Underdiagnosis of Attention Deficit Disorder in School Age Children

Deborah Health Guide
  • My son's Attention Deficit Hyperactivity Disorder (ADHD) was diagnosed early - between kindergarten and first grade. His kindergarten teacher, who had been wonderfully patient with him all year, was concerned about how much more would be expected of him in first grade behaviorally, so she encouraged us to get him evaluated.


    Despite the challenges that his hyperactivity and impulsiveness present, in a way he's luckier than I was at his age. For some reason, my hyperactivity didn't present itself until I was older, so if I had been diagnosed then, I would have been diagnosed with the subtype of Attention Deficit Hyperactivity Disorder called Predominantly Inattentive Type (IN). This subtype of ADHD is frequently called Attention Deficit Disorder or ADD, but here I will refer to it IN. 

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    I wasn't diagnosed with ADHD until fairly late in life, in my late thirties. This was partly due to my growing up in the late sixties and seventies, when mental health professionals had just left off calling ADHD "Minimal Brain Dysfunction." But to a great extent it was due to the fact that I was not hyperactive. I was "inattentive" and "distractible." Those are the technical terms for my behavior. On my report cards and in parent-teacher conferences my teachers said: "she daydreams," "doesn't pay attention" and "she's smart, and she could do very well in school...if she'd just make the effort." However, I had no behavioral problems and wasn't disruptive. Unlike my son, I never saw the inside of the principal's office.


    And therein lies the real problem for children with IN. They're generally as well behaved as children without a disorder, so they tend to escape notice. As problematic as it is for a child (and his parents and teachers) to deal with the hyperactive/impulsive aspect of ADHD, they do get noticed, and more often than not, steps are taken to get them diagnosed.


    It's crucial that children with IN be diagnosed. Two studies published last year indicate that inattention is probably more detrimental to a child's educational success than hyperactivity/impulsivity.


    According to the DSM, if your child has had at least six of the following symptoms for at least six months (to the extent that they are adversely affecting his schoolwork and personal relationships), it is essential that you make an appointment with a psychiatrist for evaluation (if possible, a child psychiatrist):


    (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
    (b) often has difficulty sustaining attention in tasks or play activity
    (c) often does not seem to listen when spoken to directly
    (d) often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
    (e) often has difficulty organizing tasks and activities
    (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

  • (g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)

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    (h) is often easily distracted by extraneous stimuli
    (i) is often forgetful in daily activities


    ScienceDaily.  (29 August 2011).  School Support for ADHD Children May Be Missing the Mark: Inattention, Not Hyperactivity, Is Associated with Educational Failure.  Science News.  Retrieved from http://www.sciencedaily.com/releases/2011/08/110829070608.htm.


    Shuf-Fen Gau, Susan, M.D., Ph.D. (1 November 2011).  Childhood Trajectories of Inattention Symptoms Predicting Educational Attainment in Young Adults.  American Journal of Psychiatry. Retrieved from http://ajp.psychiatryonline.org/article.aspx?articleid=180158.


    United Press International, Inc.  (30 August 2011).  Inattention: Why ADHD Kids Don't Graduate.  Health News.  Retrieved from http://www.upi.com/Health_News/2011/08/30/Inattention-Why-ADHD-kids-dont-graduate/UPI-48521314678710/.

Published On: April 18, 2012