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Introduction to Subtypes of ADD

Karen J. Rooney, Ph.D.
President, Educational Enterprises, Inc.
1899-B Billingsgate Circle
Richmond, VA 23238
(804) 747-1883

In order to provide intervention to students with ADD, it is critical to understand the variety of ways the disorder manifests itself in terms of learning and cognitive processing. Many interventions are not successful with ADD students because differences identified in assessment are not translated into behavioral descriptors so educational planning can accommodate the areas of strengths and weaknesses that were identified in the diagnostic process. Traditional methods do not readily adjust to the style of many students with ADD because of the rigidity of the approaches, their dependence on multiple step processing and their reliance on linear, sequential reasoning.

The first step in educational planning should be the development of a knowledge base about the effects of the attention disorder on the learning of the individual student because a plan cannot be developed on the simple label of attention disorder. Schools are struggling with intervention because the information about the impact of the attention disorder on the learning and behavior of the individual student has been lacking or too simplistic for an adequate understanding of the attention problem. Many assessments treat the diagnosis as the solution rather than as the vehicle for understanding the behavior and cognitive processing of the individual who has an attention disorder. Much of the confusion in the schools is the result of inadequate evaluations by practitioners who look at the behavioral characteristics but not at cognitive processing and academic achievement. In many cases, the diagnosis of ADD results in the termination of the evaluation process prior to any assessment of learning so educational planning has no foundation based on assessment data. Evaluations must describe the attentional behaviors that are problematic and not just produce a label of ADHD or Undifferentiated Attention Deficit as though the label conveys sufficient understanding of the problem.

DEFINITION

The definition of attention has frequently been described in global terms as though attention is a singular construct but this approach has not been supported in the literature (Goldstein & Goldstein, 1990; Keitzman, Spring & Rubin,1980; Posner & Snyder, 1975; Rosenthal & Allen, 1978). In contrast, Postle (1988) describes attention as "the process through which we construct the world we experience." Thus, a multi-factorial definition of attention is necessary for understanding the construct (Halperin, Newcorn, Sharma, Healey, Wolf, Pascualvaca, & Schwartz, 1990). In spite of this research data, when a child is diagnosed as having an attention deficit, it is rare that sufficient attention is given to identifying the types of attention problems involved. Typically, the diagnosis of Attention Deficit Disorder is treated as a definitive, singular construct that will describe the individual's disorder. The use of subtype categories can prevent the oversimplification and generic misuse of a complicated construct and make the diagnosis of an attention disorder a salient description that can be understood readily in terms of appropriate educational and behavioral interventions.

SUBTYPES

Attention can be divided into categories that describe specific aspects of attentional weaknesses. The first category deals with encoding or problems with incoming stimuli and the storage of the stimuli for processing. The following descriptors are in the encoding category:

Attention Span refers to the length of time an activity is pursued. For example, switching from task to task without completing the task is an example of a weakness in attention span. A child is not able to continue attending long enough to successfully complete the task or process.

Focusing attention refers to the ability to tune out distracting or irrelevant stimuli so that attention is directed toward the appropriate stimuli. This type of attention deficit is exacerbated as the degree of the complexity of the task increases (Zentall, 1983; Zeitzin et al, 1980).

Divided attention refers to the ability to split attention between two or more inputs or aspects of a task. Impairment in the ability to "split" or allocate attention results in deterioration in speed and accuracy of attentional processing (Zeitzan, 1980). In comparison, focused attention requires the elimination of distracting or irrelevant stimuli. For example, if a teacher is demonstrating a math problem and teaching the steps verbally, the student has to divide or allocate attention between the problem being worked and the message being delivered. If a teacher is giving an example of gravity by describing a ride while at an amusement park, the attention needs to be focused on the message and distracting, irrelevant conversations or environmental noises need to be ignored.

Sustained attention is the ability to maintain the focus of attention over time and is related to arousal or activation of the nervous system. Kahnehan (1973) states that arousal is the degree of effort required by attentional processing. If arousal is low, motivation, alertness and processing capacity are diminished and sustained attention is impaired. Many students with ADD exhibit fatigue because of the greater demands on energy when processing information or paying attention.

Intensity of attention has been shown to have an influence on focus as well as memory storage (Pettijohn, 1987). The greater the intensity of the attention from factors such as interest, motivation or novelty, the greater the ability to focus and sustain attention. Weaknesses in intensity would be similar to widespread underarousal which interferes with attentional processing capacity. Research on students with ADD indicates that the students perform better under novel, highly stimulating conditions but not under routine, boring conditions ( Zentall, 1983).

Sequential attention is the ability to focus attention on the stimuli in the order that is necessary for successful task completion or accurate comprehension. For example, if directions are being given, attention must be directed to the stimuli in order for accurate comprehension and execution to take place. Accuracy of sequential attention affects comprehension of behavioral situation s as well as academic processing because of the importance of the sequential order for comprehension and generalization.

The second category deals with selectivity of stimuli and is characterized by the following descriptors:

Selective attention is the ability to choose the appropriate stimuli for processing. After attention is focused and sustained, which pieces or stimuli are chosen for processing. For example, in a textbook, the terms are put in bold print to help the selection of these pieces of information for processing rather than other words in the text. Students with ADD have more difficulty with the selection process than non-ADD students (Hallahan & Reeve, 1980). The concept of selective attention is very important for educational planning because of the implications for studying and test-taking.

Involuntary attention is an automatic response to a stimuli. For example, if someone calls a person's name, the attentional response is immediate.

Voluntary attention is conceptually driven and refers to "the allocation of attention to stimuli that are relevant to current plans, expectations and intentions" (Keitzman et al., 1980). This type of attentional processing is intentional, deliberate and conscious. The process of choosing relevant stimuli requires excessive energy, demands extensive practice but can become more automatic over time. For example, driving a car is an example of a task involving voluntary attention that becomes an automatic process. As the car leaves the motor vehicle department, the new driver is thinking of every detail related to the driving process but with experience, the driver can look at scenery, recognize familiar friends and listen to the news while driving without interference to the driving process.

Filtering is the process of weeding out irrelevant stimuli from relevant stimuli. Theories such as the "bottleneck" suggest that information is narrowed to the most critical stimuli. However, this filtering process has also been viewed in terms of set (Broadbent, 1971). "Schema set" (Broadbent, 1971) is a filtering process that targets appropriate stimuli because of the physical properties of the stimuli. A second filtering process is called "response set" selects stimuli for further processing based on the similarity between the stimuli and the conceptual expectation. For example, if a child is told to attend to the teacher with the blue dress, the schema set would control the selection. If the child were told to attend to the teacher talking about space, the response set would control the selection. Since ADD students have difficulty with schemas, the filtering process is complicated from the organizational weakness as well as the attention focus.

CHARACTERISTICS AND ACADEMIC MANIFESTATION

DIFFICULTY WITH TRANSITION (Barkley, 1981)

Students with ADD have difficulty with transition activities because of the greater demands for cognitive flexibility, switching the focus of attention and independent structuring. Transition activities involve change and students with ADD do not adjust well to unexpected or unstructured change. Thus, interventions must teach students to use self-talk to help switch the attentional focus and to learn simple structures for common transitional activities. For example, Pat's teacher was using computer time as a reward in a behavior management program. The reward was powerful but the transition from the computer back to classwork became a real problem for Pat. He had so much trouble that the teacher was going to stop using the computer time as a reward because there was a struggle every time the reward time was over and Pat had to stop using the computer. Rather than eliminate a powerful reward, the teacher decided to try to help with the transition. She taught Pat to respond to a signal that time was up by pushing his hands together and saying to himself, "I have to change now so I need to stand up from the chair." The child was able to handle the transition because of the physical and cognitive message which supported his transition.

Problem transition times should be identified so that structures can be taught to facilitate the transition. Trouble spots throughout the student's day can be predicted by mentally walking through the day and identifying all the transition times:

Before School Jim can play a vocabulary game that is self- correcting until class starts.
Bathroom Break Jim can be the line leader to and from the bathroom.
Return from lunch Mrs. Jones will have a sheet of practice facts on the desk so Jim can complete the activity as soon as he comes into the class.
Preparation to go home Jim will have a picture chart he has drawn on his notebook to remind him of the books he needs to take home.
Walk to bus Jim walks to the bus with his best friend Bill.

Also, role-playing appropriate behavior for transition times can be helpful. A specific transition time can be identified for the class and students can take turns acting out appropriate behaviors which will enable the students to practice and learn behaviors that have been modeled by other students which may make the behaviors more acceptable.

PROBLEMS WITH MEMORY

Inattention to detail, associational thinking and lack of sustained attention make memory storage and retrieval problematic for many students with attentions disorders. Review systems that emphasize the critical pieces of information should be products of each lesson so the student is able to fill in and review at a later time. If no review system results, students may study irrelevant or unimportant material or may continue to be penalized for the initial inattention because there is no review material.

PROBLEMS WITH SPEED OF PROCESSING

Often gaps or time delays in processing interfere with comprehension because of the lack of fit with the pace of the instruction in t he classroom. If a student misses an important piece of information which is necessary for accurate comprehension, attention becomes even more problematic because of the confusion about the meaning. In order to counteract the effects of time lag in processing, pre-reading activities that identify the critical pieces in advance or graphic organizers that provide a visual structure for the material to be presented will help minimize the time delay. Preparation of questions to be asked in class the following day will also allow the student sufficient preparation time rather than having to answer "on-the-spot."

DIFFICULTY WITH FLEXIBLE THINKING

Students with attention disorders will frequently cling to rules or procedures that are no longer efficient because of lack of alternative organizational strategies. Graphic organizers that anchor the details and main ideas in clear, visual formats can be very helpful to enable the student to track detail and form concepts in a more flexible manner though the structure is very concrete and definite. The format allows for more flexibility in terms of thinking and generalization.

PROBLEMS WITH CONCEPT FORMATION

Concept formation has been found to be weak in students with attention disorders. Several causative factors may be involved but two main difficulties can be readily identified. First, attention to incorrect or insufficient detail can make concept formation much harder, if not impossible in some cases. Second, the lack of an organized integrative processing procedure may hinder the formation of the concept. In either case, the visual anchoring of the details and main ideas in a simple visual structure can improve concept formation because the correct detail is presented in relationship to the concept formed from inspection of all the detail.

PROBLEMS FOLLOWING DIRECTIONS

Weaknesses related to sequential processing, attention to detail and concept formation can affect a student's ability to follow directions. Memory difficulties can interfere with the retention of the directions for in-depth processing. In order to accommodate this weakness, direction statements can be turned into a series of self-questions to serve as a self-monitoring tool for execution of the directions: Circle the subjects and underline the predicates.

1. Did I circle the subject?
2. Did I underline the predicate?

Also, main words can be underlined to focus attention on the critical pieces of the directions.

POOR TEST-TAKING PERFORMANCE

Inconsistency is the hallmark of the test-taking profile of students with attention disorders. Inattention during instruction, weaknesses in selective attention and unorganized study routines interfere with the consistency of memory retrieval and specific application which negatively affects test-taking. Review systems focusing on the critical information to study and practice tests to identify specific application errors can support test-taking performance. Flashcard systems involving manipulative, card sort procedures can make the study routine concrete and adapt to the inconsistency of memory retention through the resulting ease of frequent repetition and review with the cards.

IMPULSIVE RESPONDING

Students calling out in class would be described as impulsive but their impulsivity also affects their academic performance because they do not think processes through to a successful conclusion, do not conduct sufficient in-depth analysis or respond before all the components have been included in the process. The use of advance visual organizers can be very helpful to provide a visual representation of the amount of processing that is necessary for successful processing. For example, if there are four steps in a process the student is to follow, the use of four squares as the visual format for the response will provide a visual structure to guide the information processing and reduce the impulsivity. Underlining (or penciling) can focus attention on the pieces of true-false or essay questions so premature responding does not occur.

INACCURATE OR INADEQUATE INFORMATION BASES

Inattention can produce gaps in learning that affect the long term accumulation of information. When new learning is attached to inaccurate previous knowledge, the current learning is negatively affected. For student with attention disorders, the information base required for successful learning or task completion needs to be built so that previous inattention or an inaccurate information base does not continue to impede performance.

MISSED STARTING POINTS

Directions and instruction have starting points that are necessary for understanding and execution. If students have a tine delay in focusing attention, are distractible or have difficulty sustaining attention, missed starting points can interfere with successful performance for years. One student who could not pass geometry was being given a lesson on the area of square and the area of a triangle. During the course of instruction, the student sat back and commented, "I have always wondered how people knew a square from a triangle." He had missed a starting point in the very early grades that was blocking his ability to understand geometry because the fundamental regarding shapes was missing. Until the missed starting point was filled in, it would be impossible for the student who work with the shapes required in geometry. For students with attention disorders, it is important to conduct task analysis prior to the new instruction so that missed instruction or starting points can be filled in to support the student's performance.

TROUBLE WITH UNSTRUCTURED ACTIVITIES

Students with attention disorders have difficulty with independent structuring so unstructured situations pose particular problems. The less structure provided, the more the student will have to be involved in structuring which will tap into his or her weakness. The best intervention for unstructured situations is to provide practice in routines or structures that can be utilized in specific situations. Role-playing behaviors or routines can help build a repertoire of learned structures for unstructured situations. For example, role-playing the entrance to a birthday party or dance can help provide learned social conventions that will provide the student with the self-structuring needed in the situation rather than depending on spontaneous structuring which may be weak.

MEMORY STORAGE AND RETRIEVAL AS RELATED TO ADD

The classic picture of the child who goes to his room to get his shoes, hairbrush and belt but is standing in the middle of his room wondering why he came there portrays the difficulties with memory associated with ADD. Though problems with memory are often the source of frustration, little research is available to describe the memory problems specific to ADD as a disorder. However, the main characteristic used to describe these problems is inconsistency. At times, children with ADD will be able to perform adequately on memory tasks but will be found to have markedly decreased performance at other times (Goldstein & Goldstein, 1990). This inconsistency often dissipates the empathy ADD student should receive because of their performance problems. People begin to think that the students could "do it" or "remember it" if they wanted to do so. This intentional slant produces a negative dynamic that affects self-esteem and performance.

Memory problems associated with emotion or anxiety have been demonstrated in the research literature (Kihlstrom, 1979) but have not been studied extensively in connection with students with attention disorders. When a child is the recipient of negative feelings, conscious or subconscious, on the part of the parent or teacher, memory processing would be predicted to deteriorate further. As an illustration of this dynamic: Barry was having a terrible time writing his term paper. He had ADD and the organization of the term paper was overwhelming. He called his tutor and desperately requested help. When he arrived for the tutorial session, he was steaming mad and threw his bookbag on the table, spilling out hundreds of little cards and copied articles. The tutor told Barry to calm down and asked him to show her the visual organizer (Rooney, 1990) he had been taught to organize his paper. Barry had been in an organizational strategy training class the previous semester and had learned organizational tools for information processing. Barry looked at the tutor and said "You never taught me that." The tutor knew that Barry had been to all the sessions and the instruction was in a group format so she pulled his file to check his work samples. There in his file was the sample of his "Wheels for Writing", proving that he had been taught the strategy. Barry was adamant that he had never learned the strategy and the tutor had proof that he had. Both were right according to a notation in Barry's file.

Barry's Dad took off work early on the days Barry had class. He would pick Barry up at the bus stop in order to make the sessions on time. On the third week, Barry's Dad waited at the bus stop but Barry did not get off the bus. His Dad went to his school and looked all over for him. Not finding him, he returned home to find Barry playing Nintendo. His Dad was furious and told Barry to get in the car immediately. Barry heard about his transgression all the way to class and was in such a fit of anger by the time he got to class that though he had completed all that was required during the class, not even a hint of the instruction remained with Barry. He had no recollection of anything that occurred during that particular session though he had done all the work.

Emotional overlays and the impact of emotional factors related to memory functioning need to be addressed through research but the effects of poor self-esteem and negative self-image need to be considered from a memory perspective when planning for education interventions to support memory. Review systems are critical so accurate information can be reviewed frequently if necessary.

Since attention can be viewed as an initial stage of the learning/memory process, the implications for students with ADD are obvious. If the initial phase is problematic, the storage, retention and retrieval will be negatively affected. The associational style often associated with the disorder frequently results in inaccurate storage of information and subsequent difficulty with retrieval. The major impact for the school-aged child occurs in the area of test-taking which requires rapid recall of information from memory and gives the student feedback on his or her performance. The feedback from tests in turn translates into the student's perception of his or her ability, not just performance. Students with ADD who have trouble studying and taking tests often view themselves as "dumb" or "stupid" because they do not make the distinction between ability and performance. Students may study very hard and not do well on a test not because of effort but because of the attention disorder. One mother's story illustrates this dilemma: My child had to read a biography about George Washington. I helped him get an appropriate book from the library and he began to read. He began telling me about the gardens at Mount Vernon. As he continued to read, he enthusiastically shared more and more about the various gardens at George Washington's home. As he began to tell more and more about the gardens, I began to be a little concerned about his focus. Finally, I asked him what he remembered from the reading. He began to describe George Washington's gardens in detail. A horrible feeling began to slide over me and I couldn't stand it any longer. I asked him who George Washington was and he had no knowledge about George other than he had terrific gardens. I began to try to imagine the chances of his getting a test question related to the gardens he read about rather than the contributions Washington made as Father of our country and for the first time I began to understand why he could do all his schoolwork and fail his tests."

USE OF PRIOR KNOWLEDGE AS RELATED TO ADD

The reading literature has emphasized the use of prior knowledge as a primary reading comprehension skill (Barked, 1991; Pazanni, 1991;Recht & Leslie, 1988; Schumm & Mangrum, 1991; Wilhite, 1989) but the use of prior knowledge has not been studied extensively in relationship to attention/memory dysfunction which may interfere with the accuracy of the prior knowledge and the effect of the inaccuracies on new learning. The few studies suggest that the development of a broad knowledge base is critical to the use of strategic techniques such as clustering (Bjorklund & Jacobs, 1985). Since students with attentional disorders often fail to build a firm, stable comprehensive knowledge base because of attentional deficits in encoding or selecting, the use of a strategy that depends on prior knowledge rather than building the knowledge base for new instruction is questionable. Without additional research on the subject to clarify the role of prior knowledge in the learning/performance problems of ADD students, interventions must seek to build the base of information /skills necessary for successful task completion.

ACADEMIC MANIFESTATIONS:

DIFFICULTY WITH TRANSITION
PROBLEMS WITH MEMORY
PROBLEMS WITH SPEED OF PROCESSING
DIFFICULTY WITH FLEXIBLE THINKING
PROBLEMS WITH CONCEPT FORMATION
PROBLEMS FOLLOWING DIRECTIONS

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