The fall season is upon us and the new school year is in full swing. The start of the school year is a time of transition, but once kids settle in, teachers begin to observe individual strengths and weaknesses. With parent-teacher conferences just around the corner, teachers may bring concerns to parents about learning and difficulties with attention. Attention challenges are becoming more and more noticeable in the classrooms especially as the world’s distractions increase with technology, social life, and other life circumstances. Children are having difficulty focusing in the classroom and these concerns can be a threat to their ability to succeed. In some cases, teachers may ask you to consult with your primary care physician for a screening. The screening may show that there are symptoms consistent with Attention Deficit Hyperactivity Disorder (ADHD) and some primary care physicians may feel that a trial medication is necessary. However, there is growing concern that the screeners are missing co-existing or perhaps underlying conditions that are mimicking the ADHD symptoms.
Attention issues are common in numerous different diagnoses, but they are often the first concern identified in schools because of the environment and the expectations made of children in that setting. It is important to understand that attention issues can occur even in neurotypical children without mental health concerns due to hunger, poor sleep, headaches, or increased stress in their lives. Attention issues are also more likely to be identified in children who are young for their grades. The causes for inattention can be diverse and do not necessarily indicate the presence of ADHD.
In children who are neurodiverse or experience mental health concerns, many diagnoses can appear like ADHD. Children with Autism often experience inattention unless they are interested in the task or motivated externally due to their social challenges. Sensory processing issues can also cause children to be overwhelmed in highly stimulating environments or underwhelmed when expected to sit and do tasks (causing these children to be moving, fidgeting, or other “disruptive” behaviors). Both types of sensory processing issues can contribute to inattention for different reasons. Children with trauma also frequently experience increased inattention due to hypervigilance to their environment. Anxiety and depression can contribute to inattention due to preoccupation with their own thoughts rather than thinking about the task that is presented to them. Children with learning disabilities also frequently show inattention because the extra effort that is required of them causes attention to wane more quickly. With so many different reasons for inattention and/or hyperactivity, it can be challenging to understand where the attention issues come from in order to understand what to do about them.
For this reason, assessment may be necessary to offer a differential diagnosis. Differential diagnosis seeks to rule out possibilities such as anxiety, learning problems, processing issues, or other conditions. Attention is a symptom of numerous other conditions which may be one explanation as to why ADHD seems over-diagnosed in the general population. A formal evaluation can offer guidance, not only to parents, but to educators as well. Of course, it is always important to make an effort at home to possibly alleviate the symptoms. Don’t forget important factors such as healthy sleep, diet, and exercise practices. It should be of no surprise that research is showing an association between screen time and problems with mood, executive functioning, and attention. If the efforts at home are proving unsuccessful, don’t hesitate to consult with a BRAINS psychologist or neuropsychologist who can determine the appropriateness of testing or make other necessary suggestions. These first few months of school are so challenging; not only for the kids but for parents as well. We want to see our kids succeed and it can be hard to hear negative reports from school. An evaluation can help to guide next steps and alleviate some of the frustration.
So, keep all of these things in mind as those parent-teacher conferences roll around. We hope that every parent, teacher, and student has a great school year ahead!
About the Authors: Dr. Christina Warholic, PsyD. is a member of the clinical team at BRAINS in Grand Rapids, Michigan. She has special interest in working with the pediatric population and has a passion for neuropsychological and psychological assessment. Read more about Dr. Warholic here.
Dr. Jennifer Maurer, PsyD. is a licensed psychologist at BRAINS in Grand Rapids, Michigan. Dr. Maurer has a love for research and a passion for understanding children with difficulties. Read more about Dr. Maurer here.