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Misunderstood Minds
Stories from the Documentary:
Nathan V. Lauren Sarah Lee Adam Nathan S.
Introduction

Attention
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Mathematics

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 Attention  ATTENTIONBasics | Difficulties | Responses

Responses

Where Do I Begin?
> Home and School Collaboration
> Parents and Teachers Communicating
> Talking with Children about Attention

What Can I Do?
> Suggestions - simple things you can do to help
> Strategies - targeting strengths and weaknesses


Where Do I Begin?

Home and School Collaboration

Attention difficulties can have a tremendous impact on all aspects of life. A candid and consistent dialogue between parents and teachers can provide significant support to a child with attention problems. Mutual respect and open communication can reduce tension and enable parents and teachers to benefit from each other's expertise and knowledge of the child from different perspectives. Working together, parents, teachers, and the children themselves can inform one another about how best to address the child's needs.

Parents and Teachers Communicating about Attention

When you suspect a child is having difficulty with attention, schedule a parent-teacher meeting to share information about the child. The following "talking points" can help structure the discussion.

Share observations about the child's profile of attention controls and discuss where the breakdown is occurring. How is the child exhibiting difficulty with attention? What attention control system seems to be problematic? Is the breakdown occurring with mental energy, processing, or production? It may be helpful to use the "What to Watch For" list from the Difficulties section as a guide.

Remember to ask for and share information on problems in other areas, such as language or memory, since attention deficit often masks other learning difficulties.

Identify and discuss the child's strengths and interests. How can they be used to enhance his or her attention abilities? Can reading a book, writing a report, or creating a drawing on a topic of interest help a child sustain attention? Have children monitor their own alertness to topics of interest.

Discuss possible strategies
. What have you tried that has been successful and not so successful? Are there other ideas that might work? Are there strategies that work both at school and at home, such as using eye contact and physical contact with a child to help sustain attention?

Acknowledge emotional reactions to the situation. Discuss how children who struggle with attention can become frustrated. Unable to sustain mental energy required for schoolwork, children may become disinterested or even disruptive. Share strategies that might help children become more efficient at monitoring their attention and behavior.

Discuss appropriate next steps. Establish a plan for ongoing discussion and problem solving. How will expectations and progress be shared? How can you best advocate for the child?

When a problem with attention has been specified:
  • Learn more about attention from other experts, reference books, and Web sites. See the Resources section of this site to get started.
  • Seek assistance from colleagues and experienced parents, professional organizations, and support groups.
  • Request that the school's special education teacher or learning specialist observe the child and consult with you about strategies to use in the classroom and at home.
  • Investigate the availability of professional help from pediatricians, learning specialists, school psychologists, and others.

Talking with Children about Attention

Children are expected to use their attention skills to succeed with schoolwork, control behavior, and relate well to others. Some children who have difficulties with attention give up and see themselves as failures; others exhibit behavior complications that relate to their difficulties with attention.

Dr. Mel Levine suggests using a process called demystification, which, through open discussion with supportive adults, helps children learn to clarify and specify their differences and understand that, like everyone else, they have strengths and weaknesses. This process creates a shared sense of optimism that the child and adult are working toward a common goal, and that learning problems can be successfully managed. The following suggestions can help as parents, teachers, and learning specialists work together to demystify children's difficulties with attention.

Eliminate any stigma. Empathy can reduce children's frustration and anxiety about their attention difficulties. Emphasize that no one is to blame and that you know that they often need to work harder than others to concentrate and monitor their attention. Explain that children differ in their attention skills. Reassure children that you will help them find ways that work for them. Share an anecdote about how you handled a learning problem or an embarrassing mistake in which your attention abilities broke down.

Discuss strengths and interests. Help children find their strengths. Use concrete examples but avoid false praise. You might say to a child who can devote total attention to an area of strong interest, "You are really able to concentrate on your video games." Identify books, videos, Web sites, or places in the community that can help children build on their strengths and interests.

Discuss areas of weakness. Use plain language to explain what aspect of attention needs to be developed or monitored. Contrast breakdowns with areas of attention that are intact, and explain the difference. You might say, "You might have difficulty paying attention to what the teacher says because you are not filtering out the other noise around you, yet your attention when working on the computer is great."

Emphasize optimism. Help children realize that they can improve -- they can work on their weaknesses and make their strengths stronger. Point out future possibilities for success given their current strengths. Help children build a sense of control over their learning by encouraging them to feel accountable for their own progress. A child with attention difficulties can become responsible over time for remembering to take frequent breaks, keep checklists, and set short-term goals.

Identify an ally. Help children locate a mentor -- a favorite teacher, an adolescent, or a neighbor -- who will work with and support them. Explain that children can help themselves by sharing with others how they learn best. Older children can explain the strategies that work for them, while younger ones may need adult support. Encourage children to be active partners with their allies.

Protect from humiliation. Help children strengthen self-esteem and maintain pride by protecting them from public humiliation related to their learning differences. Always avoid criticizing children in public and protect them from embarrassment in front of siblings and classmates. Don't require a child with attention difficulties to sit still and concentrate on a task for an extended period of time.

What Can I Do?

Suggestions and Strategies

You may use the following suggestions and strategies to help children who are experiencing difficulties with attention. Many of those listed are accommodations -- they work around a child's difficulty by offering alternative approaches. Slowing the speed of a presentation for someone who is not alert is one example. Strategies -- more research-based methods -- are designed to specifically strengthen a weakness. For example, a child with attention problems might benefit from a system of cues that helps her ability to stay focused. From the strategies suggested below, select those that you and your child think might work best.

General Suggestions

Allow longer breaks. Extending the amount of time given for breaks (such as recess) can be beneficial, especially for elementary-school children.

Use different methods of instruction. Use verbal, visual, and experiential methods to enhance attention. Make frequent shifts between discussion, reading, and hands-on group activities.

Accentuate important information. Let children know when important information is about to be presented. Slow the speed of oral delivery, include pauses, and accentuate by intonation and gesture what is most important. Preview, repeat, and summarize important points.

Have children discuss the lesson. Take time during a lesson for children to talk to each other about the facts or skills they are learning, such as what strategies they are using to complete an activity.

Be a coach or a mentor. Make statements about how you schedule your daily activities and the positive benefits of such planning and scheduling. Be a check-in person with whom the child can share what he's accomplished.

Specific Strategies

Strategies for
> Mental Energy
> Processing
> Production

Strategy Tips: Decide which strategies to try by observing the child and identifying the ways in which he or she learns best.
  • It may take several attempts to see positive results from one strategy. Don't give up too soon.
  • If the first few strategies you try do not improve the child's skills, try others.
  • Most of these strategies can be adapted for use with different age groups.

Mental Energy

(For an explanation of Mental Energy see the Attention: Difficulties section.)

Provide preferential seating. Seat children with attention difficulties close to the teacher. Make eye or physical contact to sustain attention. Tables grouped in clusters or staggered desks allow for an unobstructed view of signals and easy access for physical contact.

Provide frequent short breaks. Breaks can be especially helpful during and between tasks that require intense concentration -- and sometimes not just for one student but for the whole class. Throughout activities, intersperse brief breaks that allow children to move around. Encourage constructive movement tasks, such as collecting papers or erasing the chalkboard. At home, allow children to take a five- to ten-minute break to stretch or play with a pet after every thirty minutes of homework.

Encourage physical activity. Some type of physical activity helps children sustain their attention during classroom instruction. Doodling, squeezing a ball, rolling clay, tapping a pencil on one's thigh, or moving to a rocking chair can be helpful activities. Of course, these activities shouldn't be disruptive to other children in the class.

Find ways to make material less complex. Use outlines, color, or organizers to help make complex activities or ideas more easily understood. Warn children in advance about what will be presented. For example, tell the class that you will present five ideas. Then present the ideas in stages and check for understanding before moving on to each new next stage. Provide summary charts, partially completed outlines, or other aids to reduce the amount of mental energy required when working with complex concepts, ideas, or activities.

Prepare children before asking them to respond in class. Let children know in advance that they will be called on in class. Before the start of class say quietly to a child, "I'm going to call on you to answer the first question on the blackboard."

Keep a diary or log. Have children monitor their periods of effort and concentration with a diary or log. Children can create charts to track their improvement.

Provide opportunities for high-interest activities. Set up a space in the classroom where children can go to build on their strengths. Use their affinity areas, such as computers or art, to enhance their alertness while letting them gain more expertise in that area.

Use energy buddies. Pair children so they can work together by providing jump-starts for each other. Children can take turns starting math problems or reading the passages of a text.

Recommend a bedtime routine. Talk with children about the importance of having a consistent bedtime schedule to help them get a good night's sleep. The use of "white noise" or background noise (such as soft music) to help filter sounds that might interfere with relaxing can sometimes be helpful to children who have difficulty getting to sleep.

Monitor performance inconsistencies. Keep track of the factors that seem to affect a child's mental energy. Help children recognize the time of day and circumstances when they are most focused. Provide guidance on how to use, as well as compensate for, these highs and lows throughout the day.

Processing

Provide ongoing reference to information about an activity. Write important points or directions on the board so that children can refer to them whenever necessary.

Draw focus to important information. Have children practice underlining or highlighting key words. Use color-coding to organize key information (for example, green for main idea, red for details in reading, blue for essential information).

Use technology. Devices such as calculators, tape recorders, books on tape, word processors, and software programs may be helpful to children. These devices allow children to control how much information is presented at one time and how rapidly it is presented.

Provide outlines, maps, and graphs. Give children outlines to help them preview the most important information in a lesson or reading assignment. Have them complete a map or web of the main ideas presented in a lesson. Use graphs or graphics to draw attention to the relevancy of information, and help children understand why one piece of information may be more important than another.

Practice paraphrasing and summarizing. Ask children to write a summary of a lesson in their own words, then review that statement prior to beginning the next class session.

Promote listening strategies and build listening skills. Provide a strategy for listening actively, such as FACT (Focus attention, Ask yourself questions, Connect ideas, Try to picture important ideas).

Focus on cues for important information. Identify cues embedded in text or class lessons that children should look and listen for: for example, "In summary...", "The five reasons are...", and so on.

Promote both bottom-up and top-down thinking. Encourage children to start thinking about the details and work up to the big picture, as well as to start with the big picture and work down to the details.

Promote collaboration between children. Pair children who work well with details with children who prefer to think about the big picture. Encourage the children to talk to each other about the thought processes they employ when accomplishing a task or assignment.

Use subvocalization. After determining a key piece of information in a lesson, have children repeat it to themselves several times under their breath. Model the strategy for them.

Connect new information to prior knowledge. Pause during the presentation of new information and ask children how the new information relates to previously learned material or a personal experience.

Break tasks into smaller steps. Help children focus on important information by "chunking" assignments into smaller, more manageable segments. For example, have children highlight the symbol (+, -) in a math problem before calculating the answer.

Encourage eye contact and repetition. Have children practice making eye contact with speakers. Remind children by pointing to your eye or quietly stating, "Look at me." Ask children to repeat information, explanations, and instructions. For example, have a child repeat the directions that have been given for an assignment to check for understanding and retention.

Use memory strategies. Teach children to use strategies like imagery and elaboration to strengthen the depth of information processing. Attaching a mental image to an important piece of information, stating the reasons for its importance, and connecting the information to some prior knowledge or area of interest are all examples of memory strategies.

Review notes after instruction. Going back over newly learned information as soon as possible will enhance processing. Have children review their notes immediately after a lesson to make sure they got all the important points. Older children could tape record a class lecture, then listen to the tape after leaving class.

Teach self-testing strategies. Have children ask themselves questions they think might be on a quiz or test. When reading, have children frequently stop and ask themselves questions about information they have just read.

Structure time limits to monitor children's processing. Have children take notes on a reading passage for at least five minutes but no more than ten minutes. Impose time limits for children who are overactive processors; require them to stop or redirect them, even if they are in the middle of a task.

Use visual prompts. Attach brief notes or visual images on notebooks or desks to help children be aware of their own processing. For example, a note might say: "Am I being too passive or too active in my thinking right now?"

Teach children to prioritize. Have children complete the most difficult parts of a task when they are able to focus. Then allow them to take a break before beginning again.

Teach and model internal standards. Teach children how to use internal dialogue, or self-talk, to delay gratification when they are working on tasks that are not particularly interesting or gratifying to them. Ask them to brainstorm about rewards that will motivate them to work during periods of low interest and excitement.

Cue children to upcoming transitions. Let children know when a task is about to change and their focus will need to be adjusted. Say, for example, "In five minutes it will be time to put your social studies work away and get out your math books." Keep a schedule of activities on the board for the children to refer to.

Use computer software and games. Allow children to play subject-related computer games to extend attention, then ask them to spend the same amount of time focused on academic tasks.

Production

Provide models of assignments and criteria for success. Give children a clear sense of how a final product might look by showing examples and sharing exemplary products (such as essays or drawings). You might make work from last year available and draw children's attention to specific qualities of the work (for example, "Notice that a good paper has a clear topic sentence."). Do not, however, compare children's work with that of peers or siblings.

Build in planning time. Give children five minutes of planning time before beginning an assignment. Provide guidance in effective planning when necessary.

Use stepwise approaches. Require children to break down tasks into parts and write down the steps or stages. Compile steps of frequent tasks into a notebook for easy reference during work assignments.

Provide guidelines for self-monitoring. Give children explicit guidelines for checking their progress along the way. For example, tell children that every five minutes they should stop and check to see if their plan is still working. Use a timer to signal when to start checking. Also encourage children to self-monitor following the completion of a task (ask themselves a series of questions such as, "What have I left out?").

Provide pathways to success. Let children who may not be able to articulate a plan draw a road map to their final product. Possibly include a fork in the road showing the path to success and the path to failure.

Teach proven strategies. Provide children with specific age-appropriate strategies to use in checking work. For example, use COPS (Capitalization-Organization-Punctuation-Spelling) for proofing written work. Children can create a reminder card to keep on their desk or in their assignment book for quick reference to the strategy.

Stress the importance of organization. Have children preview an assignment and collect the materials they will need before starting it. Guide children in keeping their materials and notebooks organized and easily accessible. Emphasize the positive impact that organization and preplanning will have on the completed project or assignment.

Let children wait to turn in work. Instruct children to allow a day or two to elapse between writing a report and rereading the report for quality. This will give children enough perspective to catch errors or add more details and produce better results in the end.

Encourage self-grading. Set a standard of work quality or criteria for success for children to follow, and allow them to self-assess the quality of their work before turning it in. If the grade matches the child's appraisal, give extra points for good self-assessment.

Set goals and record progress. Have children set a short-term goal, such as completing all homework for the week. Record their daily progress toward the goal for children to observe. Graphic recording, such as plotting their own line graphs, may be particularly reinforcing for some children.

Practice estimating
. Children may benefit from estimating answers to math problems and science experiments. Stress the real-life benefits of estimating and understanding what the correct answer might look like.

Use assignment books. Teach children to use assignment books and "To Do" lists to keep track of their short- and long-term assignments, tests, and quizzes. Use peers to help monitor other children's assignment books.

Use a diary or tape recorder. Have children note what went well and where or when they went astray during the day. Encourage them to identify some techniques that can be used to improve their productivity and include them in the diary.

Eliminate incentives for frenetic pacing. Remove any positive reinforcement for finishing first. State the amount of time a task should take. This will slow down children who work too quickly and will speed up children who work too slowly.

Provide consistent feedback. Create a feedback system so children understand which behaviors, actions, or work products are acceptable and which are not. Use specifics to praise good work and recognize when children use strategies effectively. For example, "I like the way you elaborated in this description," or, "Asking to take a break really seemed to help you come back and focus."

Try a mentor. Some children may benefit from a mentor who will work with them to dissect the day, brainstorm alternative strategies, and provide recognition of progress. The mentor must be seen as credible and may be an individual from within the school or from outside the school.


ATTENTIONBasics | Difficulties | Responses


Medication UP CLOSE:
The Medication Debate


Is medication the best way to manage ADHD?

Whether one accepts ADHD as a neurobiological disorder influences the controversial question of how, or even whether, to treat it. At the center of the controversy is the increasingly common practice of treating ADHD by prescribing psychotropic medications like Ritalin to children. The question couldn't be more politically charged.

The number of children prescribed medications to manage ADHD has risen sharply in the last decade. According to estimates from the U.S. Drug Enforcement Administration, prescription rates for Ritalin and drugs like it have risen by as much as 700 percent since the early 1990s. (Read the Congressional testimony on this study.) Critics argue that these statistics reveal an alarming trend toward "quick fixes" in place of real solutions for children's behavioral problems. Others insist that children with ADHD are finally getting the help they need.

Proponents of medication insist that there is a clear link between abnormal brain chemistry and the inattentive and impulsive behaviors that define ADHD. Studies have shown that people with ADHD have less of the neurotransmitter dopamine in their brains than do other people. This chemical messenger, when present, is thought to cause the brain to be more aware and more focused. In people with ADHD, it appears the brain has more difficulty maintaining dopamine levels and so is less capable of keeping its focus. According to medication proponents, stimulants like Ritalin work to maintain dopamine levels.

The long-term risk to children who take stimulant drugs to manage ADHD is unknown; this is one of the few points on which there is some agreement. However, opponents of ADHD medications for children argue that this is one experiment that we should not be conducting. The potential risks are far too great, they say. On the other hand, experts who advocate the use of medications for treatment of ADHD argue that over the last 60 years since Ritalin was first used, no long-term side effects have arisen. They add that parents must also weigh the risks against the potential negative consequences of not giving their children medication if, in fact, they would benefit from it.

No end is in sight to this debate. Opinions abound on everything from whether or not the disorder exists, to the smallest detail regarding medication dosage. And unfortunately, there are very few hard facts to substantiate many of the opinions. So, how can parents make informed choices about ADHD treatment options?

While many experts consider medication a good potential treatment for ADHD-like behaviors, very few recommend it as the first or only step. They urge parents, educators, and family doctors to first rule out other causes for behavioral problems at school or at home. Far too often, problems that look like ADHD are masking other issues, including language or memory difficulties, learning disabilities, emotional disorders, or possibly hearing and vision problems. These underlying problems, many experts agree, often result in children being misdiagnosed with ADHD and prescribed medication that won't help them.

For parents who ultimately consider medication for a child, one study published in 1999 by the National Institute of Mental Health clearly shows that stimulant drugs like Ritalin can be effective for some children. However, it also noted that medication paired with strategies may be even more effective. See responses to the left, for examples of strategies.


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