Smartphones, stress, and even worrisome occurrences like the pandemic can muddy the waters of our attention, so it’s important that doctors rely on the foundations of solid diagnostic assessment, especially before prescribing medication like Ritalin. “You need a history,” says Dr. Fink. “You need to gather information and really put the story together for it all to make sense.” It’s important to realize that smartphones and other screens can push people on the cusp of an attention issue to a place with more symptoms. “Even if making a diagnosis, you shouldn’t just jump to medication for any kid,” says Dr. Fink. “The availability of distractions may make it much harder for people to use the attentional skills they do have.” So, the first step should be to recognize distractions, remove them as much as possible, and then try to harness those skills. Sleep deprivation also plays a key role in disrupting our attentional circuits, so sleep duration and quality are other key factors when balancing distractibility against a true ADHD diagnosis. “People with sleep apnea, for example, have terrible concentration problems and brain fog,” says Dr. Fink. “All of that gets so much better with better sleep.” Even people who don’t have ADHD go through periods of time when they’re more or less attentive, but most come back to a baseline of being able to focus like their usual selves. ADHD symptoms, however, are sustained. Symptoms present themselves and remain present, often for years—they don’t start and stop. They can become better or worse in certain situations, but fundamental challenges don’t just change or go away, says Dr. Fink.