Is ADHD a Real Neurological Disorder or Collection of Psychosocial Symptomatic Behaviors? Implications for Treatment in the Case of Randall E.

What we call something has consequences in terms of how we conceptualize and treat it. A multitude of names, all hypothesizing a neurological substrate, preceded the by-now-familiar “Attention Deficit Hyperactive Disorder” (ADHD) nosology. But what if the emphasis on its neurological origin was either wrong or irrelevant? How would this effect our approach to individuals so labeled? I contend that embracing a neurobiochemical conceptualization of ADHD has prematurely and mistakenly led us to believe that its solution must necessarily involve an organic remedy (such as medication), which often precludes psychodynamic approaches. I have worked psychodynamically with children for more than 40 years, including a host of those who have been independently diagnosed as ADHD (or many of its previous descriptors). I have concluded that this thing we call ADHD is typically related to a form of agitated depression, which is amenable to psychodynamic treatment. I have provided the psychodynamic treatment of Randall as an illustration of a child whose hyperactive symptomatology initially helped him stave off unbearable feelings of agitated depression. Even though his disorderly behavior caused Randall considerable trouble, it was the best he could do—until his underlying feelings could be analyzed, understood, and treated in a safe, human, and interpersonal interaction, sans medication.