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This chapter is a reflection on some of the findings presented and issues raised in the depictions of ADHD in the 16 countries presented in this book. As noted in the introduction, this volume is not meant to be a comprehensive depiction or comparative study per se, but rather a series of chapters presenting the state of ADHD in a global context. The goal of this final chapter is to highlight some patterns and idiosyncratic situations in the chapters, but we stop short of drawing conclusions. In working on this book, we have been struck powerfully by the paucity of a research-­ based understanding of the social dimensions , contributors, and ­ drivers of ADHD in a global context. Our pres­ ent phase of knowledge production requires more questions and more investigations, ahead of conclusions. Indeed, we hope that the many unresolved problematics arising across the chapters in this volume ­ will inspire further international social science studies of ADHD. Critics and advocates alike recognize that in the past three de­ cades ­ there has been a widespread medicalization of ­ children’s be­ hav­ ior, learning, and attention prob­ lems. By medicalization, we mean the pro­ cess by which nonmedical prob­ lems become defined and treated as medical prob­lems that often require medical treatment (Conrad 1992, 2007). Medicalization describes a so­ cio­ log­ i­ cal pro­ cess (like industrialization and secularization). This pro­ cess is not necessarily a prob­ 18 Reflections on ADHD in a Global Context Peter Conrad Ilina Singh Reflections on ADHD in a Global Context   377 lem, although critics have often used the term that way. ADHD is a classic case of medicalization (Conrad 1975) that has its roots in the United States, although the diagnosis and treatment of ADHD are becoming increasingly common in Eu­ rope, South Amer­ i­ ca, and Asia. The chapter on the United States gives a brief history of the medicalization of ADHD and the growing prevalence of the condition among both ­ children and adults in that country. Some might argue with the specific chronology, but, like many psychiatric disorders, the diagnosis we know as “ADHD” developed iteratively, in response to a changing constellation of be­ hav­ iors, alongside shifting etiological models, and in direct partnership with psychopharmaceutical treatments (Singh 2002). More recently, researchers have suggested that the spread of the ADHD diagnosis reflects the globalization (Conrad and Bergey 2014; Hinshaw and Scheffler 2014) of a medicalized category. The 16 chapters in this volume provide evidence of the continued medicalization of certain be­ hav­ iors of ­ children (and increasingly of adults) in a range of countries . This suggests that globalization may be an impor­ tant lens for understanding the spread and migration of the diagnosis. Many signs point to a globalization of ADHD, if we understand “globalization ” as an increase in global awareness of ADHD among parents and prac­ ti­ tion­ ers, a probable increase in the diagnosis of ADHD globally, and increasing global consumption of the most well-­ known ADHD drug treatment (methylphenidate and amphetamine-­based medi­cations). Even just a de­cade ago, ADHD was thought to be an “American disorder”; ­ today, a widely cited estimate suggests that 5% of­ children in the world meet the criteria for ADHD diagnosis (Polanczyk et al. 2007). More recently, ­ after examining 179 prevalence studies, Rae Thomas and her colleagues (2015) have estimated that the pooled global prevalence of ADHD is 7.2%. The assumption under­ lying such prevalence figures is that ADHD is a global category. Indeed, one response to the global prevalence estimate has been to argue that it demonstrates definitively that ADHD is not a cultural phenomenon (Moffitt and Melchior 2007). However, as several scholars have pointed out, the fact that a global prevalence estimate can be generated statistically does not make this assumption true (Parens and Johnston 2011; Singh et al. 2013). By definition , such epidemiological estimates leave out as much as they include, in the sense that comparative statistics can only be generated from studies that meet a priori criteria, including, most impor­tant, consistency in the diagnostic methods used to estimate prevalence. As the epidemiologists themselves note in ­ these papers , this methodological constraint means that many papers must be omitted 378   Global Perspectives on ADHD from the meta-­ analysis. Polanczyk et al. (2007) have proposed that the solution to this prob­ lem is greater global standardization of diagnostic methods. But this proposal side-­ steps the fraught questions that exist around the validity of the ADHD diagnosis, or, following Ian Hacking (1999...


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