‘Micro-dissociations’ as symptoms of trauma in the psychoanalytic psychotherapy of ADHD-diagnosed children with domestic violence backgrounds

With requests for ADHD assessments, and evidence of positive diagnoses on the rise, questions are now being asked about potential over/mis-diagnosis of the condition. My own experiences of working with children diagnosed with ADHD or dissociative disorders, who also have a history of domestic abuse, have prompted this investigation into potential diagnostic confusion. This study makes a start towards addressing the potential for misdiagnosis, and examines a trauma-based alternative to the current neurodevelopmental framework, specifically for children exposed to domestic abuse. A series of four case investigations shows that inattention deficit can instead be attributed to what I am calling ‘micro-dissociations’; seconds-long dissociative episodes, in this specific group of patients. The research evidences these dissociations as triggered by the, “return of a memory,” or by an interpretation by the therapist, the latter of which can be experienced as an assault in the transference. This link is demonstrated by using clinical material from children diagnosed with the inattentive form of ADHD who have experienced violence in their early years, and an operationalised description of such micro-dissociations – taking specific account of the countertransference – to differentiate between different types of inattention, In doing this, I have produced a full model of memory and forgetting, which I have named The Memory Matrix, framing all forgetting within a psychoanalytic understanding of dissociation, linked to the infantile experiences of primitive maternal functions. The outcome of this research confirms that, in one case, ADHD was a misdiagnosis in place of a more accurate description of dissociation, and in two other cases, the dissociative symptoms were, at the very least, present alongside neurodevelopmental inattention.