Rethinking medicalization: discursive positions of children and their caregivers on the diagnosis and treatment of ADHD in Chile

Abstract

The debates around the diagnosis and pharmacological treatment of Attention Deficit and Hyperactivity Disorder (ADHD) have traditionally been approached from the perspective of the “medicalization processes” of children’s behaviour. However, this perspective tends to overlook the meanings of diagnosis and treatment of ADHD for children and their caregivers. The purpose of this article is to describe the discursive positions of children and their caregivers on the diagnosis and treatment of ADHD. In-depth interviews were conducted with seven Chilean children and their caregivers. The material was analysed following the procedures of the discourse structure analysis. A discursive structure was identified that configures four emerging realities: the myth of origin of the child’s behaviour and learning problems; the ambivalences in/of medicalization; the process of identity (dis)stabilization under diagnosis and treatment; and the subversion of medicalization. It is observed that the subjective experience of the diagnosis and treatment of ADHD is not homogeneous, since different discursive positions, family and institutional understandings that enter into conflict cross it. The experiences of ADHD are shaped by discursive structures that condition the meanings of this experience. The medicalization process is not univocal, but can take different forms and have consequences on children’s experiences and social trajectories.

Excess of Attention. The Construction of a Disorder in Chilean Schools

“…linked to indices of prevalence and focused on individual symptoms, losing sight of what has been called the ADHD Situation (COTTET et al, 2019;REYES et al, 2019).…”

Exceso De Atención: De La Composición De Un Trastorno en La Escuela Chilena

“…Ello ha implicado que la atención se centre en la conducta atencional y las consecuencias individuales del diagnóstico, por sobre las experiencias subjetivas y sociales. En este sentido, la idea de un sobrediagnóstico iría de la mano de una problematización ligada a índices de prevalencia, que se centraría en los síntomas individuales, perdiendo de vista aquello que se ha llamado Situación TDAH (COTTET et al, 2019;REYES et al, 2019).…”

“…A partir de allí uno de los principales diagnósticos que se dispara en su prevalencia es, justamente, el TDAH. Por esta razón, entre otras, ha ganado importante espacio en la opinión pública la tesis de su sobrediagnóstico, sin embargo, creemos fundamental comprender desde la acción del PIE en el aula el modo en que se hace emerger aquello que denominaremos Situación TDAH (CLARO, 2015;REYES et al, 2019;URIBE et al, 2019), para apreciar el fenómeno en su conjunto. Esta apariencia de sobrediagnóstico es parte de lo que habría que explicar y no una explicación a la prevalencia.…”

Attention deficit hyperactivity disorder: A pilot study for symptom assessment and diagnosis in children in Chile

“…More specifically, the increase of ADHD diagnosis in Chile has become on 2000s, and led their incorporation into children’s health plan named “ Habilidades para la vida ” ( Chile Ministerio de Salud, 2008 ), which aims are prevent this type of disorder through a joint work between school and health services, and has been accompanied by the creation of devices such as the School Integration Program (PIE) in 2015 ( Chile Ministerio de Educación, 2015 ). This leads to another relevant issue: the fact that the diagnosis rate of “special educational need” disorders (defined by “PIE”) are the basis to a state subside to the schools, and since ADHD is one of them, they diagnosis can be used as a strategy to obtain additional economic resources, which has aroused different suspicions ( Reyes et al, 2019 ). Surprisingly or not, the sophistication of these strategies has coincided with the sustained increase of ADHD prevalence rates on child and youth population ( Uribe et al, 2019 ).…”

“…Although ADHD is configured as the most frequent neurodevelopmental disorder, few studies offer prevalence estimates regarding mental health pathologies such as ADHD in Chile. Thus, the benchmark study for Chile continues to be De la Barra et al (2013) and was noted in the country's most recent National Plan for Mental Health (2017)(2018)(2019)(2020)(2021)(2022)(2023)(2024)(2025) as the source of prevalence data, but it focuses only on the epidemiological aspect of the disorder, especially yielding information to children and adolescent mental health programmes in Chile, while a variety of strategies to detect, diagnose and treat pathologies in health and education areas have emerged (Chile Ministerio de Salud, 2008;Chile Ministerio de Educación, 2015;Reyes et al, 2019).…”