Attention: what it is, why it matters, what to do about it with Dr. Amy Moore and Sandy Zamalis

On this episode of the Brainy Moms podcast, cognitive psychologist Dr. Amy Moore and board-certified cognitive specialist Sandy Zamalis delve into the topic of attention. Tune in to learn about the three primary types of attention, things parents can do at home to improve their child’s brain function, and different ways that ADHD is often addressed in the classroom. You’ll also hear about the findings of studies on cognitive skills, including the fact that attention isn’t actually the weakest brain skill in most people with ADHD. Find out what options you may have to boost your child’s cognitive skills to the point that they may no longer need classroom accommodations, and why perceived behavioral issues may actually be about dopamine levels in the brain. If you or someone you love struggles with attention-related challenges, you don’t want to miss this episode! 

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Transcript

DR. AMY: Smart moms and dads. Welcome back to another episode of the Brainy Moms Podcast, brought to you today by LearningRx Brain Training Centers. I'm your host, Dr. Amy Moore, and I am struggling with enunciation, pronunciation and all things speaking today. I'm joined by my co-host, Sandy Zamalis. Sandy, what are we going to be talking about today?

SANDY: We are going to continue our series on cognitive skills and we're talking about attention, which is my favorite skill to talk about because it's—I call it the gatekeeper of all skills. So let's give everybody a quick recap on the last show that we did that talked about cognitive skills in general, and then we'll dive in.

DR. AMY: Yeah. So we are talking about cognitive skills because they are the skills that the brain uses all day, every day for thinking and learning. And they're super important because we need to know how they function individually and collectively, and how to recognize when there might be a weakness in one or more of those, right? So, we're going to be talking about memory, attention, processing, speed, visual processing, auditory processing, logic and reasoning, and today we're going to talk specifically about attention. 

SANDY: So most people think of focus when they think of attention, but it's actually more complicated than that. Right? Let's dig into that. What is attention? Are there different pieces to attention that a parent kind of needs to know about? 

DR. AMY: Yeah, so attention is pretty complex. I mean, overall, if you think of an overall attention umbrella, that is the brain's allocation of processing resources towards something, like towards a task or a stimulus. So, there are multiple types of attention that researchers have identified. So selective attention, divided attention, sustained attention are the primary ones, and so I think probably we should just focus on those three, even though, you know, there are probably five or six other smaller subskills. 

SANDY: Well, let's start there. Let's start with sustained attention. What is that? 

DR. AMY: Yeah. So sustained attention is the ability to focus on a stimulus or a task for an extended period of time. So that's what we think of when we think of focus, right? It's sustaining those cognitive resources towards something. 

SANDY: Where would you see, for example, with your child if they had a weakness in that area? What would kind of stand out to you? 

DR. AMY: Yeah, so the key to sustained attention is the ability to keep focused on a task without being distracted. So the ability to go from start to finish on a homework assignment or reading a chapter without getting distracted by something else happening in your immediate environment, or even from your imagination.

SANDY: I always say it also, if you get bumped out, right? Like if your brain just kicks out because you're frustrated, or a thought popped in, right? 

DR. AMY: Absolutely. And other things can impact sustained attention too. So if you're tired, right? Even if you don't have a deficit, in sustained attention, you might temporarily have a struggle with it. You know, if you're tired, if you're not feeling well, or if you're hungry. 

SANDY: How about selective attention? What is that? 

DR. AMY: Yeah. So selective attention is your brain's ability to attend to the most important task or stimuli. So it's the ability to say, “Hey, there are four things going on in the environment around me right now, and I can pay attention to the one that I need to pay attention to, the one that's most important.”

SANDY: So let's think about this in a classroom setting. So a child sitting in a classroom and they're supposed to be listening to the teacher, but, the kid behind them is clicking their pen or chewing gum. There's movement to the right. There's—a bird flew by to the left. Is that what you mean by selective attention? To be able to focus in that one zone? “I need to be listening to the teacher in front of me.”

DR. AMY: That's exactly right. Okay. So it's the ability for the brain to kind of automatically say the teacher's voice is the most important stimulus or the most important thing happening in my immediate environment that I need to be paying attention to and tune out all of those distractors or those things that aren't really relevant. You know, that's something that as an ADHD warrior I struggled with, particularly in the college classroom, because you were allowed to have, you know, soda, for example. And I could actually hear the bubbling inside the cans of people's sodas while the professor was talking. And so that so selective attention is the brain's ability to tune out the bubbling in the soda can and just pay attention to the teacher. At home, so let's say your child is doing homework, but you're cooking dinner. Their, you know, their sibling is talking on the phone, right? And so selective attention would mean they can focus on doing their homework while ignoring the pots and pans clanking in the kitchen and their sibling’s conversation.

SANDY: Okay. So the third one was divided attention. Let's kind of dig that one out. What does that one look like? 

DR. AMY: Yeah. So, divided attention is the ability to process more than one thing at the same time or to have the cognitive flexibility to rapidly switch between those two demanding tasks or stimulus. So, for example, let's say you are cooking something and reading a recipe at the same time. So it's the ability to read the recipe and crack the egg and whip it at the same time. So those are competing tasks, right? Like, so reading and then of course, comprehending what you're reading, while also using, you know, your motor skills to crack the egg, whip the egg, and then where does it go next?

SANDY: Now, we know that cognitive skills all work together. Does attention really, when we think about these different types of attention, are there other skills involved in something like, for example, divided attention? 

DR. AMY: Well, absolutely. I don't think that it's possible for us to use one cognitive skill in isolation. So when, when we're doing anything, we're using multiple skills at the same time. And so let's go back to the recipe example. Not only are you using divided attention skills, the ability to read and comprehend the recipe while also, you know, using your hands and arms to actually do the physical task involved in cooking, but you're also using reasoning skills, right? Like, so what's the strategy I have if I have to boil this egg or also included in a recipe of something else that's on the stove? For example, let's say we're making an omelet, right? Do I need to shred the cheese at the same time? At what point do I add the cheese, right? So you're using reasoning skills. You're also using working memory. How many times, for example, have you looked on the box of something that you're making, thrown the box away, gone to make the thing, and had to pull the box out of the trash can because you can't remember the temperature that you were supposed to bake the cake at?

SANDY: Almost every time. 

DR. AMY: Yes. I think there have been memes created about that ability. It's called working memory. So it's the ability to hold that piece of information in your mind—the temperature or the time that you have to let it bake—while actually preparing the recipe, right? So that's called working memory. You're absolutely going to have to use that at the same time. So you've got attention, you've got reasoning skills, you've got working memory, and also, if you've got multiple things on the stove at once, your speed of processing has to be pretty efficient too, right? You can't let something burn while you're working on another ingredient.

SANDY: So when we think of attention deficits that way, of course, think of ADHD, right? Are there other diagnoses that kind of have attention weakness as being sort of a little bit of a symptom or red flag that there might be an issue? And we can talk about ADHD specifically too, but since it covers a broad array—attention is something that we use all the time, are there other diagnoses that kind of have weak attention as part of that diagnosis? 

DR. AMY: Yeah. Well, in my experience, most diagnoses have an attention issue, right? When you're looking at neurodiversity in general, you're typically looking at some sort of dysfunction in neurotransmitter production or transmission or behavior, right? And so if our neurotransmitters are not functioning properly, particularly dopamine and norepinephrine when we're talking about attention, then, of course it's going to be associated with autism spectrum disorder, depression, anxiety, ADHD, Parkinson's[GU1] , right? There are lots of diagnoses that include attention struggles.

SANDY: Well, let's talk about ADHD specifically. You did a study on ADHD. What did you find about attention and other cognitive skill relationships? 

DR. AMY: Yeah, we've actually done a couple studies on ADHD. But we did a really big one on more than 4,000 people with ADHD from ages 4 through 40. And we looked at their cognitive profiles, right? We gave them a gold-standard IQ test and we looked at all of the subtest scoring, where we looked at all of those cognitive skills that we're talking about in this series, and we plotted them on a graph to see which ones were the weakest, which ones were the strongest, and at what age did we see differences. And what we saw consistently across age groups from age 4 through 40 was that attention was not actually the weakest cognitive skill in ADHD. Working memory, long-term memory, and processing speed were weaker than attention. Yeah, it was a fascinating finding. 

SANDY: Yeah, yeah, that makes sense, especially, you know, as you kind of dissected those different pieces of the puzzle of the different parts of attention. I can see, you know, a weak working memory or a weak processing speed really affecting attention. How would you help a parent understand that? For example, sometimes, when clients come in or when we talk to families, attention is just sort of a kind of a sticker, a label that we put on our student or child. Let's dig into what that means. Like if there's a weak working memory or weak processing speed skill set underneath that attention, what would that look like for the student? 

DR. AMY: Yeah, so .. Well, first of all, let me just say that the reason why that study was so interesting and exciting at the same time is that when we think of helping kids or adults with ADHD, we think, “Okay, what can we do to help their attention?” When if we're only focused on attention, then we're kind of missing the boat on really helping all of those struggles, that we're also needing to focus on memory and processing speed issues as well. And so, but those are going to show up. Like, this is not something that you're not already seeing. Maybe you just don't have a label for it, right? And so, let's say you give your child a three-step direction, right? “Hey, I need you to go upstairs, brush your teeth, and put your pajamas on.” Okay. Three steps. Go upstairs. Second step, brush your teeth. Third step, put your pajamas on. That requires working memory. And so you have to attend to the instruction initially, but then you have to remember what the instruction is as you're walking up the stairs. So not only do you have to remember what comes next, but also what have I already done? What were the three things that I was supposed to do? And so when you see your child not be able to complete all three steps, that's clearly a memory problem. The other issue is, let's say 30 minutes have gone by, right? It could be a processing speed problem. If your child is a slow processor, right, then that requires long-term memory, then, to keep track of all three steps, right?

That isn't happening, bam, bam, bam. That is happening over the period of 30 minutes, and they've already forgotten the third step by then. 

SANDY: And that's really important to understand, because a lot of times we think of this as behavioral, right? Like, “You weren't listening.”  You know, we think about it in lots of different ways, but really, if we think about it as a behavior, then it's easy as a parent to get frustrated. Right? It's different if you think about it as a weakness, that they weren't able to hold the information like in their working memory or they're a slow processor. And so it just took them a long time or it took them too long and now they've forgotten. That's a different mindset for a parent, don't you think? If you think about it that way you can have more empathy, I think. If you understand what's actually happening. 

DR. AMY: Right, so if your child has Type 1 diabetes and they're dependent upon insulin to keep their blood sugar regulated, you probably aren't going to get angry with them if their blood sugar becomes dysregulated. You just automatically think, “Oh. We either need some sugar or we need some insulin.” Right? In order to regulate what's happening at that last measurement when you do their glucose test. You don't typically associate that with frustration and anger. We do have this tendency to get frustrated or angry with our kids when they can't follow our three-step directions. So, if you think about it as the brain's inability to produce enough dopamine or use the dopamine efficiently, just like Type 1 diabetes is an issue with insulin—inefficient production or use of insulin, then it does help us develop some empathy. “Oh my goodness, there's a dopamine issue happening right now in the brain.” And we need dopamine for both memory and attention, and motivation, which we can talk about a different time. So then the question becomes, “Oh, what should I do to support my kid’s dopamine?”[GU2] 

SANDY:  So let's talk about what we typically do to help address attention weakness. What's the typical strategy that we use as families, as educators?

DR. AMY: Yeah. So typically we say, “Oh, we better accommodate that. This kid doesn't have strong attention skills.” Or, “They have a diagnosis of ADHD, so we better make some accommodations in the classroom.” I think we touched on that briefly in our opening show in this series. But we will do things like give the child preferential seating in the classroom so that we can “help” them tune out distractions by putting their chair right in front of the teacher. Right? Or we'll say, “Well, because they get distracted, they need longer to finish their work.” Or they need more time to take a test because they keep getting distracted, so we give them more time as an accommodation. Well, what happens if we're just accommodating it, is that we aren't actually solving the problem, right? They still can't tune out the distractions. They still take that long to do their work because of the distractions. And the thing about ADHD, it's not a lack of attention. It's named wrong, right? It's not a deficit of attention. The problem with ADHD is we have too much attention. We pay attention to everything. So we don't have strong selective attention skills because we're not paying attention to the thing that is the most relevant because we don't dopamine or our dopamine receptors aren't functioning properly. [GU3] 

SANDY: I love that picture. That really kind of helps for me solidify, you know, thinking of it as not having the tool or thing that you need in your brain in order for this to be functional and efficient. So we talked about accommodations. Medication, right, is also another tool we might use to address attention issues. 

DR. AMY: Sure, because stimulants are the typical medication that doctors would prescribe and stimulants are thought to increase dopamine and norepinephrine in the brain. 

SANDY: Will that help a working memory or a processing speed issue?

DR. AMY: Not necessarily. While we need dopamine for memory as well, it's so complicated. Remember, we talked about how all of those skills overlap. And so a stimulant might flood the cells with dopamine, but not necessarily help with how it's used. So you might see an initial increase in someone's belief in their ability to pay better attention. It doesn't necessarily increase the capacity to attend to the most relevant stimuli, if that makes sense. 

SANDY: It does. So how do we help build attention skills? What do we need to do? 

DR. AMY: Yeah, a couple ways. So we can help improve the way that dopamine receptors are functioning in the brain. There's some really cool research on the association between low omega-3 levels and the shape of dopamine receptors. So, if you have low omega-3 levels in the brain, then your dopamine receptors are actually misshapen, so they can't catch the dopamine that's naturally being produced. And so, if we increase the omega-3 levels in the brain by supplementing with omega-3 fatty acids, then we might see an improvement in the way our brains can use dopamine. So, you can solve a problem like this. A fly on the wall, you can kill it with a fly swatter, or you can kill it with a wrecking ball. Right? So both accomplish the task, the fly gets killed. But which does less damage? Right? So the fly swatter obviously does less damage. And so I'm a huge fan of the fly swatter method of solving problems when possible. And so I would always recommend looking at that research, talking to your doctor or your child's pediatrician about supplementing with omega-3 fatty acids first, prior to trying a stimulant that, while it could possibly solve some of the problem, it comes with a huge amount of side effects. [GU4] 

SANDY: What else can a family do to help develop attention skills? Would food, does food help? Like what we eat?

DR. AMY: Yeah, so there is some interesting research on sugar, that If you think about the way sugar creates inflammation in the body, well, the brain is attached to the body, right? So if there's inflammation in the body, then there's inflammation in the brain. And so if your brain is inflamed, then, you know, it's not going to function optimally. And so, there's a possibility that reducing sugar consumption can reduce inflammation and help with cognitive skills in general, right, not just attention. And then, you know, if you look at Dr. Perlmutter's work—he's a neurologist who wrote the book “Grain Brain,”—he's actually written several books. But, you know, he talks about how, grains, glutinous grains like wheat, barley, rye, they actually produce inflammation in the body as well and have that same impact on the brain and its function that sugar does. And so, perhaps reducing consumption of gluten could help as well. So, yeah, I mean, our gut is actually our second brain. Right? Eighty percent of neurotransmitters are produced in the gut, not in the brain. So what we eat is going to impact how our brain functions. 

SANDY: What about exercise? Will that help attention?

DR. AMY: Absolutely. Um, so aerobic exercises, let me start that over. Aerobic exercise produces a protein called BDNF, brain-derived neurotrophic factor, and that's like Miracle Gro for the brain. And so when we exercise, it releases BDNF and then that helps our neurons function better. 

SANDY: What about sleep?

DR. AMY: Sleep is critically important for attention. Sleep acts like putting your brain through a car wash. So during the day, as we think and learn, we use up neurotransmitters and those neurotransmitters, as they're used up, leave behind toxins when they die. And sleeping actually releases cerebrospinal fluid that washes the brain. It cleanses the brain of the toxins left behind throughout the day. And so if we have cleaned the brain at night, then that's going to contribute to better brain function the next day. 

SANDY: Okay, so we're watching what we eat, we're getting our omega-3s, we're exercising, we're getting good sleep, but we're still having trouble with attention. What do we do? 

DR. AMY: Yeah. So then we get to harness the phenomenon of neuroplasticity. And so neuroplasticity is the brain's ability to change with targeted experience. So the famous neuropsychologist, Donald Hebb, said that “neurons that fire together, wire together.” And so if we can create targeted, sustained, intense, complex experiences that can help drive changes in the brain, so drive the way that neurons fire, that neurons speak to one another, then we can improve cognitive skill function. And so we can do that through cognitive skills training. 

SANDY: What does that look like for attention? 

DR. AMY: Yeah. So the cool thing is that when you train most cognitive skills, attention is gonna be engaged at the exact same time, right? So we don't have to sit down and go, “Okay, let's train attention now,” right?

We're going to create activities that engage multiple cognitive skills and by default are going to engage attention at the same time. And because we believe, Sandy, what you and I do, that that training should not exist in a vacuum, that we aren't going to create quiet environments so that kids can perform better on these tasks. We're going to create an environment where there's lots of noise and lots of stimuli that you have to learn to tune out, right? So by default, your selective attention skills are going to improve. Your sustained attention skills are going to improve. Because you have to attend to the task that you're being trained on, that you're engaged in at the brain training game or activity that your trainer is doing with you, while tuning out all of the stuff that other trainers and clients are doing. It's kind of like when you work out at a gym with your personal trainer. You're focused on the exercise that your trainer is having you do, but there are other trainers and other gym-goers who are working on other exercises at the same time. You got to just ignore them. 

SANDY: So extras doing an exercise in general, definitely going to hit that sustained attention. We're talking about, you know, not working in a vacuum right now and hitting that selective attention so that we're really making sure we hone and target that particular skill. What about divided attention? How do we hit that divided attention side? 

DR. AMY: Yeah. So let me just say, you know, people talk about multitasking all the time, right? And, you know, “Yeah, I'm a great multitasker.” So actually, neurologically, it's impossible to multitask. Your brain cannot actually do two things at the exact same time, even though it looks like you do. It's actually that your brain has the flexibility to rapidly switch between tasks. And it, and it happens in microseconds. So it looks like multitasking, right? But it's rapid task switching. And so we can train that flexibility, that cognitive flexibility, that ability to rapidly switch tasks, by loading tasks. So while we have a primary task that we'll have a client focused on, we're going to add an element that forces them to do a second task as well. So, for example, we might be doing an attention task where they're identifying the direction of a set of arrows. But we might give them a math problem to solve at the exact same time. And so that trains that divided attention. “Okay. I have to add over here while I have to manipulate shapes over here.”

SANDY: Really kind of a mental sweat kind of scenario, right? Cause it keeps you on your toes. In our last episode, we talked about that intensity. Like it really trumps up that intensity of the task when you have a load on top of it, right?

DR. AMY: Yeah. 

SANDY: What are the potential benefits of helping yourself or your child really build attention skills? Where would you see some benefit in being, having better attention? 

DR. AMY: Yeah. So we need attention skills our whole life. We need them to drive safely. We need them to be able to set and reach goals in the workplace. In school. We need them in order to have strong personal relationships, right? I mean, how many times have you been talking to someone at home while they're scrolling on social media and not hearing what you're saying? And you have to say, “Did you hear me?” And so that weakens relationships, right? So just to have strong connections with other people, you have to have strong attention skills. But wouldn't it be nice, if you have a child who has accommodations at school, wouldn't it be nice if they didn't have to sit on the front row all of the time, right in front of the teacher and be reminded to pay attention all the time in front of the teacher? Wouldn't it be nice if they didn't have to be given extra time because they didn't need extra time to complete an assignment? Wouldn't it be nice if they were able to get their homework done from start to finish without you having to nag? I mean, these are things that having strong attention skills makes your life easier. Right? It is a struggle. It is a struggle for a child to have weak attention skills. It's frustrating, it's demotivating, it's demoralizing. Nobody likes to be nagged and reminded and made to feel bad about themselves, right? And so, wouldn't it be nice to lessen your child's struggle a little bit, or your own struggle a little bit, just by strengthening those skills?[GU5] 

SANDY: It would be a confidence builder, right? 

DR. AMY: Absolutely. We see that all day, every day. In fact, the number one reported improvement that our clients both in our clinical work all day, every day, and in our research, the number one thing they report is increased confidence and self-esteem after cognitive training.

SANDY: Amy, thanks for sharing all of this great information about attention. We have some free tools that listeners, you might really love. We're going to put that in our show notes. One is from our founder, Dr. Ken Gibson, it's his book. It's called, “Unlock the Einstein Inside.” It's a PDF copy, but it has lots of great information in there. It'll kind of replay the stuff that we've been talking about during this podcast and give you lots of great tips and ideas for things you can do at home. We're also going to put our game pack in the show notes as well. And that's just a little flyer to give you some ideas of some intense cognitive games you could play to help build skills, like attention. If you have any questions, you can catch us in social media, both on TikTok and Instagram at the Brainy Moms. We would love to answer your questions about these different cognitive skills areas. So feel free to message us and we'll include those in our series. Amy, is there anything you want to add to wrap up?

DR. AMY: Just that it's a message of hope. When we say that we're not stuck with weak attention skills, we aren't stuck with weak cognitive skills at all. I always like to stay, say “We're not stuck with the cognitive cards we've been dealt.” And so that's really cool. Like, that's really cool that we can say our brain is not stuck right now. We can do all of these cool things to help improve how it functions. 

SANDY: Thanks for sharing, Amy.

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