While the cause of ADHD is not well understood, and some cases may have neurological causes, children may respond to psychotherapy instead, noted Esther Fine, PhD, a psychoanalyst in private practice in Los Angeles, during a lecture at the American Psychoanalytic Association meeting.


“Unfortunately, it is now a prevalent notion that it is no longer necessary or relevant to understand the unconscious meaning of psychological symptoms,” Fine cautioned. “It’s becoming a popular idea to consider psychoanalysis, and even psychotherapy, ‘dinosaurs’ in the treatment of mental disorders.”


Fine said that between 1990 and 1998, the number of children and adults diagnosed with ADHD rose from 900,000 to nearly 5 million.


The increase coincides with a broader trend toward prescribing stimulants for its treatment. Since 1990, prescriptions have risen by 700%, Fine said.


The percentage of children referred to psychotherapy for ADHD fell from 40% in 1989 to 25% in 1996, and Fine said that number is even lower today.  


Over 25 years ago, when I first began practicing, and ADHD was initially recognized, I recall several parents asking me to place their children on Ritalin, because their child’s teacher made the request. I refused each and every request.  While the teacher’s input is to be considered, they cannot make a definitive diagnosis. They face many pressures, in the classroom, and giving an unruly child a drug, is a quick, but unnecessary fix.


A careful history of many children found there were issues of parental abuse that lead to their behavior and counseling assisted in improving their symptoms.  Dr.  Fine also noted similarly that teachers may be diagnosing children as having ADHD. Concerned parents then request medications from pediatricians, Fine said, and pediatricians may be too quick to comply.


“Teachers and parents are looking for a quick fix,” added Mark D. Smaller, PhD, a psychoanalyst in private practice in Chicago who was not involved in the paper. “They’re reluctant to look at what’s behind that behavior, at what’s going on at home.”


On the other hand, psychoanalytic psychotherapy may provide patients — even young ones — with an opportunity to understand how their minds work, and why it works the way it does.


Dr. Fine noted some disorders can have roots in abusive child-rearing patterns.  “Certainly, parental child abuse might well set the scene for an attention deficit disorder,” she said.


Source:   American Psychoanalytic Association: Fine E, “ADHD: A rush to judgment” APsaA 2010