Introduction & ADHD Diagnosis

Introduction to the Blog & the Diagnosis of ADHD

C.A. Childress, Psy.D. (2011)

Since filming videos for e-how.com regarding Attention Deficit Hyperactivity Disorder and other parenting issues, I’ve been receiving a number of e-mails requesting my consultation with child behavior and parenting issues.  While restrictions within professional standards-of-practice prevent me from offering specific advice in response to these e-mail requests, from time-to-time I’ve responded with general information on parenting and child development issues that may be helpful.

Many of the parents contacting me are presenting similar sorts of problems and questions, and I thought it might be more broadly helpful if I would begin to develop a blog, offering my responses more generally into the Internet community so that more parents might possibly find some help from my general parenting and child development responses.

In addition, I’m currently in consultation with some colleagues about filming and offering online a set of free parenting seminars regarding these issues as well.  So these video parenting seminars may begin to become available soon.

During these first set of blogs, I plan to establish the basic principles of developmentally supportive parenting (and psychotherapy) as well as a common vocabulary that we can use in discussing the issues related to problematic child behavior and problematic parent-child relationships.  Developmentally supportive parenting is based in the scientific research on child development, and particularly regarding the neuro-development of brain systems during childhood.  The principles and concepts are relatively straightforward and they make complete sense to all the parents I’ve worked with once I’ve explained them, but developmentally supportive parenting (and psychotherapy) is a different approach to understanding and addressing child behavior problems and problematic parent-child relationships than has typically been advocated by “behaviorists.” So, at least initially, it is important to develop a common understanding, language, and frame of reference regarding the nature and origin of child behavioral and relationship issues.

Over the years, I’ve conducted many parent and teacher seminars and I've taught the principles of developmentally supportive psychotherapy to graduate psychology students.  In my private practice I typically discuss with parents the basic principles of brain development and the impact of integrated and non-integrated functioning of certain brain systems on children’s behavioral, emotional, and relationship functioning.  The graduate students, parents, and teachers that I’ve taught have consistently expressed to me that developmentally supportive parenting (and psychotherapy) makes complete sense and becomes self-evident once it’s explained. 

They come to understand the origins of “problem behavior” (re-conceptualized as “protest behavior”) and they develop an understanding for exactly how to respond to children’s protest behavior in a way that is supportive of their children’s developmental growth and progress.  They come to understand the origins of explosive-emotional tantrums and how to respond to these emotional tantrums in a way that is supportive of their children’s healthy developmental progress.  And, what’s more, they understand the neuro-developmental brain systems origins of the symptoms of “attention problems” (actually these attention symptoms also involve motivational issues), hyperactivity, and “impulse control” problems that form the core symptoms for a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), and they understand exactly what to do in response to these behavioral symptoms in order to support children’s return to normal developmental progress.

Let me say that again, just to be clear.  Once we understand the neuro-developmental systems origins (i.e., the cause) of the attention, hyperactive, and impulse control symptoms that are typically associated with a diagnosis of ADHD, we can respond in ways that address the underlying neuro-developmental systems (i.e., we can treat the cause of the symptoms) and actually eliminate the cause, and so eliminate the symptoms.  

Does this mean that we can cure ADHD?  Yes, for the most part (depending on the specific cause, but usually).  I would offer only one qualification; that once the cause of the ADHD symptoms is understood from a neuro-developmental systems perspective I would propose that the actual diagnosis of ADHD disappears.  Knowing what I know about brain system functioning and the neuro-development of the brain in childhood, it is my professional view as a clinical psychologist treating ADHD that there is no such thing as ADHD.   Attention Deficit Hyperactivity Disorder represents a set of symptoms.  The more relevant feature is the underlying cause of these symptoms.

I’ll specifically address this diagnosis issue more fully in my video seminars, once they’re produced, but let me simply state here that in my view a diagnosis is more than simply putting the word “disorder” at the end of a set of symptoms.  If you have an infection that causes a fever and you go to see your medical doctor, your physician does not diagnose you with a “fever disorder.”  If you go to your medical doctor with a symptom of pain, your physician does not diagnose you with a “pain disorder.”  In my view, a diagnosis involves using the information derived from the symptoms to identify the cause of the symptoms. 

And, in fact, if you went to your medical physician because you had a symptom of pain and your physician diagnosed a “pain disorder” and prescribed a pain suppressant, rather than using features of the pain symptom to diagnose, and so treat, your heart attack, or your appendicitis, or a muscle tear, this would typically represent medical malpractice and be a cause for legal action against the physician.  However, currently, with regard to professional psychology, we can simply put the word “disorder” after the child’s symptoms of difficulty focusing and sustaining attention (i.e., attention deficit) and difficulty modulating arousal activation, limiting behavioral activity, and organizing behavioral focus (i.e., hyperactivity) and so claim a “diagnosis” of Attention Deficit Hyperactivity Disorder, without ever identifying and treating the underlying cause. 

Attention problems (and motivational symptoms), disrupted behavioral organization (i.e., hyperactivity), and “impulse control” problems (understanding the origins of “impulsive” symptoms requires an understanding of the functioning of the Relationship Systems and, to some degree, the role and function of protest behavior) all represent symptoms.  Simply putting the word “disorder” after the symptoms of “attention deficit” and “hyperactivity” is nothing more than “diagnosing” a fever as a “fever disorder,” or pain as a “pain disorder.”  In my view, this does not represent a diagnosis.   A diagnosis involves using the information available from the symptoms to identify the underlying cause, and to understand the cause of these symptoms of ADHD requires both an understanding of principles of brain neuro-development during childhood and an understanding of the integrated functioning, and dysfunctioning, of various brain systems relative to child development.

With medical issues, the underlying cause of a disorder or disease process often lay in disruptions to the healthy normal-range functioning of the involved physical systems, such as the respiratory system, cardiovascular system, muscular systems, etc.  In some cases the disorder or disease process may be caused by the invasion of outside pathogens, such as bacteria or viruses.  Similarly, with regard to the behavioral and emotional symptoms that are the realm of professional psychology and psychotherapy, the underlying cause of these symptoms lay in the disrupted functioning of the underlying brain systems that control and modulate the functioning of emotional-behavioral-social activity, or in some cases from “outside pathogens” involving problematic caregiving responses.  Just as a physician needs to understand the functioning of the body’s physical systems, and the effects of various bacteria and viruses on the body’s functioning, a professionally competent clinical psychologist needs to understand the functioning of the developmental brain systems governing emotional-behavioral-social activity and the effects of various caregiver-child communication and relationship features on the functioning of these systems.

In my view as a clinical psychologist who specializes in treating “Attention Deficit Hyperactivity Disorder,” ADHD as a “disorder” does not exist.  Instead, what exists are disruptions to particular underlying emotional-relationship and social communication brain systems that result in a symptom pattern of decreased capacity to focus and sustain attention, an inhibition of task-oriented/goal-directed motivation systems, hypersensitivity to emotional distress and a consequent pain-aversive motivational press, difficulty modulating behavioral arousal, and a difficulty in developing socially organized behavioral activity.  And, from a neuro-developmental systems perspective, this constellation of symptoms makes total sense relative to the disruption and non-integrated functioning of particular brain-relationship systems.  Treating the cause of the attention deficit, hyperactivity, and impulsive behavior symptoms has the potential for resolving the problem at a neurological level and thereby eliminating the symptom set.

Behavior is a symptom, the brain is the cause.

I plan to expand on this discussion over the course of my blog entries and in possible future video seminars on developmentally supportive parenting (and psychotherapy), thereby opening more complex dialogue regarding the origin and resolution of children’s behavioral-emotional problems and parent-child relationship problems. 

Welcome, and I hope you find the information helpful.