But psychologists and other
behavioral scientists say attention is a form of consciousness, hence
a hypothetical mental event and not something that can be observed. Of
course by noting what a child is doing we can guess what that child is
paying attention to, and guesswork is OK for trying out different
kinds of social intervention with children. But it's not OK for trying
out different kinds of physical intervention. The latter can, and
often does, have irreversible consequences which are far worse than
the "disorder" that is being "treated" (in the
case of Ritalin, stunting of growth, brain atrophy, loss of muscular
control, and loss of self-regard).
Clearly medical intervention differs markedly from psychological
intervention. Medical practitioners treat disorders while corrective
counselors counsel persons. Counselors join children in their social
context, medics invade children's brains - it's social intervention
versus physical interference.
According to the medical manual of mental disorders there are ten
symptoms of attention deficit that are said to cause the impairment of
attention. Most of these allegedly causal symptoms suggest that a
child pays too little attention to assignments, the rest that
this child pays too much attention to things other than
assignments. When these symptoms are assumed to be present, the claim
is that they cause impairment of the child's capacity to attend to
One problem with this idea is that what the medics call
"symptoms" are supposed to be observable, that is, visible
or audible signs of something wrong. But attention is not visible
or audible. Rather it's something that we guess is going on in the
brain of the person we're observing, when all we can see or hear is
what the person is doing. When a school boy is observed just sitting
and seemingly doing nothing, it's impossible to tell what he's paying
attention to. Of course it's obvious he's not actively engaged in
doing his assignment; whatever he's thinking about can only be a
matter of conjecture.
The other problem with the idea of attention deficit is that the
medics apparently believe it is caused by its symptoms. For sure the
medics have got it backwards, and some of us are surprised that they
haven't noticed such an obvious error. Even though medical
practitioners aren't scientists, they ought to know better than that.
It's preposterous to say that the symptoms of attention deficit cause
the deficit of attention. Even though preposterous, the medics seem to
mean what they say. For example they say that "Some
hyperactive-impulsive or inattentive symptoms that cause
impairment must have been present before age 7 years." Also they
say that "Some impairment from the symptoms must be
present in at least two settings (e.g. at school [or work] and at
home)." [DSM IV, italics mine]
If I were a medic Id be embarrassed by this sort of talk, and I
suppose that the more competent medics are somewhat embarrassed by
this obvious error. In any case the essay on attention deficit in the
DSM-IV is so poorly written that it's a wonder anybody takes it
seriously. Unfortunately a lot of medical practitioners in America do
take it seriously and even (to my embarrassment) so do some
By the way, European children seem immune to the
"disease", so the market for Ritalin is largely confined to
The expression "A.D.D." is relatively new in the medical
lexicon. Before its arrival on the scene educators had other names to
call the children who did poor work at school, expressions such as
"educationally handicapped," "learning disabled,"
"dyslexic," and other impressive but undefined designations.
But since invoking the magical "A.D.D." label quickly gets
children zapped and zombied with Ritalin, with no questions asked
about the teacher's part in the child's behavior, small wonder that
the other disguised pejoratives used by educators are used less
THE TEN "CAUSAL SYMPTOMS" OF "A.D.D." LISTED IN
THE DSM IV:
"Rarely do children afflicted with A.D.D.":
1. Obey schoolwork directives
2. Sustain attention to schoolwork
3. Bother with schoolwork details
4. Try to avoid distractions from schoolwork
5. Try to avoid mistakes in doing schoolwork
6. Listen to the teacher's directives
7. Remember school routines
8. Prepare for schoolwork
9. Organize schoolwork tasks
10. Like to do schoolwork
The claim is that children can't do these things because there's
something wrong with their brains. Nobody has come up with any
evidence that it's their brain that's at fault, but they keep looking
for it, certain that sooner or later they'll find it. In the meantime
they fall back on the idea that there's some sort of "chemical
imbalance" in the brains of these children which can be set right
by brain-altering chemicals. This is nonsense and they know it, but it
quiets the fears of parents regarding the negative consequences of
using these drugs. What the parents aren't told is that stimulants,
like sedatives and tranquilizers, are brain-disabling drugs.
Let's examine these signs of impairment one by one:
1. Doesn't obey schoolwork directives - "often does not
follow through on instructions and fails to finish schoolwork"
Certain kinds of children are interested neither in pleasing
certain kinds of teachers nor in doing their assignments. Most of
these children are similar in temperament, and very different from
their classmates. Most often they are Plato's "Artisans"
(Aristotle's "Hedonics") - concrete in perception and
impulsive in action, ever on the lookout for fun things to do in the
here and now. With this sort of temperament, it is not surprising that
most schoolwork is unappealing to them. They, far more than those with
other kinds of temperament, are prone to ignore or forget the order to
do their assigned work. This is disinterest in the teacher's agenda,
not inability to comply with it, and disinterest can hardly be taken
as evidence of brain dysfunction! The problem is really a clash
between two kinds of temperament: those who value opportunities to
have fun and those who value schedules for getting work done.
2. Doesn't sustain attention to schoolwork - "often
has difficulty sustaining attention in tasks"
The claim here is that it's hard for such children to continue
working on assignments even if they want to. But this presupposes that
the child is trying to pay attention but fails in his attempt. It
could be that his attention is elsewhere and that he's not trying to
maintain attention on some task. If there's nothing in the assignment
that appeals to this sort of temperament - concrete, impulsive,
players - then it's unlikely that such children will want to continue
doing it. The children I've known like this (in 20 years of casework)
can sustain attention to tasks they're interested in for a very long
time. Indeed, it's sometimes hard to tear them away from such tasks.
And while it makes sense to blame temperament for this flagging
interest in schoolwork, it's definitely unwise to blame the brain for
3. Doesn't bother with schoolwork details - "often
fails to give close attention to details"
Those same concrete impulsives that won't bother with the details
of schoolwork are usually capable of attending to details that their
teacher can't even see, if the details are part of some exciting
activity. But it is rather naive and a little foolish to expect them
to attend to the details of clerical work such as practice in
spelling, handwriting, grammar, or arithmetic. It's not that they
can't attend to such matters, but that they don't care to. Sorry, but
the brain is in no way implicated by this bothersome
4. Doesn't try to avoid distractions from schoolwork - "is
often easily distracted by extraneous stimuli"
Again, if they're not interested in pleasing their teacher, why
should these concrete impulsives try to ward off the distractions that
often occur so often in most classrooms? Letting themselves be
distracted is a welcome relief from filling in the empty spaces on the
mimeographed form on their desk. Concrete-impulsive option-oriented
children are indeed "easily distracted" from what must seem
to them useless exercises in futility. The degree of distractibility
in a given child is determined entirely by the attractiveness of the
assignment. As before, don't blame the brain, blame rather the
disparity of aims on the part of teacher and pupil.
5. Doesn't try to avoid mistakes in doing schoolwork
-"makes careless mistakes in schoolwork"
Certain kinds of children are careful and certain others are
carefree. Trying to be accurate in doing assignments is not of much
interest to the concrete impulsive types, who usually put as little
effort as possible in doing school work. It isn't that they make
mistakes as much as it is that they don't want to bother with such
work. The tacit assumption is that the reason for their mistakes is
that they can't keep their mind on their work. But this has to be a
faulty assumption, it being much more likely that they're not
interested in keeping their mind on their work. The medics got it
right this time: these children make "careless mistakes"
because they couldn't care less about the work they're supposed
6. Doesn't listen to the teacher's directives - "often
does not seem to listen when spoken to directly"
These children are listening all right, even though they're not
looking at the teacher. Why not? Because the teacher's usually getting
after them for not working on their assignment. For that matter, even
adults of this temperament won't look at whoever is giving them a bad
time for their shortcomings. Why then expect children to? Doubtless
they don't want to hear what's being said to them, but because they're
smarter perceptually than other types, they'll hear it all. Far from
being deficient in this kind of attention, they are usually proficient
in it, more proficient than other types of temperament.
7. Doesn't remember school routines - "is often forgetful
in daily activities"
Some children just don't take to schedules. And when they grow up
they still don't. The medics may have gotten this one right. These
children do indeed forget things that are scheduled. Not because their
brain won't let them, but because they simply aren't interested in
such things. Indeed, some are temperamentally predisposed not only to
ignore schedules but to resist them, because schedules preclude
options. This is especially true of the more impulsive children who
like to do exciting things on the spur of the moment (ten or twelve
children per class). Small wonder that they remain oblivious to school
routines - "daily activities" - when at any moment, if they
keep their eyes peeled, some fun activity may show up. Remember that
options and schedules do not mix very well.
8. Doesn't prepare for schoolwork - "often loses things
necessary for activities"
The children that are on the lookout for fun options have no
interest in getting prepared to go to work on those dull assignments
they are supposed to complete. "Be prepared" is not exactly
their motto. Indeed, theirs is more likely to be something like
"grab a hold or lose out" or "go for it,"
something like that. Equipment to be used for upcoming activities,
especially schoolwork, is of little concern to those who want to do
interesting things here and now. Can't blame the brain for that.
9. Doesn't organize schoolwork tasks - "often has
difficulty organizing tasks and activities"
I'm surprised that the medics seem not to know that it's the
teacher's job to design and schedule assignments, not the child's. The
child's job is to do the assigned task and not "organize"
it. I'm afraid the medics got this one wrong, but that's
understandable because they know very little about what goes on in
schools. In this case both the child's brain and temperament are
10. Doesn't like to do schoolwork - "often avoids,
dislikes, or is reluctant to engage in tasks that require sustained
Bingo! The medics hit the nail right on the head. For sure these
concrete impulsives don't like to expend the amount of effort required
to concentrate on what they consider to be trivial pursuits. Let's
face it, some teachers give dull assignments which bore and annoy
certain temperaments, especially those boys who are very concrete and
practical in their interests and abilities. It is natural that such a
child "avoids, dislikes, and is reluctant to engage" in what
are to him boring tasks. Give the perceptive-impulsive child a
concrete and practical assignment and he will eagerly "engage in
it" and will "like" doing it. In this neither brain nor
temperament is guilty.