Attention-deficit hyperactivity disorder: the sociocultural influences on ADHD knowledge and diagnosis decision making

Abstract

Based in biocultural medical anthropological theory, this project was designed to explore the diagnosis decision-making process in families whose elementary school children may be suffering from Attention-Deficit Hyperactivity Disorder (ADHD). Children in kindergarten and first grade (n=211) were evaluated for ADHD by their classroom teachers and assigned a risk category (low risk, high risk but undiagnosed, and previously diagnosed). A series of interviews was conducted with parents (n=51) of children in all three risk categories to evaluate their knowledge and beliefs about ADHD; their beliefs about parenting and the characteristics of "good" parenting and a "good" home life; perceptions about status competition; and their level of psychosocial, including emotional and financial, stress. In the third phase of the study, teachers at two of the study schools (n=20) were interviewed about their knowledge of ADHD and their ideas of appropriate classroom functioning and student behavior. It was believed that there was considerable diversity in the reasons behind why families chose to either accept or reject a diagnosis of ADHD for their children. More specifically, it was hypothesized that increased caregiver strain in the form of psychosocial and emotional stress, financial pressure, and performance pressure (perceived status competition) would affect the ascription of ADHD symptoms in children by their parents and, thus, elevate their risk of developing the disorder. Furthermore, it was hypothesized that belief in a cultural model of mother blame among caregivers and teachers would affect the number of ADHD symptoms found in children. Several variables associated with caregiver strain were positively associated with ADHD symptom level. Differences in symptom level as assigned by teachers and parents were also found according to a key set of characteristics believed to be associated with a model of mother blame. This project suggests the importance of shared cultural meaning and the role of social structural forces to the lay ADHD diagnosis decision-making process.