Question: My son reads well and catches on very fast. My problem is his focusing. At school, he concentrates so hard that he tunes the teacher out and does not hear her give simple instructions. Lots of times everyone else is in line to go somewhere and he is still sitting at his desk. This happens at recess time, too. It is as if he is in deep thought and just doesn't hear anyone else. When he does his homework at home, he will be sitting there doing it one minute and the next he is rolling his pencil down his head or nose, or just sitting there staring into space. I have to tell him to get back to his homework. It is as if there is a deep concentration of thinking going on somewhere else. This started happening at the beginning of first grade.

Answer: It sounds as though it is possible that your son has an attention problem. You'll want to first make an appointment with his pediatrician to discuss your concerns.

The American Psychiatric Association recognizes more than one distinct type of ADHD (attention deficit/hyperactivity disorder). The most easily recognized is the "predominantly hyperactive-impulsive type," These children tend to be overactive, intrusive and disruptive. They are hard to miss! Less obvious are those children who have the "predominantly inattentive type," who often fall through the cracks because they do not usually have behavior problems. Your son may fit in this category. These children are the daydreamers who are staring out the window and missing instructions in class; they are internally distracted. Or, because of poor organization skills, they might overlook a homework assignment or only partially complete a worksheet. They may:

• Be unable to give close attention to details or make careless mistakes in schoolwork or other activities
• Have difficulty sustaining attention in tasks or play activities
• Seem not to listen when spoken to directly
• Have trouble following through on instructions and fail to finish schoolwork or chores, (not because they object to the assignment or are unable to understand instructions)
• Have difficulty organizing tasks and activities
• Avoid, dislike or are reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• Lose things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools)
• Are easily distracted
• Be forgetful in daily activities

Ask your son's teacher to write down her observations and then discuss them with the pediatrician. The doctor can rule out any physical issues and explore interventions that might benefit your son. Finally, after you have seen the pediatrician, schedule a conference with your son's teacher to discuss the options. Some simple changes (e.g., preferential seating, ensuring eye contact while giving instructions, using a timer to space brief homework sessions with frequent breaks) might make a big difference.

Dr. Stacie Bunning, Psy.D, is a licensed clinical psychologist in the St. Louis, Missouri, area. She has worked with children, adolescents and their families in a variety of clinical settings for 20 years. She also teaches courses in child psychology, adolescent psychology and human development through the lifespan at Maryville University in St. Louis.

Advice from our experts is not a substitute for medical or other professional advice and services from a qualified health-care provider familiar with your unique situation. We recommend consulting a qualified professional if you have concerns about your child's medical or emotional condition.

November 2007