Research for your question has been particularly difficult. Although I
have read quite a bit about adult ADD during the past year, I didn't
realize how little solid information is available about some aspects
of this disorder. Here are some of the challenges that you may have
already faced before asking the question here:
-- Most studies have focused on children 6 to 12 years old. And
although recent years have seen an interest in adult ADHD, there isn't
a corresponding growth of interest in teen ADHD.
-- Inattentive ADHD doesn't cause the kind of behavioral problems that
usually lead to evaluation for a diagnosis of ADHD, so it has been
studied less.
-- The inattentive type of ADHD has only recently been recognized
under the criteria of DSM-IV.
-- What works for impulsivity may not work for distractibility or
inattentiveness, so treatment options aren't always the same.
-- Drug options for treatment of ADHD can be effective and relatively
inexpensive, so behavioral approaches haven't been given much
attention. It also seems to be a consensus among many professionals
that a behavioral approach is seldom successful without pharmaceutical
assistance.
Here is a summary of the problem:
Welcome progress in the diagnosis and treatment of ADHD in adolescence
"Although ADHD is one of the most studied childhood psychiatric
disorders, the available treatment literature is predominantly based
on the 6- to 12-year-old age group; the practice standards of the AAP
for ADHD, for example, refer specifically to 6- to 12-year-olds. An
extensive review of pharmacotherapeutic intervention studies
identified only seven studies of adolescents, compared with 140
studies of school-age children. Relatively few data exist regarding
important ADHD subgroups, such as girls and those with the
predominantly inattentive subtype, and few empirically validated
studies of psychosocial interventions have been done, despite the
social and family impairments Often associated with ADHD in teenagers.
As a result, a huge disparity exists between the small pool of
empirical investigations and the need for effective longterm
management of adolescents with ADHD."
http://www.findarticles.com/cf_dls/m0BGH/8_20/107275846/p3/article.jhtml?term=
Following is a link to one of the very few studies dealing
specifically with the inattentive subtype.
ADHD treatment and academic performance
(Journal of Family Practice, August, 2003)
"These findings call for additional research to further define
predominantly inattentive ADHD in patients who present with
inattention and academic concerns..."
http://www.findarticles.com/cf_dls/m0689/8_52/106471670/p1/article.jhtml?term=
What the study showed, basically, is that drugs aren't particularly
effective in dealing with inattention. But it didn't deal with the
effectiveness of alternatives.
Despite the scarcity of solid information, I'll provide you with some
of the key Internet resources available. Then I'll provide you with
the name of a book that looks like it might be helpful.
Here are two articles with some approaches that may be help for
dealing with inattention:
What Parents and Teachers Should Know about ADHD
"Behavior therapy/modification, in which parents and teachers are
taught how to work with their children, is the most widely recommended
and effective, nonmedical, short-term treatment for ADHD. Behavior
modification includes
"-- establishing specific daily goals for the child,
"-- establishing and consistently enforcing clear rules,
"-- giving clear and appropriate commands,
"-- praising children for desired behaviors and ignoring negative
behaviors that can be ignored,
"-- using rewards (for example, points) to encourage good behaviors,
"-- using appropriate, nonphysical punishments (for example, time out)
to discourage bad behaviors, and
"-- using a Daily Report Card to motivate the child and facilitate
communication between school and home.
It usually takes 8 to 12 clinical or inservice sessions for parents
and teachers to learn these techniques.
http://128.205.76.10/NeedToKnow.pdf
Welcome Progress in the Diagnosis and Treatment of ADHD in Adolescence
"In the absence of empirically developed, adolescent-specific
treatment guidelines, management is based largely on practices well
established in children and adapted for teenagers. In general, a
combination of educational, behavioral, and drug treatments targeting
the individual adolescent's symptoms and impairments (so-called
tailored multimodal treatment) is recommended for most adolescents
with ADHD. To maximize long-term adjustment, the treatment plan also
should emphasize and address identification of cognitive and
interpersonal strengths."
..."Academic and environmental interventions that may reduce
educational difficulties include modifications in the adolescent's
curriculum to compensate for neurodevelopmental weaknesses.
Appropriate modifications include providing written instructions,
preferential seating close to the teacher, and increased time for
examinations; reducing the amount of written work; rewarding
performance rather than speed; and breaking down long-term assignments
into shorter ones."
http://www.medscape.com/viewarticle/460591_4
The above article also gives a good overview of behavioral treatment
options. Many of them are concerned with issues related to
inattentiveness.
"Ratey and co-workers have developed another approach, which involves
teaching techniques to enhance attention and memory as well as
problem-solving techniques to improve family relationships. For
example, asking patients to repeat information can improve listening
skills, and introducing a structured problem-solving log can aid
negotiation and socialization skills. Coaching patients in time
management, organization skills, and anger-control techniques also is
recommended. Such approaches, which involve equipping parents and
teachers with effective management skills, have intrinsic appeal, and
psychoeducational treatment is a standard part of research protocols
and clinical practice."
http://www.medscape.com/viewarticle/460591_6
One study of family therapy techniques for dealing with ADHD in
adolescents showed some modest results:
A comparison of three family therapy programs for treating family
conflicts in adolescents with attention-deficit hyperactivity disorder
"Despite group improvements, analyses of clinically significant change
and clinical recovery within Ss showed that only 5-30% reliably
improved from treatment and only 5-20% recovered following treatment."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1619099&dopt=Abstract
Here's a summary of the types of nonpharmaceutical treatment available:
Diagnosis and Treatment of ADHD in Children and Adolescents
"Psychosocial interventions include parent behavior-modification
training, support groups, family psychotherapy, social skills
training, individual therapy, and day treatment programs. Educational
interventions include token economies, time-out procedures,
response-cost programs, and homework notebooks."
http://www.medscape.com/viewarticle/442882_2
And another summary of behavioral approaches:
Attention Deficit Hyperactivity Disorder in Adults
"Nonmedication interventions also are useful in the treatment of ADHD.
Education about the disorder is important. Adults with ADHD often are
relieved to find a name and a cause for their lifelong difficulties,
and knowing the exact nature of their problem allows finding ways of
coping more effectively. Examples of coping mechanisms for poor
attention span or distractibility could include minimizing external
distractions in the office or workplace, making lists, purchasing a
computerized organizer, and establishing multiple small deadlines for
finishing long-term projects."
http://www.medscape.com/viewarticle/439439_6
Time management is a major problem for the person with inattentive
and/or impulsive ADHD. Here are some time-management tips for teens:
Tips for Teens: Time Management
http://add.about.com/cs/forteens/a/teenstimemanage.htm
And some more tips:
Academic strategies to help students with ADHD overcome
neurodevelopmental deficiencies
"-- Provide written instructions to accompany oral instructions
"-- Assign student preferential seating close to the teacher or front of class
"... --Encourage active reading with note taking
"... --Reward performance rather than speed
"-- Encourage performance in areas of strength (art, music, drama,
athletics)
"... --Break down long-term assignments into shorter segments"
http://www.findarticles.com/cf_dls/m0BGH/8_20/107275846/p12/article.jhtml?term=
Now for what appeared to be the best book I could find on the subject:
The ADHD Book of Lists: A Practical Guide for Helping Children and
Teens with Attention Deficit Disorders (ISBN 078796591X)
This book provides numerous nonpharmaceutical approaches that can be
taken. Although the book apparently doesn't deal specifically with
inattentiveness as the core symptom, many of its approaches are
applicable. Here are some of the topics from the table of contents:
-- Rewards and Positive Reinforcers for School
-- Proactive Parenting: Positive Discipline
-- Rewards and Positive Behaviors for Home
-- Struggles with Organization, Time Management, and Study Skills
-- What Parents Can do to Help with Time Management
http://www.amazon.com/gp/reader/078796591X/103-4335605-5509432
Browsing through the book, here are some of the tips I found:
-- Work with teachers to make sure homework is being turned in.
-- Look for ways to make necessary tasks more interesting.
-- Use frequent rewards.
-- If homework is an issue, consider making a special study area the
students finds interesting and motivating.
-- Help the student develop a routine so that things that need getting
done get done.
-- Help with planning a "to do" list.
There are many, many more. This book is (as the title implies) a book
of lists. Much of what is in there addresses directly the issues
relating to inattentiveness. If you follow the Amazon.com link above
and are a registered user of Amazon.com site, you can browse through
the book extensively.
I wish I could have found more information, but not a lot has been
done in terms of developing nonpharmaceutical treatments for
inattentive-type ADHD in teens. Probably the best you can do at this
point is what I have suggested, to take those approaches for ADHD in
general that apply best to the problem of inattention.
Finally, here are some background articles that may also be of interest:
Adolescence and ADHD
"Adolescence, in general, creates its own set of challenges, and this
is certainly true in the treatment of attention deficit/hyperactivity
disorder (ADHD). There are both diagnostic and treatment issues that
require special attention in this developmental phase of life."
http://www.medscape.com/viewarticle/451241
Repetitive Transcranial Magnetic Stimulation (rTMS): New Tool, New
Therapy and New Hope for ADHD
This article is about a nonpharmaceutical research tool for ADHD;
however, it is not yet a treatment.
http://www.medscape.com/viewarticle/452988
Advances in the Treatment of Adult ADHD -- Landmark Findings in
Nonstimulant Therapy
This article is mostly background material and focuses little on
behavioral approaches.
http://www.medscape.com/viewarticle/458059
Helping Parents Make Sense of ADHD Diagnosis and Treatment
http://www.medscape.com/viewarticle/453700
Attention-Deficit/Hyperactivity Disorder: Management
http://www.findarticles.com/cf_dls/m3225/8_64/79151893/p1/article.jhtml?term=
I hope you have found this answer helpful and as complete as possible.
Best wishes in your pursuit of knowledge.
Sincerely,
Mvguy-ga
Successful searches on this topic:
Google search:
inattentive adhd "behavior modification"
://www.google.com/search?q=inattentive+adhd+%22behavior+modification%22
Medscape search:
adhd
http://search.medscape.com/px/mscpsearch?QueryText=adhd&searchfor=Clinical&cid=med
Medscape search:
adhd and inattentive and adolescents
http://search.medscape.com/px/mscpsearch?searchfor=clinical&cid=med&QueryText=adhd+and+inattentive+and+adolescents&SortField=score&SortOrder=desc&newestMonths=0&oldestMonths=NoLimit&ContentType=All&LeadAuthor=&Title=&submit.x=28&submit.y=9
Amazon.com search:
adolescents adhd
FindArticles search: adolescents adhd inattentive
http://www.findarticles.com/cf_dls/PI/search.jhtml?magR=all+magazines&key=adolescents+adhd+inattentive |
Clarification of Answer by
mvguy-ga
on
09 Jan 2004 12:48 PST
First of all, my apologies. I'm not sure where I got the idea you
were looking for information applied specifically to adolescents; it
certainly wasn't anything in the way you worded your question.
In any case, most of what I wrote still applies. There hasn't been a
lot of studying done with regard to the inattentive type of ADD in
children. This is primarily because the inattention doesn't
necessarily lead to lack of impulse control (and therefore
misbehavior) that causes parents and/or teachers to seek an ADD
diagnosis. Based on personal research, I suspect that one reason many
people diagnosed with ADD as adults score high in inattentiveness is
because the disorder went unnoticed (or was not thought of as a
disorder) in childhood.
Here is another source outlining the lack of attention (no pun
intended) to the ADD without hyperactivity. Note the second paragraph
I've excerpted below:
Research Needed for Subtypes of ADD
A concern raised by experts at the NIH consensus program is that most
research has evaluated children with what is considered to be the most
severe type of ADHD, the type that includes both inattention and
hyperactivity. There are two other types of ADHD: inattention without
hyperactivity and hyperactivity without inattention. Although those
experts found that stimulant treatment was superior for children with
the combined type of ADHD, the research had not separated the types of
ADHD, they said....
"'The nature of the problems is different,' said Howard Abikoff, the
Pevaroff Cohn professor of child and adolescent psychiatry and
director of research and professor of child and adolescent psychiatry
at the New York University Child Study Center. 'My hunch is that down
the road, the inattentive subset will be separated out and viewed as
its own disorder.'"
http://www.education-world.com/a_issues/issues148b.shtml
Also:
"There has been little study as yet of treatments that are
specifically effective for children with the IN type of ADHD. Clinical
experience at the Mount Sinai ADHD Center, however, suggests that the
stimulant medications that are effective in the treatment of the CB
type of ADHD may also be effective for IN. Research is also underway
at Mount Sinai, supported by a grant from the National Institutes of
Health, to investigate the unique difficulties of children with IN in
orienting and focusing, immediate and short-term memory, and in
'executive' functions, such as self-stopping, organization, and
planning. It is hoped that a better understanding of these differences
will lead to development of educational and psychological treatment
approaches that address the specific needs of children with IN."
http://www.mssm.edu/psychiatry/adhd.shtml
Fortunately, some work has been done. Here are other resources I was able to find:
Alternative Treatments
"There have been some promising results with studies of biofeedback,
sometimes called neurofeedback; however, those studies have used very
small samples, so that treatment also has not been proved by rigorous
scientific standards."
http://www.education-world.com/a_issues/issues148b.shtml
Inattentive ADD: The Quiet Disorder
"Managing the symptoms of inattentive ADDers presents a different set
of challenges, often more frustrating and less clearly defined. The
essence of inattentive ADD is passivity, so coping strategies must
first activate these students to take charge of their lives. Although
these individuals will also experience difficulties maintaining
effort, their first problem is getting started at all!"
http://www.brainworks.info/add6.html
Inattentive ADD: Working With the Wandering Mind
"Managing the complexities of inattentiveness requires multiple
strategies to address the multiple facets of the condition; however,
the success of all remediation strategies rests upon improving the
person?s general ability to focus and sustain attention."
http://www.brainworks.info/add13.html
Also, here is another book that may be useful, although I wasn't able
to browse it. It appears to have quite a bit of information about
inattention:
Problem Solver Guide for Students with ADHD
by Harvey C. Parker
ISBN: 1886941297
Amazon.com link: http://www.amazon.com/exec/obidos/tg/detail/-/1886941297/
I hope you find this information helpful. I wish I could provide more,
but there hasn't been much work done in this area. It does sound,
though, like some research in this area is beginning, so hopefully in
the next few years we will see more resources available.
Sincerely,
Mvguy-ga
Google searches:
adhd treatment inattention
://www.google.com/search?hl=es&ie=UTF-8&oe=utf-8&q=adhd+treatment+inattention&btnG=B%C3%BAsqueda+en+Google
"inattentive type" treatment
://www.google.com/search?q=%22inattentive+type%22+treatment&hl=es&lr=&ie=UTF-8&oe=utf-8&start=10&sa=N
ADHD-I
://www.google.com/search?q=ADHD-I&sourceid=opera&num=0&ie=utf-8&oe=utf-8
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