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
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