The impact of words on children with ADHD and DAMP Consequences for psychoanalytic technique

Abstract

Children with attention-deficit/hyperactivity disorder (ADHD) and disorder of attention, motility control, and perception (DAMP) are often sensitive to the analyst's interventions. This is not always due to the literal import of the intervention. The children sometimes react as if the words were dangerous concrete objects, which they must physically fend off. The author traces this phenomenon to the child's unstable internal situation. A bad, un-containing internal object is easily awakened and threatens to expel the analyst's words independently of their content. This results in violent clinical situations. Infant research and psychoanalytic work with infants and mothers evince how a complex semiotic process develops between mother and baby. The prerequisite for this process to get started and maintained is a secure external object, which gradually is internalized. Findings from developmental research and clinical infant work are used to illuminate analytic work with children with ADHD and DAMP. Vignettes demonstrate how important it is for the analyst to phrase interpretations after having gauged the state of the analysand's internal object as well as his/her own countertransference. If this is overlooked, the psychoanalytic dialogue easily capsizes. The author provides some technical recommendations on the psychoanalysis of these children. As part of the theoretical discussion he raises the general question of how the representations, which the baby forms in interaction with the mother, and the analysand forms in interaction with the analyst, should be classified. Rather than dividing them into bipartite thing- or word-presentations (Freud), the author suggests C. S. Peirce's tripartite semiotic classification in that the baby forms representations of icons, indices, and symbols.

Attention deficit hyperactivity disorder (ADHD): An affect‐processing and thought disorder?

“…My vantage point with respect to therapeutic technique in the treatment of children with severe ADHD seems to be very much in line with Salomonsson's (2006Salomonsson's ( , 2011 perspective. Starting from a description of different semiotic levels Salomonsson connected sudden deteriorations of the symbolization process in analysis to the presence or absence of an internal containing object in the patient.…”

“…Starting from a description of different semiotic levels Salomonsson connected sudden deteriorations of the symbolization process in analysis to the presence or absence of an internal containing object in the patient. If the analyst can be experienced as a representative of a good internal object the patient can understand the interpretations, the words as carriers of symbolic messages (Salomonsson, ). If the internal object cannot contain the child's wishes and affects – Salomonsson speaks of faltering containment: “Such containment jeopardizes the child's thought processes in that the transformation (Bion, ) of beta‐elements into alpha‐elements is blocked” (Salomonsson, , p. 91).…”

Interpreting the inner world of ADHD children: psychoanalytic perspectives

“…In previous articles, I have addressed the ADHD child’s thought processes (Salomonsson, 2004) and his/her hypersensitivity to analytic interventions (Salomonsson, 2006). I link the problems with how to think about his/her affective experiences to the fact that wishes and affects cannot be adequately contained.…”

Semiotic transformations in psychoanalysis with infants and adults

“…The next step in my line of argument is to equip this conceptual toolbox. I will claim that Freud's bipartite division, in which the 'word' sorts our presentations into either thing or word presentations (1915, p. 202), is insuffi cient (Salomonsson, 2006). In order to cover the multitude of clinical presentations and signs, we need a tripartite classifi cation.…”