The connection of ADHD and Social Deviance

Julie Alender

SOC3400

Social Deviance

5386 W. Calimyrna

Fresno, CA 93722

559-312-4823

email: jalender@capellauniversity.edu

Instructor: Professor Jennifer Worley

Over the past forty years there has been an dramatic increase in the diagnosis of ADHD and ADD in children and adults. There is a dramatic impact on children and their families once the child is diagnosised and labeled as ADHD. The medical industry and pharmaceutical companies have been benefiting from the diagnosis of child and adults with ADHD with the prescriptions of medication and overutilization. ADHD can be considered the medicalization of deviance when the diagnosis removes responsibility from society and the individual who has deviant behavior. This attitude continues the perpetual production of perpetrators of deviance.

Medicalization is by definition the extension of medical jurisdiction or the expansion of medical boundaries. Medicalization studies reveal how nonmedical problems become diagnosis as medical. Current perceptions of ADHD and the treatment can be seen as the medicalization of deviance by taking away the accountability of the actions. An example of this deviant behavior is a 38 year old security guard has had 128 job since leaving college. He was diagnosed with ADHD. There is no background given on why the guard was diagnosis with ADHD, but if he didn't show up for work or was lazy that may be a reason for why he had some many job in 15 years not because of ADHD. "Adult ADHD has now become the foremost self-diagnosed condition in my practice . I fear that the condition can allow an adult patient to find a biological cause that is not always reasonable, for job failures, divorce, poor motivation, lack of success, and chronic depression" (Shaffer 1994) (Thio, Calhoun, & Conyers 2010)

Attention Deficit Hyperactivity Disorder became well known in the 1960's due to the controversies regarding drug treatment. Childhood hyperactivity was first considered a medical diagnosis in the 1970's. The primary identification of children with ADHD is behavior primarily in a school setting. The first treatment for children with ADHD is Ritalin . The use of Ritalin brought increased attention to the diagnosis of ADHD because of the drug treatment imposed on children. By the mid 1970's ADHD was the most common childhood psychiatric problem.

When children are diagnosed with ADHD this medicalization of a set of behaviors as a syndrome or condition this then allows the rationalization of the use of drug treatments as a form of social control that results in the removal of political control of deviance, "by defining the overactive, restless and disruptive child as hyperkinetic we ignore the meaning of behavior in the context of the social system." (Conrad, 1975) Once a diagnosis of ADHD has been arrived at, the pressure is on to ‘treat it’, most commonly with Ritalin, a form of methylphenidate. This is the medicalization of deviance. (Watson, 2010)

Despite adoption of the ‘biopsychosocial model’ of ADHD, which understands the condition as a complexity of factors, the professional blaming of parents among doctors, educators and others is still widely found. "Bad parenting" is often cited as the cause of ADHD. Medical diagnosis of the problem can therefore absolve parents from blame, (Watson, 2010)

Both the ADHD child and his family will find that they attract a good deal of attention from school and other experts. They become subject to observation. Now any misdemeanor will be interpreted in the light of the diagnosis, and this tends to open up channels of communication between home and school that are generally negative, but this increased scrutiny may itself be productive of ‘undesirable behaviors' which further justifies the original diagnosis. (Watson, 2010)

Examination of insurance coverage. Dr. Albert Finch, executive medical director at Children's Hospital, said many pediatricians who would like to refer patients for more thorough mental-health evaluations when diagnosing ADHD find that insurance companies do not cover the evaluation. The fact that patients with ADHD participating in HMOs is frequently managed by primary care providers may partly explain the link between mental health care and general medical quality in these organizations. However, even in cases in which care is managed by a separate behavioral health organization, a health plan can influence quality of mental health care by the nature of the contract, including the use of performance standards and the degree of risk sharing. (The State of Managed Care Quality 2000. Washington, DC, National Center for Quality Assurance, 2000)

Chesapeake school psychologist LaVerne Alebiosu said she has her hands so full evaluating children for possible ADHD that little time is left for prevention efforts and for helping children who have already been diagnosed. (Simpson, 2001) There should be consideration given to hire more school psychologists. LeVerne said her studies of local school districts have shown that the children on medication and diagnosed with ADHD have higher rates of absenteeism, expulsions and repeating grades. So while the medication may be helping with symptoms, it's not always helping with schoolwork. (Simpson, 2001) Diagnosis in The United States has increased significantly in the last eighteen years. The estimated range of diagnosis is extremely skewed as a result of the methods used in the diagnosis process combined with the varying degrees of symptoms. The United States alone accounts for nearly 90% of the total ADHD diagnoses in the world (CDC, 2000).

The over diagnosis ADHD and ADD is an example of a disorder that is mixed in nature with psycho stimulant medications has simply satisfied the American need for a "quick fix". Unfortunately, this style of medical intervention has subsequently subjected generations of children to increased exposure and vulnerability of stimulant dependence (Armstrong, 2009)

The sociology theory that applies to children who have been labeled with ADHD is appropriately called "The Labeling Theory". This theory is relevant because children are being labeled as deviant when they are put into a category of being hyperactive or because there are not as focused as most children. "Some people maybe labeled deviant who in fact have not broken a rule"(Thio, Calhoun, & Conyers, 2010) People who have been labeled as a deviant share a common thread with other deviants in that they are considered outsiders to the social norms. Children who are labeled as ADHD has this label follow them through school and teachers can categorize them as troublemakers. Teachers have access to these records before they even meet the student and can make incorrect judgments. Treating a person as though he were generally rather than specifically deviant produces a self-fulfilling prophecy. (Thio, Calhoun, & Conyers, 2010)

The theory of adults with ADHD started in the late 1970's when children who had been followed with ADHD were now adults and still showed they symptoms related to the diagnosis. In the late 1980's publications were circulation that intended to tap into adults who had not been previously diagnosed with ADHD but showed the same symptoms. Psychiatric professional turned their attention to this new problem with clinics for adults with ADHD at Wayne State University and University of Massachusetts in Worchester. (Thio, Calhoun, & Conyers, 2010)

ADHD in adults present three different diagnostics problems. The first is the diagnosis must have been present in childhood. The second is it appears with other diagnosis (comorbidity) and third is that it mimics other disorders such as mood and borderline. A research on children who had ADHD by the time they were in their mid twenties only 8% met the criteria of having ADHD. (Schaffer, 1994)

"Adult ADHD has become the foremost self-diagnosed condition in my practice. I fear that the condition allows a patient to find a biological cause that is not always reasonable, for job failure, divorce, poor motivation, lack of success and chronic depression" (Schaffer, 1994) This self labeling and pursuit of diagnosis fuels the social engine of medicalizing certain adult troubles.

The medicalization of deviance removes responsibility from the individual. According to the “sick role” concept of Talcott Parsons (1953; 1975), sick people are not responsible for their conditions. Being sick is not a choice a person makes and it can be unagreeable as is not a matter of moral choice. People are “stricken” by sickness through no fault of their own. When people become sick are not to be held responsible or punished for their illness. Blaming behavioral problems on a genetic predisposition or chemical imbalance or on one’s parents, employer, and so forth, though at times there may be some basis for such claims, implies a biological or psychological determinism that is not entirely satisfactory for most social scientists. (Talcott, 1953; 1975) (Easterling, 2000)

The medicalization of deviance also removes responsibility from the society which continues the perpetual production of perpetrators of deviance. Even though a particular treatment program should actually help an individual or family, it will not have changed the social system which originally produced the problem. Medicalized deviance may be an individual’s problem in a narrow context, but it is at root a social problem. Jeffrey Reiman (1979) has stated that "the failure to focus on the social responsibility for deviance literally acquits the existing social system (hence, its oligarchic or Plutocratic leadership) of any charge of injustice". (Easterling, 2000)

The myriads of treatment programs (predominantly “for profit”) produce the convincing illusion that something worthwhile is being done about society’s “behavioral problems.” The use of the word “treatment” is deceptively comforting because it gives the impression that the problem is being “treated,”—i.e., alleviated, assuaged, “taken care of”—and by professionals, no less. “Oh well, we have a treatment program for that, so let’s worry about this other problem.” (Easterling, 2000)

The social costs of not implementing a deeply rooted social overhaul will be huge. Entire future generations will remain chained to addictions, abuses, exploitation, and insufficient social resources to maintain a state of relative health—physical, mental, and emotional well-being. The continued focus on microlevel solutions for society-wide problems will reinforce the abiding en- durance of these problems. (Easterling, 2000)

The medicalization of deviance creates a vested interest industry (Veblen, 1919) of politically and economically influential professionals whose very training and careers depend upon the treatment of individuals. There are treatment programs that been created to meet the challenge are usually associated with clinics and hospitals that see an opportunity with creating more services to treat adults with ADHD and profit from individuals and insurance companies. Not only do the patient with ADHD need treatment, but also the families. This tendency is financially beneficial to the hospitals and clinics, their stock- holders, therapists, physicians, and employees, their advertising agencies, the advertising media, and the pharmaceutical companies with chemical “solutions” for virtually every problem. (Easterling, 2000)

The sociology theory that applies to adults diagnosed with ADHD is the control theory. The reason this theory applies is because some adults are using ADHD to escape accountability for marital or job problems. The control theory assumes the existence of a common value system within the society or group whose norms are being violated. The control theory talks about attachment, commitment, involvement, and belief. To say to lack attachment to others is to lack attachment from moral restraints. To commit to conformity this means the person is invested in themselves, whenever deviant behavior is considered the investment he has made in himself. Involvement or engrossment in conventional activities is thought to be part of the control theory. Control theory assumes existence of a common belief system within a society or group. The control theory can be relevant to adults with ADHD because the deviant can rationalize his behavior so he can violate the rule and maintain his belief in it. This behavior can include loss of job, trouble with relationships, and or trouble with the law. (Thio, Calhoun, & Conyers, 2010).

Being labeled as an adult with ADHD can give an adult power to make excuses for their deviant behavior. Power was given to this label with increased media attention. Example of this was on the news show 20/20 Catherine Crier attributed to ADHD to a biologic disorder of the brain, Dr Timothy Johnson said as many as 10 million adult Americans have ADHD. The Ladies Home Journal highlighted a man that lost job after job and constantly interrupted his wife. This gentleman went on to founded the Adult Attention Deficit Foundation. The article enable heighten awareness of ADHD for adults which in turn created a job and increase income for the man who before could not keep a job.

Currently the behavior of patients with ADHD are controlled with different sympathomimetic stimulants such at methylphenidate, pemoline, and amphetamines. There is a concern with substance abuse when these medication are taken. Commonly when these medication are prescribed long term a secondary anti-depressant medication is also prescribed. There are ethical and medical implications of prescribing attention-boosting and mood-altering medications to healthy kids and adults. Due to the increase in prescriptions of stimulant medications the possibility of over diagnosis and overtreatment is clearly there. The stimulant medications can affect the brain, mood and rational thought. There is little known about the long term effects of sympathomimetic stimulants. Short term effects can be increased heart rate and blood pressure. The advantages of this method of medication control is that if someone truly has ADHD and the medication can help them focus or accomplish task if can be beneficially short term. I think long term the medication control can cause abuse and there is a negative stigma in communities with ADHD medication. The long term alternatives to medication are behavior modification, special diets, and vitamin supplements .

Policies that need to change is the realization that ADHD is a costly public health problem. A quick fix of medicating child and adults with ADHD is not the answer. Medical management treatment, although not as effective as combined medical management and behavioral treatment, is likely to be more cost-effective in routine treatment for children with ADHD, particularly those without comorbid disorders. For some children with comorbid disorders, it may be cost-effective to provide combination treatment. Without effective treatments, difficulties experienced by children with ADHD may continue or even increase into adulthood, resulting in possible justice system contacts and substance abuse troubles, as well as effects on ultimate rates of child abuse, crime, adult mental illness, and accidents with severe injuries. Economic studies of mental health services are rare in the literature and are especially scarce for specific children’s disorders, such as ADHD.

The total excess cost of ADHD in the US in 2000 was $31.6 billion. Of this total, $1.6 billion was for the treatment of patients, $12.1 billion was for all other health care costs of persons with ADHD, $14.2 billion was for all other health care costs of family members with ADHD, and $3.7 billion was for the work loss cost of adults with ADHD and adult family members of persons with ADHD. ADHD creates a significant financial burden regarding the cost of medical care and work loss for patients and family members. The annual average direct cost for each per ADHD patient was $1,574, compared to $541 among matched controls. The annual average payment (direct plus indirect cost) per family member was $2,728 for non-ADHD family members of ADHD patients versus $1,440 for family members of matched controls. (CDC)

In conclusion children with ADHD can be treated with behavior modification and medication for a short period of time. Parents should jointly make the decision with a physician if medication and behavior modification is warranted. The school should not be the one mandating medication. Adult ADHD should not be used as diagnosis to excuse deviant behavior. This actually give ADHD a bad reputation. Many adults are self-diagnosing, in contrast to the patterns of ADHD in children Self-diagnosis invokes the risk of a person seeking a biological cause for something in order to escape responsibility. In children, ADHD is often related to behavior; in adults, it is linked to underperformance. Misbehavior and underperformance both represent deviance from societal expectations. A diagnosis of ADHD offers a medical explanation for a person’s perceived underperformance, facilitating a reduction in self-blame. The extension of this medicalization of underperformance to adults has many implications for today’s society. The framework of ADHD perceives misbehavior as a chemical imbalance, not a reaction to a particular social situation.

References

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