Johnny is a busy, bright boy. However, his work is often incomplete and when it is done, it is messy. He blurts out the answers to questions and is often reprimanded for speaking to his classmates during the lesson.
Does he have Attention Deficit/Hyperactivity Disorder (ADHD)?
Ignoring is Bliss
We tend to associate ADHD with a lack of focus but a more accurate description is the difficulty in ignoring incoming information. Most of us can ‘tune out’ the sounds, sensations and sights of our environment when concentrating, but some children with ADHD experience their entire environment as equally stimulating and have difficulty in focusing on just one thing. Attention is the brain’s highlighter, zoning in on important information and ignoring the less important distractors.
Unlike other disorders, there is no blood test, scan or gene that can reliably diagnose ADHD. Specialist doctors (psychiatrists, neurologists or paediatricians) rely on questionnaires that are filled in by parents and teachers describing the child’s behaviour. Naturally, one teacher’s perspective may be different to another’s and parents may struggle to rate their children accurately without the expert knowledge of “normal behaviour”.
Discovering the real reason for a child’s inattentiveness and/or hyperactivity is important. For example, “daydreaming” can be due to anything from petit-mal seizures to boredom or depression, whilst “hyperactivity” can be because of hyperthyroidism, sensory-seeking behaviour or anxiety. Specialists observe the child in the clinic and use information from the questionnaires along with the educational assessment to diagnose ADHD, often through a process of elimination of other conditions. A trial of medication may be recommended at the end of the process. Although it is commonly believed that if the medication works, the child has ADHD, this is not accurate. In fact, stimulant medication has recently become quite the news-maker with college students using it as a cognitive enhancer during exams (much like steroids improve physical performance in races).
Despite there being no definitive and objective measure for the ADHD, educational tests can play an important role in understanding a child’s attention. Most children who are diagnosed with ADHD have been assessed for their IQ and scholastic aptitude. However, these tests don’t actually assess attention exclusively, but other skills that attention is entangled in, such as language, fine motor ability and working memory. A child may become inattentive in an activity simply because it is too difficult for him. Another factor in the assessment of attention is that there are different kinds of attention (e.g. a child may be visually attentive but struggle to pay attention when listening).
Helping us gain a better understanding of attention in a child like Johnny, is an assessment called “The Test of Everyday Attention for Children” (TEA-Ch) that solves both these problems. Although it is not a diagnostic tool for ADHD, it’s a useful part of the assessment process because it recognises that there are different types of attentional skills. It also takes into account that attention improves with developmental progress and that boys have different attention spans to girls. The information contained in this profile of attentional abilities can help parents to make informed decisions on interventions. It also allows progress to be tracked after an intervention (be it medication, change in diet, therapy or homeopathy) to determine to what extent it has made a difference.
Johnny’s mental highlighter might not be working optimally, making him “busy”, “distracted” and “messy” in the classroom. With more information about his attention- the glue that holds all his learning together- his performance can reach his potential.