The rise of ADHD in the 21st century

Last week, a consortium of researchers and practitioners going by the name of AADPA — the Australian ADHD Professionals Association — released a new set of guidelines for the condition, which is being treated as something rather more than a simple practice document. Rock star treatment would not be an inaccurate summary. The document, the product of several years of work by dozens of professionals, is being treated as a new world standard in systematising diagnosis and approach to ADHD, and claims are being made that it will reduce much of the inconsistency and caprice that currently attends the condition.

Well, many people will be grateful for that, because getting attention to ADHD — notice I’m trying to avoid the word “treatment” — can be a nightmare. It would appear possibly that it is overdiagnosed in some social groups — usually, the more powerful for various reasons — and possibly underdiagnosed in those less powerful groups, where many kids are deprived of funded health services and the consideration necessary for identification.

Belief in the condition will vary from doctor to doctor, as will the idea of what it is in those who accept it at all. If the gradual dissemination of these guidelines creates a uniform national approach — even one that can be systematically dissented from — they will mark a major advance in dealing with the condition.

But they will not in of themselves help us deal with the deeper questions about social life that the rise of ADHD as a “social object” represents. Indeed, to some extent, the setting of ADHD policy by a group formed around the assumption of its existence as a single thing could be a step backward. With diagnosis rates heading towards 10% of children (according to the guidelines themselves), and an increasing number of adults self-identifying with the condition, a more fundamental questioning about the actual nature of ADHD is becoming urgently necessary. 

That is particularly so, because the guidelines, emerging from a consortium of medical experts, make their starting point the notion that:

ADHD is classified as a neurodevelopmental disorder with an onset typically before 12 years of age (American Psychiatric Association, 2013). The symptoms include difficulties with attention and/or hyperactivity and impulsivity, which are incongruent with a person’s age and interfere with activities and participation (American Psychiatric Association, 2013).

While adding as a caveat:

There is a growing body of research exploring the numerous strengths and abilities of people with ADHD and positive aspects of ADHD features

Let’s stipulate something before we go forward, because I can sense people getting nervous. There is no denying that there is some distinct condition, perhaps frequently bound up with other conditions, that we currently call ADHD, and that it is a “non-neutral” existential condition. In a society and culture where individuals must steer and plan their own lives, where most work demands some form of project management, and where the conduct of personal relationships is not determined by rigid external rules but by continual negotiation and recommitment, ADHD can be a hell of a condition to have.

Adults diagnosed or self-diagnosed with it frequently report great relief in getting the diagnosis (and the treatment, usually chemical) because it answers years of frustration over uncompleted projects, trashed relationships, and life disorder. Children and adolescents can be less bothered by the general idea of having the condition, but suffer from the consequences of those same effects. 

But let’s also say something else. ADHD is a condition whose undesirability stems largely from it making difficult the achievement of certain life qualities set and defined by our culture. It’s not like a broken leg or asthma, which are clear dysfunctions in the universal preconditions of life. And it’s not even like some mental/neurological conditions that undermine the capacity to live any sort of life in any culture. Severe bipolar disorder (manic depression in the old money) would be an example of such — a relatively hard-wired disorder, controllable in many cases by lithium or other medication. Few non-modern cultures identify something like ADHD as a disorder, though they may well have terms for a certain type of skittish, flighty, adventurous character; most cultures, of all types, identify something like bipolar disorder as a disabling malady, however they explain it. 

So in that sense, ADHD is not a neurodevelopmental disorder at all — in the absolute way that, for example, early-onset dementia could be said to be. And though one can accept it is used as technical language, it is essentially a category error at the level of social and cultural policy. ADHD may well be a neurological constellation collectively distinct from majority settings, and it may be disadvantageous in our culture, but it is not the brain going wrong in absolute terms. In many cultures, its distinctive neurochemical settings — if they are indeed autonomous from psychological development — would simply never emerge as distinct. In other cultures, the distinctive behaviours of ADHD might emerge and be celebrated as part of group life, or even essential to it.

This fundamental framework — that ADHD is a life condition whose suffering and disadvantage arise from the cultural framework in which we live — should be a conception that overarches a specific treatment document such as the new guidelines. That would lead to a series of questions that aren’t being asked.

The most pertinent is whether our hi-tech, hyperindividualist, growth-capitalist culture has created a cultural system of work and relationships so exclusively dominated by valuing and rewarding “project management” — life lived as a series of explicit and interlocking means-ends projects — that those whose minds vary even slightly from an aptitude for such now find themselves, in adolescence, in a society and culture penalising them for being more flighty, immediately responsive, metaphorical in their thinking, kinetic and expressive in their bodies, improvised and aleatoric in their relations with others. 

Should we conclude that that is the case, then we can pretty easily conclude that what we are doing by regarding the cultural framework as fixed is deciding to take a bunch of kids with a variant subjectivity — whatever the root of its settings — and adjusting them to the cultural framework, usually by giving them amphetamines. That is a pretty serious thing to be doing, but it is inevitable if you do not question whether the social system and the education system could be altered so that what may be a form of neurodivergence can be lived without having to be rather brutally altered at the meatware level. 

This alternative account of what is labelled ADHD — or some of what is labelled ADHD — explains why this condition has emerged en masse in recent decades. In pre-modern cultures, most of its distinctive behaviours wouldn’t be a disadvantage. Fluidity, alertness, responsiveness, audacity and imagination are assets to any group of nomadic hunter-gatherers, small community farmers or the like. Situations of regimented work — slavery and industrial wage labour — offer no framework for the ADHD mind to emerge as distinct from the focused, project-oriented mind. No one cares if you can or can’t concentrate on the galley ship or the production line. The whole point of creating regimented labour is to smoothly extract pure labour power uninterrupted by actual human variation. 

This was probably the case in the modern classroom until recently. When most schooling was simply repetition, learning and routinised behaviour, which you finished at age 14 to work on the production line, only the children utterly incapable of surrendering to such would make themselves visible by their behaviour. When all you have to do is recite the 12 times table, your mind can float all over the place. Or eventually you just stopped turning up. 

But when schooling changes to an emphasis on problem-solving, dozens of little interlocking projects, which are pseudo-creative — regimented, but in a more disguised fashion — the 5-10% of kids with some measure of the conditions labelled ADHD are likely to become visible very quickly. They may not be incapable of sustained engagement. They may simply be incapable of the mix of engineered interest and futility that is at the marrow of modern schooling. After all, the purpose of the 12 times table, in industrial education, was to make you capable of both basic arithmetic and accepting of the boredom of working on the production line.

The purpose of the current education system is to train you in imposed semi-creative exercises, so you can go and do them in the bullshit jobs of a knowledge-culture society. Certain occurrences of ADHD are possibly a form of resistance to an imposed exploitative order, which the medical profession then adjusts people back to, Soviet psychiatrist style. There is a lot of speculation that it may be contributed to by the sudden, total and uncritical introduction of screens into the life of children. Equally this may well be overstated and inherently behaviourist.

What of the adults who believe themselves to have ADHD, either late-onset or undiagnosed? The ADHD neurological “ensemble” may well be present, and may well have rendered some people’s lives miserably chaotic. The relief from diagnosis and medication in this case may well be the general improvement in focus that most people feel on a slow-release amphetamine, and a degree of recognition from the “branding” of a diagnosis. The widespread adoption of the diagnosis among culture-elite circles may have also had something to do with the demands many such people put on themselves, in terms of an “ideal self” — and the pain of falling far short of that in the normal business of life. 

Thus, diagnoses of both child and adult ADHD need to be assessed with critical scrutiny, but possibly for contradictory reasons. Children are being chemically adjusted by others to a society they are coming into, while many adults are finding in the diagnosis a simple, in some cases perhaps somewhat mythical, answer to a complexity they already inhabit.

It seems likely that ADHD diagnoses are applied to children and adolescents who, in practical terms, have to be somewhat adjusted to the contemporary culture, and to another group, possibly the majority, who would not require the administering of brain-altering drugs if we could modify social and cultural frameworks, even moderately.

Restore some of the humanist innovations in education that were largely chased out by the return of heavy testing regimes in the 1990s, for instance. Vary the internal structure of work processes. Develop a more pluralist idea of life development.

But it will be years before politicians and professionals understand the need for this wider cultural framework to be applied, and it will probably only occur when the current regime of “adjustment” has become so widespread, expensive and damaging that it can no longer continue, even on its own terms. Any politician or professional who can leap ahead on this, even a little, will be doing us all an enormous service. So let’s speed things up! Oh…