Interview: Ritalin Or The Raft?
Mark Twain's Huckleberry Finn may have been a bit of a hellraiser. But as David Nylund reminds us in Treating Huckleberry Finn: A New Narrative Approach to Working With Kids Diagnosed ADD/ADHD (Jossey-Bass), he was also a noble soul who used his abundant energy to free his slave friend, Jim. Unfortunately, if Huck were alive today, Nylund posits, he would likely be diagnosed, like thousands of "unruly" children, with attention deficit disorder and put on Ritalin. We'd probably have a tamed, more attentive Huck, but a Huck less likely to commit bold acts of conscience.
Contributing writer David Ruenzel recently reached Nylund at his home in Sacramento, California, where the author-therapist discussed the forces behind ADD stories and the approach he takes to provide families with alternatives.
Q: You argue in your book that ADD is a story.
A: Yes. I see ADD as a social construct that is produced in part by the biological, medicalized lens through which we now see "disorders" such as ADD. Adding to the tendency to diagnose ADD in this country are the politics and biases of psychiatry and powerful pharmaceutical companies. ADD is largely an American phenomenon that is only beginning to be globalized.
Q: What is the usual process by which the ADD diagnosis is reached?
A: The most typical pattern involves the teacher noticing certain behaviors and introducing to the parent the idea that the child might have ADD. A rating scale for ADD is then usually filled out by the teacher. The parent then takes the kid, along with the rating scale, to a nutritionist or child psychologist. Often the parent will also take a class on ADD. Sometimes parents have had a very difficult time dealing with the child, and so they're vulnerable to the ADD diagnosis. It's an easy way to explain a child's behavior, and so many parents actually feel encouraged when their children are placed on Ritalin.
I should point out that most kids are diagnosed without ever seeing a psychiatrist; it's the scale that is diagnosing ADD. And the kids aren't even involved in the whole process; no one's even asking them what they think. This is a totally adult-centered conversation.
Q: So teachers are usually the ones to first introduce the possibility of ADD?
A: Yes, but I want to be careful here not to blame teachers. I was once an elementary school teacher, so I know the difficulties and challenges teachers face. And these have in fact been increasing with more standards, standardized testing, and accountability. ADD helps stressed-out teachers come up with an answer as to why kids aren't learning more.
"I see ADD as a
social construct," says Nylund.
Q: You say in your book that you don't directly challenge the ADD diagnosis when the family comes into therapy.
A:That's right. I resist doing that. Instead, I focus on how the parents and child feel about the ADD diagnosis. You have to remember that many parents have found the diagnosis helpful; often it has provided them with special services and an explanation. So I begin by exploring the diagnosis with them. I ask, "What is Johnny apart from ADD?" This is a key question because it helps them identify abilities or talents that have been forgotten because of the ADD conversation. They can then hone in on other aspects of the person that the ADD story has omitted. Eventually, the kids and parents begin to question the ADD diagnosis on their own accord. They realize, for one thing, that the symptoms of ADD are still there, in spite of the treatment and medication. They are disillusioned because the problems of temper tantrums, of not paying attention, are still around.
Q: What then happens in narrative therapy?
A:We don't try to rewrite the ADD story because that story has had real impact, and it just isn't going to disappear. But kids can access another type of story that can co-exist alongside the ADD story. They can begin to say, "OK, I'm ADD, but I'm other things, too." In narrative therapy, kids and parents realize that Brendan is actually a very inventive boy, gifted at computers or mathematics, or that Sally is a wonderful artist who illustrates her own stories. Once a child has access to other stories, certain behaviors associated with ADD seem to diminish. These children really are like Huck Finn. They have a lot of gifts that have been totally forgotten about in lieu of a diagnosis- rowdiness, in Huck's case-that is counterproductive.
Q: But will the positive effects of narrative therapy last? After all, kids have to return to the same classroom and society from which the ADD diagnosis originated.
A: That's a very good question, and I can give you no easy answers. The influences of culture and society are powerful, and it's going to require much more than the therapy I do in my room to make meaningful, long-term changes in the way people approach this issue. After all, this is a fast-paced, high- stress culture, and my whole point is that ADD isn't located in the brain but in that culture. Until you begin to change that culture, only so much can change. But at least a kid emerging out of the kind of therapy I do has access to abilities and new, powerful stories he or she can hold on to.
Also, the therapy I do calls for getting out of the therapy office. I consciously try to make my work political in terms of working with schools and teachers. I regularly go to the schools and so do the counselors I supervise. This way, we can see a kid in the context of school, instead of just relying on rating scales and the like. We also collaborate with teachers, who are often amazingly open when we talk to them directly. They're often ready to examine the conceptions they have about kids and ADD.
Vol. 12, Issue 4, Page 46Published in Print: January 1, 2001, as Interview: Ritalin Or The Raft?