Janet worries as she watches her 3-year-old daughter, Laura, at play. "She jumps from activity to activity. I rarely see her really focus on one thing for any length of time," she says. Janet reports that Laura most often gets sidetracked by noises. "Once in a while, she'll get involved in a book or art project, but the smallest sound near her will pull her attention away."
Like many parents of easily distracted children, Janet worries that her daughter might have attention deficit hyperactivity disorder (ADHD). However, blanket terms like this, while useful in many circumstances, don't get at the myriad reasons some children have problems paying attention. It's also important to remember that some children with developmental difficulties can have several problems at the same time. These might include:
- Over-reaction to sensory input. One child might be visually oversensitive – bright sunlight coming in through a window or an explosion of vivid colors on a poster might easily divert her. Another child may be oversensitive to smells; in school, that child might be sidetracked by the scent of her teacher's perfume or the odor from the class gerbil cage. Auditory (sound) sensitivity can be just as troublesome. Some children are so sensitive to certain kinds of low-pitched sounds that, if their classroom happens to be near the boiler room, the rumbling noise most people don't even notice will grab their attention.
- Sensory under-reaction. There are also children who are underreactive. They may not be able to focus when they hear a voice. Typically, they are not alert to sounds or to touch.
- Auditory-processing problems. This child has trouble making sense of the things she hears. If you give her three or four directions — finish your milk, get your shoes and your backpack, tell Daddy we're leaving for school — she may only get the first two. The end result is that it looks like she's not concentrating or paying attention.
- Visual-spatial processing problems. A child with this challenge doesn't need glasses; she just has difficulty organizing what she sees. For example, if you hide something in her room, instead of methodically searching in each corner or looking under things, she may get stuck looking only in one part of the room. Children with this difficulty may be overfocused some of the time and unfocused other times. They may have problems connecting what they see with what they hear — which hampers learning to read as well as attentiveness — and may appear lost or easily sidetracked.
- Motor planning, or sequencing. Some inattentive children have difficulty planning and carrying out a series of complex actions. Let's take the example of getting dressed. There may be 10 steps involved in this process. A child with sequencing trouble may be able to do only three or four steps in a row before getting distracted. Really, she's not "distracted" so much as she's lost track of the sequence. She's put on her pants and shirt, but got "lost" on her way to her socks and shoes.
Understanding the Causes of Inattention
The mind has many different functions, all of which contribute to attention. If we treat all intrusions on attention as one and the same, we can't help children master their own particular challenges. So, by looking at inattention in terms of what contributes to it, rather than as one overall problem, we are better able to identify the origins of the challenge in different children.
Some children who are inattentive are self-absorbed and daydreaming, while others show an unusual amount of activity and may even be aggressive with others. Interestingly, a lot of very active children turn out to be underreactive to things like touch and sound, and even to pain. They crave sensations and move a lot in an effort to get more sensory input. By contrast, children who are overreactive to their own movement are likely to be quite cautious.
It's important to note that worries and fears can cause children to be very active and inattentive. Some children may be showing sensitivity to medications, or to foods or chemicals in their environment. Many children become overloaded when they feel overwhelmed with noise and commotion, or when they're in a situation that's scary or abusive.
Teaming Up to Help
The best way to approach inattention (and other developmental problems) is to ask exactly which functions the child has difficulty with. Is it motor planning and sequencing? Is it understanding what he's being told? Is it responding to touch or sound? It's only then that we can try to help him work to master his troublesome functions.
While experts can and often should step in, teachers and parents should be at the forefront; after all, they know the child best. Conferring with qualified professionals can help everyone better understand her strengths and areas of vulnerability. A child psychiatrist or clinical psychologist can look at the child's processing challenges, the family dynamics, the role of anxiety, and so on, and then make suggestions.
Together, the team of parents, teachers, and professionals should identify the child's strengths, an approach that is far more nuanced than simply declaring that he "has ADHD." If you play to his strengths while working on the functions that are more troublesome, you can assess what kind of progress he can make.
Let's say a child has a typical planning and sequencing problem. She usually forgets what she's supposed to do next if she's getting ready for school. Stressing her ability to anticipate, through the use of visualization exercises, can be extremely helpful. You can sit down with her every day and talk about all the good things and all the challenging things that may happen tomorrow, and about what the she thinks she will and will not like. Together, you're building a picture of what's going to go on. This helps your child begin to anticipate — leaving her better able to plan and sequence.
You can also adjust your interaction to better meet your child's needs. For instance, if he has auditory-processing difficulties, talking to him rapidly may just make him tune out. He may focus and attend much better if you communicate slowly and calmly. Since many children with auditory-processing difficulties are strong visually, try relating to him visually as well as verbally. Pick up a cup and point to it. Then point to the milk carton and say, "Milk?"
Making sure you use words along with actions and pictures works better for a child who is a strong auditory processor but weak in the visual area. Overall, rather than using most of your time trying to correct a weakness, try spending at least half of your time helping your child develop a sense of mastery around her natural strengths.