By Mickey Skidmore, ACSW
Perhaps no other affliction in recent memory has yielded more diversity of theories, myths, opinions, controversy, and research than Attention Deficit Disorders. Hueristically speaking, most of the research appears to point increasingly towards a biological etiology to explain this phenomenon. This article however, attempts to lay the groundwork for a broader conceptualization in our understanding of this much talked about condition.
First of all, I wish to go on record as saying I do not believe that Attention Deficit Disorders are an elaborate hoax as alluded to in the student newspaper of Brevard Community College (Central Florida), (Danforth 1996). What I question is what appears to be an increasing prevalence of this condition disproportionate to the research findings. For example, the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) cites the prevalence of this “disorder” in children between 3% – 5% (APA 1994). Yet, this seems to be an increasing label associated with childhood behavioral difficulties. Moreover, longitudinal studies following ADHD children into adulthood showed that disabling core symptoms persist into adulthood in 11% to 50% of cases (Fargason & Ford, 1994).
I find myself increasingly curious, and somewhat disturbed by what appears to be a growing trend as it relates to children and teenagers. What was once considered as a fairly wide range of normal/appropriate childhood behaviors and attitudes for many have been transformed to psychopathology. Consider some of the following “symptoms”:
1) Often fails to give close attention to details or makes careless mistakes in schoolwork, or other activities. (Zentall’s 1985 research suggests children are likely to pay much more attention to colorful or highly stimulating educational materials that to relatively less stimulating or uncolored materials).
2) Often has difficulty sustaining attention in tasks or play activities. (Barkley  found this problem consistently to be a response to tasks which have little intrinsic appeal or immediate consequences for completion).
3) Often does not seem to listen when spoken to directly. (The greater obedience of ADHD children to their fathers than to their mothers is well established [Barkley, 1990]. While this should not be misconstrued entirely as maternal mismanagement, the social phenomenon of absentee father’s should not be overlooked either).
4) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). (Significant research findings suggest this may be more reflective of poor rule-governed behavior [Barkley]).
5) Often has difficulty organizing tasks and activities. (Children are not alone regarding this. Many adults struggle with this to the point that they hire executive secretaries or others to assist them in organizing themselves successfully).
6) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework). (This could also be explained as inadequate educational instruction or boredom).
7) Often loses things necessary for tasks or activities (e.g. toys, school assignment, pencils, books or tools). (When adults do this, it’s referred to as “memory problems”. When older adults do this, it’s referred to as “dementia”. When children do this it is now referred to as “ADHD”).
8) Is often distracted by extraneous stimuli. (What may be extraneous to one, might be significant to another. Some might even consider it a gift to give attention to several different stimuli simultaneously).
In summary, “inattention” is a multidimensional construct that can refer to problems with alertness, arousal, selectivity, sustained attention, distractibility, or span of apprehension. Attention itself is not a behavior or response of the individual. Instead, it is a term used (for the convenience of the practitioner) to represent a relationship between something in the environment and the behavior of the individual.
1) Often fidgets with hands or feet or squirms in seat. (This might be a high-energy child, or also be an indicator of high anxiety).
2) Often leaves seat in classroom or in other situations in which remaining seated is expected. (Children are naturally spontaneous and free spirited. Remaining seated is social construct which is learned over time as part of the “hidden curriculum” of educational institutions).
3) Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness). (So now, subjective feelings of restlessness is to be “disordered”?).
4) Often has difficulty playing or engaging in leisure activities quietly. (Why are adults so invested in squelching the expression of children anyway?).
5) Is often “on the go” or often acts as if “driven by a motor”. (One can’t help but wonder to what degree this is modeled to children by adults struggling to manage an increasingly fast-paced society).
6) Often talks excessively. (Adults complain when children talk too much, and complain when they are not forthcoming as teenagers. Does anyone see a problem here?).
In review, “hyperactivity” is referred to as excessive or developmentally inappropriate levels of activity, be it motor or vocal. Common descriptions of such activity includes: restlessness, fidgeting, generally unnecessary body movements, often irrelevant to the task or situation and at time seemingly purposeless. There are many different types of “overactivity”, which may more realistically be a result from the failure to regulate activity levels/settings or task demands.
1) Often blurts out answers before question has been completed.
2) Often has difficulty awaiting turn.
3) Often interrupts or intrudes others (e.g. butts into conversations or games).
(When children do not maintain their behavior toward an environmental event for as long as other children do, we say that they have poor sustained attention or poor attention span. When they respond too quickly or incorrectly to the presentation of a stimulus, we say they are impulsive).
Clearly the most suspect word in all three lists is “often”. This is hardly a scientific descriptor in describing the psychopathology of children (or anyone else for that matter). Russell A. Barkley, considered by many to be the leading expert on Attention Deficit Disorders distinguishes his view by referring to children (and adults) who have chronic difficulties in the areas of attention, impulsivity, and overactivity.
In many respects we should not be surprised by the increase of children labeled as ADHD. As the title of this article suggests, my own perspective is that there are numerous structures and institutions throughout our society which culminate in the cultural conditioning of shorter and shorter attention spans. Television programming has conditioned us to accept the general transition from one hour to 30 minute sitcom programming. TV commercials have gradually reduced there length from one minute to 30 seconds or less. With a few epic exceptions, we have been conditioned to accept the reduction of movies from two hours to 90 minutes (and pay more for this reduction no less!).
Political spin doctors have conditioned us to accept the explanation of complex social and political issues into shorter and shorter sound/picture bites. Marketers condition us to “buy now” buy blitzing consumers with one short-lived promotion after another. Computers heighten our inpatience by responding to the consumers demand for faster and faster pentium chips (for fear that we’ll lose attention if the modem doesn’t download fast enough). Video games are increasingly designed to accommodate the cultural conditioning of a faster paced society and shorter attention spans.
Even the food we eat and the rituals we have to prepare our nourishment is not immune to these forces. “Fast food” restaurants are one of the most powerful icons of our culture. Microwave technology enables us to prepare our food faster than ever before. Preprocessed food allows us prepare an entire meal within a few short minutes and a few touches of the microwave timer buttons.
And while research has clearly disproved the cause of sugar as a cause to ADHD features, we should not overlook our present agricultural practices, and the fertilizers we put into the ground; the run off of these chemicals into our water supplies, and what (long term) effects this may have on our body chemistry and eventual genetic lineage. Furthermore, I doubt I’m the only one who wonders about the long term effects of using such food products as aspartame.
In short, I believe we have been hypnotized by social and scientific conditioning to accept certain perceptual boundaries and structured awareness’ which have resulted in a premature cognitive commitment to a predominant biological view which is grossly oversimplified. The power of this trance persist despite Barkley’s own research which found concordance for clinically diagnosed hyperactivity was found to be 51% among the monozygotic twins and 33% among the dizygotic pairs (1990). This finding alone supports the contention that there are numerous influences beyond any biochemical abnormalities which likely contribute to Attention Deficit Disorders (and many other “biological disorders”). Additional rationales may also include comorbidity of other afflictions or conditions.
It is perhaps part of the human condition to seek out a label or simplification to an otherwise terrible disease or condition. Few would argue that there is a likely genetic predisposition to ADHD (and other conditions). Yet, it seems reasonable that the numerous other variables in large ways influence how this genetic predispostion is played out. Drug companies in particular have heavy investment and must assume some responsibility for the over emphasis of the biological view in many complicated conditions. When these perceptual boundaries are no longer used towards understanding the affliction, but rather limits our understanding to an oversimplified view of pathology, then one has to wonder about such structured awareness’. The real challenge is how to acknowledge and embraced the characteristics of Attention Deficit Afflictions and find empowering ways for those who struggle with them to improve, enhance, and excel in the personal, vocational, and social aspects of their lives.
1) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Edition. Washington DC: APA, 1994.
2) Barkley, R.A. (1990). ADHD Adolescents: Family Conflicts and their Treatment. Grant from NIMH, MH41583.
3) Barkley, R.A. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York, NY: Guilford Press 1990.
4) Danforth, Glen. “Is ADD an Elaborate Hoax?” The Capsule. Brevard Community College, Central Florida. 1996.
5) Fargason, R.E. & Ford, C.V. (1994). Attention Deficit Disorder in Adults: Diagnosis, Treatment, and Prognosis. Southern Medical Journal 87, 302-308.
6) Zentall, S.S. A Context for Hyperactivity: Advances in Learning and Behavorial Disabilities. (Vol 4, pp. 273-343). Greenwich, CT: JAI Press.