Drugs, labels and (p)ill-fitting boxes: ADHD and children who are hard to teach

Abstract

In offering a critical review of the problem we call ‘ADHD’ (Attention Deficit Hyperactivity Disorder), this paper progresses in three stages. The first two parts feature the dominant voices emanating from the literature in medicine and psychology which, when juxtaposed, highlight an interdependency between these otherwise competing interest groups. In Part 3, the nature of the relationship between these groups and the institution of the school is considered, as is the role that the school may play in the psycho-pathologisation of fidgety, distractible, active children who prove hard to teach. In so doing, the author provides an insight as to why the problem we call ‘ADHD’ has achieved celebrity status in Australia and what the effects of that may be for children who come to be described in these ways.

Notes

1. This suggests that the ‘problem’ of stimulant medication relates not to what is contained in the packet, nor in how it is being prescribed but, instead, with those administering the contents. Often the blame comes to rest with the parent who, even when following medical advice, still find themselves at the pointy end of the media-blame game, see Myler (2006). For example, a hyperlink to access a media release on Queensland University of Technology's homepage reads ‘Parents overdose children with medication’. The article describes the research into the management of fever by parents, saying ‘international studies showed more than 30 per cent of parents overdosed children, while a quarter underdosed youngsters with drugs like paracetamol and ibuprofen – or both. As part of Australia's first study into how parents manage fever in children, Ms Walsh (Myler, 2006) reviewed 24 years of worldwide research and found mismanagement of fever is a universal trend. She said while little had changed in what parents knew about fever, there was some concern about the new trend of alternating different types of medication. Problematically, only half-way through the story is it acknowledged that parents do so under medical advice. ‘A lot of parents are now being advised to give their children paracetamol and then follow up with some ibuprofen maybe two hours later’. However, the damage is done and the nurses and doctors giving the advice to parents have been effaced from the scene.

2. This includes Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) in the USA and Attention Deficit Disorder Information and Support Service (ADDISS) in the UK. These relationships are the subject of a class action suit in the USA, see Schmitt (2000).

3. Adderall is not available in Australia.

4. This is a policing system with aims similar to the Schedule II/triplicate prescription system in the USA.

5. Since the 2006 budget, up to 12 appointments with a psychologist per year are now part subsidised by the Federal Government.

6. Despite the wealth of research in speech/language that looks to the effects of language difficulties on behaviour, speech therapy services remain a predominantly private cost. Such therapy is usually ongoing and intensive and out of financial reach for many families.

7. The medications used include the psycho-stimulants (Ritalin, dexamphetamine and Concerta), anti-depressants [selective serotonin reuptake inhibitors (SSRIs) and tricyclics] and anti-psychotics, such as Respiridone.

8. Number of prescriptions dispensed for dexamphetamine sulfate, 1999–2000 per 1000 population was 43.2 for Western Australia. The next closest state was Tasmania with 16.3 (see Mackey & Kopras, 2001, p. 5).

9. One major flaw in the research that looks to comparative studies of psychological therapy + medication versus medication alone is that comparison of effectiveness against educational intervention alone is rarely done.

10. Archival records from an alternative-site placement centre in South East Queensland were obtained via application to Education Queensland Central Office and the school principal. Ethical clearance was obtained through: (1) the Human Ethics Research Committee at the Queensland University of Technology, (2) Education Queensland Central Office and (3) the Principal of the Centre. Three completely de-identified student files from the period 2000–2004 were provided to the researcher by centre staff.

11. This increased to 28 during his enrolment at the A-SPC.

12. In accordance with Speech/Language Impairment eligibility criteria a student must present at least two standard deviations below the mean to be eligible for external funding provision under the Educational Adjustment Program. Randle had an expressive language ability more than 2.5 standard deviations below the mean and thus would be considered Speech/Language Impaired and eligible for disability support funding. Unfortunately for Randle, other reasons for disruptive behaviour such as speech/language disorders must be identified before appropriate support is provided. Because “behaviour” took precedent, each of the schools he attended prior to the A-SPC failed to assess and address Randle's difficulties in learning.

13. Speech/Language Impairment is one of six categories of disability recognised and supported by Education Queensland (see Appendix 1).

14. Queensland is the only state in Australia that requires a medical diagnosis of impairment for disability support eligibility. The incidental effect of this particular policy is a direction towards the medical model. This may influence how particular behaviours are viewed.