Poles apart?

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Challenging some common conceptions of ADHD

This article discusses the findings of a small qualitative research study aimed at providing insight into what it is like to grow up with attention deficit hyperactivity disorder (ADHD). The study was conducted as part of a doctoral research project over the course of three years.

Seventeen young adults between the ages of 18 and 24, diagnosed with ADHD as children, were recruited from various locations in England and asked questions about their experiences as children and young people.

Eight participants took part in semi-structured interviews while the rest attended focus groups. All interview material was digitally recorded and then transcribed verbatim. Each transcript was then coded and analysed using grounded theory (Strauss & Corbin, 1998), a methodology which involves collecting data without preconceived ideas about what you are looking for.

After detailed and rigorous analysis, including member checking (a process which involves validating participant’s responses with them to ensure accuracy), there emerged an overarching core category of “polarisation” in our subject group.

Children with ADHD can shift quickly between extremes of emotion.Indeed, this polarisation seems to be the essence of, and fundamental factor in, all of the reported accounts provided by the participants. Polarisation is not to be mistaken for or associated with bipolar disorder which refers to manic depression, involving the presentation of hypomania with episodes of depression.

The concept of polarisation was experienced by all of the participants (100 per cent) in the study and there was a strong preponderance of “either/or” or “black/white” thinking styles. In the light of the presence of these opposites, the term “polarisational existence” was coined as a theoretical model to explain the experiences of the participants.
The majority of people experience being happy or sad, feel energetic or lethargic, have full focus of attention or are unable to concentrate; there are times when they have an urge to do something (an impulse) or feel unmotivated. However, the individuals interviewed reported their experience as extremely intense at all times and across all domains. Thoughts, emotions and behaviours were said to be polarised, occurring in every environment, situation and circumstance. This experience is not static but has its own levels of intensity. Children with ADHD can be cooperative or uncooperative, relaxed or very excited, full of attention or inattention, charming or unpleasant. Participants highlighted that there is no time scale for remaining at either pole or any real defining situation where these poles are witnessed.

The study revealed a number of recurrent themes in the types of polarisation experienced by participants, but three issues stood out as key areas of the ADHD experience.

Fluxuating emotions

Subject’s reported that their emotions and mood states dramatically fluctuated from one extreme to the other. These emotions could be either constructive (feeling happy, relaxed or excited) or destructive (feeling sad, anxious or becoming angry with self and others). The unpredictable and dramatic fluctuation between extreme and intense emotions led to participants lacking awareness as to why they felt the way they did; they were confused about what had happened to them. For example, one participant said: “I’d be crying and I don’t know why… and then the next minute, I’ll be fine”. This dramatic and polarised mood state seemed to occur when there was functional intensity and stability in their emotions. One respondent referred to this as a “feeling of entrapment”, likening it to being an “animal in a corner”.

Sustaining attention

A commonly held belief about ADHD is that individuals with the condition are unable to sustain attention. However, participants reported this to be inaccurate. There were moments where the subjects’ concentration was very poor, where inattentive behaviour could be likened to a “channel surfer”. This was described as drifting through different thought patterns, trying to settle on something that might motivate them. As a consequence, participants reported being unable to follow instructions and remain focused on tasks. However, when there was something interesting or something which had motivational value to individuals, they were hyper-focused and were able to sustain attention for enduring periods of time.

Relating to others

Relationships are central to human existence. Participants described experiences and interactions within their relationships with family, professionals and peers as being either dysfunctional, where there was a level of hostility (verbal and non-verbal), miscommunication and misunderstanding, or functional, where care, understanding and helpful communication was experienced which, for the participants, was both calming and reassuring. The study suggests that the individuals with ADHD were very sensitive to other people’s reactions. This impacted upon their interpretation of social situations and consequently influenced their behaviour, at times resulting in them feeling the need to argue their case in order to justify their behaviour. This could be viewed by observers as manipulative, defensive, dangerous and lacking self awareness – seemingly the opposite of a sensitive approach.

Conclusion

This study was small in scale and it could be argued that it is therefore difficult to generalise from it. However, it has highlighted many interesting and insightful experiences of individuals with ADHD. The reported accounts of participants are consistent in their experiences of polarisation; they seem to show how those with ADHD can veer between extremes of being lethargic (hypo-active) and hyperactive, very focused (hyper-focussed) and lacking concentration (hypo-focused), very impulsive and in control.

We believe that the concept of polarisational existence can be a very useful addition to our understanding of the emotional experience and behaviour of those with ADHD. However, while we hope it can significantly add to the debate on condition, we recognise that further research is required to fully understand the factors at work.

Further information

Dr Paul Holland is a chartered psychologist providing a range of training, consultancy and coaching services within the field of SEN:
www.drpaulholland.com

www.makatontrainer.com

Dr Madan Mall is a counselling psychologist in the North of England.

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