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Attention, as a physiologic parameter, has been generally defined by the response of clnical observations to medications.


The broader notion of attention has also been filtered through the experience of patient's parents, who have children that have school difficulties.


If school performance becomes the defining feature of attention, then attention is a social parameter, in that schools have a social function.


One might make the argument that schools have a philosophical or existential function,


In other words, that schooling, as Plato (and presumably Socrates) argued, had an edifying effect on humans. However, in an industrialized world, schooling is a social and economic event. Based on that, it is hard to make an argument that a child who simply dislikes the topics in school has a loss of attention in such a way as to be a clnical finding. The arguments of most teachers, parents, pediatricians, and child and adolescent psychiatrists about attention on this basis is spurious.


If we think of a disturbance of attention, however, as an affective disturbance in which something which the child wants is present, but the child is unable to attend to it, then we have a reasobnable argument.


This is not dissimilar to the effect of depression in disturbing the hedonic response to a preferred stimuli (such as food, sleep, drink, pleasureable social and familial actiivites, recreation, art, leisure, and avocational activities).


The depression results in a prolonged loss of response, and the ADHD then results in a short diminishment of response, which can then re assert itself.


For this reason, this model of ADHD not only requires a better definition of the affective process, but also an understanding of the affective process as a biological event and then, the implications of that for ADHD, as, again, a biological rooted phenomena.


This also allows us to see the difference between ADHD and other forms of lapses of attention.


For instance, we can then notice that depression, dementia, anxiety, hypomania, delirium, autism, intoxication, and psychologic disturbances or illnesses cn all be in the differential when ADHD is suspected. Thus, ADHD and any attention deficit disease needs to be clearly found as a diagnosis of exclusion. Anxiety, depression, developmental disability, and psychologic illnesses all need to especially be considered.


It has not been shown that the apparent occurence of attention defiict diagnoses are a product of other than inadequate diagnosis and treatment in the rushed and impoversihed treatment settings of publically financed clnics and hospitals.

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