Inattention and impulsivity in children and adolescents: a developmental and contextual framework to understand attention-deficit hyperactivity disorder and its variants

Abstract

: Inattention and impulsivity are common characteristics of children, yet we do not expect young children to sustain attention and inhibit their natural impulses to the same extent as adults. During development, caregivers naturally train their children in these attentional and impulse regulation skills to increase their capacity to delay gratification. However, when elevated or more extreme problems of inattention and/or impulsivity are present in a child, other factors must be considered in order to evaluate specific instances of “inattention” and impulsivity, and to determine whether and how to intervene with a child who appears to manifest such difficulties. In this report, we review the problems of inattention and impulsivity in children within a developmental and ecological perspective. We couple this developmental-contextual perspective with studies of the formal diagnosis of attention-deficit hyperactivity disorder (ADHD), its causes, precursors, and treatment, and apply this perspective to the diagnosis of ADHD as well as to intervention approaches—both traditional medical treatments as well as more development-contextual interventions. A developmental-contextual framework to understanding inattention and impulsivity in children and adolescents offers clinicians important therapeutic advantages. Thus, this framework of necessity requires that clinicians consider the impact of family, peer, and school settings on the actual expression and severity of a child’s specific symptoms, and based on that understanding, that they consider possible interventions/modifications of those environments as a means of assisting the child. We also review the role of medication treatments and specific principles of medication prescribing within our developmental-contextual framework.