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Global Perspectives on ADHD: Social Dimensions of Diagnosis and Treatment

in Sixteen Countries

Article in Sociology of Health & Illness · March 2022

DOI: 10.1111/1467-9566.13463

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Rhiannon Lane
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DOI: 10.1111/1467-9566.13463

BOOK REVIEW

Global Perspectives on ADHD: Social

Dimensions of Diagnosis and Treatment in
Sixteen Countries

Bergey Meredith | Filipe Angela Marques | Conrad Peter |

Singh Ilina (eds)

Baltimore, MD: Johns Hopkins University Press. 2017. £48.00 ISBN 9781421423791 (pbk)

This is an important and timely collection combining perspectives from sixteen different coun-
tries around the globe, providing some fascinating insights into the different national practices
surrounding attention deficit hyperactivity disorder (ADHD) at a moment in history where this
diagnosis continues to extend its global reach across disparate cultures. This kind of sociological
analysis is particularly vital given the rapidly evolving landscape of ADHD diagnosis, treatment
and expertise in recent times. Perspectives from a variety of continents are included, and each
chapter also features different methodological approaches, providing invaluable insights into the
way in which ADHD has advanced as a medical concept under different national contexts.
Overall, the collection clearly highlights the way in which differing national and local poli-
cies, systems and structures maintain particular ways of diagnosing, managing and conceptu-
alising ADHD. In particular, differences in health service provision and organisation; different
funding arrangements (e.g. government subsidising of medications); the influence of national
clinical guidelines and classification systems (DSM vs. ICD); the relative dominance of different
social systems (education, psychiatry, psychology, etc.) and professional groups (paediatricians,
psychiatrists, psychologists, teachers, etc.) in screening processes; and different customs around
collecting and reporting data on diagnosis and prescription rates are all factors shown to shape
national practices around ADHD.
In addition to these more systemic factors, the role of national cultural values is considered
in several chapters, for example, in Chapter Thirteen Murayama et al. suggest that the Japanese
reticence around medicating ADHD may stem from a resistance towards fundamentally altering
a person’s inborn identity and the psychoanalytic influence in France (Akrich & Rabeharisoa,
Chapter Twelve). Furthermore, the role of more local movements such as professional/patient
advocacy groups in shaping changes at a national level is also considered (in the chapters on
Portugal, Ghana, Chile and Argentina). In this way, the collection effectively weaves together the
macro-­ and micro-­social elements, which have shaped the social trajectory of ADHD in different
contexts.
One strength of this collection is that a reasonably balanced approach is taken to the topic
of medicalization. There is, understandably, some concern expressed around the dominance of

© 2022 Foundation for the Sociology of Health & Illness.

1052 | wileyonlinelibrary.com/journal/shil
 Sociol Health Illn. 2022;44:1052–1053.
BOOK REVIEW    | 1053

pharmaceutical approaches in contexts where medication is adopted as the primary mode of

treatment with little additional support (e.g. USA, Canada, Portugal and New Zealand). However,
most chapters avoid the explicit demonisation of medication, which often dominates popular
discourses surrounding ADHD, and the editors also point out the difficulties caused to service
providers and users in navigating such polarised discourses. The countries where more psychoso-
cial approaches are taken (e.g. Japan) provide an interesting counterpoint to the medically driven
approaches in many countries: it would be interesting for future research to consider comparing
the long-­term outcomes of these different approaches to ADHD in children.
Another strength is that the editors refrain from making major claims or generalisations: a
considerable amount of research remains to be done into the social science of ADHD, and this
collection raises questions that will be invaluable for guiding future research agendas. Adding
to the evidence from countries not included within the collection (e.g. within Eastern Europe,
the Middle East and Africa) will clearly be a fundamental area for further empirical inquiry. In
addition, the editors recognise the importance of advocacy networks in driving forward research
and political agendas and the linked tendencies towards ‘self-­governed medicalisation’ (covered
in the chapter on Germany). Similarly, the influence of online networks and how these may
transcend national influences on ADHD understandings will likely be an important topic within
this fast-­changing landscape.
Another important point that cuts across chapters is the complex and contested relationship
between disability and ADHD, its status as a recognised disability and its power to shape access
to additional support for those labelled. There were a few points I would have liked to have seen
considered more fully in relation to this: firstly, the concept of neurodiversity is mentioned in-
frequently, despite being a major driver of agendas for different neurodevelopmental conditions.
Secondly, the increasing role of executive functioning in current understandings of ADHD and
other neurodevelopmental disorders could be further highlighted. There is much that could be
said about how such evolving understandings of ADHD and neurodiversity may potentially con-
tribute to wider changes in popular conceptions of disability: as the notoriety and prevalence of
the diagnosis continues to grow on a global scale, this will likely become more important as an
area of inquiry.
In summary, this is a vital read for anyone interested in the social science of ADHD and
should be of interest to researchers, clinicians and those identifying with the diagnosis alike. In
exploring the evolution of ADHD across different political and cultural contexts, this collection
also arguably has wider relevance for both psychiatry and the social sciences since it constitutes
a useful case study concerning the sociology of diagnosis more generally. It provides insights
not only into current understandings of ADHD in different contexts, but into the way in which
social, political and cultural factors combine to shape the systems and practices surrounding
diagnostic entities in everyday lives and services. This collection also constitutes an important
foundation upon which further social scientific research can be built.

Rhiannon Lane

Cardiff University, Cardiff, Wales

Email: LaneRC1@cardiff.ac.uk

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