An anti-oppressive approach to AD/HD

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• AD/HD affects 5% to 10% of children and 3% to 6% of adults.
• It is a highly heredity disorder: If one person in the family has AD/HD, there is a 25% to 35% chance that another close family member will have AD/HD.
• Parenting children with AD/HD is stressful — 23% of parents of children with ADHD divorce, compared to 13% of other parents, according to a recent study.

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AD/HD: Where are the social workers?

The problem of AD/HD has been primarily viewed from an individual perspective. It is the domain of the teachers who have to deal with it, the psychologists whose tests diagnose it, and the psychiatrists who do clinical trials on the meds that manage the symptoms.

Where are the social workers in this picture?

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Societal impacts of AD/HD

AD/HD has serious societal impacts. It is dramatically over-represented among disadvantaged groups, such as the prison population and people living in poverty. Among its many consequences are higher rates of criminality, delinquency, risky sexual behaviour, high-risk pregnancies, unstable personal relationships, and lower levels of global functioning.  Adolescents 15 and older with AD/HD are far more likely to become addicted to drugs or alcohol than other youth, with half of all adults with AD/HD having a substance abuse problem. People with AD/HD also have high comorbidity with mental illnesses such as depression, obsessive-compulsive disorder, anxiety disorder, and others.

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A critical perspective on AD/HD

AD/HD has been socially constructed in a negative way. It is often viewed as the result of bad parenting or poor diet. The typical image of someone with AD/HD is a male child with poor grades who is disruptive and bouncing off the classroom walls.The parents of these boys are told to get them diagnosed and treated, because they are a classroom management problem (which may result in overdiagnosis of AD/HD in some situations).

Some groups of children are over-diagnosed, but AD/HD is also often underdiagnosed (girls, non-white children). In particular, very few black children receive treatment in the US. According to Gail Mattox, a member of the Black Psychiatrists of America, key factors in the fact that black children receive treatment at half the rate of white children are: poverty, culturally inappropriate services, lack of information and misinformation in black communities, and the fact that many black children are in care.

Many other children fall through the cracks. My son with inattentive AD/HD (without hyperactivity) quietly failed his way through school for no apparent reason, despite my repeated attempts to find out why. Girls are also often missed, partly because they present differently and partly because AD/HD has been associated with boys. Gifted children with AD/HD do not get picked up. They do well in school, but they still suffer from other AD/HD symptoms, such as low self-esteem, and later-life problems with substance abuse and intimate relationships.

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The role of privilege in diagnosis and treatment

I think that privilege plays a big role in how a parent responds to the suggestion that their child might have AD/HD. As an educated, middle-class white woman, I took steps to research AD/HD and to get my son diagnosed and treated. This is a typical response of middle class parents. But I also have friends living in poverty who do not see the point in getting their children or themselves tested and treated. The father is functionally illiterate, probably as the result of undiagnosed AD/HD and other learning disabilities. The mother believes that both parents and at least two out of three children have AD/HD, but is overwhelmed with parenting challenges and poverty. Nor does she see a benefit to a diagnosis. Other families in similar social locations are simply struggling so much that they can’t face adding anything else to their mix of problems. Or they get offended — “There’s nothing wrong with my kid.”

Often I have wondered, “How could one approach a disadvantaged family in a way that helps them understand how they might all benefit by diagnosis and treatment of one or more members?” For sure it would be quite different from how I would approach a middle class family.

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The social work contribution

The great inequities in diagnosis and treatment across social location is one important issue that social workers should be addressing. Access to treatment is another, because while Ritalin may be covered by government medication plans, multi-modal treatment for AD/HD is only available for those who can pay for it.

However, I see a double bind in providing improved access to diagnosis and treatment. Black children are currently being treated for AD/HD at half the rate of white children. But if they are labelled as having AD/HD, will they not be further disadvantaged, more so than the white children? Will the diagnosis that is meant to help them actually create additional barriers to accessing societal resources — an intersection between AD/HD and race?

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There is a crying need for anti-oppressive social workers to contribute to research, advocacy, and practice related to AD/HD. I believe that AD/HD increases the risk of poverty and the intergenerational perpetuaton of poverty, considering all the above factors.

There are many ways that social workers should be getting involved with the problem of AD/HD among children and adults — whether they are clinical or community workers, whether they are guided by a systems model or an anti-oppressive approach. I plan to work in this area — what about you?

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