpersonally with these kids, and it also provided a way for them to be assessed in a more formal manner to differentiate which type of ADHD they may have.

Medscape: Has anyone else done similar studies?
Dr. Solanto: There have been some reports in the literature of longer reaction times of these kids in laboratory tasks. There was also one other study that suggested a difference in processing speed. This is the first time where it has been demonstrated on commonly used tests that are used in psychological evaluations. What we want to do now is see if we can understand more about why processing is slower for these kids. Is it occurring on the input side, in terms of their ability to orient to a stimulus and process that stimulus, or is it occurring on the output side where they are processing the task and then deciding or executing a particular response? Other tests in the battery will hopefully shed more light on what is causing the longer reaction time. Another possibility is that they take longer to retrieve information and to call up the appropriate information for the task at hand. We’ll also be looking at that as a potential mediator.

Future studies will look at whether these children respond differently to stimulant medication than children with a combined type or perhaps they may require a different dosage. We are also collecting fMRI studies to look at whether different portions of the brain are activated in children with the two subtypes, particularly when they are doing a task that requires inhibitory control. We have data that will hopefully help to elaborate differences between the subtypes and ultimately construct treatments that are more targeted for their particular deficits.

Medscape: Is this a particular age group or is it the spectrum of children and adolescents?
Dr. Solanto: That’s an interesting issue. Studies show that the age of onset or at least the age at which children with the inattentive subtype are recognized is much later. They often do not come to clinical attention till ages 9 to 11, and it may be hard to document that there were symptoms before that. It has been proposed that the criterion for onset should be higher for the inattentive. Why this should be the case isn’t entirely clear. It could be that demands on attention don’t increase so that these children don’t look impaired in the classroom until they get to be 9 years old because they are not behaviorally disruptive, they don’t have other problems. Their problems are primarily on structured tasks that require concentration and focus. It is possible that this is a subtype that does not have an onset until later. In the study, the children were matched for age, so that wouldn’t account for differences. The age range for both subtypes was 7-12 years old.

KarenN,
Your son sounds so visual. Have you ever looked at Davis Dyslexia Correction?

No, actually he’s an auditory learner! part of the problem with assessing his attentiveness is that he often looks away even when he is fully attending. Also makes it tough to work out a system with the teacher where she cues him - cause he isn’t looking at her!

I guess what I meant was that he may be running “movies” in his mind and putting everything, including print, in a 3-d form.

Because some kids see things 3-d, when they come on something unknown, they will look at all “angles” of it to try to figure it out. This causes them great confusion. I would look into this idea. Read some of the Davis material and you will see what I am talking about. Not every dyslexic is this type, but if they are, the Davis methods will really work.

Karen, I hope I can explain things clearly. It was not that long ago my daughter was diagnosed and like I said I haven’t even had my older daughter looked at yet. I’m still learning and sometimes it’s hard for me to explain what I mean.

My daughter was initially diagnosed with visual processing impairment by the optometrist. The school speech language specialist tested her for auditory issues and came back with a few things primarily memory related. She scored down at 1% on some of these things. I took her to the neurologist who does specialize in children because I felt that we had all of these bits and pieces and before we started on any formal academic accommodations (iep, or 504) that we wanted to get the whole picture. I work in the school system and I know that if I waited for the school CST we would still be waiting. We would wait until the spring and then help wouldn’t come until some time after that.

I fully expected to come back with a diagnoses of LD and maybe ad/hd. I was very surprised that the whole diagnoses was ad/hd. I was skeptical that it was the whole problem and figured if the doctor was right we would find out soon enough. My child fit the profile of dyslexia perfectly. So far, the dr has been right. She is doing hardly any reversals. Still a few here and there but she can now recognize them and change them. Her memory is incredibly better. Everything else is falling into place. The dr. explained that the problems she was having were developmental and because of the ad/hd was not able to sort them out and really learn them well. It was all scrambled in her head because the ad/hd really very strongly affects her working memory. She was not able to accurately retrieve information and sometimes not at all. This dr works from the idea that if a child can read at all, even with difficulty, they are not dyslexic. I know other drs work from the idea that difficulty in reading fitting the profile is dyslexia. So, I really think sometimes diagnoses comes down to which dr you go to.

Medication has worked for my daughter and she is making great improvements every day. I just want to make it clear that I am not saying that medication cured dyslexia for my child. I was previously flamed for that because I didn’t make that clear. What I mean to say is that her symptoms of ad/hd mimic those of dyslexia and the meds have really addressed those issues. Her anxiety is falling into place as well. She is no longer overwhelmed when church is over and everybody is gathering outside. Loud noises are not upsetting her so I don’t feel I have to warn her that I’m going to make a loud noise.

Sorry this is getting long. As far as processing speed. The dr. did many many tests. I can’t remember them all. However, there were a bunch where she asked my daughter to listen and answer some questions and where she was asked to do some tasks with paper and pencil. The results were that she was able to perform at her level and in some things at a 3rd grade level. However, it took her a longer. In some cases, just when you thought she wasn’t going to answer she did. The dr also brought to my attention that I was in the habit of repeating directions and questions for her thinking she didn’t hear or understand. It was hard to keep my mouth shut and wait but I did. Now I find I don’t have to do that anymore. The dr also did very specific tests for memory and types of memory and after several could determine it was her working memory that was affected.

The analogy the dr used was to think of my daughter’s working memory like the Thanksgiving table being too small. Not everything fits and when you try to squeeze it in there it falls off, gets scrambled, and you can’t find what you’re looking for. She told us that medication would give her a much bigger “table.”

Don’t get me wrong in that there are still some issues we are dealing with. Not everything is all the way better but is so much more improved that there is no mistaking we have made the right choice for now. The dr is not sure that the meds are at the right dosage but wants to give her some time before adjusting anything. The best thing that has happened is my daughter’s confidence has gone way up, she can now verbally express herself more clearly, her frustration level is down and she is acting much happier.

JenM,
I think your explanation makes perfect sense, and that it sounds like you have a good doctor.

I don’t think anything cures dyslexia, and I don’t think all of my son’s problems are attributable to any one thing. I think he has broad, but mild, neurological impairment. But since he doesn’t present classicaly dyslexic, or classicly ADD, I do wonder if we find out later that medication would have allowed him to put the pieces of reading together sooner or more easily.

I really appreciate your story.

The processing speed was the major indicator for my daughter. I have worked with other children who were slow methodical processors and they too were ADD-Inattentive…They scored as slow processors on the IQ tests, they were fairly smart. They could hyper focus on the IQ tests so the Dr. felt they should be taken off meds. Once that happened with one of my students he took a tailspin as he couldn’t hold it together in middle school. After 2 months of this downward spiral, his mother marched back into the psychiatrists office and he said…”well let’s try meds again and see what happens.” He went back up to being able to attend and cope with his reading and schoolwork, granted he is still a slow processor but now with meds…he has the focus he needs to keep up…

My daughter’s ADD didn’t really hit the fan until 9 years of age. What hid it was using an Auditory trainer….this kept her focused and she was learning auditorially because she couldn’t read.

What makes my daughter a bit more challenging is she has a moderate to severe hearing impairment, which caused phonological deficitis that impacted her acquisition of reading… But even though she has a moderate to severe hearing impairment, my daugher is extremely attentive auditorially, she is detail oriented in her environment, her notebook, locker and handbag are organized, but her room looks like a bomb went off. Once she gets tired of the mess, she will clean it.

But what really broke my heart :oops: :o was when we finally decided to give into trying meds. My daughter said…”Is this what it feels like to focus? Everything is making sense now, I can put it together…I feel happy.”

Talk about GUILT!!! :cry: I was kicking myself…I wasted 3rd grade, 4th grade, and all of 5th grade before I finally put it all together..it wasn’t just the hearing loss/dyslexia it was ADD too. It was her Pediatrician who finally referred her to a specialist on ADD and our HMO paid for it…

6th grade we made up for lost time when we pulled her out of public school and put her into a small classroom setting like KarenN has her son. The facility didn’t see much of a difference in her behavior because she had always been so “good” but what really showed was her quickness of grasping of concepts that for so long had been foreign to her. :o

then you have the traditional difficult decision on your hands. You could see if any medication helps him because it sounds as if his school isn’t helping him. Sadly it can be with our children we are between a rock and hard place. Is this independent school he’s in starting to make noises about ‘not inviting him back’ or are his teachers simply a bit frustrated with him? If you’re worried they might ask you to not reenroll for the coming year, that would be one matter. If it’s just that his teachers are frustrated, that’s another. I assume you chose this school over at least several others and you remain happy with your choice.

And how much does he mind his lapses into daydreaming? Does he mind? Does he mind the frustration his teachers might show? That can be factored into the consideration you’re giving things - if he remains feeling good about himself and school, again that’s one thing. If he’s feeling the pressure of being the class daydreamer, that would be another.

Good luck.

I love the Thanksgiving table analogy! I had been told the same thing about my son’s working memory with a computer memory comparison-I like the turkey better!!!

Something else I was told when the TOVA showed slow processing was that learning with ADD was like driving a truck uphill in the wrong gear. You get there but its slower,more effort, and causes more stress on the ‘truck’ . The meds put your brain in the correct gear.

Another book I enjoyed was “right brained children in a left brained world”. The author sees adhd, dyslexia, and autism all on the same spectrum of right brainness. I think that explains so many of the overlaps we tend to see in our kids. Is it dyslexia? Adhd? One psych thought mine was Aspergers, and others here have had that same experience.

Adherence to routine, difficulty with transitions? Sounds like your child has been there too. THAT would have been the obvious symptom when y my son was young, not the inattention(of course who thinks a 3 yr old is constructing elaborate fantasies???)

Might be a good read

MaryCas, I have a similar theory. That funky brain wiring looks different on different people, but can really come from the same place. So on my kid it looks like exec. function, dyslexia… we too have had words like aspergers, gifted, obsessive thrown our way. Nothing sticks because he’s always on the mild side.

Interestingly, my son ‘s friends are all quirky kids. A little off the beaten path in their thinking. And not one of them was a normal reader: a few were unusually ealry readers, and the rest have had trouble learning to read. But not one of these kids who are just a little different had a normal trajectory to learning to read.

Sara,
Our concern is that my son is recently placed in a special LD school that caters to bright dyslexic kids. He’s only got 6-10 kids in the class, depending on the subject. Each class has 2 specially trained teachers. If he can’t attend in that environment that is telling, I think. I’d like to think they are n’t frustrated so much as concerned, but we’ll see how our next conference goes….