In My Psychological Shoes
It’s fair to say I’m an ADHD sceptic. I particularly grapple with the diagnosis and have never been part of an “ADHD clinic.” I feel uncomfortable being part of a process that diagnoses children from a young age. In my view, there are many different developmental pathways children can travel down and I remain curious about who benefits from such a label and treatment.
My scepticism has grown with experience. My curiosity about why a child displays erratic, unmanageable behaviour, and struggles to concentrate remains dissatisfied with the medical perspective. I’ve found when I’ve met with families, I’ve heard stories associated with fearfulness, anxiety, and difficult early relationships (to name a few). I would often formulate that their current concerns were connected to their child’s early attachment experiences and early trauma, rather than ADHD.
ADHD v. Insecure Ambivalent Attachment
The symptoms, or characteristics, of ADHD are similar to an Insecure Ambivalent Attachment Style. Children who develop this attachment style are unsure if the adult(s) around them are going to meet their needs. They have received inconsistent care: sometimes their needs are met, sometimes they’re ignored, sometimes intervention is intrusive and intimidating, sometimes it’s shaming. These children aren’t sure what they’re going to get or when they’re going to get it. Such parents tend to be preoccupied with their own needs, rather than their child’s.
In such circumstances, a child will put in a lot of effort to make sure they are noticed. This increases their chances of getting the adult’s attention, regardless of the response. These children are highly activated and impulsive, acting on their feelings rather than think about what they are doing. They are more likely to take risks. Their ability to think is reduced and they find it hard to concentrate for any length of time. Therefore, these children will find it hard to concentrate, are more likely to struggle academically, and will find it hard to make and keep friends. Their world is psychologically unsafe so it pays to be on the go. Yet they can be perceived as needy, maybe clingy, and find it hard to separate from the important adult(s) in their life. In fact, separation can be a challenge for them.
The symptoms for ADHD outlined in the Diagnostic Statistical Manual (DSM – 5) are all behaviours that can be found in a child with an Ambivalent Attachment style; a child who is likely to have experienced trauma, and is fearful and emotionally dysregulated. This also raises questions about the misdiagnosis and of ADHD, and how it is treated, all of which can be avoided through a comprehensive psychological assessment and formulation.
When I remember some families I’ve worked with, I wonder what may have been happening in their lives that could not be spoken about. What did I miss? What wasn’t I told? With these cases, and those who had secured a diagnosis of ADHD and medication, how much did the diagnosis become a way of avoiding the real underlying issues? Children speak volumes through their behaviour, making it imperative to remain reflective about what they are showing us when trying to make sense of their presentation within the context of their personal history.
What Psychology Can Offer
In formulating psychological difficulties I’m asking what has happened to someone rather than what is wrong with them. I’m not saying that everyone who comes to me has a traumatic history. It’s about being open minded about someone’s life, their experiences, and significant relationships. By remaining curious and offering safety, attunement, and empathy, reparative experiences can take hold. In my experience, this needs to happen with the parents or carers, offerings them a space to reflect on their child. The aim here is to empower them and to form a collaborative understanding of what might be going on. This includes thinking about difficult periods of the child’s life, and possibly the parent’s, unpicking family/parental trauma that has become the child’s, or thinking specifically about the child’s trauma and what this may mean to them. I have seen change take place through such work: it’s powerful and meaningful.
By focusing on the relationship, both therapeutic and between parent(s) and child, difficult traumatic times can be processed and understood. This allows a different dynamic to form; one that is not defined by trauma or a diagnosis. This permits families to move forward, down a different road than one that was anticipated months before.