Natalie was sitting in her classroom chair listening to her teacher, but then she started thinking about her upcoming playdate. Then she noticed that the girl in front of her had a label sticking out. Then she looked out the window to see a squirrel scurrying up a tree. She suddenly realized that she lost track of what the teacher was saying.
Natalie is an intelligent, high achieving child who works hard in school and gets excited about many things. However, she often loses attention and doesn’t finish projects or assignments. She frequently seems distracted and to not really be listening. She often loses items and struggles with organization.
When we think of ADHD, many of us think of a hyperactive and impulsive child who is always in movement, interrupts, or talks excessively. Observing these children, many parents and teachers may consider that it may be ADHD and move forward with an evaluation. However, many children have a different kind of ADHD that is more likely to be overlooked. These children do not fit the hyperactive and impulsive profile. Instead, their behavior is compliant, and they often succeed in school. Nevertheless, they may be struggling without any obvious signs. This type of ADHD used to be called ADD – Attention Deficit Disorder without the H for hyperactivity. Now, the term ADHD refers to anyone with the disorder.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) distinguishes three types of ADHD:
1. ADHD, impulsive/hyperactive type –This is characterized by impulsive and hyperactive behaviors without inattention and distractibility.
2. ADHD, Inattentive and distractible type – This type of ADHD is characterized predominately by inattention and distractibility without hyperactivity.
3. ADHD, combined type – This, the most common type of ADHD, is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility.
Natalie eventually was diagnosed with ADHD, Inattentive and Distractible type. She was prescribed medication and received therapy to help her focus and sustain attention. She also began working with an executive function coach to teach her strategies to become more organized. This type of ADHD, which affects girls in particular, is most often overlooked.
Many people struggle with organization, forgetfulness, and distractibility. However, in order to receive a diagnosis of ADHD, the symptoms need to interfere with your life, impairing social or occupational functioning.
The American Psychiatric Association’s diagnostic manual of disorders, the DSM-V, lists nine symptoms of inattentive ADHD. In a child or adolescent, at least six of these must be present and must significantly disrupt a patient’s life in order to merit a diagnosis. The symptoms of inattention must have been present for at least 6 months and be inappropriate for the child’s developmental level.
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, phones)
- Is often forgetful in daily activities.
These symptoms can apply to adults or children. Since AHDH is inherited, many adults look at themselves while having their children evaluated and realize that they have some of the same symptoms.
Meanwhile, there are many strategies we can teach individuals to address the symptoms of inattentive type ADHD or help anyone who struggles with organization or attention.
When I started my business in 1994, I knew that I struggled with organization, and I knew I had to improve these skills to successfully start and run my new business. I had the bad habit of writing everything on sticky notes and distributing them all over my desk. Then I hired the most organized person I knew to help me get organized. She worked with me for 3 days. The first thing she did was discard the sticky note approach, which she replaced with a spiral notebook to write everything down. To this date, I have probably completed hundreds of spiral notebooks. She helped me in other ways, too, and the business was quickly organized and running smoothly. Even though I was not a naturally organized person, I learned strategies to keep order and be successful.
8 Tips for Success
1. Instructions: Regarding school assignments and household requests, make sure instructions are clear. Ask your child to repeat the instructions to make sure they are understood. Limit tasks to two or three at a time. For big projects, break them down into small chunks.
2. Distractions: Students in school can receive simple accommodations like preferred seating in front or center and taking tests in a smaller group. At home, keep homework space clear of distractions like phones, TV,’s and other people.
3. Completion of tasks: Tasks do not need to be completed all at once. If attention span is short, set a timer for 20-minute intervals with 5-minute stretch breaks. Incorporate exercise before tasks and during breaks to get dopamine flowing. (This may improve motivation.)
4. Routine: Many people, especially those with ADHD, do their best with a regular routine. This includes predictable wake-up times, bedtimes, mealtimes, homework times, and fun times.
5. Organization: ADHD is often associated with executive function challenges, such as organizing time and space, and organizing thoughts to write an essay. Some helpers include timers, graphic organizers, to-do lists, planners, and calendars.
6. Rewards: Many of us are more motivated when we have a reward coming. This can be extra screen time, a special trip, and praise for hard work.
7. Listening: Make sure your child (or spouse) is looking at you when you are talking without simultaneously looking at a screen. Keep your comment brief and make sure there is an appropriate response. If there isn’t, ask your child to repeat what you said. If you want your child or spouse to listen to you, make sure you listen to them.
8. Forgetting/losing things. Assign regular places in the house, bedroom, playroom, and backpack where everything belongs. Put everything in the backpack at night. Write down notes on what to remember on paper or in the note section of your phone.
Treatment for ADHD
Once diagnosed, the following treatments have proven to be beneficial:
Medication, which can be a stimulant or nonstimulant, has been a game changer for people who struggle with ADHD, helping them focus, complete tasks, and be more organized.
A life coach or academic coach can help with organization, time management, focus, motivation, and goal setting.
A tutor can help students study more efficiently and learn techniques for organizing their work, mastering new memory strategies, and improving their writing skills.
A support group can help students discuss their challenges and strategies.
If you think your child may have inattentive ADHD, go to the pediatrician with your concerns and get started on a possible diagnosis and treatment. Meanwhile, the above strategies have been proven the help anyone who struggles with attention and organization.
By Cheryl Gedzelman, President, Tutoring For Success, Inc.