ADHD: A Path to Success
Chapter 5 of first 6 Chapters

ADHD: A Defense Mechanism

(continued)

ADHD works by the same processes and serves the same function as traditional psychological defense mechanisms. In fact, it is best thought of as a defense mechanism favored by children.

Freud talked about how repression, suppression, or denial, are ways of keeping noxious thoughts and memories out of one's consciousness. That is, they are attentional avoidance mechanisms that work just like ADHD.

Freud saw defenses as the patient's active efforts to adapt, but that ultimately, if overused, backfired. So too, it is with ADHD. Framed in terms of Conditioned Attentional Avoidance Loop Model, the patient is as an active, skilled adapter to the environmental stimuli, just as Freud saw his patients. However, in both cases, defense mechanisms have gone awry.

Like all defense mechanisms, avoidance behavior functions as a way to spare the ADHD child the unpleasant emotions — whether they are triggered by internal or external experiences. It does this by keeping annoyances out of consciousness. But the defense strategy suggested by the Conditioned Attentional Avoidance Loop Model is more obvious than traditional defenses since:

1) The behavior of children is less sophisticated and thus more obvious.

2) The noxious stimuli (parents, teachers, and schoolwork) are usually here and now a opposed to in the past or far away.

3) Adults are actively engaged in keeping the child from physically escaping.

4) Much to the chagrin of the observing or diagnosing adult, the defense mechanisms of the ADHD child are often a reaction to the adult.

ADHD is Felt as an Insult by Adults.

This last point deserves further discussion.

My perspective using the Conditioned Attentional Avoidance Loop Model allows me to focus not only on the ADHD child but also on the adults who play an important role in his environment.

Failure to consider the role of adults in the child's world has made it difficult to observe accurately and understand ADHD. That's because the role of the controlling and evaluating adult, whether teacher or parent, is crucial to filling out our picture of the child. The adult is part of the Conditioned Attentional Avoidance Loop and the adult is the one responsible for triggering the attentional avoidance.

The child, simply, is always maneuvering to stay out of reach, and he does this by directing his attention elsewhere. No matter what you ask him, you get evasive, escapist responses — "I don't know," "Doesn't bother me," "Sure, I have lots of friends," or "I don't care."

These responses occur between bouts of looking away, fiddling with things, wandering off mid-conversation, outpouring emotionally, grimacing, or glowering. These responses are an efficient smokescreen that is both difficult and frustrating for the adult to comprehend and respond to rationally.

Seeing the role of the adult as causal to ADHD behavior may at first feel upsetting and disorienting. We do not like to think of ourselves as the target of someone else's defense system. The message received is that the ADHD child is defining you as the enemy whether you like it or not.

This differs from traditional psychology that deals with patients who are defending against some internal or historical experience. The latter is much less aversive than when someone is defending against you. Despite his most caring and benevolent efforts, the ADHD child blots the therapist, parent or teacher out of his or her reality.

In fact, it is the nature of the ADHD child to refuse to connect interpersonally with you or conform to your demands. He does not seem to understand that you are trying to act in his best interests. Instead, suddenly, the adult is on the receiving end of rudeness, rejection, or insults.

Since the adult feels helpless and frustrated in controlling the child's behavior, he or she feels personally affronted. It is as if your well-meant offer of friendship is being rebuffed.

Because of this affront to you and your reality, it's easy to see ADHD children as more defective than they are. Thus, it becomes even more tempting to categorize ADHD children in an unbecoming fashion — as we are likely to do to anyone who rejects us. If the ADHD child does not like us, he must have something wrong with his brain. So we come up with labels like "Minimal Brain Dysfunction" or "neurotransmitter hypothesis," depending on what is in vogue.

While teachers and counselors insist that they are professionals and thereby do not react emotionally to the antics of children, inevitably they do respond. Not to acknowledge this emotional reaction is to blind ourselves to a major piece of the dynamics driving ADHD. We have been seduced into focusing on only one part of the feedback loop— the child.

Jane, a 14-Year-Old ADHD Girl

Jane, a 14-year-old, white female with ADHD, had been adopted at about 18 months. Her life before adoption was largely unknown except that her birth parents were alcohol and drug abusers. Despite this, she exhibited no evidence of Fetal Alcohol Syndrome.

Jane had a long history of treatment beginning in second grade. A wide variety of stimulant medications as well as a Chlonadine patch had been tried unsuccessfully. She also had been taken to numerous psychologists and other professionals to no avail. In spite of the efforts of these professionals, private sector, as well as a special education placement in the public schools, her behavior progressively worsened.

During Jane's first appointment with me, her behavior, although joking and playful, was loud and confrontational. She made her distaste for adults very clear. She wandered around, talked constantly, interrupted others, moved objects, and cussed. Her dress and behavior had a strong masculine demeanor.

On a daily basis, her school life was punctuated by open verbal and physical conflict. Being exceptionally strong for her age, she took delight in literally bouncing other boys and girls off the  lockers at school. With minimum provocation, she would regularly stand up in class and tell off the school staff with a well-developed vocabulary of expletives.

By the time she was referred to me, Jane was on the verge of being moved from her learning disabilities classes to a behavior disabilities class. Her own words pretty well summed up her situation, "My life is screwed."

Jane was certainly one of the most disturbed ADHD children I have ever seen in practice.

Our first several sessions together were focused on her anger, fear of rejection, and conflicts with peers and teachers. Because of lack of cooperation from the school, we were not able to proceed with desensitization by using tapes made by school staffers.

Her parents, though, were very cooperative, so we were able to do the desensitization tape procedure with them. By the fourth session, her parents reported that Jane showed more affectionate behavior and did homework voluntarily.

Despite the lack of cooperation from the school, by the fifth session Jane's teacher greeted the mother with praise for Jane and how well she was doing in class. At the same time, the teacher suggested that Jane would be able to get out of the Special Ed class and into regular classes if she continued her new performance level.

Jane was not able to move into all regular classrooms because, as the ADHD subsided, her true intellectual limitations became apparent. Despite some very systematic and consistent study efforts on her part, her academic performance, though much improved, was still subnormal. Jane was mildly retarded. She has, however, been successfully mainstreamed into several classes

Though she has a somewhat odd, rambunctious, and endearing social style, it is now within normal limits. She makes friends, participates in activities, and feels good about herself. Over a three year period, Jane was treated in about 35 sessions, most of which were in the first year and a half.

 She is now 17 and has not been seen for about 14 months. Follow-up telephone calls indicate that her behavior in school is normal. She is still mostly in special education classes with some mainstreaming. She has occasional minor conflicts with her parents, as is typical of most teenagers. And she is beginning to date successfully.

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