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The Reality-Sampling Deficit and ADHD: Indication for an Active Technique

Attention-deficit hyperactivity disorder (ADHD) is a common condition and one that the current evidence base highlights as not being best served by the prescription of medication alone (Jensen et al., 2007). The demand facing clinicians is twofold. For the psychiatrist, there is a need to be open to and accommodating of an analytic perspective of ADHD, as one extending understanding of the condition beyond the neurological. For the analyst, I suggest there is a requirement to be open to altering the analytic frame. It is this latter demand that I shall aim to help answer in this article, by highlighting the existence of a reality-sampling deficit in patients with ADHD. Using clinical examples, I shall examine how the concept of a reality-sampling deficit may aid our understanding of the ADHD child's internal experience and their relationship to external reality. In turn, this will lead us toward some adaptations of analytic technique, with an emphasis more upon process than content and links to mentalization-based therapy. I will discuss some relevant aspects of psychoanalytic theory as well as the current evidence base (biological, psychological, and psychodynamic) to form a platform from which we might better help the child with ADHD.