How much inattention is abnormal?

A recent article on the American Academy of Pediatrics website addressed the normal range of attention in children. This article simply stated that everyone will show difficulty paying attention in some circumstances at one point or another. Another way of stating this fact would be that it is normal for both children and adults to struggle with attention and focus at times. The following is an excerpt from this article:

ADHD – Common Behaviors and Symptoms

At one time or another, almost all children seem to show symptoms of attention deficit hyperactivity disorder (ADHD). It is normal for all children to show some of these symptoms from time to time. Your child may be reacting to stress at school or at home. You may be bored or going through a difficult time in life. It does not mean that you have ADHD.
The true symptoms of ADHD appear on a regular basis and can interfere with learning. For this reason, sometimes a teacher is the first to notice inattention, hyperactivity and / or impulsivity and call the attention of parents to these symptoms. Or perhaps questions from your pediatrician raised the problem. At routine visits, pediatricians often ask questions like the following:

o How is your child doing in school?

o Are there any problems with learning that you or your child’s teachers have seen?

o Is your child happy at school?

o Is your child having trouble completing class work or homework?

o Are you worried about any behavior problems at school, at home, or when your child plays with friends?

Your answers to these questions may lead to a further evaluation for ADHD.

This article wisely addresses some of the factors that can easily interfere with a child’s ability to learn in the classroom. Although classroom teachers often acknowledge a student’s behavior off-task in the classroom, they may prematurely assume that inattention to homework is an indication of ADHD. It is a fact that inattention is a recognized critical impairment in all children with ADHD. However, one must recognize that the symptom of inattention is the product of a variety of alternative diagnostic conditions. As stated in the American Academy of Pediatrics article, such basic factors as stress, boredom, or motivation can be reasonable explanations for a student’s off-task behavior. Additionally, there are many other routine life events and daily experiences that can effectively interfere with a student’s lack of preparation for learning in the classroom. It is alarming to me to observe the frequency of referrals with ADHD for students who are most precisely affected by learning disabilities, poor academic motivation, weak work and study habits, behavior problems, and / or emotional difficulties.

One of the main weaknesses of the DSM-IV description of ADHD symptoms is the absence of objective criteria describing the intensity, frequency, and duration of symptoms necessary to support this diagnosis. Anyone reading the list of ADHD symptoms can easily “see themselves” reflected in the description of the disability. This uncomfortable understanding is an all too frequent experience mainly due to the lack of specific criteria offered to measure the degree of inattention. Until more specific symptom criteria are offered, the diagnosis of ADHD will remain the product of clinical judgment.

Perhaps more important is the necessary recognition of the variable attention recognized in each child, including the student in the classroom. In addition to the possibility of alternative conditions that may interrupt a student’s attention in the classroom, there is also the possibility that limited attention may be better understood as simply a product of developmental immaturity. When considering younger students in the classroom, we must realize that not all children develop at the same rate. Developmental differences can be seen as substantial differences in the readiness and availability of students to learn. Failure to recognize the impact of developmental delay could result in a child being inaccurately and unjustifiably labeled and medicated. It is important for parents and teachers to remember that students develop and learn at individual rates and times that do not always match expectations for classroom performance.

This understanding highlights the importance of evaluating the whole child in the child’s individual setting. Caution should be exercised when observing the mere symptom of inattention. Unfortunately, many doctors are quick to suggest ADHD in response to a child described as inattentive. The DSM-IV ADHD symptoms simply provide a basic framework for comprehensive assessment that has yet to be completed by a child professional.