Yin and Yang of
the Bouncing Brain
Snapshot of a New Spectrum
View of Attention Differences
Prepared
for a 1997 Canadian anthology, this article gives an early overview of Carla
Nelson Berg's spectrum model of attention differences
[click on image to view
full size]
California science and health writer Carla Nelson
Berg is a
longtime leader of GO MIND, the Mind-Brain Sciences Forum on
CompuServe, a digital gathering place for scientists and mental health professionals, and
co-leader of GO ADD, the Attention Deficit Disorder Forum, where she
assisted scores of patients and interviewed dozens of specialists as a cyber "talk
show host," while raising two bouncing brained offspring.
This experience gave her an especially good bird's eye view of the entire spectrum of
attention difficulties, while her experience as a journalist provided the tools for
distilling what she learned.
"What we are calling 'ADD' is not
just about a struggle to concentrate," she reports. "It's about people who shift
between extremes of under and over focusing."
Everyone with an attention deficiency has bouts of
distractible inattention mixed with bursts of "hyperfocusing" where attention is
so locked on it's a struggle to switch it off. What distinguishes one from the next is how
much time they spend in each state, Nelson explains.
People without attention deficits are able to modulate,
switching at will from one task to the next, but people
with ADD cannot hold attention steady unless arousal is intense. Lacking that extra-strong
"stimulus fuel" their focus fades. Yet once it is found they are also prone to
over-engage, then find it hard to gear down.
In more technical terms, ADDers
require especially strong stimulation to initiate and sustain activation. As a result,
they wrestle with both under and overactivity, with some being chronically sluggish and
hard to turn on, while others are persistently hyper in body or mind and too turned on too
much of the time, each exhibiting different sides of what Nelson
also describes as an
"All-or-None Attention Span."
Three
Types in Nine Degrees
After more than three years of researching clinical
literature and comparing thousands of first-person histories, Nelson developed a spectrum
model of attention differences, previewed in her monograph, Hyperactive Hearts &
Minds, a portion of which was also condensed in the ADD Forum book, Think Fast (Underwood- Miller
1996). It is a three-type model with nine degrees that shade from one to the next,
changing hues as they progress in strength and length of attentiveness:
- Type 1: Roving [Hypofocus]
On the under, or hypo, focusing side is the "Roving" Type 1. Prone to
impulsivity and sometimes to physical hyperactivity, people who fit this
"underfocusing" profile struggle to turn thinking on and sustain concentration
for long. In Nelson's models, subtypes in this cluster range from a scattered
"Ranger" at 1.1 to the physically hyper "Racer" at 1.3. Underthinking
and overactivity are their primary obstacles.
- Type 2: Restless [Mixed Focus]
In the middle is a "Restless" Type 2 that blends traits from both sides,
shifting between over and underthinking, frequently mixing inattention with
underactivity in subtypes that range from a "Preoccupied Procrastinator" at 2.1
to an "Inconsistent Perfectionist" at 2.3. Sustaining sufficient momentum to
finish all they begin is a particular problem for these in-betweeners who slide along the
spectrum between distractedly scattered and overfocusing.
- Type 3: Relentless [Hyperfocus]
Overthinking and overactivity both combine at the other end of the spectrum where the
hyperfocusing "Relentless" Type 3 resides. For this group of folks, the term
"hyperfocus" is not just about getting lost in a task temporarily.
Subtypes in this group range from a tenacious "Boundary Bender" at 3.1 to the
all-consumed "Kamikaze" at 3.3. All of them are persistently plagued with a
surplus of both mental and physical energies, awash with so many extra-intense thoughts,
feelings, and sensations, they may become "overstimmed" and shut
down to escape the overload.
[Note: links to
illustrations are at the end of this article.]
A novel aspect of Nelson's models is that they can be used to
show how attentional states change over time as engagement ebbs and flows. Each type, or
"band," has 3 levels of intensity, yielding 9 "degrees" of attention
difficulty. People move along this spectrum as arousal rises and falls, but some brains "bounce" more than others, she says.
Types 1 and 3 tend to be "stickers" who bounce in
place, spending most of their time on the outer sides of this scale in prolonged over or
under focusing, while Type 2's are "slippers" whose states shift more
frequently, inattentive one moment, overattentive the next. Some of these differences may
not be apparent until it is time to sustain attention to step-by-step tasks that demand
patient persistence but provide low levels of feedback. This is one reason why symptoms
may not be spotted until children are farther along in school.
When The Three R's Go To School
When it comes to sustain attention in class, the underfocused Type 1 may be the hardest to
engage with lectures and books. Rovers often seek their stimulation through bodily
sensations, craving intense experience (if not also risky adventure) as a way of
heightening feeling. Frequently they will also be kinetic-style learners who benefit from
direct hands-on activities where they can observe cause and effect for themselves. Testing
may also reveal overlapping learning difficulties such as dyslexia, dysgraphia, or CAPD
(central auditory processing disorder) and/or issues with sequencing and multi-tasking,
although these issues may be masked and hard to detect on standard tests in children with
high IQs who have learned how to compensate.
Relentless Type 3's, at the opposite pole, are quite often
hypersensitive, quick to react and hard to detach once "hooked". Their
distractions flow from a swirling flood of thoughts and acute sensations that can keep
them absorbed in a "noisy" internal world or obsessively focused on what's in
front of them. Accordingly, they may need coaching about how to attend less intently.
Overlapping aspects of NBDs,
i.e. neurobehavioral disorders, such as the tics of Tourette's Syndrome (TS) or the perserverating of Obsessive- Compulsive Disorder (OCD), are often - but not always - seen in the Type 3, sometimes again in
tandem with learning difficulties. Children with non-verbal learning disorders or
traits from the autistic spectrum may also exhibit a Type 3 attention difficulty. Threads
of stronger affective disorders, such as bipolar, are also sometimes seen in this cluster,
although bipolar remains a complex and difficult diagnosis to make in childhood.
The Restless Type 2 blends paler tones of the highs and lows
from both poles in a paradoxical mix that may be confusing both to themselves and to
others. For example they may be underactive physically yet overactive mentally, dreamily
roaming far and wide but mostly inside their own minds. Or, at the other end of the Type 2
band, they may resemble their Type 3 cousins, with hypersensitive feelings that add
anxiety to erratic attention, persistently distracted by internal chatter. Either shade
may be a puzzling blend of strong potential and uneven productivity.
Imaginative lessons, avoidance of too much rote, plus
flexible pacing to accommodate waxing and waning energies can help all of the types keep
their focus raised and attentions engaged, Nelson suggests.
Connecting Comorbidities
Aspects of depression or anxiety are sometimes seen alongside attention
difficulties, particularly in adulthood and especially in the more highly focused Types 2
and 3. As noted above, the Type 3 may also exhibit traits from the autistic spectrum or
aspects of bipolar disorder. Medication is not always appropriate, especially in milder
cases, but when prescribing becomes complex, it may take a specialist who is especially
skilled in the biological side of psychiatry to tease out these overlapping, or
"comorbid," conditions and prescribe accordingly.
Type 1 patients often report being helped by standard doses
of stimulants such as Ritalin and Dexedrine, but Types 2 and 3 sometimes report
paradoxical effects with stimulants being either too sedating or too agitating. Sometimes
this is resolved by lowering or raising the dose beyond the standard levels, or by
combining it with a second drug, such as an antidepressant, or by substituting another
medication for the stimulant. [Note: This article was written before widespread
adoptiont of next generation stimulants and new forms of antidepressants that selectively
target neurotransmitters such as noraderenaline.} In all events,
patients should be prepared for trial and error while the proper drug and dosage is found,
and they should not be reluctant to query their doctors if any prescription does not
appear to be working well.
Brain chemistry can vary widely from person to person, even
those of a similar age with similar symptoms. This is also the reason why, Nelson notes,
the spectrum of attention difficulty contains so many hues.
Separate or Subdivide?
With such a broad spectrum, one has to ask if it even makes sense to call it all "ADD". Might it be better to split all these symptoms into separate
conditions with different names?
When it comes to popular use of the term ADD,
"If I could wave a wand," Nelson says with a smile, "I'd frame it as
a spectrum of 'Attention Difficulties' - emphasis on the plural - to make more space for
different types and degrees of intensity. But then, I'd vote to subdivide rather than
separate."
There is a growing body of evidence to suggest key aspects of
attention difficulties may stem from different "settings" at the same
neurotransmitter sites or on the same genes, which may be why we see more than one shade
in the same families. There is also a well-established support community providing welcome
assistance across this whole spectrum to both adults and children.
"If we split this community based on their
differences," Nelson notes,"we risk losing sight of what unites them all in the
end: all of them know how it feels to cope with an All-or-None attention span."
Details of Carla's models are available at the site she
maintains at, www.hyperthought.net, and
information about her forthcoming books for non-technical readers can be found at www.bouncingbrains.com.
