attention - deficit / hyperactivity disorder ( adhd ) is a behavioral disorder usually diagnosed during childhood .
it is characterized by developmentally inappropriate symptoms of inattention , hyperactivity and impulsivity and significant impairment in multiple domains of functioning .
diagnostic and statistical manual of mental disorders ( dsm - iv ) diagnostic criteria define three adhd subtypes based on the presence of inattention and hyperactivity / impulsivity symptoms : predominantly inattentive type , predominantly hyperactive / impulsive type , and combined type . a recent us national epidemiological study of 8- to 15-year - old school children found an 8.7% prevalence of adhd , with the predominantly inattentive type most prevalent ( 4.4% ) among the adhd subtypes ( combined type , 2.2% ; predominantly hyperactive - impulsive type , 2.0% ) .
the behavioral manifestations of adhd inattentive type differ from those associated with combined and hyperactive / impulsive type .
children with combined and hyperactive / impulsive type exhibit problems with behavioral inhibition , including interrupting , blurting out , getting out of their seat at inappropriate times , and playing loudly .
in contrast , the primary difficulties of children with inattentive type are non - disruptive in nature and are related to planning and organizing actions .
children with inattentive type often forget to complete or lose assignments , procrastinate , complete work carelessly , have difficulty planning for the completion of long - term projects and studying for tests , and have problems keeping materials organized [ 7 - 9 ] .
three treatments qualify as  well - established interventions for children with adhd : psychopharmacological therapy , behavioral parent training , and behavioral classroom management .
psychopharmacological therapy ( e.g. stimulant medication ) is the most utilized intervention modality for treating patients with adhd and produces marked improvements in sustained attention , impulse control and noisy and disruptive behaviors .
while psychopharmacology ameliorates some of the core symptoms of adhd inattentive type , there is minimal evidence to suggest that medication promotes improvements in the ability to effectively plan and organize materials and/or actions . as such
, stimulant medication is only minimally effective in improving important areas of functioning such as long - term academic achievement .
similarly , evidence - based behavioral treatments , such as parent training and classroom management , primarily target impulsive and disruptive behaviors and do not focus on the problematic behaviors associated with inattentive type .
in the past 2 years , several advances have been made in the treatment of behaviors exhibited by children with adhd inattentive type .
interventions have been evaluated that target planning , materials organization , time - management , and homework management skills .
these interventions typically focus on behavior in the school setting as demands for these skills are greatest at school and can lead to significant academic impairment .
children are taught systems for organizing school materials and managing / planning homework responsibilities . checklists with operationalized definitions of behavior are used to monitor skills implementation . similar to existing evidence - based interventions for adhd , these interventions incorporate behavioral therapeutic techniques , such as rehearsal , prompting , shaping and contingency management , to teach and promote skills use and their generalization .
for example , point systems or token economies are often utilized to monitor and reward adherence .
interventions have been evaluated that target multiple aspects of organization and planning , including : classroom preparation , organization of bookbag , binder , and locker , and planning and tracking homework assignments and long - term projects .
these interventions are associated with short - term gains on process measures of materials organization , homework management , planning and procrastination .
some of these improvements appear to be sustainable for children with adhd as assessed at 8-week   and 3-month follow - ups . at this point , it is unclear if gains on process measures ( e.g. materials organization or homework management checklists ) are ultimately associated with improvement in functional outcomes such as school performance .
only a subset of studies completed to date included both process measures and measures of functional impairment .
documented improvements in organizational skills , parent ratings of homework problems , and grade point average . however , the gains in grade point average were relatively small .
pfiffner et al .   documented improvements in organizational skills and a clinician completed clinical global impression , and these gains were maintained at a 3- to 5-month follow - up .
abikoff and gallagher   showed improvements in both organizational skills and parent - rated homework problems , but it is unknown if improvements in homework problems resulted in overall academic improvements .
hence , alternative explanations for observed patient improvements are possible ( e.g. hawthorne effects ) .
in addition , generalization across settings was not formally assessed in most of the studies .
it would be important to determine if skills generalize across classrooms or from school to home .
the behavioral difficulties of patients with adhd inattentive type may be markedly different from those of children with combined or hyperactive / impulsive type and the targets of treatment will need to be tailored accordingly . while behavioral interventions targeting organization , planning and time - management can not be classified as 
a central challenge will be figuring out how to disseminate these interventions into clinical practice .
the interventions evaluated to date have varied in where the intervention is delivered ( e.g. school , home , or clinic ) , and dissemination models will need to account for these factors . providing intervention directly in the setting where the skills are most relevant / problematic ( e.g. school ) should allow clinicians to achieve higher levels of skills generalization . to promote dissemination , intervention protocols should be developed that do not require a high degree of clinical specialization to implement and that can be implemented directly in the setting of interest .
 the behavioral difficulties of children with attention - deficit / hyperactivity disorder ( adhd ) inattentive type differ from those of children with adhd combined or hyperactive / impulsive type . 
 existing evidence - based interventions primarily target the disruptive and impulsive behaviors exhibited by children with adhd combined and hyperactive / impulsive type . 
 a number of recent advances have been made in the non - pharmacological treatment of behavioral difficulties associated with adhd inattentive type . 
 additional research using randomized controlled research designs and long - term follow - up evaluation is necessary before these interventions may be considered established evidence - based interventions for patients with adhd inattentive type . 