- When to approach your health care professional
- What will the health care professional do?
- What can be done to help with inattention?
Inattention can be simply put as a lack of attention or a reduced attention span. Attention can be defined as the concentration of mental powers upon an object (e.g. a close or careful observing or listening). Everyone is inattentive sometimes. However, for some people inattention becomes a serious condition that leads to significant problems in school or work.
Once, inattention was thought of as a problem only experienced by children. Now there is growing evidence that significant inattention effects many people of all ages.
There are many symptoms of inattention, some very obvious and some subtler. The symptoms of inattention include:
- Making careless mistakes in work or schoolwork
- Difficulty sustaining attention during a task or when playing
- Seems to not listen when spoken to directly
- Doesn’t follow through on instructions and doesn’t finish work or schoolwork
- Difficulty organising complex tasks
- Loses important items
- Avoids or dislikes activities that require long periods of concentration (e.g. homework)
Some examples of inattention in children include:
- Trouble keeping focussed during games
- Avoid school projects (which involve a long periods of concentration)
- Losing school supplies
- Difficulties completing household chores
- Easily distractible
Some examples in adults include:
- Difficulty concentrating in long conversations
- Trouble organising themselves at work
- Easily distracted by activity or noise
- Trouble remembering appointments or often being late
There are many possible causes of inattention. The most common causes are:
- Attention deficit hyperactivity disorder (ADHD), especially inattentive type ADHD
- Learning disabilities
- Oppositional defiant disorder (often co-exists with ADHD)
- Depression and anxiety: There is no strong evidence that these conditions change attention.
- Drug abuse (e.g. alcohol or cocaine)
- Other mental health disorders (e.g. personality disorder)
- Foetal alcohol syndrome
- Sleep apnoea (brief periods of time when a sleeping person will stop breathing)
There are also non-medical causes of inattention. Poor attention spans can be a result of:
- Being tired
- Sleep deprivation
- Being unfit
It is difficult to assess the true incidence of inattention. The rates of ADHD are thought to be 3-7% of school children, although they could be as high as 18%. Up to a quarter of preschool aged children will show some symptoms of inattentive type ADHD.
The rates in adults are not well known, but it is thought that 1-5% of adults have inattentive type ADHD, with males more effected than females. Severe sleep apnoea, which can lead to sleep deprivation and inattention, affects about 7.5% of the population.
Autism affects around 10-20 children per 10,000. Males are affected 4 times more commonly than females.
Many people, especially children, will be inattentive at times, and this can be due to something as simple as being tired. However, it is also important not to dismiss inattention, as this can have long-term consequences.
It is important to see a health care professional if the inattention is having a serious effect on the person’s life. Examples include a child that is misbehaving at school and falling behind in their schoolwork, or an adult who is forgetting about important meetings.
It is also important to see a health care professional if the person is experiencing other behavioural or emotional problems, such as low self-esteem, being constantly upset or angry, or relationship problems.
There are several tests that a health care professional can do to assess inattention. To begin with, the health care professional will take a full history about the symptoms, when they occur, and what else may be associated with them. Then the health care professional will ask more general questions about any ongoing medical conditions and any significant recent stresses or emotional problems. For a child, the health care professional will also ask about the development of the child. Teachers or colleagues will also be ask to fill in some questionnaires about the person’s behaviour.
After this, there are a series of specific tests to assess attention span. These include the Gordon Diagnostic System and the Wechsler Intelligence Scale for Children (WISC) tests. Both these tests are specifically designed to assess attention and have been validated by numerous studies. Below is a brief outline of what each test involves.
It is important to realise that making a diagnosis of someone with inattention is not as simple as looking at any particular test result. History, collateral history from teachers or colleagues, emotional health, and any ongoing issues or recent stresses need to be considered along with formal tests before a diagnosis is made.
The Gordon Diagnostic System
The Gordon Diagnostic System is a series of game-like tests that assess both attention and impulsivity. The system includes a "vigilance task", which shows the child a series of digits, one at a time. The child must identify every time a particular sequence of numbers appear (e.g. a 1 followed by a 9). This test is performed once visually, and once with the child listening to the numbers. There is also a test to check for impulsivity. The Gordon Diagnostic System has been validated for children between the ages of 4 and 16.
The Wechsler Intelligence Scale for Children is a large series of tests that where originally developed in 1949 and are now in their 4th edition (WISC-IV). These tests look at the areas of verbal comprehension, reasoning, speed and working memory.
To test for attention, the most important part of the WISC is the subtest for working memory. This includes the Digit Span (the child is asked to repeat ever longer series of numbers) and Letter Number Sequencing tests (the child is asked to repeat sequences of letters and numbers).
Some causes of inattention (e.g. sleep apnoea, depression) can be corrected, and there will be improvements in attention. However, most of the causes of inattention (e.g. ADHD) do not have an easy cure. It is important to manage inattention to ensure that the person lives as well as possible. This requires a broad approach that must include the parents/family of the person, as well as teachers or colleagues. Important aspects of therapy are:
- Behavioural therapy: The goals of cognitive behavioural therapy are to improve problem solving abilities and social skills.
- Anger management training: To increase the ability to cope and solve problems without anger.
- Parent skills training: Parent training includes teaching appropriate rewards and punishments (e.g. using a ‘time-out corner’ where a child is sent for misbehaviour)
- Family therapy: Family therapy focusses on problemsolving and improving communication and relationships within the family.
- Education: Involves the school and provides information to teachers on how best to engage the child.
- Suport groups
|For information on childhood ADHD and its symptoms and treatments, as well as some useful tools and animations, see Childhood ADHD.|
|For information on ADHD in adults and its treatments, as well as some useful tools and animations, see Adult ADHD.|
- Springerhouse. Professional Guide to Diseases. 8th Ed. Lippincott Williams & Wilkins; 2005.
- Mayes S, Callhoun S. Learning, attention, writing and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychology. 2007; 13(6): 469-93.
- Super S, Optom D. Medical and nonmedical causes for inattention and attention deficits [online]. Professor Selwyn Super. [cited 26 February 2008]. Available from URL: http://www.professorselwynsuper.com/ pdf/ researcher/ MEDICAL%20AND%20NONMEDICAL%20adhd.pdf.
- Arman A, Ersu R, Save D, Karadag B, Karabekiroglu K, Karakoc F, et al. Symptoms of inattention and hyperactivity in children with habitual snoring: Evidence for a community-based study in Instanbul. Child: Care, Health & Development. 2005; 31(6): 707-17.
- Children and Adults with Attention-Deficit/Hyperactivity Disorder. What we know: The disorder named AD/HD [online]. National Resource Centre on ADHD. 2004 [cited 26 February 2008]. Available from URL: http://www.help4adhd.org/ documents/ WWK1.pdf
- Smidts D, Oosterlaan. How common are symptoms of ADHD in typically developing preschoolers? A study on prevelence rates and prenatal/demographic risk factors. Cortex. 2007; 43: 710-7.
- Newschaffer CJ, Croen LA, Daniles J, Giarelli E, et al. The epidemiology of autism spectrum disorders. Annu Rev Public Health. 2007; 28: 235-58.
- Tishler P, Larkin E, Schluchter M, Redline S. Incidence of sleep-disordered breathing in an urban adult population. JAMA. 2003; 289: 2230-7.
- Warner-Rogers J, Taylor A, Taylor E, Sandberg S. Inattentive behaviour in childhood: Epidemiology and implications for development. J Learning Disabilities. 2000; 33(6): 520-37.
- Watkins M, Kush J, Glutting J. Discriminant and predictive validity of the WISC-III ACID profile among children with learning disabilities. Psychology in the Schools. 1997; 34(4): 309-19.
- National Health and Medical Research Council (NHMRC). Attention deficit hyperactivity disorder (ADHD). Publication ID. no. 1938. Comonwealth Department of Health and Family Services. 1997.
- National Institute of Mental Health (NIMH). Attention deficit hyperactivity disorder (ADHD). NIH Publication No. 3572. National Institutes of Health 2006.
- NSW Health. Attention deficit hyperactivity disorder (ADHD) [online]. Australian Psychological Society 2007 [cited 28 February 2008]. Available from: www.health.nsw.gov.au/ public-health/ adhd/ treatment