Attention Deficit Without Hyperactivity: Symptoms And Causes
Attention deficit hyperactivity disorder, commonly known by the abbreviation “ADHD,” is characterized by two distinct sets of symptoms: those related to excessive activity and behavioral impulsivity and those due to attention problems. focused and sustained.
We speak of “attention deficit disorder without hyperactivity” in cases in which the symptoms of inattention clearly predominate over those of hyperactivity and impulsivity. In this article we will analyze The characteristics, symptoms and neuropsychological causes of attention deficit without hyperactivity.
In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders, commonly known as “DSM-III”, appeared. In this version of the manual, the nomenclature “hyperkinetic reaction in childhood” was replaced by “attention deficit disorder”, leaving hyperactivity in the background at the diagnostic level.
This change in perspective was mainly due to the research of Canadian psychologist Virginia Douglas, whose results suggested that the core clinical aspects of this disorder are the difficulties paying sustained attention to stimuli to inhibit impulses and for the organization of cognitive processes.
Consequently, starting in the 1980s, a distinction began to be made between two subtypes of attention deficit disorder: one in which hyperactivity symptoms predominate, equivalent to the classic form of the syndrome, and another in which these types of signs do not exist or They are less clinically relevant than inattention and/or behavioral impulsivity.
In the DSM-IV and in the 5, which has appeared very recently, two categories of symptoms are distinguished when describing attention deficit hyperactivity disorder: those of inattention, such as problems organizing tasks and ease of distraction and those of hyperactivity and impulsivity (excessive physical and verbal activity, interrupting others, etc.).
Main symptoms and clinical picture
Attention deficit disorder without hyperactivity or predominantly inattentive disorder are characterized above all by the presence of symptoms derived from neurological problems that interfere with brain inhibition mechanisms. This makes people with this disorder have difficulty maintaining focused and sustained attention.
In this sense, the DSM-5 states that this variant of ADHD should be diagnosed when a child presents at least 6 of these symptoms markedly and persistently from before the age of 12 (in the case of adolescents and adults, 5 signs are sufficient):
On the other hand, in these cases the symptoms and signs of hyperactivity and/or impulsivity are significantly milder than those associated with attention deficits. There is also a mixed type in which important symptoms of these two main dimensions are combined.
For decades, attention deficit disorder without hyperactivity has been linked to slow cognitive tempo, characterized by hypoactivity, slowness, laziness and mental confusion. It is currently known that it also appears in cases with a predominance of hyperactivity and impulsiveness and in other psychological disorders, so it is not specific to this problem.
Causes and neuropsychological characteristics
According to the review of the available scientific evidence carried out by Adele Diamond (2006), the main cognitive problem of people with attention deficit without hyperactivity is found in operational or working memory. This set of processes allows us to store short-term information and perform operations on it.
Diamond states that the signs detected in those who have this disorder are not due so much to their greater ease of distraction or behavioral inhibition, which has been frequently proposed, but rather to the fact that They get bored easily due to chronic brain underactivity. This would explain his lack of motivation for many tasks.
At a biological-structural level, these problems seem to be related to the connections between the frontal and parietal cortex. While motor skills and executive functions, such as behavioral inhibition and planning, depend mainly on the frontal lobes of the brain, the parietal lobes are responsible for symbolic and arithmetic processing, among other functions.
Diamond’s meta-analysis suggests that the differences detected between predominantly inattentive and hyperactive/impulsive ADHD (in terms of neurological alterations, symptoms, psychopathological comorbidities and response to medication) could be sufficient to justify the division of this disorder into two distinct syndromes.
Diamond, A. (2006). Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity). Development and Psychopathology, 17(3): 807-825.
