(Article Published in the Prince George’s Sentinel, July 1st, 2004)
©Copyright Michael Milgraum 2004 . Copying only permitted when authorship attributed to Michael Milgraum and copyright information displayed.
Parents frequently ask me, “Does my child have ADD? [Attention Deficit Disorder].” My response generally is that inattention is like a fever; it can have many causes and thorough questioning and examination are needed to determine the underlying disorder. Below I discuss some of the conditions that could cause an attention problem.
1) A learning disability. Often parents notice an attention problem before the child is diagnosed with a learning disability. Children with learning disabilities can have difficulty processing information at the same rate as their peers do. School work can be emotionally and mentally exhausting for them, so that their ability to focus for extended periods of time is limited. Children with poor ability to process spoken language have a particularly difficult time maintaining their focus on instructions and information presented in class. They may become bored and fidgety, which decreases their ability to pay attention. In addition, children with learning disabilities sometimes have difficulty recalling and/or describing what they have learned. Teachers may assume that a child was not listening, but the child may have listened, and just may have difficulty recalling the right words to describe what he or she has learned.
2) Executive dysfunction. Executive functions are those processes within our brain which allow us to select appropriate goals and develop a reasonable plan to pursue those goals. These functions include our ability to inhibit thoughts and behaviors which interfere with the attainment of our goals, to hold our goals and solution strategies in mind long enough to pursue them, to make reasonable predictions, to be organized and to keep track of our progress towards goals. Mental flexibility is also an important aspect of executive functioning. Children with poor mental flexibility are likely to deal poorly with changes in routine and to have difficulty getting over disappointment. Executive functions are interrelated and children with a weakness in one of them often have weaknesses in others. There is a strong association between poor executive functioning and inattention. Unfortunately, a child’s executive functioning problems are often blamed solely on inattention.
3) An emotional problem. One of the possible diagnostic criteria for depression or an anxiety disorder is a decreased ability to concentrate. Emotional disorders affect us physically and mentally. We are biologically programmed to be less patient and less thoughtful and to desire immediate action when we are emotionally aroused. In addition, fears, guilt, worry and other negative thinking interfere with the ability to listen to what others are saying. Depression can interfere with attention in another way. The depressed child is more prone to give up and shut down when he does not understand how to do something in school. After making a mistake on his work, he may become unresponsive, not because of a primary problem with inattention, but because he is simply feeling too self-critical and hopeless to continue trying.
Each of the problems discussed above can be a serious condition which needs well informed and planned interventions to address it. Thus, it is vital that children are properly assessed to determine the underlying cause of their inattention and other symptoms. A psychoeducational assessment, by a qualified professional, should provide information on the child’s general intellectual functioning, processing style, academic achievement and social-emotional development. The assessment professional, usually a psychologist, meets with the child and performs tests on these different areas of function. The assessor also obtains information from parents and teachers and observes the child’s level of social development and his problem solving style.
The problem with ADD is that it is a solution which is too easy. People are frequently too quick to label a child with ADD and to request medications to treat it. Unfortunately, every medication has side-effects, which must be weighed against the benefits. Without a thorough knowledge of a child’s functioning (as provided in a psychoeducational assessment), such a weighing process is not possible. In addition, if the child is suffering from one of the conditions listed above, rather than ADD, merely trying to treat the ADD can divert attention away from addressing the child’s real problem. Parents need to avoid the rush to a solution before the problem is fully understood. Treating a child for ADD, when this is not the primary condition, can simply worsen the problem and cause more frustration on part of both the parent and the child.