Dr. Stanley Goldstein - Author and Psychologist

The Attention Deficit Hyperactivity Disorder (ADHD) diagnosis persists despite it possibly being the most unsophisticated notion in mental health for the past two-hundred years. In the late 1700s an English physician described the symptoms as "mental restlessness." In early 20th century America it was described as Minimal Brain Dysfunction (MBD) of which a Harvard psychiatrist remarked that any doctor who uses this diagnosis has a minimal brain dysfunction (a cute remark, I think). ADHD is merely its latest incarnation and makes no sense with more diagnoses on the East Coast than the West Coast and more boys than girls, apart from its symptoms being identical to anxiety and depression.

In both children and adults, when these symptoms are present and not related to real worry or unconscious conflict, they reflect Elements of a Borderline Psychotic Psychostructural Organization. Which does not mean Psychotic or Borderline Psychotic but rather a weakness of basic ego capacities because of faulty early developmental experience which occur during the first three years of life and affect the development of reality testing, mood regulation, sense of self, and control of behavior and thinking.

The ADHD diagnosis has persisted, I believe, for a number of reasons:
1. Large, profitable mental health and pharmaceutical industries have grown up around it.
2. Ego psychology has grown out of favor with a consequent dearth of education of clinicians on sophisticated early life ego and child development. My (long deceased but still mourned) doctoral advisor once said that to understand human behavior one must go to psychoanalytic concepts, that there is simply no where else to go, and I agree.
3. Sixty years ago most psychiatrists provided therapy but today few do, apart from those who have had psychoanalytic training and these are not many. Thus, apart from reasons 1 and 2, they prescribe drugs. Which, alas, some parents demand and doctors comply. As a mother once said to me, she would rather that her child had a brain tumor than an emotional problem since a tumor could be cut out. Most new patients don't know what therapy is and must be educated.

My experience with treating mothers has long impressed me with their strength. Despite their continuing daily tasks of tending to wandering-about youngsters, seemingly incomprehensible teenagers, difficult husbands, and an occasional sickly rabbit or other pet, they cook, clean, negotiatate with school officials, provide transportation to appointments, and cope with such intermittent crises as helping with children's homework and arranging for home repairs. All while trying, and often failing, to care for themselves.

Part of this is inevitable since, in most families, the mother is the emotional center of the family, which also makes her the major recipient of children's complaints. If a child is unhappy, it's HER fault. Is this fair? Of course not but that's how it is.

Which is not to say that the father's role is unimportant since, though the mother (or mothering figure who can be a male) is the most important figure during the first two years of a child's life, the father becomes equally important during their third year, serving to pull the child from the symbiotic relationship with their mother into the larger world and, ultimately, independent adult functioning.

While all children are sometimes irritating, occasionally they're completely impossible. I've joked with parents that the business office next to mine has a Saturday swap meet where children are exchanged.

But troublesome behavior has meaning since when a child is unhappy they don't spontaneously speak of their distress but instead act difficult. This is why Oppositional Defiant Behavior is the most common mental health diagnosis of children.

When asked to do something by their parent a child will usually comply since they want to grow up, to be an adult. Resistance thus indicates their inability to do what is asked because of illness, exhaustion, emotional upset, or an unspoken reason making sense to them but isn't logical. Then, speaking with the child is more productive than yelling, which should only be done when confronting a potentially dangerous or harmful situation. Otherwise, frequent yelling by a parent will cause warnings that a child should respect to be ignored.

While a child's birth is joyously anticipated, their parents' initial reaction is stress. This, even with a child who is generally considered easy to parent since this pain is both universal and unavoidable.

Beginning at birth, a newborn makes unceasing demands of their parents to become a more effective caretaker. Demands that are critical since a child is dependent on their parents for survival. But the adult mind is conservative and resists the rapid personality change that is needed. This clashing of demands and wills creates parental stress but, slowly, a melding of the needs of both.

An added stress is that a newborn is inserted into an ongoing (family) social system that has developed over time, and must now transform itself to incorporate this unselected newcomer.

Psychologists have long known that children in every nation become capable of speaking their nation's language not by learning that one word follows another but because the mind innately inducts the grammatical structure of their nation's language. Understandably so since the purpose of all cognition is to make sense of the personal world as quickly as possible.

It is not true that autistic children avoid communication but rather that they try to communicate in their own way. Thus, treating them with the same behavior modification method that one would use with a dog is doomed to failure. Instead, one must enter their world and wean them into the larger world, one that is unproblematic unlike the unsatisfying, psychologically non-nourishing developmental experiences that drove them from it originally.

One caution: misdiagnosis of autism in children is widespread and traditional play therapy can often reduce or eliminate a few autistic symptoms in mere months.

Communication isn't always straightforward. About the only thing that a parent can be sure of is if their child complains of feeling ill, this being evidenced by fever or another serious symptom. Otherwise, a child's complaint may be valid or indirect, which is similar to the behavior of adults.

Consider the man who is asked to purchase something by his wife and "forgets." This may be accurate if he has pressing issues on his mind or indicate his indirect expression of anger by behaving passive-aggressively. Similarly, a youth may behave in a puzzling way or make a puzzling statement to express a concern about the parent or another which they fear to express openly. Perhaps wanting greater independence than the parent allows or to react against what they interpret as the parent's deprecating comment.

As I never tire of repeating, the unconscious is very powerful and one must respect its power.

Children are usually cooperative unless they're hungry, tired, ill, or emotionally unable to do what a parent requests. Which they usually do since they want to grow up, to behave in an adult fashion.

When a child continually misbehaves it is always because they are unhappy, because their parents are not providing what they desperately need. Yet determining this may not be simple and require professional advice. My suggestion about this: if the clinician revels in jargon, is unable to explain in easily understandable language why your child is unhappy and what need be done to remedy it, find another specialist! You are the customer who need be satisfied and not the other way around.

The stress of creativity has long been known. Dedicated artists struggle all their lives, seeking financial success which is rarely achieved, motivated by what one might call their "creative addiction." But creativity, though not healing, can also grant meaning to an artist's life, rescuing them from life-long despair as they seek perfection in their work. These include such survivors of dreadful childhoods as Edvard Munch and Thomas Wolfe. Thereafter, Munch led a nomadic life and Wolfe's relationships were notoriously troubled as both unconsciously sought, through their creations, the good-enough parenting which they lacked as children.

Thirty-years ago I was asked to treat an eight-year-old child who, stricken with leukemia, had been discharged from the hospital to die at home. Though fearing the emotional turmoil, I felt unable to refuse the request, feeling that he needed someone.

The boy looked terrible at our first meeting, holding a white enamel tray lest he vomit. I introduced him to "our friends," the stuffed animals in my office (Bertram Bear and Darrell Dog and Barry Bird and Gregory Gorilla) while we played a board game. He looked healthy at the following sessions, not bringing a tray, and playing and interacting with our friends comparably to my other young patients. He seemed so normal that I embraced the frequent delusion that his doctors were wrong and he wasn't dying. Then one day, when he became too ill to travel, I went to his home and spoke with his parents in the kitchen while he lay in bed.

Despite my heavy work schedule and preoccupation with him since we met, I felt nothing when he died but my body reacted differently. Though continually healthy, I immediately developed an unpredictable explosive diarrhea which made me unable to perform my duty as expert witness in court. Medical tests found nothing wrong and when the diarrhea ended two months later, I sensed it was gone forever and it never returned. Had my body tried to expel the poisoning stress through diarrhea? I wondered. A primitive reaction explained by psychosomatic medicine which holds that what cannot be spoken will be expressed through the body.

Twenty-six-years later I was referred for treatment an adult who, after extensive surgery, was being heavily medicated by his doctor for pain and self-medicating himself with forbidden alcohol and cigarettes. Having become a troublesome hanger-out in her office, she referred him to me "for therapy." A first glance told me he was dying. He had no interest in therapy, I didn't see him for long, and my increased blood pressure lasted as briefly. A week later, without conscious intent, I spontaneously spoke of the boy who departed life too soon, leaving his parents and me and our friends to grieve. Then I did cry.

Teachers are generally clueless about teaching problematic students and for good reason: it's not their job! Most learning problems derive from inadequate early parenting which affects the development of those basic ego capacities which govern control of behavior, development of a sense of self, mood modulation, and others. Limitations in these are exacerbated by parents who didn't read to and then with their toddlers, who bossed them around rather than explaining "why" which depresses the development of the capacity for abstract thinking, and who didn't foster individual development and demand civil behavior. All else is window dressing, like the computer technology which is expected to alleviate these early life failings but can't. Thus do teachers take the rap for being unable to "re-parent," which is basically not their job and a vastly complicated business too.