How do we understand children's restlessness? A cooperative and reflexive exploration of children's restlessness as a bioecological phenomenon
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This thesis is a reflexive and cooperative exploration of children’s restlessness as bioecological phenomenon. According to the ecological systems model, development can be understood as the result of interactions between the child’s biological qualities and qualities in the surrounding ecological systems. According to the ADHD diagnosis, children’s restlessness can be understood as a neurodevelopmental disorder that can be observed as biological, psychological and social symptoms and dysfunction. As a form of vitality, restlessness can be experienced and expressed as a certain combination of movement, time, force, space and intention/directionality. In this thesis, restlessness is defined as the label given to an experienced form of vitality that appears in the space between the described and the describer. This definition points to the importance of the observing adult, and binds the acting child and the observing adult together in mutual revelation. Possible biological mechanism that can give rise to children’s restlessness include maturation, different genetic susceptibility, and play behaviour. Possible psychological mechanisms include motivation, identity formation, and musical improvisation. Possible social mechanisms include cultural mothering ideals, socioeconomic status, and child maltreatment. An ecological systems model allows for the exploration of complex and multi-level relations between the person, the context and time. A community music therapy approach points to the importance of exploring the qualities involved in these ecological processes. Children’s restless behaviours have been understood and met in different ways within music therapy, partly depending on the context and on the music therapist/researcher. I critically reflect on what happens when children’s boundaries are violated, whether restlessness can be related to gender, on the relative lack of system focus, and on the implicit goals of music therapy. I also reflect on whether theoretical orientation is related to therapeutic action, where the restlessness comes from and whether it can be understood as inter-contextual tension. Paper 1 is a critical exploration of the position of the biopsychosocial model and ADHD in Norway. I argue that the different understandings discussed can be seen as pertaining to different levels of inquiry. These come with certain possibilities and limitations. Paper 2 presents ecologically valid understandings of children’s restlessness, that were created through cooperative inquiry with professionals and parents. Data were analysed using thematic analysis. Children’s restlessness was understood as individual trait, expectations to be seen and heard, result of traumatisation, relational phenomenon, parent’s problems, lack of cooperation in the community, and as lack of structures and resources. Paper 3 is a case study of a collaborative community music therapy process with one boy and his friends. Their process is understood in terms of exploring musical vitality, consolidating positions, performing together and discovering ecological ripple effects. Children’s restlessness be understood as a bioecological phenomenon, where biological, psychological and social aspects are interrelated and co-constituting. Adding two ‘new’ levels to the ecological systems model can allow for a more precise integration of findings, and facilitate exploration of relations between findings that belong to different ecological levels. Children’s restlessness be also understood as results of interactions between process, person, context and time. Actions, vitality forms and development can be seen as taking place within a certain space of appearance. Action can be seen as inherently unpredictable, as conditioned by plurality, and as defined in relation to an already existing web of relations. Children’s restlessness can be understood on the premise that children and adults are participating subjects acting on each other. Different contexts offer different possibilities and limitations, and music therapy can be used to increase children’s possibilities for action. By regarding health as relational, function and development can be understood as relational and context-dependent. A relational approach to health can increase adults’ possibilities for action and understanding. It also points to adults’ responsibilities related to understanding children better and creating better contexts for children.
Has partsPaper I: Helle-Valle, A. (2014) How do we Understand Children’s Restlessness? A Critique of the Biopsychosocial Model and ADHD as the Dominating Perspective in Current Understanding and Treatment. Voices: A World Forum for Music Therapy, 14(1). The article is available in the thesis. The article is also available at: https://doi.org/10.15845/voices.v14i1.741
Paper II: Helle-Valle, A., Binder, P. E., Stige, B. (2015) Do we understand children’s restlessness? Constructing ecologically valid understandings through reflexive cooperation. International Journal of Qualitative Studies on Health and Well-being, 10: 29292. The article is available in the thesis. The article is also available at: https://doi.org/10.3402/qhw.v10.29292
Paper III: Helle-Valle, A., Binder, P. E., Anderssen, N., Stige, B. The dynamics of ADHD in children – a critical standpoint. The submitted manuscript is available in the thesis. The published article is available at: https://doi.org/10.1080/17482631.2017.1298266