Adlerian theoretical perspective in childhood ADHD
This paper will explore the use of play therapy from an Adlerian theoretical approach as applied with children ages 5 to 8 who have been diagnosed with ADHD. This includes evaluating signs and symptoms of ADHD, interventions, background of Adlerian theory, empirical and developmental rationale for how play therapy is used with children who are diagnosed with ADHD.
Signs and Symptoms of ADHD
For those clients under the age of 16, who present with inattention, which is explained by six or more symptoms for at least six months and is inappropriate for the client’s developmental level. The symptoms can include not paying close attention to details; unable to pay attention to tasks or while at play; not listening when directly spoken to; failure to follow instructions in school or other activities or loses focus during these activities; difficulty organizing tasks or activities; dislikes or avoids extra effort tasks; loses items needed for tasks and activities; distracted fairly easily or forgetful in everyday activities.
For those clients under the age of 16, who present with Impulsivity and Hyperactivity, which is explained by six or more symptoms for at least six months and is inappropriate for the client’s developmental level. The symptoms can include tapping, moving around, squirming or fidgeting; running or climbing at inappropriate times; moving from their seat when not appropriate; cannot play during play time or does so quietly; moves around a lot; is very chatty; speaks out of turn; has trouble waiting or interrupts others when they are talking.
In addition to meeting six of either of the above, the client must meet additional points. The client has several of the hyperactive-impulsive or inattentive symptoms prior to age 12; the symptoms must be present in two or more settings such as home and school; there is no other mental disorder that can explain the client’s actions and the clients symptoms do not occur due to schizophrenia or any other psychotic disorder.
There are three types of ADHD which can occur in a client. If the ADHD is a combined presentation, there are symptoms of both inattention and hyperactivity-impulsivity present for at least six months. In a predominantly inattentive presentation, there are symptoms of inattention for at least six months. In a predominantly hyperactive-impulsive presentation, there are symptoms of hyperactivity-impulsivity for at least six months.
Additionally, there are common behavior problems with those with ADHD. Clients can be aggressive and defiant, have emotional outbursts and refuse to follow instructions.
Your Chosen Theory/Intervention
An Adlerian approach evaluates the human condition based on the individual’s self-worth and within that, their self-esteem or lack of. The lack of self-esteem originates from feelings of inferiority. These feelings begin in infancy, and around age 6, individuals are beginning to develop and reinforce ideals about themselves. Once these ideals or “life goals” are established, the individual is driven to overcome feelings that are in conflict with these ideals, regardless of how distorted or truthful they are. (Corey, p. 104)
From an Adlerian perspective, a second-grader who is diagnosed with Attention Deficit Disorder (ADHD) and acting out in class the first week of school would behave this way because their new school environment provoked feelings of inferiority, possibly because of their inability to accomplish new tasks and, or make new friends. The behavior is an attempt to realign and assert their self-esteem which is founded on ideals about themselves. Children diagnosed with ADHD at this age are at more risk of further isolating themselves from social acceptance and “sense of belonging” (
), because unlike their peers, they have not developed the rudimentary coping skills needed to manage their feelings and emotions. With therapy, distorted ideals of self could be addressed and the drive to overcome these feelings of inferiority could be channeled into something constructive.
Empirical Rationale for Play Therapy
Although play therapy is widely used in clinical settings with young children, a study has been conducted to test if play therapy alone was an effective intervention for specifics to ADHD group of ages 5 to 11. The result of the16-week intervention was that “there [were] no compelling empirical data to support the use of traditional play therapy for the treatment of ADHD” (O’Neill, Rajendran, & Halperin, 2012). The study concluded that there was no direct correlation that play therapy alone was an effective intervention. Nevertheless, play therapy activities have been shown to be a very useful tool in working with young children in general including children diagnosed with ADHD. It can be a great technique and tool for the child’s growth, skill building, ways to speak with symbols, and to help children understand how to appropriately express themselves in a more positive way. “Neuropsychological findings indicate that children with ADHD show deficits in a wide variety of executive and nonexecutive functions that are probably linked to their behavioral difficulties (O’Neill, Rajendran, & Halperin, 2012).” So, using specific games or other play activities to target specific skill developments for ADHD children. In some cases, it was shown to have an impact when play was introduced at parent-children sessions, where the parent and child were given safe space and time to interact and play together while bonding in their relationship. Also this can be performed with peers as well to help ADHD children to learn better and healthier behaviors and social skills to interact in school or outside of home.
“Children diagnosed with ADHD often feel discouraged, inadequate, hopeless, and worth-less (Barkley, 2000).” Due to some of these reasons children have shown to act out and disrupt to seek attention and to gain power. Which is why an Adlerian approach with play therapy would attempt to readjust these feelings of inferiority by focusing on inconsistencies and distortions within the self-ideal. A therapist could use elements of play therapy like a mandala project or dolls to understand how the child perceives themselves. Incorporating play therapy would help the therapist identify distortions within the child’s self-ideal that they could work with to overcome.
Developmental Rationale for Play Therapy
Play therapy is an effective therapy approaches for working with children. Adlerian has been considered as an influential theory in social, personality, and developmental psychology. The following section will cover different aspects of developmental rationale for Adlerian theory and play therapy.
According to Piaget (1954), children at about age 7 to 8 enter the concrete operational stage and experience lots of cognitive changes, and although they become capable of mental operations and think in a more organized, logical, and flexible way, they are still not capable of reasoning about abstract and unfamiliar situation. Most children under the age of 10 do not have the skills for abstract reasoning and processing thoughts and feelings verbally; therefore, play is an effective language that allows children to express themselves naturally (Kottman, 2010, p.2). Also, neuroscience research provides support for the benefit of play therapy to children. Studies show that a successful play therapy causes an optimal amount of emotional and cognitive arousal in the client, which create great neurochemical environment for promoting neuroplasticity, forming new neural pathways, and strengthens exist pathways.There is also findings of improved emotion regulation, attention, and consciousness (Echterling, 2016).
Child Personality Development
Adlerian approach emphasizes holism and believes that “the person is an indivisible unit and should be understood in his totality” (Mosak & Maniacci, 1999, p.14).
Adler believed that humans’ personality is well formed during the first 5 years of life, and it generally remains constant throughout a person’s life (Ewen, 2003, p.95). Starting from infancy, one develops inferiority feelings as a result of being aware of his own helplessness, and everyone has an innate drive to overcome inferiority and strive for superiority, which is considered as the primary goal that underlies all human behaviors (Ewen, 2003, p.93).
Adler suggested that humans are social beings and are shaped by their social environments and interactions. He thought that humans have an innate potential for cooperating and relating with others to achieve personal and societal goals, which he referred it as social interest (Schultz & Schultz, 2017, p.116). Although social interest is innate, its development depends on the children’s early social experience with their parents. Adler emphasized the role of the mother in fostering the development of the child’s social interest and the significant impact of parental factors on the child’s personality development (Ewen, 2003, p.95). If a mother, as the first person that the infant connects with, can demonstrate cooperation, and companionship, she natures the child’s potential for social interest, and her child will form conclusions based on those experiences and approach life with the same attitude (Schultz & Schultz, 2017, p.116). On the other hand, if the mother is uncooperative, her child will learn to resist social interest. Pathogenic parental factors such as spoiling and neglect are likely to overemphasize the feelings of helplessness and cause inferiority complex (Ewen, 2003, p.95-96).
Another major social influence in childhood that has a significant impact on the development of a child’s personality is birth order. Adler suggested that siblings in the same family with the same parents are exposed to different parental attitudes and styles. Being the older or younger child of the family will experience different childhood environment and social interactions and therefore will form different kinds of personalities (Schultz & Schultz, 2017, p.117-119).
During the process of striving for compensation and superiority, the child will interpret his or her environment, different social influences, and parents’ behaviors and responds by forming life goals and a unique pattern of behaviors and characteristics which will serve him or her to attain his goals, and Adler referred to it as the style of life. (Ewen, 2003, p.98-100). It contains different aspects of one’s personality as well as core beliefs about the world.
According to Adlerian approach, all humans have an innate potential for cooperating and relating to others in order to achieve ultimate life goals. (Ewen, 2003, p. 92). The development of this potential greatly depends on the social interactions that happen in early childhood. A mother plays an important role in developing and nurturing her child’s social interest, and her actions toward the child can either support or prevent the child’s social interest development: if the mother is able to demonstrate cooperation and companion, her child will learn these qualities and develop the capacity to face future demands and challenges by cooperating with others and engaging in his community (Schultz & Schultz, 2017, p.116). Other social experiences during early childhood such as interacting with extended family members or going to school also contribute to the development of one’s social interest (Carl, 1999). Since humans are considered as social embedded creatures, they continuously adapt to their social environments based on their interpretation to their experiences (Corney, 2013, p.106).
Based on Adlerian holistic approach, an individual’s life goals, interaction with parents during early childhood, the parental style that is received, different environment and social experiences, and birth order, they all contribute to one’s cognitive development. Through all these experiences, the individual learns different ideas about the world and forms a personal interpretation about self, others, and life.
Adlerian think that emotions are motivators of behavior (Mosak & Maniacci,1999, p. 120). According to Dreikurs (1967b),“Without strong emotions, no strong acts are possible” (p. 213). The ultimate life goal for all humans is to strive for superiority and achieve the perfect self, and an individual will also have immediate goal at the moment. All human behaviors are driven by goals, and emotions motivate the individual to carry certain behaviors to attain his or her goals. Emotions are purposive and the individual, based on the individual’s goals and style of life, will choose to use certain types of emotions which can serve his or her needs and goals (Mosak & Maniacci,1999, p. 120).
Counseling Relationship and Child Development
Adlerians emphasize on developing an egalitarian and encouragement-focused relationship throughout the counseling process with children, and it focuses on the client’s strengths, responsibility, resources, efforts, and progress. (Watts & Pietrzak, 2000). Adlerian counselors consider encouragement an essential element of human growth and development because clients are discouraged rather than sick; discouragement is the cause of the client’s struggles (Crenshaw & Stewart, p.35). According to (Dinkmeyer, Dinkmeyer, & Sperry, 1987), “Encouragement focuses on helping counselees become aware of their worth. By encouraging them, you help your counselees recognize their own strengths and assets, so they become aware of the power they have to make decisions and choices” (p. 124). Through an client-counselor relationship that is cooperative, collaborative, active communicated, respectful, and encouraging, Adlerian counselors help the child to find their strengths and resources, so clients can feel more courage to develop new behaviors and positive perceptions (Watts & Pietrzak, 2000).
Alderian Play Therapy and ADHD
Children who are diagnosed with ADHD suffer with various hyperactive-impulsive or inattentive symptoms.These symptoms negatively impact their performance at school, their relationships with their parents, and other aspects of their lives. These children often have low self-esteem and feel discouraged, helpless, and worthless. Adlerian play therapy focuses on encouraging clients to explore and bringing their awareness to their own strengthen in order to empower them to form new health behavior patterns and positive core beliefs, which based on Adlerian’s view this can create long term changes on clients. It also provides a structuralized, safe, and non-judgemental space for clients to express themselves, experience positive relationship, practice social skills, and address behavioral issues. Also, using play as the mean of communication let clients to express themselves naturally and freely without being hindered by potential developmental barrier. Studies also support that successful play therapy can enhance neuroplasticity and formation of new neural pathways in clients’ brain, which can bring long term improvements to clients.
Although Aderlian Play Therapy is the third most used approach (Lambert, et al., 2007), as an evidenced-based treatment, “this theoretical model has limited research support of its efficacy”, (Dillman Taylor, D., Meany-Walen, K. K., Nelson, K. M., & Gungor, A., 2019) According to Watts & Shulman (2003), research supporting effectiveness of Adlerian Theory is limited in part because the theory still requires empirical testing and comparative analysis. Various research for individual and group Adlerian Play Therapy shows to be effective, but without further research to show independent support, it leaves much to question about details of findings delivered in the studies.
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