European History Post-1980’s
Barkley
(2010) suggested that ADHD is perceived very differently in Europe in
comparison to the US view of a developmental disorder, primarily
impacting cognition and learning. Conversely, he suggests, Europe is
preoccupied with antiquated theories emphasising hyperactivity,
disorderly behaviour, brain damage and social or family causal factors
(the latter two in combination seems somewhat counterintuitive though).
When the World Health Organization (WHO) did not follow in the footsteps
of the DSM-III (APA, 1980) down the proverbial inattention rabbit hole;
this does appear to have represented a major departure between the two
geographical locations. This divergence does continue, albeit increasing
less, to the present day.
It
is certainly true to say, that at the time, the creation of the ADD
entity was based more on enthusiasm than on hard scientific evidence.
Never the less, it did spark a great deal of ground breaking research,
and one could cautiously suggest that it was a precursor to our current
appreciation of executive functions, it certainly has played a role. At
the time, it was more prudent to view inattention with a little healthy
scepticism; the problem is with its continued blanket rejection of the
significance of inattention (beyond a cursory nod to its existence) to
this day.
The
ICD-10 argues for its exclusion based on a lack of understanding of the
aetiology and specific psychological processes underpinning it stating,
It
is widely thought that constitutional abnormalities play a crucial role
in the genesis of these disorders, but knowledge on specific aetiology
is lacking at present. In recent years the use of the diagnostic term
"attention deficit disorder" for these syndromes has been promoted. It
has not been used here because it implies a knowledge of psychological
processes that is not yet available, and it suggests the inclusion of
anxious, preoccupied, or "dreamy" apathetic children whose problems are
probably different. However, it is clear that, from the point of view of
behaviour, problems of inattention constitute a central feature of
these hyperkinetic syndromes.” (WHO, 1994; p. 206).
This
is somewhat foolhardy and ill-advised (possibly even blindingly
ignorant), since the aetiology of most, if not all psychiatric disorders
is problematic (at best), and such an argument also extends to the
entire HKD construct. Moreover, psychological processes underlying any
disorder are determined in large part by your personal theoretical
orientation, for example, psychoanalytic differ greatly from cognitive
theories. Indeed, it was due to the insurmountable debates surrounding
these issues that any reference was left out of the DSM-IV and there has
be no move to reinstate these in the revision either (Hyman, 2011).
Furthermore,
Barkley (2011) argues that this antiquated view conceives a rarer more
sever condition, which fundamentally results in behavioural and conduct
problems. In contrast, he suggests ADHD is viewed more developmentally
in the US. It would be imprudent to accept such assertions outright,
however, there is veracity to his claims. Let us consider, for example,
how ADHD is classified in these different jurisdictions.
It
was necessary to use the education arena, because European countries
have failed to include a definition for ADHD under disability
legislation, but there is usually literature (e.g., OECD, 2007)
surrounding how it is treated in schools.Globally the condition is
considered a ‘difficulty’ along with learning problems (e.g., Dyslexia),
social, emotional, and behaviour problems (S/EBD), and economic
disadvantage (OECD, 2007). Of note is its absence from the ‘disorder’
category containing medical conditions and syndromes. By contrast, in
the USA it is classified as Other Health Impairment and its medicalized
description highlights neuronal dysfunction of attention and its
adverse effects on educational attainment (Osborne & Russo, 2007).
Their neighbours to the north, Canada, include ADHD in the specific
learning difficulty category, alongside dyslexia and other cognitive
impairments, and this system separates ADHD from the behavioural /
emotional problems category (OECD, 2007).
In
contrast, the various jurisdictions in the UK and Ireland tend to use
variations of these three constructs (social, emotional, and
behavioural) in their categorization of ADHD (Cooper & Jacobson,
2011).
Although
the majority of EU countries do not have a specific classification it
appears clear that they would follow suit. In France the condition is
most likely associated with behavioural problems, and defined as a
psychological disorder which impairs social interaction (OECD, 2007).
And while Greece is likely to classify ADHD as a learning disability,
this broad term refers to all conditions beyond significant mental or
physical impairments (OECD, 2007).
The
significance of this distinction could be very significant. In a recent
international controlled research project ADHD VOICES lead by Ilina
Singh (e.g., 2011) which interviewed children with ADHD in the UK and
the USA about their experiences of ADHD and stimulant medication. The
research team observed that,
"...
the intense focus on negative behaviours in UK state school classrooms
may mean that behaviour, not learning or academic performance, becomes
children’s primary concern ..." (p. 892).
Conversely,
participants in the states were more academic performance focused,
describing problems with learning and concentrating, rather than being
preoccupied with emotional and behavioural difficulties. Singh (2011)
attributed the difference to what was culturally valued, in the UK there
may be more of an expectation to regulate one’s behaviours, and
individuality and idiosyncrasies may be less accepted, whereas, the
highly individualize culture of the US is more accepting of shows of
emotion.
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