Rafael Richman, Ph.D., Psychologist

The integrative approach to working with ADHD provides a framework for the client and the practitioner to combine the best and most effective components of traditional interventions [medication, behavior therapy] and non-traditional interventions [complementary medicine, conscious parenting]. A primary goal is to optimize functioning and well-being and to minimize unpleasant side effects, short- and long-term harm. A secondary goal is to provide the client and his family with comprehensive information about a diverse range of treatment options for ADHD and the evidence [empirical and anecdotal] for these options. In other words, the aim is to talk about interventions such as medication therapy, alternative and holistic approaches, different parenting models, and to clarify what we know and what we don’t know about the effectiveness, and the potential benefits and disadvantages of each intervention.

Two-Track Model

I incorporate a two-track treatment model in my work with children, adolescents, and adults diagnosed with “Attention Deficit Disorder” [ADD] or “Attention Deficit Hyperactivity Disorder” [ADHD], which entails the following:

Track one: rebalance the body on all levels – biological, physical, neurological, biochemical, and molecular. For this track I often discuss the connection between what the client puts into his body [e.g., food] and how he feels. In addition to diet, we may also work with other healing professionals [e.g., naturopath, family physician]. Other components of this track include looking at exposure to environmental neurotoxins [e.g., lead, chemicals], molecular imbalance, and vitamin and mineral deficiency. For example iron deficiency is often associated with poor concentration.

Track two: rebalance the person on psychological, emotional, environmental social, and family levels. For this track I use the conscious parenting approach with ADD/ADHD-specific strategies and skills, interpersonal design elements, and individual psychotherapy and/or family therapy where appropriate.

Through experience consulting with many families, I have discovered that we are more likely to achieve successful changes in behaviour and symptoms with: a whole-scale shift in attitude; and a family-based commitment to changing their lifestyle. Simply substituting a “natural” remedy in place of medication does not usually lead to noticeable improvement or symptom reduction. Rather, a holistic, integrative approach requires considerable effort, openness, patience, awareness, perseverance and commitment, on the part of the family.

Key Points

In the integrative perspective the following key points are emphasized:

Thorough Assessment
I strongly encourage and believe it is necessary to properly and thoroughly assess for ADHD.

Human Element
It is important to remember the human element:  we are dealing with people (children, teens, adults) who are experiencing difficulties – with being able to concentrate, with sustained attending, who have difficulty inhibiting what they say and what they do, and who get easily frustrated – rather than only adopting the perspective that we are working with and treating ADHD.

Specific Symptoms
It is useful to work at the level of specific symptoms, and to reframe these symptoms as natural traits and tendencies, and as occurring along a continuum. For instance, I talk about having a tendency to be impulsive, having difficulty sustaining attention, and having a hard time inhibiting what one says and does.

Wholism
Everything is connected to everything else; change in one domain impacts and influences all other domains.

Bio-Individuality and Bio-Universality
Every individual is unique; and, at the same time, all human beings share certain universal human characteristics.

Balance – Imbalance
Individuals shift through states of relative balance and imbalance. The primary goal is to re-balance – on physical, emotional, mental, and spiritual levels – and to reduce extreme swings.

Dynamic
The state of balance/imbalance and our feelings/affect are continuously changing and in flux.  Individuals experience moment-to-moment change, and hourly, daily, monthly, seasonal cycles and patterns.

“ADD is not always a deficit, not a disorder in the usual sense, not a disease. It is a label given to a child who may think, learn, behave, and feel in a different style than others.” (Sears & Thompson, 1998)