Inattentive ADD: Working with the Wandering Mind               
by Debra Moore, Brainworks

Although the specific nature of inattentiveness may still be debated by clinical specialists, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) recognizes the condition as a distinct subtype of Attention Deficit Hyperactivity Disorder (ADHD). The criteria for this predominantly inattentive variation mirrors many of the same problem areas associated with the hyperactive subtype, including difficulties with tracking details, sustaining attention, and organizing tasks. However, inattentiveness is most often defined in terms of how it differs from hyperactivity. Usually, inattentive students do not fidget, talk excessively, or have problems staying seated. Unlike hyperactives, they are overwhelmed rather than energized by stimulating situations, and they donít have problems finishing tasks so much as getting started on them. They donít react impulsively; in fact, they may not appear to react at all. As disorders come and go, inattentiveness definitely qualifies as understated.

 The conditionís low profile is reflected by the lack of information available on the topic; research and professional publications devoted specifically to inattention are scarce in comparison to the volumes of material generated on hyperactivity. Moreover, while hyperactive children are often identified through behavioral evaluations in their early school years, inattentive individuals may not be diagnosed as having learning problems until late in life, if they are identified at all. Clearly, the dramatic and observable behaviors of hyperactives receive more attention from ADHD experts and from society as a whole, but it would be a mistake to categorize inattentiveness as a mild form of ADHD. While inattentive behaviors may not be colorful or spectacular, the consequences of these behaviors can be equally tragic.

 Inattentive Tendencies 

In order for educators, counselors, and parents to assist inattentive students with successful management strategies, they must reach an understanding of the condition, but reaching this understanding is a challenge in itself. In terms of emotional issues, inattentive people tend to channel their feelings inwardly rather than express themselves openly; when faced with a crisis, they typically detach from the situation instead of taking action. Often characterized as passive daydreamers, their general unresponsiveness constitutes a barrier between themselves and others. Penetrating this barrier, even in face-to-face conversations, is an endeavor that frequently ends up as an exercise in frustration.

 Another inattentive tendency could be summarized by the adage, appearances are deceiving. Inattentive students often seem to be paying attention as they sit quietly, and, indeed, they may stare directly at the instructor for an entire class period. Yet, during this time, their thoughts have drifted from the real world around them. In such instances, their bodies remain stationary while their minds wander aimlessly through a universe of ideas and images; frequently, their academic performance reflects this lack of connection with classroom activities. 

Personal Issues

The personal lives of inattentives also tend to be less than satisfactory. They often have difficulties acquiring the basic communication skills necessary for socialization with peers and for negotiation with authority figures. Their inability to maintain concentration makes them poor listeners, and their lack of assertiveness makes it easy for them to be overlooked and to be lost in the crowd.  

Family dynamics can be equally troublesome, particularly if parents become trapped in a cycle of protecting an inattentive child from the consequences of his/her inactions. What may have begun as well-meaning attempts to help a child through a series of crisis situations soon falls into a pattern in which the inattentive individual automatically expects rescue, a condition which experts call learned helplessness. While parents focus on helping the child survive the immediate crisis, they hold to the hope that next time will be different. In the long run, their attempts to help actually reinforce the behaviors that triggered the crisis in the first place. Denied the opportunity to take charge of the problem and work toward a solution, the inattentive child does not develop the skills or the confidence needed to face the next emergency.   

Management Strategies 

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 personís general ability to focus and sustain attention. For many inattentives, achieving sustained attention may involve therapeutic medications as well as specific practice with concentration exercises. In most cases, medication can facilitate the acquisition of skills, but research and clinical experience have demonstrated medication alone will not cure the skill deficiencies which have plagued the inattentive individual throughout her or his lifetime. 

Remediation programs for inattentive clients at Brainworks typically include attention span training in fundamental areas such as listening skills and reading comprehension. On more advanced levels, clients may practice maintaining concentration for taking lecture notes as well as sustaining attention during lengthy test-taking sessions. As training sessions begin, clients work with high interest materials for only a few minutes at a time, but as their ability to concentrate improves, they move to less interesting materials and gradually extend the length of time they maintain their focus. Also, attention span training involves strengthening the individualís ability to screen environmental distractions; at the start, students practice maintaining attention in isolated study rooms, but as training proceeds, they work on maintaining their concentration in open areas with higher degrees of visual and auditory distractions present. 

Lines of Communication 

Listening skills are given special emphasis in the lesson plans of many clients because the ability to capture auditory information has a direct impact on school achievement. However, listening exerts an even more pervasive influence as an element in the communication process. Although listening appears to be a passive activity, effective listening requires the active engagement of both the brain and the ears. If the person on the receiving end of a spoken message does not capture the incoming information accurately, that personís response to the information will also be inaccurate. At this point in the conversation, communication stalls from lack of feedback, or (worse) it degenerates into confusion or conflict because the listenerís feedback was inappropriate. In conjunction with improving listening skills, clients address the skills on the other side of the communication coin by working on personal expression. People who are able to express themselves clearly will usually find success at getting their needs met; they will also feel more confident in their relationships and will experience less frustration. As our inattentive clients work on improving their expressive skills, they begin by exploring the emotional responses words can prompt and by learning how to rephrase statements to achieve the desired response from listeners. Inattentive clients at Brainworks also devote time to increasing their awareness of other areas of communication, such as body language, facial expressions, eye contact, and tone of voice. Eventually, all the tools of communication are tested in face-to-face conversations on a wide range of topics. 

Independent Problem-Solving 

After an inattentive individual is able to maintain an attention span and communicate successfully, he or she is ready to put these skills into action in problem-solving applications. In these advanced activities, clients review the principles of basic logic and critical thinking, including the errors in logical thinking which can hinder a personís ability to perceive a problem accurately. In addition, they learn structured strategies for analyzing problem situations, developing multiple options for solutions, and evaluating which options would produce the most positive outcomes. Clients also review how to monitor their solutions for effectiveness and how to adjust their solution strategies when necessary.  

As clients are introduced to the skills, they practice applying them to sample problem situations, which reflect typical real life problems. Because these problem scenarios are about fictional third-party characters, the exercises are less personally threatening and thus more approachable. However, as the inattentive client begins to grasp the principles and processes for dealing with these fictional problems, the lesson plans gradually shift to addressing the actual problem situations faced by that individual. Eventually, the client assumes a take-charge role in terms of negotiations and crisis resolution; the formerly dependent helpless inattentive becomes an independent problem-solver. 

Lost and Found  

The most insidious quality of inattentiveness is its quiet invisibility. While it has the power to erode the lives of those who exist in the world of the wandering mind, it does so without fanfare or fireworks. Inattentives can easily become lost in the shuffle of society and may never experience the power of self-direction and personal accomplishments. However, with the proper management strategies, these same individuals can find themselves by finding success in school, at the work place, and in relationships.

Reprinted with permission from the ADDA-SR Fall 2000 Newsletter.