The Great A.D.D. Hoax
The reason I speak of a hoax in the case of "attention deficit disorder" is that there is no such "mental disorder" to "diagnose" and "treat." And the reason I speak of a great hoax is that the less competent medical practitioners use this phony "diagnosis" as a warrant to "treat" millions of school children (over 5,000,000) per year by intoxicating them with brain-disabling narcotics.
And make no mistake about the power of Ritalin to disable and eventually shrink the brain. It differs little in its destructive effects from cocaine and the amphetamines, and is fast becoming the drug of choice among addicts in high schools and colleges. Children in middle schools and high schools who are required to take Ritalin daily at school are now selling their pills to their friends who want to get a quick fix. Of late the victims of pill pushers are fast becoming pill pushers themselves!
Medical practitioners have chosen the word "attention" as the key to one of 400 or so "mental disorders" they've listed in their "diagnostic manual." They say that some children don't "have" enough attention to succeed in school, and that it is wise to try to increase their attention with stimulant drugs. They say these children can't pay attention even if they try to.
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 I'd 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.":
- Obey schoolwork directives
- Sustain attention to schoolwork
- Bother with schoolwork details
- Try to avoid distractions from schoolwork
- Try to avoid mistakes in doing schoolwork
- Listen to the teacher's directives
- Remember school routines
- Prepare for schoolwork
- Organize schoolwork tasks
- 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.
Signs of Impairment
Medics claim they can observe these ten signs of impaired consciousness. But that's nonsense because consciousness is not observable. So the ten signs of A.D.D. are merely guesses and therefore cannot be seriously considered as either criteria or symptoms of some hypothetical deficit of consciousness. And to claim that these bogus symptoms actually cause an impairment of consciousness is simply preposterous.
It is therefore evil that they persist in experimenting with brain disabling drugs to get children to do as they are told.
Bear in mind that school children are told to do three things: 1. stay put, 2. keep quiet, and 3. get to work. The so-called A.D.D. afflicted child obeys the first two directives, but disobeys the third: he stays put, keeps quiet, but doesn't get to work. His reason for dragging his heels is that he probably doesn't like to do schoolwork (criterion #10), at least the kind that the less capable teacher assigns him. It's as simple as that. It's ridiculous to probe around in his brain to see if there's something wrong with it. And its preposterous to disable his brain with drugs to "help him focus on his lessons." The problem is curriculum content and instructional method, not brain defect.
Remember that the medics who prescribe stimulant narcotics, in order to be licensed to practice, are required to swear the oath of Hippocrates that they will "do no harm." Yet each of them violates that oath by doing irreparable harm to children, even four-year-olds, who are merely attending to their own business instead of their teacher's.
There is nothing wrong with these children. Neither special education nor experimental narcotherapy is the way to treat children who disobey orders to get to work. After all, it isn't so much that these children can't work as it is that they don't want to work. Their inborn temperament prevents these concrete, fun loving, and impulsive children from adapting to the school. Some day in the not so distant future the school may come to realize that not all children can be scheduled and routinized, that children, like adults, are fundamentally different in this regard. Perhaps then the school might adapt itself to those children that do not fit its curriculum or its methods of instruction.
David Keirsey is the author of Please Understand Me, Please Understand Me II, and the Keirsey Temperament Sorter.