Medicating of schoolchildren I
Joar Tranøy
|
Joar
Tranøy is a criminologist (MA), psychologist (BSc.), historian (BA) and
School Counselling Advisor. Previously a researcher/research scholar at the University
of Oslo and Senior Scientific Officer at the University College in Østfold. This
article is published here with the kind consent of the author. |
The medicating of behavioural problems in Norwegian
schools is approaching epidemic conditions with regard to diagnosing and
treating children with behavioural difficulties. This is particularly true of
the diagnosis Attention Deficit Hyper-activity Disorder (ADHD) and Ritalin
where at least 3000 schoolchildren are medicated by means of the central
stimulating agent. The number is twice as large as in our neighbouring country
Sweden, with twice our population.
Figures from the Norwegian
Pharmaceuticals Depot show that the use of Ritalin in the period 1986-96 had
quadrupled in Norway. The increase for Ritalin was 125 per cent from 1996 to
year 2000. The head of the state nationwide expertise centre for ADHD,
Tourette’s Syndrome and narcolepsy recommends that at least 10 000 Norwegian
children need Ritalin. School-related behavioural problems have become a major
individual clinical area of attention connected to regional and nationwide
centres with psychiatrists, neurologists, psychologists and special pedagogues
in a professional medical environment.
Behavioural problems are
regarded as a functional disorder in the brain of a biochemical nature.
Children are heavily medicated in order to achieve calm in the school. In this
way the adults concerned are exempted from responsibility. Such a medical disciplining
of disruptive and inattentive schoolchildren often leads to fundamental
problem-creating system conditions. Alternative provision (such as alternative
schooling) is precluded because the authorities wish to preserve the semblance
of "integration of all" within a uniform school system.
The diagnostic basis for ADHD
is extremely unclear. It is said that children are inattentive because they
have ADHD and that they have ADHD because they are inattentive. On the form for
diagnosing ADHD the question is asked, for example, whether the child has the
following bad habits: Is it not attentive enough to details or does it make
careless mistakes in its schoolwork? Does it fumble with its hands and feet, or
sit restlessly on its chair. Does it have problems in sustaining attention in
tasks or games. Does it often leave its place in the classroom or get up
elsewhere, when he/she should be sitting still? Does it not appear to hear when
being directly addressed. If the answer is ‘yes’ to these questions, the criteria
for the diagnosis are, so to speak, met. The border between "sick"
and normal is a fluid one.
The registration is
undertaken at home by the parents and at school by teachers. When the reports
from the teacher and the parents are contradictory, consideration is normally
given to the teacher’s report since the latter possesses greater awareness of
age-related norms. The symptoms are more easily registered in situations that
require self-development, as in the classroom. The deviation may actually not
be present in other situations.
The teacher’s assessment
often appears to be the decisive one, and the School-councelling service as the
expert instance normally follows up the school assessment of who is a
"normal" child. It is not necessarily the case that it is the pupils
that create the problems, but rather the school’s teaching and frameworks that
create difficulties for the pupils.
The diagnosis of ADHD is
highly subjective and is decided on the basis of culture-relative norms. In
addition there are framework conditions and contexts such as, for example, the
child’s daily pattern etc., that is not taken into consideration. Moreover the
treatment level may vary considerably with a child. Even within the same
family.
The incidence of ADHD shows itself
to be proportional to the presence of, and influence by, behaviour
diagnosticians, testers and therapists in the schools, not only in the USA but
also in Norway.
Social conditions also exert
an influence. For example there is the worsening of the physical and social
environment in the schools with reduced opportunities for play and physical
development. At the same time the pressure of theory has increased. Children
can easily be run over in the school system with its behavioural experts,
towards whom even the teachers and advisors feel powerless.
The employment of Ritalin
appears to serve as a solution or an alternative to changing the school
environment and the school system. Ritalin becomes a short-term aid. The child
becomes easier to deal with without there being a documented effect on school
performances and psychosocial functioning in the longer term. A particular
difficulty is the danger of addiction. It is difficult to stop taking the material
after long-term use. The problem is referred to as "Withdrawal
syndrome", and involves a serious and sustained depression and suicide
danger.
Follow-up examinations are
subject to serious limitations. The observation time is seldom longer than a year.
The assessment of the results are completely restricted to the actual symptoms,
and do not include subjective reports regarding well being etc.
It is not necessarily the
case that the absence of symptoms is synonymous with subjective well being and
quality of life. Even in those cases where freedom from symptoms also involves
subjective well-being, the Ritalin treatment is not necessarily ethically
defensible if, in the longer term it contributes towards social invalidity.
Ritalin and the label ADHD individualise social and moral problems. Social and
ethical problems will, by means of the diagnosis, be constructed as a question
of deficient individual adjustment. How are trouble-makers, disruptive
elements, to be dealt with? The child is rendered ill and stigmatised.
We adults save our own
honour, but not that of the child. With the power and disciplining perspectives
of Michel Foucault, we are able to regard the medicinal practice in respect of
children as a kind of separating and excluding practice, where the treatment
represents an extension of society’s excluding procedure, where children are
subjected to a chemical control.
Those who determine normality
possess power and it is groups of experts who possess this power through their
social technology. The determination of the deviation concept becomes
increasingly fine-meshed: classification of the deviation is subjected to
constant new categorising and dividing lines. It is particularly children at
whom the new diagnoses are directed. Among these are ODD (Oppositional Defiant
Disorder), CD (Conduct Disorder) and OCD (Obsessive Compulsive Disorder). The
diagnosis ODD applies to what is referred to as the defiance illness for
children aged 5-6 years who are "egocentric and narcissistic." Since
the 1950s the diagnoses in the two international psychiatric diagnosis systems
have increased more than twofold.
In conclusion: Do we wish to
have a society comprising only well-controlled and pliant people - Are we about
to realise Aldous Huxley’s frightening vision of the future in "Brave New
World"?
Connecticut approves Ritalin Law