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Attention

Do Attention Issues Always Mean ADHD?

Consider these 10 additional causes.

Key points

  • The diagnosis of ADHD in adults is increasing, particularly among women.
  • Although ADHD is the only DSM condition to have "attention" in the name, many challenge the ability to focus.
  • Effective intervention for attention issues relies heavily on their origin.

Never has there been a time either in my personal or therapist life when I have heard so much about ADHD. More people are recognizing that their longstanding difficulties with focus, executive functioning, fidgeting, and/or impulsivity are not personal failings—that there is a name for this, and that there is help. I love that.

Indeed the diagnostic prevalence of ADHD has increased. Especially among adults. One study found a nearly 1% increase in diagnosis among adults between 2007 and 2012, with women seeing the highest increase in diagnosis (London, & Landes, 2021). This may represent the beginnings of a correction of what has been a damaging misunderstanding of how ADHD presents in women and neglect of their unique needs. While more current prevalence data is still in analysis, it can only be imagined that ADHD diagnosis has continued to rise.

Overall, I believe that this trend has been a step in the direction of meeting needs that have gone unmet for a long time. Still, both mental health clinicians and the general public need to keep in mind that there can be many sources of attention issues ranging from physical illness and systemic issues to stress and many other mental health conditions. While this list is far from exhaustive, what follows is 10 additional potential sources of concentration difficulties.

1. Stress

Stress primes us to focus on escaping specific threats. In small doses, this can motivate us to tackle the source of our stress. In larger ones, however, overwhelm can limit our ability to organize our minds to tend to the tasks necessary to do so. Breaking the task down into smaller pieces, seeking support, relaxation strategies, and reaching out for help are all ways to manage stress.

2. Unmet Needs

According to Maslow's Hierarchy of Needs, we can concentrate on achievements when our physical, safety, and connection needs are met. Without these essentials, our clarity can fade as our bodies and minds signal us toward what we need. Until these needs are met, we may struggle with concentration.

3. Trauma

The experience of traumatic events can prime us for hypervigilance, placing us in a space where it is difficult to focus on more long-term goals. In addition, research utilizing eye tracking has shown that in people living with post-traumatic stress disorder, attention is often fixated on potential threats, making it difficult to redirect toward the task at hand (Lazarov et al., 2019). Working through the core traumatic event is necessary to regain focus.

4. Depression

Contrary to the stereotype of depression simply meaning being "sad," depression is a complex neuropsychiatric condition that often causes cognitive symptoms. Depression can make it difficult to focus on one thing for long as well as to multi-task and make decisions particularly when someone is in the midst of an active depressive episode (Keller et al., 2019). Treating the depression often helps.

5. Anxiety

Like stress, anxiety disorders are associated with distractibility and darting attention. Not being able to focus leads to even more anxiety, thus creating an awful cycle. Psychotherapy and mindfulness training can help individuals with anxiety disorders escape the cycle.

6. Bipolar Disorder

Concentration difficulties are common in bipolar disorder whether an individual is experiencing depression, mania, or a period of mood health. Research utilizing fMRI technology has shown differential patterns of activity when taking part in sustaining attention between individuals living with bipolar disorder and those without the diagnosis. Attention issues in bipolar disorder typically require intervention from mental health professionals.

7. Physical Illness

A variety of physical illnesses are associated with cognitive challenges, ranging from thyroid conditions (Samuels, 2014) to all sorts of neurological ones. A visit with one's primary care physician is warranted anytime attention issues are present, particularly if these symptoms are new, to rule out physical causes.

8. Relationship Difficulties and Grief

When we are struggling in our relationships, it can be difficult to focus on much else. We are social creatures. Our highest highs and lowest lows are often in the context of relationships. When grief, conflict, and other relationship difficulties take center stage, it may signal a need to slow down and tend to these.

9. Psychosis

While psychosis may not be the most common cause of attention issues, concentration issues are ubiquitous in individuals experiencing psychosis and those living with psychotic disorders such as schizophrenia. In early psychosis, cognitive symptoms including changes in the ability to concentrate can preclude the full onset of psychotic symptoms. Adolescents and young adults who are experiencing the first onset of significant concentration difficulties need evaluation by a medical professional, particularly if this is associated with other symptoms such as personality changes, paranoia, or hearing voices.

10. Sleep Disorders

Healthy sleep is necessary for proper brain functioning. Sleep disorders of all kinds, as well as sleep deprivation, can be the root of some attention issues. In these cases, treatment will depend on the nature of the sleeping problem.

To find a therapist, please visit the Psychology Today Therapy Directory.

References

Keller, A. S., Leikauf, J. E., Holt-Gosselin, B., Staveland, B. R., & Williams, L. M. (2019). Paying attention to attention in depression. Translational psychiatry, 9(1), 279.

Lazarov, A., Suarez-Jimenez, B., Tamman, A., Falzon, L., Zhu, X., Edmondson, D. E., & Neria, Y. (2019). Attention to threat in posttraumatic stress disorder as indexed by eye-tracking indices: a systematic review. Psychological medicine, 49(5), 705-726.

London, A. S., & Landes, S. D. (2021). Cohort change in the prevalence of ADHD among US adults: evidence of a gender-specific historical period effect. Journal of Attention Disorders, 25(6), 771-782.

Samuels, M. H. (2014). Thyroid disease and cognition. Endocrinology and Metabolism Clinics, 43(2), 529-543.

Strakowski, S. M., Adler, C. M., Holland, S. K., Mills, N., & DelBello, M. P. (2004). A preliminary FMRI study of sustained attention in euthymic, unmedicated bipolar disorder. Neuropsychopharmacology, 29(9), 1734-1740.

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