Introduction
ADHD is a complex mental health disorder predominantly diagnosed in children, but often persisting to adulthood. Although it can have a spectrum of different symptoms, mostly attention-deficit/hyperactivity disorder is characterised by increased impulsivity, difficulties in controlling attention, and hyperactive behaviour. ADHD severely complicates the life of people suffering from it, restricting their academic and organizational capabilities. Apart from solely medical impairments, the syndrome bears a psychological burden and social stigma. Children, whose behaviour does not fit the normalcy expectations are often criticized by adults and bullied by peers. Such attitudes lead to stigmatisation and further marginalization of individuals, imposing the feelings of self-blame and guilt and further psychological implications.
Although the term ADHD gained increased popularity and multiple discussions several decades ago, the comprehensive approach regarding both medical and social aspects is still lacking. There are two major ideas present in public opinion about ADHD. The first one sees the syndrome as a straightforward medical issue that can be easily managed and treated (Lloyd, 2003). The second trend is the caution regarding over-diagnosing and excessive labelling as an excuse for dysfunctional parenting (Lloyd, 2003). Both opinions offer a simplified version of a real situation, while the most clamant issues remain unanswered. It is evident that ADHD is a complicated disorder that has a broad spectrum of symptoms, and currently, medical treatment alone does not solve all the problems. Social adaptation of children with ADHD requires joint efforts of multiple stakeholders, including parents, teacher, mental health professionals, and children diagnosed with the disorder.
ADHD Disability as Medical and Social Construct
Medical Model of Disability for ADHD Patients
From the medical perspective, ADHD is a clinically diagnosed genetic condition that provokes conditions of hyperactivity and attention deficit and hinders the regular daily routine of an individual. Sedgwick, Merwood, and Asherson (2018, p. 241) consider that ADHD is a medically recognised disability due to “impairing levels of inattention, hyperactivity and impulsivity.” The syndrome causes states, in which a person finds normal functioning difficult, struggles with the education process, work, and behaviour control. Pharmacological treatment is used to mitigate the impact of the disorder and improve quality of life. According to Matheson et al. (2013, p. 2), stimulant treatment is recommended to reduce the negative effect of the syndrome. However, mental health care does not imply only the absence of an illness, but also includes the processes of recovery, adaptation, and coping. Thus, patients face a variety of challenges that cannot be solved with medication alone.
First of all, ADHD affects different aspects of life, such as family or interpersonal relationships, education, work, and quality of life, posing additional challenges of disability. Attention-deficit/hyperactivity syndrome is often followed by other mental health issues, such as depression, or anxiety caused by restlessness and failure to conform to behaviour norms and academic standards. People who are diagnosed with ADHD in late adolescence or adulthood are believed to suffer from the disorder more, due to limited understanding of their condition and absence of adequate treatment (Matheson et al., 2013, p. 2). They experience the burden of accumulated problems they need to face after the diagnosis, which could be avoided in case of an early diagnosis. Despite severe medical complications, the clinical burden of the disease comprises only a small proportion of ADHD challenges, as people with this disorder experience socialisation difficulties and suffer from socially constructed impairment.
Social Perspective on ADHD
Although ADHD is a medical condition, people diagnosed with it suffer not only from its direct impact but also from the social stigma and segregation entailed in it. Thus, the impairment of people with ADHD is socially constructed in a large proportion. The reason for this issue is that the main symptom of the syndrome implies a socially unacceptable behaviour that goes beyond normalcy expectations. Children suffering from ADHD face difficulties in controlling their emotions, organizing the work process, and managing their behaviour (Climie and Mastoras, 2015). Due to these issues, they suffer from negative public opinions and stigmatization “peer rejection and feelings of hostility in undiagnosed peers” (Mueller et al., 2012, p. 102). Such attitudes provoke negative mental states, such as low self-esteem, frustration, and depression, which, in turn, undermine their self-efficacy and cause further marginalisation. Thus, medical disability is not the only problem from which people with ADHD suffer. Social impairment undermines an individual’s beliefs about his or her capacity and mitigates the situation.
The social perception of the pathology is reflected in limited socialisation and marginalisation from groups of peers – the condition that has several grave implications for a person’s wellbeing. Stigma among peers is one of the most severe outcomes of ADHD that results in marginalization and hinders one’s success. It is necessary to note that not only children or adults with ADHD are stigmatised, but also their parents who are blamed for inadequate parenting. Apart from medical treatment, inclusion and creating of neurodiversity friendly environments are seen as the core solutions to approaching the social aspects of the problem. Additionally, strength perspective approach and affirmation models are used o confront the social construct of disability. Nevertheless, these tendencies are characterised with various complexities and cannot be implemented straightforwardly. Therefore, a vast scope of research should be conducted along with education programs to approach social aspects of ADHD.
Implications of Stigma in Life of People with ADHD
The social stigma placed on individuals either with diagnosed ADHD or showing its symptoms, is a heavy psychological burden that devaluates their achievements and undermines their well-being. The study conducted by Mueller et al. (2012) provides a meta-analysis of the empirical studies focusing on the implications that ADHD stigma has on well being of individuals. The analysed research recognises the dangers of the negative attitude of peers and other individuals towards the person with ADHD. According to the scholars, stigma is “an underestimated risk factor, affecting treatment adherence, treatment efficacy, symptom aggravation, life satisfaction, and mental well-being of individuals” (Mueller et al., 2012, p. 101). The scholars believe that such an attitude can significantly aggravate the situation, leading to psychiatric disorders from initially mild symptoms (Mueller et al., 2012, p. 102). The research discerns three types of stigmatisation, including public stigma, reflected in negative opinions about an individual. Moreover, there are also self-stigma or imposed feeling of limited capabilities, and courtesy stigma, which refers to the parents or other close associates of a person with ADHD.
Public stigma is seen both in public opinion represented in press, and attitudes of peers and adults towards a person with ADHD. For this treatment to occur, an individual must not necessarily be diagnosed with the disorder. Scholars argue that the behaviour is a strong predictor of peer’s beliefs about a person (Mueller et al., 2012). Moreover, the presence of a formal diagnosis and labelling play a decisive role in the attitude, as this behaviour is perceived as the symptom of an illness, not as a result of bad parenting. Apart from peer rejection, actions typical for ADHD provoke social distancing of adults and the negative attitude of teachers, especially when the diagnosis is unknown. Thus, public stigma leads to social impairment through the marginalisation of the person. Moreover, continuous scolding for the inability to control one’s behaviour and limited academic achievements cause self-stigma, which entails other mental health issues. Children with ADHD suffer from blaming and the feeling of guilt which deteriorates potential success.
However, not only the person with ADHD suffers from a syndrome-related social stigma, but also parents and close relatives experience blaming. Broomhead (2013) investigates blaming and self-blaming present in home-school communication. Mothers of children with ADHD are reported to experience regular blaming for the inability to manage their children’s behaviour when they demonstrate social difficulties (Broomhead, 2013, p. 15). These attitudes are not only self-reported by parents but also visible in the teachers’ responses. Moreover, parents who experience a social burden of poverty and unemployment are accused of bad parenting more often than those from economically secure families (Broomhead, 2013, p. 17). Thus, limited understanding of ADHD results on the imposed feeling of guilt and stigmatisation, which aggravate the situation for the patient.
Creating an Inclusive School Environment
As stigma and marginalization have a negative impact on people with ADHD, creating inclusive and neurodiverse environment seems to be a vital solution. Cordier et al. (2018) argue that children with ADHD possess necessary social skills but have difficulty in applying them in interactions with others. Thus the inclusion is seen as a driving force to “ improve the social functioning of children with ADHD” (Cordier et al., 2018, p. 1). Therefore, such interventions as peer proximity and peer inclusion are believed to be effective in the improvement of social skills among children with ADHD. Moreover, being in mainstream schools, children are integrated into society and experience less stigma. However, the primary limitation of the analysed research lies in the absence of accountability for the voice of children.
Given the mentioned above, the role of environment in the well being of children suffering from ADHD is immense. Shaw (2017) explores the question of mainstream school versus special schools for children with learning difficulties. The study that is based on the children’s opinion concludes that majority of ADHD patients are “positive about their experience at the special school but consistently negative about their experiences of mainstreaming” (Shaw, 2017, p. 292). The key reasons for this are specially designed curricula and well-trained staff of special schools. Nevertheless, such institutions cause social segregation of the children and increasing difficulties with integrating into society later. Thus, the mainstream schools have higher inclusive potential but need to undergo major changes. Inclusion is a challenging practice that requires additional education of the staff and increased quality of setting to be able to affect children with ADHD positively.
ADHD from the Strength-Perspective Approach
Strength perspective is a widely used model in sociology that implies seeing a group of people not from the point of view of deficiencies but focusing on capabilities. This approach can be seen as an affirmation model in the case of ADHD. It will relieve people from socially constructed impairment and transform the perception of medical symptoms. Climie and Mastoras (2015, p. 295) advocate for “the necessity of taking a strengths-based approach in working with and supporting these students.” Scholars believe that deficiency-focused approach directs attention to the wrongs, eliminating the importance of positive aspects of personality (Climie and Mastoras, 2015). Instead, it is suggested to emphasize the strengths of the child and develop the competencies enhancing their motivation and the feeling of self-worthiness. Interestingly, strength approach implies focusing not only on the qualities unaffected by the syndrome but also on the new capacities that ADHD brings.
As ADHD is a spectrum syndrome, the variety of symptoms and qualities differs among individuals. Sedgwick, Merwood, and Asherson (2018) believe that some of the personality aspects can have adaptive potential instead of impairing compensating for the affected deficiencies. The scholars conduct qualitative research aimed at identifying core strength that ADHD may give to a person. According to Sedgwick, Merwood, and Asherson (2018), the syndrome influences a variety of aspects, including energy, resilience, cognitive dynamism, and humanity. Scholars believe that the nonconformist approach and adventurousness promote courage, while hyper-focus and divergent thinking are responsible for cognitive dynamism (Sedgwick, Merwood, and Asherson, 2018, p. 241). Moreover, self-acceptance has the ability to increase resilience and humanity, which positively influence the person. Thus, the strength perspective reveals a variety of positive qualities caused by ADHD, the potential of which can be maximized after the elimination of stigma.
Conclusion
ADHD is responsible for many complications in the life of people suffering from it, including limited educational achievement, and low self-organisational capacity. Apart from medical impairment caused by the syndrome, people experience social pressure, stigmatisation, and marginalisation due to low behaviour and emotion control. Such an attitude can aggravate the symptoms, cause self-stigma, which results in a variety of related mental health issues. That is why designing an inclusive environment for these children is a necessity. Nevertheless, modern mainstream schools in the UK are still far from the ideal setting for children with this disorder and require significant improvements. Another method of working with children diagnosed with ADHD is the application of the strength approach. After the stigma is removed from the life of people, they have the capacity to demonstrate specific strength caused by the disorder.
Reference List
- Broomhead, K. (2013) ‘Blame, guilt and the need for ‘labels’: insights from parents of children with special educational needs and educational practitioners’, British Journal of Special Education, 40(1), pp. 14-21.
- Climie, E. A. and Mastoras, S. M. (2015) ‘ADHD in schools: adopting a strengths-based perspective’, Canadian Psychology, 56(3), pp. 295-300.
- Cordier, R. et al. (2018) ‘Peer inclusion in interventions for children with ADHD: a systematic review and meta-analysis’, BioMed Research International 2018, pp. 1-51.
- Gwernan-Jones, R. et al. (2015) ‘ADHD, parent perspectives and parent-teacher relationships: grounds for conflict’, British Journal of Special Education, 42(3), pp. 279-300.
- Lloyd, G. (2003) ‘Inclusion and problem groups: the story of ADHD’, in Allan, J. (ed.) Inclusion, participation and democracy: what is the purpose? New York: Kluwer Academic Publishers, pp. 105-116.
- Matheson, L. et al. (2013) ‘Adult ADHD patient experiences of impairment, service provision and clinical management in England: a qualitative study’, BMC Health Services Research, 13(184), pp. 1-13.
- Mueller, A. K. et al. (2012) ‘Stigma in attention deficit hyperactivity disorder’, ADHD attention deficit and hyperactivity disorders, 4(3), pp. 101-114.
- Sedgwick, J. A., Merwood, A, and Asherson, P. (2018) ‘The positive aspects of attention deficit hyperactivity disorder: a qualitative investigation of successful adults with ADHD’, ADHD Attention Deficit and Hyperactivity Disorders, 11, pp. 241-253.
- Shaw, A. (2017) ‘Inclusion: the role of special and mainstream schools’, British Journal of Special Education, 44(3), pp. 293-312.