Childhood and parenthood with ADHD in the post-modern It seems that close ones are the most effective factor that leads us to bring our own world to life, but a certain look or comment can also destroy the reality in which we have enclosed ourselves. E. Goffman
Introduction
Parents are coming more and more often to psychotherapeutic offices in urgency, asking for support in a prolonged and severe situation connected with the demands of their children’s schooling. In most cases they have already attended consultations in educational-psychological counseling, child psychiatry, and pediatric neurology offices with conclusions that are often very unclear (generally marked as Dg: v.s.) or defined as ADHD – Attention Deficit/Hyperactive Disorder. The wider lay and parent public is already very familiar with the term specific developmental learning disorder, formerly called brain dysfunction – LMD. The newly introduced term ADHD more accurately captures a child’s state with certain learning and behavioral difficulties. Often these are children with average or above-average intelligence. Yet they are often perceived by their environment as unmanageable, bad-tempered, problematic, even difficult. A child with this disorder (dysfunction) in the family emotional pattern is a pronounced specificity for others in the relational field, requiring increased care due to a volatility of emotionality and frequent emotional shifts. Very often this difficulty also appears with another difficulty in adult individuals, as the view that the problem fades with development has already been refuted by science. In adults, ADHD is often accompanied by additional problems—anxiety, aggression, as well as depressive states and various dependencies, also as a form of compensation for ongoing existential distress. In routine psychotherapeutic practice it is common that the primary diagnosis of ADHD emerges in an adult patient during therapy.
A child who has trouble maintaining attention is under constant pressure. Impulsivity and hyperactivity are accompanying signs of the above-mentioned difficulty—the hyperkinetic syndrome. Likewise, disproportionality and a certain mental and chronological imbalance indicate this possibility. It is generally reported that 44% of children with ADHD suffer from another mental disorder and 32% from a combination with anxiety and depression, and they are also more inclined to defiant and oppositional behavior and aggression. For attention disturbance to be qualified as ADHD, a marked discrepancy must be visible between the child’s intellectual capacities and school performance. Even in ontic terms it is very difficult to establish the occurrence of this disorder in the population. Specialist literature states that signs of the disorder called ADHD (formerly LMD) can be found in about 20% of boys and 8% of girls (before puberty). A clear diagnosis is always in the competence of a child psychiatrist, child psychologist, or neurologist. Psycho-educational assessment is supportive.
Diagnostic criteria fully fit ontic scientific regularities with the claim of “clare et distincte,” in the foundation of scientific thinking “more geometrico” (in geometric terms). Ontic description is found in all sciences, psychology, pedagogy, and medicine included, which however brings a problem in contexts of the foundations of human existence, in one’s individual life story and existential original orientation. Subject-object thinking (body and mind separately) has made the human body a thing that serves to fulfill possibility and performance, not in the originality of that person but as the world demands it (Hogenová 2006). Postmodern time aims at performance fulfillment, and the human constantly seeks assurance in living. Yet the loss of the value of truth and anomie has strengthened scientific Cartesianism, with the goal of maintaining power and intensifying it, repeatability, intelligibility, in a great desire to objectify what complicates human life in relation to the possibility of fulfilling performance. By describing individual parts of the body and functions of organs, scientific objectification is fulfilled. The brain, in seeking to map individual parts and functions, is examined very carefully. Yet existential facts that ground human existence—love, hatred, envy, intimacy, responsibility—could not be discovered, measured, or weighed in any part of this tissue. The body and bodily structure are also a subject, which cannot be captured in physiological and biochemical processes. If science proceeds only with “more geometrico” thinking within the validity of Cartesian subject-object framing, it loses insight into the essence of that person and moves within onticity, which is only a part of the whole—being. Human beings exist in the temporality of their life—in temporariness. Here the essential past is preserved, which is part of the present and at the same time an orientation toward the future. The human body is embodiment with a possibility of unfolding into landscape, world, and being. In a concrete difficulty, the relation of that person to being itself—to the whole—becomes clear. Precisely this moment in a person’s life is the chance to place a concrete (ontic) symptom in the whole of being—in ontological context. One must understand ontologically, not only ontically—without searching only for causal causes and consequences. One must return to the original Greek idea of Arête—balance, goodness in human existence. The search for possible paths to optimizing ADHD leads in an ontic way, but there is also a clear demand to understand ontological contexts. Ontic necessities clearly include the full set of diagnostic and subsequent special pedagogical educational and re-educational procedures. Just as important is the psychologic-pedagogical ontological approach oriented to the family emotional schema of the child and the temporal temporality of all members of the system. The current late time, as Jan Patočka calls it, in which humanity experiences its everydayness, is a time of losing one another. But also of finding, especially oneself and the other through crises and difficulties in life that can be called diagnosis, yet always with the intention of overcoming and thereby restoring the interrupted movement along the life path. The numerical diagnosis code addresses the problem only statistically.
A child entering the world is born into a specific community of people who are linked by certain genetic and biological interrelatedness in a system called in family therapy the family emotional schema. The arrival of a child requires the entire system to reorganize—both at ontic and ontological levels. Onticity, in its clarity, is present in sociological, anthropological, but also economic and other studies, with clear interpretive value in numbers, percentages, charts, and other expressions.
Ontological contexts, because of their elusiveness, remain outside research attention in concealment, yet they become clearly revealed in the concretely experienced difficulties of individual persons and of society in many areas of life performance. Life performance means the life movement in the philosophical phenomenological view of Martin Heidegger (2006)—as movement from birth to death with the possibility of overcoming life obstacles that by law fall on the “path” and call the person to original movement and thereby to overcoming them, to realization of life in the sense of doing (performance).
Original family disposition and the whole system in natural archetypal givenness is altered in postmodern time. More than half of marriages dissolve, women choose motherhood without a partner more often and care for their children alone. Fathers experience existential crises of many forms, and what is substantially changed is the cooperative energy of feminine and masculine within a whole of reciprocal fulfillment and balance. Despite these differences, even in postmodern time family remains the relational field of all participants in the claim of a chain of relationality. The controlling factor is the emotions of each individual in this grouping of biologically or nonbiologically connected people. In no way is this a random atmosphere; the whole family system is in a certain relational interdependence, including transgenerationally. The forces of the emotional field are not verifiable in a Cartesian way (ontically), but in reactions and emotional expressions of individuals when a sensitive common topic is addressed they can be recorded on the ontological plane.
Human time is not point-like time; every person lives—exists—in so-called temporal temporality, which can be experienced as a certain ordering of human presence (between birth and death) into temporal moments and phases by a certain importance, related to a specific situation and the specific person who lives it. The importance of human presence in time is staged according to present time, in which past (experience) and also an image of the future are always included. In every “here and now” one can find yields of the past, as well as orientation to the future.
Human existence (birth, as emergence from primal humanity) begins with a very fundamental and important task (act in the sense of performing)—breathing and relating to oneself and to others, to close people. A child who is born has passed through a significant phase of a separation claim, which can be compared to the performance of a prisoner in Plato’s cave who undertook a painful journey through a narrow passage to light, freedom, and openness, but also to responsibility in constant uncertainty. Existential anxiety (Pelcová 2000) accompanies a person for the entire duration of existence and in certain life moments is activated or subsided.
Unlike other creatures on the planet, the human is most dependent on others, on their protection and support in one’s fragility. As if here the human repays other creatures a certain debt for its exceptionality, privilege in the order of the world—for logos, speech, for the “House of Being” (Heidegger 2006).
After birth, the foundation is relationship, need, and its satisfaction. Here, naturally, a certain delay appears to which the child in the womb was not accustomed, because care for its life needs and overall orientation had been provided by “mother nature.” A certain delay between demand and fulfillment leads the child to frustration, but at the same time to awareness that it is a person distinct from others with the claim to be among others—to exist. The pleasure principle gradually gives way to the reality principle. Everything “right away and everything just for me” turns into “later, and not always everything.” The child builds identity that is confirmation of distinctness.
But is this only postnatal?
On the basis of the research of Stanislav Grof, Artur Janow, Christopher Masson, and Bernard Moutaud’s “perinatal unconsciousness,” the existence of a specific human can be grasped in temporal rootedness even from intrauterine experiences. Also, the way in which childbirth proceeds plays a significant role in a human life. From this perspective it is highly debatable where, and how, one should look for the origin of certain distress. One can also say that the origin of existential difficulties reaches very far back in the context of the temporal temporality of human existence. The basis remains the same—repetition of conflicting past in the present with possible transfer into the future. Everything that exceeds the critical threshold of “suffering” is inscribed in a person and then repeated with one goal—that it be overcome. Affective lack from the past asks for repair in the present.
Family as a living organism
In family life there are periods when the whole system of relativity enters an unstable relationship. A detailed overview and description is offered by E.H. Erickson (1963). Separation processes of individual actors overlap and demand, and if separation and entry into the next developmental phase are not fulfilled, chaining occurs. The result is possible complication in the form of certain “separation debts” in the sense of guilt transmitted across generations (“guilt begets guilt”).
A child bio-psycho-socially and spiritually separates into a higher developmental phase and at the same time its predecessor (parent, grandparent, etc.) shifts into a role that depends on the child’s separation. These are transitional periods of existential crises, upheavals, but also opportunities, and freedom. All of this in the claim of uncertainty, which is a basic principle of human existence. Foundational is existential anxiety, closely linked to the possibility of freedom and openness of the given person. Human freedom, which is experienced by the newborn immediately after birth, can be called philosophically and psychologically a movement inward and outward between “here and there,” with the claim of continually stepping into uncertain space of co-existence in the world with oneself, with other people, and with the totality of the world. Precisely the family, as a safe environment offering acceptance, kindness, and acknowledgement, is for the child the basis for coping with the claim of openness to the world and meeting performance in adulthood.
The postmodern world is for the person a kind of cave in which one is chained, just as the prisoner in Plato. It is flooded by entities (things) to which one “must” respond, must own, and thus fulfill one’s life with performance. Constantly increasing performance, in Nietzsche’s philosophical anticipation, leads to “overpowering.” Through this the very essence of power is fulfilled—power is strengthened and grows. In families one can spot two phenomena realizing this overpowering: “das Gestell” (enframing) and “die Machenschaft” (total manipulability). A major error of the current era is the idea that everything has “clear and bounded” (Cartesian) possibilities of solution; methodological guides offer the possibility of total manageability, and claim that all one needs is to follow the prescribed procedure. For this reason postmodern time (too late, liquid) can be said to be instant time. In the moment a specific difficulty enters family life as a complication in fulfilling generally required performance, the whole system in a context of a certain destabilization (dysareta c e) responds in a specific way (Kalábová 2010).
ADHD – a problem of embodiment
For the pedagogical world, a child and a parent with a diagnosed disorder (dysfunction), designated according to the Tenth Revision of the International Classification of Diseases as F 90–90.9, require considerable demands. This concerns expertise, but also the authenticity of every concrete educator who is participant in relationality with a pupil, but also with that family. Ontically, the explanation is a certain CNS dysfunction—the brain. Ontologically, however, it is a disequilibrium between structural and non-structural body schema.
If the body is perceived only Cartesianly—ontically—it is described in the function of individual parts and organs, thus fulfilling so-called objectification. With this thinking, the researcher gives up the ambition of “insight into essence” of that person, because thinking moves only within onticity—which is only one part of the whole, being. A non-Cartesian way of thinking, from ontological positions, acknowledges the person and therefore also the body a different dimension and value—with extension into surrounding world and with the functioning of certain oppositions (external and internal aggression), revealed by form, which is set by a boundary, i.e., peras. Body shape is enabled by formedness, linked to growth—physis. Human corporeality can be understood as an interface between body and non-body; the philosophy of corporeality grows from the traditions of E. Husserl’s (1993) phenomenology and its successors Martin Heidegger (2006), Jan Patočka (1996), and Anna Hogenová (2011).
In this approach, the body is twofold—visible and graspable—soma (morphology) and sarx (embodiedness)—but also unthinkable and ungraspable—ensouled body, pexis, pervading structure and giving the body expression. Pexis—the ensouled body—has no edges (peras), and therefore it cannot be grasped in any other way than philosophically. Through pexis, existence and embodiment become possible for the human. Soma (body form), sarx (body content), and pexis (ensouled body) form a whole—holos. Merleau-Ponty (1993) speaks of a holonymic order, which forms a non-structural schema, without edges (margo), creating one whole by connecting mind, will, feeling, and motoric function within one temporal span. The body schema here functions as background, on which individual parts appear and movement forms emerge. It has two faces—structural, which has edges (margo), and non-structural (without margo), and can be understood as BACKGROUND. A person naturally does not know this, and at the moment a “smearing” or change (disruption of body schema) occurs this state is experienced as difficulty or inability of motor or cognitive function. The background is intentionality (intentionality—the directedness of consciousness toward the world, essence of consciousness)—this is especially understandable through structural body schema. Phantom pain after amputation is a typical symptom of disruption of structural and non-structural body schema. A similar situation occurs after orthopedic operations when metal—a nail, staple, screw, etc.—is introduced into a patient’s body. The metal hardware—a nail in the floor remains a nail; in a human body it becomes part of structural and non-structural schema and in embodiment becomes part of that person’s intentionality. Eating disorders—mental anorexia and/or bulimia nervosa—and ADHD can also be classified as a certain disequilibrium, in which the whole is disrupted and the result is imbalance of will, feeling, mind, and motoric function within one time segment. Therefore, from a phenomenological perspective, the states mentioned above can be seen as disorders of embodiment, i.e., disorders in timing.
Embodiment can be understood as a specific movement of the body in the unity of soma, sarx, and pexis (structural and non-structural body schema) forward. It is guided by the hand toward things in the world (horizontally) and then by speech, which opens verticality (transcendence) for a person. The body is an anchor in the present, in connectedness with inner time perception. Embodiment therefore is continual formation of movement figures that are responses to the whole connectedness of body and environment. If the issue is approached and considered in ontological, phenomenological, philosophical terms, temporality opens not only current time but also past and future. The optimal solution is when the disorder is identified early, preferably already in preschool age. A core symptom is liveliness, but also motor ineptness and delayed onset of speech. The relation of these symptoms is explained clearly in the text above and it is clear this is a serious complication in the child’s development.
Therapeutic influence in this respect is multifactorial, always combining influence over structural and non-structural body schema with a goal of acting at the level of the whole. This approach is called holistic (holos-whole). Therapy, conducted holistically in the broadest possible extent, prevents secondary disorders in the socialization process of the given child and maximizes elimination of disequilibrium.
Yet it is necessary to realize that this is a disorder of structure and non-structure, and all pedagogical-therapeutic interventions should be directed from dysaretace toward achieving original aretace (balance, goodness). The most optimal option appears to be a combination of techniques that tune the whole organism across one time segment in the context of the whole, aiming at complexity.
Prognostically, ADHD is a lifelong tendency to occasional returning disequilibrium in structural and non-structural body schema, a problem of embodiment of varying intensity, though with the possibility of some adaptation. A major role is played by the momentary configuration in bio-psycho-social-spiritual existential experiences. These are compensatory patterns that lead to more favorable response in relation to life performance comprehensively.
A highly effective pedagogical and therapeutic approach is the combination of sensory perceptions, with possibility of using the representational system VAKOG. (V - visual, A - auditory, K - kinesthetic, O - olfactory, G - gustatory). When combined, there is increased possibility of compensation, and also one uses preference in the configured representational system, and the result is mitigation of dysaretace. These are techniques from NLP—neuro-linguistic programming, commonly used in pedagogical-psychological interventions, for example in dyslexia, where letters or words (on rough paper) are traced with the index finger of the dominant hand with verbal accompaniment. In one time segment vision, hearing, and touch as well as olfactory experiences are activated and therefore embodiment in the sense of timing becomes possible.
Conclusion
With childhood there is always linked a great existential question: “tell me who I am.” Pedagogical, but above all parental attitudes, words, gestures—everything clearly communicates who and what the child is. And these answers are determining for the child’s further development. A child with a learning and behavioral disorder is not popular among peers, teachers push them into blind professional and human corridors, and the parent is often distressed. Yet the child too! In everyday life at school and at home, they repeatedly hear that they again did not manage something, failed, that other children are more successful, kinder. For both the parent and the child, school is suffering. At times, however, in the context of genetic disposition, the parent has their own emotional injuries from their own childhood, where they faced the same problem themselves. Long-forgotten grievances and unpleasant emotions resurface, and everything is amplified in the transgenerational temporal framework.
The result is secondary neuroticization of the child and parent, followed by increased anxiety and fear that in turn worsen excessive liveliness, inattentiveness, and other symptoms associated with ADHD. Fear of failure increases tension, which manifests habitually, worsening the child’s integration in the class collective and relationship with the teacher. For parents, it worsens the possibility of being a good parent in the role of guide of their child into adulthood, with faith in the goodness of the world and one’s own existence in it. The natural central feature of child psychology—enterprise, effort, and desire to achieve recognition—is pushed aside and often completely unfulfilled, and the result is a conflict that prevents experiencing happy and harmonious childhood, but also parenthood. Everything is mutually reinforcing and mutually nourishing. In a child long exposed to the above-mentioned situations, entrenched feelings of inferiority due to lack of success occur very often. In temporal temporality (past, present, and future), this unfavorable personality trait is also a burden in future time—during childhood, basic patterns of relating with others are formed with effects into adulthood (Vymětal 2004). A child necessarily needs certainty that they are loved by other people, that they are accepted by the world. This feeling of support is foundational for a future satisfied life in adulthood. A child necessarily needs to feel that others, and not only parents, understand that they belong among them, and that here, in this world and community, they have their own significant place.
A child must love and be loved, otherwise they are emotionally deprived. In the absence of closeness, indifference takes over, which can very easily turn into rejection, rejection, and hostility. For the child this means direct threat, to which the usual response is anxiety, fear, and disproportionate experiencing of defense mechanisms.
What kind of childhood, such adulthood. Human temporality today is chaotic. The whole world, with its positivist thought, calls for power and performance. For family this time means an enormous demand for performance in many respects and areas of life. The only fact that one can spot, also concretize, and which tends toward adoration, is power and strength. A child who does not have openness to be effective and thus successful in school and in society from the very start of existence undergoes severe traumatization.
Well-defined diagnostic categories and methodologically elaborated pedagogical approaches are important, but only once—an ontic part—necessary for successful intervention. The second, equally important, is the ontological context.
Every person, child and adult, exists inwardly and authentically in his or her own essence. Ontology and onticity in connection are thinking in contextual terms and linking structure and non-structure. This opens possibilities to understand the ergons—deeds of child, parent, and educator hermeneutically and choose effective intervention as a possible path, as “care,” as dialogue. All of this appears as a task not only for parents and pedagogy in the third millennium.
The path does not lead through denial of clear givens, but through awareness of ontic and ontological regularity, and not only in the mentioned learning and behavior disorder. From current pedagogical positions it is entirely clear that this is the path to resolving resocialization problems of the postmodern time.
Author: PhDr.Helena Kalábová, Ph.D. References:
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