Inattentive Without ADHD

Why Can’t My Child Focus? It may not be ADHD

Attention Deficit Hyperactive Disorder (ADHD) diagnoses often presume that inattentiveness is the root of the problem. Most often, it is merely a symptom. As a result, for millions, it is a frustrating and demoralizing problem that erodes confidence and passion for learning. Each year, a wave of students will be mislabeled as ADHD, scarred unnecessarily and prescribed medication incorrectly. Recently, there were shortages of drugs for ADHD nationally, according to an NPR report. Most compelling about ADHD is the staggering rate of diagnosis, which has tripled in the last 15 years.

In 2012, the CDC reported that nearly 9.5 percent (5.4 million) of American children between the ages of 4 and 17 have been diagnosed with ADD; two-thirds of those kids receive daily stimulant medication treatment. The steep rise in diagnoses indicates that we may be allowing more symptoms to fall under the umbrella of ADHD while medication pretends to offer a solution. Are we becoming less attentive as a nation as the data would suggest? Have we improved our ability to recognize and assess inattentiveness? Or are we stretching the term to describe any child who demonstrates glimmers of inattentiveness?

Such a steep rise suggests that we are either only now recognizing something that has always existed or we are falsely recognizing and mislabeling a common symptom. The hope for a drug-based solution is commonly false for two reasons. First, inattentiveness is often not the root of the problem, but merely a symptom. Second, attention is a prerequisite for learning, but only one ingredient to successful learning, which is the result of the relative strength of interdependent and interconnected cognitive skills.

Even if attention is improved, learning may not be improved. There is more to attentiveness than attention and there is more to learning than merely paying attention.

Weak cognitive skills lead to symptoms of inattentiveness. A common root cause of inattentiveness is weak executive functioning skills. Located in the prefrontal regions of the frontal lobe, executive functions organize and integrate an individual’s actions and emotions in the same way a conductor dynamically unifies the distinct instruments of an orchestra. Attention, working memory and processing speed are three components of executive functioning that integrate and process information for learning. If working memory is weak, the student will struggle regardless of the strength of his attention and processing speed.

A student who has weak visual processing speed, a skill critical for reading comprehension, will avoid reading and struggle to comprehend. Reading for him is exhausting; everything around him becomes more interesting than the boring, difficult book he needs to read—hence his susceptibility to distractions. The reading struggle is rooted in the ability to visually process the information. Yet, the cognitive deficit is overlooked and the symptom of inattentiveness becomes the protagonist. Prescribing a stimulant to spark attentiveness will not increase visual processing skills, which is the root of the problem in this example.

Students rely on a host of cognitive skills to learn, and just about everyone has unevenly distributed cognitive skills. The brain can mask gaps between weak and strong cognitive skills by compensating—an innate workaround. If the gaps are too wide or relative strengths are insufficient to compensate, we fail to learn effectively. When learning is inconsistent or frustrating, the starting point should not be the pharmacy, but rather a cognitive skills assessment to understand where the gaps are.

Inattentiveness does deter learning and thus we strive to be attentive to facilitate learning. However, medication will not make better learners, and even when the root of the problem is truly attention and/or a chemical imbalance, science has proven that the window of effectiveness through medication is limited –roughly two years. For any other case, drugs will make students less fidgety and impulsive and consequently less distractible. Most likely, stimulant drugs are an overgeneralized solution to a problem that has its root in specific, individualized differences. Medication provides students with a temporary crutch that, when removed, only sets them up for failure.

Watch our Director, Javier Arguello’s TEDx talk: Learning With Skills, Not Pills