Hyper Talk: The Social Construction of ADHD in Everyday Language
School of Education
University of Missouri - St. Louis
8001 Natural Bridge Rd.
St. Louis, MO 63121
This paper examines the ways that Attention Deficit Hyperactivity Disorder (ADHD) is socially constructed and reconstructed within the everyday language use of lay persons in non-professional settings. A sample of speech acts referring to persons or events having to do with ADHD in everyday discourse constitute the core data. Through systematic screening of these 224 language-events identified in settings involving media, family, peers, and work, five emergent conceptual themes are identified. These themes are explicated using representative exemplars from the data. Further analysis identifies three specific dominant Discourses (Gee, 1992; 1996) contributing to the Everyday Discourse of ADHD; they are Media, Medical, and School discourses. Conclusions raise issues about the moral opportunities and responsibilities afforded and occluded by specific Discourses.
Hyper Talk: The Social Construction of ADHD in Everyday Language
. . . (O)ver the past decade, there has been an explosion of terms for the kinds of disabilities that can be ascribed to a child....(N)one of them should please the anthropologist, for none of them guarantees a balance point between showing how bad things are in the lives of children who need our help and showing how the problem is a product of cultural arrangements - a product of our own activities - as much as a product of the neurology, personality, language, and culture of any child.
(McDermott & Varenne, 1995, p. 331, italics original)
Cultural or social analyses of childhood disabilities and disorders have been infrequent within American educational research and scholarship (see Bogdan & Taylor, 1989; 1994; Conrad, 1975; Ferguson, Ferguson, & Taylor, 1992; Noblit, Paul, & Schlechty, 1991; Sleeter, 1986; Tyler, 1997). As Skrtic (1991, 1996) has noted, functionalist or positivist frameworks positing the existence of a biophysical condition of pathology within the individual child have dominated domestic special education research. By assuming the objective status of a biophysical deficit as the essential basis of the condition itself and as an unquestioned reality antecedent to any formal inquiry, this medicalized approach to research tends to overlook the way that childhood disorders are social and linguistic products co-fabricated within the complex construction and contestation of cultural codes, norms, and identities. It often fails to notice that researchers who "discover" childhood disorders and professionals making diagnoses of those disorders operate within a constructive and contested discursive field of political and normative meanings about the lives of children.
Utilizing a research method employed in a similar study of the language of "mental retardation" (Danforth & Navarro, 1997), this paper provides a social analysis of the lexicon of Attention Deficit Hyperactivity Disorder (ADHD), exploring the ways that a vocabulary of ADHD is utilized within the everyday language use of lay persons in non-professional settings. The purpose of this study is to provide a preliminary examination of the various social processes whereby this childhood diagnosis is produced, reified, utilized, resisted, and reconstructed within everyday life. Our access to these social processes is proffered by the tool of language, through an examination of discourse performances. This analysis provides a detailed exploration of the social discourse through which this disorder, identified as a "real thing", a named common cultural phenomenon, is internalized, refashioned, and even opposed by individuals within their daily social practices.
Previous sociological analyses of hyperactivity and attention disorders of childhood have served as a critique of the dominant functionalist/positivist school of research by reframing childhood (mis)behavior as a sociocultural issue instead of a purely medical phenomenon. The general emphasis of this line of scholarship has denaturalized the medical perspective on child (mis)behavior by placing both the diagnosed child and the medical practitioners within a cultural framework of meaning production and contestation (Ideus, 1994; Tyler, 1997).
Conrad (1975) offers the most striking and critical sociological analysis of ADHD. In Foucaultian style, he examines the historical birth and growth of hyperactivity as a medical phenomenon within the United States, explaining the way that pharmaceutical product developments and government action united to precipitate the "discovery" of childhood hyperactivity. He explains that the medicalization of child misbehavior would have been impossible without the development of psychoactive medications such as Ritalin. To some extent, the diagnosis followed the cure, opening the door for medical professionals to assert social control over the realm of deviant behavior of children in a way previously impossible. Additional social effects of the medicalization of child misbehavior include the individualization and de-politicization of deviant behavior. The actions of children fell under the gaze of scientific professionals who recast events of social and political conflict as evidence of individual pathologies requiring medical treatment.
In recent years, the gaze of the medical and psychological professionals who diagnose, treat, and research ADHD has been accompanied by the development of a very full vocabulary of terms surrounding this disorder. This vocabulary exists within the local language games of mental health and education professionals; it is also shared with the community at large. As the number of diagnoses has risen and public awareness of this named disorder has grown by way of the media and public schools, the terms and concepts of the professionals have been passed on to the public. Our investigation concerns the language of ADHD as used by the lay public, as used by individuals attempting to make sense of and cope with the problems and situations that confront them in their daily activities.
A Social Constructionist Discourse Framework
The theoretical basis for this study is a social constructionist discourse framework that draws extensively from the work of Gee (Gee, 1992; 1996; Gee, Hull, & Lankshear, 1996) and Bakhtin (Bakhtin, 1981, 1986; Sampson, 1993; Wertsch, 1998). We utilize Gee's (1992; 1996) concept of "Discourse" and Bakhtin's (1981) notion of "heterglossia" to cast common utterances and written discourse used in everyday social practices as occurring within constructed cultural and historical frames. This perspective emphasizes the way a speaker's language is appropriated from a linguistic lineage of "voices" bearing ideological shadings and constructing political hierarchies. Current language use is assumed to both meet the ordinary social purposes of communicative practices and enact cultural, historical, and ideological grammars of moral and political evaluation. In this sense, language use is entirely practical and political.
Social constructionism is the broad array of philosophical stances asserting that what is assumed and understood to be obviously real by persons in the general course of their activities is more accurately said to be forged and assembled by those persons in their thoughts, words, and interactions (Berger & Luckmann, 1967; Bogdan & Taylor, 1994; Danforth & Navarro, 1997; Ferguson, Ferguson, & Taylor, 1992; Gergen, 1985; Gergen; 1994). Social constructionism typically emphasizes the centrality of language, thought, interaction, and culture in the making of human meaning in lived contexts.
Our focus in this study is the way social realities concerning ADHD are constructed, maintained, and resisted within utterances. This does not deny the inseparable roles of thought, belief, and emotion in the construction of social meaning (e.g. Edwards, 1991). Indeed, we follow Gee's (1992; 1996) lead in formulating a theory of language that incorporates human thought, action, and language within a cultural framework. In this way, we take language not to be sounds and symbols carrying meanings between persons but complex, culturally and historically situated "saying(writing)-doing-being-valuing-believing combinations" (Gee, 1996, p. 127). We view language use as instances of social practices that construct individual and group identities (e.g. Goffman, 1959; 1963), formulate situations within an array of cultural types, cast individuals and actions along moral continua of valuation (e.g. Prilleltensky, 1997), and fabricate relations of social power and identity (e.g. Foucault, 1980).
Gee's (1992; 1996) term "Discourse" is a useful way of encapsulating this sociocultural perspective on language. Gee (1996) defines a Discourse as
a socially accepted association among ways of using language, other symbolic expressions, and 'artifacts', of thinking, feeling, believing, valuing, and acting that can be used to identify oneself as a member of a socially meaningful group or 'social network', or to signal (that one is playing) a socially meaningful role. (p. 131).
This definition theorizes language use as simultaneously reflective
(an 'artifact') of a) human consciousness (i.e. thinking, feeling)
and b) cultural processes. Language use, in other words, is productive
of individual and group identities within a social situation.
Gee assumes that this production of identities is a moral and
political act because it asserts a cultural scheme of moral valuation
and power distribution. Neatly augmenting Gee's Discourse theory
is Bakhtin's (1981) concept of "heterglossia," a notion
of "multi-voicedness" that broadens the source and meaning
of individual utterances far beyond the specific situation in
which words are spoken with the overtly intended message of the
individual speaker. Language is assumed to both reflect and shape
cultural identities by assigning understanding of what constitutes
the norms of roles that individuals can play in relation to one
another. Bakhtin invites us to notice the appropriated character
of the words and phrases, the way the linguistic tools that meet
current purposes in specific, social contexts are borrowed from
a history of previous utterances and power relations within the
cultural domain. If not for a trail of prior usage, if not for
a cultural history leading from linguistic beginnings up to the
present moment, an utterance would risk being rendered a nonsensical
novelty or oddity. It would be a mere grunt, a meaningless garble,
or a new metaphor half unfathomed by listeners. Meanings evolve
through a history of social practices (Wertsch, 1998).
The concept "heterglossia" reminds speakers that words are not merely our own, bearing only our intended meanings. We speakers participate in a form of cultural echolalia through which an entire history of ideological and political shadings attends the present usage and understandings. As Sampson (1993) explains,
The words that are formed by my vocal cords are not simply my words; they are words with a life, a story, a history, an echo that I appropriate and use and, in so doing, reveal as much about when and where I am as we erroneously assume they reveal about the individual psychology I am. (p. 135)
History and culture operate like a ventriloquist, interanimating
an individual's speech, saturating the current language with reverberations
of past speakers, past meanings, and past political relationships
(Bakhtin, 1981). In a single utterance, a history and culture
of moral and political import are appropriated and recast for
the present circumstance.
In this research, we examine the way the ADHD Discourse is (re)constructed by lay persons beyond the professional spaces in which medical and psychological Discourse originate. In analyzing the prosaic, mundane use of ADHD language, we examine the moral valuations (discernment of what is "good" and what is "bad") as well as the social production of political identities reflected in everyday language that utilizes and resists the Discourse of science.
Our research method repeats the inquiry processes we developed in a similar investigation looking at the Discourse of "mental retardation" in everyday utterances (Danforth & Navarro, 1997). In the present study, 31 research assistants documented 224 examples of discursive events using a vocabulary of ADHD in data journals collected over eight consecutive weeks. These research assistants were undergraduate special education students who served as data collectors as part of a university course. These assistants were instructed to keep a record of events in the course of their usual life, outside of university classes, in which they witnessed a spoken, written, or media reference to ADHD. They kept these descriptions of observed events in daily journal entries.
Careful measures were taken to ensure that the research assistants were "trained and prepared observers" (Patton, 1990, p. 201), persons fully prepared to write descriptive field notes that capture events with fullness, sequence, and detail. Before collecting data, assistants were provided training that included a complete overview of the purposes of the study and instruction on collecting qualitative data. This instruction emphasized the practices of writing detailed, richly textured descriptions of the setting, preceding occurrences, dialogue, gestures, and physical activities of those persons involved in each observed event. The regulation of the quality of data collection procedures within the research assistant training process attends to the "consistency" of the data collection (Lincoln & Guba, 1985). Additional steps were taken to assure the "credibility" of the data (Lincoln & Guba, 1985). During the eight weeks of data collection, the research assistants were provided with frequent opportunities to share and discuss their data and data collection questions with each other and the first author, an important means of supporting "sufficient intra-team communication to keep all the members moving together" (Lincoln & Guba, 1985, p. 307). When references to ADHD were vague and questionable (a rare case), the two co-authors judged whether the data would be included in the sample. For example, in the case of a speaker telling an individual to "take his medicine," the entry would only be considered credible if other aspects of the scene or sequence of events confirmed that the medication was actually a treatment for symptoms of ADHD. Entries lacking evidence that tied the event directly to ADHD issues were excluded from the data.
No specific geographic areas or cultural groups were specified as the site of data collection. The research assistants gathered evidence within their usual routines of social interaction: family life, work, recreation with friends, visits to public settings such as ball games and shopping malls, and interaction with electronic and print media. The research assistants lived in primarily suburban working middle class neighborhoods in a large mid-west city. All assistants were female, Caucasian, and reported their observations as occurring in social settings of predominantly Caucasian adults and children.
Of the 224 discursive events within the data, 172 were "live" discussions between "actual" persons. Fifty-two were media speech acts in which ADHD was referred to in some way on television, radio, in movies, newspapers, magazines, or books. In our data analysis, we handled both "live" and media events in a similar manner, assuming that each represents a cultural performance of linguistic communication. Our treatment of media and live speech acts as similar within the data in no way suggests that a discussion between four people in a living room carries the same cultural power as an episode of "Seinfeld" viewed by millions of passive TV consumers. Media events that formulate ADHD as an objective and standardized condition play a powerful role in the construction of this disorder in society. In this research, we acknowledge this fact while deferring for practical reasons on the complex and important issues of how and why some discursive events are more culturally influential than others.
We analyzed the data in order to find the prominent themes that recurred across the many events (Spradley, 1980). A content analysis of these 224 speech acts yields five distinct themes that provide insight into the patterns of reference to ADHD created in everyday talk and interaction. This analytical process included listing every data sample with an identifying tag line and then coding them on several possible thematic strands. If further distinctions emerged within a category, a new category or sub-category was formed (Bakeman & Gottman, 1986). If too many entries did not fit into a given category descriptor, we revised the labels to better represent the data's themes. Groupings of similar data were eventually identified in order to analyze and discuss the main clusters of ideas in the data. The resulting themes should not be viewed as exhaustive of all possible analyses of this data but they do provide a central means to develop concepts through which we may open up and organize the data for exploration and discussion.
Additionally, we identified what Gee (1991; 1996) calls the Dominant Discourses, the culturally circumscribed and ideologically loaded modes of language that run through the data, that exist across the five themes. Each Dominant Discourse originates with a specific social group (such as teachers or physicians) and spreads across other groups and settings through borrowing and situational reanimation. This analysis provides for the formulation of a discursive theory concerning the ideological-practical tools that language users utilize to mediate meanings within specific life situations.
Three Dominant Discourses Contributing To Everyday Discourse
In this preliminary sampling of ADHD discourse in non-professional interactions, we found lay persons dealing with questions concerning childhood behavior problems by constructing an Everyday Discourse of ADHD containing intertwined aspects of three identifiable, culturally dominant Discourses. By using the term Everyday Discourse, we are pointing to those conversations occurring between family members, friends, acquaintances or even strangers in which the specific, "common sense" practicalities of the social situation at hand are paramount. People are attempting to deal with what they take to be the realities of their lives. This Discourse is mundane yet powerful in the way it produces, reproduces, and contests the production of social identities through the linguistic framing of particular life situations.
In the data, we found that this Everyday Discourse borrows from, mixes, and refashions a variety of cultural Discourses. The three Dominant Discourses we can identify in our data are Medical, Media, and School. Each reflects and emanates from an influential cultural institution that impacts lives in an ubiquitous fashion.
The Medical Discourse is the primary terminology and ideology of ADHD talk in everyday life. Whether neighbors chat over a back fence or a restaurant customer discusses an issue with the waiter, it seems that speakers have to somehow deal with the concepts and terms that have been created by medical (and other mental health) professionals under the umbrella of ADHD. A large proportion of the terrain of the age-old problem of child misbehavior now seems to reside within the bounded lexicon and ideology of Medical Discourse, constrained within a scientific terminology of symptoms, diagnoses, and medications, construing child behavior issues in terms of medical descriptions and interventions. This Discourse moves with such cultural authority and pervasiveness that one wonders to what extent language users can meaningfully discuss and address child behavior issues without drawing from an ADHD terminology. This is not to say that Everyday Discourse borrows in wholesale and direct fashion from Medical Discourse without altering or resisting. Many speakers in our data rejected, contested, or refashioned large aspects of the Medical Discourse. Our claim here is that the cultural power of Medical Discourse as a way of framing childhood behavior problems is so dominant that language users have little choice but to contend with it in some fashion, whether they appropriate the Discourse with reflexive acceptance, mild modification, or dramatic resistance.
While the Medical Discourse provides the primary conceptual and linguistic framework of the disorder itself, the School Discourse seems to supply the ideological rationale that fuels parent concerns. In using the term "School Discourse" we do not limit ourselves to discussion about the way that teachers, administrators, and other school personnel talk about students. All that is crucial, yet School Discourse is a much broader social phenomenon involving all those members of the community who talk about what occurs at school in such a way that student identities of varying degrees of value are produced and transmitted. In this sense, we can see that all conversations in living rooms or pool halls or supermarkets about "how a child is doing" in school are examples of School Discourse. This Discourse locates student identities along a continuum of value that runs generally from success to failure, good student to poor student. This Discourse tends to individualize problems of social conflict and avoids questioning social hierarchy. Additionally, it tends to reaffirm the school as the primary site of child identity construction, the place where adults culturally construct the moral value of a child's character and actions. Much of who a child is and how that child is judged to be doing by interested adults comes down to vocalized interpretations of that child's performance in school. School Discourse must, in some way, handle the dual institutional priorities of behavioral conformity and academic achievement. Behavioral conformity is a dominant ideological theme enacted by school professionals who value student submission to adult authority and unquestioning adherence to codes of behavior that emphasize physical docility (e.g. sitting still, remaining quiet) (Tavares, 1996). Academic achievement is performance on assessment activities such that the "good student" ranks above peers on hierarchical schemes of grading and placement.
Both of these School Discourse priorities rely on an underlying logic of meritocracy, the belief that students who work hard will get the rewards that they deserve, both in the school program and in the broader economic marketplace (McLeod, 1995; Willis, 1977). This logic is based on the assumption that the good life consists of a community in which individuals compete for scarce resources (Prilleltensky, 1997). Social inequality, in this scheme, is valued as indicative of healthy competition.
It appears that Media Discourse as enacted in television, movies, published materials, and the Internet offers interpretations and dramatizations of the ADHD Medical Discourse occurring among physicians, psychologists, and researchers. Media speakers and writers tend to borrow the terminology of the Medical Discourse and position Medical Discourse users as authoritative, scientific experts. They provide information to the public about this childhood disorder while applying the diagnosis to a wide range of social situations. In our small sampling, we found the Media Discourse translated the Medical Discourse for entertainment purposes, lacing it with a fair dose of fear-enhancing sensationalism as well as highlighting polarized perspectives on the issue.
Five Interpretive Themes
In analyzing the data captured in field journals, we identified five emergent themes that organize the essence of these journal recordings of everyday Discourse about ADHD:
1) Appropriating the DSM-IV descriptors,
2) Schools as identity-construction sites,
3) Resistance: Biology vs. moral culpability,
4) Alternative solutions to a real problem, and
5) Relief and hope in naming experience.
In the 224 utterances recorded, recurring patterns emerge when
the language of ADHD is analyzed in situated events. These five
themes identified by the researchers represent the major pragmatic
strands in the data.. The themes are presented conceptually and
are then elaborated upon with examples and stories from the data
to illustrate and clarify meanings.
The range of responses in this set of data mirrors many of the issues under public discussion in the popular press (Time, November 30, 1998; Scientific American, 1998; Newsweek, March 18, 1996). These articles discuss the strong tension between an American predisposition to efficiently "fix" things medically with a pill, and an increasingly uneasy feeling about controlling the behavior of large numbers of young children chemically. On the one hand, the choice to medicate violates the culture's image of an autonomous hero, a rugged individual unfettered by societal constraints; on the other hand, veteran teachers and parents are encountering children with behavior challenges that seem to defy traditional solutions.
The data from our earlier study on mental retardation (MR) (Danforth & Navarro, 1998) contrasts with the current data in a few significant ways. Unlike the everyday speech samples on MR that reflect a distancing or "not-like-me" language, the current set of speech samples on ADHD primarily reference known persons with an actual ADHD diagnosis or incidents involving decisions on seeking a medical diagnosis. The fear of non-normalcy expressed in this set of data seems mild compared to the MR data noted above. The tone of the exchanges is more emotionally proximal than distal to speakers and addressees, since they often reflect personal acquaintance with the subject of the conversation.
Fifty entries, approximately one-fourth of the total, involve comments explicitly identifying persons currently taking medication for ADHD, an event necessitating a formal medical diagnosis. Other entries do not explicitly mention taking medication but describe students using language labels that suggest an ADHD diagnosis although this remains a supposition since the label is often used in School Discourse and Everyday Discourse without a medical diagnosis. Only four entries use the vocabulary of ADHD as a vehicle for humor, poking fun at behavior that mimics symptoms. Another three entries frame the ADHD behavior paradigm in a positive light, such as in the testimony offered by a successful artist who was ADHD diagnosed as a child: "I feel that these are good traits". Few individuals seem able to transform the more common negative connotations of a primarily deficit negative label.
Linguist Deborah Tannen (1986; 1990) describes in her writing how strongly "metamessages" get embedded invisibly in cultural ways of speaking: "What is communicated about relationships--attitudes toward each other, the occasion, and what we are saying --is the metamessage" (1986, p. 16). The recording of the data samples relies to some degree on the listener's interpretation of tone, rate of speed, loudness, etc. in a specific context. As the samples below will illustrate, the research assistants often weave direct quotes from those observed with the writer's own commentary and interpretation of the significance of the utterance. Each of the five themes is discussed with a few examples.
1) Appropriating the DSM-IV descriptors
Behavior descriptions matching the DSM-IV criteria are prevalent in a majority of entries using words such as the following: "inattention, hyperactivity, impulsivity, and memory problems" (DSM-IV, pp.83-85). Many detailed symptomatic listings in the DSM-IV manual under ADHD are represented in the speech acts in our data, yet speakers appropriation of them sometimes extend beyond defined symptoms to associate other negative, even criminal, behaviors with the ADHD label.
Although the Medical Discourse of ADHD attempts to set clear boundaries on how language should be taken-to-mean, the social experience of lay persons that triggers the use of that Discourse seems to undergo redefinition as it gets appropriated in everyday activity. The situated speech acts recorded in this data make use of the language of ADHD to deliver multiple and contradictory messages. Vygotsky's description of spontaneous and scientific concepts as discussed in Kozulin (1998) offers a useful frame to untangle the thinking behind language usage. "Spontaneous" explanations of human experience such as the movement of the moon or the symptoms of aging call forth explanations that seem tenable because humans are fundamentally meaning-makers. Because we have the tool of language, both oral and written, accumulated specialized knowledge can be compiled and transmitted intergenerationally which results in the organization of knowledge into disciplines or "scientific" ways of knowing. These two strands of knowing meet and mingle in the course of developmental and schooling opportunities.
The major "scientific"categories listed in the DSM-IV diagnostic criteria are echoed in the utterances recorded, but these utterances also reflect "spontaneous" understandings. The words boldfaced in the DSM-IV manual, such as "inattention, hyperactivity and impulsivity", dominate the everyday speech acts describing ADHD symptoms; one or more of the descriptors appear in almost every conversation. A catalogue of representative descriptive behaviors gleaned from the 224 sample set include the following:
. . .very unorganized, not able to pay attention to more than one thing at a time, never on task, sharpens pencil constantly, cannot focus on anything, very distracted, repetitive behaviors not on purpose, has a slow recall of facts, makes spelling errors, has unstable pencil grip, hyperactivity, restless, defiant and destructive, can't sit still, distractible, loud noises from tapping table and verbalizations, seemed really anxious and fighting a great deal, very smart, very hyper, keep busy with activity, reports often not detailed or completed, alienates everyone, nicknamed HYPO, laughs a lot, lot of energy.
The symptoms are painted with a broad stroke and usually include
descriptions of high activity levels interpreted as disruptive
- especially in the context of school as elaborated in our second
The following description tries to balance the focus on the ADHD language to a more holistic assessment of the child: "He had very poor academic performance, except for technical drawing, and spent most of the day being put out of class for being disruptive...he excelled in sports." The bulk of entries borrowing the language of the DSM-IV descriptors, however, suggest a Foucaultian gaze on individual behaviors that are barriers to success, not on potential strengths, thus reifying the association of pathology to the label. Here is one account from a research assistant that attempts to interpret the Medical Discourse:
Sheila, my boss, was talking to Ann about someone's son they knew who was being tested for ADD. Their conversation centered on this child's being very disorganized, not being able to pay attention to more than one thing at a time, very distracted, but her grades were still doing well. Sherry started talking about another form of ADD/ADHD, but she was not sure of the name. It dealt with a person's inability to do more than one thing at a time. This is when my ears really perked up because I immediately thought of a server who worked with us [in a restaurant] who cannot possibly do more than one thing at a time. A better way to describe it would be not able to concentrate on more than one thing. This is not a good characteristic to have for a restaurant worker for obvious reasons. Is this really another form of ADD or just another characteristic?
This entry captures the complexity involved in the process
of appropriation of language and concepts. The speaker struggles
to discern the relationship of behaviors to a set of labels taken
to be authoritative¼if she can just get it right. She appeals
to the professor reading the journal for clarification.
When comparing journal descriptions with the DSM-IV diagnostic manual language, we are struck with the many similarities and the fact that the everyday samples frequently include descriptions of a complex of several behaviors which is one of the pre-requisites for diagnosis. What is totally absent from the everyday speech acts is an awareness that the symptoms "must have been present before age seven years" (DSM-IV, p. 78). A "Catch-22" of appropriate ADHD diagnosis is also mentioned in the manual, namely the difficulty of making an accurate diagnosis in the pre-school years. This conundrum of assuring identified school behaviors have a retrospective basis in an earlier set of problem behaviors to warrant an ADHD diagnosis is not addressed in any of the everyday samples.
The official diagnostic criteria includes a section called "Associated Features and Disorders" that lists affective characteristics associated with ADHD, such as "low frustration tolerance, temper outbursts, bossiness, stubbornness, excessive and frequent insistence that requests be met, mood lability, etc. (p. 80). These affective descriptors may be the basis for associations made in the data set with extreme deviance from normal behavior. Interestingly, of the eight entries connecting ADHD to violent or criminal behaviors, six are media entries.
Examples of these media and non-media entries suggesting extreme deviance associated with ADHD include television bytes such as
· an adolescent murderer, diagnosed as a child with ADHD
· parents sharing fears of their own children labeled ADHD
· a psychologist mentioning the "childhood disease" of ADHD while describing a ten-year-old who tortured and kills a three year old.
Another media event involved a radio talk show about a mother
concerned that her sixth-grade daughter's propensity for stealing
may be caused by ADD. A newspaper article was reported that described
two teens accused of killing three people. The mother of one says,
"problems at school and ADHD are factors". Such subtexts
to the Everyday Discourse of ADHD associate deviance and dangerous
unpredictability with labeled persons. Our evidence suggests the
possibility that a sensationalistic media plays a role in promulgating
this frightful image.
There is no question that the language from the official diagnostic criteria has penetrated discursive practices when talking about patterns of behavior in children and adults. The cognitive schema reflected by this often focuses on a model of deficit and pathology which inexorably leads to school failure, which, in turn, preempts access to the good life. For many parents, the threat of school failure is a clarion call to action. Many seem to interpret action in terms of changing the child's behavior rather than changing the social environment of the child. The traditional Discourse of American psychology with its focus on the individual may reify this perspective (Prilleltensky, 1997; Sampson, 1993).
2) Schools as identity-construction sites
Efforts to seek an ADHD or ADD diagnosis for a child are framed as typically arising from problems with school environments and complaints from teachers. Implicit in these speech acts is the belief that access to the "good life" in American culture is linked with school success. School priorities of behavioral conformity and submission to authority seem to generate much of the ADHD-related talk and action among parents and teachers.
Talk about students who do not conform to classroom behavioral or academic expectations and who are failing to thrive in schooling environments constitutes a second major theme in our data. Many utterances identify school problems and teacher requests as precipitating causes for seeking a diagnosis. Children's inability to stay focused, to sit in seats for an expected time, to complete worksheets independently, or to cooperate with classroom rules and procedures raise suspicions of ADHD or ADD. Here is one entry in its entirety that captures the theme of school as an identity-construction site.
I had a long talk with my dad's girlfriend about her daughter Jennifer. Jennifer is in the first grade and really is a hyper child. Jennifer's first grade teacher finds her extremely difficult to work with. The teacher, mom, and school principal had a meeting concerning Jennifer's performance in first grade. They all agreed to get her tested and undergo a physician's exam. They concluded she was ADHD. Jennifer's mom refused to put her on medication. Jennifer's mom also had problems with her hyperactivity at home. Getting her to go to bed was impossible because she would bounce off the walls! (Literally she did, I've seen it several times). So her mom read something about ADHD! Give the child cold coffee before bed. So, she tried it and it worked, she would fall right asleep. During Jennifer's schooling she was being pulled out of class to work on her reading. She was also being taught focusing skills! (Whatever that is). Jennifer's mom asked me what focusing skills are and I had no idea. While Jennifer was practicing her reading, the rest of her class studied math! Jennifer would miss out on math and still get 2-3 worksheets of math a night. She really struggled in school, she constantly was punished for bad behavior. And notes home were often sent telling mom about her bad days. Jennifer's mom still refused to put her on Ritalin. She couldn't understand how making her a zombie was going to help her in math.
This entry vividly unpacks the contested space revealed in
language appropriation. The entry is framed as a power struggle
between mom and school. Consequences of the mom's resistance include
messages and actions that reinforce Jennifer's role in school
failure. The subtext on only reporting Jennifer's "bad days"
suggests selective coercion since the very next sentence reveals
the real issue being communicated: "Jennifer's mom still
refused to put her on Ritalin." The accommodations chosen
by the teacher - focus training and reading help - ironically
result in setting Jennifer up for math failure as well. The journal
entry is phrased in ways that might also suggest disapproval of
having first graders do 2-3 math worksheets a night although the
intent of including that detail is unclear. What is not suggested
by the entry is any joint collaboration between home and school
to mutually improve Jennifer's learning opportunities.
The competitive arena of the public school that has traditionally constructed student identities along a continuum from poles of success to failure is now faced with the sometimes confusing task of constructing a learning role for the student labeled with a deficit-based disability. While some students race ahead and others fall back, the Discourse of deficit-based disability asserts that every student has the right to be a successful learner, and some of those who are currently failing require proper diagnosis and medical or educational intervention and treatment.
This Discourse of individual student disability churning forth from schools into the broader social sphere positions the school as the site of homogenization. The public nature of high-stakes testing outcomes pressure teachers to reward behavioral conformity and competition. Although those labeled ADHD are often described as smart, the environment and behavior expectations of a traditional school classroom result in school failure.
Several data entries focus on students' improved ability to participate in schooling rituals successfully once on medication. What is absent from the data are testimonials indicating significant changes in academic outcomes for these students over time. Quoting teachers' voices directly, the speech samples show mixed reactions to the "wonders" of Ritalin. As the reported number of problem students increases, and experienced teachers feel unable to negotiate solutions, the lure of getting relief with medication is strong. In a few speech samples, conflict about using drug therapies arises in reference to an individual child, perceived as bright intellectually, but who has undergone noticeable personality changes with medication. Phrases such as "acting like a zombie, space cadet, and zoned out" occur in multiple entries. The following entry illustrates several tensions around the school's role in identity construction.
I was over at my best friends (sic) house from high school before going out one night when I found out her youngest brother had been diagnosed as being ADHD. We first started talking about her brother because I made the comment that he was being extremely quiet and it almost seemed as if he was (sic) drugged because he was always very hyper. He was the child who never stopped. Whenever I would be at her house he would always wind up getting on your nerves by the time you left, but that night I noticed he was a different kid.
It was then that my friend Dan and her parents began telling me the entire story about him being diagnosed as ADHD and then being put on medicine. I was totally amazed when they told me because yes he was an annoying boy at times, but he was a very smart child that never had problems at school until he was in third grade. His teacher wasn't able to keep him busy and interested, so he would always get into trouble for disturbing the class. His parents were furious, but took the teachers advice and took their son to the doctor and he was put on medicine because they said he had ADHD. When I found out about him being diagnosed, he had already been taking the medicine for about three months. The medicine made him a different kid. It was almost as if he was an entirely different person. The parents then talked to me about how they are discussing whether or not they should take their son off the medicine because they notice he is a different child when he takes it because he also is almost getting depended (sic) on the medicine. The only problem they had with taking him off the medicine was school. They are still undecided as to what they are going to do.
Issues of identity construction weave in and out of this narrative
almost asking will the "real Johnny" stand up. The cost
of school success often raises issues of individual freedoms to
construct and ontologically be a self.
A few accounts directly criticize the teacher as the source of student failure in school. One parent is recorded as saying that her "school district wants children who learn differently to just go away". Another entry records the feelings of a father who "felt that all the teacher needs to do is be patient and work with the child." He said that labels like Learning Disabilities and ADHD are " excuses for teachers not to teach children." Parent actions range from demanding a move to another classroom, refusal to put the child on medication, moving the child to an alternative school environment, and looking to support groups and literature to enact alternative solutions.
What is suggested in the data is that the majority of parents and students accord high status to teacher and principal utterances about student performance in school; succeeding in school is taken as an assumed "good" in our culture. Comments from educators are repeated to relatives and friends and carefully mined for meaning. Behaviors that conflict with school success are taken seriously and demand action. A few resistant speakers actually identify schools as the problem source, but most entries, such as the ones quoted, express ambiguity about the price of conforming to success norms. Wherever the causes of school failure may ultimately lie, there is a pervasive subtext in the entries suggesting that schools are powerful arbiters of future economic success as well as the cultural gatekeepers to higher education and the good life. They shape the roles in which we are allowed to participate.
3) Resistance: Biology vs. moral culpability
A large number of the speech samples use the ADHD descriptors from DSM-IV but critique the appropriateness of applying the Discourse of medicine or psychology to the labeled behaviors. These language users raise issues of moral responsibility in accounting for behavior. Others express concern over labeling a normative range of child behaviors as deviant or pathological. Central to this theme is the issue of how a culture views individual difference and how it tolerates non-normative behaviors, what Charles Taylor (1994) calls the "politics of recognition". These speech acts resist the legitimacy of an ADHD Discourse that explains behaviors in terms of disease or disability. While utilizing the medical terminology of ADHD, these journal selections contest the meaning and existence of this disorder in the lives of children, claiming ADHD "talk" provides excuses for children's inappropriate behaviors. To these speakers, the "real" or "true" explanation for misbehavior involves things such as lack of discipline, poor parenting, or a need to learn self-control. The medical and school explanations are rejected outright.
Last night I visited my cousin Julie. We were at her apartment just talking and sharing family gossip. She told me that she was very upset with her mother because she had put her stepbrother on Ritalin. Julie insisted that her mom was totally irrational about the situation. She said that her stepbrother, who is in third grade, walks around like a "little zombie". The child has gone through a lot this year: the divorce of his parents, a new school, a new stepfather, three new stepsisters, and the death of his grandpa. Still, my aunt, Julie's mom, decided that drugs were the answer to her problems. (not the child's problems mind you). We talked for about half an hour about this situation and I told her about this class. She's very interested. I told her I would pass along my readings.
LATER UPDATE NOTED IN JOURNAL: Julie has read several articles from this class. She is bound and determined to get her stepbrother off of Ritalin.
In this example, alternative explanations for behavior are
the basis of calling into question the use of Ritalin. Another
important issue raised is again the location of the problem. Is
it in the child (biochemical imbalance); in the step-mom (wanting
an easy fix to a perceived behavior issue); in the school (success
at any cost), etc.? Also at issue is the sharing of professional
journal articles, which may be interpreted in Bakhtinian terms
as an "inter-animation" of the Everyday and Medical
Discourses. Information about the "scientific" concept
of ADHD is used as ammunition to subvert the stepbrother's diagnosis.
No mention is made of the role of the school and the doctor in
getting the boy on medicine; the real cause is squarely put on
the stepmom's shoulders.
Other entries also suggest that motivation, self-discipline, parenting, life circumstances, etc. offer more powerful interpretive frames for behaviors than an elusive label such as ADHD:
· Medicine is easy way out. (I) still have nervous energy but have learned to channel it!
· Brian I think is just looking for an excuse not to do well in his classes, because he is not.
· Every kid I've met in the last few years has ADHD. I think it's a nineties cop-out for poor parenting or teaching skills. (Aunt who takes foster kids).
· Half the damn adult population will be on Ritalin!
· The only disability in life is a bad attitude.
· I don't really believe most of these children have ADD. Gives them a good excuse for not paying attention or doing work. (quote from media source).
· He needs a little discipline in order to settle down. (principal to special education teacher).
· He (6 yr. male) doesn't really know what it (ADHD) means, but I think he has figured out that he can blame any poor behavior on this disorder his parents are telling him he has. (relatives talking about their cousin).
These interpretative expressions provide moral markers within
complex social situations, demonstrating the perspective of the
speaker as an evaluator of social morality. Evaluative comments
by individual speakers demonstrate ways to accept or reject elements
of the Medical Discourse frame in favor of a language of moral
accountability. They protest the way that Medical Discourse can
summarize human action as arising from an invisible, underlying
condition, thus stripping away the moral import of human activity.
These speakers use the Medical Discourse terms yet subvert that
Discourse by spinning it into a moral language that raises issues
of agency and responsibility.
The following entry involves a reflective dialogue between a mother and daughter about how their beliefs shaped choices:
I was in Dallas visiting my mother and she brought up how hyper I was when I was younger and my girlfriend said that I should be put on medication now (because I still am to her). After she said that, my mother explained that she had considered it, but that she just thought it was because of my diet, and just being a normal kid. She then started talking about the number of kids today who are so quickly put on medication. She explained that many of them needed it, either for (unclear) or to help control them when they can't. She believes, like I do, that it has become an easy way out for some people, not all. She just went on to explain how she was glad she didn't do it just for the sake of her peace of mind. Sure I am still somewhat hyper or have some "nervous energy", but I learned how to channel it.
This entry exemplifies a struggle to make sense of the ADHD
Discourse by both resisting and accepting elements of the solution
for "some" while rejecting it for "others".
Issues of locating the problem source are germane to such oppositional discourse. Although brain trauma and chemistry along with genetic traits offer explanations for behavior patterns in the scientific realm, some of the everyday speech samples resist this causal frame. In situated experience, these individuals offer alternative explanations for behaviors using alternative, extra-scientific evidence as standards for truth.
A sub-theme closely related to the moral agency issue deals with concerns about fairness and justice. This discourse can be viewed as an extension of the common concerns with institutional programs such as Affirmative Action that give preference to persons who fall into specific categories. In these utterances, the speakers did not resist the diagnosis of ADHD as a real condition. Rather, the unequal treatment of ADHD-diagnosed students in school is viewed as violating beliefs about equity. This includes objections by peers about special accommodations for ADHD labeled students, such as handing in work late, being given alternative tests, or not finishing work. Others entries recorded complaints about labeled students being unable to contribute equally to group projects, etc. One younger sibling of a research assistant said he wanted to be ADHD because then he would not have to turn his work in on time. In a conversation with a friend, one young woman stated that her boyfriend's diagnosis of ADHD resulted in money from the government as long as he went for doctor appointments regularly and that he was getting scholarship money as a result of the disability as well.
In yet another example of the equity sub-theme, a university professor responds to a student who asks why one student diagnosed with ADHD is allowed to turn in assignments late. The professor briefly explains that: "(S)ome people have special exceptions mandated by the university". By framing the reply as university policy without moral justification, the professor seems to be critiquing the accommodation policy as an external constraint not to his liking, thus supporting the speaker's feelings being treated unequally.
4) Alternative solutions to a real problem
Ambivalence emerges in many speech samples around dependence on medication as a solution to deal with behaviors described as problematic in children. Alternative strategies get named and discussed in the journal entries including diet, martial arts training, caffeine, yoga, meditation, etc. These language users seem to accept the disorder as described by the Medical Discourse as "real" but resist the standard medical treatment as a satisfactory strategy to solve the problem. A plethora of new books by medical professionals support this discourse of skepticism about modes of treatment.
The pervasiveness of this thematic strand is indicative in part of a broader critique of standard medical solutions to health issues in American society. Technology resources allow individuals to seek out and exchange information that challenges a monologic medical Discourse of truth. Numerous concerns are expressed about changes to the essential self of individuals on drugs such as Ritalin. Side effects from taking medicine to control ADHD symptoms are documented as they relate to appetite, sleep patterns, interpersonal relationships, dry mouth, social stigma, and self-esteem. While essentially agreeing that the problem ADHD is a real condition, these alternative explanations of its significance open the door to rethinking therapeutic interventions of diagnosed individuals. Here are a few references from the data:
· An advertisement for a non-stimulant skin patch medication for 6-12 year old children to reduce impulsivity and hyperactivity.
· Support groups for parents and children as advertised in local media.
· Diet modifications, Feingold diet in particular.
· A request at a bookstore for a book on alternative treatments
· Martial arts training to teach control and discipline.
· More positive focused attention needed for these children.
Even in utterances in which specific alternatives to stimulant drugs are not raised, medicine is often framed as a necessary evil. A general unease with actions embedded within ADHD Discourse and practice is expressed in a set of the entries. Events brought up include accounts of teachers asking out loud in class if misbehaving students have taken medicine; of moms threatening unruly kids in shops with taking medication; of students reluctant to take medication or avoiding going to the nurse. Entries frequently express mixed feelings about medicating children for misbehavior. Other entries share personal strategies for dealing with children exhibiting hyperactivity. In the case that follows, note that suggestions originate from the parent to the caretaker but the caretaker does not share their concerns in return:
I used to be a director of Latch Key program. I had several children with ADD and ADHD, one particular child had ADHD, Tom. Tom was a third grader and very hyper. I would always have activities set aside for him. If he wasn't busy he would bite, hit, punch, scream, or run away. He would get very upset easily. His parents gave me some things to do when he would get out of control:
· have him sit on his hands
· read a book
· count to 20 with him in a soothing voice
· have him sit down with you and tell you something pleasant
These would often work when Tom lost focus on an activity.
I personally felt his problems were beyond ADHD, but I kept those feelings to myself. I would tell his parents about his day. He really had a behavior problem with authority. Example: I had two broken toes, I told the class about them and not (sic) to jump on me or my toes! Well, I asked Tom to do something, he got so angry he came up to me and jumped on my foot. As it turned out Tom left the school and went on to a special school.
The journal writer singles out Tom as exhibiting a high level
of antisocial behaviors which she intimates "goes beyond
ADHD". The communication with parents on strategies to manage
Tom's behaviors seem positive, yet the caretaker then documents
an incident of personal pain which is offered as evidence for
extreme lack of empathy. The final line suggests her "hidden"
opinion is vindicated in that the boy is moved to a special school.
The multiple meanings of ADHD in action as it plays out in social
contexts resonate several Discourses of value, as Bakhtin's notion
of heterglossia would suggest.
5) Relief and hope through naming experience
A final theme focuses on stories of relief and hope due to diagnosis and treatment. Parents and teachers coping with stressful behavior sets over time express positive feelings about improved school behaviors and outcomes once children are treated. Several speech samples involve adults appropriating the Medical Discourse of ADHD to name and explain school frustrations and failure retrospectively. They feel better about themselves because they now have a name that seems to fit their experience and that helps to explain historical school frustration despite knowing they were cognitively able students.
When medication for a child has significantly reduced stress in the lives of parents, relatives, or teachers, the adults express relief because a strategy has been found that works to remove an experienced challenge. This theme generally is demonstrated in two specific ways. First, a number of speakers express relief in "finally finding out what the problem really is". After a child or an an adult struggles for years with learning or social problems, the diagnosis gives this struggle a name, an official validation, and a sense of comfort that comes with understanding the problem. Second, going beyond the relief of "knowing" what the problem is, many find hope in the belief that medical ailments often are solved by medical solutions.
These construals can be understood in the following way: To be ADHD is to be part of a real group of people with a real disease that might be cured or effectively treated. At the very least, one is not alone. Many others are afflicted as well. In both of these sub-strands of this theme, the vague and troubling difficulties of lived experience are put into consoling and hopeful order by the authoritative Medical Discourse. Behavior changes do result for some in significant ways.
I went to Charleston to visit my aunt and uncle for spring break. Since they moved away I have not seen them much or heard about the kids. My oldest cousin Seth is thirteen. He has been kicked out of one private and one public school and now he goes to a different private school. My aunt and uncle have had many problems with him. He has a bad attitude, punches down walls, tries to start fights at school, talks back, and beats on his siblings. My aunt and uncle took him to a therapist and she recommended that he be tested for ADD. He was tested and tested positive for ADHD. They put him on Adenol. He only takes it on school days. Since he started the medication he hasn't gotten any detention (he was spending every day after school and Saturdays in detention). He has improved in his grades, and is much more pleasant to be around when I was visiting. I noticed his behavior was typical of 13-year-old boys. He had a smart mouth and didn't listen. I also noticed when he took the medicine he looked and acted so relaxed. . . . He also loses his appetite when he takes his medicine.
Many questions remain unanswered in these brief interpretive
accounts. The research assistant's words ("tested positive")
suggest a misinterpretation of diagnosis as absolute, but she
documents a set of changed behaviors that coincide with using
A teacher in another entry shares her belief: " I really believe these (ADHD) kids can be helped with medicine." Several parents, one an occupational therapist, express relief that a proper diagnosis has finally been made and the child in question has been put on medicine. One mother goes to three doctors to find one who would prescribe Ritalin to moderate her child's behaviors. Yet another account tells of parents at a restaurant discussing their relief in finally finding something to attach their child's problems to. Many adults are quoted making self-diagnoses retrospectively; the Medical Discourse provides a meaningful frame to articulate their frustrating experiences of school.
The authoritative naming of experience and the hopes or realities of medical treatment provide many with a powerful narrative of hope. Tapping into the modern narrative of scientific progress allows many speakers to find order, safety, identity, and the hope of an improved life.
Conclusion: Discourses and Disorders
Not only does the nature of our terms affect the nature of our observations, in the sense that the terms direct the attention to one field rather than another. Also, many of the "observations" are but implications of the particular terminology in terms of which the observations are made. In brief, much that we take as observations about "reality" may be but the spinning out of possibilities implicit in our particular choice of terms.
(Burke, 1966, p.46, cited in Wertsch, 1998, p.50)
When we unconsciously and uncritically act within our Discourses, we are complicit with their values and thus can, unwittingly, become party to very real damage done to others. (Gee, 1996, p.190)
The insights of Wertsch and Gee quoted above direct us as researchers,
educators, and citizens to take the linguistic construction of
ADHD and other childhood disorders seriously. They encourage us
to not worry so much about applying the right terms to the right
situations but rather to investigate and explore the moral implications
of the way we and other speakers and writers use language to fabricate
problems, solutions, dead-ends, hope, suffering, and social identities.
As language users, we act within the constraints of the possibilities
provided by our own array of terms. Gee and Wertsch remind us
of the moral and political problems inherent in both our actions
within these social worlds and our linguistic generation of these
cultural tools for naming experience. This implicates language
users and researchers within complex questions of goodness and
Wertsch and Gee have advised us that language itself traces the outlines of moral imagination, simultaneously reflecting often unquestioned cultural values while providing members of a culture with an evaluative landscape in which to construct social situations and thereby take action. The limitations and resources, the scarcity and the bounty, of a culture's terms may be the contours and content of that group's moral reasoning. In this limited exploration of the Everyday Discourse of lay persons, the language users draw heavily from dominant cultural Discourses that pose moral problems of child activity as individual phenomena subject to medical diagnosis and intervention. These dominant Discourses position the school as a vital arena in which the successes and failures of a child's current and future life are decided based on values of social conformity, submission to authority, and individualistic competition. Cultural power, in these dominant Discourses, is accorded to the public schools and medical- psychological professionals who are supported by a science of human neurology and behavior. Most language users in this study seemed to submit to these political arrangements of authority and even take hope and comfort in holding that schooling and medicine will lead the way to the good life.
We are struck by the way many speakers struggle to wrestle power back to themselves, their children, and their families, however, by subverting or reconceptualizing the significance of these individualistic and competitive themes in a practical language of social equality, communal living, and personal agency. Although dominant cultural Discourses tend to colonize many aspects of everyday talk, language use remains a fluid, creative arena of political tension and cultural contention. Language use and social meaning construction remains embroiled in what Lyotard (1984) has termed "agonistics"( p.10). The conflicted cultural terrain of communication where meanings are crafted, doubted, and opposed is constantly shifting amidst the multiple tensions, ambivalences, and innovations of postmodern living in the West. Culture and language both open but also narrow and constrict doors to experience (Wertsch, 1998). Words, operating in a specific social-contextual moment, portend certainty and solidity while, at the same time, they ironically direct our attention to the unsettling fluidity of cultural conflict and change.
At every step, individual and communal struggles concerning moral questions of "what to do" are accompanied by richly embattled, discursive considerations about "how to put it into words". Cultural tools both empower and constrain human activity. Hegemonic control of the concept of ADHD as linguistically constructed is not possible. The common "folks" choose to use these Discourse tools in multi-layered ways as seem appropriate to their purposes as Bakhtin's notion of heterglossia would suggest. These analyses of everyday speech acts generated around the concept of ADHD have attempted to elucidate some of the ways people have internalized, challenged, and resisted the dominant Discourses of ADHD. Their words have been shown to be multi-voiced and dialogic, with elements of many Discourses embedded in the illocutionary force of their communicative acts.
While it is apparent that speakers using Everyday Discourse appropriate, reaccentuate, and at times resist the dominant Discourses, we are left with a lingering concern about the moral responsibility of the creators and purveyors of the dominant Discourses. Prilleltensky (1997) encourages psychologists and helping professionals to problematize their own language, exploring moral and political consequences in their construction and utilization of authoritative cultural tools that inevitably have powerful repercussions throughout society. Those who control scientific Discourse bear significant moral responsibility for their powerful words and ideas that construct identities, the cultural shapings of human experience. The language used to organize and describe human experience maps the quality and meaning of lived lives. We are struck by the efforts of those resisting the Medical Discourse to carve out a space for a broader brand of moral conversation that views problems of child misbehavior as opportunities for parents, schools, and communities to openly discuss better ways of living together. We are left with the sense that medical and educational professionals must remain ever attentive to the possibility that a Discourse can limit the opportunities for parents, teachers, and community members to actively question and reconstruct communal life, to constructively imagine and discuss more hopeful and promising practices and structures of conviviality.
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