I'm on my own tonight, so I stopped at a Starbucks for an iced tea and to add a few thoughts to the blog. I could do this at home, but I have no reason to hurry home tonight. During my return from CE day in the NW burbs, I even stopped to take a few photos of McDonald's Store #1. I made a slight detour to get there, but I'd long planned to swing by it and snap a few shots if I ever had reason to pass that way again. I've seen it many times, but not since the 1990s, well before mobile digital and long before I carried a camera everywhere. I'll upload a photo or two tonight or tomorrow.
But first, I'm glad that I didn't find the seminar today to be a waste of time. Though I don't treat children, nor do I see patients with ADD as a primary complaint, it was nonetheless helpful to look at some ways of strengthening executive functions in individuals who have difficulty with self-regulation. I don't expect I'll use the interventions we reviewed--they wouldn't fit in with the therapeutic approaches I use--but the material could still be helpful for conceptualizing some matters that are relevant in dealing with many challenges faced by clients I see.
Earlier, I also mentioned my resistance to thinking of so-called ADHD as a disorder. I think of ADHD as part of normal human variation that could be beneficial in certain environments, either to the individual or to the group [organism] as a whole. Unfortunately or fortunately, depending on how you look at it, low-capacity for sustained attention and some of the other characteristics of what's called ADHD generally don't serve well in modern life with our emphases on sitting still in classrooms, hours of homework, scheduling, planning and permanent records of conduct and performance.
Rather than thinking of the person diagnosed with ADHD as having a "disorder," I find it more useful to think strictly in terms of their circumstantial challenges with the aim of improving adaptability in ways that are personally relevant for the individual. Not that I provide services to these people, but I talk with friends and people ask me questions, so that's my framework.
With respect to diagnosis, think about it this way: if someone is expected to hike five miles up a mountain, but they only have the endurance to walk a couple of miles on level ground, we don't say they have a hiking disorder. If they will never need to hike a mountain, it may not even be an issue. But if they're required to hike mountains, and there's no way out of the requirement, they might begin a program of training so that they could hike mountains. We might also look at options for equipment, shoes, clothing and anything else that might make the challenge more manageable.
Defining such a person as disordered isn't just conceptually problematic. Doing so may have pernicious effects on their expectations and judgments of their own potential. Problem is that insurance companies require the diagnosis of an illness. Schools also need diagnosis of a condition or disorder to justify accommodations and potentially helpful services. That's also part of our modern world.
But looking at the kid on medication, seeing a collection of psychiatrists, psychologists and tutors and also getting "special" accommodations at school, I find myself with concerns about framing it all as an illness. How does such a child view himself and his future? The lament of a friend's kid in this circumstance has been that he'll end up "a bum living on the street." Of course, our friends are very concerned about how this affects their son's self-image. Got to wonder how much he's internalizing an image of himself as defective and disordered.
Perhaps all the extra services would communicate that even if he didn't have the disorder label, but wouldn't it be better if he could experience his efforts as more akin to practicing the piano rather than regarding himself as defective? The world doesn't make much room for thinking about it this way, but it's certainly a frame that parents and therapists could present, assuming they truly think that way. For me, it wouldn't be difficult because I can see the great challenges while I really don't see so-called ADHD as a mental disorder.