Your Attention, Please

Kenneth Evans

Writer’s comment: As an English major, I rarely have the opportunity to write—I mean, really write. Sure, I’ve written essays, analyses, and explications, but those papers were generally devoid of personality, anonymous. Because of this impersonal style, many of my English papers were lifeless and difficult to write and, I imagine, equally difficult to read. So when Lecturer Boe asked my English 103F class to write using our own voices, I felt like I might finally enjoy my own writing. This research paper has a voice behind the words. It was easy to write and I hope as easy to read.
—Kenneth Evans

Instructor’s comment: Kenneth Evans’ “Your Attention, Please” was written in response to the final assignment in English 103F, Advanced Composition for Elementary and Secondary Teachers. I asked the students to read about some educational topic but also to try to gain insight into that topic through experience or conversation. Their resulting papers were then to combine personal and intellectual experience. Kenneth Evans’ paper on Attention Deficit and Hyperactivity Disorder (ADHD) was a marvelous blend of these two modes of inquiry. I was especially struck by how he used his own real life experiences and interviews to bring a critical focus to what he read. He shows in this paper how much media information about ADHD is just plain wrong, how much of what people think they know is based on misinformation and mythology.
        I wish I could say that Kenneth Evans writes so well because of my instruction. In fact, he came into my class as an excellent writer, and my major pedagogical function (a time-honored one) was to praise.
—John Boe, English Department

When I first heard about ADHD (Attention Deficit and Hyperactivity Disorder), I thought, “C’mon. This psycho-babble has gone too far.” I saw psychologists, researchers, lawyers, teachers, parents, all talking seriously about this claimed disorder. But what I didn’t think about was where this information was coming from. Many talk shows have featured ADHD, where self-righteous citizens cheer, boo, and hiss like a jury at some medieval witch trial. A writer for the reputable publication New York magazine wrote: “[ADHD] is certainly a fitting disorder for the Nintendo and MTV generations—children who seem more at home playing computer games than having a quiet dinner conversation with their parents,” which sounds like it was written by a disgruntled “parent” rather than an unbiased reporter (Blau 45). And an article in Time ran quotes from erudite psychologists like Robert Reid, who said that ADHD is just an ego-preserving excuse, merely “a label of forgiveness” (Wallis 42). Newspapers ran these argumentative headlines: “Some Skeptical of Surge in Attention-Deficit Diagnoses” and “Overreacting to Attention Deficit Disorder” (Perkins A1, Vatz 82). And before I began learning about ADHD, I too was a media-driven skeptic. But, as with most things, knowledge begets understanding.
         Recent media coverage might lead one to believe that ADHD is something new, a nineties thing, some vogue malady that somehow explains our disaffected modern youth. Yet the hyperactive child has always been around. He was class clown, the kid in the back row who never shut up. He was the kid whom the teacher constantly sent out of the room or to the office. In the past, these were the children who fell through the proverbial cracks in education.
         Throughout the seventies and eighties, these hyperactive children were commonly treated with prescription drugs such as Ritalin, the drug that seems to be such a hot topic of debate today. (I can almost hear Geraldo asking his audience, “Today’s topic: Are we drugging our children?”) According to the Journal of the American Medical Association, between 1987 and 1989, “major national television talk show hosts (e.g., Oprah Winfrey, Geraldo Rivera, Phil Donahue, and Morton Downey, Jr.) . . . allowed anecdotal and unsubstantiated critical allegations concerning Ritalin use and side effects to be aired” (Safer 1004). To make matters worse, a Washington lawyer initiated nearly twenty lawsuits contending that Ritalin was being indiscriminately prescribed, as children suffered damaging side effects. At the time, “the attorney was treated in the media as an expert on methylphenidate” (Safer 1004). Later, it was discovered that the lawyer had ties to the Church of Scientology, an organization notorious for media manipulation and opposition to established psychological practices.
         Because Ritalin—methylphenidate hydrochloride—is a psychostimulant, there were concerns that children could become dependent on the drug (yes, Geraldo, they do give these kids “speed”). However, Ritalin is a mild stimulant prescribed in doses of 5, 10, and 20 milligrams, depending on the severity of the problem—not enough to get them high or hooked. In ADHD in Schools, George J. DuPaul, a researcher and specialist on ADHD, says that possible side effects of Ritalin—drug addiction, depression, and “other emotional difficulties”—have been proposed “primarily in the popular media. These claims have no basis in the empirical literature and should not be considered actual treatment risks” (152). Of the children treated with Ritalin, seventy percent respond positively to the drug, but, contrary to popular ignorance, medication is only one aspect of ADHD treatment. Behavior modification techniques, family counseling, and specific teaching strategies also help diagnosed children cope with their attention deficit.
         As the public became more aware of what is now called ADHD, there was a consequent surge in ADHD cases. Many parents who were as yet unaware of ADHD symptoms became informed, as did teachers. The surge then attracted more media attention, which sparked yet more diagnosed cases, and so on. It’s no wonder, then, that ADHD has become the most prevalent disorder reported by elementary schools (Cowart 2647). Yet even with this great influx of new cases, the actual percentage of diagnosed ADHD children in schools remains three to five percent, many of whom suffer from other learning disabilities as well.
         What the media do not always include in their stories are the dry facts. For instance, ADHD is not merely a school-related problem. Children with ADHD have social as well as academic difficulties. Lynn Weiss, in Attention Deficit in Adults, relates the story of “Marcus,” who at age nine had not yet been diagnosed:

He only knew that his inability to concentrate was bringing daily scoldings in the classroom, which were systematically eroding his self-esteem. He was also on the basketball team. Because of his general behavior . . . he was also losing self-esteem in the eyes of his teammates, and began to suffer that painful harassment that nine-year-olds are so good at handing out. (31)

As Marcus’ story shows, the impulsiveness and social inconsistency that ADHD children exhibit often create difficulty in making friends, contributing to a low self-concept. Like Weiss, Dr. Melvin D. Levine, Professor of Pediatrics at the University of North Carolina School of Medicine, finds that children with attention deficits “exhibit an inordinate need to inspect, manipulate, or provoke their peers. Their social temptations and drives are frequently out of control” (Levine 118).
         Peter Bennett, a seventeen-year-old diagnosed-ADHD student, relates the frustration of living with undiagnosed ADHD: “They’d give me a test in school, and I’d say, ‘I’m not taking it,’ because I’d rather be bad than stupid,” he explains. “Because I wasn’t passing, the popular kids didn’t accept me. So I got in with the bad crowd, where I was accepted. I could end up in jail” (Blau 78). He’s right about jail. Dr. James Satterfield, who followed 110 boys with ADHD symptoms for nine years, found that “as adults, nearly fifty percent were arrested for felonies, and twenty-five percent had been institutionalized at some point for anti-social behavior” (Perkins A1).
         Another popular debate stems from ADHD diagnosis. It seems like anyone reading the symptoms—being fidgety, distracted, disorganized, excessively talkative, and so on—could easily attribute these behaviors to their own child or even to themselves (DSM-IV 306). As Stephen Garber explains in his book, If Your Child is Hyperactive, Inattentive, Impulsive, Obstinate. . ., symptoms “are all diagnosticians have to go by in detecting this disorder” (44). However, clinical diagnosis is far more involved and far less newsworthy. First, and most important, environmental causes must be ruled out (CH.A.D.D. 2). This primary step is usually done informally at school, and if the student fits the profile, his teacher will work with the school psychologist to help that child in the classroom. If the child exhibits pronounced ADHD symptoms, then following informal examination, a clinical diagnosis will be made by either the school psychologist or a physician. The diagnostician must obtain written accounts of the child’s behavior from his teacher and parents. The teacher and parents also must fill out questionnaires about the child’s behavior.
         However, dry facts are just that: dry. What is reported, instead, are claims of over-diagnosis or misdiagnosis. A local newspaper, the Sacramento Bee, for instance, quotes educational psychologist Joan Smith: “Attention deficit disorder is being way over-identified, and that is scary” (Perkins A1). Nowhere in the article are the actual procedures for identification described in detail, which leaves the readers to rely on the quoted experts’ views on the subject. Instead, the article relies heavily on personal opinions that for the most part criticize the diagnostic method or express concern over the ADHD “epidemic” (Perkins A1).
         I only know two people who have been diagnosed with ADHD, and neither is misdiagnosed. When I met Shaun, I was convinced that he had an expensive cocaine habit. He spoke as fast as an auctioneer and had a tendency to interrupt what I was saying if it didn’t come out fluently. I learned that if I wanted to tell him something, I would have to (1) wait for him to take a breath, (2) condense my statement to twenty words or less, (3) make sure not to stutter or otherwise confuse my speech, (4) make sure he was looking at me, and (5) say it all at once without a break. Casual conversation wasn’t possible.
         I can understand how someone with little patience, or even normal patience, might find dealing with Shaun a strain. Many times his interruptions seem rude, as if what I’m saying isn’t important, but I know it’s because I didn’t sufficiently spark his attention at the outset. I learned how to talk to him before he was diagnosed two years ago at age twenty-nine. He doesn’t use the diagnosis as an excuse for his behavior.
         Most people can tune out superfluous sensory stimulation, but people with ADHD find focusing on one thing difficult. Shaun explained to me that when he’s talking to someone, things happening in the periphery draw his attention: “When I talk to people, like I’m talking to you now,” he said, “I get distracted by everything that’s happening around us.” Because of this distraction, sometimes he loses concentration during the conversation. He also becomes easily side-tracked at work: “If someone comes up and asks me a question about something, a lot of times I’ll get so involved with them that I forget what I was doing.”
         Josh I have known for many of his fifteen years. I interviewed him to find out first hand what it’s like to have ADHD as a student. At thirteen, he was diagnosed with Tourette’s Syndrome, an affliction that is characterized by nervous tics, and he has since been diagnosed with ADHD as well. He describes himself as “very, very hyper—I know that I am.” After an hour of “I dunno,” and many digressions, I discovered that teachers “suck” (except for Mr. Waterstreet, the art teacher) and school “sucks.” I also discovered that he is often disciplined for acting up in class: “I get in trouble for being funny,” he said. Many times he’s punished for talking in class, even if he’s not the only one talking. Teachers, it seems, have a preconceived notion about Josh’s behavior, which is one of the downfalls of being diagnosed with ADHD.
         Coincidentally, I tutor at Josh’s high school and had the opportunity to ask a teacher, with some confidence, what he thought about ADHD: “It’s a joke,” he said. “It’s the joke of the department. If I have one in my class, I’d rather send him out than have to deal with him.” Unfortunately, I’ve heard many similar unsubstantiated reports of skepticism from educators who should know better. But I don’t blame them. They watch TV. They read the papers. They know what’s going on.

Works Cited

Blau, Melinda. “A.D.D.: The Scariest Letters in the Alphabet.” New York 13 Dec. 1993: 44.

CH.A.D.D. Attention Deficit Disorders: A Guide for Teachers. Prepared for distribution by the Education Committee of Children With Attention Deficit Disorders. Plantation, Florida, 1993.

Cowart, Virginia S. “The Ritalin Controversy: What’s Made This Drug’s Opponents Hyperactive?” Journal of the American Medical Association 259 (1988): 2521.

Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington, DC: American Psychiatric Association, 1994.

DuPaul, George, and Gary Stoner. ADHD in the Schools: Assessment and Intervention Strategies. New York: Gulford, 1994.

Garber, Stephen. If Your Child is Hyperactive, Inattentive, Impulsive, Obstinate. . . . New York: Villard, 1990.

“Josh.” Personal Interview. 13 March 1995.

Levine, Melvin D. “Attention Deficits: The Diverse Effects of Weak Control Systems in Childhood.” Pediatric Annals 16.2: 117-30.

Perkins, Kathryn. “Some Skeptical of Surge in Attention-Disorder Diagnosis.” Sacramento Bee 5 Dec. 1994: A1.

Safer, Daniel J., and John M. Krager. “Effect of a Media Blitz and a Threatened Lawsuit on Stimulant Treatment (lawsuits and Ritalin prescription).” Journal of the American Medical Association 268 (1992): 1004.

“Shaun.” Personal Interview. 9 March 1995.

Vatz, Richard E., and Lee S. Weinberg. “Overreacting to Attention Deficit Disorder.” USA Today Jan. 1995: 84.

Wallis, Claudia. “Life in Overdrive.” Time 18 July 1994: 42.

Weiss, Lynn. Attention Deficit Disorder in Adults. Dallas: Taylor, 1992.