ADHD and reification: Four ways a psychiatric construct is portrayed as a disease

INTRODUCTION: The descriptive classification Attention-Deficit/Hyperactivity Disorder (ADHD) is often mistaken for a disease entity that explains the causes of inattentive and hyperactive behaviors, rather than merely describing the existence of such behaviors. The present study examines discourse on ADHD to analyze how authors passively and actively contribute to reification—a fallacy in which a concept is represented as a thing existing on its own. METHODS: Critical Discourse Analysis and Qualitative Content Analysis of academic textbooks, scientific articles, websites and videos were used to analyze how ADHD is reified. RESULTS: The analyses reveal four ways in which inattentive and restless behaviors are presented as an entity by means of the ADHD classification: language choice, logical fallacies, genetic reductionism, and textual silence. First, language choice, such as medical jargon and metaphors aid in representing ADHD as a disease entity. Second, several logical fallacies do the same, including the relatively unknown “ecological fallacy” that refers to the erroneous belief that average group findings, such as average brain size of groups of those with an ADHD classification, can be applied on an individual level. Third, genetic reductionism is often achieved by overstating the results of twin studies and being silent about the disappointing molecular genetic research. Such textual silence is the last identified mechanism of reification and includes instances in which societal factors that affect the ADHD construct are often omitted from texts, thereby obscuring the extent to which ADHD is a limited heuristic. DISCUSSION: It is essential that discourse communities do not repeat these four ways of reifying behavior and social relations into an alleged entity with the acronym ADHD. The errors and habits of writing may be epistemologically violent by influencing how laypeople and professionals see children and ultimately how children may come to see themselves in a negative way. Beyond that, if the institutional world shaped to help children is based on misguided assumptions, it may cause them harm and help perpetuate the misguided narrative. To counter the dominant, reifying and medicalizing view, guidelines such as the recently published “Dutch ADHD Psychoeducation Guidelines” might be helpful.