What does it mean to have attention problems? Hyperactivity and inattention are problems that can make a child’s academic experience miserable, and lead to serious self-esteem issues stemming from feeling and being told they are “stupid” or are “behavior problems.” It disrupts a person’s ability to learn, read, concentrate, and makes them an inadvertent lightning rod for continual criticism and discipline. In part, this is because it becomes frustrating for teachers, parents, spouses, co-workers, employers, etc. to perpetually adjust their routine to someone who does not have good impulse control or an attention span similar to their own.

These problems are commonly seen when someone has Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD). Fortunately, we live in an age when there is relatively simple, effective, and low-risk treatment for ADD/ADHD (i.e., stimulant medication), and many children and adults benefit and function better in school, work, and their home-life as a result.

However, over time, we have come to think of having a hard time concentrating or being unable to “sit still” as synonymous with having ADD/ADHD. This is a little like saying that there is only one medical condition that can cause a fever. Many people diagnosed with ADD/ADHD still find that their attention does not respond well to stimulant medications. In part, this is because, ultimately, having attention problems is only a symptom of a person’s attentional system not working properly. There are several possible reasons why a person’s attentional system may be disrupted. The following are some of the most common:

• ADD/ADHD:
  • Symptom Onset – early childhood/elementary school
  • Primary Underlying Problem – low levels of dopamine in the cortical & subcortical neural pathways which allow the frontal lobes to control and direct attention and behavior
  • Treatment – stimulant medication has been found to effectively raise dopamine levels in these pathways
• Anxiety/Trauma/Depression/Chronic Stress:
  • Symptom Onset – adulthood (sometimes late adolescence)
  • Primary Underlying Problem – chronic disruption of the amygdala/hippocampus system (i.e., short-term memory system) by high levels of adrenaline and cortisol, impairing long-term potentiation resulting in distracted/clouded thinking and difficulty storing and retrieving memories
  • Treatment – psychotherapy (i.e., counseling) combined with medications has been found most beneficial
• Autism Spectrum Disorders:
  • Symptom Onset – early childhood/elementary school, depending on severity
  • Primary Underlying Problem – structural/systemic subcortical abnormalities result in hyper-focused attention, and mental and behavioral rigidity
  • Treatment – behavioral interventions focused on the specific functional deficits have been found most beneficial
• Medical Conditions:
  • Symptom Onset – following the development of chronic health problems
  • Primary Underlying Problem – the side effect of various conditions which result in hormonal imbalances including diabetes, thyroid and parathyroid problems, etc.
  • Treatment – treatment of the medical condition and hormonal imbalance has been found to be most beneficial
• Prenatal Chemical Exposure:
  • Symptom Onset – infancy/early childhood
  • Primary Underlying Problem – various chemicals including tobacco, alcohol, methamphetamine, etc. ingested during the first trimester hamper neural development resulting in various subcortical structural abnormalities with a wide range of resulting attention problems
  • Treatment – behavioral interventions focused on the specific functional deficits have been found most beneficial

Each of these conditions has a unique time of onset, symptom profile, and most effective treatment approach. Importantly, the treatment that works for one problem will likely have limited usefulness in treating one of the others. Further, it is possible to have more than one of these conditions contributing to a person’s attention problems.

ADD/ADHD can be diagnosed and treated through interviews, behavioral checklists, and an office visit with your physician. However, a significant number of people experience attention problems from a different cause, requiring a different treatment approach. So, if you or someone you love has a later symptom onset, does not demonstrate “typical” hyperactive symptoms, has had poor response to stimulant medications, or even suspects the situation is more complex than it looks on the surface, a more in-depth neuropsychological or psychological assessment may be required. An appropriate initial diagnosis tends to save people time, energy, and frustration in the long run.

Daniel Traughber, Ph.D. earned a Master’s Degree in Experimental Psychology with an emphasis in neuroscience. He then went on to earn his Doctoral Degree in Clinical Psychology. He utilizes his neuroscience training in providing evidence-based assessment and treatment for children and adults. Dr. Traughber sees clients at Sanctuary: Neuropsychology & Treatment Consultants. For more information or an appointment, call (208) 417-0623.