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Are you paying attention? ADHD and attention problems

• Monday, March 14, 2016
• Shona Innes Psychology

It’s very, very hard to learn new things when your brain won’t let you focus and won’t let your body be still.  ADHD is a syndrome that is brain-based and highly genetic.  It’s also a syndrome that gets bandied around lots – so much so that I think many teachers, and perhaps judges and legal representatives, roll their eyes when they hear about it.

Being able to attend well is yet another feature of our remarkable brains.  Paying attention is something we take for granted when it works well.  Without having a brain that can attend well, it gets harder to get started on a job, it can be difficult to keep focused, it can be hard to sustain effort, and very tricky to hold things in your memory long enough to work on them.  Attention can also have implications for our ability to manage our emotions and frustrations and to regulate or give ourselves feedback.   All of these brain functions depend on parts of the brain being structured and connected properly, both in physical structure plus in the ways that the brain’s chemicals move between and around these parts of the brain.

Properly diagnosis ADHD means that these executive brain functions are not working properly and that a child will need extra help to get things done. Attention Deficit Hyperactivity Disorder (ADHD) has three types an inattentive type, a hyperactive type and a combined inattentive-hyperactive type.

It is so very important that a very thorough assessment is done of a child with attention problems before we call it ADHD.

A child’s ability to attend can be affected by lots of things including brain injury and emotional trauma.  If you have been through a frightening situation, your brain will want to keep scanning the world for the next scary thing rather than learn how to do algebra.  When it comes to a child’s attention, we also need to check that the problems are not being caused by vision or hearing issues, autism spectrum concerns or by some other emotional issue or learning disorder (it can be hard to pay attention to reading if you are struggling with reading).  Simple things like sleep, getting the right amount of natural light, avoiding drugs and alcohol and having breakfast  can all aid attention and focus.  A gifted child might also have troubles maintaining attention if the work is so easy that they just feel like drifting off to think about something more challenging and exciting.  Diagnosing ADHD can also be made tricky because it can co-occur with many of these other issues.

On more than one occasion over my years of working with children, I have heard others say that the label of ADHD has been misapplied to a child.  Sadly, this can give those who genuinely have attention problems a bad reputation.

People will also often suggest that because a child can focus on a video game, that they do not have problems with attention.  It’s not that simple.

I’ve also heard people question whether properly diagnosed ADHD is really a problem or whether the child is just lazy or manipulative.  Is it that they can’t do it or that they won’t do it?  Sometime it’s a bit of both.  If it’s hard to do something, then we generally don’t like doing it.  It feels awful.  If we can help the child learn with the scaffolding they need, then learning becomes more pleasant and they will be less inclined to avoid it.

There are some things that make it harder for a child with attention problems.  If they really do not like a particular teacher or a particular subject, then things can get worse.  Children with attention problems seem to do better where teachers are perhaps a little firmer and confident.  They definitely do better when teachers understands their condition and work with them around the best ways to get things done.  It can help if they sit away from distractions and close to the teacher.

Children with attention problems really need help in being organised.  I remember watching one little fellow in a classroom.  He was sitting with his back to the board and the students were copying something the teacher had written onto a worksheet.  He sat down to start, but couldn’t find his pencil.  He decided to go and ask a friend if he could borrow one.  I watched him leave his seat and take a good five minutes to make it to his friends (so many distractions along the way), get the pencil, and then the long journey back to his spot, via his spilled lunchbox on the floor.  Of course, once he sat down, he had to keep twisting to read the board, remember what he had read, then turn back and write it down.  He was already behind his classmates in getting the work done and he was not going to finish it in the time allowed.  With a little more scaffolding (someone there ensuring he had what he needed, that he was sitting facing his work and the board, and that he had gotten started) could have made a big impact to how that lesson went for him.

BE VERY WARY – there are plenty of fad treatments and programs with little evidence to support them out there waiting for desperate parents and grandparents to part with hard earned coin to assist their struggling child.

The evidence-based treatment for thoroughly diagnosed ADHD involves a combination of medication to manage the brain’s functioning and therapy to address thoughts, organisation and coping strategies.  Medication should be carefully prescribed and monitored.  Through psychological therapy, a child can be assisted to build new skills and coping strategies and there are often associated emotional and interpersonal aspects of ADHD.

ADHD can co-exist with depression, anger and problems getting along with others so each of these problems should be monitored.  Of course, then, it makes sense that the medical practitioners and the psychologists should work closely together with each other, family and school.

So what do we need to do to help kids with attention problems?

• We need to identify these children early so we can give them the appropriate scaffolding before they incorrectly learn that learning is too hard or too boring. We need to help scaffold them before life gets too messy and complex and they decide it’s all too hard and give up on learning.
• Once identified, we need to give them proper assessments.
• If the assessment is quick and a label given after just one appointment, then I would query the diagnosis.
• Assessment should involve talking with the child, talking with the parents, testing the child using certain psychological tests, and where possible, watching the child in a learning situation.
• Once identified, then medication may be appropriate.  Again, if you are going to medicate a young child, you want the diagnosis to be spot on and you want to be closely monitoring.  If the medicine is not working, then something is wrong with either the diagnosis or the treatment, or both.

We need to know the profile of the child’s brain functioning so that we can use the strengths and scaffold the weaknesses to help them chose subjects and set learning goals.

The profile of their executive abilities can also tell us what kind of help they need on a day to day basis in the classroom – extra help in organisation, monitoring to keep them engaged, proximity to the teacher, extra breaks to manage fatigue, give them extra reminders and warnings that topics are about to change, fidget toys – all strategies crafted to match the individual and their specific profile.

Overall, you can see that ADHD and attention problems should not be discounted merely because a child can attend to their favourite computer game.  Attention is needed across all of life’s activities.

The ideal solution to attention problems will likely involve medical intervention, special education accommodations and psychological intervention for support with understanding ADHD, problem solving, behavioural skills and mood monitoring.