|Misunderstood Minds Info
Basics of Attention
Paying attention refers to the brain's ability to take all of the stimuli around us, immediately categorize and organize information as relevant or irrelevant, and focus the mind on one thing. For a child in a classroom, paying attention to the teacher means filtering out as many as 30 other students and the dynamics between them, visual or outside distractions, noises, and more.
The psychological and medical communities as a whole have accepted a set of criteria for diagnosing chronic attention problems, and have grouped these problems under the name Attention Deficit and Hyperactivity Disorder (ADHD). However, this term and its use in diagnosis remains controversial, and the approaches to attention problems are varied.
This diversity of views comes in part from the fact that although paying attention may seem like an isolated task, it is an elaborate neurocognitive process. Consider everything that is stimulating your senses as you read this sentence. Perhaps there are background noises or a conversation nearby, the aromas of food or pangs of hunger, distractions in your peripheral vision, thoughts of things to do, recent conversations or events still fresh in your mind. Now consider another setting: listening to a class lecture or watching a film. Everyone has experienced a lapse in attention in such settings from time to time. But what if paying attention were a chronic challenge? For some students it is, and they are unable to focus no matter how hard they try.
People with chronic attention problems describe their world as a cacophony of distractions, with no sound or image necessarily more important than any others. Ambient sounds -- papers rustling, pencils tapping -- demand as much attention as a set of verbal instructions.
"Attention deficit" is one of the most widely used phrases when it comes to learning problems, but it may also be one of the most common misdiagnoses. Although there is much information about ADHD available to schools, focusing on attention deficit may be causing parents and teachers to overlook other learning problems. Dr. David Urion, Director of Neurology and Learning Disabilities at Children's Hospital in Boston, suggests that parents and teachers look closely at any inconsistencies. If a child has trouble paying attention or focusing in one subject area, but not all subjects, a lack of attention may be the symptom of a different learning problem. Only a small percentage of children with learning problems have a neurocognitive breakdown in attention.
If your child's attention problems tend to be in one of the following subject areas, visit that section of the site:
Difficulties with Attention
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a standard reference source published by the American Psychiatric Association, there are three patterns of behavior that indicate ADHD: inattention, hyperactivity, and impulsivity (difficulty controlling one's actions).
Signs of inattention as outlined in the DSM-IV include
becoming easily distracted by irrelevant sights and sounds
failing to pay attention to details and making careless mistakes
rarely following instructions carefully and completely
losing or forgetting things like toys, or pencils, books, and tools needed for a task
Signs of hyperactivity and impulsivity are
feeling restless, often fidgeting with hands or feet, or squirming
running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected
blurting out answers before hearing the whole question
having difficulty waiting in line or for a turn
Because everyone shows some of these behaviors at times, the DSM-IV contains very specific guidelines for determining when they indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least six months. In children, they must be more frequent or severe than in others the same age. Above all, the behaviors must create a real handicap in at least two areas of a person's life, such as school, home, work, or social settings. A child with some attention problems but whose school work or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child who seems overly active at school but functions well elsewhere.
Proper diagnosis offers some insight into what a child may be experiencing and helps direct parents and teachers to appropriate responses. Dr. Mel Levine and other researchers are developing an understanding of how brain function contributes to attention, and what interventions may work for some students. Dr. Levine views attention as consisting of three control systems: mental energy, processing, and production. Some children experience problems with all of these attention systems, while others may show strengths and weaknesses in different systems.
Attention Control Systems (Three)
1. Mental Energy
The first attention control system, mental energy, regulates and distributes the energy supply needed for the brain to take in and interpret information and regulate behavior. Children whose mental energy is not working effectively may become mentally fatigued when they try to concentrate, or have other problems related to maintaining the brain energy needed for optimal learning and behavior.
There are FOUR MENTAL ENERGY CONTROLS.
The first is alertness, a state of mind in which a child can effectively listen to and watch information being presented. Children who experience difficulty with alertness can appear to be daydreaming.
The second mental energy control is sleep and arousal balance. This control affects the ability to sleep well enough at night to be sufficiently alert during the day. Children who are experiencing trouble with sleep and arousal may find it difficult to get to sleep at night, or they may sleep poorly. They then have trouble getting up in the morning and may appear tired in class.
The third mental energy control is mental effort. This control initiates and maintains the flow of energy required for a child to start, work on, and complete a task. Mental effort is particularly important when children are faced with tasks that may not be especially interesting or personally motivating. Children who have difficulty with mental effort can benefit from having tasks broken down into smaller, more manageable parts.
The fourth mental energy control is performance consistency. It works to ensure a reliable, predictable flow of energy from moment to moment and day to day. Children who have trouble with performance consistency don't have problems all of the time. Sometimes they can concentrate and perform well, while other times they cannot. Their work output and behavior may be impossible to predict.
The second attention control system is called processing. This system helps a child select, prepare, and begin to interpret incoming information. Children who have difficulty with processing may have a range of problems related to regulating the use of incoming information.
There are FIVE PROCESSING CONTROLS.
The first is saliency determination. It involves selecting which incoming information is the most important. Children who have difficulty with this control may be distracted by things that aren't relevant and miss important information being presented.
The second processing control is depth and detail of processing. It controls how intensely children can concentrate on highly specific data. It enables them to focus deeply enough to recognize and remember necessary details.
The third processing control is cognitive activation. This active processing connects new information to what has already been learned through prior knowledge and experience. Children who are inactive processors are unable to connect to prior knowledge to assist their understanding of new information. In contrast, overactive processors are reminded of too much prior knowledge, making it difficult for them to maintain focus.
The fourth processing control is focal maintenance. This allows a child to focus on important information for the appropriate period of time. As Dr. Levine explains, "It isn't so much how long your attention span is, as it is how well-matched the duration of your attention is to the target at hand." Some children who don't concentrate long enough on certain things may concentrate too long on others.
The fifth and final processing control is satisfaction control. This control involves a child's ability to allocate enough attention to activities or topics of moderate or low levels of interest. "Insatiable" is a term used for children with poor satisfaction control who may be unable to concentrate on activities that are not exciting enough.
The third attention control system is production. This area governs output -- including what children generate academically, behaviorally, and socially. Children with production control problems have a range of difficulties related to regulating academic and behavioral output. They may do things too quickly without thinking, planning, or previewing outcomes.
There are FIVE PRODUCTION CONTROLS.
The first is previewing. It involves considering more than one action or response and anticipating the likely outcome of a particular choice. Children who have difficulty with previewing may plunge into activities instantly and react too quickly.
The second production control is facilitation and inhibition. This is the ability to exercise restraint and not act immediately, to consider multiple options, and to choose the best one before acting or starting on a task. Children who have trouble with facilitation and inhibition frequently act impulsively and may appear to be doing only the first thing that comes to mind. These children may blurt out answers before being called upon in class.
The third production control is pacing, which means doing tasks or activities at the most appropriate speed. Pacing difficulties often show up in children's reading. Their reading pace may be so fast that they skip over words, have difficulty with multisyllable words, and show little reading comprehension.
The fourth production control is self-monitoring. It allows children to evaluate how they are doing while performing and after completing a task. This control allows children to regulate their attention and take corrective action.
The fifth production control is reinforceability. It allows children to use previous experience to guide current behavior and approaches to current tasks. Often called hindsight, this ability enables children to make use of precedent, experience, and prior knowledge to guide their decision making and actions.
Although scientists still know very little about the cause of ADHD, research suggests the disorder is biologically based. This means that there are likely chemical and/or structural problems in the brains of people with ADHD that inhibit their ability to focus, plan ahead, finish tasks, and so on.
Studies have shown significant structural and functional differences in the brains of children with ADHD relative to the brains of children who are progressing normally. One such study found several brain regions (prefrontal cortex, striatum, basal ganglia, and cerebellum) of children with ADHD to be significantly smaller than the same regions in children without ADHD.
Similarly, a study found that children with ADHD had much lower activity levels in areas of the brain that control attention, social judgment, and movement relative to non-ADHD kids. These decreased activity levels may be the result of structural problems in the brain -- connections that just don't exist -- or they may originate in chemical differences between ADHD children and non-ADHD children.
The neurotransmitter dopamine is an important brain chemical that has been linked to ADHD. A kind of chemical messenger, dopamine is thought to facilitate critical brain functions, including the ability to pay attention. In people with ADHD, researchers have found that receptors in the brain that normally respond to dopamine fail to work properly -- either because the brain is not producing enough dopamine or because it is reabsorbing the chemical too readily. Many researchers believe stimulant drugs like Ritalin work by making more dopamine available.
Unfortunately, there is still much that remains a mystery. While researchers have identified chemical and structural differences between children with ADHD and non-ADHD kids, they are no closer to understanding what may cause these differences. Current research is focusing on environmental toxins, drugs, and genetic factors as possible causes of ADHD.
Given this uncertainty, the debate about how best to manage attention problems is not surprising. Although there is clear evidence that some children have benefited from drugs like Ritalin, for others, this may not be an appropriate response.