Social construct theory of ADHD

Attention-deficit hyperactivity disorder (ADHD) is listed as a developmental, neurobehavioural disorder, widely recognized by the medical and scientific community as causing impairment, especially in children. Still, scientists can't conclusively state what causes ADHD. Social critics question whether whether ADHD is wholly or even predominantly a biological illness. Critics outside of majority or minority opinion on this topic, maintain that ADHD and ADD "were invented and not discovered," [http://www.nexusmagazine.com/articles/ADHDisbogus.html Extract from Nexus Magazine, Australia, by Bob Jacobs, PsyD, JD © September 2004] saying that the symptoms associated with ADHD are ordinary adolescent behavior and not a true condition. They believe that no disorder exists and that the behaviour observed is not abnormal and can be better explained by environmental causes. The theory does not state that individuals across a behavioral spectrum are identical neurologically and that their life outcomes are equivalent. It is not surprising for PET scan differences to be found in people at one end of any behavioral spectrum. The theory simply says that the boundary between normal and abnormal is arbitrary and subjective, and hence ADHD does not exist as an objective entity, but only as a 'construct'.

ADHD as a social construct

Psychiatrists Peter Breggin and Sami Timimi oppose pathologizing the symptoms of ADHD. Sami Timimi, who is a NHS child and adolescent psychiatrist, explains ADHD as a social construct rather than an objective 'disorder'. [http://bjp.rcpsych.org/cgi/content/full/184/1/8 (Timimi, 2002] . Timimi argues that western society creates stress on families which in turn suggests environmental causes for children expressing the symptoms of ADHD. [Timimi, S. & Begum, M. (2006). Critical Voices in Child and Adolescent Mental Health. London: Free Association Books.] They also believe that parents who feel they have failed in their parenting responsibilities can use the ADHD label to absolve guilt and self-blame. A common argument against the medical model of ADHD asserts that while the traits that define ADHD exist and may be measurable, they lie within the spectrum of normal healthy human behaviour and are not dysfunctional. However, by definition, in order to diagnosed with a mental disorder, symptoms must be interpreted as maladaptive.

In this view, in societies where passivity and order are highly valued, those on the active end of the active-passive spectrum may be seen as 'problems'. Medically defining their behaviour (by giving labels such as ADHD and ADD) serves the purpose of removing blame from those 'causing the problem'. Controversy over the social constructionist view comes from a number of studies that cite significant psychological and social differences between those diagnosed with the disorder, and those who are not. However, the specific reasons for these differences are not certain, and this does not suggest anything other than a difference in behavior. Studies have also shown neurological differences, but whether this signifies an effect rather than a cause is unknown. Such differences could also be attributed the drugs commonly prescribed to people with this disorder. More recently, studies have also been able to differentiate ADHD from other psychiatric disorders in its symptoms, associated features, life course, and comorbidity.

[Sami Timimi and Eric Taylor (2004) In Debate: ADHD is best understood as a cultural construct. The British Journal of Psychiatry 184: 8-9.] [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.] [Taylor, E., Sandberg, S., Thorley, G., et al (1991) The Epidemiology of Childhood Hyperactivity.Maudsley Monograph No. 33. Oxford: Oxford University Press.] [Meltzer, H., Gatward, R., Goodman, R., et al (2000) Mental Health of Children and Adolescents in Great Britain. London: Stationery Office.]

Questioning the genetic basis of ADHD

There are radically different opinions between researchers in the field and other critics about whether there is a genetic basis. While there have been repeated articles citing physical differences in the brain of those with ADHD, most of these have not stood up.Fact|date=March 2008 Xavier Castellanos MD, then head of ADHD research at the National Institute of Mental Health (NIMH), believes that ADHD is a biological illnessFact|date=April 2008,but acknowledged that little is known about ADHD in a 2000 interview with Frontline [ [http://www.pbs.org/wgbh/pages/frontline/shows/medicating/interviews/castellanos.html PBS - frontline: medicating kids: interviews: xavier castellanos, m.d ] ] .

Alternatives to medication

Social critics question if environmental changes should be the main line of treatment for those with a diagnosis of ADHD, instead of the medical model which predominantly usess medication and to a lesser extent, behavior modification.Who|date=April 2008They believe schools and the health system force children to conform to a narrow, predefined standard of child development.Fact|date=April 2008These critics believe that these institutions are propagating the dangerous viewpoint that children with ADHD are maladaptive and disabled simply because they do not conform to a socially constructed norm.Who|date=April 2008 Some people including retired neurologist and CCHR medical expert Fred Baughman have suggested that this viewpoint is ultimately being pushed by the pharmaceutical industry in order to sell Anti-ADHD drugs. [ [http://www.adhdfraud.org/ adhdfraud.org] ] Moreover, the argument against ADHD asserts that changing the child through medication regimes may cheat them of certain unique and positive personal characteristics that in turn may limit our collective future. For example, Ben Franklin was notorious for being a failure in the public education system yet became a highly regarded scientist, statesman, and public servant. Hartmann (2003) points out that had Ben Franklin been forced to fit in, the American Revolution may have never happened. [Hartmann, T.(2003). The Edison Gene: ADHD and the Gift of the Hunter Child. VT: Park Street Press.]

Use of medication to eliminate or ease symptoms does not prove the disorder

Nor does elimination of symptoms persuade the social constructionist; for example the American National Institute on Drug Abuse [ [http://www.drugabuse.gov/Infofacts/Ritalin.html InfoFacts - Methylphenidate (Ritalin) ] ] reports that Ritalin is abused by non-ADHD students partly for its ability to increase their attention. Evidence showing that ADHD is associated with certain liabilities does not appear to undermine this view either; normal-variant behavior could have certain liabilities as well, and a life outcome cannot be predicted with certainty for any given diagnosed individual.Fact|date=October 2007

Criticism

Critics of the social constructionist view contend that it presents no hard evidence in support of its own position. Proponents of this view disagree that criteria for falsifiability are lacking. One way, for example, is to show that there exists an objective characteristic possessed by virtually "all" diagnosed individuals which does not exist in "any" non-diagnosed individual. However, because diagnosis of psychiatric disorders is based on opinion, this would be difficult to prove. Also, whether this would demonstrate any actual abnormality as opposed to the labeling of certain behaviors is unknown. Current candidates for falsifiability include PET scans, genes, neuroanatomical differences, and life outcomes. However, none of these have been shown to be precise predictors of a diagnosis or lack thereof. Also, as previously stated, neurological differences do not indicate a cause, nor do genes indicate a direct impact.Fact|date=February 2007 Such criteria are generally fulfilled by well-understood medical diseases.Fact|date=February 2007

Critics of this view also assert that it is not consistent with known findings. For instance, they claim that ADHD is as frequent in Japan and China as in the USFact|date=October 2007, yet in such societies (which supposedly favor child obedience and passivity) one would expect higher rates of ADHD if this theory were correct.Clarifyme|article|date=March 2008 However, this is also disputed on the grounds that more aggressively obedient societies may suppress 'symptoms' of rebellion or 'ADHD'. The style in which individuals of these nationalities interact in their home countries, which is typically much more reserved and serious than in the United States, seems to suggest this. However, there is no solid proof of this assertion.Fact|date=October 2007 Additionally, rates of medical diagnoses in China cannot be a reliable indicator of ADHD prevalence, especially for such non-life-threatening disorders as ADHD, due to the large peasant population in that country who cannot easily seek the services of a trained child psychologist. Timimi's view has been seriously criticized by Russell Barkley and numerous experts in Child and Family Psychology Review (2005). In any case, it has been shown that Chinese and Indonesian clinicians give significantly higher scores for hyperactive-disruptive behaviors than did their Japanese and American colleagues when evaluating the same group of children. [cite journal | author=E. M. Mann, Y. Ikeda, C. W. Mueller, A. Takahashi, K. T. Tao, E. Humris, B. L. Li, D. Chin | title=Cross-cultural differences in rating hyperactive-disruptive behaviors in children | journal=American Journal of Psychiatry | year=1992 | volume=149 | issue=11 | pages= 1539–1542] Significant differences in the prevalence of ADHD across different countries have been reported, however [http://adc.bmjjournals.com/cgi/content/full/90/suppl_1/i10 (Dwivedi, 2005)] . Timimi himself cites a range of prevalence that goes from 0.5% to 26% as support for his theory.

External links

Further reading

*Joseph, J. (2000). "Not in Their Genes: A Critical View of the Genetics of Attention-Deficit Hyperactivity Disorder", "Developmental Review" 20, 539-567.

References