The clinic / exam setting is not the child's ideal environment.  Whatever information you  get from a clinical examination should be complemented by examining the child in other settings as well as getting a history from the mother/ parent.

Observe the child in whatever activity he/she is engaged in. Assess the child's ability to look, listen and concentrate. Try to distract them by pulling their attention to some other activity.  Comment on the child's attention, how long(time ) they spent on a particular activity. How long do they spend with an interesting toy? How long do the spend looking at a picture book? How long can they sit still? Are they constantly changing activity?

- 6 months fleeting attention
- 1 year  concentrate to the purposeful stimulus
- 2years  concentrate to own choice of activity
- 3years  look and listen, attend to adults choice of activity and can be interrupted
- 4years  can listen to any direction without interrupting their task