Psychoanalytic Treatment of ADHD Children in the Frame of Two Extraclinical Studies: The Frankfurt Prevention Study and the EVA Study

Abstract

We are pleased that psychoanalytic therapy with so-called “ADHD-children” has been elected as subject of this journal. As we have discussed at length in a previous article, psychoanalysts in the last few years have been increasingly engaged in a heated discussion about ADHD (Leuzinger-Bohleber and Fischmann, 2010). As many of the contributions in this volume deal with psychoanalytic conceptualizations of the genesis, psychodynamics, and interdisciplinary approaches of ADHD, we will limit our contribution to the depiction of our attempts to provide psychoanalytic treatments — within the framework of divers prevention-programs — for “children at risk” in kindergarten. Children involved here also comprise those showing a preform of ADHD. The focus of this article is on psychoanalytic treatments of these children in the frame of two large extraclinical studies. Therefore, we will only briefly delineate our motivation to engage together with our colleagues of the Institute for Psychoanalytical Child and Adolescent Psychotherapy (IAKJP) in the endeavor of such early prevention projects. Subsequently the design, some results, and the exemplary supervision- and therapy-experiences with “ADHD children” in the Frankfurt Prevention Study and of the thereupon developed and still ongoing EVA Study will be summarized. We conclude with a short outlook.

Notes

¹ Mattner (2006), Amft (2006), and Gerspach (2006) gave a short overview of the historical and societal context in which this increase of Ritalin and other psychopharmacological medication for children could be understood. Mattner (2006) elaborates that the search for neurophysiological reasons for explaining socially deviant behavior has a long tradition in European countries, particularly in Germany . . . In the 1980s, the “Minimal Cerebral Dysfunction” (MCD) was widely spread (see Mattner, 2006). It was seen in close connection with the oppositional defiant disorder. This connection could already be observed in the 1950s. At that time German authors discussed “Encephalopathische Psychopathie” (Enke, 1953), “hirnorganisch-psychisches Achsensyndrom” (Göllnitz, 1954), and “frühkindliches exogenes Psychosyndrom” (Lempp, 1970). In Switzerland one used the term “frühkindliches psycho-organisches Syndrom” (POS) (Ruf-Bächtinger, 1987); Berger (1977) talked about “Teilleistungsstörungen” or “Teilleistungsschwächen.”

²The responsibility of the professional execution lay in the hands of Angelika Wolff (IAKJP). We would like to thank theZikann Stiftung, the Polytechnische Gesellschaft, the Crespo Foundation, the Ursula Ströher Stiftung as well astheCity of Frankfurt for their financialsupport of STARTHILFE. We also are grateful to the 30therapists andsupervisorswhi have been engaged in this study (clinical chair: Angelika Wolff, scientific chair: Marianne Leuzinger-Bohleber (names and further information: seewww.sigmund-freud-institut.de).

³The main responsible scientists are Luise Laezer, Birgit Gaertner, Mjriam Weissenburger, Inka Werner, Marianne Leuzinger-Bohleber, see ww.sigmund-freud-institut.de

⁴The EVA study is conducted by a large team (Scientific Chair: M. Leuzinger-Bohleber, main responsible scientsts: Luise Laezer, Nicole Pfenning, Peter Ackermann, Verena Neubert, and others as well as around 15 child therapists and supervisors, see www.sigmund-freud-isntitut.de)

⁵Scientific Team: M.Leuzinger-Bohleber, Clinical Chair: Claudia Burkhardt-Mußmann, Project team: Munise Agca, Nasim Ghaffari,Liz Holland, Sybille Stock

⁷The study was financially supported mainly by the Zinnkan Foundation, but also by the Research Advisory Board (RAB) of the International Psychoanalytical Association, the Hertie Foundation and the Polytechnische Gesellschaft, Frankfurt.

⁶This chapter has already been published in Tisantis and Trowell (2010, pp. 159–177).

⁸It has been an open question if we will be able to offer psychoanalytic therapies to children of low and problematic social groups, children who would never find their ways into private practices of our psychoanalytic colleagues. Until now we were able to offer such therapies to 17 children. For 10 other children we saw an indication for psychoanalytic treatments but the parents were not willing to accept treatments.- We are evaluating therapy outcome of these 17 children (with F90 diagnosis) and other children of the outclinic service of the institute for Psychoanalytic Child and Adolescence Therapy in Frankfurt in another study.

⁹We also would like to mention that none of the 412 children in our prevention group had taken Ritalin or another Amphetamine what means that the medical doctors in Frankfurt are acting according to the German law, which does not allow these medications to be given to children younger than six years.

¹⁰The following section and the conclusions of this paper are based on the summary of a former paper (Leuzinger-Bohleber and Fischmann, 2010).

¹¹This project is a replication study of the Frankfurt Prevention Study (FP). The study is a cluster randomized design in 14 kindergartens comparing the effectiveness of two prevention programs: EARLY STEPS and FAUSTLOS with “children at risk.” In contrast to the FP experienced child psychoanalysts are working weekly in the kindergartens, offering child therapies and crises interventions for parents there and support the teachers in their daily work, supervision is provided every second week.The excellent but time consuming attachment instrument, the MANCHESTER CHILD ATTACHMENT STORY TASK (developed by Jonathan Green and his research group) has been added as measure, to test our hypothesis that only by the psychoanalytic oriented program EARLY STEPS we will be able to achieve a change of the attachment pattern from an unsecure to a secure attachment pattern.

¹²This study realizes a Cluster Randomized Controlled Trial-Design (CRCT), where day-care facilities are randomly allocated to one of the two intervention conditions. The choice of the day-care facilities is based on the representative baseline evaluation of the Frankfurt Prevention Study of the SFI, which was conducted in 2003 in all of its municipal daycare facilities with a sample of N = 5300 children. In this baseline evaluation the collectivity of children were evaluated regarding asocio-statistical criterion (financial support of daycare fee) as well as personality characteristics of the children (aggressivity, hyperactivity, anxiety) were screened. Based on this baseline of those daycare centers were included in the EVA Study, which had a high percentage of children of families with low socio-economic status and impressed with higher occurrence of screened personality characteristics. To safeguard the sampling further social-statistic indicators on urban district levels (percentage of citizens with migration background, percentage of unemployment, youth-unemployment as well as expert judgments) were included.The determination of sample size of N = 14 daycare centers was performed according to a mathematical calculation of CRCT-Designs. Control of cluster effects was secured by estimation of the Intracluster-Correlation-Coefficient (ICC) on the basis of the results of the Frankfurt Prevention Study.