Attention & ADHD

What is Attention?

As with most of the things we struggle to understand about ourselves, it is helpful to know a bit about how our brain works. What does it mean to pay attention? Why is it easier to do at some times than at others? And why does it seem like so many of us have trouble with it in general?

Attention Deficit/Hyperactivity Disorder, or ADHD, is very commonly diagnosed, but poorly understood. It is very important to recognize when a child is struggling to pay attention to lessons, keep track of their assignments, and control impulsive behavior. But as with other diagnostic labels, while it provides a helpful shorthand to describe the nature of  the difficulties and get appropriate support, the label is not the whole story. We have to look deeper to understand what kind of learner the child is, what does capture their attention, and how can we help them enjoy learning.  At least part of the reason that more and more children are being diagnosed with ADHD is that more and more often we are expecting them to sit still and be passive listeners, rather than active learners, for too much of the day and at too young an age.  Children learn best through direct sensory experience of the world – moving themselves and moving the things around them, pushing, jumping, climbing, touching, building and breaking things. But I have visited many first grade classrooms where children are described as “hyperactive” because they have difficulty sitting still (!)

The executive system controls both input – whether we attend to an event or ignore it,  and output – whether we initiate a response or inhibit it.  Attention deficit/hyperactivity disorder (ADHD) or “executive dysfunction”  describe problems with control – poor concentration and distractibility, and poor impulse control, or impulsivity.  The Executive system is very vulnerable, because it requires optimal functioning. We have to be at our best, “firing all cylinders” for it to work well. If we are tired, sick, anxious or depressed, we can’t focus, and we can’t plan, we can’t get started, and we can’t problem solve. So executive dysfunction is actually a symptom of lots of different things. A primary deficit of executive function deficit, that is, not caused by another condition, is actually quite rare.

How Attention works and why it often doesn’t

There are two sources of input to the brain via the Sensory system – from the external environment (the world) and the internal environment (the body). The brain’s job is to integrate this information so that the needs of the body can be matched with the opportunities in the environment.  Because we humans are highly evolved organisms who navigate a very complex environment, we need to filter much of the information available and prioritize our needs. It is the job of the Executive system – the process of attention – to enable us to ignore unimportant events (like the hum of the refrigerator) and focus on the most important event (making the sandwich).  And, if a grisly bear were to step into the kitchen, our Affective system would quickly downgrade the priority of the sandwich – in light of the bear – resulting in a shift of both our attention and our behavior. So the Affective system drives the Executive system – emotion directs attention.  The result is that we have great difficulty paying attention to something if it is not the most emotionally important thing going on.  The problem is that much of the time we are not in control – or even aware – of what is most emotionally important to us at a given moment.

The Executive System

The Executive system controls input and output. It determines which of the events in our environment we attend to, and which we ignore, and which responses we initiate, and which we inhibit. Processes of the Executive system include working memory, retrieval fluency, and processing speed.

The Executive system is driven by the Affective system, because the brain’s primary job is the survival of the body – getting needs met and avoiding damage, and this is done via pleasure and pain. It is the strength of the emotional charge – positive or negative – that determines what we notice and what we do about it.  Ultimately, it is emotion that drives our experience and our behavior.

Executive function is disrupted if the brain thinks the body is not safe, and therefore there is something more important to pay attention to or think about. Executive function is also disrupted if there is not enough energy for the brain to work at its maximum level – “firing all cylinders,” as well we are tired or sick. And, because the Cognitive system depends on the Executive system for its best functioning – we need working memory and retrieval fluency for problem solving, cognitive function is also disrupted in these situations.