'Inattentive' ADHD is serious disorder

Question: I wonder why ADHD-inattentive type was not mentioned in your recent column on attention deficit hyperactivity disorder (ADHD). From the research I have done, it seems as if the manifestation of this disorder is quite different from the hyperactive, impulsive type of ADHD you described.

In childhood, people with the inattentive type are likely to be shy, sluggish and prone to daydreaming. They are also more likely to report symptoms of depression and anxiety.

It is my experience that ADHD-inattentive type is also ignored in the schools. These kids don't cause problems, so their cognitive deficits are overlooked. This is a serious disorder that has lifelong consequences affecting success and self-esteem. By ignoring it, you have helped perpetuate the illusion that it is not a problem. -- M.D., Tomball, Texas

Answer: Thanks for writing to us with this important information. We wish we had been able to cover this disorder in our column on ADHD, as well as others in which early identification, careful evaluation and treatment can make such a big difference. Unfortunately, space did not allow us to.

Attention deficit hyperactivity disorder, inattentive type, is seen as a subtype of ADHD. A child with this form of the disorder may appear forgetful, careless and oblivious to details. Parents and teachers are bound to feel that she is "off in her own world," as if she is not listening and won't do what she's told.

Such children often are distractible. They have difficulty following instructions and completing tasks. Often they avoid tasks that demand focused attention.

It's easy to see how children like this who do not receive help early soon learn to feel like failures.

Of course, most children can seem forgetful or distractible from time to time. The diagnosis of ADHD-inattentive type is made only when these and other symptoms are persistent and when they cause serious interference in more than one area of a child's life (for example, social interactions and schoolwork). The predominant symptom is usually present before age 7.

Parents should know that inattention, hyperactivity and impulsivity can be symptoms of other disorders. They are also seen in children who are under stress.

Anxiety and depression certainly can accompany ADHD, whether the predominant symptom is inattention or not. But anxiety, depression and other disorders are also, at times, misdiagnosed as ADHD.

Auditory processing and memory problems (when a child can't remember, make sense of or keep track of what he hears) can also make a child seem inattentive. Gifted children in settings that do not challenge them may also appear inattentive.

Perhaps we are doing a disservice to the children you are so rightly advocating for when we lump what may in some cases be different disorders under one heading: ADHD. As a result, we may not be able to individualize our understanding of children's needs. Or, as you point out, we may fail to identify other children who could be helped.

Children with ADHD inattentive type deserve individualized attention, and we are grateful that you have called this subtype of ADHD to our readers' attention.

Question: My boyfriend has a daughter who will soon turn 6. We are both very concerned that she is not yet potty-trained.

Her mother has custody of her, and we only get to see her every other weekend. When she is with us, she seems willing to forgo her diapers, but then she gets upset and says things like "I need to use them. Mommy just bought me these." Sometimes she throws a tantrum.

I do not have a good relationship with her mother, and I don't feel that I should interfere with raising her child. Her ex-husband has talked to her, to no avail.

Her mother has kept her out of school (because they don't accept children in diapers). Children have been teasing her. We're very worried about her. Do you have any advice on how to deal with this? - - Name and address withheld

Answer: We are worried about her, too. The fact that she has to be kept out of school and that children are teasing her shows that this delayed training is already invading her life.

Self-esteem is at stake when a child's toilet training is delayed, for other children may begin to embarrass her and shun her.

You are, of course, in a difficult position to make suggestions to her mother. We suggest that her father contact her pediatrician to discuss the delayed training and the serious consequences you describe. If at all possible, he and the girl's mother should do this together.

From your account, it certainly seems like time to seek help -- medical and psychological -- for this child.

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 122 E. 42nd St., New York, N.Y. 10168. Questions may also be sent by e-mail to: nytsyn- families@nytimes.com. Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well- being, consult your child's health-care provider.

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