Inattentive ADHD: The Often-Missed Subtype in Assessment
This post on inattentive ADHD is written by Sarah Krogh, MS
Key Insights
- Recognize What Inattentive ADHD Actually Looks Like – Unlike hyperactive/impulsive ADHD, inattentive ADHD isn’t disruptive or flashy. It shows up as disorganization, careless mistakes, losing items, forgetting routines, and difficulty maintaining focus on uninteresting tasks.
- Understand the Overlap With Sensory Overload – Inattentive ADHD’s sensory overload happens when the brain struggles to filter out background noise or stimuli, leading to mental exhaustion, irritability, or brain fog. This differs from autism’s sensory overload, which involves specific, consistent triggers and can result in stimming behaviors.
- Notice the Masking Effect During Evaluations – Students with inattentive ADHD can appear polite, quiet, and compliant during assessments, sitting still and making eye contact, while internally losing track of time or questions, making careless mistakes, and struggling to stay focused.
- Distinguish It From Overlapping Conditions – Inattentive ADHD can resemble anxiety, depression, or autism on the surface, but key differences exist. For example, depression’s core symptoms like depressed mood or feelings of worthlessness don’t overlap with inattentive ADHD.
- Seek Comprehensive, Informed Assessment – Proper evaluation should include executive functioning testing, developmental history review, continuous performance tests, and repeated directions when needed, since presentation varies significantly from person to person.
When people think of Attention Deficit Hyperactivity Disorder (ADHD), they often picture hyperactivity: a child full of energy unable to slow down, sit still, or follow rules. But hyperactive/impulsive is just one subtype of ADHD. Oftentimes, the inattentive subtype is overlooked because it isn’t big, flashy, or disruptive. But inattentive ADHD still impacts daily functioning and the ability to focus. So, what can inattentive ADHD be mistaken for? What exactly does inattentive ADHD look like in different settings? How can teachers and psychologists look for some of these signs during assessments? And finally, what are some treatment options?
What Inattentive ADHD Can Be Mistaken For
Inattentive ADHD can be mistaken for anxiety because they can both involve trouble focusing and staying organized. For anxiety, this can be due to constant worry and nervousness. For inattentive ADHD, this is due to difficulty concentrating and maintaining focus and organization.
Inattentive ADHD can be mistaken for depression because they can both have mental fatigue, low motivation, and trouble remembering information. Other symptoms of depression, like depressed mood, loss of interest in normal activities or items, feelings of worthlessness, and potential suicidal ideation, do not overlap with inattentive ADHD.
Inattentive ADHD can also be mistaken for autism because they can both involve social communication challenges and sensory overload. For autism, sensory overload involves too much or too little reactivity to a specific thing. An example could be bright lights, clothing tags, etc. These high-intensity “triggers” are specific and consistent, often building up mental stress over time. Overload can result in emotional dysregulation, and stimming behaviors to self-soothe can be seen. For inattentive ADHD, sensory overload can occur when the brain struggles to filter out background information like noises, lights, etc., such as when too many items grab your attention all at once. The brain gets exhausted trying to focus on just one thing. Overload can look like mental exhaustion, irritability, or brain fog.
How Inattentive ADHD Shows Up at Home, School, and During Assessments
At school, inattentive ADHD could look like struggling to stay organized with assignments, making careless mistakes on assignments and exams, fidgeting at their desk and appearing restless, often losing and misplacing assignments, pencils, jackets, and other classroom materials, submitting incomplete assignments and struggling to maintain effort for uninteresting tasks, trouble focusing during lectures and when taking exams, “zoning out” and daydreaming, and being easily distracted by random noises or movement with difficulty returning focus to the task.
At home, inattentive ADHD could look like struggling to keep their room or house/apartment organized and clean, often losing items like a cellphone or car keys, forgetting daily tasks or routines like brushing teeth or remembering to take personal items when leaving home, trouble focusing during activities that involve multiple steps, avoiding chores or tasks that require more focus like cleaning their room or organizing a backpack, and shutting down or becoming irritable after school due to using all their mental energy to try and stay focused and behave in class.
For psychologists completing psychological evaluations and for teachers conducting standardized testing, inattentive ADHD could look like fidgeting in their chair, twirling a pen, tapping a foot, losing track of time or answering questions and needing prompts repeated, making careless mistakes when answering questions or on timed tasks, being easily distracted by random noises or movement, and having difficulty returning focus, all while remaining polite and compliant, often sitting quietly and making eye contact (which can mask internal racing or drifting thoughts).
Supporting Inattentive ADHD: Assessment and Treatment
So, how can psychologists and teachers account for inattentive ADHD during assessments? The first step is recognizing how inattentive ADHD can affect assessment scoring, with particular attention to working memory and processing speed. Within the standardization of the exams and to the best of their ability, they can allow the repetition of directions and questions whenever possible during standardized assessments. They can take detailed notes on the student’s performance, noting any lapses in reaction time, repeated prompts, etc. These notes can be super helpful when planning interventions. Psychologists can also conduct executive functioning assessments that measure working memory, processing speed, and organizational skills to help rule out any conditions that could have similar presentations and evaluate developmental history to look for signs of ADHD present across multiple settings and over time. Another thing psychologists can do is conduct continuous performance tests that measure sustained attention and reaction time over long periods. Now that we know what inattentive ADHD looks like and have a professional diagnosis, what are some treatment options?
- Accommodations for school and/or work
- Therapy and coaching can help build better daily routines and improve time management and self-regulation skills
- Medications can help regulate focus
- Environmental tools like timers, checklists, quiet workspaces, and support from teachers and parents can help with staying on track
In Summary
Overall, it is most important to recognize that the presentation, or the unique combination of symptoms, can be different for everyone. Inattentive ADHD can often be mistaken for other conditions and, because of its nondisruptive nature, can go unnoticed by teachers in school. Understanding the common symptoms of inattentive ADHD and how they can present in different settings is the first step towards a proper diagnosis and planning interventions.
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