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07-SEPTEMBER-2008 03:17:44 - construct theory of ADHD This article or section has multiple issues. Please help improve the article or discuss these issues on the talk page. It reads like a personal reflection or essay. Tagged since March 2008. It may be too long. Some content may need to be summarized or split. It may need to be wikified to meet 's quality standards.Tagged since March 2008. It may require general cleanup to meet 's quality standards. Tagged since March 2008. Attention-deficit hyperactivity disorder ADHD is listed as a developmental, neurobehavioural disorder, widely recognized by the medical and scientific community as causing impairment, especially in children. Still, scientists can't conclusively state what causes ADHD. Social critics question whether whether ADHD is wholly or even predominantly a biological illness. Critics outside of majority or minority opinion on this topic, maintain that ADHD and ADD were invented and not discovered, 1 saying that the symptoms associated with ADHD are ordinary adolescent behavior and not a true condition. They believe that no disorder exists and that the behaviour observed is not abnormal and can be better explained by environmental causes. The theory does not state that individuals across a behavioral spectrum are identical neurologically and that their life outcomes are equivalent. It is not surprising for PET scan differences to be found in people at one end of any behavioral spectrum. The theory simply says that the boundary between normal and abnormal is arbitrary and subjective, and hence ADHD does not exist as an objective entity, but only as a 'construct'. Contents 1 ADHD as a social construct 1.1 Questioning the genetic basis of ADHD 1.2 Alternatives to medication 1.3 Successful use of medication does not prove the disorder 1.4 Criticism 2 External links 3 Further reading 4 References ADHD as a social construct Psychiatrists Peter Breggin and Sami Timimi oppose pathologizing the symptoms of ADHD. Sami Timimi, who is a NHS child and adolescent psychiatrist, explains ADHD as a social construct rather than an objective 'disorder'.2. Timimi argues that western society creates stress on families which in turn suggests environmental causes for children expressing the symptoms of ADHD. 3 They believe that parents who feel they have failed in their parenting responsibilities can use the ADHD label to absolve guilt and self-blame. A common argument against the medical model of ADHD asserts that while the traits that define ADHD exist and may be measurable, they lie within the spectrum of normal healthy human behaviour and are not dysfunctional. However, by definition, in order to diagnosed with a mental disorder, symptoms must be demonstrated as maladaptive. In this view, in societies where passivity and order are highly valued, those on the active end of the active-passive spectrum may be seen as 'problems'. Medically defining their behaviour by giving a label such as ADHD serves the purpose of removing blame from those 'causing the problem'. This model would require removing non-hyperinteractive forms of attention deficit into a completely distinct diagnosis. Evidence presented against the social constructionist view comes from a number of studies that demonstrate significant differences between ADHD and typical individuals across a wide range of social, psychological, and neurological measures as well as those assessing various areas of functioning in major life activities. More recently, studies have been able to clearly differentiate ADHD from other psychiatric disorders in its symptoms, associated features, life course, comorbidity, and adult outcome adding further evidence to its view as a true disorder.4 5 6 7 Questioning the genetic basis of ADHD There are radically different opinions between researchers in the field and other critics about whether there is a genetic basis. While there have been repeated articles citing physical differences in the brain of those with ADHD most of these have not stood up.citation needed Xavier Castellanos MD, then head of ADHD research at the National Institute of Mental Health NIMH, and firmly convinced that ADHD is a biological illnesscitation needed, acknowledged that little is known about ADHD in the 2000 interview with Frontline 8. Alternatives to medication Social critics question if environmental changes should be the main line of treatment for those with a diagnosis of ADHD, instead of the medical model which predominantly usess medication and to a lesser extent, behavior modification.who?They believe schools and the health system force children to conform to a narrow, predefined standard of child development.citation neededThese critics believe that these institutions are propagating the dangerous viewpoint that children with ADHD are maladaptive and disabled simply because they do not conform to a socially constructed norm.who? Some people including retired neurologist and CCHR medical expert Fred Baughman have suggested that this viewpoint is ultimately being pushed by the pharmaceutical industry in order to sell Anti-ADHD drugs.9 Moreover, the argument against ADHD asserts that changing the child through medication regimes may cheat them of certain unique and positive personal characteristics that in turn may limit our collective future. For example, Ben Franklin was notorious for being a failure in the public education system yet became a highly regarded scientist, statesman, and public servant. Hartmann 2003 points out that had Ben Franklin been forced to fit in, the American Revolution may have never happened.10 Successful use of medication does not prove the disorder Nor does evidence of successful treatment persuade the social constructionist; for example the American National Institute on Drug Abuse 11 reports that Ritalin is abused by non-ADHD students partly for its ability to increase their attention. Evidence showing that ADHD is associated with certain liabilities does not appear to undermine this view either; normal-variant behavior could have certain liabilities as well, and a life outcome cannot be predicted with certainty for any given diagnosed individual.citation needed Criticism Critics of the social constructionist view contend that it presents no evidence in support of its own position. Proponents of the view disagree that criteria for falsifiability are lacking. One way, for example, is to show that there exists an objective characteristic possessed by virtually all diagnosed individuals which does not exist in any non-diagnosed individual. Current candidates for falsifiability include PET scans, genes, neuroanatomical differences, and life outcomes. However, none of these have been shown to be precise predictors of a diagnosis or lack thereof.citation needed Such criteria are generally fulfilled by well-understood medical diseases.citation needed Critics of this view also assert that it is not consistent with known findings. For instance, they claim that ADHD is as frequent in Japan and China as in the UScitation needed, yet in such societies which supposedly favor child obedience and passivity one would expect higher rates of ADHD if this theory were correct.clarify However, this is also disputed on the grounds that more aggressively obedient societies may suppress 'symptoms' of rebellion or 'ADHD'. Of course, whether or not the societies of Japan and China value passivity and obedience is not experimentally verified; calling them such amounts to stereotyping.citation needed Additionally, rates of medical diagnoses in China cannot be a reliable indicator of ADHD prevalence, especially for such non-life-threatening disorders as ADHD, due to the large peasant population in that country who cannot easily seek the services of a trained child psychologist. Timimi's view has been seriously criticized by Russell Barkley and numerous experts in Child and Family Psychology Review 2005. In any case, it has been shown that Chinese and Indonesian clinicians give significantly higher scores for hyperactive-disruptive behaviors than did their Japanese and American colleagues when evaluating the same group of children.12 Significant differences in the prevalence of ADHD across different countries have been reported, however 13. Timimi himself cites a range of prevalence that goes from 0.5% to 26% as support for his theory. External links Further reading Joseph, J. 2000. Not in Their Genes: A Critical View of the Genetics of Attention-Deficit Hyperactivity Disorder, Developmental Review 20, 539-567. References ^ http://www.nexusmagazine.com/articles/ADHDisbogus.html Extract from Nexus Magazine, Australia, by Bob Jacobs, PsyD, JD © September 2004 ^ http://bjp.rcpsych.org/cgi/content/full/184/1/8 Timimi, 2002 ^ Timimi, S. Begum, M. 2006. Critical Voices in Child and Adolescent Mental Health. London: Free Association Books. ^ Sami Timimi and Eric Taylor 2004 In Debate: ADHD is best understood as a cultural construct. The British Journal of Psychiatry 184: 8-9. ^ Taylor, E., Chadwick, O., Heptinstall, E., et al 1996 Hyperactivity and conduct problems as risk factors for adolescent development. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1213 -1226. ^ Taylor, E., Sandberg, S., Thorley, G., et al 1991 The Epidemiology of Childhood Hyperactivity.Maudsley Monograph No. 33. Oxford: Oxford University Press. ^ Meltzer, H., Gatward, R., Goodman, R., et al 2000 Mental Health of Children and Adolescents in Great Britain. London: Stationery Office. ^ PBS - frontline: medicating kids: interviews: xavier castellanos, m.d ^ adhdfraud.org ^ Hartmann, T.2003. The Edison Gene: ADHD and the Gift of the Hunter Child. VT: Park Street Press. ^ InfoFacts - Methylphenidate Ritalin ^ E. M. Mann, Y. Ikeda, C. W. Mueller, A. Takahashi, K. T. Tao, E. Humris, B. L. Li, D. Chin 1992. Cross-cultural differences in rating hyperactive-disruptive behaviors in children. American Journal of Psychiatry 149 11: 1539-1542. ^ http://adc.bmjjournals.com/cgi/content/full/90/suppl_1/i10 Dwivedi, 2005 Retrieved from http://en..org/wiki/Social_construct_theory_of_ADHD Hidden categories: articles needing style ing from March 2008 | All pages needing to be wikified | Wikify from March 2008 | Cleanup from March 2008 | All pages needing cleanup | All articles with statements | Articles with statements since March 2008 | Articles with statements since April 2008 | Articles with specifically-marked weasel-worded phrases | Articles with statements since October 2007 | Articles with statements since February 2007 | articles needing clarification Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 11 July 2008, at 01:36
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