Attention

Overview

Attention is not a single, unitary function. It is a multi-component higher neural function (HNF) responsible for selecting, sustaining, shifting, and regulating cognitive resources toward relevant stimuli while suppressing irrelevant inputs.

1. Definition (Operational)

Attention is the cognitive process that enables:

Selection of relevant sensory or internal information
Sustained engagement over time
Flexible shifting between tasks or stimuli
Control of interference (inhibition of distractions)

2. Core Components of Attention

A. Alertness (Arousal)

Baseline readiness to respond
Maintained by brainstem systems

Clinical note: Reduced in delirium, fatigue, depression

B. Selective Attention

Ability to focus on one stimulus while ignoring others

Example: Listening to one speaker in a noisy room
Failure: Distractibility

C. Sustained Attention (Vigilance)

Maintaining focus over prolonged periods

Example: Reading, monitoring tasks
Failure: Attention drift, fatigue-related lapses

D. Divided Attention

Managing multiple tasks simultaneously

Example: Driving + conversation
Failure: Task breakdown under load

E. Alternating Attention (Cognitive Flexibility)

Shifting focus between tasks

Example: Switching between writing and calculations
Failure: Perseveration, rigidity

F. Executive Attention (Control / Inhibition)

Top-down regulation of attention
Resolving conflict between competing stimuli

Example: Ignoring impulses, resisting distractions
Failure: Impulsivity, poor decision-making

3. Operational Model of Attention

Stepwise Processing Model

Input Stage
- Sensory stimuli enter via sensory systems
Filtering (Selective Gate)
- Thalamus + cortical filtering determine relevance
Allocation of Cognitive Resources
- Frontal-parietal networks assign attentional weight
Sustained Engagement
- Maintained via cortical activation loops
Monitoring & Adjustment
- Executive systems adjust based on task demands

Simplified Functional Loop

Stimulus → Selection → Engagement → Monitoring → Shift / Sustain / Inhibit

4. Neuroanatomical Basis

Key Brain Regions:

Prefrontal Cortex (PFC) → Executive control
Parietal Cortex → Spatial attention
Thalamus → Sensory gating
Reticular Activating System (RAS) → Arousal
Anterior Cingulate Cortex (ACC) → Conflict monitoring

5. Neurochemical Modulation

Dopamine → Motivation, reward-based attention
Norepinephrine → Alertness, vigilance
Acetylcholine → Focus and signal-to-noise enhancement

6. Clinical Impact of Attention Dysfunction

Hypofunction (Common)

Distractibility
Poor task completion
Forgetfulness
Reduced academic/work performance

Seen in:

Attention-Deficit/Hyperactivity Disorder
Major Depressive Disorder
Generalized Anxiety Disorder
Delirium

Hyperfunction (Less discussed but important)

Hyperfocus (difficulty disengaging)
Over-attention to detail (rigidity)
Reduced cognitive flexibility

Seen in:

Autism Spectrum Disorder
Obsessive-Compulsive Disorder

7. Attention in Real-Life Functional Domains

Attention underpins:

Learning and memory encoding
Task management and productivity
Social interaction (listening, turn-taking)
Emotional regulation
Safety (e.g., driving)

Practical Clinical Insight

Attention is best understood as a resource allocation system:

Too little → Chaos (distractibility)
Too rigid → Stagnation (inflexibility)
Optimal → Adaptive functioning

9. High-Yield Summary Table

Component	Function	Failure Pattern
Alertness	Readiness	Drowsiness
Selective	Focus filtering	Distractibility
Sustained	Maintain focus	Fatigue lapses
Divided	Multitasking	Overload failure
Alternating	Task switching	Rigidity
Executive	Control/inhibition	Impulsivity

Attention related impairements

1. What Counts as “Impaired Attention” (Operational Definition)

Attention impairment = failure in one or more subdomains:

Alertness (arousal)
Selective filtering
Sustained focus
Divided attention
Alternating attention (shifting)
Executive control (inhibition)

Impairment may be:

Global (all domains affected)
Selective (domain-specific)
Fluctuating (state-dependent)

2. Major Clinical Conditions Associated with Attention Impairment

A. Neurodevelopmental Disorders

1. Attention-Deficit/Hyperactivity Disorder

Core pathology: attention dysregulation
Pattern:
- ↓ sustained attention
- ↓ selective attention
- ↓ executive control
- ↕ fluctuating alertness
Hallmark: inconsistency rather than absolute deficit

2. Autism Spectrum Disorder

Pattern:
- ↓ alternating attention (poor shifting)
- ↓ divided attention
- ↑ narrow focus (with global attention impairment)
Key issue: rigidity + context integration failure

3. Specific Learning Disorder

Pattern:
- ↓ sustained attention (task persistence)
- ↓ selective attention (academic filtering)
Often secondary to cognitive load

B. Psychiatric Disorders

4. Major Depressive Disorder

Pattern:
- ↓ alertness (psychomotor slowing)
- ↓ sustained attention
- ↓ executive control
Mechanism: reduced dopaminergic + cortical activation

5. Generalized Anxiety Disorder

Pattern:
- ↓ selective attention (threat bias)
- ↓ sustained attention
- ↓ executive control
Key issue: attention captured by perceived threat

6. Obsessive-Compulsive Disorder

Pattern:
- ↓ attentional flexibility
- ↓ executive inhibition
- ↑ intrusive attentional capture
Net effect: impaired functional attention despite overfocus

7. Schizophrenia

Pattern:
- ↓ selective attention
- ↓ sustained attention
- ↓ executive control
Mechanism: frontal-parietal network dysfunction

C. Acute & Neurological Conditions

8. Delirium

Prototype of global attention failure
Pattern:
- ↓↓↓ alertness
- ↓↓↓ sustained attention
- ↓↓↓ selective attention
Clinical hallmark: inability to maintain focus even briefly

9. Dementia

Pattern:
- ↓ sustained attention
- ↓ executive attention
- Progressive global impairment
Early vs late stage differentiation important

10. Traumatic Brain Injury

Pattern:
- ↓ processing speed → secondary attention deficits
- ↓ divided attention
- ↓ executive control
Severity-dependent

11. Stroke

Pattern depends on lesion:
- Right parietal → spatial neglect (selective attention failure)
- Frontal → executive attention deficit

D. Sleep & Fatigue-Related Conditions

12. Sleep Deprivation

Pattern:
- ↓ alertness
- ↓ sustained attention
- ↓ vigilance
Mechanism: reduced RAS + cortical efficiency

13. Obstructive Sleep Apnea

Pattern:
- ↓ sustained attention
- ↓ executive attention
Chronic hypoxia + sleep fragmentation

14. Chronic Fatigue Syndrome

Pattern:
- ↓ sustained attention
- ↓ processing speed
Often described as “brain fog”

E. Substance & Medication Effects

15. Alcohol Use Disorder

Pattern:
- ↓ selective attention
- ↓ executive control

16. Sedative-Hypnotic Use

Pattern:
- ↓ alertness
- ↓ sustained attention

3. High-Yield Pattern Recognition (Clinically Critical)

1. Global Attention Collapse

Seen in: Delirium
Red flag → urgent medical evaluation

2. Fluctuating Attention

Seen in: ADHD, sleep deprivation
Key clue: variability across context/time

3. Rigid / Inflexible Attention

Seen in: ASD, OCD
Problem is not lack of attention, but poor control

4. Slowed Attention

Seen in: Depression, dementia
Often missed → appears as “low motivation”

5. Threat-Captured Attention

Seen in: Anxiety disorders
Attention is hijacked, not absent

4. Subdomain × Condition Summary

Subdomain	Most Commonly Impaired In
Alertness	Delirium, sleep deprivation
Selective	ADHD, schizophrenia, stroke
Sustained	ADHD, depression, OSA
Divided	TBI, ASD
Alternating	ASD, OCD
Executive	ADHD, schizophrenia, frontal lesions

5. Clinical Bottom Line

Attention impairment is transdiagnostic
Pattern recognition is more important than diagnosis alone
Always ask:
1. Which subdomain?
2. What severity?
3. What pattern? (global vs selective vs fluctuating)

Attention related hyperfunction/giftedness

1. What “Hyperfunction” Actually Means

Attention working “better than average” is not a single phenotype. It typically manifests as one or more of:

High signal-to-noise filtering (exceptional selectivity)
Prolonged stability (sustained attention without fatigue)
Rapid, precise switching (efficient alternating attention)
Strong top-down control (executive inhibition, goal shielding)
Deep task immersion (“flow” / hyperfocus)

These can be adaptive (performance-enhancing) or maladaptive (rigidity, overcontrol) depending on context.

2. Conditions / States Associated with Superior Attention

A. Performance-Optimised, Non-pathological States

1. Flow State (Task-Optimal Attention)

Concept popularised by Mihaly Csikszentmihalyi
Profile:
- Extremely high sustained attention
- Minimal distractibility
- Time distortion
Mechanism: Balanced dopaminergic + noradrenergic tone
Trade-off: Difficulty disengaging; neglect of other needs

2. Expert / Elite Skill Performance

Seen in surgeons, pilots, athletes, chess players
Profile:
- Highly efficient selective attention
- Rapid switching under load
- Low cognitive noise
Mechanism: Experience-driven neural efficiency (PFC + parietal tuning)
Trade-off: Narrow domain specificity

3. High Cognitive Control / High Executive Function

Often seen in high-performing professionals
Profile:
- Strong inhibition (resists distraction)
- Goal-directed persistence
Trade-off: Overcontrol → reduced spontaneity, rigidity

B. Neurodivergent Hyper-attention Phenotypes

4. Hyperfocus in Attention-Deficit/Hyperactivity Disorder

Important nuance: ADHD = dysregulation, not just deficit
Profile:
- Intense sustained attention when task is rewarding
- Near-total exclusion of external stimuli
Mechanism: Dopamine-driven reward gating
Trade-off: Poor flexibility; neglect of routine tasks

5. Monotropic Attention in Autism Spectrum Disorder

Theory: Attention “tunnels” into limited interests
Profile:
- Exceptional depth of focus
- High detail sensitivity
Trade-off: Impaired shifting; reduced global integration

6. Detail Bias / Overfocused Attention in Obsessive-Compulsive Disorder

Profile:
- Persistent focus on specific thoughts/tasks
- High error detection sensitivity
Trade-off: Intrusiveness, compulsive loops

C. Temperamental / Personality-Linked High Attention

7. High Conscientiousness (Trait-Level)

From personality frameworks (e.g., Big Five)
Profile:
- Strong sustained + executive attention
- Task completion reliability
Trade-off: Perfectionism, stress vulnerability

8. High Trait Mindfulness / Meta-attentional Awareness

Profile:
- Stable attention with awareness of attentional drift
- Rapid correction
Mechanism: Enhanced anterior cingulate + insula activity
Trade-off: Rarely maladaptive, but can reduce spontaneity in excess

D. Altered Neurobiological States

9. Stimulant-Enhanced Attention (Pharmacological)

e.g., methylphenidate, amphetamines
Profile:
- Improved signal filtering
- Increased sustained attention
Trade-off: Overfocus, anxiety, reduced flexibility at high doses

10. Hypomanic States (Selective Enhancement)

Seen in bipolar spectrum
Profile:
- Increased alertness
- Rapid attentional engagement
Reality check:
- Often pseudo-enhancement (efficiency ↓ despite energy ↑)
Trade-off: Impulsivity, distractibility

Item #5

3. Subdomain-Level Hyperfunction Mapping

Subdomain	Hyperfunction Expression	Risk
Alertness	High arousal, vigilance	Anxiety, burnout
Selective	Extreme filtering	Misses broader context
Sustained	Long-duration focus	Task-locking
Divided	Rarely truly “superior”	Cognitive overload
Alternating	Rapid switching (experts)	Shallow processing if excessive
Executive	Strong inhibition/control	Rigidity, perfectionism

4. Critical Clinical Insight (Don’t Miss This)

“Superior attention” is often asymmetric, not global.

A person may have:
- Excellent sustained attention
- but poor shifting (alternating)
Or:
- Strong selectivity
- but over-exclusion of context

This is especially true in:

Autism Spectrum Disorder
Attention-Deficit/Hyperactivity Disorder
Obsessive-Compulsive Disorder

5. Functional Advantage vs Pathology — Decision Heuristic

Feature	Adaptive	Maladaptive
Focus duration	Task-appropriate	Cannot disengage
Selectivity	Filters noise	Ignores relevant input
Control	Goal-directed	Rigid / perfectionistic
Engagement	Productive	Obsessive

6. High-Yield Summary

There is no single “super-attention disorder.”
Instead, superior attention emerges as:
- State (flow)
- Trait (conscientiousness, mindfulness)
- Skill (expertise)
- Neurodivergent profile (ASD, ADHD hyperfocus)
Every hyperfunction pattern carries a cost of flexibility.

Integrated Strength × Impairment Matrix

1. How to Read This Matrix

Each attention subdomain is mapped across a functional spectrum:

Zone	Meaning
Strength (Hyperfunction)	Above-average performance (may be adaptive or rigid)
Optimal (Normative)	Balanced, flexible functioning
Impairment (Hypofunction)	Deficit or dysregulation
Clinical Risk	When intervention is usually required

2. The Matrix

A. Alertness / Arousal

Domain State	Clinical Features	Associated Conditions
Strength (↑)	High vigilance, rapid responsiveness	Anxiety traits, high-performance states
Optimal	Stable wakefulness, responsive	Healthy baseline
Impairment (↓)	Drowsiness, slow response	Major Depressive Disorder, Sleep Deprivation
Severe Risk	Fluctuating or reduced consciousness	Delirium

B. Selective Attention (Filtering)

Domain State	Clinical Features	Associated Conditions
Strength (↑)	Strong filtering, ignores distractions	Experts, flow states
Optimal	Balanced filtering	Normal cognition
Impairment (↓)	Distractibility, noise sensitivity	Attention-Deficit/Hyperactivity Disorder
Distorted (Bias)	Threat-focused attention	Generalized Anxiety Disorder

C. Sustained Attention (Vigilance)

Domain State	Clinical Features	Associated Conditions
Strength (↑)	Prolonged focus (hyperfocus/flow)	Attention-Deficit/Hyperactivity Disorder (contextual), Autism Spectrum Disorder
Optimal	Maintains focus as needed	Healthy baseline
Impairment (↓)	Attention drift, fatigue	Major Depressive Disorder, Obstructive Sleep Apnea
Severe Risk	Cannot sustain attention at all	Delirium

D. Divided Attention (Multitasking)

Domain State	Clinical Features	Associated Conditions
Strength (↑)	Efficient dual-tasking (rare)	Expert performance
Optimal	Handles limited multitasking	Normal cognition
Impairment (↓)	Task breakdown under load	Traumatic Brain Injury, Autism Spectrum Disorder
Severe Risk	Cannot manage dual input	Dementia, severe ADHD

E. Alternating Attention (Shifting)

Domain State	Clinical Features	Associated Conditions
Strength (↑)	Rapid, efficient switching	Experts, high EF individuals
Optimal	Flexible switching	Healthy baseline
Impairment (↓)	Rigidity, perseveration	Autism Spectrum Disorder, Obsessive-Compulsive Disorder
Severe Risk	Cannot disengage or shift	Frontal lobe dysfunction

F. Executive Attention (Control / Inhibition)

Domain State	Clinical Features	Associated Conditions
Strength (↑)	Strong inhibition, goal focus	High performers, conscientious traits
Optimal	Balanced control	Healthy baseline
Impairment (↓)	Impulsivity, distractibility	Attention-Deficit/Hyperactivity Disorder
Severe Risk	Disinhibition, unsafe behaviour	Schizophrenia, frontal lesions

3. Cross-Domain Integration (Critical Patterns)

1. Hyperfocused but Inflexible Profile

↑ Sustained
↓ Alternating
↓ Executive flexibility
Seen in:
- Autism Spectrum Disorder
- Obsessive-Compulsive Disorder

2. Distractible / Dysregulated Profile

↓ Selective
↓ Sustained
↓ Executive
↕ Alertness
Seen in:
- Attention-Deficit/Hyperactivity Disorder

3. Globally Reduced Attention

↓ across all domains
Seen in:
- Delirium
- Dementia

4. Threat-Biased Attention

↑ Selective (toward threat)
↓ Executive control
Seen in:
- Generalized Anxiety Disorder

5. Cognitive Slowing Profile

↓ Alertness
↓ Sustained
↓ Executive
Seen in:
- Major Depressive Disorder

4. Severity Overlay (For Scoring Systems)

Score	Interpretation	Clinical Action
0–1	Strength / optimal	No intervention
2	Mild imbalance	Monitor / behavioural strategies
3	Moderate impairment	Structured intervention
4	Severe dysfunction	Full clinical workup

5. Clinical Decision Heuristic (Highly Practical)

Ask 3 questions:

1. Is attention LOW, HIGH, or UNSTABLE?

LOW → Depression, delirium
HIGH (rigid) → ASD, OCD
UNSTABLE → ADHD

2. Is the problem CONTROL or CAPACITY?

Capacity ↓ → fatigue, dementia
Control ↓ → ADHD, frontal dysfunction

3. Is the issue GLOBAL or DOMAIN-SPECIFIC?

Global → medical/neurological
Domain-specific → neurodevelopmental/psychiatric

6. Why This Matrix Matters (Your System Context)

This is now a bidirectional model:

Detects deficits
Identifies hidden strengths
Enables precision profiling

A Domain × Disorder × Severity matrix

This matrix maps attention subdomains to disorders and severity gradients. It is designed for clinical reasoning and screening tool development

1. Severity Framework (Standardised Across Disorders)

Level	Description	Functional Impact
0 – Optimal	Efficient, flexible attention	High performance
1 – Mild	Occasional lapses	Minimal impairment
2 – Moderate	Frequent dysfunction	Noticeable impairment
3 – Severe	Persistent dysfunction	Major functional impairment
4 – Extreme	Near-complete disruption	Dependency / unsafe

2. Attention Subdomains Included

Alertness / Arousal
Selective Attention
Sustained Attention
Divided Attention
Alternating Attention
Executive Attention (Inhibition & Control)

3. Domain × Disorder × Severity Matrix

Key:

↓ = Hypofunction (deficit)
↑ = Hyperfunction (over-focus / rigidity)
↕ = Fluctuating / unstable

A. Neurodevelopmental Disorders

Subdomain	Attention-Deficit/Hyperactivity Disorder	Autism Spectrum Disorder	Pathological Demand Avoidance
Alertness	↕ (2–3)	↕ (1–2)	↕ (2–3)
Selective	↓ (3–4)	↑/↓ (2–3)	↓ (3–4)
Sustained	↓ (3–4)	↑ (2–3)	↓ (3–4)
Divided	↓ (3–4)	↓ (2–3)	↓ (3–4)
Alternating	↓ (3)	↓ (3–4)	↓ (3–4)
Executive	↓ (4)	↓ (2–3)	↓ (3–4)

B. Mood & Anxiety Disorders

Subdomain	Major Depressive Disorder	Generalized Anxiety Disorder
Alertness	↓ (2–4)	↑ (2–3)
Selective	↓ (2–3)	↑ bias to threat (3)
Sustained	↓ (3)	↓ (2–3)
Divided	↓ (2–3)	↓ (2–3)
Alternating	↓ (2–3)	↓ (2–3)
Executive	↓ (2–3)	↓ (2–3)

C. Acute & Neurocognitive Conditions

Subdomain	Delirium	Dementia
Alertness	↓↓↓ (4)	↓ (2–3)
Selective	↓↓↓ (4)	↓ (2–3)
Sustained	↓↓↓ (4)	↓ (3)
Divided	↓↓↓ (4)	↓ (3)
Alternating	↓↓↓ (4)	↓ (3)
Executive	↓↓↓ (4)	↓ (3–4)

D. Obsessive / Control Disorders

Subdomain	Obsessive-Compulsive Disorder
Alertness	↑ (2–3)
Selective	↑ rigid focus (3–4)
Sustained	↑ (3–4)
Divided	↓ (2–3)
Alternating	↓ (3–4)
Executive	↓ inhibition failure (3)

4. Cross-Disorder Patterns (Critical Clinical Insights)

1. Global Hypoattention Pattern

Seen in: Delirium, ADHD (severe), Dementia
Features:
- ↓ across all domains
- Loss of functional independence

2. Dysregulated Attention (Fluctuating)

Seen in: ADHD, PDA
Features:
- Inconsistent performance
- Context-dependent attention

3. Hyperfocused / Rigid Attention

Seen in: ASD, OCD
Features:
- Strong sustained attention
- Poor shifting (alternating attention ↓)

4. Cognitive Slowing Pattern

Seen in: Depression
Features:
- Reduced alertness + sustained attention
- Generalised slowing

5. Threat-Biased Attention

Seen in: Anxiety disorders
Features:
- Selective attention skewed toward perceived threats
- Reduced cognitive efficiency

5. Severity Interpretation Layer (Clinical Use)

Severity Pattern	Clinical Meaning	Action
Domain-specific (1–2)	Mild dysfunction	Monitor / behavioural strategies
Multi-domain (2–3)	Functional impairment	Structured intervention
Global (3–4)	Severe impairment	Full clinical workup
Fluctuating	Regulatory issue	Consider ADHD/PDA
Hyper-rigid	Control imbalance	Consider ASD/OCD

6. How to Use This Matrix (Practical CDSS Logic)

Stepwise Clinical Use:

Identify affected subdomains
Assign severity score (0–4)
Look for pattern signature
Map to likely disorder cluster
Trigger:
- Further diagnostic pathway
- Intervention protocol

7. Forward Integration (for your system)

This matrix is ready to be converted into:

Excel CDSS
- Auto-scoring + radar chart
WPForms JSON
- Subdomain scoring → real-time triage
Elementor interactive tool
- Traffic light output (Green / Amber / Red)
Clinical flowchart
- NICE-aligned referral pathways

Scoring And Inspiration

create a printable multi-page NICE-aligned clinician tool

Patient & Assessment Details

Patient Identification

Name:
Age / DOB:
Sex:
ID / MRN:
Informant (self / parent / caregiver):
Setting: ☐ Clinic ☐ School ☐ Home ☐ Workplace

Assessment Context

Primary concern:
Duration of symptoms:
Onset: ☐ Acute ☐ Subacute ☐ Chronic ☐ Lifelong
Fluctuation: ☐ Stable ☐ Variable ☐ Situational

Risk Screening (Tick if present)

☐ Acute confusion / fluctuating consciousness → consider Delirium
☐ Severe functional decline
☐ Head injury / neurological event → consider Traumatic Brain Injury / Stroke
☐ Marked mood symptoms → consider Major Depressive Disorder
☐ Severe anxiety symptoms → consider

Attention Subdomain Screening (Clinician Checklist)

Scoring System (per item)

Score	Meaning
0	Strength / Above average
1	Normal
2	Mild difficulty
3	Moderate impairment
4	Severe impairment

A. Alertness / Arousal

☐ Appears drowsy or slow to respond
☐ Fluctuates in alertness during conversation
☐ Needs repeated prompting to stay engaged
☐ Over-alert / hypervigilant (easily startled)

B. Selective Attention

☐ Easily distracted by background stimuli
☐ Difficulty filtering irrelevant information
☐ Misses key details in focused tasks
☐ Overfocus on irrelevant stimuli (bias)

C. Sustained Attention

☐ Cannot maintain focus over time
☐ Frequently abandons tasks
☐ Attention declines rapidly with effort
☐ Hyperfocus (cannot disengage when needed)

D. Divided Attention

☐ Difficulty handling more than one task
☐ Performance drops with multitasking
☐ Avoids tasks requiring simultaneous inputs

E. Alternating Attention (Shifting)

☐ Difficulty switching between tasks
☐ Gets “stuck” on one activity
☐ Resists transitions

F. Executive Attention (Control / Inhibition)

☐ Acts impulsively without thinking
☐ Difficulty resisting distractions
☐ Poor goal-directed behaviour
☐ Overcontrolled / rigid behaviour

Strengths Identification (Critical for Neurodiversity)

(Score strengths separately: 0 = absent, 1 = present, 2 = strong)

Observed Strengths

☐ Sustained deep focus (hyperfocus)
☐ High resistance to distraction in preferred tasks
☐ Strong task persistence
☐ Rapid task switching (when motivated)
☐ High attention to detail
☐ Strong inhibitory control

Functional Context of Strengths

Occurs in:
- ☐ Structured tasks
- ☐ High-interest tasks
- ☐ Low-stimulation environments
- ☐ Social contexts

Domain Scoring Grid

Subdomain	Score (0–4)
Alertness
Selective
Sustained
Divided
Alternating
Executive

Total Score: ______ / 24

Severity Interpretation

Total Score	Interpretation	Triage
0–6	Optimal / Strength-dominant	🟢 Green
7–12	Mild imbalance	🟡 Amber
13–18	Moderate impairment	🟠 Orange
19–24	Severe dysfunction	🔴 Red

Pattern Recognition (Diagnostic Heuristic)

Tick the closest pattern:

☐ Distractible / Dysregulated Profile

Suggests: Attention-Deficit/Hyperactivity Disorder

☐ Rigid / Hyperfocused Profile

Suggests: Autism Spectrum Disorder / Obsessive-Compulsive Disorder

☐ Global Attention Decline

Suggests: Delirium / Dementia

☐ Cognitive Slowing Profile

Suggests: Major Depressive Disorder

☐ Threat-Biased Attention

Suggests: Generalized Anxiety Disorder

NICE-Aligned Clinical Decision Layer

Step 1: Rule Out Acute Causes

If RED + acute onset → urgent medical evaluation (delirium, neurological)

Step 2: Developmental vs Acquired

Lifelong → ADHD / ASD
Recent onset → mood, neurological, sleep

Step 3: Functional Impact

☐ Education
☐ Work
☐ Social functioning
☐ Safety (driving, machinery)

Step 4: Next Actions

🟢 Green

Reassurance
Optimisation strategies

🟡 Amber

Behavioural strategies
Monitor

🟠 Orange

Formal assessment pathway
Consider referral

🔴 Red

Urgent specialist referral
Full medical workup

Clinician Summary & Plan

Primary Attention Profile:

☐ Strength-dominant
☐ Mixed
☐ Impairment-dominant

Likely Domain(s) Affected:

☐ Alertness
☐ Selective
☐ Sustained
☐ Executive

Provisional Impression:

Plan:

☐ Further diagnostic testing
☐ Psychological intervention
☐ Pharmacological evaluation
☐ Environmental modification