These individual factors are nested within a further set of influences which are of a structural and cultural nature (Cooper, 1997; Ideus, 1997). For example, we can think of ADHD not so much as a disorder, but as a cognitive style which is not well adapted to modern life in the industrialized world. The child’s problems’ in this context are characterized by an apparent inability to conform to social and procedural rules, in the home and school; extreme difficulty in maintaining effort and interest in school and leisure activities, particularly those involving sustained attention, and problems of over activity and impulse control that make the individual appear self centered and antisocial.
These behavioral patterns are rendered problematic in environments where a high value is placed on methodical rule observance, predictable behavioral patterns and the ability to sustain effort on sedentary tasks in group situations. Throughout the world, where there is mass schooling, these are qualities commonly required of the student.
In western culture, these expectations of conformity and self control go hand in hand with a paradoxical emphasis on early childhood as a period of relative freedom from such constraints. For the child with a tendency to develop ADHD concerted and intensive early intervention designed to influence the development of internal controls would seem to be essential. This becomes problematic when we place it alongside what some commenter’s see the disintegration, throughout the developed world, of the social and familial networks which traditionally provided support, expertise and resources necessary to fulfill this need (Ruther and Smith, 1995).
While there is an increasing consensus, among clinicians, about the nature of ADHD, its management and particularly the use of medication has become a subject of controversy. In the US between 2 and 2.5 percent of all school aged children are prescribed some form of medication for...