Journal of Psychology & Psychotherapy
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Attention-deficit and Disruptive Behavior Disorders. A Philosophical and Psychoanalytic Reflection

Wilfried Ver Eecke^{* *}Correspondence: Wilfried Ver Eecke, Department of Psychology, Georgetown University, Washington, United States, Tel: + (202)803-8633, Email:

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Introduction

Elaborating the problem: Phenomenological analysis

Both DSM-IV-TR and DSM-5-TM provide information which justifies looking to the three disorders of ADHD, conduct disorder and oppositional defiant disorder as having a common theme. Indeed, DSM-IV-TR tells us that “individuals with Attention- Deficit/Hyperactivity disorder develops secondary oppositional attitudes towards such tasks and devalues their importance, often as a rationalization for their failure” [1]. These children can be seen as having oppositional defiant disorder. DSM-IV-TR tells us also that “children with Attention-Deficit/Hyperactivity disorder often exhibit hyperactive and impulsive behavior that may be disruptive” and thus could be seen as having conduct disorder. DSM-IV-TR also reports that “A substantial proportion (approximately half) of clinic referred children with Attention- Deficit/Hyperactivity Disorder also have Oppositional Defiant Disorder or Conduct Disorder” [1].

DSM-5-TM reports that “oppositional defiant disorder co-occurs with ADHD in approximately half of the children with the combined presentation” (DSM-5-TM, 65). DSM-5-TM also reports that “Conduct disorder co-occurs with ADHD in about a quarter of children or adolescents with the combined presentation” [1].

The definition of these three disorders invites us to see if there is not a clear common underlying feature. We read that “The essential feature of Oppositional Defiant Disorder is a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months” and that “The essential feature of Conduct Disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated and that “The essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development [1].

Compared with the definition of the two other disorders, ADHD seems to me to lack focus. Inattention points to a failure, an inability or, as the definition itself makes clear, a deficit. On the other hand, hyperactivity seems to me to be a form of acting out.

This poses the question of the existence of a positive kernel of ADHD disorder. Some of the diagnostic subdivisions might give us a hint. Indeed, we find the following descriptions: “They [children with ADHD] often do not follow through on requests or instructions and fail to complete schoolwork, chores, or other duties (Criterion A1d). [This disorder manifests itself in] “Frequently interrupting or intruding on others to the point of causing difficulties in social, academic, or occupational settings (Criterions A2i). “Individuals with this disorder typically make comments out of turn, fail to listen to directions, initiate conversations at inappropriate times, interrupt others excessively, intrude on others, grab objects from others, touch things they are not supposed to touch, and clown around” [they engage] “in potentially dangerous activities without consideration of possible consequences.

We can argue that these secondary features in the description of ADHD help us to understand that conduct disorder and oppositional defiant disorder have progressively more serious problems with rules which help human beings in living reasonably and peaceful together. The authors of DSM-IV-TR explicitly point out that ADHD is commonly present in the two other disorders and they identify Conduct Disorder as a more serious form of the Oppositional Defiant Disorder when they write: “The disruptive behaviors of individuals with Oppositional Defiant Disorder are of a less severe nature than those of individuals with Conduct Disorder and typically do not include aggression towards people or animals, destruction of property, or a pattern of theft or deceit. Because all of the features of Oppositional Defiant Disorder are usually present in Conduct Disorder, Oppositional Defiant Disorder is not diagnosed if the criteria are met for Conduct Disorder” [1].

The authors of DSM-IV-TR provide also information about contributing or predisposing conditions of the three disorders of ADHD, Conduct Disorder and Oppositional Defiant. The following are called predispositions for ADHD: “[In Attention- Deficit /Hyperactivity Disorder] There may be a history of child abuse or neglect, multiple foster placements, neurotoxin exposure (e.g., lead poisoning), infections (e.g., encephalitis), drug exposure in utero, low birth weight, and Mental Retardation”.

Predispositions for Conduct Disorder are: “parental rejection and neglect, difficult infant temperament, inconsistent child- rearing practices with harsh discipline, physical or sexual abuse, lack of supervision, early institutional living, frequent changes of caregivers, large family size, history of maternal smoking during pregnancy, peer rejection, association with a delinquent peer group, and certain kinds of familial psychopathology “Oppositional Defiant Disorder is more prevalent in families in which child care is disrupted by a succession of caregivers or in families in which harsh, inconsistent, or neglectful child-rearing practices are common”. Also, Oppositional Defiant Disorder is more common in families in which there is serious marital discord. Also remarkable is the observation that “symptoms of the disorder [Oppositional Defiant Disorder] are typically more evident in interactions with adults or peers whom the individual knows well [1].

Among the predisposing factors, mentioned in DSM-IV-TR for the three disorders of ADHD, Conduct Disorder and Oppositional Defiant Disorder, we find that a number of family situations are reported as predisposing factors.

For ADHD, DSM-IV-TR mentions that “Family discord and negative parent-child interactions are often present” and that “There may be a history of child abuse or neglect, multiple foster placements, neurotoxin exposure (e.g., encephalitis), drug exposure in utero, or Mental Retardation.

For Oppositional Defiant Disorder, DSM-IV-TR writes that “Oppositional Defiant Disorder is more prevalent in families in which child care is disrupted by a succession of different caregivers or in families in which harsh, inconsistent, or neglectful child- rearing practices are common”. “Oppositional Defiant Disorder is more common in families in which there is serious marital discord” [1].

For Conduct disorder, DSM-IV-TR mentions the following conditions as predisposing factors: “parental rejection and neglect, difficult infant temperament, inconsistent child-rearing practices with harsh discipline, physical or sexual abuse, lack of supervision, early institutional living, frequent changes of caregivers, large family size, history of maternal smoking during pregnancy, peer rejection, association with a delinquent peer group, neighborhood exposure to violence, and certain kinds of familial psychopathology (e.g., Antisocial Personality Disorder, Substance Dependence or Abuse) [1].

The common theme among those family situations is neglect, abuse and frequent changes in caregiver, harsh and inconsistent child-rearing practices and serious marital discord. Does this suggest that the children were unable to learn something about the beneficial consequences of rules as it harmonizes conflicts between people?

I believe it is also worth noticing the following observations about children with ADHD. The symptoms of ADHD, so say the authors of DSM-IV-TR, vary a great deal, even in the same child, depending on circumstances. On the one hand, “Symptoms typically worsen in situations that require sustained attention or mental effort or that lack intrinsic appeal or novelty. On the other hand, “Signs of the disorder may be minimal or absent when the person is receiving frequent rewards for appropriate behavior, is in a novel setting, is engaged in especially interesting activities, or is in a one-to-one.

The above observations indicate that the symptoms of ADHD diminish automatically when the person’s desire is involved because it is a novel or interesting activity or because the person receives frequent rewards or because the person receives recognition by being in a one-to-one situation.

Clarifying the problem of not following rules--the basic problem in the three disorders--will therefore have to take the form of looking for factors that make following rules (more) difficult or moreeasier. We already discovered that in the case of ADHD the structure of the patient’s desire might be involved.

In Search of Constructive Ideas

I will be using three authors for approaching this problem. The first author is Sigmund Freud (and the psychoanalytic tradition) who locates the agency for obeying rules in the super-ego. The second author is Kant, who explains the paradoxes involved in following rules, specifically moral rules. The third author is Hegel, who points out those following moral rules leads to conflicts and difficulties unless the proper language is found to mediate these conflicts. I will present the ideas of these authors first in their own right. I will then point to areas where the ideas of these three authors overlap. Finally, I will formulate a number of steps that should prove helpful for adults who have to deal with children affected by disorders involving problems with following rules.

Sigmund Freud and the Psychoanalytic Tradition

We discovered that among the predisposing conditions for ADHD are child-abuse, child neglect, a disruptive succession of child-care givers, lack of supervision, inconsistent child-rearing practices with harsh discipline, and serious marital discord among parents. In these entire cases one can see that the parental role for incorporating the guidelines is not optimal. Indeed, Freud originally thought that the super-ego was the internalization of guidelines and prohibitions of parents whom the children loved and feared [2]. The argument went that the children wanted the love of the parents and feared their disapproval or their punishments. So, the children started to do what the parents wanted them to do. They did so first under the influence of the parents and then later under the direction of the internalized parental authority [2].

But if the child was not supervised, or was neglected or had a disruptive succession of caregivers or if there was serious parental discord, then the child lacked the opportunity to discover and internalize a set of guidelines and prohibitions. If the child had been abused, then it might have internalized the idea of disruptive aggressive behavior. In both cases the inability to follow proper rules can be thought of as being the result of a defective super- ego, either because of lack of effective models for the child or because of a bad model. However attractive, this straightforward explanation is not satisfactory because the super-ego cannot be understood as simply being the internalization of empirically observed guidelines or prohibitions [2].

Freud himself and some of his followers observed several manifestations of the super-ego which resist the simple explanation that the super-ego is but the interiorization of empirical behavior of other people. First, the prohibitions of the super-ego of a child are different than those concrete prohibitions imposed by their own parents or the own educators. Freud observed also that the severity of the super-ego is sometimes the inverse of the severity of the parents’ severity towards the child [3]. Thus, children of very liberal parents have sometimes a much more severe super- ego than children of parents who are strict with their children [3]. These observations suggest that the creation of the super-ego is not just a response to empirical givens, but might be a response to a structural requirement.

Second, the structural law inherent in the super-ego is not restricted to the oedipal law of incest prohibition. The law of the super-ego is enriched, so Freud noticed, by cultural-social demands finding their origin in education, religion and morality [2,3]. But the demands of education, religion, and morality are not empirical demands. They are more often than not verbal demands that are general rather than empirical or concrete requests. Freud said as much when he wrote that the super-ego contains much verbal material in the form of guidelines derived from listening.

Some psychoanalytic authors connect a proper super-ego not so much with the empirical guidelines and prohibitions offered by the parents as they derive it from the triangular relation between the parents. Thus, Lacan argues that the child creates a special relationship with the maternal figure. In order to overcome its anxiety over its total dependence, the child projects onto the mother a sense of omnipotence and simultaneously sees itself as the object that can fulfill all the mother’s desires [4,5]. It thereby subjectively has the certainty that it will always be taken care of by another, who in turn is thought to be omnipotent. Such a subjective attitude on the side of the baby is often described from the outside as the attitude of his or her “majesty the baby.” This expression points to a moment of grandiosity or of narcissism present in the original relation of the child to the maternal figure. If the child takes on such an attitude or accepts such a subjective position, then rules that limit it or rules that demand that it share things with other children are not easily accepted. In such a subjective position, the child wants everything and does not accept the rights of other children. This is obvious in the frequently occurring phenomenon of sibling rivalry [5,6].

According to the theory of Lacan, this situation changes completely with the Oedipus complex as Lacan understands it. When the child starts to observe that the mother has an emotional relation with another (e.g., the father) then the child receives two messages from the mother. The child learns that the mother is not omnipotent (i.e., self-sufficient) because she enjoys a relation with another. Furthermore, the child learns that it is not the sole object of desire of the mother, since the mother enjoys a relation with another. These messages are unwelcome and most children refuse to receive the messages by, for instance, interrupting the relation between the parents: they interrupt the parents when they talk, they push them apart when they embrace each other, or they assure the mother that they will take care of her when the father has to go on a business trip. They even interrupt the mother when she talks on the phone. But when the message is permanently present, it reaches its destination. The child has no choice but to face the new reality: i.e., that it is not just part of a dyad but that it is situated in a triad.

The realization by the child that it is part of such a triad demands according to Lacan that the child re-situate itself. The child needs to accept the narcissistic wound that it is not everything for the mother. The child deals with that challenge to its self-worth by searching for a mark in the father that might be the reason of mother’s interest in the father in order to identify with that mark and thus to recuperate the interest of the mother [5-7]. At the same time the child realizes that it is not the father that it will have to work in order to become like the father. It thus also needs to accept that it is not what it wants to be and that it needs to learn patience. Lacan further argues that the Oedipus complex understood as triangulation has a pacifying function. It makes the child accept its limits and thereby learns that it is one among other children.

Lacan emphasizes that the Oedipus complex is the occasion for the child to re-situate itself with reference to itself, with reference to its mother and with reference to others. If such a re-situation takes place, Lacan says that the paternal metaphor has taken hold of the child. From the point of view of the child, the crucial moment was the moment in which it realized that it lost the exclusive relation with the mother. It felt expelled from the dyadic relation with the mother. Such expulsion, Lacan connects with the well-known psychoanalytic idea that for the child to mature it has to accept the prohibition of incest. For Lacan, acceptance of the prohibition of incest is the basic law for human beings. Without the acceptance of this law, no other law is ever fully acceptable.

This Lacanian approach is able to explain several of the predisposing factors for the three disorders that we study. In particular it can explain why “families in which there is serious marital discord” predispose children to a lack of respect for rules and for other people. Marital discord destroys a message necessary for the child to accept triangulation, because it undermines the message that another than the child is emotionally significant for the mother. Neglect, abuse, frequent changes in caregiver, lack of supervision and early institutional living might not give the child the opportunity to learn sufficiently about triangulation. Harsh and inconsistent child-rearing practices could be an indication that the parents misunderstand the method of teaching the child respect for rules. Within the frame of Lacanian theory, the child must first learn to accept the rule of prohibition of incest which it learns by messages that invite the child to accept triangulation which in turn encourages the child to re-situate itself from a position in which it thinks of itself as his/her majesty the baby to a position in which it must earn respect. If the child has not re-positioned itself then any imposition of limits and rules will be resented rather than accepted. This can be expected to be the case even more if the rules are applied inconsistently and harshly.

Prohibition of incest has a broad meaning. Incest is not just intercourse between a mother and her child. Incest covers also incestuous feelings of a child wanting to have intercourse with its mother.

However, when Lacan makes comments on a concrete case (the Wolf-man), then it looks as if accepting rules and respecting others requires more than a successful triangulation through the Oedipal complex. The requirements that need to be fulfilled for a child to be able and willing to behave properly seem to be very complex in Lacan’s eyes.

Thus, Lacan argues that the Wolf-man missed “a clearly authorized voice. A father who incarnates the good, the symbolic father” [8]. Nevertheless, “the Wolf-man loved his father who was very affectionate with him. The father, however, had rejected to marry a poor girl; he loved, in favor of a lady, who was from a wealthier class. He had also gambled away money, of his companions in the army, which had been confided to him. Lacan gives as further reason for the lack of proper super-ego in the Wolf-man, the fact that he had been “separated from all that he could, on the social plane, constitutes for him a model”. Consequently, so argues Lacan, the Wolf-man established a provocative attitude in order to obtain one satisfaction: to be punished by his father. It thus looks as if for the child there is an intimate connection between acceptance and refusal of rules and the relation with the representative of the rule or of the law: the symbolic father.

From the American psychoanalyst, Roy Schafer, we learn about one more complication about the super-ego. Consider the following statement: Parental gentleness and leniency form no obstacle to the child’s forming a critical superego, as Freud well knew. And while he did not say, in so many words, that the child needs a parental superego of optimal strength in order to live and develop, he did say that “the ego needs the superego’s love to live” [9]. Shafer thus suggests that the superego should not just impose rules and issue prohibitions, the superego should be felt to do so with love. For that to be possible Schafer argues that parents, who influence greatly and unavoidably the characteristics of the superego, should possess certain qualities. Thus, he writes: “Much will depend on how right and conflict-free the parent feels in his role of moral guide, how much he can genuinely and realistically act ‘in the divine conviction of doing the right thing’” [9]. He then continues: “Unconflicted gentleness [of the parents] is likely to go hand in hand with unconflicted firmness”. However, we know from the philosopher Kant, that moral life is paradoxical. To have reached a position in which moral life is not conflictual means that at least the basic paradoxes of morality are solved. For children to have a good superego, we now understand that the parents of the child must have solved the conflict originating in the paradoxes of moral life. Let us therefore look towards the origin of conflict in moral life.

Immanuel Kant and the Paradoxes of Respecting (Moral) Rules

The first difficulty with moral rules, according to Kant, is the fact that moral conscience is caught in a paradox. On the one hand, it experiences duty as supreme. But, duty is contrary to some inclinations like cravings and concupiscence and thus causes pain. Pain is felt because duty is the prohibition of some desire, some self-satisfaction. On the other hand, moral conscience cannot negate its desire for happiness. Kant presents as a solution to this paradox the postulate of a Being, i.e., God, who must guarantee the necessary harmony of duty and happiness [10].

The second difficulty of the moral world exposed by Kant is the fact that the conflict between duty and happiness is experienced by consciousness itself as existing within itself. Consciousness is awareness of duty and awareness of motives and passions which conflict with its sense of duty. Kant presents as a solution for this problem the postulate of infinite time to purify motives and passions and thus to bring them in line with duty: i.e., the postulate of immortality [10].

The third difficulty of the moral world exposed by Kant is the fact that moral consciousness needs to act. Moral consciousness is, however, confronted with a difficulty. It has a feeling that its pure moral duty commands respect (ADHD children sometimes have a very keen sense of what they see as justice). However, the feeling of respect for pure moral duty is not a sufficient guide to act. A moral consciousness, ready and willing to act morally, needs further guidelines to act morally [11]. Indeed, a sense of sacred moral duty is not enough to help someone to decide whether to spend more time on one’s professional duties such as preparing for lectures, or spend less time on professional duties and more on non-professional duties such as helping the homeless, visiting the sick, and caring for one’s own children. However, moral consciousness is not able to create, on its own authority, these further guidelines with the same absolute certainty as it has about the sacredness of pure moral duty. Moral consciousness has no other choice but to accept a number of specific moral laws as valid which it, itself, does not produce. It accepts for instance, the Decalogue, proverbs, Esope’s or Lafontaine’s fables, and the morals of stories such as that of Chaucer’s clerk’s tale. Still, moral consciousness is responsible for the concrete moral laws it chooses to obey. However, choosing which moral laws to obey is not the same as producing or generating them. Because moral consciousness can only choose its concrete moral laws and not produce, create, or deduce and thus cannot certify them itself, there arises in moral consciousness a profound dissatisfaction. According to Kant, the only way to remove the dissatisfaction of a concrete acting moral consciousness is by postulating a Holy Lawgiver.

The clerk’s tale is about a king testing his wife. As I understand the moral of the story, Chaucer implies that it is reasonable to test people with whom one will build a life together. The tendency to test, however, can go too far and become absurd as in the case of the king with his wife Griselda. The moral is summarized as follows: “Griselda and her patience both are dead and buried. in some far Italian vale. So, let it then in open court be said, husbands, be not so hardly as to assail the patience of your wives in hope to find Griseldas, for you certainly will fail.” [12].

Sartre is probably the twentieth century philosopher who emphasized the most this dimension of human freedom. Thus, he wrote: “The existentialist, on the contrary, thinks it very distressing that God does not exit, because all possibility of finding values in a heaven of ideas disappear along with Him; there can no longer be an a priori Good, since there is no infinite and perfect consciousness to think it. Nowhere is it written that the Good exists, that we must be honest, that we must not lie; because the fact is we are on a plane where there are only men. Dostoevski said, `If God didn’t exist, everything would be possible.’ That is the very starting point of existentialism” [13].

Thus, within a Kantian framework, concrete moral guidelines are first discovered as maxims. Moral consciousness then uses the universalization principle to select from among those maxims the ones that are moral. Moral consciousness thus selects as concrete moral guidelines something that is given to it. It would therefore be wrong to claim that moral consciousness creates its principles.

“The moral laws. Must be regarded as commands of the Supreme Being.”

What is the function of the postulate of a Holy Lawgiver for moral consciousness? First, the Holy Lawgiver is supposed to help moral consciousness bridge the gap between the desire for absolute sacredness of the moral law and the feeling that the concrete laws lack such absolute sacredness. Concrete moral laws lack absolute sacredness because moral consciousness must take account of nature in order to act morally (I need to earn a living in order to provide for my family, but how much? I must love my neighbor but I may not covet his wife). Nature is not consciousness, it is alien to consciousness. For its encounter with this alien nature, moral consciousness lacks the resources in itself to create concrete moral guidelines that have the desired absolute sacredness. By postulating a Holy Lawgiver moral consciousness transforms the impersonal laws it sees in nature into conscious judgements of the Holy Lawgiver. As these conscious judgments are the judgments of the Holy Lawgiver, they are as sacred as consciousness’ own feeling of the sacredness of pure moral duty [14]. Moral duties are seen as divine commands.

Kantian Implication for Children with ADHD

Intelligent therapeutic intervention requires that one understands the maladaptive behavior of the patient. I therefore wish to ask the question: what would make it reasonable for a child to resist actively the internalization of new prohibitions or the connection of these new prohibitions with the power of the super-ego to internalize prohibitions? Kant’s theory of morality can provide us with several insights.

The super-ego is partially explained by Freud as internalization of the prohibitions of the parents or the internalization of the super- ego of the parents. These internalized prohibitions are the many laws which the moral consciousness of the child needs in order to guide itself so that it is able to act morally. The function of these borrowed prohibitions is to help the moral consciousness of the child in solving the third moral paradox. We also learned from Schafer that the parents need to feel right and conflict-free in their role of moral guides so that they can act “in the divine conviction of doing the right thing” [9]. Schafer then reassures us that “Unconflicted gentleness [of the parents] is likely to go hand in hand with unconflicted firmness” [15]. Schafer thereby affirms that, solving the third paradox, effectively provide specifications for moral action-- parents need also have solved for themselves the first moral paradox: i.e., that moral duty is not in conflict with the desire for happiness.

The requirement for solving the basic moral paradox is the assurance and experience that moral behavior will lead to happiness. If the parents or the adults around the child take their moral duties seriously, but appear to the child as being unhappy, then the child has an objective reason to confirm its subjective inclination to refuse to internalize the moral prohibitions of its parents as part of its super-ego. On top of that the parents or adults around the child might themselves not have the firmness to insist consistently and firmly on moral limits because they themselves are not free of conflict about moral life.

A requirement for solving the basic moral paradox is that the concrete moral prohibitions appear as sacrosanct, as the sense of pure moral duty. On Kant’s account the difficulty for accepting specific prohibitions or specific moral rules is that they lack the sacrosanct character that consciousness requires in order for consciousness to submit itself to their restriction. Kant grants consciousness the ability to feel that it has, unconditionally, a moral duty. Awareness of moral duty, in general, is even constitutive for consciousness, according to Kant.

Consciousness needs help in order to accept the specifications of its moral duty. Parents perform for their children the psychological function that Kant assigns in his system to the Holy Lawgiver. However, if the parents, or the adults around the child, are perceived not to respect enough their own prohibitions then we have discovered an additional reason for the child not to internalize the parent’s prohibitions as part of its own super- ego. The parents’ perceived condescension or inconsistent attitude towards their concrete moral duty provides the child an external confirmation of what it, for internal reasons, likes to refuse: acceptance of specific moral duties. In Kant’s philosophy the concepts of God and of Holy Lawgiver solve one paradox. However, God is the Holy Lawgiver. Parents are expected to perform vis-a-vis their children the double role of Kant’s God and Holy Lawgiver.

A more refined way to put this point is to say that hyperactive children or children with attention deficit have unmet needs. These children are not able to solve the moral paradox described by Kant. These children thus need additional help, specifically with Kant’s moral paradoxes. Where for other children some real or perceived inconsistency by the parents in their moral attitude might not be detrimental, such real or perceived inconsistency in the parents’ moral life must, according to my line of reasoning, make it more difficult for hyperactive children or children with attention deficit to solve the moral paradox. Upon further reflection one could describe the problem of these children more generally as the difficulty they have with all rule-oriented behavior, whether that rule be a moral one or a technical one. In this latter case too, Kant may be able to enlighten us as to what makes any rule guiding behavior distasteful. Kant’s ideas might also be able to clarify what it is that allows most human being to overcome their distaste for rule governed behavior. Kant’s insight is that rule governed behavior demands respect and as such is a form of humiliation to self-interest and self-conceit that serves the self-interest of the person [10]. Kant gives us further hints for our problematic when he claims that there is a connection between beauty and morality. Thus, he writes: “the beautiful is the symbol of the morally good”. Given the connection Kant sees between beauty and morality he can advise the following: “Hence it appears plain that the true propaedeutic for the foundation of taste is the development of moral ideas and the culture of the moral feeling”. Kant’s insight is that human beings learn simultaneously respect for beauty, morality and laws of nature (technical rules). In terms of Kant’s moral psychology, the question then becomes: first, why do some children develop the necessary respect for beauty, law, and rule governed behavior, notwithstanding the humiliation it causes to the self and, second, why do other children feel the humiliation so much that they cannot develop the respect needed to obey the law, accept rule directed behavior, or admire beautiful things?

In a similar way, a parent is expected, according to Schafer, to be “conflict free in his role of moral guide” [9]. This will allow the child, so continues Schafer, to feel that he can “genuinely and realistically act ‘in the divine conviction of doing the right thing”. Hence the specific moral behavior that the children imitate from their parent gives moral demands a kind of sanctity.

Thus, I have been able to deduce from Kant’s philosophy two reasons to explain the lack of internalization of prohibitions in children. First, the children must learn what the concrete moral prohibitions are. This requires that the parents be consistent in obeying the important moral laws. Second, the children must experience that moral duty and happiness go together, as they see in the pride and happiness that the parents sow when performing their moral duty. We also learned that children experience all rules as limitations, not just moral rules. By using these insights, one should be able to recommend additional strategies for helping hyperactive children, children with attention deficit or children with disruptive behavior disorders.

We are able to give two recommendations to adults around those children: one, take your moral obligations seriously, and two, be happy with them and show that you are so. By following this new prescription, the parents perform, however minimally, the function of Kant’s postulated Holy Lawgiver or God for solving paradoxes of moral life for their children.

Hegel’s reflection on morality and the importance of moral language.

Hegel claims that an effective moral attitude requires the presence of a moral conscience. Such a consciousness unifies two elements. First, it is certain of the sacredness of pure moral duty. Second, it is also certain about the moral value of its concrete actions. This certainty expresses itself in the moral conviction about concrete acts [16]. With the introduction of the concept of moral conviction Hegel goes beyond Kant.

This conviction, so Hegel continues, carries with in itself implicit demands not clearly visible in the concrete moral acts themselves. Indeed, a moral conviction implies a thought. This thought is that the acts have moral and thus spiritual or universal value. Acts, however, are particular and thus arbitrary. The acts are also objective, material and thus not necessarily of spiritual value.

Hegel’s genius is to see that a moral subject who has a conscience tries to give a universal, spiritual or moral value to its concrete and thus material acts by appealing to others for recognition. In order for others to recognize universal validity in the particular moral acts of a human being, it is necessary that these acts have three characteristics. Firstly, in the acts there must be something objective. Secondly, that objective characteristic must be visible for all others. Thirdly, the objective characteristic must make visible the subjective aspect which is the essence of the moral conviction. For Hegel, these three aspects are present in the language of moral justification of one’s particular acts. Language is thus credited with the possibility of maintaining the universal dimension necessary for one’s particular acts to be moral. It is therefore not surprising that Hegel finds that the highest moral act is a linguistic act: i.e., the act of forgiving [16]. He even calls forgiving the act which initiates “absolute Sprit” and calls it also the appearance of God amongst the mutually forgiving human beings.

Hegelian Applications

Hegel provided a logical argument for the need to use the language of moral justification as part of the solution to the moral problem. This idea allows us to infer additional remedies to help hyperactive children or children with attention deficit. These children need help in order to create effective consciences. The movement from an abstract moral consciousness to a moral conscience makes the child vulnerable to the problem of moral recognition by others. It raises the question as to how others will interpret my actions, if they are not aware of my morally good intentions. According to Hegel, the problem of recognition can be solved only by language. Hyperactive children and children with attention deficit can, according to that line of thinking, be helped, if they feel that the goodness of their intentions is heard. To succeed in that challenge hyperactive children and children with attention deficit need help. They need to be provided with the moral language by which they can describe the moral intentions in their acts such that others can recognize the morally good aspects of their actions.

A child may be eager to help in the kitchen. While helping in the kitchen, the child may drop a cup which then breaks. This in turn may shake the child and put into question the goodness of its original intention to help in the kitchen. A parent can reassure the child truthfully in the goodness of its intentions and teach it about the unavoidable risks of good intentions by mentioning that: “only someone who helps in the kitchen can break something in the kitchen.”

Here is an example: Bill a young child falls and cries. Peter, an older brother genuinely tries to help Bill, who gets angry. Only clarifying words can solve this family drama. Those were provided by the mother who said to Peter: “Peter, helping Bill is very nice, but Bill is really hurt and does not want to be touched now.” The mother showed respect for the morally ambiguous act of Peter who was both trying to help Bill and to show off as the big brother. At the same time the mother introduced linguistically the distinction between showing off and genuine affection for another person.

This line of reasoning, however, creates its own problem. It locates a deficiency in child development in a deficiency of the parents. This could provoke guilt--not the best emotional state to help children with a deficiency in the super-ego. Such guilt might be ameliorated or avoided by what could be called a therapeutic explanation to the parents. Such an explanation can appeal to the philosophical tradition that I have used in my paper. The therapeutic explanation needs to convince parents that the development of moral life is a tremendous challenge because it must overcome several difficulties to which adults can provide more or less help [17,18]. These difficulties are:

1) Achieving the willingness to give some kind of absolute value to rules which are inherently relative.

2) Developing the ability to see and to feel that the pain of accepting concrete moral rules is worth it because it leads to happiness.

3) Developing the ability to discover the proper and successful verbal formulas for receiving confirmation by others of the morality of one’s morally ambivalent acts.

Conclusion

In this article we started from the observation of DSM-5-TM that children diagnosed with either Attention-deficit/hyperactivity disorder or Conduct disorder or Oppositional defiant disorder all have difficulty with following rules. These children sometimes even have difficulty following moral rules. We made use of both philosophy and psychoanalysis to discover what the origin of those difficulties might be. We were then able to formulate advice for parents having to deal with children who have one of the above mentioned three diagnoses. We pointed out that all rules, even moral rules impose limitations. Rules that children are expected to follow, even and especially moral rules must be made consistent and lovable. Parents must show that they consistently follow themselves the rules they expect their children to follow. They must further make those rules lovable by showing that following these rules makes them, the parents, feel happy.

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