Underdogs on top : troubling positions for boys and a diagnosis of Attention Deficit Hyperactivity Disorder.
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Date
2017
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Abstract
Attention Deficit Hyperactivity Disorder (ADHD) accounts for one of the largest number of health referrals amongst children. As a mental health diagnosis, it has undergone multiple conceptual revisions over the years, where it is now classed as a neurodevelopmental disorder. ADHD remains a highly controversial subject, sparking debate at the interface of parenting responsibilities, effective schooling practices, predisposing trauma, and the ethics of the medicated child. In the midst of these debates, one of the strongest issues to emerge is the high proportion of boys that are diagnosed with ADHD, as well as the sex and gender divide in symptoms, referral, and treatment choice.
Lack of research involving children, particularly those with disabilities, highlights the limitations of ableist and developmental assumptions. Although there is a growing body of peer-reviewed literature on young people’s experiences of ADHD, these accounts tend toward the descriptive and fail to take account of how young people manage their condition as part of identity-making processes. Given the above, the main objective of the study was to understand how boys who were diagnosed with ADHD understood their illness and managed their condition in a school setting. Educators’ views were also sought to bring an adult perspective to this issue.
The study was guided by feminist post-structural ethnography, located at one public full service school named Riven Primary. Given the in-depth nature of the study, attention was also granted to situated performances of boys across Remedial and Mainstream learning spaces and public or private conversational spaces. Analysis focused on group interactions and private interviews with nine boys aged 9 to 11 years of age, all of whom had previously received a diagnosis of ADHD and medical forms of management. Five of these boys were enrolled in the on-site Remedial Unit, while four boys were based within the Mainstream section of the school. Separate focus group interviews were also held with Remedial and Mainstream educators from the site.
Analysis of the educator and boy accounts reinforce the power and prevalence of the biomedical discourse. Accounts of ADHD stigma was related to observed behaviours and public responses towards diagnosis and medication. Educators’ perceptions of risk and vulnerability associated with ADHD typically intersected with broader social assumptions of childhood, sex, and gender. For this group, three broad storylines emerged (flunk, hunk, or punk), which provide different claims as to the deterministic nature of ADHD and the levels of accountability for the child and the family system.
Medication was a powerful signifier for responsibility and success, among boys and educators alike. It was also symbolic of chronic illness and weakened masculinities. Boys were palpably aware of their ADHD-related social and educational vulnerabilities that rendered them as biologically faulty, underachieving, and unhinged outcasts. However, the label of ADHD or the experience of medication was not taken up by all boys in a one-dimensional manner. Instead, there were tendencies to reinforce, resist and, at times, reframe representations of the unruly ADHD child through resources and strategies that spoke to broader narratives of success, maturity, and heroism. In this regard, the so-called “Underdogs” worked very hard to regain credibility through discourses of shared disadvantage, as well as a passion and determination to succeed through adherence to the ADHD medication.
Boys were also careful not to take up illness positions when it rendered them powerless. Typically, masculine constructs such as sport and future employment were constructed as potentially enabling spaces for ADHD, in efforts to counter responses around illness and dependency on medication.
In general, the study findings resist the notion of ADHD as a singular, universal concept and instead make a cogent argument for the socially situated nature of the diagnosis. The feminist post-structural analytical frame helped to disrupt simplistic constructions of ADHD through making visible the impairments boys experienced at the interface of shifting social identifiers and in different conversational contexts. These situated performances ultimately worked to reframe their disabilities and masculinities in either beneficial or problematic ways.
Engaging in research that involves children with disabilities elevates discourses of risk, stigma, and protection. Working in these contexts makes visible the insecurities that plague research development and clinical practice, while also expanding considerations of what constitutes ethical conduct for adult stakeholders. In closing, recommendations are made for investing in strength-based or resiliency enhancing processes that help boys cope with the stigma associated with ADHD.
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Doctor of Philosophy in Psychology. University of KwaZulu-Natal, Durban 2017.