In This Article Sociological Perspectives on ADHD

  • Introduction
  • General Overviews
  • History
  • Philosophies
  • Populist Critiques
  • Medicalization
  • Labeling and Stigma
  • Social Control and Docile Bodies
  • Risk and Risk Discourse
  • Diagnostic Uncertainty
  • Teacher Role in Assessment and Treatment
  • Multimodal Treatment and Assessment
  • Recent DSM Changes
  • Teacher Attitudes
  • Media and Discourse
  • Gender Differences
  • Social Class and Race
  • Adulthood
  • Alternative Therapies
  • Motherhood

Childhood Studies Sociological Perspectives on ADHD
by
Claudia Malacrida, Tiffani Semach
  • LAST REVIEWED: 28 April 2017
  • LAST MODIFIED: 30 January 2014
  • DOI: 10.1093/obo/9780199791231-0090

Introduction

A sociological approach to Attention Deficit/Hyperactivity Disorder (ADHD) begins from the position that social and historical contexts matter deeply in the ways that ADHD is understood, experienced, and managed. Thus, for example, intra-professional or parent-teacher discord over the correct way to deal with symptoms, shifts in economies and educational systems that provide services to families and children, gendered stereotypes and processes of racialization, or ways of framing children as risky to others or at-risk to themselves are important aspects of how ADHD exists in the social world. ADHD is, sociologically speaking, a very interesting and important problem in great part because these social and historical aspects of ADHD continue to trouble medical and educational approaches to diagnosis and treatment. Diagnostic rates of ADHD have burgeoned over the past decades, beginning in the United States in the 1970s and 1980s, then moving primarily into other developed countries in subsequent decades. Despite much public debate, ADHD has been enormously “successful” as a diagnostic category. Similarly, rates of treating ADHD-identified children with stimulant drugs have risen in much of the developed world, although diagnostic rates vary considerably both within and between countries. Some of the controversies underpinning the ADHD debates can be seen in the section on Diagnostic Uncertainty. Nevertheless, ongoing and highly public debates persist concerning the diagnosis and medical treatment of ADHD. Researchers and lay writers have argued, for example, that children with ADHD symptoms who go untreated are at risk for adult depression, heightened rates of addiction and criminality, and increased school dropout rates. On the other hand, the risks for children who do receive a diagnosis have been argued to include stigmatization as a result of being labeled with a mental health condition and dependencies on medication in both the short and the longer term for children whose treatment is typically psychopharmaceutical rather than behavioral. Some writers have argued that while ADHD may be a legitimate medical or psychological condition, medication is not the most appropriate response to its treatment, and classroom interventions should be the first, and perhaps the primary, response to children’s challenges, particularly when those challenges are experienced mainly in the classroom. Within this contested terrain, parents, children, educators, and helping professionals must make critical decisions about how best to respond to and assist children who are identified as problematic. It is our hope that the following bibliography may help inform such decision-making positively.

General Overviews

Historians and theorists studying modern education, medicine, and childhood note that the Industrial Revolution produced an increasing need for trained, educated, and regulated workers; further, this congregation of children produced two outcomes. First, children were, for the first time, congregated in ways that made their differences easier to mark and track. Second, as Malacrida 2003 and Rafalovich 2004 describe, the advent of compulsory education, arising from the needs of capitalism, meant that schooling became a key vehicle for the production of children as potential workers and citizens. Further, this congregating of children in publicly run facilities like schools resulted in an increasingly narrow range of behaviors that were deemed normative, and this in turn gave rise to segregating and categorizing “abnormal” children so as to facilitate their management. Conrad 2006, a foundational book on the subject, outlines how the rise of medicine and psychiatry as professions and the eventual development of a non-addictive form of stimulant in Ritalin coincided to produce a climate of readiness for entering ADHD into the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders III (DSM III) in 1980. This was aided through efforts to legitimate ADHD as a diagnosis by parent lobby groups seeking to absolve their children (and themselves) from public blame, casting ADHD as a medical issue rather than a social problem. However, as all three authors report, problems with ambiguity in the diagnostic process, the increasingly broad criteria that have been included in subsequent versions of the DSM, and ambivalence about medicating children have engendered considerable resistance and controversy. This section includes a pair of edited collections concerning ADHD that are exemplary in the ways they outline some of the controversies, congruencies, and challenges in responding to children’s behavioral challenges. Cooper and Ideus 1997 provides an overview of the state of ADHD’s acceptance and the implementation of ADHD assessment and treatment in the British context. It includes a range of international scholars and professionals who outline some of the controversies surrounding ADHD, but who generally argue for its legitimacy as a diagnostic category best treated through multimodal treatment and assessment (MTA) including stimulant drugs. As the title suggests, the edited collection Lloyd, et al. 2006 engages in a more critical and firmly sociological approach, examining social aspects of ADHD and its construction as a childhood disorder from a multicultural perspective.

  • Conrad, Peter. Identifying Hyperactive Children: The Medicalization of Deviant Behavior. Burlington, VT: Ashgate, 2006.

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    This is a revised edition of Conrad’s classic (1976) case study of how childhood differences came to be accepted as medical rather than social problems. Examines the history of the disease and Ritalin, and outlines key players who lobbied for the legitimation of the diagnosis, including the parent support group Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), whose activities were in part funded by a major pharmaceutical company. In this edition, Conrad also discusses changes in ADHD diagnosis since his original publication.

  • Cooper, Paul, and Katherine Ideus. Attention Deficit Hyperactivity Disorder: Educational, Medical and Cultural Issues. 2d ed. Maidstone, UK: The Association of Workers for Children with Emotional and Behavioural Difficulties, 1997.

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    Written when ADHD was being introduced in the UK against significant resistance. Authors include Russell Barkley, an American psychologist with long-term CHADD affiliations, and Australian-trained pediatrician Geoff Kewley, affiliated with a network of private assessment and treatment centers for behavioral disorders. Cooper and Ideus conclude that ADHD’s acceptance would improve inter-professional collaboration among special educational needs coordinators, pediatricians, and psychiatrists and result in better services to children.

  • Lloyd, Gwynedd, Joan Stedd, and David Cohen, eds. Critical New Perspectives on ADHD. London and New York: Routledge, 2006.

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    Another edited collection that includes overviews of philosophical and critical understandings of ADHD, a number of interesting cross-cultural case studies tracing ADHD’s trajectory from its introduction to a cultural context to accepted or refuted diagnostic category, tensions between parents and teachers over diagnosis and management, questions of racialization and ADHD, and pedagogical approaches and challenges to understanding ADHD.

  • Malacrida, Claudia. Cold Comfort: Mothers, Professionals, and Attention Deficit (Hyperactivity) Disorder. Toronto: University of Toronto Press, 2003.

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    Malacrida’s comparative Canada-UK study examines mothers’ experiences of dealing with their “troublesome” children, within a skeptical UK climate concerning ADHD and a strongly medicalized Canadian context. She outlines social and political aspects of the diagnosis through parent interviews and professional and lay discourse, and highlights disjunctures between the promise of medicalization and the delivery of subsequent services in both contexts.

  • Rafalovich, Adam. Framing ADHD Children: A Critical Examination of the History, Discourse, and Everyday Experience of Attention Deficit/Hyperactivity Disorder. Lanham, MD: Lexington Books, 2004.

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    Rafalovich combines current interview data with children, parents, and clinicians, alongside historical debates on ADHD, to contextualize the human experience of the disorder in the home, classroom, and clinic. The study shows how ADHD is a complex and ambiguous social construct, highlighting the lack of an “easy fix” to children’s problems.

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