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Making Sense of Attentional Issues - featured August 24, 2010

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Making Sense of Attentional Issues

By Guest Blogger: Loren Shlaes, OT
Certified Teacher of the Alexander Technique


Very often, a parent will say to me, "My child couldn't possibly have any attentional issues. He has an amazing ability to focus! He can spend hours and hours playing a video game {or putting together Legos, or watching television} without ever so much as looking up. He gets so lost in what he's doing sometimes that we have to call his name several times to get him to respond. There's nothing wrong with his attention span!"

What his teachers will tell me: "The child often can't attend to what is required of him at any given moment in class and we spend a great deal of our energy and resources trying to get him to settle down and focus. Or when he does manage to sit and concentrate {on something of his own choosing, like a book or a puzzle,} he becomes so absorbed in what he's doing that he's no longer actively participating in the group. He has very little in available to him between those two extremes, and can't attend successfully to class activities or assignments when there are other things going on around him. He has to shut it all out completely, or he will become distracted and disorganized. He often needs a grownup nearby to help steady him, and demands a lot of extra attention, by either approaching the teacher to tell him what to do or by his actions, which require redirection."

Attention is the ability to concentrate on some feature or features of the environment, to the relative exclusion of others.

It's the word "relative" that is the gold standard here. Everyone is capable of getting completely lost in what he's doing. One of the very great pleasures of life, in fact, is becoming so absorbed by an activity that the world falls away. We are in a reverie, at one with our hands, our imaginations, and our materials. We are in another world entirely. When we are forced to come away from this state before we are ready, we are often a bit discombobulated and have difficulty transitioning back to our actual environment.

This is a delightful state, and how great art and works of genius are made. But hyperfocus, to the exclusion of everyone and everything, is not appropriate for most of the demands of modern life. It doesn't work at school. The kind of attention we need to succeed there is more flexible than this complete, all encompassing absorption, and is more in tune with the rest of the environment. It doesn't completely exclude our surroundings. It doesn't take us so far away from everyone and everything that we need to be called and called to come back. It allows us to exclude what is irrelevant while remaining in synch with everything around us.

When we are in the classroom, even if we are concentrating hard on our assignments, we should be able to maintain an easy awareness of everything that is going on around us. Although we may be choosing not to respond to it, we know that there is noise and movement swirling around us, and there are other people in the vicinity talking and doing things. Although we are focused on the task at hand, we should be able to be called out of ourselves quite easily, respond, and then go back to what we are doing without becoming derailed by the interruption. We should be able to do this even when the class is noisy, there are other things going on at the same time, or when the other children sitting next to us at the table may be engaged in some other pursuit. We should be able divide our attention easily. School, like life, requires us to be able to attend to several things at the same time. While working on an automatic task, for example cutting or coloring, we should be able to cut or color easily and accurately while chatting with our neighbors and keeping an eye out for the teacher.

The ability to attend is a complex skill and is predicated on many things. We need be able to control our need and desire for movement so that we can sit still. We need to be able to filter out distractions. We need to have the instinctive ability to focus on what is relevant and ignore what is irrelevant to us in that moment. We need to have excellent command of our close vision. We need to have the internal structure and maturity in place that would allow us to focus on something other than what would necessarily motivate us. We need to be able to tolerate frustration, so that when something doesn't come automatically or easily, we are willing to struggle without instantly giving up. We need to have sufficient control over our impulses, so if the thought "I'm thirsty" floats into our minds, we stay focused and do not immediately jump up and run in search of a drink. If people around us are talking, we should not get so distracted by the conversation that we can't attend to what we're doing. If people get up and start walking around, we should not be so pulled out of what we are doing to watch them that we forget the task at hand.

If a very young child is having difficulty attending at school, it may be that the school's expectations of the children's abilities are not realistic. I have visited so many classrooms over the years where the teacher is spending a large portion of her time and energy just trying to get the children to sit still. I always want to take these teachers aside and point out that the reason these children can't keep still is because they need to be moving! Movement is what activates the brain and drives development forward. We should be providing ample opportunities for young children to move, not denying them, especially to children who live in cities and who don't have ready access to nature.

Or perhaps the child's maturity and temperament are not right for that particular classroom. If a child is someone who has a high energy level and needs to move a lot, it's not fair or realistic to put him in a classroom that requires him to sit for long periods, skimps on the recess and structured movement opportunities, and then to expect him to thrive there. Most three year old boys are just not ready to go to school. If he is struggling there but is functioning appropriately everywhere else, chances are he's just not ready and would be better off waiting another year or two.

There are some things we can do to help very small children learn the skills to pay attention. I would strongly recommend reducing or eliminating television viewing, including educational videos. The most resourceful, independent, creative people I know didn't watch television when they were children.

The same for computers. Children need to spend their time manipulating three dimensional objects and moving their bodies against gravity before the age of six. Three year olds do not need to be sitting in front of a keyboard looking at a two dimensional screen. They have no opportunity to develop depth perception, balance, or fine and gross motor coordination there. They'll have the rest of their lives, after they have acquired those essential developmental skills, to sit in front of a computer or a television.

I also recommend making sure the bulk of the child's toys are things that lend themselves to creative play and are open ended. I advise parents to limit toys that have lots of bells and whistles but don't actually require much interaction from the child.

Help a child learn to tolerate frustration and solve his own problems by not jumping in every time he struggles. Play board or card games to teach social interaction skills and learn to lose gracefully. Other family activities that teach good social interaction and expand attentional skills are charades, stink pink, Fictionary, Pictionary, and those old fashioned games you play in the car like looking for license plates.

Cooking and structured crafts, activities which have a distinct beginning, middle and end and require patience and delayed gratification, are excellent ways to improve and expand on attention and build internal structure.

To understand what is interfering with a child's ability to attend, it's important to know what the child's situation is outside of the clinic or classroom, and the severity and extent of his sensory issues, so that they can be addressed as part of his treatment plan.

What is the child's diet? Does he get to bed every night at a reasonable hour? Does he have allergies? What is his breathing like? {Shallow breathers often have attentional difficulties because their brains are starved for oxygen, and because shallow, rapid breathing puts a child in a chronic fight or flight state.} What is his vestibular functioning? {High vestibular threshold means low muscle tone, low arousal and decreased ability to attend, unless he gets frequent, intense movement.} Is he defensive, or does he demonstrate low registration? What does he seek? What does he avoid?

The more we can clear up those issues, and make his body a more comfortable, reliable home for him, the more we can open up that middle range between hyperfocus/shutdown and disorganized/unable to focus.

Our Featured Author: Loren Shlaes, OT

Thanks to Loren Shlaes for providing us with this article.

Loren Shlaes is a pediatric occupational therapist specializing in sensory integration and school related issues, particularly handwriting. She lives and practices in Manhattan. She blogs at http://www.pediatricOT.blogspot.com/.

Tags: Article OT Special Education Parental Involvement ADHD