Making ADHD Evident: Data, Practices, and Diagnostic Protocols in Portugal

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.

Not all diagnoses are created equal: Mothers' narratives of children, ADHD, and comorbid diagnoses

Social research examining patients' and caretakers' narration of mental disorders, including ADHD, has been remarkably silent about comorbidity. Centering the theme of uncertainty and the question of what is "at stake" in mothers' mental health narratives of children (Kleinman, 1988), we characterize the patchwork process by which mothers deploy ADHD and comorbid diagnoses to account for key experiences and struggles in their and their child's lives. We found that ADHD had limited purchase in accounting for the emotional and social difficulties that were most urgent in mothers' narratives, despite the medical authority behind the ADHD label, which the mothers mostly accepted. However, mothers remained pervasively uncertain about the relationship between ADHD and comorbid mental health conditions, paralleling debates on the relationship between ADHD, emotion, and comorbidity in the psychiatric and psychological literature. Our findings contribute a conceptualization of comorbidity as a web of diverse moral vocabularies, institutional outcomes and perceptions of personhood, through which mothers of ADHD children maneuver over time. Through this perspective we illustrate how ADHD is co-constructed as a narrow neurological problem of 'attention,' and demonstrate the overlooked and crucial ways that comorbidity may shape parents' pragmatic and interpretive negotiation of ADHD. Kleinman, Arthur. (1988). The illness narratives: Suffering, healing, and the human condition. New York: Basic Books.

Negotiating human rights narratives in Global Mental Health: Autism and ADHD controversies in Brazil

Promoting evidence-based treatments and the human rights of people living with mental illness are the two pillars of Global Mental Health (GMH). Critics counter that human rights narratives must also include social justice frameworks. We draw on the cases of autism and ADHD in Brazil to discuss the role of human rights in mental health in the context of GMH. A human rights perspective involves citizenship rights for individuals living with mental distress and provides a framework to problematise the logic of GMH centred on individual rights and rights to treatment. We begin with an overview on human rights discussions in GMH and examine the introduction of human rights discourses in the Brazilian psychiatric reform. We then explore how autism and ADHD became priorities of GMH interventions as well as the constitution of two styles of activism and mobilisation of human rights around these conditions. One follows the universal public health logic and promotes health as a social right. The other follows the logic of parents' associations that redefined those conditions as forms of disability to advocate for specialised services and interventions. Finally, we discuss these forms of human rights mobilisation and their implications for Brazilian mental health and GMH.

The Political Economy of Attention

Attention has become an issue of intense political, economic, and moral concern over recent years: from the commodification of attention by digital platforms to the alleged loss of the attentional capacities of screen-addicted children (and their parents). While attention has rarely been an explicit focus of anthropological inquiry, it has still played an important if mostly tacit part in many anthropological debates and subfields. Focusing on anthropological scholarship on digital worlds and ritual forms, we review resources for colleagues interested in this burgeoning topic of research and identify potential avenues for an incipient anthropology of attention, which studies how attentional technologies and techniques mold human minds and bodies in more or less intentional ways.

Negotiating ADHD: Pragmatic medicalization and creolization in urban India

Although a growing number of studies have demonstrated differences in responses to ADHD-like behaviours, very few studies have focused on theorizing diversity in the way ADHD is framed and approached globally. To contribute to the study of medicalization in a global context, this study examines the discursive field in which care professionals explain and treat ADHD among children in metropolitan India and addresses the need for an analytic framework to grasp the variations in the way ADHD is understood and approached. Building on the concepts of pragmatic medicalization and creolization, we study ADHD discourses in India asking 'What is at stake' and 'What matters most'? In this mixed methods study, 64 care professionals regularly involved in assessing ADHD-like behaviour completed an online Q-sort, and 21 professionals participated in face-to-face interviews. The Q-data were subjected to factor analysis. The interviews were analyzed using qualitative content analyses. Our study identified six distinct ADHD discourses, which showed that care professionals combine explanatory and treatment models. Professionals adapt their explanations and treatments of ADHD to parents' worries regarding academic performance, family prestige, stigma and side effects of allopathic medicine. Our findings indicate that an awareness of local concerns and adjustments to structural opportunities can diversify how ADHD-like behaviour is framed and responded to. This study demonstrates that medicalization operates between the emerging institutions of care and the everyday concerns of families and care professionals and reveals the need to examine conflicting stakes as drivers of diverse responses to ADHD diagnosis and treatment in India and the rest of the world.

[Situating atention deficit and hyperactivity in Portugal: social, historical, and ethical dimensions of an emerging global health issue]

Attention deficit and hyperactivity disorder (ADHD) is considered one of the most frequent behavioral and neurodevelopmental problems in school-age children and adolescents, both in Portugal and worldwide. The diagnostic categorization of ADHD and the prescription of psychostimulants as its first-line treatment have been the object not only of scientific research and clinical validation, but also of controversy and social critique, especially in light of the concept of medicalization. Despite its high profile and salience in such diverse fields as education, pharmaceuticals, mental health, and public policy, a significant gap remains in the characterization of social-historical, ethical, and institutional dimensions of ADHD outside English-speaking countries. Combining historical and ethnographic research with document and media analysis, the article addresses that challenge by tracing the social trajectory of ADHD in Portugal, from the emergence of "hyperactivity" in the 1970s and 1980s to the current public and political debates on psychostimulant treatments and prescribing trends. From this interdisciplinary perspective and based on the Portuguese case study, the aim of this article is to contextualize the definition, validation, and expansion of ADHD as part of a dynamic and socially situated process in which global diagnostic and pharmaceutical systems intersect with institutional and socioeconomic contingencies, as well as local specificities and needs. More broadly, the article discusses how the case study of ADHD contributes to the development of interdisciplinary research that helps rethinking the social scope of mental health across local and global health contexts.

Challenges in ADHD care for ethnic minority children: A review of the current literature

While attention deficit hyperactivity disorder (ADHD) has been extensively studied in the past decades, the role of social and cultural practices in its assessment, diagnosis, and treatment has been often overlooked. This selective review provides an overview of research that explores social and cultural influences on help-seeking behavior in ethnic minority children with ADHD. Studies were selected that address cultural diversity in three areas of ADHD help-seeking: problem recognition, access to mental health services, and treatment. Special attention was given to studies of treatment selection and adherence in minority groups. Findings suggested that cultural disparities in ADHD care among ethnic minority children occur in the early stages of problem recognition, through service selection, and in the quality of treatment. Ethnic minority children were less likely than their nonminority counterparts to be diagnosed with ADHD and its comorbid conditions and less likely to be prescribed and adhere to stimulant drug treatment. These differences reflect cultural diversity in norms and attitudes towards mental health issues (e.g., fear of social stigma) as well as limited access to qualified health care. Paradoxically, cultural, racial, and language bias may also lead to the overidentification of ethnic minority children as disabled and to higher ratings of ADHD symptoms. This review highlights the importance of sociocultural factors in understanding developmental psychopathology and help-seeking behavior. In addition, it further supports calls for increasing cultural competence in communications during clinical assessment, diagnosis, and treatment in minority communities. Clinical, theoretical, and methodological considerations for future research are discussed.

Caregiver-Attributed Etiologies of Children's Attention-Deficit/Hyperactivity Disorder: A Study in Taiwan

The aim of this survey study was to examine the etiologies of attention-deficit/hyperactivity disorder (ADHD) attributed by caregivers of Taiwanese children with ADHD, particularly factors affecting such attribution. This study had 400 caregivers of children with ADHD as participants. We examined the caregiver-attributed etiologies of ADHD and factors affecting such attribution. Caregivers completed the self-report questionnaire to rate how likely they perceived various etiologies of ADHD to be; the Affiliate Stigma Scale for the level of affiliate stigma; and the short Chinese version of the Swanson, Nolan, and Pelham, Version IV Scale for child’s ADHD and oppositional symptoms. Brain dysfunction (84.8%) was the most commonly attributed etiology, followed by failure of caregivers in disciplining the child (44.0%); a poor diet, such as a sugar-rich diet (40.8%); a poor living environment (38.8%); the child imitating their peers’ improper behavior (37.3%); failure of school staff in disciplining the child (29.0%); the education system’s overemphasis on academic performance (27.3%); and supernatural beings or divination-based reasons (3.8%). Caregivers’ affiliate stigma was significantly associated with the attribution of several nonbiological etiologies other than brain dysfunction. Caregivers’ education level and children’s sex, hyperactivity/impulsivity, and oppositional symptoms were significantly associated with various caregiver-attributed etiologies. Therefore, to deliver more accurate knowledge about ADHD in educational programs, health professionals should consider those etiologies that are attributed by caregivers of children with ADHD.

Mini Review: Socio-Cultural Influences on the Link Between ADHD and SUD

Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development and persistence of substance use disorders (SUD). The prevalence of ADHD in patients with SUD varies across countries and cultures. So far, cross-cultural variance in ADHD prevalence rates among SUD patients was mainly ascribed to methodological differences between studies, leaving the role of societal and cultural practices in the ADHD-SUD link hardly acknowledged. The aim of the present mini review is to address this gap in the literature by providing evidence for the effect of socio-cultural practices on the ADHD-SUD link and suggesting directions for future research. To achieve this goal, we map the influence of socio-cultural factors on the ADHD-SUD link along three lines of research. The first line is concerned with the role of socio-cultural factors in the recognition, diagnosis and treatment of childhood ADHD. The second line of research is concerned with socio-cultural influences on substance use (e.g., religion, ethnic identity, acculturation, and socio-economic status). Finally, we describe potential socio-cultural factors which may operate as mechanisms for reducing or increasing access to substance abuse treatment (e.g., ethnic disparities in health care utilization). Identifying socio-cultural influences on the ADHD-SUD link may provide further insight into the bidirectional association between ADHD and SUD in different contexts and encourage future research in the field.