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2 Mar 2019

Ponnou S et al. Health 2019; Epub ahead of print

ADHD has been widely covered in the media, which has contributed to shaping the public’s perception of the disorder, and the growing use of the Internet since the 2000s has changed how individuals look for information about health and medical conditions. The aim of this study was to assess how ADHD was portrayed in TV programmes and the lay public press in France between 1995 and 2015. In addition, with the growing use of the Internet during this period, the study also aimed to determine which scientific material is available to the French lay public, depending upon the source of information used.

Information on ADHD was collected from the first 50 French websites dedicated to ADHD as referenced by Google when entering the keyword “hyperactivity”. The French lay public use this phrase more than the translated term for ADHD. The researchers who were involved in the coding process investigated the websites on 1 May 2017 to ensure there was no discrepancy in the data collected. The websites varied from a single webpage offering succinct information on ADHD, to whole websites composed of several links and tabs. Since hyperlinks could not be randomised in the analysis, data collection was limited to the websites shown by Google. Using the McMillan’s (2000) framework for content analysis of the World Wide Web, information on the websites could be analysed, and research questions* were narrowed down to a few key elements using the categories of content identified from previous media studies (Ponnou, Gonon 2017). Researchers gathered as much information as possible from each website without following hyperlinks; if a website did not disclose all pieces of information, this was noted as “not mentioned”. The reliability of the independent coding system between the researchers was tested using a Kappa statistic which provided a result of p = 0.007 (95% confidence interval) and, therefore, demonstrated excellent reliability between the two researchers who coded the information from the websites. The thematic analysis conducted was quantitative; however, the authors indicated that illustrative examples derived from the websites were sometimes used to support their arguments.

The 50 French webpages indexed by Google included: relays of general mass media (n = 13); medical information websites (n = 11; public or independent institutions, n = 4; private or collaborative information sources, n = 7); Internet versions of magazines focused on childhood, parenthood or education (n = 8); newspapers (n = 7); associations of parents and friends of people with ADHD and other psychiatric disorders (n = 6); commercial websites advertising psychotherapies or alternative therapeutics for ADHD (n = 6); online versions of academic articles (n = 4); radio channels (n = 3); book presentations about ADHD (n = 2); information websites (n = 2); and a TV channel (n = 1).

Representations of ADHD

Almost all websites, except four, which did not convey any specific representation of ADHD, agreed with the sole biomedical model of ADHD. One website favoured the psychodynamic concept and three included both the biomedical and psychodynamic concepts. These data suggest that the biomedical model of ADHD is widely represented on the Internet. This is in line with observations related to representations of ADHD in TV programmes but differs from results obtained from academic literature, lay public press, social work literature and student representatives, where the biomedical and psychosocial concepts of ADHD are more balanced.

Genetic factors for ADHD

A total of eight websites stated that genetic factors strongly contributed to the aetiology of ADHD and did not mention environmental risk factors. Genetic and environmental factors contributing to ADHD aetiology were mentioned in 11 websites; however, seven of them still favoured genetic causation, and two websites refuted the involvement of environmental risk factors and emphasised genetic risk factors for ADHD. Overall, 15 websites favoured the genetic aetiology of ADHD, whilst no websites stated that environmental factors could play a major role in ADHD.

Neurological or neurodevelopmental aetiology of ADHD

Neurological or neurodevelopmental dysfunctions related to ADHD were mentioned in 31 websites, five of which were traditional mass media web relays. Most websites (n = 29) portrayed ADHD as a neurological or neurodevelopmental disorder based on scientific arguments which have been called into question in academic literature, and two websites challenged the aetiology of ADHD with scientific arguments.

Environmental and social risk factors for ADHD

The risk of ADHD and its links to prematurity were reported by six websites, and questions regarding the link between ADHD and education and schooling appeared on nine websites. In addition, 17 websites referred to risk factors that have been identified in international literature, including: television, video games, low economic status of the family, low educational level of the parents, single mother, young maternal age at birth and exposure to toxic products. Three websites contradicted the effects of these social and educational risk factors for ADHD, and disagreed with scientific observations that poor parent–child interactions, and mental illness in one of the parents of a child with ADHD, are linked to the development of ADHD. Marginal environmental determinants, such as iron, magnesium or vitamin B9 deficiency during pregnancy, smoking or alcoholism of the mother during pregnancy, meningitis and diet, were mentioned in websites.

Therapeutic options advocated for ADHD

Overall, 30 websites included a combined approach to treating ADHD using psychotherapy and medication. No websites recommended the use of psychotherapy alone, and four websites exclusively mentioned drug treatment. Two of these websites (which relayed traditional media) questioned the effectiveness of methylphenidate; the recommended psychotherapies only discussed cognitive and behavioural therapy. Alternative therapies such as thermal cure, aromatherapy, healthy diet and dietary supplements, were discussed on five websites; however, 11 websites did not suggest any therapeutics for ADHD or any kind of educational support for individuals with ADHD. There were no major differences between websites relaying traditional media and others with regard to therapeutic options for ADHD.

Long-term risk associated with ADHD and the effect of methylphenidate

Long-term academic underachievement and its association with ADHD was included in 27 websites; 11 websites mentioned the risk of antisocial behaviour and 10 included the risk of drug abuse from adolescence to early adulthood with ADHD. Of the 27 websites that emphasised the risk of academic failure with ADHD, only three claimed that psychostimulant medication could protect children with ADHD, and only one website used evidence to argue that medication failed to protect individuals with ADHD from this long-term risk.

Gifted child and the risk of ADHD

Creativity and its association with children and adults with ADHD was highlighted on seven websites. These websites claimed that ADHD and its associated academic failure more frequently occurs in gifted children as their schooling does not match their specific needs; however, the authors stated that they are not aware of any scientific study which supports this claim.

The present study had some limitations. Firstly, the data collected focused on the representations of a single pathology, namely ADHD. Secondly, results were limited to one country, which could mean the data are nationally specific. The authors indicated that this study could be replicated for other psychiatric disorders, and for other health issues in France and in other European countries.

The authors concluded that this study highlights that representations of ADHD and their comparison with TV programmes and lay public press show discrepancies between mass media information and scientific consensus. In general, mass media information about ADHD favours the biomedical approach, which has been widely counteracted in academic literature and has not yet been fully proven. The biomedical model of ADHD also does not include educative and social preventative policies and practices, which deal directly with risk factors for ADHD. The authors indicated that it seems necessary for mass media to also relay psychosocial approaches which are linked to ADHD, and that since the conceptions of ADHD available on the Internet are primarily biomedical, they comprise an important level of scientific distortion about ADHD.

Read more about ADHD and its possible distortion in the French media here


*Eight main questions were used to categorise the content of the 50 French websites dedicated to ADHD: (1) Do the websites mainly support the biomedical model of ADHD, the psychodynamic understanding, or both points of view? (2) Do the websites argue in favour or against the hypothesis of biological factors involved in ADHD aetiology (genetic, neurologic and neurodevelopmental), or are both points of view (pros and cons) represented? (3) Are environmental and social factors associated with ADHD mentioned and discussed? These included premature birth, inappropriate education and other causes discussed in the scientific literature (e.g., anaesthesia, poverty, adoption and excessive exposure to alcohol, food additives, pesticides or television). (4) Are the long-term risks associated with ADHD mentioned: academic underachievement, antisocial behaviour and drug abuse? (5) The fifth category was related to ADHD treatment: when a website tackles this question, does it favour medication, psychotherapy or a combined treatment? (6) Is medication effective to decrease the risk of academic underachievement: yes/no/both opinions? (7) Is brain imaging relevant to diagnose ADHD: yes/no/both opinions? (8) Are potentially outstanding capabilities of children suffering from ADHD mentioned (e.g., occurrences of “gifted child” or “enthusiastic child”)?
Some of these websites included different sources, for example, three parents’ association websites, three medical information websites, two traditional mass media sites (newspaper and television) and two magazine sites

Ponnou S, Gonon F. How French media have portrayed ADHD to the lay public and to social workers. Int J Qual Stud Health Well-being 2017; 12: 1298244.

Ponnou S, Haliday H, Gonon F. Where to find accurate information on attention-deficit hyperactivity disorder? A study of scientific distortions among French websites, newspapers, and television programs. Health 2019; Epub ahead of print.

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