ADHD – Mismatch or Illness?
At 6, Lilly was in lots of trouble. She and her family had been referred to family therapy by the school who had become exhausted by her inattention, distractibility, and violence towards other children.
In the first session attended by the whole family it became clear that there was much that could not be openly discussed, and that the reality presented did not match the facts. Later it was disclosed that Lilly had been born into a frightening world of addiction, violence and instability punctuated by police and legal involvement which resulted in her father’s disappearance explained as ‘Dad working away from home’. Throughout the first visit of an hour and a half Lilly played quietly and intently with her younger siblings, clearly listening but not interrupting. Seen alone for the next session she was co-operative and attentive especially as she spoke about her fears that both parents may die, and she would be responsible to care for the young ones. At our third session a very different child appeared. Lethargic and disinterested she spent the bulk of the session with head on arms leaning on the sofa. Her mother explained that school could no longer tolerate her behaviour and had suggested she was suffering ADHD and referred them to a pediatrician who prescribed medication. The school, her mother reported was well pleased with the result.
It is many years since meeting Lilly, but she came vividly to mind on reading a paper by biological anthropologists Syme and Hagen (2020) who challenge traditional psychiatric approaches, noting that. ‘Scientists understand little about the etiology of mental disorders, however, and many of the most popular psychopharmacological treatments, such as antidepressants and antipsychotics, have only moderate-to-weak efficacy in treating symptoms and fail to target biological systems that correspond to discrete psychiatric syndromes’. Their analysis of ADHD was particularly striking where they suggest that it may be ‘a harmful (but not dysfunctional) mismatch between highly structured modern environments and less structured ancestral ones’. With low hereditability and high population prevalence it is characterized by symptoms specific to ‘contexts requiring sustained attention and behavioral restraint such as the classroom or the workplace, and it is not clear how problematic this phenotype is in less structured environments. It may be that this ‘disorder’ is a result of a ‘mismatch between normal child development and classroom environments’. Their final word on this subject was particularly poignant given my clinical experience ‘ADHD is perhaps another example in which the illness label serves the interests of the powerful (e.g., teachers, parents) at the expense of the powerless (e.g., children). It is far easier to control rambunctious and inattentive children using medication than it is to restructure the school environment to accommodate normal variation in development.’ One could add that it is also easier to medicate a child than face the distressing chaos of the world in which they reside.
Syme KL, Hagen EH. Mental health is biological health: Why tackling “diseases of the mind” is an imperative for biological anthropology in the 21st century. Yearbook Phys Anthropol. 2020;171(Suppl. 70):87–117
NDIS Services
Bower Place is an experienced NDIS service provider, of therapeutic practice, support coordination, and therapeutic mentoring with expertise in services for complex, co-morbid, child, adolescent and adult mental health, disability and child protection matters. We work therapeutically with cognitively challenged clients and those with significant cultural, language or religious differentials. Bower Place works in 7 first languages; English, Mandarin, Farsi, Dari, Arabic, Dinka and Russian.
Bower Place is seasoned in face-to-face and online service delivery and we have organised our staff into expert teams to respond to each client’s need in their unique context. This may be for direct services to clients or those providing other forms of care. All staff have access to the most recent and secure technology in order to offer the highest level of therapeutic services on-line and with safety and confidentiality. We are skilled in working with individuals, couples, families and work groups. We also provide support and guidance to those who work with their own clients or patients.
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Graduate Diploma in Family Therapy and Systemic Practice
This 2-year post graduate qualification is accredited with the Australian Association of Family Therapy (AAFT). On completion, with an additional 50-hours group or individual supervision and 500-hours clinical experience, students are eligible to apply to join AAFT as a Clinical Family Therapist and identify themselves as such.
Students participating in the Bower Place Graduate Diploma in Family Therapy and Systemic Practice work with Bower Place Complex Needs Clinic clients on a Wednesday evening. Sessions are facilitated by a first and second-year student together with continuous and direct oversight by educators, Melissa Minney, Program Director, AAFT Clinical Member and Clinical Psychologist, and Catherine Sanders, Bower Place Director, AAFT Clinical Member and Clinical Psychologist. Catherine meets all new clients as part of the first session and participate in sessions as required.
On completion of this course students should be able to:
- Identify the central theoretical tenets of a systemic approach to family therapy
- Describe the relationship between a systemic approach and the personal, relationship and ethical difficulties experienced by clients
- Describe the way in which a systemic approach is applied to individuals, couples, families and wider systems
- Apply theory of systemic practice to work with a range of presenting problems and family arrangements
- Have developed an understanding of their own personal responses to human difficulties as a result of experiences in their family of origin and life experience and be skilled at managing and utilising their resources.
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Knowledge and Training – Professional Development
Professionals in both the public and private sectors have expertise in their chosen field, be it medicine, law or accounting, but are constrained to respond to the emotional demands of their clients. They may also feel overwhelmed by those demands. The task of emotional helping requires specialist expertise in managing complex situations, an ability to assess the dynamics and difficulties that present both individually and relationally and understand the impact of the current health crisis on individuals, families and the work contexts. This is particularly true of those working in the human services field; psychology, social work, accounting, law whose clients look to for clear, unequivocal guidance, support and advice. As the demand from our clients increases, we may find ourselves doubly overwhelmed and unable to adequately respond to them and others in our world.
High quality training and professional development to colleagues, business leaders, teams and organisations will continue to be offered as on-line supervision and training. Input can be tailored to the specific needs of the individual practitioner, team or work group to help them work more effectively with their client group while remaining effective and functional.
Bower Place provides confidential expert face-to-face and online consultations for children, adolescents, adults, couples and families experiencing the impact of the COVID-19. When humans experience extraordinary external stressors, individual and relationship distress between couples and within families can escalate.
For bookings or further information please contact Bower Place (08) 8221 6066 or info@bowerplace.com.au