ADHD and Differentiation of Self

ADHD as we know it today was not recognized during the early 1960s when Dr. Bowen was finalizing Bowen Family Systems Theory. Does Bowen Theory have anything to offer for our understanding of ADHD? To start, let’s do a comparison between aspects of ADHD and lower levels of differentiation.

The lists above are not exhaustive, and everyone with ADHD experiences the symptoms differently. What you may notice in the lists, however, is the significant overlap in the descriptions of each. For example, hot temper and quick to anger; decision paralysis and difficulty making decisions; low frustration tolerance and withdrawing to cope with discomfort. I have a theoretical question and an applied question: (1) Does having ADHD inherently mean being lower on the scale of differentiation of self? (2) Does knowing that someone has ADHD change how we approach treatment in family systems work?

ADHD and Emotion Regulation

One of the most impactful experiences of those with ADHD is emotion dysregulation. One of the markers of low DoS is emotion dysregulation (reactivity). Are these the same, and if not, what do they have in common and where do they differ? They can both show up as being quick to anger or withdraw, high intensity, and impaired functioning. The difference(s) between them, however, is more difficult to identify. The way I’ve chosen to explore this is by distinguishing between brain processing and capacity. Brain processing is the way a person’s brain receives, organizes, interprets, and responds to information. Capacity refers to one’s ability to observe themselves, to process and respond to emotions, and to tolerate discomfort.

An individual’s place on the scale* corresponds with their depth of capacity. As we know, it is important to explore one’s capacity rather than assuming level of differentiation based on topography (i.e., what the behaviour looks like). This is particularly important when ADHD is a factor due to the topographical similarity we see in those who are lower in differentiation. If we assume lower differentiation based on high emotional expression, we may be a negative impactful by misunderstanding our clients with ADHD.

Evaluating Capacity and Differentiation of Self

Evaluating DoS and a client’s level of functioning can help clinicians to determine our approach to working with a client.  For example, understanding roughly where someone is on the scale, can help determine which questions to ask them, how much we can challenge them, and how much guidance they may need in the beginning. This is where a clinician’s approach is pivotal. We might assume that someone is lower on the scale of differentiation (i.e., has low capacity) because they describe instances of becoming quickly frustrated, struggling to regulate their emotions, and difficulties in coping with stress, for example.

The problem is that if the reason for these struggles is actually ADHD, then the client may have a higher capacity than we assumed. When we do this, we are missing huge opportunities for growth with this client, potentially losing the client, or worse, inadvertently causing harm (e.g., reinforcing a client’s belief that they are incapable). If we can look to understand someone’s capacity to learn, to interrupt reactivity, to self-reflect, and to be thoughtful, we open the possibility of accessing more of a client’s solid self beyond their ADHD experiences. It isn’t so much about the initial reaction; it’s about what one does with that initial reaction. The big question is: How do we evaluate capacity?

Thank you for your interest in Family Systems.

This post was provided by: Rebecca Van Der Hijde

Rebecca is a Family Systems + Behaviour Analyst with Living Systems. In her private practice, Resonance Autism + Family Therapy, she works with a variety of families, including those who are raising neurodivergent children. She has been working in the field of autism and developmental disability for over 20 years and is very excited about integrating Bowen Theory with Behaviour Analysis in her practice.

* An individual’s place on the scale is not fixed, nor is it precisely consistent across all areas of life. For the purpose of this article, I refer to being “lower” and “higher” to indicate the relativity of differentiation of self