"A massive long way": interconnecting histories, a "special child," ADHD, and everyday family life

Sensitive Child, Disturbed Kid: Stigma, Medicalization, and the Interpretive Work of Israeli Mothers of Children with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a rapidly globalizing medical category, and there is a need to attend to the on the-ground processes through which laypeople deploy the ADHD label in different local contexts. Based on in-depth interviews with Israeli mothers of children with ADHD, this article explores how mothers, as lay actors in the social field of diagnosis, interpreted the origins and meanings of their child's 'troubles'. The temporal perspective on mothers' meaning-making processes revealed a progression of four common phases through which mothers revisited their understanding of ADHD, and recast their own responsibilities and moral roles. We found that mothers' self-understanding was crucially impacted by the invisibility of the disability and the fact that diagnosis did not fully relieve them from blame for their children's stigmatizing behavior. While not all mothers accepted the validity of the diagnosis, participating in the medicalization of their child's condition allowed them to reach similar pragmatic and narrative goals. We discuss the cultural and institutional features of the Israeli ADHD landscape that shape mothers' narratives of their children, and their relations with expertise. We point to a culturally unique framing of children with ADHD in Israel as those characterized by emotional vulnerability and risk of social exclusion.

'That thing in his head': Aboriginal and non-Aboriginal Australian caregiver responses to neurodevelopmental disability diagnoses

Little is known about the significance of cultural differences to how caregivers receive a diagnosis of neurodevelopmental disability. As part of a Fetal Alcohol Spectrum Disorder prevalence study among sentenced, detained youth, our qualitative study explored the experiences of diagnostic assessment among detained young people and their caregivers. We present findings from the perspectives of caregivers. In conversation with the sociology of diagnosis literature, we present vignettes of three Aboriginal and two non-Aboriginal caregivers' experiences of the diagnostic assessment process. We found that Aboriginal caregivers conceptualised their children's diagnosis and ongoing management in the context of their family networks and community. In contrast, non-Aboriginal caregivers focused on how the diagnosis would affect their child and interactions with various institutions including healthcare systems and schools. Caregivers' engagement with diagnostic reports and resources also followed cultural lines. Reflections on intergenerational drinking were voiced by Aboriginal caregivers, who expressed shame at receiving diagnosis. These findings advance our appreciation of cultural difference in receiving a diagnosis, the examination of which is in its nascent stages. We also suggest ways to mitigate harm from a stigmatising diagnosis and soften the well-established effects of medical dominance over the process of defining a person's capacity and status.

Complicating "the good result": narratives of colorectal cancer screening when cancer is not found

OBJECTIVES

In this paper, we analyze narratives from a Photovoice project on colorectal cancer screening that was carried out with people who had undergone screening and were found to not have cancer.

METHODS

Three groups, totaling eighteen participants, took part in the project, meeting multiple times over the course of approximately 10 weeks, and discussing photos they took about colorectal cancer screening.

RESULTS

A common way in which the participants conveyed their screening experiences was through reflection on their own or other people's illnesses. Our findings highlight the multiple meanings of receiving a "good" or noncancerous screening result after undergoing cancer screening.

CONCLUSION

Such findings suggest that framing noncancerous results only in terms of relief or other positive emotions may ignore the realities people and their families face and their remaining concerns. This paper has broader implications for policies to reduce cancer disparities as well as public health and patient-provider communication about screening.

Parenting experiences of living with a child with attention deficit hyperactivity disorder: a systematic review of qualitative evidence

BACKGROUND

Attention deficit hyperactivity disorder is the most prevalent mental disorder among children and adolescents worldwide. Parenting a child with attention deficit hyperactivity disorder is challenging and parents find it difficult to raise the child and struggle to get professional support. Research has shown how living with a child with Attention Deficit Hyperactivity Disorder influences the families' daily life. This includes how the parents manage to maintain a bearable family life, supportive or not supportive factors as well as parents' experiences of collaboration with professionals in diverse settings.

OBJECTIVE

The objective of this systematic review was to identify and synthesize the best available evidence on parenting experiences of living with a child with attention deficit hyperactivity disorder, including their experiences of health care and other services.

INCLUSION CRITERIA

This review considered research articles with qualitative data examining the experiences of parents of children with attention deficit hyperactivity disorder. The phenomena of interest were parenting experiences of living with a child with attention deficit hyperactivity disorder, including their experiences of health care and other services, and collaboration with professionals.

SEARCH STRATEGY

Retrospective and prospective searches were conducted in MedNar, ProQuest Dissertations and Theses, PubMed, Embase, PsycINFO and CINAHL. The reference lists of the included research articles were searched for additional studies, and a search for cited citations in Web of Science was conducted.

METHODOLOGICAL QUALITY

Two independent reviewers assessed articles selected for retrieval for methodological validity prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute, the Qualitative Assessment and Review Instrument.

DATA EXTRACTION

Data were extracted from research articles included in the review using the standardized data extraction tool from the Qualitative Assessment and Review Instrument.

DATA SYNTHESIS

Qualitative research findings were pooled using the Qualitative Assessment and Review Instrument. This involved aggregation and synthesis of findings.

RESULTS

A total of 21 research articles were included in the review. The review process resulted in 129 study findings that were aggregated into 15 categories. The categories generated six synthesized findings: 1) An emotional roller coaster between hope and hopelessness, 2) Mothers as advocates in a battlefield within the system and family, 3) Parental experiences in a crossfire of blame, self-blame and stigmatization, 4) Shuttling between supportive and non-supportive services and professionals, 5) Routines, structures and strategies within everyday life, and 6) Despite multiple challenges, it is not all bad.

CONCLUSIONS

The findings illustrate the complexity of parental experiences that are influenced by guilt, hope, blame, stigmatization, exhaustion, reconciliation and professional collaboration. The findings address the impact attention deficit hyperactivity disorder has on the everyday family, and how parents seem to adapt to their life situation in the process of accepting their child's disorder.

IMPLICATIONS FOR PRACTICE

Health care systems and other professionals need to provide support and understanding to families of children with ADHD.

IMPLICATIONS FOR RESEARCH

Further research is needed to examine how professionals in health care settings can address the individual needs of the families and how future interventions may support the families and improve competences of health professionals.

Innocent or Intentional?: Interpreting Oppositional Defiant Disorder in a Preschool Mental Health Clinic

Based on 9 months of ethnographic fieldwork in a U.S. mental health clinic focused on the treatment of preschool-aged children who exhibited extremely disruptive behavior, this article examines the contradictions clinicians faced when trying to identify and attribute "intentionality" to very young children. Disruptive, aggressive behavior is one of the central symptoms involved in a wide-range of childhood psychopathology and the number one reason young children are referred to mental health clinics in the United States. In the clinic where I conducted my research, clinicians were especially interested in diagnosing these children with oppositional defiant disorder (ODD), in order to identify those at risk for more serious mental illness later in the lifecourse. In this article, I look at the different strategies clinicians used in interpreting whether aggressive, defiant behavior was a part of the child's "self," a biologically driven symptom of a disease, or a legitimate reaction to problematic social environments. I argue that conceptualizing intentionality as a developmental, interpersonal process may help to make sense of the multiple discourses and practices clinicians used to try to reconcile the contradictions inherent in diagnosing ODD.

Emplotting Hikikomori: Japanese Parents' Narratives of Social Withdrawal

Hikikomori, often glossed as "social withdrawal," emerged as a sociomedical condition among Japanese youth at the end of the twentieth century, and it continues to fascinate and concern the public. Explanatory frameworks for hikikomori abound, with different stakeholders attributing it to individual psychopathology, poor parenting, and/or a lack of social support structures. This article takes an interpretive approach to hikikomori by exploring parents' narrative constructions of hikikomori children in support group meetings and in-depth interviews. I argue that some parents were able to find hope in hikikomori by 'emplotting' their children's experiences into a larger narrative about onset, withdrawal, and recovery, which helped them remain invested in the present by maintaining a sense of possibility about the future. Contrary to literature that examines hikikomori as an epidemic of isolated individuals, I demonstrate how parents play a key role in hikikomori through meaning-making activities that have the potential to shape their children's experiences of withdrawal.

The Fracture of Relational Space in Depression: Predicaments in Primary Care Help Seeking

Primary care clinicians treat the majority of cases of depression in the United States. The primary care clinic is also a site for enactment of a disease-oriented concept of depression that locates disorder within an individual body. Drawing on theories of the self and stigma, this article highlights problematics of primary care depression treatment by examining the lived experience of depression. The data come from individuals who screened positive for depressive symptoms in primary care settings and were followed over ten years. After iterative mixed-methodological exploration of a large dataset, we analyzed interviews from a purposive sample of 46 individuals using grounded and phenomenological approaches. We describe two major results. First, we note that depression is experienced as located within and inextricable from relational space and that the self is experienced as relational, rather than autonomous, in depression. Second, we describe the ways in which the experience of depression contradicts a disease-oriented concept such that help-seeking intensifies rather than alleviates the relational problem of depression. We conclude by highlighting that an understanding of illness experience may be essential to improving primary care depression treatment and by questioning the bracketing of relational concerns in depression within the construct of stigma.

Beyond the reproduction of official accounts: parental accounts concerning health and the daily life of a California family

Considering the purported bias of interviews to elicit "official accounts"--conveying conventional teachings from health promotion--and limited insights individuals may have into their own health behaviors, the challenges of relating health as talk (directed at researchers) to health as enacted are examined. Focusing on one family from a study of dual-earner middle-class Los Angeles families, I propose and apply four analytic lenses to a conjoint analysis of ethnographic interviews and videorecordings of family life to examine the parental claim that their family is a "healthy family." Findings indicate that parental accounts enable deeper insights into health as entrenched in everyday life, here revealing the centrality of a relational view of health as "family well-being" (vs. individual health) extending into the social world. Discussion considers debates over the extent to which "discursive consciousness" in interview settings illuminates health-relevant practices in everyday life contexts.

Sense and the Senses: Anthropology and the Study of Autism

As a clinical category and a sociocultural phenomenon, autism occupies a prominent albeit ambiguous place in ongoing social science and humanities debates about empathy, intersubjectivity, intentionality, epistemological certainty, and moral agency. Autism is used as a counterexample to feeling empathy and understanding other people's beliefs and intentions. Alternatively, it is given as evidence of the limitless potential and neurodiversity of the human mind. This review examines the field of autism research relevant to anthropology of the senses. It considers the production of knowledge about autism as a clinically relevant category at the intersection of sense as culturally organized competence in meaning making and the senses as a culturally normative and institutionally ratified sensory and perceptual endowment. In such a distinction, both sense and the senses are paths toward and objects of the empirical understanding of autism.