every single day some parent would come up to me and say ‘your child did this, that, that to my child what you going to do about it?’ and I said
‘I’m sorry I can’t do anything’, I said ‘I apologise I can’t do anything else’.
(Ingrid: ibid.: 208)
These are common descriptions of mothers’ experiences in relation to their children with ADHD and they use them to describe the difficulty of their situation and also to resist discrediting versions of themselves as failing parents. It is important to note that these are situated accounts of experience rather than fixed enduring identity categories of ‘victim’
or ‘perpetrator’ in the sense that they are familiar forms of social iden- tity categories, arising from culturally recognisable ways of describing the world. They are used in social interactions as a flexible, discursive resource. In other places in their account of experience, mothers might describe themselves differently and in more positive terms. A vic- tim identity works to claim the moral high ground which is a way of recruiting support for troubles and resisting condemnation. However, a victim identity is also a risky one to take up as it can reproduce and reaffirm discourses of blame and stigma. As Zverina et al. (2011: 2388) state, ‘it is not surprising that identity work […] involves a delicate bal- ance in which victim identities are both embraced and resisted’. Paula and Ingrid, the mothers who took up a stigmatised, victim identity (above) also took up very positive, pro-active mother identities at other times.
Resisting Discourses of Blame: Turning to the
of children and parents that populate the discourse of ADHD.
Furthermore, it is significant that the take up of biomedical explana- tions and medicalised interventions for ADHD is conflictual for par- ents as we now demonstrate in relation to mothers’ discourse. Mothers draw on biomedical knowledge in certain situations, but they reject it in others.
Similar to Singh’s (2004) findings, the mothers’ narratives in Davies (2014) tended to be organised around before and after stories of diag- nosis, which enabled the ‘transformation of blame from mother to brain’ (Singh 2004: 1194). The ‘before’ stories consisted of very raw accounts of trouble, which gave way to less troubled ‘after’ (post diag- nosis) stories. ‘Troubles-telling’ (see Jefferson 1988) is particularly rele- vant to accounts of parenting children with ADHD. On the one hand, troubles-telling is a necessary feature of accounting for and seeking validation for ADHD. Without ‘troubles’, there would be no reason for medical or educational intervention, help or support. Put simply,
‘troubles-telling’ is a way of conveying to the listener how problematic an event or experience has been. In one example, a mother explained how her decision to seek a diagnosis came after a pre-school visit: ‘and he’s running about off there and he’s pulling it down and he’s kick- ing it and he’s pushing in I couldn’t it was too much so I did what I could eventually I did get him diagnosed’ (Donna: cited in Davies 2014: 144). However, troubles-telling such as this can also suggest a problematic identity. In the case of parents of children with ADHD, this might be indicated by a parent being unable to cope with their
‘disruptive’ child. Parents have to navigate these tensions in their talk, and as Miller and Silverman (1995) point out, troubles talk in ordi- nary conversation is ‘complex and varied, even disordered’ (p. 727).
With the variable and situated nature of accounts in mind, we note the pragmatic function of troubles-telling in mothers’ accounts of ‘before diagnosis’.
The mother-blame/brain-blame binary (see Blum 2007; Singh 2004) describes how the ‘medicalization of problematic behaviors in young boys includes an inherent narrative of blame transformation’ from mother to brain (Singh 2004: 1193). In Davies (2014), most of the mothers accounted for ADHD by locating the cause within the brain:
it’s a brain…it’s a problem with the brain it’s something to do with the uhm frontal cortex or something of the brain and the frontal lobes or something not working properly. (Paula: ibid.: 138)
Paula credentials her familiarity and knowledge of ADHD in much the same way as the media might report on science research by drawing on technical terms that demonstrate familiarity with the neuroscience of ADHD. Mothers routinely offer biological explanations for ADHD sometimes suggesting that their children’s ‘difference’ was evident from birth, or even within the womb (Bull and Whelan 2006). For example:
I knew the minute he could walk there was something I mean I knew there was something wrong when he was tiny […] he used to do some quite bizarre stuff. (Paula: cited in Davies 2014: 180)
Early indicators of ‘atypical’ behaviour in their children are common in mothers’ accounts representing ADHD as something intrinsic to the child, rather than due to the environment or their parenting. In describ- ing these initial concerns about their child’s behaviour, even in vague ways, such as ‘something wrong’, mothers are also depicting themselves as observant, knowledgeable good mothers, who monitor the progress of their children. As Goffman (2006) suggests, vagueness and ambiguity are useful strategies for managing a positive ‘face’, as they deter chal- lenge and examination (see also Potter 1996; Macmillan and Edwards 1998). The ‘pervasiveness of the discourse of normative child devel- opment’ (O’Dell and Brownlow 2015: 302) is evident in the way that mothers indirectly orient to their children’s deviation from ‘normative’
developmental expectations: ‘he didn’t like to be touched he didn’t like to be picked up and things like that’ (Paula: cited in Davies 2014: 180).
The Significance of Diagnosis as a Pivotal Event
The significance of the competing nature of biological and psychosocial explanations of ADHD is made clear in Ingrid’s relief at the doctor’s diagnosis of her son’s ADHD:
and he said ‘you’re doing fantastically there’s absolutely nothing that you’ve done wrong’ […] we phoned everybody I phoned my mum I was like […] like ‘this is the happiest day of my life’ […] yeah so relieved and somebody actually told us told us that ‘you’re doing a great job’ he said
‘you are fantastic. (Ingrid, in Davies 2014: 178)
This example is typical of parental relief at medical diagnosis of ADHD (see Ghosh et al. 2016; Neophytou and Webber 2005; Singh 2004;
Segal 2001; Klasen and Goodman 2000). Ingrid makes clear what is at stake for her (and her partner) with regard to obtaining this diag- nosis for their child. The doctor’s independent and expert diagno- sis is presented through the use of reported speech (see Potter 1996;
Widdicombe and Wooffit 1995; Wooffitt 1992), and this provides Ingrid with a vindication of her parenting in his words, ‘you’re doing fantastically there’s absolutely nothing that you’ve done wrong’. Her use of extreme case formulations (ECFs) (Pomerantz 1986) such as
‘phoned everybody’ and the ‘happiest day of my life’, even if understood as non-literal, shows her investment in this explanation for her child’s problems. Indeed, we understand this to be a day which makes sense of her parenting experiences and, in her narrative, the diagnosis features as a pivotal event that brings her relief.
Expressing relief about this diagnosis is risky for parents. Parents are often accused of jumping on the ADHD bandwagon in media reports that represent an ADHD diagnosis as an excuse or a way of securing financial support (see Chapter 3; Harwood et al. 2017; Horton-Salway 2012). One way that mothers orient to this is by establishing their own initial reluctance in accepting an ADHD diagnosis. For example:
and then when he went to primary school the teacher was very worried about his eye contact and they asked us to get him […] to the GP and get him seen and we thought “they know nothing” […] it took two years of me saying “no there’s nothing”….’ (Julie: cited in Davies 2014: 147) Julie’s description of her initial resistance to a medical diagnosis is typi- cal of many mothers’ accounts. Her original opposition to the teacher’s suggestion, and to medical intervention, “they know nothing”, manages
the controversial issues arising from the diagnosis of ADHD. Parents can be accused of having their own agenda so the management of stake and interest is an important aspect of constructing a credible account.
Stake management is a key feature of establishing lack of motive or bias in every-day discourse (Potter 1996; Edwards and Potter 1993). A par- ent who had not initially sought this diagnosis is less likely to be heard as jumping on the bandwagon.
Securing a Diagnosis: Taking on the Experts
The full extent of what is at stake, for the mothers of children with ADHD, can also be heard in the descriptions of difficulties they face in obtaining a diagnosis. In contrast to accounts which downplay their initial engagement with the idea of a medical diagnosis there are also accounts which describe how mothers actively work to secure such a diagnosis, even if this means challenging or rejecting the opinion of unsympathetic practitioners. Many of the mothers talked about unsym- pathetic doctors, quite often GPs. One mother, whose child had a dual diagnosis of autism and ADHD, describes how her son’s GP did not know about autism: ‘he’s got autism spectrum disorder and his GP a senior GP went ‘what’s that?’’ (Linda: cited in Davies 2014: 154). The doctor’s status as ‘a senior GP’ is further called into account by Linda’s suggestion that ‘anyone on the street’ or any ‘non-specialist’ would rec- ognise that her son is autistic. Querying the expertise of health pro- fessionals is one way that lay people respond to lack of recognition for controversial health categories and this also mirrors the undermining of consulted health professionals in the media (Lloyd and Norris 1999) and the decline of medical authority observed by Norris and Lloyd (2000).
Medical practitioners who do not endorse an ADHD diagnosis are described as problematic by parents who are keen to secure recognition for this diagnosis and help for their children. Generally, parents draw on the authority of medical knowledge to support their claims about ADHD. In contrast, unsympathetic medical opinion is formulated as being so because of ‘contingencies’ such as the doctor’s personality, age
or unhelpful characteristics, rather than based on scientific knowledge (see also Gilbert and Mulkay 1984):
he was just up there and he said there’s nothing called ADHD it doesn’t exist he was a very old doctor. (Ingrid: cited in Davies 2014: 153)
I think he’s quite close to retirement. (Linda: ibid.: 154)
In both accounts, the doctors are constructed as old, their views as old-fashioned and, consequently, it is implied that their knowledge is inadequate. These mothers represent ADHD (and autism) as requir- ing a modern understanding and an up-to-date body of knowledge that some doctors have and others might lack. This allows a criticism of medical practices that does not threaten the status of the medical model (see Chapter 1 discussion of empiricist and contingent repertoires, Gilbert and Mulkay 1984).
As we saw in Chapter 3, the challenge to medical opinion takes place within a culture of increasing ‘mediatisation’ of medical knowl- edge (Seale 2003) and take up of media representations along with the definition of health ‘consumers’ encourages individuals to take up whichever expert opinion matches their own viewpoint (see Valentine 2001). The availability of knowledge about ADHD, especially from medical websites that list diagnostic criteria (Conrad and Bergey 2014;
Foroushani 2008), makes everyone a potential expert meaning ‘the pro- fessional hero is no longer a secure category’ (Seale 2003: 523). Parents are able to challenge professional decision making because they now have access to different perspectives on medical knowledge.
On the one hand, it is tempting to interpret mothers’ accounts of challenging professional authority as acts of resistance and empow- erment. However, these acts take place within a context of a perva- sive mother-valour/mother-blame binary (see Blum 2007). Either way, mothers are held accountable for their children’s outcomes. This includes becoming experts on ADHD. As one parent put it: ‘it’s such a hard slog to get actually […] to get the help we got him the help he obviously needed’ (John: 178). Mothers’ challenges to professionals can be interpreted as demonstrations of good mothering and maternal
fitness, where mothers wield medical and psychological knowledge to gain the best results for their children.
These examples have demonstrated the complexity and variability of accounts relating to diagnosis, indicating what is at stake for mothers when they are talking about diagnosis of their child’s medical condi- tion. The mothers interviewed all engaged with a biomedical explana- tion for ADHD, but accountability and blame are reframed rather than entirely abolished within these accounts (see Bailey 2014; Blum 2007;
Singh 2004). So enduring is the spectre of mother-blame, that a bio- medical diagnosis of ADHD simply reconstitutes it in a different form (Blum 2007; Singh 2004). Blum (2007) identifies this blame as ‘prox- imate blame’, in which mothers, although free from blame for causing their child’s condition, are held responsible for the subsequent man- agement and care of their children. This reconstitution of blame can be seen in the way that mothers are held to account over issues relating to medication.
Transformative Accounts of Medication
Concerns and accounts of guilt about medication feature commonly in mothers’ accounts. Mothers are caught in a moral dilemma of social condemnation. As one mother put it, ‘I feel damned if I do give him the pills and damned if I don’t’ (Taylor et al. 2006: 120). Seale’s (2003) argument that media audiences participate in a dialogue with ‘an imag- ined community of other viewers, people ‘like me’’ (p. 517) is highly pertinent to the way that mothers negotiate the moral positioning they experience in relation to the circulating discourse of ADHD and med- ication. Singh (2004) points out, for example, that mother-blame is
‘reconstituted’ through media discussions of medication, where mothers seeking medical intervention are represented as self-serving. The mother in the following example shows awareness of how she is positioned within the discourse of ADHD:
the other thing I think parents get with ADHD is uhm I think it’s a label you can’t win it’s a label which is ‘there’s nothing wrong with them it’s just
the parenting… oh they just drug that child. (Caroline, cited in Davies 2014: 184–185)
She is aware of how the ‘imagined community’ might interpret her deci- sion to medicate her son: ‘there’s nothing wrong…they just drug that child’. Stories depicting medication as a ‘chemical cosh’ or those that link medication with ‘fear of harm’ invite mothers to recognise themselves as the subjects of this critical discourse (see Chapter 3; also Harwood et al.
2017; Horton-Salway 2011; O’Dell and Brownlow 2015).
As a consequence, mothers’ accounts of their decisions to medicate orient to the possibility of public condemnation and are carefully man- aged. For example, many of them deploy transformative stories to illus- trate the beneficial effects of medication for their children:
he’s exhausting I mean physically and mentally exhausting […] we had huge huge meltdowns massive anxiety uhm that I by that stage was pretty skilled and I knew what I was doing so I was able to work with him very intensively to try and you know bring down his anxiety and the other thing I did was […] I went privately to a consultant […]immediately put him on medication and the transformation was unbelievable […] com- pletely changed his life overnight on the first dose within half an hour […] he had transformed. (Caroline: in Davies 2014: 185–186)
In Caroline’s example, the contrast between the extreme meltdowns
‘before’ and the change in his life ‘after’ pivots around medication such that the account functions as an endorsement of this course of action.
However, the dilemma of troubles-telling is clear here. On the one hand, there is an interactional and moral requirement for Caroline to describe the ‘troubles’ experienced by her son and family in some detail to warrant her decision to seek medical intervention. On the other hand, troubles talk, and the need for medication, positions the child as challenging and Caroline as unable to cope with him. This potential for
‘reconstituted blame’ is countered by working up her own identity as a skilled mother who was not overwhelmed by the difficulties her son presented or looking for a ‘quick fix’ to manage her son’s behaviour, as suggested by some media stories (Harwood et al. 2017).
A common way that mothers resist ‘reconstituted blame’ is by linking the use of medication with positive educational outcomes: ‘and he was like a different child and suddenly he was able to focus and he could learn’ (Caroline: 186). Medication becomes aligned with better school performance; the account of ‘troubles’ is therefore closed, and ‘business as usual’ is resumed (see, for example, Jefferson 1988). These examples alert us to the dilemmas that mothers must manage with regards to medication. Within the biological repertoire, medication for the ‘sick’
child is not only reasonable, but to some extent, expected or a require- ment of the educational context. Parents who seek medication for their children are ‘doing right by their child’, and maximising their poten- tial to achieve at school. From this view a parent who resists diagnosis and medication is neglecting their duty, and risks their child’s exclusion from school. Contrary to this are psychosocial explanations in which children are constituted as ‘normally’ naughty, or so extremely naughty that parenting interventions might be suggested.