Tes talks to...Gaia Scerif

Attention difficulties are more complex than you think and are broader than ADHD, the Oxford academic tells Zofia Niemtus
11th May 2018, 12:00am
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Tes talks to...Gaia Scerif


Paying attention may be more complicated than you think. That’s the thought Gaia Scerif would like teachers to hold in their minds next time they challenge a pupil who, once again, is out of their seat or staring out of the window. The professor of developmental cognitive neuroscience at the University of Oxford conducts research on how attentional control is developed, the ways that difficulties can occur in the process and how this can impact on cognitive ability.

She works with children at risk of attentional disorders (both environmental and genetic), and supports them in and out of the classroom. And she believes that attention is often seen in too simplistic terms in schools.

For example, attentional difficulties can be quite varied in their cause and, while many see attention deficit hyperactivity disorder (ADHD) as the totality of problems, Scerif says a diagnosis of ADHD describes just one subset of children with attention difficulties.

All teachers deal with attention issues, Scerif says, because minds will always wander. But teachers may find issues difficult to spot in younger children or in crowded classrooms. And it’s important to understand that there are also issues that can be much harder to recognise as attention problems, she says.

“Those include the executive functions relating to attentional difficulties,” she says. “These are things like the ability to plan, maintain a goal and be cognitively flexible enough to switch between ideas.”

She adds that these challenges can cause serious issues for students as tasks become “progressively more complicated and require more working memory”.

Teachers also need to be aware that children with attentional difficulties may not present with this initially but may struggle in other ways - their attentional difficulties may mean that their reading progression is slow, for example, which can often lead to an initial misdiagnosis of dyslexia.

And then there’s the issue of behaviour. Scerif says that hyperactivity is often more easily spotted and addressed as it can present as behavioural difficulty, such as ignoring instructions. Inattention, on the other hand, is less disruptive but “much more closely linked to underachievement in the classroom”, she says, because it can have “a big impact on what that child absorbs”.

It’s complex. And the cause of these issues is also complex. Genetics is a factor - those with parents or siblings who have attentional difficulties are more likely to have the same issue - but researchers have also found that environment can play a major role.

While there is plenty of advice out there for supporting those with an ADHD diagnosis, attention issues in general, of the kind teachers deal with daily, are more readily written off as a choice made by the individual.

Scerif says that, actually, there are things we can do to help all these students. They shouldn’t be marked out as wholly different from their classmates, she says, but rather seen to be experiencing extreme examples of things that happen to everyone (albeit on a much more regular basis).

‘Breaking learning down’

One strategy is to break learning down to a much more granular level.

“Teachers are very sensitive to this idea,” she says. “They already pay attention, not just to the material but also to how children might be paying attention to that material. But there are further modifications and adjustments that can be made to the environment and learning activities that will help children with those difficulties.”

If a child struggles with maintaining goals for a long time, for example, teachers can try breaking down the overall goal of the lesson into sub-goals.

“This is something that a lot of teachers already do but that, for some children, may need further adjustments; more structure and more sub-goals,” she says. “These can really help, especially children with inattention, rather than hyperactivity.”

And for those students who struggle with being overly active in the classroom, she continues, it is helpful to consider what tasks can allow them to use their energy in a way that won’t disturb other children. For example, asking a child who struggles to stay seated to distribute materials or collect them at set times can give a sense of responsibility and control.

One support method that is particularly popular at the moment is computer-based training, but Scerif says the hard evidence of positive outcomes is yet to emerge.

“There’s a lot of excitement about the computerised training regimes at the moment,” she says. “But the evidence has not been all that positive. For example, engaging computer games have been designed to stretch children’s ability to maintain information in memory. However, so far the evidence suggests that these games improve memory but the improvement does not extend to the skills that teachers are aiming to boost.

“That’s not to say that computerised training is not the right way to go. It may be that the training regimes that have been used so far haven’t been that well designed. But there is a worry that - so far, at least - the evidence is not very positive.”

There is also research taking place into curriculum-based interventions, Scerif reveals. While the computer training approach sets students to work on tasks that are separate from their classroom learning, the curriculum-based model identifies activities that are already taking place in the classroom and modifies them to increase attention demands. This enables students to work on their attentional skills as they undertake everyday activities.

For example, in preschool, young children may engage in buddy reading (reading picture books to each other), practising taking turns over increasingly longer bursts of time.

“The curriculum-based approaches are interesting because they work in partnership with teachers, rather than introducing things that teachers don’t necessarily do,” she explains. “They are partnerships, and they probably work best because they also work on children’s language, communication, understanding and comprehension.

“But from a scientific point of view, we need more research to say they are better. It requires a much bigger evidence base and we need more randomised control trials, but the initial studies have been more positive.”

Ultimately, she says, the evidence suggests that attentional skills can be improved, although this doesn’t always have the desired impact of improving achievement in the classroom in a significant way. The challenge now, she continues, is to work out why this is the case, and so understand better how to transfer gains to improvements in the classroom.

Is medication part of the solution for those with the most severe difficulties? Certainly the perception is that many children with ADHD are using medication. That’s not actually the case, says Scerif: it’s relatively rare for children in the UK to be medicated for attentional difficulties.

“Psychiatrists collaborate with the team of practitioners working with that child to consider very carefully what alternatives and what additions to medication there may be as a potential treatment,” she says.

“In that context, with a full diagnosis from a psychiatrist on board, then medication with Ritalin or an equivalent is often what is recommended, but not in isolation.

“If medication is used, it is used very carefully alongside a set of other interventions, including plans for the child’s environment and education. This will be agreed by the team that supports the psychiatrist, including a clinical psychologist, parents and teachers.”

To those completely against medication, Scerif advises that it is worth seeking out multiple viewpoints, particularly by talking to young people using medication.

“There’s really interesting literature that comes from what these children say about treatment,” Scerif says. “They are not completely for or against medication. There are some young people who are very positive about how it has helped them in the classroom, and there are others who are not so positive. It’s not a clear-cut situation.”

She adds that you should be wary of anyone advocating medication as a single solution. “People on both sides of the debate need to be reminded that medication on its own is not a good or recommended approach,” she explains.

Ultimately, she says, the priority has to be getting to a greater understanding of attentional difficulty in schools and how to limit its negative impact on pupils.

“It’s becoming more and more important that we understand how attention difficulties interact with learning, because more and more children are receiving diagnoses and presenting with complex needs in the classroom,” she concludes. “It’s leading to a lot of research and a lot of interesting debate about what works and what doesn’t.”

Zofia Niemtus is a freelance writer

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