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 assignments.
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 psychologists.
By the way, European children seem immune to the
"disease", so the market for Ritalin is largely confined
to America.
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 frequently.
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 it.
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 "symptom."
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 to do.
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 exonerated.
10. Doesn't like to do schoolwork - "often avoids,
dislikes, or is reluctant to engage in tasks that require
sustained mental effort"
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.
