Attention deficit hyperactivity disorder inattentive
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Understanding Inattentiveness in Attention-Deficit/Hyperactivity Disorder (ADHD)
Introduction to ADHD and Inattentiveness
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. These symptoms significantly impact the functioning, productivity, and quality of life of individuals with ADHD . Among these symptoms, inattentiveness plays a crucial role but has been relatively less studied compared to hyperactivity and impulsivity .
Genetic and Environmental Influences on Inattentiveness
Research indicates that ADHD, including its inattentive symptoms, is highly heritable. Genetic factors account for approximately 71% of the variance in inattentiveness . Interestingly, the type of genetic influence differs between inattentiveness and hyperactivity. Dominant genetic effects are more significant for inattentiveness, whereas additive genetic effects are more prominent for hyperactivity . Environmental factors, although present, have a smaller impact on inattentiveness compared to genetic factors .
Neurobiological Distinctions in Inattentive ADHD
Inattentive ADHD (ADHD-I) is proposed to be neurobiologically distinct from the combined type of ADHD (ADHD-C). The primary disturbance in ADHD-I is suggested to be in the cortex, particularly involving a frontal-parietal loop, as opposed to the striatum involvement seen in ADHD-C . This distinction implies that ADHD-I may involve issues with working memory and motivation rather than inhibitory control .
Validity of ADHD Subtypes
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies ADHD into three subtypes: predominantly inattentive (ADHD-I), predominantly hyperactive-impulsive (ADHD-H), and combined (ADHD-C) . While the DSM-IV criteria effectively identify individuals with significant impairments, the validity of these subtypes, particularly ADHD-H, is questioned due to their instability over time and minimal support for distinct etiological influences . An alternative model suggests using dimensional modifiers to reflect the number of inattention and hyperactivity-impulsivity symptoms at the time of assessment .
Genetic Associations with Inattentive ADHD
Genetic studies have identified associations between ADHD and specific genes, such as DRD5. This association appears to be confined to the predominantly inattentive and combined subtypes of ADHD . These findings underscore the importance of genetic factors in understanding the etiology of inattentive ADHD.
Long-Term Outcomes and Treatment
Long-term outcomes for individuals with ADHD, including those with inattentive symptoms, are generally poorer compared to those without ADHD. However, treatment, whether pharmacological, non-pharmacological, or multimodal, can improve these outcomes, although not to normal levels . This highlights the importance of early and sustained intervention for individuals with ADHD to mitigate long-term negative impacts.
Conclusion
Inattentiveness in ADHD is a critical yet under-researched aspect of the disorder. Genetic factors play a significant role in its manifestation, and neurobiological distinctions suggest that inattentive ADHD may be fundamentally different from other subtypes. While current diagnostic criteria and treatments provide some relief, there is a need for more comprehensive and targeted approaches to better understand and manage inattentive symptoms in ADHD. Future research should continue to explore these distinctions and develop more effective interventions.
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