PAY ATTENTION! By Teri Allen, OTR Please, pay attention! We say this to children often but don't stop to analyze what we are really asking. We usually mean: sit still, listen, and look at me while I'm talking to you. Then; remember what you've seen and heard, follow the instructions and stay with the task until you are done. That's a pretty complex set of directions! When there is a break down in the child's ability to do this, its common for parents and teachers to wonder if the child has an attention problem. Problems with attention are receiving a lot of media publicity, but the media rarely defines attention for us. Attention is a very complex behavior that requires the integration of several areas of the brain. The first component of attention is frequently called "registration". This is our initial awareness of change. For example, if a child is playing outside and an ice cream truck comes into the neighborhood, registration is the child's initial awareness of the metallic music. The second component of attention is referred to as "orienting". Our level of alertness increases and in the case of our example, the child may stop playing to listen more intently. The third component of attention involves "effort". As the child explores the stimulus he is putting forth effort. In our example, it would be a safe bet that the child will expend the effort necessary to obtain a loan from Mom and explore the variety of ice creams on that truck. Each area of the brain involved in the attending process plays a different role in the three components of attention. Dysfunction in any area will cause a unique set of attention problems. This is one of the reasons we see such a variety of behaviors in children we describe as having Attention Deficit Disorder. For example, we can see two completely different problems with the registration component. Some children register to any new stimulus in the environment. Before they can expend the effort to explore this, they register to something else. We describe these children as "distractable" and indeed they are! In contrast, other children do not register when they should. They are relatively unresponsive to what we say or show to them. They may not make eye contact with us or imitate what we do. We may also see problems in either the orienting or effort components. As with registration, this could be two different extremes. A child may exhibit difficulty with one, two or all three of the components of attention. They are other disorders which frequently mimic attention problems. This adds to our confusion in trying to diagnose and treat these children. For instance, a child with a hearing impairment may not register or orient to sounds such as verbal directions or reprimands. He may put forth no effort or the wrong effort which could be mistaken for lack of attention. Some children have difficulty with motor planning and are unable to translate an idea or verbal directions into movement. They have difficulty following directions and we may mistake this for poor listening skills (orienting) or lack of motivation ( effort). Other children cannot recall sequences of directions. Again, we may think these children are not listening or lack motivation. The child who has poor visual perception usually reduces effort when a visual task becomes too difficult, but his primary problem is not an Attention Deficit. Obviously, attention is a complex skill, and we can expect to see children who exhibit a variety of problems. Diagnosing Attention Deficit Disorder requires the expertise of professionals trained in this area. By understanding the three components of attention we can provide these professionals with valuable information and help ourselves effectively meet these children's needs. |
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