A Review of "ADD: Practical Coping Methods" by Barbara Fisher

Although a lot of books have been written on ADHD there are very few books that focus on Inattentive ADHD.

Best sellers like Driven to Distraction usually devote a few pages to discussing this disorder and often leave the reader confused about which type of ADD the author is referring to.

In ADD: Practical Coping Methods, Barbara Fisher, a neuropsychologist, takes an in-depth look at the differences between ADHD Inattentive type and the impulsive/hyperactive type of ADHD.

A summary of Fisher's desricption of the two types of ADD can be found here.

According to Fisher, Inattentive ADHD is an anxiety driven disorder. People with inattentive ADD tend to have introverted personalities and are physically restless because they have high levels of anxiety. This helps explain why many people with ADHD Inattentive type have a poorer response to stimulant medications than those with classic ADHD. The boost in concentration that stimulants provide is often undermined by increased anxiety and muscle tension.

Fisher claims those with ADHD have a profound problem with impulse control, which is not shared by those with inattentive ADD. Genuine hyperactivity in ADHD is caused not by anxiety, but by problems with the frontal lobes of the brain, which encourages people who are impulsive and hyperactive to seek out novel, dramatic or dangerous situations.

Fisher claims that many people with inattentive ADD are being misdiagnosed because their restless anxiety is being mistaken for impulsive hyperactivity.

From the perspective of someone with inattentive ADHD, Fisher's book is the best on the market, simply because there aren’t any other books which devote as many pages to discussing this type of ADD. The only book which comes close is Sari Solden’s Journey’s Through Addulthood.

Fisher’s book does have some shortcomings. For example, she suggests that people with inattentive ADD should take calcium with stimulants to reduce anxiety, despite the fact there are no scientific studies (as far as I know) that support this idea. Fisher is no English major and her prose is pretty stiff and awkward at times. She is also unable to explain why some people with inattentive ADD appear hypoactive and don’t seem to have significant problems with anxiety.

However, Fisher’s book is clear and well reasoned and unless someone comes up with something better it will remain the best book on inattentive ADD for some time to come.

Inattentive ADHD and Caffeine

At Johnath’s Blog there is an interesting article on the effects of Caffeine.

He makes the point that a stimulant like Caffeine is probably only useful if you are feeling tired. If you are already feeling tense and alert then Caffeine is likely to be counter-productive.

I have also read that the impact of caffeine varies between extroverts and introverts. Introverts are more likely to benefit from caffeine in the evening since they are more likely to be afternoon people, while extroverts are more likely to benefit from caffeine in the morning. Since people with Inattentive ADD tend to be introverts, they may benefit from using caffeine as an afternoon pick-me-up.

Many people with Inattentive ADD though have high anxiety levels, which are made worse by high levels of caffeine. This also means that they don’t tend to respond well to stimulant medication.

I usually only drink a couple of cups of tea in the morning and can’t sleep well if I drink caffeine in the evening.

ADD Definitions

As someone who thinks ADHD is very different to ADD Without Hyperactivity, I am a little annoyed with the latest ADD definitions that have been adopted by the American Psychiatric Association.

Whereas the two disorders were previously defined separately, ADD Without Hyperactivity is now a subset of ADHD. ADD without hyperactivity is now called ADHD Inattentive type. However, it could have been worse, for a while ADD Without Hyperactivity was called ADHD Undifferentiated type.

Although it may make scientific sense to label ADD/WO as a subset of ADHD it only adds to confusion among the public. ADD/WO is also a far less conspicuous type of disorder since people with ADD/WO tend to be fairly quiet introverts that don’t have significant behaviour problems.Hence it isn’t in the interest of people with this disorder to be put under the ADHD label.

Many of those that are sceptical of the existence of ADHD believe it is an excuse for bad behaviour. However, if it is shown that a sizeable percentage of people with attention problems don’t have behaviour problems then the sceptics will be forced to reappraise their opinions.

Calling ADD without hyperactivity inattentive ADHD is likely to confirm the popular view that ADD is primarily about hyperactivity and impulsive behaviour.

However, in my posts I'll go along with the new definitions to avoid adding to the confusion.

ADD and body type

Neurophyschologist Barbara Fisher describes people with Inattentive ADHD as anxious and unable to relax.

Conversely, other ADD experts claim that many people with Inattentive ADHD tend to be lethargic and hypoactive. These contradictory descriptions may possibly be related to body type.

Males tend to fall into three main body types: mesomorphs, endomorphs and ectomorphs. Mesodomorphs tend to be muscular and moderately energetic, ectomorphs tend to thin and nervy, while Endomorphs tend to be sluggish, easy-going and prone to putting on fat. Women also fall into these three main body types although the differences are not usually as pronounced.

Hence it may be that Inattentive ADD types who are hypoactive tend towards the endomorphic body type, while Inattentive ADD types who are anxious and restless lean towards the ectomorphic type.

I tend to have a lot of physical restlessness with my ADD symptoms and I definitely have an ectomorphic body type. I usually constantly fiddle with things like pens and find it hard to sit still and concentrate if I don’t get some physical exercise during the day. Even though I tend to be short on mental energy a lot of time I usually have plenty of physical energy.