Reference
Guide | Reference

28  Attention, Executive Function, and Neurodevelopmental Experiences

28.1 Summary

  • Differences in attention, organization, impulse control, or social communication that are often longstanding and context-dependent.

28.2 Patient-Language Phrases

  • “I can’t stay focused unless I’m really interested.”
  • “I lose track of time and tasks.”
  • “I miss social cues or feel out of sync.”
  • “Sounds, lights, or textures feel overwhelming.”

28.3 Core Features

  • Inattention, distractibility, or hyperfocus.
  • Impulsivity or difficulty with planning and follow-through.
  • Social communication differences or sensory sensitivity.

28.4 Boundary Markers

  • What it is: persistent patterns across time and settings.
  • What it is not: acute attention changes driven by mood, sleep loss, or substances.

28.5 Variants / Spectrum

  • Inattention-dominant presentations.
  • Hyperactivity or impulsivity-dominant presentations.
  • Social communication and sensory regulation differences.
  • Learning-related challenges.

28.6 Severity Anchors (0-4)

  • 0: No significant impairment in attention or executive function.
  • 1: Mild, situational, manageable.
  • 2: Moderate, recurring, impacts function.
  • 3: Severe, persistent, with clear impairment.
  • 4: Extreme, disabling or unsafe.

28.7 Time-Course Patterns

  • Lifelong or early-onset patterns.
  • Stable with situational fluctuations.

28.8 Functional Impact

  • Work/school: missed deadlines, disorganization, inconsistent performance.
  • Relationships: miscommunication, conflict, or withdrawal.
  • Self-care: routine instability, forgetfulness.

28.9 Common Mimics / Differential

  • Mood or anxiety-driven inattention.
  • Sleep deprivation or substance effects.
  • Trauma-related hyperarousal.

28.10 Medical / Substance Rule-Outs

  • Sleep disorders, thyroid issues, neurologic contributors.
  • Stimulant or sedative effects.

28.11 Developmental Expression

  • Childhood: attention, behavior, or learning challenges.
  • Adolescence: academic demands reveal deficits.
  • Adulthood: organizational strain and burnout.

28.12 Cultural / Context Notes

  • Expectations of attention and behavior vary by context.
  • Environmental mismatch can amplify impairment.

28.13 Measurement Prompts

  • Brief attention/executive screening.
  • Collateral reports or rating scales.

28.15 Documentation Snippet (1-2 lines)

  • “Longstanding attention and organization difficulties across settings; Cognitive Control 3; chronic course.”