In a 2017 study published in Sociological Perspectives, Zachary Simoni, of the University of Texas at Dallas, conducted a qualitative investigation of teacher attitudes surrounding medication for ADHD-associated characteristics and their relationship to both race and social class. His study finds skepticism regarding pharmacological interventions for ADHD-type student behaviors among African American educators and those working in low SES communities, compared to a heightened preference for ADHD use among white participants and those working in upper-class neighborhood-level communities. Further, teachers in upper-class communities endorsed the potential for students medicated for ADHD to “transcend normalcy or maintain a performance edge.”
While the medicalization of common personality traits and in-school behaviors, as well as personality change post-medication, were identified as limitations to ADHD medication adherence observed by some participants, others regarded medication for ADHD as a catalyst for competitive academic performance. In addition to dissecting emergent themes, Simoni’s article provides thorough contextual justification for the investigation, as well as a compelling analysis.
“Although the medical community prescribes medication for ADHD, teachers interact with students who exhibit ADHD behaviors,” Simoni writes. “In addition, teachers serve as information sources for parents looking for advice about ADHD and may discuss medication use with parents. Thus, it is important to understand how teachers view ADHD medication and their attitudes supporting or opposing its use.”
Simoni highlights recent studies that have examined attitudes towards trends in medication as influenced by racial and demographic factors, many of which have found that both African American students and professionals regard medication for psychological difference or dysfunction less favorably than non-Hispanic whites. Differences in viewpoint regarding the notion of mental health conditions as medical disease contribute to polarity in attitudes towards the use of prescription ADHD medication for children.
“There is a paucity of qualitative literature investigating teachers’ attitudes about ADHD medication use and how attitudes vary across neighborhood-level social class and race. This study aims to fill that gap.”
Building upon Bussing and colleagues’ mixed methods approach to exploring adolescents’, teachers’, and healthcare professionals’ perspectives regarding ADHD medication among students, Simoni selected a qualitative semi-structured interview methodology to allow for participant elaboration. Simoni spoke exclusively with teachers in his interviews, but his sample represented schools across low-social class, middle-class, and upper-class neighborhoods within a medium-sized metropolitan area in the southeastern United States.
Participants were recruited primarily through chain-referral sampling, and although Simoni strived for gender, racial, and socioeconomic diversity in his sample, recruitment methods may have limited the feasibility of these efforts. Simoni aimed to achieve equal representation of male and female participants but ended up speaking with more female than male teachers (reflective of an imbalance visible in schools across the country).
Behavioral normalcy and academic normalcy were trends in participant interpretations of the benefits of ADHD medication among students. Grappling with pressure to teach to tests and to meet class-wide academic and behavioral benchmarks, some teachers indicated that ADHD medication made a difference in some students’ abilities to keep up with their peers.
In contrast, teacher concerns pertaining to ADHD medication included the risks of personality change (the dulling of emotional range, reduction of enthusiasm, etc.), as well as macro, sociocultural shifts leading to the medicalization of behaviors associated with ADHD.
Teachers expressed concerns surrounding stigmatizing labels and treatments for behaviors that may, at other moments in history, have been considered normal or been handled differently. Interestingly, younger and non-Hispanic white teachers were more amenable to medication use to treat ADHD-type behaviors than older and non-white participants, and those in school districts within lower-class neighborhoods. Simoni writes:
“This study adds depth to the sociological literature by investigating different attitudes in favor of and in opposition to ADHD medication use. This study found that teachers express a degree of medicalization in society as it relates to medication use for ADHD. This may be indicative of further awareness of medicalization processes from teachers and the impact on medication use in contemporary society.”
Simoni’s study, however small his sample, indicates that the implications of ADHD medication among children, a common course of treatment for the 7% of American children satisfying diagnostic criteria for the DSM-5 conceptualization of ADHD, may vary across communities and cultures. While some teachers believe that ADHD medication can provide students with academic advantages to which they may not otherwise have been entitled, others worry it may also stifle student enthusiasm, creativity, and social development.
Simoni, Z. R. (2017). Medicalization, Normalization, and Performance Edge. Sociological Perspectives. (Link)