from the archives of Carla (Nelson) Berg and the original bouncingbrains.com


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Hyperactive Hearts & Minds:
Towards a Unified View of Attention Difficulties?

Drawn from the monograph of this title published in January 1996, this text is adapted from workshops
by Carla (Nelson) Berg at the Midwinter Brain Sciences Colloquium in Palm Springs, February 1997 and 1998.

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Part 1: Introduction and Background

Paradigm Pyramid

This diagram is a "mind map" of my paradigm of attention differences. The triangles indicate where concepts move from more general to more specific and back again, while the exhibit numbers along the side correlate with my slides. I prepared this conceptual snapshot to show how the parts relate to the whole and to answer questions about how these models connect with diagnoses described in the DSM (note for non-technical readers: "DSM"is shorthand for the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association).

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  Scores of experts have described parts of the puzzle of Attention Deficit Disorder, or ADD, but what we still lack is a lid, a box top with a picture that shows how it would look if all those pieces were put side by side together. What you see here on the wall here are sketches of my box top for attention difficulties, viewed at different levels from very general to more specific. But before I get in to what these pictures mean, let me sketch in some background about how this work evolved.

Yes but
Almost everything I read about ADD leaves me saying "Yes.. but." That's partly true, but not complete -- you're describing some but leaving out others. That yes-but feeling increases if you spend much time among ADDers and hear their stories.

I've been exposed to thousands of first person histories while helping run the ADD Forum on CompuServe where I have served as an online advisor and virtual "talk show host" interviewing dozens of specialists. The common threads between all the stripes they describe ring loud and clear -- such as distractibility, waxing and waning intensity, and stimulus- dependency -- but the contrasts are just as stark.

Where some are mellow and hard to rouse, perpetual space cadets in effect, others are hyperkinetic if not also anxiously hyperreactive. Where some are extra expansive, others are extra constrained. Where some are especially laid back, others are especially precise. Few conditions in the DSM span so many contrasting character types.

This is one of many reasons some believe the diagnosis is so ambiguous as to be meaningless. Many clinicians would not even agree that all of the people I meet should be called "disordered" at all since they sit so close to that ill-defined line we draw in our minds between what is "normal" and what is not, and more than a few are very bright folk who have achieved a great deal in life despite their attention differences.

What belongs in the DSM and what it should be named, I leave for others to debate. In real life, every type I describe herein has been diagnosed "ADD" by somebody somewhere, and it is my conviction there is a great deal to be learned by understanding the traits that unite them before we split them apart.

Driven to Discover
Looking at all the yes-buts, not just among people who write to me but in my own family of bouncing brains who were so alike yet so different, I was driven to find some answers.

I am a person who can't let go until I have a context for what puzzles me. This puzzle was also a mystery of the sort I love to solve.. a Big Picture/Top Down sort of query where the holes might be filled in by zooming out out far enough with a wide angle lens looking for patterns across the population as a whole.

For more than three years, I digested research clips and books and lecture notes from conferences, then compared it all with scores and scores of intimate first person histories. I can speak of its genesis now in a rather linear way, but the process was anything but. I worked on several angles at once and when I got stuck put one aside to attack another, then found after more reading and analysis an "aha!" perked up from one of the several stew pots simmering on the back burners of my brain.

Stringing those aha's together eventually built a model that others now tell me is evoking all sorts of aha's for them too, making it easier to contrast one style of ADD with another and providing a context for the all the variability we see.

It is my hope that this in turn might help people with attention difficulties sort through the sometimes conflicting advice they get from physicians and therapists. It is also my hope to help provide a common lexicon for clients to use when they describe their own issues, and possibly for clinicians to use with each other, especially when communicating across the platforms of mulitple disciplines.

Dimensions vs. categories
The clinicians I communicate with most were trained to use the DSM as a virtual bible, which usually means it is reflexive for them to be categorical not dimensional. Most have been trained to build compartments, not continuums, and that makes sense given that classic reductionist science is meant to divide and classify. But my aim here has been just the opposite -- to connect and unify.

In an elemental way my models take a leaf from "new edge" sciences, such as systems and complexity theories. I borrow from systems theory in organizing by patterns and degrees with devices such as matrices instead of hierarchical lists. And I borrow from chaos theory a bit, in the sense of shifting states and cycles that can combine and compound to build up to critical mass over time.

New edge sciences often work top down, general to specific, because the specifics of complex systems such as the weather are too enormous and often too unknown, but the overall dynamics reveal symmetries of their own. So it is, I contend, with systems of mind and brain. Divide part too much from whole, and you may lose sight of how the parts can combine to produce even larger phenomenon.

Learning theorists and cognitive scientists analyze how we learn and perceive; psychiatrists and psychologists analyze how we feel and believe; while neurosci guys try to parse it all in terms of bio and chem; each wandering through the forest of the brain concerned with their own kinds of trees. To an extent, this limits how much of the forest they can see. What I am trying to do is provide a birdseye view that allows us to look at them all together to compare and contrast what they tell us about attention differences.

To that end, this paradigm portrays a functional model of internal experience, the impact of attention difficulties on state of mind, not the content of the thinking itself. One can get obessive about the theory of relativity or about what kinds of food to eat; it's the process not the content I am describing.

These models also demonstrate different ways to portray the intersection of interacting elements, such as arousal and atttention, and their impact on each other. My paradigm may also serve to help clarify one source of those "yes-buts" -- global vs. local frames of reference. By layering from specific to general, macro to micro if you will, my models permit comparisons between things that may be true of ADDers in general but vary between individuals.

Another important thing I want do with this dimensional modeling is interject time as an element. The checklists and categories clinicians employ suggest something fixed instead of states and traits that wax and wane in response to change. To portray the shifting nature of mind and mood, this spectrum is dynamic, not fixed. It suggests a "default" mode where one begins and neighboring states where one moves along a spectrum in time in response to internal and external stimuli.

Before we proceed, let me also give a context for this paradigm as a whole: it is a schematic, a heuristic sketched in functional equivalents that will hopefully seed a trail of clues to possible etiologies and how they might combine. Thus it portrays the "what" and "how" of attention difficulties, but only hints at the "whys." That part again I leave for clinicians and scientists who are much better equipped than I to explore what these possible correlations imply.

Viewing any DSM diagnosis dimensionally requires a paradigm shift, so I am going to ask your indulgence on one score before we begin, to wit -- please suspend disbelief for a bit.

Pretend this model is already being talked about and that you are here to understand what it suggests. Please don't pick it apart in your head just yet, or you might miss your chance to shift your frame of reference. After you see how it seems to me, if you'd like to critique, I welcome all feedback.


This presentation was obtained from the Internet beginning at http://www.hyperthought.net/PS/HH1.html

Copyright 1995, 1996, 1997, Carla (Nelson) Berg and the Hyperthink Press. So long as this notice remains attached, permission is given to copy this article for personal use or viewing by non-profit groups if no reader is charged. Web links are also welcome, just please let us know as we may wish to cross-link with you. For any and all other uses, please click on the license icon below and then let us know via email to editors @ sandbergpubs.com.

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