Attention Deficit Hyperactivity Disorder (ADHD) Discourses in Saudi Arabia

Abstract

ADHD is the most commonly diagnosed neurobehavioral disorder among children. While ADHD in Western countries has long been recognized and increasingly diagnosed in recent years, there is a growing recognition of this disorder as a significant cross-cultural phenomenon. Saudi studies to date vary in their estimation of prevalence of ADHD, with overall prevalence estimated to be between 3.5% and 6.5%, while the worldwide prevalence of ADHD is 5.29%.This study is a thesis by three articles. The first article examines the representations of ADHD by the Saudi ADHD Society members on Twitter because, as the only charity serving people with ADHD in Saudi Arabia, they have come to define how ADHD is talked about there. The Society’s Twitter account (@adhdarabia) has over 13,500 followers. Tweets posted between December 1st, 2016 and January 31st, 2017 were collected, with those announcing events and retweets from other accounts eliminated. This resulted in 141 tweets discussing the nature, causation, and treatment of ADHD. The content of these tweets was analyzed using Foucauldian discourse analysis. Findings reveal that the Society’s Twitter account shows members constructing ADHD as an experience of suffering; their comments position children with ADHD as sufferers, often subject to additional problems. An alternative discursive construction of ADHD is that caring for a child with ADHD is a ‘different’ kind of responsibility for parents and teachers, who must be advised by ‘experts’. The implications of these discourses are discussed in this paper.The second article uncovers the lived experience of parents with a child who has had an ADHD diagnosis in Saudi Arabia, and examines how their experiences can be understood in relation to the multiple and competing discourses of ADHD that frame their daily lives. Which discourses do parents draw upon – and reinforce – as they describe their experiences of ADHD, and which discourses do they resist? This study carried out in-depth interviews with seven Saudi parents who have at least one child diagnosed with ADHD, or any of its subtypes, between the ages of two and 11. Foucauldian discourse analysis (FDA) is applied in analyzing parental ADHD discourses, uncovering how these parents made sense of ADHD pre- and post-diagnosis. Four main discourses emerged in the process: ADHD as normal behavior (pre-diagnosis), and ADHD as emerging from supernatural/religious, medical, and social environment contexts (post-diagnosis). This paper also emphasises that the causes of ADHD must be considered in the wider context of misconceptions and uncertainty among Saudi parents. All the participants in this research were influenced by a combination of discourses in their attempts to make sense of their children’s symptoms.The third article explores the discourses drawn upon, reinforced and resisted by six Saudi teachers and four clinicians as they describe their experiences and understanding of ADHD. Saudi clinicians approach ADHD as an extension of American medical views in terms of its causes, diagnosis and treatment. Alarmingly, in light of the shortage of recommended ADHD medications, there are accounts of antipsychotic medications being prescribed for children. Saudi teachers’ views of ADHD were an extension of the medical discourse; this meant that students’ strengths were ignored and the focus was entirely on negative behavioral patterns. Despite a tendency to attribute ADHD to genetics, teachers objectified students who ‘acted out’ as having ADHD or even other disorders (when the child’s behavior or symptoms diverged from their limited understanding of ADHD). Parents who do not comply with teachers’ suggestions are blamed for any lack of improvement in the child’s behavior or academic attainment. Teachers’ accounts also revealed some serious pressures on them as a result of large class sizes and a lack of training in how to teach and manage students with ADHD. These findings have implications for individuals and institutions providing ADHD education to both doctors and teachers, and reinforce calls for researchers to examine ADHD outside of the genetic ‘box’.