Treating Huckleberry Finn: Working Narratively with so-called ADHD David Nylund, MSW, PhD
What accounts for ADHD’s popularity? • Reduced funding for schools? • Failure of conventional schools to meet the learning needs of some students? • Effects of a rapid fire culture? • Increasing pathologizing of kids? • Increasing power of pharmaceutical companies? • Increasing pressure for children?
CHALLENGING ASSUMPTIONS OF THE ADHD PARADIGM:Assumption 1: ADHD is a Biological Disorder • Predominant view—ADHD is a biological intervention and is not caused or helped by psycho-social interventions • Faulty research—Zamektin (decreased glucose metabolism in ADHD brains); not replicated in other studies • PET Scans-the so-called differences between normal and ADHD brains may not be due to inherent neurological problems in the ADHD groups (environment has a big effect on brain metabolism) • ADHD looks more like a complex interaction between the brain and the world than any kind of intrinsic medical problem located solely in the genes or brain chemicals of a child.
Assumption 2:ADHD can be objectively diagnosed through rating scales • Behavior rating scales rest entirely on subjective judgments • Assessments are de-contextualized
Assumption 3:ADHD is most effectively treated with stimulants such as Ritalin • Ritalin can subtly undermine a child’s sense of responsibility by causing him to attribute his positive and negative behavior to a drug • Research evidence shows that many kids don’t like the side effects of Ritalin • The use of Ritalin can be a cause for disqualification of military participation or college athletics. • Ritalin does work effectively in quelling a child’s impulsivity or hyperactivity but keeps people from attempting non-medical approaches/solutions that can be much deeper/richer.
Potential Useful Effects of ADHD paradigm • Reduces the impact of parent blaming • Educational services become available to the child • Stimulant meds may be helpful for some children
Possible Detrimental Effects of ADHD • Has a totalizing and stigmatizing effect on children • Discourages kid from appreciating unique abilities • Discourage parents/teachers/child from having personal agency • Effects of Ritalin • Therapist/teacher resignation
SMARTNarrative Therapy • Separating the problem • Mapping the effects of the problem • Attending to unique outcomes • Re-membering special abilities • Telling others of the new story
SMART THERAPY • Influenced by postmodernism—disorders such as ADHD are produced in a socio-cultural and political context • Narrative Therapy • Solution-Focused Therapy
Guiding Attitudes of SMART professional • Curiosity • Respect • Hopefulness • Not-knowing • Attention to social context
SMART ASSESSMENT • Meanings the family/child makes of ADHD • Environmental checklist • SMART Rating Scale • Collaborative Goal Setting • Medication Option
Meanings Made by Family/Child TO PARENTS • What is your understanding of ADHD? • How did you learn about ADHD? • How has the diagnosis been helpful? TO CHILD • What does ADHD mean to you?
Environmental Checklist • Trauma? • Major changes in family structure? • Parent stressors? • How much TV (other media outlets) is the kid watching? • What’s the kid’s classroom context? • What’s the teacher’s teaching style? • What is the size of the classroom? • Has the child experienced racism, classism, sexism, homophobia...?
Collaborative Goal Setting • Salient to the family • Small • Concrete and specific • The presence rather than the absence of something • Miracle question
Goal Setting Questions • Suppose you go to be tonight and while you are sleeping a miracle happens and ADHD is gone. When you wake up the next day, how will you be able to tell your miracle really happened? • Who will be most surprised? • How about school? What will be the first thing your teacher notices that indicates you have changed?
Separating the Problem/Mapping the Effects • Think of ADHD as a thing, object, and/or person • Encourage the kid to name the problem • If the child cannot think of a name, tentatively name something
Separating the Problem • ADHD is the doctor’s name for the problem. What name would you give it? • Families have found it helpful to view the problem as something outside the child. Is it OK if we experiment with talking about ADHD in this way?
Interviewing ADHD • ADHD’s purposes • ADHD’s goals for the kid • The myriad of techniques ADHD uses to gain influence over the kid • Who stands in league with ADHD (exceptions) • Times when the kid has frustrated ADHD’s plans • The goals of the child • Who stands with the child
Expressive Arts Therapy Works with: • Kids who are not very verbal, including those who have language based difficulties • Kids for whom art, sand tray, or drama therapy are their preferred modes of communicating • Kids who are primarily visual and kinesthetic learners
Inviting Kids into Play Therapy • What does ADHD look/seem/feel/sound to you? • Can you show it in a drawing, clay, mask? • Does the problem look like one of these puppets to you? Would you rather use puppets to talk? • Show me in the sand-tray what it looks like when the problem takes grip? • Could you show me in the sand-tray what happens you are the boss of ADHD?
Mapping the Effects For the child • What effect does ADHD have on you on school? • What classroom behaviors does it recruit you into? • Does ADHD follow you home? • Has it earned you a reputation at school? • Who are ADHD’s friends? • What does ADHD want you to thank about yourself? • Does ADHD make you allergic to homework?
Mapping the Effects For the parents • What effect does ADHD have on you as parents? • What does ADHD do to your identity as parents? • Does ADHD make you feel helpless and frustrated? When frustration takes over, what kinds of things you do in relation to your child?
Deconstructing Questions • Are you familiar with the idea that kids who have been diagnosed with ADHD are somehow broken or flawed? What effect might this have on the kid? • What if we were to view the problem as a living imbalance rather than just a chemical imbalance? • How does the ADHD label effect your son’s view of himself? • What messages do you think your child is receiving about taking Ritalin?
Attending to Exceptions/Re-membering Special Abilities • Has there been a time when ADHD could have taken control in the classroom but didn’t? • What’s different about the times you do your homework? • Even though ADHD tries to tell you that you’re dumb, you are good at computers. Has ADHD been lying to you? • What parts of ADHD are friendly to you? • What are you doing to strengthen your concentration? • How did you use BOREDOM to your advantage rather than for ADHD’s purposes? • How have you been channeling ADHD for your aims? • How does karate get you turn down the TORNADO inside?
Parents as Exception Finders • If you followed your child around each day this week, what places or situations would you find him/her behaving slightly better? • In which situations does your child get along socially? • Recall times during your child’s school career when he did well. What was different during those times?
Other Exception Tools • Detective Club • Making the Child the Expert • Reputation Re-working
Reclaiming Special Abilities:Using exceptions to assemble a new story Landscape of Action Questions • When Boredom tried to take advantage of you in the class, how did you use it as an opportunity to pay attention? • How did you get yourself ready to take this step?
Reclaiming Special Abilities:Using exceptions to assemble a new story Landscape of Meaning Questions • What does it tell you about yourself that you are staying out of Trouble’s way? • What does it say about your goals for your future that you are paying attention in class? • (for parent) What hidden abilities do you think Jimmy has to help him improve his grades? • (for parent) What qualities do you think you have as parents that enable you to hang in there with Jimmy?
Re-membering questions • Jimmy by any chance are you weirdly abled? • What special talents do you think you possess that go unnoticed by your teacher? • How do your imaginary friends help you calm your Temper? • (for parent) How you have you nurtured your child’s special abilities?
Telling Others of the New Story • Letters • Outsider witness groups • Consulting your consultant interview “Who needs to brought up to date with these changes?”
David Nylund 6000 J St. Sacramento, CA 95819 USA email@example.com