Focusing Problems in Children

What are Focusing Skills in Childhood?

Focusing skills in childhood are about paying attention to information in the environment. For example, kids need to pay attention in the classroom to perform well in school. They need to be able to focus on their peers to make friends on the playground. Finally, the ability to pay attention is needed to follow directions at home and to navigate the community.

Focusing problems include challenges with attention, hyperactivity, and impulsivity. If your child is hyperactive, they may be fidgety and move around constantly. Impulsive children often act without thinking. Children who are inattentive tend to drift easily off-topic, daydream, and lose focus often. Both hyperactive and inattentive children may have trouble sitting still and seem to bounce from one activity to the next, lacking direction. In the articles that follow, we will review all of these types of focus issues in more detail.

Attention and focus problems are often evident both at home and in the classroom. 

At home, a child with limited attention skills may seem to space out a lot. They may not look up when you call their name. They may require 3-4 prompts before following your directions. Children who struggle with attention often take a long time to get ready for school in the morning.

At school, the teacher may note that your child does not adhere to classroom rules and routines. They may seem to be in their own world, two steps behind classmates to gather supplies, finish work, and line up for recess. You might find yourself saying, ‘he could do great work if he could focus long enough to finish it.’ In the articles under this facet, you will learn about various types of attention; identify where your child may be struggling, and understand what you can do to help.

In the articles within this facet, you will learn the types of attention problems and the relative level of concern associated. Sometimes at-home interventions are enough to help your child improve their attention. Other times, they may require clinical help. These articles will help you discern which attention areas may be problematic for your child and what you can do as a parent to help.

General Categories of Focusing Problems

• Hyperactivity– excessive movement, acting as if driven by a motor 
• Impulsivity– acting without thinking, acting first and thinking about consequences later
• Joint attention– social attention, noticing something interesting to something else and sharing attention, or vice versa, pointing out something of interest to you to another person
• Focused attention– being able to focus on something that may be relatively boring for an extended period of time, like a textbook, a lecture in school, a program, without being super interested in the topic
• Internally focused– focusing on your daydreams and internal thoughts and missing some of what is going on around you, hard to shift from something interesting internally

Children who struggle with focusing may have a hard time ‘shifting attention.’ It may be hard for your child to stop doing one activity and switch to another. This challenge may be evident during center time in the classroom when your child refuses to put down the iPad and change over to the writer’s workshop. There may also be problems with sustained attention. Sustained attention, also known as focused attention, is the skill of sticking with something or staying on task. Children with poor sustained attention might be able to shift to a new task but cannot stay with it for very long.

Although many children with these challenges may have Attention Deficit Hyperactivity Disorder (ADHD), there are various other reasons why a child’s attention may be impaired. 

Some children with poor attention have emotional problems such as anxiety or depression. Children with anxiety often ‘freeze up’ and cannot focus as well. Children with depression may not focus because they may lack the motivation to complete tasks, not care as much about the outcome, and tire out quickly. 

Other neurodevelopmental disabilities, such as autism, impact attention skills. Children with autism tend to be able to sustain their attention with adequate reinforcement but struggle with shifting attention.

Symptoms of Focusing Problems in Childhood

Inattention

• Your child is off task: instead of doing their homework, you find your child playing with their pencil or has taken the piece of paper near them and created a toy. 
• They are easily distracted: by someone walking by the classroom, hearing the rumble of an old car, or even by their thoughts!
• You find your child will start something to be quickly lost in something else: your child will begin their homework, think of something funny, which makes them think of laughing at lunch today, which will make them think of grabbing a snack, which makes them wander aimlessly into the kitchen.
• Drifting constantly when the smallest thing catches their eye: You may hear family members say, “Look, squirrel!” jesting that your child is easily distracted by the smallest thing 
• Having trouble finishing homework: avoiding their homework and generally can’t tell you how they got off task in the first place
• Challenges with working memory: your child has trouble holding information in their head long enough to use it. For example, if you say ‘first get your shoes and then brush your teeth,’ the second step is forgotten before they leave the room

Hyperactivity

• Acts wound up: seems to have boundless energy
• Moves constantly: always out of the seat in school, at the dinner table, when reading a book with parents
• Fidgets more than other children: constantly moving, tapping, playing with something, drawing, chewing, etc.
• Gets in trouble at school: talks when the teacher is talking, moves around the room, disrupts other children
• Bumps into other kids: may have trouble staying in their own space in the classroom, on the playground
• Makes a mess: when your child leaves the room, the toys and activities and household items are everywhere, like a tornado
• Too loud: loud voices, constant singing, talking, banging, jumping 

Impulsivity 

• Failing to stop and think: Acting now and thinking later
• Accidently breaks things or hurts people: Making mistakes and feeling remorse afterward
• Failing to reflect: Never thinking about their actions or the consequences
• Unsafe in public: Running away from you at the grocery store or in a parking lot
• Taking frequent risks: Seeming to have no concern for safety
• Bothering others: Acting hyper and intrusive, even when another child has had enough
• Overly physical with others: Liking to hug and roughhouse, even with kids who do not appear to be having fun
• Teenagers taking unsafe risks: older kids and impulsive teenagers may take uncalculated risks, resulting in trouble with the school or the law. It is important to understand that there are treatments for impulsive kids that could result in improved behavior and better outcomes

Causes of Focusing Problems in Childhood

Causes of inattention

• Neurological differences: differences in the brain’s prefrontal cortex are associated with ADHD, which is often a disorder with a genetic predisposition. Inattention is the primary symptom of ADHD.
• Due to a disability: your child might be unable to pay attention due to another disability and would be responsive to other associated treatments. For example, some children with poor attention may have a trauma history, anxiety, poor cognitive ability, or Autism Spectrum Disorder.
• Trauma or anxiety: Severe childhood trauma and anxiety can mimic the symptoms of ADHD. Anxiety and stress can make it hard for kids to focus or pay attention when their mind is worried about what could happen. Trauma changes the neural pathways in the brain. If a child does not feel safe after school or on weekends, it may be hard for them to focus in class. This focusing issue may not be due to trauma, not ADHD. For a kid who is not in a safe environment, their focus and attention are about keeping themselves safe. For example, a kid who goes home to a parent who struggles with alcohol and yells or becomes violent has a nervous system is set to look for and scan for danger. Their fight/flight/freeze system is constantly activated, and they cannot relax or focus. You may say they are hyper-vigilant. Hypervigilance can present as not being focused. 

Causes of hyperactivity

• Excess energy: some children have a higher energy level than others. They need more opportunities to move and release energy to pay attention and be successful
• Poor diet and exercise: children need to eat a healthy diet and get regular movement and exercise. It can increase hyperactivity if a child is not provided with these outlets.
• Low birth weight: often, a history of low birth weight has led to more hyperactivity in childhood. A low birth weight could be influenced by the use of substances like cigarette smoking during pregnancy.
• Sensory processing differences: children who are more sensory seeking, which is sometimes related to ADHD or an autism spectrum disorder, can be hyperactive
• Mood difficulties: children who have mood or anxiety disorders may exhibit hyperactivity or restlessness.
• Poor sleep: children who do not sleep well can have issues with dysregulation and that may relate to hyperactivity
• Other medical causes: children with other medical issues can be hyperactive. Talking with your child’s pediatrician to rule out other causes of hyperactivity is a good idea. Share your child’s medical history with a knowledgeable doctor.

Causes of impulsivity

• Brain wiring & immaturity: The root cause of impulsivity is generally different brain wiring. Your child’s judgment and reason aren’t fully mature until about 20 years. On top of that, many children simply have naturally less developed impulse control and will need help learning to manage their behavior and decision-making.

Here’s a sample situation. A child sees the cookie on the table and knows that mom has said to wait until after dinner. The child instantly grabs the cookie and devours it, much to their own surprise. When mom enters the room, wagging her finger and asking, “Why did you do that,” the child has no idea. 

• Attention problems: Impulsive behaviors could be related to attention challenges and a genuine lack of impulse control. It may seem like the child or teenager has no mental brakes. If a child cannot slow down, stop and think before acting, then bad decisions may result. 

These symptoms of hyperactivity and impulsivity may be related to Attention Deficit Hyperactivity Disorder (ADHD). If you are wondering about this, most primary care doctors and pediatricians can diagnose this disorder and provide recommendations and referrals for treatment.

• Inhibition: To inhibit responses means to stop oneself from being pulled away by not talking to the person, not walking toward the distracting object, or not looking at the distracting situation. 

In medical terms, inhibition is the ability to inhibit prepotent responses. A prepotent response is a response you would naturally want to do. 

For example, to practice inhibiting your own prepotent response, you might try looking at a picture of the sun and saying ‘night’ and then looking at a picture of the moon while saying ‘day.’ 

• Emotional regulation: Some impulsive behaviors have an emotional origin. That is, your child may be somewhat out of control in terms of managing their feelings, leading to regrettable behavior.

Impulsivity in the context of irritable mood or frequent mood swings might indicate a Mood Disorder. Your child’s tendency to be grouchy, angry, or moody may lead to erratic and unpredictable behavior.

• Social skills: The underlying problem here could also be related to social awareness, social perspective-taking, or social understanding, which are challenges commonly associated with an Autism Spectrum Disorder.

Failing to read other children’s cues effectively can lead to social mistakes. Children with ASD may have an impaired ability to read social space or refrain from giving a bear hug to a shy classmate. Thus, your child’s behaviors may seem impulsive when they are actually lacking social savvy.

• Behavior problems: Impulsive children may act in a certain way without understanding the ramifications of their actions. For example, the child may push a child out of their way to get to the front of the line at the playground.

What to Do About Focusing Problems in Childhood

The ability to pay attention is extremely important to your child’s development. 

DO obtain an accurate diagnosis: it is important for parents to be aware that attention and related problems can significantly impact a child’s functioning and that an accurate diagnosis by a doctor who has experience with mental health diagnosis in childhood is important. 

Some pediatricians feel uncomfortable making these diagnoses. Ask your child’s pediatrician if they have training in diagnosing attention issues and prescribing. If not, ask for a referral.  

DO consider combined treatments: Most psychologists and medical doctors agree that psychological and medical treatments are required for ADHD. It may be that your child’s diet, sleep, or neurological differences impact their ability to focus in school. If this is the case, your child is at a disadvantage in the classroom.

An assessment of these difficulties should shed light on the severity of the challenges and determine if they are related to ADHD. It is important to note that children with ADHD often have significant problems in school, socially, and in the community.

If ADHD is indeed diagnosed, your family will still be in control of any decisions made regarding your child’s medical interventions and supports.

DO consider other disorders: it may be that your child is unable to pay attention due to another disability and would be responsive to other associated treatments. For example, some children with poor attention may have a trauma history, anxiety, or Autism Spectrum Disorder.

Accommodations are key for focusing issues

If your child has ADHD or a related issue, accommodations at home and in the classroom can make a huge difference and encourage growth in skills. 

School accommodations: extra time, a quiet space to work when distracted, the opportunity to take breaks, to use fidget toys, and to stand up during work time.

Home accommodations: having a quiet designated space for work, using a timer to keep homework sessions manageable, and offering rewards like game time for completing assignments. Use a sticker chart and a visible schedule for the daily routine.

At-home parenting strategies for focusing issues

• Provide many outlets for your child’s energy. Activities like swimming, horseback riding, and gymnastics can be therapeutic for a very active child.  
• Practice mindfulness and relaxation in everyday life. You may find that taking time to relax and recognize feelings in their body can help your child be more aware and less impulsive. This practice may be best to do right before bed as a way of calming down and getting to sleep.
• Think carefully before taking your child to a tea party, movie theater, library, storytime at the bookstore, or adult birthday party. Your child may not be able to maintain their composure in quiet places, so set them up for success with activities where they can excel. Climbing gyms are fun. Bounce places, the zoo, or an engaging and interactive museum are great options.
• A list of kids’ books, such as Personal Space Camp [1] and Ms. Gorski, I Think I Have The Wiggle Fidgets [2], is provided below. Reading these books with your child can help ‘put a name on’ their challenges. They can learn that many children have the same struggles.

When to Seek Help for Focusing Problems in Childhood

If your child is struggling with attention, hyperactivity, or impulsivity, it is extremely important to seek professional help. If these challenges are clinically significant, they can have a pervasive impact in many areas of your child’s life. 

If at-home strategies do not fix the problem, your child will likely need some support. Children who are highly distracted tend to have challenges at school and home because they often miss key instructions and information.

Unfortunately, this symptom is often linked to poor behavioral inhibition, which leads to getting in trouble at home and at school.

Research has shown the challenges inherent in significant attention problems. The largest scale study ever to be conducted (to date) by the National Institute of Mental Health (NIMH) investigated the impact of ADHD on children and families. The study involved over 600 students with attention problems in six sites across the country [3]. 

Findings were as follows:

• “Two-thirds of these children had at least one other disorder, such as depression, anxiety, or learning disabilities.”
• Medication alone was more effective than behavioral interventions alone
• Medication alone was almost as effective as the combined treatment of medication plus behavioral interventions
• Many students may be receiving medication doses that are too low for maximum improvement in school work and behavior” 
• The authors of this article have been involved in a meta-analysis of ADHD interventions. This meta-analysis, a report on a group of studies, found that although many behavioral interventions for ADHD are effective, the individual studies themselves were typically not as systematically conducted (that is, involving pre- and post-testing, ‘dosage levels,’ and effect size), as were the medication studies.
• This difference may be why it sometimes appears that medication alone can be more effective than combined treatment. Most psychologists and medical doctors agree that combined behavioral and pharmaceutical intervention is best.
• In addition to the above research on the under-identification issues for ADHD, there is a large body of evidence to show that girls are specifically missing out on an ADHD diagnosis and the associated supports. This lack of diagnosis and intervention further expands the gender gap in education and employment for girls.

Taken together, parents need to be aware that attention problems can significantly impact a child’s functioning. Providing an accurate diagnosis and psychological and medical interventions can bring lasting positive change.

Further Resources for Focusing Problems 

Psychologist or neuropsychologist: to conduct a full assessment and to examine symptoms for a relevant diagnosis as indicated

School psychologist: to determine learning needs based on your child’s neuropsychological profile; perhaps an IEP, 504 plan, or RTI is warranted to help your child. Perhaps tutoring is recommended, and your school psychologist can help you locate resources.

Psychotherapist or play therapist: to treat emotional symptoms that arise at different ages and to help with social skills training, planning, and organization

ABA therapist: to treat behavior; to conduct an analytical Functional Analysis of the function of the behavior that can help guide treatment

Psychiatrist: to prescribe and manage psychotropic medication for inattention or impulsivity; stimulant medication for ADHD is effective in a high percentage of children with focus and impulsivity challenges

Developmental pediatrician: to help guide behavioral and medical treatment. These doctors specialize in children with developmental concerns. They can be a helpful resource for diagnosis or treatment

Executive functioning tutor or coach: to help your child focus and organize school work and keep up with study skills 

Resources for Focusing Problems

[1] Cook, Julia (2012). Personal space camp. 

[2] Esham, Barbara (2015). Mrs. Gorski, I think I have the wiggle fidgets. (New edition) (Adventures of everyday geniuses.)

[3] Zeigler Dendy, Chris A. (2011). Teaching teens with ADD, ADHD & executive function deficits: A quick reference guide for teachers and parents.

Books for clinicians

ADDItude Editors (n.d.) Focus the Attention of Distracted Children 

Linder Ed.D., Toni & Petersen-Smith Ph.D., Ann (2008) Administration Guide for TPBA2 & TPBI2 (Play-Based Tpba, Tpbi, Tpbc). Paul H. Brookes, Inc. 

Lewis, Ph.D., Jeanne, Calvery, Ph.D., Margaret, & Lewis, Ph.D., Hal (2002). Brainstars. Brain Injury: Strategies for Teams and Re-education for Students. US Department of Education: Office of Special Programs.

Books for parents

Zeigler Dendy, Chris A (2003). Teaching teens with ADD and ADHD. Woodbine house.

Zeigler Dendy, Chris A. (2011). Teaching Teens With ADD, ADHD & Executive Function Deficits: A Quick Reference Guide for Teachers and Parents.

Cooper-Kahn, Joyce & Dietzel, Laurie C. (2008). “Late Lost and Unprepared”: A Parent’s Guide to Helping Children with Executive Functioning.

Barkley, Russell A. (2013). Taking charge of ADHD, 3rd edition: The complete, authoritative guide for parents.

Giler, Janet Z. (2011). Socially ADDept: Teaching social skills to children with ADHD, LD, and Asperger’s.

Siegel, Daniel J. & Bryson, Tina Payne (2012). The Whole Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s Developing Mind. 

Greene, Ross W. (2001). The explosive child: A new approach for understanding and parenting easily frustrated, chronically inflexible children. 

Smith, Bryan & Griffen, Lisa M. (2016). What were you thinking? Learning to control your impulses (Executive function). 

Books for kids

Cook, Julia (2006). My mouth is a volcano.

Stein, David Ezra (2011). Interrupting chicken.

Cook, Julia (2012). Personal space camp. 

Esham, Barbara (2015). Mrs. Gorski, I think I have the wiggle fidgets. (New edition) (Adventures of everyday geniuses.)