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The Emergence of ADHD in Australia By Western standards, Australia has a relatively short official history. Originally inhabited by a diverse array of more than 500 Indigenous groups, the “Australia ” that is widely recognized ­ today first came into being as a British penal colony in the late 1700s. Over the period of the next 150 years, the Anglo-­ Australian population grew and diversified through several waves of Eu­ ro­ pean immigration, but retained its deep cultural, po­ liti­ cal, and economic ties with Britain. The Second World War became a turning point in this relationship. Disquiet over the rising death toll of Australians fighting to protect British interests in Eu­ rope, Indo-­ China, the ­ Middle East, and North Africa, along with fear from the threat from Japan in the Pacific, led to a change in Australia’s economic and defense posture, resulting in a growing alliance with the United States (Lee 1992). From the 1950s, Australia increasingly identified with the United States—­ first strategically and then culturally. This shift also had material effects, particularly in the areas of medicine and health (Graham 2010). Since the 1970s, Australia has tended to follow the United States in ­ mental health directions, especially in relation to a cultural preference for pharmacological treatment within a medical model of care. 4 Historical, Cultural, and Sociopo­ liti­ cal Influences on Australia’s Response to ADHD Brenton J. Prosser Linda J. Graham Historical Influences on Australia’s Response to ADHD   55 An example of this tendency can be found in the case of the diagnostic category of hyperactivity (a precursor to ADHD). The 1970s ­ were a turning point for public and professional opinion in relation to ­ mental disabilities in Australia (AIHW 2004), with greater recognition of their existence (through the adoption of the American Psychiatric Association’s [APA’s] Diagnostic and Statistical Manual of ­ Mental Disorders [DSM] and the impact of the deinstitutionalization movement ) and the responsibility of governments to provide support for greater social participation for affected individuals. Hyperactivity became well known during this period, with a number of advocacy groups (including in­ de­ pen­ dent state-­ based hyperactivity support associations such as the Hyperactivity Association of South Australia and the Hyperactive ­ Children’s Association of Victoria) emerging across Australia. ­ These groups facilitated conferences and educational seminars (most of which focused on medical and educational interventions for individuals), whereas the public debate focused on a range of questions that are still commonly raised with ADHD more than three de­ cades ­ later (such as its “real­ ity” and the appropriateness of treatment with psychostimulants). In the Australian context, “hyperactivity” was the launch point for a diagnostic category that evolved into other nomenclatures (e.g., “ADD” and “ADHD”) that ­ were identified within the DSM (Smith 2008) and ­ were to come to the attention of Australian prac­ ti­ tion­ ers, professionals, and the public in the early 1980s. Growth and Prevalence in Australia Since the 1970s, Australian medical prac­ ti­ tion­ ers have drawn primarily on the DSM, which is now in its fifth edition (APA 2013). Although this manual covers an ever-­ growing array of disorders, ADHD and its precursors have held a consistent place within it. Due to the historical and cultural influences identified above, ­ there has been relatively ­ little use of the World Health Organ­ ization’s (WHO’s) International Classification of Diseases (ICD-10) (1992), which has been preferred in Eu­ rope. Whereas the ICD-­ 10 refers to hyperkinetic disorder—­ and requires symptoms relating to the full triad of impairments (impulsivity, hyperactivity , and inattention) to be pres­ ent for a diagnosis to be made—­ the DSM, in contrast, categorizes ­ these symptoms into three subtypes (predominantly inattentive , predominantly hyperactive, and combined type). This allows a diagnosis to be made when only some symptoms are pres­ ent (Thomas, Mitchell, and Batstra 2013). The use of the ICD-10 is frequently associated with lower rates of diagnosis (Amaral 2007); consequentially, the standardization of diagnostic protocols around the DSM in Australia has been identified as one ­ factor in the dramatic 56   Global Perspectives on ADHD increase in ADHD diagnosis and psychostimulant treatment (Prosser and Reid 1999), paralleling trends in the United States (Conrad 2007). Like the United States, Australia experienced a fivefold increase in medi­ cation use for ADHD during the 1990s (Hazell, McDowell, and Walton 1996). Rates and growth of prescription varied among Australian states, possibly­ because of differing recording procedures, but growth did occur in all states (Valentine, Zubrick, and Sly 1996). New prescriptions for ADHD grew 26...


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