Quiet ADHD? What Are the Symptoms? | Songdo ADHD

Quiet ADHD? What are the symptoms? | Songdo ADHD

Hello, this is Baekrokdam Korean Medicine Clinic.

Are you perhaps someone like this?

You often hear that you are quiet and well-behaved around others, but... your head is always cluttered, you are always tired, and tasks keep piling up.

You sit down to concentrate but other thoughts keep intruding, you procrastinate on tasks again today and engage in self-blame, and at night you wonder why you are like this... thoughts keep chain-reacting.

These are common concerns that people like this experience.

"Could this be ADHD? But I am not really distracted..."
"Am I just lazy? Why can I not do this?"

Today, we would like to share the concept of "Quiet ADHD" for those people.

Quiet, yet why are you so tired?

When we think of ADHD, the image that usually comes to mind is being distracted, running out of class, and talking non-stop. However, not all ADHD manifests that loudly.

Some people are not distracted at all. They are actually too quiet, too well-behaved, and trying too hard alone. But their heads are truly cluttered.

They have many tasks to do but cannot get started, they plan and plan only in their heads, cannot execute, and end up exhausted in their daily life.

But people around them say things like this:
"You seem quiet and fine"
"Just pull yourself together, you just lack willpower"

But the person knows. I am really trying my best... but something keeps not working.

What is Quiet ADHD?

Quiet ADHD is actually not an official diagnostic term. It was not a concept created by doctors either. Quite the opposite.

Countless people, especially girls and adult women, saying "I do not think I have ADHD... something feels off" and "Am I the only one this tired and distracted?" gradually made this concept clearer and more distinct.

In the DSM-5 diagnostic criteria, it may correspond to Predominantly Inattentive ADHD, but Quiet ADHD has a much broader spectrum than that.

The characteristics are as follows.

• Does not appear distracted
• No hyperactivity
• But the mind is hyperactive
• Too many thoughts, thoughts and emotions tangle together making escape difficult
• Weak executive function, slow decision-making, frequent procrastination
• Frequent self-blame, declining self-esteem
• But nobody realizes this person is struggling

In other words, there is no external problematic behavior characteristic of ADHD, but internally there is a continuous dissonance between executive function and emotion.

A diagnostic blind spot

Quiet ADHD is extremely difficult to diagnose. Because it does not "cause" problems. Teachers and parents quickly notice children who cause problems in the classroom. But quiet, well-behaved children are simply seen as "good children."

In particular, girls often miss this diagnosis. Because according to social norms, a "quiet little girl" is not unusual. In fact, they seem well-adjusted.

But the inside is different. They are always tired, their self-esteem is chipped away, and they repeat the thought "Why can I not do this?" And only when they become adults do they belatedly realize. Ah, I was struggling back then.

Obsessive thoughts? Anxiety disorder? Or ADHD?

The reason Quiet ADHD is difficult is because the symptoms also overlap with anxiety disorders, obsessive thoughts, and depression.

• Too many random thoughts in your head? → Anxiety disorder?
• Repeatedly falling into the same thoughts? → Obsessive thoughts?
• Frequently procrastinating, severe self-blame? →

  Depression?

However, inattentive ADHD is similar to these but slightly different. The biggest differences are attention switching and executive function.

You clearly recognize the tasks that need to be done in your head, but it does not lead to execution. And as you repeatedly fail, feelings of self-blame accumulate. This is not a simple mood issue, but a state where the brain's 'organizational ability,' 'priority setting,' and 'task initiation' functions are weak.

How should it be treated?

Rather than blindly using stimulant-centered medications as with typical ADHD, inattentive ADHD requires a more delicate approach.

Stimulants that are too strong can worsen anxiety and mood swings, and training to strengthen executive function is key. Structured conversations that explain 'why this isn't working' are necessary.

Cognitive behavioral therapy is good, and emotion-acceptance-based approaches such as ACT (Acceptance and Commitment Therapy) are also a good fit. Additionally, from a Korean medicine perspective, treatments that calm excessive thinking in the mind and coordinate the routines of body and mind through diagnoses such as Simsin-buran (mental-physical instability), Simbi-bulgyo (heart-spleen deficiency), and Ganul-giche (liver qi stagnation) can be effective.

For example, in cases of excessive thinking, poor sleep, and loss of appetite, Sanjoin-tang or Ondam-tang series are effective; for women with mood swings and severe influence from the menstrual cycle, Gami-soyosan series may be applied.

Being 'quiet' does not mean it is okay

'Inattentive ADHD' is not a disease name, but a narrative. Many people who could not reveal their inner complexity have gained a single word to describe themselves.

Having a name that allows you to understand yourself is, in itself, the starting point of recovery.

If you are also someone who always tries their best but has a mind that is too cluttered, consider the possibility of inattentive ADHD at least once.

It is not your fault, nor is it laziness or a lack of will.
You may have endured far too much in silence until now.

#ADHD #InattentiveADHD