As she emptied her son's preschool cubby, Mary Robertson wept. She felt that she must be a terrible mother -- why else would 5-year-old Anthony have been kicked out of school for throwing blocks while the other students raptly enjoyed story time? After his expulsion, learning experts diagnosed Anthony with attention deficit hyperactivity disorder (ADHD), a condition thought to affect at least one kid in every classroom. His mother, meanwhile, worked out an individualized educational plan for him so he could continue in a regular classroom and became an active member of Children With Attention-Deficit/ Hyperactivity Disorder (CHADD), a national support organization.
Knowing that these kinds of problems tend to run in families, the Lexington, KY, mother feared a similar ordeal when her second child was born. Instead, daughter Samantha was so laid-back that she never even received a time-out.
Surprisingly, Samantha's transition to school was also tough. Although she sat quietly, Samantha couldn't focus well enough to learn or even to play with the other kids. "There I was, on the national board of CHADD, and I completely missed that my daughter also had attention issues!" exclaims Robertson.
If even this savvy mom was caught off guard, how can less informed parents know when their youngster needs help? Indeed, more and more experts are saying that the way kids with attention troubles have been identified has done American families a disservice. They're adamant that half of all kids with these difficulties are not being diagnosed, and those like Samantha -- who lack focus but don't exhibit other behavior that attracts notice -- are the most likely to slip through the cracks. (Often confusing is the clinical diagnosis for Samantha's problem: ADHD, predominantly inattentive type. In other words, she has a hyperactivity disorder without the hyperactivity.)
The latest thinking is that lumping the two kinds of kids -- the fidgety ones and the unfocused ones -- together under the same diagnosis is actually preventing children like Samantha from getting the help they need.
"The problem is that the disorders sound like cousins, but the research indicates they are completely distinct and unrelated problems," says Richard Milich, Ph.D., professor of psychology at the University of Kentucky, Lexington, and a prominent researcher on ADHD. "(An inattention issue) may not be a behavioral but a learning or developmental disorder. We don't know where it fits -- but it's not, as previously believed, with ADHD."
It's a theory that's grabbing attention. Russell A. Barkley, Ph.D., an ADHD specialist at the University of Massachusetts Medical School at Worcester, has even proposed a new name: focused attention disorder.
Still, even as researchers dig deeper, parents and teachers often fail to recognize the condition. Here's what you need to know.
Spotting The Struggle
Richie Whitman's difficulties began in the third grade. When reading, he couldn't focus on long passages. He was easily distracted, his backpack looked like a trash can, and he often forgot to hand in his homework.
"Inattentive kids are in their seats, but they're in another world. They have to go over material three, four, five times to answer questions," says Clare B. Jones, Ph.D., a diagnostic specialist. According to Jones, these youngsters are extremely forgetful -- to the point that they can't seem to remember to feed the dog even though it's a daily chore or will raise their hands but forget the answer when the teacher calls on them. And, significantly, they look like daydreamers. (For more, see "Pinpointing Attention Problems.")
Other kids may call them couch potatoes or airheads. "Some common symptoms in these children -- being sluggish, lethargic, or spacey -- aren't even listed in the official diagnostic manual," says Caryn L. Carlson, Ph.D., associate professor of psychology at the University of Texas at Austin. In the past, inattentive kids were often targeted as lazy and unmotivated. But most need a cure, not criticism.
"It's essential that these children's problem be diagnosed as a true impairment -- not a lack of motivation -- so they can be helped," says Rosemary Tannock, Ph.D., senior scientist with the Research Institute of the Hospital for Sick Children in Toronto. That's one reason these kids have been going unnoticed: Even caring teachers often fail to see that it's a matter of "I can't" rather than "I won't." And attention troubles are even less likely to be perceived in girls, in part because such problems are assumed to be a guy thing. "What gets a boy tested often gets a girl corrected: 'Sit up, try harder,'" says Jones.
Growing up on Long Island, Rose Nicolosi's* daughter Marielle* was a sweet, albeit shy, girl. But when Marielle stopped at her locker between classes, she'd lose track of time and end up needing a late pass; her grades were disappointing despite painful amounts of effort. As often happens, her attention deficit wasn't discovered until later, when Marielle was in middle school.
"My daughter has tremendous self-esteem problems because of this disorder," says Nicolosi. "Just having a diagnosis has been a help."
Being blamed for behavior like Marielle's -- and riding a downward spiral of negative self-worth -- is one of the most devastating effects of undiagnosed attention issues. Tammy Amoroso, a mother in Phoenix, learned that she had the disorder at the same time as her 8-year-old daughter, Ashley. Amoroso looks back on her school years with regret. "The other kids laughed at my mistakes," she says. Her insecurities were so overwhelming that, when she finished high school, she turned down an acceptance to design school. Today, she's getting treatment alongside her child.
Identifying the Condition
This summer, psychologists will have a new diagnostic tool. The Brown Attention-Deficit Disorder Scales for Children uncover clues to inattention and enable specialists to interpret tests that measure IQ, memory, and ability to concentrate.
In addition, discovering that a kid has attention deficit could mean other issues are present. "If you think a lack of focus is your child's only problem, chances are two out of three that you're wrong," says Peter Jensen, M.D., director of the Center for the Advancement of Children's Mental Health in New York. These kids are likely to have a reading, writing, or math disability or an anxiety disorder; they also have an increased likelihood of developing a major depression before adulthood.
"Don't hesitate to get the evaluations you need for a complete picture," advises Joanne O'Brien,* a mom in Hawaii. In the second grade, her daughter, Lauren,* would have done anything to avoid beginning her class work. Trouble getting started is a key indicator of the condition. But Lauren had an inability to focus plus some specific learning disabilities. In these cases, kids need more than remedial work to catch up. Plans were made (and are often updated) for changes in Lauren's regular class; she also gets special education and tutoring.
Zeroing in on How to Help
For years, Ritalin and ADHD have almost always been talked about in the same breath. But contrary to what you may think, medication shouldn't be the first line of treatment for the unfocused kids; experts believe that customized education and lifestyle changes should be. Though parents of hyperactive children often describe medication as a miracle cure--"It turned my Mr. Hyde back into Dr. Jekyll," according to one mom--the effects can be quite subtle on youngsters whose main symptom is a tendency to zone out, and lower doses often work best.
Take the experience of two young brothers in Washington, DC. Damien Flynn* is a bright boy with ADHD whose fidgeting and complete inability to follow directions got him booted out of three preschools; on medication, he displays markedly fewer behavior problems. But when the same drug was prescribed for his brother, Carlton,* who has attention deficit without the hyperactivity, changes were less apparent. After his dosage was raised, Carlton seemed to be in more of a dream world than before. He continues to take a low dose, says his father, because it does improve his concentration a little.
So if Ritalin isn't the magic bullet, what is the latest thinking on how to treat unfocused kids?
- Help with learning. "It's not just pills, it's skills," says Jones. If a child hasn't been paying attention, chances are that educational gaps need to be filled. After Richie Whitman's first year of combined medication and tutoring, he received the most-improved-student award. "When they do better, don't say, 'I see that pill is really helping you.' Say, 'I can see that you're really putting in the effort,'" Jones says.
Some children may need simple measures such as a front-row seat and a teacher who double-checks that they turn in homework. Others need an adapted curriculum, a different teacher, or a new school.
- Change parenting strategies. Recognize that forgetfulness is a sign of a disability and not willful misbehavior. Giving age-appropriate chores is reasonable, but don't expect your child to act without a reminder. "I would point out an unmade bed and then -- instead of giving Lauren time to take that in -- tell her to pick up the toys on the floor. That wasn't helping," recalls O'Brien. Now she gives Lauren instructions one task at a time.
- Reorganize systems for chores and homework. Your child may need a distraction-free zone and lots of encouragement. To teach her daughter to use the school's agenda book to track assignments, Nicolosi offered an incentive: Any week the teacher marked all OKs in the journal, Marielle got an ice cream cone or bowling outing. "It worked--but the ultimate reward for her was fixing the problem," says Nicolosi.
- Get HER counseling. Attention deficit can negatively impact a child's self-esteem; connect her with a psychologist or family counselor.
- Nurture your kid's social life. Unfocused children may have trouble listening to friends or finding activities that don't bore them. "That's typical of inattentive kids," says Jones, who calls them unhappy wanderers. In their houses, she finds dozens of abandoned hobbies.
"Help them find an interest, and then promote the heck out of it," advises Kathleen G. Nadeau, Ph.D., director of Chesapeake Psychological Services in Silver Spring, MD. To minimize frustration and expense, look for things that don't require lots of practice, she suggests. For example, singing in the choir might be better than taking up the violin. A church group or scouting can provide a ready-made social life for a child who is lonesome.
As experts uncover new findings, insights, and important tools, the payoff makes it all worthwhile. Says the recently diagnosed Amoroso, "We know so much more than when I was a kid. I feel that my daughter, with treatment, can accomplish anything."
Hawaii-based Susan Ince covers health for many national magazines.