Attention Deficits in Adolescence: Description, Evaluation, and Management

Attention deficits may persist through childhood and into adolescence or they first may become manifest in adolescence. Their manifestations are often more subtle but Severe enough to exact a significant toll on academic performance. Associated learning disabilities, behavioral problems, and affective dysfunction, especially low self-esteem, are frequent concomitants or complications. On the other hand, some traits (such as creativity) of attention deficits may serve as redemptive features. Evaluation necessitates a systematic gathering, synthesis, and interpretation of a vast amount of information as well as direct testing and observation. Compensatory strengths and other positive attributes should be elicited and mobilized. Management should be individually tailored to the adolescent's specific needs and resources and implemented in a stepwise fashion. Intervention is usually multimodal, because attention deficits invariably affect several areas of function: academic, behavioral, social, and emotional. Management might include educational interventions, counseling, cognitive behavior therapy, behavior modification, and pharmacotherapy. Management should always include demystification, construction of a functional profile, specific advice-giving, encouragement, advocacy, and long-term follow-up, roles for which the pediatrician is especially qualified. With increased awareness of the plight of adolescents with attention deficits, the pediatrician, working closely with other professionals, has an extraordinary opportunity to minimize the accusations, suffering, and maladaptive, self-destructive behaviors that have been so much a part of the adolescent's condition in the past. As we become more sensitive to the effects of endogenous dysfunction during adolescence, it will become increasingly possible to redeem the struggling young people in their own eyes and in the eyes of important adults in their lives. Optimal evaluation and treatment is likely to be taxing, time-consuming, and expensive for all involved. However, the price of neglect, false attributions, and failure will be far higher.