Stigma & Ableism

How does stigma reinforce friendship difficulties for students with ADHD?

Stigma is a term used to describe the discriminatory and often hateful attitudes towards individuals who are diagnosed with or are thought to have a certain mental health condition or dis/ability (Mayo Clinic 2017). Social stigma may lead to decreased protections, rights, and opportunities for individuals with dis/abilities; misconceptions around how a dis/ability might actually affect a person or group of people; and derision and exclusion from the neurotypical and/or ablebodied public. Nathan Stewart explains that

stigmatizing discourse often reinforces perceptions that ADHDers suffer from a character flaw as a consequence of poor upbringing, social circumstances, or other sources of learned behavior....One study found that media representations of ADHD have a tendency to use danger terminology to associate physical violence and emotional abuse with ADHD. (Stewart 2017, pg. 16)

In other words, children with ADHD, due to the stigma of their dis/ability label, might be viewed as troublemakers, bullies/the bullied, overly sensitive, intellectually slow, fidgety, or lazy, depending on how symptoms manifest. Their home environments or cultural upbringings might be blamed for the dis/ability, raising questions about the intersections of racism, classism, and ableism. When stigma becomes apparent to the child themselves, their efforts to fight this stigma may be emotionally exhausting and cause them to neglect schoolwork. Alternatively, they may begin to fulfill these negative stereotypes (i.e., a feedback loop). Brian Ahmedani, in their study of mental health stigma, delineates the dimensions of stigma, one of which is peril, or when

the general public perceives those with mental disorders as frightening, unpredictable, and strange. Corrigan (2004) also suggests that fear and discomfort arise as a result of the social cues attributed to individuals. Social cues can be evidenced by psychiatric symptoms, awkward physical appearance or social-skills, and through labels. (Ahmedani 2011)

Neurodivergent children, whose symptoms affect their ability to regulate their behavior and function socially and whose school environments often do not respond appropriately to learning, behavioral, and social variations, are especially at risk for bullying, ableist misunderstandings, and the trauma(s) associated with both (Mayo Clinic 2017). As a result, students with ADHD may withdraw from or have a difficult time navigating friendship situations.

Perceptions of students with IEPs/504s

Many children diagnosed with ADHD also have an Individualized Education Plan (IEP) or 504 Plan, first developed under the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973, respectively. An IEP, a legal document, provides special education and related services to children with one of the 13 disabilities listed by the IDEA that affects their performance in a general education setting, oftentimes including access to an Integrated Co-Taught (ICT) classroom and paraprofessionals (Understood.org, Kaelin 2021). If a student has a 504, the school must "remove barriers" in order to help dis/abled (this term is "more loosely defined" than with an IEP) students learn alongside their general education peers, such as granting the student preferential seating and extended time on exams and assignments (Understood.org, Kaelin 2021). ADHD is listed under the heading Other Health Impairment (OHI) in the IDEA; a student with ADHD who has co-morbid diagnoses (e.g., autism, dyslexia, generalized anxiety) may be listed as having Multiple Disabilities. IEPs and 504s are typically used to implement academic supports for students, though social-emotional supports can also be put in place if needed (St. Croix River Education District).

Although IEPs and 504s are specifically designed to help students with ADHD and other dis/abilities flourish in their school environments, the ways in which these processes and interventions are carried out can be isolating and stigmatizing (DeWitt 2011). The IDEA specifies the right of the child to a Least Restrictive Environment (LRE), or "the requirement in federal law that students with disabilities receive their education, to the maximum extent appropriate, with non-disabled peers and that special education students are not removed from regular classes unless, even with supplemental aids and services, education in regular classes cannot be achieved satisfactorily" (20 United States Code (U.S.C.) Sec. 1412(a)(5)(A); 34 Code of Federal Regulations (C.F.R.) Sec. 300.114.). Even with this requirement in place, students may still feel emotionally, socially, and academically sequestered when they instead need connection, acceptance, and understanding; they still may feel the mark of stigma in the absence of adequate social-emotional integration. It can be argued that a student's placement in a "resource room," near a paraprofessional, or with a small group of other neurodivergent and/or dis/abled children in a classroom is not inherently shameful, especially if it's what the student truly needs at that point in time. However, the current inevitability of ableism in our communities and society at large can subject children to bullying, condescension, and isolation (both self-imposed and from a social group) (DeWitt 2011).

The influence of societal and communal factors on these perceptions is undeniable. Discourse among families in a community about their dis/abled children may produce stigma, collectivized pity, and misunderstandings towards children, even when the intent is to nurture and protect them (Syed 2017, DeWitt 2011). Similar to the phenomenon described by autistic people regarding "autism moms" and "autism warrior parents," parents of children with ADHD and other neurodevelopmental differences, although they know their children very well, might not be adequately informed about how ADHD is affecting their child, and might be nervous or uncomfortable talking to their child about what's affecting them socially and emotionally. These adults -- most of them neurotypical -- may spend a lot of time searching for a "cure" for ADHD instead of searching for ways to address the actual needs and strengths of the neurodivergent child (Rauch-Elnekave/Caregiver.com). They may center themselves as tireless "champions" for their dis/abled children as opposed to supporters of the student's personal journey of self-actualization.

Parents and educators may not be aware of how having IEP and 504 may impact a student's self-image, morale, and ability to see themselves as part of a peer group, especially when their behaviors are stigmatized (DeWitt 2011, Rauch-Elnekave/Caregiver.com). To complicate this, adults in the child's life may harbor certain negative biases and anxieties around diagnosis and medication, as the "clinical diagnostic process of identifying symptoms involves the reliance on identifying a behavior or pattern of behaviors that are implied to be negative relative to social expectations" (Stewart 2017, pg. 20). When children are not involved in their own IEP and 504 planning processes, cultural anxieties cause children with ADHD to be treated as though they are voiceless and cannot advocate for their own needs (Waisman Center, Pacer Center). It is incredibly important for families and educators to help children develop self-advocacy, self-awareness, and self-determination: skills which will contribute to the student's social-emotional wellbeing and ability to begin/maintain deep and satisfying friendships.

Addressing ableism

ADHD's status as an invisible dis/ability leads to children with ADHD's illegibility. In other words, due to ADHD's multidimensional symptoms, children both diagnosed and undiagnosed may become objects of curiosity and confusion. Misconceptions about the origin of ADHD behaviors, and to what extent these behaviors are pathological vs. socially constructed, lead teachers and peers to be frustrated and on-edge (Ahmedani 2011). Neurotypical children may be confused about or annoyed at their classmates' behavior, turning to teachers, parents, and peers as models for how to treat their neurodivergent classmates (Mikami & Normand 2015). Immersed in an ableist society, neurotypical children may hear terms such as "weird" or "crazy" and begin to internalize these stereotypes, leading them to exclude children with ADHD from social situations.

Children with ADHD also internalize ableist slurs and attitudes and consequently develop low self-esteem and social anxiety. These students may struggle to conform to what is expected of them both socially and academically. Students who do conform to what is expected of them (at least outwardly) more than other neurodivergent students may be invalidated and told that they do not actually struggle (especially if they are "high-achieving" or have been socialized as female) (Kok et. al. 2016). In order to fit in socially at school, ADHDers may consciously or unconsciously develop techniques to mask their symptoms, which can be both physically and emotionally exhausting, since they do not feel safe being themselves. Finally, we cannot address the complicated nature of ableism without also discussing its intersections with sexism and racism, and I explore such stacked stigmas in Social-Emotional Challenges for Black and Latine Students with ADHD and Struggles & Stigmas for Girls* with ADHD.

In the Interventions section of this site, I suggest ways to offset social stigmas and foster a more accepting and friendly school environment for neurodivergent children through principles related to anti-ableism and Universal Design for Learning.