ADHD and Technology Research

ADHD and Technology Research – Investigated by
Neurodivergent Readers
Katta Spiel Eva Hornecker
HCI Group || TU Wien Bauhaus Universität Weimar
Vienna, Austria Weimar, Germany
katta.spiel@tuwien.ac.at eva.hornecker@uni-weimar.de
Rua M. Williams Judith Good

University of Purdue University of Amsterdam
West Lafayette, IN, United States of America Amsterdam, The Netherlands
rmwilliams@purdue.edu j.a.good@uva.nl
ABSTRACT ACM Reference Format:

Technology research for neurodivergent conditions is largely Katta Spiel, Eva Hornecker, Rua M. Williams, and Judith Good. 2022. ADHD
and Technology Research – Investigated by Neurodivergent Readers. In
shaped by research aims which privilege neuro-normative out-
CHI Conference on Human Factors in Computing Systems (CHI ’22), April
comes. As such, there is an epistemic imbalance in meaning making 29-May 5, 2022, New Orleans, LA, USA. ACM, New York, NY, USA, 21 pages.
about these technologies. We conducted a critical literature review https://doi.org/10.1145/3491102.3517592
of technologies designed for people with ADHD, focusing on how
ADHD is framed, the research aims and approaches, the role of 1 INTRODUCTION
people with ADHD within the research process, and the types of
The term neurodiversity refers to the diversity of neurological make-
systems being developed within Computing and HCI. Our analy-
ups across populations, emphasizing the diversity of cognitive pro-
sis and review is conducted explicitly from an insider perspective,
cessing or cognitive styles. It originated through self-advocacy and
bringing our perspectives as neurodivergent researchers to the
rejects the labelling of neurotypes as deficit or impairment [133].
topic of technologies in the context of ADHD. We found that 1)
Dalton’s discussion of the potential of the concept of neurodiversity
technologies are largely used to ‘mitigate’ the experiences of ADHD
for technological design and research [32] first introduced this to
which are perceived as disruptive to neurotypical standards of be-
HCI, calling on HCI researchers to collaborate with neurodivergent
haviour; 2) little HCI research in the area invites this population
populations, and to identify and support the abilities of neurodi-
to co-construct the technologies or to leverage neurodivergent ex-
vergent people. In this context, the term neurodivergence refers to
periences in the construction of research aims; and 3) participant
the experience of significant difference from what is understood as
resistance to deficit frames can be read within the researchers’ own
the norm of cognitive functioning and expression (neurotypical),
accounts of participant actions. We discuss the implications of this
[133], (which includes medical labels such as, for example, autism,
status quo for disabled people and technology researchers alike,
dyslexia, and attention deficit hyperactivity disorder (ADHD)) [153].
and close with a set of recommendations for future work in this
Similarly, Mankoff et al. called for research on assistive technol-
area.
ogy to be informed by the perspective of disability studies and to
actively engage with disability communities [108].
CCS CONCEPTS Subsequently, recent trends in Computer Science and Human-
• Social and professional topics → People with disabilities; Computer Interaction (HCI) have seen an increase in research on
Assistive technologies; • Human-centered computing → Acces- neurodivergent populations with the understanding of terminology
sibility theory, concepts and paradigms; Accessibility design similarly following suit as a result of analyses by neurodivergent
and evaluation methods. scholars (e.g. [153, 173]). With respect to ADHD (Attention Deficit
Hyperactivity Disorder1 ) specifically, initial suggestions for the de-
KEYWORDS sign of technologies exist, albeit largely from a medically informed
perspective [147]. Recently, Cibrian et al. provided an overview of
ADHD, literature review, critical theory, neurodiversity, neurodi-
technologies designed to support self-regulation for children with
vergence, disability studies, cripping, methodology
ADHD [26]. What has been missing to date is a critical investi-
gation which focuses on how technological research operates in
the context of ADHD – particularly from a perspective explicitly
shaped by people with ADHD.
This work is licensed under a Creative Commons While modern HCI research in the realm of technologies and
Attribution-NonCommercial-NoDerivs International 4.0 License. disabilities is increasingly informed by theories and practices from
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA 1 We use the abbreviation of the medical term for lack of an empowering self-
© 2022 Copyright held by the owner/author(s). determined, non-deficit oriented reference. However, in line with existing literature
ACM ISBN 978-1-4503-9157-3/22/04. on neurodiversity [133], we understand ADHD as a variance that does not comprise a
https://doi.org/10.1145/3491102.3517592 ‘disorder’.
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA Anonymous
disability studies, e.g. [32, 108, 154], the first-person perspective of ADHD mainly affects boys) and on the other hand, defining it as a
disabled people (be they researchers or not) is crucial to understand- childhood disorder meant that adults who sought a diagnosis were
ing how these technologies operate [108]. These perspectives have ignored [65, 96]. The belief that ADHD was something that one
historically been less prominent [178], although the field has seen ‘grows out of’ persisted, with research suggesting that the preva-
a recent influx of autoethnographic studies [76, 86] and research lence of ADHD in the general population declines steadily across
oriented on agency and self-determination [12, 172]. age groups [74]. This belief continues to persist [104], although
To this growing body of work, we add a critical literature re- there is increasing recognition that the fundamental neurological
view of HCI and computer science research broadly concerned with differences that characterise ADHD remain throughout life. ADHD
ADHD. This is in line with previous analyses of technologies and might be less apparent in adults due to a lack of comparability in
neurodivergence or disabilities more generally, including the re- living conditions (occupation status, family life, etc, whereas in
view on technologies for autistic children by Spiel et al. [152], the most countries children all go to school) and the development of
survey on accessibility research by Mack et al. [106], investigations a range of contextual masking strategies over time, leading to the
on wearables in the context of autism intervention [173] and in- assessment that it is not well recognised is and subsequently heav-
vestigations into research pertaining to neurodivergence and play ily under-diagnosed in adults [87]. Additionally, the presentation
[153]. Our work additionally responds to and augments previous of characteristics is tied to conventional norms along gender [48]
suggestions for understanding potential design strategies regarding and race [7], leading to misdiagnoses of depression or oppositional
technologies for people with ADHD [147]. What our review adds defiance disorder2 respectively.
to a description of the current state of research in ADHD, is pre- People who are diagnosed with ADHD have, in recent years,
cisely an account of our reading as people with ADHD, i.e. that our helped to increase our collective understanding of what the condi-
work is specifically informed by our perspectives and experiences tion feels like and how it operates in daily lives (e.g. Dani Donovan3 ,
as neurodivergent technology researchers. We deem it particularly the ADDitude Mag4 , or Pina (ADHD Alien)5 ). These accounts are
relevant to explicitly take on this subjective perspective, given that augmented by critical and appreciative approaches in research [111]
neurodivergent people are largely excluded from the research about and people with ADHD openly entering into research on ADHD
them [152]. However, our personal involvement comes with impli- [65]. Here, advocacy is largely oriented around providing counter-
cations for our reading, analysis and interpretation of the corpus arguments for common harmful assumptions and societal stigma
material. Subsequently, our writing is, in parts, inseparably tied to [64], which is often internalised [131]. Such advocacy work within
our affective responses as to how our colleagues describe us, our and alongside research has helped to identify the strengths that
communities and our loved ones. are part of ADHD, such as cognitive dynamism, courage, energy,
To set the scene for our work, we now provide background on humanity, resilience or transcendence (hyperfocus) [135] and to
our understanding of ADHD, delineate prior work in the context propose appreciative approaches in attending to these [29].
of HCI and neurodivergence further and introduce our theoreti-
cal backing from Critical Disability Studies and particularly Crip 2.2 HCI & Neurodivergence
Technoscience. We then provide insights into our overall approach.
When proponents in HCI state that they conduct accessibility re-
Our analysis and the subsequent findings illustrate how current
search, what they specifically mean is not always clear or shared.
research predominantly presents ADHD as a problem space for
In a survey of self-identified accessibility research papers published
technology design as a result of solutionist [15] and paternalistic
between 1994 and 2019, Mack et al. note that neurodivergent popu-
attitudes towards the target population. From these findings, we
lations (including autistic populations) are of concern in only about
derive suggestions for the technical research community, speculate
5% of papers [106]. A recent review by Spiel and Gerling on HCI
on alternatives, reflect on the implications of reading works with
games research and neurodivergent populations similarly identified
personal affect but also line out potentials for future work.
a significant focus on autistic populations over other conditions,
with ADHD being relevant in 11% of the papers in their corpus
2 BACKGROUND [153]. Subsequently, many existing reviews in this space are con-
We briefly define ADHD before attending to existing work in the cerned with autism [173], especially autistic children [152]. To date,
realm of HCI and neurodivergence, before our presentation of rele- two reviews provide implications for technological research specif-
vant theories drawing on Critical Disability Studies and particularly ically in the context of ADHD, albeit one driven predominantly by
the concept of ‘crip technoscience’. a medical and deficit oriented perspective [147] and the other with
a focus specifically on children with ADHD [26].
2.1 ADHD We provide here a brief overview of existing recent work ex-
pressly addressing neurodivergence in technological design. This
Within medical contexts, ADHD is officially characterised by hy-
research includes situations in which neurodivergent individuals
peractivity, impulsivity and inattention [44]. Diagnosis is often
conducted along different presentations: predominantly inatten-
tive, predominantly hyperactive-impulsive, or combined [ibid.]. 2 We encourage readers to engage directly with Ballentine’s text on the matter, which
ADHD, or hyperkinetic behaviour syndrome as it was known pre- illustrates that access to diagnosis and adequately respectful recognition of differences
viously, was originally characterised as a childhood disorder [101]. is itself fraught with politics and privilege [7].
3 https://www.adhddd.com
On the one hand, this early characterisation did not cover the ‘inat- 4 https://www.additudemag.com
tentive’ (daydreamer) type (which long resulted in the belief that 5 http://adhd-alien.com
ADHD and Technology Research – Investigated by Neurodivergent Readers CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA
were involved in the design of data visualisations due to nonstan- many more concepts exist, the most popular distinction made is
dard processing of visual information [177] or the creation of shared the one between a medical (or deficit oriented) model of disabil-
spaces in which neurotypical and neurodivergent people can meet, ity, focused on the individual, and the social (or access oriented)
for example, as kids during play [53] or as adults in work envi- model of disability, focused on environmental barriers [109]. The
ronments [63]. Rarely do we find published work resulting from differentiation across models here is difficult to translate to the con-
self-determined design experiments, such as an artistic exploration text to ADHD, though the notion of neurodiversity [133] offers a
of the specifics of neurodivergent embodiments by Damiani [33]. non-deficit focused concept of understanding different neurotypes
We deem these to be important instances of what research and without attributing a qualitative value to that difference; rather, it
design can look like when driven by neurodivergent people, and is constructed as a mere difference (akin to [8]).
it indicates a similar potential for research and design concerning Nonetheless, the experience of living with an ADHD neurotype
people with ADHD. is characterised by a mismatch between external expectations and
Recognising an overbearing load of externally driven research in differences in processing external input and information. In conjunc-
the context of autism, Parsons et al. illustrate the knowledge- as well tion with the prevalent stigma associated with disclosing ADHD
as human-rights-based implications of including autistic people in and asking for accommodations [115], disabling experiences be-
research about them [123] following a proverb in disability activism come integral to our lives. As a result, we have decided to use the
more generally, which claims “Nothing about us without us.” [154]. term ‘disability’ in solidarity with other people who make these
Closer to HCI, Ymous et al. illustrated how disabled perspectives experiences as one seeking crip kinship [91] and one describing
generally, and neurodivergent perspectives more specifically, are parts of our self-determined identity [136]. Taking on this identity
not only given less credibility in research, but also in the broader as disabled is subsequently a political act [128], that we engage
circumstances in which research activities takes place [178]. One with deliberately, given that not doing so or operating from a medi-
case they present concretely illustrates how the disclosure of an cal perspective on disabilities is a similar political act, in that any
ADHD diagnosis led to one author no longer being considered for a presumption of a default status is inherently political.
job posting they were otherwise qualified for [ibid]. Including neu- Within an understanding of disability – and in consequence,
rodivergent populations in research as neurodivergent researchers the technologies that operate in the space of disabled people’s
further brings implications for mutually negotiating a disabled (or lives – as political, Hamraie and Fritsch offer a set of alternatives
nondisabled) identity [20]. Overall, though, what self-determined for understanding such technologies [66]. Their concept of crip
and participatory research might look like in the context of ADHD technoscience is oriented on centring disabled people as well as
has garnered little attention, and a number of researchers with making commitments to access, interdependence7 and disability
ADHD have decided not to disclose ADHD publicly [178]6 . Hence, justice [125]. While the concept of neurodiversity has already been
our work adds to existing investigations on neurodivergence and introduced to HCI [32], crip technoscience has not previously been
technology design and development by providing an analysis dedi- analysed in its applicability to neurodivergent groups.
cated to the context of ADHD, conducted by authors who explicitly
do so as an affected party. 3 METHODOLOGY
The project of this literature review spanned two and a half years,
2.3 Critical Disability Studies & Crip starting in early 2019. We illustrate our process starting with the
Technoscience specific positionality from which we conducted our reading and
In 2010, Mankoff et al. introduced Disability Studies as a productive which also fundamentally motivated this research. Additionally, we
theoretical background to HCI researchers [108]. In particular, the delineate how we constructed and analysed the overall corpus.
self-determined foundation of Disability Studies [154] offers a criti- The project is motivated by all authors’ professional reading
cal opposition to how technologies for disabled people are conven- of technology research in the context of ADHD. The first author
tionally conceptualised: as tools focused on upholding a corporeal contacted neurodivergent peers to discuss the issues they saw in
standard [21] more so than supporting disabled individuals in their the descriptions of others about themselves. We met at a conference
unique strategies of navigating environments fundamentally not in early 2019 so that everyone would get to know each other and to
made with them in mind [28]. Shew coined the term technoableism kickstart the project. At that time, we also defined early points of
to describe this tendency in technological development and research interest and distributed reading lenses among each other. In part,
[139]. Contemporary Disability Studies has built on traditions of our motivation of showing how this work resonates with people
Feminist Theories, Queer Theories, and other critical disciplines with ADHD lies in the hope that we “might support the creation of
to explore alternative ways of knowing about what it means to be ‘safer’ spaces for marginalised academics and students” [124], here
disabled. Such alternative ways of being are often referred to as specifically neurodivergent peers.
‘crip’, reflecting disabled activists’ reclamation of a common slur In conducting this work over the span of two and a half years,
(akin to ‘queer’) [114]. Within HCI, perspectives from disability we made explicit space for different temporalities in this project,
studies are increasingly taken up in form of e.g., workshops [154], following Kafer in taking up crip time, which “bends the clock to
active debates [174] or as analytic lenses [12]. meet disabled bodies and minds” [90] instead of vice versa. We
Relevant to understanding our work, our positionality and our
analysis is the concept of different models of disability. Although 7 Interdependence describes how individuals interact with and rely on other people
and objects in their daily lives, which is a particularly pronounced experience made
6 Also verified in private correspondence. by disabled people [11].
further need to acknowledge that we had to incorporate grief time so that we as a field can do better. Our aim was to ensure that these
(akin to [134]) into this crip time, as we lost peers and friends or emotions would be present but not override our analysis while
had to deal with the ramifications of a global pandemic, including further being used as an analytical tool. The extended time frame
individual illness, ourselves. of our data analysis and subsequent write-up served to distance
ourselves from first reactions. Moreover, we iteratively discussed
among the collective of authors how and where these emotions
3.1 Positionality were relevant to include and consider (see also, Section 3.3).
We explicitly position ourselves in our work due to our commitment
to feminist methodologies [70]. For one, such positioning operates 3.2 Corpus Construction
from a point of solidarity with other marginalised researchers and We constructed two corpora, the core corpus and a further extension.
the population researched in the papers analysed (e.g., [45]). Hence, Our combined corpus consists of conference/journal publications
we dissolve the traditional split between subjects and objects in reporting on conducted research (full/long papers, short papers,
research that characterises so much of (post)positivist research Work-in-Progress and Posters, Demonstrations, journal articles),
[69]. This is in line with standpoint theory, which conceptualises thus not including workshop descriptions, panels, or proposals for
knowledge production as led by marginalised researchers (arguably special interest group gatherings. For the initial, core corpus, we
including openly neurodivergent ones) as fundamental to a holistic conducted a search using the terms ADHD and ADD in the title, ab-
understanding of a topic area [71]. This is particularly relevant in stract or keywords of publications within the ACM Digital Library
ethnographic work [78], but similarly in synthesising and analysing Guide to Computing Literature8 as well as the hcibib9 indexing
multiple works in an area, given that personal experiences and im- platform (although the latter stopped indexing content in 2018)
plications shape the reading, analysis and interpretation thereof on February 19th, 2019. Our analysis is thus intentionally limited
[150]. However, it remains necessary to curate the disclosure of per- to Computing and HCI literature. This resulted in 56 papers. We
sonal information according to comfort and safety [103]. Hence, we inspected all abstracts and identified four papers unrelated to our
report some aspects of ourselves as an aggregate without individual inquiry10 , which we subsequently removed from the corpus, leav-
specificities, to ensure that the broad epistemological commitments ing us with 52 papers for our core analysis. We did not further
and contextual positions are clear as a matter of transparency, whilst reduce the corpus, allowing us to analyse the differences between
avoiding making ourselves unnecessarily vulnerable. longer and shorter publications as well as to cover ongoing devel-
That said, we are a group of four HCI researchers: two of us are opments. Relying on only these two sources means that we have
non-binary, two are women. Two people have tenure and two do not explicitly looked at technical publications from more clinical
not. We are all neurodivergent, with three having been formally di- or medical journals. However, our focus lies on how ADHD and
agnosed with ADHD. Our work operates in the contexts of gender, the technologies in that context are specifically constructed within
disability, neurodivergence and children, with technologies span- computing, and especially in HCI-oriented literature.
ning games, wearables, tangibles and virtual reality. The research This core corpus was later extended through a survey of more
we conduct is informed by emancipatory approaches, feminist the- recent publications, using the same source, from ca. mid 2018 to
ories, and, as it relates to disability, grounded by Critical Disability end 2020, with the aim of determining whether the trends we had
Studies and the neurodiversity paradigm [162]. identified persisted in these new publications, and/or whether new
From the start, our intention was to develop this review from an trends became apparent. We discarded anything unrelated to our
explicitly reflected positionality, taking on the perspectives of the inquiry that came up in this search (one workshop and one paper
neurodivergent populations addressed in the research we analysed. in a language none of the authors confidently comprehend, as well
This included reflecting on whose perspectives are present and as online versions of full PhD theses). This yielded another 48
engaged with, who the research aims to empower (and how), and publications (after a removal of duplicates), which we refer to as
what power relations are implicit in the situations and scenarios the ‘extended corpus’. We then performed a high level analysis of
addressed. While conducting the survey, it became impossible for us the papers in this extended corpus with the goal of challenging
to remain detached - reading often affected us emotionally. Imagin- our initial analysis in light of an increased number of publications
ing ourselves or people we love in the position of study participants around neurodivergence within HCI more generally.
affected us, particularly when it came to children. Even though
reading any of the papers on their own might have led to unease, 3.3 Analysis
reading the corpus as a whole left us with a sense of disquiet, pain,
and even fear, resulting in the need to step back from the analysis at For the core corpus, all four authors closely read the material [110],
points. This perspective influences our writing style, but it consti- each with a specific focus, namely either participants (i.e., who
tutes a vital part of our analysis. Epistemologically, we follow here was included or addressed in the research and how did potential
Jaggar who states that “[i]t is easy to see the ideological function participants act), disability (i.e., how did authors conceptualise and
of the myth of the dispassionate investigator. It functions, obvi- explain ADHD), researchers (i.e., the larger research framing and
ously, to bolster the epistemic authority of the currently dominant disciplinary origin of the work) and technology (i.e., the design
groups (...)” [85]. Subsequently, abstracting away the anger and
8 https://dl.acm.org Please note that this means we sourced publications from several
hurt that we felt when reading would undermine the very project
publishers and did not exclusively rely on ACM publications.
we attempt here – which is to highlight the implicit–albeit largely 9 https://hcibib.org
unintended–violence at the heart of such neuronormative projects 10 Two of those consisted of abstracts only and two additional ones referred to patents.
and development processes, including the artifacts and their pur- 4 RESULTS
pose), to diversify the initial reading. The definition of separate In presenting our results, we start by providing readers with a
reading lenses was done to a) accommodate chunky reading in a descriptive summary of the corpus before considering individual
structured fashion and b) allow for potentially diverging reading works to illustrate how knowledge related to technological design
of the same papers to appropriately account for different strengths and development is created in the context of ADHD. We then dive
in the research we surveyed. We then procedurally coded along deeper into the technological aspects of the works in the corpus,
subcategories of these foci individually before contrasting and con- specifically by focusing on what these technologies communicate
textualising our analyses across individual contributors. The author through their material and algorithmic make-up. Finally, we analyse
team read each other’s comments and codes, and a number of pa- how these papers configure their population of interest as one that
pers were discussed that had been evaluated divergently. The intent provides tech researchers with problems in need of solutions.
here was not to homogenise the diverging assessments but rather to
use them productively to better understand both the strengths and 4.1 Corpus Description
weaknesses of a given paper. In addition, papers were categorised
Due to the inconsistent classification of paper types across venues,
for the descriptive analysis in Section 4.1, which provides a general
we decided to categorise our corpus according to the length of text,
overview of the corpus.
as this tends to provide some indication of the size of the contribu-
For our theoretical analysis, we started by conceptually mapping
tion and amount of work involved. We distinguish here between
out the papers in the corpus [6]. We then drew on theories from Crit-
long, medium-length and short papers. Paper length denotes total
ical Disability Studies (among them, [13, 66, 108, 168]) to analyse
length, including references. Given that formatting has a significant
the implications of the papers from the perspective of neurodiver-
effect on length, we took this into account, based partially on our
gent readers. In so doing, we were guided by Boyatzis’ approach to
own experience of reformatting texts, e.g. between the ACM double-
thematic analysis, which allows for inductive and deductive coding
column format and the Extended Abstract format that is frequently
by multiple coders, whilst acknowledging the situatedness and sub-
required for Work in Progress or Posters, or for the common layout
jective quality criteria of appropriate coding [17]. We deliberately
for Springer book-style publications.
opted against a more quantitatively oriented codebook approach
Our ‘long’ category corresponds in length to what is currently
to favour multiple perspectives in our analysis, and strengthen our
common for full papers at ACM conferences, and includes jour-
results through negotiating divergence among us.
nal articles. Our ‘short’ category combines papers in the format
The extended corpus was similarly analysed by two out of the
common for ACM Extended Abstract publications and those up
four initial coders to identify trends in current research compared
to half the length of long papers, including formats from different
to our initial results. This analysis was based on the codes already
publishers (e.g., Springer) with an equivalent word count.
established, with new codes only added if a novel trend could be
As described above, our core corpus consisted of a total of 52
identified. Findings that differ from the initial ones are discussed
papers: of these, 31 were short papers 11 , while 15 were medium
in separate paragraphs along the topical sections. In a number of
length12 . Only six papers in our corpus could be considered to
cases, papers from this extended corpus provide a good example
be long/full papers, with five conference papers in ACM double-
for a particular trend found in the overall corpus, and are labelled
column format ranging from 10-13 pages, and one journal paper in
as belonging to the ‘extended corpus’.
IEEE double-column format (see Figure 1).
It is important to note that we make no assumptions as to the
We then categorised the research and development aims, distin-
neurotype of the individuals involved in conducting the research
guishing between 1) technical work (e.g. signal processing) or work
described in our corpus. Indeed, we are acutely aware of the poten-
on systems/methods for diagnosing ADHD (labelled ‘diagnosis’), 2)
tial negative repercussions associated with disclosure [178]. Instead,
development or evaluation of behavioural therapy tools/devices and
our analysis focusses solely on the discursively relevant aspects of
other interventions aimed at treating ADHD symptoms, support-
the presented research approach and positioning.
ing therapy or generally supporting everyday life of people with
Overall, the quality and rigour of our analysis stems from 1) our
ADHD, as well as work deriving requirements for such systems (all
theoretical immersion in Critical Disability Studies, 2) the situated
labelled as ‘intervention’), and 3) other work mentioning and dis-
but multiple perspectives of the neurodivergent authors as members
cussing ADHD but not aimed at ADHD people as users/recipients,
of the population of interest who are intended as recipients of
e.g. framework papers (labelled ‘other’).13
the technologies described within this corpus, and who also are
all experienced HCI researchers, 3) the collaborative processes in 11 Nine in ACM’s EA landscape format, three 2-pagers, nine 4-pagers as well as two
coding and theming our reading, and 4) the extension of our corpus 5-pagers in ACM double-column format, five of 4-6 page length in Springer format,
as a response to the interrupted and prolonged analysis process. two of 7-10 page length and one of 11 page length.
12 Six of 6-7 pages ACM style, another five were 8-9 pages long, two were 12-15 pages
Our goal is not to establish generalities from our reading, but rather in Springer format, and two were 5 pages in IEEE double column format.
to contribute to an increased understanding of the specificities of 13 To provide an idea of typical publication venues (for simplicity sake for the entire
different interpretations and knowledges; or, to say it with Haraway, corpus): interventions/tool papers usually appear at SigCHI and SigACCESS confer-
ences, such as CHI, ASSETS, IDC, OzCHI, CHIPlay, TEI, UbiComp, at health-related
to take the “privilege of [our] partial perspective[s]” seriously [69]. conferences such as PervasiveHealth, the REHAB workshop, or E-Education related
conferences, occasionally within a Computer Graphics context. For Non-ACM HCI
conferences, Interact and HCI International are frequent. Papers on ADHD diagnosis
appear at non-HCI conferences, such as the Int. Conf on Multimedia, ICMI, the ETRA
eye-tracking symposion, in Bioinformatics, IEEE communications magazine, Frontiers
in Technology, with only one CHI paper among these.
[144–146, 148, 149]. Another cluster deals with diagnosis and ac-
tivity measuring [31, 179]. The remaining two clusters comprise
short/extended abstract (EA) format publications, both of which
focus on designing interventions for emotional regulation [49, 50]
and planning skills [165, 180, 181], respectively. This indicates that
only a few systems have been deeply evaluated (or iterated upon)
from an HCI perspective and then published within HCI (or com-
puting). While there are various reasons why this might be the case
(e.g. submissions might get rejected), this is in stark contrast to the
amount of highly-visible and long HCI publications of work related
to autism. Thus, within HCI, there is a deficit regarding detailed
studies of design and user experience and in consequence, little
accumulation of design knowledge of how to design for ADHD,
more generally.
4.1.2 Gender and Age. Of the papers in the core corpus, almost a
Figure 1: Length of papers within the core corpus and repre-
quarter (23.1%, or twelve papers) did not involve any participants in
sentation of the three topical areas.
the research. Of the remaining papers, 25 (48.1% of all papers) did
not report participants’ gender. Of the 15 papers that did (28.8% of all
When comparing the distribution of papers across both paper
papers), a total of 235 men/boys (74.8%) and 78 (24.8%) women/girls
length and the type of work (see Figure 1), the balance (distribution)
were involved, with one participant not disclosing their gender. It
of topic areas almost reverses with increasing paper length. The ma-
should be noted that for the work of Morris et al. [118], we inferred
jority of shorter papers and WiP format publications describe work
gender of the ADHD population by the percentage of overall gender
on interventions and behavioural therapy tools, while almost none
representation across the 38 participants who identified as having
of the long papers focus on these topics. In contrast, more technical
ADHD. While ADHD is approximately two times more likely to
work on diagnosis of ADHD is dominant in long papers. Of the 31
be diagnosed in boys than in girls, for adults the (binary) ratio is
short papers, only five deal with the diagnosis of ADHD and simi-
almost identical, indicating a tendency for women to be diagnosed
lar technical work (not related to interventions), while 23 propose
later in life [48]15 . This suggests that future research on technol-
and/or test behavioural therapy devices or other tools for ADHD
ogy to support people with ADHD should ensure that the gender
people. Of the 15 medium-length papers, seven deal with diagnosis
representation of participants is more representative of the overall
of ADHD and similar technical work (including experiments), and
ADHD population.
another seven propose and/or test behavioural therapy devices or
Additionally, papers were predominantly concerned with chil-
suggest other kinds of tools or approaches. Of the six long papers,
dren (32, 61.5%), with seven (13.5%) explicitly focusing on youth
two focus on diagnosis methods/algorithms (including one journal
(i.e., teenagers). However, in some cases, authors referred to similar
publication [9]), while another one measures inattention in the gen-
age groups either as children or as youth. Finally, ten papers (19.2%)
eral population. Only one proposes behavioural interventions or
considered adult populations with the remaining three (5.8%) not
tools, while another two are more abstract/general (e.g. providing
referencing any specific age group. This shows a fundamental skew
a framework). We also found four papers (of variable length) that
towards younger populations in technology research.
employ ADHD as a narrative or potential frame without necessarily
We can only speculate on reasons for this skew. It might be based
addressing the condition or people with it (for a general overview
on the the popular belief frequently still conveyed in the media
of the papers in the corpus in terms of topic and length, see Table 1).
that ADHD is a condition one “grows out of” and thus requires
Thus, publications that discuss e.g. sensor data analysis for diag-
intervention in childhood so it can be ameliorated or erased in
nosis of ADHD are more likely to be long or medium-length papers,
adulthood see Section 2.1. There is also the common assumption
whereas work that investigates behavioural therapy interventions
that children need the most support or would benefit most from
or that collaborates with ADHD people and their environment (e.g.
early intervention [169]. In addition, behavioural and special needs
parents and teachers) to develop technology concepts tends to be
education is often already located at schools, creating a convenient
published as work in progress, poster or demo, and in shorter for-
institutional frame for inquiry. Yet, given we know that ADHD is
mats. In many of those shorter papers, a prototype was developed,
present throughout one’s lifespan, this collective body of research
and sometimes tested with a small number of users, and then often
is effectively ignoring a significant part of the population that it
appears to ‘disappear’ 14 .
purports to address, focusing on childhood intervention rather than
4.1.1 Low Degree of Clusters. In our set of 52 papers, we only found life-long assistive technology applications.
five clusters of publications that build upon each other (indicat-
Description of the extended corpus: The extended corpus (pub-
ing a longer-term research effort), of which two of the clusters
lications from mid 2018 to end 2020) consists of an additional 48
are part of the same PhD student’s work on Chillfish and Mobero
papers, showing an increase in the rate of publications on ADHD,
14 For a few prototypes that we found interesting we did actively search for follow-up
work by the authors or mentioning the prototype name on their website and via Google 15 Please note that the source for this information only operated on binary notions of
Scholar. gender.
Topic Length Papers n
Diagnosis short [3, 24, 73, 105, 163] 5

medium [2, 31, 47, 75, 97, 117, 179] 7
long [9, 80] 2
14
Intervention/Therapy short [1, 4, 10, 39, 46, 49, 55, 67, 72, 92, 102, 143, 164]
[50, 61, 120, 132, 145, 146, 149, 165, 180–182] 23
medium [42, 59, 81, 113, 126, 144] 7
long [148] 1
31
ADHD as narrative short [166] 1

medium [60, 158] 2
long [99] 1
4
Abstract/General medium [119] 1

long [118, 147] 2
3
Table 1: Research approaches in papers in the core corpus along size with references
given that these papers were published within a much shorter time 4.2.1 ADHD as Individual Suffering. Authors often used the lan-
frame than the core corpus). The trend for research on ADHD in- guage of suffering to frame ADHD participants. For example:
terventions to be ’short’ papers (rather than longer) persisted (20 “. . . children around the world suffer from ADHD” [120], ADHD is “a
out of a total of 27), but we now also found a larger proportion of common cognitive disorder afflicting many children and adults” [105],
short papers on ADHD diagnosis (seven out of a total of 15). The and “the consequences of this impairment. . . can be devastating” [102]
proportion of long ‘intervention’ publications appears to increase (also refer to: [1, 3, 80, 97, 113, 119, 126]). Many authors expressly
slightly (six out of the total of 48 - on par with seven long diagnosis identify ADHD participants as being distinct from “healthy” or “nor-
papers). Again, most appear to be ‘one-offs’, continuing the trend mal” participants (as in [47, 61, 80, 102, 132, 179]), and ADHD traits
noted in analysis of the core corpus. The one clear cluster of papers and behaviours as being “undesire[able]” [164], “excessive” [59, 119],
from this period include work on co-regulation of behaviour and and “invasive” [9] (also refer to: [3, 102, 118, 120, 145, 163, 182]).
emotion of children with ADHD with their caregivers [27, 40, 157] In so doing, authors use two specific rhetorical strategies: 1) fram-
and work developing inclusive play spaces for neurodiverse chil- ing ADHD as deviant other [37], and 2) determining the condition
dren [18, 19]. Overall, we observe a sharp rise in the number of as detached from the individual diagnosed with it. By crystallising
publications, though a slower trend towards longer papers. specific aspects of ADHD, the condition is framed as an entity dis-
tinct from, and invasive to, any person diagnosed with it as well as
4.2 Defining (People with) ADHD in their adjacent social unit. This is a common discursive practice that
Technology Research has been critiqued in disability studies for decades, specifically for
In aggregate, the works in the corpus contextualise people with the context of autism [112, 141], but also negates the fundamental
ADHD as comprising some kind of larger problem, not primarily for way the associated neurology shapes an individuals’ perception of
the individual, but more so for their immediate social environments their environment as well as their processing of external signals
as well as society at large. Frequently, via the abstract or within [111]. Furthermore, such a rhetorical strategy runs counter to ACM
the first few lines of introductory text, ADHD is presented as a SIGACCESS accessible writing guidelines [68], which suggest to
discrete entity detached from the person diagnosed with it, a source consider disability as one aspect of a person, that does not define
of familial burden or a threat to collective capital, and thus, an them in total but makes up part of their identity. Assuming that
urgent problem requiring early intervention. We now analyse dif- people with ADHD ‘suffer’ from having a specific neurotype fails to
ferent rhetorical strategies employed in our corpus to illustrate how consider that people appreciate the strengths that come with it, and
research publications in computing articulate and define (people instead frames our existence as undesirable, and the researchers
with) ADHD. addressing ADHD as altruistically motivated helpers [28].
4.2.2 ADHD as a Burden to Others. ADHD is furthermore fre- researchers actively engaged with, and what roles these people
quently described as a burden to others and to society as a whole. had; that is, how, beyond being conceptualised as users, they were
In our corpus (core and extended), children with ADHD are often considered as testers, or actually able to shape the work, either as
described as being “at risk” of underachievement [4, 9, 55, 81]), sub- informants or as design partners (akin to the definition of roles by
stance abuse ([1, 144]), and criminality ([1, 9, 145]), due to having Druin [41]). We categorised publications based on whether they
ADHD traits. However, there have been numerous developments follow a user-centred design (UCD) approach, and whether they
in critical psychology that acknowledge that ADHD traits do not engage in co-design (where stakeholders take an active role in idea
play a causal role in these outcomes in isolation from societal dis- generation and prototyping).
crimination and stigma [22, 121, 161]. Eleven of the 31 papers presenting an intervention or a tool for
The papers we surveyed often aimed at reducing the ‘burden’ assisting ADHD people do not explicitly mention a UCD process,
of ADHD, but none recognised socio-cultural contexts and disabil- nor do they provide any evidence of such a process: only the design
ity stigma as producing “suffering” or contributing to “outcomes”. rationale and features of a given technology are described (e.g.,
While these projects might be well-intentioned, the approaches pur- [42, 92, 164, 182]). One paper mentions plans for future UCD work;
sued often reinforce societal behavioural expectations and thereby three papers claim to have followed a UCD process, but provide no
place the burden on the ADHD person to adjust, constituting a further evidence, or keep participant involvement to an absolute
focus on curative rather than on assistive technology [156]. minimum (e.g., conducting a passive survey [39]).
Many authors further emphasised the burden to family, care-
givers, teachers, and broader society. For example: “there is a sig- 4.3.1 User-Centred or Non-User Centred Design? 16 papers orig-
nificant burden on those affected, their families and society” [148]; inating from twelve different research projects followed a design
“ADHD can be challenging for a parent or caregiver with an individual process that could be considered user-centered in terms of inves-
who has this disorder” [1]; “a big threat for public health” [97]; and tigating requirements, interviewing stakeholders and conducting
“can have a huge emotional and economic impact on families” [ibid] iterative development and testing. Out of these 16, six described
(see also: [55, 80, 126, 145, 147, 148]). Here, these research projects some form of co-design (four projects), where stakeholders are in-
become legitimised by an unsubstantiated assertion that the family volved in design workshops. The short definition of UCD stresses
unit is suffering as a result of the ADHD person. Other authors that “designers focus on the users and their needs in each phase
appeal to ADHD’s disruption to a person’s productivity as a risk to of the design process” and “involve users throughout the design
individual success (as in: [1, 4, 55, 80, 147]) and imminent threat to process”16 . ‘Throughout the design process’ implies that relevant
national capital (as in: [39, 50]). Following from these implications, stakeholders are not only involved for testing, but that designers
ADHD thus becomes an urgent societal problem solved only by engage with representatives of the relevant populations in early
intervention on the individual, rather than on the society which stages to understand their needs and perspectives [137]). A full
problematises their embodiment. This negates how people with UCD process should consider all stakeholders, especially the in-
ADHD often have strategies and traits that allow them to make tended end users. This is also emphasised in the child-computer
substantial contributions to collectives and societies [135, 167]. interaction literature [79, 129], which discusses how to ‘engage with
the voices of children with disabilities’ [83]. Even in the emerging
4.2.3 ADHD as an “interesting argument”. We identified four pa- area of Animal-Computer Interaction, principles of UCD are ex-
pers utilising ADHD as a keyword, but do not actually address tended across species barriers [107], considering e.g. dogs as active
ADHD. ADHD is instead used to motivate the relevance of the participants with agency, preferences and feelings. Yet, closer in-
research, however studies are run with “healthy” (sic!) participants, spection of the corpus reveals that projects rarely include people
misconceptualising ADHD as an illness. This includes a study of in- with ADHD as the core stakeholders and end users in an active
terruption effects, motivated by the assumption that smartphones role that directly contributes to the development process. Of 52
create ADHD symptoms [99], or one on modality effects on at- papers, 19 claim UCD principles. We consider 16 (related to 12
tention [166]. What is problematic here (from our perspective), is projects) as actually following through with a UCD approach, but
that these studies are not relevant to ADHD and, in some cases, only five projects actually include people with ADHD as (primary)
grounded in faulty assumptions which equate inattention due to informants and/or co-designers. We acknowledge that sometimes
interruptions or modality uses to ADHD). Phrased more directly: institutional ethics review boards might prevent researchers from
ADHD is utilized here as a sales pitch and attention grabber, with more directly engaging with ADHD participants, given their com-
little interest or regard for the people behind a catchy diagnostic mon status as a vulnerable population. Nevertheless, publications
criterion. The principle behind the neurotype gets exploited as an should at least mention not having had direct input and feedback
argument lens, to be useful to neurotypical people. from ADHD participants as a limitation of the research.
Of the projects which follow a UCD (but not co-design) approach
4.3 Shifting in and out of Focus – People with (ten papers, eight projects), none include ADHD people in either pre-
ADHD in Technology Research design interviews/workshops or interviews post-intervention/ex-
Here, we summarise our analysis regarding the methods utilised, periment. Instead, the work was informed only by discussions and
in particular regarding the engagement with participants. This is interviews with teachers, parents, or with medical, clinical and
limited to publications presenting or discussing (potential) inter-
ventions and leaves out purely technical contributions or work 16 Quotes taken from https://www.interaction-design.org/literature/topics/user-
on ADHD diagnosis. For this analysis, we took notes on who the centered-design (September 7th, 2021).
other professional ADHD ‘experts’17 (sometimes solely with the 4.3.2 Participating in Design. Work following a Participatory De-
latter) (e.g. [59, 72, 126, 144, 149]). Several projects involve an eval- sign (PD)/CoDesign approach appears to be more likely to engage
uation study, where the given technology is deployed. However, directly with ADHD children, teenagers or adults as active con-
the people with ADHD who, for instance, are made to wear a tributors to the design process and as conversation partners in
wearable device are rarely questioned about their experiences af- evaluation (e.g.[46, 50, 67, 165, 180]). We highlight the work by
terwards (with one notable exception [81]). Evaluation findings Eriksson et al. [46] who ran future workshops and conducted lo-fi
tend to focus on whether teachers or parents (or therapists) see prototyping sessions with students that have ADHD to explore their
improvements, thus prioritizing a ‘view from the outside’, rather conceptions of time. The aim was to develop appropriate represen-
than subjective well-being and individual meaning-making. This tations for a tool that enables them to tell the time in a way that fits
goes against principles of user-centered design, which is meant to their individual perception and thinking, helping to develop better
consider all stakeholders, in particular end users, as well as con- time-processing abilities. This addresses the ADHD characteristic
sidering trade-offs between those stakeholders. To put it bluntly, of difficulty in telling the time and time perception [14]. Zuckerman
by excluding people with ADHD from central participation and et al. [165, 180, 181] similarly actively involved ADHD children to
testimony, the focus of research in this corpus is not to support peo- develop Tangiplan, a tool that supports the planning of daily tasks
ple with ADHD in their daily lives, but rather appears to be lying and scaffolds their execution. They interviewed child-parent pairs
on bringing “relief” to their parasocial environment through the and encouraged the children to play with the potential interaction
upholding of neurotypical standards of behaviour and expression. using a paper mockup. Moreover, with the tool, children can define
Not involving people with ADHD early on often creates funda- their own routines, set their own goals, and decide where to put the
mental issues for the validity of designs that are only recognised late Tangiplan hourglass reminders, and, thus, are in full control. This
in the process, if at all. For instance, in the development of ChillFish, was one of very few projects to give agency to people with ADHD
a breath-controlled biofeedback game, Sonne and Jensen [144, 145] and seek to support their individual strategies. Another example in
collaborated with medical/therapeutic professionals for the design our core corpus is a project that interviewed adults with ADHD [81]
and tested it very late with children with ADHD18 , which revealed to understand their self-chosen strategies for personal information
that the device did not work adequately for them. management, though it appears that there is no follow-up work.
Other work by Sonne et al. [146, 148] focuses on ‘involving However, even CoDesign processes may ignore the perspectives
families’ in improving morning and bedtime routines of children of those with ADHD. For instance, Pina et al. [126] claim to be ‘work-
with ADHD, and includes parents and domain professionals (i.e., ing with families’ to develop a prototype that would provide parents
clinicians) in the design process. They developed a mobile app that with in-situ cues for behavioural coping strategies. However, read
reminds children of a bedtime routine and steps them through it closely, we noticed they only involve parents in interviews and
using timers and ‘star’ rewards. The design was iterated based workshops, enquiring about their needs, and later, about their expe-
on parents’ feedback and after a two week study, parents were riences after deploying the tool (which helps parents structure their
interviewed. Parents were also responsible for defining the routine interactions with children and provides prompts and interventions
that the children were then guided through by the app. In this when parents become stressed), whereas they did not enquire with
entire process, it is not mentioned that the children were ever the children about how this affected them. While it could be argued
consulted about their preferences and experiences: in any case, the that this tool enabled parents to deliver parental strategies more
publications do not include children’s perceptions, comments or effectively, it ignores the nature of their interactions with children,
feedback. While children with ADHD tend to exist within family whether these are adequate, and what these mean for the ADHD
units, not explicitly attending to their specific perspectives amplifies child. As such, it is possible for maladaptive parenting strategies to
the power structures enacting on them in their daily lives. Garcia persist, and even worsen. Such an approach removes the agency
et al. [59] developed wearable activity monitoring devices coupled of people with ADHD, not just in design processes but also the
with a portable feedback mechanism that rewards children for resulting interactions with technologies.
being still and not moving too much. The mechanism follows a
behaviourist script in which a virtual character becomes more and 4.3.3 Participant Resistance. We found several examples of enacted
more happy the less the child moves. They observed classes at a resistance which can be read as commentary on technology inter-
specialist school, interviewed teachers, parents and specialists, and ventions for ADHD [169, 173]. For instance, when tactile feedback
brainstormed with teachers. The children played only a passive was intended to function as a corrective sensation for participants
role in lab tests and in the actual intervention during two days of to attend to and adjust their behaviour accordingly [97], ADHD par-
school by wearing the devices. Only at the very end of the project ticipants instead enjoyed the tactile sensation, and would engage
was a focus group interview held with the children in the class, in behaviour that triggered more of it, resulting in paradoxically
which is too late in the process to meaningfully enable participants higher “scores” on the game while rating lower on “performance”
to challenge and contribute to its design. in terms of the intervention’s behavioural aims.
17 Of
Given the nature of ADHD, time was a common site of contention
course, there is a specific irony in not acknowledging the actual expertise held by
people with ADHD, a move also common in research on autism [116]. within the corpus. In the Mobero study [148], the researchers de-
18 As indicated by the authors in the presentation of their work during TEI 2016, they ployed novel timer devices to “assist the child in becoming indepen-
were not given permission by their institutional ethics review body to include children dent and lowering the parents’ frustration levels.” Yet the devices
with ADHD earlier in the process. These less than ideal circumstances are often outside
of authors’ control, but affect the quality of the design and research in the ways we caused some participants stress and frustration. One participant
describe here. protested the intervention by hiding the timers during meal times.
In another time-based intervention for adults [50], participants engaged with teaching staff, school psychologists and behaviour an-
rated the intervention as “intrusive”, with “one participant with- alysts. The work resulted in a glanceable classroom display where
drawing from the trial after receiving ten false alarms within two all children can see each other’s status, and which displays warn-
hours.” By engaging with ADHD participants as design informants, ings in the event of undesirable behaviours. Over a ten month
Eriksson et al. [46] were able to recognise how neurodivergence deployment, the classroom teacher and behaviour analyst were
contributes to time perception difficulties, and thus - rather than repeatedly interviewed. Park et al. [122], in a team involving UX
reinforcing normative patterns - sought to design for “a more useful designers, pediatric psychiatrists and developmental disorder ther-
representation of time.” Through participatory practice, they were apists, interviewed parents of children diagnosed with ADHD to
then able to design for time to be “organized into activities in a derive requirements for a mobile voice-bot to assist the children in
certain order as a stretch of time, rather than its relation to specific daily routine tasks, but not the children themselves.
hours and minutes”, illustrating how an appreciative engagement
with participants can yield more appropriate technological interven- 4.3.4 Summarising The Role of People with ADHD as Stakeholders.
tions which marry neurodivergent preferences and neurotypically As we delineated above, ADHD people are involved in experiments
formed expectations. and studies, but very rarely are asked about their opinions, needs,
Additionally, we have identified a unique literacy of resistance desires, and experiences. Experiments often involve rather invasive
from this ADHD technology corpus: embodied resistance. While in procedures, such as strapping wearable sensors to participants’ bod-
previous work [169], resistance came about through participant ies, e.g. to detect ‘excessive motor activity’ or to infer attention loss
action, in this study, resistance can often be read within the partici- [1, 59, 143, 163], sometimes for extended time periods, occasionally
pants’ bodily and autonomic reactions to protocol. ADHD bodies explicitly without their consent, and providing them with positive
are witnessed resisting detection: “the quality of the ADHD image or negative feedback on their behaviour, either directly/individually
is worse than that of the control image, probably due to the move- (e.g. vibration alerts) or via contextual interventions (alerts to e.g.
ment of the children during image acquisition.” [2]; “...the data from teachers or parents, displays visible to the entire class). When re-
the user study was unreliable. . . [because]... the children found it porting on the study, none of these publications provide a rationale
hard not to fiddle with the EDA electrodes” [149]. ADHD children or explanation for why ADHD children or teenagers were not inter-
in digital sensor apparata both “out” themselves through hyper- viewed directly. There is little further information on how consent
activity while simultaneously concealing the detail of their own or assent was gained apart from parental consent (whereas the
biosignals, disrupting the efficacy of algorithmic feature extraction child-computer interaction literature recommends to “actively seek
and classification. consent from children” [129])20 . This is not to suggest that child
consent was not obtained by any of the studies reported upon, but
Extended Corpus. The ratio of UCD approaches has only margi- that this has not been made explicit either.
nally increased in the more recent publications of our extended We assert that, overall, there is a lack of engagement with core
corpus. Of 27 ‘intervention’-oriented publications, only 14 report stakeholders (the direct end users on the ‘receiving end’ of any
on a UCD approach. Of these fourteen, eleven use a classical UCD interventions) in this technology space, that is, people with ADHD.
process. Six of these actively engage with teachers, therapists, or Instead, a by-proxy approach is taken, of working with professional
parents, but not with the ADHD people involved as study subjects. ADHD experts, teachers or parents. This ignores not only the sub-
Only four publications (all from the same project [25, 27, 40, 157]) jective perspectives, interests, needs and desires of ADHD people,
engage directly with ADHD children. Unfortunately, even though but also the power-differential between children/teenagers and par-
the researchers here consulted with their core stakeholders, when ents/teachers/medical experts, as well as the inherent conflicts of
the children requested design specifications that went against the interest between these stakeholders (e.g. teachers may just want
researchers’ agenda – in this case, that the children do not want to the class to be quiet and well-behaved, whereas a child needs more
share data with parents and teachers as it violates their privacy – activity). Moreover, by focusing on children in this context, the
this input was ignored. Whilst we recognise the various trade-offs power differentials between researchers and their ADHD audience
that can occur during the design phase, with some ideas taking are amplified, further limiting the agency of ADHD adults as well.
priority over others, we nonetheless feel that a discussion of why If people with ADHD are not systematically engaged in designing
young people’s input into the design was sought, but not necessar- and making meaning of the technologies that are built to operate
ily acted upon, is merited [130]. Thus, direct participation is not in their lives, the resulting artefacts will very likely embody and
a guarantee for having one’s agency acknowledged and actively materialise neurotypical expectations more than self-determined
included. Further, we found one survey study with ADHD adults support, which is why we take a closer look at these in the follow-
[38]. Only Boyd et al. engage in CoDesign activities with families ing section. We need to emphasise here again that neurodivergent
and interview ADHD children [19]. researchers might also end up creating products that embody neu-
However, the majority of UCD-style projects continue to ignore rotypical norms as these are powerfully present in Western societies
the perspective of those people whose interests the research sup- and often internalised by neurodivergent people as well.
posedly supports and helps. For instance, Spiller et al. [155] aim to
implement behaviour management strategies in classrooms, based 20 That Child-Computer Interaction researchers emphasize that this should be the
on a ‘token economy’19 (a reward system for ‘good’ behavior), and standard indicates that it is not always a given. Note that Ethics Boards often only
19 However, require parental consent, and only require that children cannot be forced to take part.
as Kohn reminds us, “[a]ttempts to short-circuit [the teaching] process by This ignores the impact of family power dynamics on children’s ability to decide for
dangling rewards in front of children are at best ineffective, and at worst counterpro- themselves.
ductive” [95].
4.4 Technological Artefacts in the Context of 4.4.1 Specific Purpose: Controlling Body Movements. In our analy-
ADHD sis, we found numerous examples where children were equipped
with wearable devices in a way that is intrusive, stigmatising, and
When considering technologies designed for intervention, we clas-
that frequently employs classical stimuli-response conditioning
sified the corpus according to the type of technology that was
approaches, as training to suppress certain types of actions or to
developed and utilised. We identified four clusters of technologies
encourage others. Blurtline [143], intended for classroom use, is
that occurred most frequently, and in at least two distinct projects
designed to warn children that they are about to speak impulsively
within our core corpus (with the number of papers reporting each
through a belt worn around the chest which detects deep inhaling.
type of technology shown in parentheses):
Notwithstanding the intrusiveness of such an approach, the design
• Wearables (10x) in different form factors, ranging from a risks false alarms, e.g. if a child attempts to do breathing exercises
hugging vest for deep touch pressure therapy (e.g. [42]), in order to calm down. Sonne et al. [149] equip children with no
wristbands combined with e.g. smartphones [49, 50, 126], less than eight accelerometers on their limbs, a heartrate sensor
belts that measure inhalation or acceleration [59, 143], to and an EEG headset to infer loss of attention during school classes,
smartwatches [39] and other wearable devices and sensors; and then alert the child to their lack of attention. In addition to the
• EEG (4x) ranging from mobile EEG devices for every- obvious issue of stigma, there is no consideration of the fact that
day tracking [10], applications for neurofeedback training such alerts might feasibly act as distractors in and of themselves,
[113, 132] to the use of EEG as an evaluation tool for media and may well cause distress to the child21 . Garcia et al. [59] develop
consumption [102]; a ‘portable companion creature’ that provides vibration feedback to
• Smartphones (4x) appear either as general purpose tech- children and makes an unhappy face if ‘motor excess’ is detected,
nology [99] or as a platform for time structuring applications thus motivating children to make the toy smile by sitting still. From
[146, 148, 149]; and such a system, it is possible for children to internalise that their
• Augmented and Virtual Reality (3x) are used as simula- natural bodily movements make other people sad. Similarly, there is
tion environments to train specific skills [120], time percep- a watch which provides feedback on ‘performance’ in the evening.
tion [61] or as an interactive frame for another technology This follows a classical behaviourist conditioning strategy while
(in this case, a Brain Computer Interface (BCI)) [164]. ignoring the role that movement might have for a child, e.g. sup-
porting them in finding an outlet for their activity impulse or to
Other technologies appear only once or twice, e.g. eye tracking calm down, and thereby enabling them to focus [5].
games [1], a handheld game controller for breathing exercises [144], The high frequency of wearables can, subsequently, be traced
fidget toys [67], full body games [72], and Tangible Interfaces [165, to attempts to monitor ADHD people (usually children) in daily
181]. Robots were used twice [97, 182]. life, often to provide in-situ interventions or to enable reflection
The biggest group of projects (10) in our core corpus aim to train about their day. It should be noted that some of these setups are
focus, concentration or attention (span), usually of children [1, very extensive and not realistic; in particular they run the risk of
4, 67, 72, 92, 99, 102, 132, 164, 182], with another two projects aiming further fuelling already prevalent stigma. However, they also fuel
to support self-regulation of attention directly [113, 149]. Other internalised oppression by communicating to the wearer that the
projects are concerned with frustration tolerance as a related ways in which they feel comfortable in their body and the ways
topic [120] or working memory [61]. Hyperactivity is utilized they like to move are inappropriate and need to be changed to
as an indicator for diagnostic technologies [9, 117, 179], although belong to dominant society22 .
only a subset of ADHD people are hyperactive.
4.4.2 Specific Purpose: Diagnosing the Disordered. Research into
Another cluster of projects aim to support self-regulation, with
technologies for diagnosing ADHD is frequently motivated by the
different foci: emotional and cognitive control, e.g. through breath-
need for ‘less subjective’ and hence more ‘objective’ measures [105,
ing exercises [49, 50], self-management of emotion by predicting ag-
117, 179] and, as is implied, more accurate assessments: “Since most
itated situations [163] or of “motor excess” [59]. Impulsive action
ADHD diagnostic procedures are based on subjective assessments,
is deemed to be in need of suppression, so there are two projects
the goal of this study was to develop an objective assessment (...)”
focusing on self-regulating of impulsivity [72] and impulsive speak-
[105]). Further, it is often argued that automated diagnoses will
ing [143]. The breathing exercises with Chillfish [144] similarly are
reduce the workload for medical and therapeutic professionals to
aimed at training approaches for calming down. A small cluster fo-
let them have an “accurate, less time consuming and a less tedious
cuses on supporting the perception of time [46, 59, 61] and two
job” [3]. In addition to the initial diagnosis, it is envisaged that
projects support routines in the home: morning [146, 148] and
some methods may further be used in monitoring the outcomes of
evening [180, 181] respectively. Pina et al. [126] share this focus
interventions (e.g. [88]).
on families by supporting parenting strategies and interven-
Common approaches include fMRI and MRI (6x) [e.g., 2, 47, 80]23 ,
tions. Only one project looked at personal information man-
EEG or other brain waves (2x) [e.g., 75], eye tracking (3x), analysis
agement strategies of adults with ADHD [81]. A smaller num-
ber of projects have aims that do not neatly fit with descriptions 21 It is interesting to note that ADHD is already a predictor for anxiety - though not
of ADHD but are more aligned with research typically focussing vice versa - in three-year-olds [58].
22 Expectations on paper length preclude us from discussing this further, but suffice it
on autism, e.g. improving sensory processing via deep touch pres-
to say that Foucault [51, 52] would have had a field day with this.
sure therapy [42] or helping children to learn how to use touch 23 Most MRI and fMRI studies appear to be motivated by the 2011 ADHD-200 Global
appropriately and become used to social touch [97]. Competition on identifying ADHD bio-markers from brain imaging data, which states
of touchscreen interaction data or general movement data (6x) [e.g., primarily embody neurotypical expectations rather than neuro-
9, 117, 179], based on the assumption that ADHD people will fidget divergent needs and desires, as well as a singular framing of the
or exhibit particular movement patterns, as well as more complex target population as a source of “problems to solve”. We now discuss
combinations of bio-data (motion data, eye movement, heartrate, the implications of these findings in terms of understanding who
body temperature) (2x) [e.g., 163]). Three publications use screen- “the user” is for a specific technology in neurodivergent contexts
based computer-led tasks [73, 105, 179]. Others employ machine and what technological alternatives might look like based on the
learning to analyse questionnaire data to predict ADHD, or monitor concept of crip technoscience [66].
user performance during task switching [e.g., 73].
Of the twelve publications in our core corpus which focus on 5.1 Defining the Population of Interest
diagnostic technologies, the intended audience consists exclusively In numerous instances within both of our corpora, the emphasis on
of medical professionals and clinicians, sometimes additionally in- diagnosis and intervention means that the research conducted does
volving special education teachers. All of these publications rely not focus on people with ADHD as the “population of interest”,
on some form of outside observation. Only one considers that diag- but instead reduces them to a list of symptoms that need to be diag-
nostic tools could be helpful for self-diagnosis as a matter of clarity nosed and subsequently addressed, and ignores their perspectives,
and to identify personal access needs [179]. The focus on diagnosis experiences and wishes. As such, the research conducted embodies
from measurable behaviour can further be read as a distrust in a neurotypical perspective that subjects people with ADHD to so-
‘lived experience’ as almost none consider the inside perspective cietal norms. Subsequently, most technologies are not intended to
of what it is like to undergo diagnosis. Only one recent 2020 CHI be used by or to be in the control of people with ADHD, but rather
paper [88] reports to have interviewed children that took part in a by others in their environment, including professionals upholding
study with diagnostic tasks about their experience. This ties in with neurotypical norms (in line with what has been observed for autis-
a resistance to “subjective” (i.e family and self-reported) diagnostic populations previously [152]). In the spirit of “nothing about us
tics for something that is deeply experiential, embodied, culturally without us”, we identify a fundamental lack of active involvement
mediated, and lived [35]. Automating diagnostic procedures further of people with ADHD across the corpus, particularly in cases where
inherently reduces individuals to a set of symptoms (as previously they are relegated to act as a data source or acting as objects to be
shown in the context of autism [94]), an aspect that none of the tracked in a technological setting. These are precisely the settings
publications we surveyed critically grapple with. in which people with ADHD must be actively involved24 in the
Extended Corpus. The updated corpus reveals that the range of design of technologies from the outset so as to ensure that the
areas that are addressed has diversified somewhat in recent years. resulting technologies avoid amplifying existing power dimensions
Attention and concentration are still the dominant categories detrimental to neurodivergent individuals and that they actually
(7x), which includes training the ability to focus a target on a screen benefit people with ADHD. In this light, we now reflect on the lack
or training attention via an eye-gaze game [23] or adaptive learning of meaningful inclusion of people with ADHD within our corpus
environments that guide attention via a virtual agent on-screen. more generally.
Two projects address time management (this includes the only
paper focusing on adults [38]). Recent more extensive projects 5.2 UCD without the Users?
focus on self-regulation of behaviour and behaviour management The development process of most systems described in our corpus
(including [40]). These tend to build on the behaviourist notion of does not fulfil the criteria expected in modern day quality standards
a ‘token-based economy’ that reinforces ‘good behavior’ through for user-centred design (UCD) [79, 137]. A few pay lip service to the
rewards, such as being allowed to play a favourite game at the end approach, without the involved methodological and epistemological
of the day [155]. Two projects aims to train response inhibition commitments (i.e., not presupposing needs and desires), while oth-
or reduce impulsivity [16, 157]. One project develops a voice ers follow the general process in a rudimentary way, establishing
bot to support and scaffold daily task execution, goal setting requirements, and then move on to development and an evalua-
and planning [122]. An outlier, following a completely different tion study, whilst ignoring a key principle, that of focusing on all
approach, is the project by Boyd et al. [19] on sensory-inclusive play stakeholders (compare Section 4.3). This is at odds with textbooks
spaces for neurodiverse children. These support open-ended play on Interaction Design and UCD [77, 137, 140], which stress the im-
and develop ideas for play types from children’s sensory preferences portance of involving ‘real users’ in the design process, consulting
and needs. them, and taking account of their input, including their reactions
to prototypes. End user tasks and goals should drive development:
5 DISCUSSION “it is imperative that representative users from the real target group
Overall, our results show a preponderance of technologies for inter- be consulted” [137, p.432].
vention and diagnosis in the context of ADHD. We further identified
the exclusion of people with ADHD from knowledge production 24 Thisdoes not mean that researchers need to have or to publicly disclose ADHD,
of technologies for/about them. This leads to technologies which but refers to a process that actively elicits the perspective and opinions of people
with ADHD in both requirements analysis and evaluation, e.g. through interviews
the aim of understanding the neural basis of ADHD (http://preprocessed-connectomes- and other methods, or through co-design approaches that explicitly make space for
project.org/adhd200/) to inform diagnosis of ADHD and guide clinical decision-making their respective agency. It is decidedly not about research identity, but about an
for treatment. While the overall goal behind this might be well-intended, it makes us epistemological stance oriented on creating spaces for the meaningful collaborative
passive objects in a competition that treats our lives and selves essentially as extractable shaping of technologies together and a generally appreciative stance to take on in
(and, hence, discardable) data sources. technology research on ADHD.
As noted above, the ‘end users’ in many cases are not actually represent the desires of people with ADHD? Here, we need an
conceptualised as being people with ADHD, which leads to most of awareness of living expertise of people with ADHD akin to rising
these technologies amplifying neurotypically (in)formed positions awareness of the expertise of autistic people [116].
and perspectives. Basing a design solely on input from medical The way that ADHD individuals are treated in some of the work
experts (as done by some of the papers in our corpus) can mean we surveyed relegates us to detached objects involved in collecting
only involving ‘proxy users’ [137]. Most of the papers we analyzed data (e.g., by wearing trackers), but not involved in making mean-
actively consulted teachers and parents of ADHD individuals and ing about said data or ourselves. Ethics and IRB committees appear
not the individuals themselves. Yet in UCD, the latter (who are to approve of such research (possibly because they tend to derive
required to wear/use/be monitored by these systems) need to be from health research, which primarily discuss potential harms, and
considered direct users or primary stakeholders. This illustrates that where treatment is provided through doctors and other experts,
in research involving marginalised populations, who is identified who then also evaluate the outcomes). Moreover, ethics committees
as the primary stakeholders is not just a factual or designerly, but a consider disabled people and children as vulnerable to exploitation
critical and political decision. or loss of privacy, where it is deemed relevant to protect them from
Only few of the projects took an effort to understand the needs outsiders in their everyday life. Thus, especially with a prevalent
of people with ADHD and the consequences such technological focus on children with ADHD, at least two issues come together
interventions have on their well-being, experiences and overall that create an incentive to not work directly with them, as it is
lives. Indeed, many studies revealed cases of ‘resistance’, where procedurally less complex to rely on teachers and parents to ad-
participants did not behave as expected, rendering the intervention, minister and monitor a study, and rely on their feedback. The latter
essentially, useless (see Section 4.3.3). Hence, testing systems on issue extends to user testing of prototypes, frequently conducted
neurotypically presenting people cannot replace user tests with with neurotypical individuals, particularly when the concern is
ADHD individuals. In analogy, it is meanwhile well established with ADHD children. When ethics committees consider children
that interfaces for disabled people cannot be effectively designed with ADHD as a ‘vulnerable population’ or ‘high risk group’, they
or tested by participants temporarily putting themselves into a will only approve evaluation with ADHD people once prototypes
position emulating a disability, since the lived experiences with dis- have been pre-tested (as is the case with, e.g. [144, 145]). This is
abilities and the strategies involved therein cannot be momentarily presumably meant to spare vulnerable populations from a bad ex-
experienced and simulated [12]. perience when testing unstable and unusable systems, but leads to
The number of projects that sought to interview and gain feed- designs not being critically challenged early on and subsequently
back from ADHD individuals only covers roughly 12% of papers in the continued development of designs that ultimately turn out to be
the core corpus. Of other publications, few provided a rationale or much less helpful than imagined. The thinking behind this is flawed,
explanation for not consulting them, or listed this as a limitation assuming that if a system works for neurotypical populations, it
of the research. Yet within HCI, there has been a great amount of will similarly work for people with ADHD.
discussion of how to design for - and with - vulnerable populations Thus, institutional regulations can create hurdles for actively
(from homeless people, refugees, people living with dementia, the involving ADHD individuals. Unfortunately, we found little direct
visually impaired, to breast cancer patients) [159]. Thus, the impor- evidence that ethics committees prohibit the active involvement of
tance of doing so is known. Moreover, as participants in our corpus ADHD people and an inquiry into their experience within technol-
skew towards younger populations, it is commonly deemed insuffi- ogy trials, as none of the papers surveyed provided any rationale
cient in the area of Child Computer Interaction to take account of for not interviewing them. Here, we rely on future work interview-
children’s cognitive development as reported by medical and edu- ing authors on their experiences with formalised ethics procedures
cational experts, but that children need to be directly involved in to augment our theoretical inference. As we stated earlier, not
the design of technologies, and that active involvement is preferred, having done so should be explicitly highlighted as a research limi-
at minimum as testers (who provide feedback), if not as informants tation. Nevertheless, researchers could advocate stronger for UCD
or design partners [41, 79, 84, 129]. approaches that involve ‘vulnerable’ populations.
As it stands, though, the technologies resort to a rhetoric imply-
ing their population of interest being people with ADHD, while
5.3 People with ADHD as Study Subjects - But privileging perspectives that uphold neurotypical norms. This is
without Subjectivity? done by relegating individuals with ADHD to passive roles within
Only a few of the papers we reviewed consider the perspective the design and development processes of technologies that concep-
and the goals of the supposed population of interest. Instead, re- tualise us as passive in their interaction scenarios as well. Further,
searchers tend to consult parents, teachers, or medical-therapeutic by focusing on the vulnerability of the population, people with
professionals, thus exaggerating hierarchical power structures and ADHD are systematically kept outside the meaning making of tech-
potentially increasing conflicts (see also, [28]). This further raises nologies about us as part of the fundamental research design. This is
issues around informed consent: In the case of children with ADHD, below standards for the involvement of and considerations regard-
can we assume that parents can provide consent for their children ing neurotypical populations more generally, but also falls below
or should we acquire explicit consent from children? How can we HCI and Interaction Design standards for treating children, animals
even acquire genuine consent in the context of power hierarchies and other neurodivergent populations in research.
in schools and families [151]? In the case of adults with ADHD, can
we assume that medical professionals and therapists adequately
5.4 Speculating on Crip Technoscience for –; this orientation requires researchers to explicitly understand the
ADHD Technology Research resulting technological artifacts and implications as political. Refus-
ing an explicit position does not mean that the resulting artifacts
In preparation of our recommendations below, we now speculate
are less political [cf. 175] they might similarly embody specific pol-
on alternatives for technology research in the context of ADHD. We
itics themselves in return [89]. Hence, we recommend reflecting
do so by taking inspiration from the Crip Technoscience Manifesto
on and communicating the politics shaping research explicitly and
published by Hamraie and Fritsch [66]. By no means, we intend
hope researchers recognise interdependence as a stance in combi-
this to represent the desires of neurodivergent people at large or
nation with the last point of the Crip Technoscience Manifesto, the
even all people with ADHD. Fundamentally, our speculations do
commitment to disability justice.
not replace actually involving people with ADHD in (technology)
research about ADHD; they are ours alone. The manifesto lines out 5.4.4 “Crip technoscience is committed to disability justice.” [66]
four different principles we adapt for our specific context. Even though not all authors of this review understand their
5.4.1 “Crip technoscience centers the work of disabled people as experiences with ADHD as disabling, we share with the disability
knowers and makers.” [66] community the fundamental exclusion on meaning making about
As shown above, people with ADHD are largely not acknowledged our own lives and the technologies governing those. However,
in their expertise or being involved in generating designs. To some we further imagine here a commitment to crip kinship [91] in
extent, this is entangled with the tensions identified by Liang et al. that people with ADHD and researchers in this space think about
in research involving marginalised participants more generally re- disabilities and differing needs holistically and with a justice lens.
garding exploitation, membership, disclosure, and allyship [103]. We In that, we encourage technology researchers, akin to the Design
envision ADHD research to orient itself on collaborative partner- Justice principles, to “prioritize design’s impact on the community
ships between researchers and participants, while acknowledging over the intentions of the designer” [30]. Technology researchers
that these groups do not have to be and should not necessarily be need to actively attend to the harms they have (often inadvertently
completely distinct. However, disclosing membership is fraught but nevertheless) introduced to marginalised communities and to
with power dynamics considering that ADHD is partly understood position themselves towards those. This process is likely disruptive
a learning disability, which, if taken for granted on a surface level, and painful, but necessary to establish respectful and equitable
is counter-intuitive to also holding steady employment25 as a re- partnerships between researchers and marginalised communities.
searcher [178]. Hence, even if disclosure as a member is not possible,
positioning non-exploitative research from a place of allyship that
centers people with ADHD contextually, practically, and materially 5.5 Reading Research while Neurodivergent
can comprise a way to conduct future work in this area. Through the redefinition of people with ADHD as the explicit popu-
lation of interest and taking on commitments of Crip Technoscience,
5.4.2 “Crip technoscience is committed to access as friction.” [66] we envision future technology research in the context of ADHD to
We envision that the involvement of people with ADHD in re- be more equitable and better oriented on the needs and desires of
search and the resulting technologies should not try and orient this population. Of course, our perspective is biased. As neurodiver-
themselves to removing friction from interactions. Not just the gent readers ourselves, what we read are descriptions referring to
power dimensions inherent in such endeavours, also the diverging us and our families, descriptions that are oriented on deficits, study
ways of perceiving and processing environmental input lead to designs that employ drill techniques and behavioral conditioning
potential for different interpretations and priorities. Prior research methods based on reward and punishment approaches. The way in
involving groups of neurodiverse children has shown that differ- which the participants were described, the things they were asked
ent attitudes towards design [93] as well as deliberately agonistic to do, or discouraged from doing, and the expectations for ‘desired
strategies [54] have fundamentally productive consequences not behaviours’ underlying these interventions frequently showed little
just for more collaborative interactions among neurodiverse groups consideration for the actual needs and the emotional well-being of
consisting of neurodivergent and neurotypical individuals, but also neurodivergent participants, even if the intention of the researchers
for the design of technological artefacts. We do not recommend was ‘to do good’ [108]. Over and over again, we read about study
here to actively introduce harmful aspects of friction, but rather sit designs that treat our peers as research subjects without any agency,
with emerging ones, questioning why this friction became appar- who are seen to depend on being conditioned to behave according
ent at a given moment and what underlying dynamics govern it, to norms set by medical experts and teachers because their lives
instead of trying to smooth them over as a reflex. would otherwise be doomed to failure. This is emotionally difficult,
5.4.3 “Crip technoscience is committed to interdependence as politi- feels offensive and violating, and contradicts our lived experiences
cal technology.” [66] as agential beings. Hence, our reading is influenced by this affec-
We further speculate on research valuing interdependence more, tive, emotional and very personal reaction towards the texts in the
i.e., attending to how everyone depends on others to survive, which corpus. However, precisely because our perspective is marginalised
is pronounced for disabled people [11]. This “possible orientation” while the perspectives of medico-therapeutic professionals as well
[ibid] – which we, in line with Bennett et al. do not mean as prescrip- as those of researchers and funding bodies at large dominate the
tive, but rather suggest as a commitment to access more generally discussion of which technologies are relevant to design, develop
and assess in the context of ADHD, our interpretation and analysis
25 within the limits of neoliberal academia provides an additional viewpoint to consider. We do not claim that
our reading stands for all neurodivergent people or for all people solely on which behaviours teachers and parents (or medical ex-
with ADHD, but it is an instance of an assessment that compliments perts) want to suppress in children or youth, and which to increase,
and challenges the status quo we found in our corpora. working with systems of punishment, social ostracism and rewards.
There is no investigation into how the objects of such procedures
6 IMPLICATIONS FOR RESEARCH actually feel, how these procedures affect pupils, and what they
genuinely need and want.
Understanding existing concepts of ‘users’, prevalent scripts and
Essentially, we urge our professional colleagues to take up the
the potentials of crip technoscience comprises only the first step
responsibility that comes when working with marginalised groups
for researchers to critically and equitably engage with technology
in research. Even if researchers are lured in by the rhetorics of
research involving people with ADHD. While other researchers and
‘helping’ and ‘supporting’ [43], they need to a) acknowledge the
even other researchers with ADHD might come to differing sugges-
potentially harmful implications their work might have [171], b)
tions, we provide some guidance as to how, from our perspective,
use appreciative language that is not oriented on a presumed deficit
technology researchers might conduct work with this population in
and c) acknowledge that the people behind a supposedly ‘other’
the future. Our recommendations start suggesting alternative ways
group might be closer than initially assumed. We are technology
of conceptualising ADHD and the people diagnosed with the con-
researchers as well and we are deeply affected by how the field
dition from a disability studies perspective. We then propose some
conceptualises us and our peers.
considerations to directly and equitably involve neurodivergent
people in technology research concerning them and the exciting
space opening up for critically informed technological development 6.2 Involving Neurodivergent People as
in this space more generally. Partners in Research
People with ADHD need to be acknowledged as core stakehold-
6.1 Conceptualising ADHD ers in research. We call for researchers to actively advocate with
We need to fully acknowledge that we already started from the point IRB and ethics committees for user-centered and participatory ap-
proaches, which empower participants and meaningfully involve
of view to understand ADHD not along notions of pathology but
them. Researchers need to provide more extensive argumentation
instead as a neurological variance among many neurotypes (akin to
neurodiversity [32]). However, in reviewing our corpus, we find that for why ADHD children (and adults) are not at ‘higher risk’ as par-
the fundamentally dominant way in which ADHD is conceptualised ticipants of a study than neurotypical children and why their active
is rooted in the notion of a medical deficit model of disability. This participation is indispensable for ensuring the resulting systems
is not only a question of values and conceptual differences (albeit are adequate and improve their quality of life. The research commu-
it is that as well), but also leads to the proliferation of plain faulty nity could contribute to this by collating examples of IRB-approved
assumptions of what might support people with ADHD and, in CoDesign and UCD studies with populations that typically are con-
some cases, introduces active harms. sidered vulnerable. In that, we hope that our indication that this
As an example, many of the publications we surveyed aim to comprises an ethical issue through our review supports authors’
arguments within their institutions.
train the ability to focus attention on a task. The assumption here is
Methodologically, we see an implication for future research in
that neurotypical modes of ‘paying attention’ are helpful for people
with ADHD in the same way. For one, this seems to only consider directly including people with ADHD in research about ADHD.
distractability without acknowledging periods of intense focus dur- Instead of talking about individuals (and inherently conceptualis-
ing which people with ADHD find themselves so immersed in a ing them as not worth talking with), actively involving them is the
given activity that we might even ignore bodily needs for as long basis for respectful and appreciative partnerships. This can, for ex-
as possible [82]. It is typical for people with ADHD to go into this ample, happen in the form of collaborating with other researchers
kind of ‘hyperfocus’ [65, 96] once they achieve focus on a task with ADHD, with activist organisations or, within the adequate
that they are genuinely interested in. Attention thus is generally, epistemological commitments, as active participants. Fundamen-
but in particular for us, highly contextual and a given strategy tally, though, and following Walker et al., we urge researchers to
that works for a specific context (e.g., building prototypes) does consider how their work and actions relate to existing power differ-
entials and might introduce new ones, to conceptualise consent in a
not readily transfer to another (e.g., writing a paper). Studies that
meaningful way for all parties involved, and to center people with
train attention on random tasks in a lab-setting have the inherent
weakness that the skills trained in this way do not transfer to other ADHD in technology research and design, starting with the use of
contexts and situational demand-structures, and ignore the role of respectful and appreciative language [160]. Some examples in our
motivation and goals. corpus already started conducting such work (e.g., [27]), though
Moreover, many of the interventionist and ‘therapeutic’ ap- such work mostly occurs in the extended corpus (i.e., in recent
proaches as well as diagnostic technologies all play together to years) and is few and far between.
amplify the harm done to people with ADHD [142]. While de-
bunked in other contexts as not only ineffective [62], but deeply 6.3 Attending to Technology
harmful [98], behaviourism is still prevalent in the technologies The technologies represented in our corpora largely hail from fram-
we surveyed. The consequences thereof include a higher rate of ing ADHD as a deficitary difference requiring correction and cure
depression among people with ADHD [34] as well as a higher rate [28], a problem requiring a solution [15] – preferably a technical one.
of suicidal ideation [56]. Many of the publications surveyed focus What is lacking, however, are technological designs that adequately
account for neurodivergence and ADHD as a mere difference [8], their technological interactions compared to adults. Hence, delib-
that attend to existing strengths, akin to ability-based design [176] erately engaging with adults has the potential to challenge the
and allow for self-determined engagement with technologies ori- dominant paternalistic paradigms governing much of technology
ented on the populations’ needs. The potential of attending to these research in the context of ADHD currently.
strengths has been additionally shown by a recent interview study Similarly, we see potential in technologies supporting executive
about the positive aspects of ADHD with successful adults with functioning on self-given tasks. In opposition to making people with
ADHD [135]. We argue, that the development of technologies ori- ADHD adhere to an externally defined task regime, we suggest iden-
ented on supporting agency and choice provides ample research tifying opportunities for supporting and allowing people to figure
opportunities in this area that remain largely untapped. In the out how to get those things done that they want to succeed at in-
remainder of this section, we illustrate some of these potentials. trinsically26 . Even though we see many strengths in our neurotypes
While it makes sense to focus on children, simply because due and how they are influenced by ADHD, we also acknowledge that
to their on-going development, technological research can be grat- some difficulties could do with support; however, this should be
ifying for researchers and funding bodies alike, we identified a driven by the needs and desires of people with ADHD, instead of
significant lack of technologies for adults with ADHD. These adults using every technological design in this space as an opportunity
include the authors of this paper and might be colleagues and collab- for externally driven interventions.
orators. Hence, adults with ADHD can and do lead successful work Apropos strengths of ADHD: As mentioned above, research
lives, but might require different stimuli to work well in their areas in our combined corpora largely configured ADHD as a deficit.
of expertise. Additionally, technologies offering to structure daily Hence, these works did not consider supporting any strengths in
life can be useful, but should provide flexible options to account ADHD, given these were conceptually absent. Such strengths are
for the individual complexities involving, for example, the care for expressed individually for every person with ADHD and might lie
children and/or other family members or a demanding social and/or in enhanced creativity, being able to make connections between on
work life. surface different areas, abstracting content or planning (for others).
Finally, we strongly recommend moving away from behaviourist Given that many adults with ADHD have developed a range of
interventions that solely aim at disciplining people with ADHD strategies for coping with the demands of neurotypically shaped
into acting more neurotypically. This has fundamentally negative societies, technologies could also have a role in supporting such
impacts on their lives largely due to associated stigmas [138] as strategies (similar to [81] in our core corpus).
seen in increased depression [127] as well as suicide rates [57]. Finally, we see potential in taking a step back and looking at
Similarly, technologies supporting diagnostic processes could be how people with ADHD already use and appropriate existing tech-
more humane by being oriented on providing an opportunity for nologies. One example could be how they seek and distribute infor-
supporting an individual with ADHD compared to identifying and mation on social media to create communities oriented on meaning
managing them. These technologies could be oriented on the dialog- making about themselves. There is similarly no work available
ical process involved in diagnosis [35], acknowledge the differences trying to understand why many of the strategies working for neu-
in presentation e.g., along age or gender and include strategies that rotypical individuals fail ADHD people in structuring their lives
support the identification and establishment of self-determined (e.g., weekly calendar planning [100]).
management of the condition and its presentation in a neurotypi- The possibilities for such projects, considering ADHD holisti-
cally structured world. cally along multiple facets, involving people with lived experiences
adequately, understanding technology with the potential for eman-
cipation and attending to questions that remain open from a self-
determined perspective, show us that the status quo of how technol-
6.4 Gaps in Research ogy research in the context of ADHD can be challenged. Hence, we
Next to the direct implications for ADHD technology research in encourage our colleagues as well as our peers (and those who fall
general, we also identified a number of gaps that could redefine in both categories) to contribute to actualising these possibilities –
and further explore the role(s) technologies play in this context. fully acknowledging that technology researchers need to build up
We present only a few as a starting point for conversations about trust first [170]. Here, we hope that our work might contribute to
alternative approaches; this is by no means a complete list. However, building a foundation to start a productive conversation.
it shows that beyond language use, the involvement of people with
ADHD and a closer look at the discursive and material consequences 7 CONCLUSION
technologies embody, there are core topical gaps in the knowledge We presented an analysis of works discussing technologies in the
production about ADHD and technologies. context of ADHD from the perspective of neurodivergent readers.
Most of the works we surveyed focused on ADHD in children In our results, we delineated how people with ADHD are often kept
and even where this was not the case, often opted for young partic- from co-producing the technologies that are proposed to assist them.
ipants (i.e., children or adolescents). One (to us) glaring gap lies in We further identified that technological research largely focuses on
the need for research involving adults, including especially older diagnostic and interventionist approaches, with changing attitudes
adults with ADHD. As adult life is typically less externally struc-
tured compared to children’s lives, technologies likely would take 26 The language here is deliberately chosen to echo self-determination theory [36] in
on different roles. Additionally, children tend to be more entrenched the spirit done for autistic people [168] and neurodivergent populations in a different
in power structures and are attributed less agency in deciding about technological context [153].
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ADHD and Technology Research

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ADHD and Technology Research – Investigated by

Rua M. Williams Judith Good

ABSTRACT ACM Reference Format:

Topic Length Papers n

Diagnosis short [3, 24, 73, 105, 163] 5

ADHD as narrative short [166] 1

Abstract/General medium [119] 1

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