daydreaming"My son is 15, in Grade 9 and not a typical ADHD kid. He has the quiet ADD, the one where he is well behaved and compliant, he withdraws and everyone thinks he is getting it but in actual fact he is a million moons away.

He has struggled through school since he started school but works so hard to get through. He has learned to be organised and diligent â he never misses an assignment deadline and hardly ever leaves homework undone, unless it's maths and he has no idea where to go next.

We have had him on Ritalin which helped a little but not a major change, it also made him feel terrible.

Since then we have had him assessed by an Ed. Psychologist and for me the diagnosis was very unclear not a hands down ADD, dyslexia or anything, it was maybe this or maybe that there is something that is not computing but for me it clarified nothing and gave us no concrete solutions.

Slowly but surely he has become more and more anxious about school, more specifically writing tests and exams and his teachers are not the most understanding, â€" they often throw around very callous, unfeeling remarks about poor work ethic and laziness â€" which pushes him further into his cave.

We have now put him on Concerta which is helping a little but his anxiety is still there in a big way and his marks have not shown a marked improvement.

I am not sure what our options are now and where we go from here. I know I have a highly intelligent child but how do I unlock this in him and help him to achieve what he clearly has the potential to achieve?

Do you have any advice for me?"

Dave Pughe-Parry replies

This is a typical tale of the lesser known type of ADHD - the Inattentive Type. While this type are predominantly female, that is not exclusive.

As you described, medication is often not very effective. There is one critical characteristic between the Inattentive and Hyperactive type. Hyperactives have a very low arousal threshold, they have to stop themselves from impulsively doing a myriad of things. Along with this, they have a strong predisposition to procrastinate.

The Inattentives on the other hand have a very high arousal threshold. Despite making the decision to do something, they struggle to actually get aroused sufficiently to act. Opposite to the Hyperactives, this inability to act is not procrastination, it is what we call inertia. Like a heavy wet blanket, they simply can't, much to their own frustration, and often humiliation. Parents, partners, and teachers are exasperated and often cruelly cutting.

bored with homeworkThe Inattentive type spend a large part of their waking hours living in their highly intelligent brains. Paradoxically - ADHD is full of paradoxes and incomprehensibles - the Inattentive brain operates at warp speed - it is a very hyperactive brain. This is not a consequence of anything, just the way our brains operate.

You see, all ADHD brains are a wonderful place to spend time in. Most of our brain activity is in the occipital lobe, the rear of the right brain, where all humans think in pictures. We daydream in HD-3D, with 16.2 surround sound with multiple sub-woofers. In fact the only thing we can't do (yet) is recreate the smell.

But, we also brood with the same clarity and vividness. Because we don't manage time properly - that's a brain thing too, not wilful - and we have quite serious short-term memory loss, getting anxious about what we don't know (read can't remember) is very easy to do. Our brains are subject a continuous bombardment of sensory input that we cannot prioritise which input to pay attention to. We are often overwhelmed by just ordinary everyday living.

Your son needs to learn how to diminish the impact and effect of distraction, how to get out of dark moods that seem to sweep over for no apparent reason, how to get his self esteem up, and to start building a track record of success.

LADD Treatment WheelHere is our basic treatment wheel:

We work with the ADDer and the family - even the school - to get the environment adapted so he can flourish.

This is not an easy road to travel, nor a quick one, but it is achievable and extremely worthwhile.

A characteristic peculiar to the Inattentive type that has a bearing on this is that they are late bloomers. They will bloom - spectacularly bursting into their world any time from 28 years to about 35. Up until that time, they seem to be hibernating in a cocoon. They can function, but with difficulty.

Those that I have coached and provided with the very practical tools have done well, even in the cocoon, but the blooming is something magical to behold - you wonder where they have been and why it took so long.

The coaching is structured and targeted at specific areas identified in an impairments assessment, which is where we start.

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