There are many ways to think about ADHD, but here's another one. 

By Nathaniel Strenger, M.A., Doctoral Intern | Apr 13, 2016
Our Adhd 01

Starting around the 1920s an American psychiatrist named Harry Stack Sullivan started sharing some of his ideas about people.  He also made a bit of a splash doing it.  Put simply, he challenged the popular idea that people had their own personalities, like little unchanging things they carried around inside them.  Instead, Sullivan said that the personality was like a system that was always changing based on its surroundings.  Our personalities fluctuate based on who's around us and how they make us feel.  Did you see the movie Inside Out yet?  Riley’s little islands of personality appeared, disappeared, and changed based on two things: (1) Changes in the ways she interacted with her parents and (2) changes in the ways her surroundings made her feel about herself.

This might sound a little bit weird, but think about it.  Are you always the exact same person, no matter who you are with?  Or are there different traits and tendencies that come out with different people?  It is almost like saying, “I don’t make my personality by myself; we are making it together right this second.”  And to take it further, it is even like saying, “My personality will be a little bit different when I am with somebody different than you.”

So what does all this have to do with Attention-Deficit/Hyperactivity Disorder (ADHD)?  Well, Harry Stack Sullivan had another idea he called “Selective Inattention.”  Let me try and explain this one.  Sullivan said that all of our personality-building thoughts and behaviors are motivated by just a few things:  

·         We are motivated by a desire to fend off anxiety

·         We try to protect our self-esteem

·         We avoid rejection from others 

He called these “security needs.”  Sullivan thought these security needs could sometimes be so strong that we may zero in on them, losing focus on anything else around us.  What’s more, we might even do this without even being aware of it!

To explain a little more, I’ll adapt one of Sullivan’s little fables: Let’s go bird watching.  Pretend you are out in the Texas woods with your trusty binoculars.  You’ve set out into the brisk wilderness in search of the Black-tailed Godwit (I’m not much of a birder myself, but this is apparently a rare find).  As you walk, you and your birding partner can hear nothing but your own rhythmic breath and the light crunching of leaves beneath your boots.  Suddenly, you freeze.  Off in the distance, atop a crooked branch, you spot your target.  The Black-tailed Godwit!  You pause in your tracks, raise your binoculars, and take aim.  In that moment, nothing else around you matters but what you have in your sights.  Now imagine your pal, who has joined you out in the woods that day, decides to play a bit of a joke.  He pulls out a little sharp-pointed pin, and gives you a little poke on the shoulder.  Expecting a hilarious reaction, your friend waits and waits, pokes and pokes.  But you don’t even seem to notice!  You are just too focused on that Godwit…

Alright.  So in our little scenario here, the birder might be little Tommy’s ADHD acting up again.  The Black-tailed Godwit might be little Tommy’s security needs.  And those pin pricks might be that dang reading assignment you have been trying to get him to finish for the past two-and-a-half hours.  You can poke him and poke him, but he’s so zeroed in on those security needs (e.g., preventing anxiety, maintaining his self-esteem, and avoiding rejection) that he doesn’t even notice.  Maybe he sees your poking as a sign you are getting angry at him and are about to reject him, or maybe he sees your poking as a reminder that he doesn’t feel very good about his reading skills these days.  If that’s the case, he might even zone out that poking without even knowing it.  He’ll lose his focus on that reading assignment even more, or he’ll frantically start some other activity that he knows he’s better at than reading.  Is this starting to sound like ADHD to you?

Now, ask all the therapists you know, and they’ll tell you there are a lot of ways to skin a cat, and there are just as many ways to think about ADHD.  What I’m talking about here is just one of those ways.  While some behaviors that suggest ADHD definitely warrant a diagnosis and medications, not all do.  Instead, they may be unique cases of a child acting out in ways to get their relationship “security needs” met, applying that “selective inattention” to do so. 

It might sound weird to say, but perhaps in these cases Sullivan’s ideas can be helpful.  Little Tommy’s ADHD may not be some unchanging problem inside him that we need to medicate.  It may be something that looks like ADHD, coming out as little Tommy seeks his security needs in his relationship with us.

It may not be his ADHD, it may be our ADHD. 

This is why we therapists always look at Tommy’s behaviors as they occur in a whole bunch of different contexts and relationships (e.g., with different parental figures, with teachers, with peers, etc.).  Sometimes we need to look at these things first before going to medication, especially if Tommy has experienced any trauma or other big “security-need” disruptions in his life.

Think about it.  Is it his hyperactivity or is it genuine attention-seeking behavior in our relationship?  Perhaps he is a child who’s been told time and time again that he’s no good at math, but he sure seems to be able to make other kids laugh.  Is it his distractibility or is it the tendency to leave a difficult task prematurely because it doesn’t bolster self-esteem fast enough in our relationship?  In a lot of these cases, the ADHD behaviors might be a child simply trying to take whatever shortcuts are available to get those Sullivan security needs met with you.  The kid wants to feel less anxious with you, more self-confident with you, and fully accepted by you. 

It’s not just his or her ADHD, it is our ADHD.

So what do we do with this? Well, in these cases, Harry Stack Sullivan might say that the trick is pretending your kid is like that bird watcher.  And your pokes aren’t going to do much good until you get into his or her sights.  And you do that by addressing those security needs first.  This doesn’t mean you don’t poke or set any limits, but you do so after you’ve gotten their true attention by engaging their needs for acceptance, self-esteem, and regulated calm.  To do that, here are a few tips you might think about:

(1)    Calmly and assertively acknowledge behaviors and what feelings they might reveal.  Empathy is kind of like the oxygen the security-seeking child needs to breathe.  By naming the feelings that motivate the behaviors, you demonstrate the a child that you understand their security needs and are ready to walk him or her through what appears to be a challenging task.  This, in turn, calms that security-need anxiety and opens up the hunters gaze to feel the gentle and helpful poking you can offer.  “Sounds to me like you really wish I’d quit checking your homework and leave you in charge of it.  It makes you mad, I can tell!”

(2)    Always gauge the right amount of assistance to give a child in order to bolster his or her sense of self-mastery.  We call this “scaffolding.”  By doing this, we meet kids right at the edge of what they feel they can do and what they can’t yet.  When kids are disengaging from challenging tasks too frequently, the key is to calmly and assertively redirect their attention back to the task while also restructuring it so it is just achievable with some encouragement and support.

(3)    Use praise and connect success with effort and perseverance.  If a child is avoiding a task that feels like it might challenge self-esteem, maybe through ADHD-like behaviors, providing some praise can help.  In fact, a lot of praise might be needed sometimes. “It sure feels to you like video games are way easier than this multiplication. I can understand that. But look how much you’ve already done right! You got all of these correct before struggling with this one problem. Keep at it and I’ll give you some video game time for sticking it out.”

By integrating these a little more into your interactions with Little Tommy, you might tap into those Sullivan security needs that are motivating the behaviors in the first place!  Again, if it’s not just his ADHD, but our ADHD, we take these ideas seriously so we can do our part in reducing those symptoms making things difficulty.  We have just as much a role to play!