Children and youth in behavioural and emotional difficulties, skyrocketing diagnosis and inclusion/exclusion processes in school tendencies in Denmark

Abstract

In parallel with a national school policy on an inclusive school with a marked reduction in the number of pupils who, due to their disruptive behaviour, are referred to educational provisions outside of the ordinary school environment, a sharp rise has been seen in the number of children and teenagers who are given a clinical diagnosis, first and foremost that of ADHD (Attention Deficit and Hyperactivity Disorders). Over just a few years, the skyrocketing of diagnoses has turned notions of children and teenagers with emotional and behavioural difficulties upside down. From being young people who should ‘just pull themselves together and behave properly’ many have become pupils with a neurological dysfunction that requires treatment. The article provides insight into how diagnoses over very few years have come into focus in schools and in special needs education, and how this has made a deep impression and changed understandings of the best possible special and general educational provisions for children and teenagers with behavioural and learning difficulties. The article focuses on trends in Denmark and therefore builds primarily on Danish sources.

Keywords:

• inclusive school politics
• neuroscience
• diagnosis and comorbidity
• behavioural and learning difficulties
• self-responsibility and sanctions
• SEN in Denmark

Notes

^1. The population of Denmark is around 5.6 million.

^2. The use of the number of people who are treated with medication as an indicator of the number of people with an ADHD diagnosis is due to the fact that Denmark works clinically with the World Health Organization’s ICD-10 diagnosis manual, which does not include the diagnosis of ADHD (it includes instead the more restrictive ‘hyperkinetic disturbances’). However, the American ADHD term (from the DSM-IV diagnosis manual with three ‘degrees’ of ADHD) is increasingly used, amongst other reasons because international research on the phenomenon uses the ADHD diagnosis category (Referenceprogrammet 2008). In itself it seems that this tendency to change the clinical perspective can explain part of the marked increase in the number of diagnosed children and teenagers in that the prevalence of the psychiatric dysfunction on the basis of ICD-10 is estimated at 1–2% of the population, while on the basis of DSM-IV it is believed to be 3–5% (Bilenberg 2007).

^3. As a member of the evaluation panel behind the report, I gained, through many visits to schools and administrative units around Denmark, and through interviews, not only a surprising picture of the differences between school cultures, but also a clear impression of there being many common characteristics in relation to the different groups of pupils with behavioural and emotional difficulties.

^4. An example of this kind of link between ADHD and behavioural difficulties is a research study that concludes that children with ADHD seem to have 6.6 times greater probability for conflicts with their classmates and 6 times greater probability for conflicts with their teachers than other children. And – what is perhaps even more thought-provoking – they seem to have 50 times less chance of having a good friend (the study was carried out by Bengtsson, Hansen, and Bøgeskov in 2011 and is referred to in Bengtsson et al. 2011, 27).

^5. A corresponding problem has emerged in relation to children and teenagers who are first- or later-generation immigrants, who are also greatly under-represented amongst those diagnosed with ADHD. This under-representation is explained as the likely result of ‘prejudices amongst professionals’ and that ‘they interpret ADHD behaviour as an expression of culture, identity crises, war traumas or family problems’ (Social Consultant Doctor Jon Arnfred, quoted in Mygind 2008, 1).

^6. Christoffersen and Hammen (2011) provide a survey of international research-based knowledge of ADHD treatment.

^7. A questionnaire survey of teachers gives an impression of how many work with one or more of the rapidly growing ‘conceptual pedagogies’: Cooperative Learning 68%; Classroom Management 57%; Step-By-Step 53%; LP (or the equivalent) 46%; PALS (or the equivalent) 6%; KASA (or the equivalent) 4%; Other 16%; None 16%. Even though some of these concepts are known outside Denmark, the overall picture gives an impression of the extent and it is notable that only 16% said that they did not use concepts that come from outside. NB It was possible to give more than one answer; therefore, the sum of the percentages is not 100 (EVA 2011, 27).