Taking issue with ADHD

I am pleased to see that NICE has produced, as promised, a draft guideline for consultation on ADHD. This will lead logically to a clinical practice guideline on pharmacological and psychological interventions in children, young people and adults for NHS services in England and Wales. But it’s the psychological interventions I’m interested in.

If we backtrack, for a moment, ADHD has been called variously a “disease”, a “condition”, “a mental disorder”, “a persistent and chronic condition for which no medical cure is available”, and “a behavioural disorder”.

Kid’s Health probably sums up the feelings around a label of ADHD: “Difficult to diagnose and even harder to treat.”

I dislike the medical definitions, as a diagnosis of ADHD probably includes rather more of the manageable psychological aspects that we can help the young person to deal with than medical deficits that need drugs. That’s not to say no one should use drugs. But everyone needs to be aware that there are various non-pharmaceutical treatments for ADHD, including social, psychological, behavioural and dietary interventions.

Children with severe ADHD often have low self-esteem, emotional and social problems, and underachieve at school. So a lot of initial help could be available through well-versed counselling services that are accessible and publicised.

I once watched a DVD in which Don Blackerby (of Rediscover the Joy of Learning fame, and an expert in treatment of ADD) was getting an audience to find out how ADD feels. He asked three people to stand behind a fourth, tapping this person on the back each time they (all together) demanded an action: run! draw! print! sing! shout! etc for a minute or two. That was a lot of demands!

A fifth person stood in front of the “victim” at the same time and pretended to be either a kind or a critical parent, saying phrases to him/her that were appropriate to the chosen parental role: “Of course you can do it”, “Try harder”, “Hurry up”, “I’ll help you” etc. The question was: How many of the orders could the “child” remember? And what were their feelings on being told to do all these things? Blackerby likened it to having to watch several slide screens operating simultaneously (and going faster and faster), and having to report on them all accurately. You can’t control them or organise them, and you seem to want to physically respond to each scene.

Blackerby came to the conclusion that the resulting feelings from all this input included stress, trauma, frustration, inability to act, rage, and all those diagnostic symptoms we read about: hyperactivity, impulsiveness, distractibility, disorganisation, forgetfulness and procrastination. It was these that he recommended treating.

He used to work within the NLP model to successfully address these issues with school children. He now uses it in conjunction with Emotional Freedom Technique (EFT) as it’s quicker at resolving some aspects. (A free manual on the basics of EFT can be downloaded here.)

I await NICE’s final report with interest, but as therapists we can already address some of the child’s needs with the skills that we have or could learn.