Randall Neustaedter OMD, LAc, CCH
The Issue of Attention
How does a child pay attention, focus, and concentrate persistently on tasks? What constitutes the norms of attention? What are the cultural expectations projected on children? How do these effect the child’s view of herself? How do attention functions intersect with other issues in a child’s life? What is the homeopathic view of attention issues and how should the homeopathic treatment be integrated with other approaches?
Attention as an issue has become a focus for our culture in recent years. Although the allopathic treatment of attention problems has not changed much over the past quarter century, the amount of interest in this field has grown tremendously. In fact there is now an entire industry devoted to attention problems with departments in University medical centers and their affiliated programs dedicated to treating this supposed disorder. The identified syndrome has an official allopathic diagnostic name, Attention Deficit Disorder with or without Hyperactivity (ADD and ADHD). Children are labeled with the disorder, the pharmaceutical industry supports research on the various corresponding drugs, scholarly books are written on the subject, huge parent support groups have formed, catalogues of educational materials are published specific to this disease, and regular conferences are held on the disorder.
My fundamental assumption is that children are naturally inquisitive, explorative, demonstrative, and sensitive. If this is the natural state of a child, then an environment which confines the child in some way is contrary to her fundamental nature. Although children are expected to learn certain rules of social interaction and respect others in their environment, it is not reasonable to expect that most children will thrive in an environment as restrictive and stultifying as a classroom. Admittedly, there are some schools that respect the individual child and her learning style, providing opportunities for creative discovery and freedom. The majority of schools, however, demand that children conform to more or less rigid expectations for behavior and punish any significant deviations. The truly amazing thing about this is that parents tolerate it.
A child may choose one of several styles of reaction to a classroom that suppresses her fundamental nature. Often children learn to repress their natural inclinations and seek styles of behavior that will win them praise and recognition. When a child chooses some other reaction, such as rebellion, or simply cannot repress a natural exuberance for learning and social interaction, then the whole industry of academic disciplinarians, psychologists, and physicians is brought into the game. A child reacts to all of this with typical and predictable behaviors and emotions which are studied, dissected, and treated. I say all of this to place the blame for these symptoms squarely where it belongs, on the child’s environment. Some children, of course, do have a state of imbalance and express symptoms prior to entry in school. Many infants and preschoolers are in need of homeopathic treatment for an imbalance that manifests as temperament extremes and behavioral symptoms which have a variety of causes, chemical, environmental, miasmatic, and spiritual. Often parents can cope with these symptoms and develop a sensitivity to their child’s individual nature that promotes their growth, development, and healing. Then when they hit the environment of school with its unusual expectations that the true conflict arises. Then the child’s nature is pitted against the school in an unfolding drama.
The irony is that the ADD industry sees itself as humanizing the treatment of children. Instead of blaming children for their antisocial behavior, this new field seeks to identify a disorder that underlies the symptoms. The problem is that like most allopathic diagnostic entities, ADD does not exist. The identification and labeling of ADD provides a mechanism for its chemical investigation and chemical treatment. It is the typical allopathic paradigm, first identify a theoretical disorder through observation of symptoms, then observe the chemical nature of this group of patients, then treat the chemical problem with chemicals. This process conforms easily to the model of double blind studies because of its reductionist nature. And now we have drugs that allow children to sit in a stultifying classroom. This is not like science fiction, it is science fiction.
Our culture expects conformity, rational behavior, and a predictable civilized style of being. Any deviation from that mode is usually seen as threatening, eccentric, and cause for concern. Consider the nature of an attention problem in children residing in a tribal village in the upper Amazon, or the Kalahari plains. This may place in context our own culture’s rigidity. The more a culture values self-exploration and harmony with the forces of the multidimensional world around us the less use we will have for diagnostic terms like ADD. A child who focuses only on what is personally compelling, say the formations of clouds or the nuances of mechanical motion, may be more in touch with reality than we realize. What an incredible disservice we provide to our children when we deny their true nature and yearnings and force them to sit with worksheets in kindergarten and provide them with lifelong tedious intellectual exercises. How can we ignore our children’s repeated statements that they hate school? When they are distracted by the world around them, impulsive in their pursuit of creative ideas, and craving active exploration of the world and their own innate urges they are given a diagnosis. This condescending attitude gives a clear message about what we value. The child receives the message that she needs to be fixed. Parents become convinced that something is wrong with their child. Then the child’s fundamental way of being in the world is seen as a disease. This is insanity.
Understand the Child
Children who come for homeopathic treatment with these types of symptoms, attention and behavior problems, are either already in trouble with school or just disruptive enough to the family so that their parents seek help. Sometimes the homeopath will discover a problem in this realm when the parents seek care for something else such as allergies or recurrent ear infections. The homeopathic case depends upon detailed description. The choice of a remedy hinges upon the essential nature of the child as well as the subtle character of symptoms. It is helpful to separate the description into the classical homeopathic categories, mental, emotional, and physical.
The assessment of the cognitive realm in a child’s case should always include attention functions and the issues which intersect with attention, especially the associated emotions. The twelve areas of attention and intention functions are summarized in Table 1. It is helpful for me to keep these areas in mind when interviewing the parents and the child, focusing on those specific functions which are relevant in the case. It is important to keep these functions in perspective. For example, motor control is a relative issue. Some children find it impossible to keep still and this interferes with their ability to fall asleep, to read, and to get a haircut. Other children are just very active and their parents describe them as a handful because they require so much chasing after. The homeopath should evaluate how limiting a symptom is for the child’s life and how dramatic it is. This will determine what emphasis it should have in the differential remedy decision process. Once these areas of attention are brought into consciousness and clarity for the homeopath, the degree of weight that each should have in the case is usually self-evident. Some functions such as sensory control, or associative control, or the level of a child’s distractibility may not be visually obvious to the homeopath or the parents and could be an underlying cause of attention problems. Asking about distractible tendencies, daydreaming, spacing out, or losing the train of thought in academic work are useful realms to pursue in order to develop a complete case and treatment plan.
TABLE 1: Attention and Intention Functions
Focus and Concentration
Focal strength and quality (attention to salient detail)
Feedback responsiveness (self-monitoring and self-correction)
Sensory control (auditory and visual distractibility)
Appetite control (insatiability; distracted by desires)
Social control (distracted by peers)
Behavior or Intention
Motor control (overactive)
Behavior control (disruptive; aggressive)
Reflectivity-impulsivity (forethought and planning)
Associative control (daydreaming)
A detailed description and understanding of attention in each child’s case will facilitate finding the right remedy and developing an overall plan for approaching behavioral problems. The child with externalizing, aggressive, demonstrative, and intense behaviors may present quite a confusing picture making it difficult to sort out the various issues involved. Approaching the case in an organized way evaluating attention functions, emotional reactions, and family issues will help to develop clarity. Similarly, the introverted, internalizing, withdrawn child who chooses not to reveal much may be a difficult case. It is helpful here as well to understand the roles of attention problems, emotional reactions, and the environment within the child’s constellation of symptoms such as spaciness, depression, and avoidance of family conflicts. These areas of assessment are summarized in Table 2.
TABLE 2: Assessment Areas
(1) Attention and Intention (behavior)
(2) Emotions and behavior
(3) Family dynamics and the family’s reactions
(4) School issues
Attention and emotions have an intimate relationship. Firstly, some attention functions such as social control, reflectivity-impulsivity, and behavior control may directly involve the expression of emotions. For example, a child who is exuberantly impulsive may blurt out all kinds of emotional reactions, some of which may be genuinely comical and some of which may get her into trouble with others who feel offended or angered. This can wreak havoc on one’s social life. An inability to control behavior can turn friends into enemies, upset the delicate social balance of a peer group, and result in ostracism and bewilderment. Secondly, children react emotionally to their attention problems. This is especially the case when they receive negative feedback. An active, impulsive child who is constantly told, “no, don’t do that” will eventually develop emotional reactions to this negative feedback from the environment. She is likely to think, “nothing I do is right” and become depressed, hostile, or resentful. This is only natural, but it is useful for the homeopath and the parents to understand the source of these emotional reactions. Sorting out the issues can be a first step in resolving the causes and arriving at the correct remedy. After all, from a homeopathic perspective it is extremely important to know about resentment and indignation in a child’s case. The fact that these natural emotional reactions and the attention symptoms themselves exist is important to know, but they are not a disease, a syndrome, ADD, or any other entity.
The family dynamic is another important area that intersects with attention functions in a child’s case. Some behaviors may serve to protect or encourage certain family interactions. The dynamics of the family may be perpetuating the problem, focusing on the child as the carrier of the family’s illness. Curing the child with a homeopathic remedy may upset this balance and the child could feel responsible for the resulting disharmony. Or the family’s need to keep the child’s symptoms may be so strong that it presents a true obstacle to recovery for the child. A vast array of family problems may be associated with a child’s case and it is wise to examine them in order to understand the whole picture. On the other hand, once a family understands the true nature of a child’s problem, then the parents can often rally to the child’s aid and bring about solutions on many fronts.
The school issues cannot be neglected in assessing a child’s attention and behavior symptoms. If the noxious classroom situation is the major contributing cause, then this is a force to be reckoned with. If the child is absolutely unsupported for who she is by her environment, then the prospect for cure is rather bleak as long as the situation remains the same. Parents may have significant ability to change the school setting, either by moving the child to a school that is a better fit or by influencing the teacher to change her style of relating to this child. A supportive, caring, and responsive teacher can often work wonders in a situation that has previously been irresolvable. On the other hand, a deeply disturbed school situation which is suppressive and antagonistic to the child’s best interests can elicit a tremendous response. Children may be put into survival mode with the resultant fear, hostility, defensiveness, and violence that the situation warrants. Putting metal detectors at school doorways may prevent shootings at school, but it does not solve any problems for the kids.
The development of a plan for children depends upon an understanding of the entire case. This may be accomplished by several professionals working in a coordinated effort or the homeopath may undertake this himself.
Description and Metacognition
Some level of educational effort for the parents (and for older children) is essential. There is so much propaganda and cultural judgment about these symptoms and supposed ADD that parents need to understand what is truly occurring. It is helpful for the homeopath to describe what he sees. Placing the symptoms in perspective for parents can stimulate a point of awareness in them that sparks a process of cure. For example, if parents understand that a child’s impulsive style is the very nature of the creative process and that most breakthrough ideas are impulsive, then they can achieve a deep appreciation for their child’s exuberance which has previously been so frustrating for them. This can lead them to develop ways to enhance and enrich their child’s experience of her own impulsivity. The cure then lies within the awareness. Then their understanding becomes a spark to develop solutions which can take the form of enrichment, bypass strategies, and advocacy in the school system. When parents see the child’s emotional reactions to frustration in their true light, then they can take steps to correct the situation rather than continue in their own emotionally charged responses to the child.
This metacognition can occur in the child as well. As soon as a child is told, possibly for the first time, that distractibility is a tremendous advantage, then she is freed from her previous negative enforcement about it. Distractibility and hyperattentiveness to the environment can lead to constant discovery and personal evolution. Daydreaming can open the doors to dimensions that are hidden behind the mind’s limiting control mechanisms. If creativity and intuitive understanding are the keys to reality, then a child with free ranging association is at a distinct advantage for the process of discovery. The problem is that these qualities are usually only admired in accomplished adults who have rejected many of society’s values. Our culture is so intent on rationality as the most valuable commodity of mind that children’s creativity is constantly suppressed. Those qualities that foster natural creative expression deserve our recognition. A child who feels this admiration for her true nature will blossom. Then areas of attention that are weak can be addressed. But they must be seen in perspective and the child must feel validated for who she is as a creative being.
The Homeopathic Medicine
The correct constitutional homeopathic remedy can free the child. This is especially true in the area of attention. Since attention problems reflect an imbalance in the body, they will usually normalize under the action of a remedy. For example, in a child who cannot remain still long enough to focus on a task, the homeopathic medicine will enhance the natural ability to calm the mind and willfully bring motor activity under control. This is an ability that a homeopathic medicine encourages in the same way that immune system function improves after homeopathic treatment. For a homeopathic medicine there is no difference between mental mechanisms and physical functions.
Attention problems or dysfunctions that truly limit the child’s freedom and prevent learning are important keys to the mental aspect of the homeopathic case. These may involve any of the twelve areas listed in Table 1. The homeopath’s job is to discern the problem areas, evaluate their importance in the case, and use them as building blocks in the construction of the rationale for the remedy. This will depend upon the same considerations as any other symptom. If an attention dysfunction is intense and extremely disruptive to the child’s well-being and efficiency, then it should have a prominent place in the differential process leading to the remedy. Therefore, if a child’s behavior controls her and causes suffering and discomfort, then it needs to be addressed with a remedy. A child with a severe sleep-arousal imbalance who cannot get to sleep at night, whose sleep is disturbed, and who falls asleep in class needs a remedy covered by these rubrics and their detailed modalities. A child who cannot stop moving will usually have such a dramatic presentation in this activity realm that the class of Tuberculinum, Veratrum, Tarentula remedies will immediately suggest itself to the homeopath’s mind. The differential considerations will occur in the nature of the psychological presentation, for example, the haughtiness and philosophical curiosity of Veratrum, or the typical physical characteristics, the knee-chest sleep position and head sweats of Tuberculinum. This amounts to the integration of attention issues into the technical repertorization and hierarchy of the case.
The emotional overlay in children who have these problems becomes more complex. This is when it is important that the homeopath derive a sense of the cause of emotional symptoms. If the emotional symptoms originate in the child’s refusal to participate in an abusive environment, then this aspect of the emotional case should be recognized as a healthy reaction. If a child’s sadness and poor self-esteem arise from an inability to recognize social cues and a dullness in response to social stimuli, then this aspect of the case may have primary significance and lead to remedies in the Baryta-carbonica, Causticum, Natrum-muriaticum realm.
Several issues within the homeopathic case warrant some discussion in relation to children with attention problems. These children often have extreme temperament characteristics which are difficult for parents to accept. A child who as an infant was colicky and screaming, as a toddler threw temper tantrums, and during the school years is intense, negative, resistant, and disruptive creates a challenge for parents and homeopath. These kids make parents fear for their lives during the teen years. The homeopath is challenged by all of this energy these children generate. It is important that the child see the homeopath as an advocate who understands her difficulties. This will lay the foundation for communication about symptoms that is so essential to homeopathic prescriptions. The prescriber is challenged by the parents’ frustrations and the child’s confusion. This makes it difficult to know when to repeat or change remedies. Maintaining open communication about the issues involved in repetition or change in remedies will elicit parents’ help in this decision process.
The ideal in constitutional prescriptions for these children is the single remedy which works at a curative level for months or years. Miraculously, this occurs in a large percentage of children’s cases. Sometimes, however, flexibility in the prescribing approach is necessary for children who are constantly confronted with the stresses that trigger symptoms. These children often are so energy intensive that they seem to require more frequent repetition of a constitutional that seems to burn out. Other creative prescribing approaches may be needed as well, such as daily dosage of a remedy that corresponds to an especially resistant attention symptom. Constitutional remedy pictures may also change as these children seem to metamorphosize like plastic from one behavior pattern to another.
In a situation where remedies relieve behavior symptoms for a time only to have them reappear in the same or a slightly altered form, the homeopath should also consider that the underlying emotional issue has not been addressed by the remedy. This may be due to a lack of clarity in the homeopath’s view of the case which needs to be reconsidered. It may also be due to a continual external force that is causing symptoms. A homeopathic remedy will not solve problems that are caused by the child’s current environment. It may render the child more resistant to the stress of the environment in the same way that a homeopathic remedy will raise the threshold to environmental allergens. But it would serve the child’s best interests to attempt to relieve the obstacle to cure, in this case the school.
The most difficult aspect of attention problems is not understanding the child, but coping with the artificial environment of school. This is because the child is infinitely flexible and schools are structurally rigid. Parents must be vigorous advocates for their child. What is a parent to do when confronted with a system dedicated to negating a child’s way of being in the world, a system that enforces drugs for children? How can a parent combat the horrific message that the child must take drugs in order to conform to the system? What bizarre message does a child receive who is prescribed the sanctioned psychoactive drug for her attention problem and then told by the same system that other drugs used on the street for coping with the cultural imperatives are forbidden? Is it any wonder that these children are alienated? They had better be, or how could they survive?
The best that parents can do is to get whatever concessions of humane treatment they can from the school system since the teachers and administration are often determined to treat the child in some way or other. If the child is to remain in school, then perhaps a determined parent can make the experience a bit more tolerable. Parents can suggest alternate styles of educational approaches to the teacher that may fit this child of theirs a little better. After all, who could know this child better than her parents? Suggestions that will make the teacher’s life easier are often readily accepted, especially if they are simple and offered in a spirit of cooperation. For example, a child with auditory distractibility will benefit from frequent repetition and reinforcement with written lesson plans and material consistently presented in a visual format.
These kinds of bypass strategies that seek to avoid the weakest areas of attention will usually enable children to process more efficiently. Other useful techniques include sitting the child closer to the teacher, and developing a code system for the teacher and student to use for communication about attention issues. For example, when the teacher senses that the student’s mind seems to be wandering, then she can bring her back to the task with a gentle touch on the shoulder. These types of communication devices can be established at a meeting with parents, student, and teacher. Many teachers will respond to an open and positive approach to solving these attention issues, although each teacher will have a limit as to how far they are willing to put themselves out for an individual child, especially one who has already managed to consume what seems like inordinate amounts of classroom time already. A preventive approach is often useful. Get to each teacher in September and communicate about the best learning styles that seem to work with this individual student. This pro-active approach may be met with receptivity.
The best situation is one where the teacher understands the limitations of the system and is willing to approach the problem with an open mind. Then creative solutions can be found through flexibility. Allowing an active child to learn while moving around the classroom, sending her on frequent errands to the school office, or appointing her to coordinate field trips and other activities will focus the student’s energy on tasks that liberate her kinetic energy. There are hundreds of these types of interventions contained within the literature dedicated to attention problems. But these attempts to make a terrible situation a little better are superficial and palliative in nature. If the problem lies in the foundations of our educational system and its basic assumptions, then only a revolutionary change in these institutions will begin to correct the situation.
I will conclude by quoting two passages from Howard Gardner’s recent book on education which describe the state of affairs now and a glimpse of the future (The Unschooled Mind, 1991).
“Attendance in most schools today does risk ruining the children. Whatever significance schooling might once have held for the majority of youngsters in our society, it no longer holds significance for many of them. Most students (and, for that matter, many parents and teachers) cannot provide compelling reasons for attending school. The reasons cannot be discerned within the school experience, nor is there faith that what is acquired in school will actually be utilized in the future….Much if not most of what happens in schools happens because that is the way it was done in earlier generations, not because we have a convincing rationale for maintaining it today. The often-heard statement that school is basically custodial rather that educational harbors more than a grain of truth….
“If we are to configure an education for understanding, suited for the students of today and for the world of tomorrow, we need to take the lessons of the museum and the relationship of the apprenticeship extremely seriously. Not, perhaps, to convert each school into a museum, nor each teacher into a master, but rather to think of the ways in which the strengths of a museum atmosphere, of apprenticeship learning, and of engaging projects can pervade all educational environments from home to school to workplace. The evocativeness and open-endedness of the children’s museum needs to be wedded to the structure, rigor, and discipline of an apprenticeship. The basic features I have just listed may assume a central place in educational environments that span the gamut of ages from preschool through retirement and the full range of disciplines.”
When educators are willing to change their approach to children and use methods that encourage learning instead of simply feeding our children information, then the system will adapt to the individual needs of students. These educational methods exist now. It is up to our schools to institute programs that allow learning to take place in all children. Only a fundamental shift in consciousness will solve the attention dilemma. Society must listen to what these students are saying. As usual with homeopathic understanding, the symptoms speak. They communicate the fundamental imbalance in the system and call for its cure.
Dr. Neustaedter has practiced homeopathy and oriental medicine for over 25 years, specializing in child health care. An accomplished and well-recognized author, he has written The Vaccine Guide: Risks and Benefits for Children and Adults (North Atlantic Books, 2002), a book that helps consumers make informed choices about vaccination. His new book, Child Health Guide: Holistic Pediatrics for Parents (North Atlantic Books, 2005), represents a state of the art guide to raising children with natural medical care. He can be reached through his extensive website at www.cure-guide.com.