Why don't we just measure attention?

A common topic in paediatric consultations is a kid's problem with 'attention' (or concentration, or focus etc.).

It's worth thinking about what people really mean when they say that a child has an 'attention problem'.

Attention deficit hyperactivity disorder - 'ADHD' - remains controversial. Especially the associated use of particular medications in children.

Wouldn't it all be a lot easier if we could just measure a child's attention control ability? We can measure intelligence, after all. Sure, the concept of IQ still fuels hot arguments, especially around race, poverty, and opportunity, and rightly so. But 'IQ' does mean something. If a young child is found to have an IQ of 50, no one would claim that their life prospects are just as bright as any other child's, or that they won't benefit from extra support.

Similarly, 'paying attention to' something, or when something 'comes to your attention', these are real concepts. We all have a similar, plain English, understanding of these terms.

So why hasn't anyone developed an operationalised instrument to measure attention, as has been done for intelligence? Then kids who score under, say, 70 for their 'Attention Quotient' could receive a formal, objective ADHD diagnosis (and a fast-track to an authority script for stimulant medication). Come on, brainiac neuropsychologists, what are you waiting for?

It wouldn't work, of course. I doubt there'll ever be a standardised operationalised instrument to measure someone's attention control ability, in real life. Too may confounders cause too much disruption, in any situation. Anyone's attention control ability is influenced, moment to moment, by a vast range of human, often physical factors. Hunger, sleep deprivation, emotional state, you name it. And even more profoundly by aspects of higher mental function - motivation, confidence, engagement, novelty, familiarity.

(So how then is ADHD 'diagnosed'? That's a question for another post. In which the widespread practice of calling a parent/teacher questionnaire an 'ADHD assessment' will be examined.)

Also, there are different facets to one's attention control ability. There are older concepts like 'sustained attention' (how long I can keep my attention on one object), and 'selective attention'. And related concepts like 'attentional set-shifting'. Attention control ability might depend as much on one's ability to inhibit task-irrelevant motor responses, or to disengage from information recently attended to but no longer useful, as it does on one's raw attentional stamina.

Modern neuropsychology has settled on 'executive attention', as a (quite complex and technical) catch-all term.

For one coherent, interesting, model of this, see Tiego J et al., "A hierarchical model of inhibitory control" (2018) 9 Frontiers in Psychology 1339.
https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01339/full

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One more feature of attention control - it's hard to think or talk about the concept, without becoming immediately entangled in questions which seem slippery, or worse still, philosophical.

A kid has more trouble than his peers, in attending to the teacher's classroom instruction. He really wants to be good. Each morning on the way to school, he consciously tells himself that he must listen to the teacher today, and not get in trouble. But in the moment, in the classroom, he can't help but be distracted by something shiny and new. He can't resist the temptation to loudly crack the joke which an opportunity desperately calls for.

This is how I myself might describe events in the life of a 'classic ADHD' kid, in these terms. But if someone were to press me, on just what I mean by 'wants to be good', 'consciously tells himself', 'can't help but be distracted', etc., I'd find it difficult to elaborate further. There aren't many explanatory stops between these terms, and the timeless philosophical mysteries of 'consciousness' and 'free will'.

Further reading:

Engle RW, "Working Memory and Executive Attention: A revisit" (2018) 13 Perspectives on Psychological Science 190.  http://englelab.gatech.edu/articles/2018/Engle%20POP%20revisit%20of%202002%20paper.pdf

Heisler JM et al., "The attentional set shifting task: a measure of cognitive flexibility in mice" (2015) 96 Journal of Visualized Experiments e51944.  https://www.jove.com/video/51944/the-attentional-set-shifting-task-measure-cognitive-flexibility
This is one of my favourite research papers ever.