Truly unhappy is the person who is unable to concentrate on anything. According to the English writer Emma Barker, concentration is the key to strength. Mature and strong, we rightly consider the one who knows how to calmly, businesslike, without fussing and not being distracted by trifles, solve the problems that confront him.
Of course, a person does not acquire this ability immediately. A small child is impulsive by nature, his behavior is subject to momentary impulses and incentives. Growing up, he learns to «control himself», plan his behavior, refrain from hasty steps that distract from a serious goal.
However, not everyone manages to learn this. Another child, ceasing to be a cute fidget, becomes in the eyes of others “restless”, and even “unbearable”. He behaves inappropriately, studies badly, and it is no wonder that his life turns into hell, because he is not able to solve a single problem properly.
The problem of hyperactivity is as old as the world, although serious scientific research in this area began a little over a quarter of a century ago. As if making up for the accumulated deficit, experts from various industries began to explore and discuss what previously seemed unimportant and banal. Specialized journals appeared, international scientific conferences on hyperactivity began to be held annually (the last one took place in May last year in Salzburg). The phenomenon of «bad behavior» has turned into a pathological syndrome that needs adequate diagnosis, treatment and correction.
But what is really behind it?
For many years, increased excitability and inability to concentrate were considered a natural feature of age. Teachers of the past wrote about the «violent temper» and «wild playfulness» of the child, which must be pacified through education. Education itself was considered by many as instilling discipline in a child: teach your son obedience and then you can easily teach everything else. If the desired result could not be achieved, such failure was attributed to difficult-to-explain individual character traits, as well as omissions in education, which was probably not strict enough.
The transition to mass schooling forced us to consider this issue more carefully. Special categories of children who do not cope well with educational activities were identified. Traditional forms of upbringing and education turned out to be ineffective here, therefore, such students began to be called exceptional (in a negative aspect), emphasizing the painful nature of their mind and character.
Study history
The French authors J. Philippe and P. Boncourt in the book “Psychic Anomalies Among Students” (translated into Russian, the book was published in 1911) among “mentally abnormal students”, along with retarded, epileptics, asthenics, hysterics, singled out and so called unstable students. Their description is so recognizable that any modern practitioner can easily supplement it with specific examples:
“Schools first classify the unstable as unruly. This banal name remains with them until the educator notices that all their behavior has a painful origin. These disciples do not tolerate any guidance, because they cannot keep up with it. Their physical mobility is downright amazing: they never sit in one place and every minute jump up from the table for no reason. When playing, they quickly move from one game to another. Their mental mobility is no less: as soon as they start reading, they already want to write and count.
The authors also note: “We should not forget about two types of undisciplined: one is conscious, spontaneous … the other is painful. The type we have described has a painful basis, namely, a pathological state of the nervous system. These are the sick… In the interests of the future of such children, they must be influenced by medical and pedagogical methods at the same time.
The medical techniques that have been used in such cases are well known. These were general strengthening physiotherapeutic procedures — not useful, but extremely ineffective in pedagogical terms, as well as drugs with a calming or, in other words, inhibitory effect. As for pedagogical methods, J. Philippe and P. Boncourt, without much enthusiasm, characterize them as follows: “ Only an experienced educator, accustomed to adjusting his teaching to the mental capacity of his students and giving it in strictly measured doses, manages to maintain for some time the ever-moving and scattered attention of such students. But even then, even the student soon forgets everything, and in order to drive any concepts into his unstable brains, one has to constantly resort to repetition and hammering (martellement). Hence the need to confine ourselves to the most elementary, without covering too extensive a field of study.
Domestic approach
In the domestic psychological and pedagogical science, attention was also paid to hyperactivity, but by no means paramount. Thus, the famous psychiatrist V.P. Kashchenko singled out a wide range of character disorders, to which, in particular, he attributed “morbidly expressed activity”. In his posthumously published book “Pedagogical Correction” we read: “Each child is characterized by mobility, both bodily and mental, that is, thoughts, desires, aspirations. This is his psychophysical property, we recognize as normal, desirable, extremely sympathetic. A strange impression is produced by the child being lethargic, inactive, apathetic. On the other hand, an excessive thirst for movement and activity (painfully expressed activity), brought to unnatural limits, also attracts our attention. We then note that the child is constantly in motion, cannot sit still for a single minute, fidgets in place, dangles his arms and legs, looks around, laughs, amuses himself, always chatting about something, does not pay attention to comments. The most fleeting phenomenon escapes his ear and eye: he sees everything, hears everything, but very superficially … At school, such painful mobility creates great difficulties: the child is inattentive, naughty a lot, talks a lot, laughs endlessly at every trifle. He is extremely scattered. He cannot or with the greatest difficulty brings the work he has begun to the end. Such a child has no brakes, no proper self-control. All this is caused by abnormal muscular mobility, painful mental and general mental activity. This psychomotor increased activity then finds its extreme expression in a mental illness called manic-depressive psychosis.
Kashchenko attributed the described phenomenon to «character flaws, due mainly to active-volitional moments», also singling out the absence of a specific goal, absent-mindedness, and impulsiveness of actions as independent shortcomings. Recognizing the painful conditionality of these phenomena, he offered mainly pedagogical ways to correct them — from specially organized physical exercises to the rational dosing of educational information to be mastered.
It is difficult to argue with Kashchenko’s recommendations, but their vagueness and generality raise doubts about their practical usefulness. “It is necessary to teach the child to desire and to carry out his desires, to insist on them, in a word, to fulfill them; for this it is useful to give him problems of varying difficulty. These tasks should be available to the child for a long time and become more difficult only as his strength develops.
This is undeniable, but hardly sufficient. It is quite obvious that it is not possible to solve the problem at this level.
Over the years, the impotence of pedagogical methods for the correction of hyperactivity has become more and more obvious. After all, explicitly or implicitly, these methods relied on the old idea of the flaws in education as the source of this problem, while its psychopathological nature required a different approach. Experience has shown that the school failure of hyperactive children is unfairly attributed to their intellectual disability, and their indiscipline cannot be corrected by purely disciplinary methods. Sources of hyperactivity should be sought in disorders of the nervous system and, in accordance with this, corrective measures should be planned.
Causes
Research in this area led scientists to the conclusion that in this case, the cause of behavioral disorders is an imbalance in the processes of excitation and inhibition in the nervous system. The «site of responsibility» for this problem was also localized — the reticular formation. This department of the central nervous system is “responsible” for human energy, for motor activity and the expression of emotions, influencing the cerebral cortex and other overlying structures. Due to various organic disorders, the reticular formation may be in an overexcited state, and therefore the child becomes disinhibited.
The immediate cause of the disorder was called minimal brain dysfunction, that is, a lot of microdamage to brain structures (arising from birth trauma, asphyxia of newborns, and many similar causes). At the same time, there are no focal brain lesions. Depending on the degree of damage to the reticular formation and disturbances in the nearby parts of the brain, more or less pronounced manifestations of motor disinhibition occur. It was on the motor component of this disorder that domestic researchers focused their attention, calling it hyperdynamic syndrome.
Anatomy of Hyperactivity
In conventional science, mostly American, special attention was also paid to the cognitive component — attention disorders. A special syndrome was identified — attention deficit hyperactivity disorder (ADHD) — Attention-Deficit Hyperactivity Disorder (ADHD).
A long-term study of this syndrome made it possible to identify its extremely widespread prevalence (according to some reports, it affects from 2 to 9,5% of school-age children worldwide), as well as to clarify the data on the causes of its occurrence.
Various authors have tried to link childhood hyperactivity with specific morphological changes. Since the 70s, the reticular formation and the limbic system have been of particular interest to researchers. Modern theories consider the frontal lobe and, above all, the prefrontal region as an area of anatomical defect in ADHD.
Concepts of involvement of the frontal lobe in ADHD are based on the similarity of clinical symptoms observed in ADHD and in patients with lesions of the frontal lobe. Patients in both groups showed marked variability and impaired regulation of behavior, distractibility, weakness of active attention, motor disinhibition, increased excitability, and lack of impulse control.
The decisive role in the formation of the modern concept of ADHD was played by the work of the Canadian researcher of the cognitive orientation Douglas, who for the first time in 1972 considered the attention deficit with an abnormally short period of its retention on any object or action as a primary defect in ADHD.
In clarifying the key characteristics of ADHD, Douglas, in her subsequent work, along with such typical manifestations of this syndrome as attention deficit, impulsivity of motor and verbal reactions and hyperactivity, noted the need for significantly more than normal reinforcement for the development of behavioral skills in children with ADHD. She was one of the first to come to the conclusion that ADHD is caused by general disturbances in the processes of self-control and inhibition at the highest level of regulation of mental activity, but by no means by elementary disorders of perception, attention and motor reactions.
The work of Douglas served as the basis for the introduction in 1980 in the classification of the American Psychiatric Association DSM-IV and then in the ICD-10 classification (1994) of the diagnostic term «attention deficit hyperactivity disorder».
According to the most modern theory, dysfunction of the frontal structures may be due to disorders at the level of neurotransmitter systems. It is becoming more and more obvious that the main research in this area belongs to the competence of neurophysiology and neuropsychology. This, in turn, dictates the appropriate specifics of corrective measures, which, alas, remain insufficiently effective to this day.