Reviewing and reframing the influence of relative age on ADHD diagnosis: beyond individual psycho(patho)logy

Koutsoklenis, Athanasios; Honkasilta, Juho; Brunila, Kristiina

doi:10.1080/14681366.2019.1624599

Cited by 9 publications

(27 citation statements)

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“…Asserting that ADHD is a neurodevelopmental disorder is a scientific conceit on one hand and reflects the DSM's political, cultural, and financial role in the psychiatrization of children's everyday lives on the other. ADHD diagnosis has expanded globally via institutions such as school (e.g., Hinshaw and Scheffler, 2014 ; Koutsoklenis et al, 2020 ), pharmaceutical industry, and western psychiatry along with the DSM (Conrad and Bergey, 2014 ), in all of which the psycho-medical discourse on deficit, disorder and disability is adopted and mobilized. In and through this discourse, ADHD exists as a neurobiological or neurodevelopmental condition within an individual caused by development processes of nature over which etiology individuals, society, or culture has no power.…”

Section: Quasi-scientific Basis Of Adhd In Dsm-5mentioning

confidence: 99%

“…To better understand how these processes work, we will next focus on meanings given to the ADHD diagnostic entity and their functions deployed through cultivating psycho-medical discourse of ADHD in institutional and social practices. Drawing from our previous research on how identities, agencies, and moral responsibility are negotiated in relation to the ideas about ADHD (Honkasilta et al, 2015 , 2016 ; Honkasilta and Vehkakoski, 2019 ) and medication use (see Honkasilta and Vehkakoski, 2017 ) as well as how the diagnosis impacts social and educational practices (see, Koutsoklenis and Gaitanidis, 2017 ; Koutsoklenis, 2020 ; Koutsoklenis et al, 2020 ), we have identified four functions and nine specific forms of the ADHD diagnosis as a semiotic mediator in the literature. Below, we present and analyze each of them and provide examples drawn from empirical studies (see Table 2 for a summary).…”

Section: How Does Adhd Become Real? Functions and Forms Of The Diagno...mentioning

confidence: 99%

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The (Un)real Existence of ADHD—Criteria, Functions, and Forms of the Diagnostic Entity

Honkasilta

Koutsoklenis

2022

Front. Sociol.

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The contemporary conceptualization of Attention Deficit Hyperactivity Disorder (ADHD) as a complex, multifactorial neurodevelopmental disorder cannot be understood as such without a complex assemblage of political, economic, and cultural processes that deem the conceptualization to be valuable and useful. In this article we use the notion of psychiatrization as a lens through which to see parts of these processes that make up ADHD what it is. In the first part of the article, we critically assess the scientific basis of the ADHD diagnosis via examining its diagnostic criteria as presented in the current fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM), the so called “Bible” of modern psychiatry. The second part of the article asks what is done with the ADHD diagnostic entity and with the idea that it represents a natural neurodevelopmental state within an individual—something an individual has—as represented in the DSM-5. Drawn from our previous research, we analyze how ADHD becomes real in discourse practice as a powerful semiotic mediator through analysis of the various functions and forms in which it takes shape in institutional, social, and individual levels. We conclude that the frequent changes in the diagnostic criteria of ADHD do not reflect any real scientific progress. Among other reasons, they change to match better the maneuvers of individuals when navigating an increasingly psychiatrized society in the search for recognition, support, category membership, immunity, sympathy, and sense of belonging.

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Section: Quasi-scientific Basis Of Adhd In Dsm-5mentioning

confidence: 99%

Section: How Does Adhd Become Real? Functions and Forms Of The Diagno...mentioning

confidence: 99%

The (Un)real Existence of ADHD—Criteria, Functions, and Forms of the Diagnostic Entity

Honkasilta

Koutsoklenis

2022

Front. Sociol.

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“…Inequalities have also been observed in children’s birth months relative to the school entry cutoff date. Several empirical studies, systematic reviews, and meta-analyses from around the world have shown that, compared with their oldest classmates, the youngest students—those born in the months immediately preceding the school entry cutoff date—were overrepresented among children identified as having an ADHD diagnosis and taking ADHD medication [ 14 , 15 , 16 ]. The mechanisms behind this phenomenon are not yet well understood.…”

Section: Introductionmentioning

confidence: 99%

“…Among the hypotheses advanced, most studies target children’s immaturity, described as a lag in cognitive, behavioral, or emotional development. Nevertheless, they imply different and sometimes contradictory underlying mechanisms [ 16 , 17 ]. Because these hypotheses are associated with different implications and solutions, it seems very important to gain a better understanding of the causes of the relative age effect (RAE) in ADHD, which may in turn help explain ADHD overdiagnosis.…”

Section: Introductionmentioning

confidence: 99%

Relative Age Effect in Attention Deficit/Hyperactivity Disorder at Various Stages of the Medicalization Process

et al. 2022

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Diagnosis and pharmacological treatment of ADHD are more common among the youngest children in a classroom, born in the months immediately preceding the school entry cutoff date. The mechanisms behind this phenomenon, called the relative age effect (RAE), are not yet well understood. Nearly all hypotheses involve the school system, various teachers’ actions, and concern children’s immaturity. However, most previous studies have been based on reports of health professionals’ diagnoses and prescriptions found in official databases rather than on reports of teachers’ behavior identification or suspicion of ADHD, despite their being at the first stages of the medicalization process. Our study overcomes this limitation by using reports of parents’ and teachers’ behavior identification or suspicion of ADHD within a three-level multilevel survey design, comprising 1294 children, 130 teachers, and 17 elementary public schools. The goal of our study was to investigate whether RAE stems (1) from adults’ judgement of the child’s expression of immaturity or (2) from the consequences associated with the child’s double burden of being immature and exhibiting ADHD behaviors. Our multilevel analyses put forward the first hypothesis only, supporting the medicalization of immaturity. RAE in ADHD seems mostly initiated by teachers’ pre-diagnostic actions toward younger children.

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“…Författarna lyfter fram ett flertal punkter på hur diagnosen är missvisande, eller pedagogiskt inadekvat. Ett exempel är att diagnostiseringen av ADHD är relativ i förhållande till ett barns skolstart; barn födda sent i förhållande till skolstart diagnostiseras i högre grad än övriga (se vidare Koutsoklenis, Honkasilta & Brunila, 2019). En annan punkt som tas upp är att det inte finns någon enskild biologisk markör (eller social för den delen) som orsakar ADHD varvid den neurogenetiska hypotesen är överskattad.…”

Section: Diagnosen Adhd Som Irrationell Uppfostringsrationalitet -Ett Inledande Exempelunclassified

Relationär pedagogik - för ett sannare liv: En essäistisk sammanläggning om dys/funktionell uppfostran: exemplet ADHD

Sjöberg¹

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The present dissertation is a complitation thesis composed of four published articles and a substantial introduction. The writing style of the introduction is essayistic. The overarching leitmotif is to propose a pedagogical argument for the idea that we need to live otherwise than we live today, if the aim is to live a good, as in a more true, life; i.e. so as to reach eudaimonia through the practice of padeia. The method used is threefold but still unified: it includes the digging mole, the philosophical owl, and the pedagogical eagle. Based on a critical examination of the diagnosis of ADHD (and closely related diagnoses), it is argued that the well-known diagnosis of ADHD is not as clearcut as the dominant “neuropsychiatric” paradigm would have it. This dominant paradigm generally assumes that an increased group of citizens suffers from a neurogenetic “deficit” and “disorder”, and that this group is best managed by medical and behaviorist models of “care” – in the thesis referred to as neuro-behaviorism. In the thesis it is argued that the diagnosis of ADHD (and similar diagnoses) is based on modern sophistry, which forms a negative identity-logic and a bio-pedagogic that results in the constitution, and instrumental treatment, of the (negative category) dysfunctional Other(s). The analysis shows that the dominant neuropsychiatric paradigm is irrational from a pedagogical point of view. Yet, this dominant paradigm is often referred to as rational. The analysis also shows that the diagnosis of ADHD belongs to a paradigm which is not only irrational, but also injust, inpure, evil, and violent. This result is primarly based on theoretical arguments developed in dialogue with thinkers such as Michel Foucault, Karen Barad, Michel Serres, Baruch Spinoza, and not least the philosopher Alain Badiou. An important argument driving the thesis, which is based on Badiou’s mathematical ontology, is that the diagnosis of ADHD stems from a paradigm that presupposes finite ways of thinking about what it means to be(come) human in an “in-human” world. Accordingly, the thesis makes for a pedagogical-philosophical critique of the diagnosis of ADHD, but at the same time it formulates a pedagogical alternative beyond the individual diagnosis. Against the dominant techno-positivist (therefore relativist) and pragmatic (therefore non-ontological) paradigm, a differently conceived pedagogical rationality is suggested. This pedagogical rationality is fundamentally relational; the relational alternative suggested is rational and indeeed materialistic. A main ontological axiom that the pedagogical alternative suggested draws from, is that if “the One” is not, then nothing is. This also means that Badiou’s mathemathically based ontology makes it possible to deconstruct every effect of oneness; the ontologically based axiom that there is no a priori “Other”. Yet, what there is (on the level of ontology) is a being that is equivalent with pure multiplicity or infinite alterity named void and symbolized with Ø. The thesis argues that in the void/Ø lies a potential to live a (more) true life. Further it is argued that void/Ø holds a pedagogical potential, via the unique encounter, to make the world exist from the perspective of Two rather than from the perspective of One (the dominant order). It is argued that the place where this unique encounter can take place is the so-called Two-scene of love, and that it is the pedagogue’s “slave-duty” in the world to make room for the Two-scene of love. The thesis closes with the rethorical question if the pedagogue, through a decisive decision, should act militant – as in go many miles – following the universal idea that it is possible for everyone to live a more true life, or if we, as pedagogical subjects, should continue to re/produce a society that through quasi-diagnostics renders equality an in-existent reality.

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Reviewing and reframing the influence of relative age on ADHD diagnosis: beyond individual psycho(patho)logy

Cited by 9 publications

References 61 publications

The (Un)real Existence of ADHD—Criteria, Functions, and Forms of the Diagnostic Entity

The (Un)real Existence of ADHD—Criteria, Functions, and Forms of the Diagnostic Entity

Relative Age Effect in Attention Deficit/Hyperactivity Disorder at Various Stages of the Medicalization Process

Relationär pedagogik - för ett sannare liv: En essäistisk sammanläggning om dys/funktionell uppfostran: exemplet ADHD

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