Part 1 and Part 2 in this series have taken up this question from the parent’s perspective and from the child’s perspective. This final installment discusses the benefits of a psychodynamic approach to therapy for children with ADHD who are struggling socially. While all approaches to therapy have important features in common, psychodynamic therapy offers distinct benefits because of its emphasis on understanding root causes for difficulties. 

A Psychodynamic Approach

Psychodynamic therapy helps people to better understand themselves, the causes of their difficult experiences, and the contexts that influence them. All of this occurs in the context of a trusting relationship with a therapist. This relationship provides a safe space for individuals to explore difficulties, the ways they defend against them, and the possibilities for new ways of being in the world.

Attachment theory, an outgrowth of psychodynamic theory, emphasizes the crucial role of caregiver relationships in child development. By empathizing with a child’s painful feelings, soothing a child’s distress, and modelling effective ways of relating, parents help children to experience their home as a ‘secure base.’ The secure base allows the child to face the challenges of the world with confidence and to return home to safety when overwhelmed. Strengthening a child’s attachment relationships can support them to develop deeper relationships with peers.

But in order to support a child feeling confident in the world, we must begin to understand what shook their confidence to begin with. The child with ADHD may come to see the world as threatening, unhelpful, misunderstanding, or critical – leading to their withdrawing from important learning opportunities. Psychodynamic therapy moves beyond skill deficits and unhelpful thought patterns to deeply consider why a child may be struggling and where they are struggling the most. It allows for a rich understanding of both the child and their relationship with their environment.

Children with ADHD may feel resistant to therapy or other forms of social support. Words like resistance or defense are sometimes cast in a negative light. But from a psychodynamic perspective, resistance and defenses are a normal response to distress and threats to autonomy. The therapist empathizes with these ways of responding to the world, encourages the child to be curious about them, and, ultimately, supports the child to develop new ways of relating.

A Neurodiversity Lens

Neurodiversity, a blend of the words neurological and diversity, was first popularized by Judy Singer (a sociologist and autism advocate) and Harvey Blume (a journalist). Neurodiversity is a play on the ecological concept of biodiversity. Much as the term biodiversity draws our attention to the rich complexity of the natural world, neurodiversity draws our attention to the rich complexity and variation of human minds. Neurodiversity is both an identity and an activism movement that aims to honor the needs and gifts of individuals with diagnoses like ADHD, autism, dyslexia, etc. Neurodiversity is not a therapeutic orientation, but it can be a useful perspective to adopt in therapy with children whose minds are different from established norms. This is because it moves away from a deficit model that offers blanket solutions and toward a strengths-based model that honors a child’s unique experience.

From this perspective, the way to help a child with ADHD develop friendships is not just to teach skills to adapt to their environment but also to find and create a niche that will set them up for success. Doing this requires taking stock in a child’s strengths and identifying their specific needs. The therapist and parents can then advocate for a child’s needs (such as educational accommodations) and build bridges between the child and their environment that allow them to develop and display their gifts.

A Playful Niche

Play – the ability to creatively and enjoyably relate to one’s environment – is an essential human capacity. It allows people to find ways through some of the toughest challenges. But it requires the right environment. Gardeners know that a garden’s needs will vary from microclimate to microclimate. The same holds true for children. My approach to therapy with neurodiverse children is to support them (and their parents) to find and develop a niche where they can play and flourish. This process typically focuses on the following:

• Experience over activities – experiences are the foundation of our learning. The path to new experiences requires thinking about current experiences. So I frequently ask parents and children to join me in thinking through examples from their daily life to reflect on experience and what we might learn from it.
• Observation and deep listening – With so much complexity and nuance, careful ongoing observation and deep listening are key to understanding a problem and considering solutions.
• Setting the child up for success – Ongoing observation and collaboration allows the therapist to support parents to set their child up for success by thinking about the types of friends, types of activities, and types of settings that will allow their child to most easily apply skills learned in therapy.
• The importance of relationship – the therapist models for the child ways they can think about the world, ways they might consider others’ thoughts and intentions, and ways they can advocate effectively for their needs and resolve conflicts. As trust builds in the therapy relationship, children (and parents) become more open to thinking about their difficulties and more creative in their problem-solving.
• Respecting autonomy – The child with ADHD has as much to teach as they have to learn – like any child. Respecting the needs and values that are important to them and their capacity to take part in their own solutions helps to build confidence and teach lifelong skills of assertion and agency.
• Supporting advocacy – Children with ADHD often require some form of accommodation in school and relationships. But some relational issues can also be resolved when the child with ADHD learns to explain what is different about them, what they need, and what they can offer.

I hope this series has shed some light on the social experience of children with ADHD and the ways that therapy can be a support to them.