Attention Deficit/Hyperactivity Disorder: Diagnosis and Stereotypy

The official symptoms of attention deficit disorder and attention deficit/hyperactivity disorder (ADHD) as first codified in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders bear an uneasy resemblance to potent caricatures of Blacks that had long been in circulation in the United States. In effect, traits such as laziness and troublesomeness persistently associated with Blacks became symptoms that could be had by anyone, Black, White, or other. But just as racial imagery plays on stereotypes, the ADHD diagnosis itself has become a stereotype. Only stereotyped figures have the telltale marks of identity that children with ADHD are said to have. As we have known at least since the time of the prejudice studies cited by the United States Supreme Court in 1954, stereotypes can be highly injurious, especially if they are internalized by their objects. Children who grow with the diagnosis of ADHD, incorporating it into their sense of self even while it is under construction, may well internalize its messages. That in turn may have something to do with the dismal long-term outcomes of ADHD despite the relative rarity of severe cases.Keywords: stereotype; self-control; essentialism; stigma; labelIn a series of studies beginning in the late 1930s, Kenneth Clark and his wife, Mamie Clark, showed that Black children preferred White dolls, so deeply had they absorbed the prejudice against their own skin (Clark & Clark, 1950). In 1954, a statement of their findings by Kenneth Clark was cited by no less a body than the United States Supreme Court, in its historic Brown v. Board of Education of Topeka decision striking down the "separate but equal" doctrine. In the same year, Gordon Allport published a classic of social psychology, The Nature of Prejudice, in which stereotypes-the fixed ideas associated with a certain group in the minds of others- function as a vehicle of social animus (Allport, 1954). Given this history and given all we have come to know about the injurious nature of stereotyping, it seems ironic that psychiatry itself has authored a powerful stereotype in the attention deficit/hyperactivity disorder (ADHD) diagnosis. To begin with, the statutory symptoms of ADHD bear an uncomfortable resemblance to traits strongly associated with Blacks at the time Allport wrote. As we glean from his study, these centered on messiness, a propensity for disorder and troublemaking, and a disregard for the work ethic-all of which now belong to ADHD.Although Americans certainly had stock caricatures of Jews and others, in Allport's judgment, their most damaging stereotypes were of Blacks. According to a study cited by Allport (1954) where subjects were interviewed instead of ticking items on a list, the attributes associated with Blacks were as follows, in descending order of frequency:Sloppy, dirty, filthyDepreciate propertyTaking over; forcing Whites outLazy, and slackers at workLow character; immoral and dishonestLower standards; lower classIgnorant; low intelligenceTroublesome and cause disturbances . . .Don't save (p. 197)Appropriately toned down, this portrait of laxity and indiscipline comes to resemble an ADHD child whose own laxity and indiscipline are everywhere on display. The sloppiness that seems to be a prime identifier of the Black becomes, in the terminology of Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5), the "messy, disorganized work" and disorderly habits that proclaim ADHD. Disrespect for property reappears as the bad habit of "using other people's things without asking or receiving permission." By analogy with the stereotype of "taking over," people with ADHD often "take over what others are doing." Slackers at work become those who "fail to finish . . . duties in the workplace"; laziness becomes an aversion to "sustained mental effort" (see American Psychiatric Association [APA], 2013, pp. …