Understanding Children’s Attention, Focus and Distractibility

Parent-teacher conferences are planned for this month and most parents are looking forward to hearing praise that their child is doing well. But some parents may have had hints of teacher concerns by notes sent home in their child’s backpack. Michael seems to wiggle a lot, daydreams, has trouble focusing, and is easily distracted. Emily may forget assignments, and although she is very smart, struggles staying on task, needs frequent redirection and makes simple mistakes because she did not check her work.

What does this mean? Is it serious or just kids being kids?

The common fear parents have upon hearing these symptoms stated is that the teacher will then utter the dreaded initials: ADHD. Common misconceptions then take over and the next concern is that the parents will have to consider starting their child on ADHD medicines.

Well, things have changed. In our new world of neuroscience we better understand these learning issues, and the decisions of how to help the child don’t have to include the short term symptom relief of ADHD meds.

What do we know today about these inattention and distractibility symptoms?

Your child has an executive in his brain that functions to direct how he learns. These functions are called executive functions. The specific one controlling learning processes is working memory. This working memory is short-term memory similar to a computer’s RAM. It is responsible for helping us work through a problem. Specifically it is responsible for:

  • Staying focused (processing information while listening).
  • Staying on task (inhibiting irrelevant thoughts and distractions).
  • Sorting information (identifying what is important).
  • Remembering multiple steps and which you have already done.
  • Resisting the impulse to talk.
  • Storing appropriate information in long term memory and remembering where it can be retrieved later.
  • Time management.
  • Planning and goal-setting.
  • Self-monitoring.

If a child has these working memory deficits, what are the options for help?

The old treatment was prescribing drugs or doing nothing. Neuroscience research has given us new treatment with a more complex plan of options. The first action of a diagnosis of working memory difficulty is to have a more thorough executive function assessment. This details exactly the child’s specific problems. Other executive function skill weaknesses may be found, such as emotional control and brain flexibility issues. These may require additional attention. Each child is different and not all children have all the possible executive function difficulties.

A tailored plan arises from this knowledge and the physician can work with the schools to set up helpful programs. An example of this would be a school IEP (Individual Education Plan). Through recent neuroscience research, we know that executive function skills can be taught.

There is an exciting new computer-training program, Cogmed, to teach working memory skills. Cogmed is a series of computer games that become more complex as the child masters the easy levels. The program gives long-term skills to this life long problem of working memory deficits. It is taken on the family’s home computer, monitored by a trained medical professional and the child and parent are coached on weekly progress. The initial program is intense for five weeks and decreases over a year. That seems like a long time, but these problems are not outgrown. Current medical treatment with daily medicines has a place in the total treatment in some children. This needs to be coordinated with the professionals helping the child, but is no longer the only treatment and may possibly be discontinued with the success of the other therapies.

You can find out more about the program at www.cogmed.com

The sooner working memory difficulties are found, the sooner help can begin and your child’s education experience can be a successful one.

Robert J. Hudson, MD, FAAP,
“Dr. Bob,” is a clinical professor of Pediatrics at the OU School of Community Medicine and the Co-Director of the Center for Resilience and Development.
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Categories: Big Kids