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Column originally published Dec 3, 1997

Children With Difficulty Paying Attention Need Assessment

Question: I am really confused. Our daughter is in grade 5 this year. She has done well in school all along until now. This year, her marks have dropped, and she has lost interest in school. Her previous teachers had told us that she had difficulty paying attention. Homework was never easy, although we managed. This year, the teacher suggested that we should consult a specialist because of her attention. Our family told us that the teacher is over-reacting, and just wants to put our daughter on drugs. What should we do?


Your daughter’s teachers are probably talking about a medical condition called Attention Deficit Disorder. Let me explain to you about this condition so that you can make an informed decision for her.

Attention Deficit Disorder was first described by a British paediatrician about one hundred years ago. Since that time, knowledge about this condition has increased steadily. It has been called many different names, but the most widely accepted names nowadays are Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD).

The most important aspect of this condition is difficulty in focusing attention, especially in school where students are expected to focus and learn. Children with ADD can focus on things that interest or stimulate them, like certain sports or computer games. However, when they have to focus on learning school-related items, they can get tired or distracted.

In school, teachers often notice ADHD children being slower to get ready. Some will not pay attention and frequently talk to, or disturb, other children. Others will play with items on their desks, which can be a pencil or an eraser. Some may appear to be sitting there paying attention, but their mind is actually somewhere else. This is called daydreaming.

Sound or movement can easily distract these children. If they are required to read or work on assignments, any noise from students around them, or next door, can catch their attention. Many children with ADHD will admit that they can hear things down the hall much better than what the teacher says. People walking around or things happening outside the window are also highly distracting to them.

They can also get distracted by whatever that comes to their mind. This can be movies that they have watched recently, or what they will do after school. They can spend a lot of time in their “dreamland” without the teacher ever noticing it.

Because of difficulty focusing attention and frequently getting distracted, many children with ADD have difficulty performing well in classroom. Some may still do well in the first few years. However, when they get into higher grades that need more attention, their academic performance starts to flounder and their marks often drop.

Occasionally, children with ADHD can manage quite well through high school. When they enter college or university, however, the added requirement for attention can finally catch up with them. Many will drop out unless they are offered special help there.

Another characteristic of ADHD children is impulsivity. That is, they have difficulty controlling themselves. Some are verbally impulsive, talking all the time and cannot stop. Others will barge into conversations and ignore others who are speaking. Some children are impulsive in doing inappropriate things, like jumping in front of cars, throwing rocks, starting fires, taking apart things just to look inside.

Of course, one cannot just pick on one item and diagnose any child with ADHD. We have to look at the whole picture. That is why assessment of these children is a rather lengthy process. Doctors often have to get information from parents and teachers. Parents should get educated about this condition so that they can understand the reason behind any recommendation that is given.

From your description, there is a possibility that your daughter may truly have ADHD. My advice is not to worry too much whether she may need medication or not. Doing that will be like putting the cart in front of the horse, and it never works. I don’t think there is ever a parent who will refuse assessment of their sick child for diabetes just because of worries about insulin injection.

One thing to remember is that there is no blood test for ADHD. Certain psychological tests can be useful to determine the child’s strengths and weaknesses in learning. However, one cannot make a diagnosis of ADHD based on the results of these tests.

There are many strategies that can help children to focus and reduce distraction. Once the diagnosis is made, these strategies can be put in place, both in school and at home. It is not possible to predict whether a child is going to need medication or not.

One final advice: when children do poorly in school, it can affect their self-esteem. This is a serious problem that parents often don’t recognize. When ADD children get the proper help (which includes strategies as well as medicine), they often do better academically and become more self-confident. Get your daughter to see the specialist soon.