November 4, 2021

ADHD 1 – The Problem of Attention

By Mihai Simionescu MD By MS
Complexity rating Basic
Evidence Well Known
Read time 4 minutes

The Problem of Attention in ADHD


There is much more stuff happening ‘out there’ than any of us could notice, recognize, understand and make sense of. Actually we filter out most of it. And we have to do it because we just do not have the ‘brain power’ to get everything in. This filter that decides what goes in and what stays out, ignored, is called attention.


Attention is the cognitive process of selectively concentrating on one aspect of the environment while ignoring other things. 



Types of Attention


There are several types of attention (see below). The more you go down the list, the more difficult that type of attention is. 

Focused attention is the ability to respond to that one thing that matters.

Sustained attention is the ability to maintain focus on what matters.

Selective attention is the ability to resist distractions and stay with what matters.

Alternating attention is the ability to shift between two activities that matter. 

Divided attention is the ability to respond simultaneously to multiple tasks 


Many people (even without ADHD) struggle with  alternating and divided attention tasks

’Focusing attention’ is, like the name suggests, to zero-in on what needs to be done. To focus is to ‘initiate’ attention. The child with ADHD may do reasonably alright focusing on one thing if the situation is almost perfect. This would be working 1:1 with a patient adult, in a place with little distractions, if the task is exciting or pleasant, if the mood is OK, if he is not tired, if it is not too late in the day and so forth. But if we give 3 instructions at the same time, in an irritated tone of voice, just after we took the remote control of the video game… .

Even in the best day he will have a hard time sustaining that focus over time and persist with what is required. He is also more sensitive to distractions than most of the other children. If a sibling is playing, making noises, if there is a bird singing outside the open window, completing that homework becomes suddenly much more difficult and much less likely to be completed in a reasonable time and without a struggle.



Symptoms of Inattention in ADHD


The child:

  • has significant difficulty sustaining attention 
  • is easily distracted
  • loses things 
  • is forgetful 
  • has significant difficulties organizing tasks and activities 


The child appears to the adult like he….

  • avoids tasks that require sustained mental effort 
  • does not seem to listen and/or fails to give close attention to details 
  • makes careless mistakes  and/or does not follow through 




Inattention in ADHD, affects academic achievement and school performance. This may be followed by a stream of consequences such as liking school less, feeling less confident, acting less ‘motivated’, or trying to impress in other ways like goofing off. These are not symptoms of ADHD, but complications of ADHD that unfortunately may open the door to demoralization, ‘giving up’, social isolation and other behavioral problems.  



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