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The trajectory of the emergence and solidification of attention deficit–­ hyperactivity disorder (ADHD) in Canada is, as former Canadian Prime Minister Pierre Trudeau once famously said about Canada-­ US relations in general , reflective of sleeping with an elephant, in that “no ­ matter how friendly and even-­ tempered is the beast . . . ​ one is affected by ­ every twitch and grunt” (O’Malley and Thompson 2003: vii). The introduction of ADHD as a legitimate diagnosis and of psychopharmaceutical medi­ cation as its primary treatment, the populist reactions to ­ those developments, and the grassroots activism and regulatory policies that have arisen in Canada to manage ADHD and its treatment have all unfolded within the context of American influence by way of a highly permeable US-­ Canadian border. As ­ will be discussed more fully below, suspicions have been expressed in the popu­ lar media and among the general public and some professionals that the emergence of ADHD in Canada has not only been influenced by, but also echoes, the United States in terms of diagnosis and treatment. That said, more recent developments in advocacy and professional practice relating to ADHD indicate that ­ there have been efforts to move away from American models to carve out a more specifically Canadian approach. 3 In the Elephant’s Shadow The Canadian ADHD Context Claudia Malacrida Tiffani Semach The Canadian ADHD Context   35 The Perceived Legitimacy of ADHD and US-­ Canadian Border Permeability Part of the shared context centers on the criteria used in diagnosing ADHD in Canada and the United States. Canada has long accepted the American Psychiatric Association (APA) guidelines outlined in its Diagnostic and Statistical Manual of ­ Mental Disorders (DSM), which includes much broader symptoms and earlier acceptable ages of identification than ­ those outlined by the World Health Organ­ ization’s (WHO) International Classification of Diseases (ICD) (Malacrida 2003). In addition, the contexts of public discourse relating to both favorable and critical arguments about ADHD and its treatment are similar in Canada and the United States. Of course, mommy blogs, psychological and medical information sites, and virtual support groups have the capacity to transcend all national borders in terms of transferring information and support, but in Canada both the blogosphere and more traditional media are heavi­ ly influenced by US content. In terms of lay lit­er­a­ture on health, “prob­lem” ­children, education, and ADHD, most of the parenting magazines available on Canadian newsstands are American; Canadian bookstores carry books about self-­ help, health, psy­ chol­ ogy, and parenting that are primarily published in the United States; and American tele­ vi­ sion programming dominates Canadian airwaves (Clarke 2011). Fi­ nally, up ­ until recently, the US-­ based ­ Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), which describes itself as a recognized authority on ADHD and which has sustained a strong lobbying effort ­ toward legitimating the disorder (Conrad and Schneider 1980; Conrad 2006), has operated as many as 40 chapters in Canada (Malacrida 2003).1 Among the activities sponsored through the Canadian CHADD groups have been a number of regular “ADD fairs” that offered workshops for professionals, a place for ser­ vice providers to market their wares, and information for parents about both mainstream and alternative treatments for ADHD. At ­ these venues, much of the information (including US-­ based keynote speakers) and most of the products, ranging from biofeedback techniques and be­ hav­ ior modification protocols to “nutraceuticals” (dietary supplements and super-­ vitamins), came from US sources (Malacrida 2002, 2003). Given the pervasive presence of American media, products, and ser­ vices available to concerned parents and educators, it is fair to state that the US-­ based normalization of ADHD as a common childhood disorder (Mayes, Bagwell, and Erkulwater 2009) has deeply influenced how Canadian parents, medical professionals , and educators respond to ADHD. 36   Global Perspectives on ADHD Although much of the information and knowledge that crosses the US-­ Canadian border is positive in tone, it also includes a significant amount of negative coverage about ADHD as a diagnosis and, most pressingly, about the aggressive and inappropriate use of medi­ cation in young ­ children, producing an ambivalent context in which educators and parents must operate (Clarke 2011). Much of this discourse draws on strong anti-­ Ritalin activism originating from the United States, in par­ tic­ u­ lar through Peter Breggin, a prominent anti-­ psychiatry figure who has conducted speaking tours in Canada and whose books and website are part of the populist Canadian landscape concerning ADHD. During the late 1990s, several series of articles in local...


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