(Please note - for the most accurate version of this paper, with final page layout, please refer to Mellor, N. ( 2005). Attention
Seeking: The paradoxes of an under-researched concept. Educational & Child Psychology,22(4),94-107)
Attention seeking: the paradoxes of an under-researched
concept
Nigel Mellor
Abstract
The term attention seeking has been used in association with major behaviour
difficulties at home and school. The concept has, however, an ambivalent position in
the literature and remains largely unresearched. To survey its use, electronic
databases MEDLINE , PsychINFO and ERIC were searched (up to October 2003)
using the key words “attention seeking”. In addition 133 books were surveyed in
the fields of educational and clinical psychology and psychiatry. No comprehensive
review of published material in this area was discovered from a period covering
four decades. The term, however, had a wide spread, although very thinly spread,
occurrence. It was, however, usually employed without any, or any adequate,
definition. Overall the conclusion of the survey was that there was an absence of
thorough discussion of a term in academic and common use that referred to
potentially serious problems, and two paradoxes emerged. There was thus a
possibility of great scope for misunderstanding of the implications of behaviours
labelled attention seeking. Wide ranging research was needed.
Introduction
p.1 of 28
The purpose of this paper is to report the results of a survey of the extent of the use
of, and some of the implications of, the term attention seeking. It is difficult to think
of another concept in the fields of psychology, education or psychiatry with such
extensive spread, which has had so little investigation. No comprehensive review of
published material in this area has been discovered. This article seeks to begin to
redress this omission and generate debate and research.
Superficially it would be easy to assume that we all just “know” what attention
seeking is, and that we all agree on its definition. In reality, however, there is
apparently massive disagreement, and these disagreements cover its definition, its
incidence, its perceived seriousness and whether or not it can be regarded as a
specific phenomenon in its own right.
The status of attention seeking behaviours – whether they represent a symptom of
some other underlying cause, or whether they can legitimately be seen as a problem
in themselves (whatever that might mean) - will only briefly be addressed here. The
main focus will simply be on highlighting the widespread occurrence of the term and
associated confusions, to open up the debate.
There is evidence that the description attention seeking has been applied to
behaviour difficulties associated with very serious problems for children, their carers
and schools (see for example Berridge and Cleaver, 1987; Jones et al,1991;
Donoghue & Abbas, 1971; Fuller & Sabatino, 1996; Mellor, 1997 & 2000; Peretti et
al, 1984; Saxena, 1992; Surya Prakash Rao, 1977; Taylor & Carr, 1992; Taylor et
al, 1993; Wiessen & Watson, 1967 ). However, many texts concerning behaviour
difficulties have given the concept little or no consideration. Considering sources in
educational psychology and education where the topic might reasonably be expected
to appear (for instance Farrell, 1995; and the Elton report, DES, 1989) only passing
comment is found.
The term attention seeking appears very briefly in the psychiatric literature. In one
common, extensive volume on children and adolescents there is scant reference (for
instance in Cox, 1994). In adult psychiatry, attention seeking appears, for example,
p.2 of 28
in the diagnostic criteria for Histrionic Personality Disorder ( American Psychiatric
Association, 1994) and as a possible motivation in certain cases of factitious
disorders ( Feldman & Ford, 1994; Munro & Thrusfield, 2001). This article will
focus on children.
The major points which arise from the survey below are (a) the occurrence of
behaviours labelled attention seeking in a wide spread set of contexts, and examples
of successful interventions but (b) confusion over the definition, origin, status and
prevalence of attention seeking behaviour.
Method
Occurrence of the term attention seeking was determined by a search of MEDLINE,
PsychINFO and ERIC from the earliest entries (1960s) onwards. As an additional
approximate indication of occurrence, the index entries of 133 books were surveyed.
These were drawn from the author’s personal collection, mainly of psychology and
education texts, and from potentially relevant works, judged from book titles (i.e.
implying coverage of child or adolescent emotional, behavioural or psychiatric
problems) in the medical library of Newcastle University (psychiatry, clinical
psychology and therapy sections).
Results
1. Definitions of attention seeking were inconsistent and most authors used the term
without definition (for example in 78 per cent of the articles surveyed).
2. An extremely wide range of behaviours has been labelled attention seeking (see
Appendix 1 for examples) and attention seeking can present a serious problem (see
above).
3. Citations of the term attention seeking appeared in an extremely wide range of
contexts (see later discussion and Appendix 2).
4. These citations were, however, very thinly spread over four decades.
5. Estimates of the incidence of attention seeking varied widely. No reliable estimate
of prevalence was discovered.
p.3 of 28
6. There was widespread disagreement over the origins of, and implications of,
attention seeking.
7. The apparent importance of attention seeking varied widely between authors. For
example, judging by the occurrence of book index entries, 88 per cent of the books
surveyed had no entry for attention seeking, and coverage within texts was almost
invariably slight, yet six books reported attention seeking as a very common
problem (see later).
8. Despite these confusions, a number of accounts of successful interventions were
reported.
Discussion
Definition
Part of the problem with any discussion of attention seeking behaviour, its
implications and its prevalence, may lie in its actual definition (see Deb et al (2001)
on parallel problems arising from having no agreed definition, with adults).
Campbell (1996, p.72) and Dreikurs et al (1971, p.72) used the phrase “attention
getting” and Wickstrom & Fleck (1983, p.227) used “negative attention seeking
dependency” but neither terminology appears to have been adopted more generally.
Dictionary definitions of attention seeking (e.g. Reber & Reber, 2001; Wolman,1989
) potentially allow a limitless collection of behaviours to be included under that
label. Reber and Reber (2001, p.62) for example have “generally, descriptive of any
behaviour engaged in for the purpose of securing the attention of others”.
This apparently simple concept, however, has many facets and may depend as much
on the beliefs, attitudes and perceptions of those who define the behaviour this way
as it does on the actual behaviours observed (again see Deb et al (2001) for a
parallel). The definition below tried in part to capture one characteristic feature of
attention seeking interactions: the individually perceived “irritating” nature of the
problem (see Balson (1982) esp. ch.4, and a parallel discussion in Foote (1999)).
p.4 of 28
As illustrated in Appendix 1, an immense spread of behaviours has been included
under the label attention seeking (see also Mellor, 1997, 2000). In view of this, it
would appear that any attempt to give examples of “typical attention seeking
behaviours” as an aid to definition, would be unlikely to be successful. Mellor
(1997) offered a working definition, as an aid to practitioners, although this should
be balanced by careful discussion, observation and information from more than one
source (see Dawson, 1985; Mellor & Harvey, 2003).
... attention seeking ... [refers] to those behaviours which, through their
very irritating nature, bring a child to the attention of a number of adults in a
persistent manner over a lengthy period of time, causing great concern. We
would exclude, for instance, the sudden reaction of a child to an upset at
home lasting for a few days or weeks. In addition, the pattern should appear
in more than one setting (e.g. with several teachers or with teacher and
parents / carers) (p13).
But this definition itself may be too restrictive. Some children do display attention
seeking interactions only at home and not at school for instance; the need to
prioritise referrals lay partly behind this particular formulation. Through its wording,
the definition may also carry an implication that the child is somehow the source of
the problem. This was not the intention. Finally, the description of interactions
which it tried to capture may best be seen as marking one extreme end of a
continuum. A more general definition might simply exclude the last sentence.
While everyday, unproblematic and also positive forms of attention seeking occur, it
seems clear from the context that, when authors cited in this current paper have used
the term attention seeking, they have been referring to negative forms or
“inappropriate attention seeking” (e.g. Armstrong & Drabman, 1994 p.44).
However, most authors have used the term without any definition at all (for instance
78% of articles cited in this paper had no definition and the rest generally simply
used brief lists of example behaviours), yet even amongst professionals the term
attention seeking has not been well understood and incorrect usage may be very
frequent (see Morgan & Hastings, 1998).
p.5 of 28
Thus, when the field is left, as it is, in a state of some confusion, a paradox arises.
Two opposing forces may come into play: over-inclusion and under-inclusion. For
some of those who accept the concept of attention seeking as a problem in its own
right (whatever that might mean) there may be a danger of over-inclusion. Given the
vast range of behaviours which have been labelled attention seeking, and given
flexible definitions such as Reber & Reber (2001) and Wolman (1989), there may be
a temptation to see many, or even most, behaviour problems as attention seeking.
However, there may be at the same time, a parallel but opposing tendency to underinclusion. Given the general lack of discussion and recognition of attention seeking,
as evidenced by, for instance, absence of reviews for 40 years, it would appear that
there is little “official status” for the concept. There may thus be a number of
practitioners who do not accept attention seeking as a problem in its own right. Thus
many behaviours which could be part of attention seeking cycles may not have been
included by practitioners or researchers within a category labelled “attention
seeking”. The concept may thus simply have been overlooked.
Overall, it appears that attempts at defining attention seeking have led to a number
of still unresolved problems.
Occurrence of the term
The description attention seeking has generally not been applied to routine day-today interactions. Most commonly the term has been used to describe situations
where a great deal of attention was being sought, and this was judged to be in some
way inappropriate i.e. situations where “problem behaviour … is described”
(Odendaal, 2000 p.276). However, not all demands for attention should potentially
be labelled attention seeking (see below). In addition, attention seeking may also
have been seen in a positive context, such as with the development of humour (
McGhee & Lloyd, 1982; Fern 1991; but see Damico & Purkey, 1978, on “class
clowns”).
p.6 of 28
The term was found to have occured explicitly in a number of checklists (e.g.
Coopersmith, 1981; Sroufe et al ,1983; Stott, 1974, Williams et al,1990) there was,
however, no consistency in the way the concept was defined within these, if it was
defined at all. In other common instruments, however, it simply did not appear (see
below).
Finally, in view of the absence of discussion of attention seeking behaviours in many
potentially relevant publications, a wide range of citations has been included below
and in Appendix 2 to establish beyond doubt the occurrence of the concept in the
academic literature. It should be emphasised, paradoxically, however, that the
apparent breadth of material collected here and in the appendix gives a rather false
picture of activity in this field, as most sources have given the subject cursory
treatment. Furthermore they cover a very extensive period: some four decades of
psychiatry, psychology and education research output.
Using rather arbitrary categories, for convenience of reporting, attention seeking
interactions being reported have been noted as occurring: (a) across the age range (b)
alongside many special difficulties (c) in many cultures and (d) in different living
arrangements. It must be stressed here that there is no implication that attention
seeking was a necessary part of any of these categories, situations or difficulties; the
breakdown is simply to aid discussion of a rather unwieldy list of citations. The
pre-school articles have been considered first, in some detail, to highlight the
confusions in the field, and point towards some resolution (older children are
included in other categories)
(a) Across the age range: the pre-school years
The description “attention seeking” has been attached to children of all ages and to
adults; this paper focuses on children. One of the earliest ages noted, where the label
attention seeking has been applied, is two and a half years (Eisenberg et al,1996). In
their abstract , however, Jacobs and Moss (1976) attached the description to three
month old babies, but the body of the article implied a rather different connotation to
that used by the present author.
p.7 of 28
Green (1987) provided practical advice on intervention in the toddler stage. Enlow
(1968), drew on behavioural psychology, and incidentally provided a good example
of extensive negative attention seeking, illustrating the vast range of behaviours
available. At all ages the field shows a broad pattern of a few authors providing
detailed treatment in textbook or case study formats, in other research papers the
topic has been given scant coverage (see examples following).
Several studies addressed the pre-school years with a mixture of aims, but with no
or no adequate definition of attention seeking and scant discussion, other than noting
that boys predominated (Alfgren et al, 1979; Jacobs & Moss, 1976; Fahrenfort et al,
1996; Johnson and Breckenridge, 1982; Kashani et al, 1986; Luby et al, 1995;
McGhee and Lloyd, 1982; Mendelson et al, 1994; O’Donnell & Van Tuinan, 1979;
Turner, 1991). A number of surveys covered this age range, but again, with no
definition of attention seeking and little discussion (Charlton et al, 1994; Faruk &
Deb, 1992; Hannesdottir et al, 2000; Rai et al, 1993; Stjernqvist, 1996; Taleb,
2001). Problems arising from the structure of survey instruments are discussed later.
One group of studies of preschool children, mainly drew on a framework of research
into “dependency” (Bhogle, 1983; Cornelius & Denney, 1975; Gewirtz, 1956;
Rosenthal, 1967 a & b; Scher, 1971; Stein & Wright, 1964). This group is
bedevilled, as is so much work in this field, by inconsistency in the definition of
attention seeking, in some cases implying little more than routine re-assurance
seeking in one-off experimental arrangements.
Sroufe et al( 1983) made the link between dependency and attachment perspectives,
and more recent studies have considered attachment difficulties( Oppenheim, 1997;
Shaw et al, 1994; Turner, 1991) or relationship disorders (Anders, 1989; Zeanah et
al, 1997). These two later frameworks, appeared to offer more productive areas for
current research. Although again, within these studies, attention seeking has
remained a slippery concept, an association between anxious/ambivalent attachment
and persistent negative attention seeking has been suggested (Crittenden, 2001,
personal communication; see also Byng-Hall, 2001; Crittenden, 1999).
p.8 of 28
(b) Alongside many special difficulties
Attention seeking interactions have been recorded in accounts of children displaying
a wide range of special difficulties - using this description very broadly, as a
convenient umbrella term (see Appendix 2). A somewhat counterintuitive example,
worthy of note, is the reported occurrence of attention seeking in autistic children
(Howlin & Rutter, 1987). If confirmed by other work (see for example discussion in
Jordan & Powell, 1995; Taylor & Carr, 1992) this might raise interesting questions
about aspects of the nature of autism.
Overall, the most frequent report of attention seeking appears to have been in
children with severe learning difficulties. This might be simple a statistical quirk,
since, for example, this group may have included many others. It could, however,
have been a result of the, apparently, more common use of functional analysis (see
below) with children with severe difficulties.
(c) In many cultures
Most sources which have been uncovered, originated in North America, Australia or
the United Kingdom. The summary in Appendix 2 establishes that the term was
current in other countries/cultures – from Bangladesh to Sweden, however, there are
caveats. Such studies are comparatively rare and there is little evidence to judge how
the label has been used. In addition, some of the children have been described as
experiencing very distressing circumstances – it is clear that it is the circumstance
that has needed to change (see Jessee et al, 1992). Lacking specific definitions of
attention seeking, however, further investigation would be needed to clarify exactly
the meaning of the term in these different settings.
(d) In different living arrangements
Attention seeking behaviour has been noted in children in a variety of family and
living arrangements, for example, with birth parents, single parents, reconstituted
p.9 of 28
families (Mellor, 2000) and different foster/ adoption/ residential settings (Bartollas
& Sieverdes,1983; Berridge & Cleaver, 1987; Dubowitz & Sawyer, 1994;
Lochman et al,1986; Massey & Murphy, 1991; Phillips, 1990). This suggests that
there is vast scope for research into the many complex mechanisms that may have
been involved in the development of attention seeking interactions.
In conclusion, from this overview, there is some indication that the concept of
attention seeking behaviour has been used in a very widespread range of
circumstances. The prevalence of such behaviours is, however, a matter of some
dispute.
Prevalence of attention seeking behaviour
Attention seeking, by some accounts, constitutes a very common problem.
Montgomery (1989) reported attention seeking to be the highest priority of all
behaviour problems identified by teachers on in-service courses. Balson (1982,
1987), Conway (1990), Grimshaw & Berridge (1994), Hannesdottir et al(2000),
McManus (1995) and Peagam (1994) also emphasised its high incidence .
In a recent study, 7 per cent of referrals to educational psychologists for behaviour
emotional and social difficulties mentioned attention seeking as the reason (Rees et
al, 2003). Fuller & Sabatino (1996) found 14 per cent of children in “alternative
schools” displaying attention seeking behaviours. An attention seeking factor was
confirmed by factor analysis in different contexts by Fuller & Sabatino (1996),
McDermott (1984) and O’Donnell & Van Tuinan (1979), in addition, Sears et
al(1965) examining clusters of behaviour associated with dependency, found only
one achieved statistical significance: “negative attention seeking”. An ICM poll of
1050 adults (The Guardian 15.8.00) identified attention seeking as the most common
childhood problem perceived in friends’ children.
However, large scale research into the prevalence and socio-economic and cultural
characteristics of attention seeking behaviour is notable by its absence. No specific
surveys have been uncovered of the child population as a whole, the nearest being
p.10 of 28
The National Child Development Study (Davie et al, 1972). The authors reported a
rate of nearly 7 per cent of children displaying “anxiety for adult acceptance” using
the 1963 Bristol Social Adjustment Guide. Stott et al (1975) interpreted this
category as attention seeking, but this term only really appeared in later editions of
the guide (which, judging by citations, is in any case now rarely employed).
The rather striking variation in the reporting of attention seeking in the literature is
difficult to explain; in many cases it simply does not appear (see earlier). Variations
in definition, or even absence of definition, may be one cause. Another avenue to
explore may be the actual content of questionnaires and checklists currently used in
research. A brief inspection of examples readily to hand reveals that, apart from in
those few listed earlier, the phrase “attention seeking” is rarely included. If further
investigation showed that this is typical of the material in most common use, then
the absence of reporting of attention seeking is a potentially unsurprising chicken
and egg problem. It will only appear if already built into the instruments we employ.
Moving away from such instruments, from experience, a functional analysis of
behaviour (e.g. Taylor, 1994) is most useful in identifying attention seeking. Even
quite simple questions such as “Does the child appear to gain anything from
behaving this way?” have the potential to throw up clues to many aspects of
behaviour, including attention seeking.
Origins and implication of attention seeking
While socially acceptable behaviours may be included in an attention seeking
repertoire (see Mellor, 1997) of most concern to teacher and carers are persistent
unacceptable behaviours. However, whether these are consciously displayed by the
child as overt “demands” for attention, or have become a kind of habit, or whether
these unacceptable behaviours represent a separate phenomenon or a symptom of
some other malaise, are unresearched topics, as are the extent to which attention
seeking could arise from maltreatment or organic causes.
p.11 of 28
A number of authors have offered a variety of attempts at understandings of the
development of attention seeking behaviour. Shaw et al(1994) for example
addressed early mother-child interactions; Dreikurs et al(1971) and Griffin & de la
Torre (1983) discussed a typical trigger – the arrival of a new baby; Peretti et
al(1984) explored parental rejection and Hetherington (1972) father absence; Connor
(2001) noted the impact of formal tests (SATs) on young children. Mellor (1997,
2003, 2004a) examined Adler’s views and a range of other perspectives
(behavioural theories; a “maladjustment” viewpoint; an analogy with “deviance
amplification”; attachment disorders; a view from chaos theory).
While several authors apparently readily saw attention seeking as a problem in its
own right, and a serious one at that, paradoxically, in the vast majority of books
surveyed (88 per cent), it has not even rated an index entry. Overall there has been
no systematic work on clarifying the origins and implications of attention seeking
behaviour.
Interventions
Webster-Stratton & Herbert (1995 p.240) asserted that “the basic principle behind
the development of many common behaviour problems is that children work for
attention from others ...whether it is positive ...or negative”. The authors gave
detailed advice on managing attention seeking behaviours and Herbert (1981)
provided a lengthy case study of one four year old displaying marked attention
seeking behaviour.
In class and at home, many strategies used by teachers and parents, quite routinely,
have been effective in dealing with moderate levels of attention seeking: selective
ignoring, planned consequences and attention for acceptable behaviour, will come as
no surprise to practitioners. What may be surprising is the range of barriers to
effective intervention - conceptual, emotional and practical - when attention
seeking is severe (see Mellor, 1997, or Mellor, 2000 on “troubleshooting”),
particularly in the light of the enormous range of behaviours which may be
p.12 of 28
considered, as illustrated in Appendix 1. Practitioners may find this work much more
challenging.
Taking a few other examples of interventions in illustration, Armstrong & Drabman
(1994) described an imaginative use of the development of sports skills with pupils
displaying attention seeking behaviour and Kearney (2001) explored approaches to
school refusal associated with attention seeking. Hoffmann (1975) advocated an
Adlerian counselling approach while Stein (1998) described a psychodynamic
approach (which appeared to involve mainly increased adult attention). Barker &
Fraser (1968) explored drug treatments. Cipani (1998) described attention seeking
interactions in class, and gave some guidelines for intervention and considered the
potential reinforcing role of other pupils (see also Rogers, 2000). More general
school-based and early years issues were addressed in Balson (1982), Dreikurs et al
(1971), Mellor (2001), Robertson (1989) and Welford (2002).
Research into the intervention implications of the possibility of attention seeking
arising from maltreatment or organic factors has been absent. However, in more
general practice, some limited evidence of successful interventions has been
presented via a selection of long term, case study follow-ups in Mellor (2000), and
via ongoing work in Mellor (2004b) but large scale, well designed research has been
lacking. One tentative approach to tailoring interventions is mentioned below.
Conclusion
Two paradoxes emerged from this survey. First, it was clear that attention seeking
has been neglected in much of the literature, when the enormous time scales of the
above survey is taken into account. Yet there is evidence that attention seeking,
whatever it represents, has been a very widespread, and potentially serious,
phenomenon which needs systematic research. Inconsistencies in its inclusion in
questionnaires, and even its definition, may partly explain the reason for this
paradox.
p.13 of 28
Second, there may have been pressures towards both under-inclusion and overinclusion of behaviours under the label attention seeking. There is thus potentially
great scope for misunderstanding of the implications of attention seeking behaviours
and for misuse of the term. From experience, confusion with ADHD has been a
particular hazard (see Mellor 2000, 2004a).To complicate matters further, it has
appeared quite possible for attention seeking and ADHD to exist together. We also
need to clarify how to differentiate attention seeking from other childhood problems
such as conduct disorder and oppositional-defiant disorder.
The question of how far and under what conditions attention seeking might indeed
represent a separate entity (which might be appropriately addressed though targeted
intervention), or how far the behaviours referred to are simply symptoms of other
conditions, is a key aspect which urgently needs consideration. The research
programme outlined below may go a long way to resolving this.
An approach with the potential for getting an overview of some of the many issues
involved may be to consider different developmental pathways. One categorisation
of these would be to compare those more clearly reactive in origin (e.g. reacting to
the arrival of a new baby or parental separation) with those more broadly interactive
in origin (e.g. resulting from gradually developing attachment or relationship
disorders, with no clear single trigger point). These histories may lead to shadings of
interventions (for instance addressing sibling rivalry more, or attachment
difficulties more – compare Speltz, 1990) although the main thrust of any effective
strategy is likely to continue to focus on the three elements (ignoring etc) outlined
earlier, which address those factors maintaining attention seeking cycles in the
present.
However, given the absence of systematic study in the field, the overall picture
which emerged from the survey above was of more questions than answers. There
was evidence that attention seeking could represent a serious problem which might
occur extensively, but investigation is clearly needed into all aspects: definition and
differentiation, questionnaire construction, origins, prevalence and intervention.
Functional analysis, Adlerian and behavioural psychology, have offered useful
p.14 of 28
perspectives on its origins and maintenance. However, the vast literature on
attachment theory offers a promising framework for investigating the beginnings of
attention seeking cycles. Overall, attention seeking offers a rich potential for
research on many levels.
Address for correspondence
Nigel Mellor, Educational Psychology Team, Chapel Lane Education Centre,
Chapel Lane, Monkseaton, Tyne and Wear, NE25 8AD Email :
nigel.mellor@newcastle.ac.uk
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Appendix 1 Examples of the wide range of behaviours which have been described
in certain contexts as attention seeking.
Aggression; disruption; self stimulation (Taylor & Carr, 1992).
Challenging behaviour (Harris et al,1996).
Coming in late; reading failure (Balson, 1982).
Disruptive and easily distracted, lacking in concentration, seeking to gain friendship
by any means, soiling himself frequently (Scott, 1980).
Fighting, kicking, biting, boisterous, talkative, restless, swearing, quarrelsome,
throwing things, whispering, crying, pouting, stubbornness, temper tantrums
(Saxena, 1992); laziness (McManus, 1995).
Licking her nose to make children sick, cheating, destroying her coat. Restlessness,
touching other children, picking his nose, crawling under desks etc., dropping things
thus providing excuses to grope around rocking on his chair, laughing quietly at
nothing in particular, staring at his neighbour until their attention is obtained,
moving furniture about, losing worksheets or destroying them, humming, banging
under desk with feet. Tantrums; coming without equipment (Montgomery, 1989).
Putting up his hand to ask unnecessary questions, lying on his back with his legs in
the air and banging his head on the desk. Unable to remain in his seat during group
work, continually interfering with other children (Merrett, 1993).
Fake illnesses (Pollard 1985); accident repeating (Manheimer & Mellinger, 1967);
pseudoseizures (Buchanan & Snars, 1993, Irwin et al, 2000 ).
Running off, tantrums, shouting, swearing, kicking, stealing, urinating in containers
(Wade & Moore, 1984).
Scapegoating (Saunders, 1979).
Running round barefoot, loud burps (Galloway, 1976).
Screaming, whining and crying; biting hands or hitting head with hand; saying “No”
to adult requests (Carr & Durand, 1985).
Shouting out; asking questions unrelated to work (Gray & Richer, 1988).
Stealing (Leung et al,1992); self injury ( Jones et al,1991).
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Tapping pencils; whining; remaining in the corridor; wearing long earrings; stealing;
lying (Dreikurs et al,1971).
Teasing; exhibitionism; practical joking (Maier, 1988).
Tics, stammering, bedwetting, temper tantrums, thumb sucking, food refusal, pain in
the knees, breath holding spasms, pain in abdomen, headache, hand shaking (Surya
Prakash Rao, 1977)
Appendix 2: Citations of attention seeking

In conjunction with special difficulties
Accident repeating (Manheimer & Mellinger, 1967); ADHD (Cooper & Ideus,
1996); autism (Howlin & Rutter, 1987); cerebral palsy (Finnie, 1974); deafblindness (Van Dijk, 1991); drug abuse (Coghlan, 1973); Down syndrome (Byrne et
al,1988); FG syndrome and Williams syndrome (Graham et al,1999); hearing
impairment (N.M.H.E.P., 1996); learning difficulties (Barton et al,1987, Carr &
Durand, 1985; Donoghue & Abbas, 1971; Gardner, 1971; Hingsburger, 1994; Lyle
1961; Taylor & Carr, 1992;Tizard, 1970; Wiessen & Watson, 1967) and children in
mainstream with apparent learning difficulties (Balson, 1982); poor social
acceptance (Lorber, 1969); pseudoseizures (Buchanan & Snars, 1993, Irwin et al,
2000 ); school refusal (Kearney, 2001; Lee & Miltenberger, 1996); self injurious
behaviour (Murphy & Wilson, 1985 provide a large number of examples; see also
Jones et al,1991); short stature (Stabler et al, 1994); tuberous sclerosis (Hunt &
Shepherd, 1993); victims of bullying (Lowenstein, 1978) and false victims (Besag,
1989); visual impairment (Harrison & Crow, 1993).

In different countries/cultures
Bangladesh (Faruk & Deb, 1992); Finland and Iceland (Hannesdottir et al, 2000);
India (Bhogle, 1983; Rai et al, 1993; Saxena, 1992; Singh & Kapur, 1984; Surya
Prakash Rao, 1977); Israel (Oppenheim, 1997); Jordan ( Taleb, 2001); Macedonia
and Germany (Dikaiou, 1989); Mexican American ( Johnson & Breckenridge,
1982); Netherlands (Fahrenfort et al, 1996); St. Helena (Charlton et al, 1994);
Sweden (Stjernqvist, 1996).
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