Elisabeth Punzi

A discursive analysis concerning information on "ADHD" presented to parents by the National Institute of Mental Health (USA).

A discourse analysis was performed based on an online document under the headline: “What is Attention Deficit Hyperactivity Disorder (ADHD, ADD)?” published by the National Institute of Mental Health (NIMH), USA. Three parts of the document were analysed: (1) The introductory part, as this sets the tone of the whole text. (2) Parts of the text that were specifically addressed to parents. (3) Etiology and pathology of “ADHD” with reference to a number of different symptoms and behaviors. Inattention and hyperactivity are presented in the document as a floating spectrum of symptoms caused by “ADHD.” Other factors of importance for childrens development, that is, early attachment, close relationships, previous experiences, culture, and contexts are ignored. Children who are perceived as inattentive and hyperactive are portrayed as having inherent difficulties with no reference to their emotions or efforts to communicate. The child is viewed as suffering from a lifelong disorder that might not be cured but controlled by a diagnosis and subsequent medication. Parents are advised to control their childs behavior and to strive for early diagnosis in order to receive treatment provided by experts. Those who are presented as experts rely on a biomedical model, and in the document, detailed descriptions of medication to correct the undesired behaviors are provided. The value of judgment in the assessment of different symptoms and behaviors that signifies “ADHD” is absent, rather taken-for-granted beliefs were identified throughout the document. A heterogeneous set of behaviors is solely described as a disorder and hereafter it is stressed that the same behaviors are caused by the disorder. In this manner, cause and effects of “ADHD” are intertwined through circular argumentation.A discourse analysis was performed based on an online document under the headline: “What is Attention Deficit Hyperactivity Disorder (ADHD, ADD)?” published by the National Institute of Mental Health (NIMH), USA. Three parts of the document were analysed: (1) The introductory part, as this sets the tone of the whole text. (2) Parts of the text that were specifically addressed to parents. (3) Etiology and pathology of “ADHD” with reference to a number of different symptoms and behaviors. Inattention and hyperactivity are presented in the document as a floating spectrum of symptoms caused by “ADHD.” Other factors of importance for childrens development, that is, early attachment, close relationships, previous experiences, culture, and contexts are ignored. Children who are perceived as inattentive and hyperactive are portrayed as having inherent difficulties with no reference to their emotions or efforts to communicate. The child is viewed as suffering from a lifelong disorder that might not be cured but controlled by a diagnosis and subsequent medication. Parents are advised to control their childs behavior and to strive for early diagnosis in order to receive treatment provided by experts. Those who are presented as experts rely on a biomedical model, and in the document, detailed descriptions of medication to correct the undesired behaviors are provided. The value of judgment in the assessment of different symptoms and behaviors that signifies “ADHD” is absent, rather taken-for-granted beliefs were identified throughout the document. A heterogeneous set of behaviors is solely described as a disorder and hereafter it is stressed that the same behaviors are caused by the disorder. In this manner, cause and effects of “ADHD” are intertwined through circular argumentation.

Challenging the ADHD consensus

.. (Published: 5 April 2016) Citation: Int J Qualitative Stud Health Well-being 2016, 11: 31124 - http://dx.doi.org/10.3402/qhw.v11.31124ISSN: (Print) 1748-2631 (Online) Journal homepage: http://www.tandfonline.com/loi/zqhw20 Challenging the ADHD consensus Soly Erlandsson & Elisabeth Punzi To cite this article: Soly Erlandsson & Elisabeth Punzi (2016) Challenging the ADHD consensus, International Journal of Qualitative Studies on Health and Well-being, 11:1, 31124, DOI: 10.3402/ qhw.v11.31124 To link to this article: http://dx.doi.org/10.3402/qhw.v11.31124

Excessive sexual activities among male clients in substance abuse treatment. An interview study.

Purpose: The co-occurrence of substance abuse and excessive sexual activities is acknowledged in research and treatment practice. Men seem particularly at risk for developing excessive sexual activities. Excessive sexual activities complicate substance abuse treatment, and clients with such co-occurring difficulties have considerable treatment needs. It is therefore considered important to investigate how male clients who had enacted excessive sexual activities, perceive their excessive sexual activities, and themselves. Design: Interviews were performed with five male clients in substance abuse treatment, who had enacted excessive sexual activities. The interviews concerned the participants’ perception of themselves and how they came to enact excessive sexual activities. The interviews were analyzed using thematic analysis. Results: Two major themes were identified. One theme concerned overwhelming shame and difficulties to discuss sexuality in treatment. The second theme concerned how perceptions about masculinity had influenced sexual activities. Sexuality was described as an absent topic in their previous and ongoing treatment, and the participants described a need to discuss sexuality. Implications: It seems important that future studies investigate how excessive sexual activities might be identified and handled in treatment. It also seems important to investigate how gender-perceptions might influence excessive sexual activities. As a suggestion, practitioners should address sexuality, shame and perceptions about gender during treatment. Keywords : Excessive sexual activities; Interview study; Masculinity; Shame; Substance abuse; Treatment

Student responses to a reflexive course evaluation

Abstract Simple surveys are the predominant tool for course evaluations in most universities, but their validity has been questioned. They have been criticized for being a ritual way of complying with administrative regulations rather than a way of improving educational quality. Moreover, there is often a focus on student satisfaction, where the complexity of learning processes and the development of learner identities are lost. As an alternative approach, a qualitative course evaluation was tested that consisted of a single question: What could have been done in this course in order to better support your learning? Twenty-one second-year psychology students completed the evaluation at the end of a course. They provided rich answers describing learning activities and communication, and they described both teachers and students as agents. Going beyond merely reporting possible improvements, the students saw their learning processes in a context of academic demands and social mechanisms. It is argued that qualitative course evaluations can provide information about students’ understanding of their own learning that is difficult to uncover in a traditional survey. It is concluded that qualitative course evaluations would support the development of a student learner identity and help create a role for students as co-producers of knowledge.

Neuropsychological Assessment in Substance Abuse Treatment—Focusing on the Effects of Substances and on Neuropsychological Assessment as a Collaborative Process

Substance abuse is connected to considerable suffering and symptoms. Neuropsychological assessment supports understanding of the distress and the symptoms of the individual client and therefore is increasingly requested in substance abuse treatment. Substances, however, influence neuropsychological functions and emotional states. Therefore, assessment often needs to be postponed. Conducted at a suitable point of time, with respect to abstinence and treatment planning, assessment might provide understanding of the needs and possibilities of the client. This work contributes with suggestions on how neuropsychological assessment might be conducted in substance abuse treatment. Because the effects of substances are considerable, an overview of the effects of varying substances on neuropsychological functioning is presented. It is also suggested that assessment should be understood as a collaborative process that should support clients’ understanding of themselves.

Behavioral misuse among clients in substance abuse treatment: an interview study

Abstract Background: The co-occurrence of substance misuse and behavioral misuse such as excessive food intake, sexual activities, gambling and exercise has been increasingly acknowledged in both research and treatment practice during the last decades. It has also been showed that behavioral misuse complicates substance abuse treatment, and that clients with such co-occurring difficulties have considerable treatment needs. Methodology: This study is based on interviews with six clients in substance abuse treatment, who also had a history of behavioral misuse. The interviews concerned the participants’ perception of their behavioral misuse and of themselves, and were analyzed using interpretative phenomenological analysis. Findings and clinical implications: The participants perceived behavioral misuse as an escape from self-criticism and experiences of non-coherence. They also perceived relations and affects as overwhelming. Through behavioral misuse, relational and affective needs, as well as distressing self-experiences, were mitigated. The participants also described the efforts they had made to comprehend themselves. Their experiences were interpreted with respect to dissociation and concretization. It is suggested that during treatment, practitioners need to support client’s comprehension and their capacity to approach affects and relational needs, and in this process, dissociation and concretization need to be handled.

Co-occurring Self-Reported Behavioral Problems in a Substance Use Disorder Treatment Population: Treatment Perspective

Research and clinical experience indicate that individuals with substance use disorders (SUD) may also experience problems with excessive food intake, sexual activity, exercise, and gambling. Such behavioral problems cause individual suffering and might also complicate substance abuse treatment. In clinical practice, however, behavioral problems seem to escape identification. Through the use of a questionnaire, this study investigated whether patients in substance abuse treatment considered themselves having experienced behavioral problems, and whether behavioral problems had been acknowledged during treatment. Sixty-nine individuals in substance abuse treatment answered the questionnaire. Sixty-seven percent of the participants reported behavioral problems, predominantly two or more behaviors. Forty percent of the participants reported that their behavioral problems had been acknowledged in treatment. Based on these findings, it is suggested that treatment units should be prepared to identify behavioral problems and meet the treatment needs of patients who experience one or several behavioral problems.

A biased ADHD discourse ignores human uniqueness

There is a tendency in our current society to perceive human experiences, emotions, behaviors, relations, and difficulties as expressions of neurobiological functions and dysfunctions. Studies indicating that hardships like those just described should be understood as representing biochemical or neuroanatomical deviations are published in academic journals and presented in popular media. Although these studies represent a rather one-sided research focus, they create a sense that we live in an era where scientific progress is greater than ever before, with no need to look backwards (Lewis, 2006). This special issue in IJQHW on “Understanding children and young adults diagnosed with ADHD—a critical standpoint” lends its voice to experienced clinicians and researchers coming from a diversity of disciplines and countries in the world. Included here are papers written by researchers who criticize the current situation, but also point to alternative understandings, approaches, ethics, and treatments. Epigenetic research can teach us that we must pay attention to the impact of the social context on brain development. This impact includes early-life experiences but also how epigenetic pathways responsible for detecting the input from the environment act, and what influences phenotypic variations have across generations. As Champagne (2013) summarizes in a study explaining the contribution of epigenetic factors to our present knowledge of the link between the human brain and the environment: “Scientific progress is made through the careful research steps that build a foundation that is larger than the sum of its parts” (p. 634). We simply need to discover more about the nature-nurture interaction to understand how to meet the challenges that we have to face in a fast changing society. To disregard individuals’ experiences, even from an early age, and the influence on emotional and cognitive functions those experiences may have, is one way to reduce humans to neurobiological objects. In times when, more than ever, we need to acknowledge and understand the diversity of peoples’ experiences, the current focus on diagnostics and brain dysfunctions in people instead contributes to the marginalization and stigmatization of individuals. An important side of the discourse on ADHD relates to academic study books and how the authors in these books describe underlying mechanisms, and more specifically the genetics, of ADHD to students who will become future healthcare professionals. In one of the articles in this special issue Meerman, Batstra, Hoeckstra, and Grietens (2017) examined a section on ADHD in study books used for (pre)master programs from 10 universities in the Netherlands. They applied a framework including four categories (A,B,C,D) for defining how the authors of the books mention or omit effect sizes of quantitative and molecular ADHD genetics. The presence of effect sizes related to quantitative genetics such as twin studies and molecular genetics such as candidate gene studies were scored. Approximately half of the selected books did not mention “the low explained variance of molecular genetic studies”. About one quarter mentioned both quantitative and molecular effect sizes; however, in the final quarter of study books, no effect sizes were mentioned. The authors note that an important gene related to ADHD might have been around for 50,000 years, and note that it has not been clarified why the expression of this gene suddenly should provoke certain problematic behaviors in children. In line with the idea of scientific progress, biopsychiatry became dominant over more humanistic traditions during the late-twentieth century. ADHD is a paramount example of our society’s tendency to emphasize neurobiological explanations for human behavior, emotion, and reactions. A precursor of ADHD was included in the DSM II in 1968, namely Hyperkinetic Reaction of Childhood. In later editions of DSM, the terms Attention Deficit and Attention Deficit Hyperactivity Disorder were included. In DSM5, ADHD is presented as a neurodevelopmental disorder. This means that the highly elastic criteria for the diagnosis, a priori become viewed not only as a disorder but also as a disorder within the nervous system. National authorities such as The National Institute on Mental Health in the USA and The National Board of Health and Welfare in Sweden

Voluntary work with sporting activities for Jewish children and teenagers: commitment to inclusiveness, Jewish identity, and a future Jewish life – an interview study

ABSTRACT Membership in Jewish congregations seems to be declining and modern society has been described as a challenge to Jewishness and to the future for Jews as a people with shared characteristics and traditions. Activities for children and teenagers have gained increasing attention, since such activities might be a reassurance of a future Jewish life. To arrange such activities is, however, demanding and individuals who commit themselves to voluntary work are essential. In this study, six members of a Swedish Conservative congregation, who were committed to voluntary work with sporting activities for children and teenagers, were interviewed about the way in which they perceived their voluntary work. A thematic analysis was conducted. The volunteers concluded that everyone should feel included in the activities. They had a nuanced view of Jewish identity and also welcomed those who were not considered halakhically Jewish. Moreover, they wanted to support a positive Jewish identity in the new generation. Their work was perceived as meaningful even though they said that congregants who felt that the activities should adhere to Halakhah had criticized them. It is proposed that congregations should support voluntary workers and facilitate their efforts, otherwise experiences of misrecognition might evolve, experiences that are counterproductive for a vital congregational life.

‘Any room won’t do.’ Clinical psychologists’ understanding of the consulting room. An interview study

In the social sciences, there is increasing interest in spatial practices and the meaning of places. The meaning of the psychotherapeutic room and its boundaries has traditionally been underlined in psychodynamic practice. In this study we investigated how clinical psychologists, working from different perspectives and with varying interventions and populations understand and use the consulting room. Five clinical psychologists were interviewed about how they perceive and use consulting rooms. The interviews were analysed using Interpretative Phenomenological Analysis. The participants understood the consulting room as a logistic unit but also as a welcoming place for relational encounters and sensed that spatial stability was important for their capacity to be fully attentive to their clients. Moreover, technological booking systems could hinder clinical work. The results were understood with respect to Winnicott’s theories of transitional space and holding. In sum, the importance of the room does not seem to be of concern exclusively to psychodynamic psychologists. On the contrary, it seems as if psychologists working with varying interventions and from different perspectives emphasise stable and personal consulting rooms that permit them to adapt to the needs of the clients, be attentive, and avoid disturbances.