Ritalampmaartenlyndonsmith.com/wp...report_SmithRietmeijer.pdfADHD [14]. The main symptoms of the...

DBP003 - Physical and Social Rehabilitation January 12, 2017, Eindhoven, The Netherlands

Maarten SmithIndustrial Design Eindhoven University of TechnologyEindhoven, 5612 AZ The [email protected]

Simone RietmeijerIndustrial Design Eindhoven University of TechnologyEindhoven, 5612 AZ The [email protected]

AbstractDuring the last decade, the use of Ritalin quadrupled in the Netherlands. With a heavy focus on medication, the treatment of ADHD lies on changing the individual and there is little attempt to make changes to the environment in order to benefit individuals. Ritalamp is developed to raise discussion questioning this choice. The lamp is situated inside a glass head surrounded by a clear liquid and has no switch, it burns continuously. The bright light can only be dimmed by adding medication. As a critical design the lamp is docked through media coverage, expositions and social media at various places in the problem landscape to raise discussion at those points where it can make a difference.

Authors KeywordsCritical design, ADHD, Medication

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders that affects children. The Netherlands Youth Institute estimates that between 2% and 6% of youth in the Netherlands is diagnosed with ADHD [14]. The main symptoms of the disorder include inattention, hyperactivity and impulsivity [2].

These symptoms can be an obstacle for people with a diagnosis, particularly children, but can just as well be beneficial for them, depending on the context. An analogy that can be made is that of a Ferrari in brain,

Ritalamp


with bicycle brakes [10]. Because of this, a lot of treatment towards ADHD is focused around suppressing the symptoms when they are obtrusive (making the Ferrari slow down) [11], although some therapy also focusses on utilizing some aspects of ADHD for the benefit of the child [17].

This project is part of a design brief to design products and services that enhance social and physical rehabilitation, reintegration and wellbeing.

Throughout the process we operated under the mantra to design for ADHD as if it were a superpower, putting the qualities in the spotlight and empowering children and youth with a diagnosis.

This pictorial describes the Reflective Transformative Design Process [12] that we undertook to design for this brief. An overview of the process can be found in [fig 1] and [fig 2].

[fig 1]

[fig 2]


An initial explorationIn the opening stage of the process, attempts were made to empathise and get closer to the lives and experiences of the target users in order to increase the likelihood of the final design meeting the user’s needs [13] and scope the brief.

In order to observe and engage with our users, a co-creation session [fig 3] was organised in which 6 girls with ADHD (aged 17-23) were invited to share their experiences with ADHD and ideate. The session was structured into a segment where participants share negative and positive aspects of ADHD and a segment where ideas were generated using an idea matrix [9] and further conceptualised.

Next to a selection of concepts the session generated further learning outcomes. Many ideas were linked to communicating the users current feelings/thoughts to the outside world. A feeling of not being understood was mentioned. Also, many of the negative symptoms are relatable for

people that don’t have the diagnosis. To gain more empathy for stakeholders closely involved with our target group such as parents and teachers as well as more insight into the status of treatment for ADHD, the “Balans Kennis Symposium” [fig 4,5] was attended. Here, speakers with an academic background (developmental psychology), child and youth psychiatrists and psychologists and other experts gave talks. Some of the key learning outcomes included the cruciality of not identifying a child by its “label” and a questioning of the necessity to to change the behaviour of the child, (“Why does my child have to be able to do this?”). Next to that, the current inflexibility of the education system was noted, along with some techniques to help children/youth with ADHD to cope with their negative symptoms, such as mindfulness, and a note of caution with regards to picking and choosing seperate techniques used in complete therapies [16].

[fig 3]

[fig 4]

[fig 5]


First ConceptsThe input gained from the co-creation session and symposium was clustered by affinity into more specific problems and opportunities surrounding children and youth with ADHD. Each cluster was ideated on separately and ideas were noted on post-its with small sketches. These were then evaluated and discussed according to their feasibility, viability and desirability and the insights that had been gained from empathising with the users and the personal learning goals that had been set for the project.

This way the ideas were filtered down to two main concepts. The first being a design intended to share the

reality of a child or youth with ADHD with the rest of society. The practice of sitting down on the sofa after a day at work and spending time to “let your head deflate“ that was mentioned during the co-creation session, inspired the form of a glass head which filled with water the more it was spoken to [fig 6].

The second concept was a toolkit, a selection of artifacts intended to enhance/enable various aspects of therapy and/or coaching or help the youth to make the most of the positive aspects of ADHD [fig 7].

Both concepts were prototyped in order to gain more insight into their function in use and in context.

[fig 6] [fig 7]


EvaluationThe two concepts differ fundamentally in the way design is employed to make a positive difference for the social wellbeing of the target group [fig 8]. A presentation of the concepts was utilised to discuss these design trajectories and make a choice between the concepts. Eventually, the head was chosen because next to having intriguing aesthetic qualities, it would be a bigger challenge. with respect to personal learning goals,

The prototype was used to experiment with the aesthetics of light being refracted through water with the intention of translating the metaphor of a “head filling up and deflating” from within the head through its located space, hereby using its aesthetic qualities to play into the somatic awareness of an audience. Feedback from experts challenged the search for an additional function of the design. This resulted in the lamp being able to print a text transcript of everything it had recorded [fig 11]. The design was then deconstructed into a set of parameters that could be changed to get the desired effect.

[fig 8] [fig 9] [fig 10]

[fig 12][fig 11]


that because of this, children with ADHD-characteristics encounter constraints which they would not encounter in a less demanding environment [8]. The AJN (Artsen Jeugdgezondheidszorg Nederland) confirms this and supports it with the example that currently, there is a regular application of young boys by schools with the question whether or they might have ADHD [1]. In many cases, these are boys (around 6 years old) who have gone to grade 3 early due to the changed age limit and written justification that is required if a choice is made to retain in the 2nd grade [1]. ADHD does not play a role here, instead it is an education level that is simply too high for the child in question.

The examples above give a strong indication that the current school system plays a role in the increase of the use of Ritalin (or other similar medication) and furthermore suggests that children or youth with ADHD could possibly do without (or with less) medication if this system would be changed.

Reintegration of qualitiesThe design should cultivate in the public a critical sensibility towards the use of medication for young children with ADHD and allow complete freedom to discuss alternatives. In order to do this we proposed a design criterium of directly linking the core functionality of the design with that what is taken for granted in society, the act of giving medication. This then allowed us to map different functions with the previously separated aesthetic qualities in an idea matrix [9] and come up with new ideas.

current perspective of society towards people with ADHD and towards people with ADHD and not critical of it. This led to a deep reflection session in which the complete design process was mapped out and the qualities of the design were seperated from its core idea.

In order to be more in line with Hawthorne’s vision, it was necessary to design with the intention of transgressing and undermining social conformity and passivity in the hopes of bringing about social emancipation [3]. This ethical stance in design is articulated by its founders, Dunne and Raby, as “critical design” [4,5]. Critical design uses design as a strategy to cultivate in the public a critical sensibility which, at its most basic, is simply about not taking things for granted, to question and look beneath the surface [6,7].

Validation of critical statementsHaving adopted this stance, various deliberately unspecific critical statements that could be proposed to challenge the current societal norm were collected and ideated. These were then “tested” for their discussion-generating qualities by being proposed to groups of 2-4 peers. A statement that generated a lot of discussion from various perspectives and on various levels was the following: “Young children should not be given medicine for ADHD.” This led to further investigation of medical treatment for children with ADHD in primary and secondary schools.

MedicationThe use of Ritalin in the Netherlands between 2003 and 2013 has quadrupled [8]. In 2012 the Dutch government requested advice from the Health Council on the issues surrounding ADHD. In 2014 they published a report in which was constituted that the pressure to perform in theoretical skills at school has increased and it is likely

Societal VisionAfter the decision was made between the two concepts the need to clearly define a societal vision for the trajectory of the design was recognised.

Prof. dr. Susan Hawthorne explains how currently, the prominent view of ADHD confines ADHD’s dysfunctions within individuals with the result that social contributions to “disorder” and social contributions to its relief are left underexamined. Next to this, people’s commitment to intervening at the individual level is often strengthened by the assumption that the social structure cannot (significantly) be changed. In short, she recommends that in the general approach towards ADHD, there should be less focus on changing individuals and more on changing society [11].

A presentation of the concept in front of experts generated critical feedback about the core of the concept being contradictory to this vision, namely, affirmative to the


Ideation and ConstructionThe outcome of the ideation was a lamp that is constantly on. A lamp that has no off-switch and that metaphorically represents the constant energy of a child with ADHD. A lamp which can only be dimmed by adding Ritalin, the most widely used and recognized medication for ADHD in Dutch society.

A visual of the concept enabled us to evaluate the embodiement of the critical idea in the design [fig 13,14]. Evaluation resulted in the form of the lamp being changed to that of a child’s head in order to communicate the metaphor more clearly. Envisioning this design in use also generated the criterium that the lamp should allow more freedom for the user to change its position or location, or at least imagine doing so. This in order to more accurately match the possibilities parents often have to change or influence the position of their child in society as well as their own perception of the child.

sodium phsophate and mag-nesium sulphate (Na++PO4

3-+ Mg2++SO4

2- > Na++SO43-+

MgPO4) gave us sufficient parameters to alter in order to achieve the desired effect.

The first stage to prototyping this concept was the definition of criteria for the desired dimming effect. In order to achieve the organic and direct aesthetic visual effect, a chemical reaction that was safe and affordable was needed, so a meeting with chemical expert Jan Melsen was organised. The precipitation reaction of

During the construction of the prototype we encountered set-backs. In order to add medica-tion to the lamp, a hole needed to be drilled in the top of the head [fig 16]. To prevent the

glass from shattering during this procedure, the head needed to be heated up, releasing tensions in the glass. The first head shat-tered in the oven after being heated up too quickly [fig 17].

The base of the lamp (bamboo) expanded after some use and did not fit anymore [fig 18]. We solved this by fitting a new base and letting it expand be-fore sealing it to the base.

[fig 13] [fig 14]

[fig 15] [fig 16] [fig 17] [fig 18]


Final ArtefactThe final artefact was named “Ritalamp”. A working prototype that allowed the accurate fine-tuning of the dimming affect by alteration of the concentrations of sodium phosphate, magnesium sulphate and soap (emulsifier) in the reaction.

this in turn again changes their perception of the lamp. The fact that the lamp has no cable or stand allows the user to imagine how the lamp could otherwise be interacted with

The intention is that the light coming from the lamp not only serves as a metaphorical indicator of a childs energy level, but actually contributes to how the user percieves the context and space around him/her. Therefore, any alteration of this light changes the perception the user has of the space they are in and

in such a way that using the medication to dim the light would not, or at least not always be necessary and what the consequences of these interactions would be. In this

way the lamp serves as an analogy to seduct users into exploring and discussing the critical idea from various an-gles and perspectives. The next step was to design a system to

deliver the design through other media and capture the following discussion, hereby exploring the complexity of the problem and painting a clearer picture of the “problem landscape”.

[fig 19] [fig 20] [fig 21] [fig 22]

[fig 23] [fig 24] [fig 25] [fig 26]


Design in contextA key element of critical design is how it is delivered to the target audience. The complexity of the problem calls for the discussion of the critical idea to be strategically “dockable” in various places in society. This way, the idea can be adopted by different actors and distributed according to the different positions these actors have in society, therefore involving perspectives from as many involved segments of stakeholders as possible.

To enable this, a press release was written, a website was set up and a video and photos with high communication value were taken. These elements, in combination with the lamp

itself, make up the entirety of the design, as they are of core functionality for achieving the designs purpose. This collection of elements made it easy for journalists such as the Cursor [fig 27][15] (Campus newspa-per) and Eindhovens Dagblad [fig 28][18] (regional newspa-per) to pick up the critical idea and distribute it to the masses.

Although this distribution has a large audience, it was not possible to evaluate the extent of the intended resulting dis-cussion. In order to observe and engage in discussion the design was placed in an online shop, in an ADHD community-support group on Facebook as well as an exposition in the Design Hotel in Eindhoven [fig 29] and Eindhoven University.

[fig 27] [fig 28]

[fig 29]


After publication of this pictorial, exhibitions will be held in a public library and in a theatre performance. On the left [fig 30], an actor network diagram of how the design is envisioned to work in context is displayed. The designed system can be “docked” at various “stations” that interpret the critical idea and distribute it in their own way. Some of these “dockings” can be strategically controlled and some of them are out of control or only partially in control. The distribution of the idea accross different channels in the “problem landscape” gener-ates intended discussions. The discussions we are able to observe are then interpreted by us, the designers, to further uncover the extent and complexity of the “problem landscape”. Please note that at the time of publication, the actor “Integration Into Theatrical Piece” has not yet been executed.

We organised expositions and docked the design in an ADHD community Facebook page, which resulted in dis-cussions with some of the key stakeholders involved in the problem that we observed and/or engaged in. This enabled us to make an initial interpretation of the problem landscape [fig 31]. This problem landscape is only intend-ed to give our interpretation of an overview of the com-plexity of the problem and the forces at work. It in no way places blame on any segment of involved stakeholders.

ResultsSome quotes from the resulting discussions were: “Although the medication specifies it should only be used as part of a complete treatment procedure, other methods of treatment weren’t even suggested to me.” ~ Mother of a daughter with ADHD.

“The school system is very result-oriented and parents have a lot to do with this.” ~ Father of a child with ADHD.

TeachersParents

Schools

Experts / Therapists

Teacher education(PABO)

Economic forces Government

Children / Youthwith diagnosis

Behavioural ExpectationsCreates

expectations from

Informs

Set by


RitalampPress release

Video

Pictures

WebsiteCursor

Live Expositions

Facebook ADHDCommunity Page

Integration into Theatrical Piece

Designers

Government

Teachers


Parents

EindhovensDagblad

Discussions we did not observe

Discussions we observed Problem landscape

* * *

*

* * *

*

*

* * *

*

*

* *

*

*

Created by

Docked in

Interpreted by

Uncovered by

Discussion*

Design in context

Problem landscape

TeachersParents

Schools


Teacher education(PABO)

Economic forces Government


Behavioural ExpectationsCreates

expectations from

Informs

Set by

[fig 30]

[fig 31]


Our gut feeling is that the balance between nuance and communication potential is a compromise and an optimal solution to this compromise does not exist. Nevertheless, further investigation could be done to challenge this intu-ition.

Future plans The Ritalamp will be exhibited on the 25th of July, 2017 in “De Nieuwe KHL” in Amsterdam and for a two week period in March 2017 in the public library in Maastricht, where the library will support the exhibition by collecting relevant literature and presenting it together with the Ritalamp.

AcknowledgementsWe thank our client, I. Krabben, coach, dr. ir. E. I Bara-kova and experts involved in the project, namely: R. Van Berkel, I. J. Boloz, dr. ir. J. P. Melsen, prof. dr. G. W. M. Rauterberg and ir. M. Traenkle.

References1. Artsen Jeugdgezondheidszorg Nederland. (2012,

December 10). Visie van AJN op “toename ADHD en demedicalisering” [Bijlage bij kamerbrief]. Retrieved from https://www.rijksoverheid.nl/binaries/rijksoverheid/documenten/publicaties/2012/12/10/visie-van-ajn-op-toename-adhd-en-demedicalisering/visie-van-ajn-op-toename-adhd-en-demedicalisering.pdf

2. American Psychiatric Association. (2015, October). Help with ADHD. Retrieved January 07, 2017, from https://psychiatry.org/patients-families/adhd

3. Bardzell, J., & Bardzell, S. (2013, April). What is critical about critical design? In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI ‘13) (pp. 3297-3306). New York, NY: ACM.

“The child should only have to use medication when they want to.” ~ Teacher “Since I have regulated my own learning, I have significat-ly reduced my use of medica-tion.” ~ Student with ADHD “I am thankful I can take medication because now I can make friends.” ~ Child with ADHD

“I am thankful I can take medication because now my teacher doesn’t get angry with me” ~ Child with ADHD

ReactionsIn general, the final designed system was reacted on posi-tively. It was not difficult to arrange exhibitions in local libraries and small venues. The local press enthusiastically picked up the design and pub-lished an article about it. Our client, Ilse Krabben, reacted with the following quote: “I find the object so beautiful and in line with my message that I felt inspired to have it integrat-ed into my theatrical piece and have a composer write music to accompany it.”

The communication potential of the design was fur-ther complemented on by Geert van Velten (Journalist at Eindhovens Dagblad) and Norbine Schalij (Journalist at Cursor). In the ADHD support group and during the exhibitions the design generated discussion and attracted attention.

DiscussionBecause the core functionality of the design is to com-municate a message, we strived to make the design as realistically functional as possible, but this could be im-proved. One could argue that the design could be signifi-cantly improved from a functional perspective. Although the workings of the design send a clear message, the reaction cannot be endlessly repeated which is unrealis-tic. The same goes for the light, which lasts 24 hours and does not endlessly shine. Although we strived to make the design as realistic and therefore believable as possible, these discrepanties were a nuisance behind the scenes.

One could also argue that the complexity of the prob-lem is not obvious from the Ritalamp itself, and that this results in some audience members interpreting the design as a general attack on medication and not participating in the discussion. In response to the press article in the cursor one youth with ADHD said: “Sorry, you lost me at the subtitle. I am allergic for all articles about Ritalin. (My prejudice is that I have too often had to defend my use of medication).” This points to the flaw that, although the lamp communicates a message quickly, the nuance and complexity of the problem are communicated in an augmented way, which is not attractive to some audiences and can lead to misconceptions.


4. Dunne, A. (2006). Hertzian tales: Electronic products, aesthetic experience, and critical design. Cambridge MA: MIT Press.

5. Dunne, A., & Raby, F. (2001). Design noir: The secret life of electronic objects. Basel, Switzerland: Birkhäuser.

6. Dunne, A., & Raby, F. (2007). Critical Design FAQ. Retrieved December 2, 2016, from http://www.dunneandraby.co.uk/content/bydandr/13/0

7. Dunne, A., & Raby, F. (2009). Interpretation, collaboration, and critique: Interview with Dunne and Raby. Retrieved December 2, 2016, from http://www.dunneandraby.co.uk/content/bydandr/465/0

8. Gezondheidsraad. (2014). ADHD: Medicatie en maatschappij. Retrieved from https://www.gezondheidsraad.nl/sites/default/files/adhd_medicatie_en_maatschappij_201419.pdf

9. Gray, D., Brown, S., & Macanufo, J. (2012). Gamestorming. Deventer, The Netherlands: Kluwer.

10. Hallowell, E. (n.d.). Your brain is a Ferrari. Retrieved from http://www.additudemag.com/adhd/article/9338.html

11. Hawthorne, S. C. C. (2014). Accidental intolerance: How we stigmatize ADHD and how we can stop. New York, NY: Oxford University Press.

12. Hummels, C. & Frens, J. (2009). The reflective transformative design process. In CHI ‘09 Extended Abstracts on Human Factors in Computing Systems (CHI EA ‘09) (pp. 2655-2658). New York, NY: ACM

13. Koskinen, I., & Battarbee, K. (2003). Introduction to user experience and empathic design. In I. Koskinen, K. Battarbee, T. & Mattelmäki (Eds.), Empathic design, user experience in product design (pp. 37–50). Helsinki, Finland: IT Press.

14. Nederlands Jeugdinstituut. (2015, October 13). Cijfers - ADHD. Retrieved January 07, 2017, from http://www.nji.nl/ADHD-Probleemschets-Cijfers

15. Schalij, N. (2012, December 16). Ritalamp laat denken over medicijngebruik bij ADHD. Cursor. Retrieved from https://www.cursor.tue.nl/nieuwsartikel/artikel/ritalamp-laat-denken-over-medicijngebruik-bij-adhd/

16. Schenk, J. A. M. (2016, October). Gestoei met ontwikkelingsstoornissen: Is ons gestoei reëel? In S. Woldhuis & I. Krabben (Chair), Stoeien met ontwikkelingsstoornissen. Symposium conducted at Balans Kennissymposium 2016.

17. Storimans, M. (2015). Storimans therapie. Retrieved December 02, 2016, from http://www.storimanstherapie.nl/

18. Van Elten, E. (2016, December 28). Troebel hoofd door Ritalin. Eindhovens Dagblad, p. 2.

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