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A Systems-Based Holistic Approach to Addressing ADD and ADHD Behaviors
For a deep, comprehensive understanding of youth behavior issues, and a range of interventions that empower clinicians to facilitate rapid, lasting progress in clients without the need for medications or intrusive behavior modification plans
Jed Shlackman, L.M.H.C., C.Ht.
Copyright 2004, 2005 – All Rights Reserved. This text may only be distributed in its entirety and may be quoted based on fair use provisions of U.S. Copyright Laws.
With nearly 15 years of research and clinical experience in psychology and counseling, Jed Shlackman has worked to integrate the most effective interventions and most advanced theoretical perspectives to facilitate positive transformation and lasting improvements in clients. Jed has examined the roles of many treatment approaches for addressing emotional and behavioral challenges with children, including cognitive, behavioral, psychosocial, pharmacological, nutritional, dietary, family therapy, educational, spiritual, oriental medicine, energy medicine, energy psychology, play therapy, expressive therapy, sound therapy, biofeedback, neurofeedback, hypnosis, and parenting skills. Through research and experience, Jed has recognized the need to examine all aspects of a person's being and the interactions between the individual and the individual's environment in order to identify ways of facilitating change. The existing dominant models to address these issues are only designed to address behaviors and emotions from a limited perspective. It is recognized that any human perspective is inherently limited, and that part of growth as a therapist may include expanding one's perspective and awareness in order to have more resources and insights to assist clients. As a result of these recognized limitations in the mental health field, response to treatment is often inconsistent and unpredictable. In some cases, common treatments may only facilitate short term improvements, may only facilitate slow or minimal progress, or may even be followed by deterioration or a shift in symptoms rather than clear positive outcomes. It is hoped that by helping caretakers and professionals expand their perspectives and their awareness of issues relevant to youth psychological functioning, those who are in a position to guide and nurture youth will be better prepared to handle youth who present significant challenges and will be aware of more treatment options and of existing clinical and empirical findings associated with a broad spectrum of treatment methods.
One of the goals of this course and text is to present a systems based holistic approach to addressing ADD & ADHD behaviors.
Readers and course participants will be able to do the following upon completion of the course:
- Understand these behaviors as often indicative of difficulties with self-regulation and balancing.
- Recognize that the mind and body are an integrated feedback system.
- Learn to decode this feedback rather than merely suppressing the behaviors for convenience.
- Value the individual's self-healing instincts and coping skills.
- Understand how stressors can lead to reactions of hypervigilance or scattered attention
- Recognize how lack of nurturance can lead to reactions of excessive stimulation-seeking behaviors
- Learn how nurturing the body, enhancing family relationships, and managing stress help restore balance and resolve ADD/ADHD symptoms.
- Recognize that stress is a quality of experience that can be triggered by anything that disrupts routine or threatens the sense of balance and well-being within an individual or system.
- Identify potential benefits of the following:
> Physical Exercise
> Massage, Bodywork, & Energywork
> Oriental Movement Arts
> Family bonding
> Energy Psychology
> Nurturing creativity
- Understand how the interaction of the individual with his/her environment shapes brain development and brain activity.
- Conceptualize ADD/ADHD functioning as part of a continuum of functioning that tends to be fostered or augmented by an individual's reaction to certain types of environmental variables - not a "disorder" pre-ordained by genetics or any other specific factor.
- Recognize how behavioral and pharmacological interventions may impair emotional development and maturation if used in place of interventions suited to building internal locus of control and coping skills.
- Examine how current major approaches to "managing" ADD/ADHD symptoms may perpetuate the underlying patterns within the individual and the environment that give rise to the dysfunctional behaviors, regardless of short term success in suppressing symptoms.
- Recognize how mental health diagnoses are based upon subjective comparisons to social norms rather than upon an objective definition of "disorder."
- Examine assumptions inherent in common efforts to get individuals to conform or adapt to social demands and the role of individuality in society.
- Understand how the standard methods of diagnosing and categorizing behaviors often limit the practitioner's ability to analyze the circumstances surrounding the client's state of functioning as well as the ability to recognize the range of interventions that are likely to facilitate positive growth and transformation in the client.
- Generate hypotheses and examine existing research about the comparative effects of interventions, focusing on identifying which approaches are likely to produce permanent or lasting resolution of disturbances.
The goal here is to empower the client to function in a healthy, balanced manner, independent of external management. This empowers the client and reduces health care costs, benefiting everyone except for those who may expect to maintain business by providing ongoing care to manage (rather than help clients resolve) mental health problems or adaptation difficulties.
Since each person is unique, the means of restoring balance will not be identical for all persons who have been diagnosed with a given condition. Thus, research efforts focusing on a magic bullet pill or specific psychosocial intervention will fail to achieve progress toward addressing the full needs of an identified population.
To begin the discussion of the ADD/ADHD controversy, I will mention here that approximately 10% of children in the United States have been diagnosed as having ADHD or other disruptive behavior disorders. Major medical and mental health organizations estimate that approximately 80% of children diagnosed with ADHD will continue to have this condition through adolescence and adulthood. The most widely promoted and prescribed treatments include psychotropic drugs, primarily stimulant drugs, although anti-depressants and anti-psychotic drugs are also prescribed to manage and suppress ADHD associated behaviors. If the alleged "disorder" remains then these treatments must not be offering any resolution or healing for those being treated. Those truly benefiting from this situation are people and organizations who sell pharmaceutical drugs and who provide various books, classes, and management strategies for "coping with ADD/ADHD." One of the more prominent persons who has built his career on promoting orthodox ADD/ADHD beliefs is Russell Barkley, Ph.D.. If he suddenly admitted that everything he has been claiming for the last few decades is misleading then his career and income flow would be expected to rapidly wane. In a personal communication with Dr. Barkley, he reported to me:
"I do not give equal weight to all proposals of etiologies or management of ADHD regardless of the quality or lack thereof concerning the literature that may exist about them."
Dr. Barkley avoided addressing specific issues I raised with him about empirical data related to ADHD and ADHD treatments, while he acknowledged that a small percentage of his income comes from pharmaceutical industry sources. He referred me to a previously published 2002 consensus statement about ADHD which itself ignored the issues I questioned Dr. Barkley about. This is the state of the mainstream research and treatment community's approach to understanding ADHD - protecting dogmatic views which keep a system in place that maintains reputations and wealth for people in certain industries. Meanwhile, there are increasing reports of adverse experiences related to pharmacological treatments of mental health concerns and reports of ongoing increases in mental health disturbances in the population. So, it would appear that mental health treatment is overall not very effective, which necessitates a need for ongoing "management" of symptoms. Claiming that ever more people have mental illnesses and need treatment is in part a way to support "growth" in the mental health industry, as the socio-economic paradigm in which we live is based on this idea of business and corporate growth. Actually offering effective healing support would harm the industry, for once people are "cured" and in charge of their own health, then who would be left to treat?
IMAGINE for a moment that you look at a movie or picture with stimulating content, such as violence or eroticism. Does your pulse, breathing, or body posture shift in association with this experience? Most likely, YES! Now, suppose you took a drug or herb of some sort that triggered a similar shift in your body's vital activity; would this lead you to start thinking about violence or eroticism? Depending upon your past experiences and resultant mind-body associations, it certainly might. Some people consume alcohol and feel relaxed and calm, while others consume alcohol and become rude and violent. Same chemical, yet different reactions! Simplistic linear thinking cannot provide an adequate understanding of ADHD/ADD behaviors or any other health issue. The dynamic interactions of mind, body, and environmental variables must be examined and conceptualized to provide insight and generate positive healing interventions.
Each human being is a manifestation of multiple levels of consciousness. Behaviors can be quantified, but consciousness can't. Consciousness lies behind all behaviors, yet the psychological field has no way of directly measuring consciousness. Instead, behaviors are measured and plans are made to provide interventions that are expected to influence some level of consciousness to facilitate a shift in the behaviors. For example, a token economy may be instituted to increase a desired behavior or limit a disruptive behavior due to the idea that the individual's motivation to gain the identified rewards or reward credits will override whatever was motivating the individual to act in unacceptable ways. Family therapy may be employed due to the idea that an individual's behavior is motivated by his/her reaction to patterns of behavior or communication involving other family members. Psychotropic medicines or nutritional supplements may be prescribed due to the idea that the individual's mood or actions are motivated by some response to the biochemical state of the brain. Notice how each intervention focuses on a specific area or factor that is believed to influence motivation, and presumes that the targeted area or level is of greater significance than other levels for addressing the therapeutic concerns that have been presented. Also, most theories attempt to outline linear cause-effect relationships between variables, ignoring the evidence that consciousness functions in non-linear dynamic systems. As clinicians it is useful for us to examine what assumptions underlie our interventions and to be able to step outside of these assumptions to see a larger context.
Let's look at the implications of key words we will use in discussing these issues:
Consciousness - a quality of awareness. The "mind" that we normally think of is a self-aware form of consciousness that has a concept of "self" and external surroundings. Many scientists, philosophers, and theologians are convinced that all things in creation exhibit signs of consciousness, but at much different levels on a continuum of self-awareness. Each cell in our body has an awareness of what it needs to do to stay alive and function according to its role in the human body. Our ordinary conscious mind has minimal influence over involuntary body activities, and at most times only guides voluntary movement. However, research in hypnosis and other states that access deeper levels of awareness/consciousness show that there are levels of the mind that exhibit much control over seemingly involuntary body processes, such as perception of pain, allergies, hormone regulation, immune function, asthma, and other phenomena. Consciousness, at the very least, cannot be thought of as something not influencing physical processes. In leading theories generated by theoretical physicists, physical reality and matter are ultimately illusory and are just a product of how we [through human incarnations] perceive fields of energy and information generated by consciousness.
Motivation - a function of consciousness that guides behavior. Etymologically, this word suggests the idea of that function of the mind which puts things in motion or action. Since a human being is a composite of multiple layers of consciousness, different motivations may conflict with one another in the same individual, and different motivation sources may dominate depending upon the issue in question. For example, one may consciously feel motivated to jump in the air and fly from the top of one skyscraper to another. However, even if a person were consciously unaware of gravitational forces or the inevitable result of such a jump, there would usually be some level of awareness within that person which would lead him/her to refrain from the jump due to the motivation to stay physically alive. Even persons who have never learned that snakes and spiders may sometimes be poisonous will often have fears of these animals that have no identifiable conscious origin. Another provocative example is a person who loves to taste peanuts, but displays a severe allergy upon coming in contact with peanuts. The conscious mind is motivated to taste peanuts but the consciousness of the relevant system of the body is acting to reject this food. People with habits and addictions that frustrate them are another example of this phenomena of conflicting motives. Most psychological theories and therapies have a chart or formula of some type to explain how motivation works in the theory, even if the term motivation isn't mentioned. Unfortunately, these theories do not consider the complex and multi-leveled nature of consciousness and motivation that we are attempting to examine here. Popular psychological theories are often useful for examining some forms of motivation, but will leave a clinician stuck if motivations related to therapeutic concerns lie beyond the scope of the theory.
Behavior - observed actions. This is easiest to define. This is the outermost level of what psychology is concerned with. However, in the modern managed care model of mental health, behavior has become the focus of diagnosis and treatment, leading clinicians away from examining consciousness and motivation in an in-depth manner and instead shifting toward therapies that focus on the "conscious" level of mind and biochemistry. Popular current approaches include "brief therapy," behavior modification, and pharmacotherapy. Current mental health institutions often use the phrase "behavioral medicine" in their name, reflecting the bias toward examining and manipulating behavior rather than balancing and transforming consciousness.
Cognition - active awareness. Cognition means the act of awareness. This includes the idea that our minds function to process information from our environment and experiences. Thus, whatever we become aware of gets processed in some way according to our existing beliefs, values, expectations, etc. Cognitive therapies focus on the conscious level of this process, but usually don't take into account that an individual's mind is not integrated and unified in its beliefs, motives, values, etc. For example, one's conscious mind may recognize that fear of being on an elevator is irrational and disabling, but some aspect of the person's consciousness may still react to elevators with panic.
Emotion - a quality of experience that provides feedback to the individual regarding how experiences relate to the individual's values.
For example, when a person experiences fear in response to the environment then there is most likely a value of safety or stability that has been threatened based upon the individual's perception of the environment. If a person had no value or concern for being physically alive then situations considered by others to be dangerous would not produce any fear or unease in this particular person. In fact, if the person wished to leave the physical realm and highly valued the prospect of entering an afterlife state then the signs of physical hazard could facilitate happiness or enthusiasm in that person. This is an extreme example, especially since the life-preserving instincts/values of the body would normally override any "death wish" developed by the conscious mind. Nevertheless, this shows how emotions provide feedback related to values, and it can't be assumed that people will always react the same to any external situation or environment. Emotions are usually powerful energizers of behavior, in that the more strongly someone feels about something the more likely that individual is to act. Lasting reduction of dysfunctional behavior usually necessitates work on neutralizing and transforming the emotions that drive the behavior, whether the client is conscious of the emotions or not. A combination of psychodynamic, cognitive, and mind-body (holistic) therapies may be helpful in facilitating the release/dis-charge of suppressed feelings and a shift in values and beliefs to minimize the likelihood that unhealthy emotions and associated behaviors would be recreated. Physical detoxification and improved nutritional and lifestyle practices may also help with this emotional cleansing and psychological transformation.
Brain Hemisphere Duality & Synchronization - in humans, the brain is divided into 2 hemispheres, which are normally active separately in processing information and have limited communication between one another. The left hemisphere is usually active in logical, linear thought processes and linear mathematical calculations. The right hemisphere is most active when a person is engaged in creative activities and receiving intuitive impressions. There are some structural differences in brain morphology between human males and females that could explain why the genders have been historically adapted to different societal roles, although these differences can be substantially overridden by how we use our minds, as brain activity responds to psychological activity just as much as psychological functioning is influenced by physical brain characteristics and neurological activity. Sound tones, visual patterns, and other stimuli have been used to help persons enhance communication between brain hemispheres and improve utilization of the brain's cognitive processing capabilities. The brain appears to function as an interface for consciousness to interact with the physical realm using the body, and there has been much evidence accumulated to refute the idea that consciousness arises as an effect of the brain's development. Just as a computer is not a root source of information or data but a tool for input, output, and processing of information for humans, the human incarnation is metaphorically just such a tool for aspects of consciousness which are part of an immeasurable spiritual creative source. I encourage everyone to consider the implications of these concepts, and how such concepts challenge limitations and deterministic assumptions often maintained in the health care field. To use another metaphor, if one's TV cable line is malfunctioning, does that impair the production of the show or source of the transmission, or just the transfer of the signal/data to your own home and TV set? When someone is "brain dead" the physical realm does not cease to exist nor does the spirit/consciousness that has been immersed in the physical realm. Those in comas sometimes recover and report witnessing things that actually happened while they were virtually "brain dead," since their consciousness was able to view the physical realm from an "astral" or etheric perspective that doesn't depend upon physical body senses and the brain's processing/filtering of those physical sensory inputs.
Dissociation & Multiple Personality Syndromes - persons suffering from trauma, especially early trauma or severe trauma, may display a fragmentation of personality. Distinct personalities may develop that are unaware of other personality fragments and of actions carried out by the other personalities, with these alternate personalities alternating control of the person's conscious mind according to external cues and stressors. Nazi scientists in Germany were involved in experimenting on subjects to develop methods of creating dissociative identities which could be directed for intelligence and espionage purposes. This research was later expanded by groups in other countries, including the U.S. CIA, which further developed these efforts in sub-projects under the MK-ULTRA project umbrella. Many leading doctors and mental health professionals worked with these projects and accumulated extensive information about the dissociative process and methods of deliberately programming persons based on these findings. Distinct changes in physical condition and physiology have been documented with personality shifts among those with genuine dissociative syndromes. Understanding the realities of DID and MPD are useful in recognizing the complex nature of consciousness and personality structure.
Feedback System - a system where there are one or more units that process information and adjust their activity according to the perception and processing of information generated by this system. All feedback systems present the possibility and likelihood of change, as a system where change is impossible would not be able to use feedback. In our world where our physical body is integrated with our mind, we have "experience" which is the feedback generated by how we perceive external occurrences associated with our presence in the physical world. Our body has "programs" to protect itself and preserve its integrity, so it perceives things which may harm it as unpleasant - for example, you feel pain when you touch a fire or hot iron, your sinuses feel irritated when you are first exposed to cigarette smoke, you feel pain when physically struck, etc. Psychological programs, however, may often override these body programs - for example someone may begin to crave cigarettes, feel stimulated by physical abuse, and even be able to numb physical sensation when touching flame. We have "programs" for handling feedback, while we are able to adapt or transform these programs as our awareness shifts. Our individuality and self-awareness are key to our power and capacity for change. When we experience an unpleasant symptom we can try to trace the symptom to the factors that lie at its origin. For instance, a phobia will be triggered when we become aware of some external stimulus that elicits fear in some aspect of our consciousness. How did this fear develop or become a program in one's consciousness? Usually, some past emotional reaction to an experience is involved. Beneath the emotional memory may be a dysfunctional belief or identity structure. Even if we access and clear the memory pattern and emotional charge the belief may remain and contribute to future emotional reactions that trigger symptoms. Also, if we confront and transform the belief on a conscious level, we may still encounter residual symptoms from the emotional charge and the body, as these are guided by deeper levels of consciousness. The new awareness and beliefs must be communicated through ALL levels of consciousness connected to the individual. Conventional therapeutic modalities do not utilize such a concept and don't have techniques for facilitating such communication.
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