Defining "INATTENTION" in ADHD

ADHD doctors often talk about "inattention" as a symptom of ADHD. When we talk about "attention" or "inattention" we need to find ways to conceptualize just what the words mean. One way to look at it is as two different kinds of cognitive abilities:

• The ability to focus on a specific and targeted task put in front of us to do, such as school work, and
• the ability to pay attention in a more global sense to the world around us, for example the buzz of the lights overhead, and the touch of the clothes on your skin, and the children playing outside of the classroom.

In this model there are two different kinds of paying attention. And the better and faster you are at being able to shift from one kind of attention back to the other, the better you are at paying attention. But when one cannot shift easily from global attention to focused, or visa versa, then this neurological inflexibility is a problem. It is a form of "inattention" and is a problem with ADHD.

Paying Attention to the Right Thing

One good definition of "Paying Attention" is - “Sustaining attention to the right thing at the right time.” One part of that definition is that the person with ADHD has to pick the right thing to pay attention to. That's the “selecting” part of the definition. A better word might be "Filtering." The brain is supposed to filter out distractions, or stimuli which compete for our attention, but might not be important at that moment. Many children with attention problems pay attention to everything in the world around them equally, such as giving equal time to the touch of the clothes on their skin, the buzz of the lights overhead, the kids outside the classroom, and the math worksheet in front of them. This, of course, is a problem if he needs to be paying attention to only the math worksheet or the teacher.

So this kind of "inattention" is being unable to resist distractions and focus to the right thing. The person with ADHD responds to the distraction, which of course keeps them from ever completing the task at hand. There are lots of "shiny things" in every ADHD person's life, or room, or office, or garage. Of course, the better someone is at filtering out or resisting being distracted by shiny things, the better they are at completing their tasks or reaching their goals. We call this "focus" and focus helps.

An interesting neurological note is that this type of distractability is not located in the area of the brain that processes "sensory" information. The person with ADHD does not have a "sensory processing" problem or a "perception" problem. They perceive the world like everyone else does. They see the same, hear the same, though they may be a bit more sensitive to some sounds and lights. But ADHD is not a perception problem. The big problem with ADHD is that they have great difficulty resisting the distractions and staying focused to the job at hand. This distractability is on the motor side of the brain, it is behavioral. It is a motor abnormality that they simply cannot resist moving to check out the shiny thing. They get up, look at it, touch it, talk about it. But it is just a shiny thing - a distraction
from the job at hand. For more information on how to reach Doug Cowan, visit http://douglascowan.me.

ADHD and Executive Function

Dr. Russell Barkley, a professor of psychiatry at the University of South Carolina, is a leading expert on ADHD. Here he discusses the five cognitive abilities that appear to be impaired in children with ADHD. For more from the Child Mind Institute v...

Perseverance as Part of Attention Too

Another part of inattention in ADHD is a lack of persistence and perseverance in working to complete a job, or reach a goal. In this type of inattention the problem is the lack of ability to sustain focus and attention over time in order to complete the job, task, or goal. This is "sustained attention" or "time on task" in the classroom or office. The problem is that ADHD is characterized by a lack of persistence This too is from the motor areas of the brain, not the perception or sensory areas. There is not enough self-motivation to stay focused, rather there is the impulse to get up and check out the shiny things. This keeps people with ADHD on task long enough to complete the job.

This is the "moving from one task to another" without finishing anything. Unless the task is very rewarding, like a video game or TV, the person with ADHD will move from one thing to another to another.

The motor aspect of this inattention, the moving from one thing to another, is the difference between this kind of inattention and the inattention caused by depression, or anxiety, or learning disabilities, or hearing voices in your head. These are more perceptual processing problems, though there can be a lot of restlessness with any of them. But ADHD is a motor problem causing a lack of focus and perseverance to a task.

Boring School Work Causes Inattention

Many Children with Attention Disorders have trouble concentrating on the specific task in front of them, especially if they are working on something like school work or chores that are only moderately interesting, or not interesting at all. These tasks are simply not rewarding or motivating. One of the characteristics of inattention in ADHD is a lack of self-motivation. There just is not that internal drive and desire to finish a boring task. External motivations like the rewards from video games will capture the attention, but tasks without these external rewards will not get done.

ADHD kids have to be very motivated, very excited, very interested in what they're doing in order to pay attention. Now, you might be thinking, "This is not my kid. I have a kid who could play Nintendo, and be so focused that the house could burn down around him, and he'd never notice." Well, that could be. A lot of these kids could do just exactly that. Nintendo is interesting, its challenging, and its fun. Kids get immediate feedback, they could play Nintendo for hours.

But just put a math worksheet in front of them and see how different it is. They have a terrible time paying attention to something that's not interesting or that's not motivating, which accounts for about 85% of school work, and about 100% of chores.

Lack of Flexibility with Attention

Part of the problem with Attention Deficit Hyperactivity Disorder – ADHD - is a lack of FLEXIBILITY with attention. A person without ADHD has the ability to shift from attention that is focused on a specific task at hand to the kind of attention that is global many times in just a few seconds. Whenever he wants, someone without ADHD can shift from reading a book, to scanning the room to know where our kids are and what they are doing, and then very quickly returning to focus on reading.

Those without ADHD have Flexibility in their ability to Focus, shifting from specific focus to global focus at will and very quickly. Individuals with ADHD do not have this same Flexibility of focus. Those with Attention Deficit Hyperactivity Disorder have a very difficult time shifting from a global focus, such as they might have at recess or lunch break, to a specific focus that would be required when they return to the classroom to study math and work on the math worksheet in front of them.

This is why it seems that kids with ADHD could play Nintendo, be really focused on that task, and not notice the house burning down around them.

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Working Memory and ADHD

Another ADHD characteristic is the difficulty in getting back to work, returning to the task, once having been distracted by the shiny thing in the room, or outside of the room. People with ADHD don't return to the task that they just left, they just move on to the next thing. Even when having been distracted people without ADHD can keep in mind what they have been working on and why. This is referred to as "working memory" which is different from either long-term memory functions or short-term memory functions. Working memory is remembering what you need to do, and how to do it, so that you can get it done before it's too late and while it still matters.

People with ADHD have impaired working memory. They have trouble keeping the information in mind that they need for the task so that they can complete the job or reach the goal. So they just wander from thing to thing, task to task, without ever completing anything really. This is a "working memory" deficit in ADHD. This is a time problem, a focus problem, a remembering what it takes to get the job done problem. And yes, it is what you see in older people as their working memory and executive functions begin to wane.

In this sense ADHD is not a deficit of skills, or knowledge. It is a deficit of results. It is a problem with performance.

Working memory deficits also impact one's ability to tell time. Not as in looking at a clock and knowing what time it is, but rather being aware of how long something will take to do, or how long it has been since leaving for school, or whatever. ADHD causes an awareness of time deficit. ADHD causes people to live in the moment (which has now passed), without really thinking much about the future. Things in the future simply have little value when compared to what is happening right now. As a result it is common to see people with working memory deficits from ADHD to be unprepared when the future does arrive. Homework is not finished, the report not done. Preparations for winter not made. Its not procrastination as much as living in the "now". Both past and future have little value compared to the present.

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

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