Focused Attention

Is your child:

• Off-task?
• Experiencing difficulties staying focused for more than a few seconds?
• Having trouble finishing schoolwork?
• Being distracted easily?
• Drifting constantly when the smallest thing that catches his or her eye?
• Moving from one thing to the next to the next?
• Hearing from teachers say to ‘pay more attention?’

As a parent of a child with these challenges, you may hear yourself say, “That child would lose his own head if it wasn’t screwed on.”

Teachers may say, “He does well when he is paying attention…it’s just hard for him to focus.”

The ability to attend to the task at hand and to block out distracting sights, sounds, smells is known as focused attention.

Children who struggle with this issue are easily distracted by someone walking by the classroom, by hearing the rumble of an old car, or even by their own thoughts!

Some children will begin homework, think of something funny, which makes them think of laughing at lunch today, which will make them think of grabbing a snack, which makes them wander aimlessly into the kitchen.

This child may not be avoiding his homework and generally can’t tell you how he got off task in the first place.

These types of challenges are not due to the inability to pay attention but rather with the inability to control what one pays attention to in the environment. And, more importantly, what one doesn’t.

You may hear family members say, “Look, squirrel!” jesting that your child is easily distracted by the smallest thing. Another way to think about it is focused attention is not a “do” function but a “don’t do.” This skill is critical for learning in the classroom, socializing and completing academic and household tasks.

If you see this challenge impacting your child in school, it is important to look further into the problem. It may be that a cognitive or neurological problem is causing your child’s difficulties.

The ability to pay attention is extremely important to your child’s development. This skill can be defined as,

“Attention is the ability to sustain focus on the information necessary for learning or completing a task. Many children with reduced attention seem to ignore or not “hear” directions and appear to have a “memory” problem” [4].

The challenge here could be with focused attention or impulsivity. These skills go hand in hand and share a symbiotic relationship in your child’s learning.

Focused attention refers to the ability to concentrate on uninteresting tasks, which requires the child to inhibit the urge to do something else. Focused attention is then the ability to refrain from responding to other things in the environment.

In order to focus, your child will need to inhibit responses via sensory output, including speech, movement, or visual.

To inhibit responses means the child will have to stop himself from being impulsive by not talking to the distracting person, not walking toward the distracting object, or not looking at the distracting situation.

In medical terms, inhibition  is known as the ability to inhibit prepotent responses. A prepotent response is the response you would naturally want to do. For example, to practice inhibiting your own prepotent response, you might try looking at a picture of the sun and saying ‘night’ and then looking at a picture of the moon while saying ‘day.’

A test for this that psychologists use involves a list of color words. The word green might be written in yellow and the word red might be written in blue. In order to do this test, you have to inhibit your initial (prepotent) response to read the color you see in front of you.

Challenges with attention processes may be the result of ADHD, a traumatic brain injury, or other conditions. It will be important to consider what can be done to help your child learn to stay on task.

In order to stay on task, your child will need to learn the skills required to not respond to distractions in the learning environment. If your child is struggling with attention, it is extremely important to seek professional help. Attention problems can have a pervasive impact in many areas of your child’s life.

Research has shown the challenges inherent in significant attention problems. The largest scale study ever to be conducted (to date) by the National Institute of Mental Health (NIMH) investigated the impact of ADHD on children and families. The study involved over 600 students with attention problems in six sites across the country [5]. Findings were as follows:

• “Two thirds of these children had at least one other disorder, such as depression, anxiety, or learning disabilities.
• Medication alone was more effective than behavioral interventions alone
• Medication alone was almost as effective as the combined treatment of medication plus behavioral interventions
• Many students may be receiving medication doses that are too low for maximum improvement in school work and behavior” [5].

The authors of this article have been involved in a meta-analysis of ADHD interventions. This meta-analysis, a report on a group of studies, found that although many behavioral interventions for ADHD are effective, the individual studies themselves were typically not as systematically conducted (that is, involving pre and post testing, ‘dosage levels,’ and effect size), as were the medication studies.

This difference may be the reason that it sometimes appears medication alone can be more effective than combined treatment. Most psychologists and medical doctors agree that combined behavioral and pharmaceutical intervention is best.

Taken together, it is important for parents to be aware that attention problems can have a significant impact on a child’s functioning and that the provision of accurate diagnosis, psychological and pharmaceutical intervention can bring lasting positive change.

If you are wondering about your child’s tendency to lose focus easily, he or she is likely going to need some support. Children who are highly distracted tend to have challenges at school and home because they often miss key instructions and information.

Unfortunately, this symptom is often linked to poor behavioral inhibition, which leads to getting in trouble at home and at school.

An assessment of these difficulties should shed light on the severity of the challenges and determine if they are related to ADHD. It is important to note that children with ADHD often have significant problems in school, socially, and in the community.

Too often, parents are hesitant to get a diagnosis because, “I don’t want to put my kid on medication.”

If ADHD is indeed diagnosed, your family will still be in control of any decisions made regarding your child’s medical interventions and supports.

Medication options should be discussed with a psychiatrist or primary care physician and not with school staff or other therapists.

Another option may be that your child is unable to pay attention due to another disability and would be responsive to other associated treatments. For example, some children with poor attention may have a trauma history, anxiety, or Autism Spectrum Disorder.

In these cases, treatments are available to encourage growth in skills.

For ADHD, research suggests a combination of environmental supports and stimulant medication is the most successful treatment. At school, modifications may include extra time, a quiet space to work when distracted, the opportunity to take breaks, to use fidget toys, and to stand up during worktime.

At home, environmental supports can include having a quiet designated space for work, using a timer to keep homework sessions manageable and offering rewards like game time for completing assignments. Use a sticker chart and a visible schedule for the daily routine.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Shifting Attention (Focusing or Flexibility): difficulties with focused attention may be accompanied by challenges with shifting attention
• Executive Functions (Organizing): difficulties related to planning, sequencing, and organizing information can co-occur with challenges in focused attention
• Processing Speed: difficulties with fluency and other areas of cognitive processing may be impact attention

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Attention Deficit Hyperactivity Disorder (ADHD): children with attention problems may have challenges sustaining attention (focused attention), shifting attention, focusing attention, and screening out other sensory stimuli. They also tend to struggle with distractibility and impulsivity
• Traumatic Brain Injury: children who have hit their heads and suffered an injury may have unexpected memory loss as well as emotional changes, headaches, and challenges with attention
• Trauma: many children with a trauma history will present with behavior problems and may have poor attention
• Attachment: children who have experienced neglect or mistreatment from caregivers often have attention problems. It is often the case that adopted children have challenges with attachment that may lead to behavioral dysregulation and inattention
• Anxiety: many children with anxiety have trouble focusing. They may wiggle or appear restless in class. An evaluation by a psychologist can help to differentiate between Anxiety and ADHD or any potential comorbid conditions

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
• Neurologist: to look at other brain-based causes for visual memory deficits if these deficits seem to be severe across multiple settings. It would be important to rule out TBI
• School Psychologist: to determine learning needs based on your child’s neuropsychological profile; perhaps an IEP, 504 plan or RTI is warranted to help your child. Perhaps tutoring is recommended and your school psychologist can help you locate resources.
• Psychologist or Neuropsychologist: to conduct a full assessment and to examine symptoms in a mental health and/or behavioral context

These professionals may recommend or administer the following tests for this symptom:

• NEPSY, RAVLT, CVLT: assessment to examine memory, attention and processing strengths and weaknesses with this measure for children. The NEPSY provides a number of batteries looking at attention, motor, and memory (Neuropsychological or psychological evaluation)
• WISC-V: intelligence assessment to establish a baseline of intellectual abilities. The cognitive assessment is important because it will provide an idea of your child’s cognitive strengths and weaknesses and will assess working memory directly, which is highly related to attention
• TOL-2, CTMT, WCST: executive functioning assessment to determine the skills and resources your child has, such as the ability to plan, organize, and pay attention (Neuropsychological evaluation)
• BASC-3, Clinical Interview, Brief Projective Measures: emotional assessment through drawing tasks, open-ended questions, interviews, and rating scales to evaluate emotional symptoms, behavior, and personality (Neuropsychological or psychological evaluation)
• Stroop: neuropsychological assessment of inhibitory control and executive functions
• Test of Variable Attention (TOVA): neuropsychological tests of attention and impulse control

For clinicians:

[1] Kroncke, Anna; Willard, Marcy & Huckabee, Helena (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings.

Springer: http://www.springer.com/us/book/9783319255026

Amazon: https://www.amazon.com/Assessment-Autism-Spectrum-Disorder-Psychological/dp/3319255029/

[2] ADDItude Editors (n.d.) Focus the Attention of Distracted Children http://www.additudemag.com/adhd/article/1032.html

[3] Linder Ed.D., Toni & Petersen-Smith Ph.D., Ann (2008) Administration Guide for TPBA2 & TPBI2 (Play-Based Tpba, Tpbi, Tpbc). Paul H. Brookes, Inc. Amazon:

Amazon: https://www.amazon.com/Administration-Guide-TPBA2-TPBI2-Play-Based/dp/1557668736/

[4] Lewis, PhD, Jeanne, Calvery, Ph.D., Margaret, & Lewis, Ph.D., Hal (2002). Brainstars. Brain Injury: Strategies for Teams and Re-education for Students. US Department of Education: Office of Special Programs.

For Parents:

[5] Zeigler Dendy, Chris A (2003). Teaching teens with ADD and ADHD. Woodbine house.

Amazon: https://www.amazon.com/Teaching-Teens-ADD-ADHD-Reference/dp/1890627208/

[6] Zeigler Dendy, Chris A. (2011). Teaching Teens With ADD, ADHD & Executive Function Deficits: A Quick Reference Guide for Teachers and Parents.

Amazon: https://www.amazon.com/Teaching-Teens-Executive-Function-Deficits/dp/1606130161/

[7] Cooper-Kahn, Joyce & Dietzel, Laurie C. (2008). “Late Lost and Unprepared”: A Parent’s Guide to Helping Children with Executive Functioning.

Amazon: https://www.amazon.com/Late-Lost-Unprepared-Executive-Functioning/dp/1890627844/

For kids:

 [8] Cook, Julia (2012). Personal Space Camp. National Center for Youth Issues.

Amazon: https://www.amazon.com/Personal-Space-Camp-Julia-Cook/dp/1931636877/

[9] Esham, Barbara (2015). Mrs. Gorski, I think I have the Wiggle Fidgets. (New edition) Adventures of Everyday Geniuses.

Amazon: https://www.amazon.com/Gorski-Fidgets-Adventures-Everyday-Geniuses/dp/1603368175/

Image Credit:
Description Schoolgirl
Stock Photo ID: #93541203 (iStock.com)
By: mamahoohooba
How-to-help-your-child-focus-and-pay-attention
Previously Licensed on: May 13, 2017
Stylized by Katie Harwood exclusively for Clear Child Psychology

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