Hallowell on VG and AH

The following excerpts (in full t e c h n i c o l o r) are from Driven to Distraction (by Drs. Edward Hallowell and John Ratey). I use blue to indicate those parts of Hallowell’s characterization of ADD/ADHD which I associate with the VG, and red for those I associate with the AH.

First, from page 280:

“Where one individual is withdrawn and overwhelmed by stimuli, the next is hyperactive and can’t get enough stimuli.”

This is part of our distinction between VG and AH, but this isn’t the entire picture. Next, on page 281, Hallowell talks about Larry Silver’s interpretation of the neurological difference associated with Attention Deficit:

“In this model, an injured/faulty system in the RAS (reticular activating system) doesn’t screen out irrelevant information and sensory information as well as it should, and the individual is overloaded.”

Then, in the very next paragraph, Hallowell says,

“Another way of understanding ADD is that the person does not receive enough input from the lower areas of the brain to the frontal areas. Thus the distractible, hyper, risk-taking behavior attempts to raise the level of arousal in the frontal cortex”

These two models are oppositional to one another (a maddening feature of modern psychology) - can they both be correct? It appears that Hallowell doesn’t believe that both these explanations are simultaneously plausible. The model that Hallowell most accepts is that ADD/ADHD is the inability to stop receiving messages rather than receiving the wrong messages.

From page 282:

“Instead of... an inability to pay attention to cues,... [the ADDer] pay[s] attention to many more cues... Instead of... an inability to concentrate,.. it [is] an ability to concentrate on everything.”

I claim the source of Hallowell’s misinterpretation is that his (Farmer) medical training says that the there is only one type of Attention Deficit, therefore precisely one model has to be used to explain the problem. The reasoning goes that because the symptoms (i.e., observed ADDer behaviors are very similar, so must be the cause. However, I claim that this can be explained by an analog of the biological concept called convergence (two different species can have very similar traits if they fill analogous ecological niches).

Hallowell says that although the difference may appear semantic, it does couch the condition in more positive (i.e., politically correct) terms, but that’s because it describes the VG and not the AH.

More from Hallowell on page 283:

“[The ADDer] can’t stop the relentless flow of events... Everything runs together unbraked, uninhibited... [T]he verbal rush, the inability to stop the words, and the verbal paralysis or stuttering, derived from the inability to stop the thoughts long enough to find the words. The social intrusiveness... is the inability to stop at the other's boundaries. The failure to form intimate relationships is the inability to pause long enough to listen to the other... The impulsivity, the lack of planning, and the outbursts are the inability to restrain the flow of action and feeling.”

On page 276, Hallowell discusses the connection between ADD/ADHD and right-hemisphere dysfunction:

“The right hemisphere generally controls our... executive or decision-making capacities, our visual-spatial abilities, and our ability to process many sources of stimuli simultaneously. Some specific deficits associated with right-hemisphere dysfunction include topographagnosia (getting lost a lot!) and social-emotional learning disabilities... [R]ight-hemisphere disabilities... sounds... like... patients... losing their keys, always getting lost, never paying attention to the big picture, and never quite understanding other people.

On pages 108-109, Hallowell introduces Sam and Mary who solicited him for marriage counseling:

“Mary began, then paused, as if gathering many thoughts... ‘But what i do mind is that he doesn’t know that I exist. He is so wrapped up in himself that I might as well be a robot. He has no conception of what my inner life is... [T]he man i’m married to doesn’t know me... [H]ow do you tell ADD from being selfish?... [I]sn’t there such a thing as pathological narcissism?... He’s only aware of himself.’”

Hallowell’s reply was:

“Maybe we could look at it a bit differently. He seems only to be aware of himself because he’s constantly being distracted, or he’s being drawn to some form of intense stimulation to avert boredom. ”

With all due respect to Hallowell, I disagree strongly. His explanation of Sam’s behavior could be used to explain the characteristics of the VG. However, Sam is clearly an AH. In contrast, Mary is a wacky VG, but observe that I make no claim that Mary has an attentional deficit.