What happens when a child is diagnosed with ADHD and medicated with stimulants? In the thesis: “When ‘ADHD’ comes through the door”, reactions to ADHD diagnosis and drug treatment are separately explored from children’s and their mothers’ and fathers’ perspective. Little is known about: 1) children’s experiences and understandings of ADHD diagnosis and drug treatment, and the effect this has on their identity and sense of self, who they are and who they can be; and 2) the implications diagnosis and medical treatment have for parents’ understandings and experiences of their child and for the relationship between parent and child. This thesis presents findings from a qualitative study involving nineteen children (seventeen boys and two girls), and their mothers and fathers. In-depth-interviews were conducted with each of the participants using a psychosocial methodological approach, which emphasizes the intimate connection between the inner and outer worlds, as well as the intertwined character of social class and gender in the production of meaning.
The findings show that most of the children experience the diagnosis as a stigma. The children expressed a strong desire to be an ordinary boy or an ordinary girl. Three dominant psychic strategies were identified for handling the stigma: 1) Denial (the child does not consider the diagnosis as relevant); 2) identification (the child has adopted a medicalized view and understands him(her)self in relation to the diagnosis); and 3) negotiation (the child negotiates with parents and doctors, and suggests that there are different grades of ADHD and that it is not necessarily anything to worry about. Only two children talk favorably about the effects of the medication. The majority give contradictory narratives and struggle to decide whether their behavior reflects themselves or whether it is a reflection of the medication. Two children say they hate the pills. Although few children talk explicitly about their negative views, their rich narratives of how awful the pills look, taste, are to digest, and of the unpleasant side-effects they describe, are interpreted as a way for the children to express their negative feelings about the medication in a non-controversial language. Only two children talk favorably about the effects of the medication. The majority give contradictory narratives and struggle to decide whether their behavior reflects themselves or whether it is a reflection of the medication. Two children say they hate the pills. Although few children talk explicitly about their negative views, their rich narratives of how awful the pills look, taste, are to digest, and of the unpleasant effects they describe, are interpreted as a way for the children to express their negative feelings about the medication in a non-controversial language.
For the mothers, the child’s diagnosis and medical treatment initially elicits feelings of relief and hope. As time passes, more contradictory feelings emerge. Some fear their child may be stigmatized, and for others, the desired effect of the medication is confounded by worries over possible side-effects. The analysis shows that the mothers defend themselves against these difficult feelings by exercising different forms of denial. This results in side-effects being unrecognized. The author suggests that mothers find themselves in a ‘double bind’ and attention is given to the role played by school and the official discourse on ADHD.
The fathers are more likely to resist the medical understanding of their son’s behavior and they are more resistant to drug treatment with stimulants than mothers. They identify more with their son’s symptomatic behavior and more often understand their son from a gendered perspective. Although the fathers’ interpretation of their sons’ behavior vary across class differences, (fathers from a working class background typically use a “boys will be boys” discourse), as a group, the fathers incorporate the medical understanding to a lesser degree, than the mothers. One significant finding was that the mothers more often seemed to exchange their implicit everyday psychological understanding of the child with the medical understanding. After the diagnosis the story of the child was written again, with ADHD as the main turning point.
This study challenges taken-for-granted opinions that favor diagnosis and medical drug treatment of ADHD-symptoms. It also points to the importance of clinicians paying more attention to the child’s experience; that they listen to and take seriously what the child has to say. This is particularly important considering the serious side-effects that many children will experience from taking the drugs.