Paper short abstract:

Diagnosing ADHD involves normative practices with different levels. Besides differentiating mental health and disorder, the diagnosis process reshapes and is shaped by the norms and worth socially ascribed to the child and childhood, as well as reconfigures the aim and task of psychiatry itself.

Paper long abstract:

The global surge in attention deficit/hyperactivity disorder (ADHD), the most prevalent mental disorder during childhood, continues to reshape the norms and worth socially ascribed to children. However, the ambivalence of the diagnostic criteria (in terms of seemingly deviant behavioral symptoms without cognitive problems), treatment modalities (mainly the physical and social psychological side effects of stimulant medications), and bio-pathological basis (lack of specific biomedical evidence) related to ADHD adds clinical uncertainty to the practice of psychiatrists. Clinicians do not practice in a vacuum. Their experiences in diagnosing and treating ADHD-suspected children are affected by well-publicized concerns and controversies about ADHD. By analyzing in-depth interview data from 10 psychiatrists in Taiwan, this study elucidates how psychiatrists harbor varying degrees of clinical uncertainty regarding ADHD. Every diagnostic strategy employed by psychiatrists involves a whole set of presuppositions regarding the ontology, epistemology, and methodology of mental disorders (that is, "What is ADHD?" "How is ADHD diagnosed correctly?" and "How is ADHD treated properly?"), as well as the normative expectations regarding "the child" and "the childhood" per se (such as "What are the normal behaviors of naughty boys?" "What is the nature of the childhood?" and "What is 'the best' for a given child?). At the same time, the aim and task of psychiatry itself (for example, "Is psychiatry a tool of social control?" "What exactly is a psychiatrist's role in the face of the entangling biological and environmental factors surrounding a child's condition?") is continually reflected and reconfigured during the process of diagnosing ADHD.