CCiittyy UUnniivveerrssiittyy ooff NNeeww YYoorrkk ((CCUUNNYY)) CCUUNNYY AAccaaddeemmiicc WWoorrkkss Dissertations, Theses, and Capstone Projects CUNY Graduate Center 5-2018 TThhee NNaattuurree ooff DDeeffeennsseess UUsseedd bbyy SScchhooooll--AAggeedd CChhiillddrreenn wwiitthh AADDHHDD Laurie G. Slodounik The Graduate Center, City University of New York How does access to this work benefit you? Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/2671 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] THE NATURE OF DEFENSES USED BY SCHOOL-AGED CHILDREN WITH ADHD by Laurie G. Slodounik A dissertation submitted to the Graduate Faculty in Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2018 i © 2018 LAURIE G SLODOUNIK All Rights Reserved ii The Nature of Defenses Used by School-Aged Children with ADHD by Laurie G. Slodounik This manuscript has been read and accepted for the Graduate Faculty in Psychology in satisfaction of the dissertation requirement for the degree of Doctor of Philosophy. ____________________ __________________________________________ Date Steven B. Tuber, PhD Chair of Examining Committee ____________________ __________________________________________ Date Richard Bodnar, PhD Executive Officer Supervisory Committee: Steven B. Tuber, PhD Hilary Gomes, PhD Lissa Weinstein, PhD THE CITY UNIVERSITY OF NEW YORK ABSTRACT iii THE NATURE OF DEFENSES USED BY SCHOOL-AGED CHILDREN WITH ADHD by Laurie G. Slodounik Advisor: Steven B. Tuber, PhD. This study sought to develop a more nuanced clinical picture of children with ADHD by examining the relationship between their emotional dysregulation and their use of defense mechanisms—the unconscious mental processes that guard against strong emotions. Children’s responses to the Thematic Apperception Test (TAT) were examined for evidence of defense mechanisms using an empirically validated scale, the Defense Mechanism Manual. The study employed a mixed between-within nonequivalent group design to examine the responses of 37 children ages 7-10. It was hypothesized that children with ADHD would use more frequent and more immature defenses than their peers without the disorder. Additionally, those TAT cards designated as “high arousal” were predicted to elicit more defense mechanisms than those considered to be less emotionally stimulating. Results indicated that ADHD was not a significant predictor of defense use. However, arousal level and age were found to be significant predictors of defense use. Implications of these findings and directions for future research were discussed. iv ACKNOWLEDGEMENTS A wholehearted and sincere thank you to: My chair and mentor, Dr. Steve Tuber, for always holding the net under my tightrope at the just-right-distance for me to feel brave enough to keep inching forward, no matter how slowly. The remaining members of my committee, Drs. Hilary Gomes and Lissa Weinstein, for their wisdom, generosity and especially, patience. And my readers, Drs. Benjamin Harris and Diana Puñales, for their encouragement and insight. Dr. Sarai Batchelder for her statistical expertise and guidance. Dr. Liz Bernbach, my supervisor, colleague and friend. Drs. Patty Yoon and Kahlila Robinson, steadfast companions on the quest to attain DMM reliability. Drs. Sarah Kay and Tzachi Slonim (and their families) for being the best things I've gotten from these ten years of training, aside from my doctorate. My family for being my secure base: Aaron, my partner and champion; Ezra and Amos, my wondrous and wonderful sons; Paul, my inspiring brother; and Sam, my sister-friend. And finally, my parents, Dr. Barry Stengel, of blessed memory, and Dr. Jill Allen. Thank you for teaching me to be deeply empathic, curious and playful. I'm proud to join you in this community of scholarly helpers. v TABLE OF CONTENTS Page CHAPTER ONE – LITERATURE REVIEW 1 Introduction 1 Emotional Development 2 Definition of Emotion, Feeling, and Affect 2 Developmental Model of Emotion 4 Emotion Regulation 6 Social Aspects of Emotion Regulation 7 Neurophysiological Aspects of Emotion Regulation 7 Intrapsychic Aspects of Emotion Regulation 9 Defense Mechanisms 10 Historical Definition 10 The Evolution of the Concept 11 Developmental Model of Defense 13 Defense mechanisms vs. coping mechanisms 14 Cramer’s model of defense development 14 Development of defense and its relation to psychological health 17 Measuring Defense Mechanisms 18 vi Attention Deficit Hyperactivity Disorder 20 Epidemiology and Phenomenology 20 Academic and social consequences of ADHD 21 Comorbidity 22 Theories of Etiology 23 Neuropsychological theories of etiology 24 Psychodynamic theories of etiology 25 Defense Mechanisms of Children with ADHD 27 The Thematic Apperception Test 28 High vs. Low Arousal Cards 29 The TAT as a Measure of Defense 30 Study Rationale 31 CHAPTER TWO – METHOD 32 Participants 32 Measures 34 DSM-IV ADHD Rating Scale 34 KSADS 35 Thematic Apperception Test 35 Defense Mechanism Manual 36 Design 37 Procedure 38 Hypotheses 38 vii CHAPTER THREE – RESULTS 39 Preliminary Analyses 39 Demographic Characteristics 39 Reliability 40 Summary Statistics 41 DMM Norms 44 Relationships among Subscales 44 Relationships of Demographic Variables to Outcome Measures 45 Tests of Hypotheses 46 Hypothesis 1: Relationship Between ADHD and Total Defense Use 46 Hypothesis II: Relationship Between ADHD and Use of Denial 47 Hypothesis III: Relationship Between Arousal Level and Defense Use 47 Hypothesis IV: Relationship Between ADHD, Arousal Level and Defense 48 Post Hoc Analyeses 48 Relative Use of Projection 48 Relative Use of Identification 49 Immature Defense Responses to the Low Arousal Cards 49 Arousal Effect 50 viii CHAPTER FOUR – DISCUSSION 51 Significant Findings 51 Empirical Support for Cramer’s Stage Theory of Defense 51 Contribution to Literature on TAT 53 Insignificant Findings 53 The Sample as a Whole 53 Nature of the TAT and DMM 54 Study Limitations 55 Directions for Future Research 56 Conclusion 56 APPENDIX A: DMM SCORING MANUAL 58 APPENDIX B: TAT CARD DESCRIPTIONS 78 REFERENCES 79 ix