A Hidden Disorder in Plain Sight

by Cynthia Hammer, MSW

 Children with the hyperactive type of ADHD are diagnosed, on average, by age 7, but children with the inattentive type of ADHD still are rarely diagnosed by age 7.

Does it matter? Yes, it does! This article will explain why and why it is essential for elementary school personnel to seek out children with inattentive ADHD.

Let me briefly review the symptoms of inattentive ADHD, provide information from recent research demonstrating why early diagnosis is crucial, and explain the vital role of elementary school counselors/teachers in identifying children with this possible disorder.

The DSM-V lists nine symptoms of ADHD of the Primarily Inattentive Type (the correct name but so cumbersome that I use inattentive ADHD.) The symptoms must persist for over six months and be observed in two settings, e.g., school, home, and social groups.

The symptoms negatively impact academic and social functioning. However, this can be misleading as girls with inattentive ADHD often mask their symptoms. Children with inattentive ADHD can be bright and do well academically despite their undiagnosed inattentive ADHD. However, when academics get more challenging, these children might hit a wall when they enter middle school or high school.

The child should demonstrate six or more of the symptoms listed below. However, recent research shows that even a child with fewer symptoms is negatively impacted to almost the same degree as children with six or more symptoms.

• Displays poor listening skills

• Loses and misplaces items needed to complete activities or tasks

• Sidetracked by external or unimportant stimuli

• Forgets daily activities

• Diminished attention span

• Lack of ability to complete schoolwork and other assignments or to follow instructions

• Avoids or is disinclined to begin homework or activities requiring concentration

• Fails to focus on details and makes thoughtless mistakes in schoolwork or assignments

When the diagnosis of inattentive ADHD is delayed, the child suffers and is often labeled "lazy, irresponsible, unmotivated, inattentive, and uncooperative." These labels, which persist as the child grows up, get internalized and damage the child's self-esteem and self-confidence.

They wonder why they can't focus and stay on task. When the child becomes an adult, his undiagnosed ADHD is associated with numerous problems.

· Low self-esteem, depression, and anxiety

· Difficulty in relationships

· Job instability: People with undiagnosed ADHD may be less likely to graduate from college or high school, and their inability to stay focused at work impacts their employability.

Drug and alcohol misuse, although research demonstrates that effectively treating ADHD may help protect against substance abuse.

· Increased mortality rate: Adults with undiagnosed ADHD die, on average, years earlier than their peers, mostly due to accidents. (https://pubmed.ncbi.nlm.nih.gov/25726514/)

Elementary school counselors and teachers can identify children with possible inattentive ADHD because they have studied normal child development and can observe the day-to-day behavior of children in structured situations. School personnel in middle and high school will never know any child as well as elementary school personnel.

If a child slips through the cracks in elementary school, i.e., doesn't get diagnosed, they will likely never know they have ADHD. Less than 20% of adults with ADHD have been diagnosed.

The child with inattentive ADHD might try their best, but how their brains are wired means specific tasks are very challenging for them. If they are not interested in the topic, their mind wanders off.

They cannot compel their brain to stay on task when the task is uninteresting or too complex. They might strive to be a good student, but their [sw1] extraordinary effort often takes a toll.

Occasionally, he may excel when he finds a topic that holds his attention. But the variation in his academic performance adds to the misunderstandings as parents or teachers say, "Yesterday you finished your school work in record time, but today I have to keep after you to finish."

The child doesn't understand the reason for her variability in performance. She doesn't know other children don't have similar struggles. The more years that pass without her learning that her undiagnosed inattentive ADHD causes her challenges, the more likely she is to develop co-occurring conditions.

He may develop depression from being unable to be consistent in his performance or anxiety from not knowing how to improve his performance. Men with inattentive ADHD diagnosed later in life have similar co-morbid conditions.

She may become a perfectionist as she believes that is the only way to be acceptable—and striving for perfection wears her out and contributes to her anxiety. She may learn to mask and hide her real self, as she is too ashamed to tell people about her struggles. [sw3]

The delay in the diagnosis makes an unacceptable situation intolerable. The statistics about life problems for people with undiagnosed ADHD are difficult to read.

They have earlier deaths, vehicle accidents, personal injuries, increased physical health problems, and substance abuse issues and are victims of domestic violence. If their ADHD is untreated, they are more likely to commit suicide.

If they are lucky as adults, they finally hear about inattentive ADHD and recognize themselves. They are surprised to learn there is a type of ADHD that doesn't include hyperactivity. They are amazed that ADHD doesn't impact only little, hyperactive boys.

Elementary school personnel have an essential role to play. If they help even one child to be diagnosed with inattentive ADHD, they will change that child's life trajectory. Many adults say, "Having ADHD isn't the problem. Not knowing I had ADHD was the problem."

Children with inattentive ADHD will remain overlooked unless elementary school personnel learns what behaviors to watch for. The Child Questionnaire details the behaviors a child displays with possible inattentive ADHD. It can help school staff ferret out the one or two children with likely inattentive ADHD in each classroom.