Psychiatric diagnoses of ADHD have increased globally since the 1980s, reaching an explosive rate during the first decades of the twenty-first century (in Sjöberg 2019, 3; Simoni 2018) in Israel and elsewhere. ADHD is often presented by sociologists as the quintessential example of medicalization (Conrad & Potter 2000), the process “by which nonmedical problems become defined and treated as medical problems, usually in terms of illness and disorders” (Conrad 2007, 4). While seminal sociological studies (Conrad & Potter 2000;  Lakoff 2000) have elucidated the social origins of the current “epidemic” of ADHD, little attention has been paid to local mechanisms of ADHD medicalization and the ways in which laypeople negotiate the meaning of ADHD. In addition, research emphasizes that it is important to deepen the understanding of how the phenomenon is shaped “by the specific institutional, social, and cultural factors” (Frazzetto et al., cited in Frigerio and Montali, 2013). Following Conrad and Potters' (2000) call to investigate the local mechanisms of medicalization, this research explores teachers' positioning in the social field of medicalization. Analyzing in-depth interviews with teachers from two Israel schools, I show how they view their role while encountering ADHD children in school and how contemporary cultural tendencies in Israel shape this role.

 School is the most common institutional context for the discovery of children’s difficulties (Rafalovich 2005), and the categorization of their academic and social functioning via available systems of knowledge (Singh 2006). Studies point to the increasingly clinical role of schools in medicalizing childhood, while teachers are perceived as a “primary source of diagnostic information” (Garro & Yarris 2009, 563). It is argued that teachers identify, assess, and administer medication to “problematic” children, acting as intermediaries between clinician and parent (Malacrida 2004 Rafalovich 2005; Hjörne 2005). At the same time, teachers’ expectations of the students are influenced by diagnoses (Batzle et al. 2010).

The perceptions and positioning of teachers in the social field of ADHD is an important subject of research, primarily because of the controversial nature of ADHD as a diagnostic and clinical category. ADHD is one of the most controversial psychiatric categories. As “academic critiques spill over into popular discourse” (Malacrida 2004, 64), there is contentious debate among the lay public on the legitimacy of using medication to treat ADHD (McLeod et al. 2007), while different groups of social actors, among them teachers, frame problems linked to ADHD using different explanations and mixed discourses (Frigerio and Montali 2013). Thus ADHD children are at the center of a social controversy about the “real” causes of their behavior and the “best” way to treat them (Frigerio and Montali, 2013, 586).

 I will illustrate that teachers use various, sometimes contradictory, discourses to explain ADHD diagnosis, and develop what might be called a unique pedagogical expertise. Such “lay expertise” (Eyal 2019) is based on their practical experience rather than on formal training. Teachers felt that they must find pedagogical strategies to cope with the ADHD student and see themselves as morally committed to include such student within the learning process, whether this student is officially diagnosed or not, whether they’re “with a pill [medication] or without it.” However, they enact their expertise under conditions of public mistrust: parents’ “accusation” that teachers are the main supporters of troubled students’ medication challenges teachers’ ability to be perceived as reliable pedagogical experts with the ADHD children. Despite parental mistrust, teachers are motivated to include/contain "problematic" children. I explain such motivation by local cultural and institutional conditions.

The research is based on 27 semi-structured interviews with teachers working in two Israeli schools (elementary and middle). Previous research has indicated that, during the elementary and early middle school period, there is an increase in the number of children diagnosed with ADHD (Froehlich et al., 2007), i.e., in those ages in particular the “problematic” children are often framed through the diagnosis, while teachers take part in the process of indicating and coping with them. All the participating teachers taught in classes with at least one student identified as having ADHD. The first school was a middle school located in a small town in southern Israel. Among the 14 teachers teaching in this school and participated in the study, 10 mentioned that they have a child or close relative diagnosed with ADHD. The second school is an elementary school located in a big city in southern Israel. Thirteen teachers working in this school participated in the research; among them, four reported that they are closely familiar with the disorder as parents of ADHD children. The seniority of teachers in both schools was between 3 and 28 years. The interviews were conducted by two trained research assistants lasting approximately one hour face-to-face or via Zoom software. They began with broad questions about the teachers’ background and experience, and moved to more specific questions about the ADHD category, such as: “How do you understand ADHD?” “How is it manifested in the classroom?” “How do you explain the disorder and its rapid rise?” “What challenges do you face while working with such children?” The interviews were conducted in a nonjudgmental, collaborative interview style, in which teachers were invited to narrate their teaching experience, while inserting their own meanings into the interview prompts. Interviews were recorded and transcribed, and were coded using the atlas.ti program. To analyze the interviews, we have used Grounded Theory. Grounded Theory’s emphasis on meaning without assuming the existence of a unidimensional external reality (Charmaz 2014) particularly fits this project, as it aims to grasp the meaning-making processes. Open coding of the transcribed protocols of the interviews was done to identify and define the key categories emerging from the data.

I argue that teachers’ experience-based expertise with ADHD children is not a function of their own narrow interests in achieving class management; rather, it is informed by the moral imperative of inclusion that characterizes the current Israel’s educational policy. The Hebrew concept "hakhala" may explain teachers’ motivations and positioning as lay experts with ADHD children. This concept has two meanings in Hebrew, inclusion and containment, and both meanings are used by teachers interchangeably. First, the word is used to frame teachers’ general inclusive orientation and motivation when they encounter ADHD children. Teachers talked about "hachala" of ADHD children as a kind of imperative to make an effort not to leave the “troubled” child behind and help them succeed. This usage of the concept resonates with the perception of inclusion as “an ethical obligation, grounded in notions of equity and social justice for all groups and at all stages of education” (Koutsouris et al. 2022, 880). Second, teachers use the concept "hachala" in terms of a containment. Thus, they talk primarily about personal semi-therapeutic qualities, which they use in order to cope with “troubled” children. The interchangeable usage of both meanings by the teachers not only resonates with the argument that inclusion is a “vague and ambiguous concept that is sometimes unproblematized or oversimplified” (Koutsouris et al 2022, 880). It also reflects the institutional context of ADHD in Israeli school and the cultural tendencies that shape education arena in contemporary Israel, such as growing dominance of the social model of disability. This case study sheds a light on the local mechanisms of medicalization of childhood in Israeli schools, and on the bottom-up understanding of the term “inclusion” by the specific actors - teachers - in the social field of ADHD.

Charmaz, K. 2014. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis (2nd ed.). London: Sage Publications. Conrad, P. 2007. The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore: The Johns Hopkins University Press. Conrad, P. & Potter, D.. 2000. “From Hyperactive Children to ADHD Adults: Observations on the Expansion on Medical Categories.” Social Problems 47: 559–582. Garro, L. C. & Yarris, K. E. (2009) ‘‘A Massive Long Way’’: Interconnecting Histories, a “Special Child,” ADHD, and Everyday Family Life. Cult Med Psychiatry 33: 559. DOI: 10.1&/s11013-009-9155-1 Hjörne, E. 2005. “Negotiating the ‘Problem-Child’ in School: Child Identity, Parenting and Institutional Agendas.” Qualitative Social Work 4 (4): 489–507. Eyal, Gil 2019. Crisis of Expertise. Cambridge: Polity Press Frigerio, A, Montali,L., Fine, M. 2013. Attention deficit/hyperactivity disorder blame game: A study on the positioning of professionals, teachers and parents. Health 17(6): 584-604 Froehlich, T. E., Lanphear, B. P., Epstein, J. N., Barbaresi, W. J., Katusic, S. K., & Kahn, R. S. 2007. Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Archives of Pediatrics & Adolescent Medicine, 161(9): 857-864. Koutsouris, G., Stentiford, L., Norwich, B. 2022. A critical exploration of inclusion policies of elite UK universities. British Educational Research Journal, 48: 878-895 Lakoff, A. 2000. “Adaptive Will: The Evolution of Attention Deficit Disorder.” Journal of the History of the Behavioral Sciences 36 (2): 149–169. Malacrida, C. 2004. “Medicalization, Ambivalence and Social Control: Mothers’ Descriptions of Educators and ADD/ADHD.” DOI: 10.1177/1363459304038795. McLeod, J. D., D. L. Fettes, P. S. Jensen, B. A. Pescosolido & J. K. Martin. 2007. “Public Knowledge, Beliefs, and Treatment Preferences Concerning Attention-deficit Hyperactivity Disorder.” Psychiatric Services 58 (5): 626–631. Rafalovich, A. 2005. “Relational Troubles and Semiofficial Suspicion: Educators and the Medicalization of ‘Unruly’ Children.” Symbolic Interaction 28 (1): 25–46. Singh, I. 2006. “A Framework for Understanding Trends in ADHD Diagnoses and Stimulant Drug Treatment: Schools and Schooling as a Case Study.” BioSocieties 1 (4): 439–452. Sjöberg, M. N. 2019. “Reconstructing Truth, Deconstructing ADHD: Badiou, Onto-Epistemological Violence and the Diagnosis of ADHD.” Critical Studies in Education, DOI: 10.1080/17508487.2019.1620818 Simoni, Z. R. 2018. “Medicalization, Normalization, and Performance Edge: Teachers’ Attitudes about ADHD Medication Use and the Influence of Race and Social Class.” Sociological Perspectives. 61 (4): 642–660.