"He is a lovely child--the sweetest most personable lovely guy--and so everyone is like, we will provide you all the support that you need and no problem. And then there is another child who is also very sweet but presents a more abrasive manner; so I go to the school meeting there and the teachers are like, ‘oh, he is not even trying!’ So really and again, if you look at research, kids who are more attractive, more personable are more likely to have interventions in place because people want to help them, whereas kids who are not as attractive…. Unfortunately…this (other) guy is a very sweet kid but you have to get through his crunchy outer layer which I think is true for lots of kids in lower income areas."

Haley honed in on one of the one of the conundrums of ADHD identification:

"If the child is attractive and personable they are more likely to have a mentor and a mentor can change the outcome of your life…if you have one teacher who believes in you and one person that you can go to, a teacher or a counselor, someone in your life maybe your church, you are more likely to be successful in your life, but if you are abrasive and not attractive then the chances of your having a mentor are much lower because people respond to the way you look and the way you respond to them."

The interpersonal relationship highlighted in Haley’s account potentially can snowball into a notion of not feeling that one deserves the diagnosis and was echoed by Ananya, a straight, cisgender, South Asian gastroenterologist in her 40s. Ananya does not have a formal diagnosis but understanding ADHD and its manifestations has helped her design and navigate her life. She echoes the school struggles; that it took her hours to read the same amount that her sister could in a fraction of the time. Ananya recalls nights when she had very little sleep—a couple of hours at the most—trying to finish homework or studying for a test. Her mother, a pediatrician, stayed up with her, getting her coffee if she needed, but did not attribute Ananya’s struggle to ADHD since she did not display the hyperactive component. Ananya’s struggle was internal, she had no outward signs of dysfunction, her colleagues would not have gleaned that she struggled because her work was always at par or above. She also came from a family of “speed readers.” Through trial and error, self-governance and extensive personal research, Ananya started identifying her areas of strength and weaknesses. She found that she could bring forth deep attention to kinesthetic projects—an attribute that helps her succeed in the lab and while conducting surgical procedures—but reading through sheaves of paper was still a challenge. Ananya constructs her daily life around the knowledge of ADHD. As a doctor, she informs me of two medical situations where women are at a disadvantage: cancer and heart attacks. Ananya claims, women and minorities, people who carry the emotional, physical and financial burdens of caregiving, do not necessarily come forward with physical symptoms as soon as perhaps men do—she cited that cancer is often diagnosed later in women and minorities and the same group also sees greater number of deaths through heart attacks—perhaps having ignored symptoms earlier by minimizing physical discomfort, by not wanting to take the time for self-care, or, simply by not being assertive. Ananya notes that women are more likely to dismiss a little fatigue whereas men typically want to get to the bottom of discomfort without much ado. How does this set up our perception as teachers and parents? Do we expect boys to be healthier, higher functioning and reach out to help if we find they are falling behind? Could this explain the gender gap in diagnosis? I address teacher bias later in the paper.

To step back a little, what are the dynamics that make Attention Deficit Hyperactivity Disorder?’ And why is it so difficult to diagnose? How do we know if we have Attention Deficit Hyperactivity Disorder or, if one is simply attention deficit? A psychiatrist I spoke to said, “concentration is like common cold; it can be bacteria, virus or allergies. You could have inattention because you are depressed…you could be impulsive because you are bipolar or, you could be impulsive because you have ADHD.” Further discussions with professionals in the medical health community brought forth their criteria for one overarching diagnostic factor in concluding whether a child has ADHD: is there dysfunction in a person’s social, emotional or, professional life?

It helped to think though the field of ADHD with S. Lochlann Jain, author of Malignant: How Cancer Becomes Us. Jain, says of her book, “Malignant builds on an idea presenting cancer as a process and a social field, while also exploring its brutal effects at the level of individual experience” (4). I wish to build on an idea “presenting ADHD as a process and a social field, while also exploring its brutal effects at the level of individual experience.” I do not wish to question the validity of the disorder but understand the cultural forces that form it. Since its existence is reliant heavily on our education system, its structure and resources, and it is spotted and diagnosed, more often than not at schools and pediatricians’ offices, how do we make sense of the dizzying array of data that goes into making ADHD, to quote Jain again, a “devious knave” (3)? How do we look at the set of relationships—institutional, economic (labor, market forces), social (family and friends), medical (Adderall, Ritalin), and personal, that inform our knowledge and experience of ADHD? And through it all, who claims knowledge of ADHD? And, how are subjects constituted through this extraordinarily complex web of relationships?

Ryan is a white, gay man in his late 40s. He is a regular presence at his son’s school and the PTA, and both of them are well versed with ADHD and, dyslexia. Ryan was diagnosed with ADHD as an adult. Looking back at his childhood, Ryan notes that he was a high functioning child; someone who would finish his math homework while still in class and turn it in on the way out. However the precociousness did not sit well with his teacher who “took it as an affront to his ability.” Ryan’s parents advocated for him by saying he wasn’t being disruptive and helped him navigate that year and because he was high functioning, Ryan managed to get through school without any noticeable failures. In college, Ryan changed his major several times. Being told that “you can be anything you want” was a disservice to him since he felt that he needed a lot more structure. Following college, Ryan went through addiction issues; looking back, he notes that those were also his best and most successful years at the workplace – the amphetamines in the drugs were giving him the focus he needed. However, he chose to walk away from that path and sought refuge in rigorous physical activity; he was working out two hours a day, six days a week. Post workout, Ryan took to shopping. Finally, when he did seek help, the psychiatrist diagnosed him as bipolar and started him on Depicor, a medication for bi-polar disorder.

Two weeks later Ryan was suicidal. Through all the ups and downs, Ryan had never been suicidal before. He stopped the medication and was afraid to go back for help for the next couple of years. Finally, he met the doctor who diagnosed him with ADHD, got him the right medication and started him on the path to living productively with ADHD. Ryan currently runs his own business, is an active PTA volunteer and a fierce advocate for kids with learning disabilities.

Of the four stories narrated above, Ryan is the one who relies on his medication the most. His story illustrates that AD(H)D does not look the same in any two people and that, the intensity of AD(H)D often determines the need for medication. Ryan’s story also illustrates “people and groups differ in unlimited ways” (Epstein, 250). Not only that, assumptions that “the ways of differing that are the most socially salient and “obvious” are necessarily the ones that carry the most explanatory weight” are problematic (Epstein, 250). Ryan, is a “normative standard” –a white middle aged man—the one clinical research findings were centered on until the 80s (Healy qtd. in Epsein, 1). Ryan perceived himself as the ‘non-standard,’ for example, when narrating his experience with amphetamines he often described his friends as “standard,” as those who were losing their homes and careers to addiction to amphetamines. In his recounting, he believed that being high functioning and AD(H)D helped him when he was on the street derivatives of amphetamines. Did the psychiatrist who diagnosed him with bipolar disorder assume that if he had AD(H)D, as a white male, he would have been diagnosed as a child? To turn to Stephen Hinshaw’s interview again, he recalled that when he was in graduate school over three decades ago, “hyperactivity was a white middle-class male phenomenon: ADD (the new name in 1980) was about the disruptive boy—Dennis the Menace. It was the Tom Sawyer syndrome.” Based on his account, Ryan should have been diagnosed as a child but he was no Dennis the Menace or, Tom Sawyer, highlighting Epstein’s claim “some individuals may receive the wrong diagnosis or treatment if they are approached as a representative member of their social group” (250).

Kim at a young age decided that the medication did not suit her and “did not want to put chemicals in her body.” Ryan, went through a misdiagnosis and bi-polar medication while he was still trying to get help. Even though he understands how the medication works, he hopes that at some point he will not have to take it anymore. Kathy equated the experience of taking Adderall to ‘speed’ or cocaine; saying that these are addictive and dehydrate the body. Additionally, it takes about a week to get off them. However, Kathy noted that the drugs helped her “access the kind of thinking she wanted” especially when rigors of academia so demanded. Going forward, she says she would not give Adderall to her child should there be an ADD diagnosis. To understand the pharmacological phenomenon I turned to Julian Gill-Peterson’s neurofeminist eco-pharmacological framework as well as Edward Cornstock’s essay on the genealogy of AD(H)D.