What kind of ADHD do you have?

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Psychiatric diagnoses are notoriously invalid and unreliable. Study after study has shown this. 

I remember way back in the 80s when the DSM III came out, a study was done when the same case example was given to multiple diagnosticians in the US and the UK and something like 65% of US diagnosticians  diagnosed schizophrenia while 65% of diagnosticians in Great Britain diagnosed BiPolar. I thought that finding was a hoot. There are few psychiatric diagnoses where a differential diagnosis has a bearing on treatment, but Bipolar is one because Lithium just came into common use and was pretty effective.

One of the models of psychotherapy where external factors are taken seriously and incorporated into treatment is Narrative therapy which Michael White and David Epston pioneered. One of the key concepts in Narrative therapy is externalization. The person's not the problem, the problem is the problem. Externalizing the problem leads to "externalizing conversations." I start each one of my psychotherapy sessions asking, "What's happened to you since we last met?"

I remember Michael White consulting on a case where a 10 year old child suffered from significant symptoms of ADHD. The parents had taken him to therapist after therapist and tried all kinds of medications to no avail. Finally they wind up in Michael's office as kind of a last ditch effort. 

After saying hello to the parents and the boy and listening to their story about how they had wound up in his office, when the parents tell Michael their son has been diagnosed with severe ADHD, Michael asks with a straight face, "That's very interesting. What kind does he have?" 

The parents were quite taken back, and said, "We didn't know there were different kinds." 

Michael says, "Oh, yes," and looks at the boy and asks, "What kind of ADHD do you have?" 

The kid says, "The kind that gives me headaches and keeps me awake at night."

And a wonderful externalizing conversation goes on from there that left the boy and the parents hopeful that there were things that could be done to interfere with the nasty things the ADHD was doing to their lives.