Have We Been Thinking About A.D.H.D. All Wrong?
That might sound a little mushy — that the point of A.D.H.D. treatment is to help you build relationships and improve your self-esteem, rather than the more scientific-sounding goal of repairing your malfunctioning brain. But think back to that controversial statement in Martine Hoogman’s 2017 paper. She wrote that it was important to interpret the Enigma data as confirmation that A.D.H.D. patients “have altered brains,” because that biological explanation would “help to reduce the stigma of A.D.H.D.” But does portraying A.D.H.D. as a “disorder of the brain” actually reduce its stigma? Might it not, in fact, increase a young person’s sense of shame and isolation to be told they have a brain disorder?
An Australian psychologist named Luise Kazda has studied this very question. In a 2021 review paper, she and her colleagues found 14 studies in which receiving an A.D.H.D. diagnosis created a sense of “empowerment” by “supporting a sense of legitimacy accompanied by understanding and sympathy as well as decreased guilt, blame and anger.” But in 22 other studies, Kazda wrote, “a biomedical view of difficulties was shown to be associated with disempowerment. By providing an excuse for problems, a decrease in responsibility by all involved can occur, often followed by inaction and stagnation.” An additional 14 studies found that the diagnosis increased feelings of stigmatization. “The diagnosis can create an identity that enhances prejudice and judgment,” Kazda reported, “which are associated with even greater feelings of isolation, exclusion and shame.”
It’s still not entirely clear why the simple act of providing a diagnosis of A.D.H.D. seems to have such profound effects on some children and their families. But it is certainly true that under the medical model, a diagnosis sends a very different message than it does under a model like Sonuga-Barke’s, which sees a person’s A.D.H.D. symptoms as, at least in part, the product of a mismatch with a particular environment.
For some parents, it may indeed be less stigmatizing, and more comfortable, to be able to say, “My child has A.D.H.D., a medical condition, so he needs to take this medicine every day,” rather than, “I want my kid to succeed in environments for which he’s not well suited, so therefore I want him to take these pills.” For many children, however, a diagnosis of A.D.H.D. that is communicated via the dominant medical model can feel like more than a stigma; it can feel like a life sentence. The message to children is often that A.D.H.D. is a binary, biological category, and if your symptoms place you in that category, your brain has a deficit, and you have a disorder.
The alternative model, by contrast, tells a child a very different story: that his A.D.H.D. symptoms exist on a continuum, one on which we all find ourselves; that he may be experiencing those symptoms as much because of where he is as because of who he is; and that next year, if things change in his surroundings, those symptoms might change as well. Armed with that understanding, he and his family can decide whether medication makes sense — whether for him, the benefits are likely to outweigh the drawbacks. At the same time, they can consider whether there are changes in his situation, at school or at home, that might help alleviate his symptoms. If he is also experiencing other psychological conditions — anxiety or depression or post-traumatic stress — they can take steps to address those deeper issues, independent of his inability to focus in math class.
