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Monthly NewsNote
March 2008
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Paying Attention To Attention
We all know that inattention is the hallmark of Attention Deficit Disorder. That’s only logical. But words don’t necessarily describe the impact of the condition, as illustrated in two very recent cases I’ve seen. One is an adult and one is a child. I’d like to discuss these cases to focus on the major difficulties that failure to pay attention can cause.
Neither of the following patients is using medication at this time. Both are male, but females have similar problems.
Let me start with the adult situation. In this case, the failure to pay attention was disruptive both in the morning and at dinner. Dave was the one with the problem in a family with several children, and marital stress. His lack of attention made it much harder for the family to function smoothly. It started in the morning, perhaps with a simple request from his wife, Sheila. It could be to help a child find his shoes, or get his homework organized. Not listening meant that nothing was done. Sometimes without really listening Dave said, “Okay,” and Sheila assumed that the request would be taken care of. Again nothing happened and this time there was anger and outbursts because the response made it seem as if the request was heard and the help was going to be forthcoming. But in fact there was no real attention paid, and the day was off to an angry start.
At dinner when attention was needed to listen to the children reporting on their day, Dave was not paying attention. He would get up to do a small task as they were talking and could never listen for more than a very few minutes. The children felt they were being ignored by dad, which made them very unhappy. So both at morning and at night, Dave’s lack of attention caused anger, frustration, and unhappiness.
Children who don’t pay attention can also have a major negative impact on their surroundings. Such is the case of Rog, an ADHD child. His attention is short and poor, and we knew this. But we failed to focus on the effect of the deficit in the hours before school. During this time he would drift around, lose his sneakers as he went, and be playing games instead of getting to breakfast.
But this is just a description of Rog’s morning behavior, and doesn’t begin to illustrate the total effect of his lack of attention. What was actually happening involved not only Rog, but also the other family members. His mom was shouting at him. His dad, who was downstairs making breakfast, got angry with his mom for not making things work more smoothly. His sister was always fighting with him. The tension was high and their day never began nicely.
There are many possible examples, and in some cases medication may help. But in many cases some additional treatment is useful.
It is fine to do guidance work in these situations. In my experience a diagnosis of the problem is very important. That is, the factors leading to the difficulties need to be clarified and go beyond just a label of ADD.
Very often in ADD cases the problem is, indeed, lack of attention. While we know of the symptom, I’m suggesting that we often fail to isolate the specific results of the lack of attention. If this is done there is much better understanding of the causes of the problem and we are, therefore, more likely to bring about improvement.
Making the individual aware of the impact of the attention lack is of great importance. Therapy can be more focused and may include cognitive behavioral therapy as an approach to help the individual gain control.
The cases mentioned are new and we have a good deal of work to do. Hopefully focusing on the effects of the attention deficit will prove helpful.
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