The Emotional Roots of Inattention

Parents, teachers, daycare workers, pediatricians, camp counselors, scout leaders, coaches, playground monitors, and anyone who has any regular interaction with children are all acutely aware of the growing prevalence in our culture of Attention Deficit Disorder (ADD), and Attention Deficit/Hyperactivity Disorder (ADHD). Certainly the recognition of ADD and ADHD as real psycho-biological disorders has positively impacted those children and parents who were suffering helplessly with highly disruptive behavior and symptoms that hampered learning, damaged relationships, and stressed families to their breaking points.

Through the implementation of medication therapy, supportive counseling and behavior management, these families are having some success at overcoming the problems associated with these disorders. At the same time, as often happens with "public advertising," the diagnoses of ADD and ADHD have become the catch all for a myriad of child related problems, particular for those children who are in the school system.

There are a number of reasons why this has occurred. Part of it has to do with the increasing tendency in our culture to overburden the educational system with a whole host of tasks that go far beyond academic instruction. Teachers, guidance counselors and principals find themselves intervening in social and family problems, dealing with difficult disciplinary challenges, and often standing in for parents as the source of emotional guidance and support.

Conversely, no one can ignore the tremendous stress endured by parents who are struggling to meet the basic economic needs of the family while also providing the proper amount of nurturing and care for their children. Very often and especially in the wake of high rates of divorce and single parenthood, these responsibilities are overwhelming and create insurmountable obstacles that ultimately take their toll everyone.

On a larger societal basis we can see yet another factor, which is a culture that feeds on high degrees of stimulation whether it comes from entertainment, media, or general activity. We find ourselves racing from one thing to another in our work, our play, and even unfortunately often in our relationships. It isn't really so strange that we would see an increase in hyperactive children in a culture that seems to define itself in hyperactive terms.

What all of this means is that when we begin to examine the problem of attention deficits and hyperactivity, we see that the explanation, diagnosis, and solutions to such problems are quite complex. We must carefully consider each individual separately in terms of all the possible factors that could be contributing to the problem before deciding a course of treatment or intervention.

Since the problem is rather complex, I would like to discuss it over several articles beginning in this writing with an explanation of the emotional factors that influence attention. For continued discussion read the articles entitled "Attention Deficit Disorder" and "Understanding ADHD."

Origins of Attention

The ability to attend is initiated very early in life during the first several months after birth. As the new infant emerges from the safety and warmth of the womb, he is initially assaulted with a variety of sensory experiences as the rude light of reality descends upon him in the labor room. In the hours, days and weeks that follow, these sensory experiences begin to take a regular shape in the sound of mommy's soothing voice, the warmth of her smiling gaze, or the security of being tucked in her arms and rocked. As she makes little faces at him, lovingly cups his feet, or coos at him, the baby is beginning to organize his senses to take in experiences and respond to them emotionally.

Baby's sensory experiences, particularly those involving mommy (or his primary caretaker) become both a means of stimulation and excitement, as well as mechanisms for self-soothing and reaching a state of calm (Greenspan, 1999, p. 24). Mommy's voice is very exciting when she is making high-pitched sounds accompanied by funny faces, and is in turn very soothing when she speaks to baby in soft, low-pitched tones while stroking or holding him.

It is this regular and predictable interaction between mother and baby characterized by warmth and protectiveness that supplies the infant with the first means for attending to and harnessing the senses in ways that provide the opportunity for learning while regulating and calming oneself. In fact, "baby's ability to hear and respond to" mommy's voice "is one of the primary ways in which he learns how to take a deep breath, calm down, and pay attention to you and the world," (p. 30). It is in the convergence and experience of all the senses at once during the loving interactions with mommy that baby's basic ability to attend and regulate the emotions are established. Moreover, the basic sense of trust and security that is built during these first few months provides the background from which attention is derived and steadied.

Greenspan points out that this stage in a baby's development is crucial. The absence of loving caregivers "to help babies become interested and engaged in the world around them" (p. 25) can prevent the achievement of this basic sense of security, and at its worst, result in infants that are "self-absorbed" and who lose interest in the their surroundings.

In speaking of cases of severe emotional neglect, Greenspan reports that these infants can become so self-absorbed that they lose muscle tone, sometimes resulting in an inability to even move their heads (p. 25). This underscores the very important link between emotional security and the ability to attend.

The Elements of Attention

Attention is usually thought of as the ability to focus mentally in a singular direction for a specified length of time during which other objects of interest or focus can be put aside or kept on the periphery. What usually is not included in the definition is the dynamic quality of attention. It is an interactive process in which the person attending interacts with the object of attention in such a way that there is a reciprocal interchange.

Using baby as the example, if baby attends to mommy's face, her expressions, gaze, movements, and so forth communicate something back to him. If mommy smiles and winks, a feeling of warmth and receptivity is communicated which is felt by him in the process of attending. In turn, there is a reaction communicated back to mommy either in terms of expression, a felt emotional response, or perhaps a return smile, squeal, or giggle. Even with inanimate objects such as a toy or a book, the process of attending is a dynamic one in which the words or pictures communicate something to the child as he or she looks at the book. Or perhaps the color and shape of the toy communicate some sense of excitement or interest as the child picks it up, handles it, looks at it, and so forth.

Attention, then, requires a certain degree of interest coupled with enough interactive reciprocity so that interest and focus are maintained over time. Although the act of focusing the mind can be considered to be a mental skill, it is the elements of interest, interaction, and involvement that are the emotional elements of the process without which attention could not be sustained.

Based on this dynamic interpretation, we can make the following assertions about attention:

• The capacity to attend is initiated during the first three months of life as a result of the nurturing relationship between the infant and primary caretaker in which the sensory system is alternately stimulated and soothed.
• Paying attention is an interactive, dynamic process that engages and focuses the mind in a singular direction.
• It requires an emotional investment based on interest and motivation.
• It is enhanced in children by a steady sense of emotional security and trust.
• It requires the ability to calm and regulate the emotions.
• It is best when the reciprocal feedback from the act of attending is positive.
• It is easily interrupted by stress, emotional problems, and overstimulation.

Let's examine the following scenario to see how these assertions play out. Sara is a 9-year-old fourth grader who has a good relationship with her parents, feels comfortable in her family life, and has no particular learning disabilities. She likes puzzles and problem-solving sorts of games, and is particularly good at math. When asked to do a timed math quiz at school involving multiplication, she easily attends to the task at hand, finishes before the time is up, and relishes having her answers checked because she feels confident she will have done well. She gets most or all of the answers correct, her teacher gives her a big smile and tells her "good job," and she goes about the rest of her day with a sense of accomplishment and contentedness.

David, also a 9-year-old fourth grader, lives with his mother (Dad left the home last year). His mother works two jobs, is highly stressed, and David spends a good deal of time with other caretakers along with his younger brother. He misses his Dad, but sees him only occasionally. David also historically has not done well with math and he has felt humiliated a number of times when other children made fun of him during class math games. Under the same quiz circumstances, he becomes highly anxious, fidgets in his chair, is unable to focus on the problems, daydreams, and doesn't finish the quiz in the allotted time. Worse yet, he gets many or most of the problems wrong. He doesn't get the teacher's smile, his mother isn't happy with his performance, and he is left feeling incompetent and discontented as he moves on to his other daily activities.

Sara's circumstances contain all of the necessary ingredients for being able to attend well in the above scenario. She has had and continues to have ongoing emotional nurturing from her parents. She lives in a family and environmental situation that is not overburdened with stress and conflict. She has attained the capacity to focus and calm herself when the need arises, and in this particular situation, she is involved in an activity that is easy for her, she excels at, and from which she receives reinforcement in terms of her competence and self worth. She has both interest in the math games and an emotional investment in the results she will attain from doing well.

David  is somewhat emotionally neglected in view of his father's absence and his mother's inability to both support the family and adequately attend to his needs. In fact, the fallout from the recent marital separation is sapping both his and his mother's energy. His ability to calm and regulate his emotions has diminished as the stress of the separation spills over into his daily living. Math is not his best subject and he has already learned that his inability to perform well in this area has resulted in negative reactions from others. For him, there is no real interest in the subject, it isn't easy, and he is not emotionally invested in participating as he suspects the outcome will bring negative responses and ultimately further emotional despair. It's not surprising that David has great difficulty in attending to the task at hand.

What Parents Can Do

Extracting from David's and Sara's situations above, it would seem that there are certain key elements that need to be in place for a child to be able to attend well. They are as follows:

Develop and Maintain a Strong Emotional Connection

Beginning at birth and continuing throughout childhood and adolescence, children need a warm, loving relationship with their parents (or parent if only one is available). This relationship begins in the first three months as described above, and must by nurtured continually. This means spending time with children, trying to understand their distinctive dispositions and needs, and confirming them as valuable family members as well as individuals. Children who are neglected emotionally are particularly at risk for attention problems.

Minimize Stress and Conflict

Keep stress, overstimulation and conflict to a minimum. Family conflicts, particularly marital problems, are highly stressful to children even if they appear not to be directly effected. What happens is that their emotions become tied up with the stress they are experiencing so that they are unable to use their energy in other pursuits such as learning. Other types of overstimulation include abuse, yelling, too much nudity in the home, chaotic living patterns, etc

Focus on Strengths

Build on strengths instead of focusing primarily on weaknesses. You want to give equal if not more time to supporting your child's talents and abilities. If you have a good reader, show your support by getting a library card, making up stories together, and sharing your pleasure in your child's interest.

Problem-Solve Deficits

Don't ignore deficits, but assist your child in learning how to work through and around them. If there seems to be a problem with any particular area of learning, get a thorough evaluation done to see if there are some specific learning problems that need additional educational assistance. Keep in mind that very often children who have attention problems do not have them across the board, but only in relation to certain kinds of situations.

Maintain Reasonable Behavioral Expectations

Finally, set reasonable limits on behavior, and follow through consistently with them. Children who have permissive parents can have attention problems simply because they have not internalized the self-discipline that goes hand in hand with parental limits.

What About ADHD?

There are some children that have problems with attention, and some of them severe, even if they have been raised in nurturing, stable environments as suggested above. These children fall under the category of Attention Deficit Hyperactivity Disorder. Basically, this is a problem with adequate production of dopamine in the brain. Dopamine is the neurotransmitter that is related to attention, the modulation of emotions, executive function (the ability to see things objectively and make decisions), and impulse control. For children with ADHD, other types of behavioral techniques are necessary, and some require medication if severe enough. For more about ADHD, read my other two articles on this subject.

_{Greenspan, Stanley I. Building Healthy Minds. Cambridge, Massachusetts: Perseus Books, 1999.}