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

SMART Narrative 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 dknylund@csus.edu