Opinion: Let's Talk About Attention and Focus with Science, Compassion and Common Sense

Let's Talk About Attention and Focus With Science, Compassion, and Common Sense
By Dr. Tina Narayan
For forty years as a pediatric neurologist, I have worked with children struggling with attention and focus difficulties, autism spectrum disorders, and other neurobehavioral and learning challenges. I’ve sat with over 40,000 families, listened to their stories, and helped them navigate the complex and often confusing world of childhood attention and behavior issues. That’s why I feel compelledto speak now.

A recent opinion essay about Management of ADHD by Paul Tough in The New York Times sparked widespread debate, questioning whether we’ve misunderstood the actual issues. The responses — from clinicians, educators, parents, and researchers — have ranged from thoughtful agreement to strong rejection. Some praised Tough for raising important questions; others criticized the piece as oversimplified and potentially harmful. As someone deeply immersed in this field, I believe the path forward lies not in division, but in grounding our understanding of attention challenges on three essential pillars: science, common sense, and compassion.

Let’s begin with science. Attention and behavioral challenges are not a cultural invention. These are  well-documented genetically influenced neurodevelopmental conditions Brain imaging studies, research, and genetic analyses all support the reality of attention challenges/ADHD as a biological difference in brain function — especially in how attention, impulse control, and executive function are regulated. But science doesn’t offer us final answers; it evolves. And we must remain open to new data while continuing to rely on the evidence we already have.

At the same time, we must apply common sense. Today’s children grow up in a
hyperstimulating, fast-paced, screen-saturated world. Long hours indoors, fragmented
schedules, poor sleep, and highly processed diets can all worsen attention and regulation— in children with and without attention challenges. Recognizing these influences doesn’t negate the legitimacy of the diagnosis; it enhances our ability to tailor solutions. It reminds us that attention challenges don’t exist in a vacuum, and environment matters. Children with a genetic tendency to dysregulation with unbalanced or immature brain chemicals, will likely be more negatively impacted by challenging environments than those with more stable neurotransmitter development.

And finally, we must lead with compassion. Every child is unique. Every family has its
own story. We must understand what’s happening at school, at home, in their health, and in their relationships. Worry, trauma, sleep disturbances, learning differences, and family stress are not footnotes — they are central to understanding our children. Real care begins with real listening.

Paul Tough : Have we been thinking about attention challenges all wrong? New York Times Magazine:2025