The social construction of hyperactivity is the creation of a medical definition of deviant behavior. This chapter presents an analysis of how children are diagnosed as hyperactive at the Hyperactivity-Learning Disabilities (HA-LD) clinic of Northeastern Pediatric Hospital Medical Center (NPH). It analyzes how a diagnosis of hyperactivity is made through the construction of medical meanings and the minimization of uncertainty, and presents brief discussion of the role of uncertainty in medicine in general. Although uncertainty is always a concern in medicine there are certain conditions that make it a particularly central issue in the evaluation for hyperactivity at the HA-LD clinic. These conditions include: the concept of hyperactivity; the state of the diagnostic art; the ambiguity of the evidence; the situation of the physicians; the role of medications; and myth and lore about hyperactivity. The chapter presents an analysis of the strategies used to minimize uncertainty, and discusses the ramifications of the research.

This chapter discusses how deviance is initially identified, how it becomes defined as a medical problem, and how children are finally referred for hyperactivity to the Hyperactivity-Learning Disabilities (HA-LD) clinic. The first stage in the process of the identification of hyperactive children is that of identifying behavior as deviance, that is, when behavior or performance is initially observed, noticed, or recognized by some significant audience as deviant. In the case of identifying hyperactive children there are two major significant audiences: family and school. When the parents are initial identifiers of behavior as deviance, the identification is made in terms of the child's role performance; usually the child is not meeting the parents' performance expectations. The chapter divides the sample, for analytical and heuristic reasons, into two subsamples: family definition of deviance as a medical problem and school definition of deviance as a medical problem.

This chapter presents a theoretical review and analysis of the development of hyperkinesis as a medical diagnosis. It describes the diagnosis, reviews the pertinent literature relevant to its development, and also presents a sociological analysis of its discovery. In developing an analysis of the discovery of hyperkinesis it is useful to divide the relevant factors into those that might be considered clinical factors and social factors. The social factors affecting the discovery of hyperkinesis can be divided into three areas: the pharmaceutical revolution, trends in the medical profession; and government action. The chapter discusses the three issues: how children's deviant behavior became conceptualized as a medical problem, why this occurred when it did, and what are some of the implications of the medicalization of deviant behavior. The discovery of hyperkinesis highlights important sociological question: Does the invention or discovery of new forms of medical social control lead to new medical labels.

This chapter discusses outcomes of evaluations at the Hyperactivity-Learning Disabilities clinic, describes some implications for medical practice, and suggests some areas for further research. It focuses on the medicalization of deviant behavior and the sociology of hyperactivity. Although there may be some humanitarian benefits from the medicalization of deviant behavior, there are also important sociological ramifications. These include: the problem of expert control, medical social control, the individualization of social problems, and the depolitization of deviant behavior. A social system approach to hyperactivity is proposed as a contrast to the medical-clinical approach. Behavior is seen as meaningful in the context of the situation in which it occurs, especially in the light of discrepant reports of deviance from various social systems in which the child operates. Both the medicalization of deviant behavior and sociology of hyperactivity are fertile areas for future sociological research.

The location of the participant observation and the source of the sample was the Hyperactivity-Learning Disabilities (HA-LD) clinic of Northeastern Pediatric Hospital Medical Center (NPH). The HA-LD clinic is part of the "medical diagnostic unit" of the outpatient department of NPH. The HA-LD clinic functions primarily out of the doctors' lounge and the small examining rooms along the right-hand side of the corridor. The sample was selected from children evaluated at the HA-LD clinic from February through May 1975. In describing the sample the author differentiate between recognizing a problem in the child and referring the child to the HA-LD clinic. The children referred to the HA-LD clinic have a variety of "outcomes." Hyperactive—either specifically labeled hyperactive, minimal brain dysfunction, minimal cerebral dysfunction, or primary attentional disorder, or given treatment with stimulant medications.

This chapter outlines a social system approach to hyperactivity as a contrasting model to the medical-clinical approach, which is the predominant model for explaining the causes of hyperactivity. In presenting this approach, a concept of "situational hyperactivity" will be developed with examples from the research. The prevailing explanations of etiology for hyperactivity are generally in the medical-clinical framework. They postulate some type of organic base or dysfunction. From a social system perspective, the designation "hyperactive child" does not describe individual pathology but rather refers to a label that is applied to that child. The sociological model of etiology is in contrast to the medical-clinical, behavioral, or psychological models. The behavior may be an adaptation to the situation, a conflict within the situation, or a comment on the social system. The medical-clinical model assumes organic dysfunction; the behavioral model assumes that the behavior is either "bad habits," inadequate socialization, or an adaptation to the environment.

In this chapter, the authors describe the concept of "anticipatory medicalization" and a particular example as another mode of increasing medicalization. They use the example of the rise of "preconception care" in medicine, or the idea of caring for non-pregnant women with the purpose of alleviating any risks to pregnancies. Anticipatory medicalization revolves around the expectation of a medical diagnosis or medical outcome; it depends not on a present condition, but rather on putative potential problems. Health risks may or may not be visible or detectable, but in the framework of anticipatory medicalization, the clinical concern is about risks. Anticipatory medicalization is related to conceptions in medical sociology. Scholars have paid attention to ways in which medicalization has expanded through increased focus on prediction, predisposition, and proto-disease. Anticipatory medicalization refers to measurable forms of risk as well as any demonstrable effects on subjective feelings of risk.

This chapter examines an analogous process for medicalization, and focuses on the emergence of the diagnosis of Attention Deficit-Hyperactivity Disorder (ADHD) in adults in the 1990s. It also focuses on key claims and counter-claims made by mental health and medical professionals, as well as lay leaders, support groups, and conferences. The revised diagnostic criteria did not refer to the disorder in adulthood, but opened the door slightly for an expanded definition beyond "adult hyperactives" to "ADHD adults" who had no childhood diagnosis. Clearly a diagnosis of adult ADHD carries with it a certain currency in the public sphere. Adult ADHD offers a clear example of how a medicalized category can expand to include a wider range of troubles within its definition. Genetics is the rising paradigm in medicine and an increasing number of human problems are being attributed to genetic associations, markers, or causes.

This chapter presents a first statement towards a theory of the medicalization of deviant behavior. The theory is presented in the form of seven conditions contributing to the medicalization of deviant behavior. The conditions of medicalization are presented as five antecedent conditions and two contingent conditions. The first three antecedent conditions are: behavior is defined as deviant and as a problem in need of remedy by some segment of society; previous or traditional forms of social control are not efficient or acceptable; and medical forms of social control are available. The next two antecedent conditions are: some ambiguous organic data must be present as to the source of the problem; and the medical profession is willing to accept the deviant behavior as within its jurisdiction. The two contingent conditions are: how much it benefits established institutions; and how well the proposed scientific explanation is accepted by significant segments of society.

An increasing amount of deviant behavior is being conceptualized as illness in a medical framework. The general conceptual framework is the labeling or societal reaction approach to deviance. There has been recent notice of the increasing medicalization of deviant behavior and the medical institution's expanding role as an agent of social control. This chapter focuses on the empirical analysis of the process of medicalization. It examines how deviant behavior gets defined and treated as a medical problem; specifically, how children who exhibit certain types of deviant behavior become labeled as hyperactive. Since Talcott Parsons' seminal essay conceptualizing illness as deviance in the development of his sick role theory, there have been a number of fruitful considerations of the relation of illness to social deviance. The chapter also presents an overview on the key concepts discussed in this book.

This article is a replacement of the previous edition article by M. Lock, volume 14, pp. 9534–9539, © 2001, Elsevier Ltd.

Illness is a ubiquitous experience in all societies. Until the past two decades, illness remained largely a private experience. With the development of the Internet, especially what has been termed Web 2.0, with interactive websites, illness has become increasingly a public experience. Vehicles like bulletin boards, chat rooms, listservs, electronic support groups, and more recently social media facilitate thousands of online communities where individuals with illness share information, interaction, experience, and advocacy. With the advent of social media, communication has increased and brought new challenges for online interaction. It is likely that the transformation of illness from a largely private to an increasingly public experience is a revolutionary change that is here to stay, with numerous social consequences.