The consequences of ADHD diagnosis: integrating scaffolding and perezhivanie to redesign pedagogy for ADHD-diagnosed children

Abstract

Diagnosis is widespread and influential in contemporary life, determining for example, how decisions are made about employment, whether one is eligible for benefits from the government, whether one can enrol in a selective school, or how one is categorised and educated within the schooling system. The widespread appeal of diagnosis (conducted both by professionals and through self-diagnosis via online sites) is that it apparently reveals a ‘truth about oneself’ that otherwise would remain hidden (Jutel 2011). Diagnosis as ‘truth-telling’ opens up a vista of new possibilities for one’s identity, whether it be a new career, or access to social benefits, or enrolment into a selective school, or categorisation as a particular kind of student. In this sense, diagnosis is a threshold phenomenon that shifts the person from a ‘past self’ into a new space:time, a new chronotope, where one’s sense of self and relationships with others are reconfigured (Davies 2016). By focussing on the consequences of diagnosis, the papers in this special issue can be regarded as explorations of the diagnostic chronotope – what happens when one enters the new time:space created by the process of diagnosis? In particular what happens to children when a diagnosis of ADHD is made? What time:space lies beyond the ADHD diagnosis? ADHD is the most commonly diagnosed neurodevelopmental disorder amongst children, estimated to affect about 7% of the child population (Graham and Tancredi this volume). However, its status as a universally occurring impairment remains controversial. For example, in comparing the historical uptake of ADHD as a diagnostic category across different countries (Canada, UK, Scandinavia, China and India) Smith (2017) argued that it depends on the level of promotion by psychiatrists and pharmaceutical companies with some countries embracing the disorder and others rejecting it (see also Bergey et al. 2018, for another cross-country comparison of ADHD diagnosis). Underlying such variations, Smith (2017) suggested, are distinctive culturally-grounded notions of psychiatry and child guidance as well as the influence of prominent advocates who shaped public opinion and educational practices at particular times in different countries. Smith (2017) concluded that when one examines the conditions in which the diagnosis of ADHD flourishes, it seems to be a product of culture and history rather than an inherent neurobehavioural impairment (Smith 2017, 770). The papers in this special issue do not address this fundamental issue directly, focussing rather on the consequences of diagnosis, that is, on ‘what lies beyond ADHD diagnosis.’ The diagnosis of ADHD operates to influence the lives of children in decisive ways, for example, by segregating them from their peers (Hjörne and Säljö) and producing treatment options not considered for nondiagnosed children (Honkasilta and Vehkakoski). Increasing rates of diagnosis also produces justification for significant investment in material infrastructure that locate children in extreme learning environments such as the instructional cubicles documented by Hjörne and Säljö. Diagnosis enables reclamation by parents of their moral status as ‘good parents’ of ADHD-