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 nonmedical 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
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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
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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
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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
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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