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What is the Predominantly Inattentive Subtype of ADHD?

In 1994, the Predominantly Inattentive Type of Attention Deficit Hyperactivity Disorder (PIT ADHD) has been recognized as “lacking in concentration with apparent lack of effort”.

Students with PIT ADHD without hyperactivity or impulsivity are often overlooked, rarely identified or referred for treatment. Yet, the schools and classrooms have students with PIT ADHD, just as those children with AD/HD who are seen at mental health centers.  It can be assumed that the rationale for professionals to overlook students with PIT ADHD without hyperactivity or impulsivity can be because these students are not behaviorally disruptive or difficult to manage.  Instead, this student may appear to be underachieve or daydreaming.  Students with PIT ADHD without hyperactivity or impulsivity have just as much difficulty with their attending as those with Attention Disorders that have hyperactivity and impulsivity symptoms.  Teachers call upon them, and they have no idea of what was being discussed, they have difficulty processing new information, and may show more characteristics and are mislabeled as  “slow learners” or “learning Disabled”.  The tragedy for students with PIT ADHD without hyperactivity or impulsivity is that most of the time these student underachieve… and no one notices that they are not working to their true potential.

In addition to their academic difficulties, children with PIT ADHD often have social problems. Their classmates see them as "tuned-out," or not "with it," and they are more likely to be ignored and friendless. One recent study suggests that the social problems of children with attention deficits may have different causes and different results. (Maedgen & Carlson, 2000). Children with the Combined Type of Attention Deficit Disorders tended to annoy others with their provocative, intrusive and sometimes aggressive behavior. As a result, the children were more likely to be socially rejected. Children with PIT ADHD were more likely to lack the wisdom needed in social skills. In part, their difficulties were due to a failure to pay attention to the social nuances — the nonverbal cues or "body language" — which are an important part of social communication.  

A survey given showed an interesting distribution between the sexes. Whereas the Combined type of Attention Deficit Disorder is about four times more common among boys than girls, the PIT ADHD is more evenly distributed between the sexes with a boy: girl ratio closer to 2:1. In fact, if a girl has ADHD, she is more likely to have the PIT ADHD without hyperactivity or impulsivity type. (Wolraich, Hannah, Pinnock, Baumgaertel, & Brown, 1996).

Another important finding is that the PIT ADHD may have a later age of onset than the other types. Although all subtypes must have an onset by age seven in order to meet current DSM-IV criteria for AD/HD, these more recent studies suggest that many cases with PIT ADHD without hyperactivity or impulsivity may not actually become apparent until age nine, and then the impairment may not be significant until age 11. (Applegate et al., 1997).

If you happen to see students or have a child that exhibits the symptoms of having a PIT ADHD, it is highly recommended that a parent conference with the school administrator occur.   At this meeting a discussion of your concerns needs to happen and then the family needs to be directed to their pediatrician.  It is also recommended that the schools allow the pediatrician to direct the family from that point forth, and to work in a “team effort” between student, parent, school and medical professionals to identify and acknowledge the student’s individual needs.

At this time, studies involving treatment plans that are specifically effective for children with PIT ADHD without hyperactivity or impulsivity are limited. Research is underway at the Mount Sinai ADHD Center, supported by grants from the National Institutes of Health (NIH), to investigate the effectiveness of stimulant medications in children with PIT ADHD without hyperactivity or impulsivity. The most recently funded study will examine the use of functional Magnetic Resonance Imaging in identifying unique patterns of brain activation in children with PIT ADHD without hyperactivity or impulsivity. It is hoped that a better understanding of these differences will lead to the development of educational and psychological treatment approaches for these students.  ChildD.org recommends the continued use of a consistent behavioral management plan that is age appropriate, realistic and motivating to the individual needs that the student faces in combination with organizational skills and time management practices. 

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