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Living and working with ADHD & ASD: T e art & science of systemic diagnosis, treatment & support

Presenters: Gary Robinson and Lucia

Whitney This workshop was as fast and furious

as some of the children I have seen fl ying in and out of the ADHD clinic in North Devon CAMHS. So much information, such controversy and so much at risk as we attempt to make sense of ‘disorder’ in a child’s behaviours. The presentation opened by provoking us to think about diagnosis and treatment of ADHD and ASD with extracts from an essay written by the sister of a recently diagnosed patient. The young woman’s sister had ‘crashed’ following diagnosis, and the impact reverberated throughout the family with a sibling feeling marginalised and deeply unhappy. This was a salutary reminder of the power of professional authority, as both experts and parents perhaps perilously pursue the holy grail of diagnosis without paying due care and attention to the possible aftermath. How then, could our presenters attempt to justify their work in a neuro-developmental clinic where labels have already been attached by very virtue of attendance in this clinic? ‘Whose diagnosis is it anyway?’ positions

us in collaboration with families to construct a diagnosis that both makes sense and is useful to children and young people. Gary and Lucia use bio-medical, cultural, social and environmental models to guide their practice and off er systemic and educational interventions to families who often feel blamed and shamed by behaviours that attract criticism and denigration from others. Searching for a scientifi c ‘truth’ may be less than helpful – particularly in light of recent science, questioning the previously ‘known fact’ that E=mc2

– which is based on

there being nothing faster than the speed of light; we may now have to re-think our ‘truths’ about the universe. There may be advantages and

disadvantages in having a diagnosis, but the therapeutic relationship lies at the heart

38 Lucia Whitney and Gary Robinson Context February 2012

of our work. Transparency is essential as we explore a child’s experiences in the past and present and support them into the best possible future. Experts in the fi eld are urged to explain their line of questioning as, what may seem usual to us, can be strangely extraordinary to families who may not previously have equated early infancy experiences with current challenges to learning or socialisation. A participant wondered if there is a

gendered diff erence to being heard when asking for help with their child? Are mothers heard less well than fathers? It seems as though they may well be and I wondered if we secretly blame and shame our mothers too, but this may well be the topic for another workshop…….. We heard another story from the clinic:

one of complexity and high risk but where the diagnosis was not crucial to treatment. Gary and Lucia reminded us of the notions of curiosity, neutrality, hypothesising, therapist availability, safe uncertainty and authoritative doubt – all helpful tools as we navigate the unclear world of neuro-

developmental disorder. Do we need to be more directly engaged with families in this clinic, as opposed to the refl ections of refl ections and circular questions? We are encouraged to be confi dent and off er our expertise as required, as families do seem to want to hear our suggestions (tentatively off ered) and to have a plan and structure in place. Paulo Bertrando’s plenary at the conference

gave us the idea of: “… being able to tell myself, my truth, about myself”, and it seems to me it could help us to be transparent and real as therapists to those who ask for our guidance, particularly when we straddle the fi elds of medicine and therapy. It was also good to be reminded that; Not everything that steps out of line, and

thus ‘abnormal’, must necessarily be ‘inferior’ (Hans Asperger, 1938). Thank you Gary and Lucia: this was a

much-needed workshop in a burgeoning area of work.

Julie Brough, systemic family therapist/ manager, CAMHS North Devon

AFT National Conference workshop reports

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