When order becomes disorder: A cross -cultural study of attention deficit hyperactivity disorder and its implications for the social construction of “normal”
This study probes reasons for a relatively high diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in children in the United States and a relatively low diagnosis of the disorder in England. The study's first research objective was to assess the degree to which the behavior of children in both societies could be labeled as expressive of the symptoms of ADHD. A research protocol was created in which mostly nondiagnosed children were evaluated for those symptoms. A second research objective was to investigate the environmental (including cultural) contexts affecting the observed behaviors.
In England, two primary sites were researched: a publicly funded primary school in Oxfordshire, England, and a specialist school for severely dyslexic children. In the United States, a publicly funded middle school was the site at which the research was conducted. It was decided to work with preadolescent 10- and 11-year-old children. In all, intensive day-to-day research was conducted for approximately 15 months, and over 100 children were observed.
Analysis of the qualitative and quantitative data suggests that there is no difference in the behavior of the children in the two societies. That analysis further suggests that the behaviors characterized as symptomatic of the disorder are widespread among nondiagnosed children. Furthermore, the major influences on variations in those behaviors were found to be environmental factors, particularly teacher in the room. Still further, no relationship was found between levels of expression of the symptomatic behaviors and school achievement. Nor was there a relationship between those levels of expression and sex, although males are much more likely to be diagnosed for the disorder than females. Therefore, it was concluded that it is the culturally mediated perception of the behaviors rather than their actual expression that apparently leads to the large difference in diagnosis for ADHD in the two societies. In short, ADHD is a socially constructed disorder.
It was further concluded that the apparent variation in perception could potentially be explained by different social orientations in the two countries. Data showed England to be more cooperatively oriented, while the United States seemed more individually oriented. Students in both countries are encouraged to seek to achieve at levels as high as they are capable of. However, in England, that individual excellence is encouraged to be directed to the benefit of the whole society, while in the United States, that excellence inures to the individual's benefit. Thus, in England, to label a child as disordered carries the potential of losing that individual as a contributor to the commonweal, while in the United States, labels are used to help individuals improve their educational opportunities. (Abstract shortened by UMI.)