Abstract
This paper dwells on the question of how we can enhance perspectives on the enhancement of attention in children. By shifting the neuro-enhancement of attention debate from the field of (pediatric) biomedicine into the area of philosophy of technology of control and philosophy of attention, I render two concepts operative for the neuroethical debate on enhancing children’s attention in self- melioration: control and autonomy in attention enhancement. The shaping of a self entails three things: First, individual work on personality traits. Second, the cultural notion of collective formation in a world shaped by others. Third, it includes self-melioration (Selbstverbesserung) that contains both terms of self-formation and Kipke’s narrow account of Neuro-enhancement. Concerning attention enhancements in children music enrichment as well as mathematical skill-formation will be analysed briefly.
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Notes
- 1.
When the term “neuro-enhancement” is used, it usually deals with mood improvements (and the change in the existential self-feelings of being), prosocial behaviour (trust) increase and (affective) cognitive enhancements such as sustained attention, executive function, working and episodic memory (cf. de Jongh et al. 2008: 773), reasoning and intelligence “enhancements”. The classical view on neuro-enhancement entails a sense of “performance enhancements” or augmentation of possibilities of mental functions. Hence, even the idea of “moral enhancement” of moral judgement and decision-making and taking moral action is part of neuro-enhancement.
- 2.
In my view bio-conservative conjectures, as proposed by Habermas (2001), have to be opposed. Instead of following prohibitive bio-conservative positions, we ask more openly if enhancement, as well as its overcoming and transcending status quo states, can be defined as part of human techniques. These techniques include the development and progress of biomedicine and not just off-label (enhancement) uses of medical technology and devices. Besides off-label uses of drugs, as well as medical healing, social, personal and bodily well-being and quality of life (Lenk 2011: 120), methodological advances and progress in the treatment of deficit states (and its medicalisation) of the embodied mind have to be accounted for in attention enhancements of children. The betterment of children’s cognitive capacities such as attention should not only be treated in a framework of Medical Enhancements (cf. Gordijn and Chadwick 2008: 1–5). Hence, this paper does not adhere to a dichotomic view of treatment versus enhancement. Nevertheless, it acknowledges the practical importance of a case-to-case distinction led by the determination of the severity of need to treat a disorder or a deficit state—that I would call for restorative therapeutic enhancement for repair—first before any other reasons for enhancement in order “(…) to protect the just allocation of resources according to need” (McKeown 2017: 193).
- 3.
Cf. Erik Parens (2014: 5–6, 31–44) binocularity view in “Shaping Ourselves. On Technology, Flourishing and a habit of thinking” that suspends judgement for the complexity of the issue of enhancement at stake and resists as long as possible to choose sides in bioethical debates to let converging views be able to foster a dialogue.
- 4.
Only an attitude that takes into account enhancement of cognitive attention modes and functions in the sense of being a proven enhancer, in the long run, seems the inevitable choice when dealing with children and adolescents. Without giving new technological means and devices a try starting from a state of uncertainty, especially if we have reason to believe that it is enhancing cognitive capacities and that it should not have side effects, we will not get data on its use and know about tested positive or unpredictable negative results. In this sense, it is impossible to advance new technology without a position that can be called in dubio pro techné. But in the case of children, the precautionary principle should prevent us from applying new emergent technologies to children, before having tested them sufficiently in adults as the first to enhance themselves and to conduct risk assessments. Before children apply any new enhancement device onto their brains in development, we should have evidence-based adult studies about the safety and longitudinal effects. Even though this position might imply the problem of paternalism/adultism, I would defend the case of new enhancement devices for children, as long as we do not have proof of safety standards from longitudinal adult studies. Wearable external devices are clearly favoured over devices that have to be implanted.
- 5.
Cf. Gerner 2017. A specific case of collective human enhancement would be the schooling and university system for the improvement of cognitive and social enhancement or techniques of socialisation: although a schooling system does not necessarily already include the Enlightenment ideas of general access to knowledge and education for moral progress (moral enhancement), in my view it is nevertheless based on ideas of education as sustainable development to overcome—at least in a certain degree—imperfection (cf. Michael Sandel’s (2004) case against perfection). Moral enhancement does not automatically imply a perfectionist normative ideal of child-rearing; for an instance against comprehensive enrolment of children (Clayton 2006, 2011) in which autonomy of children in the sense of independence is defended against perfectionist child rearing, see Clayton 2015; critical Bou-Habib and Olsaretti 2015.
- 6.
In the case of memory systems, this leads us to shortcomings to fullfill the task of clarifying cognitive memory enhancement in general as an insufficiently vague endeavour, unless considering concrete ethical and practical implications of precisly the prepersonal underlying multiple memory subsystems—for instance, the autobiographical memory, working memory, semantic memory and procedural memory—and their behavioural expressions, as well as the different brain structures involved.
- 7.
In relation to “noninvasive” brain stimulation (NBS), Luber (2014) defines a zero-sum game as follows: “The zero-sum conception thus makes sense when the NBS is causing a change in a limited capacity system to increase processing resources in one part of the system to the detriment of another part. It does not address a situation in which the NBS is actually increasing overall resources and capacity”.
- 8.
Hereby Benedict et al.’s (2014) study should be replicated for the purpose to imply the use of Modafinil as a variant factor. Important hereby is the observation in the modafinil study—that claims an improvement of spatial working memory—that the participants were not sleep deprived. Cf. Müller et al. (2013).
- 9.
The reversibility effect is related to temporal cost-benefits as it poses the following question: Can the temporal cost-benefit of the enhancement be positive in the long run? Or as Brem and colleagues put it: “A momentary cost may be acceptable in exchange for a prolonged improvement, whereas a prolonged cost may not be acceptable” (Ibid.) How does enhancement of one functional part (the increase in sustaining or maintenance of attention to an attentional theme), as in the case of Modafinil, used in off-label use without indication of narcolepsy, enhancing the possibility of staying alert/awake (Repantis et al. 2010)?
- 10.
For enhancement interpreted as necessary “deviation”, see Gerner (2014: 97–112). Pushing off-label uses into the field of medicine could be interpreted in certain cases as “medicalisation” or “disease mongering”. For the dynamics of treatment and enhancement exemplified in the case of ADHD, see Schermer (2007). Hellinger (2010) has another important point of view in this debate on enhancement and its underlying concept of health: A relational suspension of the enhancement-treatment mutual exclusion account. According to Heilinger orthodox biostatistical definition strategies of defining enhancement presupposes the clarification of what health or healthy states are. Enhancements act as an intervention. As Neil Levy first described—the most common strategy to define enhancement is separating it from treatment. Hence, the enhancement/treatment dichotomy—inside (a) the split of enhancement as treatment of the healthy and (b) (medical) treatment as treatment of the ill—implies a separation line that is moral about “allowed” and “forbidden” interventions: “The treatment/enhancement distinction marks a difference that is morally significant” (Levy 2007: 88). Beyond objective and subjective accounts of health and disease, Heilinger proposes to look at a relational account of health and disease enhancement. Besides scrutinising an “objective” biostatistical account of health and a subjective well-being account, Hellinger puts forward a “(…) relational understanding of health and disease tries to avoid an exaggerated emphasis on either subjective or objective component by introducing a high degree of context-sensitivity. Thereby, in contrast, to the until now in beforehand introduced tentative definitions [objective and subjective definitions of health and their consequence for enhancement; A.G.], this model is methodically more demanding but loses more of its selectivity to the distinction of enhancement and treatment” (Hellinger 2010: 66, my translation).
- 11.
The sociocultural and family environment, temperament as well as genetic factors all contribute to differences in individual factors of self-control in children and adolescents. As Tao et al. (2014: 1) put it: “Early self-control has a profound and lasting effect on one’s life in adulthood”.
- 12.
One debate is still missing that would exceed the scope of this chapter but will be developed soon. What are parallel issues and ontological differences in the semi-autonomy of children in a perspective of adultism and the semi-autonomy of self-driving cars or other AI/robots agency, the latter of which can’t or shouldn’t achieve full autonomy, and status quo enhancements to arrive at full moral and autonomous agent status?
- 13.
Casey et al. (2011).
- 14.
Cf. Casey et al. (2016).
- 15.
Reward system stabilisation seems to be one basic characteristic that can mark a difference between adolescence and adulthood: “Pubertal development was linearly related to NAcc activity suggesting a driving factor of puberty in the increased response to rewards (Crone and Dahl 2012). An important direction for future research is to investigate which factors lead to stabilization of the response to rewards in early adulthood, which could potentially be related to reductions in NAcc volume with age (Urošević et al. 2012; Mills et al. 2014), top-down control of prefrontal cortex over the NAcc (Peper et al. 2013), or environmental factors. Understanding the longitudinal patterns of brain responses to motivational events is key for the future understanding of deviant developmental trajectories, such as substance abuse or crime (Steinberg 2008; Spear 2013)” Braams et al. (2015: 7237).
- 16.
Steinberg (2013).
- 17.
Cf.: Eme (2016).
- 18.
“Moral adultism is the preoccupation with adult moral status, behavior, values, preferences, etc. It is a claim about the value of childhood maintaining that children’s future selves have priority over their current desires” (Wiesemann 2016: 6).
- 19.
cf. Glover (1988: 133) cit. in Kipke (2011: 73).
- 20.
For Kane these self-forming actions (SFAs) in his freedom of self-formation account by which we shape our character over time are distinct from actions that are determined by our freely formed characters. Kane’s view has been challenged from different points of view, recently, for example, by Campell that questions the determinacy of Kane’s SFAs and hence “undermine the control agents have over the formation of their own characters” (Campbell 2017: 31).
- 21.
This being said, nevertheless enhancements should be valorised more if they are close to the experience of the person to be enhanced. This means that enhancements, for instance, of attention in children should be assessed in the sense in how much they fulfill the criteria of being close to human or children’s experience patterns: Let us consider the intervention depth (von Gleich 2013: 60–64) of each technological intervention used and its short- and long-term consequences not only for purpose and success assessment of cognitive enhancement of attention, but as well for deliberating the development of the actual and future autonomy of the child, the possibility to grow up in a way that fosters stability or growth of autonomy and well-being.
- 22.
For Kaldis (2010: 37–41) the new dimension lies in the convergent aspects of technologies that become possible and the driving force of medicalisation in the mentioned self-formation encompassing technical and poetic aspects. My position does not ethically define medicalisation as a negative term in itself when referring to medical enhancements, in which I include both repair strategies for hindering of the suffering of a patient and the aim to lead a good life which can consist of medical, but not only therapeutic enhancements.
- 23.
Although unrealistic accounts might lead some scholars, physicians or parents to adopt amendments, to use what I would call technopharmacological tools for social repair, that is, strategies to try to fix the situation of social and scholarly disadvantage purposefully, for instance, by neuro-enhancers/stimulants instead of solving “the problem of poor education without stimulants” (Ray 2016: 36), in which the US society would “have to repair many broken systems” (Ibid.) trying to eliminate social disadvantage, by attention enhancement drugs, including vigilance enhancement by Modafinil in order to study more time towards a time-consuming exam. This approach, however, is empirically and ideologically highly doubtful, as neuroethical criticism on these premises shows that, for instance, ADHD medication such as methylphenidate (Ritalin) or amphetamines should be cognitively transformative and improve beyond the basic notion of calming down and putting pupils in a position to be able to attend classes without disturbing themselves or others. It might not be actually the case that Ritalin or Adderall are good-grade pills after all (Currie et al. (2014) study states lower achievements of medicated children)—they are not (Sharpe 2014a). The problem is that these “good-grade pills” (Sharpe 2014b: 147) or “mental steroids” (Ibid) do actually not guarantee (in the medium or long run) a better achievement in school or social adjustment in general.
- 24.
- 25.
Mischel and Ayduk (2011) and Peake et al. (2002).
- 26.
“Hyper attention is characterized by switching focus rapidly among different tasks, preferring multiple information streams, seeking a high level of stimulation, and having a low tolerance for boredom” (Hayles 2007: 187).
- 27.
For the topic of divergent attention as an enhancement of attention principle, see Gerner (2014). Hereby several cognitive attention modes are described that children have to learn: (a) habit change as a deviation, (b) abduction as a strategy of deviation and (c) diagram transformation as a deviation of attention, divergent thinking and abstractive distraction.
- 28.
“This form of activity of the person is named post-voluntary attention by Dobrynin. When attention becomes post-voluntary, the intention that has led to it remains actively pursued, but the experience of effort significantly decreases or disappears completely” (Dormachev 2011: 301).
- 29.
“(…), all things have a tendency to take habits. (…) This tendency itself constitutes a regularity, and is continually on the increase (…) its own essential nature is to grow (…); it causes actions in the future to follow some generalisation of past actions, and this tendency is itself something capable of similar generalisations; and thus, it is self-generative” (Peirce 1958: CP1.409).
See Kilpinen 2009 for Peirce’s non-Humean notion of the habit concept, in which habit is not a routine concept but is open to a reflection of the actions that lead to new habits.
- 30.
Flow is a holistic experience: “The flow (…) capture(s) directly merging of action and awareness (e.g., “I don’t see myself as separate from what I am doing”), centering attention (e.g., “my concentration is like breathing I never think of it”), and loss of self-consciousness (e.g., “I am less aware of myself and my problems”) and implicitly autotelic nature, feeling of control, and coherent, noncontradictory demands and feedback. In all, (this) seem to capture the kernel of the construct, as defined by Csikszentmihalyi (1975/2000) in 1975” (Moneta 2012: 27).
- 31.
The subcortical sound processing fostered by musical training is an essential factor in language skill development; see Thierney (2015: 10062).
- 32.
The prolonged developmental trajectory for inhibitory control is described, for example, in Becker et al. (1987), Bialystok (2005), Booth et al. (2003), Luna et al. (2001), Tipper et al. (1989), and Williams et al. (1999).
- 33.
Executive function of attention, according to Bush et al. (2000), implies influencing sensory or response selection (or both); monitoring competition, complex motor control, motivation, novelty, error detection and working memory; and anticipation of cognitively demanding tasks. In their meta-analysis of studies 2010–2016 on positive effects of music training in primary age children, Dumont et al. (2017) state referring to music training and attention/executive function skills: “The impact of music interventions on attention and several executive function skills was reported in seven studies with mixed evidence. One study of 102 7–12 year-olds (…) found that, those, who were able to synchronize to a driving beat (in the context of a music class), were more attentive, showed less ADHD-like behaviors (rated by teachers) and performed better on an attention control task, in comparison to those who were less capable of synchronizing. (…) Although part of the evidence points to potential benefits, more research is needed to determine whether music can positively impact these skills” (Dumont et al. 2017: 14–15).
- 34.
Moreover, a methodological problem has to be addressed in general: How can we compare, for example, music training (Thierney 2015) with the stimulation of interareal theta phase synchronisations in the frontal cortex (Reinhart 2017), tracking the full-time course of behavioural advantages or losses of each stimulation and training protocol?
- 35.
Computerized working memory training (CWMT)—typically 5–7 weeks during 30–40 min 5 days a week—has been related to enhanced academic performance (Nutley and Söderquist 2015) particularly by fostering a general learning route (Nutley and Söderquist 2017: 10) by working memory training additional to education and less by the direct performance route (Ibid., 2) outcome of reading or mathematical core skills.
- 36.
For Looi and Kadosh (2016: 358–360), so-called noncore skills include cognitive executive functions, including inhibitory control, working memory, spatial cognitive skills (as well important for descriptive and inventive geometry in my view) and attention (orienting, shifting and executive control). They call these abilities noncore skills because they are non-exclusive for mathematical contexts.
- 37.
Rubinsten and Henik (2009: 95) distinguish developmental dyscalculia (DD) from more common mathematical learning disabilities that imply difficulties in handling magnitudes and identifying numbers related to deficits in working memory, attention and spatial processing. DD as well appears in co-morbid phenomena. (1) ADHD in which to the deficiency in numerical processing, a difficulty in executive function (the ability to control preinstalled responses habits, temptations, or distractions) is added. (2) Co-morbidity of dyslexia in which problems in associating phonemes with graphemes lead to deficits in associations of magnitudes with symbols.
- 38.
Clarifying conceptually mathematical accomplishments is not an easy task, but at least should include (a) spatial-temporal analysis and logical reasoning including not only deductive but inventive abductive diagrammatic logic, hypostatic abstraction and theorematic reasoning (Peirce) and, according to Passulunghi and Lanfranchi (2012), (b) numerical/arithmetic abilities, e.g. the understanding of basic arithmetic operations and acquisition of the concept of natural and other types of numbers, and c) spatial-geometrical and topological skills such as capacity to locate objects in space and identification of paths including visuospatial short-term and working memory (Szüks et al. 2014; Cragg et al. 2017).
- 39.
According to Uttal et al. (2013: 355), spatial skills can be either (a) intrinsic and static such as perceiving objects/paths and spatial configurations mixed inside distracting background informations or (b) intrinsic and dynamic such as in putting objects together into more complex configurations, visually and mentally rotating or transforming objects, for example, in their dimensions, e.g. from 3D to 2D. Spatial skills can as well be (c) extrinsic and static, for example, in the understanding of abstract spatial principles (e.g. horizontal invariance) or (d) extrinsic and dynamic such as in visualisation spatial orientation of an encompassing environment from a different observer position.
- 40.
Of particular interest are adoptive control deficits of error processing in ADHD (van Meel et al. 2007).
- 41.
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Acknowledgement
The research for this chapter was funded by a Post-Doc grand (SFRH/BPD/90360/2012) on “Philosophy of Cognitive Enhancement” by the Portuguese Foundation of Science and Technology (FCT).
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Gerner, A.M. (2019). Self-Melioration, Autonomy and Music-Enriched Self-Control: On Enhancing Children’s Attention. In: Nagel, S. (eds) Shaping Children. Advances in Neuroethics. Springer, Cham. https://doi.org/10.1007/978-3-030-10677-5_11
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