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Book Reviews   |    
Framing ADHD Children: A Critical Examination of the History, Discourse, and Everyday Experience of Attention Deficit/Hyperactivity Disorder
Reviewed by Maureen Kaplan
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.4.586
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By Adan Rafalovich; Lanham, Maryland, Rowman & Littlefield Publishing Group, 2004, 208 pages, $75

Ms. Kaplan is a doctoral fellow at the Smith College School for Social Work and a clinical social worker at the Brattleboro Retreat in Brattleboro, Vermont.

Adam Rafalovich's Framing ADHD Children: A Critical Examination of the History, Discourse, and Everyday Experience of Attention Deficit/Hyperactivity Disorder offers an effective example of how real-life narratives provide richness and multidimensionality to a topic, broadening his original hypothesis about attention-deficit hyperactivity disorder (ADHD) from the specific to the general. Rafalovich, assistant professor of sociology at Texas Tech University, demonstrates in highly readable fashion how "the experiences people associated with ADHD have are connected to the various and sundry ADHD discourses that are found in the medical and popular literature."

The book opens with a history of what we now know as ADHD, tracing its roots back to the 19th century, when the disorder was called "idiocy" and "imbecility." Rafalovich then describes his study, in which he recruited 90 participants constituting groups of clinicians, teachers, parents of children with ADHD, and the children themselves to participate in structured interviews about their experiences with the disorder.

One theme that runs throughout the book is how ADHD is conceptualized by each group, which in turn influences the outlook of other groups. Another theme is the persistent ambivalence that exists within each group, driving home the lack of any consensus on the issues surrounding ADHD. Clinicians battle between psychodynamic and neurologic explanations. Teachers act as middleman between the clinician and the parent, demanding intervention to successfully perform their jobs. Parents become informal experts, seeking to understand the labyrinth of questions about the cause of the disorder, diet, medication, therapy, and social stigma. As in many debates, all points of view deserve careful consideration, and Ravalovich leads readers through the maze.

Rafalovich concludes that "ADHD is a socially negotiated phenomenon," a disorder "riddled with reliability and validity problems, shown in the plurality of ways ADHD is understood." What mental health professionals already know about the desire for the quick fix is reconfirmed: "rapid fire culture fails to ponder ADHD in any critical way because it lacks the time," and thus for "children who cannot successfully negotiate the experience of rapid fire culture, the care they receive is pharmacological."

Throughout the book, the reader is presented with a succession of study participants grappling with unanswerable questions. One cannot ignore the faint tick-tock of a giant clock reminding us of the need for a timely consensus on how best to approach ADHD. In the meantime, we are left to struggle with the guilt stirred up by the words of a pediatrician, who states "our society is not geared to children; it hates children, it sees them as a necessary nuisance."

Rafalovich supplies a helpful reminder of the issue's scope: that, according to the American Academy of Pediatrics, currently four million schoolchildren in the United States have been given a diagnosis of a form of ADHD. This provocative book has a place on the shelf of doctors, psychiatrists, psychologists, social workers, teachers, and parents—all those who are in a position to make a decision in the best interest of those children.

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