Attention Problems in Children and Their Causes

Attention Problems
Difficulties with planning sequences of behavior, comprehending verbal or visual information, or reacting to sensations all influence our attention. Each child may have a different reason or reasons for having a hard time paying attention. Clinically, my sense is that the difficulty in planning or sequencing actions or behavior is the most common contributor to attentional difficulties. A child with this difficulty cannot do things on "automatic pilot," as other children may. Obvious behaviors, such as checking your book bag to see if you have your homework books, require conscious effort and therefore can be forgotten.

Motor planning or sequencing difficulties will be discussed later in this chapter. We will discuss each general area that can influence attention, beginning with comprehending sensations.

Information-Processing Difficulties
As I explained earlier, some children have difficulty paying attention because of the way they take in and interpret what they hear or see. They are easily distracted because sights or sounds (words) haven't sufficient saliency and meaning to hold their attention.

Problems in processing information that a child hears are known as auditory-verbal processing difficulty. It is hard for such a child to hold a sequence of sounds or words in her mind. As a baby, she may not respond as pleasurably as other babies to complex rhythms. For example, she may only brighten up and look interested with simple rhythms, such as "BUM bum, BUM bum." If you hum the rhythm "BUM bum-bum-bum-bum BUM BUM" ("Shave and a haircut . . . two bits") she may turn away. She can't decode or comprehend the pattern, and she loses interest. (It's like playing classical music to someone who is unfamiliar with it. Because he doesn't comprehend the pattern in the music, he doesn't find it interesting and begins daydreaming rather than listening.) A toddler with auditory processing difficulty has trouble following simple instructions because it's hard for her to hold sounds in her mind. For example, she reacts with puzzlement to the instruction, "Come here!" But if you point to the child and then point to yourself, saying "Here, here," she sees and responds to your gesture. By the age of two to two and a half, when most children can comprehend a couple of instructions in a row, such as "Please pick up your plate and give it to Mommy," this child may obediently pick up her plate, but then stop, staring at you in puzzlement. You may then have to repeat, "Give it to Mommy."

As a preschooler, she may have problems opening and closing what we have described as circles of communication. For example, when you are playing with her and you wonder aloud why one doll is beating up another doll, she may look confused and simply repeat what she has just said.

As a school-age child, she encounters difficulties comprehending instructions. When the teacher says, "Get a piece of paper and a pencil out of your desk and write down these words," she may be confused because there are too many commands at once. Distracted, she tunes out, daydreaming until the teacher asks her why she hasn't taken out her pencil and paper. Remembering school lessons or phone numbers poses a problem, and reading skills may come slowly because she has difficulty connecting sounds to letters.

As she gets older, she may have difficulty comprehending abstract concepts that are communicated through what she hears. She may have a hard time with words that portray abstract concepts and may reason more in terms of action patterns and spatial concepts. For example, when most of us as children heard a new word, we thought about other words in association with that new word in order to figure out its meaning. (A child might, for example, hear the word "objectionable" for the first time. When a parent explains it in terms of a series of simpler, more familiar words, such as "not nice," she must hold in her mind the series of simpler words and the new word and understand the connection between them - quite a challenge for someone who has trouble holding in mind verbal patterns.) Similarly, trying to figure out the meaning of a story involves understanding the author's use of metaphor or other descriptive techniques, a hard chore if verbal patterns are not easily understandable.

Many children with verbal processing difficulty go on to become gifted interpreters of literature or become erudite in philosophy or social sciences. What many such individuals have done is to use their superior spatial abilities to buttress their weaker verbal pattern comprehension abilities. In other words, they may take a little more time to study a passage, visualize it, and then dissect it with almost mathematical precision and logic.

Often, a child with weak auditory processing skills may have excellent analytic or "big picture" thinking abilities. She is less oriented toward detail and more toward how the parts fit together. Academically, she struggles with the rote, memory-based skills that characterize the early school years, but has an easier time in high school, college, and graduate school when concepts and analytic reasoning skills become more central.

Sometimes a child with auditory processing difficulties faces problems finding the right words to express herself - a word retrieval difficulty. She may have trouble describing her day or answering teachers' questions. She tunes out and daydreams while talking, causing endless annoyance to parents and teachers. "You're not answering my question!" they say in exasperation over and over. Two-way conversations are hard for a child who has word retrieval difficulties. Sometimes she knows the answers but can't find the words to express them. This difficulty with word retrieval may be part of a problem with the motor system (which will be discussed shortly) or it may exist on its own.

Another processing problem is visual-spatial difficulty, in which a child has trouble comprehending what she sees. A baby with such a challenge may be able to look at you more easily when you simply smile at her than when you smile and wiggle your hands at her, for example. A toddler may tune out and get distracted when pictures in a book become too intricate. She is better able to focus on simpler pictures. A preschooler might get confused by such games as sorting blocks by shape. A school-age child would probably have difficulty in such subjects as math and geography because they involve picturing objects in space. She will have more trouble solving a maze or finding her way around unfamiliar places, such as a new neighborhood or new school.

Sometimes the child who is relatively weaker in visual-spatial abilities may be stronger in the auditory-verbal processing area. Thus she may be more sensitive to nuance, subtlety, and detail and have a harder time with the big picture - she has more difficulty in understanding how the pieces fit together. For example, she tends to learn math in a rote way - memorizing addition and subtraction rather than picturing the concepts in her mind. She hasn't a feel for quantity. She will, for instance, simply memorize that 8-2=6, rather than visualizing, say, eight apples and then imagining two taken away to leave six.

This child is likely to have difficulty with abstractions that are communicated through what she sees, such as mathematical and scientific concepts. Understanding the concept of velocity or acceleration in physics, for example, involves picturing different types of movement patterns and requires visual imagery rather than just memorization of a formula.

Most children tend to have a mixture of strengths and weaknesses. Children who are weak in visual-spatial skills tend to have strong auditory-verbal skills, for example. So the child who may not be able to find her way around a new neighborhood or school easily, for example, because of weak visual-spatial skills, will probably pay more attention to what people say. Since she is sensitive to subtlety and nuance, she may turn out to have strong writing or critical skills. Conversely, the child who is strong in visual-spatial skills may lean toward science or mathematics or architecture or enjoy working in hands-on situations, in mechanics or with computers.

An interesting point worth remembering is that our schools, in the early years, tend to be biased toward children who are strong auditory-verbal learners. Verbal systems are highly valued as children learn to talk, read, and write. Even if they have trouble picturing math concepts, they can master them in these early years because the simple concepts can easily be memorized. Because the verbal system is so overvalued in those early years, visual-spatial learners, who can understand math concepts but may not be able to memorize multiplication tables and have more difficulty with reading and writing, are thought to be slower in learning. Verbal children are more apt to be labeled "gifted" in those early years. Later, in high school and beyond, when science and math become more challenging and when even subjects like English and history are more analytical than factual and descriptive, visual-spatial learners (who are very analytical) may begin doing better. Some of the gifted auditory-verbal learners who depended too much on their outstanding memories and never grasped the concepts or principles behind what they were learning may begin to struggle.

Instead of assigning equal value to strengths in different areas in the early grades, we tend to try to explain away this bias. The child who struggled in earlier grades but now performs well is called an "overachiever," while the "gifted" student who is now struggling is "lazy" and not trying - an "underachiever." These labels may not fit at all. Nor have the "less smart" kids suddenly become smart while the "smart" kids have suddenly become average. Rather, the criteria for success have changed. Ideally, we should value different types of skills even in the early school years, so that children get a sense of their relative strengths, no matter what they are. The child who can find his way to his grandma's house, even after going there only once, should feel just as smart as the child who can read directions about how to go to grandma's house. Also, if we value different types of abilities in the early school years, we can be more tolerant of children's relative weaknesses. Children who fit a certain mold will not get a false sense of "I'm good at everything," leaving them unnecessarily depressed when they discover in college that certain areas are very hard for them. Instead, they would have had the opportunity to work on their more vulnerable areas as they were growing up.

Related to auditory-verbal reasoning and visual-spatial reasoning are other unique abilities that children possess. The ability to see beauty in nature and re-create it in art certainly is enhanced by strong visual-spatial perception, but it involves much more, such as motor performance. Creative writing ability, as opposed to simple verbal fluency and competence, is certainly related to the auditory-verbal system, but the creative aspect cannot be reduced to one skill. Musical ability does involve aspects of auditory perception, but characterizing it in that way alone would be simplistic. The ability to perceive subtlety and nuance in musical sounds, while more prevalent in people who have sensitive auditory perception, has many other aspects that stand on their own. Children's talents are best described in their own unique terms. While for discussion purposes I have to simplify the world into broad areas, such as auditory-verbal, visual-spatial, motor, and so on, we shouldn't lose sight of the fact that many of our unique human talents involve combinations of these skills and have their own, often indescribable characteristics.

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