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Ethical Human Psychology and Psychiatry


An International Journal of Critical Inquiry

Ethical Human Psychology and Psychiatry, Volume 14, Number 1, 2012

The Social Construction and Reframing of Attention-Deficit/ Hyperactivity Disorder


Barbara A. Mather, MBA, MA, CMC
Mather Consulting Group, Inc.
In this article, I integrate research in social construct theory, the medicalization of attentiondeficit/hyperactivity disorder (ADHD), and strengths-based theory to propose a change in the way American society negatively labels and interacts with people diagnosed with ADHD. This article presents examples of global perspectives on ADHD, the nature of stigma that occurs to those who receive a medical diagnosis of ADHD, and the need to reframe ADHD from a disease to that of a positive difference. The reader is asked to consider the implications for millions who suffer from the stigma of ADHD. Starting with children diagnosed with ADHD, I suggest that members of society begin to reframe ADHD as a social construct recognizing the strengths and positive traits because there are many. This is a call to all members of society, especially those professionals of the medical, psychological, social, and educational systems, to adopt a strengths-based model of support for those diagnosed with ADHD.

Keywords: ADHD; social construct; strengths-based theory; reframing; stigma; negative label; medicalization; positive psychology

he concept of social construction, as defined by Berger and Luckman (1966), starts with people in the social system who interact together. These interactions create concepts of each others actions over time, and people become accustomed to these roles by frequent exposure or repetition. As these roles or experiences are introduced to other members of society and are understood and practiced by society at large, these interactions become institutionalized and adopted by society as knowledge. The method of transmission of this knowledge is through language. Berger and Luckman (1966) explain how only a portion of human experience is retained in the conscious mind. They explain that as these experiences are retained, they become sedimented, as in settled or deposited in a more stable state. As these experiences are shared with others, intersubjective sedimentation occurs as more and more individuals share this common biography. These shared experiences are made available to an entire community, and,
. . . language provides the means for objectifying new experiences, allowing their incorporation into the already existing stock of knowledge, and it is the most important means by which the objectivated and objectified sedimentations are transmitted in the tradition of the collectivity in question. (pp. 6364)

Social construction theory includes interpretive examination of contemporary social phenomena in which people describe or explain the world in which they live. Social
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construction theory involves discourse around the social interactions that occur and form a socially constructed relationship. Based on contemporary events and interpretations of these events, the theory holds that peoples beliefs about the world are social inventions. Reality is socially constructed based on peoples definitions (Cheung, 1997, p. 332). Similarly, an organisms condition that has been determined to be not normal or not operating at a level that society expects is believed to be abnormal and labeled as such. The language pertaining to this abnormality or disorder may warrant this condition or disease to be proven abnormal through empirical evidence, and the results declared scientifically valid. It is through the social construction of mental illnesses that I present examples of what has been defined as abnormal or outside societys acceptance of normal human experience by the American Psychiatric Association (APA).

ADHD: Social Construction of a Mental Disorder?


The Diagnostic and Statistical Manual of Mental Disorders (DSM), a publication of APA, reflects American cultural and societal trends relative to societal beliefs and behaviors. Many developed countries in the world follow the DSM, but it is important to understand that mental disorders are defined from American science and ontology. The international discourse on psychiatric or mental disorders, as is the case with the diagnosis of attention deficit hyperactivity disorder (ADHD) in children, is considerable (Amaral, 2007; Berbatis, Sunderland, & Bulsara, 2002; Lloyd & Norris, 1999; Moffitt & Melchior, 2007; Norris & Lloyd, 2000; Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007). Brief examples follow to demonstrate, first of all, how the power of the DSM influences American societal norms, beliefs, and behaviors. It was in the DSMI (1952) that homosexuality was listed under the category of sociopathic personality disturbance. The DSM historically undergoes rigorous review and update as a byproduct of scientific research and knowledge and standardization of psychiatric diagnoses (Mayes & Horwitz, 2005). In 1973, the DSMII listed homosexuality under personality disorders and certain other nonpsychotic mental disorders. In defining diagnostic criteria for homosexuality in the DSMII, and this exemplifies social construction, patients who performed homosexual acts while imprisoned for at least 1 year without access to the opposite sex were excluded from this diagnosis (Feighner et al., 1972). Finally, in 1980, the APA removed homosexuality entirely from the DSMIII as a mental disorder. Furthermore, the controversy of introductions and deletions on that which warrants psychiatric diagnosis does not withstand consistent empirical rigor (Zucker & Spitzer, 2005). Passiveaggressive personality almost became the term for a psychiatric disorder to be identified and included in the DSMII. It was determined that further studies would be needed to establish the validity for this perceived psychiatric disorder (Feighner et al., 1972). During the timeframe of the 1960s to early 1970s, one may assume that the passiveaggressive personality style within society became objectified and was thought to be abnormal and possibly a form of mental illness. In this example, the rigor of scientific research did not support passiveaggressive behaviors as disorders. Historically, the social construction of disease has generated mobility of important resources to help support genuine social and health problems. Fox (1989) writes of the social movement that was constructed around the phenomenon of Alzheimers disease in

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the early 1980s. Social structural changes that were, and continue to be, a goal of this social movement include shifts in the allocation of health and social service resources for persons with the disease and their care givers (p. 65). Alzheimers disease became the seventh leading overall cause of death for all ages during 20032004; and for ages 65 and older, the fifth leading cause of death in the United States (Centers for Disease Control, 2007). The changes reflected in the DSM with each newly minted publication are reflective of American societal and cultural trends. The preceding discussions are shortened examples of the American Psychiatric Associations methodology, but the purpose is to reflect a progression of changes that have significantly impacted society. The case of homosexuality demonstrates that diagnostic criteria may be socially constructed when there is no causal biomarker to scientifically validate it as a psychiatric disorder but that which is based on syndrome or behaviors. This is the central issue surrounding the discourse on ADHD diagnoses because there also is no blood test or biomarker to determine the presence of any form of a disease or biological or chemical disorder.

The History of ADHD and the DSM


References to individuals with inattention tendencies trace back to Shakespeare in his reference to one of his characters in King Henry VIII. The character was referred to as having problems with inattention, hyperactivity, and poor impulse control (Barkley, 1997, 2005, p. 4). Studies by an English physician, George Still, in 1902 describe in detail the struggles of 20 children in his practice with similar behaviors and aspects of ADHD that are now detailed 100 years later. In the early 1920s, ADHD-like behavioral problems were believed to have arisen from birth trauma or various head injuries. In the 1950s, the syndrome would become known as minimal brain dysfunction or MBD (Barkley, 1997, 2005; Nadeau, 1995). The DSMI, published in 1952, contained no discussion about attention deficits or difficulties (APA, 1952). In 1968, the DSMII was published and made reference to hyperkinetic reaction of childhood, referring to attention disorders. In DSMII, the syndrome was defined simply as this disorder is characterized by overactivity, restlessness, distractibility, and short attention span, especially in young children; the behavior usually diminishes in adolescence (APA, 1968, pp. 6364). Twelve years later, at one stroke, the diagnostically based DSMIII radically transformed the nature of mental illness . . . Psychiatry reorganized itself from a discipline where diagnosis played a marginal role to one where it became the basis of the specialty (Mayes & Horwitz, 2005). The label of attention deficit disorder (ADD) was published for the first time in DSMIII (APA, 1980). The DSMIV publication formed ADHD as the official acronym to be representative and inclusive of all subtypes of ADHD. Three subtypes of ADHD are specified: hyperactiveimpulsive type, inattentive type, or combined type (hyperactive-impulsive and inattentive). ADHD is included in the DSMIV under the section of Disorders Usually Diagnosed in Infancy, Childhood, or Adolescence (APA, 2000). One final resource is provided on the discussion of ADHD as socially constructed disease. Theories abound as to ADHDs physical, social, dietary, environmental, or neurobiological basis. The evolutionary history of ADHD is provided by Williams and Taylor (2006) as they perform a detailed analysis of one trait, unpredictability, a well-established

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characteristic of individuals diagnosed with ADHD. They present scientific analysis of the specific benefits from ADHD for society, by presenting evidence that unpredictable behavior by a minority may bring beneficial results to the group. An example of an unpredictable behavior is in risk-taking borne primarily by one individual; if successful results occur, a group as a whole may benefit. When sufficient information can be obtained by a minority and passed on to the group, there is no longer any need for all individuals to explore (Williams & Taylor, 2006, p. 402). The reader is encouraged to read this scholarly, scientific account of the evolutionary status of ADHD if this is a topic of interest to him or her.

Discourse and Ideologies on the Diagnosis of ADHD


Three primary ideologies exist surrounding the diagnosis and treatment of ADHD. For purposes of this discussion, the focus is on children diagnosed with ADHD, not adults. The APA is in the process of preparing DSMV, in which new criteria are being rigorously established for diagnosis in adults (Barnard, Stevens, To, Lan, & Mulsow, 2010). The final release of DSMV is expected to be available in May, 2013 (DSM-V: The Future Manual, 2010). The first view of the condition of ADHD is that of a biological perspective. This view is by scientists and researchers who speak of where they believe the attention focus of the brain is located. The belief is that the frontal lobe (prefrontal cortex) is underactive and caused by neurotransmitter dysfunction or missing synapses. Medication is essential to correct the biological functioning and is supplemented by behavioral and educational strategies. Psychosocial treatments beyond medication are important to help overcome the childs problem with low self-esteem, inherent in children with socially inappropriate, hyperactive, or impulsive behaviors. In support of this biological disorder, a recent research study reports that MRI scans of the brain in 446 children showed underdevelopment of the brains in children diagnosed with ADHD. Research scientists posit that this underdevelopment creates a lag in brain development in the prefrontal cortex area by 3 years as compared to their peers (Shaw et al., 2007). Further research addressed the concern over adverse effects of psychostimulants on the developing brains of children diagnosed with ADHD. Researchers compared the MRI images of the brains for those who did not take psychostimulants to those who did for children diagnosed with ADHD. It was determined that drug treatment for children diagnosed with ADHD provided no difference in the development of the cerebral cortex as compared to children diagnosed with ADHD who did not use psychostimulants (Shaw et al., 2009). A more recent study concludes that cortical thinning of the brain, as evidenced through MRI imaging, emerges as a potential neurobiological marker for ADHD (Shaw et al., 2011). The second perspective on ADHD is more of a middle ground. It accepts the premise that there is a biological trigger in the brain and cautiously supports the use of medications such as Ritalin. In the United Kingdom, many professionals who espouse this second perspective believe that Ritalin is moderately useful as a therapy for severe cases but that the wide usage of medication in the United States is unwarranted (Norris & Lloyd, 2000). Practitioners with this perspective endorse behavioral therapy treatments and educational programs for parents and children. Lawrence Diller (1998) has written extensively on his concerns of the over-diagnoses of attention disorders and the high consumption percentage of Ritalin in the United States. He posits,

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Cultures differ, for example, in the degree to which their members accept emotional distress or tolerate underperformance . . . As Ive noted, the ADD diagnosis and Ritalin use remain overwhelmingly a phenomenon of white, suburban, middle- and upper-middle-class children. Its in this slice of society, of course, that expectations run highest and anxieties about performance shortfalls lately have become acute. (p. 317)

The third and final perspective does not support the biological premise of ADHD and is critical of the idea of ADHD as a syndrome. These medical professionals view varying degrees of childhood behaviors as a function of psychological and behavioral development. Those following this ideology express concern over the use of psychostimulants to medicate small children and view it as highly suspect. This group of medical professionals sees the overdiagnoses of ADHD as a catchall when overdiagnosis cannot be established and as a means of labeling and controlling children who exhibit difficult behaviors. Followers of this third view believe that children are being given drugs unnecessarily to control their behaviors. In short, using medication as a means of social control (Norris & Lloyd, 2000, p. 133). Thom Hartmann advocates for this perspective. Hartmann (2003) presents a positive, hopeful view of ADHD as a trait, not a syndrome. He believes that Thomas Edison demonstrated ADHD traits and discusses the hunter and farmer traits of society of past centuries. The farmer skills were important to the livelihood of society as were the hunters abilities. It was the hunter with a short attention span who could monitor the environment against dangerous threats. The hunter was innovative, yet impatient, and thrived in an adventurous and changing world (Hartmann, 2003). The controversy between these groups generates considerable research and discourse. For purposes of this article, my preference is to agree with the third group. One of the primary reasons for my position on ADHD is the countless numbers of individuals with ADHD who are highly successful in life. In many of these cases, individuals with ADHD have not suffered the stigmatization by others and, in fact, have been celebrated and highly successful even though they have ADHD-like traits. It is unlikely that this discourse will be quieted and settled until society and the scientific community can agree and resolve the myriad of complex issues relative to ADHD.

ADHD Diagnosis
In the case of ADHD, it is through the collective social responsibility of physicians, parents, and other members of society that defines the diagnostic threshold (Amaral, 2007). The present criteria for the diagnosis of ADHD are defined by the APA through the DSMIV. The prevalence of incidence rates and the medical and psychological practices used to treat those diagnosed with ADHD are based on American standards. Many European countries do not use DSM criteria for ADHD but instead define behaviors as hyperkinetic disorder or HKD (Lloyd & Norris, 1999). To understand the differences between United States and Europe, it is important to consider the method and criteria for diagnosis. For instance, Polanczyk et al. (2007) discovered a significant difference in diagnostic criteria in their research. European researchers use the stricter International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) for diagnosis, whereas United States researchers use DSMIV. The ICD-10 requires that a child must exhibit all three dimensions of inattention, hyperactivity, and impulsivity; and they must meet these criteria both at home and school. In contrast, the DSMIV criteria is considerably more lenient, requiring that

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a child must meet one of the three dimensions and exhibit symptoms either at school or home (Polanczyk, et al., 2007).

Results of Medicalization of ADHD


Medicalization is the extension and expansion of medical boundaries, making the boundaries become broader and more inclusive. Medicalization studies report how nonmedical problems in society become defined as medical illnesses or disorders (Conrad & Potter, 2000). Such is the case with ADHD. It is not the intent of this article to evaluate or critique the process of medicalization but to highlight the ramifications of the diagnosis of ADHD based on sociohistorical circumstances and with the diagnosis, the resulting medicalization of ADHD. As ADHD became medicalized, the primary treatment in children and adults with ADHD became pharmacological. The primary ingredient in the medication is methylphenidate. Methylphenidate is a controlled substance, and global licit medical consumption is tracked. The world consumption rates of methylphenidate in 2008 per 1,000 populations are: United States, 12.03; Canada, 6.12; Netherlands, 4.02; United Kingdom, 3.67; Switzerland, 3.44; Sweden, 2.51; Germany, 2.19; New Zealand, 1.79; Australia, 1.53; and Spain, 1.18. The increase in global consumption more than doubled, from 25 tons in 2007 to 52 tons in 2008, primarily because of the manufacture, use, and heavy advertising in the United States (Report of the International Narcotics Control Board: Psychotropic Substances, 2009). These statistics suggest, for example, that the United States consumption of methylphenidate is more than three times that of the United Kingdom and ten times that of Spain. The consumption of methylphenidate demonstrates the threshold or tolerance for societies in these developed countries. With the United States holding, by far, the largest consumption percentages of methylphenidate, pharmacological treatment of ADHD in the United States is pronounced. These numbers reflect how medical doctors defending the medical model from which they practice are far different from other corners of the world. This consumption of methylphenidate implies that in American society it is more socially acceptable to treat childhood behaviors pharmacologically. The United States, more than the rest of the world, is using broader diagnostic criteriasocially constructedand is seeing these behaviors as indicators of disease.

STIGMA AND SOCIAL IDENTITY: REFRAMING OF ADHD Effects of Negative Labeling on Social Development
Goffman (1963) is renowned for his work in defining stigma. He writes of societys categorization of people with attributes that are deemed ordinary or natural for members of a particular category. Goffman defines social identity as a way to code the persons attributes. However, it may be over time in getting to know this person that one may realize the person does not possess the expected attributes for his or her particular category. So in effect, in ones mind, that person is tainted and discounted as less than what is expected. This failing, shortcoming, or handicap creates an overall discrediting of the person or what has become know as stigma (Goffman, 1963).

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Goffman discusses three types of stigma: (a) various physical deformities; (b) individual character blemishes that arise from weakness of characteras in dishonesty or unnatural beliefsor caused by imprisonment or mental disorders; and (c) a form of tribal identification based on race, religion, ethnicity, or other lineage. Goffman (1963) writes,
The attitudes we normals have toward a person with a stigma, and the actions we take in regard to him, are well known, since these responses are what benevolent social action is designed to soften and ameliorate. By definition, of course, we believe the person with a stigma is not quite human. On this assumption we exercise varieties of discrimination, through which we effectively, if often unthinkingly, reduce his life chances. We construct a stigma-theory, an ideology to explain his inferiority and account for the danger he represents, sometimes rationalizing an animosity based on other difference. . . . (p. 5)

In a recent research study on social reactions to children with mental health problems, researchers proposed a general model of stigma and studied the results of what individuals bring to social interactions with others in a series of vignettes. Martin, Pescosolido, Olafsdottir, and McLeod (2007) report through clear evidence that the
disturbing behaviors associated with ADHD and depression increase preferences for social distance, a pattern that, in the case of ADHD, persisted across all models . . . the label of mental illness has a significant negative impact on the publics willingness to socially engage with children with [perceived] mental health problems. (pp. 6162)

The authors call for the stigma surrounding childrens mental health issues to be addressed by society through political, legal, and research agendas (Martin et al., 2007). The behaviors of children diagnosed with ADHD children may be uncontrolled, impulsive, hyperactive, or disruptive in educational or other settings. Through the lenses of children diagnosed with ADHD, one may see environments that are overwhelmingly negative. The messages that these children receive regularly are from the multiple systems that interact to regulate or control the childs behaviors. On behalf of themselves and their children, parents look for support from others to recognize the difficulties and struggles of their children diagnosed with ADHD (Norris & Lloyd, 2000). These negative messages from others contribute to the individuals low self-esteem and poor self-confidence over the long-term. Many succeed in overcoming those earlier negative messages received related to their diagnosis of ADHD, whereas many others will struggle and suffer from low self-esteem, poor self-image, and inability to self-regulate their entire lives. Recognition of the cumulative effect of ones history can sometimes lead to permanent internalization of these messages, leaving adults with AD[H]D believing that they are indeed lazy, stupid underachievers (Murphy & LeVert, 1995, p. 20). Goffman (1963) discusses the concept of social identity and group alignment. For one who is aware and understands, there are stigmatizing labels that have been applied to himself or herself, it is important to understand and give consideration to the role of information in stigma management. Although maintaining ones personal identity is essential, the more allied the individual is with normals, the more he will see himself in nonstigmatic terms (p. 107). Goffman recommends that the stigmatized individual find a way out of his or her dilemma. If unable to do this on his or her own, Goffman recommends trained professionals to help the stigmatized individual develop an appropriate attitude

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regarding the self. Authenticity of self, recognizing the strengths and positive attributes of self is crucial to overcoming stigmatization.

Strengths-Based Models Needed for Individuals With ADHD


The proposal herein is to consider strengths-based support and encouragement as particularly beneficial to those diagnosed with ADHD. Children should be a priority to target as a group to help offset the risks of poor self-identity and low self-esteem. Ramirez-Smith (1997) notes that many children diagnosed with ADHD are, in fact, gifted learners and recommends a multidimensional intervention program in what she labels children first (p. 5). She encourages setting realistic expectations to help the children diagnosed with ADHD learn to develop and utilize their strengths. Spinelli (1998) encourages resource center teachers to be mindful of adolescents with ADHD and assist through guidance, support, and encouragement to promote self-advocacy, awareness, and confidence. The strengths-based model designed by Smith (2006) for at-risk youths is particularly relevant to children diagnosed with ADHD. Smith advocates the investment in children as the United States wastes human potential and incurs financial losses when it fails to develop the assets of its youth (p. 15) as she cites the billions of dollars spent on youth alcohol abuse, financial costs of teenage pregnancies, and high school dropout rates. The strengths-based counseling model that Smith endorses is significant because it represents a dramatic shift from the medical model of disease and pathology to a model that emphasizes developing strengths and assets in the individual. The underpinnings of Smiths model are from positive psychology, positive youth development, social work, and solution-focused therapy. This comprehensive model defines and categorizes strengths, and strengths-based counseling theory is an integrated approach that blends several theories, movements, and techniques. Several similar traits and characteristics are regularly seen as strengths in many individuals diagnosed with ADHD. Descriptions of people diagnosed with ADHD indicate they are right-brain thinkers, creative individuals, out-of-the-box thinkers, highly imaginative and intelligent individuals, big picture thinkers, high risk-takers, leaders, conceptualizers, and multi-taskers (Weiss, 2005). Children, society, and families will benefit from support systems and treatments that focus on helping to identify and develop the strengths, talents, abilities, and interests of children diagnosed with ADHD. Focusing on what a person does well builds self-confidence, self-esteem, coping skills, and other positive traits. Positive psychology and strengths-based literature suggests that to excel in life and find lasting satisfaction, an individual needs to become expert in finding, applying, practicing, and refining ones strengths (Buckingham & Clifton, 2001). Adults with painful memories of stigma and negative labeling throughout childhood find that their lives have manifested into that of suffering, misery, a chronic sense of underachievement, and intense frustration. When considering the value of positive psychology and strengthsbased theory, individuals of all ages diagnosed with ADHD could benefit from a regimen of positive support and development from the systems within society that focus on strengthsbased theory. Positive psychology is a branch of psychology that can be traced back as far as 1954 to Abraham Maslow in his classic book Motivation and Personality. The humanistic movement in psychology was born in the 1950s and began to pick up considerable interest over the next few decades (Crain, 1992). Kauffman (2006) explains how positive psychology shifts

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the practitioners attention away from pathology and pain and directs it toward a cleareyed concentration on strength, vision, and dreams (p. 220). Kauffman notes, despite this focused intent, positive psychology practitioners still find it difficult to transcend the medical model because much of psychological training, language, and assessment tools are grounded in pathology and problems.

Implications of Reframing ADHD as a Difference Versus a Disorder


Smith (2006) discusses reframing that allows one to examine a previous unpleasant or negative life situation and then to reframe it. An example might involve describing the experience from a fresh perspective and describing how it could be viewed in a positive light. Smith reports the difficulties for medical and psychology professionals to break out of the use of old frameworks. She also discusses how strengths-based counseling represents a paradigm shift in psychology from the deficit medical model to one that stresses clients strengths. Smith believes the strengths-based counseling model is wellgrounded in historical as well as current psychological research. Additionally, she recognizes how clients capabilities can help to build confidence, motivation, and feelings of power. Smith states, My clinical interventions on strengths create an empowering therapeutic relationship. Clients come to believe that good things can happen and that they can be the engineer summoning and directing those good things in their lives (p. 136). Marty Sapp (2006) discusses Elsie Smiths strengths-based model utilized with at-risk youths. In his practice, Sapp offers youth encouragement and focuses discussion on the patients strengths as opposed to weaknesses. Sapp notes the paucity of articles on strengthsbased perspectives in counseling and believes that Smiths scholarship has contributed to positive psychology, and I hope it will promote social change within counseling psychology and the larger society (2006, p. 116). Individuals diagnosed with ADHD need a balanced treatment plan that focuses not only on managing undesirable behaviors but also builds on their strengths and positive aspects. Hallowell and Ratey (2005) see a second revolution occurring in the way in which the disorder is defined. When experiencing the negative or unmanageable symptoms of an individual diagnosed with ADHD, in a classroom, a workplace, or family retreat, it is hard to focus on the individuals positive traits and character strengths. An agenda for change within ADHD support systems must begin as members of society understand the implications of the negative labeling that underpins ADHD as a mental illness. Scholars, medical professionals, educators, familiesall members in society are impactedneed to reframe ADHD from a disease to a socially constructed concept of positive support for the ADHD individuals strengths, talents, abilities, and interests.

CONCLUSION
This article addresses a critical review of the literature on ADHD and integrates theories to propose an alternative way to understand and treat ADHD. Included here is discussion on the social construction and ideologies surrounding ADHD, the stigma associated with its symptoms, the reframing of ADHD, and the consideration of strengths-based theory as an alternative approach to treating those diagnosed with ADHD. As society plays a

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significant role in the way children diagnosed with ADHD are treated, it is incumbent upon all of us to make improvements in the lives of children who have been unfairly stigmatized and in many cases, ostracized from positive childhood development efforts. Our purpose should be to reexamine the responsibilities and activities of researchers, health practitioners, educational professionals, and parents to encourage the understanding of the problems facing individuals who have been labeled with a form of mental illness ADHD. Parents should not have to worry about sharing information about their childs attention differences and having the child suffer from negative consequences. Children should not be recipients of negative labels from educators, friends, teammates, neighbors, or other members of society. We need to develop the skills within our children to help them deal with misguided and damaging comments from those who have been entrusted to care, nurture, and assist them in developing. Another goal for society should be to help others in the rethinking and reframing of ADHD from a disorder or deficiency to that of an attention differenceattempting to remove the negative labeling that has harmed so many by categorizing us as possessing a form of a mental illness. Only then can we enable members of society to begin the dialogue around the question of what is the process by which a disorder like ADHD can be redefined as strength?

REFERENCES
Amaral, O. B. (2007). Psychiatric disorders as social constructs: ADHD as a case in point. American Journal of Psychiatry, 164(10), 1612. American Psychiatric Association. (1952). Diagnostic and Statistical Manual of Mental Disorders: DSMI. Washington, DC: Author. American Psychiatric Association. (1968). Diagnostic and Statistical Manual of Mental Disorders: DSMII (2nd ed.). Washington, DC: Author. American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders: DSMIII (3rd ed.). Washington, DC: Author. American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: DSMIVTR (4th ed., text ed.). Washington, DC: Author. Barkley, R. A. (1997, 2005). ADHD and the nature of self-control. New York: Guilford Press. Barnard, L., Stevens, T., To, Y. M., Lan, W. Y., & Mulsow, M. (2010). The importance of ADHD subtype classification for educational applications of DSM-V. Journal of Attention Disorders, 13(6), 573583. Berbatis, C. G., Sunderland, V. B., & Bulsara, M. (2002). Licit psychostimulant consumption in Australia, 19842000: International and jurisdictional comparison. Medical Journal of Australia, 177(10), 539543. Berger, P. L., & Luckmann, T. (1966). The social construction of reality: A treatise in the sociology of knowledge. Garden City, NY: Doubleday & Company. Buckingham, M., & Clifton, D. O. (2001). Now, discover your strengths. New York: Free Press. Centers for Disease Control. (2007). National Vital Statistics Reports, 55(19), August 21, 2007, p. 2. Cheung, M. (1997). Social construction theory and the Satir model: Toward a synthesis. The American Journal of Family Therapy, 25(4), 331343. Conrad, P., & Potter, D. (2000). From hyperactive children to ADHD adults: Observations on the expansion of medical categories. Social Problems, 47(4), 559582. Crain, W. (1992). Theories of development: Concepts and applications. Englewood Cliffs, NJ: Prentice-Hall.

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Spinelli, C. G. (1998). Facilitating and promoting academic and social success for the adolescent with Attention Deficit Disorder. US Department of Education. Weiss, L. (2005). Attention deficit disorder in adults: A different way of thinking (4th ed.). Lanham, MD: Taylor Trade. Williams, J., & Taylor, E. (2006). The evolution of hyperactivity, impulsivity and cognitive diversity. Journal of the Royal Society Interface, 3(8), 399413. Zucker, K. J., & Spitzer, R. L. (2005). Was the gender identity disorder of childhood diagnosis introduced into DSMIII as a backdoor maneuver to replace homosexuality? A historical note. Journal of Sex & Marital Therapy, 31(1), 3142. Barbara A. Mather is an organizational change, certified management consultant and is in the final stages of obtaining her PhD in Human and Organizational Systems from Fielding Graduate University, Santa Barbara, CA. Her dissertation research question addresses the workplace challenges of young adults diagnosed with ADHD. More information about Mather and her consulting firm may be found at www.matherconsulting.com. Correspondence regarding this article should be directed to Barbara A. Mather, MBA, MA, CMC, President, Mather Consulting Group, Inc. E-mail: bam@matherconsulting.com

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