So I poured my heart into a 4-page letter to the editor about ADHD, only to discover the journal doesn’t do letters to the editor! The management committee indicated they don’t do critical discussions on their previously published articles. 🤔 So, here’s the shortened version on my blog instead. Let’s open up the conversation here! Curious to hear what you all think.
Dear Editor,
I am writing to provide a critical enquiry into Laura Wilson’s article titled “ADHD – Attention Deficit or Deficit of Attention? A Reverie on Attachment, the Self and Discontinuity” published on June 2024 in The Therapeutic Conversation Issue 8 2024. While I appreciate the exploration of different perspectives on ADHD, an analysis of the paper reveals several critical issues that need to be addressed. As a psychologist with ADHD and the professional qualifications to diagnose and treat it, I feel compelled to share my perspective and clarify misconceptions.
The rticle provides a comprehensive understanding of trauma, however it lacks a nuanced understanding of ADHD. It leans heavily on the role of attachment and psychodynamics, downplaying the significance of neurobiological factors and individual differences. Generalisations about the relationship between trauma and ADHD fail to recognise that correlation does not imply causation. It is important to acknowledge that not all individuals with ADHD have experienced early childhood trauma, and not all individuals with trauma have ADHD. Additionally the article cites research from 1999 and 2001 as “contemporary psycho-neurobiology” and “advanced research.” However, according to Dr Russell Barkley, ADHD research has significantly progressed since then, with over 200,000 papers published on the topic since 2011.
A 2023 Australian Senate inquiry into the Barriers to consistent, timely and best practice assessment of attention deficit hyperactivity disorder (ADHD) and support services for people with ADHD indicated undiagnosed and untreated ADHD carries significant risks. This includes increased suicidal ideation and completion, marginalisation, co-occurring mental health conditions, employment instability or unemployment, and poor educational outcomes. Furthermore inadequate ADHD support services have long-term consequences for individuals, families, and healthcare, education, and justice systems. The senate inquiry further highlighted lived experiences of people living with ADHD where they described how poor therapy experiences can be traumatic, exacerbating ADHD symptoms. Given this, there is a need for trauma-informed and culturally appropriate practices when addressing ADHD.
Wilson’s article implies that the client, Ben, has ADHD without a formal assessment. This is concerning because the author, a psychotherapist relied on a self-diagnosis, this alone is insufficient for a comprehensive understanding of an individual’s condition. It is important to rule out other medical conditions and comorbidities must be assessed and treated appropriately. The article also made generalisations that people living with ADHD have a fragmented sense of self which in my view is problematic. Many individuals with ADHD have a strong and cohesive sense of self. It’s also important to recognise that broader systemic issues contribute to misconceptions about ADHD which can lead to shame and blame. As such people do not get the help and support that they need. Executive functioning difficulties in ADHD can make an organised life challenging, but a multifaceted approach treatment including medication (if appropriate) lifestyle changes, psychoeducation, behavioural approaches, and positive support networks can help manage these challenges.
Wilson seems to project ADHD in a negative light, confusing fragmentation and dissociation with ADHD traits like hyperfocus. Traumatic memories usually trigger dissociation, often accompanied by negative emotions. Hyperfocus, on the other hand, is intense focus on a person’s interest and generally generates positive emotions. As therapists, we should focus on a person’s strengths, including their unique talents and abilities. Recognising and appreciating these strengths can significantly improve emotional well-being and foster a positive sense of self.
Promoting inclusion and recognising a person’s inherent value regardless of their disability is crucial to ensuring optimal care for individuals with ADHD.
I urge you to address the concerns raised in this letter in a manner that you deem appropriate for the journal.
Thank you for your attention to this matter.
Warm regards
Mary Joy Basilio
References
Australian ADHD Professionals Association. (2022). Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD) (1st ed.) [Clinical practice guideline]. https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/ADHD-Clinical-Practice-Guide-041022.pdf
Barkley, R. A., & Benton, C. M. (2022). Taking charge of adult ADHD: Proven strategies to succeed at work, at home, and in relationships (2nd ed.). The Guilford Press.
Brown, T. (2017). Outside the Box: A Practical Guide. American Psychiatric Publishing.
Community Affairs References Committee. (2023). Assessment and support services for people with ADHD. Parliament of Australia. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ADHD/Report
Falk, D. E., Yi, H., & Hiller-Sturmhöfel, S. (2006). An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders: 1 Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research & Health, 29(3), 162-171.
Meares, R. 2012. A Dissociation Model of Borderline Personality Disorder. W. W. Norton & Company: New York.