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If attention deficit–­ hyperactivity disorder (ADHD) in the United Kingdom­ were a word cloud that attempted to capture its status as a social object, it would be characterized most prominently by a bold assemblage of biological and developmental research and researchers, intertwined with national guidelines and epidemiological reports. The phar­ ma­ ceu­ ti­ cal industry, health economics–­ related terms, and media reports would appear in smaller, lesser font caught up within this bold assemblage in a minor way. Smallest of all, ele­ ments related to ADHD as a lived experience would be (if we imagine this to be a three-­ dimensional word cloud) sucked into the vortex of the assemblage, a tiny object in the depths of a black hole. ­ These ele­ ments and this configuration make up ADHD in the United Kingdom in the early twenty-­ first ­ century. I start with this attempt at a three-­ dimensional image ­ because the content of this chapter is unsatisfyingly two-­ dimensional: it provides statistics on the prevalence of ADHD in the United Kingdom and stimulant drug use, it suggests some reasons why ­ those statistics have stayed relatively low in comparison to­ those in other countries, and it offers some scenes of what ADHD looks like “on the ground.” The three-­ dimensional image should serve as a reminder that the primary power and authority in UK ADHD resides within the bold assemblage, which produces and pres­ ents ADHD primarily in the form of ge­ ne­ tic and brain 6 ADHD in the United Kingdom Conduct, Class, and Stigma Ilina Singh 98   Global Perspectives on ADHD biomarkers, complex cognitive endophenotypes, and lots of numbers. What is most in­ ter­ est­ ing, perhaps, is that the authority of ADHD in this empiricist form has not translated into widespread, positive public uptake of the diagnosis or its treatments in the United Kingdom. This is not good news for families and­ children struggling with access to ADHD evaluations and support, ADHD stigma, and ADHD identity concerns. On the other hand, it does mean that diagnosis of ADHD and use of stimulant drug treatment are not (despite occasional media hype) at “epidemic” proportions in the United Kingdom. In fact, ADHD in the United Kingdom pres­ ents an object lesson in how powerfully national values can operate both at the level of public engagement with ADHD diagnosis and treatment and, less transparently, in the production of national guidelines and in the management of ­ children in schools, families, and clinics. This chapter also includes some personal observations and experiences. I have spent the past de­ cade working on ADHD in and around scientists, clinicians , patients, and parents in the United Kingdom, and my research has, in both explicit and implicit ways, become part of the national discourse on ADHD. I do not develop a sustained critical analy­ sis of my role or engagements; instead, I use my experiences to illuminate dynamics and actors that have informed the development of ADHD in the United Kingdom outside the formal pro­ cesses of the National Health Ser­ vice (NHS), the evidence base, and public groups and discussions. ADHD Prevalence in the United Kingdom Prevalence estimates for ADHD in any country are difficult to interpret­ because the methods for obtaining them vary across studies. In the case of ADHD estimates, data can be derived from parent reports, physician databases, population studies, and so forth. The data frequently do not differentiate among types of ADHD diagnosis (mild, moderate, severe; inattentive, hyperactive, or combined type); diagnostic criteria used by the clinician (dif­fer­ ent versions of the American Diagnostic and Statistical Manual of ­ Mental Disorder [DSM] or the International Classification of Diseases [ICD]); or diagnostic methods used in the clinical evaluation pro­ cess (parent report, teacher and parent report, child interview , developmental history interview, ­ etc.). Even when the same diagnostic methods are used, ­ those methods can be applied differently. On the ground, approaches to ADHD diagnosis frequently vary (to a greater or lesser degree) according to clinician, ser­ vice, location, and the type of health ser­ vice coverage ADHD in the United Kingdom   99 (NHS or private). ­ These complexities are why prevalence estimates often include wide statistical ranges. ­These caveats invite a critical reading of ADHD diagnosis and stimulant drug treatment reports in any country, but this orientation should not necessarily discount epidemiological estimates. In the United Kingdom, a recent systematic analy­ sis provides an estimate of 1.9%to5%ofUK­childrenwhomeetcriteriaforanADHDdiagnosis—­interestingly, this most recent analy­ sis was performed by a group of US researchers...


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