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                        How and Why Do We Evaluate Attention?
  

One of the more confusing aspects of the diagnosis of Attention Deficit Disorder is how the concept of proper attention is evaluated.  In this brief overview, we will attempt to clarify some of the issues that are a central component in evaluating attention.  The main factors affecting attention span are discussed below in more detail:

Type of Attention
Learning Disabilities
Amount of Energy
Distractibility Level
Impulsivity Level
Anxiety or Obsessive Thoughts

To begin with, the evaluator will want to determine if someone’s attention is selective versus mood dependent. For example, some people's attention may depend upon whether the task is interesting or challenging.   For others, their attention depends upon what type of mood they are in at the time.  An interesting question poses: is it easier to do an unpleasant task in a good mood, or a pleasant task in a bad mood?  For many, if the task is unpleasant or boring they cannot pay attention.  For others, if the task is challenging and interesting they can pay attention.  These examples are all central to understanding the way attention works among various individuals. 

Specific Learning Disabilities can also muddle the clinical picture due to the fact that many of these cause cognitive confusion that interferes with concentration.  Testing for specific learning disabilities is a crucial component to any evaluation, as is testing for hearing and vision. 

The next piece that is looked at is how much energy it takes to concentrate.  For example, we would want to review if there is insufficient strength of focus, in that it takes too much physical energy to accomplish the task.  Likewise, distractibility is a strong component to measuring one's attention span.  For some, becoming distracted by things in the environment such as a bird outside the window, a truck doing deliveries in the area, or any of a number of common events will cause the individual to shift attention from the task at hand to the more irrelevant things around them. 

We would also want to know about impulsivity, sometimes defined as saying things without thinking, a racing mind, perhaps out of control.  If an individual states that too much is going on in their head and their thoughts are going too fast, this indicates another possible problem.  We would ask the question, does your mind go faster than your body, or does your body go faster than your mind?  If they had a pause button or a stop button somewhere on their head, do they think they would need to push it often in order to slow down or pause their racing thoughts?  If no matter how hard they try, they just cannot focus, no matter how novel or interesting the subject is, this will takes us in another direction in evaluating this individual. 

If the individual worries or obsesses in such a way that interferes with concentration, this is yet another differential.  The first part of this is to determine if the person obsesses more versus worries more.  Obsessive Compulsive Disorder is frequently confused with ADD.  For example, concentration is very difficult if you are thinking about the same thing over and over.  If the child in the classroom is counting the holes in ceiling, or the adult is making sure that everything feels just right or that everything is in its proper place, concentration will be impaired.  What takes place in his or her own head, such as repetitive thoughts, will take control over what the individual wants to attend to at the time.  We would want to know if someone could pay attention in a quiet room, devoid of distractions such as noise or visual cues, and that they could then get a lot of work done.  However, if they have extraneous things that arise in their mind, then we take a different tack. 

Summary

As you can see, the simple word, attention, is broad and a central piece of our everyday life in order to live successfully and deal with school, work, and every other aspect of what we do.

Author

William J. Shryer, DCSW, LCSW
Clinical Director, Diablo Behavioral Healthcare

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