Pupils’ inclusion as a process of narrative interactions: tackling ADHD typification through MADIT methodology | BMC Psychology

First investigation area – ADHD as clinical condition

Table 3 delineates key DRs pertinent to the first investigation domain, alongside the corresponding archipelagos of meaning and their respective dW within the configuration (for the detailed results regarding all the 24 DRs, see Supplementary Materials 4a).

As the table shows, the most used DR is “Certify Reality”^{Footnote 5}. This DR is characterised for creating a reality of sense that poses itself as a “matter of fact”. The data regarding the archipelagos of meaning, then, show how this way of configuring reality mainly conveys contents related to the technical features of the diagnosis (prognosis, aetiology, comorbidity, incidence and prevalence), with discursive production such as:

“behaviour disorders necessarily have an organic aetiology”.

The example shows how, using this discursive modality, ADHD aetiology is rooted into the organism of the person, without making explicit the criteria adopted to claim so. This way the description of the characteristics of the diagnosis is poorly intelligible, resulting in confusion for the receivers of the information as shown also by [40]. To deal with this, teachers could use these clinical elements appealing to personal interpretations, or even ignore them. This can reduce the capacity of these materials to aid teachers in adjusting their activities and approaches to accommodate the clinical characteristics of ADHD. Moreover, the configuration of the organism as the only possible “intervening dimension”, allows us to anticipate how these texts could be used to justify possible academic failures, ascribing them to a biological dimension where the teachers have no margin of intervention. In this regard, Te Meerman et al. [47] and Freedman [37] point out how the controversial but widespread characterization of ADHD as a genetic neurodevelopmental disorder may render educators and other teaching professionals inadequate, potentially compelling them to seek solutions beyond their own skills and resources. This reluctance may also precipitate in a more severe consequence wherein educators demonstrate an aversion to assuming responsibility for students with special needs [48].

The second DR in order of frequency of occurrence is the one of “Specification”^{Footnote 6}. This DR belongs to the Hybrid typology; thus, it cannot occur on its own, but needs to be associated with another. In this sense, its impact on the configuration will depend on the repertoire to which it will link.

Looking at the archipelagos of meaning, it is possible to see how this DR is used especially with reference to “relational issues”, “neurobiological elements” and “behavioural issues”. An example of the use of this DR can be observed in these two text excerpts:

In this case, the second text excerpt is used to specify the reality of sense generated by the first one, providing more details about the circumstances where the attentional deficit emerges. Therefore, the text supports the established reality of sense derived from the initial one.

The third DR is the one of the “Confirmation”^{Footnote 7}. Also, this DR belongs to the Hybrid typology. Referring to the example below, one can observe the varying “support” provided by this DR, in contrast to that of the “Specification” DR. In fact, while the latter works by adding details to the configuration, the former plays a role of “reinforcement” providing textual elements that contribute to the maintenance of the reality of the sense generated as a sort of “proofs”.

Finally, the observed value of dW (0.3 dW) underscores the prevalent application of stabilisation DR, leading us to conclude that the narrative construction of ADHD as a clinical condition creates a “closed” interactive scenario. From a more operative perspective, this suggests that teachers are likely to use clinical information on ADHD to sustain (or justify) the current situation, rather than to create new approaches for addressing and managing the unique challenges faced by these students (see also Te Meerman [47]).

Furthermore, given the critical role teachers play in the diagnostic process, the implicit value of the provided information can lead to subjective understandings of ADHD characteristics. Additionally, Freedman [37], analysing the diagnostic criteria for ADHD, identified the same subjectivity, thereby underscoring the importance of this issue. Relying on personal criteria, in fact, introduces substantial risks to the reliability and validity of the diagnosis, potentially leading to an increase in the incidence of false positive or false negative assessments.

Second investigation area – ADHD in the scholastic setting

Table 4 contains the most frequent DRs and archipelagos of meaning used to generate the discursive configuration in relation to the second investigation area, as well as the dW of it (for the detailed results regarding all the 24 DRs, see Supplementary Materials 4b).

Also in this case the most used DR is “Certify Reality”. However, precisely because of the different investigation area, it’s possible to observe how it was used to configure reality of sense regarding different themes, as the analysis of the archipelagos of meaning shows.

“Teachers and parents report that children with ADHD seem not to listen or have their heads elsewhere when you talk to them directly”.

Comparing this example with the one from the first area of investigation reveals that, despite differences in content, the narrative process promoted remains consistent: language usage is marked by reliance on personal references and theories, and it constructs a reality of sense characterised by absoluteness and immutability. This way a factual scenario is generated, where the ADHD student can occupy only the position of the problematic pupil. This stigmatising effect of ADHD information is particularly stressed also by Erlandsson et al. [38], highlighting how the analysed NIMH’s documents omit any mention of observable strengths and positive characteristics in the child.

The second most widely used DR in terms of frequency is “Cause of Action”. This DR belongs to the Stabilization typology too, nevertheless it is characterised by a different “logic”. In fact, it refers to an use of language that creates causalist links, such that given a certain element, another necessarily follows.

“[…] often changes games or activities because in a short time he gets bored with what he is doing he is therefore looking for new things, for more and more exciting stimulation:” (CA).

As the previous example shows, the “Cause of Action ‘’ DR accounts for a language use which poses boredom and the pursuit of excitement as the causes for the change in the game being played. Given this we can anticipate, on the teacher’s side, an “overwriting” of the actual reasons behind the change of activity of the pupil. The factuality and the absoluteness through which this causalist relation is posed may limit the teacher’s exploration of alternative solutions for addressing distractions, that is, to consider different narratives surrounding these challenges. Also this “overwriting” issue is corroborated by Erlandsson et al. [38], who note in their analysis that even when alternative explanations for a child’s behaviour are considered, they still pertain to the child’s internal state and thus are linked back to signs of a psychiatric disorder.

Overall, the 0.3 dW index represents these stabilisation trends. In fact, the argumentative modalities outlined above factually denote the criticalities encountered by the “student with ADHD” at school. Both concerning the challenges in task execution, behaviour and relational dimension, the dW index accounts for the promotion of narratives designed to stifle “potential movements” of the discursive process towards alternative scenarios.

Third investigation area – scholastic management strategies for ADHD

Table 5 contains the most frequently used DR in the configuration of the third investigation area, as well as the archipelagos of meaning most often linked to these discursive modalities and the dW of the configuration (for the detailed results regarding all the 24 DRs, see Supplementary Materials 4c).

Also for the third investigation area, the most used DR is the one of “Certify Reality”, although with a lower percentage of occurrence if compared with the other two investigation areas. In this case, the contents most often associated with this DR are: the effectiveness of interventions, the teacher training and the psychoeducational interventions. Using the DR of “Certify Reality” to convey these contents, in turn, implies that the variety of potentially generable scenarios – with respect to intervention modalities – is exhausted by the ones offered in the texts. In this sense, despite the amount of strategies provided, we can observe how they are conveyed in a “compartmentalised way”, like in the example that follows:

“The only way to reduce the behaviour of making noise is to ignore it actively, withdrawing all attention from the child”.

The example allows us to observe how the suggested strategy, lacking a well-defined overall goal, results in a compartmentalised action aimed at addressing a specific issue of the pupil (the noise in this case). Starting from this, two possible critical pitfalls can be anticipated. The first regards the case in which the specific action will fail, leaving the teacher without any other solutions. The second one, instead, is related to the possible occurrence of criticalities not previously anticipated and for which, by consequence, specific “counteraction” have not been defined. Koutsoklenis [49] reached similar conclusions, highlighting that psychosocial training programs adhere to a “manualized” approach, which inhibits teachers from employing their unique knowledge and skills to create innovative and flexible interventions tailored to the specific needs of their pupils.

This “trend” in presenting the strategies is then supported by the contribution of the second and the third most frequent DR. The “logic” that characterises the DR of the “Specification” has already been discussed. Focusing thus on the DR of the “Prescription”^{Footnote 8} we highlight how also this DR belongs to the Hybrid typology. It follows that its contribution to the configuration will depend on the other DRs composing the discursive configuration. In this sense, the prescriptions outlined in the analysed texts support the depicted scenario by dictating the actions that teachers are expected to follow.

In the example, the first text excerpt establishes that giving time for the child to practise skills is fundamental for managing critical characteristics of pupils with ADHD. Starting from this, the second excerpt works in a supportive way with respect to the first, more precisely, by defining the role of the teacher as the one in charge of providing the pupil with specific feedback.

Given the Hybrid nature of the “Prescription” DR, it contributes to enhance narrative’s “malleability”, particularly by getting into the specific definition of teacher’s role functions (e.g. offering specific feedback). However, in the observed stabilisation configuration, the full inclusive potential of this excerpt is somewhat impeded by its link with CR’s utilisation of personal references. In the example, for instance, the implicit value of “appropriately” leads the interactive management back to the subjective interpretation of this element. Concluding, coherently with the value of dW measured (0.4 dW), despite the lower percentage occurrence of Stabilization DR, the third investigation area is also oriented towards the generation of a reality of sense posed in terms of unicity and immutability. This data allows us to prefigure the criticalities described above when discussing the pitfalls deriving from the use of the DR of “Certify Reality” in relation to the third investigation area.

General configuration

Table 6 contains the most frequently used DR in the whole configuration, as well as the archipelagos of meaning most often linked to these discursive modalities and the dW of the general configuration (for the detailed results regarding all the 24 DRs, see Supplementary Material 4d).

As we can see from the table, and according to the previously described results, the most used DR in the general configuration is “Certify Reality”, which, among the stabilisation DRs, is the one with lowest dW, indicating its strong impact in creating immutable and factual realities.

The general configuration repeats quite consistently the results discussed for the previous survey areas, with “Specification” and “Cause of Action” as, namely, the second and the third most frequent repertoires. The DR of the “Cause of Action”, however, share the same percentage of the hybrid DR of “Possibility”^{Footnote 9}. Focusing on the latter, it is characterised by generating a reality of sense posed in terms of uncertainty and possibility. In this sense it could be useful to break the stabilisation “coherence” of the configuration. Nevertheless, this DR, lacking a base of shared and third elements, offers no guarantee regarding the impact it will have with respect to the discursive process in which it is used. Belonging to “Hybrid” typology, it will assume a generative or a maintenance valence depending on its interaction with the other repertoires present in the discursive configuration. Considering the prevalent use of stabilisation DR, it can be anticipated that the uncertain reality of sense produced by the “Possibility” DR will recede and be integrated into the narratives created through DRs like “Certify Reality”.

Concluding, referring to the data presented in Supplementary Material 4d, we can observe how the general configuration is composed also by Generative DRs, such as the one of the “Description”^{Footnote 10}. This DR is characterised for building narrations based on third elements, which are commonly intelligible for the interactants. Thanks to this, “Description” is the most generative DR and it is able to maximise the possibility for narrations to “connect” and interact within each other, generating new possible and unpredicted scenarios. An example of this DR is the following text excerpt:

“While doing homework and in-class tests, the student is concerned about the amount of exercises to be done, keeps checking how much is left to the end but fails to plan the execution of the activity.

The student struggles to compile a hierarchy of what is most important and where to start.” (DE).

As we can observe from the example, the narration is characterised by portraying a widely recognizable scenario. In fact, using the “Description” DR, implies the use of elements whose value is made explicit and shared. Building the narration without connoting it with any personal judgement or opinion allows the generation of a narrative that all involved roles can use as a common reference. This, in turn, increases the possibility for each role involved (from the teacher, to the parent and the student) to provide its contributions to the interaction, promoting, between the same, assumption of responsibility and social cohesion.

Concluding, the total dW of the configuration (0.4 dW), allows us to assert how, despite the presence of Generative DR, the overall narration of the analysed material is more directed to the generation of a unique reality, which will tend to keep itself the same.