Attention-deficit hyperactivity disorder (ADHD) is a complex condition no expert can fully describe. A lifetime’s understanding of psychology, philosophy, biology (neurobiology, sleep biology), sociology, economy, physics, and medicine, isn’t enough to fully comprehend the concept of attention. Those in disagreement may be victims of the just-enough-knowledge-to-feel-like-an-expert effect.
Let’s first look at the word deficit. We often define things in terms of efficiency or deficiency, however, we should first recognize that attention is a highly regulated aspect of biology. As a reminder, we have not, and are not close to, conquering biology. To be clear, the descriptions and treatments that have brought orientation and relief to those who have been diagnosed with ADHD are real. However, we will not be well served to authoritatively label a brain function as deficient when it is clear that our brains operate in incomprehensible layers of complexity.
Consider that what is perceived to be a ‘deficiency of attention’ is really a ‘fracture of attention’.
The concept of a deficiency of attention requires sociological agreement as to what deserves our attention. Our biology may consider a sociological notion of what is worthy of our attention, but it will calculate its expenditure of attention based on innumerable hidden variables (such as body sense and control).
What is described by ADHD, everything from hyperactivity to personality traits, can represent the same cluster of symptoms but from different causes. There is no purpose to this article other than expanding the number of things to consider when we speak of ADHD. The ideas presented here can engage deeper considerations for understanding and treatment, as well as empathy, for this human condition.
There is a math to attention
It’s important to understand the phrase ‘executive function’ in a literal sense: executing tasks. It is not enough to have knowledge of a goal task. Nor is it enough to be convinced of the value of that goal task. The concept of attention makes sense when we consider that we have mechanisms that spare us from expending unnecessary energy.
Those diagnosed with ADHD have a particularly difficult time giving attentional resources to anything deemed disagreeable or unworthy of attention. What our minds deem worthy of attention may split from what our brains deem worthy of attention. Although mindsets can provide temporary breakthroughs, our brains will eventually win the long game. While medications help, they do so incompletely. We are better served considering that brain rewiring and time are needed, in addition to the search for near-term functionality.
Attention has two components: focus and awareness. Focus represents a dense amount of attention given to a smaller set of perceptions and ideas. Awareness is attention that is spread out to catch peripheral perceptions and ideas. More focus, less awareness. More awareness, less focus.
Focus and awareness are affected by our senses, perceptions, and past experiences with feedback (cumulative results of a lifetime of A/B testing, for the nerds).
We may feel certain goals are unworthy if we already feel other aspects of our life are neglected. And what can make us feel this way? Relationships, recent or remote, intimate or working. Relationships assign values to everything that fuels it. These values are held long after a relationship has changed. Is it possible to find value in things that are not linked in some way to a relationship? Even constructing something while in isolation involves the mind imagining its impact should it be seen.
Relationships often cause impossible resolutions and contradicting values, “Hurry up, but drive safe”. Constant double-binds can sink our energy (and attention) in a never-ending spiral of rule-shifting and hypocrisy.
Limits of testing
The result of a positive ADHD diagnosis, even on neuropsychological testing, would be typical for someone who has been 1) chronically disallowed participation in life decisions and 2) put in constant contradictory positions, having to make similarly contradictory decisions. Passive or conflicting experiences inhibit the natural development of our ability to plan and execute tasks. If ‘doing’ is dangerous, then the ‘doing’ brain does not develop.
Chronic learned helplessness leads to underdeveloped brain areas like the prefrontal cortex, an important part of executive functioning. When ‘doing’ isn’t thought of, the body thinks we aren’t doing enough. It would be natural the believe that internal restlessness is the body’s natural reaction, saying ‘do something that leads to something new’.
The diagnosis isn’t specific enough
The name ADHD is an example of how little is known about what is happening. There is a comment about “attention deficiency”, and then the diagnosis contains a comment about what it’s normally associated with: restlessness. These two comments do require social agreements: 1) How and what attention should be paid, and 2) the amount of time one should stay still. We can look at any spectrum diagnosis and restrict diagnostic criteria to the “top 10%” problematic population, however, it is also fair to consider that it is unnatural to sit for hours a day.
We generally look for a diagnosis, however, diagnosis, despite giving direction and understanding, often inhibits further investigation.
For example, chronic fatigue syndrome could give the indication that someone investigated a patient’s symptoms and has determined that nothing explains fatigue better than a general description. This often keeps physicians from re-examining their patient’s conditions. New complaints of fatigue may be attributed to the original syndrome when it could be a sign of a more serious condition.
A diagnosis, especially those merely providing general descriptions, can leave patients living years in middling suffering because “none of the known treatments are working for this label”. It is often used in less thoughtful situations to avoid further medical and systemic investigation.
