Life is full of inconvenient truths. Galileo. Darwin. Climate change. The parts of our personal, national, and cultural history we barely admit to ourselves, would much rather forget, and never, ever talk about.

In every case, the core argument is the same: “thus-and-such couldn’t possibly be the case because what’s being proposed is simply an outrage.”

Now this is not to delegitimize outrage as a whole but simply to caution against using it as an epistemological device (are you listening, Tea Party?). To put the matter somewhat differently, things can’t be propelled into a state of inexistence by the intensity of the offense we take to them. If they could, they’d disappear each and every time someone got furious at them.

It follows from this that arguing against magical thinking of this sort isn’t the same as saying that something offensive should exist and/or that this is a good thing. No.

It’s simply, in the case of climate change, acknowledging the mountains of scientific evidence that point to the earth currently undergoing a major fluctuation in temperature that is not the result of a natural process and threatens the existence of humans. Of course the oil companies are up in arms about this, and of course they’re working round the clock to call it a “myth.”

In a similar way, neurologists, pediatricians, educators, and parents have been putting their heads together for a long time around something rather important. This is something that continues to gain definition, and something I argue is worth taking seriously instead of dismissing as based on a myth or exaggeration.

This is ADHD. What is it and why is it so controversial? In order to answer that question, we have to look at what the diagnosis is based on (what the aforementioned article disparages, diminishes, and dismisses): attention.

At least this way, if and when someone is still inclined to reject the notion of an attention span, they’ll at least have a better idea of what it is they’re rejecting.

What is Attention?
Science is full of analogies. Light is like a particle; no, it’s like a wave; all right, it’s like a wavicle. Same with attention: science is always looking for newer and better ways of describing a set of phenomena which have drawn a particular kind of interest. When your primary concern is helping a particular kind of child navigate through school and life, you ask certain questions that lead you to look at certain things with greater precision.

While the analogy isn’t perfect (no analogy really is), one of the best ways I’ve found to describe attention is as a beam of light. To use a light effectively, there are a few things you have to know or learn how to do in short order. They are: turning it on, keeping it on, holding it still, switching it from one thing to another (and back), and turning it off.

Attention first of all has to be initiated. That means getting started with a task: taking the first step, sitting down at your computer, getting behind the wheel. This is easy enough for most of us most of the time. However, all of us know what it’s like to be so overwhelmed by a task that we don’t know where to begin.

Imagine looking at a messy room, messy house, or driveway full of snow. It can be dispiriting enough to postpone any action taken to make it better, and the more we postpone, the bigger the task becomes in our mind. The garage. The tax return. Ugh.

Now imagine that life itself felt like a messy room. Imagine everything feels like a chore, but not so much because you’re depressed (although you may also be), but because you have such a hard time identifying a time and place to begin.

Imagine also that, as for most of us, once you get started things flow smoothly. Once someone sits you down in front of the computer your novel or dissertation pours out; it’s just getting to your desk that’s the problem. Imagine that your taxes or billing do themselves once someone forces you to do them.

In many cases, you may even forget how burdensome the task seemed once you’re on a roll. What’s up with that? Why is it that all you seem to need in life is a nudge, a more or less gentle push to get going? Why is it that, in order to focus your attention on something, someone or something has to direct it for you?

You start to wonder, at whatever age, what makes you so different from everybody else.

Once you’ve turned the attentional light on, your next job is to keep it on. For most of us, attention is like a flashlight with a full battery: once on, stays on. Recharge every so often, but no real effort is required to keep it going once it’s going.

Now imagine that instead of a solid-state battery you have a manual one. You know, the kind with a crank you have to turn by hand to charge a battery. Imagine further that your battery only holds charge for a few seconds, which forces you to crank and crank and crank just to be able to see where you’re going on a dark night.

All of us know how hard it is to keep focusing on a boring lecture, passage, or person. Now imagine the whole world felt like a boring lecture. No, you’re not sleepy, but everything seems to require so much mental effort.

Let’s say starting tasks isn’t hard, it’s just slogging through them that kills you. At any time of the day there’s any ton of things you’d rather be doing. Problem is, once you’re doing them, you want to be doing anything else.

You have a hard time explaining an odd paradox to yourself, to say nothing of everyone else: while just about every task feels odious enough to avoid at all costs, you’re not at a state of mental rest. Quite the opposite, you feel deeply restless inside.

And despite society’s reasoned judgment that you must be lazy, you know you have mental energy. How else would you, in many cases, have such a rich fantasy life?

What you don’t understand is why life gave you a crank-operated cell where everyone else seems to have a battery. Your task, growing up, is to find some explanation for this that doesn’t cost you your self-esteem.

As if things couldn’t get more complicated, you sometimes come into places where they tell you to turn that (at times bleeping) attentional light off. Don’t look! Or at least don’t be obvious about it.

Worse, there are times and places where you’ve not only managed to start a task, and are off and running with it, when along comes someone telling you to stop. Pencils down. Our time is up. Sorry, but I forgot to mention that I’m married.

Ouch. That’s when we find ourselves hitting the brakes, and surprise, surprise: not all of us have the same brand and kind of brakes. Some of us can bite our tongue better than others, not blurt out the answer or secret to the magic trick, keep from telling the semantically or socially inappropriate anecdote, or get dressed and shimmy down the fire escape faster than others.

People call you “impulsive,” and wonder why you can’t be like everyone else. You may or may not be fidgety. Depending on how old you are when people start noticing this, and depending on how much neuropsychology they know, you might start wondering what’s wrong with you, as well.

Let’s say you can do everything else with your light – turning it on, turning it up, turning it off – but moving it back and forth really kills you. Over here, no, over here – why are two people trying to have separate and simultaneous conversations with you in each ear?

For most of us, dichotic listening tasks are something we only encounter at parties or in laboratories. But imagine life being a series of relentless, contradictory, and incommensurable demands for an attention of yours that’s in constantly short supply.

Imagine you’re at the amusement park and you have to hit the clown’s nose with a water pistol in order to blow up your balloon. Now imagine you have to blow up three balloons: yours and your two neighbors’ and that time is running out. Ugh! You missed! You dropped the ball!

Imagine life being like that. Imagine that since you were a kid, you’ve hated transitions. One classroom to another, one car trip after another. You’re fine once you get used to it, but you’ve come to loathe the words “change of plans!”

Since you can remember, you’ve loved nothing more than sitting in a quiet, dimly lit room with a book, a phone, or your thoughts, but never the company of more than one. Imagine loving people but hating gatherings because being around more than one person at a time just drives you nuts.

Imagine being furiously jealous of and despising the person who can’t stop switching their gaze from you, the TV set, and the other people at the bar.

Imagine having to explain this to people over and over throughout your life. Imagine the toll it takes on you if this fact is brought to your attention by a teacher or parent in a less than compassionate way, at an early age.

Ok, now imagine you have the opposite kind of shifting difficulty. Instead of being unable to peel your light off one thing and attend to another, you can’t hold your light on one thing for more than a few seconds.

When you can’t, or have trouble doing so, here’s what you hear: “look at me, please,” “where is your mind right now,” “pay attention,” or “am I really that boring a date?”

All you know is that your mind is a grasshopper jumping around, and that it takes every effort on your part to keep your eyes or mind on one thing. You may or may not have figured out, or been told, that it helps to sit in the front row or take dates to the quietest, least visually stimulating places possible. You may or may not have found your way to nicotine, which really helps you focus, or to meditation.

You’ve known all you life you have a restless mind, but you wonder what could ever be done about it.

So here’s your handy-dandy acronym for the attentional functions: Initiate, Sustain, Inhibit, Shift, Stay = ISISS (n.b.: many folks leave off the last S for savings). Think light beam or spotlight and you’re off to the races. šŸ™‚

Why is ADHD controversial?
Criticism of the diagnosis comes in many flavors. There are concerns about pathologizing ordinary differences between people, thus stigmatizing them, and an overreliance on medical solutions to everyday problems. There are also understandable concerns about the influence of the pharmaceutical industry in generating the science that medicine is based on.

There are also concerns about unfairly demonizing the video game industry. Today you may also encounter the belief that the diagnosis is entirely the result of poor teaching or classroom management, which suggests that its symptoms should disappear outside of the school environment.

ADHD can show up as impulsivity and/or one or more of the forms of inattention I described above. There are medicines one can take, as well as therapies that involves training the mind through meditation, mindfulness, or brainwave biofeedback.

So what’s the big deal?
The most common thing people face with attentional conditions is being labeled “lazy,” or “inattentive” as if it were a moral failure instead of a clinical condition. Of course the earlier this happens in someone’s life the greater the chance it will work its way into the self-esteem and become a self-fulfilling prophecy.

Here’s a typical scenario: you’re told you’re of average to above-average intelligence, but that you don’t “apply yourself” in school. Nobody knows why they have to tell you or push you to do everything, or why everything overwhelms you. You don’t know why mental tasks that seem so easy for everyone else – reading a book all the way through, paying attention in class or in a conversation, revising an essay, checking your work – are all so much harder for you.

You don’t know why you can’t sit still, focus (unless you have a cigarette), keep from interrupting or blurting out the answers. All you know is that you act first and think later, and that this has cost you dearly throughout your life.

You may or may not get mad, at others, society, and/or yourself, and channel that rage in more or less appropriate ways. You could turn it outward and become an political leader or educator. You could also turn it inward and think less of yourself or your abilities.

Now because your society is still learning about all this, you’re at especially high risk for making the awful and incorrect assumption that your attentional challenges have anything to do with your overall intelligence. You may or may not act in accordance with what you’re being encouraged to believe about yourself, often by the people closest to you.

The easiest thing for your culture and you to do is assume your failure to meet cultural expectations with regard to output, efficiency, or focus can be remedied through exhortation and blame. The harder thing is to peel the pejoratives away, look at what’s happening, and suggest a solution.

A change of classrooms, some timely teaching tips administered in a non-threatening way, a more structured work or learning environment, medication, meditation, or a really cool new app for your phone all could be part of the solution and an end to your suffering.

But only if you believe that what’s happening to you is real, not a moral failing, and not just an inconvenient truth for someone else.


2 thoughts on “Attention

  1. Nice post. There is also the problem of mis-diagnosis. Something that happens all the time with improperly trained MDs. They are not perfect, and yet we tend to overlook their part in this and their own biases with this particular disease (and many other syndromic conditions).

    1. Thanks! I think the proper diagnosis can be made (or ruled out) by a physician when symptoms are overt and clear. Some of the distinctions here, however (such as switching challenges) probably require a full neuropsychological assessment.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s