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The Child with Attention Problems - Inattentive

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All of us spend our waking time paying attention to things in the outside world or to thoughts in our internal world. Sometimes, we can become inattentive to the outside world because we are attending to our inner world (i.e., thinking about what to make for dinner and not paying attention to traffic, while crossing the street). Sometimes our attention to one thing can be distracted and drawn to something else. (i.e., while talking to a friend, a noise in the other room draws our attention away from the conversation). And sometimes we really have to work hard to focus on an uninteresting task, when we would rather be relaxing or spending time with family and friends. These are all examples of how we experience attention every day.
 
 As we get older, we learn to control and manage our attention. The ability to control and manage our attention (often called regulating attention by psychologists) is an important skill. It allows us to stay on task for extended lengths of time and block out unwanted distractions. It also allows us to focus on details and exclude background information. It allows us to follow conversations and read social cues. In children and teenagers. Good attention skills are necessary for both social and academic success.
 
Some of us are better than others at regulating our attention. We know people who are highly focused, highly motivated or do not get bored easily. Think of tennis players who works on their serve or musician who practice their scales, without giving up. Think of the student who works on their assignment late into the evening while blocking out any urge to watch T.V. or play on the computer . These are examples of well developed attention skills.  
 
It is important for parents to understand that attention is a behaviour. There are internal psychological processes that help in the performance of attention. There are also external environmental factors that make paying attention harder, especially in children. Attention capacity is also developmental. Attention capacity improves with age. Some children’s attention capacity improves faster than others. All this will be discussed further in the “Beliefs” subchapter.
 
In some children and teenagers, poor attention can be debilitating. It can affect their relationship with friends, create stress at home and affect their ability to learn at school. Recognizing, when inattention is more than just a momentary concern, but a functional problem, is important. There are practices that can be put in place to help support attention limitations. They will benefit children and teenagers with poor attention capacity, and they can also make life a little easier for everyone.

Some children with poor attention also have poor regulation of behaviour. Parents may also wish to refer to the chapter on Impulsivity for further information.

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All children appear to be inattentive at times. Young children have very short attention spans. Preschoolers may only pay attention for a few moments when involved in a quiet activity like colouring or listening to a story.
 
Parents should always think about supporting attention when teaching routines and new skills to their children. They should ask themselves how can I reduce distractions and is this task too demanding for my child. They should make learning new skills exciting and fun. And most important, they should make sure that their children are not feeling distressed in the process of learning new skills. By fostering attention as part of the learning process, parents will also be improving a child’s attention capacity.

A child’s developmental task at this age is to acquire new skills and to show parents and caregivers new competencies that he or she has acquired. Attention and remembering are tightly linked in younger children. There are certain developmental milestones related to attention that a younger child should reach. Children begin to practice joint attention as early as 9 months of age. By three years this should be an integral part of their lives. This involves both the child and an adult gazing at the same object and sharing in the experience. By three to three and a half years, they should be able to hold two rules in memory. For example, they should be able to sort objects by both colour and shape. By four years, they should be able to sort cards using three rules. They should be able to sort by colour first, then by shape and, finally, by colour and shape together.
 
 Children use their attention when learning to speak and when listening to others’ speech. Remember, that in young children, attention capacity is limited, but developing. This will affect the amount of language they can process. Sentences should be short and words should be familiar. A simple rule for sentence length is age plus three. For example, a child who is four, can process sentences up to seven words.
 
Children 3 to 5 years of age usually should be able to remember to do things they are told if:
 
  • instructions are given one at a time, rather than in a series
  • a prompt is given close in time to when a child is required to do an action
  •  once prompted on an activity that is part of a routine, the child will incorporate the activity into his or her routine, usually without forgetting. Prompting may be required more in the learning phase (i.e., how to brush your teeth) and less once the child has mastered the skill
  •  the supervising adult gives immediate praise to the child for doing the appropriate action
  • the child has the necessary skills to learn the action (developmentally & linguistically)
  • the child is not upset, tired, in pain or hungry
  • the child is practicing a familiar routine (getting dressed in the morning or going to bed at night)
  • the child is not distracted by exciting activities going on around them
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Inattention is often overlooked in a child because, alone, it is not a disruptive. Unless parents and caregivers have other children to compare behaviours, it can be difficult to judge age appropriate attention skills in younger children. As well as inattentive behaviour, parents should be aware of other unusual behaviours that occur concurrently with inattention to signal concern.
 
Inattention enters the yellow light zone and becomes more of a problem when:
 
  • child has difficulty following common daily routines. (i.e., they may stop getting dressed in the morning and start playing with a toy)
  • child may need more directions to do a simple task
  • child forgets simple instructions such as in what sequence to get dressed in the morning or remembering to brush their teeth before going to bed
  • child often asks “what was that again?”
  • child drifts away from a task and appears to daydream
  • child appears to have difficulty focusing or organizing an answer to a question
  • child’s daycare or kindergarten teacher expresses concern about hearing
  • child’s daycare or kindergarten teacher expresses concern about fine motor skills
  • child tends to misplace or forget things both at home and in daycare. (i.e. toys and items of clothing)
  • child appears to have low energy
  • child appears more anxious than peers
  • child appears to be accident prone
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Inattention and forgetting enter the red zone and are cause for concern and intervention when:
 
  • the child has difficulty keeping track of belongings. For example, the child is constantly looking for their favourite toy or doll. If the child is in kindergarten, they may constantly forget items of clothing.
  • the child does not seem to listen when spoken to directly
  • the child has difficulty following instructions and completing activities
  • the child quickly loses interest in play activities with friends or adults
  • the child has a hard time getting started on activities, especially if they are new or effortful
  • the child has a hard time remembering, especially activities that involve 2 or 3 procedural steps
  • the child does not show improvement in their ability to sustain attention, remember instructions or follow through on tasks
  • the child struggles with acquiring skills that require fine motor skills (e.g., handwriting)
  • the child appears to have low energy
  • the child appears to be more anxious or withdrawn than peers
  • the above behaviours extend over time and cannot be attributed to other external factors

Behaviours associated with inattention, such as forgetfulness and difficulty attending to tasks at hand are cause for concern and may be indicative of a mental health problem. The behaviours listed in the yellow zone should be considered moving into the red zone when:
  • several indicators of inattention are evident much of the time
  • they increase in intensity and frequency as learning demands increase
  • the behaviours occur in a variety of settings, such as at home, at day care and in the playground
  • the child appears less mature than peers, especially in kindergarten. This must be very evident when compared to the rest of the class. Please keep in mind that it is hard to gauge appropriate levels of maturity in this age group. Recent research has shown that kindergarten students who are born later in the year (July through December) have been inappropriately identified with poor attention skills.
  • the attention problems are not attributable to any personal events (i.e., family loss, trauma, health related problems)
  • there is no physical or social explanation for these behaviours
  • if this pattern is evident, the child should be referred to a paediatrician, psychologist, psychological associate or psychiatrist for assessment to determine whether they have a diagnosable attention deficit. (please see Beliefs subchapter for information about ADHD)
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As school becomes part of your child’s life, it is helpful to develop routines at home that will also be of benefit at school. Many of these daily routines are good for all children, whether or not they have attention difficulties. It is important to instil the importance of these routines during middle childhood because as your children reach early adolescence, they will desire more independence and they will not be as receptive to your suggestions. If they have internalized what you have taught them during this time in their life, they will use these skills to deal with more complex learning tasks.

It is also important to develop a parenting style during this time that models desired behaviour, and sets appropriate limits, yet is also flexible and supportive. Parenting that is overly strict and punitive is counterproductive. For children, having positive experiences promotes better motivation and engagement in tasks that may be challenging or not of interest. As well, children with attention problems benefit from structure and predictability. Parenting that is too open and unstructured does not work for children with attention difficulties.

For children with attention difficulties (those falling into the yellow and red zones), it is especially important that parents establish good communication with their child’s school. In most cases, attention problems are not associated with competence (what your child knows), but with performance (showing what they know). Also, in some cases, attention problems may extend into your child’s social life. Problems making friends or being bullied may occur. Finally, all children with attention problems struggle with processing information. Accommodations at home and at school go a long way to promoting academic success and promote better mental well-being in your children.

Many factors influence attention including age, amount of prior knowledge a child brings to an action and the level of mental demands required for the task at hand. Here are some rules parents should keep in mind when thinking about their child’s attention abilities:
  • Attention is age sensitive. It improves as a person gets older
  • Most children should be able to sustain up to 20 minutes on a task
  • This can be enhanced with interest. This enhancement is known as motivation
  • During the period from 6 through 12 years of age, children should learn to control their attention. This means blocking out unwanted stimulation, and increasing on-task time
  • Children at age 6 may still be using self-talk as a method for maintaining their attention to task. This will become inner thought as they get older
As children approach early adolescence, there is greater classroom demand on independent and sustained work. Attention capacity and related thinking skills become dominant cognitive processes for learning. Remember, young children use memory to think and as they move into early adolescence, children begin to use thinking to remember.
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In middle childhood, children with attention problems start to exhibit a variety of behaviours that may not be evident in children with normal attention skills. Some of these behaviours make sense as attention related. At first glance, other behaviours may not appear to be connected to inattention. Understanding the cognitive processes that drive attention will increase your understanding of these behaviours (see Beliefs – biological, congenital and/or health factors).
 
Inattention enters the yellow zone and should be viewed as a problem when:
 
  1. Your child doesn’t seem to listen or hear you. They may not respond to you when you call them from another room or even across the room. They may drift off while you are talking to them or appear to be zoned out.
  2. Your child appears to be forgetful. They may fail to do chores, forget instructions you just gave or forget items of clothing and books at school.
  3. Your child is disorganized. They are constantly losing things. They can’t seem to organize their room or their equipment if they play sports. They end up forgetting items needed for activities. They may go to play hockey and forget their skates.
  4. Your child has a hard time managing their time. They are constantly late or they lose track of time.
  5. Your child has a hard time starting a task. They appear to either put off doing something or when they sit down to do their task they have a hard time starting their work.
  6. Your child has a hard time planning ahead. They may have to do a school project that requires some planning. They realize the night before that the project is due and they haven’t started.
  7. Your child’s manner may appear to be immature. They don’t seem to act their age. They may have trouble making friends with children their age. They may choose to play with younger children.Your child may appear to be overly emotional or anxious. They have problems with transitions. They don’t like surprises and change in plans. They worry a lot or seem to always be filled with negative thoughts (i.e., “No one likes me” or “My teacher thinks I’m stupid”).
  8. Your child may have low energy. They may always appear to be tired or unmotivated to do physical activities. They may complain about feeling tired when they come home from school, rather than full of energy and ready to play. 
  9. Your child may have problems with sleep, either falling asleep at night or waking up in the morning.Your child may have difficulty with morning routines. They may be slow to start, get distracted, lose things and not realize the consequences of being late.
  10. Your child may find it hard to make friends or keep friends. 
  11. Your child may also have problems with hyperactivity and impulsivity. For example, they may have a hard time sitting still, they may be constantly “on the go”, they may interrupt others during conversations, and get easily frustrated when waiting their turn.
  12. Your child may have more or less severe emotional problems in conjunction with their attention problems. Emotional problems can include anxiety and/or depression.
  13. Your child may have behaviour problems at school and/or at home if the attention problems are not recognised and addressed
 

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Behaviours associated with inattention, such as difficulty staying on task, being easily distracted, forgetful or disorganized may be indicative of a mental health problem. Behaviours listed above and in the yellow zone should be considered to enter into the red zone when:
  • Several of the listed indicators are evident at one time
  • They increase in frequency and intensity
  • They have persisted for at least 6 months
  • They are pervasive (occur in more than one setting, like at home, at play and in the classroom)
  • The inattention and forgetting is impairing to academic performance and/or friendships
  • The attention problems cannot be attributed to any personal events (i.e., family loss, death of a pet, trauma, or health related problems, like side-effects from a medication)
  • There is no other physical or social explanation for these behaviours
  • If this pattern is evident, the parents or caregivers should refer their child to a paediatrician, psychologist, psychological associate or psychiatrist for an assessment to determine whether their child has a diagnosable attention deficit.
  • A diagnosis of attention deficit may also include symptoms associated with hyperactivity and impulsivity (attention deficit/hyperactivity disorder, ADHD). ADHD is very common in children, with a worldwide rate of 5% to 7%.
  • Two of three children diagnosed with ADHD will also have mental health conditions and/or learning disabilities
  • The most common mental health conditions associated with ADHD include anxiety and depression
  • The most common learning disabilities associated with ADHD include oral language problems, reading disorders and difficulties with written language expression
  • Inattention symptoms are frequently overlooked (especially in girls), because they are not as disruptive or noticeable as are symptoms of hyperactivity and impulsivity
  • Inattention symptoms, but not hyperactivity symptoms are associated with poor academic achievement (especially reading and writing problems)
  • Early inattentive symptoms should be considered a developmental risk factor for later academic underachievement. Don’t wait to address school concerns around poor attention/concentration in your child
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Early adolescence (13 to 15 years) is a time of transition for your child, both in terms of their external social world and in terms of their own internal biological world. In their external world they are either preparing to leave or transitioning away from elementary school. Some will be leaving for middle school and others will move on to high school. In both cases, the method by which they experience learning will change radically. They may also be leaving old friends and meeting new kids from different neighbourhoods. They may find that adults begin to treat them differently and have different expectations of them.

At the same time, they are physically changing. Their bodies begin to take on adult physical qualities. And, their brains begin the second major restructuring (first was between the ages of 0-18 months). Their brain will begin the process of shedding unused brain cells (grey matter) and increasing the myelination (white matter). Myelin, a white sheathing that forms around each cell’s axon allows cells to communicate with other. This process signals the linking of parts of the brain that will be involved in what is called executive function (top-down thinking). It can be thought of as building expressways to connect different parts of the brain.

During this time, brain regions controlling the following parts will go through the biggest changes:
Attention system – the ability to focus and sustain attention
Goal directed behaviour – ability to set long term goals and work towards them
Reward evaluation – ability to evaluate long terms rewards and motivate oneself to persevere
Impulse control – to think before you act
Emotional intelligence – regulate and utilize emotions in an age appropriate way

Needless to say, these changes do not happen overnight. In fact, early adolescence is only the beginning of this process. Their brains can be seen as “under construction” during this time. This may present many interesting challenges for parents. Remember, this is only the beginning of a process that will continue throughout later adolescence and into adulthood.

It becomes very difficult to understand the development of “attention” without appreciating these big changes that are taking place in the brain. Goal-directed behaviour is dependent on sustained attention. Reward evaluation (motivation) requires pushing on with tasks that may not gratify one in the moment (i.e., studying for exams, doing homework) Impulse control will help students focus on tasks at hand, and block out counter-productive urges and stimulations. And finally, emotional intelligence will signal the journey towards maturity and the social values that come with that.

Parents need to understand that this may appear to be a hard time to influence your child’s behaviour. As mentioned, their bodies and brains are beginning to change. Their interests focus more on friends, peers and peer approval. They appear to be more emotionally charged, and in some cases, have trouble controlling those emotions. As a result, their decision-making may appear to be in the moment and lack any long term insight. But that said, parents should continue to be supportive, set appropriate limits, and teach skills necessary for adulthood.

Early adolescence is a time of change. During this process, it is expected that young teenagers will acquire more independence. They will be expected to think and to problem solve on their own as well as, plan and organize more complex tasks. They will have to learn to set priorities and often delay gratification (i.e., do assignments for which grades are assigned much later at the end of the semester). Their memory demands will increase once they enter middle and/or high school. They will have multiple teachers and multiple subjects. In both middle and high school, they will become one of many students that subject based teachers have to work with. . In elementary school their teacher had them for most of the day and all year. In high school, their subject teachers will see them for an hour per day. As a result, the individualized attention they experienced will not be as prominent as it was in elementary school.

During this time, the following skills should be in the process of developing:
  • They should be able to focus on tasks for an extended period of time. 20 minutes of uninterrupted work should be expected at the minimum. This should improve with each year.
  • They should be able to organize their school materials and binder. Their notebooks and textbooks should also be well organized. Schedules and important dates should be listed. They should feel comfortable using an agenda book.
  • They should be learning to prioritize what is expected and what is important. If they are in a semester school, they will be responsible for 4 subjects. If in a year long school, they will have to manage 8 subjects. This may be slightly different for middle schools. Each teacher will expect them to put their subject first. As well, they may be participating in after-school sports and clubs. They will need to plan, organize and set priorities for all these activities and their expectations.
  • They will be learning to regulate their emotions. This may appear to be a challenge for many early teens, but they should be improving their ability to let their thinking affect their emotions, rather than the other way around.
  • They should be acquiring the ability to motivate themselves. A big part of maturity is taking responsibility for your actions. Part of this involves learning to delay gratification. A major test or assignment will have to take precedence over seeing or talking to friends.
  • They should start to get a sense of how they best work and learn. Some teens will discover that they need a space with no distractions. Others will be able to block out distractions and work in almost any setting.
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During this time in their development, some young adolescents may have difficulties with the following behaviours.
  • They may have a difficult time paying attention. They may appear to pay attention to everything at one time and have difficulty selecting what is important. They may appear not to pick up cues when you’re talking to them and they may enter in the middle of your conversation. It is not unusual for them to ask you to either repeat what you said or incorrectly guess at what you have said. They may also appear to be easily distracted or become spacey while you are talking to them.
  • They may be forgetful about chores, appointments and remembering to bring school materials home.
  • They may appear to be terribly disorganized. Their rooms may be a mess. They can never find anything. If they play sports, they may forget to pack certain items of equipment.
  • They may have poor time management skills. They are always late for appointments or getting home from a friend’s house. They also may have a poor sense of judging time. They may have unrealistic expectations of what can be done in a fixed time frame.
  • They may have difficulty planning ahead. This can affect their school work, their social life with friends or their home life. Making a commitment to future events is a challenge. They appear to do everything on the spur of the moment.
  • They may have a hard time starting a project or may procrastinate around doing chores.
  • They may appear to be slow at processing information. They get it, but it appears to take much longer.
  • They may have low energy when they get home from school. Trying to keep up and focused at school may take a lot of energy.
  • They may have trouble getting to sleep at night and be slow to rise in the morning.
  • In some cases, they may actually appear to be less mature than their friends or they may have trouble making friends with kids their own age.

Many teens with attention problems struggle at school, especially when they transition into middle and high school. Attention problems should not be confused with learning disabilities, though some children may have both. A simple rule of thumb for parents and teachers is that problems with core academic skills, such as reading, writing and math are problems related to learning disabilities, and problems with academic enablers, such as study skills (note taking, test taking skills, homework and time management), motivation, active engagement (active mental participation in learning) and interpersonal skills are related to attention problems.

Academic enablers play an important role in high school and post secondary education. Academic enablers are dependent on executive functions. Poor attention is tightly linked with weak executive functions. Awareness of this is the first step to addressing the problem.


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If your teenage child begins to struggle in middle or high school and they exhibit many of the behaviours listed above in the yellow zone, there should be concern. Ask yourself:
  • Whether there have been behaviours associated with paying attention, being absent-minded, losing or forgetting things or being disorganized throughout your child’s life. They may not have affected your child’s school performance until they leave elementary school.
  • Whether these behaviours have been evident at home or in other activities, such as sports, with friends or in club activities.
  • Whether there have been any personal events for which you can attribute this behaviour.
  • Whether there are any social or health explanations for their behaviour
  • Whether your child is on a medication that may affect their attention skills

If this pattern is evident, your child should be referred to a family doctor, psychologist, psychological associate, or psychiatrist for an assessment and to determine if there is any diagnosable attention deficit.
  • A diagnosis of attention deficit may also include symptoms associated with hyperactivity and impulsivity (attention deficit/hyperactivity disorder, ADHD). ADHD is very common in children, with a worldwide rate of 5 to 7%
  • Two of three children diagnosed with ADHD will also have mental health conditions and/or learning disabilities
  • The most common mental health conditions associated with ADHD include anxiety and depression
  • The most common learning disabilities associated with ADHD include oral language problems, reading disorders and difficulties with written language expression
  • Inattention symptoms are frequently overlooked (especially in girls), because they are not as disruptive or noticeable as are symptoms of hyperactivity and impulsivity
  • Inattention symptoms, but not hyperactivity symptoms are associated with poor academic achievement (especially reading and writing problems)
  • Early inattentive symptoms should be considered a developmental risk factor for later academic underachievement. Don’t wait to address school concerns around poor attention/concentration in your child



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Like early adolescence, adolescence is a time of continued transition. But, in the case of adolescence the transition is into adulthood. This is recognized in our society by a variety of markers. By 16 years, some privileges associated with adults are conferred onto teens. They are allowed to drive a car. Curfew restrictions are lifted. And parents are no longer legally responsible for their children’s behaviours. In terms of education, school programs are planning the transition away from high school and into post secondary choices. Projects and assignments become more demanding. Students are expected to take more responsibility for their performance in class. They are also expected to be more self motivated, exercise long-term planning and organization and concentrate longer and harder on work demands.

At the same time that society’s expectations are changing, nature is also changing their biology. Changes begun in early adolescence continue to unfold throughout adolescence. The attention system continues to develop, long term goal-directed behaviour should be becoming more evident (planning well beyond the moment), recognizing long-term rewards as motivation to work at less desirable tasks, curbing impulsive behaviours and developing insight into their emotional self are all part of development.

There are also adolescent drives that may present challenges and often have to be channelled into constructive behaviours. Adolescence is a time of sexual awakening. Romantic interests begin to preoccupy a lot of time. Friends and peer groups begin to take precedence over family. It is also a time of risky behaviour and sensation seeking. Researchers have suggested that there is still a developmental disjoint between reason and emotions, with reason still not being able to fully regulate emotional drives.

The mix of pushing for independence, the power of peer group influence and the “in progress” process of learning to regulate one’s emotions can present a challenge to parents. At the same time, it can be a wonderful time for them. Teenagers moving towards adulthood are also full of passion about their world, eager to take on larger adult roles and wishing to make a difference. Being positive and supportive during this time can be satisfying to parents.

The following actions should be starting to appear in adolescence. They reflect the development of behaviours necessary for success in adult life. They include:
  • Your adolescent should be able to extend their attention beyond that of the early adolescent stage. They should be able to be alert and on task anywhere from 30 minutes to 90 minutes depending on the degree of interest they have in the topic or activity.
  • Your adolescent should be able to set priorities. They should be able to identify what is important and delay doing less important things, even if they offer immediate rewards. In other words, they should be developing the ability to delay gratification.
  • Your adolescent should be able to organize and plan their day’s activities. They should be able to schedule work time and play time appropriately.
  • Your adolescent should be able to plan for projects, schedule study time for tests and exams.
  • Your adolescent should be developing the capacity to regulate their emotions. They should be able to stop and think before they react emotionally.
  • Your adolescent should be getting better at self motivation (not waiting to be told what to do). They should be able to take responsibility and do what they have committed to even when it doesn’t appeal to them at that moment.
  • Your adolescent should be getting more comfortable at talking with adults and sharing their thoughts, ideas and feelings.
Parents should remember that many of these behaviours are in progress of developing. They may not always be consistent but should be evident at times. Back to top

Inattention enters the yellow zone and should be viewed as a problem when the adolescent:
  • Appears to have difficulty paying attention or following a conversation. Sometimes parents say that their teenage children don’t listen to them. This is a little different. Youth with attention problems don’t choose not to listen. They may miss the beginning of a conversation, get easily distracted by something else or zone out in the middle of the presentation. In any case, it can lead to misunderstanding at home, and when it happens at school, it can present problems, especially in classes where lecture formats are very common.
  • Appears to have a hard time sustaining their attention to task at hand. This is a problem with “staying power”. It presents itself in many forms. Generally, the teenager loses interest in whatever they are doing. They tend to describe the activity as boring. As a result they move onto something else before completing what they are supposed to be doing. Parents often say: ”I don’t understand how my son or daughter can spend hours on the phone or computer, yet they don’t last more than 10 minutes at their homework”. This may be a developmental issue. They have not developed their ability to delay gratification or regulate their inner feelings. In turn, this expresses itself as a motivation concern. These issues are discussed further under executive functions (see Beliefs).
  • Appears to be easily distracted by either external stimulations such as the TV in the other room or by internal intrusive thoughts (e.g., “I wonder what my friend is doing this weekend. I think I’ll text them and find out”). The ability to focus on task and block out unwanted stimulation is closely related to working memory (see Beliefs). Working memory capacity varies by person and by age.
  • Appears to have a hard time starting up a task or tend to procrastinate much of the time. Often the task is associated with something they don’t particularly enjoy. At home this can include doing chores or cleaning their room. At school, assignments and homework are often hard to begin. A poor sense of time may contribute to problems starting. Anxiety around the scope of the task may have some bearing on this. As well, procrastination and avoidance can be linked to executive function deficits.
  • Appears to be forgetful. Many times this type of behaviour is misinterpreted as noncompliance. In fact, forgetfulness and attention are often closely linked. Usually either only part of the message is picked up or it may not be stored in long-term memory. If you teenager is expected to store information to utilize much later, then the chances are even greater they will not remember.
  • Appears to have poor organizational skills. Many teenagers with poor attention also show poor organization. This can happen at home, at school and in their social lives. It can be poor time management, losing of personal belongings, failure to plan for school projects or messy room. Again, parents may have a hard time understanding why their teenager can’t organize their room, school work or personal life, yet may excel at organizing something that is special, like their music selection for their MP3 player. Again, motivation and interest increase the ability to sustain attention and focus on task. The challenge for teenagers is to apply their ability to focus on more mundane tasks.
  • Appears to have difficulty planning ahead. Whether it is school work, a family event or social activity, some teenagers just can’t get their act together. They appear to function better in the moment. This can be a challenge as they take on more adult responsibilities. Senior high school and post-secondary education expects students to plan ahead with assignments and projects.
  • Appears to be careless with chores at home and with work at school. Paying attention involves monitoring whether the job is being done properly. Often teenagers with poor attention appear not to be fully engaged in what they are doing. They appear to be going through the motions, rather than monitoring the quality of their work. This may have less to do with having low standards and more to do with executive function problems. Sustaining attention alone is hard work for teenagers with attention problems. They may continue to work on a task, but already be disengaged from paying attention. They may not be aware of maintaining quality of work, since their goal is just to finish.


Specific school-based problems associated with poor attention in core academic areas can include:
  • Poor reading comprehension: they can read, but can’t recall what they have read.
  • Poor writing:– taking notes in class, copying notes off the blackboard and writing essays all present a challenge
  • Math problems usually involve word problems, or math tasks that require multi-steps [incomplete sentence]

More often, problems associated with poor attention affect what are known as academic enablers. Academic enablers are secondary skills that ensure success in high school and post secondary education. They include:
  • Study skills such as note-taking, time management, test taking skills, and organization skills
  • Motivation – this is the ability to begin a task and stay on task even when one doesn’t wish to
  • Active engagement – this is the ability to mentally participate in the learning process, rather than just absorbing information. It means taking a full interest in the knowledge being acquired.
  • Interpersonal skills – students with good interpersonal skills are better at engaging in the learning process

Parents who suspect that their teenager may have poor attention:
  • Should be aware of the high correlation between inattention and driving accidents. Driving a car requires good attention. Teenagers with poor attention skills are easily distracted from the task at hand. Teenagers with poor attention should be encouraged to drive with minimal distractions.
  • Should be aware of a high correlation between inattention and other mental health concerns, such as anxiety, poor mood regulation, low frustration tolerance, boredom and substance abuse.
  • Should be aware of sleep disturbance. This can include a hard time getting to sleep at night, restless sleep, and a hard time getting up in the morning.
  • Should be aware of the connection between poor attention, hyperactivity & impulsivity. As children enter their adolescent years the hyperactivity & impulsivity may express itself as restlessness and impatience. Teenagers may show this behaviour, but not meet criteria for a diagnosis of Attention Deficit Hyperactivity Disorder, which has a clinical threshold for diagnosis. But, even if your teenager does not meet the threshold, the cluster of behaviours may affect their performance at school and their participation at home. (see Red Light for more information)

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Behaviours associated with inattention in adolescence, such as poor concentration, being highly disorganized, being forgetful or lacking any motivation should be of concern and may indicate a mental health problem. Behaviours listed in the yellow zone should be considered entering the red zone when:
  • Several of the behaviours listed in the yellow zone are evident at the same time
  • They increase in intensity and frequency with mental demands. This can include activities requiring high levels of sustained attention, learning something new, or having to do activities that have a limited time frame.
  • There is a history of this behaviour that extends back more than six months
  • The symptoms are pervasive. They occur in a variety of settings including home, school and out in the community.
  • The symptoms are causing distress in your child’s life. This may not have been evident until they are in high school where the mental demands are much greater.
  • There is no physical or social explanation for the behaviours
  • The inattention cannot be attributed to any personal events (trauma, recent loss, either through a death or breakup of romantic relationship, family problems or grief reaction)
  • They are not on any medication that may have inattention like side-effects
  • If this pattern is evident, you should encourage your teenager to see a health specialist. An assessment can be done by a psychologist, psychological associate or psychiatrist to determine whether there may be a diagnosable attention deficit.
A diagnosable attention deficit is usually diagnosed as attention deficit hyperactivity disorder (ADHD). In adolescents the behaviours associated with hyperactivity and impulsivity often appear as restlessness and impatience, but if your teenager meets criteria for a diagnosis, it is important to know that the disorder can be functionally debilitating both at home and at school. It is also important to know that ADHD is a common disorder, with a rate ranging between 5 to 7%. In children, boys are diagnosed at a rate of 3:1, but by adulthood as the hyperactivity and impulsivity become less prevalent the ratio balances out for males and females. It is also important to know that ADHD often occurs in conjunction with other mental health problems including anxiety and mood disorders. Teenagers who are treated for their ADHD have better school outcomes than those who are not.
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It is always important to remember that attention is a behaviour. Behaviours are the result of a mix of internal mental processes and external environmental factors. Parents and teachers know that children’s ability to pay attention improves as they get older. They also know that children’s attention wanders when they find something mentally too demanding or verbally too difficult to understand. This is why it is important to take into consideration the many factors that can affect a child’s ability to pay attention and, in the process, to learn. Back to top

The behaviour of attention is dependent on a variety of cognitive systems. Parents should make themselves familiar with these terms, since they may appear on a school report or IEP, if their child is struggling with learning difficulties, especially if they are related to problems with attention.

Executive Functions: Executive Functions are often described as the CEO of the brain. They are linked to our ability to sustain attention, manage our actions and regulate our emotions. Examples of executive functions include our ability to plan, organize, begin activities, monitor our actions, while blocking out unwanted stimulations and controlling our emotions and immediate impulses.

Executive functions are slow to develop. Their development is observable in children. Young children begin to use self-talk as a method of monitoring behaviour and regulating emotions. Research has shown that children as young as three and half years of age can hold two items in mind, block out external stimulation and use the two items in mind to do a task. Research has also shown that executive functions develop over three to four decades, with a dramatic change beginning in adolescence. During early adolescence there are strong emotional drives (i.e., parents often jokingly describe this as hormonally driven behaviour). By late adolescence and into the early twenties, there should be development towards regulating these emotional drives and putting more sustained attention and managed actions in their place. In simple terms, thinking should control feeling to define behaving.

Working Memory: Working memory is an important cognitive process. It is responsible for translating and transferring sensory input into long term memory. In doing so, it must function as an on-line mental workspace, matching new with known information, quickly manipulating it, and then packaging it for storage as knowledge. Working memory is a limited capacity (3-4 items) and limited time ( up to 10 seconds) process. Deficits in working memory create problems with attention and directly affect behaviour. Its capacity and time span also can be effected by stress, anxiety and depression.

Processing Speed: This is the rate at which an individual processes incoming and outgoing information. Processing speed is closely linked to working memory, since working memory is time limited. Children and adolescents with slower processing speed may have difficulty following instructions, tend to work slowly and may be slow readers which, in turn, affects their ability to remember what they have read.
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Family stress can affect attention. Parents should recognize events that promote feelings of anxiety and fear can have a direct affect on a child’s attention capacity. Children learn and develop in a safe and nurturing household. Back to top

Children with severe attention problems may be diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) The diagnosis of ADHD is done by a highly trained expert, usually a paediatrician, psychologist, psychological associate or psychiatrist. The following information is to help parents understand ADHD. More information about ADHD is available at http://research.aboutkidshealth.ca/teachadhd
 
What is ADHD?
ADHD is a common neurobiological disorder. It can have serious consequences including school failure, poor relationships, driving accidents in teenagers, higher than average risk for substance abuse and under employment in adult life. Hence, early identification and treatment is critical.
ADHD affects 5 to 12% of the population.
ADHD interferes with an individuals capacity to:
a)      self-regulate activity level (hyperactivity)
b)      inhibit behaviour (impulsivity)
c)       attend to task at hand in an age appropriate way (inattention)
 
  • ADHD is a chronic problem. Up to 80% of children diagnosed with ADHD show symptoms into adolescence and adulthood
  • ADHD in adolescence looks different from childhood. Restlessness associated with childhood is replaced by an “inner restlessness”. Symptoms associated with inattention continue throughout life.
  •  ADHD symptoms are clustered into two groupings; those behaviours associated with hyperactivity and impulsivity and those symptoms associated with inattention.
  •  ADHD symptoms associated with inattention are associated with academic challenges
  • ADHD is less obvious in girls because they tend to have more symptoms associated with inattention
 
How is it Diagnosed?
ADHD must be diagnosed by a trained health specialist (i.e. paediatrician, psychologist, psychological associate, or psychiatrist). There is no blood test or diagnostic machine that can diagnosis ADHD. The specialist must collect information from many sources to make a diagnosis. These sources include a child’s developmental history, interviews with parents and teachers for school age children and behaviour rating scales. Specialists may also use school records including report cards for school age children.
 
Criteria for ADHD are listed in the Diagnostic and Statistical Manual- 4th Edition – Text Revision (DSM-IV-TR). A person must exhibit several criteria for a diagnosis of ADHD. These include:
Evidence of 6 of 9 symptoms of Inattention and/or symptoms of Hyperactivity/Impulsivity
Symptoms must be developmentally inappropriate for the child
Symptoms must be impairing in at least two settings in the child’s life, such as home, in the community, in the classroom or daycare and in social situations
Symptoms must appear early in life, before 7 years and must continue for at least 6 months
 
The following are examples of symptoms of inattention:
1.       Easily distracted
2.       Difficulty concentrating on tasks for a reasonable time
3.       Often fails to pay close attention to details or makes careless mistakes (i.e., rarely checks work submitted for school)
4.       Difficulty keeping track of personal belongings and organizing self for activities
5.       Does not seem to listen when spoken to directly
6.       Problems following instructions
7.       Difficulty starting or staying on task , especially when task is effortful or challenging
8.       Often forgetful – forgets to write things down and/or forgets routines
9.       Loses things
 
The following are examples of symptoms of hyperactivity and impulsivity:
1.       Often squirming, fidgety, or turning around in seat
2.       Can’t sit still
3.       Seems constantly moving about or “on the go”
4.       Makes lots of noise, even during play and leisure activities
5.       Interrupts others’ conversations or activities
6.       Blurts out answers to questions before hearing the whole question
7.       Talks incessantly when they are not supposed to talk
8.       Runs about or climbs when it is not appropriate
9.       Gets easily frustrated when waiting in line or during turn taking
 
Parents should understand that preschoolers on occasion may show some of these symptoms and some of these symptoms may, in fact, be age normal behaviours. Parents should pay close attention to severity of the symptoms, duration and impact on daily activities in making a decision on whether to pursue professional help. In the case of school age children, often a gap will begin to appear between a student’s competence (what they know ) and performance (what they do in class). Teenagers who are very bright may get all the way to high school before there is strong evidence of ADHD. Demands on their organizational abilities, self motivation and independent work tax attention that make school success a challenge.
 
It should also be noted that the symptoms associated with ADHD distribute to some degree across the population. We all have one or two symptoms, but the more symptoms one has, especially those associated with “inattention”, the more mental work it takes to do school related tasks. The combination of limited attention resources coupled with mental effort, can lead to giving up on the task at hand.
 
It should also be noted that there is a high overlap (called co-morbidity) between a diagnosis of ADHD and other mental health problems and learning disabilities. It is estimated that 2 out of 3 children diagnosed with ADHD will have a secondary disorder.
 
ADHD look a-likes. ADHD symptoms can also occur with other health problems and as side-effects from medications.
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Much like physical development, cognitive development can vary from child to child. Recent research has shown that children with severe attention problems (ADHD) also show delayed maturation in parts of their brain. Their brain development does catch up with that of peers by adulthood. This information should help parents and teachers understand and plan for what appears to be age inappropriate behaviour.

Students who lag in terms of their maturity should not be punished. They will eventually catch up. Negative reactions from adults, may be counter-productive. Instead, appropriate strategies should be put in place to support their development. (see - Course to Follow)
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Identifying the relationship between inattention and modern society is a complex question. The research that is looking into this link is just beginning. Parents often identify two areas of concern; one is junk food and sugar intake and the other is the role of modern media.

Research has shown that there is no link between these food types and inattention over the long term. Adults know that coffee can give them a short boost in the morning. This is also the case with junk foods and sugars. They may increase a child’s activity level for a very short term, but they do not alter the process responsible for good attention.

Research on attention and new media is still very new and limited. Parents should understand that media that requires passive engagement (i.e., just watching and listening) does not improve attention skills. Media that requires active engagement (i.e., thinking and interacting) may have potential for improving attention, but more research is needed.
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Children who experience trauma or loss, or may be in the midst of a crisis will have problems focusing and sustaining attention. Parents should take a safe opportunity to ask their child, if they are distressed about anything or whether there is something that makes them feel worried. Back to top

Attention can be enhanced through a variety of factors. Changes in the environment make paying attention easier. How information is organized and delivered make paying attention easier. Using assistive technologies makes attending easier. As children get older, teaching strategies for memory and attention will help. In children who have severe attention problems (ADHD), medication should also be considered. Back to top

Strategies to gain the child’s attention and ensure comprehension:
 
  • Gain a child’s attention by being in the immediate vicinity
  • Gain and hold eye contact
  • Keep instructions simple and in words that the child understands
  • Give one instruction at a time
  • Prompt the child to verbally repeat instructions (“OK, so tell me what you must do”)
  • Gradually build up the number of steps
  • Always remember to praise/acknowledge each completed step
  • Provide visual prompts for teaching routines, such as putting toys back in bin or hanging up clothing
  • Use rhymes to help child remember actions that require sequence or steps
  • Encourage children to “think aloud” when trying to recall information
 
Use behaviour management principles of reinforcement to shape and sustain the behaviour that the child needs to develop. These include learning rules, learning to start and finish a task and managing their own behaviour. Also, remember behaviour management should teach skills, not punish behaviour. Keep in mind the following three personal rules:
 
1.       Reward immediately those behaviours that are appropriate
2.       Ignore punishing behaviours that are off-task
3.       Instead, re-direct the child back to on-task behaviours
 
Use language that reduces choice. For example do not say “if you drink your milk, then you can play”. Say “when you drink your milk, then you can play.”
Use language that is positive. Rather than saying “don’t” or “no”, use prompts or verbal cues like “let’s try this again”
 
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When children enter into the yellow zone, parents may want to pay close attention to following practices (these practices benefit all children):
  • Create a structured house, with many reminders to keep your child on track
  • The following structuring activities will serve as practice for when your child begins school. These include:
  • A quiet space for quiet play
  • A time for planning the next day’s activities
  • Teach your child about reminder checklists. Use favourite animal stickers as rewards. Always make sure that at least one thing on the checklist is rewarded each day
  • Begin to teach your child about colour coding and labels for organizing toys and clothing
  • Keep toys and special items in the same place all the time

All children benefit from a positive and encouraging adult. The following practices will help support your child:
  • Set positive expectations. Use praise as often as possible. Try to avoid negative feedback. Try to use a “learning model “approach. Instead of “no”, “that’s wrong” or “what did I say”, use “let’s try this again” or “how do you think mommy or daddy would do this?”
  • Always use prompt feedback
  • Make the consequences for broken rules the same
  • To the best of your abilities, create consistent routines around getting up in the morning, eating, play time, quiet play time, bed time and other regular activities
  • For younger children use visual prompts to cue transitions or to do certain chores
  • For older children (around four years) introduce a checklist
  • Identify triggers for behaviour problems. Some children have difficulty with transitions. Others may act out if they get too tired.
  • Involve your child in problem solving around unwanted behaviours.

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Studies have shown that children with severe attention problems benefit from medical attention. A decision to use medication in a preschool child is a decision that should be made with consultation between the family and the prescribing physician.

Behaviour therapy also helps. Behaviour therapy helps a child become more responsible for their behaviour and supports that process. Because severe attention problems (ADHD) affect all areas of a child’s life, behaviour treatment programs should include both parents.
Behaviour treatment programs for parents of children with ADHD include:
  • Learning about the disorder
  • Understanding why your child may behave the way they do
  • Learning skills and strategies to support your child
  • Coping with stress

There are various behaviour programs for parents. These include: counselling, parent training and support groups.
  • Counselling will teach parents how to work with their younger children with attention difficulties. Parents may learn how to help organize their child, structure their home environment, develop good routines and help with communication skills for the child.
  • Parent training should promote good “authoritive” parenting skills, not “authoritarian” skills. Authoritive parenting allows for teaching rules, but also for being flexible and positive, rather than rigid and punitive.
  • Support Groups are often part of organizations that educate and advocate for children, youth and adults with ADHD. These organizations are good to get involved with for support, education about ADHD and advocacy for your child when and if needed.
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