Despite the fact that ADHD is constantly in the news for one reason or another, there is no consensus on what it actually is and as more time goes by and more information is collected the more confusing the topic. Since ADHD has no definitive way of being diagnosed then the question remains what it is that is being treated and why medication is being prescribed, sometimes for life, for something that cannot be proven to fundamentally exist? Is this diagnosis simply as a result of the changing times or the fact that as a society will are all expected to conform to a standard set of behavior or else deemed lacking in some way?
Attention Deficit/Hyperactivity Disorder or ADHD is a common psychiatric condition that affects both children and adults. It is more likely to be diagnosed in childhood and in more boys than girls are said to have this disorder. There is debate as to whether children can outgrow their symptoms or whether it continues into adulthood or whether it is just a behavioral problem that will just go away as more adults than every are being diagnosed. Symptoms of ADHD include but are not limited to: hyperactivity, lack of concentration, day dreaming, impulsiveness and restlessness.
In ADD (Attention Deficit Disorder) the individual is usually described as a daydreamer and in AHD (attention Hyperactive Disorder) the individual is deemed restless or high spirited. Treatment for this disorder range from increased exercise and a diet that does not include carbohydrates and sugar to medicinal intervention in the form of methylphenidates and amphetamines such as Ritalin or Adderall. There is no one test for ADHD – a diagnosis is reached upon by the doctor after having had parent and teacher reports and from interaction with the child or adult.
One of the main reasons that the diagnosis of ADHD remains so controversial in many medical circles is the fact that there is no one definitive way in which to test for it. Most of the time the conclusion that an individual (usually a child) has ADHD is as a result of parent reporting and/or teacher intervention. Some would argue that this makes the whole process subjective instead of objective and therefore does more harm than good especially since once a child is put on medication it is recommended by many doctors that he/she continues to take it into adulthood as the symptoms will not decrease or stop over time.
Considering the fact that the pharmaceutical industry has a lot to gain from recommending the prolonged usage of drugs for ADHD and there are no studies showing the effects of the long term use of the methylphenidates and amphetamines commonly used, it is only natural that there should be queries into whether the disease actually exists or if it is possible that it could be something else all together.
Although there are many who say that the conclusion that hyperactivity is relative and opinion may thus vary from one medical practitioner to another there are those that say there is evidence that it is present in some who have ADHD and the proof is in the brain structure and function and in the DNA composition. This combined with environment leads to what is known as ADHD because it is a multi faceted disease and to try and pin it down to just one cause would be futile and would result in tunnel vision as far as treatment goes.
There is evidence to show that severe hyperactivity in children leads to serious developmental stagnation and misdiagnosis or non diagnosis of behavioral disorders such as ADHD leads to educational and occupational failure, inability to have nurturing relationships and stagnation in adulthood. In fact, is estimated that most addicts like gambling, alcohol and drug have some form of ADHD. Experts who agree with this school of thought are adamant that to claim that ADD is a social construct would only hurt those who suffer from it and delay or deny them the treatment that they so desperately need.
It must be noted however, that the proponents of ADHD as a social construct are not opposed to getting to the bottom of the reason why an individual might be hyperactive, distracted and unable to concentrate. What they are against is the label itself which they believe will lead individuals into a mentality that they are somehow defective and need to be on medication for most of their lives. What they do advocate for is a strengthening of the family unit and a more child centered way of life. Social construct theorists conclude that in modern western culture factors uch as loss of extended family support, family life being increasingly busy, a cultural system that emphasizes individuality and competition and increased stress from the school systems all contribute to what can otherwise be termed as ADHD symptoms. They conclude that it is for this reason that ADHD was not prevalent until the Industrial Age when people’s lifestyles drastically changed – there was no longer enough play space and increased schooling pressures became increasingly problematic for children who were boredom intolerant. Children put in this unnatural environment coped by either tuning out (ADD) or becoming restless (ADHD).
Social construct theorists believe therefore that it is not a medical intervention that is needed but a cultural one. An example of where a cultural intervention is needed is in some western school systems whereby there is intolerance for what can be termed as “active children”. Though social construct theorists do agree that on some level there could be biological factors what may be the reason that a child or adult is inattentive what they argue is that the school system and society has failed to integrate them and has chosen instead to set them aside and label them as disordered.
Different methods of learning instead of the rote memorizing of facts where all individuals are supposed to learn the same thing at the same time and at the same pace will result in an environment where those with different learning styles are made to feel welcome instead of feeling like failures because they do not fit in. In this way, social construct theorists and their opponents are in agreement when they say that a multi pronged approach should be used in tackling and handling behavioral problems.
Those against the social construct theory have long been advocates of more open classrooms and more flexibility as pertains to school settings and educational purposes in order to help those who have been diagnosed with ADHD cope with their symptoms. Along with medication, they also stress the importance of getting exercise and having a balanced diet so as not to exacerbate the effects of the disorder. Medication is only part of the solution, not all of it. one point of contention between those who support the social construct theory and those who oppose it is the over and under diagnosis of the disease.
Social construct theorists claim that this is because there is no proven way that one can test for the disease and therefore the diagnosis will tend to fluctuate depending on race, social standing, gender, cultural differences and geographical location the theorists claim that if ADHD were are real mental disease the discrepancies would not be so high and so varied. In studies done all around the world, what is known to western countries, especially the United States as ADHD behavior is seen everywhere. What differs is the interpretation of an individual’s action.
In some countries and cultures active children are considered the norm or even encouraged. Even in societies where obedience is expected of all youngsters, there are less likely to attribute it to a mental disorder and more likely to claim it is growing pains, simply a stage that will pass. Even the methods used to diagnose ADHD are different – in America the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders 4th Edition) while in Europe the ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision).
This results in 3-4 times fewer diagnoses in Europe than in the United States. Part of the conflict between those who say that ADHD is a real mental condition and those who say that it is a social construct is that there is really no general consensus on what ADHD really is or how to diagnose it. What both sides do agree on is that behavioral problems left untreated will often end up hurting not only the individual affected but all those around him/her and later on, society in general.
Social construct theorists in general tend to be against the label of ADHD with the claim that it is one that is stuck with an individual for life and may thus hinder his/her development with pills serving as crutches. They also say that the diagnosis tends to be prevalent in cultures where passivity and order are highly valued. Those who disagree saying that leaving the problem untreated will put those suffering from the disorder at unnecessary risk and stagnate their development. Part of the conflict seems to be what one group thinks the cause should be and/or the treatment required if any.
It is important to note that social construct theorists are usually not the same as those who say that behavioral problems are just a result of bad parenting and one should not spare the rod in rectifying the problem. They are not saying that behavioral problems do not exist, just that the cause, treatment and effect should be different.. Whether or not ADHD is a social construct is a debate that is not likely to end any time soon and a resolution is not anywhere in sight. Social construct theorists will always argue that until ADHD is shown to be a true disorder instead of collection of traits then the label should not be used as it hinders more than it helps. On the other hand, those who say that ADHD is a true disorder are more likely to claim that not giving the disorder a label is very detrimental to the individual concerned. There are those who say that ADHD being a real psychiatric disorder being a social construct are not mutually exclusive. This means that thought they do believe that ADHD exists they do not think it is as prevalent as the pharmaceutical companies and the media make it out to be.
Any behavioral problem that cannot be pinned down and diagnosed is bound to have its opponents and ADHD is one of them. Even those who do claim that it is a valid medical diagnosis and not just a label used to describe behaviors that fall outside the prescribed societal norm do admit that it is multi faceted and multi layered and no two individuals have the exact same symptoms. Social construct theorists on the other hand cannot dismiss the fact that behavioral disorders must be identified and dealt with even though they may not agree with the treatment prescribed or the reasons given for the behavior.
With research still being done and studies being carried out it will be a while before any reasonable and scientifically viable conclusion can be reached that will validate either side. As with any mental condition that is difficult to diagnose, it is impossible to have all interested parties come to the same conclusion as it is highly individual and a form of treatment that works for one may not work for another. The very fact that the discussion is taking place and that the debate goes on could be of benefit to all interested and concerned parties.
References Barkley, R. A. , Cook, E. H. Jr, Diamond, A. , et al. (2002) International Consensus Statement on ADHD. Clinical Child and Family Psychology Review, 5, 89 –111. [CrossRef][Medline] Breggin, P. (2002) The Ritalin Fact Book. Cambridge, MA: Perseus Publishing. Meltzer, H. , Gatward, R. , Goodman, R. , et al (2000) Mental Health of Children and Adolescents in Great Britain. London: Stationery Office. Moll, G. , Hause, S. , Ruther, E. et al (2001) Early methylphenidate administration to young rats causes a persistent reduction in the density of striatal dopamine transporters. Journal of Child and Adolescent Psychopharmacology, 11, 15 –24. [CrossRef][Medline] Prout, A. & James, A. (1997) Constructing and Reconstructing Childhood: Contemporary Issues in the Sociological Study of Childhood. London: Falmer Press. Sayal, K. , Taylor, E. , Beecham, J. , et al (2002) Pathways to care in children at risk of attention-deficit deficit hyperactivity disorder. British Journal of Psychiatry, 181, 43 –48. [Abstract/Free Full Text] Schachar, R. & Tannock, R. (2002) Syndromes of hyperactivity and attention deficit. In Child and Adolescent Psychiatry (4th edn) (eds M. Rutter & E. Taylor), pp. 399 –418. Oxford: Blackwell. Sproson, E. J. , Chantrey, J. , Hollis, C. , et al (2001) Effect of repeated methylphenidate administration on presynaptic dopamine and behavior in young adult rats. Journal of Psychopharmacology, 15, 67 –75. [Abstract/Free Full Text] Taylor, E. Sandberg, S. , Thorley, G. , et al (1991) The Epidemiology of Childhood Hyperactivity. Maudsley Monograph No. 33. Oxford: Oxford University Press. Taylor, E. , Chadwick, O. , Heptinstall, E. , et al (1996) Hyperactivity and conduct problems as risk factors for adolescent development. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1213 –1226. [CrossRef][Medline] Timimi, S. (2002) Pathological Child Psychiatry and the Medicalization of Childhood. Hove: Brunner-Routledge.