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Attention deficit–­ hyperactivity disorder (ADHD) has been the most commonly diagnosed ­ mental disorder of childhood and adolescence in Taiwan over the past de­ cade. According to surveys based on community samples, the estimated prevalence of ADHD among ­ children 7 to 15 years of age is between 6.3% and 12% (Huang 2008), which is higher than the estimated global average prevalence of 5% (Polanczyk et al. 2007). Compared with ­ these estimates, the number of ADHD diagnoses in Taiwan’s National Health Insurance (NHI) database of medical claims has been much lower. The most recent research using NHI data based on a random population sample of 378,881 patients 4 to 17 years of age found that the prevalence of the ADHD diagnosis between 2010 and 2011 was 2.3% (Chen et al. 2016). Another study, which recruited all newly diagnosed ADHD patients 18 years of age or younger from 2000 through 2011, revealed that the annual prevalence of ADHD increased 10.3 times (from 0.1% to 1.3%) throughout the duration of this study, and about 60% of the ADHD patients ­were prescribed medi­ cation to manage their condition (Wang et al. 2015). The same study also showed that the male-­ to-­ female ratio for ADHD was about 3.7 to 1 in Taiwan. Although more updated statistics are currently unavailable, ADHD diagnoses and the use of stimulant treatment among Taiwanese ­ children and adolescents are believed to have continued to increase since 2011.1 16 The Development of Child Psychiatry and the Biomedicalization of ADHD in Taiwan Fan-­Tzu Tseng Development of Child Psychiatry and ADHD in Taiwan   333 The challenge lies in explaining the rising prevalence of ADHD and the increase in stimulant use to treat it. This condition is the archetype of the study of medicalization (Conrad 2006) in that deviant be­ hav­ iors such as hyperactivity, impulsivity, and inattention are classified as medical conditions and therefore fall ­ under medical jurisdiction. Related lit­ er­ a­ ture reveals that the engines driving the medicalization of ADHD include changing diagnostic criteria and diagnostic expansion, promotion by big pharma, campaigns led by parent associations, transformation of educational institutions and educational culture, and con­ temporary social and cultural changes (Degrandpre 1999; Lloyd and Norris 1999; Conrad and Potter 2000; Mayes, Bagwell, and Erkulwater 2008; Singh 2008; Bailey 2009; Vallée 2010; Edwards and Howlett 2013; Rafalovich 2013; Singh et al. 2013). The case of Taiwan is seemingly similar to the classical medicalization thesis, and it emphasizes the imperialistic tendencies of the medical profession in which doctors monopolize power over the ADHD diagnosis and prescriptions. However , I argue that the medicalization of ADHD in Taiwan, as a latecomer to Western medicine, has a dif­fer­ ent trajectory from its original context. Taiwanese child and adolescent psychiatry was still struggling to establish itself as a specialty at the turn of the twenty-­ first ­ century, by which point the biomedical framing of be­ hav­ iors associated with ADHD and related medi­ cation treatment­ were already well established in American research and clinical practice. This context deeply ­ shaped the local approach to ADHD in Taiwan, where the American medical model has guided medical education and health care since the Second World War (Liu 2012). Although the specialty of child psychiatry was yet to be established in the late twentieth ­ century, long before the category of ADHD was introduced to Taiwan, knowledge and techniques of child psychiatry ­ were already ­ adopted by non-­ psychiatric professionals to address ­ children’s challenging be­ hav­ iors in school contexts, especially the disciplinary prob­ lems related to acting out. However, the approach to child psychiatry at the time was very dif­fer­ ent from the current biomedical paradigm. Considering this desynchrony, I conceptualize “child psychiatry” in Taiwan to be a “network” linking agents, objects, concepts, and techniques, as well as institutional and spatial arrangements, rather than a “profession” (Eyal 2013). This approach helps focus beyond child psychiatrists per se to follow “a history of tasks and prob­ lems” (Abbott 2014: 314) on the understanding and ­ handling of the “prob­ lem child” in terms of knowledge and techniques of child psychiatry, which have been imparted to dif­fer­ ent actors outside the psychiatric profession. 334   Global Perspectives on ADHD During this pro­ cess, the medicalization of ADHD in Taiwan has been co-­ produced with the stepwise formation of a child psychiatric network in local society. The medicalization of deviant be­ hav­ ior in its original society usually includes five sequential and overlapping...


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