So let’s talk about this [VG] type. The kids who come to see us who don’t show problems with hyperactivity, who aren’t impulsive... This is a real attention disorder with real information processing deficits, and it has little in common with the other two kinds of [AH]. The hyperactive type ... and the combined type ... are the same disorder...
...Because [VG] children come in with the opposite symptoms. Instead of being hyperactive, intrusive, distractible, [VG kids] are lethargic, slow-moving, hypoactive, spacey, daydreamy, quiet, passive, withdrawn, confused, in a fog. [VG kids] are the polar opposite of the [AH] child in their clinical presentation.
...[VG kids] have deficits in an area we call selective attention. Selective attention is how quickly you can deduce what’s important from unimportant in a spatial array of information, how fast you accurately process information coming at you. [AH] children have no trouble with selective attention.
[VG] kids make more mistakes in academic work than [AH] children do, many more mistakes. The problem that [AH] children have is with productivity; number of problems attempted. The problem with [VG] kids is accuracy. The number of errors made, so that [VG] kids have a real problem with input coming into the brain, how quickly [VG kids] can handle it, how accurately [VG kids] can select it out, and deal with it. [VG] children have memory problems. [AH] children do not. [VG] children have trouble with getting information out of short term and long term memory and doing it correctly... [VG] children have a very different social profile.
The traditional [AH] child is often a rejected child, because [AH kids] are immature, and emotional, and hot headed, and demanding and controlling and impulsive and often aggressive, so that when we compute a social profile of the [AH] children often wind up as being the least liked, the least popular and most likely to fight.
[VG kids] are the staring, daydreamy, hypoactive... Unengaged is a better term for them. [VG kids] are not disliked by the other kids. [VG kids] are not rejected by them. The other kids just don’t know them. [VG kids] are not engaging. [VG kids] are not out there participating. [VG kids] are just kind of passive kids. [VG kids] have more friends than [AH] children have, actually...
Other differences: there is no affinity of this disorder for Oppositional (Defiant) or conduct disorder that we can tell. [VG kids] basically have the same base rates as the normal population.... Those three disorders - [AH], ODD and CD - are all part of a larger category we call the disruptive disorders.
Other differences that we see: by definition of course [VG] kids are not impulsive. [VG kids] don’t have any difficulties with inhibition... Ninety-two percent of [AH] children respond to stimulants. Twenty percent of [VG] children respond to stimulants... [AH] children tend to better on moderate to high doses. ..if [VG kids] are going to respond at all, it’s at very light doses, small doses.
Do not treat them the same and do not tell their parents to read the books on [AH kids] that are at ... your local bookstore ... because those books are not about this group. Those books, including my own, are about that hyperactive, impulsive group of kids. There are only two pages in my parents book, Taking Charge of ADHD, on [VG kids], and it tells you what I just told you... You are just going to have to cobble together some help any way you can and hope that it works, because there is no science beyond what I just told you.
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