Hearts & Minds
Towards a Unified Theory
of Attention Difficulty?
by Carla (Nelson) Berg
Strip off the clinical labels, look beyond the symptom checklists, and most of the talk
about what is an attention deficit - and what is not - boils down to two critical
elements: arousal and focus.
Without a source of keen stimulation to keep arousal
raised, people with an attention deficiency cannot consistently concentrate.
Thus to see the whole of what we call
we must look not just at what it takes to focus, but what it takes to
activate. Every person
with an attention difficulty finds their lives defined by a tortuous struggle to keep
these two elements synchronized. Yet most discussions consider arousal and attention
separately - if the former is mentioned at all - as if the two factors were independent
rather than linked.
Prevailing models of ADD sort
clinical symptoms into two
physically hyperactive and/or mentally inattentive, as reflected by the slash in
formal name: AD/HD. But the wider spectrum practitioners see
patients report defies this implication of a divided body and mind and its suggestion
that "hyperactivity" can only be of a kinetic, physical kind. Those who understand this struggle up close know that one can be "hyper" in
thinking or feeling or doing, or some of each combined.
It has been suggested many times that the division between
physically hyperkinetic and
be even more firmly drawn with the latter,
non-hyper, kind placed in a separate diagnostic
category apart from AD/HD. My paradigm takes a
different stance: that the most accurate view requires more synthesis, not more splitting.
Scores of respected experts have written about AD/HD, and
parts of the puzzle have taken shape, including possible links to various neurobiological
irregularities and neurochemical deficiencies, and differences in blood flow and
anatomical structures. We even have leads to some potentially wayward genes. But
despite all that has been studied and speculated, we still lack a box top for this puzzle,
a sketch of the larger picture, a vivid impression of the
How might it look if all the pieces were placed together? Can all the symptoms and
subtypes these experts describe, some of them polar opposites, ever rest side-by-side? I
believe they can, but only if we look at arousal and attention together and at the same
moments in time.
It is to that end this heuristic has been designed.
Three Types in Nine Degrees
How well we attend and how much we engage are separate, but interactive, variables. One
can have too much action, but not enough focus, or too much focus but not enough action,
or too much of both at once, each creating a different set of challenges in life. But at
root, it is this continual flux between extremes of attention and arousal, and their
impact on each other, that I believe frames the whole of what we are calling "ADD."
No fixed list of symptoms can depict all these ups and downs or the many ways they can
combine. But if attention and arousal are plotted as axes on a chart, each from abnormally
low to abnormally high, a much different picture takes shape, a dynamic portrait of
shifting states that vary with time in response to stimuli.
The result, as presented within, is a matrix of inattentive states in three types and
nine degrees, a multidimensional continuum that progresses in length and strength of
attentiveness along a spectrum that shades from underfocusing low arousal with sporadic
hyperactivity to hyperaroused hyperfocusing with its flooding of sensory overwhelm.
With such a model we can, in fact, make space for all the puzzle pieces that have been
called ADD, not only to coexist, but to connect into a larger whole
that makes practical sense, even to a non-specialist.