Representing Behavioral Pathology: The Importance of Modality in Medical Descriptions of Conduct, ADHD as Case Study

Figures & data

Table 1. Contrastive account of modality in the DSM, the BNC medical and natural sciences corpus, the ADHD and ODD sections.

	DSM-5 (449,197 words)			BNC (medicine and natural sciences) (2,557,269 words)			ADHD section of the DSM- 5 (3,523 words)			ODD section of the DSM-5 (2,021 words)
	Hits	Normalized frequency^a	% of modality^b	Hits	Normalized frequency	% of modality	Hits	Normalized frequency	% of modality	Hits	Normalized frequency	% of modality
May	3432	7.6403	55.71	7094	2.7741	53.68	43	12.2055	47.25	9	4.4532	23.08
Often	685	1.5249	11.12	1502	0.5873	11.37	24	6.8124	26.37	15	7.4221	38.46
Must	399	0.8883	6.48	1239	0.4845	9.38	5	1.4192	5.49	4	1.9792	10.26
Tend(s) to	153	0.3406	2.48	298	0.1165	2.25	4	1.1354	4.40	0	0.0000	0.00
(un)common(ly)	698	1.5539	11.33	1353	0.5291	10.24	6	1.7031	6.59	7	3.4636	17.95
More likely/unlikely/likelihood	409	0.9105	6.64	609	0.2381	4.61	5	1.4192	5.49	0	0.0000	0.00
Probable/probability	84	0.1870	1.36	1015	0.3969	7.68	1	0.2838	1.10	0	0.0000	0.00
Typically	301	0.6701	4.89	106	0.0415	0.80	3	0.8515	3.30	4	1.9792	10.26
Total	6161	13.7156	100	13,216	5.1680	100	91	25.8303	100	39	19.2974	100

^aFrequencies have been normalized per 1000 throughout.

^bInter-modality ratios, modality distribution.

Table 2. Modality in the DSM-V corpus compared to the BNC (medical and natural science) corpus.

	Observed frequencies		Expected frequencies		Over/under-use	Log Likelihood	Normalized frequencies
	DSM	BNC	DSM	BNC			DSM	BNC
May	3432	7094	1572.69	8953.31	+	2053.76	0.00764	0.00277
Often	685	1502	326.76	1860.24	+	371.48	0.00152	0.00059
Must	399	1239	244.73	1393.27	+	99.27	0.00089	0.00048
tend(s) to	153	298	67.38	383.62	+	100.41	0.00034	0.00012
(un)common(ly)	698	1353	306.44	1744.56	+	461.38	0.00155	0.00053
more likely/unlikely/likelihood	409	609	152.10	865.90	+	380.47	0.00091	0.00024
probable/probability	84	1015	164.20	934.80	-	54.49	0.00019	0.00040
typically	301	106	60.81	346.19	+	711.90	0.00067	0.00004
TOTAL words (corpus)	449,197	2,557,269

Table 3. Modality in the ADHD corpus compared to the DSM-V corpus.

	Observed frequencies		Expected frequencies		Over/under-use	Log Likelihood	Normalized frequencies
	ADHD	DSM	ADHD	DSM			ADHD	DSM
May	43	3432	27.04	3447.96	+	8.05	0.01221	0.00764
Often	24	685	5.52	703.48	+	34.09	0.00681	0.00152
Must	5	399	3.14	400.86	+	0.94	0.00142	0.00089
tend(s) to	4	153	1.22	155.78	+	3.98	0.00114	0.00034
(un)common(ly)	6	698	5.48	698.52	+	0.05	0.00170	0.00155
more likely/unlikely/likelihood	5	409	3.22	410.78	+	0.85	0.00142	0.00091
probable/probability	1	84	0.66	84.34	+	0.15	0.00028	0.00019
typically	3	301	2.37	301.63	+	0.16	0.00085	0.00067
TOTAL words (corpus)	3,523	449,197

Table 4. Modality in the ADHD corpus compared to the ODD corpus.

	Observed frequencies		Expected frequencies		Over/under-use	Log Likelihood	Normalized frequencies
	ADHD	ODD	ADHD	ODD			ADHD	ODD
May	43	9	33.04	18.96	+	9.24	0.01221	0.00445
Often	24	15	24.78	14.22	-	0.07	0.00681	0.00742
Must	5	4	5.72	3.28	-	0.24	0.00142	0.00198
tend(s) to	4	0	2.54	1.46	+	3.63	0.00114	0.00000
(un)common(ly)	6	7	8.26	4.74	-	1.62	0.00170	0.00346
more likely/unlikely/likelihood	5	0	3.18	1.82	+	4.53	0.00142	0.00000
probable/probability	1	0	0.64	0.36	+	0.91	0.00028	0.00000
typically	3	4	4.45	2.55	-	1.23	0.00085	0.00198
TOTAL words (corpus)	3,523	2,021

Table 5. Modality types in ADHD representation.

Modality resources	Hits	Type	Orientation	Value	Context of use
May	43	Modalization: Probability & Usuality	Subjective	Low	- Diagnostic criteria - Diagnostic features - Associated features - Development and course - Risk and prognostic factors - Culture-related diagnostic issues - Functional consequences - Differential diagnosis - Comorbidity
Often	24	Modalization: Usuality	Objective	Middle	- Diagnostic criteria - Associated features - Development and course - Functional consequences - Comorbidity
Must	5	Modalisation: Probability (& Modulation)	Subjective	High	- Diagnostic features - Differential diagnosis (modulation)
Tend(s) to	4	Modalization: Usuality	Objective	Middle	- Diagnostic features - Functional consequences - Differential diagnosis
(un)common(ly)	6	Modalization: Usuality	Objective	Low/Middle	- Associated features - Development and course - Differential diagnosis - Comorbidity
More likely/unlikely/likelihood	5	Modalization: Probability	Objective	Middle/Low	- Risk and prognostic features - Gender-related diagnostic issues - Functional consequences
Probable/probability	1	Modalization: Probability	Objective	Middle	- Functional consequences
Typically	3	Modalization: Usuality	Objective	Middle	- Diagnostic features - Differential diagnosis

Table 6. Functions of “may” in the DSM-V’s description of ADHD.

Type: Epistemic-oriented (Modalization: Probability & Usuality)	Examples
(1) Expression of a strong or “certain” possibility	“Impulsive behaviors may manifest as social intrusiveness”
	“The increased motoric activity that may occur in ADHD”
(2) “Objective possibility.” A fact X has been evidenced as occasionally being the case.	“e.g., (…) may start using other people’s things without asking or receiving permission (…)”
	“individuals with ADHD may exhibit cognitive problems”
(3) Expression (mainly) of hypothesis. The fact is possible in logical terms but assumption of low probability.	“A minority of cases may be related to (…) aspects of diet”
	“There may be a history of child abuse (…)”
	“Family interaction patterns (…) are unlikely to cause ADHD but may influence (…)”