When “Attention Problems” Are Not ADHD

By June 10, 2019NESCA Notes 2019

By Jessica Geragosian, Psy.D.
Pediatric Neuropsychologist

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurological disruption of the arousal system in the brain resulting in difficulties regulating attention and activity levels. ADHD can present with or without hyperactivity. Children with ADHD often have trouble engaging in expected tasks and maintaining appropriate behavioral control due to problems with inattention and lack of self-regulation. This can result in problems in the home, at school, and in peer relationships.

When concerns regarding attention or activity level are raised by parents or teachers, common practice is to consult with the child’s pediatrician. Parents and teachers might fill out rating scales asking questions like: Does your child have problems paying attention? Does your child have a hard time sitting still? Is your child having problems with learning? Is your child having difficulty following directions at home? When the answers to these questions are “yes,” a diagnosis of ADHD may seem appropriate.

However, there are many cases where inattention and/or impulsive behavior present as a symptom of another underlying problem and are not attributable to a primary attention disorder (ADHD).

The 5 most common misattributions I have seen in my clinical practice as a pediatric neuropsychologist in New Hampshire and Massachusetts are:

  1. Anxiety—When an individual is in a state of “fight or flight,” the brain lacks appreciation for information from the external environment that isn’t critical. When an individual is in a generalized state of anxiety, it is extremely difficult to remain focused and engaged in expected tasks.
  2. Learning disability—A student may have a disability in a core academic area. For example, a teacher may observe a child as being inattentive, when, in fact, they are several grade levels behind in reading. Thus, they cannot access the materials being distributed to the class.
  3. Communication disorder—If a child’s primary deficit is in the way they process language, you can be sure they look inattentive (e.g., not responding accurately to questions, inability to follow directions, etc.)
  4. Autism spectrum disorder (ASD)—Some children on the autism spectrum appear quite inattentive. In my experience, many children with ASD are often more tuned in to their internal environment (i.e., their thoughts and interests) at the expense of the external/social environment (i.e., parent, classroom and social expectations). While this can look similar to ADHD, the treatment approach is quite different.
  5. Other neurocognitive disorder (e.g., Processing speed deficit)—Other cognitive deficits can also make a student appear inattentive. If a student has slow processing speed, for example, the individual may not be able to keep up with the pace of instruction, resulting in an inability to absorb all of the lesson.

Other less common issues can also present as inattention, including trauma, absence seizures, hearing impairment, hallucinations, Tourette’s syndrome, among others. Because the root cause of inattention can sometimes be something very specific and complex, it is important to get a thorough evaluation.

It is also not uncommon for ADHD to present alongside the challenges identified above. In this case, effective intervention requires a simultaneous treatment plan addressing all challenges concurrently.

It is important to get a big picture—and accurate—understanding of a child’s neuropsychological profile in planning effective interventions. Our brains are complex, and one symptom can be common to many different origins. Getting the correct diagnosis the first time helps to put the right treatments in place.

 

About the Author:

Dr. Jessica Geragosian is a Licensed Psychologist in Massachusetts and New Hampshire. She has a wide range of clinical experience – in hospital, school and clinic settings – working with children and adolescents presenting with a wide range of cognitive, learning, social and psychological challenges.

Dr. Geragosian operates under the primary belief that all children want to, and can be, successful. The primary goal of her work is to identify the child’s innate strengths and find any underlying vulnerabilities preventing a child from achieving success. Whether the primary problem is an inability to acquire academic skills, maintain friendships, control emotions, or regulate behavior to meet expectations; she takes a holistic approach to understand the complex interplay of developmental, neurological and psychological factors contributing to a child’s presenting challenges.

Dr. Geragosian earned her doctoral degree from William James University, before completing postgraduate training in pediatric neuropsychology at the Massachusetts General Hospital for Children at North Shore Medical Center, where a focus of her work was neuropsychological assessment of young children with developmental challenges.

 

To book an evaluation with Dr. Geragosian or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.