As a therapist for over 25 years, I have seen a dramatic rise in teens and adults struggling with attention and focus. Many of my patients ask whether they might have attention-deficit/hyperactivity disorder (ADHD). This concern is consistent with the documented spike in ADHD medication prescriptions for adults.
There could be alternative explanations for their struggles. Increasing rates of depression, anxiety and sleep insufficiency, as well as being pulled in different directions by rapidly changing technology, are all contributing to our deteriorating attention.
We should be careful not to pathologize the wide range of human experience because it can, among other consequences, undermine human resilience, penalize neurodivergence and lead to overmedication.
Diagnosing ADHD
The gold standard for ADHD evaluation is an assessment that includes a thorough clinical interview with the patient and others who knew them as children or tweens, as well as neuropsychological measurements of cognitive functioning, executive functioning and attentional processes.
Neuropsychological assessments, however, are long and expensive. Most diagnoses of ADHD, instead, come during a shorter visit to a primary care doctor or mental health professional.
At a minimum, these visits should include a thorough clinical interview to assess not only symptoms but also age at onset and how pervasive and impairing they are. An ADHD diagnosis requires that people older than 17 exhibit at least five inattentive or hyperactive/impulsive symptoms that started by age 12.
Inattentive symptoms — which are more common in adults — include:
- Frequently missing details.
- Making careless mistakes.
- Forgetting or losing important things.
- Significant difficulty in paying sustained attention, avoiding distraction, following instruction, listening, organizing, and persisting in tasks and activities.
Hyperactive symptoms include:
- Talking excessively.
- Blurting out answers.
- Having difficulty sitting still, being quiet or waiting a turn.
- Being fidgety.
- Always being “on the go.”
- Interrupting others.
These symptoms must be present in at least two life domains — for example, a person needs to have attention problems in another context beside work — to be diagnosed with ADHD. Symptoms also must affect different parts of their life in a negative way.
A 2015 study by the Centers for Disease Control and Prevention found that 1 in 5 children with ADHD were improperly diagnosed by doctors.
Individuals should consider whether their attention problems may be better explained by other factors such as depression, anxiety and related disorders, sleep deficits and overreliance on technology.
Many other conditions also are associated with attention deficits, such as autism spectrum disorder, epilepsy, learning disabilities, chronic fatigue syndrome and traumatic brain injury.
Depression, anxiety and related disorders
Most of my patients with depression and anxiety have a hard time focusing, even on undemanding tasks such as watching a movie.
One of the symptoms of major depressive disorder is “diminished ability to think or concentrate.” Research has shown that paying attention and ignoring distracting information can be compromised in depressed individuals.
Anxiety and related disorders such as obsessive-compulsive disorder are related to deficits in the ability to be focused, organized, stay on task and persist in a chosen activity. Symptoms of generalized anxiety disorder include difficulty concentrating or finishing tasks, mind going blank, as well as being restless and struggling to sit still.
A study with Vietnam veterans diagnosed with PTSD found that their heightened arousal and hypervigilance contributed to attention problems.
If the attention problems start when people get depressed or anxious, then ADHD is unlikely.
Inadequate sleep
It is hard to concentrate when we haven’t slept well or slept long enough. Research has linked both the quantity and quality of sleep with attention problems.
The mind has a limited amount of attention and other cognitive resources, which are replenished overnight. When we do not get enough rest, we experience difficulty concentrating. The ability to focus attention is one of the first things to go when people lose sleep, says Charles A. Czeisler, a professor of sleep medicine at Harvard Medical School, in “Stolen Focus: Why You Can’t Pay Attention — and How to Think Deeply Again.”
Overreliance on technology
Among U.S. adults, 31 percent said they were online “almost constantly,” up from 21 percent in 2015, according to a Pew Research Center survey conducted Jan. 25 to Feb. 8, 2021. We also spend a staggering average of over 11 hours of our day looking at screens.
In the past decade, I have seen a similar shift in my patients’ reliance on phones, computers and tablets. These devices can be highly distracting — which tracks with the increase in reported attention difficulties.
Common complaints revolve around an inability to focus on anything because of constant interruptions and feeling like one is constantly pulled to check their email, text messages, social media or dating apps — even when the notifications are turned off. As a result, we often try to do two or more things at the same time and end up depleting our attentional resources. A study of young teens in the Netherlands showed that those who engaged in more media multitasking showed more attention problems with time.
If someone is having trouble with attention to the extent that it is significantly affecting their life, they should consult a health-care provider. It is crucial to distinguish between when a person may be suffering from ADHD and when their attention difficulties are because of other factors so that they can receive proper treatment.
Jelena Kecmanovic, PhD, is a clinical psychologist and professor in the D.C. area. She focuses on anxiety and the adverse effects of modern life on well-being.
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