Event Title
Facts, values and ADHD: Gender differences, concepts and practice
Start Date
25-6-2010 1:00 PM
End Date
25-6-2010 2:30 PM
Description
This presentation is part of the The Role(s) of Values in Science track.
Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed behavior disorder in children, and it is increasingly diagnosed in adults as well. Recent studies suggest a prevalence of 8% to 10% (Biederman and Faraone 2005; Froehlich, Lanphear et al. 2007) as does recent U.S. practice: about 7.8% of children and adolescents have been diagnosed (Centers for Disease and Prevention 2005). ADHD “management” also involves millions of parents, doctors and psychologists, teachers and school administrators, and law enforcement and public health officials. Pharmaceutical companies profit immensely from prescription sales, and thriving basic and clinical research programs investigate aspects of the disorder. In short, ADHD is a fixture of U.S. culture, though one that continues to inspire controversy.
Two contrasting issues might concern feminists who observe the science and practice surrounding this prevalent phenomenon. The first is a marked gender differential in knowledge and practice. ADHD research has been markedly slanted toward study of boys (Hinshaw and Blachman 2005), and, although the difference has decreased in recent years, diagnosis and treatment rates remain much higher in boys (Bussing, Zima et al. 2003; Quinn and Wigal 2004). Interpretation of this difference is an open question. It may reflect absolute differences in prevalence in males vs. females, or it might stem from perceived lesser urgency of the problems ADHD-diagnosable girls and women face, or the lesser trouble diagnosable girls and women cause their contacts. If not a prevalence difference, these differentials threaten to leave affected girls and women underrecognized and undertreated, with potentially serious ramifications for their life prospects.
The second issue is that current ADHD concepts and practices tend to stereotype and dichotomize. I have argued elsewhere that this is the case for the predominant, biologized concept of ADHD, considered without attention to gender issues (Name withheld, forthcoming 1; Name withheld, forthcoming 2). That analysis builds on the work of feminist philosophers of science who have exposed epistemic and social factors that contribute to creating and holding false dichotomies, such as those between races (Gannett 2001), genders, social categories (Anderson 2004), or—more broadly—between science and society (Longino 1990; Longino 2002). Non-dichotomized views of science:society interaction help illuminate the deep mutual influences between them. In the case of ADHD, scientific and social practices and values have together reified another false dichotomy—that between ADHD and non-ADHD, or “normal.” Dichotomization isolates ADHD-associated valuations to the “ADHD” group—and group members—in a way that downplays the marked variation among ADHD-diagnosable people. Many of the attributed values are negative, referring to ADHD-diagnosable individuals’ failures to meet norms of behavior and achievement. The negative valuations and stereotyping, together with practices that limit options available to ADHD-diagnosable individuals, constitute a form of institutionalized intolerance of ADHD traits and behaviors, and those who exhibit them. Additionally, the negative valuations become embedded in scientists’ methodology and conclusions (Name withheld, forthcoming 1), limiting the resources of science (at least as currently practiced) to critique the present situation.
Much current literature proposes that ADHD concepts and practices should be further divided along gender lines. Differences may include variation in presentation, course, and treatment (Gaub and Carlson 1997; Greene, Biederman et al. 2001; Newcorn, Halperin et al. 2001; Zalecki and Hinshaw 2004; Graetz, Sawyer et al. 2005; Levy, Hay et al. 2005; Ohan and Johnston 2005; Quinn 2005; Hinshaw, Carte et al. 2007), and in perceptions of parents, teachers, peers, and interested others about ADHD in girls/women vs. ADHD in boys/men (Thurber, Heller et al. 2002; Bussing, Gary et al. 2003; Singh 2003; Quinn and Wigal 2004; Chen, Seipp et al. 2008). If these differences hold up to scrutiny, and the pattern of negatively valenced attributions associated with ADHD concepts and practices does not change, girls and women may be subject to forms of stereotyping or intolerance to which boys are not, and vice-versa. As with the first issue, this may have significant ramifications for diagnosable individuals.
The two issues contrast: The first suggests that the ADHD construct and related practices are approximately accurate, but that political will is needed to ensure equity in care. The second views the current construct and practices more skeptically, suggesting priority to refining the science. I suspect I will argue that the second issue is more serious, based on my current views about the role of values in ADHD science and practice. But because this abstract represents a refinement I plan to undertake, building on my earlier work, I leave the door open to reinterpretation or surprises. Certainly, both issues could be problematic. Or, if dichotomization is a concern because it downplays variability, perhaps scientific recognition of gendered patterns in ADHD phenomenology represents a step toward a more complex, nuanced view of ADHD, rather than another layer of stereotyping. I will also need to revisit an important counterargument to my thesis that current ADHD science and practice reinforce intolerance—the view that biologization of behavioral traits tends to reduce, rather than reinforce, intolerance. In any case, my methodology will emphasize close reading of the science, as well as the growing philosophical literatures on stigmatization and on values in science.
Facts, values and ADHD: Gender differences, concepts and practice
This presentation is part of the The Role(s) of Values in Science track.
Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed behavior disorder in children, and it is increasingly diagnosed in adults as well. Recent studies suggest a prevalence of 8% to 10% (Biederman and Faraone 2005; Froehlich, Lanphear et al. 2007) as does recent U.S. practice: about 7.8% of children and adolescents have been diagnosed (Centers for Disease and Prevention 2005). ADHD “management” also involves millions of parents, doctors and psychologists, teachers and school administrators, and law enforcement and public health officials. Pharmaceutical companies profit immensely from prescription sales, and thriving basic and clinical research programs investigate aspects of the disorder. In short, ADHD is a fixture of U.S. culture, though one that continues to inspire controversy.
Two contrasting issues might concern feminists who observe the science and practice surrounding this prevalent phenomenon. The first is a marked gender differential in knowledge and practice. ADHD research has been markedly slanted toward study of boys (Hinshaw and Blachman 2005), and, although the difference has decreased in recent years, diagnosis and treatment rates remain much higher in boys (Bussing, Zima et al. 2003; Quinn and Wigal 2004). Interpretation of this difference is an open question. It may reflect absolute differences in prevalence in males vs. females, or it might stem from perceived lesser urgency of the problems ADHD-diagnosable girls and women face, or the lesser trouble diagnosable girls and women cause their contacts. If not a prevalence difference, these differentials threaten to leave affected girls and women underrecognized and undertreated, with potentially serious ramifications for their life prospects.
The second issue is that current ADHD concepts and practices tend to stereotype and dichotomize. I have argued elsewhere that this is the case for the predominant, biologized concept of ADHD, considered without attention to gender issues (Name withheld, forthcoming 1; Name withheld, forthcoming 2). That analysis builds on the work of feminist philosophers of science who have exposed epistemic and social factors that contribute to creating and holding false dichotomies, such as those between races (Gannett 2001), genders, social categories (Anderson 2004), or—more broadly—between science and society (Longino 1990; Longino 2002). Non-dichotomized views of science:society interaction help illuminate the deep mutual influences between them. In the case of ADHD, scientific and social practices and values have together reified another false dichotomy—that between ADHD and non-ADHD, or “normal.” Dichotomization isolates ADHD-associated valuations to the “ADHD” group—and group members—in a way that downplays the marked variation among ADHD-diagnosable people. Many of the attributed values are negative, referring to ADHD-diagnosable individuals’ failures to meet norms of behavior and achievement. The negative valuations and stereotyping, together with practices that limit options available to ADHD-diagnosable individuals, constitute a form of institutionalized intolerance of ADHD traits and behaviors, and those who exhibit them. Additionally, the negative valuations become embedded in scientists’ methodology and conclusions (Name withheld, forthcoming 1), limiting the resources of science (at least as currently practiced) to critique the present situation.
Much current literature proposes that ADHD concepts and practices should be further divided along gender lines. Differences may include variation in presentation, course, and treatment (Gaub and Carlson 1997; Greene, Biederman et al. 2001; Newcorn, Halperin et al. 2001; Zalecki and Hinshaw 2004; Graetz, Sawyer et al. 2005; Levy, Hay et al. 2005; Ohan and Johnston 2005; Quinn 2005; Hinshaw, Carte et al. 2007), and in perceptions of parents, teachers, peers, and interested others about ADHD in girls/women vs. ADHD in boys/men (Thurber, Heller et al. 2002; Bussing, Gary et al. 2003; Singh 2003; Quinn and Wigal 2004; Chen, Seipp et al. 2008). If these differences hold up to scrutiny, and the pattern of negatively valenced attributions associated with ADHD concepts and practices does not change, girls and women may be subject to forms of stereotyping or intolerance to which boys are not, and vice-versa. As with the first issue, this may have significant ramifications for diagnosable individuals.
The two issues contrast: The first suggests that the ADHD construct and related practices are approximately accurate, but that political will is needed to ensure equity in care. The second views the current construct and practices more skeptically, suggesting priority to refining the science. I suspect I will argue that the second issue is more serious, based on my current views about the role of values in ADHD science and practice. But because this abstract represents a refinement I plan to undertake, building on my earlier work, I leave the door open to reinterpretation or surprises. Certainly, both issues could be problematic. Or, if dichotomization is a concern because it downplays variability, perhaps scientific recognition of gendered patterns in ADHD phenomenology represents a step toward a more complex, nuanced view of ADHD, rather than another layer of stereotyping. I will also need to revisit an important counterargument to my thesis that current ADHD science and practice reinforce intolerance—the view that biologization of behavioral traits tends to reduce, rather than reinforce, intolerance. In any case, my methodology will emphasize close reading of the science, as well as the growing philosophical literatures on stigmatization and on values in science.