Parenting Solutions: Attention Deficit

The Change to Parent For

Your child learns strategies that stretch his ability to focus, recall important information, and pay attention without prompting or help.

Question: "Our son has always been a lively, spontaneous, and rather impulsive kind of kid, but his teacher thinks he has something called Attention Deficit Disorder and should take a drug every day called Ritalin. She complains that he doesn't pay attention and gets so distracted that he can't finish his work. How do we know when to worry because this isn't normal boy behavior?"

Answer: Many kids have trouble paying attention, but far fewer have an actual diagnosable problem such as Attention Deficit Disorder (ADD). Of course, you should work with the teacher to find ways to handle your son's attention problems so that he can succeed in school. But use these three factors to help you decide if your child's behavior really warrants a label:

1. The attention difficulty is clearly noticeable—even extreme—when your child's behavior is compared to other kids the same age and gender.
2. The attention problem has lasted at least six months and is evident in at least two different settings (such as home and school, and not just at school).
3. Your child's inability to pay attention significantly interferes with his ability to function and thrive in life and is not something your child can control.

If all these three factors apply to your child, then he is clearly struggling and will be at risk for everything from low self-esteem, school failure, and friendship troubles to drug abuse. It is time to pick up the phone and seek the advice of a trained expert.

Late-Breaking News

Limit Early Television Viewing

Children's Hospital and Regional Medical Center, Seattle: A study of over twenty-six hundred children found that each daily hour of television a child one to three years of age watched increased the risk of later attention problems almost 10 percent.¹ What's more, those attention problems, such as trouble focusing and restlessness, didn't show up until around seven years of age. Researchers surmised that those rapid-fire television images impact early brain development and may affect our children's concentration abilities. So consider limiting your child's TV exposure, especially during those early formative years. Doing so may reduce attention problems later in the school-age years.

Pay Attention to This!

Could It Be ADHD?

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) is the official manual published by the American Psychiatric Association that lists all recognized mental and behavioral disorders.⁴ Doctors in the United States currently recognize three types of attention deficits:

1. Inattentive: The child has difficulty paying attention to tasks or play activities; makes careless mistakes; doesn't seem to listen when spoken to directly; is often easily distracted and forgetful; does not follow instructions; and fails to finish schoolwork, chores, or duties.
2. Hyperactive: The child fidgets or squirms in his seat, leaves his seat when he is expected to remain seated, talks excessively, has trouble waiting, appears in perpetual motion, interrupts or intrudes on others, blurts out answers before questions are complete, and is often "on the go" or acts as if "driven by a motor."
3. Impulsive: The child often blurts out answers before questions have been finished, has trouble waiting his turn, and interrupts or intrudes on others.

The evaluation is complicated because types of ADHD can also be combined into three different diagnoses: Combined Type (multiple symptoms of inattention, impulsivity, and hyperactivity), Predominately Inattention, and Predominantly Hyperactivity-Impulsivity. Specific factors are also required for each diagnosis. For instance: Inattention or Impulsivity diagnosis requires that the child display at least six or more problem behaviors for at least six months, which are significantly disruptive and not consistent with normal child development. If you suspect your child has an attention disorder, seek the evaluation only of a physician, child neurologist, psychiatrist, psychologist, or pediatric specialist credentialed in child behavior and development.

Why Change?

Let's face it: some kids have a much harder time paying attention, and that inability will probably make their lives a bit more challenging. After all, a big part of getting along as well as learning new information entails tuning in to what we see and hear. But it doesn't mean that we should rush to judgment and assume that our kids have a clinical disorder or need medication if they can't sit still. That said, one in thirty American youngsters between five and nineteen years of age is currently taking the drug Ritalin, and the number over the past two decades has been steadily increasing. Parents currently spend over $1.3 billion each year on the three leading drugs prescribed for kids who have received a diagnosis of ADD.² In some U.S. schools, as many as 30 to 40 percent of the children in a typical classroom may be taking prescribed stimulants to control their classroom behavior. Reports say that ADD affects up to 9 percent of school-age children, but even then some people in the medical field fear that only half of those have been properly diagnosed.³

Regardless of whether your child is a bit "more spirited" or truly does have an attention deficit, he will need to learn to focus and stay on task longer. The good news is there are simple techniques you can use to increase your child's ability to concentrate, attend longer, and even recall what he hears or sees. In fact, teaching these attention-stretching skills will enhance any child's chances of success, so this entry offers practical solutions to help you start the change for your child.

Signs and Symptoms

Here are common signs of kids who have trouble paying attention:

• Poor recall. The child needs to have instructions repeated several times; he can't remember more than one direction at a time. (If you ask him to go to the kitchen for water, he'll go to the kitchen but forget why he went there.)
• Trouble sustaining attention. He has trouble focusing on a task for any length; teachers complain that he doesn't pay attention.
• Distraction. The child daydreams or always looks around; he is easily sidetracked from the task.
• Poor attention to detail. He doesn't give close attention to details and makes careless mistakes.
• Poor listening skills. The child does not seem to listen when spoken to directly.
• Poor organization skills. He has difficulty arranging or sorting tasks; loses things (toys, school assignments, pencils, books, or tools); and has trouble keeping track of possessions and materials.
• Avoidance of mental effort. The child dislikes or is reluctant to engage in tasks requiring prolonged mental exertion.
• Trouble waiting. The child fidgets, has difficulty waiting, and interrupts or intrudes on others; he butts into conversations or games.

The Solution

Step 1. Early Intervention

• Identify attention stealers. Most parents assume there must be a clinical reason, such as ADD, for their kid's focusing troubles, but there may be a number of causes. Start instead by identifying possible reasons for your child's attention problems in the following checklist so that you can determine which you can improve on. Here are a few:
  • Impaired cognitive ability. Your child has a neurological impairment, a learning disability, seizures.
  • Auditory or language deficit. Your child has hearing loss, an ear infection, a language or speech delay, or an auditory processing problem.
  • Fatigue. Your child is ill, overtired, sleep deprived, overscheduled with no downtime.
  • Emotional problem. Your child is depressed or under stress; has experienced a trauma, such as an accident, divorce, or the death of a loved one; is in a state of tension from bullying; lives with family instability.
  • Inappropriate expectations. Instruction or content is not geared to your child's natural learning strengths, internal time table, style, or abilities.
  • Poor instructions. Directions are poorly given, or the child is not expected to listen.
  • Distractions. The environment is too noisy, too bright, too distracting; there is too much or too little stimulation.
  • Manipulation. Your child selectively listens only to what he chooses; he uses inattention to avoid what he doesn't want to do; he realizes someone will do the task for him; he is disobedient.
  • Genetics. Although no specific "gene" for attention deficits has been identified, the disorder appears to run in families. One-half of parents with ADHD and 10 to 35 percent of close relatives of children with ADHD have the disorder as well.⁵
• Set appropriate expectations. Make sure your child's schoolwork matches his appropriate academic capabilities. For instance, if he tests at a 1.5 reading level, don't expect him to read at the 4.2 level. Assignments should be geared only slightly higher than children's ability, otherwise they tune out and will have problems attending. Also make sure that the task isn't set at too low of a level so as to cause boredom, which also causes inattentiveness. Your child's teacher can provide you with that information.
• Watch those labels! Avoid using any negative labels or derogatory nicknames about your child ("the Attention Deficit Kid," "our absent-minded professor," or "space cadet"). They can become daily reminders of incompetence and turn into self-fulfilling prophecies. What's more, they often stick and become difficult to erase. One good rule to use: if the nickname does not show respect, it's best not to use it. And if you hear anyone using a less than flattering term about your child, give it a positive spin. Instead of "He's so hyper," say "Yes, he's really energetic." Or: "She's really spacey." Turn it: "She gets her best ideas daydreaming."

Step 2. Rapid Response

• Get an accurate picture. Your first step to a new response is to figure out your kid's true attending capabilities. For instance, what is the usual length of time your kid can focus before he tunes out? Which things does he have no problem attending to? For instance, does he spend hours sorting his hockey cards, playing a certain video game, or skateboarding? Which tasks are most frustrating? And what works to help your child focus best? For instance, giving directions using a quieter tone, repeating them twice, drawing a picture to help him remember? Developing an accurate picture of your child's attending capabilities and problems may take time, but is essential. You can also pass on to other caregivers what works best to help your child focus. So take notes and watch to determine which techniques work and which ones don't. Be sure to observe your child in different settings, and do seek the advice of his teacher, coach, and other caregivers.
• Review your current response. Experiment until you discover what works best to help your child attend, and then consistently use that new response. Here are few techniques to try:
  • Get his attention first. An old teacher rule is always to get the students' attention before giving a direction, thus increasing the likelihood that they will pay attention.
  • Make eye contact. Get eye to eye with your child to state your directions, or say "Eyes please," which cues your child to look at you and then listen.
  • Lower your voice. Use a quiet and calm voice.
  • Use touch. Lay your hand gently on your child's shoulder or hand to get his attention.
  • Be brief. Keep your directions short and to the point.
  • Use a visual cue. Put your hand out like a stop signal as a cue to stop what he's doing and focus instead on the task.
  • Use a bookmark. Put your finger on the spot on the paper your child should be focused on, or teach him to use a bookmark to focus on only one line at a time.
• Keep to a schedule. Children who have trouble paying attention benefit from routines. Those repetitive schedules create predictability, which reduces stress and helps kids focus. The trick is to find the best time for your child's homework, bed, dinner, and so on, based on his attending ability. Warning: the times for these activities may be different from those your other kids. Post those times on the refrigerator or bulletin board as a reminder and stick to the same daily routine as best you can.
• Reduce distractions. Kids with short attention spans are distracted easily by noises, smells, and images. So tune in a little more closely to determine what things hinder your child's concentration (for instance, the flickering overhead lights, the cuckoo clock, a barking dog, the neighbor kids yelling) and reduce what you can. Also, turn off the television when it is not being watched. A University of Massachusetts-Amherst study found that the background sound or image on the television reduces children's focusing ability even if the image is viewed in snippets.⁷
• Set up the ideal work place. Once you discover what helps your child attend best, set up a study spot that provides his ideal working conditions. Usually it's a smaller, more confined space with no windows, hallways, or sources of noise. Placing the desk against a blank wall can also reduce distractions. Some kids benefit from earplugs, earphones, or even certain types of music. Might these help your child? Involve him in the "discovery process" so that he recognizes what helps him learn; keep experimenting until you find the best options. For example: at his son's suggestion, one dad cut away the side of a refrigerator crate and put a small desk inside. It did the trick.
• Allow some fidgeting. A new study from University of Central Florida finds that many ADHD kids use movement to keep themselves alert, especially while performing tasks that challenge their working memory. Researchers recommend that when your child is doing homework, let him fidget, stand up, or chew gum. Unless his behavior is destructive, severely limiting his activity may actually reduce his attending abilities. Experiment with what works to help your child do those math problems or more challenging tasks that require concentration.⁸
• Offer frequent feedback. Acknowledge any effort your child makes to stay on task: "You're getting it!" "Thanks for looking at me to hear what I had to say." "Way to stop and think first." He needs to hear positive messages. Some kids benefit from a token reinforcement system in which they earn points toward a prize or treat for completed tasks. The trick is to wean the child from the reward system as soon as it is no longer needed. A teacher could help you set up a good behavior modification plan tailored to your child.
• Get everyone on board. If at all possible, try to work with your child's teacher (as well as counselor, pediatrician, and so on) to create a positive behavior and academic plan. Ask if a school psychologist should evaluate your child. You will be more successful in reaping positive results if everyone is on the same page and uses the same responses.
• Get treatment early. Researchers at Cincinnati Children's Hospital Center studied over three thousand children ages eight to fifteen and found that although almost 9 percent of children meet the criteria for some form of attention deficit, fewer than half receive treatment.⁹ Girls in particular are less likely to be recognized. A three-year study found that most kids treated for ADD—whether with medication, behavioral therapy, or both—do improve over time.¹⁰ If you suspect that your child has more than just simple trouble focusing, seek an evaluation from a credentialed specialist. Don't wait! Kids with an attention deficit often suffer from low self-esteem, have trouble with peers, and struggle in school.

Step 3. Develop Habits for Change

• Burn off extra energy. Research finds that kids with attention deficits are often "calmer, more focused, and more able to follow directions after a time outside, especially in settings like a part or backyard."¹² It seems a brief time in the great outdoors gives kids the chance to burn off excess energy before tackling homework, and actually helps increase attention spans. Look for active outdoor outlets your kid might enjoy that help him work off that "surplus oomph" and help him focus for longer stretches. Possibilities might include gymnastics, tae kwon do, karate, basketball, bike riding, swimming, or skateboarding. Just choose what turns your kid on.
• Create an organizational system. Poor organizational skills are common for kids with short attention spans. So help your child learn to organize tasks so that he is less likely to forget assignments. Here's how. First provide a small date book with a page for each school day on which to write assignments. Then purchase a small binder with a different colored divider for each school subject plus two additional dividers. Print "To Do" on the front of one divider and "Finished" on another, and then write the name of each subject on the remaining dividers. If your child has trouble reading the terms, create a symbol for each (such as a book to signify "reading" and numbers for "math"). Then, one at a time, teach your child to do these six steps:
  1. Date. Write each assignment in the datebook on the due date the minute it is given.
  2. Store. Put each assignment in the To Do section.
  3. Do. The first homework task is to review the datebook assignments. Then remove your papers from the To Do section.
  4. Cross off. As each task is completed, cross off the assignment in the datebook.
  5. Finish. Put each completed assignment in the Finished section of the binder.
  6. Store. When all assignments are crossed off, put the notebook in the backpack, and place the backpack in the same "safe" spot (such as by the front door) to find the next morning.

The trick is to teach only one organizational step at a time and then review the step with your child until it becomes a habit.

• Chunk the tasks into smaller parts. Kids with short attention spans often feel overwhelmed with "so much" on a page. If this is your child, "chunk" down tasks into smaller parts to help him stay focused. If he feels overwhelmed even getting started, ask "What's just the first thing you need to do?" If the whole math page seems daunting, fold the paper in thirds and tell him to do the top part first (then the middle, then the end). Suggest he do the most difficult part of the task first to get it out of the way and reduce the stress.
• Enhance recall. Children with attention deficits often focus on the wrong details or have trouble "holding a thought" in their head. These strategies help kids hold a mental representation of important facts and pay closer attention to key ideas or important points:

What's your "keeper"? After your child has read, listened to a story, or watched a documentary, ask, "What's your keeper?" (Which means, "What is the most important thing you want to remember?" ) Use the question when your child's attention starts to ebb.

Drawing it. Drawing what they hear or read helps some kids stay focused.

Highlighting a fact. Encourage your child to highlight key ideas with a colored highlighting pen as he reads. Tell a younger child that the yellow puts "sunshine" on the most important ideas.

Dinner-hour paraphrasing. Each family member takes a turn briefly describing something that's happened during the day. The next speaker must correctly restate the previous talker's ideas, before contributing his experience. To make it challenging, after everyone's had a turn, see if anyone can identify one important idea from each person's conversation. The game helps kids pay closer attention to a speaker's words.

One-fact note cards. Teach your child to stop at the end of every sentence (or paragraph or page) he reads or hears. He then writes or draws "one fact" on a three-by-five card. When the assignment is finished, help your child review the fact cards and then store them in a recipe-size box. He can later review cards for tests and recall the main ideas.

What To Expect By Stages And Ages

Preschooler   Typical behaviors—such as not listening, difficulty settling down, and lack of interest in paper tasks—can easily be confused with true attention deficits, but are common with many preschoolers. Doctors generally won't diagnose ADD because most preschoolers can be forgetful, lose their belongings, and be easily distracted to some degree and are unable to sustain attention for long periods (especially boys). So don't jump to the conclusion that your child has a disorder. Pay attention instead to extreme behavior patterns: your child is noticeably more distracted than other kids, constantly in trouble with friends, and repeatedly must be asked to listen.

School Age   More severe symptoms may surface in first and second grade when a child is unable to follow directions and can complete only small quantities of work. Milder attention problems may not surface until third or fourth grade, when kids are expected to function more independently. Symptoms are most likely to be seen at school (the child has greater difficulty completing class work) and at home (homework can take several hours to finish). About 3 to 5 percent of school-age kids are diagnosed with ADD or ADHD, especially boys (by a five-to-one ratio), who tend to have more difficulty focusing.¹³

Tween   Schoolwork and grades can suffer and self-esteem can plummet as workload and academic pressures increase. Stress, peer pressure, bullying, overextended schedules, and lack of sleep peak and can contribute to concentration difficulties as well. Tweens diagnosed with ADD or ADHD are prone to have more problems, including shoplifting, substance abuse, and delinquent and risky behavior that could cause physical injury (especially boys).¹⁴ Of tweens diagnosed with clinical attention deficits, 70 to 80 percent still have symptoms as teens and adults.¹⁵

One Parent's Answer

A mom from Baton Rouge shares:

Homework was such a nightly struggle because my son's attention span was so short. I finally figured out the longest time he could focus, and then set mini five-minute study breaks where he could take a drink of water, do a few jumping jacks, or just squeeze a Koosh ball a few times. Those brief breaks seemed to help him refocus and reduced our battles. My next step is to gradually decrease the breaks as his concentration increases. We're using "Slow but sure" as our motto.

Pay Attention to This!

Should You Medicate Your Child?

Medicating kids for attention deficits is a hotly debated issue and should never be taken lightly. To date, medication can be the most effective treatment for children correctly diagnosed with a severe case of ADD or ADHD. Even so, be cautious and seek facts. Here are questions to ask your doctor to help you make the right decision for your child if medication is suggested:

• Why do you advise this medication? How many other children have you prescribed this medication for? Was it helpful? How do you know it was helpful? (Get as many details as possible.)
• How long do you anticipate my child will be on this medication?
• What exact changes should I see in my child? How long will those changes take? (Ask for specifics based on your child's needs. Will this decrease tantrums, help him stay on task, reduce the fidgeting?)
• What is the lowest dose that might be effective? (Ideally use the rule "Start low and go slow.") What happens if he misses a dose? Does he need to take it daily? What about weekends?
• Where do I read about the research and possible side effects of this medication?
• What are the alternatives? What is our next step? How will you monitor my child's progress?

Don't stop with these answers. Get a second medical opinion so that you are confident that your decision about medication is the best option for your child. Even then, medication should be only part of your child's treatment plan. A three-year study found that most kids treated for attention deficits who received the right treatment— whether with medication or behavior therapy or both—improve greatly within a few years.¹¹ So don't stop until you get the right treatment!

One Simple Solution

Change Your Child's Sleep Patterns

In some cases, the solution to your child's attention problems may be simpler than you think. Sleep-deprived kids often have trouble paying attention and display symptoms of impulsivity and hyperactivity.⁶ So before jumping to the conclusion that your kid has an attention deficit, try changing his sleep habits to help him get a more restful night's sleep (See Sleepless, p. 585.) Research shows that a simple change to your child's bedtime routine, such as tweaking his bedtime, can have great results in stretching his attention span.

More Helpful Advice

ADHD: Attention-Deficit Hyperactivity Disorder in Children, Adolescents, and Adults, by Paul H. Wender

From Chaos to Calm: Effective Parenting for Challenging Children with ADHD and Other Behavioral Problems, by Sharon Weiss

Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach, by Vincent J. Monastra

Taking Charge of ADHD: The Complete, Authoritative Guide for Parents, by Russell A. Barkley

The ADD and ADHD Answer Book: Professional Answers to 275 of the Top Questions Parents Ask, by Susan Ashley

The Myth of the A.D.D. Child: 50 Ways to Improve Your Child's Behavior and Attention Span Without Drugs, Labels, or Coercion, by Thomas Armstrong

Treating Huckleberry Finn: A New Narrative Approach to Working with Kids Diagnosed ADD/ADHD, by David Nylund