Lately, likely due to the increased coverage on television and in social media, many people have been coming in to see me saying they have poor attention, they can’t focus, and they think they may have ADHD. Some do, some don’t.
When they do have it, the best treatment often isn’t what they were expecting. The media portrays ADHD treatment one way, pediatricians frequently treat it another way, and the complex nature of why you might not be able to concentrate leads to a lot of confusion about it.
While individuals may feel like they can’t focus, not everyone who comes in needs treatment specific to that complaint. An inability to focus is frequently due to depression or anxiety, or other things going on in their lives that are affecting their ability to concentrate. Treating for ADHD when that is not the primary issue can make the actual problem worse.
Additionally, many people come in having already been treated for reported problems with concentration. They don’t understand why they aren’t better or have gotten worse since starting their current treatment. It’s because they were initially taken down an incorrect path.
They thought they had ADHD, but maybe it was never formally diagnosed. Sometimes no testing was completed, or they took an online test that told them they have ADHD and they were incorrectly started on medication to treat it, rather than the problem that was actually underlying their recent change in focus.
There’s no doubt that some cases are legitimately undiagnosed ADHD, but many cases like this are people who were led to believe they have it due to media influence. Unfortunately, the pharmaceutical ads have gotten very good at convincing us there is a problem when there likely isn’t one.
We’ve been led to believe that everyone needs to be hyper-focused on work or school one hundred percent of the time, but this is problematic for two reasons:
- Our biology isn’t built for this. We aren’t meant to be focused solely on specific tasks for extended periods of time
- We often can’t concentrate because of today’s intense level of distractions; media and entertainment diversion, the ads we are fed, and so forth. So many things are competing for our attention these days!
Children And ADHD Diagnoses
Kids who have concentration issues often end up seeing their pediatrician about potentially having ADHD. The problem is that pediatric doctors have general knowledge on the subject, but very little actual training in ADHD – often only a day or two of instruction, at best.
This is a radically different background than that of a child psychiatrist who has had years of specialized training in the condition.
Because they have such general knowledge of ADHD, most pediatricians will go straight to the top of the pyramid of treatment guidelines, which is the use of amphetamines. Since they don’t have specialized training, they aren’t well informed about other pathways of treatment that may be more appropriate. Instead, they use these medications as a first line of treatment.
Amphetamines, however, are not benign. They can cause weight loss, sleep issues, decreased stature as the child grows, and other long term effects like heart morbidity problems. For some children, these are the right medications, but they should be the last form of treatment after trying other things.
Most kids respond to less strenuous treatment, such as psychotherapy, and don’t necessarily need to be on medication.
For those who do need medication, we can start with a medication that has very little in the way of long-term consequences. It is only with reluctance that we get to that high level of medication in our situation as psychiatrists. It has to be necessary before we will add it to the child’s treatment plan.
Frequently, a child’s attention problems stem from anxiety, depression, problems with classmates, or other stressors. They are not attention problems at all.
A key factor to look at, for both kids and adults, is to ask yourself if the problem is new or if it has always existed. ADHD symptoms should have been present throughout the person’s lifetime, seen from an early age, and seen in multiple settings.
True concentration problems aren’t specific to just one school subject or only seen in one setting, such as just at school or just in math class. If it is exclusive to that setting or subject, there is likely something else going on rather than a concentration problem. For example, maybe the child hates math or can’t connect with their teacher, so they don’t do well in that subject.
Media Influence Has Fueled The Increase In ADHD Diagnoses
The media and the pharmaceutical industry have created a furor by saying that all people must be focused one hundred percent of the time, but this isn’t true. We aren’t biologically wired that way.
We are supposed to be distractible as a safety measure to notice what’s happening around us. From an evolutionary standpoint, if we were laser focused, we would miss the possibly dangerous details of our surroundings. A great example is a person who concentrates so much on taking the perfect selfie that they walk off a cliff or out into traffic while doing so.
Over the course of the last ten years, we have been incessantly bombarded with different sources of information and things seeking our attention. Advertisers have gotten very creative. We spend a lot of time scrolling on social media, YouTube, TikTok, and these things are very distracting for us. People who were fine even a few years ago are now more distracted.
Our new inability to focus isn’t a pre-existing condition, it’s a created condition for most people. Medication is not going to be able to treat it. Instead, we need to look at behavior modification to help stop doing those things.
The media and writers who are not experts in the field have done such a good job of talking about ADHD that currently there is a shortage of amphetamines and other similar medications. It’s not because the drug companies are suddenly having trouble making them, it’s because we have had a drastic increase in the number of people taking them.
What’s changed? Along with the media barrage, we’ve had more stress in the past couple of years due to the pandemic. People are now taking ADHD medications because they are trying to alleviate their symptoms, but they aren’t getting to the root of their problem.
It’s important that patients get the right kind of care and that we find them the best option. It’s also important, especially for kids, that we find the mildest thing that will do the job, whether or not they have ADHD problems.
Dangers Of Taking “Just A Little Pill” For Concentration Problems
When it comes to taking medications, there is a whole gamut of things the layperson doesn’t understand that is important. There is a reason the United States government has declared amphetamines a controlled substance – because they are dangerous if used incorrectly, and are habit forming.
Thinking that if you just take some pills and your ADHD goes away, is easy when we listen to what the media would have you believe; these are cure-all medications that will help you achieve a wonderful life.
The truth is that they increase dopamine in your body, which can lead to anxiety, sleep disturbances, even mania and psychosis. The person taking them must be carefully monitored and their medications controlled.
It’s important for people to seek the right level of care and get help, but by using the least addictive and mildest option that is the most helpful treatment for the problem. We must prescribe the right medication for the right patient, at the right time. And we must not leave out psychiatric treatment when appropriate, which it frequently is.
Why Kids Can’t Concentrate In School
Concerns about an inability to focus is where I’m spending half of my clinical time lately, and 10 years ago virtually no one would have come in talking about it. It’s not that this problem hasn’t been around for a while, but now people are seeking treatment for normal levels of attention.
I have a background in education. When developing a lesson plan, educators are taught that people can only pay attention for about ten minutes, and then they need a distraction. Students should get no more than a ten minute lecture and that should be followed by a few reinforcing exercises. Think of long lectures you’ve attended – no matter how interested you are in the topic, your mind will start to wander after about ten minutes.
We’ve known this for more than a hundred years, but most teachers, work seminars, and college courses don’t follow this principle. The result is that kids and adults have been told over and over by the media that their lack of concentration is the problem, rather than fixing the poor instructional design to better fit how people learn.
If your concentration has changed, you probably should see someone like me, but please understand that your inability to focus may not be concentration-related. We need to look at whatever else is going on in your life, because you may be having trouble paying attention due to family issues, work concerns, and so on. Many people can likely be helped without getting to the point of needing to use medications.
Hopefully this article will help you to come in to our clinic a little more informed, and from there, we’ll do our best to improve things.
We’re Here For You
If you are worried you or a loved one may have ADHD, our licensed, professional therapists are here to listen and offer effective solutions. For more information, contact us or call us today at 561-496-1094.
About Jerome Siegmeister, MD, MaED (Child And Adolescent Psychiatry / General Psychiatry)
Jerome Siegmeister, MD, MaED, is a South Florida Native. He has worked with clients of all ages, and believes that the whole person needs to be treated. Consequently, he evaluates all aspects of the situation, from medical to situational, to determine the best initial course. He has a background in both individual and group therapies, employing supportive, behavioral, and insight oriented approaches, as appropriate to best fit his client’s needs, as well as comfort with medical treatment of any underlying conditions that might manifest psychiatrically. He has significant experience in all forms of psychiatric issues, including mood symptoms, thought disorders, anxiety, phobias, attention deficits, behavioral issues, insomnia, compulsive disorders, emotional lability, substance abuse, and trauma.
Dr. Siegmeister graduated with his Bachelor’s from Florida International University, after which he spent a number of years teaching, and obtained a Masters from the University of South Florida in Career and Technical Education/Adult Education. Upon deciding to pursue medicine, he initially completed a Post Baccalaureate Pre-Medical Certificate program at the University of Miami, and then obtained his MD from the University of Miami Miller School of Medicine, staying there afterwards for his specialty training in Psychiatry, followed by a fellowship in Child and Adolescent Psychiatry, where he served as Chief Fellow, and was awarded with a Research Distinction. After training, he has worked providing Emergency care, with additional work in inpatient settings, both in mental health and as a consultant to medical units at multiple hospitals. He is currently Board Certified by the American Board of Psychiatry and Neurology in both general Psychiatry, and Child and Adolescent Psychiatry, and by the National Board of Physicians and Surgeons in Psychiatry.