Many factors can cause lack of concentration in a child. ADHD is often the first disorder associated with inattention, but it’s not always the correct diagnosis. Different forms of anxiety, obsessive-compulsive disorder, trauma, stress, or learning disorders may be the culprit.
Not All Attention Problems Are ADHD
It's a common assumption, but there are other causes that are easily overlooked
Clinical Experts: Jerry Bubrick, PhD , Jamie Howard, PhD
What You'll Learn
- What do symptoms of ADHD look like?
- What other conditions cause problems with attention?
- How can I make sure my child gets the right diagnosis?
Lots of kids have short attention spans. They get easily distracted. They have trouble following instructions or sitting still. These can be symptoms of ADHD. But there are also other conditions that cause attention problems. It’s important to rule these out or a child can be misdiagnosed with ADHD and get the wrong treatment.
Anxiety is one issue that can cause attention problems. When kids worry a lot, it can make concentrating in school very hard. For example, kids with separation anxiety may be distracted worrying that something will happen to their parents. Some kids might not hand in homework or respond to teachers because they are so worried their answers won’t be perfect.
OCD is another condition that can be confused with ADHD. Kids with OCD have obsessive worries about bad things happening. When a teacher calls on them, they seem like they’re not paying attention.
Trauma can also make it hard for kids to pay attention. Kids who have been through very scary or stressful experiences can be nervous, jumpy, or spacey. These behaviors can make it look like they have ADHD.
A learning disorder can also cause an attention problem. These kids might be having trouble with their academic work, and they often get frustrated and embarrassed when they can’t keep up.
It’s important not to jump to the conclusion that your kid has ADHD just because a teacher reports an attention problem. A mental health expert should examine your child. That expert should ask a lot of questions and observe their behavior. Then they’ll be able to figure out the real problem and give your child the right treatment.
Trouble paying attention is often first identified by a teacher who notices that a student seems more easily distracted than most other kids his age.
Maybe the child takes an unusually long time to finish schoolwork in class. Maybe when the teacher calls on him, he doesn’t seem to have been following the lesson. Maybe he seems to tune out when instructions are given, or forget what he’s supposed to be doing. Maybe homework assignments often go missing.
While all children, especially those who are very young, tend to have shorter attention spans and be more distractible than adults, some have much more trouble focusing and staying on task than others.
Since difficulty paying attention is widely associated with ADHD, that tends to be the first thing teachers, parents, and clinicians suspect. But there are a number of other possibilities that can be contributing to attention problems. To avoid misdiagnosis, it’s important that these other possibilities, which are not always obvious, not be overlooked.
Here is a checklist of some of the other issues that may make a child struggle to pay attention in school:
A child who seems not to be focusing in school could have chronic worries that teachers (and even parents) are not aware of. There are many different kinds of anxiety, but what they have in common, says neurologist and former teacher Ken Schuster, PsyD, is that anxiety “tends to lock up the brain,” making school hard for anxious kids.
A child with separation anxiety might be so preoccupied about something bad happening to her parents while she is apart from them that she is unable to concentrate on schoolwork.
Some kids are extremely worried about making a mistake or embarrassing themselves. When the teacher is calling on them, they may try to disappear, Dr. Shuster notes. “They might look down, they might start writing something even though they’re not really writing something. They’re trying to break the connection with the teacher in order to avoid what’s making them feel anxious.”
Sometimes when a child takes an unusually long time to finish her work in class, it’s not because she’s daydreaming but because she’s, struggling with perfectionism that requires her to do things exactly the right way. Or if she doesn’t turn in her homework, it could be not because she didn’t do it, but because she is worried that it isn’t good enough.
Kids with OCD, which often starts in the grade-school years, have an added source of distraction: They not only have obsessive thoughts, but feel they must perform rituals, or compulsions, to prevent bad things from happening. A child with OCD might be compulsively lining things up on his desk, or tapping, or counting in his head. Or he might be focused on needing to go to the lavatory to wash his hands.
“A kid may be sitting in class having an obsession about needing to fix something, to avoid something terrible happening. Then the teacher calls on him,” says Jerry Bubrick, PhD, a clinical psychologist at the Child Mind Institute who specializes in anxiety and OCD. “When he doesn’t know the answer to the question, it looks like he wasn’t paying attention, but it’s really because he was obsessing.”
Since children with OCD are often ashamed of their symptoms, they may go to great lengths to hide their compulsions while they’re in school. To a teacher who’s not aware of the OCD, distraction might look like ADHD, but it isn’t.
Stress or trauma
Children can also appear to be suffering from inattention when they have been impacted by a trauma. Kids who’ve witnessed violence or other disturbing experiences may demonstrate difficulty paying attention and a persistent sense of insecurity called hypervigilance.
Kids whose home lives involve acute stress may develop these symptoms, or even post-traumatic stress disorder.
“Many of the symptoms of PTSD look like ADHD,” explains Jamie Howard, PhD, a clinician at the Child Mind Institute who specializes in trauma. “Symptoms common in PTSD, such as difficulty concentrating, exaggerated startle response, and hypervigilance, can make it seem like a child is jumpy and spacy.”
When a child seems to be looking everywhere but at the pages of the book she is supposed to be reading, another possible cause is that she has a learning disorder.
Children with undiagnosed dyslexia might fidget with frustration or feel ashamed that they can’t seem to do what the other kids can do, and be intent on covering that fact up.
If a child struggling with math, he might welcome distractions that allow him to think about something else, or avoid completing the assignment.
Auditory processing problems could cause a child to miss some of what the teacher is saying, even if she’s listening, and that could look as if she’s not paying attention.
Some kids are able to compensate for their learning disabilities by working extra hard, and they may be successful until they reach a grade where the work becomes too challenging.
“They’ve been able to hide their weakness until they get older and there’s just too much heavy lifting,” notes Nancy Rappaport, MD, a Harvard Medical School professor who specializes in mental health care in school setting. “They’re often diagnosed with ADHD or depression, unless someone catches the learning problem.”
Is it really ADHD?
Inattention that is outside the typical range is one of the three key symptoms of ADHD, along with impulsivity and hyperactivity. Some kids do demonstrate only inattentive symptoms. But a diagnosis of ADHD shouldn’t be made just on the basis of teacher reports or one quick visit to the pediatrician.
To make an accurate diagnosis, a clinician should collect information from several people who have observed your child, including you, other caregivers, and teachers. Parents and teachers should be asked to fill out a rating scale, to capture an accurate assessment of the frequency of symptoms. The behavior has to continue over an extended period, and be observed in more than one setting-both at home and at school, for instance. And clinicians should carefully rule out other possible reasons for his behavior.
It’s also important that a child’s ability to pay attention be compared to others of his own age, not everyone in his grade. A study published in 2012 found that boys who are the youngest in their class are 30% more likely to be diagnosed with ADHD than the oldest boys in the class, and younger girls are 70% more likely to be diagnosed than the oldest girls. This suggests that that immaturity may also be mistaken for ADHD.
Frequently Asked Questions
To help a child who has trouble focusing, you can work with a mental health professional to get the child an accurate diagnosis. A number of different challenges can cause trouble focusing, including ADHD, anxiety, trauma, and learning disorders. Getting the right diagnosis is the first step to getting your child the support they need.