Improving attention spans

Dr Rabeen LutchmanPaediatrician

Rondebosch Medical CentreTel: 021 685 0336

OverviewIntroduction to attention span of the young child

GIVE Attention to GET Attention

Good sleep, Great Attention Span

Dietary Influences on Attention Spans

Decreasing Distractions

Attention Disorders

Introduction4-5 year old can stay focused for about 5

minutes times their age – eg 5 year old +- 25 minutes

Rough guide

Must be contextualized - morning / middle of the day / before naptime / before bedtime

Great Variation throughout the day

ATTENTION SPAN IS ELASTIC

GIVE attention to GET attention

To get a child’s attention, parents must also give attention

Best way to get them to pay attention is to be physically close to them

Make eye contact / be at eye level / touch shoulder

How much attention your child gives an activity depends on how much he is enjoying the activity –

They struggle when the have to do what they don’t want to do

Turn Dull into FUN!!

Workbooks can be overwhelming – get a chalkboard!!

Instead of writing “A” – Look through a magazine and cut out every “A” - Amy not help with penmenship for the day but still allows then to focus on a task and stimulates fine motor coordination

Get to know your child –

Count cars / wheels add them together, drive them around in various shapes, get different colour cars (Numbers ✓Shapes ✓ Colours ✓ Maths ✓)

Teacups/ dolls / action figures / lego

GET creative : Count beans/ stick pasta shells/ cotton wool clouds

PARENTS MUST PAY ATTENTION/ GIVE ATTENTION to Get Attention!!

Good Sleep, Great Attention Span

A child who does not sleep well, does not perform optimally at school

Sleepless child affects the WHOLE family unit

Poor sleep – poor daytime performance/mood changes/ behaviour problems/ disrupted meal times/ poor nutrition

Strong association between medical conditions and sleeplessness in children

Conditions must be correctly diagnosed and appropriately managed

Allergic Rhinitis

Untrolled – often have poor sleep

Difficult to fall off to sleep and restless throughout the night

Symptoms: runny nose/ nasal congestion/sneezing itchy eyes/ daytime fatigue

Rx: Intranasal steroids and antihistamines

Atopic Dermatitis (Eczema)

Itching and scratching – restless night

Effective treatment is long term and challenging

Acute/ Chronic Otitis Media (Middle Ear Infection)

Fever /earache/ decreased appetite/ vomitting

repeated or prolonged waking up periods - increased daytime sleepiness – lack of interest daytime activities

Chronic ? Conductive hearing loss – Speech and Language development

Medication – Related Sleep Disturbance

Over the counter drugs

Combination drugs

Consumption withdrawal caffeine/ nicotine/alcohol/ stimulant drugs – adolescents!!

Chronic Illness

Asthma/Reflux/ Diabetes/ Migraines / Juvenile Arthritis

Nutritional Deficiency

Iron deficiency

- Fatigue/exercise intolerance/ daytime sleeping

- Behavior abnormalities and suboptimal intellectual functioning

Zinc deficiency

- Some evidence that deficiency results in behavioral abnormalities

Dietary InfluenceRefined Sugar

May affect behavior and attention spans (formal studies are inconclusive)

Theory that some have an allergy to refined sugar

Another theory suggests that children get a reactive hypoglycemia (which then triggers other stress hormones like adrenaline)

Good choices snack – unsalted popcorn/whole grain pretzels/ dried fruit/ raw veggies dipped with hummus/ yogurt/ peanut butter

Food Additives (artificial colors/flavors/ preservatives)

Some kids have a sensitivity to specific additives

Suggested as a cause for hyperactive behavior – studies show mixed results

Major practice guidelines do not recommend a total elimination diet

Micronutrients

Iron and Zinc

Essential Fatty Acids (Omega 3 and 6)

Are necessary for the development and functioning of neuronal membranes (cells of the brain and the nervous system)

Some studies have shown decreased levels in children with ADHD and a deficiency may play a role in the cause of the illness.

Definitely needed for brain growth and development

Supplementation if diet deficient

Decreasing Distractions?Hungry – Healthy snack before starting homework

?Tired – EVERYONE NEEDS DOWNTIME – if overstimulated they plead downtime with their behaviour

Siblings ? Distract or Motivate

- Separate rooms

- Different tasks or same tasks ? Musical chairs

- No tv/computer games until everyone is finished with homework

AAP recommends 1-2 hours of screen time per day – includes tv/video games/computer/Ipad/ phone

Study in Pediatrics 2011 – Fast paced cartoons e.g. SpongeBob shortened attention spans of 4 year olds

Alternatives to the TV/Smartphone

Help make dinner

Involve with household chores

Have a conversation with the child – focus on the child and listen NB! The middle child

Exercise/ sport – set aside specific time

Build a puzzle together/ make a fort with furniture / READ READ READ

Attention DisordersSometimes attention problems are difficult to solve

with simple strategies

Need help from teacher, pediatrician, child psychologist, occupational therapist

Important to exclude any underlying cause or influencing factors on attention span

Parents must realize the child’s potential and not have unrealistic expectations

Inattentiveness, impulsivity and hyperactivity occur in some extent in ALL children

However to meet the criteria for ADHD these symptoms of inattentiveness/impulsivity and hyperactivity must:

Be present in more than one setting (eg at school and home or mosque)

Persist for at least 6 months

Be present before the age of 12

Impair function in acedemic, social and occupational activities

Be excessive for the developmental age of the child

Not be caused by other disorders

ADHD (Attention Deficit Hyperactivity Disorder)

Disorder that manifests in childhood with the symptoms of hyperactivity, impulsivity and/or inattention

These symptoms affect the academic/ behavior/ emotional/ thinking and social functioning of the child

Cause not definitively known but a genetic imbalance of hormones in the brain play a primary role in the structure and functioning of the brain.

Co morbid disorders often found with include: conduct disorder/ Anxiety Disorder/ Learning Disability/ Oppositional Defiant disorder/ Depression – Need psychiatrist to make these diagnosis

Red flag signs:

- 4-5 year old having consistent trouble engaging with anything for more than 2/3 minutes

- Needing constant guidance to do an activity that should be manageable for age

- Easily distracted

- Jumping from one activity to another with completing tasks

- Leaves seat in the classroom/church

- Unable to control impulse/ difficulty awaiting turn/ blurts out answers before question complete

Evaluation includes : teacher / paediatrician/ child psychologist / occupational therapist

ConclusionGIVE Attention to GET

Attention

Good sleep, Great Attention Span

Thank You