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Taking ADHD to Ghana This chapter explores the diagnosis and treatment of attention deficit–­ hyperactivity disorder (ADHD) in Ghana. The emergence of diagnosis and treatment in the Global South has been researched only partially. African countries remain particularly under-­ researched, with South Africa being the exception (Meyer and Sagvolden 2006; Snyman and Truter 2010; Seabi and Economou 2012). We know about the diverging prevalence of ADHD in dif­fer­ ent regions across the globe (Polanczyk et al. 2014). Much less is known about what ADHD means and how diagnosis and treatment are employed across dif­fer­ ent settings. We explore precisely this, from a biosocial perspective, attending to niche variation in ADHD in relation to contextual institutional differences (Singh 2012). To our knowledge, this is the first study on the clinical use of the ADHD diagnosis and treatment in Ghana or any other sub-­ Saharan African country so far, apart from South Africa (e.g., Meyer and Sagvolden 2006; Snyman and Truter 2010). ­There are no prevalence statistics or clinical rec­ords concerning ADHD in Ghana. We therefore approached clinicians and policymakers and searched the media for references to ADHD. Since the ADHD diagnosis is only sparsely used in Ghana, we ­ were able to survey almost the ­ whole field. At pres­ ent, ­ there is some recognition of ADHD among ­ children in ­ mental health policy, limited pro17 Exploring the ADHD Diagnosis in Ghana Between Disrespect and Lack of Institutionalization Christian Bröer Rachel Spronk Victor Kraak Exploring the ADHD Diagnosis in Ghana   355 visions, and some calls for “upscaling” treatment. ADHD among adults and disparities among groups remain almost unknown. Researching Ghana therefore offers the opportunity to obtain an early introduction of the disease category. We explore how the introduction of diagnosis and treatment is related to the following institutional contexts: ­ mental health provisions, nongovernmental organ­ izations (NGOs), educational facilities, and cultural understandings of intergenerational relations. The question of ­whether the introduction of the ADHD diagnosis and treatment addresses unmet needs or reflects social transformations is beyond the scope of this chapter. Even if medicalization is not at the center of the analy­ sis, but rather the “glocalization” (Robertson 1995) of ADHD, this chapter points to some “vehicles of migration” (Conrad and Bergey 2014) of this medical diagnosis and its treatment. Ghana has an estimated population of 25.4 million (World Bank Ghana 2014), 64% of whom live in rural communities. It is ranked as a “lower middle-­ income” country and has experienced a period of significant economic growth, boosted by oil and gas extraction. The gross domestic product per capita was $40.7 billion in 2012. Although many ­ people live in poverty, a growing group in Ghana has access to modest financial resources. Not surprisingly, Ghana has a poorly developed ­ mental health and educational sector. Even if psychiatric diagnoses seem to be on the rise, concerns about deviant be­ hav­ ior or—­ depending on one’s perspective—­ mental health, are often couched within a spiritualistic explanatory model in Ghana (Doku et al. 2008; Read 2012; Read and Doku 2013). Our exploration suggests that corporal punishment, traditional healing, and prayer seem to remain the first treatments for ­ children who are brought to the attention of clinicians who diagnose and treat ADHD. This situation might change given the attempts of Ghanaian health professionals, policymakers , NGOs, phar­ ma­ ceu­ ti­ cal companies, and journalists to “raise awareness” about ADHD. And, even though the importance of school per­ for­ mance is an issue in Ghana almost as much as it is in the West, the difference lies in the fact that school per­ for­ mance more explic­ itly connotes ­ family status and potential for income generation and upward social mobility, rather than academic accomplishment. We find that “ADHD” is not a culturally established category, as it is, for example , in many countries in the West. However, ­ there might be a niche in the making: disrespect for parents, teachers, and the el­ derly seems to be at stake when the ADHD diagnosis and medi­ cation are sought in Ghana. 356   Global Perspectives on ADHD Niches for ADHD Worldwide Following up on Singh’s (2012) comparison of the United States and the United Kingdom, this chapter asks ­ whether ADHD in Ghana is used for child be­ hav­ ior in specific social situations and in combination with distinct cultural connotations. Our analy­ sis seeks to avoid a strict nature-­ nurture divide (Singh 2002). This biosocial perspective situates diagnosis and treatment in institutional contexts and provides space for...


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