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

Adapted from workshops presented by Carla (Nelson) Berg at the Midwinter Brain Sciences Colloquium in Palm Springs, February 1997 and 1998

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If attention and arousal are plotted as axes on a chart, a more vivid image takes shape, one in which focal strength can wax and wane in response to stimuli...


No fixed checklist of symptoms can fully depict the dynamics of these ups and downs or all the ways they may combine. But if attention and arousal are plotted as variables, in steps from abnormally low to abnormally high a more vivid image takes shape, one in which focal strength can shift over time in response to stimuli.

Thus the third way I model this same range of traits is with a matrix in which these highs and lows can be compared and contrasted by allowing attention and arousal to vary relative to each other. You've seen how my symbolic spectrum of "brain beats" corresponds to the baseline of my symbolic "bell of attention." In an alternative view, the same conceptual spectrum can be "split" in two to plot attention on one axis and arousal on another, allowing either factor to rise or fall compared to each other matrix-style.

In its simplest form, that matrix looks like this [exhibit] . Across the horizontal axis at the top, you see the effects of increasing attention: under, over and hyper. Down the vertical axis on the side are the effects of increasing arousal, under, over and hyper again. This slide [exhibit] compares the matrix and the bell to each other to show how the two correlate. They are alternate perspectives on the same set of concepts. All three views, spectrum, bell and matrix, portray 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, postulating three primary styles of attention difficulty (AD):

  • 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 their thinking on and maintain concentration for long. As detailed in matrix view, this group has a spectrum of subtypes inside that runs from the spacey unfocused low arousal of the 1.1 to the hyperaroused thrill-seeking archetype at 1.3.
  • Type 2: Restless [Mixed/Alternating]
    In the middle of the spectrum is a "Restless" Type 2 that blends traits from both ends, shifting between over and under focusing. Sustaining momentum to finish all they begin is a particular problem for these in-betweeners. This group has a spectrum of subtypes that runs from a dreamy preoccupied procrastinator at 2.1 to an overfocused but inconsistent perfectionist at 2.3
  • Type 3: Relentless [Hyperfocus]
    At the opposite end of the spectrum from the Type 1 are the mostly hyperfocusing folk, the "Relentless" Type 3, persistently plagued with a surplus of mental and physical energies, a flood of extra-intense thoughts, feelings and energies that can be very hard to turn down. Subtypes within range from the boundary bending tenacity of the 3.1 to the all-absorbed 3.3 who may be consumed in a "noisy" internal world, flooded with stimuli.

The simpler version of the matrix you saw above has whimsical names in each space to give a sense of character types. More technical versions provide descriptions of the processes each "cell" on this chart represents, comparing different angles such as lability. Please note again that all of these representations are hypotheses, not correlates that anyone has demonstrated clinically. This heuristic is meant to facilitate further query by posing questions that others may wish to pursue; it does not purport to offer proof but to muse upon patterns seen and what they might mean.

As Michael Schwartz MD once observed in a class for clinicians, "a good heuristic asks the right questions; it doesn't answer them."

How did this model wind up positing three focusing types instead of two, you might wonder. I didn't start out seeing, or seeking, three primary types of ADD. In fact, for a long time I only saw the symptoms in terms of their two poles, ON and OFF, hypo and hyperfocusing.

But one of the missing links that popped out midstream with a big "aha!" was the presence of a 'dipolar' state in between ( I originally called it a "bipolarity," but switched to "di" at the suggestion of an MD friend who feared it would be confused with what bipolar means in the DSM). These are people who fluctuate between under and overfocusing, not just once in awhile, but chronically. For them, "attention deficit" might better be called "attentional inconsistency." They slip back and forth between over and underfocusing rather than hypo and hyper. Because these in-between states are less intense, it's easier to slip back and forth between them and their attentions tend to be more labile than their neighbors who get stuck in extended bouts of hyper or hypofocusing.

These in-betweeners may be so because they combine an overfocusing cognitive style with traits of depression that dampen arousal. Or they may be overfocusers who also have learning differences that make it more difficult to sustain some kinds of cognitive effort. Or they may simply be people who have no diagnosible LD or depression, but whose cognitive stamina is depleted by the relative intensity of their mental sprints.

It was very validating some months later to attend one of Tom Allen's workshops and hear he'd found similar patterns in his analysis of the brainwaves of ADDers on EEG: one type that was mostly "on," a second that was more often "off," as well as a third type that cycled back and forth. My matrix proposes exactly the same with its three types of focusing; hypo, hyper, and mixed in between. But it took some more months and the development of my attentional bell before I could explain what that pattern might mean by showing how the Type 2 band as a whole straddled both sides of the modulating middle, in the process also demonstrating, since they are the closest to what we call "normal," why many Type 2's may have been told they do not "really" have an attention deficiency.


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Carla (Nelson) Berg
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