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Examining the Stigma of ADHD Diagnosis and Treatment Approaches
The notion that ADHD treatment aims to foster relationships and enhance self-esteem, rather than solely focusing on correcting a ‘malfunctioning brain,’ might initially seem overly sentimental. However, consider the controversial assertion in Martine Hoogman’s 2017 study. She emphasized the importance of interpreting data as validating that individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) possess “altered brains.” Her rationale was that this biological explanation would “help to reduce the stigma of ADHD.” Yet, does framing ADHD as a “brain disorder” genuinely lessen stigma? Could informing a young person they have a brain disorder actually amplify their feelings of shame and isolation?
Conflicting Perspectives on ADHD Diagnosis: Empowerment or Disempowerment?
Australian psychologist Luise Kazda investigated this precise question. In a 2021 review, she and her colleagues analyzed 14 studies indicating that receiving an ADHD diagnosis generated a sense of “empowerment.” This empowerment stemmed from “supporting a sense of legitimacy accompanied by understanding and sympathy as well as decreased guilt, blame and anger.” Conversely, in 22 other studies, Kazda observed that “a biomedical view of difficulties was shown to be associated with disempowerment.” She noted that “By providing an excuse for problems, a decrease in responsibility by all involved can occur, often followed by inaction and stagnation.” Furthermore, 14 additional studies revealed that the diagnosis heightened feelings of stigmatization. Kazda stated, “The diagnosis can create an identity that enhances prejudice and judgment,” which in turn, “are associated with even greater feelings of isolation, exclusion and shame.”
The Dichotomy of Diagnostic Messages
The reasons behind the profound impact of an ADHD diagnosis on certain children and their families remain somewhat unclear. However, it is evident that under the conventional medical model, a diagnosis conveys a significantly different message than in alternative frameworks, such as Sonuga-Barke’s model. This alternative perspective views ADHD symptoms, at least partially, as a result of incompatibility with a specific environment.
Medical Model Stigma versus Environmental Context
For some parents, attributing their child’s struggles to ADHD, a “medical condition,” might feel less stigmatizing and more convenient. It allows them to rationalize the need for daily medication by stating, “My child has ADHD, a medical condition, so he needs to take this medicine every day.” This contrasts with acknowledging, “I want my child to thrive in environments they are unsuited for, therefore I want him to take these pills.” However, for numerous children, an ADHD diagnosis communicated through the prevalent medical model can feel like an enduring label, exceeding mere stigma. The message often conveyed is that ADHD is a definitive, biological category. If symptoms align with this category, it implies a brain deficit and a disorder.
An Alternative Perspective: Environment and Continuum of Symptoms
In contrast, an alternative model offers a different narrative. It suggests that ADHD symptoms exist on a spectrum, where everyone falls somewhere. A child’s experience of these symptoms may arise as much from their surroundings as from their inherent nature. Consequently, alterations in their environment could potentially modify these symptoms over time. With this understanding, both the child and their family can collaboratively decide if medication is appropriate, weighing potential benefits against drawbacks. Simultaneously, they can explore modifications to the child’s school or home environment that might alleviate symptoms. If co-existing psychological conditions, such as anxiety, depression, or post-traumatic stress, are present, these deeper issues can be addressed independently of challenges with focus in academic settings.
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