Monday, April 30, 2012

ADHD: The Story of a Social Construction

For as long as society has had social rules and norms, there have been people, “deviants” if you will, who break them. As explained by Becker, deviance is “the infraction of some agreed upon rule” created by society, “deviant behavior is behavior that people so label (39).” In other words, deviance is essentially a social construction. A social construction is a widely held belief that is often value-laden, and allows for the policing, monitoring, and control of deviant behavior (Williams). Social constructions have no reality beyond our understanding of them. In essence, they are what we, society, say they are. Social constructions vary greatly by time, location, context, and by person (Williams).  It is important to remember that science can be skewed by the thoughts, opinions and methods of people performing it. That is to say, "scientific" diagnoses of disorders, like ADHD for example, are not immune to the influence of social constructions of the time in which they arise. As such, it is imperative to examine the emergence of ADHD through the lens of sociology, and more specifically, as a construction of deviance. What is it about society’s social constructions that make the behaviors associated with ADHD so deviant, thereby making ADHD seem rampant throughout society? After conducting such an analysis, one may conclude that the emergence of ADHD as one of the most prevalent "mental disorders" in the United States is a result of our social constructions and society's narrowly defined norms of behavior.
History and Synopsis of ADHD
Attention Deficit Hyperactivity Disorder (ADHD) is not a new disorder; it has actually been around for many years. A disorder known as the “Hyperkinetic Reaction of Childhood,” characterized by “a short attention span, hyperactivity and restlessness,” appears as early as 1968 ("ADHD: The Diagnostic Criteria"). The disorder was revised to ADD (Attention Deficit Disorder) in the Diagnostic and Statistical Manual for Mental Disorders (DSM) in 1980. This definition focused the diagnosis as a problem primarily with inattention, with the categories of ADD/WO (without hyperactivity) and ADD/H (with hyperactivity).  This concept of ADD/WO has been debated since its inception ("ADHD: The Diagnostic Criteria”). As a result, the diagnosis was redefined to ADHD in 1987 with the issue of the DSM-IIIR, which “consolidated the symptoms into a unidimensional disorder, with no subtypes at all ("ADHD: The Diagnostic Criteria”).” Under this definition an individual could not have the disorder without hyperactivity.  Finally, ADHD as we know it today was conceptualized in 1994 with the publishing of the DSM-IV. The current diagnosis incorporates both inattentive and hyperactive behaviors, and then breaks the diagnosis into categories of predominantly inattentive, predominantly hyperactive or combined ("ADHD: The Diagnostic Criteria”). Due to its prevalence in the media, most people are familiar with the symptoms of ADHD. Currently six or more of the symptoms in the DSM must have been present to a degree that is “disruptive and inappropriate for developmental level” for at least six months ("ADHD, Symptoms and Diagnosis”). They include: “Is often easily distracted,” “often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools,” “often does not seem to listen when spoken to directly,” “Often fidgets with hands or feet or squirms in seat when sitting still is expected,” “often does not follow through on instructions and fails to finish schoolwork,” and “Often blurts out answers before questions have been finished.” ("ADHD, Symptoms and Diagnosis”). According to the Center for Disease Control this disorder has been “growing” rapidly, diagnosis increased by an average of 3% every year from 1997-2006 and by an average of 5.5% every year from 2003-2007 ("ADHD, Data and Statistics”).
Current Debate of the Diagnosis
Although this disorder is not new by any means, the recent surge of diagnoses in the United States would indicate that “children went mad” over the last couple decades (Generation Rx). ADHD seems to have become the catch all phrase for disruptive children. Many people feel that blaming ADHD and medicating for it has eclipsed parenting and mentoring. Others feel the disorder over diagnosed, while some think the disorder is a fraud all together.  For example the article, “Are some ADHD-labeled kids just young for their grade?” points to two studies which indicate that some kids on the younger side of the age cut off for their grade are being diagnosed with ADHD when they just have not matured yet. The study found that “being young for [a] grade more than doubles the [chance] that a student is diagnosed with or treated for ADHD (Harmon).” ADHD is allegedly a neurological problem and rates of diagnoses should not change dramatically from one age to the next. Additionally, the film Generation Rx makes several claims that would discredit the prevalence of this disorder. The film purports that this vast and rapid increase is an economic endeavor, not a scientific one.  They claim the drugs used to medicate for ADHD (among other mental disorders like depression) can cause chemical imbalances in children. They also point out the fact that 90% of all Ritalin is consumed in the U.S. and the happy coincidence that 100% of the members of the FDA’s panel on mood and psychotropic drugs have financial ties to the pharmaceutical industry. Rx argues the growth in ADHD can be attributed to greed, corruption, and manipulation of the American public through advertising. These accusations give rise to some very real fears of the over diagnosis of ADHD and over use of drugs to treat it.
On the other hand, there are proponents of the diagnosis who feel that people afflicted with this disorder benefit from a diagnosis and need the treatment that comes with it. One critic to the “backlash” against ADHD is Emily Willingham, saying that ADHD is “a real and often disabling disorder with limited but effective treatment options.” Willingham mostly cites Dr. Harold S. Koplewicz’s rebuke of Dr. L. Alan Sroufe’s claim that ADHD drugs do more harm than good. In addition to Kopelewicz’s supporting argument, Willingham conveys her personal experience with her 9 year-old son experiencing “daily and persistent public humiliation for his ADHD.” She then claims that medication can reduce the behaviors of ADHD which bring on this humiliation and “improve a child’s life (Willingham).” Another well known proponent of ADHD is Dr. Edward Hallowell, founder of “The Hallowell Center” and co-author of “Driven to Distraction.” Dr. Hallowell claims in an interview with “The Revolution News” on ABC that undiagnosed ADHD can ruin your family life, school life, cause unexplained underachievement, lead to prison, cause divorce, unemployment or even addiction. If you could only get the diagnosis you could “skyrocket,” “soar,” and “achieve your goals (Hallowell).” According to Dr. Hallowell, medication for ADHD is “safer than aspirin” if prescribed by a doctor that “knows what they are doing.”
Social Constructions of ADHD
Unfortunately, due to the nature of the human experience it is impossible to know everything for oneself. One cannot be an expert astrophysicist, attorney, architect, brain surgeon, stockbroker, and psychiatrist simultaneously, as performing just one of these professions can be overwhelming. As a result, we are forced to trust in the judgment of experts in their field, and make judgment calls about whom and/or what is credible.  As you can see there is no consensus among “scientific” experts about the nature or validity of ADHD and credible experts on both sides of the issue assert vastly different views. As such, it is difficult to ascertain the reality of the disorder.  In order to better understand the disorder an analysis of the social constructions surrounding it is warranted.
 Within the very definition of criteria for ADHD is a social construction, “developmental level (“ADHD, Symptoms and Diagnosis”).” This refers to how intellectually and behaviorally mature a child is compared to others of the same age. The underlying construction is that children of the same age should all behave the same, and they should behave a certain way. These constructions of age appropriate behavior change constantly throughout time, entirely different behaviors are expected of children now compared to the time of the industrial revolution. Which begs the question; in what socially constructed context do we notice these “deviant” behaviors? Katherine Harmon’s article is chiefly about diagnosis based on grade level. Emily Willingham’s experience points to her 9 year old sons humiliating experience at school or an “environment that require[s] a specific behavioral conformity.” In the interview with Dr. Hallowell ADHD causing problems in school is mentioned frequently. It would seem then, that the answer is school.
The school system is in itself a social construction, one that was “designed, conceived and structured for a different age” during “the intellectual culture of the enlightenment and in the economic circumstances of the industrial revolution (Robinson).” The context of this unnecessary emphasis on adherence to strict behavioral conformity, concepts of behavioral conformity which are created by us, make these behaviors deviant. These inattentive, hyperactive behaviors are mostly noticed in the classroom, during an era that is the most stimulating in history (Robinson). There are constant pulls for attention from video games, computers, movies, sports, and advertising, while academia is a largely unexciting endeavor for most children. Outside of school, the majority of the “symptoms” of ADHD are barely visible. There is no biological requirement for how children should behave. Age is a convenient frame of reference but it is a social construction, which creates problems when society attaches real value to it. The assumptions about how children should act, based on their age, are too narrowly defined by society to account for variations in child development, and children’s personalities, as is made apparent by the current ADHD “epidemic.” 
The CDC states that parents reported 9.5 % of children ages 4-17 (essentially school aged children) have been diagnosed with ADHD, compared to 0.26% for people with diabetes under 20 or 8.3% of the U.S. Population (“ADHD, Diagnostics and Statistcs,” "Overweight and Obesity: Data and Statistics). Which seems more reasonable, that a mental disorder like ADHD is more prevalent than diabetes in a population of people whom 35% are considered obese, or that some flaws in our rigid social constructions of how children behave in classrooms and the current dichotomy of academic and non-academic thinking cause a serious distortion of the ADHD “epidemic.” Instead of diagnosing and medicating our children into conformity, we need to work on fixing the social constructions that give rise to things like ADHD.
Next, I would like to consider the implications of the media and self-diagnosis in the emergence of the Adult ADHD phenomenon. The social construction of the ADHD diagnosis has been perpetuated by the media since its apparent “discovery” in the 90’s. Originally ADHD was a diagnosis reserved for school aged children. But as Conrad and Potter show, it has been medicalized to include adults through claims by the media, professionals and self-diagnosis among lay peoples (138).  Conrad and Potter point out that Dr. Hallowell and Ratey provided a great boost to Adult ADHD in 1994 with their publication of “Driven to Distraction.” They claim that although Hallowell and Ratey’s “affiliation with Harvard Medical School gave them some academic legitimacy,” they approached the area of Adult ADHD more as “entrepreneurs for the adult diagnosis” than as scientific researchers (140). This in combination with popular news clips about the disorder seemed to create a fad of self-diagnosis. “Virtually all children were referred by parents or schools to physicians,” while self-referral is commonplace with adult ADHD. They quote one psychiatrist as saying “Adult ADHD has now become the foremost self-diagnosed condition in my practice. I fear that the condition allows a patient to find a biological cause that is not always reasonable, for job failure, divorce, poor motivation, lack of success, and chronic depression (Conrad and Potter 141).”
It’s frightening how nonchalantly, and often, the diagnosis is tossed around. For example, at the end of the end of the interview with Dr. Hallowell when he diagnosis a woman with ADHD in less than a minute on national television. Allegedly, there is a quiz that can define whether or not you have ADHD. It follows; do you have trouble wrapping up the final details of a project, getting things in order, or remembering appoints and obligations? Do you have trouble procrastinate, do you fidget or squirm when you have to sit still, do you feel overly active? If so you have adult ADHD (Hallowell). These “catch-all” blanket questions are absurd on a prima facie level. However, it is valuable to examine the underlying social constructions they indicate.
All of these questions pertain to being able to be successful in the current economic environment.  At the heart of the issue is the economic imperative, a social construction. “Money has been consecrated as a value in itself, over and above its expenditure for articles of consumption or its use for the enhancement of power (Merton 22).” Given the emphasis on money as a value by society, it is not surprising that people unable to obtain it would willingly take on a diagnosis that compensates for their failure to assimilate. In this case, the social pressure to be successful, and wealth as a principal symbol of success, pressures people into ADHD.
The financial conflicts of interests in the field of psychiatry are astounding, discrediting the ADHD diagnosis. Unfortunately, some people do have ADHD and real problems that stem from the disorder. However, the casualty with which the diagnosis seems given undermines the very real need of treatment for some individuals. The intense marketing campaign and knee-jerk reaction to medicate have caused a rapid over diagnosis and a backlash that the truly afflicted must deal with. The very looseness given to the disorder discredits its validity and can make some people who need help feel like they may not deserve it. All of these issues have deep underlying social constructions, woven into the fabric of our society. While these inherent cultural values and paradigms are not to blame for all ADHD necessarily, their influence in its ubiquity is undeniable.  Furthermore, it may be that the institutions that make the “disorder” noticeable need treating, not necessarily the individual with the disorder.  Word Count: 2283

Becker, Howard. “Labeling Theory.” Readings in Deviant Behavior. Ed. Alex Thio, Thomas Calhoun, Addrain Conyers. Boston, MA: Hanson 2010. 39-41. Print.
Conrad, Peter and Deborah Potter. “The Emergence of Hyperactive Adults as Abnormal.” Readings in Deviant Behavior. Ed. Alex Thio, Thomas Calhoun, Addrain Conyers. Boston, MA: Hanson 2010. 138-143. Print.
Hallowell, Edward. “ADHD Interview with Dr. Hallowell.” The Revolution ABC National News. 22 Mar. 2012. Web/Television Broadcast. <>
Harmon, Katherine. “Are Some ADHD-labeled Kids Just Young for Their Grade?” Scientific American. 17 Aug. 2010.Web. 30 Mar. 2012 <>
Robinson, Ken, perf. Changing Education Paradigms. RSA Animate, 2010. Film Clip.
Willingham, Emily. “ADHD: Backlash to the Backlash.” Scientific American. 23 Feb. 2012.Web. 30 Mar. 2012 <>
"ADHD: The Diagnostic Criteria." Medicating Kids. PBS Frontline. Web. 29 Apr. 2012. <>
"ADHD, Data and Statistics." Center for Disease Control and Prevention. Web. 29 Apr. 2012. <>
"ADHD, Symptoms and Diagnosis." Center for Disease Control and Prevention. Web. 29 Apr. 2012. <>
"Overweight and Obesity: Data and Statistics." Center for Disease Control and Prevention. Web. 29 Apr. 2012. <>
Generation Rx. Dir. Kevin P. Miller. Common Radius Films, 2008. DVD
Merton, Robert. “Strain Theory.” Readings in Deviant Behavior. Ed. Alex Thio, Thomas Calhoun, Addrain Conyers. Boston, MA: Hanson 2010. 21-26. Print.
Williams, Meredith. Washington State University. WSU Vancouver Campus, VMMC Building, Vancouver, WA. 17 Jan 2012. Lecture.

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