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How Much Inattention is Abnormal?

A recent article in the American Academy of Pediatrics website addressed the normal range of attention in children. This article simply stated that everyone will show difficulty with attention in some circumstances at one time or another. Another way of stating this fact would be that it is normal for children and adults alike to struggle at times with attention and focus. The following is an excerpt from this article:
ADHD - Common Behaviors and Symptoms
At one time or another, almost all children seem to show symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). It is normal for all children to show some of these symptoms from time to time. Your child may be reacting to stress at school or home. She may be bored or going through a difficult stage of life. It does not mean she has ADHD. 
True ADHD symptoms appear on a regular basis and can interfere with learning. That is why a teacher sometimes is the first to notice inattention, hyperactivity and/or impulsivity and bring these symptoms to the parents' attention. Or perhaps questions from your pediatrician raised the issue. At routine visits, pediatricians often ask questions such as the following:

o How is your child doing in school?
o Are there any problems with learning that you or your child's teachers have seen?
o Is your child happy in school?
o Is your child having problems completing class work or homework?
o Are you concerned with any behavior problems in school, at home or when your child is playing with friends?
Your answers to these questions may lead to further evaluation for ADHD.
This article wisely addresses some of the factors which may easily interfere with a child's ability to learn in the classroom. Although classroom teachers often recognize a student's off-task behavior in the classroom, they may prematurely assume that task inattention is an indication of ADHD. It is a fact that inattention is a critical impairment recognized in all ADHD children. However, one must recognize that the symptom of inattention is a product of a variety of alternative diagnostic conditions. As stated in the American Academy of Pediatrics article, factors as basic as stress, boredom, or motivation can be reasonable explanations of a student's off-task behavior. In addition, there are numerous other routine life events and daily experiences that can effectively interfere with a student's lack of learning readiness in the classroom. It is alarming for me to observe the frequency of ADHD referrals for students who are more accurately impaired by learning weaknesses, poor academic motivation, weak work-study habits, behavior problems, and/or emotional difficulties.
A major weakness of the DSM-IV description of ADHD symptoms is the absence of objective criteria describing intensity, frequency, and duration of symptoms necessary to support this diagnosis. Any one reading the ADHD symptom list can easily "see themselves" reflected in the description of impairment. This uncomfortable realization is an all too frequent experience primarily due to the lack of specific criteria offered to measure the degree of inattention. Until more specific symptom criteria are offered, the diagnosis of ADHD will remain the product of clinical judgment.
Perhaps of more importance is the necessary recognition of variable attention recognized in every child including the student in the classroom. In addition to the possibility of alternative conditions which may be disrupting a student's attention in the classroom, there is also the possibility that limited attention can be best understood as simply a product of developmental immaturity. When considering younger students in the classroom, we must realize that not all children develop at the same rate. Developmental differences can be observed as substantial differences in students' readiness and availability for learning. Failure to recognize the impact of developmental delay could result in a child being inaccurately and unjustifiably labeled and medicated. It is important for parents and teachers to remember that students develop and learn at an individual pace and time that may not always coincide with the performance expectations in the classroom.
This realization highlights the importance of evaluating the whole child in the child's individual environment. Caution should be recognized when observing the mere symptom of inattention. Unfortunately, too many practitioners are quick to suggest ADHD in response to a child described with inattention. The DSM-IV symptoms of ADHD merely offer a basic framework for the comprehensive evaluation that still needs to be completed by a child professional.
George Gallegos, Ph.D.

George Gallegos is a licensed clinical psychologist practicing in the Sate of Colorado. He has maintained a private practice for over twenty five years during which time he has developed a long developing expertise with ADHD children. His current work with ADHD assessment and identification is conducted cooperatively with a large pediatric practice. Dr. Gallegos has more recently developed a 78-item test for ADHD entitled the ADHD Pre-Diagnostic Assessment (PDA). The PDA is an ADHD test for parents to use when initial concerns arise about their child. The PDA is intended as a primer measure when considering the possible need for a professional evaluation. The PDA can be used to discriminate essential factors that are predictive of ADHD or alternate conditions that interfere with classroom performance including learning disabilities, sensory integration dysfunction, developmental delays, or emotional/behavioral problems.



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