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Rethinking ADHD: Integrated Approaches to…

Rethinking ADHD: Integrated Approaches to Helping Children at Home and at… (2002)

by Ruth Schmidt Neven

Other authors: Vicki Anderson (Author), Tim Godber (Author)

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One feature of how we view ADHD is the strongly held belief that it is a discrete and exclusively medical condition. This, as the authors argue in Rethinking ADHD – An Illness For Our Time, is a simplistic misrepresentation of the context of the problem – namely, the complex interrelationship between the children's psychological and physical aspects, their parents and family relationships and the wider community. Labelling ADHD as a disease shuts out consideration of the broader context and may lead to the child's isolation, the disempowerment of the parents and, ultimately, to misdirected treatment.

Rethinking ADHD attempts a new dialogue between neuropsychology and a psychodynamic understanding of child development within the broader social context. This interdisciplinary dialogue attempts to forge more creative links between an understanding of the physical aspects of brain activity associated with attentional processes and the psychological development of the mind and the child's capacity for thought. Central to this argument is a recognition that the attachment of infants and young children to their caregivers forms the emotional foundation for life and interacts with and gives rise to neurological functioning, thus contributing to the child's capacity for learning, social interaction and sense of self.

ADHD is an apt illness for our time since there has never been a time in western society when we have been as inundated and overwhelmed with demands on our attention from all quarters as we are today. These emanate from a variety of sources; from new technology; the media, from the tension associated with our reconstructed work settings and our changing family lives to name but a few. These competing and often contradictory demands on our attention contribute to ever increasing levels of fragmentation and an alarming sense of being out of control.

The irony is that this problem of fragmentation of attention is rarely viewed as a feature of the adult world and a sign of anxiety of the times but instead has become constructed as a problematic condition of childhood. This leads to the consideration of a hypothesis that at times of great social change and upheaval the most vulnerable members of society – children - become subject to limiting and constraining definitions of childhood that reflect this current turmoil. As the Australian epidemiologist Fiona Stanley observes: "Biological determinism always appears to be popular in eras of political conservatism."

The most significant change or indeed rebirth of an idea in our current times is one, which advocates a mechanistic world view, one that reframes children's behaviour within a bio-behavioural paradigm. This paradigm lends itself to a classification system of understanding children's emotional lives and fulfils contemporary economic rationalist demands for the complexity of children's problems to be reduced preferably to one single element such as ADHD that can be costed and "treated".

The bio-behavioural paradigm also fits neatly into what one might see as the current paradigm of childhood which could be described as the "commodified child". Within this paradigm childhood is not viewed as a useful status in its own right but is predicated on an assumption of promoting "product" and "outcome". The marketing mantra that "children are growing older younger" is one example of this assumption since it justifies the targeting of children as major consumers for a variety of products. The multi-million dollar industry that has grown up around providing drugs for problematic children may be seen as another example of children's apparent "demand" fitting in with a ready market "supply".

Once the individual context for behaviour is eliminated it becomes easier to refer to "populations" of children who can all be described through a common standardised "global symptom" that says: "They are all ADHD". An example of this kind of thinking in the UK was the decision by the government to commission the National Institute of Clinical Excellence to explore the possibility of prescribing trial prescriptions of psychostimulants to large populations of children diagnosed with the "combined type" ADHD, inattention, hyperactivity and impulsiveness.7 The cost of such a project appears to have been the main deterrent to proceed. However, the extraordinary assumption behind such an initiative suggests a conviction that we can "inoculate" large populations of children and adolescents against the expression of particularly troublesome behaviours in the same way that we can inoculate them against rubella or whooping cough.
  antimuzak | Oct 23, 2006 |
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Author nameRoleType of authorWork?Status
Ruth Schmidt Nevenprimary authorall editionscalculated
Anderson, VickiAuthorsecondary authorall editionsconfirmed
Godber, TimAuthorsecondary authorall editionsconfirmed
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