Media portrayals of psychotropic agents in AD/HD treatment: A social constructionist approach

In recent decades there has been a significant increase in diagnosing children and adults with Attention-Deficit/Hyperactivity Disorder (AD/HD), and in the use of pharmacological treatment with Ritalin, Concerta and Strattera for AD/HD. This development has given rise to scientific criticism, claiming that the pharmaceuticals prescribed by doctors are, to a large extent, ineffective or harmful. This study discusses media's portrayal of treatment of AD/HD. The aim of the article is to develop a social constructionist perspective, highlighting how scientific critique of pharmaceuticals for AD/HD is handled in the mass media. The authors introduce the concept of "psychopharmacological extensibility," which demonstrates the importance of collective definitional processes in society. Psychopharmacological extensibility reflects the fact that the perception of AD/HD agents as beneficial medicines or harmful drugs is open to interpretation and dependent on social factors related to context, power, rhetoric, and marketization. The empirical data are based on 211 articles from eight of the largest newspapers in Sweden, published between 2002 and 2021. The result shows that Swedish mass media, in numerous ways, neglects or undermines the scientific criticism made, thereby facilitating an increased use of the diagnosis and of psychotropic agents in society.

'I want to die on my own terms': Dominant interpretative repertoires of 'a good death' in old age in Dutch newspapers

RATIONALE

There is a paucity of empirical studies exploring how death and dying in old age are actually represented and debated within the Dutch society.

OBJECTIVE

This study examines the discourse used in Dutch newspapers on the good death and dignified dying. It analyses how different types of social actions and positions are construed, thereby describing how death and dying in old age are portrayed in newspaper media.

METHODS

173 newspaper articles between 2010 and 2020 were selected from five Dutch national newspapers. Data were thematically coded and scrutinised for discursive patterns in order to identify interpretative repertoires and their functions.

RESULTS

Four interpretative repertoires of good death and dying in old age were identified, all drawing on the assisted dying debate: Choice, Risk, Care, and Complexity. Each repertoire constructs a particular image of death and dying, varying from it being a personal choice; a last resort; a joint journey; to a contingent quest. The different repertoires imply distinct identities and actions. The Choice-repertoire construes older people as active subjects who autonomously determine their own death. The Risk- and Care-repertoires both construe older people primarily as passive and acted upon: either threatened by illness, decline and death; or protected and cared for by others and society. The Complexity-repertoire construes older people's situation as an object of reflection.

DISCUSSION AND CONCLUSION

The strong prevalence of the Choice-repertoire in Dutch newspapers construes good death and dignified dying in old age in a salient way, unrepresentatively highlighting assisted dying as the preferred imagined practice. It is hypothesised that reimaging the Care- and Complexity-repertoires in such a way that they construe older persons in a more active subject role could help depolarise the debate on death and dying in old age.

More scientific, more ethical: The ADHD controversy and boundary-work in Taiwan

Attention-deficit/hyperactivity disorder (ADHD) is one of the most controversial childhood psychiatric condition. With the globalisation of its diagnosis and treatment, Taiwan has followed other medically advanced countries in meeting the challenge of medicalising children's problematic behaviours and encountering the resistance discourses on ADHD. To contribute to the extant literature, this study employs the social worlds framework to decipher the relational dynamics amongst these competing discourses on ADHD, namely the mainstream psychiatry, the critiques of overdiagnosis and the antipsychiatric protest, and to suggest the links between these domestic advocacies and the relevant debates abroad. In addition, the concept of boundary-work is used to analyse the strategies through which these collective actors pursue legitimacy for their respective claims. Based on the existing research of scientific and ethical boundary-work, this study argues that when it comes to clinical practices fraught with uncertainties, these two seemingly distinct forms of boundary-work may become mutually supportive in order to act as arbiters of disputes. Despite the disparity of power amongst these social worlds in this case study with seemingly predictable outcomes of the dispute, representing their heterogeneous narratives and the process of discursive struggle helps to destabilise the seemingly naturalised conceptualisation of biomedical ADHD.

The Recognition of Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and Conduct Disorder in Adolescents and Adults—Assessing Differences in Mental Health Literacy

This was a Mental Health Literacy (MHL) study looking at three disorders, part of a systematic research programme on MHL using vignette methodology to examine lay people’s knowledge and recognition. The study compared the recognition of the disorders in children and adults. In all 485 participants, aged 18–69 years, read three vignettes describing a person with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Conduct Disorder (CD). Vignette characters were described as either a child (aged 8yrs) or adult (aged 28 yrs). Participants attempted to label the disorder and then rated perceived seriousness and likelihood of disorder. Results from a 2 (sex) × 3 (disorder) way analysis of variance showed that CD was significantly perceived as the most serious disorder. ADHD was significantly considered more likely to be a disorder in adults yet recognised more in children. Younger participants correctly recognised ADHD, yet gave lower seriousness ratings. ASD was considered more serious in children. Women and highly educated individuals perceived ASD more seriously and recognised it more. Parents incorrectly identified CD but considered all disorders more seriously than non-parents. Clinical behaviours are more likely to be perceived as a disorder if they occur in adults, rather than children.

Born which Way? ADHD, Situational Self-Control, and Responsibility

Debates concerning whether Attention Deficit/Hyperactivity Disorder (ADHD) mitigates responsibility often involve recourse to its genetic and neurodevelopmental etiology. For such arguments, individuals with ADHD have diminished self-control, and hence do not fully satisfy the control condition for responsibility, when there is a genetic or neurodevelopmental etiology for this diminished capacity. In this article, I argue that the role of genetic and neurobiological explanations has been overstated in evaluations of responsibility. While ADHD has genetic and neurobiological causes, rather than embrace the essentialistic notion that it directly diminishes self-control and, therefore, responsibility, we ought to think of ADHD as constraining only some self-control practices. In particular, situational self-control strategies remain feasible for people with ADHD. However, not all individuals have access to these strategies. I suggest a way to evaluate responsibility in terms of situational rather than agential pleas, which tracks whether the individual had access to self-control behaviors. While I restrict my discussion to ADHD, the access-based approach is also relevant for assessments of responsibility for other cases where self-control failures are at stake.

Messaging in Biological Psychiatry: Misrepresentations, Their Causes, and Potential Consequences

Most experts in the field of psychiatry recognize that neuroscience advances have yet to be translated into clinical practice. The main message delivered to laypeople, however, is that mental disorders are brain diseases cured by scientifically designed medications. Here we describe how this misleading message is generated. We summarize the academic studies describing how biomedical observations are often misrepresented in the scientific literature through various forms of data embellishment, publication biases favoring initial and positive studies, improper interpretations, and exaggerated conclusions. These misrepresentations also affect biological psychiatry and are spread through mass media documents. Exacerbated competition, hyperspecialization, and the need to obtain funding for research projects might drive scientists to misrepresent their findings. Moreover, journalists are unaware that initial studies, even when positive and promising, are inherently uncertain. Journalists preferentially cover them and almost never inform the public when those studies are disconfirmed by subsequent research. This explains why reductionist theories about mental health often persist in mass media even though the scientific claims that have been put forward to support them have long been contradicted. These misrepresentations affect the care of patients. Indeed, studies show that a neuro-essentialist conceptualization of mental disorders negatively affects several aspects of stigmatization, reduces the chances of patients' healing, and overshadows psychotherapeutic and social approaches that have been found effective in alleviating mental suffering. Public information about mental health should avoid these reporting biases and give equal consideration to the biological, psychological, and social aspects of mental health.

Where to find accurate information on attention-deficit hyperactivity disorder? A study of scientific distortions among French websites, newspapers, and television programs

Attention-deficit/hyperactivity disorder is the most frequent mental disorder among school-age children. This condition has given rise to a large mediatic coverage, which contributed to the shaping of the lay public's perceptions. We therefore conducted two studies on the way attention-deficit/hyperactivity disorder was portrayed in the TV programs and the lay-public press in France between 1995 and 2015, but the growing part played by the Internet required an additional study to analyze and compare the scientific material which is available to the French lay public depending on the source of information used. We studied the 50 first French websites dedicated to attention-deficit/hyperactivity as indexed by Google^® search engine using a structured quantitative content analysis for the web. We illustrate our results with excerpts derived from the websites. The conceptions of attention-deficit/hyperactivity disorder available on the Internet are essentially biomedical and comprise an important level of scientific distortion. Findings concerning other mass media such as television programs and the press also demonstrate massive and systematic distortions caused by the role of experts and the pharmaceutical industry. Furthermore, the most consulted media present the highest level of scientific distortions.

'You must know what you mean when you say that': the morality of knowledge claims about ADHD in radio phone-ins

Drawing on a corpus of radio phone-ins, we present a discursive psychological analysis of how mothers carefully tailor their knowledge claims regarding their children with Attention Deficit Hyperactivity Disorder (ADHD). Mothers typically claim knowledge about their children's good intentions, but not about the 'ADHD-ness' of their conduct. Whereas the former is seen as appropriate knowledge for a concerned parent, the latter is treated as a matter of expert knowledge. We show that as soon as problematic behaviour is treated as observable from the outside and describable by mothers and other lay persons, it becomes vulnerable to being formulated as 'normal disobedience', rather than symptomatic of a professionally administered, doctorable condition. We argue that it is important to be aware of the moralities hidden in knowledge claims, as they help sustain an unproductive perspective in which either the child's brain or his mother is blamed for behaviour perceived as problematic.

How French media have portrayed ADHD to the lay public and to social workers

Two models of attention deficit hyperactivity disorder (ADHD) coexist: the biomedical and the psychosocial. We identified in nine French newspapers 159 articles giving facts and opinions about ADHD from 1995 to 2015. We classified them according to the model they mainly supported and on the basis of what argument. Two thirds (104/159) mainly supported the biomedical model. The others either defended the psychodynamic understanding of ADHD or voiced both models. Neurological dysfunctions and genetic risk factors were mentioned in support of the biomedical model in only 26 and eight articles, respectively. These biological arguments were less frequent in the most recent years. There were fewer articles mentioning medication other than asserting that medication must be combined with psychosocial interventions (14 versus 57 articles). Only 11/159 articles claimed that medication protects from school failure. These results were compared to those of our two previous studies. Thus, both French newspapers and the specialized press read by social workers mainly defended either the psychodynamic understanding of ADHD or a nuanced version of the biomedical model. In contrast, most French TV programmes described ADHD as an inherited neurological disease whose consequences on school failure can be counteracted by a very effective medication.

Medication-taking experiences in attention deficit hyperactivity disorder: a systematic review

Background

Although attention deficit hyperactivity disorder (ADHD) is a common condition for which pharmacotherapy is considered an effective treatment, guidelines on the treatment of ADHD have been challenging to implement. Considering the views of patients and caregivers involved in medication-taking could help shed light on these challenges.

Objective

This review combines the findings of individual studies of medication-taking experiences in ADHD in order to guide clinicians to effectively share decisions about treatment.

Methods

Five databases (MEDLINE, Embase, PsycINFO, SCOPUS and CINAHL) were systematically searched for relevant published research articles. Articles were assessed for quality using a Critical Appraisal Skills Programme checklist, and synthesis was performed using meta-ethnography.

Results

Thirty-one articles were included in the final synthesis, comprising studies of caregivers, paediatric patients and adult patients across seven countries. Findings were categorized into five different constructs, including coming to terms with ADHD, anticipated concerns about medication, experiences of the effects of medication, external influences and the development of self-management. The synthesis demonstrates that decisions surrounding medication-taking for ADHD evolve as the child patient enters adulthood and moves towards autonomy and self-management. In all parts of this journey, decisions are shaped by a series of 'trade-offs', where potential benefits and harms of medication are weighed up.

Conclusions

This review offers a comprehensive insight into medication-taking experiences in ADHD. By considering the shifting locus of decision-making over time and the need for individuals and families to reconcile a variety of external influences, primary care and mental health clinicians can engage in holistic conversations with their patients to share decisions effectively.

Adolescents With ADHD: Experiences of Having an ADHD Diagnosis and Negotiations of Self-Image and Identity

OBJECTIVE

To develop an understanding of the meanings and consequences of a diagnosis of ADHD for young people during the transition from childhood to adolescence.

METHOD

Nine youth with an ADHD diagnosis were interviewed using a semi-structured interview guide on topics of management of identity and their own experiences of their difficulties relating to ADHD.

RESULTS

The meanings and consequences of the ADHD diagnosis is best understood in terms of overall identity development and social connectedness. In addition, cultural understandings of what ADHD is play a major role in negotiating the role of ADHD in identity.

CONCLUSION

Youth with ADHD moving from childhood to adulthood need support for identity development. Health care professionals should be aware of young people's experiences of ADHD symptoms in the context of their life situations and the cultural understanding of ADHD during treatment and psychoeducation.

Heroic struggles, criminals and scientific breakthroughs: ADHD and the medicalization of child behaviour in Australian newsprint media 1999-2009

There is a dearth of scholarly analysis and critique of the Australian newsprint media’s role in the medicalization of child behaviour. To begin to redress this lack this paper analyses newsprint media’s use of metaphors that re/describe and construct realities of ADHD with a medicalizing effect. The interdisciplinary team used the Factiva^TM database to locate and review 453 articles published in Australian national and metropolitan newspapers during the decade 1999–2009. Data analysis involved generating statistical descriptions of the dataset according to attributes such as: date, state, newspaper titles and author names. This was followed by inductive analysis of article content. Content analysis revealed pervasive and striking use of metaphor in newsprint media reporting of ADHD content, especially when describing health professionals, educators, parents and children. This collection of metaphors was striking, and while the metaphors deployed were varied, this diversity seemed underscored by a common functionality that increased the risk that child behaviour was explained using medicalized knowledge. We contend that these metaphors collectively and coherently functioned to simplify and delimit meanings of children’s health and behaviour to favour depictions that medicalize problems of children and childhood.

Attention Deficit Hyperactivity Disorder on YouTube: Framing, Anchoring, and Objectification in Social Media

This study investigated videos about Attention Deficit Hyperactivity Disorder (ADHD) on YouTube in terms of issues, sources, and episodic-thematic aspects. A total of 685 videos uploaded onto YouTube between 2006 and 2014 were content analyzed. Results demonstrated that the top three key issues about ADHD were symptom, child, and treatment. Doctor, patient, and supporter were the three most interviewed sources. Videos from the public sector including the government, company representative, and public organizations were relatively rare compared to other sources suggesting the potential for a greater role for the government and public sector contributions to YouTube to provide credible information relevant to public awareness, campaigns, and policy announcements. Meanwhile, many personal videos in the episodic frame advocated social solutions. This result implies that YouTube videos about health information from the private sectors have the potential to affect change at the social level.

"Listen to your body": Participants' alternative to science in online health discussions

We present a discursive psychological analysis of how the idiomatic expression “Listen to Your Body” is deployed in online forum discussions about ADHD medication and aspartame. The Listen to Your Body device allows participants to demonstrate to others that they take their health seriously and for that reason avoid scientific knowledge. They contrast Listen to Your Body with “blindly following science,” presenting Listen to Your Body as the more critical and, therefore, more rational behavior. Instead of treating the idiomatic expression as “anyone’s knowledge,” speakers and recipients compete for the right to own it. It is discussed what these results mean for the role of and relation between experiential knowledge (“lay expertise”) and scientific expertise in online discussions about health issues.

An Ethnographic-Discursive Approach to Parental Self-Help Groups: The Case of ADHD

Mutual aid groups have become a common form of help in the mental health field. Although self-help groups are associated with a range of health and social benefits, they remain poorly understood in terms of the dynamics of their interactions. Adopting an ethnographic-discursive approach, we conducted a 6-month observation of the meetings of a self-help group of parents with children diagnosed with attention deficit/hyperactivity disorder (ADHD) to analyze the discursive dynamics of the interactions that characterized the group. Using a set of discursive strategies and practices, the parents promoted a homogeneity of viewpoints and experiences within the group and constructed a shared and consensual narrative to endorse a specific understanding of ADHD. The production of both homogeneity within the group and a shared narrative served to absolve parents of guilt, helped parents to signify their experience within a blaming social context, and preserved their identities as "good parents."

The impending globalization of ADHD: notes on the expansion and growth of a medicalized disorder

Attention Deficit Hyperactivity Disorder (ADHD) has been medicalized in the United States since the 1960s. Primarily used in North America until the 1990s, ADHD diagnosis and treatment have increasingly been applied internationally. After documenting the expansion of ADHD in a global context, this paper presents five brief international examples examining ADHD usage and expansion: the United Kingdom, Germany, France, Italy and Brazil. We then identify and describe several vehicles that facilitate the migration of the ADHD diagnosis: the transnational pharmaceutical industry; the influence of western psychiatry; moving from ICD to DSM diagnostic criteria; the role of the Internet including the related advent of easily accessible online screening checklists; and advocacy groups. Finally, we discuss what this globalization of a diagnosis reflects about the potential global medicalization of other conditions.

Negotiating parental accountability in the face of uncertainty for attention-deficit hyperactivity disorder

Despite extensive research into attention-deficit hyperactivity disorder (ADHD), parents' constructions of their children's behaviors have received limited attention. This is particularly true outside North American contexts, where ADHD is less established historically. Our research demonstrates how United Kingdom parents made sense of ADHD and their own identities postdiagnosis. Using discourse analysis from interviews with 12 parents, we show that they drew from biological and social environmental repertoires when talking about their child's condition, paralleling repertoires found circulating in the United Kingdom media. However, in the context of parental narratives, both these repertoires were difficult for parents to support and involved problematic subject positions for parental accountability in the child's behavior. In this article we focus on the strategies parents used to negotiate these troublesome identities and construct accounts of moral and legitimate parenting in a context in which uncertainties surrounding ADHD existed and parenting was scrutinized.

Attention deficit/hyperactivity disorder blame game: a study on the positioning of professionals, teachers and parents

Attention deficit/hyperactivity disorder is currently the most debated childhood psychiatric diagnosis. Given the circulation of competing perspectives about the 'real' causes of children's behaviour and the 'best' way to treat them, we aim to analyse the interactions of the central social actors' discourses about attention deficit/hyperactivity disorder children within the Italian context. Adopting a multi-method approach, we focus on the polyphonic chorus of voices surrounding the child, studying the discourses of mental health professionals, teachers and parents. These actors are representative of three contexts that are deeply engaged with attention deficit/hyperactivity disorder: medical institutions, schools and families. Our theoretical and methodological approach integrates positioning theory, the Bakhtinian notion of dialogical thinking and discourse analysis to study stakeholders' reflexive and interactive positioning in terms of the attribution of rights, duties, responsibilities and power issues. The results show that mutual blame is a constitutive element of relational dynamics among the key adults surrounding attention deficit/hyperactivity disorder children. We argue that these conflicting relationships are not merely related to the debate regarding the validity of the attention deficit/hyperactivity disorder diagnosis. Rather, the mutual blame centres on questions of compliance, recognition of authority and morality. Through the blame game, adults negotiate their own and others' subjectivity in ways that simultaneously (re)produce power relationships and resistance efforts.

Gendering attention deficit hyperactivity disorder: a discursive analysis of UK newspaper stories

Discursive psychology is used to study the gendering of attention deficit hyperactivity disorder in UK national newspapers in the period of 2009-2011. The analysis examines how gendering is embedded in causal attributions and identity constructions. Attention deficit hyperactivity disorder is portrayed as a predominantly male phenomenon with representations of attention deficit hyperactivity disorder being gendered through extreme stories about victims, villains or heroes that depict boys and men as marginalised, exceptional or dangerous. There is also a focus on mothers as the spokespersons and caretakers for parenting and family health while fathers are rendered more invisible. This contributes to our understanding of how attention deficit hyperactivity disorder is constructed in the media using a range of gendered representations that draw on cultural stereotypes familiar in Western societies.