IDENTIFYING HYPERACTIVE CHILDREN: THE MEDICALIZATION OF DEVIANT BEHAVIOR Peter Conrad Aldershot: Ashgate 2006, 160pp, AUD 79.95, 0 7546 4518 5
This is a re-issue in a new series (Ashgate Classics in Sociology) of Peter Conrad's classic study of attention deficit disorder (ADD) first published in 1976. This volume contains an introduction to this expanded edition and a new chapter (with Deborah Potter) detailing the rise of adult Attention Development Hyperactivity Disorder (a process that Conrad and Potter refer to as medicalised category expansion). Developing out of labeling theory, Conrad's was the first of the case studies of the medicalisation of everyday life, examining how the deviant behavior of children in the classroom was reconstituted from naughty to sick. Rather than adopt a clinical or psychological approach to the issue, he asks the sociological question: what actions in what contexts become ADD? In making this move Conrad could point to the fact that there is no identifiable underlying biological cause for the condition and that the clinical assessment of the 'disease' was based entirely on the social evaluation of the children's behavior developing out of the interaction of the parents, teachers and doctors. This lack of biological base was confirmed in the Diagnostic and Statistical Manual of the American Psychiatric Association (1994) where the condition is defined as 'developmentally inappropriate inattention and impulsivity'.
Conrad draws attention to the impact of the medicalisation of social problems, in that it individualises and depoliticises the issue, and prevents the development of a social system approach to explaining what is going on. A social systems approach would point to issues such as the student-teacher ratio in the classroom, the structure of an age based schooling system, the need for middle class parents to provide an account of why it is that their children are not performing well at school, and the search by psychologists for a toe-hold inside the medical system.
What is striking about Conrad's book thirty years on is its continuing pertinence to the issue of ADHD today. While it is still diagnosed in the USA at 10-30 times the rate of other countries, it has spread to countries like Australia, where prescriptions for the drug of choice in treatment, methyl phenidate, have jumped from 13,000 in 1980 to 96,000 in 1990, with five million children now diagnosed as having the condition. It is now diagnosed in girls (in 1970 the gender ratio was nine boys to one girl; now it is three to one) and has been extended to be a life-long condition affecting adults (with some estimates suggesting that up fifty per cent of affected children will continue into adult life with the diagnosis). And all this notwithstanding the fruitless search for a neurological or biological basis for the condition: though a genetic explanation is now postulated and being sought. …