Post on 22-Feb-2023
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Owning up to Complexity:
A Socio-cultural Orientation to ADHD
Jack S. Damico, Ph.D., Nicole Müller, DPhil,.
And
Martin J. Ball, Ph.D.
The University of Louisiana at Lafayette
Address: Jack S. Damico, Ph.D. P.O. Box 43170 The University of Louisiana at Lafayette Lafayette, Louisiana 70504-3170 (337) 482-6551 jsdamico@louisiana.edu
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Abstract
To enrich our conception of ADHD, it is necessary to take a wider orientation to this
disability category than has traditionally been advocated. Over the past decade there has been an
emerging conception of ADHD from a social-cultural perspective and this orientation, when
linked to the traditional bio-medical perspective, provides a more accurate and authentic
construct of ADHD. In this article, we advocate that speech-language pathologists approach
ADHD with a mindset that is open to the complexities of context-bound human functioning at all
levels. Four sources of data demonstrating the richness of the socio-cultural orientation are
presented and clinical implications are detailed
Keywords: ADHD, complexity, socio-cultural perspective
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Attention Deficit Hyperactivity Disorder (ADHD) has been discussed as a medical
condition with various psychological and educational implications since its first entry as a
diagnostic category in the Second Edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-II) (American Psychiatric Association, 1968). From this first mention as
“hyperkinetic reaction of childhood” until the more commonly recognized label of ADHD, the
assumption has been that this disability category represents a subtle neurological deficit resulting
in a negative impact on affect, behavior and learning (e.g., Cantwell, 1996; Castellanos, 1997).
Consistent with this orientation, the vast majority of articles focusing on this disorder take a bio-
medical perspective (Damico, Damico, & Armstrong, 1999).
This predominant medical orientation has created a set of beliefs about the nature of
ADHD that have informed both our perceptions of ADHD and our clinical practices. As a result,
ADHD is listed in both the Diagnostic and Statistical Manual for Mental Disorders (DSM IV-
TR) (American Psychiatric Association, 2000) and the 10th edition of the International
Classification of Diseases (ICD-10) (World Health Organization, 2002) as a medical condition
and it has a long history of medical diagnosis and pharmacological treatment (e.g., Frick &
Lahey, 1991; Reid, Maag, & Vasa, 1994; Klasen, 2000; Safer, 1997). For the most part, this
perspective has been successful. Many of the issues currently addressed in the literature of
ADHD and even the majority of the articles in this volume show the advantages of this
traditional orientation and its various clinical applications.
The Emerging Social Perspective on ADHD
Over the last decade, however, an emerging orientation has gained attention and appears
to hold promise for extending and enhancing our clinical practices regarding ADHD; namely the
consideration of ADHD from a socio-cultural perspective. This orientation views ADHD as
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multi-faceted and more complicated than originally conceived (e.g., Cantwell, 1996; Hill &
Cameron, 1999; Klasen, 2000). For example, Whalen and Henker (1997) have advocated a view
of ADHD as a unique constellation of problems arising from both biological and social/
contextual variables that often result in negative impact in multiple domains of functioning. For
this reason, an individual diagnosed as ADHD may not present apparently consistent symptoms.
Rather, he/she may exhibit different symptoms at different times and in different situations. This
is due to the fact that the manifestations of ADHD are heavily influenced by various contextual
variables (Jensen, Mrazek & Knapp, 1997). Indeed, multiple experiences with this observation
have prompted some researchers and clinicians to refer to ADHD as an “environmentally
dependent disorder” (Powler, 1994). Based on experiences like this one, there is a call for
greater variation in conceptualization of ADHD and in how this conceptualization informs both
the kinds of treatment advocated and the contexts within which treatment occurs (e.g., Barkley,
1998; Cherkes-Julkowski, Sharp, & Stolzenberg, 1997; DuPaul & Eckert, 1997; Mulligan, 2001;
Pelham & Gnagy, 1999).
Thus there is now a body of work that advocates the description and interpretation of the
behavioral symptom-complex collectively labeled as ADHD within the multiple, nested complex
systems represented by the human organism interacting with its environment. Complex systems
have been variously defined (see e.g. Bar Yam, 1997; 2003). A classic definition of a ‘problem
of organized complexity’ is that of a problem that involves ‘dealing simultaneously with a
sizable number of factors which are integrated into an organic whole’. (Weaver, 1948: 539).
A readiness to embrace the notion of complexity in general and the importance of socio-
cultural variables operating within ADHD specifically is effectively demonstrated in Barkley’s
(1997a) “biopsychosocial model” of ADHD. As an attempt to create a unified model of ADHD,
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Barkley has woven together the different elements of this disability condition and stressed the
need to focus on the potential biological substrate, its psychological operational impact, and the
social reactions that might act to reduce or exacerbate these psychological manifestations (see
Damico, Tetnowski & Lobdell, this volume). As a leading researcher and author in the area of
ADHD, Barkley’s increased emphasis on social and contextual variables has significantly
extended the awareness of the socio-cultural facet of ADHD. Importantly, such an emphasis
encourages a richer perspective on ADHD; one that involves the more complex and socially
relevant phenomena that are so important to our understanding of ADHD and how it operates in
the real world. By employing such a socio-cultural perspective, we are better able to recognize
the complexity of issues involved with ADHD and its impact on individuals identified as
exhibiting this disability. This awareness and knowledge, in turn, can increase the effectiveness
and efficacy of our ADHD service delivery.
Given the promise and importance of the socio-cultural orientation to ADHD, this article
will highlight some of the emerging issues within the socio-cultural perspective. By reporting on
some of the social and cultural issues involved in ADHD, we aim to provide the practicing
clinician with a richer conception of this disability category, its social implications, and a
perspective of how ADHD operates as a component of social action. Based upon these
considerations, some specific implications for ADHD service delivery will be discussed.
Relevant Data Sources Generated by the Socio-cultural Orientation
While there are a number of important socio-cultural issues and data points that can
enrich our conception of ADHD and inform our service delivery, we will discuss only a few.
However, through these examples of relevant data and concepts we hope to illustrate the
advantages and necessity of employing this more inclusive socio-cultural orientation to ADHD.
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ADHD as a Synergistic Phenomenon
Within the last decade the emerging orientation to ADHD as a more socio-cultural
phenomenon has employed an application of systems-theory as an explanatory mechanism. This
particular version of systems-theory recognizes that social phenomena such as the behaviors
manifested by students with ADHD are synergistic in nature. That is, they are dependent on the
complex and dynamic interplay between the genetic/biological traits of the individual and the
myriad variables available in the environment (e.g., Bateson, 1972; Weaver, 1993). In fact, it is
this very interplay between the internal and external environments that uniquely characterizes
those behaviors that are symptomatic of ADHD. Within this synergistic conception, there is
little need to engage in a debate regarding the impact of the biological/neurological variables
versus environmental/contextual variables as causal factors in ADHD. Rather, this disability
condition is viewed as consisting of both dimensions. That is, the individual’s traits and
characteristics (e.g., lack of inhibitory capacity) interact with environmental/contextual factors
(e.g., classroom teacher’s expectations) to influence one another and create the behavioral
manifestations that we have come to expect in ADHD. In fact, one might even suggest that a
strict dividing line between internal and external factors, or factors pertaining to an individual
human being versus factors pertaining to the environment in which this human being functions is
an artificial construct. A human being does not function ‘context-free’, and every observed
behavior should therefore be described and analyzed as a contextualized, rather than an isolated
phenomenon.
Weaver (1993; 1994) has discussed the implications of a systems-theory approach to
ADHD. She suggests that the best understanding of ADHD is as a social construct and that it
should be viewed not so much as a disorder but, rather, as a “set of dysfunctional relationships
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between an individual with certain predispositions and an environment that generates certain
expectations, demands, and reactions.” (1993: 80). Perhaps the most important point taken from
this socio-cultural concept is that the synergistic characterization of ADHD is consistent with
Barkley’s emphasis on environmental/contextual variables. That is, the impact of the complex
internal states summarized and diagnosed, or labeled, as ADHD will interact with, and may be
exacerbated by environmental/contextual constraints, demands, and expectations. The key, then,
would be to recognize the transactional impact of not only the individual’s behavioral
predispositions but also the impact of the environment on these predispositions.
ADHD as a Contested Diagnostic Category
Once ADHD is viewed from a socio-cultural perspective, even the concept of ADHD as a
disability category becomes a more complex issue. In reality, ADHD is not an objective and
easily verifiable empirical construct, that would be comparable to and quantifiable in the same
way as, for example, brain damage after CVA. Rather, it is a social construct and it has been
argued that the diagnostic criteria employed for its identification have been constructed on the
basis of a number of socio-cultural factors that mirror the prevailing ideologies in vogue at any
given time (e.g., Reid, Maag, & Vasa, 1994; Shaywitz, Fletcher, & Shaywitz, 1994). This means
that the diagnostic category of ADHD may be complicated by ambiguity and subjectivity and
this lack of definitional rigor may result in various types of problems.
Most relevant to the clinical context, the socio-cultural perspective situates ADHD as a
potentially contested diagnosis. That is, there may be controversy surrounding the legitimacy of
ADHD as an authentic disability category. In his book, Illness and culture in the postmodern
age, Morris (1998) has discussed this possibility for a number of illnesses and/or diagnostic
categories. He has suggested that ADHD and some other socially constructed diagnostic
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categories (e.g., Gulf war syndrome, chronic fatigue syndrome, multiple personality disorder)
may be defined as “postmodern illnesses”. This term is used for categories of illness or
behavioral states that are vaguely and subjectively defined and that are controversial with regard
to their legitimacy as real illnesses. According to Morris, these diagnostic categories often
puzzle mainstream medicine, are sensationalized and augmented by the popular media, are
confusing to the general public and have a tendency for abuse by working professionals.
Morris explains this pattern of attention and abuse by suggesting that rather than
legitimate and objective disease states or disability conditions, these specific illnesses represent
changing patterns of human experience and affliction that are shaped by the convergence of
biological states, cultural beliefs and social actions. In fact Morris and others (e.g., Armstrong,
1997a; Breeding & Baughman, 2001; Klasen, 2000) express concern regarding whether these
postmodern illnesses are real biomedical conditions or just exaggerated responses to other socio-
cultural stresses or expectations. For example, Armstrong (1997b) has suggested that the
labeling of a child as ADHD may often be less the result of a neurological condition and more
due to a developing tendency of society to treat teachers’ and parents’ anxieties regarding
childhood by routinely drugging children into good behavior; that is, social control through
medication.
In the case of ADHD, there are legitimate concerns regarding the actual diagnostic
category. A number of researchers have expressed concern regarding ADHD’s vague set of
behavioral criteria and the lack of basic biological diagnostic certainty. This research indicates
that as a diagnostic entity, ADHD’s behavioral criteria are too vague and confusing to provide a
clearly delineated disability construct (e,g, Damico, Augustine & Hayes, 1996; Reid, Maag, &
Vasa, 1994; Shaywitz, Fletcher, & Shaywitz, 1994) and the existence of a biological etiology for
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ADHD is not substantiated; much of the research into the etiology of ADHD is inconclusive and
even contradictory. As stated by Reid, Maag, and Vasa, “...the nature of presumed underlying
organic deficits (if any) remains a mystery, and evidence in support of any particular etiology is
sparse.” (1994, p. 202).
As a general disease state or diagnostic category, of course, there are far more research
findings and publications that support the existence of ADHD. At worst, it is a controversial
topic. On an individual basis, however, the qualities inherent in this social construct (e.g., vague
and confusing diagnostic criteria, a tendency to employ to medication for behavioral control, the
ease of shifting responsibility to a disease state rather than parental or teacher effectiveness, or
other environmental factors such as the organization of the school day) may result in an over-
identification or misdiagnosis of children as ADHD. This tendency for the social construction of
disability, the assignment of handicapping labels, and an abuse of this social construct has
certainly been documented in other areas such as learning disabilities (Coles, 1988; Taylor,
1991). Of course, disabilities and handicaps are to an extent always socially constructed, in that
their perceived severity is context-dependent, and at least partly context-created. A quantifiable
impairment such as age-related reduction in hearing (even within ‘age-normal’ limits) may
constitute a career-destroying handicap for the conductor of a symphony orchestra, but not for
someone in a different walk of life. Consequently, as clinicians we should not simply reify
labels such as ADHD and consider them as ‘absolute’, objective categories. Rather, we should
be circumspect with regard to our beliefs about the validity of this diagnostic category. Above
all, we should carefully consider how important it is to properly identify children with true
ADHD and we should avoid the tendency to label children without definite and objective data to
support a diagnosis.
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Too often we operate within our cultural milieu without a critical analysis of our practices
and the conceptualizations that underlie them. The problem with this, of course, is that we might
become blind to our poorly justified practices or tendencies or we might ignore new or
inconsistent data that could potentially undermine our assumptions about what ADHD is and
how it should be addressed, and indeed who should be labeled ADHD. Therefore, we must be
circumspect with our current conceptualizations and practices. By employing a more socio-
cultural orientation, we can turn our analytic powers onto the very contexts and assumptions that
we often take for granted when working with ADHD and we can better serve the needs of our
clients.
The Influence of Social/Contextual Variables on ADHD
Inherent in the socio-cultural orientation to ADHD is the contention that the behaviors,
the diagnostic indices, and the consequences of ADHD do not exist or operate in isolation,
devoid of context or functionality; to make an impact, ADHD literacy must operate in a situated
context. This is the primary point of the synergistic description previously discussed.
On a practical level, this means that we must recognize that there are numerous social and
contextual variables that influence the impact of ADHD, and the severity of the symptoms so
labeled. Jensen, Mrazek and Knapp (1997) emphasize this point when they describe ADHD as a
“disorder of adaptation”. Based upon their research and experience, they discuss the fact that
ADHD may manifest itself differently in different environments. That is, a child may exhibit
different kinds of symptoms, at different degrees of severity, and even greater or lesser degrees
of success at a given constellation of tasks, depending on how the context (both physical and
social) reacts to his/her behavioral predispositions. In one context, the impact of the ADHD
might be significantly reduced while in another the problems might be exacerbated. In each
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case, it is the interaction of contextual variables with behavioral predispositions that make the
difference. An unfavorable constellation of factors (for example, repeated insistence on timed
activities carried out in sequence, in an inflexible schedule without sufficient ‘downtime’ on the
one hand, and a predisposition towards short attention span, and distractibility on the other) can
result in a positive feedback loop of reactions and behaviors that neither the child nor the persons
around him/her are capable of deconstructing. A review of the literature in ADHD does support
this “disorder of adaptation” contention (e.g., Cooper, 1997; DuPaul & Eckert, 1997; Mandal,
Olmi, & Wilczynski, 1999). Hill and Cameron (1999), for example, documented that the time-
on-task and the level and degree of over-activity in ADHD children are highly dependent on how
interested they are in a task initially and the kind of social encounter that is involved. Based
upon their data, they provide detailed instructions on how to be cautious in the screening and
identification of children with ADHD tendencies. Similarly, the comprehensive research of
Bussing and colleagues (e.g., Bussing, Schoenberg, & Perwien, 1998; Bussing, Schoenberg,
Rogers, et al, 1998; Bussing, Zima, Gary, & Garvan, 2003) details the influence of cultural,
racial, gender, and ethnicity factors in the identification and the assessment of ADHD. In much
of this research these variables tended to impact identification and the judgment of severity
regardless of whether the differences existed in the children being assessed or in the adults doing
the evaluations.
Social and contextual variables were even more pronounced when their impact on the
accessibility and effectiveness of treatment was studied. Ingram, Heckman and Morgenstern
(1999) found that the prognosis for treatment success for ADHD was heavily influenced by
many factors including the socioeconomic status of the family, the social interactions within the
family constellation, the ways that the family handled adversity, the personality traits of the
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individuals that interacted with the ADHD child. Research has documented many other socio-
cultural variables as well. The type, degree and frequency of intrinsic rate of reward during
treatment (e.g., Corkum, Rimer, & Schachar, 1999; Damico, Augustine & Hayes, 1996), the
kinds of explanatory models that the family has regarding ADHD (e.g., Bussing, Schoenberg, &
Perwien, 1998; Bussing, Schoenberg, Rogers, et al, 1998; Corkum, Rimer, & Schachar, 1999),
the ease of accessibility to treatment (Bussing, Zima, & Berlin, 1998a), the cultural, racial, and
ethnic backgrounds of the children (Bussing, Zima, Berlin, 1998b; Weisz, Suwanlert, Chaiyasit,
et al, 1988 ), even the parents perceptions of ADHD and the efficacy of the interventions (e.g.,
Barkley, Anastopoulos, Guevremont, & Fletcher, 1992; Bussing, Schoenberg, Rogers, et al,
1998; Bussing, Zima, Gary, & Garvan, 2003; Weisz, Suwanlert, Chaiyasit, et al,1988) are all
examples of how ADHD service delivery is influenced by social and contextual variables. To
best meet the needs of our clients with ADHD, therefore, it is essential that we account for as
many of these variables as is possible. The socio-cultural perspective provides us with the best
opportunity meet these requirements.
The Impact of ADHD on Significant Others
Our final example of socio-cultural issues that can enrich our ADHD service delivery
involves the impact of ADHD on the social context itself. In a very detailed analysis of the
social facets of ADHD, Frederick and Olmi (1994) noted that not only are children with ADHD
more likely to be rejected by their peers, the ADHD operates to modify the social context so that
all social interaction is negatively affected. Campbell, Endman, & Bernfeld (1977), for example,
found that teachers who focused on the behaviors of a child with ADHD tended to direct more
negative attention to their classes in general than when compared with teachers that did not have
children with ADHD present. Similarly, Cantwell (1996) Barkley (1997b), and Powler (1994),
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documented problems with the social relationships and the contexts within which social
encounters occur as a result of ADHD.
One area of detailed research looks at the effects of ADHD on the family constellation
and the social context that is created and employed in homes where an individual with ADHD is
present. In this work, Lewis-Abney (1993) found significant negative correlates of family
functioning in the presence of ADHD and Kendall (1997; 1998; 1999) found similar difficulties
when investigating the impact of ADHD on the diagnosed child’s siblings, on the ways in which
the social aspects of ADHD negatively affected the families, and on how much additional effort
families were required to employ to reduce the negative influence of ADHD in the social context
of the home. This negative influence was present across the age range from young children
through to adolescence. Indeed, Barkley, Anastopoulos, Guevremont & Fletcher (1992) noted
significant negative changes in mother-adolescent interactions that carried over to family belief
systems. Clearly, the ADHD negatively influenced not only the social abilities of the identified
individuals but the abilities of those around them as well. Given the importance of social and
contextual variables in treatment accessibility and prognosis, this information is quite
problematic.
Clinical Implications from the Socio-cultural Orientation to ADHD
While these four data sources reveal only a portion of the valuable information that can
be derived from the socio-cultural orientation to ADHD, the data described and the concepts
employed suggest several important implications for ADHD service delivery.
First, these data sources support the conception of ADHD as a complex social
phenomenon. Consequently, it is important that the practicing clinician adopt a more robust
conception of ADHD, one that is more socially situated and more contextualized. It is not
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enough to take a biomedical perspective; as with all human phenomena, social and cultural
factors do hold sway and must be taken into account.
Second, with regard to service delivery, the approaches to both assessment and
intervention must be more reflective of the underlying complexity of ADHD as situated in the
socio-cultural context. Assessment must be more functional, descriptive, and contextualized
(e.g., Damico, Damico & Armstrong, 1999; Hill & Cameron, 1999; Maag & Reid, 1994;
Mandal, Olmi, & Wilczynski, 1999) and there needs to be a move away from a reliance on norm-
referenced tests that are poorly suited to describe the behaviors noted in ADHD (Barkley, 1998).
Additionally, care should be taken when employing singular approaches to assessment and this
caveat applies most specifically to rating scales (Vitaro, Tremblay & Gagnon, 1995; see Pierce
and Reid, this issue). Since the context is so important to the impact of ADHD, any assessment
should strive to employ comparisons within the classroom contexts and comparison “norms”
should always be determined (Fabiano & Pelham, 2003). As the phenomenon under analysis,
ADHD is simply too complex to allow a simplistic notion of assessment.
With regard to treatment, the approaches employed must be specifically designed to fit
the needs of the particular child (Conners, 2000) and to account for the constellation of variables
that affect prognosis. Barkley (1995) has advocated a ten principle-centered approach and while
it has been primarily directed toward parents, it is designed to address both the synergistic nature
of ADHD and the need for incorporating the socio-cultural context. By striving for consistency
and focusing on the actual symptoms, these principles create both a developmental and a
functional intervention framework.
Third, in order to learn more about the complexity of ADHD from a socio-cultural
perspective, there needs to be a greater focus on research and research methods that can address
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the complexity of ADHD and that can do so within an authentic context. This can be
accomplished by employing qualitative research methodologies that are designed to address
complexity rather than ignore it (Damico & Simmons-Mackie, 2003). Within the area of ADHD
research there have been a number of excellent demonstrations of how qualitative research can
be employed (e.g., Bussing, Schoenberg, & Perwein, 1998; Bussing, Schoenberg, & Rogers,
1998; Damico & Augustine, 1995; Fabiano & Pelham, 2003; Kendall, 1997; 1998; 1999;
Kendall, Hatton, eckett, & Leo, 2003; Reid, Hertzog, & Snyder, 1996; Weisz, Suwanlert,
Chaiyasit el at., 1988) but much more is needed.
Finally, the practicing speech-language pathologist must be circumspect in how they
approach the construct of ADHD. Once we employ a socio-cultural orientation that may
enhance the bio-medical perspective, we must be willing to constantly employ all our analytic
skills to ensure that we account for this enriched construct and its complexity. To do otherwise
reduces our effectiveness and the potential improvement of our ADHD clients.
Conclusion
When dealing with children diagnosed as ADHD we will be more efficient and effective
in the long run if we embrace the reality of the multiply nested complex system that interacts in
all aspects of human functioning. We need to be capable of contextualizing a medical diagnosis,
such as a diagnosis of ADHD, and then we should strive to discover the reality behind the label
and the individuality of each client’s condition. As we mentioned above, each handicapping
condition and disability is a social construct. We may add here that how we deal with
handicapping conditions and disabilities is equally socially constructed, and the ideological, or
theoretical, orientation of the ‘expert’ (the pediatrician, child psychologist, speech-language
pathologist) is of crucial importance here. A context-bound, socio-cultural outlook on ADHD of
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necessity needs to adopt the stance reminiscent of what Luria (1987b, p. 6) calls “romantic
science”, namely an approach that attempts “neither to split living reality into its elementary
components nor to represent the wealth of life’s concrete events in abstract models that lose the
properties of the phenomena themselves. It is of utmost importance to romantics to preserve the
wealth of living reality, and they aspire to a science that retains this richness.” This “wealth of
living reality”, the functioning of a child diagnosed with ADHD, and her/his family members, in
the multiple contexts of daily life, may not lend itself to a reductionist approach of quantification
(in Luria’s terms (1987a) the “classical” approach in science) as biological or physiological
factors that can be measured in a controlled setting. However, this does not mean that we can
ignore this ‘messy’ and complex reality. Indeed, this complexity is what socio-cultural
functioning is all about and to ignore it in our ADHD service delivery would be both
unsatisfactory and non-efficacious.
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References
American Psychiatric Association (1968). Diagnostic and Statistical Manual of Mental Disorders. (2nd ed.) Washington, DC. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.), text revision, Washington, DC. Armstrong, T. (1997a). Labels can last a lifetime. Learning, 24, 41-44. Armstrong, T. (1997b). The myth of the hyperactive child: Fifty ways to improve your child’s behavior and attention span without drugs, labels, or coercion. New York: Plume. Bar-Yam, Y. (1997) Dynamics of Complex Systems. Boulder, CO: Westview Press. Bar-Yam, Y. (2003) About complex systems. NECSI Guide: http://necsi.org/guide. Accessed July 2004. Barkley, R.A. (1995). Taking charge of ADHD – The complete, authoritative guide for parents. New York: The Guilford Press. Barkley, R.A. (1997a). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 12, 65-94. Barkley, R.A. (1997b). ADHD and the nature of self-control. New York: Guilford Press. Barkley, R.A. (1998). ADHD – A handbook for diagnosis and treatment (2nd Edition). New York: The Guilford Press. Barkley, R.A., Anastopoulos, A.D., Guevremont, D.C., & Fletcher, K.E. (1992). Adolescents with attention deficit hyperactivity disorder: Mother-adolescent interactions, family beliefs and conflicts, and maternal psychopathology. Journal of Abnormal Child Psychology, 20, 263-288. Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine Books. Breeding, J. & Baughman, F. (2001). The ethics of informed parental consent to the psychiatric drugging of children. Ethical Humanities and Science Services, 3, 175-188. Bussing, R., Schoenberg, N.E., & Perwien, A.R. (1998). Knowledge and information about ADHD: Evidence of cultural differences among African-American and white parents. Social Science and Medicine, 64, 919-928. Bussing, R., Schoenberg, N.E., Rogers, K.M., et al (1998). Explanatory models of ADHD: Do they differ by ethnicity, child gender, or treatment status? Journal of Emotional and Behavioral Disorders, 6, 233-242.
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Bussing, R., Zima, B.T., & Berlin, T.R. (1998a). Differential access to care for children with ADHD in special education programs. Psychiatric Services, 49, 1226-1229. Bussing, R., Zima, B.T., & Berlin, T.R. (1998b). Variations in ADHD treatment among special education students. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 968-976. Bussing, R., Zima, B.T., Gary, F.A., & Garvan, G.W. (2003). Barriers to detection, help-seeking, and service use for children with ADHD Symptoms. The Journal of Behavioral Health Services & Research, 30, 176-189. Campbell, S.B., Endman, M., & Bernfield, G.A. (1977). A three-year follow-up of hyperactive preschoolers into elementary school. Journal of Child Psychology and Psychiatry, 18, 238-249. Cantwell, D. (1996). Attention deficit disorder: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 978-987. Castellanos, F.X. (1997). Toward a pathophysiology of attention deficit/hyperactivity disorder. Clinical Pediatrics, 36, 381-393. Cherkes-Julkowski, M., Sharp, S., & Stolzenberg J (Eds.) (1997). Rethinking attention deficit disorders. Cambridge, MA: Brookline Books. Coles, G. (1988)The learning mystique: A critical look at “learning disabilities”. New York: Pantheon Books. Conners, C.K. (2000). Attention-deficit/hyperactivity disorder. Historical development and overview. Journal of Attention Disorders, 3, 173-191. Cooper, P. (1997). Biology, behaviour and education: ADHD and the bio-psycho-social perspective. Educational and Child Psychology, 14, 31-38. Corkum, P., Rimer, P., & Schachar, R. (1999). Parental knowledge of attention deficit hyperactivity disorder and opinions of treatment options: Impact on enrollment and adherence to a 12-month treatment trail. Canadian Journal of Psychiatry, 44, 1043-1048. Damico, J.S. & Augustine, L. (1995). Social considerations in the labeling of students as attention deficit hyperactivity disordered. Seminars in Speech and Language, 16, 259-274. Damico, J.S., Augustine, L., & Hayes, P. (1996). Formulating a functional model of attention deficit hyperactivity disorder for the practicing speech-language pathologist. Seminars in Speech and Language, 17, 5-20. Damico, J.S., Damico, S.K., & Armstrong, M.B. (1999). Attention-deficit hyperactivity disorder and communicative disorders. Child and Adolescent Psychiatric Clinics of North America, 8, 37-60.
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Damico, J.S. & Simmons-Mackie, N.N. (2003). Qualitative research and speech-language pathology: Impact and promise in the clinical realm. American Journal of Speech Language Pathology, 12, 131-143. DuPaul, G.B. & Eckert, T.L. (1997). The effects of school-based interventions for ADHD: A meta-analysis. School Psychology Review, 26, 5-27. Fabiano, G.A. & Pelham, Jr., W.E. (2003). Improving effectiveness of behavioral classroom interventions for attention-deficit/hyperactivity disorder: A case study. Journal of Emotional and Behavioral Disorders, 11, 122-128. Frederick, B.P., & Olmi, D.J. (1994). Children with attention-deficit/hyperactivity disorder: A review of the literature on social skills deficits. Psychology in the Schools, 31, 288-296. Frick, P.J., & Lahey, B.B. (1991). The nature and characteristics of attention-deficit hyperactivity disorder. School Psychology Review, 20, 163-173. Hill, P. & Cameron, M. (1999). Recognizing hyperactivity: A guide for the cautious clinician. Child Psychology and Psychiatry Review, 4, 50-60. Ingram, S., Hechman, I., & Morgenstern, G. (1999). Outcome issues in ADHD: Adolescent and adult long-term outcome. Mental Retardation and Developmental Disability Research Review, 5, 243-250. Jensen, P.S., Mrazek, M.D., Knapp, P.K. et al (1997). Evolution and revolution in child psychiatry: ADHD as a disorder of adaptation. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1672-1679. Kendall, J. (1997). The use of qualitative methods to generate wellness-enhancing strategies for ADHD children and their families. Journal of Child and Adolescent Mental Health Nursing, 10(4), 27-38. Kendall, J. (1998). Outlasting disruption: The process of reinvestment in families with ADHD children. Qualitative Health Research, 8, 839-857. Kendall, J. (1999). Sibling accounts of ADHD. Family Relations, 38, 117-136. Kendall, J., Hatton, D., Beckett, A., & Leo, M. (2003). Children’s accounts of attention deficit/hyperactivity disorder. Advances in Nursing Science, 26, 114-130. Klasen, H. (2000). A name, what’s in a name? The medicalization of hyperactivity revisited. Harvard Review of Psychiatry, 7, 334-344. Lewis-Abney, K. (1993). Correlates of family functioning when a child has attention deficit disorder. Issues in Comprehensive Pediatric Nursing, 16, 175-190.
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Luria, A.R. (1987a). The Man with a Shattered World. Cambridge, Mass: Harvard University Press. Luria, A.R. (1987b). The Mind of a Mnemonist. Cambridge, Mass: Harvard University Press. Maag, J.W. & Reid, R. (1994). Attention-deficit hyperactivity disorder: A functional approach to assessment and treatment. Behavioral Disorders, 20, 5-23. Mandal. R.I., Olmi, D.J., & Wilczynski, S.M. (1999). Behavior rating scales: Concordance between multiple informants in the diagnosis of attention deficit/hyperactivity disorder. Journal of Attention Disorders, 3, 97-103. (Morris, 1998). Mulligan, S. (2001). Classroom strategies used by teachers of students with attention deficit/hyperactivity disorder. Physical and Occupational Therapy in Pediatrics, 20(4), 25-44. Pelham, W.E. & Gnagy, E.M. (1999). Psychosocial and combined treatments for ADHD. Mental Retardation and Developmental Disabilities Research Review, 5, 225-236. Powler, M. (1994). Briefing paper on ADHD. Washington, DC: National Information Center on Children and Youth with Disabilities (NICHCY). Reid, R., Hertzog, M., & Snyder, M. (1996). Educating every teacher, every year: The public schools and parents of children with ADHD. Seminars in Speech and Language, 17, 73-90.. Reid, R., Maag, J.W.,& Vasa, S.F. (1994). Attention deficit hyperactivity disorder as a disability category: A critique. Exceptional Children, 60, 198-214. Safer, D.J. (1997). Central stimulant treatment of childhood attention deficit hyperactivity disorder: Issues and recommendations from a US perspective. CNS Drugs, 7, 264-272. Shaywitz, S.E., Fletcher, J.M., & Shaywitz, B.A. (1994). Issues in the definition and classification of attention deficit disorder. Topics in Language Disorders, 14, 1-25. Taylor, D. (1991). Learning denied. Portsmouth: Heinemann. Vitaro, F., Tremblay, R.E., & Gagnon, C. (1995). Teacher ratings of children’s behaviors and teachers’ management styles: A research note. Journal of Child Psychology and Psychiatry and Allied Disciplines, 36, 887-898. Weaver, C. (1993). Understanding and educating students with attention deficit hyperactivity disorder: Toward a system theory and whole language perspective. American Journal of Speech-Language Pathology, 2, 79-89.
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Weaver, C. (Ed.) (1994). Success at last! Helping students with AD(H)D achieve their potential. Portsmouth, NH: Heinemann. Weaver, W. (1948). Science and complexity. American Scientist, 36, 537-544. Weisz, J.R., Suwanlert, S., Chaiyasit, W. et al. (1988). Thai and American perspectives on over- and undercontrolled child behavior problems: Exploring the threshold model among parents, teachers, and psychologists. The Journal of Nervous and Mental Disease, 181, 401-408. Whalen, C.K. & Henker, B. (1997). Attention deficit/hyperactivity disorder. In T.H. Ollendick & M. Hersen (Eds.). Handbook of Child Psychopathology. (3rd Edition). (pp 181-212) New York: Plenum Press. World Health Organization. (2002). International Classification of Diseases (ICD-10). Geneva: World Health Organization.
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Self Evaluation Questions for Owning up to Complexity:
A Socio-cultural Orientation to ADHD
1. The Emerging Perspective of ADHD a. Provides a clearer vision of pharmacological issues in ADHD b. Employs an experimental research format as its primary innovation c. Provides a socio-cultural view of ADHD d. Requires a focus on bio-medical issues
2. Barkley’s biopsychosocial model of ADHD: a. Focuses greater attention on pharmacological treatment b. Stresses the impact of prior schooling c. Provides a greater emphasis of a triad of variables d. Reduces the focus on social variables in ADHD
3. A “post-modern” critique of ADHD:
a. Reviews the literary contributions of authors with ADHD b. Questions the existence of ADHD as a diagnostic category c. Advocates a language arts approach to intervention d. Provides an analysis of ADHD as portrayed in fiction
4. Which of the following may be seen as a cognate of ADHD in terms of its identity as a
postmodern illness? a. Heart Disease b. Diabetes c. AIDS d. Multiple Personality Disorder e. Traumatic Brain Injury
5. When referring to ADHD as a “disorder of adaptation”, the intent was to highlight:
a. The manifestations of ADHD are overt b. The manifestations of ADHD require conscious effort to exhibit c. ADHD is independent of the context d. The manifestations of ADHD are context dependent e. The manifestations of ADHD are medically fragile
Answers: 1-c 2-c 3-b 4-d 5-d