|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
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
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
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
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.