Exploring clinician uncertainty in the diagnosis and treatment of attention deficit hyperactivity disorder

Abstract

Based upon analyses of interview data collected from twenty-six clinician respondents, this study explores two facets of clinician uncertainty related to the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in children. First, this study explores clinician reservations about the diagnostic validity of ADHD as it is described by the American Psychiatric Association (1994) in DSM IV . Second, this study explores clinician ambivalence regarding the physical and social-psychological sideeffects of stimulant medications, such as Ritalin. In applying the sociological discussions that address uncertainty in clinical settings and through reviewing a sizable cross-section of the popular and research-oriented literature demonstrating the contentious nature of the ADHD phenomenon, this study illustrates that clinicians do not practice within a vacuum, but are instead largely affected by the marked scepticism that surrounds ADHD. In being affected by this scepticism, it is concluded that clinicians who assess and treat ADHD are autonomous in how they interpret the diagnostic and treatment protocols for this mental disorder.

The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician’s point of view

“…Rafalovich (27) conducted a sociological study using qualitative methods to explore clinicians' experiences of diagnosis and treatment of ADHD in North America. However, his aim was to identify how clinicians' experiences "are affected by the well-publicised concern about the validity of ADHD and the chemical means in which the disorder is most commonly treated" (p. 308).…”

Medical Uncertainty and Clinician–Athlete Relations: The Management of Concussion Injuries in Rugby Union

“…2 I have explored the effects of commercialization on the treatment of sporting injury (Malcolm & Sheard, 2002), critiqued epidemiological work which falsely portrayed an "injury crisis" in rugby union (Malcolm, Sheard & Smith, 2004, 2005, examined the changing character of sports medicine provision in the game (Malcolm 2006b), and sought to explain why sport clinicians wield relatively little influence in professional sport (Malcolm 2006a). The research included both a questionnaire survey and semi-structured interviews, though it is the latter that centrally informs the analysis here.…”

“…Light (1979) argues that post-training physicians seek to increase control over clinical uncertainties through the assertion of individualized judgments made on the basis of personal experience, and by adopting particular treatment paradigms. Rafalovich (2005) identifies ways in which epistemological uncertainty can lead clinicians to be ambivalent towards diagnostic criteria. His study of the treatment of attention deficit hyperactivity disorder (ADHD) found that practitioners become more flexible in their implementation of diagnostic and treatment protocols when faced with patient/parent resistance, which has itself been fuelled by broader public debate over the condition.…”

Through the looking-glass: a critical review of sociology and medicine towards the diagnosis of ADHD1

“…Hence, it could be argued that the rise of the diagnosis ADHD is the result of processes leading to a medical or 'psychiatrized' explanation of human distress and to the organization its practitioners. Therefore the extension of the diagnosis of ADHD may be accounted for in terms of trends such as the medicalization of human conduct and deviant behavior, as argued by Conrad (1975); the expansion of medical categorization (Conrad and Potter, 2000); and the neurologization of the mental health, as described by Rafalovich (2001;2005).…”