Exploring ADHD

An ethnography of disorder in early childhood

Simon Bailey

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781136316678
• Topic: Bildung
• Subtopic: Bildung Allgemein

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed psychiatric condition of childhood worldwide, yet the medical and psychological perspectives that dominate our understandings of ADHD present problems in their reductive understanding of the condition. Exploring ADHD incorporates Michel Foucault's notions of discourse and power into a critical ethnographic framework in order to analyse ADHD in terms of both the historical conditions that have shaped understandings of the disorder, and also the social conditions which build individual diagnostic cases in today's schools and families.

In this ground-breaking text, Simon Bailey also:

• acknowledges the necessary work of classrooms, schools and families in contributing to a social order;
• examines the problem of teacher autonomy and the constraints placed on schools to 'perform';
• describes the role of nurture groups in governing the emotional conduct of children;
• presents a unique gender analysis of ADHD.

This fascinating new book will be of interest to researchers and academics in the field of early childhood education, special and inclusive education, and will illuminate and spark new debate in the arena of ADHD.

1

INTRODUCING ADHD

Attention Deficit Hyperactivity Disorder (ADHD) has become the most commonly diagnosed psychiatric condition of childhood worldwide (Timimi, 2005b). In this book I offer a sociological perspective on ADHD, and its place in the life of the school and family. The prevalent professional viewpoint on ADHD in the UK is that it is a biologically based disorder, with causal factors in genetics and neurochemistry (Kutcher et al., 2004). This perspective goes on to claim that impairing symptoms of impulsiveness, hyperactivity and attention deficit will present in sufferers from an early age and will continue in some form into adulthood. One of the most controversial claims of this argument is the need for pharmacological intervention, and the trend whereby more and more young people are being placed on some form of psychoactive drug has attracted much contestation (Miller and Leger, 2003). This contestation has fuelled a politically charged and polarised debate about ADHD, circling around the somewhat intellectually stale question of its existence. ADHD also has an increasingly successful life in popular images; Bart Simpson has it, popular films and songs reference it, a new magazine in Liverpool, UK, adopts it as a name and mission statement: ‘ADHD – Attention Deficit in High Definition – magazine is a free arts and culture publication, with few words, where you can let your mind wander free’ (King, 2012).

My focus here is on the process of diagnosis and the production of the medical perspective on ADHD through the school and family. I will argue that everyday practices shape the social coordinates required for the application of a diagnosis. A simple analogy for this argument would be the preparation of ground ready for the ideal growth of a crop. Pursuing this analogy a little further, I argue that such practices derive from embedded assumptions concerning growth and development, and well-intentioned attempts to nurture robust and healthy crops. Such practices, assumptions and attempts can become concealed beneath names such as ADHD, and what follows in this book is an attempt to attract attention to some of these everyday means of ADHD production.

One of the key places I will locate this analysis is in the representations made of ADHD and of those personally and professionally associated with it. This focus on representation derives from Foucault’s (1972) use of the term discourse, through which he analysed what we know and how we come to know it. I follow Hall (1997) in using the term representation to talk about discourse in terms of practices which signify a certain ‘mode of seeing’ (p. 65). I will begin the analysis with a recent example of ADHD representation in the popular media.

Popularising ADHD

On the 13 August 2008, the US swimmer Michael Phelps became the most decorated Olympian in the modern history of the games; much media attention followed. The only article I read on the subject was printed in the Guardian the following day (Kelso, 2008). I might not have read the piece at all if my eye had not been caught by a striking photo of Phelps in mid-butterfly stroke taking up much of the page. Beneath the photo was stated: ‘Phelps was diagnosed with attention deficit disorder as a young child. He competed in his first Olympics at age 15.’ Eager to know the significance accorded this particular piece of information I read on, however the one further mention I found merely restated the photo sub-line: ‘Diagnosed with attention deficit disorder as a young child, he became an Olympian at 15 and now stands as the athlete with more golds than anyone in history.’

Given such little information only questions remain. What is the significance of this particular piece of information, which made it worth selecting from Phelps’ personal history? What point is the newspaper trying to make? What knowledge must the paper be assuming of its audience in order to print this information in this obscure way? How well and widely known must ADD/ADHD have become in order for these assumptions to be made?

When I first came to know about ADHD, over 20 years ago, it was not at all well known. I know now that there was still a significant research literature at this time, but I do not think the popular media would have been able to assume audience knowledge in the manner implied by the Phelps example. Even when I started studying ADHD academically, almost 10 years ago, I still had to explain what the four letters stood for to the majority of people. That is no longer the case. Now ADHD, hyperactivity and Ritalin are common parlance: if we read about an Olympian with a diagnosis of ADD we should all know what that means.

Bourdieu (1984) wrote that, ‘the power to impose recognition depends on the capacity to mobilise around a name’ (p. 481). The Phelps example suggests that a considerable capacity has mobilised in the name of ADHD, but what recognition is being imposed through such a mobilisation?

It could be speculated that the newspaper is using the diagnosis to emphasise the magnitude of the achievement: these gold medals mean that much more because of the past adversity faced by the athlete. The image of the proud, patriotic, disciplined Olympian is held up against its own real-life abject, the disaffected, disruptive, anarchic youth: this one came good. But then, the opposite could be speculated, perhaps the diagnosis is being used to tame the out-of-this-world achievement: the athlete was pre-conditioned toward Olympic success through his hyperactive, obsessional nature. All he required was the right outflow for all that excess energy, a place where a pathological inability to pay attention would not be a problem.

Foucault (1996a) argued that focusing on ‘the play of the true and false’ should divert attention away from such speculations, instead questioning the manner in which something becomes known as true or false. This line of questioning will be pursued in greater detail in the following chapters, for the purposes of introduction, it seems that ADHD represents something and that it is conceived as something important regarding Phelps’ historic achievement.

If this is the case then surely I should not be required to speculate upon this subject. I have spent much of the last ten years studying ADHD, surely I should know by now what people with ADHD represent and why that should be important for the attainment of Olympic swimming medals? That I really should know what all this means is further shaped by the fact that Phelps and I share more than a love of swimming: I was also diagnosed with ADHD as a young child. Yet I am putting this information forward here as a means to disrupt these assumptions of representation and meaning. According to these assumptions, Phelps and I must share some essence; I should be able to look at the newspaper article and feel solidarity. If anyone should be allowed to get sentimental about Phelps’ achievement then it should be me (and others of our kind) because we understand what it is he’s been through. Yet of the two known similarities between us, vis-à-vis swimming and pathologisation, I am undecided as to which is the more coincidental and devoid of deeper meaning.

This is not to say that I accord ADHD an insignificant role within my current occupation. It is to say that I am perpetually unsure of what the precise meaning of this role is. I see this as a strength; a ‘privilege’ as Haraway (1988) might describe it. My experiences, first at home and school, later at work, in relationships, and in academia, have had much influence on my choice of topic. I do not use my experience to suggest that I represent any particular group; indeed the idea that I do makes me distinctly uncomfortable. I do not wish to wage war on the medical profession. Nor do I use it to suggest I have some unique formula; the ADHD kid come good, carries with it a conceited and hypocritical sentimentality I do not wish to replicate here. I do, however, wish to question the cultural assumptions implied by the Phelps example in a way that goes beyond deconstructing the superficial binaries of the mass media.

Four years on, the 2012 Olympics, and Michal Phelps won a further four Olympic gold medals, making him the most decorated Olympian in history with 22 medals in total, 18 of which are gold. He has since retired. This time the Guardian ran a piece which asked: ‘What can athletes with ADHD teach us about the condition?’ (Barkham, 2012). Along with Phelps, two more Olympic athletes, Louis Smith and Ashley McKenzie, are introduced to us as having ADHD:

Suddenly, a condition that is hugely stigmatised and still controversial, is unexpectedly in the spotlight. It raises several interesting questions. Does ADHD hinder or help sporting success? And can the Olympics offer a positive legacy for people suffering from it?

(Barkham, 2012)

Interesting questions indeed. The article continues, describing the young Phelps seeking ‘sanctuary’ from his condition in the swimming pool; how Louis Smith learned ‘discipline’ via gymnastics; and how McKenzie ‘credits judo with saving him from prison’. Of the three athletes discussed, McKenzie is presented as the one with the greatest struggle; unable to take medication for his ADHD because it is banned in judo, the story tells how he struggles to ‘control his behaviour’.

While it certainly flirts with a dualism of good and bad, embodied by Phelps and McKenzie respectively, the newspaper article progresses with some more balanced reasoning, via the thoughts of Andrea Bilbow, founder of ADDISS, a charity and support service for ADHD. She states: ‘Your ADHD isn’t going to get you there, it’s hard work that will. ADHD is not a contributor towards success but equally it is not a barrier to success.’ Having realigned Olympic success with hard work, Bilbow goes on to state that many children find sport a constructive means of ‘managing the condition’, and criticises the prevalent norms in many schools, who ‘scoff at the disorder, believing there are only naughty children – and bad parents’, a scenario which often results in sporting opportunities being taken away from children with ADHD as a punishment for bad behaviour. The article concludes optimistically, suggesting that athletes such as Phelps and McKenzie should be used to inspire children ‘who are having a miserable time at school’.

I have spent a little time going through this article, not because I believe it to be a particularly outstanding piece of writing, but because it offers a succinct way in to many of the issues presented by the existence of this thing called ADHD, which are to be the subject of further exploration throughout this book.

First, there is the assumed existence of the thing itself. This is an independent force called ADHD which exerts particular pressures on the bodies and minds of children, producing particular expressions, utterances and behaviours from them. It is something that people ‘suffer from’ and ‘live with’; it becomes the ‘bad person within’. There is much contention around this issue and yet it has become a stale and polarised debate between those who claim that ADHD is real and those that claim it is a myth (Laurence and McCallum, 1998; Bailey, 2008). Though intellectually stale, this is a highly political debate with many stakeholders and many interests: the professional interests of psychiatrists and other mental health practitioners, the financial interests of pharmaceutical companies, and the interests of the social and economic order as embodied by governments, teachers and parents.

A thing like ADHD does not have an existence independent of all these other things any more than a domestic cow has an existence independent of the production of milk and beef. This is not to say, however, that either cows or ADHD have no reality at all. Certainly the behaviours associated with ADHD are real enough, as is the distress frequently caused to, and by, those who are so labelled. Rather, what it means to destabilise the reality of a thing in this manner is to prompt a questioning of the social and cultural structures beneath which lie assumptions and expectations which shape the perceived nature of things.

The sociologist Howard Becker (1963) advanced this premise in the simplest of terms with his argument in Outsiders: creating a norm creates positions on both sides of it, it creates those on the inside and those on the outside. Therefore, rather than talking about a ‘delinquent’, ‘deviant’, or ‘criminal’ as a set of more or less essential characteristics, as independent forces in themselves, we might instead talk about them in terms of their position according to the social norms which have produced the categories of ‘legal/illegal’, ‘good/bad’, ‘normal/abnormal’ and so forth. The liberatory potential of this premise is that rather than there being a thing such as a criminal, with essential and largely unchangeable characteristics, there are instead norms, rules and codes which are socially defined and which can be changed. To do so, however, requires the assumptions that keep them in operation to be disturbed.

It is very difficult to make these argument in relation to ADHD without it being perceived by many of those stakeholders mentioned above that you are siding with the myth makers: understood as denying the very existence of ADHD, and that you have no capacity to care for the suffering it produces, that you are a radical, a theorist with no interest in empirical realities, only a political agenda (Barkley, 2002). In the past decade I have worked with many different stakeholders in the world of ADHD, and I have been called many of these things in one form or another. Yet I reject the very terms of the debate. I am well aware of the realities of what is perceived to be abnormal behaviour and the sense of alienation that accompanies it. I do not seek to undermine or deny such experiences in anyone labelled with ADHD. One of the attempts I make in this book is to seek a language that can inhabit (Derrida, 1967) this dichotomy of myth/reality, that can acknowledge the multiple realities and the multiple myths that surround, shape and give meaning to ADHD, and that can seek to disturb certain myths without making accusations of falsehood at children, parents, teachers and doctors. This attempt has been described as providing critical support (Lloyd et al., 2006).

The second issue the article presents is discipline, which it invokes in two senses: the discipline of sport which the Olympian must subject him or herself to in order to achieve success, and the disciplinary practices of schools, in this case the exclusion of children from sporting activities as a punishment for bad behaviour. Discipline is also of fundamental importance to the arguments in this book, channelled via the work of Michel Foucault, which will be introduced in more detail in Chapter 2.

The two variants of discipline in the newspaper invoke the use of discipline as both an object and an action, and as both a means of external control and self-regulation. The aspiring athlete attempts to discipline him or herself through the discipline of sport – the first usage is the verb, the action: I discipline myself, you discipline yourself – the second usage is the object: the discipline of sport, which is separated into many separate disciplines: swimming, athletics, gymnastics and so on, each constituted by a set of practices. Practice, like discipline, can be both object and action, and discipline and practice are deeply embedded in one another: in order to discipline oneself, one must practise, a set of practices makes up a discipline. Practice and discipline are therefore objects and actions that can be applied to bodies in order to achieve particular things, and to produce particular outcomes.

These distinctions are semantic, but they are more than this as well. The distinction between object and action in the use of discipline and practice, draws out the more difficult distinction between self and other. In the newspaper article, this distinction is drawn with relative clarity. Regarding the self, there is the discipline that the aspiring athlete subjects themselves to in the interests of achieving Olympic success. Regarding the other, there is the punitive practice of the school through which the badly behaved child is made an object of discipline. Within the context of the newspaper article, the fact that it is about something, ADHD, makes the distinction very easy to break down: the athlete sought the discipline of sport as a means to discipline the behaviour that was not sanctioned by the school. The active self-subjection was therefore presupposed by...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Abbreviations
• 1 Introducing ADHD
• 2 Time, space and possibility
• 3 Children, schools and families
• 4 Routine conduct
• 5 Boys will be boys
• 6 Invisible parentwork
• 7 The nurturing formula
• 8 Another order is possible
• Appendix I
• Appendix II
• Appendix III
• Appendix IV
• Appendix V
• Notes
• Bibliography
• Index