So far, this chapter has examined how ADHD has come to be a contested and controversial category. It has argued that changing historic definitions have contributed to the existing vagueness around the category, but that a pervasive concern with ADHD as a moral category has threaded itself throughout these shifting understandings and categorisations, in particular, through changing formulations of hyperactive and impulsive behaviour as a sign of social deviance, immoral weakness and criminality. Medical, psychological and social research has sought, respectively, to discover the organic, cognitive/emotional and
environmental foundations for this lapse of morality. As Horton-Salway (2011) points out, the discourse of morality continues to be woven throughout current literature relating to ADHD (Schubert et al. 2009; Rafalovich, 2008; Klasen and Goodman, 2000).
The chapter has also argued that controversy around the category remains due to issues relating to diagnosis, the causes of ADHD and medication. The
controversial and contested status of the category further implicates ADHD as a moral category. Controversial categories are, by their very nature, understood in different and contrary ways; these ways of thinking about and conceptualising such categories are created by processes of history which inform our
contemporary ideology (Billig et al., 1988). As outlined at the beginning of this chapter, dilemmas around organic versus environmental aetiology have influenced the debate around the category ADHD. The availability of contrary themes around a topic informs our (at a societal and individual level) thinking around a topic but, these contrary themes are also employed by us in our everyday discourse. In talking about controversial social phenomenon such as ADHD, we draw upon the linguistic resources, or interpretative repertoires (Edley, 2001a; Potter and
Wetherell, 1987; Gilbert and Mulkay, 1984), made available by each of the contrary themes and formulations of ADHD. Interpretative repertoires are
described as ‘the building blocks used for manufacturing versions of actions, self and social structures in talk … resources for making evaluations, constructing factual versions and performing particular actions’ (Wetherell and Potter 1992:90). As Billig et al. suggest the availability of competing linguistic versions of a
phenomenon means that the selection of a particular version over another expresses a moral evaluation. This is particularly true for a category such as ADHD whose aetiology is so strongly contested.
Biological versus psychosocial repertoires of ADHD
As outlined earlier, there are three competing versions as to the ‘truth’ about the causes of ADHD. First, that it has an organic provenance. Second, that it is socially produced. Third, that it is the combination of environmental factors and a genetic predisposition to the disorder. These different versions of the causes of ADHD perform distinct moral work, and make relevant very different subject positions (identities made relevant by the specific ways of talking) for the
individuals implicated by the categorisation (see Horton-Salway, 2011; Edley, 2001a). Horton-Salway’s study of the UK media (2011) indicated that the two main repertoires presented were the biological and psychosocial ones and she outlines how children and their parents are positioned within these different repertoires. Within the biological repertoire, the behaviour of children with ADHD is disruptive and problematic. However, crucially, this is a symptom of their neurobiological atypicality and, consequently, children, and their parents, are not to be blamed or held responsible for this behaviour. As Gray (2008) suggests, parents are
positioned as external to the child’s difficulties. Within a medical repertoire, it is not problematic for parents to seek medication for their children, as it is interpreted as acting in their best interests. Both child and parents are positioned as in need of support and intervention, in particular, medical and expert involvement in the life of the family. Certainly, existing literature suggests that parents, and, specifically, mothers seek medical diagnosis of their children’s behaviour (Bennett, 2007; Singh, 2004; Malacrida, 2001; Norris and Lloyd, 2000).
Within the psychosocial repertoire, a child’s unruly behaviour is represented as being socially deviant, for which environmental, social and cultural explanations are sought. Typically media representations of ADHD invoke modern life as a contributory factor in children’s disruptive behaviour (Horton-Salway, 2011). Children’s lives are portrayed as being adversely affected by excessive use of TV and computer games, excessive consumption of fizzy drinks and additives in food, and by a decline in discipline and social control. All of these factors are seen to contribute to children’s unruly behaviour. As it is parents who typically mediate between the wider social environment and their children’s lives, they are held responsible for their children’s behaviour. Consequently, as ADHD is not understood medically, then within this repertoire it is problematic for parents to seek a medical diagnosis. Medication is represented as being overprescribed, and
an extreme and inappropriate solution which, at times, is represented as abusive (Horton-Salway, 2011). Instead of medical intervention, within this repertoire, the behaviour of these ‘undisciplined’ children can be managed by intervention at a family level, such as through parenting classes.
The subject positions made available through this repertoire are very distinct from those made available within the biological repertoire. The child is represented as a ‘normal’ but socially deviant child in need of discipline. As parents are held, at least partially, responsible for this lack of discipline, they are positioned as ineffective and unskilled for the job of ‘parent’ (Horton-Salway, 2011). They are represented as lacking in discipline. This is in contrast to parents of the past, who are represented as having a disciplinary presence (Horton-Salway, 2011). The contrast with the past also makes relevant certain gendered subject positions: In particular, the traditional association of discipline with effective fathering. Within this repertoire, parents who seek to medicalise their child’s behaviour are
represented as self-interested, and even abusive, as discussed in the section on medication above.
However, despite the quite substantial disparities in diagnostic rates, persuasive arguments that posit the contributory role of the environment, and the fact that there is ‘no neurological, metabolic or attentional tests to confirm the existence of ADHD’ (Stolzer, 2009), the DSM’s medical classification of ADHD presents itself as ‘the truth’ and the everyday understanding of ADHD within many cultures is that it is a valid neurological disorder.