ADHD in Context

A Qualitative Exploration of Diagnostic Frameworks, Lived Experiences, and Cultural Influences in India

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a common neuro-developmental disorder, affecting around 7.1 % children in India, but its diagnosis and recognition is largely influenced by cultural, structural and gendered contexts that are not fully captured by the standardised and westernised diagnostic tools like DSM-5. The study investigated the applicability of the criteria for ADHD diagnosis as presented in DSM-5 in the Indian sociocultural context with the viewpoints of clinical psychologists as well as those of adolescents diagnosed with ADHD. A qualitative research design was used and included conducting semi-structured online interviews with five psychologists (aged 25–29 years, and with one to four and a half years of clinical experience) and four adolescents (aged 16–19 years) from India. Interviews were audio recorded and analysed using an inductive and semantic thematic analysis method. The psychologist interviews yielded thirteen themes and the adolescent interviews yielded twelve themes. Four main convergence points were present in both groups: that emotional dysregulation is a clinically significant but unrecognized feature of ADHD; that masking and delayed diagnosis, especially among girls, is common; that there is pervasive stigma and mislabelling of ADHD symptoms as behavioural or moral problems; and the school system is both a venue of diagnosis and a primary locus of impairment. The DSM-5 also was found to be very westernized and psychologists suggested the need for an Indian specific clinical interview protocol, while the adolescents focused on the emotional, social and identity aspects of life with ADHD. The results overall reflect the need for a culturally responsive, gender-sensitive, strengths-based approach to assessment and intervention for ADHD in India.