The way that I and many of my colleagues who work with children prefer to think about attention is that it's a dynamic, active process involving many parts of the nervous system at the same time. Attention involves taking in sights and sounds and touch; it involves processing information; it involves planning and executing actions. If you can take in information, process and comprehend it, and plan and execute actions based on this information, you can pretty well pay attention. It's not just about sitting still; there are many gifted people who are very active - they're moving around or fidgeting all the time - yet are very successful professors or engineers or doctors or lawyers or chefs and wonderful parents. What determines whether they're what I would call "functionally attentive" (i.e., taking in and mastering their environment) is how well they get all the different abilities just mentioned working smoothly together. When they are, a person is attentive.
If we think about attention that way, it helps explain the variety of problems that I see in my practice. Of the children who come to see me having been diagnosed with ADD or ADHD, a great majority have what we call "motor planning and sequencing" problems. Almost all of them have difficulties with carrying out a many-step action plan in response to either a verbal request or visual information or an implicit demand of the environment, like solving an obstacle course. Other children - not all of them, but some of them - are overreactive to things like touch or sound, so they get overwhelmed and very easily distracted, for example, by another child sitting next to them at school who's making noise. Their overresponsiveness leads them to be less attentive. How Is ADD Diagnosed
Children who are underresponsive or underreactive to sensation - for whom a normal speaking voice won't feel
you touching them unless you use firm pressure - are also going to appear inattentive.
For example, a little boy came to my office the other day, and I talked to him for a good five minutes in a normal tone of voice before he finally looked up from his electronic game and noticed me. I let it go on for a while because I wanted to see how much he could tune out and how underreactive he was. I learned during the session with him that, when I increased the energy in my voice, I could get his attention within a second every time, but if I talked to him in a normal tone of voice, he basically tuned me out. When we went through his history very carefully, it turned out that he was underreactive in a number of his senses.
Sensory-seeking children may or may not be underreactive but are constantly looking for more touch, more sight, more sound, more movement, and so they're going to be very active, distractible, and inattentive - they are the typical children who get diagnosed with ADHD.
Other children diagnosed with ADHD may have a problem with processing and sequencing information. If you say, "I need you to go upstairs, put on your shoes, come back down, and get ready to go outside because we're going out to lunch," he may be able to process only the first part of that sequence - "I need you to go upstairs" - and then he forgets what he's supposed to do. His problem with sequencing information makes it difficult for him to hold on to complex verbal instructions. He's going to seem very inattentive because on the way to his room he gets so distracted by a toy that he forgets why he went up in the first place.
The ability to plan and sequence actions and solve problems is commonly referred to as "executive functioning." It's related to motor planning and sequencing and also to sequencing and problem solving with ideas. A good way to think about executive functioning is that it's the child's ability to take in information through the senses, process that information, and then use that information in a sequence of actions to solve a problem. We notice the last part of executive functioning - the planning and sequencing actions or words - but it depends on the first two steps, as well. How Is ADD Diagnosed
Other problems, such as in visual-spatial processing can play a part in attention. A child who can't see the big picture goes upstairs to find her shoes but doesn't know how to look systematically because she doesn't have a picture of her room. So she goes and looks near the bed, doesn't see them, and then gets distracted because she doesn't have a mental picture of other places the shoes might be.
From these examples we see that a diagnosis of ADD or ADHD may not be simple at all. The inattention is the outward symptom, but the problem is rooted in these deeper elements, like motor planning and sequencing, overreaction, and visual-spatial difficulties. To learn more, you can check out How Is ADD Diagnosed.
