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Wright, Gloria Sunnie. “ADHD Perspectives: Medicalization and ADHD Connectivity.” Presented at the Joint AARE APERA International Conference, Sydney, Australia, 2012. https://eric.ed.gov/?id=ED542257.
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FirstPresenter:: Wright, Gloria Sunnie
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Title:: ADHD Perspectives: Medicalization and ADHD Connectivity
Year:: 2012
Citekey:: wrightADHDPerspectivesMedicalization2012
itemType:: presentation
Location:: Sydney, Australia
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Abstract
Today’s ‘ADHDscape’ is no longer confined to images of fidgety children falling off classroom chairs. Trans-generational images flood popular culture, from ‘ADHD creator’ with entrepreneurial style, to ‘ADHD troublemaker’. Indeed, ADHD’s enigmatic characteristics seem to apply as much to crying babies as to forgetful grannies. With the recent expansion of ADHD definitions (Conrad, 2007), the key question to pose is this: how and in what ways is ADHD ‘understood’? By drawing on the association between ‘ADHD’ as a mental disorder and ‘medicalization’ as a social phenomenon, and in the interactionist tradition utilized in Peter Conrad’s sociological analysis of ADHD, this paper presents aspects of the complex nature of ADHD through a description of contrasting perspectives. .
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Imported: 2025-02-28 2:21 am
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‘Medicalization’, a term which emerged in the 1970’s through the work of Conrad (Conrad, 1975), refers to the phenomenon whereby nonmedical problems are identified and then redefined and treated as illnesses and/or disorders. Before this, notions of medicalization were already conceptually underway by sociologists interested in theorizing social control. Today, the term ‘medicalization’ is seen as multidimensional in both meaning and scope, encompassing increasing applications to understandings of the human condition (Ballard, 2005).
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To add to the complex nature of interpreting disease and illness, ‘medicalization’ of particular “disorders” is itself not static. Some ‘conditions’ are ‘demedicalized’ and then ‘remedicalized’ (Conrad, 2007). For example, homosexuality, once believed to be an illness, and then a lifestyle right, is now once again viewed medically through psychobiological portrayals of the “gay gene” (Annicchiarico, 2009; Conrad & Markens, 2001; Mustanski, et al., 2005).
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Notions of ADHD are as varied as they are contentious. Even so, biochemical and neurological explanations characterizing ADHD as a psychiatrically derived ‘disorder’ continue to dominate academic publications and media representations alike (Coghill, 2005). Despite this, there is mounting disquiet surrounding ADHD ‘realities’, rendering it a topic which some describe as “divisive” (Hildebrand, 2007).
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Some critics, such as Breggin (1995, 1998) completely reject the notion of ADHD, believing it to be a scandalous fraud. Cohen (2006), for example, thinks of ADHD and its common form of treatment, Ritalin™, as a marker of the psychiatric colonization of childhood. Others, such as Carey (2002) and Diller (1998), allow for the possibility that such a condition is legitimate, in a descriptive sense, for some children, but that current treatment practices have strongly diminished the value of ADHD’s identification. Still others, such as Goodman (1992) and Armstrong, (2006, p. 34) suggest that ADHD is a postmodern condition reflecting what he describes as a “short attention span culture”. Social critic, Conrad (2007), directs comment on the legitimacy of ADHD in a biological sense, to examination of the sociological impact of its presence in the broader context of the medicalization of society
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The neurological stance towards ADHD forms the central pillar of the dominant medical model. This perspective, in simplistic terms, epitomizes a ‘hard science’ approach to the aetiology of ADHD.
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The neurological perspective is arguably the most influential perspective of all because it influences policy-making at various levels. It is notable that some earlier neurological studies conducted by Barkley (1991, 1997), for example, have been used to inform definitions and government policy on ADHD.
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The psycho-neurological sub perspective of ADHD can be described in terms of a ‘medical model’ in its purist sense. Within this framework, ADHD is commonly constructed as an inheritable disorder of the brain as an organ, which directly affects the behaviour of the person ‘suffering’ from it.
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Psycho-enviro perspective This position proposes that ADHD is caused by interplay between environmental conditions (social and/or physical) and a ‘pre-existing’ neurological problem in an individual. The spectrum of possible environmental factors believed to expose or ‘activate’ ADHD is endless making classification near impossible.
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Diller (1998) and Furman (2005) typify yet another strand of thinking which implicates family dynamics and traumatic life events as being possible triggers for ADHD. This view is reminiscent of earlier 1920’s ideas that connected childhood neurosis with childhood misbehaviour. Those of a Freudian persuasion popularized psychoanalysis in children and the ADHD debate shifted to interpretations of unwanted social behaviour as an outcome of the psyches’ adjustment to latency (Freud, 1946)14.
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Comparatively, an important distinction between the psycho-environmental and the psychoneurological perspectives is the treatment of ADHD. The former accepts the role of pharmacology to degree, yet allows for the possibility of improvement in symptoms through therapy and or environmental management including pedagogy and family therapy. The latter focuses on treating the
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brain as an organ and relies heavily on psychotropic treatment alone.
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In contrast to previously discussed ‘perspectives’, this section describes a quite dramatically different view. Rather than simply presenting alternative views to the dominant bio-neurological position, the tenets of social constructionism turn the focus to the notion that perceptions of ADHD are related to the social experiences and beliefs of actors, rather than mere descriptions of such perceptions. As such, the ‘social constructionist perspective’ represents an approach to the exploration of ADHD ‘meanings’, the social actors who may be involved, and their social reactions to it. For this reason, as ‘medicalization’ is in itself a constructionist ‘idea’ (Conrad & Potter, 2000), consideration of views deemed to reflect a ‘social constructionist perspective’ may be useful in exploring underlying beliefs and reactions connected with it.
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In sum, a social constructionist standpoint reveals there can be no objective ADHD fact. Therefore, it can be argued that the leverage social constructionist thinking has within the broad range of ADHD perspectives, is its facilitation of ADHD as an object with which people interact. Social constructionist ideas, therefore, form a natural conduit to the exploration of social reactions to human behaviour through the formation of moral judgements.
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ADHD is predominantly framed in terms of problematic social behaviour. As stated, ADHD is reported in academic literature and popular culture in markedly diverse ways. The perpspectives presented in this paper suggest that everyday images are strikingly different.
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Some claim an authoritative stance exuding ‘expert’ knowledge of ADHD’s pathology (Barkley, 2000; Biederman & Farone, 2004; Selikowitz, 2004). As seen in the array of perspectives described in this paper, I contend that ADHD remains an enigma that most people have a definite opinion about; a ‘condition’ which blankets the globe in all manner of ways, leaving most who would analyse the wide variety of views sure of little more than to be ‘ADHD’, is to be “different”.
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