Attention Deficit and Hyperactivity Disorders

http://www.psychoanalysis.center/issues-assisted/attention-deficit-and-hyperactivity-disorders

ADHD Attention Deficit and Hyperactivity Disorders

ADHD disorders are characterised by developmentally inappropriate levels of inattention, being over active, unable to concentrate, being impulsive and abnormal presentation of behaviours.  This leads to problems with learning, working, social interaction, relationships and family life.

Secondary effects of ADHD characteristics

Having negative effects on many aspects of life means that there is disruption to those elements. Work, play, social, relationship and family life disruption can lead to conflict, emotional rejection, feelings of guilt, anger, maladaptive behaviours and all sorts of resultant effects from anxiety to depression and stress to anger. Thus the core effects then cascade through the normality of life interactions leading to more problems and co-morbidity.

Treating ADHD with psychological therapies

ADHD is often thought of as being a condition where drug treatment is the primary or only response, and although medication can be useful there are psychological therapies that can be useful as well.

Much of the research and study in the field has been based around intervention with young children and adolescents using methods like Behavioural Parent Training, Behavioural Classroom Management and Behavioural Peer Interventions.

Adults and older teens with ADHD may benefit from skill based interventions which address elements like social problems, disorganisation and functional difficulties with concentration. This requires careful monitoring and analysis of what is actually happening in the environment (college, work, home etc) and then adjusting behaviour and interpretations in example situations. Thus a situational analysis is completed, understandings drawn out, and then new behaviours and perceptions introduced.  This might include elements like speaking slower, allowing the other person to complete their comments, maintaining eye contact, allowing appropriate personal space, awareness of body language. Abikoff et al (2012)  found that those receiving such interventions were better organised, had better academic functioning and less social and home based conflict.

Cognitive Behavioural skills based interventions according to Knouse & Safren (2013) found positive results from analysing goals, impediments and creating new cognitive and behavioural strategies in adults. This type of method includes psychoeducation of clients as to the effects of their behaviours, thus empowering them to understand the effects and build empathy for others.

Mindfulness based interventions have been studied with positive results, including by Zylowska et al (2008) and Philipsen et al (2007). Mindfulness enables better understanding of the client’s own internal emotional states, making them aware of their perceptions and interpretations, which may have been driving maladaptive behaviours.

Interventions with the assistance of partners or spouses can also be useful in adults, with a number of studies including Barkley (2006), Dixon (1995) and Kapalka (2010) (all cited in Kapalka 2014) all finding positive outcomes from the spouse being “on board” as part of the process. Understanding, team work and positive reinforcement all can play a role in assisting the client.

Combined interventions (drugs plus psychology)

According to Kapalka (2014) there is not a clear and decisive balance of evidence to suggest one way or another whether combined approach is superior, largely because of the difficulty having competent and educated people on board across the different environments to study people with medication also receiving consistent social reinforcement and psychotherapeutic training.

Psychological interventions for the additional problems in ADHD cases

As discussed above, many ADHD effects are additional and snow-ball out of the disruption that the key aspects of ADHD present. Thus there may be issues of anxiety, stress, depression, anger, lack of appropriate assertiveness, guilt, self esteem and many others.

All of these can be co-morbid in cases of ADHD and may need additional therapeutic assistance. For discussion of many of these, with appropriate references, see other areas of the site.

It is important however for the therapist to respect that although skills training or other condition management techniques are required to help the client, they may also require symptomatic relief and assistance with co-morbid issues as well. An integrative approach therefore may be useful.

Who provides ADHD psychological therapy support?

Stuart is an analyst (cognitive behavioural and psychodynamic), clinical hypnotherapist and stress management counsellor with additional training and registration in psychology, psychotherapy and counselling. He is trained in a range of psychological therapies including cognitive behavioural therapies. His post qualification training includes clinical training in CBASP and mindfulness. He has also received specific training in complementary health education and client training leading to an NVQ Level 4 Training and Development award in the context of this provision. He is also a Fellow of the Royal Society for Public Health, a Fellow of the Institute of Health Promotion and Education and an affiliate fellow of the Royal Society of Medicine (not a qualification).

References for above information:
Abikoff H et al (2012) “Remediating organisational functioning in children with ADHD: Immediate and long term effects from a randomised controlled trial. Journal of Consulting and Clinical Psychology 81, 113-118
Kapalka (2014) Treating Disruptive Disorders. A guide to psychological, pharmacological and combined therapies. Routledge Press
Knouse & Safren (2013) “Psychosocial treatment for adult ADHD. ADHD in adults: A practical guide to evaluation and management (pp119-136) New York Humana Press
Philipsen et al (2007) Structured group psychotherapy in adults with ADHD: results of an open multicentre study. Journal of Nervous and Mental Disease, 195, 1013-1019
Zylowska L et al (2008) “Mindfulness meditation training in adults and adolescents with ADHD: A feasibility study. Journal of Attention Disorders 11, 737-746

Key Words
ADHD, attention deficit and hyperactivity disorders, hyperactivity, attention problems, disruptive disorders, treating disruptive disorders, treating ADHD, psychotherapy, psychoanalysis, skills training, psychoeducation, counselling, mindfulness, life coaching, psychology, cognitive behavioural analysis, CBASP, situational analysis, self help, relationship therapy, anger management, stress management, body language, behavioural therapy, psychological therapy, anxiety therapy, Edinburgh, Glasgow, Falkirk, Stirling, therapy, therapist, psychotherapist, CBT, counsellor, psychoanalyst, analyst.

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