Six-year-old Stephen just got his first "bad" report card from his teacher, and his mom, Cynthia, is upset. "His teacher tells me that Stephen doesn't seem to be able to focus on an activity, regardless of what it is, for any length of time. He buzzes around the room, bumping into chairs, tables, even other kids. Naturally, all this activity disrupts and upsets everyone else." She has started to wonder if he could have ADD.
Stephen's mom is wise to be concerned, and he should be properly evaluated to see if it could be Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). ADD and ADHD are characterized by several symptoms, including difficulty in paying attention, distractibility, having a hard time following through on things, and sometimes, over-activity and impulsivity.
While this collection of symptoms may result in a diagnosis of ADD or ADHD, it doesn't always have one underlying cause. Clinical observations of children with ADD and ADHD suggest quite the opposite: that there are many different reasons children have these symptoms. To make matters more confusing, two children can display the very same symptoms for completely different, and in fact, totally opposite, underlying reasons.
The Patterns of ADD/ADHD
One child with focus issues may be overly sensitive to his environment. Sights, sounds, smells, even other kids' movements are all overwhelming to him. In a busy classroom, this child is experiencing a sort of sensory overload, distracting him and making him appear inattentive. Meanwhile, another child may underreact to things like touch and sound. Rather than feeling overwhelmed by sensory input, this child actually craves more of it. He requires increased sensory involvement in order to remain attentive, and without it, he seems to have retreated into himself.
However, the symptoms of children who underreact can differ. Sometimes children who underreact have low muscle tone. In this case, a child's muscles are not very strong, and he finds it difficult to move easily. Some children with low muscle tone have a hard time simply standing, walking, or sitting — so they find it easiest to elect to play alone in a corner. If the child is very imaginative, he may be involved in pretend play all by himself, talking to himself, retreating from the world, and living in daydreams.
Other kids who underreact might have fine muscle tone, and they are quite physically active. An underreacting child like this doesn't just enjoy movement, he actually craves it to increase his sensations. In other words, because he's not "feeling" a ton of sensory information, he tries to find more of it in his world. This child is into everything. He bounces into people, furniture, and walls. Craving commotion and loud noise, he becomes a sort of one-man band, creating action wherever he goes.
Some children may be more defiant, stubborn, and negative. A child may be oversensitive to stimuli and try to control her world so that she won't become overloaded. She is focusing on trying to remain calm. Often, such a child is blessed with a strong visual-spatial capacity and is a good big-picture thinker, so she anticipates the overload and tries to prevent it. It's the stubbornness and negativism that end up interfering with completing tasks. Since she experiences classroom activities as overloading, she will avoid them, and do her own thing instead. Often such children are labeled ADHD early in life but surprisingly become successful later, finding their interests in adolescence or adulthood when they can be more in control of their world.
Problems With Planning
These four patterns of ADD/ADHD are often coupled with problems in planning or sequencing activities. A good example of a sequencing problem would be a child who has obvious difficulty following two- or three-step instructions: "Please pick up your toy, put it in the bin, and put your jacket on."
A child with planning and sequencing problems will certainly appear inattentive or distracted because he has trouble completing a plan of action. Let's say he's supposed to be drawing. He has his own crayon in hand, but then he sees the child beside him with an interesting red crayon and gets distracted. He's having trouble following the steps and planning out his next move, and the immediate appeal of other child's crayon is enough to shift him off track. The more severe the planning and sequencing problems, the more challenging the child's attention problems are likely to be.
How to Help
Any of the causes discussed here can explain distractibility and inattention. Now the question becomes, what can you and your child's teacher do to help? Fortunately, especially with young children, there are plenty of opportunities to work on the underlying issues that lead to inattentiveness.
- Become a keen observer. It's imperative to carefully observe children who may have ADD/ADHD, and try to figure out what's behind their behavior. What you're trying to do is look for the circumstances and situations in which your child is both inattentive and attentive. Let's say your child is usually attentive in a quiet one-on-one setting. Then, when she's surrounded by a lot of commotion, her attention wavers or disappears. This suggests she is oversensitive to sensations. It might be worthwhile to ask your child what kind of sounds she likes best, and which she hates. You'll probably discover that she finds high-pitched noises unpleasant.
Let's say you've observed that your child, in relatively quiet situations, ends up whirling about in activity. Likely, this child is underreactive and craves sensations. The quiet is too much for her. Ask her what she likes best in terms of play: chances are, she enjoys dancing, roughhousing, and wrestling with her brothers.
Watch how your child reacts when he's given a task that requires more than one step. If he indeed has poor motor-planning and sequencing abilities, he'll struggle with the task, and you'll be able to read that frustration in her actions.
- Compare notes with your child's teacher. Your child's teacher is, of course, a valuable source of information (as you are to the teacher), as children behave differently at home and school. Compare notes with each other in your effort to figure out what underlies your child's difficulty paying attention.
- Play to your child's strengths. Try to address your child's particular needs. There may be ways you can strengthen her processing capacities, for example, if that is where her issues lie. It is also very important to take a good look at your child's current environment, both at home and at school. Is it supporting her attention capacity — or making things worse? A child who is hypersensitive to touch and sound and is part of a busy, active household might find school overwhelming. Talk to your child's teacher to see how she might be able to make the classroom more soothing.
- Consider outside factors. Is your child on any medication? Some, such as those to treat allergies, may make him irritable and cause him to over-react. Ask your pediatrician or allergist if you're unsure. Your child may have a language problem that underlies his apparent attention issues. If he doesn't completely understand what you or his teachers are saying, it stands to reason he'll appear inattentive. If that's the case, your child may be greatly helped by speech and language therapy. The child who has motor-planning and sequencing problems may benefit from occupational therapy.
Ultimately you'll have to face the question: "What do we do about our child's ADD?" Talking with your pediatrician, and perhaps getting a referral to a professional, is your first step. There has been tremendous pressure in recent years to put younger and younger children on medication. Unfortunately, parents feel the pressure even before their children have received an adequate clinical evaluation (if they ever do). So if your child's attention problems are severe enough to warrant considering medication, then they are certainly serious enough to warrant a full clinical evaluation by a trained professional.