Is this approach to adhd psychotherapy of any use?
September 8, 2011 6:31 PM Subscribe
Psychologist says his approach to ADHD is based in developmental psychopathology and that he thinks disruptions in parental attachments could cause ADHD symptoms - is there any basis to this?
Looking at google scholar and the more scholarly-looking offerings for this on googlebooks gives me mixed results - some sources indicate little basis for this, others seem to give some credit to this approach. Is it now an out of date approach? Is there any validity to it? Should I avoid? Any references to helpful scholarly articles, even if they are behind paywalls would be appreciated. (This is in addition to medication from a medical practitioner - but they don't address family problems or offer any kind of help beyond medication and there are huge gaps between appointments) Thanks!
Looking at google scholar and the more scholarly-looking offerings for this on googlebooks gives me mixed results - some sources indicate little basis for this, others seem to give some credit to this approach. Is it now an out of date approach? Is there any validity to it? Should I avoid? Any references to helpful scholarly articles, even if they are behind paywalls would be appreciated. (This is in addition to medication from a medical practitioner - but they don't address family problems or offer any kind of help beyond medication and there are huge gaps between appointments) Thanks!
Here is a critical view of the genetics based view, BUT it also doesn't take the view that parental attachments have anything to do with it. They mention this view
posted by melissam at 6:49 PM on September 8, 2011 [2 favorites]
DeGrandpre (1999) sees the condition as the result of some children’s problems with impulse control in our increasingly ‘rapid-fire culture,’’ leading to children’s ‘‘rapid-fire consciousness’’: "At the heart of the developmental problem lies the emergence of a phenomenological experience of unsettledness, characterized by feelings of restlessness, anxiety, and impulsivity. Hyperactivity and the inability to attend to mundane activities exemplify the type of escape behavior that the ‘‘sensory addicted’’ child or adult uses in order to maintain his or her needed stream of stimulation. (p. 32)"I don't have a dog in this fight, I was reading about spandrals today and came across that paper. Probably, like almost every psychological issue, it's a combination of genes and environment. Datapoint is that I have ADHD and I certainly didn't have any disruptions in parental attachment since I was breastfed for four years and homeschooled for 15. I am definitely a sensory addict and come from a family of addicts. I benefitted from cognitive behavioral therapy, which helped me develop strategies for focusing on my work and not acting hyperactive. Some people also benefit from drugs, but I think it is a good idea to combine drugs with therapy.
posted by melissam at 6:49 PM on September 8, 2011 [2 favorites]
Even if this was a valid scientific position, attachment-based therapists don't just come out and say, "it's a disruption in the parental attachment," because that can come off as overly punitive to a parent. They craft interventions to work on the attachment and invite parents to be part of the treatment, rather than sitting back and pointing a finger. What was his attitude toward what the treatment plan would actually be?
posted by so_gracefully at 6:58 PM on September 8, 2011 [3 favorites]
posted by so_gracefully at 6:58 PM on September 8, 2011 [3 favorites]
This came out of left field right at the very end of an initial appointment where the treatment plan was put off to the next appointment due to lack of time, and when I challenged him ( because we had been talking about events when I was aged about 12) that my symptoms predated the major rift in my family circumstances, he said that the other things I'd said indicated that there were attachment problems in the earlier parts of my childhood. I was puzzled by this because I didn't think that what I said indicated this and when I asked him if there was anything I could read about his approach, he told me to google developmental psychopathology, (which I have to say I did not find satisfactory).
posted by Flitcraft at 7:06 PM on September 8, 2011
posted by Flitcraft at 7:06 PM on September 8, 2011
I don't think there is any basis to it, personally.
In my experience, ADHD and related issues (social anxieties, etc.) are a bag of genetics and experience. ADHD is somewhat of an anxiety disorder - and therapies that seek to mitigate anxieties aren't entirely barking up the wrong tree. But, I think focusing on a specific cause sort of misses the forest for the trees.
My son has ADHD, and I think we had the greatest success with therapies that addressed coping/living skills (how to remember to hand in work, etc.) and those that addressed immediate behavioral concerns (tantrums, running out of class when angry, making and being friends, etc.).
My concern has always been trying to prepare my son to deal with life if the medications should cease being effective or available. So my goal was to try and use the windows of clarity provided by the medication to teach and reinforce those life lessons that would most help him later in life - either through therapy with a therapist, or just through parental involvement and reinforcement.
It's a strategy I think has paid dividends - he's nearly 17 now, and the medication is not as effective as it once was. However, he is much better at mediating his behavior and maintaining self regulation. His school performance has been OK, and his behavior is pretty good. Most importantly, he's still motivated to try. ADHD is a thing he has to work around, not a defining characteristic of his life.
He has his moments, but I think he's well prepared for adulthood - better than I was at his age, actually.
All this to say, I think you'll be better served by therapies to address future issues than chase theoretical past ones. I know these are somewhat interlinked, but I hope you get my meaning.
posted by Pogo_Fuzzybutt at 7:09 PM on September 8, 2011 [1 favorite]
In my experience, ADHD and related issues (social anxieties, etc.) are a bag of genetics and experience. ADHD is somewhat of an anxiety disorder - and therapies that seek to mitigate anxieties aren't entirely barking up the wrong tree. But, I think focusing on a specific cause sort of misses the forest for the trees.
My son has ADHD, and I think we had the greatest success with therapies that addressed coping/living skills (how to remember to hand in work, etc.) and those that addressed immediate behavioral concerns (tantrums, running out of class when angry, making and being friends, etc.).
My concern has always been trying to prepare my son to deal with life if the medications should cease being effective or available. So my goal was to try and use the windows of clarity provided by the medication to teach and reinforce those life lessons that would most help him later in life - either through therapy with a therapist, or just through parental involvement and reinforcement.
It's a strategy I think has paid dividends - he's nearly 17 now, and the medication is not as effective as it once was. However, he is much better at mediating his behavior and maintaining self regulation. His school performance has been OK, and his behavior is pretty good. Most importantly, he's still motivated to try. ADHD is a thing he has to work around, not a defining characteristic of his life.
He has his moments, but I think he's well prepared for adulthood - better than I was at his age, actually.
All this to say, I think you'll be better served by therapies to address future issues than chase theoretical past ones. I know these are somewhat interlinked, but I hope you get my meaning.
posted by Pogo_Fuzzybutt at 7:09 PM on September 8, 2011 [1 favorite]
Sorry, I assumed you were a parent talking about a child from my read of the question! However, knowing that this person told you that as an adult is really perplexing; I wonder how he plans to address your symptoms based on telling you it's because of fragmented attachments with your parents?
In general, the most effective and not-coincidentally evidence-based treatments on the psychotherapy end of things involve management of the troubling symptoms and development of adaptive skills, not so much rooting around about the causes. There are many, many, many therapists who are great at helping with those things.
posted by so_gracefully at 7:18 PM on September 8, 2011 [1 favorite]
In general, the most effective and not-coincidentally evidence-based treatments on the psychotherapy end of things involve management of the troubling symptoms and development of adaptive skills, not so much rooting around about the causes. There are many, many, many therapists who are great at helping with those things.
posted by so_gracefully at 7:18 PM on September 8, 2011 [1 favorite]
disruptions in parental attachments could cause ADHD symptoms
I think some of the people answering here are missing that last word.
Disruptions in parental attachments can cause a variety of symptoms in common with ADHD. I would not consider him a quack for considering if you are suffering from a variety of issues, some directly related to ADHD and others not.
It doesn't sound like he's suggesting that you stop your ADHD medication. It just sounds like he wants to broaden the approach a little; If some of your symptoms aren't directly caused by ADHD they're not going to go away based on the meds.
posted by Tell Me No Lies at 7:28 PM on September 8, 2011
I think some of the people answering here are missing that last word.
Disruptions in parental attachments can cause a variety of symptoms in common with ADHD. I would not consider him a quack for considering if you are suffering from a variety of issues, some directly related to ADHD and others not.
It doesn't sound like he's suggesting that you stop your ADHD medication. It just sounds like he wants to broaden the approach a little; If some of your symptoms aren't directly caused by ADHD they're not going to go away based on the meds.
posted by Tell Me No Lies at 7:28 PM on September 8, 2011
Best answer: If some of your symptoms aren't directly caused by ADHD they're not going to go away based on the meds.
I have ADHD and PTSD. The meds for either don't make the symptoms "go away," they are a tool that helps me utilize the skills I need to cope.
Yes, some of my symptoms could be "ADHD" or "PTSD" but in combination, and with knowledge of my detailed history, all together they're both.
Therapy is like dentistry or any other medical endeavor. If you don't trust the guy working in your head, it's time to move on to another practitioner. This guy wouldn't be a good fit for me, and it sounds like he's not a good fit for you. That doesn't necessarily make him a quack, but you're not satisfied with his reasoning. The first few appointments are kind of like tryouts. This guy didn't make your team.
posted by bilabial at 8:05 PM on September 8, 2011 [3 favorites]
I have ADHD and PTSD. The meds for either don't make the symptoms "go away," they are a tool that helps me utilize the skills I need to cope.
Yes, some of my symptoms could be "ADHD" or "PTSD" but in combination, and with knowledge of my detailed history, all together they're both.
Therapy is like dentistry or any other medical endeavor. If you don't trust the guy working in your head, it's time to move on to another practitioner. This guy wouldn't be a good fit for me, and it sounds like he's not a good fit for you. That doesn't necessarily make him a quack, but you're not satisfied with his reasoning. The first few appointments are kind of like tryouts. This guy didn't make your team.
posted by bilabial at 8:05 PM on September 8, 2011 [3 favorites]
Ask him for specific references to back up his claims. If he can't give you book-and-verse citations, he's full of shit, period.
If he does have the citations, examine them. Are they articles in trade journals? Or are they from Madam Zelinsky's Amethyst Holistic Connections Free Journal and Coupon Book? Google the authors; do they have reasonable credentials (other publications, speaking engagements, faculty positions).
posted by IAmBroom at 8:09 PM on September 8, 2011 [2 favorites]
If he does have the citations, examine them. Are they articles in trade journals? Or are they from Madam Zelinsky's Amethyst Holistic Connections Free Journal and Coupon Book? Google the authors; do they have reasonable credentials (other publications, speaking engagements, faculty positions).
posted by IAmBroom at 8:09 PM on September 8, 2011 [2 favorites]
Best answer: Therapy isn't an intellectual process, and whatever attachment problems you may have had, it doesn't sound like you are forming a good attachment to this guy.
If you're interested in the latest work on attachment, you could read Beebe (e.g., this) but like bilabial says above, if the first few sessions didn't go that well, I'd shop around further.
posted by Obscure Reference at 5:18 AM on September 9, 2011 [1 favorite]
If you're interested in the latest work on attachment, you could read Beebe (e.g., this) but like bilabial says above, if the first few sessions didn't go that well, I'd shop around further.
posted by Obscure Reference at 5:18 AM on September 9, 2011 [1 favorite]
If he thinks that may play a role in ADHD symptoms in some cases, that doesn't on the face of it sound crazy to this ADD-boy.
If he thinks that's a comprehensive explanation for ADHD in general, that sounds crazy to me, and I'd run screaming from his care.
posted by Zed at 12:11 PM on September 9, 2011
If he thinks that's a comprehensive explanation for ADHD in general, that sounds crazy to me, and I'd run screaming from his care.
posted by Zed at 12:11 PM on September 9, 2011
You might find the book ADHD in Adults: What the Science Says interesting and possibly useful. I recently got it from the library and have begun slowly making my way through.
FWIW, I don't have it handy, but I just used Amazon's "search inside" function to search for "attachment" and got 0 results. "Parental" returned 32 results; "developmental" returned 54; "psychopathology" returned 18. "Developmental psychopathology" returns 6 results; only one of them is for the actual phrase and occurs in the context of one of the authors' bios, saying that she's "published numerous articles on ADHD, developmental psychopathology, and neuropsychology".
On a slight tangent, there was an interesting post on Sociological Images recently: Neurology vs. Psychiatry: The Social Production of Knowledge, looking at which disorders are considered "neurological" and which are considered "psychiatric" by medical professionals.
posted by Lexica at 1:32 PM on September 9, 2011 [1 favorite]
FWIW, I don't have it handy, but I just used Amazon's "search inside" function to search for "attachment" and got 0 results. "Parental" returned 32 results; "developmental" returned 54; "psychopathology" returned 18. "Developmental psychopathology" returns 6 results; only one of them is for the actual phrase and occurs in the context of one of the authors' bios, saying that she's "published numerous articles on ADHD, developmental psychopathology, and neuropsychology".
On a slight tangent, there was an interesting post on Sociological Images recently: Neurology vs. Psychiatry: The Social Production of Knowledge, looking at which disorders are considered "neurological" and which are considered "psychiatric" by medical professionals.
posted by Lexica at 1:32 PM on September 9, 2011 [1 favorite]
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The Lancet
Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome-wide analysis
American Journal of Medical Genetics via Science Daily
The Telegraph 9.10. 2010
Google Scholar links.
posted by Ideefixe at 6:41 PM on September 8, 2011 [5 favorites]