Pharmaceutical Identity: How Psychopharmacological Experiments Changed the Adhd Patient Profile

Jonathan Ruiz, University of California, San Diego

This paper traces the discursive history of childhood behavior disorders from the proliferation of post-encephalitic children in the 1920s to the delineation of attention deficit disorder (ADD) in the DSM-III (1980). At stake here is an empirical puzzle: how is it that childhood behavior disorders were simultaneously being diagnosed at increasingly high rates while the diagnostic profile itself was undergoing drastic changes before being stabilized in the form of ADD? Drawing on recent scholarship in the sociology of expertise, I argue that the simultaneous proliferation of diagnoses on the one hand, and changes in the patient profile on the other can be productively understood in terms of a transformation in the network of expertise within which these children have been established as problems to be solved. What started off as a medico-legal network that first established legally burdensome children as objects of clinical intervention gradually gave way to a more diffuse network of actors that established these children as targets of pharmaceutical intervention in the service of standardizing a set of reliable diagnostic criteria. I specifically focus on one part of the emergence and stabilization of this new network: the use of methylphenidate in the development of severity ratings scales in the 1960s. The explicit aim of ratings scales was to establish reliable diagnostic criteria in outpatient settings in order to facilitate double-blind psychopharmacological studies on hyperactive children. At the same time, the production of ratings scales helped stabilize understandings of hyperactive children among an increasingly diverse set of actors, including teachers, parents, pharmaceutical companies, and clinicians. Ultimately, these rating scales played a central role in establishing ADD as a discrete diagnostic condition in the DSM-III.

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 Presented in Session 83. Intellectual Diversity and Mental Health