ADHD as a Social Construction

Summary

In this video, Dr. Thomas Armstrong challenges the conventional view of ADHD as a medical disorder, suggesting instead that it is a social construct. He traces the evolution of ADHD's diagnosis, from early labels like 'defective moral control' to the modern designation of ADHD. Armstrong explores the cultural, sociological, and economic factors that contributed to the rise in ADHD diagnoses, highlighting the role of pharmaceutical companies, media advocacy, and educational policies. He urges a more nuanced understanding of ADHD, advocating for language that separates the disorder from the child and emphasizes the social forces shaping its prevalence.

Takeaways

• 😀 ADHD symptoms exist, but ADHD as a specific medical disorder is a social construct, according to Dr. Armstrong, based on decades of study.
• 😀 ADHD has evolved through multiple terms and social contexts, from 'defective moral control' to 'attention deficit hyperactivity disorder' (ADHD).
• 😀 The DSM (Diagnostic and Statistical Manual) changes its definitions of disorders through committee decisions, not lab tests, which may contribute to ADHD's growing diagnosis rates.
• 😀 ADHD's rise can be attributed to various social, cultural, and economic factors, including cognitive psychology research, media influence, and drug company lobbying.
• 😀 The initial ADHD term came from a shift in psychology from behaviorism to cognitive psychology in the 1960s, focusing on attention rather than hyperactivity.
• 😀 Parent advocacy groups, such as CHADD, played a significant role in pushing for ADHD to be recognized as a handicapping condition for special education services.
• 😀 The introduction of ADHD medications, such as Adderall, and direct-to-consumer pharmaceutical advertising, led to an increase in ADHD diagnoses and treatment through drugs.
• 😀 By 2022, ADHD diagnoses had reached nearly 10% of children, with millions using ADHD medications, reflecting the significant growth of ADHD as a cultural and medical phenomenon.
• 😀 The ADHD diagnosis is part of a larger market, including drugs, diagnostic tools, books, and educational materials, which has grown into a multi-billion-dollar industry.
• 😀 Social values, such as the Protestant work ethic, may influence the labeling of children with ADHD, particularly those who struggle with impulse control and delayed gratification.
• 😀 Dr. Armstrong recommends using more precise language when referring to children diagnosed with ADHD, such as 'the child diagnosed with ADHD,' rather than labels like 'ADHD child,' to reduce stigmatization.

Q & A

What is Dr. Thomas Armstrong's main argument regarding ADHD?

Dr. Thomas Armstrong argues that ADHD is not a medical disorder, but rather a social construct. He believes that the symptoms associated with ADHD exist, but that they can be explained through various other perspectives, and that the diagnosis of ADHD has been shaped by social forces over time.

How does Dr. Armstrong describe the historical evolution of ADHD?

Dr. Armstrong traces ADHD's evolution through various diagnostic terms, such as 'defective moral control' and 'minimal brain dysfunction,' each of which emerged from different social contexts. He explains that these terms reflected cultural shifts in understanding children's behavior, moving from moral judgments to medical diagnoses over time.

What role did cognitive psychology and psychiatry play in the emergence of ADHD as a diagnosis?

In the 1960s, cognitive psychology and psychiatry shifted focus to brain-based explanations for mental health issues. Researchers became interested in attention and cognitive processes, which contributed to the conceptualization of ADHD. This led to the formal diagnosis of Attention Deficit Disorder (ADD) in 1980 and ADHD in 1987.

What influence did pharmaceutical companies have on the rise of ADHD diagnoses?

Pharmaceutical companies played a significant role in expanding the ADHD diagnosis. They marketed drugs like Adderall and worked to influence medical professionals through advertising, workshops, and even funding ADHD research. These companies created a demand for ADHD diagnoses and treatments among parents and doctors.

How did media and parent advocacy groups contribute to the growing recognition of ADHD?

Parent advocacy groups like CHADD and media outlets helped bring attention to ADHD, with discussions appearing in magazines, talk shows, and news reports. These advocacy efforts pushed for ADHD to be recognized as a legitimate condition and to ensure that children diagnosed with ADHD received special educational services.

What is the significance of the DSM (Diagnostic and Statistical Manual) in the ADHD diagnosis?

The DSM, published by the American Psychiatric Association, is the primary guide for diagnosing mental disorders in the U.S. ADHD has been redefined and renamed multiple times within different versions of the DSM, which reflects how the understanding of ADHD has evolved within the medical community. Armstrong highlights that the changing definitions raise questions about the stability and validity of the diagnosis.

What social forces does Dr. Armstrong identify as shaping ADHD diagnoses?

Dr. Armstrong identifies several social forces, including research priorities, parental politics, media advocacy, school bureaucracy, and pharmaceutical interests, as key factors in the rise of ADHD diagnoses. These forces combined to create a widespread cultural belief in the existence of ADHD as a legitimate medical condition.

What is the 'Protestant work ethic,' and how does Dr. Armstrong link it to ADHD?

The Protestant work ethic emphasizes values such as ambition, delayed gratification, and productivity. Dr. Armstrong suggests that these values influence how ADHD is understood, as children who struggle to conform to these ideals—such as those with impulsive behaviors or difficulty focusing—are more likely to be diagnosed with ADHD.

How does Dr. Armstrong propose we should refer to children diagnosed with ADHD?

Dr. Armstrong suggests moving away from terms like 'the ADHD child' or 'the child with ADHD' and recommends using more accurate language, such as 'the child diagnosed with ADHD,' 'the child identified as having ADHD,' or 'the child labeled as having ADHD.' This language emphasizes that the diagnosis is a social act and avoids implying that ADHD is an inherent trait of the child.

What does Dr. Armstrong mean by saying ADHD is a 'social construction'?

By calling ADHD a 'social construction,' Dr. Armstrong means that the diagnosis and understanding of ADHD have been shaped not by objective medical evidence, but by social, cultural, and economic factors. The definition of ADHD has been influenced by societal values, media attention, educational systems, and pharmaceutical interests, rather than being a purely biological or clinical discovery.