Last week, a consortium of researchers and practitioners going by the name of AADPA — the Australian ADHD Professionals Association — released a new set of guidelines for the condition, which is being treated as something rather more than a simple practice document. Rock star treatment would not be an inaccurate summary. The document, the product of several years of work by dozens of professionals, is being treated as a new world standard in systematising diagnosis and approach to ADHD, and claims are being made that it will reduce much of the inconsistency and caprice that currently attends the condition.
Well, many people will be grateful for that, because getting attention to ADHD — notice I’m trying to avoid the word “treatment” — can be a nightmare. It would appear possibly that it is overdiagnosed in some social groups — usually, the more powerful for various reasons — and possibly underdiagnosed in those less powerful groups, where many kids are deprived of funded health services and the consideration necessary for identification.
Belief in the condition will vary from doctor to doctor, as will the idea of what it is in those who accept it at all. If the gradual dissemination of these guidelines creates a uniform national approach — even one that can be systematically dissented from — they will mark a major advance in dealing with the condition.
But they will not in of themselves help us deal with the deeper questions about social life that the rise of ADHD as a “social object” represents. Indeed, to some extent, the setting of ADHD policy by a group formed around the assumption of its existence as a single thing could be a step backward. With diagnosis rates heading towards 10% of children (according to the guidelines themselves), and an increasing number of adults self-identifying with the condition, a more fundamental questioning about the actual nature of ADHD is becoming urgently necessary.
That is particularly so, because the guidelines, emerging from a consortium of medical experts, make their starting point the notion that:
ADHD is classified as a neurodevelopmental disorder with an onset typically before 12 years of age (American Psychiatric Association, 2013). The symptoms include difficulties with attention and/or hyperactivity and impulsivity, which are incongruent with a person’s age and interfere with activities and participation (American Psychiatric Association, 2013).
While adding as a caveat:
There is a growing body of research exploring the numerous strengths and abilities of people with ADHD and positive aspects of ADHD features
Let’s stipulate something before we go forward, because I can sense people getting nervous. There is no denying that there is some distinct condition, perhaps frequently bound up with other conditions, that we currently call ADHD, and that it is a “non-neutral” existential condition. In a society and culture where individuals must steer and plan their own lives, where most work demands some form of project management, and where the conduct of personal relationships is not determined by rigid external rules but by continual negotiation and recommitment, ADHD can be a hell of a condition to have.
Adults diagnosed or self-diagnosed with it frequently report great relief in getting the diagnosis (and the treatment, usually chemical) because it answers years of frustration over uncompleted projects, trashed relationships, and life disorder. Children and adolescents can be less bothered by the general idea of having the condition, but suffer from the consequences of those same effects.
But let’s also say something else. ADHD is a condition whose undesirability stems largely from it making difficult the achievement of certain life qualities set and defined by our culture. It’s not like a broken leg or asthma, which are clear dysfunctions in the universal preconditions of life. And it’s not even like some mental/neurological conditions that undermine the capacity to live any sort of life in any culture. Severe bipolar disorder (manic depression in the old money) would be an example of such — a relatively hard-wired disorder, controllable in many cases by lithium or other medication. Few non-modern cultures identify something like ADHD as a disorder, though they may well have terms for a certain type of skittish, flighty, adventurous character; most cultures, of all types, identify something like bipolar disorder as a disabling malady, however they explain it.
So in that sense, ADHD is not a neurodevelopmental disorder at all — in the absolute way that, for example, early-onset dementia could be said to be. And though one can accept it is used as technical language, it is essentially a category error at the level of social and cultural policy. ADHD may well be a neurological constellation collectively distinct from majority settings, and it may be disadvantageous in our culture, but it is not the brain going wrong in absolute terms. In many cultures, its distinctive neurochemical settings — if they are indeed autonomous from psychological development — would simply never emerge as distinct. In other cultures, the distinctive behaviours of ADHD might emerge and be celebrated as part of group life, or even essential to it.
This fundamental framework — that ADHD is a life condition whose suffering and disadvantage arise from the cultural framework in which we live — should be a conception that overarches a specific treatment document such as the new guidelines. That would lead to a series of questions that aren’t being asked.
The most pertinent is whether our hi-tech, hyperindividualist, growth-capitalist culture has created a cultural system of work and relationships so exclusively dominated by valuing and rewarding “project management” — life lived as a series of explicit and interlocking means-ends projects — that those whose minds vary even slightly from an aptitude for such now find themselves, in adolescence, in a society and culture penalising them for being more flighty, immediately responsive, metaphorical in their thinking, kinetic and expressive in their bodies, improvised and aleatoric in their relations with others.
Should we conclude that that is the case, then we can pretty easily conclude that what we are doing by regarding the cultural framework as fixed is deciding to take a bunch of kids with a variant subjectivity — whatever the root of its settings — and adjusting them to the cultural framework, usually by giving them amphetamines. That is a pretty serious thing to be doing, but it is inevitable if you do not question whether the social system and the education system could be altered so that what may be a form of neurodivergence can be lived without having to be rather brutally altered at the meatware level.
This alternative account of what is labelled ADHD — or some of what is labelled ADHD — explains why this condition has emerged en masse in recent decades. In pre-modern cultures, most of its distinctive behaviours wouldn’t be a disadvantage. Fluidity, alertness, responsiveness, audacity and imagination are assets to any group of nomadic hunter-gatherers, small community farmers or the like. Situations of regimented work — slavery and industrial wage labour — offer no framework for the ADHD mind to emerge as distinct from the focused, project-oriented mind. No one cares if you can or can’t concentrate on the galley ship or the production line. The whole point of creating regimented labour is to smoothly extract pure labour power uninterrupted by actual human variation.
This was probably the case in the modern classroom until recently. When most schooling was simply repetition, learning and routinised behaviour, which you finished at age 14 to work on the production line, only the children utterly incapable of surrendering to such would make themselves visible by their behaviour. When all you have to do is recite the 12 times table, your mind can float all over the place. Or eventually you just stopped turning up.
But when schooling changes to an emphasis on problem-solving, dozens of little interlocking projects, which are pseudo-creative — regimented, but in a more disguised fashion — the 5-10% of kids with some measure of the conditions labelled ADHD are likely to become visible very quickly. They may not be incapable of sustained engagement. They may simply be incapable of the mix of engineered interest and futility that is at the marrow of modern schooling. After all, the purpose of the 12 times table, in industrial education, was to make you capable of both basic arithmetic and accepting of the boredom of working on the production line.
The purpose of the current education system is to train you in imposed semi-creative exercises, so you can go and do them in the bullshit jobs of a knowledge-culture society. Certain occurrences of ADHD are possibly a form of resistance to an imposed exploitative order, which the medical profession then adjusts people back to, Soviet psychiatrist style. There is a lot of speculation that it may be contributed to by the sudden, total and uncritical introduction of screens into the life of children. Equally this may well be overstated and inherently behaviourist.
What of the adults who believe themselves to have ADHD, either late-onset or undiagnosed? The ADHD neurological “ensemble” may well be present, and may well have rendered some people’s lives miserably chaotic. The relief from diagnosis and medication in this case may well be the general improvement in focus that most people feel on a slow-release amphetamine, and a degree of recognition from the “branding” of a diagnosis. The widespread adoption of the diagnosis among culture-elite circles may have also had something to do with the demands many such people put on themselves, in terms of an “ideal self” — and the pain of falling far short of that in the normal business of life.
Thus, diagnoses of both child and adult ADHD need to be assessed with critical scrutiny, but possibly for contradictory reasons. Children are being chemically adjusted by others to a society they are coming into, while many adults are finding in the diagnosis a simple, in some cases perhaps somewhat mythical, answer to a complexity they already inhabit.
It seems likely that ADHD diagnoses are applied to children and adolescents who, in practical terms, have to be somewhat adjusted to the contemporary culture, and to another group, possibly the majority, who would not require the administering of brain-altering drugs if we could modify social and cultural frameworks, even moderately.
Restore some of the humanist innovations in education that were largely chased out by the return of heavy testing regimes in the 1990s, for instance. Vary the internal structure of work processes. Develop a more pluralist idea of life development.
But it will be years before politicians and professionals understand the need for this wider cultural framework to be applied, and it will probably only occur when the current regime of “adjustment” has become so widespread, expensive and damaging that it can no longer continue, even on its own terms. Any politician or professional who can leap ahead on this, even a little, will be doing us all an enormous service. So let’s speed things up! Oh…
I strongly suspect that I have ADHD. High school subjects largely blurred into meaninglessness after several minutes, and I had to repeat a couple of years. Ditto for university, where I struggled badly, and repeated more years. My brother went through high school with great marks and no repeats, and through two degrees afterwards, one with honours. He was diagnosed with adult ADHD five years back. Go figure.
By the way, it takes me twice as long to get through some of your articles as most of the other Crikey writers. I don’t know if that’s me, or if that’s you, but it was a good article today and much needed.
Out of interest, how do you know how long it takes other Crikey readers to get through Rundle articles?
Got no idea, Bob. I’m the only person I know who subscribes to Crikey. I did need to look up the meaning of the word ‘aleatoric’, so that slowed me a bit.
I stand corrected! I misread your comment. Apologies.
Hey, me too. I don’t usually get to the end of them, even, but did today, slowly and looking up the same word – not expecting to find it – hoping for a practical suggestion of how to manage the kid in the corner of the classroom breaking chairs while the rest of the class hurries out to the grass to continue the lesson.
Amphetamine enabled the German army’s blitzkrieg, when they defeated France by never stopping to sleep. It then enabled the great escape at Dunkirk, when the krauts inevitably ran out of joie de guerre and couldn’t even scratch themselves for several days. Hitler was famously addicted by doctor-prescribed amphetamine and cocaine injections. Anyway, I wouldn’t recommend it for the kid in the corner, but what would I know – not much.
Repetition and rote learning taught me to read and write after which I’d have been better off with a virtual reality helmet containing the internet. I was taught nothing about money or sex, knowledge of which would have saved me much trouble. Lessons on relationships and communication would also have been handy. Changing the car’s oil. Today it would be screen do’s and don’ts as well. None of which gets the kid out of the corner, perhaps. A school gym with lots of punchbags might. Another one for teachers.
I had to look it up, too, Frank. Sad thing is once my mind would have retained it after one dictionary check, now it won’t because I’m getting older.
Crikey writers he said Bob, not readers. And I get it. Grundle’s style is wordy and overly intellectual. I’ve had to re-read some, and gave up on others. this one was ok. His knowledge class series left me flat.
^^^^ yes, see my comment above.
Life is too short to trudge through to the end of grundle articles – or, some might say, even begin them.
Harsh but true. Simplicity and brevity is powerful.
Over 1,800 words to say little that more than you did above – “go outside and smell the roses“.
Grundle never uses a single, plain, suitable word when a half a dozen ever so clever ‘look-at me’ ones clamour to be shoe-horned in, however inappropriately – eg aleatoric rather than chance/random – d’ya reckon he gets off on the ‘had to look it up’ comments?
There is clearly a besotted fanclub (3-5ish) who assiduously d/v any suggestion of their golden one being FeS2 or having clay feet.
I like being challenged to think hard. There’s too much lazy thinking in the world, that’s why we’ve got all these conspiracy groups running rampant.
But then again, I truly enjoy reading Shakespeare.
This is unkind, to put it mildly. You don’t enjoy them – that’s fair. I for my part like his articles. Always interesting subjects, well written. Smart and thought provoking. Nothing wrong with intellectual. Nothing wrong with learning something.
He said writers not readers.
It’s not just you. I’m someone who’s fortunate enough to have never had any ADHD-like struggles in the education system, but it does take me significantly longer to read Rundle’s articles too.
To be fair to him, I think that’s unavoidable to a certain point, as Guy is often writing about more complex philosophical ideas than most of the other Crikey writers, who write more straightforward (though still interesting) journalism pieces. But Guy does, ironically, fall at times into an academic knowledge-class style, with long sentences consisting of multiple parenthetical clauses, and some use of the technical jargon of humanities scholarship. That said, I can sense that he works hard to make this stuff more accessible to a lay audience. He’s nowhere near as bad as most contemporary academic writers (*cough*Judith Butler*cough*)
P.S. Still love your work though, Guy 😀
I think theres a difference between ideas that are complex, and academic language. I hope to avoid the latter as much as possible. But the avoidance of complex ideas is the reason why the handling of ADHD has become circular in its reasoning. We have to question what a concept like ‘neuroadaptive’ means to know that it hides a cultural decision, within biological language. Not simply done.
Very true. And I appreciate the difficulty of writing about ideas that come out of academic theory to a general audience. How far to simplify the language before the full meaning becomes butchered. Where to draw the line between making oneself understood and infantilising the reader. To be clear, I think you do a pretty darn good job of it most of the time. Definitely better than I could haha
What’s your experience with ADHD people, Guy? What have you observed?
It’s not just you. I’m someone who’s fortunate enough to have never had any ADHD-like struggles in the education system, but it does take me significantly longer to read Rundle’s articles too.
Like you I am fortunate never to have any ADHD-like problems and it also takes me a longer time to read Guy’s articles. But that is a deliberate strategy on my part – and maybe results from a strategy Guy uses deliberately.
There is a lot of content in his pieces and I often skip over them on my first Crikey-read-through. I leave Guy’s articles until I have the time to dedicate to a careful reading with pauses to make sure I have not mis-read or mistaken what he intended.
I appreciate the work that goes into an article that challenges me to read carefully and think about what the writer has written. It makes a pleasant change from the superficial stuff so common in much of the current msm.
Similar things happened to me Frank Dee. School reports saying I dreamt too much, was dreamy but capable, lacking in application (code for lazy) and so on. Strangely, there was a subject area I was fascinated in, biology. I was a standout at it. I left school fifty years ago, so I was caned for inattention, which heightened my resentment of the system. When I was around 15, a teacher contributed to an important change in my life. She kept me back about once a month and looked through my exercise books, etc. She kicked my backside, but she also bolstered my confidence. The following year I was elevated two levels in the school’s classification system. It was a start, but I went along a faltering road for a while. I might say the teacher who helped was an old student of the school, and I heard in later years that she helped other pupils in similar ways.
If there is such a thing as ADHD, it’s possible that the “H” part wasn’t me. I feel fortunate in not being diagnosed, because I wouldn’t have appreciated taking the drugs.
Not everyone who is diagnosed with ADHD takes the drugs. It is helpful to have the diagnosis to better understand yourself, and embrace or work around your differences.
Understanding that ADHD is a real thing has helped my husband come to terms with my lost items, scraped car, missed appointments and other foibles. If we didn’t understand my brain I doubt we would still be married.
It all takes us twice as long to get through a Rundle article, vis-a-vis others. It isn’t ADHD — its Rundle!
Guy Rundle’s articles are the reason I subscribe to Crikey.
I often think GR gets things wrong, but he does make me think. Always worth reading.
My son at the age of 30 had a diagnosis of ADD 12 months ago. He also has a learning disorder which meant school was a nightmare for him. This diagnosis and the medication he has been prescribed has been life changing for him. In 12 months we have seen him change careers, able to concentrate on researching and writing tasks that he believes would have been impossible prior to the diagnosis. He is lucky that his strength is interpersonal skills which meant he has also had success in other ways. He is thankful every day for this diagnosis and the turn around this has had not just in his work life but in his personal relationships as well. A diagnosis like this is not easy and perhaps part of the success for him is how he sees himself and his increasing self confidence.
Guy is making several points, and offering a couple of opinions.
Guy’s comments and observations are insightful, and no doubt the products of decades of experience and thought. However, I wonder if his pessimism is as necessary now as it might have been ten years ago.
Two decades of internet commerce, and in particular the last 3 pandemic years have revealed work from home, solo entrepreneurism, and self-management are viable productivity models which advance post-industrial capitalism in demonstrable ways.
Flexible work is here to stay, at least for a certain class of people who know how to access it. For these people, whether they are online merchants, academics, financial advisers, psychologists, software engineers, web designers, paralegals, insurance reps, or bookkeepers, dexamphetamine and ritalin are powerful tools that give them the means to take control of their days.
And ADHD management is a lot more than drugs. Insights from CBT psychologists have led to apps, hacks and routines that empower ADHD types to gain control of their own agendas as much as the drugs do.
These new guidlines will form the basis for ADHD management to evolve even further, because ADHD types will be able to compare notes, develop a vocabulary for their challenges and successes, and spread the practice of successful methods that help to make them more effective in doing what they want to get done in this post-industrial world.
Guy’s warning are valuable too, if we understand he is looking out for powerless people who have to do shit jobs at the direction of other people. However, without ADHD awareness and management, their lives are worse because their cruel bosses just treat them mindlessly. The guidelines and growing awareness of what ADHD looks like might just as well form the basis for an improvement in their lot. Or it might lead to standardised methods of oppression and exploitation. That’s a whole other discussion, but for now, these guidelines are a useful starting line in the sand for the evolution of ADHD roles in our society.
Good to see this being discussed so wide-rangingly and free of the suffocating qualifications that drown academic thought.
I think your structural point about contemporary society not fitting a significant minority of people’s character has some merit.
However, I think the constant bombardment of our attention, via screens and other vectors, is a major factor. Anyone who’s done menial work will know it requires its own kind of attention and focus and I doubt whether someone with what’s constructed as ADHD would do well with hours, days, months of menial work. Johan Hari’s Stolen Focus is a good account of how almost all of us seem to feel we can’t focus like we used to.
Although it’s fashionable to poo-poo the effect of screens, I’m convinced they have a major effect on our attention and ability to focus. Both because of their intrinsic, passive, unimaginative quality and because of their general, braindead content. It is probably no coincidence that the US, the society saturated by tv (and post-tv) screens for the longest, is the homeland of ADHD – and countering your structural hypothesis, Guy, among western nations, it still has a comparatively high level of menial work and rote, meaningless education.
Having a young kid myself, who gets close to zero screen time, I’m horrified by the ubiquity of screens for most kids, even toddlers and younger and how solo and unshared it is. I find it hard to believe removing a child from social interaction and/or the wanderings of their own mind so much can’t be deleterious, not to mention the disempowering, unimaginative passivity of the experience.
Bravo, Guy Rundle, on ADHD!!!!!