Attention Disorders: In one ear and out the other

January 13, 2008

—Nina Pierpont, MD, PhD

Last time I talked about mental energy, consistency, and sleep problems in attention disorders (ADHD for short).  Today I’ll talk about the processing or “input” controls.

We don’t simply absorb everything that goes on around us.  There is too much, and often a lot happens at once.  Think of talking to someone in a noisy place:  you tune out the other conversations around you and focus on the person you’re talking with.  But what if the conversation is boring, and you hear your name spoken nearby?  Your attention may swivel around to that other conversation, as you tune out the person in front of you.  Until, all of a sudden, she asks you a question, and you’re scrambling to say something sensible.  It’s hard to stay with both at once.

Some of these decisions are made consciously, and others unconsciously, as we decide what are the most important things to pay attention to.  Information, sensations, ideas, images, feelings—the things which grab our attention come from both inside and outside.  How do we decide what is most important?

Emotions play a big role in letting us know what’s most important (at least to us).  Surprise, delight, or a little fear or embarrassment can really focus our attention, but too much anger or fear is destructive, pulling attention to the inside and blocking out important things from the outside world.  It can be important, in an inattentive child, to find out what hurt and anger he is nursing.

Interest also plays a big role in letting us know what is most important.  Some kids with attention problems seem to have too much interest—in their friends, noises, the clock, the things in their desks, the squirrel outside the window.  But in fact it’s more realistic to think that they don’t have enough interest.  A telltale sign of a child with an attention problem, I find, is their telling me, “Everything is boring.”  Things don’t grab their minds deeply.

Which brings us to the next “input” control:  depth of processing.  Some older kids have described this to me in so many words:  that they hear things, but the things don’t seem to stick.  Instead, they glance off the surface of the mind and keep on going.  At the end of a page of reading, nothing remains.  The child or teen might read every word perfectly, but recalls nothing.  Reading or listening like this is really boring.  Interest, meaning, and memory are all closely intertwined functions at a deeper level of the mind.

This brings us to the next “input” control:  mind activation.  The active mind makes lots of connections as new information comes in, with the feeling of a bell going off, “aha!” or a question being answered.  This mind sensation is exciting.  In an underactive mind, new information goes “thud.”  No bells go off.  The new stuff makes no sense and seems to connect with nothing the child has experienced.

Some minds are too active, however, spinning off on tangents or “mind trips” from even single words that drift by.  These are the daydreaming children, like Calvin of Calvin and Hobbes, who is off riding dinosaurs and flying fighter jets while his teacher is talking about math.  Active and overactive minds both use the imagination, but for the overactive it is a distraction.  For the normally active mind the imagination is a blessing, the creator of connections, meaning, and memory for new information or experiences.

The final “input” control, satisfaction, is one of the most interesting.  Some kids with ADHD want excitement all the time and wear out their parents with demands for activity.  Dad is tired after the day’s fishing trip but 9 year old junior, not missing a beat, is out jumping his bike off a ramp he pestered dad into building for him last week.  His 14 year old brother is out on his dirt bike.  Other kids are insatiable for things.  They collect stuff and pester their parents in stores.  A 12-year-old knows every computer gadget and dreams of having a credit card.

Insatiability (trouble getting satisfied) is a critical issue as children with ADHD grow up.  Though many children grow out of ADHD, learning to modulate their feelings, thinking, and actions, others do not.  Older teens and adults with ADHD, especially untreated, face higher rates of dependence on tobacco, alcohol, and other drugs of abuse.  In the brain, pathways and neurotransmitters for addiction, reward, and attention are closely related.  Some of the compulsive behaviors of adults (for example, shopping, reckless driving, or other risky behaviors) are easily recognized as adult versions of the insatiability of the ADHD child.

Next time:  planning output, or look before you leap.