Part One: The Nature of Attention

Deficit Disorder
1: So Much Soup and Garbage Can
Realization: It seemed to me that I had found the passage to those dark recesses
of my mind from which chaos issues without warning. It hurls thoughts, plans,
emotions, and intentions in all directions.
Gives coherence to humiliations and failures, to unfulfilled plans and unkept
promises. It also makes sense of gusts of manic enthusiasm that consume
themselves in their own mad dance, leaving emotional debris.
Behavior patterns:
Sudden eruptions of bad temper and complete irrationality.
Paralytic rage when confronted by instructions telling me how to do
something.
Awareness that he has talents or insights or some undefinable positive
quality he could perhaps connect with if the wires weren’t crossed.
Moods fly back and forth from lethargy and dejection to agitation.
It would be nice to get a break from myself, at least for a little while.
One longs to escape the fatiguing, ever-spinning, ever-churning mind.
I am sick and tired of being sick and tired.
2: Many Roads Not Traveled
ADD is defined by three major features
Poor attention skills
Deficient impulse control
Hyperactivity
Poor attention skills
Absence of mind is one cause of the distractability and short attention spans
that bedevil the adult or child with ADD
EXCEPT around activities of high interest and motivation
Distractibility fosters chaos
 Completely lacking in the mind of ADD is a template for order, a mental
model of how order comes about
Perfected the skill of nodding. Ashamed to admit his lack of comprehension
and knowing the futility of asking for clarifications that he would grasp with
no greater success
Distractibility in ADD is not consistent, to some activities might be able to
devote, if anything hyper concentrated attention
Hyperfocusing that excludes awareness of the environment also
denotes poor attention regulation
Passive attention
watching tv, permits the mind to cruise on auto without
requiring the brain to expend effortful energy
Active Attention
mind fully engaged and brain performing work, only found in
special circumstances of high motivation
ADD brain lacks this whenever organized work needs to be
done, or when attention needs to be directed to something of
low interest
ADD needs a much higher level of motivation to focus than the
normal person
“He is able to focus his attention on something that he is really
interested in, which for patients afflicted with ADD is very
difficult”
That is not what is difficult, what is difficult is to arouse the
brain’s motivational apparatus in the absence of personal
interest
ADD is situational: in the same individual it’s expression May very
greatly from one circumstance to another.
There are certain classes for example which the child may perform
remarkably well, while in others is scattered, unproductive and
perhaps disruptive.
Impulsiveness of word, deed with poorly controlled emotional reactivity
Constant background noise in the brain, a ceaseless “white noise”
 “I always think I should be doing something, but I don’t know what it is”
Restlessness coexists with long periods of procrastination.
Threat of failure or promise of reward has to be immediate for the
motivation apparatus to be turned on. (Without it inertia prevails)
On the other hand, when there is something one wants, neither patience
nor procrastination exist.
One has to do it, get it, have it, experience it, immediately.
An adult with ADD looks back on his life to see countless plans never fully
realized and intentions unfulfilled.
“I am a person of permanent potential”
Courses began and quit
Books half read
Many, many roads not travelled
The moods of ADD are capricious, happy smiles being transformed into
frowns of displeasure or grimaces of despair in a matter of moments.
Events anticipated with joy and begun with exuberant energy often end in
bitter disappointment and sulking, accusatory withdrawal.
Emotional states of adults with ADD also go through rapid and unpredictable
up and down swings. Good days and bad days alternate without apparent
reason.
3: We Could All Go Crazy
Are we not to be held accountable for what we do?
Is ADD a license for self-indulgent or hurtful behavior?
WE MUST ALL ACCEPT RESPONSIBILITY FOR OUR ACTIONS, ELSE THE
WORLD BECOMES UNLIVABLE.
We are not helpless in the face of ADD, so on the personal level an attempt to
shift responsibility for negative behaviors onto brain circuits is unhelpful.
IT LOCKS A PERSON INTO VICTIMHOOD
No one else should have to feel a sense of responsibility to accept you for who
you are, accept the hurt you cause or the pain you have given
IT IS STILL UP TO THE INDIVIDUAL TO PLOT THE COURSE.
4: A Conflictual Marriage (ADD and the Family [1])
Environment does not cause ADD any more than genes cause ADD. What
happens is that if certain genetic material meets a certain environment, ADD
may result.
Without that genetic material, no ADD. Without that environment, no ADD.
There was never any question of a lack of love in our home. But love felt by the
parent does not automatically translate into loving experienced by the child.
The environment in our home was often one of open or suppressed emotional
conflict between the parents, mutually disappointed expectations and profound
anxieties we were not even aware of.
He begins to work too hard to get his needs met: demanding contact, acting out
or trying to please the parent to gain approval and attention
There were many good times, where I felt connected and the warmth and
love of my parents and that for each other
The thought times came often enough to make it confusing .
The emotional climate was too unpredictable and confusing
Second judgment or blaming is not the point. Understanding is!
5: Forgetting to Remember the Future
“ADD is not a problem of knowing what to do: it is a problem of doing what you know”
Some aspects of the individual’s mental and emotional functioning are normal for
chronological age; others remain mired in an early childhood phase.
“He can be so cooperative and mature one minute, and in the next he is
behaving like a two-year old”
The major impairments of ADD (Distractibility, poor impulse control) reflect a
lack of self-regulation.
Self-regulation = someone can direct attention, control impulses and can
consciously and mindfully be in control of his body.
Reactions can be gratifyingly mature at one time but distressingly immature at
another.
If some deeply unconscious anxiety is triggered, a person may respond with
the lack of emotional self-regulation characteristic of an infant.
 A fully grown adult exhibiting the rage of an infant is terrifying and
potentially dangerous.
The brain centers where the deepest emotions of fear or rage are generated
simply overwhelm the higher centers meant to govern them.
‘Acting like a child”: is so often dominant in ADD and reflects incomplete
development of pathways in the cerebral cortex, and between the cortex
and the lower parts of the brain.
Can localize much of the organisation basis of ADD in what is called the
right prefrontal cortex (Area of the brain just behind the forehead)
Functions: impulse control, social-emotional intelligence and motivation.
Also participates in directing attention.
Page 41 is important