Lecture 20: ADHD

Question 1

Causes of ADHD - POV of Thomas Armstrong

Answer 1

• Canaries in the coal mine
• ADHD is a symptom of a sick society - creates unrealistic expectations for children (leads to Medicating them which is harmful)

Question 2

AD(H)D: Norms and disciplining institutions

Answer 2

• Life stages (childhood)
• Family (motherhood)
• Education (citizens vs workers competition between schools) - education is changing in its expectations - raising citizens to now raising workers
• Medicine - how we should medicate ADHD.
  - Malacrida, Claudia - looks at ADHD as something that gives us information about society
  - Ethnographic work - more nuanced and anchored in our daily life (she is a step forward in sociological thinking)

Question 3

What does Claudia Malacrida explore?

Answer 3

• Foucauldian discourse analysis
• Feminist standpoint theory
• Ethnography - goes into the field and encounters different institutions - key to understand how our interactions with institutions are shaped.
• Experiences of mothers caring for “different children” and the discursive practices and powers of professionals

Question 4

What is discourse? What does Michel Foucault define it as?

Answer 4

● Michel Foucault,
Discourse” isn’t just language, but a system of knowledge and power that shapes how we think, speak, and act
● This system shapes social structures and power relations
● Power is not simply exerted from the top down (it is something that we self-impose on ourself, reality around us creates what is right and wrong)
● It is produced and exercised through discourse.
● Discourses shape our understanding of the world, and in doing so, they also shape our actions and behaviors

Ie: sexuality is an example of discourse
Knowledge about sexuality is diffuse, surrounds us in everyday life.

ie: Gossip is a form of social discourse (diffuse understanding)

ie: Health is an example of social discourse - what should the body should look like

Question 5

How do we learn what is normal?

Answer 5

• Norms are part of the discourse.
• Where are they coming from amd how they are imposed.

Question 6

Is ADHD a neurobiological condition or is it a symptom of something going wrong in society (like armstrong suggests)?

Answer 6

• overworking career moms are neglecting the kids (on one hand)
• Moms are irresponsible, undiscipline
• Moms are pushing kids too fast (overachieving) - overmedicate their kids
• Mothers are blamed regardless which way you look into this.

Question 7

Children with AD(H)D “at risk”

Answer 7

• These Children are seen to be at risk for themselves but also risk to others.
• For themselves: social isolation, low self-esteem, depresssion, suicide
• A danger for society: potential school failure,antisocial,lacking in judgment, risk-takers, and have high rates of alcoholism, unemployment, and criminality in adulthood

Question 8

AD(H)D: History and Culture - Claudia Malacrida
How is social control constructed? Policy is a discourse

Answer 8

● ‘Psychiatrization of difference’
● Medicalization - Larger parts of our lives come under the medical domain
- More and more things that we do is examined by physicians and prescribed in terms of health
● Childhood – the most intensely regulated field
- Childhood was constructed, we keep reinventing childhood, shaped and re-shaped by social construct.
- Childhood = space that adults need to protect, beings need to be constantly regulated in order for them to be protected.
● Knowledge sharing between school clinics, pediatric medicine psychology
- Contact between all these institutions is becoming more and more unified.
● Medical surveys and statistics
- Appearance of data collection (medical data…), constant information and statistical data
- More data = greater range of what is normal (a larger spectrum) - more and more of them are identified as difficult due to all this data and information
● Individual children are measured against the LARGE NORMAL
● The difficult child, the neurotic child, the eneuretic child, the maladjusted child, the unstable child, the delicate child, and the solitary child
● “Precariously normal” and require constant vigilance
- Now all these children are constantly on the brink of falling into these bad categories

Question 9

Medically accepted diagnosis - Claudia Malacrida

Answer 9

● AD(H)D is a behaviourally based diagnostic category that could be applicable to all children
● Development of a reputedly benign medical treatment (Ritalin)
- Protect these kids from falling into this bad categories
● AD(H)D has become normalized in popular discourse
● Arsenal of assessment tools
-Parents are worried about their kids falling into these categories.
- Various approaches to deal with it.

Question 10

Social problems approach: what is a moral entrepeneur?

Answer 10

• ‘Moral entrepreneurs’ - often the value system of society is at stake with this problem
  - Individuals who use the strength of their positions to encourage others to follow their moral stances (usually without any actual evidence).
  - Public figures, parents or concerned citizens
• Moral entrepreneurs are the “rule creators” who typically argue that their cause is for the betterment of individuals (Becker 1963)
• ‘Moral entrepreneurs’ act in formal and informal ways to legitimate an aspect of social life (Conrad and Schneider 1980)

Question 11

Who are the moral entrepeneurs when it comes to ADHD?

Answer 11

• Pharmaceutical companies - start to gain traction especially in US
• The medical profession,
• Government,
• Parental lobby groups - tend to push in both directions

Question 12

How are these groups moral entrepeneurs?

Answer 12

Parental groups
* ‘Sick’ children instead of ‘bad’ children are more likely to receive services than punishment
- Not deserving of punishment but deserving of extra time.
* Parents are less stigmatized
- If a child is not showing bad behaviour, the child is actually in need of medical care.

Pharmaceutical companies
* 1960s onward - intensive marketing with physicians
* Retalin is marketed to medical professionals who then recommend to parents

Governmental committee comprised of physicians
* ‘Only physicians make the diagnosis and prescribe treatment’
* Medical rather than behavioural or social interpretation of its cause and treatment

Question 13

Education system role in ADHD

Answer 13

● Transformations in the labour market late 1950s
- You need more and more education to integrate into the market
● Industrial - > a technological revolution
● Demand for math- and science-based curriculum
- Result of the labour markets
● Longer training period before employability
● Higher levels of attention and concentration
● Docile and compliant student body
- Listen carefully, sit long hours → more docile individuals
● Chronic problem with students/teachers ratio
- 1 teacher for many students, demands are not met
● From punishment to discipline
● Funds to schools with identified AD(H)D children
- More funding will go to schools with more diagnosis of ADHD - makes sense to diagnose children.

Question 14

Education System - The Hidden Curriculum

Answer 14

● Education helps children to move beyond differences of class, race, gender, and ability.
● Latent functions of education: the replication of social class structure
● Hidden Curriculum: student-teacher interactions, classroom structure an bureaucratic organization

Question 15

Motherhood
Knowledge:freedom/oppression

Answer 15

• Mother as a consumer of and handmaid to disciplinary knowledge
• Medical knowledge about raising a healthy child
  - Mothers start to educate themselves more and more - what the health of children should look like.
  Educational knowledge about ideal socialization, emotional wellbeing, intellectual development
  - Being educated by experts to know what is healthy for your children, for your family → foucault way (expert advice)
• Mothers are accountable to physicians, educators,welfare and social workers, and family doctors.
  - Held accountable for how well they raise their children and held to certain standards.

Question 16

Good mother - “Intensive mothering”

Answer 16

• Child centered,
• Expert guided,
• Emotionally absorbing,
• Labor intensive,
• Financially expensive
  The measure of a good mother is a perfect child

Question 17

Sites of surveillance and management of AD(H)D - mothers are constantly surveilled for how well they are doing in:

Answer 17

● The home,
● The community,
● The day care or preschool
● The psychologist’s office,
● The hospital,
● The physician’s office,
● The school.

Question 18

How are Parents being pushed by school to think about diagnosis

Answer 18

In the case of discrepancies between parent and professional assessments relating to AD(H)D, ‘primary consideration should be given to the teacher reports because of greater familiarity with age-appropriate norms’ (Kiger, 1985: 79 in Malcarida 2003).

Question 19

What is the most significant stress for mothers?

Answer 19

• expert opinion and professional orders: constant expectations for mothers to justify their actions to others

Question 20

Debate over the legitimacy of ADHD

Answer 20

● Psychiatrists,
● Psychologists,
● Physicians,
● Nutritionists,
● Educators
● Community

Everyone has different opinions