Understanding Inattention: Diagnosis and Misdiagnosis

Derick E. Vergne, MD


December 11, 2014

In This Article

Attention and Inattention

When a teenager is called out in front of class because his teacher perceives him as not paying attention to the day's lecture, the teacher might say something like, "Tom, you're not paying attention!" or "Tom, focus; I don't want to have to explain the equations again!" She might also say, "Where is your concentration?"

Chances are that Tom was hyperattentive, unfocused, but at the same time hyperconcentrated. Attention as a cognitive domain refers to the ability to attend to, or notice, a particular aspect of the environmental domain at the expense of other environmental options—in other words, to notice a tree and not a flying airplane while outside at a picnic. This is to be differentiated from purposeful attention, or directing attentional capabilities toward achieving a particular goal. The attainment of a goal requires the totality of the so-called executive functions, which relates to a set of mental processes that connect past experience to present action—that is, planning, organizing, strategizing, paying attention to, and remembering details, and appropriately managing time.[1]

Attention to, and strategizing to deal with, the effects of the environment became an evolutionary necessity for ancestral humans if they were to survive. Yet, inattention leading to either excessive focus on stimuli unrelated to the survival needs of the organism, or the disparate shift of attention to different alternating stimuli, although at the opposite end of the attention spectrum, would lead to the same end result: likely the organism's demise. In other words, there are two pathways to the same end: either one focuses too much on that which is not needed for the task at hand, or one focuses on too many environmental stimuli without proper attention to that which was initially needed to complete the task. In ancient times it would have led to being unprepared for the winter season (a disaster at that time), for instance. In modern times it may lead to the unfinished project that costs the company millions.


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