Title: Beyond Medicalization
Description: Attention Deficit-Hyperactivity Disorder diagnoses have been rising steadily since the early 1990s. Today, about 10 percent of the school-aged population has been diagnosed with the disorder, and prevalence is increasing steadily among preschool children and adults. Most of the individuals diagnosed with the disorder use stimulant medications to treat the symptoms. Both the rapidly rising number of diagnoses and the substantial variation in prevalence and treatment utilization -- across states, regions, gender, race, ethnicity, and socioeconomic status -- have attracted attention and raised concerns about under and over recognition and treatment. The implicit justification for the increasing awareness and recognition of the disorder is that it is a valid clinical object that matches medically-proven treatments with those reliably expected to benefit from them. From this perspective, the uptake in prevalence results from changes in environmental determinants or scientific advances in neurology, psychiatry, diagnostic protocols, or pharmaceutical research.

But a widespread argument among teachers, parents, policy makers, the general public, and academic researchers -- including sociologists -- is that the development and success of the disorder results from a medicalization process. Medicalization encompasses a social construction critique that contradicts the environmental/scientific advance claims, but medicalization research also emphasizes macro-level actors that forcibly advance the medical label and treatment. Traditionally, medicalization studies focused on the disproportionate power of the medical profession vis-a-vis patients, but more recently they have begun to emphasize a broader range of actors pursuing a medical label -- pharmaceutical companies and even consumers influenced by new forms of advertising. Those arguments assume that educational institutions act in concert with those pushing the medical label. The goal of this dissertation is to provide an account of diagnostic prevalence and treatment utilization (and their uneven distribution) that debunks explanations based solely in science but that also demonstrates the insufficiency of the medicalization account.

Together, the chapters show that there is no correlation in timing between the surge in diagnoses and the processes implied by either medicalization or scientific progress arguments, there is little support in the micro-level data for a strictly medicalization account, and there is substantial evidence that macro-level educational institutions and the school context play a significant role in reshaping the category. The chapters emphasize that the success of the category lies in the confluence of technoscientific innovation, social control of troublesome behaviors, the increased activism of parents along with direct-to-consumer pharmaceutical advertising, encroachments of the law into student discipline and into the health care industry, the institutional needs of schools, a cultural emphasis on high academic achievement, and the influence of parallel and predecessor classifications, among other factors. The category -- a result of multiple institutions working to recraft expertise – is a school-specific medical disorder that includes a heterogeneous symptom complex, one that is understood differently within school and medical milieu.

Although the chapters do not disprove medicalization, they suggest that the medicalization framework overstates the importance of medical professionals and medicine broadly defined for the success of the category.