• Book club: Attention, genes, and developmental disorders

    Coming up for air after election day, I decided to actually tackle something that didn’t involve people screaming at each other about Medicaid, health insurance exchanges, and the rest. By chance, I ran across a fascinating, albeit challenging book, Attention, genes, and developmental disorders, published two years ago by Oxford University Press. It’s by Kim Cornish and John Wilding, two scholars who research the neuropsychology of genetic disorders. I don’t know if I have the chops to seriously engage this volume. I’m finding out by blogging about it.

    Chapter 1 begins with a bravura example, unpacking the complexity of an apparently routine task. Imagine that you go to your local supermarket searching for your favorite yogurt. In your mind’s eye, you know what the container looks like. From experience, you know roughly where it can be found on the store shelves, though the store might have moved the yogurt display since your last visit. Along the way, you may be distracted by a toddler screaming, by running into a friend, by a text buzzing through on your smartphone. You might encounter an especially attractive or frightening person. Once you find that general area, you need to carefully sift through various similar-looking brands to find the correct item. More serious distractions might arise, too. A fire alarm might ring. A fellow shopper might get sick.

    In short, a lot is going on here:

    Searching for an object in the supermarket is not just an exercise in simple problem-solving; it is full of demands on attention in various different senses of that much-used term. Indeed we may say that all successful behavior that is not instinctively preprogrammed or well learned requires selection and organization of a correct sequence of actions from among competing alternatives and hence involves selective attention, maintenance of attention (sometimes called sustained attention) and control of attention.

    As Cornish and Wilding unpack these processes, it becomes immediately obvious that one must clarify what the catch-all phrase attention actually means, and where this multi-faceted process might seriously go awry. This particular book club won’t appeal to everyone. It gives me a nice opportunity to learn-through-explanation about some of the important facets of ADHD, autism, fragile X syndrome, and Down syndrome, as well as two less-familiar ones known as Williams syndrome and 22q11 deletion. This is also useful groundwork for my embryonic book on developmental disability policy.

    This seems unusually narrow for a TIE topic. I believe it still fits our ecosystem. If one wishes to write about health policy in matters of cognitive or behavioral disorders, it’s valuable to know at least a little something about the actual conditions people confront: their etiology, how these are measured, conventional wisdom about the possibility and limitations of treatment interventions.

    Anyway, we’ll see how this goes. If you are an expert in these matters, I especially hope that you will participate and comment.


    • I am an expert in long-term services and supports, but not developmental disability. Frankly, I can think of nobody who has significant expertise in both. This means that I am looking forward to that book on DD policy when it comes.

      The Wikipedia page on attention (the psych concept) is a reasonable starter for what I think these researchers mean. Briefly, I think the authors are defining attention as the cognitive process of selectively concentrating on one or some aspects of the environment, and ignoring others. There’s also the concept that our brains have a limited amount of resources with which to process external stimuli or internal thoughts, and attention is linked to the process of allocating those resources.


      And I have a friend with a developmental disability (brain tumor at young age), and you can definitely see significant deficits in her attention, broadly defined. And traumatic brain injuries would usually affect attention more than memory.

      In contrast to attention, I’d suspect that dementia primarily affects memory to start, not attention – although with severe dementia, maybe attention is affected as well. Dementia, of course, is the primary concern in LTSS policy for older adults.

    • The intersection of arenas of knowledge involving healthcare are profound, as you intimate with this Post. The partnering of this post and the other post identifying the local mortality patterns within our country inplies a need to consider justice as a key attribute for healthcare reform. I have begun to read “Health Justice” by Sridhar Venkatapuram published last year. His view of justice for healthcare is particularly important since it is a definition based on a person’s capabilities. What then are the elements of healthcare that are necessary to provide the justly accessible health care based on each person’s capabilities? We have a very arduous task ahead. See: “Small Primary Care Practices Face Four Hurdles–Including a Physician-Centric Mind-Set–In Becoming Medical Homes” Paul Nutting et al, HEALTH AFFAIRS, November 2012. It highlights the historical evolution of Primary Physicians as they adapt to the work realities triggered by their training and the greater healthcare industry.