Attention Deficit/Hyperactivity Disorder (ADHD) can present in many different ways. Typically when we think of ADHD, we think back to when we as parents were in school and there were kids climbing onto the roof; calling out in class; and getting into fights. And although these types of behaviours could be seen in children with diagnoses of ADHD, it also presents in many more subtle ways.
First it is important to distinguish between ADHD’s three presentations: inattentive; hyperactive; or combined. Tonight we will be focusing on ADHD – Inattentive presentation. The inattentive presentation is the most common and is typified by: making careless mistakes; difficulties concentrating or sustaining attention; failing to listen; and forgetfulness. When diagnosing an inattentive presentation of ADHD it is important to determine where the inattention is coming from. We have spoken previously about cognitive assessments, and they really come into their own when diagnosing ADHD. It is a little-known fact that there are many types of attention. The main ones we investigate are: a capacity for attention; an ability so switch attention (ruling out distractions); and an ability to sustain attention. In inattentive ADHD, a child may have difficulty with one or all of these areas.
A reduced capacity for attention might present as a failure to listen and forgetfulness (think single-step instructions). Difficulties with switching attention may present as high distractibility and constantly moving from one activity to another whilst completing none; and difficulties with sustaining attention may present as frequent daydreaming or “zoning out”. However, children can also “appear” inattentive even if they don’t have a genuine attention difficulty. How you might ask? Something I commonly see is children with a difficulty in their long-term retrieval. In this case, teachers might complain that they appear to daydream; and parents might claim that they can’t seem to remember simple things. In the case of long-term retrieval, the issue is not with an inability to remember facts, but with an ability to recall them quickly. When a child experiences long-term retrieval difficulties, they struggle to quickly recall previously-learned information. In a classroom, this presents its own set of difficulties when learning new information because when we can’t recall foundational knowledge, we have nothing to attach new concepts to. In this case, children have two options: spend all their time trying to recall the foundational knowledge and miss out on the new concept; or listen to the new information but have nothing to “attach” it to (preventing them from “expanding” their knowledge). It is important to note that long-term retrieval difficulties are not the same as an inability to learn. They are a difficulty with recalling information.
Another less-known reason for perceived inattention is auditory processing difficulties.When a child has an auditory processing weakness, their brain has difficulties in discriminating between competing sounds, to be able to decide where to allocate their attention.In this case, a child may appear inattentive at school, in an environment which we consider “language-rich”, but not at home.This is because home environments typically are not as language intensive, therefore children do not need to discriminate between sounds. A difficulty with auditory processing may present as zoning out; needing silence to concentrate; and difficulties understanding auditory information despite no hearing loss.
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