From ABCs to ADHD… - Australian Association for … ABCs to ADHD… The role of schooling in the construction of ‘behaviour disorder’ and production of ‘disorderly objects’

* Linda J. Graham, Centre for Learning Innovation, Faculty Of Education, Queensland University Of Technology (QUT), Kelvin Grove QLD 4059, AUSTRALIA, Email: [email protected]

From ABCs to ADHD… The role of schooling in the construction of ‘behaviour disorder’

and production of ‘disorderly objects’

Linda J. Graham*

Queensland University of Technology

GRA06089: AARE November 2006, Adelaide

Discussionȱ ofȱ AttentionȬDeficit/Hyperactivityȱ Disorderȱ (ADHD)ȱ inȱ theȱ media,ȱ andȱ thusȱ muchȱ popularȱdiscourse,ȱ typicallyȱ revolvesȱ aroundȱ theȱ possibleȱ causesȱ ofȱ disruptiveȱ behaviourȱ andȱ theȱ “behaviourallyȱdisordered”ȱchild.ȱ ȱTheȱusualȱsuspectsȱȬȱtooȱmuchȱtelevisionȱandȱvideoȱgames,ȱfoodȱadditives,ȱbadȱparenting,ȱlackȱofȱdisciplineȱandȱsingleȱmothersȱ–ȱfeatureȱprominentlyȱasȱpotentialȱcontributorsȱtoȱtheȱspirallingȱrateȱofȱADHDȱ diagnosisȱ inȱ Westernȱ industrialisedȱ nations,ȱ especiallyȱ theȱ Unitedȱ Statesȱ andȱ Australia.ȱȱConspicuouslyȱabsentȱfromȱtheȱfieldȱofȱinvestigation,ȱhowever,ȱisȱtheȱsceneȱofȱschoolingȱandȱtheȱinfluenceȱthatȱtheȱdiscoursesȱandȱpracticesȱofȱschoolingȱmightȱbringȱtoȱbearȱuponȱtheȱconstitutionȱofȱ“disorderlyȱbehaviour”ȱandȱsubsequentȱrecognitionȱofȱparticularȱchildrenȱasȱaȱparticularȱkindȱofȱ“disorderly”.ȱȱThisȱpaperȱreviewsȱaȱsampleȱofȱtheȱliteratureȱsurroundingȱADHD,ȱinȱorderȱtoȱquestionȱtheȱfunctionȱofȱthisȱabsenceȱand,ȱultimately,ȱmakeȱanȱargumentȱforȱanȱinterrogationȱofȱtheȱschoolȱasȱaȱsiteȱforȱtheȱproductionȱofȱdisorderlyȱobjects.ȱ

Introductionȱ

AttentionȱDeficitȱHyperactivityȱDisorderȱorȱ“ADHD”ȱasȱ itȱ isȱnowȱcommonlyȱknown,ȱ isȱaȱmodernȱphenomenonȱ thatȱhasȱsparkedȱvirulentȱdebateȱ inȱrecentȱyearsȱsinceȱanȱexponentialȱ increaseȱ inȱ theȱrateȱofȱdiagnosisȱhasȱoccurredȱ Ȭȱmostȱnoticeablyȱ inȱ theȱUnitedȱStatesȱ(Goldmanȱetȱal.,ȱ1998;ȱSaxȱ&ȱKautz,ȱ 2003)ȱ andȱAustraliaȱ (Australianȱ Socialȱ Trends,ȱ 2000;ȱDavisȱ etȱ al.,ȱ 2001;ȱMackeyȱ&ȱKopras,ȱ2001).ȱ ȱInȱpopularȱdiscourse,ȱ theȱ“truth”ȱofȱADHDȱremainsȱrelativelyȱuncontestedȱandȱargumentsȱthatȱquestionȱitȱasȱ‘mythȱorȱreality’ȱ(Armstrong,ȱ1996;ȱLaurenceȱ&ȱMcCallum,ȱ1998)ȱappearȱtoȱhaveȱbeenȱsuccessfullyȱmarginalisedȱ(Sava,ȱ2000).ȱȱAsȱsuch,ȱtheȱdominantȱdiscoursesȱthatȱsurroundȱchildȱbehaviourȱ nowȱ constituteȱ anȱ intellectualȱ truthȬgameȱ characterisedȱ byȱ territorialȱ skirmishesȱ asȱ toȱwhoseȱtruthȱshouldȱreignȱ(Atkinsonȱ&ȱShute,ȱ1999;ȱFornessȱ&ȱKavale,ȱ2001).ȱȱWorksȱthatȱhaveȱsoughtȱtoȱchallengeȱ theseȱ truthȬclaimsȱbyȱpointingȱ toȱ theȱ“constructedȬness”ȱofȱchildȱbehaviourȱdisorderȱ(Conrad,ȱ 1975)ȱ haveȱ beenȱ sidelinedȱ orȱ evenȱ colonisedȱ toȱ theȱ pointȱwhere,ȱ inȱ someȱ cases,ȱ anyȱargumentȱasȱ toȱ theȱ socialȱconstructionȱofȱADHDȱ simplyȱworksȱ toȱ reaffirmȱ thatȱwhichȱ itȱ seeksȱ toȱdenyȱ(Calhounȱetȱal.,ȱ1997).ȱȱȱ

ȱ Expressedȱmostȱ acutelyȱ inȱ popularȱmediaȱ (Norrisȱ&ȱ Lloyd,ȱ 2000),ȱ dominantȱ discoursesȱ thatȱconceptualiseȱtheȱ“socialȱconstruction”ȱofȱADHD,ȱdoȱsoȱinȱreductiveȱwaysȱbyȱpointingȱtoȱtheȱillsȱofȱcontemporaryȱsocietyȱtoȱexplainȱtheȱoccurrenceȱofȱdisorderlyȱbehaviour:ȱȱȱ

GRA06089 Linda J. Graham

Whyȱdoȱ soȱmanyȱneedȱ specialȱhelp?ȱ ȱSometimesȱ theyȱareȱ childrenȱwhoȱhaveȱmissedȱoutȱveryȱearlyȱon,ȱandȱ theirȱbehaviouralȱdisordersȱstemȱ fromȱ theȱ frustrationȱofȱneverȱbeingȱ inȱtheȱ race,ȱ especiallyȱ ifȱ theyȱ areȱ oneȱ ofȱ theȱnearlyȱ 30ȱperȱ centȱbornȱ outȱofȱwedlockȱwhoseȱmothersȱstruggleȱtoȱbeȱtwoȱpeople.ȱȱ(Shanahan,ȱ2004,ȱp.ȱ4)ȱ

Inȱthisȱway,ȱ“socialȱconstruction”ȱcomesȱtoȱbeȱreadȱsimplisticallyȱas:ȱtheȱdisordersȱofȱsocietyȱcreateȱdisordersȱ inȱourȱ children.ȱ ȱWhetherȱourȱ childrenȱ reallyȱhaveȱdisordersȱ (Panksepp,ȱ1998),ȱwhatȱ isȱandȱwhoȱdecidesȱwhatȱconstitutesȱaȱdisorderȱ (Crowe,ȱ2000;ȱWakefield,ȱ1992),ȱandȱwhoseȱ interestsȱ“disorderedness”ȱ servesȱ ȱ (Slee,ȱ 1994)ȱ areȱ argumentsȱ thatȱ remain,ȱ onȱ theȱwhole,ȱ isolatedȱ toȱ theȱacademyȱandȱtoȱincreasinglyȱmarginalisedȱfieldsȱwithinȱit.ȱȱȱ

ȱ MediaȱdiscussionȱofȱADHD,ȱwhichȱinformsȱmuchȱofȱpopularȱdiscourseȱonȱtheȱsubjectȱ(Danforthȱ&ȱNavarro,ȱ2001),ȱrevolvesȱmainlyȱaroundȱ theȱpossibleȱcausesȱofȱdisruptive,ȱdisorderlyȱbehaviourȱ(Fields,ȱ2000;ȱNorrisȱ&ȱLloyd,ȱ2000).ȱ ȱTheȱusualȱ suspectsȱ Ȭȱ tooȱmuchȱ televisionȱandȱvideoȱgamesȱ(Walker,ȱ2004),ȱfoodȱadditivesȱ(Dengate,ȱ1994),ȱaberrantȱmaternalȬchildȱinteractionsȱ(DuPaulȱetȱal.,ȱ2001),ȱinconsistentȱparenting,ȱlackȱofȱdiscipline,ȱsingleȱmothersȱ(Armstrong,ȱ1996;ȱShanahan,ȱ2004),ȱandȱtemperamentalȱdispositionȱ(Powellȱ&ȱInglisȬPowell,ȱ1999)ȱ–ȱareȱtrottedȱoutȱperiodically,ȱamidȱpanickedȱ interviewsȱ withȱ theȱ “experts”ȱ ofȱ childȱ behaviour;ȱ paediatricians,ȱ psychologistsȱ andȱpsychiatristsȱ(Dalley,ȱ2000;ȱGaviria,ȱ2001).ȱȱItȱappearsȱthat,ȱotherȱthanȱtoȱconfirmȱstoriesȱaboutȱtheirȱwildlyȱ outȬofȬcontrolȱ child,ȱ parentsȱ areȱ rarelyȱ consultedȱ Ȭȱ perhapsȱ becauseȱ parentsȱ areȱ oftenȱconsideredȱ aȱ largeȱ partȱ ofȱ theȱ problemȱ (FynesȬClinton,ȱ 2005;ȱ Johnston,ȱ 1996;ȱNeophytou,ȱ 2004;ȱSmelterȱetȱal.,ȱ1996).ȱ ȱAnȱattendantȱargument,ȱandȱoneȱ thatȱreceivesȱundueȱcoverageȱ inȱtheȱmediaȱandȱprofessionalȱliterature,ȱisȱthatȱparentsȱareȱcomplicitȱinȱtheȱincreasingȱrateȱofȱdiagnosisȱbecauseȱaȱmedicalȱlabelȱisȱsaidȱtoȱrelieveȱthemȱofȱresponsibilityȱorȱblameȱforȱtheirȱchild’sȱbehaviourȱ(Atkinsonȱ&ȱShute,ȱ1999;ȱSmelterȱetȱal.,ȱ1996).ȱ ȱSimilarly,ȱparentsȱandȱchildrenȱareȱviewedȱsuspiciouslyȱandȱpositionedȱ asȱ deceitful,ȱ undeservingȱ orȱ ‘fightingȱ forȱmoreȱ thanȱ theirȱ shareȱ ofȱ scarceȱ resources’ȱ(Lloydȱ&ȱNorris,ȱ1999,ȱp.ȱ506).ȱȱȱ

ȱ Throughȱsuchȱaȱlens,ȱaȱdiagnosisȱofȱ“ADHD”ȱcomesȱtoȱbeȱseenȱasȱaȱ‘labelȱofȱforgiveness’ȱ(Slee,ȱ1995,ȱReidȱ&ȱMaag,ȱ1997ȱasȱcitedȱinȱLloydȱ&ȱNorris,ȱ1999,ȱp.ȱ507);ȱanȱexoneratingȱconstructȱ(Sava,ȱ2000)ȱwhichȱworksȱtoȱrelieveȱtheȱindividualȱofȱresponsibilityȱforȱtheirȱactionsȱ(Reidȱ&ȱMaag,ȱ1997),ȱand/orȱ provideȱ themȱ withȱ greaterȱ accessȱ toȱ additionalȱ schoolȱ supportȱ servicesȱ (Augustineȱ &ȱDamico,ȱ1995;ȱProsserȱetȱal.,ȱ2002).ȱȱHowever,ȱrecentȱworkȱbyȱGrahamȱ(2006a)ȱhasȱindicatedȱthatȱtheȱpresumptionȱofȱcharacteristicsȱconsistentȱwithȱthatȱmakingȱupȱtheȱADHDȱdiagnosticȱtriad,ȱactuallyȱservesȱtoȱalterȱtheȱdiagnosticȱterrainȱwhereȱchildrenȱexperiencingȱdifficultiesȱinȱlearningȱcanȱbecomeȱineligibleȱforȱlearningȱsupportȱservicesȱifȱthoseȱdifficultiesȱcanȱbeȱattributedȱtoȱdifficultȱbehaviour,ȱpoorȱattentionȱorȱlimitedȱmemory.ȱȱTherefore:ȱȱ

…problematicȱ behaviour,ȱ andȱ educationalȱ difficultiesȱ therein,ȱ becomeȱ managedȱ throughȱbehaviourȱmanagementȱpolicyȱandȱprograms,ȱnotȱsupportedȱinȱtheȱsameȱwayȱasȱeducationalȱdifficultiesȱarisingȱfromȱaȱ“recognizedȱimpairment”ȱwithinȱtheȱlearningȱdisability/disabilityȱcategories,ȱasȱproblematicȱasȱtheseȱprocessesȱmayȱbe.ȱȱ(originalȱemphasis,ȱGraham,ȱ2006a,ȱp.ȱ17)ȱȱȱ

WhenȱDavidȱHayȱ inȱanȱ interviewȱonȱAustralia’sȱABCȱRadioȱNationalȱ (Swan,ȱ2000),ȱpointsȱ toȱ theȱdilemmaȱthatȱparentsȱfaceȱinȱrespectȱtoȱADHDȱdiagnosis,ȱtheȱaccusationȱthatȱparentsȱmedicateȱtheirȱchildrenȱ inȱorderȱ toȱexonerateȱ themselvesȱappearsȱevenȱmoreȱfallacious.ȱ ȱInȱreality,ȱaȱdiagnosisȱofȱADHDȱdoesȱnotȱequateȱ toȱ sympathyȱbecauseȱ ‘societyȱdoesn’tȱ likeȱ it.ȱ ȱYou’reȱaȱbadȱparent,ȱ that’sȱbeenȱ theȱstandardȱexplanationȱofȱADHD.ȱ ȱYou’veȱaȱchildȱwithȱanȱobviousȱphysicalȱdisabilityȱyouȱgetȱsympathy,ȱyourȱchildȱwithȱADHDȱyouȱgetȱcriticism’ȱ(HayȱasȱcitedȱinȱSwan,ȱ2000).ȱȱThisȱpainȱandȱ

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senseȱofȱbeingȱatȱblameȱfeaturesȱheavilyȱinȱtheȱstoriesȱofȱmothersȱwhoȱcontributedȱtoȱNeophytou’sȱstudy,ȱwithȱ oneȱmotherȱ saying,ȱ ‘You’reȱ judgedȱ byȱ yourȱ offspring,ȱ you’reȱ judgedȱ byȱwhatȱ youȱparent’ȱ (Neophytou,ȱ2004,ȱp.ȱ66).ȱThisȱdoesȱnotȱmeanȱ thatȱ thereȱ areȱnoȱparentsȱguiltyȱofȱ ‘doctorȱshopping’ȱorȱgratuitouslyȱmedicatingȱtheirȱchildrenȱsoȱthatȱtheyȱperformȱbetterȱatȱeliteȱlevelsȱ(HayȱasȱcitedȱinȱMitchell,ȱ2004,ȱp.ȱ6)ȱbutȱthisȱpercentageȱofȱparentsȱisȱmuchȱsmallerȱthanȱmanyȱwouldȱhaveȱusȱbelieve.ȱȱȱ

ȱ Aȱveryȱrealȱdangerȱinȱlookingȱcriticallyȱatȱtheȱcurrentȱmedicalisationȱofȱchildȱbehaviourȱisȱthatȱoneȱ mayȱ simplisticallyȱ dismissȱ theȱ difficultiesȱ facedȱ andȱ desperationȱ feltȱ byȱ theȱ parentsȱ andȱchildrenȱ involvedȱ (DuPaulȱ etȱ al.,ȱ 2001).ȱ ȱ Theȱ questionȱ oughtȱ notȱ toȱ be:ȱ areȱ theyȱ lookingȱ forȱ anȱexcuse?ȱȱBut,ȱinstead:ȱwhatȱmakesȱthingsȱsoȱhard,ȱwhatȱareȱparentsȱmostȱafraidȱof,ȱwhatȱoptionsȱdoȱtheyȱ feelȱ theyȱhaveȱandȱwhatȱ canȱbeȱdoneȱ toȱalleviateȱ theȱ struggleȱ inȱaȱwayȱ thatȱdoesȱnotȱmakeȱthingsȱworseȱthroughȱtheȱlabelling,ȱstigmatisationȱandȱmedicationȱofȱchildren?ȱ

ȱ WhilstȱthereȱisȱanȱabundanceȱofȱliteratureȱthatȱlooksȱtoȱtheȱeducationalȱimplicationsȱofȱADHDȱ(Bradshaw,ȱ 1998;ȱHocuttȱ etȱ al.,ȱ 1993;ȱMcBurnettȱ etȱ al.,ȱ 1993;ȱZentall,ȱ 1993),ȱprofferingȱ behaviourȱmanagementȱ strategiesȱ forȱ theȱ classroomȱ (Burchamȱetȱal.,ȱ1993;ȱHodges,ȱ1990;ȱStormontȬSpurgin,ȱ1997),ȱ andȱ targetedȱ educationalȱ interventionsȱ (Fioreȱ etȱ al.,ȱ 1993;ȱ Reiberȱ &ȱ McLaughlin,ȱ 2004);ȱconspicuouslyȱabsentȱfromȱtheȱfieldȱofȱinvestigationȱisȱtheȱcomplicityȱofȱtheȱeducationalȱinstitutionȱitself,ȱparticularlyȱ theȱuseȱofȱpsychopathologisingȱdiscoursesȱandȱ influenceȱofȱ schoolingȱpracticesȱuponȱ theȱ constitutionȱ ofȱ “disorderly”ȱ behaviourȱ andȱ theȱ subsequentȱ recognitionȱ ofȱ particularȱchildrenȱ asȱ aȱ particularȱ kindȱ ofȱ “disorderly”ȱ (Graham,ȱ 2006a).ȱ ȱ Inȱ anȱ attemptȱ toȱ steerȱ theȱconversationȱ inȱ thisȱdirection,ȱ Iȱ reviewȱ aȱ sampleȱofȱ theȱ academicȱ literatureȱ surroundingȱADHD,ȱquestionȱ theȱfunctionȱofȱ thisȱabsenceȱandȱargueȱforȱanȱ interrogationȱofȱ theȱschoolȱasȱaȱsiteȱforȱ theȱproductionȱofȱ‘disorderlyȱobjects’ȱ(Grahamȱ&ȱSlee,ȱ2006b).ȱȱȱ

(Re)ViewingȱAttentionȱDeficitȱHyperactivityȱDisorderȱ(ADHD)ȱ

Reviewsȱofȱ theȱ literatureȱsurroundingȱADHDȱareȱnumerousȱ(Cooper,ȱ2001;ȱKosȱ&ȱRichdale,ȱ2004)ȱand,ȱalthoughȱnowȱsomewhatȱdated,ȱstudiesȱbyȱTysonȱ(1988)ȱandȱTannockȱ(1998)ȱprovideȱperhapsȱtheȱmostȱcomprehensiveȱofȱsurveys.ȱ ȱThus,ȱitȱisȱnotȱnecessaryȱtoȱrepeatȱtheȱsameȱprocessȱhere.ȱ ȱInȱanyȱcase,ȱmyȱobjectiveȱisȱnotȱtoȱdelineateȱwhatȱADHDȱisȱbutȱinsteadȱtoȱquestionȱwhoseȱinterestsȱitȱservesȱ andȱ ultimately,ȱwhetherȱ theȱ constructȱ isȱ educationallyȱ helpful.ȱ ȱ Therefore,ȱ Iȱ progressȱ byȱprovidingȱanȱoverviewȱofȱ theȱdominantȱ conceptualisationsȱofȱADHD,ȱ inȱorderȱ toȱ contextualiseȱaȱreviewȱofȱtheȱliteratureȱrelatingȱtoȱtheȱconnectionȱbetweenȱtheȱincreaseȱinȱdiagnosisȱofȱADHDȱandȱpracticesȱofȱschooling.ȱȱ

UnravellingȱADHDȱ

Accordingȱtoȱmostȱpositivisticȱaccounts,ȱinterestȱinȱtheȱsymptomatologyȱdescribedȱunderȱtheȱmostȱrecentȱlabel,ȱAttentionȱDeficitȱHyperactivityȱDisorderȱ(ADHD)ȱhasȱbeenȱdocumentedȱforȱaboutȱtheȱpastȱhundredȱyearsȱ(Kosȱ&ȱRichdale,ȱ2004).ȱȱCreditedȱasȱaȱpioneerȱinȱ1902,ȱDrȱGeorgeȱStillȱfromȱtheȱRoyalȱCollegeȱofȱPhysiciansȱhadȱtheȱdubiousȱhonourȱofȱbeingȱ‘oneȱofȱtheȱfirstȱtoȱnoteȱthatȱsymptomsȱofȱ thisȱdisorderȱwereȱ“unnatural”,ȱrelativeȱ toȱ theȱbehaviourȱofȱ“normal”ȱchildrenȱofȱ theȱsameȱageȱgroup’ȱ (Neophytou,ȱ2004,ȱp.ȱ16).ȱ ȱMeanwhile,ȱCooperȱ (2001,ȱp.ȱ388)ȱgoesȱbackȱ furtherȱ thanȱmost,ȱarguingȱthatȱtheȱ‘clinicalȱhistoryȱofȱtheȱbehaviouralȱsyndromeȱunderlyingȱtheȱAD/HDȱdiagnosisȱcanȱbeȱ tracedȱ backȱ overȱ 200ȱ yearsȱ inȱ theȱmedicalȱ literature’.ȱ Despiteȱ Cooper’sȱ endorsementȱ ofȱ theȱmedicalȱconceptualisationȱofȱADHDȱ(Cooper,ȱ2001;ȱLloydȱ&ȱNorris,ȱ1999),ȱtheȱmedicalȱliteratureȱbyȱnoȱmeansȱindicatesȱconsensusȱandȱmedicineȱremainsȱaȱculturallyȱinfluencedȱpracticeȱcharacterisedȱbyȱmanyȱunknowns.ȱȱȱ

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ȱ TooȱmuchȱofȱtheȱliteratureȱinȱsupportȱofȱADHDȱasȱaȱdiagnosticȱconstructȱrefersȱsimplisticallyȱtoȱdescriptionsȱofȱfidgety,ȱdistractedȱbehaviourȱ inȱchildrenȱofȱ theȱpostȬVictorianȱeraȱ inȱanȱattemptȱ toȱ‘showȱthatȱADHDȱ(relatedȱbehaviours)ȱisȱnotȱaȱnew,ȱsociallyȱconstructedȱphenomenonȱbutȱrather,ȱisȱaȱchildhoodȱconditionȱthatȱhasȱexistedȱforȱatȱleastȱtheȱpastȱcentury’ȱ(Kosȱ&ȱRichdale,ȱ2004,ȱp.ȱ22).ȱȱInȱthisȱway,ȱdescriptionsȱ ofȱ behaviourȱ causedȱ byȱheadȱ traumaȱ isȱ conflatedȱwithȱ thatȱ causedȱ byȱ anȱencephalitisȱoutbreakȱ inȱ theȱ earlyȱ 1900s,ȱwhichȱ thenȱ comesȱ toȱbeȱ subsumedȱwithinȱ theȱ evolvingȱbehaviouralȱdescriptorsȱmakingȱupȱ theȱDSMȱdiagnosticȱcriteriaȱ forȱADHDȱ (seeȱ forȱexampleȱSava,ȱ2000,ȱpp.ȱ150Ȭ152).ȱ ȱNoȱdefinitiveȱcausalȱ linkȱhasȱbeenȱ foundȱbetweenȱ theȱ“symptomatology”ȱandȱanyȱoneȱphysiologicalȱsource,ȱhowever.ȱȱȱ

ȱ Theȱconfusedȱandȱcontentiousȱhistoryȱofȱtheȱpsychiatricȱcategoryȱ“ADHD”,ȱcharacterisedȱbyȱtheȱrevisionismȱinȱmedicalȱnomenclatureȱ(Hyndȱ&ȱVoeller,ȱ1991;ȱMcBurnettȱetȱal.,ȱ1993)ȱandȱexpansionȱofȱ diagnosticȱ criteriaȱ (Conrad,ȱ 1975;ȱ Conradȱ &ȱ Potter,ȱ 2000),ȱ lendsȱ itselfȱ toȱ doubtȱ andȱ hence,ȱgenealogicalȱcritiqueȱ(Laurenceȱ&ȱMcCallum,ȱ1998).ȱ ȱNotȱsurprisinglyȱthen,ȱsuspicionȱcomesȱtoȱbeȱreflectedȱinȱmediaȱandȱpopularȱdiscourse.ȱȱThisȱhasȱpromptedȱproponentsȱofȱADHDȱtoȱpointȱtoȱanȱallegedȱcontinuityȱinȱsymptomatology,ȱratherȱthanȱinȱtheȱoftenȱconflictingȱmedicalȱexplanationsȱofȱit,ȱinȱanȱattemptȱtoȱresistȱtheȱ‘wealthȱofȱliteratureȱwhichȱchallengesȱtheȱvalidityȱofȱtheȱdiagnosisȱandȱtheȱpositivisticȱassumptionsȱonȱwhichȱitȱisȱbased’ȱ(Cooper,ȱ2001,ȱp.ȱ387).ȱȱItȱappearsȱthatȱthisȱisȱdoneȱinȱorderȱtoȱ(re)secureȱtheȱvalidityȱofȱADHDȱasȱaȱdiagnosticȱcategoryȱ(Cooper,ȱ2001;ȱKosȱ&ȱRichdale,ȱ2004;ȱ Sava,ȱ 2000),ȱ butȱ thisȱ isȱ aȱ strategyȱwhichȱ givesȱ riseȱ toȱ anȱ uneasyȱ andȱ paradoxicalȱ allianceȱbetweenȱmedicineȱandȱpsychologyȱȬȱoneȱthatȱisȱworthȱteasingȱoutȱhere.ȱ

Medicineȱ&ȱADHDȱ

Attentionȱ Deficitȱ Hyperactivityȱ Disorderȱ isȱ oneȱ ofȱ theȱ mostȱ widelyȱ researchedȱ topicsȱ withȱscholarshipȱ spanningȱacrossȱmultipleȱdisciplines:ȱmedicine,ȱpsychology,ȱ socialȱwork,ȱ criminologyȱandȱ educationȱ Ȭȱ toȱ nameȱ justȱ aȱ few.ȱ ȱ Ofȱ theȱ multipleȱ waysȱ ofȱ lookingȱ atȱ theȱ phenomenonȱencapsulatedȱ withinȱ theȱ ‘lexicalȱ label’ȱ (Mehan,ȱ 1996,ȱ p.ȱ 345)ȱ thatȱ isȱ “ADHD”,ȱ twoȱ paradigmsȱdominate:ȱmedicineȱandȱpsychology.ȱ ȱWhilstȱthereȱisȱsomeȱoverlapȱbetweenȱtheȱtwoȱ(forȱexample,ȱbetweenȱneurologicalȱmedicineȱandȱneuropsychology)ȱtoȱcategoriseȱbroadly,ȱtheȱmedicalȱmodelȱcanȱbeȱcharacterisedȱbyȱtheȱargumentȱthatȱ“AttentionȱDeficitȱHyperactivityȱDisorder”ȱisȱtheȱnameȱgivenȱtoȱ representȱ aȱ constellationȱ ofȱ behavioursȱ Ȭȱ theȱ excessiveȱ displayȱ ofȱ whichȱ isȱ saidȱ toȱ reflectȱneurologicalȱdysfunctionȱ inȱ theȱ frontalȱ regionȱofȱ theȱbrain,ȱanȱareaȱ thoughtȱ toȱbeȱ responsibleȱ forȱinhibitionȱandȱ attentionalȱ controlȱ (Barkley,ȱ 1997;ȱHolmes,ȱ 2004;ȱTannock,ȱ1998).ȱ ȱDespiteȱgeneralȱacceptanceȱofȱtheȱhypothesisȱthatȱADHDȱ“symptomatology”ȱderivesȱfromȱneurologicalȱanomalyȱinȱtheȱcorticalȱorȱfrontalȱlobeȱareaȱofȱtheȱbrain,ȱ‘thereȱcontinueȱtoȱbeȱdissentingȱopinions’ȱ(Riccioȱetȱal.,ȱ1993,ȱp.ȱ120).ȱȱȱ

ȱ Forȱ exampleȱ inȱ 1991,ȱ Hyndȱ andȱ Voellerȱ studiedȱ theȱ neurobiologicalȱ basisȱ ofȱ ADHD,ȱ toȱcautiouslyȱconcludeȱthat:ȱȱ

Onȱ theȱbasisȱofȱ theȱpresentȱevidenceȱ itȱcannotȱbeȱconcludedȱ thatȱallȱchildrenȱwithȱADHDȱhaveȱ symptomsȱ thatȱ reflectȱ neurologicalȱ dysfunction.ȱ However,ȱ accumulatingȱ evidenceȱfromȱ theȱ genetic,ȱ biochemical,ȱ neurobehavioural,ȱ andȱ neuroimagingȱ studiesȱ stronglyȱsuggestȱaȱneurologicalȱetiologyȱ inȱmostȱchildren…ȱTheȱconsistenciesȱamongȱ theseȱdiverseȱdataȱsourcesȱareȱconsideredȱmoreȱ thanȱcoincidental.ȱ ȱTheȱ findingsȱofȱ theȱstudiesȱnotedȱ inȱthisȱreviewȱpointȱtoȱspecificȱbrainȱregionsȱandȱfunctionalȱsystemsȱwhichȱmayȱbeȱassociatedȱwithȱADHD’ȱ(Hyndȱ&ȱVoeller,ȱ1991,ȱp.ȱ7).ȱ

Thenȱinȱ1993,ȱwhilstȱacknowledgingȱaȱconcordanceȱinȱresearchȱimplicatingȱneurologicalȱprocessing,ȱRiccioȱetȱal.ȱ(pp.ȱ118Ȭ122)ȱstate:ȱȱ

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OneȱofȱtheȱproblemsȱfacingȱresearchersȱattemptingȱtoȱlocalizeȱorȱidentifyȱtheȱbasisȱofȱADDȱisȱtheȱ inabilityȱ toȱ mapȱ behavioralȱ descriptorsȱ ontoȱ relevantȱ neurologicȱ components…ȱȱAlthoughȱ evidenceȱ hasȱ supportedȱ theȱ roleȱ ofȱ bothȱ neurochemicalȱ andȱ neuroanatomicalȱperspectivesȱofȱADD,ȱneitherȱ theory,ȱ takenȱ individually,ȱ fullyȱaccountsȱ forȱ theȱmyriadȱofȱbehavioursȱ associated…ȱ Researchȱ findings,ȱ however,ȱ haveȱ notȱ unequivocallyȱ supportedȱanyȱofȱthisȱevidence…ȱ ȱItȱisȱunlikelyȱthatȱtheȱquestionsȱregardingȱtheȱneurologicalȱbasisȱofȱADDȱ willȱ beȱ answeredȱ unlessȱ aȱ setȱ ofȱ reliableȱ criteriaȱ thatȱ areȱ researchȬbasedȱ canȱ beȱestablishedȱandȱconsistentlyȱemployedȱinȱtheȱdiagnosisȱofȱtheȱdisorder…ȱInȱtheȱabsenceȱofȱclearȱ neurologicalȱ evidenceȱ forȱ theȱdiagnosis,ȱ cliniciansȱwillȱ continueȱ toȱmakeȱ diagnosesȱbasedȱonȱbehavioralȱobservations.ȱ

Fourȱ yearsȱ laterȱAustralianȱ researchersȱLevy,ȱHay,ȱMcStephen,ȱWoodȱ andȱWaldmanȱ (1997)ȱ inȱ aȱpaperȱthatȱ ‘wonȱtheȱprizeȱ inȱ1997ȱforȱtheȱmostȱ importantȱchild/adolescentȱpsychiatryȱpaperȱ inȱtheȱUS’ȱ(HayȱasȱquotedȱinȱSwan,ȱ2000),ȱreportedȱfindingsȱfromȱaȱgeneticȱanalysisȱlargeȬscaleȱtwinȱstudyȱandȱconcludedȱ thatȱasȱaȱdiscreteȱ“disorder”ȱADHDȱdidȱnotȱexistȱ (Hayȱasȱquotedȱ inȱSwan,ȱ2000).ȱȱInstead,ȱ Levyȱ etȱ al.ȱ (1997)ȱ foundȱ thatȱ theȱ “symptomatology”ȱwasȱ geneticallyȱ presentȱ acrossȱ theȱwholeȱpopulationȱ inȱdifferingȱdegreesȱandȱ thus,ȱADHDȱcouldȱbeȱ ‘bestȱdescribedȱasȱaȱcontinuum,ȱwhichȱ impliesȱ thatȱ thereȱ isȱnoȱphysiologicalȱsignificanceȱattachedȱ toȱanyȱdiagnosticȱcutoffȱcriteriaȱbasedȱonȱaȱnumberȱofȱsymptoms’ȱ(Levyȱetȱal.,ȱ1997,ȱp.ȱ743).ȱ ȱThisȱmeansȱsimplyȱthatȱsomeȱpeopleȱareȱgeneticallyȱpredisposedȱtoȱengageȱinȱnormalȱbehavioursȱatȱlevelsȱthatȱareȱconsideredȱextremeȱbyȱothers.ȱ ȱHowever,ȱwhilstȱHayȱ (Swan,ȱ 2000)ȱ refersȱ toȱ bloodȱ pressureȱ andȱ bloodȱ sugarȱ levelsȱ asȱanalogousȱcontinuumsȱuponȱwhichȱarbitraryȱcutoffsȱareȱalsoȱemployed,ȱtheȱmethodsȱforȱmeasuringȱtheseȱphenomenaȱareȱfarȱmoreȱsophisticated,ȱreliableȱandȱobjectiveȱthanȱtheȱmethodsȱcurrentlyȱusedȱtoȱ“measure”ȱbehaviour.ȱ ȱThatȱ is;ȱwhatȱ isȱbothersomeȱ toȱmeȱmightȱnotȱbeȱ toȱanotherȱandȱ soȱon.ȱȱWhatȱ isȱ bothersomeȱ aboutȱ thisȱ thoughȱ isȱ thatȱ teacherȱ attitude,ȱ tolerance,ȱ pedagogicalȱ styleȱ andȱbeliefsȱhaveȱenormousȱinfluenceȱand,ȱinȱmanyȱcases,ȱtheȱclassȱteacherȱcanȱbeȱtheȱdecidingȱfactorȱasȱtoȱwhetherȱaȱchildȱgetsȱpickedȱupȱonȱtheȱADHDȱradarȱ(Glassȱ&ȱWegar,ȱ2000).ȱ

ȱ Meanwhileȱleadingȱdiagnosticiansȱinȱtheȱfield,ȱsuchȱasȱDrȱDarylȱEfron,ȱaȱpaediatricianȱwithȱtheȱRoyalȱChildren’sȱHospitalȱinȱMelbourne,ȱacknowledgeȱthatȱtheȱdiagnosticȱprocessȱisȱsubjectiveȱandȱfarȱfromȱevidenceȬbased:ȱ

It’sȱ justȱ oneȱ ofȱ thoseȱ fieldsȱwhereȱ there’sȱnotȱ anȱ absolutelyȱ clearȬcutȱ answer,ȱdespiteȱ theȱenormousȱamountsȱofȱresearchȱinȱthisȱfield;ȱit’sȱnotȱasȱthoughȱthereȱisn’tȱevidence,ȱit’sȱ justȱthatȱ theȱ startingȱ point,ȱ theȱ diagnosticȱ criteria,ȱ areȱ aȱ littleȱ bitȱ blurred.ȱ ȱ Ultimatelyȱ eachȱquestionȱonȱ eachȱquestionnaireȱ isȱ subjective,ȱ andȱ theȱoutcomesȱ areȱ incrediblyȱdifficultȱ toȱmeasureȱ(DrȱDarylȱEfronȱasȱcitedȱinȱSwan,ȱ2000,ȱ23rdȱOctober)ȱ

Inȱherȱ reviewȱofȱ theȱ literature,ȱTannockȱ (1998,ȱp.ȱ68)ȱmaintainsȱ thatȱmuchȱofȱ theȱdifficultyȱ inȱ theȱaetiologyȱofȱADHDȱcouldȱbeȱbecauseȱ ‘[m]ostȱofȱtheseȱmodelsȱseekȱaȱsingle,ȱunitaryȱcause,ȱ locatedȱwithinȱ theȱbiological,ȱneurological,ȱand/orȱgeneticȱsubstrateȱ–ȱ thatȱ is,ȱwithinȱ theȱ individual’.ȱ ȱSheȱarguesȱ thatȱ ‘ADHDȱ andȱ itsȱ componentȱ symptomsȱ areȱ likelyȱ toȱ ariseȱ fromȱmultipleȱ interactingȱfactorsȱ thatȱ cannotȱ beȱ understoodȱ inȱ isolation’ȱ (Tannock,ȱ 1998,ȱ p.ȱ 68)ȱ andȱ advocatesȱ aȱdevelopmentalȱ systemsȱ (orȱbiopsychosocial)ȱperspectiveȱ inȱ futureȱ researchȱwhichȱwouldȱneedȱ toȱ‘incorporateȱprofessionals,ȱtheoriesȱandȱmethodsȱfromȱaȱvarietyȱofȱfieldsȱincludingȱbehaviouralȱandȱmolecularȱ genetics,ȱ cognitiveȱ andȱ developmentalȱ psychology,ȱ neurology,ȱ neuroscience,ȱ andȱmedicine’ȱ(Tannock,ȱ1998,ȱp.ȱ90).ȱȱInterestingly,ȱresearchȱfromȱtheȱfieldȱofȱeducationȱdoesȱnotȱappearȱtoȱbeȱconsideredȱanȱimportantȱcontributor,ȱdespiteȱtheȱpivotalȱrelationshipȱbetweenȱtheȱdemandsȱofȱschoolingȱandȱtheȱbehavioursȱthatȱcomeȱtoȱbeȱrearticulatedȱasȱ“behaviourȱdisorder”.ȱȱWhilstȱIȱbaulkȱatȱtheȱcategorisationȱofȱstudentsȱinȱpsychobiologicalȱterms,ȱPurdie,ȱHattieȱandȱCarrollȱ(2002,ȱpȱ89),ȱ

5


makeȱaȱstrongȱargumentȱwhenȱtheyȱstateȱ‘ifȱweȱareȱlookingȱtoȱpromoteȱeducationalȱsuccessȱamongȱstudentsȱwithȱADHD,ȱweȱmustȱuseȱstrategiesȱthatȱdirectlyȱaddressȱtheirȱacademicȱdifficulties’.ȱ

ADHDȱ&ȱMedicine/sȱ

Itȱ appearsȱ thatȱ theȱ generalȱ acceptanceȱ ofȱ neurologicalȱ involvementȱ hasȱ contributedȱ toȱ aȱ greaterȱacceptanceȱ ofȱ theȱ prescriptionȱ ofȱ restrictedȱ classȱ psychopharmaceuticalsȱ toȱ childrenȱ andȱ youngȱpeople.ȱȱAsȱRiccioȱetȱal.ȱ(1993,ȱp.ȱ121)ȱpointȱout,ȱsinceȱresearchersȱ‘haveȱgenerallyȱacceptedȱthatȱtheȱcatecholaminesȱ (dopamine,ȱ norepinephrine)ȱ areȱ implicatedȱ inȱADD’ȱ (Riccioȱ etȱ al.,ȱ 1993,ȱ p.ȱ 121),ȱthereȱ hasȱ beenȱ anȱ increasedȱ recourseȱ toȱ psychopharmaceuticalsȱ Ȭȱ particularlyȱ theȱ substancesȱclaimedȱ toȱbeȱ theȱmostȱeffective,ȱmethylphenidateȱandȱdexamphetamineȱsulfate.ȱ ȱResearchersȱstillȱdoȱnotȱknowȱexactlyȱwhatȱtheseȱsubstancesȱdo,ȱhowever.ȱȱStimulantȱmedicationȱisȱthoughtȱtoȱincreaseȱtheȱlevelȱofȱdopamineȱandȱnorepinephrineȱbetweenȱtheȱsynapsesȱorȱneurotransmittersȱofȱtheȱbrainȱ(Whalenȱ&ȱHenker,ȱ1998)ȱorȱtoȱincreaseȱtheȱbloodȱflowȱtoȱareasȱofȱtheȱbrainȱ(Holmes,ȱ2004)ȱbelievedȱresponsibleȱ forȱ executiveȱ control,ȱ however,ȱ theȱ difficultiesȱ inȱ pinningȱ downȱ neurologicalȱinvolvementȱnotedȱearlierȱtranslateȱtoȱsimilarȱproblemsȱinȱworkingȱoutȱnotȱonlyȱwhatȱstimulantsȱdoȱandȱhowȱtheyȱdoȱitȱbutȱalsoȱwhatȱlongȬtermȱeffectȱtheyȱmayȱhaveȱuponȱdevelopingȱbrainȱchemistry.ȱȱȱ

ȱ Despiteȱ theȱ lackȱ ofȱ definitiveȱ explanationȱ orȱ conclusiveȱ proofȱwithȱ regardsȱ toȱ eitherȱADHDȱaetiologyȱ orȱ theȱ functionȱ ofȱ stimulantȱmedicationȱ (letȱ aloneȱ theȱ longȬtermȱ educationalȱ orȱ healthȱeffects,ȱ seeȱ discussionȱ inȱ Levy,ȱ 2001,ȱ p.47),ȱ theȱ productionȱ ofȱ methylphenidateȱ (Ritalin)ȱ andȱdexamphetamineȱ sulfateȱ (Dexedrine)ȱhasȱ soaredȱ sinceȱ 1990.ȱ ȱ Inȱ theȱUS,ȱprescriptionsȱ forȱRitalinȱ‘roseȱdramaticallyȱ inȱ theȱ earlyȱ1990sȱandȱhaveȱ sinceȱ levelledȱoffȱatȱapproximatelyȱ11ȱmillionȱperȱyear.ȱ ȱ Inȱ comparison,ȱ amphetamineȱ prescriptions,ȱ primarilyȱ Adderalli,ȱ haveȱ increasedȱdramatically…ȱfromȱ1.3ȱmillionȱinȱ1996ȱtoȱnearlyȱ6ȱmillionȱinȱ1999’ȱ(seeȱStatisticsȱonȱStimulantȱUseȱinȱ Gaviria,ȱ 2001).ȱ ȱ Onȱ theȱ otherȱ hand,ȱ Australianȱ statisticsȱ presentȱ aȱ slightlyȱ differentȱ pictureȱbecauseȱ dexamphetamineȱ hasȱ beenȱ subsidisedȱ underȱ theȱ Commonwealthȱ GovernmentȱPharmaceuticalȱBenefitsȱSchemeȱandȱthisȱhasȱinfluencedȱusageȱpatterns.ȱȱȱ

Ritalinȱ (methylphenidate)ȱ isȱ theȱ drugȱmostȱ commonlyȱ associatedȱwithȱ theȱ treatmentȱ ofȱADHD.ȱȱInȱAustralia,ȱRitalinȱisȱnotȱlistedȱonȱtheȱPharmaceuticalȱBenefitsȱSchemeȱ(PBS)ȱandȱthereforeȱtheȱcostȱofȱtheȱdrugȱisȱnotȱsubsidisedȱbyȱtheȱCommonwealthȱGovernmentȱforȱtheȱtreatmentȱofȱADHD.ȱ ȱAccordingly,ȱaȱ farȱgreaterȱnumberȱofȱprescriptionsȱareȱdispensedȱ inȱAustraliaȱforȱdexamphetamineȱcomparedȱtoȱRitalin.ȱȱ(Mackeyȱ&ȱKopras,ȱ2001,ȱp.ȱ1)ȱ

Theȱdramaticȱ increaseȱ inȱprescriptionȱofȱ stimulantsȱ inȱAustralia,ȱ coupledȱwithȱaȱ ‘disparityȱ inȱ theȱnumberȱ ofȱ prescriptionsȱ forȱ dexamphetamineȱ sulfateȱ dispensedȱ inȱ differentȱ partsȱ ofȱ Australia’ȱ(Mackeyȱ &ȱ Kopras,ȱ 2001,ȱ p.ȱ i)ȱ hasȱ notȱ goneȱ unnoticed,ȱ triggeringȱ aȱ numberȱ ofȱ Parliamentaryȱinquiriesȱintoȱtheȱmatter.ȱȱTheȱmostȱrecentȱreportȱpublishedȱinȱ2001ȱattestsȱthatȱ‘inȱ1991,ȱlessȱthanȱ10ȱ000ȱprescriptionsȱwereȱdispensedȱforȱdexamphetamineȱsulfate.ȱȱInȱ1998,ȱnearlyȱ250ȱ000ȱprescriptionsȱwereȱdispensedȱforȱtheȱsameȱdrug,ȱanȱincreaseȱofȱ2400ȱperȱcent.ȱȱOverȱtheȱsameȱperiod,ȱprescriptionsȱdispensedȱ forȱ Ritalinȱ increasedȱ fromȱ 13ȱ 398ȱ toȱ 96ȱ 582,ȱ anȱ increaseȱ ofȱ 620ȱ perȱ cent’ȱ (Mackeyȱ&ȱKopras,ȱ2001,ȱp.ȱ4).ȱ

ȱ Accordingly,ȱDillerȱarguesȱthatȱ‘Australiaȱappearsȱtoȱbeȱtheȱonlyȱnationȱthatȱhasȱexperiencedȱaȱdocumentedȱ increaseȱ inȱpsychostimulantȱuseȱ thatȱparallelsȱ thatȱwhichȱhasȱoccurredȱ inȱ theȱUnitedȱStates’ȱ(DillerȱasȱcitedȱinȱProsserȱ&ȱReid,ȱ1999,ȱp.ȱ111),ȱwhilstȱpsychiatristȱGeorgeȱHalaszȱmaintainsȱthatȱAustraliaȱisȱnowȱthirdȱhighestȱinȱstimulantȱmedicationȱuseȱbehindȱCanadaȱandȱtheȱUSȱ(Halaszȱasȱ reportedȱ inȱ Mitchell,ȱ 2004).ȱ ȱ Strangely,ȱ despiteȱ theȱ controversyȱ surroundingȱ stimulantȱprescriptionȱratesȱinȱAustralia,ȱRitalinȱ(methylphenidate)ȱwasȱaddedȱtoȱtheȱPharmaceuticalȱBenefitsȱ

6


Schemeȱ inȱ2005ȱ toȱostensiblyȱ ‘provideȱpatientsȱwithȱaȱ choiceȱofȱ twoȱPBSȬlistedȱdrugsȱ forȱADHDȱ[costing]ȱtheȱPBSȱbetweenȱ$1.4ȱandȱ$1.7ȱmillionȱeachȱyearȱ(Miranda,ȱ2005,ȱp.ȱ1).ȱ

ȱȱ Psychostimulantȱmedicationsȱ suchȱ asȱdexamphetamineȱ andȱmethylphenidateȱ areȱ believedȱ toȱhaveȱaȱ“paradoxicalȱeffect”ȱuponȱ individualsȱexhibitingȱbehavioursȱconsistentȱwithȱ thoseȱmakingȱupȱtheȱDSMȬIVȬTRȱdiagnosticȱtriadȱforȱADHD:ȱhyperactivity,ȱ inattentionȱandȱdistractibilityȱ(APA,ȱ1994).ȱ ȱHowever,ȱresearchȱhasȱsinceȱshownȱthatȱpsychostimulantȱmedicationȱaffectsȱallȱindividualsȱwithȱsomeȱ levelȱofȱ improvementȱ inȱconcentrationȱandȱenergyȱ (Purdieȱetȱal.,ȱ2002;ȱSwansonȱetȱal.,ȱ1993).ȱ ȱ Theȱ variableȱ nowȱ appearsȱ toȱ beȱ theȱ degreeȱ ofȱ effect.ȱ ȱ Mostȱ problematicallyȱ though,ȱpsychostimulantȱmedicationȱ canȱhaveȱ severeȱ sideȬeffectsȱ suchȱasȱappetiteȱ suppression,ȱ insomnia,ȱteethȱgrinding,ȱtics,ȱtachycardia,ȱemotionalȱinstability,ȱgrowthȱretardationȱandȱsoȱonȱ(Greenȱ&ȱChee,ȱ1997;ȱ Purdieȱ etȱ al.,ȱ 2002)ȱ andȱ anyȱ soȬcalledȱ “therapeutic”ȱ effectȱ isȱ temporaryȱ (Selikowitz,ȱ 1995).ȱȱEvenȱtheȱnatureȱofȱthatȱ“therapeutic”ȱeffectȱisȱtheȱsubjectȱofȱdebate,ȱasȱcomprehensiveȱresearchȱhasȱdemonstratedȱ thatȱ theȱ ‘estimatedȱ effectȱ onȱ behaviourȱ isȱmuchȱ largerȱ thanȱ theȱ estimatedȱ effectȱ onȱachievement’ȱ (emphasisȱadded,ȱSwansonȱetȱal.,ȱ1993,ȱp.ȱ156).ȱ ȱDespiteȱ theȱ researchȱevidence,ȱsomeȱproponentsȱofȱtheȱmedicalȱmodelȱmakeȱclaimsȱtoȱtheȱcontrary:ȱ

Inȱaȱchildȱwhoȱ isȱreceivingȱanȱappropriateȱmedicine,ȱallȱotherȱ formsȱofȱ treatment,ȱsuchȱasȱeducationalȱandȱpsychologicalȱ intervention,ȱwillȱbeȱmoreȱeffective.ȱ ȱTheseȱmedicinesȱhelpȱtheȱchild’sȱbrainȱtoȱfunctionȱlikeȱtheȱbrainsȱofȱother,ȱnormalȱchildren;ȱtheyȱdoȱnotȱsedateȱtheȱchild.ȱȱMost,ȱbutȱnotȱall,ȱchildrenȱwillȱbeȱhelpedȱbyȱmedication.ȱȱItȱisȱimportantȱtoȱnoteȱthatȱtheseȱmedicinesȱofferȱtreatment,ȱnotȱaȱcure.ȱȱThisȱmeansȱthatȱtheirȱeffectȱonȱbehaviourȱlastsȱonlyȱasȱlongȱasȱtheȱmedicineȱremainsȱinȱtheȱchild’sȱbody,ȱalthoughȱanyȱskillsȱtheȱchildȱhasȱlearnedȱwillȱpersist.ȱȱ(Selikowitz,ȱ1995,ȱp.ȱ151)ȱ

ProblematicallyȱSelikowitz’sȱbook,ȱ likeȱothersȱ thatȱ skimȱoverȱ theseȱ controversiesȱ (Greenȱ&ȱChee,ȱ1997;ȱWallace,ȱ1999),ȱareȱmarketedȱatȱparentsȱwhoȱmayȱmakeȱtheȱdecisionȱtoȱmedicateȱbecauseȱtheyȱbelieveȱitȱwillȱhelpȱtheirȱchildȱbyȱremovingȱ“behaviouralȱbarriers”ȱpossiblyȱaffectingȱtheirȱlearningȱprogress.ȱ ȱ Givenȱ thatȱ successȱ inȱ schoolȱ isȱ suchȱ aȱ determiningȱ factorȱ inȱ lifeȱ choices,ȱ itȱ isȱunderstandablyȱthatȱparentsȱworryȱaboutȱtheirȱchild’sȱabilityȱtoȱsurviveȱandȱdoȱwell.ȱȱHowever,ȱasȱTeeterȱ (1991,ȱp.ȱ5)ȱacknowledgesȱ ‘neurochemicalȱstudiesȱconsistentlyȱshowȱ thatȱwhileȱmedicationȱreversesȱhyperactivity,ȱ learningȱdeficitsȱpersist’.ȱ ȱThisȱwasȱ stillȱ theȱ caseȱwhenȱPurdie,ȱHattieȱandȱCarrollȱconductedȱaȱmetaȬanalysisȱofȱinterventionsȱinȱ2002,ȱconcludingȱthatȱ‘theȱpresentȱfindingsȱdoȱnotȱindicateȱthatȱsuchȱflowȬoverȱeffectsȱtoȱlearningȱorȱachievementȱoccur’ȱ(Purdieȱetȱal.,ȱ2002,ȱp.ȱ88)ȱandȱthatȱtheȱmajorȱimpactȱofȱmedicationȱwasȱonȱimprovedȱbehaviour,ȱmoreȱbenefitingȱteachersȱandȱparentsȱ thanȱ theȱ child.ȱ ȱ Thus,ȱ argumentsȱ thatȱ advocateȱ theȱ medicationȱ ofȱ childrenȱ forȱ theirȱeducationalȱorȱlearningȱbenefitȱbecomeȱallȱtheȱmoreȱtenuous,ȱforȱasȱHyndȱet.ȱal.ȱ(1991)ȱattest,ȱ

parentsȱandȱteachersȱmayȱexpectȱthatȱonceȱtheȱinattentionȱandȱmotorȱoveractivityȱassociatedȱwithȱ ADHDȱ areȱ diminishedȱ dueȱ toȱ stimulantȱ medication,ȱ learningȱ difficultiesȱ mayȱ beȱequallyȱattenuated…ȱmethylphenidateȱ(Ritalin)ȱseemsȱtoȱaffectȱmetabolicȱactivityȱassociatedȱwithȱtheȱmotorȬreadinessȬimpulseȱcontrolȱsystems…ȱbutȱitȱdoesȱnotȱappearȱtoȱhaveȱaȱdirectȱeffectȱ onȱ regionsȱ ofȱ theȱ brainȱ typicallyȱ associatedȱ withȱ cognitiveȱ processesȱ requiredȱ inȱlearningȱcomplexȱinformation.ȱȱ(Hyndȱetȱal.,ȱ1991,ȱp.ȱ2)ȱ

Thus,ȱtheȱquestionȱbegs,ȱ“therapeutic”ȱforȱwhom?ȱȱIfȱmedicationȱisȱeffectiveȱinȱreducingȱbehaviouralȱ“symptoms”ȱasȱ indicatedȱ inȱ theȱ literatureȱandȱ relativelyȱ ineffectiveȱonȱ learning,ȱ thenȱwhatȱ isȱ theȱmedicationȱ ofȱ childrenȱ andȱ youngȱ peopleȱ reallyȱ doing?ȱ ȱWhatȱ isȱ theȱ goal?ȱ ȱ Ifȱ pharmaceuticalȱsuppressionȱofȱbehaviourȱdoesȱnotȱtranslateȱtoȱbetterȱacademicȱachievementȱasȱoneȱmightȱassumeȱitȱwouldȱ (lessȱ distraction:ȱ moreȱ workȱ done,ȱ moreȱ attentionȱ paid:ȱ moreȱ absorptionȱ ofȱ academicȱ

7


material,ȱlessȱactivity:ȱlessȱdistraction:ȱmoreȱattentionȱtoȱlearning…ȱandȱsoȱon),ȱthenȱwhatȱexactlyȱisȱmedicationȱachievingȱandȱforȱwhom?ȱ

ȱ Indeed,ȱmedicationȱ isȱonlyȱ foundȱ toȱbeȱ“effective”ȱ (thatȱ is,ȱwhenȱmedicationȱactsȱ toȱsuppressȱproblemȱbehaviours)ȱ inȱonlyȱaboutȱ twoȱ thirdsȱofȱchildrenȱdiagnosedȱwithȱADHDȱ(Greenȱ&ȱChee,ȱ1997;ȱSwansonȱetȱal.,ȱ1993).ȱȱThoseȱforȱwhomȱmedicationȱhasȱnoȱeffectȱareȱcalledȱ“nonȬresponders”ȱandȱ areȱ subsequentlyȱ leftȱ outȱ ofȱmedicationȱ trialsȱ andȱmuchȱ ofȱ theȱ conversationȱ surroundingȱADHDȱ (Hechtmanȱ etȱ al.,ȱ 2004).ȱ ȱWithȱ thoseȱ childrenȱwhoȱ doȱ respondȱ “positively”ȱ toȱ stimulantȱmedication,ȱtheȱsideȬeffectsȱofȱstimulantsȱmeansȱthatȱdosageȱmustȱbeȱcarefullyȱregulated,ȱsoȱthatȱtheȱeffectsȱareȱsufficientlyȱdulledȱtoȱallowȱtheȱchildȱtoȱeatȱandȱfallȱasleepȱatȱnight.ȱȱHowever,ȱnoneȱofȱtheȱmedicationȱ usedȱ inȱ theȱ “treatment”ȱ ofȱ ADHD,ȱ andȱ thisȱ includesȱ theȱ SSRIȱ andȱ tricyclicȱ antiȬdepressantsȱ andȱ evenȱ theȱ bloodȱpressureȱmedicationsȱ oftenȱ calledȱupon,ȱ canȱ layȱ claimȱ toȱ curingȱthoseȱ“symptoms”ȱ (behaviours)ȱsaidȱ toȱbelongȱ toȱAttentionȱDeficitȱHyperactivityȱDisorder.ȱ ȱOnceȱtheȱdrugsȱwearȱoff,ȱlittleȱJohnnyȱorȱJennyȱ(andȱtheirȱparents)ȱareȱrightȱbackȱtoȱwhereȱtheyȱwereȱ–ȱatȱtheȱ unacceptableȱ endȱ ofȱ theȱ behaviouralȱ continuum.ȱ ȱ Interestingly,ȱ thisȱ isȱwhereȱ itȱ appearsȱ theȱcomplicatedȱ interdependencyȱbetweenȱmedicineȱandȱpsychologyȱ comesȱ intoȱplayȱ andȱwhereȱ theȱmedicalȱandȱpsychologicalȱparadigmsȱdivergeȱonlyȱtoȱ(re)converge.ȱ

Psychologyȱ&ȱADHDȱ

Theȱpsychologicalȱliteratureȱfeaturesȱcompellingȱargumentsȱthatȱsuchȱbehavioursȱcanȱbeȱinfluencedȱbyȱ extrinsicȱ factorsȱ outsideȱ theȱ child’sȱ control,ȱ suchȱ asȱ environmentȱ (Christian,ȱ 1997;ȱ Panksepp,ȱ1998;ȱPellegriniȱ&ȱHorvat,ȱ1995)ȱasȱwellȱasȱtheȱotherȱ“usualȱsuspects”ȱȬȱfamilialȱandȱsocioeconomicȱstatus,ȱmaternalȱlevelsȱofȱeducation,ȱabuse,ȱdepressionȱandȱpreȱandȱpostnatalȱtraumaȱȬȱtheȱliteratureȱonȱwhichȱ isȱ tooȱnumerousȱ toȱ listȱ (seeȱdiscussionȱ inȱWhalenȱ&ȱHenker,ȱ1998).ȱ ȱAccordingly,ȱmanyȱpsychologistsȱ argueȱ forȱ aȱ psychosocialȱ understandingȱ ofȱ problematicȱ behaviour,ȱ however,ȱ thereȱappearsȱ noȱ escapingȱ theȱ suppressionȱ ofȱ thoseȱ sameȱ symptomsȱ withȱ ‘activeȱ medicationȱmanagement’ȱ(Levy,ȱ2001,ȱp.ȱ45),ȱtheȱoccurrenceȱofȱwhichȱprivilegesȱmedicalȱconceptualisationsȱofȱADHDȱandȱtheȱinvolvementȱofȱtheȱneurologicalȱsystem.ȱȱThisȱcanȱbeȱdangerous,ȱasȱLevineȱ(1997,ȱp.ȱ200)ȱpointsȱout,ȱbecauseȱ theȱmedicalȱmodelȱ ‘whichȱhighlightsȱ theȱnotionȱofȱ individualȱdeficiencyȱfromȱaȱprimarilyȱbiologicalȱperspective,ȱrobsȱpractitionersȱofȱtheȱopportunityȱtoȱappraiseȱtheȱimpactȱofȱenvironmentalȱinfluencesȱonȱdiagnosesȱsuchȱasȱȱADHD’.ȱȱȱ

ȱ Writingȱinȱtheȱfieldȱofȱsocialȱwork,ȱLevineȱ(1997,ȱp.ȱ199)ȱdeploresȱ‘narrowȱformsȱofȱinterventionȱthatȱ ignoreȱ suchȱ societalȱ concernsȱ asȱ overburdenedȱ families,ȱ underfundedȱ andȱ overcrowdedȱschools,ȱpoverty,ȱsexismȱand,ȱforȱsomeȱchildren,ȱtraumaticȱexposureȱtoȱviolence’.ȱȱHeȱstatesȱthatȱtheȱ‘impositionȱofȱpowerfulȱmedicationsȱmayȱeliminateȱunpopularȱsymptoms,ȱbutȱtheyȱalsoȱmayȱmaskȱaȱchild’sȱattemptȱtoȱconveyȱvariousȱformsȱofȱtraumaȱ[since]ȱchildrenȱfrequentlyȱdisplayȱbehavioursȱthatȱ discloseȱ experiencesȱ theyȱ cannotȱ communicateȱ throughȱ verbalȱ language’ȱ (p.ȱ 201Ȭ202).ȱ ȱ ToȱLevine’sȱcautionȱthatȱprocessingȱskillsȱandȱselfȬcontrolȱcanȱbeȱinfluencedȱbyȱdiverseȱfactors,ȱsuchȱasȱpoverty,ȱhungerȱandȱ leadȱ toxicityȱ(Levine,ȱ1997,ȱp.ȱ201),ȱIȱwouldȱaddȱ thatȱdistractibility,ȱattentionȱandȱactivityȱlevelsȱcanȱalsoȱindicateȱchildrenȱwhoȱexperienceȱdifficultiesȱinȱreceptiveȱandȱexpressiveȱlanguage,ȱ semantic/pragmaticȱ propertiesȱ ofȱ language,ȱ phonologicalȱ andȱ auditoryȱ processing,ȱabstractionȱandȱotherȱareasȱessentialȱtoȱlearningȱ(Cantwellȱ&ȱBaker,ȱ1991;ȱHeydonȱ&ȱIannicci,ȱ2002;ȱRiccioȱ&ȱHynd,ȱ1993).ȱȱȱ

ȱ Suppressingȱ theȱ behavioursȱ throughȱ medicationȱ (orȱ exclusionaryȱ behaviourȱ managementȱtechniques)ȱmayȱachieveȱaȱmoreȱorderlyȱclassroomȱ(Slee,ȱ1994,ȱ1995)ȱbutȱalsoȱmayȱresultȱinȱtheȱchildȱneverȱgettingȱ theȱ supportȱandȱunderstandingȱ theyȱ reallyȱneed.ȱ ȱ Instead,ȱasȱLevineȱ (1997,ȱp.ȱ202)ȱargues,ȱȱ

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…theȱnarrativesȱofȱtheseȱchildrenȱconsistentlyȱshowȱtheirȱsenseȱofȱlonelinessȱandȱisolation,ȱusuallyȱ immersedȱ inȱ shameȱandȱ cloakedȱ inȱ selfȬdirectedȱblame.ȱ ȱVeryȱ fewȱ childrenȱ showȱdisplayȱawarenessȱofȱtheȱsituationalȱcontextȱinȱwhichȱtheirȱsymptomsȱemerge.ȱȱTheyȱtendȱtoȱadoptȱtheȱharmfulȱculturalȱtaleȱthatȱthereȱisȱaȱgreatȱdealȱwrongȱwithȱthem.ȱ ȱTypically,ȱthisȱprecludesȱanyȱrecognitionȱofȱtheirȱownȱstrengths.ȱȱȱ

Theȱincompatibilityȱbutȱsuspectedȱinvolvementȱofȱgenetic,ȱneurologicȱandȱsocialȱfactorsȱhasȱmeantȱthatȱ asȱ aȱ conceptȱ “ADHD”ȱ comesȱ toȱ beȱ understoodȱ throughȱ aȱ biopsychosocialȱ theoreticalȱframework,ȱbutȱdistinctȱstudiesȱstillȱoccurȱwithoutȱmuchȱcrossȬfertilisation.ȱȱAsȱtheȱformerȱeditorȱofȱTheȱJournalȱofȱtheȱAmericanȱAcademyȱofȱChildȱandȱAdolescentȱPsychiatryȱstates,ȱ

…ȱbiopsychosocialȱ theoryȱhasȱnotȱadvancedȱ sinceȱEngelȱproposedȱ itȱ inȱ theȱ1970s.ȱ ȱ Itȱ isȱaȱtheoryȱ thatȱ simplyȱ tellsȱ usȱ thereȱ areȱ threeȱ dimensionsȱ inȱ humanȱ behaviour,ȱ andȱ stops.ȱȱThereȱisȱnoȱintegrationȱofȱtheȱthreeȱlevels,ȱnoȱtheoryȱbuilding.ȱȱIfȱyouȱdon’tȱbelieveȱme,ȱlistenȱtoȱ aȱ presentationȱ atȱ theȱ nextȱ caseȱ conference,ȱ orȱ toȱ candidatesȱ atȱ theȱ ABPNȱ boardȱcertificationȱexam.ȱȱAtȱbestȱyouȱwillȱhearȱaȱcarefulȱrecitationȱofȱthreeȱseparateȱlistsȱofȱfactors,ȱunrelatedȱtoȱeachȱother.ȱ(McDermott,ȱ2004,ȱp.ȱ657)ȱ

Thisȱ isȱ particularlyȱ theȱ caseȱ withȱ ADHDȱ withȱ neglectȱ toȱ researchȱ thatȱ looksȱ notȱ justȱ toȱ theȱimplicationsȱofȱADHDȱforȱeducationȱbutȱtoȱtheȱriseȱofȱADHDȱasȱaȱsymptomȱofȱtheȱdisordersȱofȱschooling.ȱ

ADHDȱ&ȱtheȱpsychologiesȱ

Somewhatȱproblematically,ȱtheȱtentativenessȱwhichȱcharacterisesȱmuchȱofȱtheȱmedicalȱ literatureȱ isȱnotȱalwaysȱcarriedȱthroughȱelsewhere.ȱ ȱForȱexample,ȱpsychologistsȱKosȱandȱRichdaleȱ(2004,ȱp.ȱ24),ȱconcludeȱ thatȱ becauseȱ ‘difficultiesȱ withȱ overactivity,ȱ impulsivity,ȱ andȱ attentionȱ haveȱ beenȱdocumentedȱ forȱ overȱ aȱ century’,ȱ theȱ existenceȱ andȱ statusȱ ofȱ ADHDȱ asȱ “truth”ȱ canȱ thusȱ beȱ‘supportedȱ byȱ researchȱ andȱ clinicalȱ findingsȱ overȱ thisȱ time’.ȱ ȱHoweverȱ asȱ discussedȱ earlier,ȱ theȱliteratureȱsurroundingȱADHDȱbyȱnoȱmeansȱreachesȱconsensusȱandȱmedicalȱresearchersȱhaveȱfailedȱtoȱ findȱ aȱ comprehensiveȱ linkȱ betweenȱ theȱ soȬcalledȱ “symptomatology”ȱ constitutedȱ byȱ theȱbehaviouralȱ descriptorsȱ associatedȱ withȱ ADHDȱ andȱ anyȱ coreȱ biophysiologicalȱ orȱneurophysiologicalȱregion;ȱthatȱis,ȱtheȱproblem,ȱaccordingȱtoȱRiccioȱetȱal.ȱ(1993),ȱappearsȱtoȱbeȱinȱtheȱgeneralisability,ȱapplicabilityȱandȱvalidityȱofȱtheȱbehaviouralȱdescriptorsȱthemselves.ȱȱȱ

ȱ InterestinglyȱunlikeȱCooperȱ(2001)ȱwhoȱdoesȱengageȱwithȱatȱleastȱsomeȱofȱtheȱdissentingȱvoicesȱwithinȱ theȱ literature,ȱ Kosȱ andȱ Richdaleȱ (2004)ȱ appearȱ unawareȱ ofȱ theȱ subtleȱ butȱ importantȱcontradictionsȱplaguingȱ theȱconceptȱofȱADHD.ȱ ȱTheseȱareȱnonethelessȱcontradictionsȱwhichȱhaveȱgivenȱriseȱtoȱdeepȱconcernȱoverȱnotȱonlyȱtheȱvalidityȱofȱtheȱdiagnosisȱbutȱtheȱethical,ȱphilosophicalȱandȱ socialȱ implicationsȱ ofȱ pathologisingȱ andȱmedicatingȱ childrenȱ (Damicoȱ &ȱ Augustine,ȱ 1995;ȱDanforthȱ&ȱNavarro,ȱ2004;ȱGraham,ȱ2006b;ȱGrahamȱ&ȱSlee,ȱ2006a;ȱGrahamȱ&ȱSlee,ȱ2006b;ȱHarwood,ȱ2006;ȱLevy,ȱ2001;ȱSlee,ȱ 1995;ȱTait,ȱ 2001;ȱThomasȱ&ȱGlenny,ȱ 2000).ȱ ȱ Insteadȱofȱacknowledgingȱ theȱcomplexityȱ ofȱ theȱ terrain,ȱ Kosȱ andȱ Richdaleȱ argueȱ forȱ theȱ validityȱ ofȱ theȱ ADHDȱ constructȱ byȱpointingȱ toȱwhatȱ theyȱseeȱasȱaȱcontinuityȱ inȱ theȱsymptomatology,ȱ forgettingȱasȱdoȱothers,ȱ thatȱ theȱ“symptomatology”ȱ isȱ contingentȱ uponȱ theȱ subjectiveȱ judgementȱ ofȱ teachersȱ orȱ parentsȱ orȱcontinuallyȱnarrowingȱculturallyȱnormativeȱconceptionsȱofȱchildȱbehaviour.ȱȱȱ

ȱ Problematically,ȱ theȱ foundationȱ forȱ thisȱ “continuity”ȱ isȱ anȱ allegedȱ correlationȱ betweenȱ theȱ‘majorityȱ ofȱ theȱ behaviouralȱ difficultiesȱ describedȱ inȱ Still’sȱ [1902]ȱ lectures…ȱ [and]ȱ …ȱ threeȱchildhoodȱdisordersȱdescribedȱ inȱ theȱ [DSMȬIV]ȱ…ȱADHD,ȱOppositionalȱDefiantȱDisorderȱ (ODD),ȱandȱConductȱDisorderȱ(CD)’ȱ(Kosȱ&ȱRichdale,ȱ2004,ȱpp.ȱ22Ȭ23).ȱȱInȱmakingȱthisȱconnection,ȱhowever,ȱKosȱandȱRichdaleȱblithelyȱ ignoreȱ theȱheterogeneityȱ inȱ theȱbehavioursȱofȱ theȱpopulation/sȱ saidȱ toȱ

9


exhibitȱ ADHDȱ “symptomatology”ȱ (seeȱ discussionȱ inȱ Tannock,ȱ 1998,ȱ pp.ȱ 66Ȭ69)ȱ andȱ insteadȱconcentrateȱonȱusingȱtheȱtenuousȱconnectionȱtoȱsubtlyȱadvanceȱaȱpsychologicalȱperspective.ȱȱThus,ȱbecauseȱmedicineȱ cannotȱ conclusivelyȱmapȱ behaviouralȱ descriptorsȱ toȱ relevantȱ neurologicalȱ orȱindeedȱ biophysiologicalȱ origins,ȱ norȱ locateȱ ‘biologicalȱ markersȱ forȱ ADHDȱ orȱ itsȱ componentȱsymptoms’ȱ (Tannock,ȱ 1998,ȱ p.ȱ 89),ȱ Kosȱ andȱ Richdaleȱ (2004)ȱ argue,ȱ albeitȱ obliquely,ȱ forȱ aȱpsychologicalȱconceptualisation.ȱȱHoweverȱinȱdoingȱso,ȱtheyȱprivilegeȱtheȱnebulousȱandȱvalueȬladenȱbehaviouralȱdescriptorsȱwhichȱhaveȱthemselvesȱgivenȱriseȱtoȱmuchȱofȱtheȱcontroversyȱrelatingȱtoȱtheȱvalidityȱofȱtheȱADHDȱdiagnosticȱcategoryȱ(Riccioȱetȱal.,ȱ1993;ȱTait,ȱ2001;ȱThomasȱ&ȱGlenny,ȱ2000).ȱȱItȱisȱnotȱhardȱtoȱseeȱwhyȱtheseȱnormativeȱandȱmoralisticȱdescriptorsȱhaveȱgivenȱriseȱtoȱcritique:ȱ

Forȱ example,ȱ beingȱ forgetful,ȱ fidgetyȱ andȱ unableȱ toȱ maintainȱ attentionȱ areȱ featuresȱ ofȱADHDȱ(APA,ȱ2000).ȱȱLosingȱone’sȱtemper,ȱarguing,ȱbeingȱspiteful,ȱandȱannoyingȱothersȱareȱcharacteristicȱ ofȱODDȱ (APA,ȱ 2000),ȱ andȱ threateningȱ others,ȱ hittingȱ childrenȱwithȱ sticks,ȱkillingȱanimals,ȱstealingȱandȱsettingȱfiresȱareȱallȱbehavioursȱassociatedȱwithȱCDȱ(APA,ȱ2000).ȱ(Kosȱ&ȱRichdale,ȱ2004,ȱp.ȱ23)ȱ

Theȱattemptȱtoȱpointȱtoȱtheȱcontinuityȱofȱ“symptomatology”ȱoverȱtheȱcourseȱofȱ100ȱorȱmoreȱyears,ȱwhilstȱsimultaneouslyȱadvancingȱaȱpsychosocialȱperspectiveȱwithȱregardsȱtoȱcausality,ȱisȱaȱseriouslyȱflawedȱargument.ȱ ȱTheȱtenȱplusȱdecadesȱspanningȱ1902ȱtoȱ2006ȱhaveȱundoubtedlyȱbeenȱwitnessȱtoȱtheȱmostȱsocialȱandȱtechnologicalȱchangeȱinȱhumanȱhistory.ȱ ȱForȱexampleȱinȱ1902,ȱnineȱyearsȱafterȱneighbouringȱNewȱZealand,ȱAustralianȱwomenȱwereȱfinallyȱgrantedȱ theȱrightȱ toȱvote.ȱ ȱSinceȱthenȱthereȱhasȱ beenȱ rapidȱ industrialisation,ȱ twoȱWorldȱWars,ȱ anȱ economicȱdepressionȱ andȱnumerousȱrecessions,ȱ andȱ theȱ developmentȱ ofȱ weaponsȱ ofȱ massȱ destruction.ȱ ȱ Thereȱ hasȱ beenȱ increasedȱavailabilityȱofȱantibioticȱtherapy,ȱwhichȱhasȱbroughtȱaboutȱtheȱvirtualȱeradicationȱofȱdiseasesȱsuchȱasȱsmallpox,ȱpolioȱandȱtuberculosisȱinȱmostȱdevelopedȱcountriesȱbut,ȱatȱtheȱsameȱtime,ȱweȱhaveȱseenȱtheȱdevelopmentȱofȱresistantȱsuperbugs,ȱlikeȱStaphylococcusȱAureusȱ(GoldenȱStaph)ȱandȱHIV/AIDS.ȱȱThereȱ hasȱ beenȱ rapidȱ computerisation,ȱ antiȬdiscriminationȱ legislation,ȱ decentȱ contraception,ȱ testȱtubeȱbabies,ȱlongȬdayȱcare,ȱfastȱfoodȱandȱfastȱcapitalism.ȱȱTVȱkilledȱtheȱRadioȱstore,ȱBarbieȱisȱlosingȱmarketȱshareȱtoȱBratzȱ(Morganȱ&ȱMoses,ȱ2002)ȱandȱElvisȱtoȱEminemȱ(Rich,ȱ2002).ȱȱȱ

ȱ Inȱshort,ȱtheȱsocialȱworldȱofȱchildrenȱinȱ2006ȱisȱcompletelyȱalienȱtoȱthatȱofȱchildrenȱinȱ1976ȱ(whenȱIȱwasȱaboutȱtheȱageȱmyȱchildrenȱareȱnow)ȱȬȱletȱaloneȱtheȱlivedȬexperiencesȱofȱchildrenȱinȱ1906.ȱȱYetȱweȱ areȱ expectedȱ toȱ acceptȱ thatȱbecauseȱ ‘aȱGermanȱdoctor,ȱHeinrichȱHoffman…ȱ clearlyȱdescribesȱADHDȬrelatedȱbehaviours’ȱ(Kosȱ&ȱRichdale,ȱ2004,ȱp.ȱ22)ȱinȱtheȱchildren’sȱstoryȱheȱwroteȱforȱhisȱsonȱinȱtheȱlateȱ1800s,ȱthatȱtheȱ‘developmentȱofȱtheȱcurrentȱdefinitionȱofȱADHDȱhasȱaȱlongȱhistory’ȱ(Kosȱ&ȱ Richdale,ȱ 2004,ȱ p.ȱ 22).ȱ ȱ Or,ȱ mostȱ problematically,ȱ thatȱ theȱ activityȱ levelsȱ ofȱ childrenȱ inȱcontemporaryȱ timesȱ canȱ beȱ directlyȱ comparedȱ toȱ andȱ correlatedȱ withȱ thoseȱ ofȱ childrenȱ whoȱhappenedȱtoȱcomeȱunderȱadultȱscrutinyȱinȱtheȱrepressiveȱVictorianȱera.ȱȱ

ȱ Theȱfieldȱofȱpsychology,ȱdiverseȱthoughȱitȱis,ȱtendsȱtowardsȱaȱpsychosocialȱparadigmȱtoȱprovideȱexplanationȱofȱandȱ interventionȱforȱchildȱbehaviourȱ thatȱ isȱconsideredȱundesirable.ȱ ȱPsychologicalȱtheoryȱ isȱ deeplyȱ imbricatedȱ inȱ theȱ industryȱ surroundingȱ childȱ behaviourȱ “disorderedness”.ȱ ȱ Inȱmanyȱ instances,ȱpsychometricȱ testingȱ againstȱnormativeȱ standardsȱ remainsȱ oneȱ ofȱ theȱmeansȱ byȱwhichȱ“abnormal”ȱchildrenȱbecomeȱdefinedȱandȱlocated.ȱȱDespiteȱtheȱunreliabilityȱofȱpsychometricȱtesting,ȱparticularlyȱwithȱrespectȱtoȱdiagnosingȱADHDȱ(Wolraichȱetȱal.,ȱ2003),ȱaȱchild’sȱperformanceȱonȱpsychometricȱsubȬtestsȱcanȱdetermineȱwhetherȱ theirȱproblemsȱ inȱschoolȱwillȱbeȱclassifiedȱ (andȱsupported)ȱasȱaȱ“recognised”ȱlearningȱdifficultyȱorȱwhetherȱtheirȱdifficultiesȱinȱlearningȱareȱcausedȱbyȱtheirȱproblemsȱwithȱattentionalȱcontrolȱand,ȱthusȱviewedȱasȱproblemsȱtoȱbeȱ“managed”ȱthroughȱeitherȱmedicationȱorȱexclusionaryȱbehaviourȱmanagementȱtechniques(seeȱGraham,ȱ2006a).ȱ

10


ȱ Despiteȱ aȱ generalȱ lackȱ ofȱ agreementȱ asȱ toȱwhetherȱ thereȱ isȱ aȱ discreteȱ biologicalȱ causalȱ linkȱ(Hyndȱ&ȱVoeller,ȱ1991;ȱLevyȱetȱal.,ȱ1997;ȱRiccioȱetȱal.,ȱ1993),ȱtheȱmedicalȱmodelȱofȱADHDȱcontinuesȱtoȱpositȱneurobiologicalȱdysfunctionȱ(aȱhypothesisȱthatȱappearsȱtoȱhaveȱgainedȱtheȱstatusȱofȱtruth)ȱasȱtheȱcauseȱforȱdisorderlyȱbehaviour,ȱwhichȱleadsȱtoȱ‘medicalȱpractitionersȱhavingȱtheȱprimaryȱroleȱinȱinterventions’ȱ(Atkinsonȱ&ȱShute,ȱ1999,ȱp.ȱ124).ȱȱThisȱisȱtoȱtheȱapparentȱdetrimentȱofȱpsychologistsȱkeenȱtoȱremainȱkeyȱplayersȱinȱtheȱsatelliteȱindustryȱsurroundingȱbehaviourȱ“disorderedness”ȱ(Slee,ȱ1995),ȱpromptingȱsomeȱinȱtheȱacademyȱtoȱsuggestȱthatȱpractitionersȱofȱpsychologyȱavoidȱtheȱuseȱofȱwordsȱ ‘suchȱasȱ“symptoms”ȱandȱ“diagnosis”ȱ [which]ȱautomaticallyȱgiveȱprecedenceȱ toȱaȱmedicalȱmodelȱofȱADHD’ȱ(Atkinsonȱ&ȱShute,ȱ1999,ȱp.ȱ123).ȱ

ȱ Inȱ relationȱ toȱ theȱ “treatment”ȱ ofȱADHD,ȱ inȱ theȱmain,ȱ psychologicalȱ paradigmsȱ deferȱ toȱ theȱmedicalȱexplanationȱofȱneurologicalȱdysfunctionȱandȱtheȱprescriptionȱofȱpsychopharmaceuticalsȱasȱaȱ “firstȬlineȱ approach”ȱ (Wallace,ȱ 1999),ȱ however,ȱ becauseȱ medicationȱ hasȱ failedȱ toȱ provideȱ aȱsolutionȱtoȱtheȱ“problem”ȱitȱwasȱmeantȱtoȱsolve,ȱpsychologistsȱhaveȱbeenȱsuccessfulȱinȱarguingȱforȱaȱmultiȬmodalȱapproachȱtoȱtheȱtreatmentȱandȱmanagementȱofȱADHDȱthroughȱbehaviourȱmodificationȱtechniquesȱ andȱmanagementȱ programsȱ (Atkinsonȱ &ȱ Shute,ȱ 1999;ȱWallace,ȱ 1999).ȱ ȱ Asȱ such,ȱ theȱensuingȱreciprocalȱrelationshipȱthatȱhasȱdevelopedȱbetweenȱmedicalȱandȱpsychologicalȱpractitionersȱhasȱ beenȱ theȱ conditionȱ ofȱ possibilityȱ forȱ theȱ expansionȱ ofȱ theȱ conceptȱ ofȱ childȱ behaviourȱ“disorderedness”ȱ Ȭȱ forȱ aȱprotractedȱwarȱ betweenȱ theȱ twoȱparadigmsȱwouldȱweakenȱ ratherȱ thanȱstrengthenȱ claimsȱ onȱ bothȱ sides.ȱ ȱ Despiteȱ researchȱ thatȱ demonstratesȱ medicationȱ effectsȱ onlyȱbehaviourȱandȱhasȱrelativelyȱnoȱimpactȱonȱtheȱhigherȬorderȱandȱlongerȬtermȱprocessesȱofȱlearningȱ(Hyndȱ&ȱVoeller,ȱ1991;ȱPurdieȱetȱal.,ȱ2002;ȱSwansonȱetȱal.,ȱ1993;ȱTeeter,ȱ1991),ȱtheȱdominantȱ“reachȱbeforeȱ youȱ canȱ teach”ȱ ethosȱ allowsȱ medicalȱ practitionersȱ toȱ acknowledgeȱ theȱ psychologicalȱperspective,ȱwhilstȱremainingȱfirmlyȱwithinȱandȱgivingȱprecedenceȱtoȱtheȱmedicalȱconceptualisationȱofȱADHD:ȱȱȱ

Nowadays,ȱmostȱchildrenȱwithȱmajorȱADHDȱwillȱstartȱstimulantsȱonȱtheirȱfirstȱvisit.ȱȱIfȱyouȱreachȱ(withȱstimulants)ȱthenȱyouȱareȱableȱtoȱteachȱ(withȱbehaviourȱprograms,ȱtherapyȱandȱschooling).ȱȱ(originalȱemphasis,ȱȱGreenȱ&ȱChee,ȱ1997,ȱp.ȱ144)ȱ

Byȱ theȱ sameȱ token,ȱhavingȱdevelopedȱaȱworkingȱ relationshipȱwithȱmedicalȱpractitionersȱ throughȱmultiȬmodalȱ treatmentȱ arrangements,ȱpsychologicalȱpractitionersȱ secureȱ aȱ legitimateȱplaceȱ inȱ theȱspaceȱsurroundingȱtheȱ“behaviourallyȱdisordered”ȱchild.ȱȱPsychologicalȱtreatmentȱofȱchildrenȱwhoȱcomeȱ toȱ beȱ describedȱ asȱ “attentionȱ deficitȱ hyperactivityȱ disordered”ȱ aimsȱ toȱ teachȱ inhibitoryȱresponsesȱthroughȱwhatȱcouldȱbeȱsimplyȱdescribedȱasȱcauseȱandȱeffectȱtraining.ȱȱHowever,ȱseveralȱmajorȱstudiesȱhaveȱfailedȱ toȱdemonstrateȱ thatȱpsychologicalȱ interventionsȱ(intensiveȱorȱotherwise)ȱprovideȱanyȱbenefitȱoverȱmedicationȱaloneȱ (Hechtmanȱetȱal.,ȱ2004;ȱLevy,ȱ2001;ȱWhalenȱ&ȱHenker,ȱ1998).iiȱ ȱ ThusȱmultiȬmodalȱ treatmentȱmodels,ȱwhilstȱ generallyȱ consideredȱ theȱ bestȱ optionȱ inȱ theȱmanagementȱofȱADHDȱ (Atkinsonȱ&ȱShute,ȱ1999),ȱdoȱnotȱ liveȱupȱ toȱeitherȱexpectationȱ (Whalenȱ&ȱHenker,ȱ1998)ȱorȱpromiseȱ(Wallace,ȱ1999).ȱȱȱ

ȱ Thisȱmayȱbeȱbecauseȱ“multiȬmodal”ȱmodelsȱtendȱtoȱprivilegeȱpsychologicalȱ“treatments”,ȱratherȱthanȱ educationalȱ (asȱ inȱpedagogical)ȱ interventions.ȱ ȱComplicatedȱ responseȬcostȱ selfȬmanagementȱpracticesȱareȱnotȱonlyȱdifficultȱforȱteachersȱtoȱrunȱinȱconjunctionȱwithȱtheirȱalwaysȬalreadyȱcrowdedȱcurriculumȱandȱteachingȱresponsibilities,ȱbutȱsuchȱpracticesȱdoȱnothingȱtoȱaddressȱaȱchild’sȱlearningȱneedsȱwhen,ȱforȱexample,ȱtheyȱmayȱhaveȱdifficultyȱunderstandingȱabstractȱorȱcomplexȱinstructions.ȱȱInȱ addition,ȱ psychologicalȱ servicesȱ areȱ difficultȱ toȱ access.ȱ ȱ Publicȱ servicesȱ areȱ plaguedȱ byȱ longȱwaitingȱ listsȱandȱprivateȱservicesȱareȱprohibitivelyȱexpensiveȱ (GiffordȱSawyerȱetȱal.,ȱ2004).ȱ ȱGivenȱthatȱ theȱeffectivenessȱofȱpsychologicalȱ interventionsȱ isȱequivocalȱandȱ thatȱ theyȱareȱhardȱ toȱaccessȱ

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andȱcanȱbeȱexpensive,ȱitȱisȱnoȱsmallȱwonderȱthatȱmanyȱparentsȱresortȱtoȱmedicatingȱtheirȱchildrenȱdespiteȱtheȱoverwhelmingȱmajorityȱcallingȱforȱmoreȱsupportȱ(GiffordȱSawyerȱetȱal.,ȱ2004,ȱp.ȱ1362).ȱȱȱ

ȱ Theȱ ironyȱ isȱ thatȱ stimulantȱmedication,ȱ byȱ farȱ theȱmostȱprescribedȱmedicationȱ inȱ relationȱ toȱADHD,ȱoperatesȱduringȱschoolȱhours.ȱȱInȱorderȱthatȱtheȱchildȱcanȱeatȱandȱsleep,ȱtheȱmedicationȱmustȱwearȱoffȱbyȱlateȱafternoon.ȱParentsȱhaveȱtoȱdealȱwithȱtheȱreboundȱeffectsȱofȱthatȱmedicationȱwhich,ȱincidentallyȱcanȱcauseȱbehaviourȱfarȱworseȱthanȱthatȱwhichȱtheȱchildȱwasȱoriginallyȱmedicatedȱfor.ȱȱAlso,ȱ toȱoffsetȱ theȱ sideȬeffectsȱ (suchȱasȱgrowthȱ retardation)ȱ specialistsȱ sometimesȱadvocateȱ“drugȱholidays”ȱ(Greenȱ&ȱChee,ȱ1997).ȱȱTheseȱdrugȬfreeȱperiodsȱareȱusuallyȱduringȱweekendsȱandȱschoolȱholidaysȱ–ȱtimesȱwhenȱparentsȱcontinueȱtheȱbattleȱaloneȱwithȱaȱchildȱwhoȱliterallyȱdoesȱnotȱknowȱwhetherȱtheyȱareȱcomingȱorȱgoing.ȱȱAsȱsuch,ȱtheȱargumentȱthatȱparentsȱmedicateȱchildrenȱforȱtheirȱownȱbenefitȱisȱludicrous.ȱȱMoreȱresearchȱisȱneededȱintoȱtheȱpressureȱthatȱschoolsȱandȱteachersȱplaceȱparentsȱunderȱ toȱmedicateȱ theirȱchildrenȱandȱ theȱmotivatingȱ factorȱ thatȱ fearȱofȱschoolȱ failureȱhasȱuponȱparents.ȱ ȱ Inȱaddition,ȱ Iȱwouldȱargueȱ thatȱmoreȱ researchȱ isȱneededȱ intoȱparentȱperspectives,ȱwhyȱtheyȱmightȱmakeȱtheȱdecisionȱtoȱmedicateȱand,ȱmostȱimportantly,ȱwhetherȱtheyȱstillȱwouldȱȬȱifȱtheirȱchildrenȱwereȱbetterȱresourced,ȱsupportedȱandȱunderstoodȱinȱschool.ȱȱȱ

Medicine,ȱPsychologyȱ&ȱADHDȱ

Whilstȱ Iȱ amȱ favourȱ ofȱ neither,ȱ theȱ fundamentalȱ differenceȱ betweenȱmedicalȱ andȱ psychologicalȱmodelsȱ liesȱ inȱ theirȱ respectiveȱ theorisationȱofȱ agency,ȱ reasonȱ andȱ controlȱwithȱ anȱ effectȱ towardsȱperceptionsȱ ofȱ responsibilityȱ andȱ culpability.ȱ ȱ Theȱ medicalȱ modelȱ appearsȱ toȱ acceptȱ theȱ“disordered”ȱchildȱasȱhavingȱlittleȱorȱnoȱcontrolȱoverȱtheirȱactions.ȱȱTheȱpsychologicalȱmodel,ȱonȱtheȱotherȱhand,ȱisȱdependentȱforȱitsȱveryȱexistenceȱonȱtheȱparadoxicalȱassertionȱthatȱtheȱchildȱcanȱexertȱorȱlearnȱselfȬcontrol.ȱȱDifficultȱbehaviourȱisȱinterpretedȱasȱmisdirectedȱbehaviourȱ(Atkinsonȱ&ȱShute,ȱ1999)ȱorȱseenȱasȱbehaviourȱ thatȱ isȱgainingȱaȱpayȬoffȱwhichȱcanȱbeȱ fixedȱbyȱreȬarrangingȱ theȱ termsȱ(Wallace,ȱ1999).ȱ ȱOnȱtheȱsideȱofȱtheȱmedicalȱmodel,ȱthereȱisȱtheȱassertionȱofȱaȱlackȱinȱtheȱ facultyȱtoȱcontrolȱ (Greenȱ&ȱChee,ȱ 1997;ȱHolmes,ȱ 2004;ȱNationalȱ Instituteȱ ofȱMentalȱHealth,ȱUSȱDepartmentȱ ofȱHealthȱandȱHumanȱServices,ȱ1994),ȱwhichȱresultsȱinȱaȱviewȱofȱtheȱchildȱasȱnotȱentirelyȱresponsibleȱforȱtheirȱactions.ȱȱȱ

ȱ However,ȱ psychologicalȱ conceptsȱ relyȱ onȱ theȱ operationȱ ofȱ thisȱ facultyȱ (Ollendickȱ&ȱHersen,ȱ1998;ȱPowellȱ&ȱ InglisȬPowell,ȱ1999;ȱWallace,ȱ1999),ȱandȱ thisȱconstitutesȱ theȱshakyȱepistemologicalȱbaseȱ uponȱwhichȱ psychologicalȱ interventionsȱ (behaviourȱmanagement/modification)ȱ rest.ȱ ȱ Iȱ sayȱshakyȱbecauseȱif,ȱasȱAtkinsonȱandȱShuteȱconcur,ȱ‘theȱgenerallyȱacceptedȱpremiseȱisȱthatȱtheȱmedicalȱmodelȱ isȱ theȱappropriateȱone’ȱ (Atkinsonȱ&ȱShute,ȱ1999,ȱp.ȱ124)ȱandȱADHDȱandȱotherȱdisruptiveȱbehaviourȱ“disorders”ȱareȱbehaviouralȱ reflectionsȱofȱneurobiologicalȱanomaliesȱaffectingȱaȱchild’sȱabilityȱ toȱselfȬregulate,ȱ thenȱwhereȱdoesȱ thatȱ leaveȱbehaviourȱmodificationȱ techniquesȱ thatȱrequireȱselfȬregulatoryȱabilities?ȱȱIndeed,ȱpsychologyȱisȱforcedȱtoȱsubordinateȱtoȱmedicineȱwhenȱfacedȱwithȱthisȱproblematic:ȱ

…diverseȱpsychosocialȱandȱbehaviouralȱ treatmentsȱhaveȱbeenȱappliedȱ toȱADHD…ȱparentȱtraining,ȱ andȱ familyȱ counselling,ȱ socialȱ skillsȱ training,ȱ academicȱ remediation,ȱ cognitiveȬbehaviourȱ modification,ȱ biofeedback,ȱ insightȱ therapy,ȱ andȱ evenȱ exerciseȱ regimens.ȱCognitiveȬbehaviouralȱapproachesȱappearedȱespeciallyȱȱpromising,ȱgivenȱtheȱpervasiveȱselfȬregulatoryȱdeficitsȱofȱADHDȱchildren,ȱbutȱtheȱoutcomeȱdataȱhaveȱbeenȱdisappointing…ȱInȱtheȱ vastȱmajorityȱ ofȱ controlledȱ studies,ȱ nonȬpharmacologicalȱ approachesȱ paleȱ relativeȱ toȱstimulantȱ treatment,ȱ andȱ theȱ questionȱ ofȱwhetherȱ anyȱ psychosocialȱ treatmentȱmakesȱ anȱadditiveȱcontributionȱremainsȱopen.ȱ(Whalenȱ&ȱHenker,ȱ1998,ȱp.ȱ200)ȱȱ

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Despiteȱ theȱ evidenceȱpointingȱ toȱ aȱ lackȱofȱ effectivenessȱ inȱpsychologicalȱ intervention,ȱwithinȱ theȱschoolingȱcontextȱbehaviourȱ interventionȱtechniquesȱ informedȱbyȱtheȱpsychologicalȱmodelȱprevailȱoverȱmedicalȱconceptualisationsȱofȱbehaviourȱ“disorderedness”ȱandȱitsȱmoreȱconservativeȱestimateȱofȱtheȱagentiveȱcapabilitiesȱofȱtheȱchildiii,ȱhowever,ȱitȱmustȱbeȱstatedȱthatȱtheȱmedicalȱmodelȱisȱjustȱasȱproblematicȱ andȱ notȱ justȱ becauseȱ ofȱ theȱ increasingȱ recourseȱ toȱ psychoȬpharmaceuticalȱ controlȱ(Mackeyȱ&ȱKopras,ȱ2001).ȱ ȱDespiteȱlargeȬscaleȱresearchȱthatȱshowsȱeducationalȱinterventionsȱtoȱbeȱmoreȱ successfulȱ inȱ respondingȱ toȱ problematicȱ behaviourȱ inȱ schoolsȱ (Purdieȱ etȱ al.,ȱ 2002),ȱpsychologicalȱ conceptualisationsȱ predominateȱ –ȱ particularlyȱ thoseȱ whichȱ privilegeȱ theȱ useȱ ofȱbehaviourȱmanagementȱtechniquesȱdrawingȱonȱtheȱ ‘inherentlyȱauthoritarian’ȱ(Grieshaber,ȱ1997,ȱp.ȱ33)ȱandȱexclusionaryȱlogicȱofȱcognitive/behaviouristȱpsychology.ȱȱȱ

ADHDȱ&ȱSchoolingȱ

Accordingȱ toȱAustralianȱBureauȱofȱStatisticsȱdata,ȱ increasingȱnumbersȱofȱschoolȬagedȱchildrenȱareȱbeingȱ describedȱ asȱ ‘behaviourallyȱ disordered’ȱ andȱ diagnosedȱ withȱ theȱ psychiatricȱ disorderȱcommonlyȱknownȱasȱADHDȱ(ABS,ȱ2000).ȱȱCorrespondingly,ȱthereȱhasȱbeenȱaȱsustainedȱincreaseȱinȱprescriptionsȱ forȱ stimulantsȱ administeredȱ toȱ childrenȱdiagnosedȱwithȱADHDȱ (Davisȱ etȱ al.,ȱ 2001;ȱMackeyȱ &ȱ Kopras,ȱ 2001;ȱ Prosserȱ etȱ al.,ȱ 2002).ȱ ȱ Statisticsȱ inȱ theȱ Commonwealthȱ Governmentȱpublication,ȱAccountingȱforȱChangeȱinȱDisabilityȱandȱSevereȱRestriction,ȱ1981Ȭ1998,ȱnotȱonlyȱconfirmȱthisȱtrendȱbutȱisolateȱunparalleledȱgrowthȱinȱtheȱdiagnosisȱofȱADHDȱamongstȱboysȱ5ȱtoȱ15ȱyearsȱofȱageȱ(Davisȱetȱal.,ȱ2001).ȱ ȱTheȱreportȱ indicatesȱ thatȱdueȱ toȱ theȱriseȱ inȱADHDȱdiagnoses,ȱ theȱnumberȱofȱyoungȱboysȱdiagnosedȱwithȱeitherȱaȱmentalȱorȱbehaviouralȱconditionȱincreasedȱalmostȱtenfoldȱinȱtheȱperiodȱbetweenȱ1988ȱandȱ1998;ȱfromȱ2,200ȱboysȱ toȱ20,800ȱrespectivelyȱ(Davisȱetȱal.,ȱ2001,ȱp.14).ȱ ȱItȱalsoȱdrawsȱ attentionȱ toȱoneȱ spectacularȱ increaseȱ inȱADHDȱdiagnosisȱoverȱ aȱperiodȱofȱ someȱ fiveȱyearsȱtoȱillustrateȱtheȱscaleȱofȱtheȱrise,ȱstatingȱthatȱ“[b]etweenȱtheȱ1993ȱandȱ1998ȱsurveys,ȱtheȱrateȱofȱADHDȱincreasedȱmarkedly,ȱparticularlyȱamongȱboysȱagedȱ5ȱtoȱ14.ȱȱTheȱnumberȱwithȱADHDȱinȱ1998ȱ(10,700)ȱwasȱgreaterȱthanȱtheȱtotalȱrecordedȱwithȱaȱmentalȱdisorderȱinȱ1993’ȱ(emphasisȱadded,ȱDavisȱetȱal.,ȱ2001,ȱp.15).ȱ ȱEvidentlyȱgirlsȱhaveȱnotȱbeenȱimmune,ȱasȱtheȱnumberȱofȱgirlsȱdiagnosedȱwithȱmentalȱandȱbehaviouralȱconditions1ȱdoubledȱinȱtheȱtenȱyearsȱbetweenȱ1988ȱandȱ1998ȱ(Davisȱetȱal.,ȱ2001).ȱȱ

ȱ Amongȱexistingȱexplanationsȱareȱassertionsȱthatȱparentsȱ(Shanahan,ȱ2004)ȱand/orȱlobbyȱgroupsȱ(Conrad,ȱ1975)ȱareȱbehindȱtheȱexponentialȱgrowthȱinȱdiagnosesȱofȱpsychiatricȱbehaviourȱdisordersȱandȱthisȱargumentȱisȱalsoȱreflectedȱinȱtheȱprofessionalȱliteratureȱ(Atkinsonȱ&ȱShute,ȱ1999;ȱReidȱetȱal.,ȱ1993;ȱSmelterȱetȱal.,ȱ1996).ȱ ȱHowever,ȱ thisȱ isȱ tooȱ simplisticȱanȱexplanationȱasȱ toȱwhyȱ increasinglyȱlargeȱnumbersȱofȱschoolȬageȱchildren,ȱparticularlyȱ thoseȱ inȱearlyȱprimary,ȱareȱbeingȱdiagnosedȱasȱpsychiatricallyȱandȱbehaviourallyȱdisordered.ȱȱParticularlyȱwhenȱresearchȱindicatesȱthatȱteachersȱareȱoftenȱtheȱfirstȱtoȱsuggestȱaȱdiagnosisȱofȱADHDȱ(Saxȱ&ȱKautz,ȱ2003)ȱorȱrecommendȱthatȱparentsȱtakeȱtheirȱ childȱ toȱ aȱ “professional”ȱ toȱ investigateȱ theirȱ hyperactive,ȱ distractible,ȱ impulsiveȱ behaviourȱ(Neophytou,ȱ2004).ȱ

ȱ Itȱ isȱ interestingȱ toȱnoteȱ thatȱDavisȱ etȱal.ȱ (2001)ȱpointȱ toȱaȱ correlationȱbetweenȱaȱpeakȱ inȱ theȱDisabilityȱandȱSevereȱRestrictionsȱRateȱ (measuringȱdiagnosisȱofȱmentalȱandȱbehaviourȱdisorder)ȱandȱtheȱstartȱofȱcompulsoryȱschoolȱattendance.ȱȱDueȱtoȱtheȱimpactȱofȱADHDȱdiagnoses,ȱtheȱrateȱpeaksȱatȱfiveȱ yearsȱ ofȱ ageȱ andȱ isȱmaintainedȱ steadilyȱ fromȱ thereȱ untilȱ droppingȱ againȱ postȬcompulsoryȱschoolingȱageȱ(Davisȱetȱal.,ȱ2001,ȱp.ȱ6).ȱȱWhilstȱtheȱreportȱconsidersȱseveralȱpossibleȱimpactȱfactors,ȱi.e.ȱthatȱthereȱisȱnoȱreliableȱreportingȱagencyȱtrackingȱchildrenȱonceȱtheyȱleaveȱschoolȱ(Davisȱetȱal.,ȱ2001,ȱ p.6);ȱ itȱ appearsȱ theȱ contributionȱ ofȱ pedagogicalȱ discourses,ȱ policiesȱ andȱ practicesȱ toȱ theseȱescalatingȱratesȱreceivesȱscant,ȱifȱanyȱconsideration.ȱȱȱ

1 Differentiation between disorders is not made for girls in this report.

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AttentionȱDeficitȱHyperactivityȱDisorderȱ (ADHD)ȱ isȱ characterisedȱ inȱ theȱDSMȬIVȬTRȱbyȱ theȱpresenceȱofȱbehavioursȱapparentlyȱincongruentȱwithȱthoseȱmostȱdesiredȱforȱsuccessȱinȱtheȱclassroomȱenvironmentȱ(StormontȬSpurgin,ȱ1997).ȱ ȱForȱexample,ȱtheȱDSMȬIVȱdiagnosticȱprocessȱrequiresȱthatȱtheȱchildȱmeetȱsixȱorȱmoreȱcriteriaȱinȱeitherȱ(1)ȱInattentionȱorȱ(2)ȱHyperactiveȬImpulsiveȱcategoriesȱ(APA,ȱ1994),ȱlistedȱbelow:ȱ

(1)ȱInattentionȱ

(a)ȱ oftenȱfailsȱtoȱgiveȱcloseȱattentionȱtoȱdetailsȱorȱmakesȱcarelessȱmistakesȱinȱschoolȱwork,ȱwork,ȱorȱotherȱactivitiesȱ

(b)ȱ oftenȱhasȱdifficultyȱsustainingȱattentionȱinȱtasksȱorȱplayȱactivitiesȱ

(c)ȱ oftenȱdoesȱnotȱseemȱtoȱlistenȱwhenȱspokenȱtoȱdirectlyȱ

(d)ȱ oftenȱ doesȱ notȱ followȱ throughȱ onȱ instructionsȱ andȱ failsȱ toȱ finishȱ schoolȱwork,ȱ chores,ȱ orȱdutiesȱ inȱ theȱ workplaceȱ (notȱ dueȱ toȱ oppositionalȱ behaviourȱ orȱ failureȱ toȱ understandȱinstructions)ȱ

(e)ȱ oftenȱhasȱdifficultyȱorganisingȱtasksȱandȱactivitiesȱ

(f)ȱ oftenȱavoids,ȱdislikes,ȱorȱisȱreluctantȱtoȱengageȱinȱtasksȱthatȱrequireȱsustainedȱmentalȱeffortȱ(suchȱasȱschoolȱworkȱorȱhomework)ȱ

(g)ȱ oftenȱ losesȱ thingsȱ necessaryȱ forȱ tasksȱ orȱ activitiesȱ (e.g.ȱ toys,ȱ schoolȱ assignments,ȱ pencils,ȱbooks,ȱorȱtools)ȱ

(h)ȱ isȱoftenȱeasilyȱdistractedȱbyȱextraneousȱstimuliȱ

(i)ȱ isȱoftenȱforgetfulȱinȱdailyȱactivitiesȱ

(2)ȱ HyperactivityȬImpulsivityȱȱ

Hyperactivityȱ

(a)ȱ oftenȱfidgetsȱwithȱhandsȱorȱfeetȱorȱsquirmsȱinȱseatȱ

(b)ȱ oftenȱleavesȱseatȱinȱclassroomȱorȱinȱotherȱsituationsȱinȱwhichȱremainingȱseatedȱisȱexpectedȱ

(c)ȱ oftenȱ runsȱ aboutȱ orȱ climbsȱ excessivelyȱ inȱ situationsȱ inȱ whichȱ itȱ isȱ inappropriateȱ (inȱadolescentsȱorȱadults,ȱmayȱbeȱlimitedȱtoȱsubjectiveȱfeelingsȱofȱrestlessness)ȱ

(d)ȱ oftenȱhasȱdifficultyȱplayingȱorȱengagingȱinȱleisureȱactivitiesȱquietlyȱ

(e)ȱ isȱoftenȱȈonȱtheȱgoȈȱorȱoftenȱactsȱasȱifȱȈdrivenȱbyȱaȱmotorȈȱ

(f)ȱ oftenȱtalksȱexcessivelyȱ

Impulsivityȱ

(g)ȱ oftenȱblurtsȱoutȱanswersȱbeforeȱquestionsȱhaveȱbeenȱcompletedȱ

(h)ȱ oftenȱhasȱdifficultyȱawaitingȱturnȱ

(i)ȱ oftenȱinterruptsȱorȱintrudesȱonȱothersȱ(e.g.ȱbuttsȱintoȱconversationsȱorȱgames)ȱ

ȱ

Aȱ cursoryȱ glanceȱ atȱ theȱ listȱ aboveȱ isȱ enoughȱ toȱ noticeȱ thatȱmostȱ ofȱ theȱ behavioursȱ listedȱ areȱconnectedȱ withȱ (andȱ oneȱ couldȱ evenȱ argueȱ contingentȱ upon)ȱ theȱ demandsȱ ofȱ schooling.ȱ ȱ Notȱblurtingȱ outȱ answersȱ inȱ class,ȱ remainingȱ inȱ one’sȱ seatȱ andȱ beingȱ stillȱ andȱ quietȱ areȱ culturalȱexpectationsȱbroughtȱaboutȱbyȱ theȱadventȱofȱmassȱ schooling.ȱ ȱForȱ example,ȱ ifȱ childrenȱwereȱ stillȱworkingȱ inȱ theȱminesȱ atȱ nineȱ yearsȱ ofȱ ageȱ theirȱ energyȱ levelsȱ wouldȱ beȱ consideredȱ aȱ bonus.ȱȱHowever,ȱ theȱ modernȱ andȱ increasinglyȱ unnaturalȱ demandsȱ ofȱ schoolingȱ haveȱ resultedȱ inȱ theȱ

14


rearticulationȱ ofȱ normalȱ childhoodȱ exuberance,ȱ curiosityȱ andȱ energyȱ asȱ “unnatural”.ȱȱProblematicallyȱ theȱ contributionȱ ofȱ changesȱ inȱ schoolingȱ demandsȱ Ȭȱ suchȱ asȱ loweringȱ ofȱ schoolȱentryȱages,ȱincreasedȱemphasisȱonȱacademicȱlearningȱandȱseatȱwork,ȱpressureȱforȱchildrenȱtoȱlearnȱtoȱreadȱearlierȱandȱbetter,ȱcrowdingȱofȱtheȱcurriculum,ȱtheȱshorteningȱofȱchildren’sȱrecessȱandȱlunchȱtimesȱ–ȱbarelyȱrateȱaȱmentionȱinȱtheȱmyriadȱofȱcontributingȱandȱcausalȱfactorsȱbeingȱconsideredȱinȱtheȱliteratureȱaroundȱADHD.ȱ

Addȱ toȱ thisȱ theȱproblemȱofȱ teacherȱsubjectivity.ȱ ȱForȱexample,ȱ theȱNSWȱAssociationȱofȱGiftedȱandȱTalentedȱChildrenȱwebsiteȱ(NSWȱAssocationȱ forȱGiftedȱ&ȱTalentedȱChildrenȱInc.,ȱ2006)ȱlistsȱsomeȱcharacteristicsȱofȱgiftednessȱas:ȱ

Needsȱlittleȱoutsideȱcontrolȱ–ȱappliesȱselfȱdisciplineȱx

x

x

Hasȱaȱpowerȱofȱconcentration,ȱanȱintenseȱattentionȱthatȱexcludesȱallȱelseȱ

Hasȱaȱlongȱattentionȱspanȱinȱareasȱofȱinterestȱ

Butȱ Ȭȱhowȱdoȱweȱmeasureȱ little,ȱ intenseȱorȱ long?ȱToȱwhoseȱunderstandingsȱofȱ theseȱ thingsȱdoȱweȱrefer?ȱ

Doesȱthisȱmeanȱthatȱtheȱlittleȱgirlȱwhoȱsitsȱquietlyȱandȱcoloursȱinȱ“intensely”ȱandȱconcentratesȱcarefullyȱtoȱstayȱwithinȱtheȱlinesȱforȱthirtyȬfiveȱminutesȱisȱ“gifted”?ȱȱOurȱresponseȱasȱeducatorsȱandȱourȱconceptualisationȱofȱtheȱchildȱdeterminesȱtoȱaȱlargeȱdegreeȱhowȱtheȱchildȱcomesȱtoȱcharacteriseȱthemselvesȱandȱultimately,ȱwhetherȱ theȱ childȱ isȱ identifiedȱasȱ“gifted”.ȱ ȱWhatȱaboutȱ theȱboyȱwhoȱfidgets,ȱcallsȱoutȱinȱclass,ȱisȱcarelessȱinȱhisȱworkȱandȱspendsȱlongȱepisodesȱstaringȱintenselyȱoutȱtheȱwindow?ȱ ȱ Couldȱ heȱ beȱ “gifted”ȱ orȱ doȱ hisȱ characteristicsȱ alignȱmoreȱ easilyȱwithȱ theȱ followingȱdescriptorsȱ takenȱ fromȱ theȱaforementionedȱDSMȬIVȱ listȱsaidȱ toȱ indicateȱ theȱpresenceȱofȱAttentionȱDeficitȱHyperactivityȱDisorder:ȱ

Inattention:ȱ oftenȱfailsȱtoȱgiveȱcloseȱattentionȱtoȱdetailsȱorȱmakesȱcarelessȱmistakesȱinȱschoolȱwork,ȱorȱotherȱactivities;ȱ

Hyperactivity:ȱ oftenȱfidgetsȱwithȱhandsȱorȱfeetȱorȱsquirmsȱinȱseat;ȱ

Impulsivity:ȱ oftenȱblurtsȱoutȱanswersȱbeforeȱquestionsȱhaveȱbeenȱcompleted.ȱ

So,ȱwhoȱisȱgifted?ȱȱTheȱthingȱis,ȱweȱcanȱneverȱknowȱdefinitively.ȱȱTeachersȱmakeȱupȱtheirȱourȱownȱmindsȱaboutȱwhatȱ theyȱ thinkȱconstitutesȱ“giftedness”ȱandȱalsoȱaboutȱwhatȱbehavioursȱ theyȱ thinkȱareȱ“normal”.ȱ ȱTheȱproblemȱ isȱthatȱweȱtreatȱchildrenȱaccordinglyȱandȱtheȱbrightȱ littleȱboyȱtappingȱhisȱ fingersȱ onȱ hisȱ deskȱ andȱ daydreamingȱ asȱ heȱ staresȱ outȱ ofȱ theȱwindow,ȱ disengagedȱ fromȱ theȱbusinessȱofȱ learningȱ isȱappreciatedȱ forȱneitherȱhisȱdiscerningȱ tasteȱnorȱhisȱboundlessȱenergy.ȱ ȱHeȱbecomesȱ labelledȱ asȱ “ADHD”ȱ becauseȱ inȱ theȱmomentȱ theȱ teacherȱ interpretsȱ hisȱ behaviourȱ byȱreferringȱtoȱtheȱrepertoireȱofȱsignsȱ(i.e.ȱbehaviouralȱcategories)ȱwithȱwhichȱhe/sheȱcanȱmakeȱsenseȱofȱthatȱparticularȱchild,ȱ theȱ“ADHD”ȱsignifierȱcomesȱ toȱdisplaceȱ theȱcompetingȱsignifier,ȱ“gifted”ȱorȱtheȱweakestȱsignifierȱofȱall,ȱ“normal”.ȱȱȱ

ȱ Characteristicsȱofȱvalueȱ inȱourȱ societyȱhaveȱmorphedȱoverȱ time.ȱ ȱWeȱareȱmovingȱawayȱ fromȱcommodityȱbasedȱeconomiesȱintoȱtheȱknowledgeȱeconomy;ȱaȱglobalised,ȱinformationȱsociety.ȱȱOneȱeffectȱ ofȱ thisȱ hasȱ beenȱ theȱ gradualȱ depletionȱ ofȱ unskilledȱ labour,ȱ anȱ increaseȱ inȱ theȱ youthȱunemploymentȱrate,ȱaȱconsequentȱrequirementȱforȱyoungȱpeopleȱtoȱremainȱatȱschoolȱforȱlongerȱandȱtoȱgainȱhigherȱcredentials,ȱandȱpressureȱonȱschoolsȱ toȱretainȱstudentsȱ thatȱpreviouslyȱwouldȱhaveȱ

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beenȱ ejectedȱ eitherȱ intoȱ theȱ tradesȱ orȱ largerȱunskilledȱ labourȱmarketsȱ (Slee,ȱ 2001).ȱ ȱAȱderivativeȱeffectȱisȱthatȱthereȱisȱnowȱincreasedȱemphasisȱonȱseatȬworkȱandȱaȱprivilegingȱofȱtheȱcharacteristicsȱrequiredȱtoȱmoreȱeasilyȱconformȱtoȱthisȱmodeȱofȱlearning.ȱȱ

ȱ SomeȱproponentsȱmaintainȱthatȱchildrenȱdiagnosedȱwithȱADHDȱbenefitȱfromȱmedicationȱinȱthatȱtheyȱbecomeȱbetterȱdisposedȱtoȱlearningȱ(Greenȱ&ȱChee,ȱ1997).ȱȱThisȱisȱnotȱsupportedȱbyȱextensiveȱresearchȱthatȱhasȱdemonstratedȱthatȱuseȱofȱstimulantȱmedicationȱdoesȱnotȱresultȱinȱlearningȱbenefitsȱforȱtheȱmedicatedȱchildȱ(Hechtmanȱetȱal.,ȱ2004;ȱSwansonȱetȱal.,ȱ1993)ȱbutȱinȱmoreȱdocileȱbehaviourȱappropriateȱ toȱ theȱorderlyȱrunningȱofȱ theȱclassroomȱ (Slee,ȱ1994,ȱ1995).ȱ ȱ Interestingly,ȱPurdieȱetȱal.ȱ(2002)ȱfoundȱinȱtheirȱreviewȱofȱtheȱinterventionsȱadvocatedȱforȱuseȱwhenȱdealingȱwithȱbehavioursȱsaidȱtoȱindicateȱAttentionȱDeficitȱHyperactivityȱDisorder,ȱthatȱtheȱeffectsȱonȱeducationalȱoutcomesȱwereȱ greaterȱ forȱ educationalȱ interventionsȱ thanȱ forȱ anyȱ otherȱ typesȱ ofȱ interventionȱ Ȭȱ includingȱmedical,ȱpsychosocialȱandȱparentalȱtrainingȱinterventions.ȱȱOtherȱresearchersȱobserveȱtheȱdangerȱinȱmedicalisingȱ theȱ educationalȱproblemȱofȱdisruptiveȱbehaviourȱ inȱ schoolsȱbecauseȱ thisȱmayȱ causeȱeducatorsȱ toȱ seeȱ suchȱbehaviourȱasȱ ‘strictlyȱbiologicalȱandȱoutsideȱ theirȱ expertise’ȱ (Prosserȱ etȱal.,ȱ2002)ȱorȱindeedȱasȱaȱdispositionalȱproblemȱ(Thomasȱ&ȱGlenny,ȱ2000)ȱnotȱrelatedȱtoȱtheirȱchoiceȱofȱpedagogyȱorȱabilityȱtoȱengageȱchildrenȱinȱlearning.ȱ

TheȱInclusionȱofȱStudentsȱwithȱADHDȱȱ

MuchȱofȱtheȱliteratureȱthatȱlooksȱtoȱADHDȱinȱrelationȱtoȱschoolingȱfocusesȱuponȱwhatȱcanȱbeȱdoneȱtoȱ facilitateȱ theȱ “inclusion”ȱ ofȱ theȱ ADHDȱ childȱ intoȱ theȱ “regular”ȱ orȱ “mainstream”ȱ classroomȱ(Bradshaw,ȱ1998;ȱSava,ȱ2000).ȱȱPrivilegingȱtheȱstatusȱquoȱinȱthisȱwayȱhasȱledȱtoȱanȱemphasisȱonȱwhatȱadjustmentsȱcanȱbeȱmadeȱtoȱtheȱchild,ȱleavingȱpedagogyȱrelativelyȱunaltered.ȱȱEvenȱresearchersȱlikeȱStormontȬSpurginȱ (emphasisȱadded,ȱ1997,ȱp.ȱ270),ȱwhoȱoffersȱaȱmyriadȱofȱ strategiesȱ forȱ teachers,ȱstates:ȱ

Theȱabilityȱtoȱbeȱorganizedȱisȱaȱparticularlyȱimportantȱtopicȱinȱtheȱeraȱofȱinclusiveȱeducationȱandȱinȱlightȱofȱtheȱsubsequentȱcallȱforȱteachersȱtoȱmakeȱaccommodationsȱforȱstudentsȱwithȱdisabilitiesȱandȱotherȱspecialȱneedsȱinȱtheȱregularȱclassroom…ȱInȱviewȱofȱtheȱfactȱthatȱstudentsȱwithȱADHDȱareȱmostȱlikelyȱtoȱbeȱeducatedȱinȱgeneralȱeducationȱsettings,ȱmostȱofȱtheȱstrategiesȱprovidedȱrequireȱminimalȱchangeȱfromȱtraditionalȱteachingȱtechniques.ȱȱ

Theȱstrategiesȱsheȱoutlinesȱendȱupȱconstitutingȱpartȱofȱaȱstudentȱ‘treatmentȱplan’ȱ(p.ȱ271)ȱasȱopposedȱtoȱ aȱ pedagogicalȱ orȱ teachingȱ adjustmentȱ plan.ȱ ȱ Theȱ studentȱ “treatmentȱ plan”ȱ involvesȱ dataȱcollectionȱbyȱtheȱteacherȱ(i.e.ȱcountingȱtheȱnumberȱofȱtimesȱtheȱstudentȱhasȱlostȱsomething)ȱandȱtheȱsettingȱofȱobjectivesȱtoȱbeȱachievedȱthroughȱtheȱimplementationȱofȱtheȱstrategiesȱsuggested.ȱȱTheseȱrangeȱfromȱcooperativeȱhomeworkȱteams,ȱpositiveȱreinforcementȱandȱwrittenȱbehaviourȱcontracts,ȱroutinesȱ andȱ lists,ȱ assignmentȱ foldersȱ andȱ dailyȱ planners,ȱ andȱ increasedȱ collaborationȱ andȱcommunicationȱbetweenȱteachers,ȱparentsȱandȱstudents.ȱȱInterestingly,ȱStormontȬSpurginȱ(emphasisȱadded,ȱ 1997,ȱ p.ȱ 272)ȱ notesȱ thatȱ ‘theȱ strategiesȱ canȱ beȱ usedȱ withȱ anyȱ studentsȱ whoȱ haveȱorganizationalȱproblems.ȱȱInȱfact,ȱmanyȱofȱtheȱfollowingȱstrategiesȱwouldȱbeȱusefulȱforȱallȱstudents’.ȱȱHere,ȱsheȱunwittinglyȱstumblesȱonȱoneȱofȱtheȱfaultȬlinesȱtraversingȱtheȱturbulentȱterrainȱofȱADHDȱandȱschooling.ȱ

ȱ ȱIfȱallȱstudentsȱwouldȱbenefitȱfromȱtheȱuseȱofȱsuchȱstrategies,ȱthenȱwouldȱitȱnotȱbeȱreasonableȱtoȱargueȱ thatȱ allȱ teachersȱ shouldȱ beȱ ableȱ toȱ assistȱ studentsȱ inȱ learningȱ suchȱ skills?ȱ ȱ Shouldȱweȱnotȱexpect,ȱ givenȱ theȱ benefitȱ ofȱ ‘anȱ orderlyȱ environment’ȱ (Reiberȱ &ȱMcLaughlin,ȱ 2004,ȱ p.ȱ 2),ȱ thatȱclassroomsȱ beȱ organisedȱ themselvesȱ –ȱwithȱ theȱuseȱ ofȱ routines,ȱ listsȱ andȱ clearȱ guidelines?ȱ ȱThatȱteachersȱandȱparentsȱworkȱ collaborativelyȱandȱ shareȱknowledge,ȱunderstandingȱandȱ ideas?ȱ ȱ Itȱ isȱtellingȱ thatȱ inȱQueensland,ȱdepartmentalȱ literatureȱoutliningȱ inclusiveȱpracticesȱ inȱ schoolsȱpointsȱ

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outȱthat,ȱ‘notȱallȱstrategiesȱthatȱworkȱeffectivelyȱforȱtheȱmajorityȱofȱstudentsȱworkȱforȱstudentsȱwithȱlearningȱ difficultiesȱ andȱ learningȱ disabilities’ȱ (Appraisementȱ Intervention,ȱ 2001,ȱ p.ȱ 5).ȱ ȱ Asȱ such,ȱEducationȱ Queenslandȱ recommendsȱ thatȱ teachersȱ makeȱ ‘adaptationsȱ andȱ modificationsȱ toȱ theȱteachingȱstrategies,ȱresourcesȱandȱclassroomȱlearningȱenvironment’,ȱbecauseȱ‘strategiesȱthatȱsupportȱstudentsȱwithȱlearningȱdifficultiesȱandȱlearningȱdisabilitiesȱusuallyȱsupportȱallȱstudents’ȱ(emphasisȱadded,ȱAppraisementȱ Intervention,ȱ2001,ȱp.ȱ5).ȱ ȱSomehowȱ though,ȱ“support”ȱbecomesȱ rearticulatedȱintoȱ “management”ȱ whenȱ particularȱ kindsȱ ofȱ childrenȱ displayȱ particularȱ kindsȱ ofȱ behaviourȱ(Graham,ȱ 2006a).ȱ ȱ However,ȱ suchȱ “management”ȱ strategiesȱ canȱ playȱ outȱ inȱ classroomsȱ inȱexclusionaryȱandȱrepressiveȱways.ȱ

ȱ Forȱ example,ȱ aȱ keywordȱ searchȱ usingȱ theȱ termsȱ “behaviour”,ȱ “behaviourȱ disorder”ȱ andȱ“behaviourȱmanagement”ȱnetsȱaȱnumberȱofȱ linksȱonȱ theȱEducationȱQueenslandȱwebsite.ȱ ȱOneȱofȱtheseȱ isȱ aȱ shortȱ articleȱ postedȱ byȱ aȱ teacherȱ outliningȱ tipsȱ forȱ successfulȱ classroomȱmanagementȱ(Hodges,ȱ1990).ȱȱWhilstȱtheȱteacherȱexperiencesȱdifficultyȱwithȱatȱleastȱsixȱchildrenȱinȱherȱclass,ȱthisȱarticleȱisȱaȱcaseȱstudyȱofȱ“Billy”ȱȬȱaȱsixȱyearȱoldȱboyȱwhomȱtheȱteacherȱdescribesȱasȱhavingȱ‘severeȱbehaviouralȱproblemsȱandȱsomeȱdamageȱasȱaȱresultȱofȱreportedȱabuse’ȱ(Hodges,ȱ1990,ȱp.ȱ1).ȱȱTheseȱproblematicȱ behavioursȱ areȱ notȱ describedȱ further,ȱ norȱwhatȱ adjustmentsȱ (ifȱ any)ȱ toȱ pedagogy,ȱcurriculumȱorȱenvironmentȱviaȱchangesȱtoȱtheȱteachingȱprogramȱhaveȱbeenȱattempted.ȱȱInstead,ȱtheȱauthor/teacherȱ statesȱ thatȱ sheȱ ‘triedȱ theȱusualȱdisciplinaryȱ actionsȱ butȱwithoutȱ success’ȱ (Hodges,ȱ1990,ȱp.ȱ1).ȱ

ȱ Disturbingly,ȱ thisȱ articleȱ featuresȱ aȱ pejorativeȱ undercurrentȱ –ȱ theȱ languageȱ isȱ autocraticȱ andȱjudgemental.ȱȱInȱaddition,ȱtheȱchildȱisȱovertlyȱstigmatisedȱandȱobjectifiedȱwithȱnoȱapparentȱconcernȱbyȱtheȱauthor.ȱȱFirst,ȱsheȱdescribesȱ“Billy”ȱasȱ‘veryȱaggressiveȱverballyȱandȱphysicallyȱ[with]…ȱveryȱfewȱlearningȱorȱsocialȱskills’ȱ(Hodges,ȱ1990,ȱp.ȱ1).ȱȱSheȱthenȱstatesȱflatly,ȱ‘Hisȱmotherȱwasȱinformedȱthatȱ aȱ specificȱ programȱwasȱ toȱ beȱ implemented’ȱ (p.ȱ 1).ȱ ȱ Thisȱ isȱ highlyȱ problematicȱ forȱ obviousȱreasons.ȱȱHere,ȱtheȱteacherȱisȱoperatingȱinȱisolationȱwithȱnoneȱofȱtheȱcollaborativeȱorȱcommunicativeȱactionȱrecommendedȱbyȱStormontȬSpurginȱandȱothersȱ(Burchamȱetȱal.,ȱ1993),ȱincludingȱtheȱteacher’sȱownȱDepartmentȱ ofȱEducation.ivȱ ȱByȱ “informing”,ȱ ratherȱ thanȱ “consultingȱwith”ȱ theȱparent,ȱ theȱteacherȱ failsȱ toȱ gainȱ valuableȱ insightsȱ fromȱ theȱ child’sȱmother.ȱ ȱ Unfortunately,ȱ itȱ appearsȱ theȱ“reportedȱ abuse”ȱ mayȱ haveȱ influencedȱ theȱ teacher’sȱ attitudeȱ towardsȱ theȱ parent,ȱ ultimatelyȱusurpingȱparentalȱauthorityȱandȱquashingȱtheȱmother’sȱabilityȱtoȱadvocateȱforȱherȱchild.ȱ

ȱ Theȱ behaviourȱmodificationȱ regimenȱ describedȱ inȱ thisȱ article,ȱ TIPS:ȱ Caseȱ studyȱ inȱ classroomȱmanagement,ȱ isȱ exclusionaryȱ andȱ drawsȱ heavilyȱ onȱ theȱ principlesȱ ofȱ cognitiveȬbehaviouristȱpsychology.ȱ ȱTwoȱ“Billy”ȱtargetsȱareȱset:ȱ(1)ȱhandȱupȱtoȱspeakȱandȱ(2)ȱsitȱinȱseat.ȱ ȱTheȱconsonanceȱbetweenȱ theseȱ targets,ȱ theȱdemandsȱofȱ traditionalȱ schoolingȱ andȱ theȱDSMȬIVȱ criteriaȱ forȱADHD,ȱindicatesȱtheȱimportanceȱstillȱaffordedȱtoȱsilentȱseatȬworkȱinȱschools,ȱdespiteȱtheȱsoȬcalledȱincursionȱofȱconstructivismȱandȱactiveȱ learningȱenvironmentsȱ (DEST,ȱ2005a,ȱ2005b,ȱ2005c).ȱ ȱNowhereȱ inȱ theȱarticleȱdoesȱ theȱ teacherȱ reflectȱ thatȱ theȱchildȱ isȱonlyȱsixȱyearsȱoldȱandȱ thatȱ thisȱwouldȱbeȱhisȱ firstȱintroductionȱtoȱformalȱschooling.vȱTherefore,ȱputtingȱhisȱhandȱupȱtoȱspeakȱandȱsittingȱinȱaȱseatȱatȱaȱdeskȱwouldȱbeȱnewȱexperiencesȱforȱhim.ȱȱNorȱdoesȱitȱappearȱtoȱbeȱconsideredȱthatȱaȱtokenȱeconomyȱmayȱfirst,ȱbeȱtooȱsophisticatedȱforȱaȱchildȱofȱthisȱageȱandȱsecond,ȱthatȱthereȱareȱproblemsȱassociatedȱwithȱ selfȬmanagementȱ andȱ cognitiveȱ trainingȱ strategiesȱ (Abramowitzȱ&ȱOȇLeary,ȱ 1991;ȱReiberȱ&ȱMcLaughlin,ȱ2004).ȱ ȱNorȱ isȱthereȱanyȱacknowledgmentȱthatȱearlyȱchildhoodȱeducationȱphilosophyȱadvocatesȱ activeȱ learningȱ andȱ investigativeȱ playȱ overȱ seatȱworkȱ andȱ thatȱ thisȱmayȱ beȱ aȱmoreȱappropriateȱ teachingȱmethodologyȱ inȱ aȱ classȱwhereȱ atȱ leastȱ sixȱ youngȱ childrenȱ areȱ experiencingȱdifficulty.ȱȱ

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ȱ TheȱtechniquesȱrecommendedȱbyȱHodgesȱ includeȱsendingȱ“Billy”ȱtoȱsitȱinȱaȱcircleȱonȱtheȱfloorȱawayȱfromȱ theȱclassȱforȱ1Ȭ2ȱminutes,ȱ thenȱreturningȱuponȱ tellingȱhisȱ teacherȱ theȱ targetȱbehaviour.ȱȱAfterȱgoingȱtoȱtheȱcircleȱthreeȱtimesȱ(noȱstipulationȱisȱmadeȱaboutȱtimeȱduration;ȱi.e.ȱthreeȱtimesȱinȱanȱhourȱorȱthreeȱtimesȱinȱanȱentireȱday),ȱ“Billy”ȱwouldȱbeȱsentȱtoȱtheȱofficeȱforȱtimeout.ȱ ȱTheȱtimeȱspentȱinȱtimeoutȱwasȱtoȱbeȱmadeȱupȱduringȱlunchȱorȱafterȱschool,ȱfurtherȱreducingȱopportunitiesȱforȱtheȱchildȱ toȱexpendȱenergyȱ inȱplayȱandȱsocialȱ interaction.ȱ ȱTheȱauthorȱalsoȱrecommendsȱaȱrewardȱsystemȱwithȱtallyȱmarksȱonȱtheȱblackboardȱeachȱday,ȱhowever,ȱthisȱisȱaȱstigmatisingȱpracticeȱasȱtheȱvisualȱ remindersȱmakeȱ youngȱ childrenȱ veryȱ awareȱ ofȱwhoȱ theȱ “bad”ȱ andȱ “good”ȱ kidsȱ are.ȱ ȱ Inȱaddition,ȱ“Billy”ȱwasȱgivenȱanȱ individualȱ rewardȱ sheetȱuponȱwhichȱwereȱmarkedȱ eitherȱ ticksȱorȱcrossesȱdependingȱuponȱhisȱcomplianceȱwithȱ theȱ targetȱbehaviours.ȱ ȱTheȱ teacherȱstatesȱ thatȱ ‘laterȱ“Billy”ȱcouldȱplaceȱhisȱownȱtickȱorȱcross…ȱ[and]ȱshowedȱaȱdefiniteȱmodificationȱinȱbehaviourȱandȱmostȱimportantlyȱwasȱanswerableȱtoȱhisȱactions’(Hodges,ȱ1990,ȱp.ȱ2).ȱ

ȱ Theȱpresenceȱhereȱofȱpsychologicalȱnotionsȱrelatingȱ toȱselfȬregulationȱ throughȱpracticesȱofȱ theȱselfȱ(Foucault,ȱ1978)ȱfunctionȱtoȱabsolveȱtheȱteacherȱofȱresponsibility,ȱplacingȱitȱentirelyȱuponȱtheȱsixȱyearȱ oldȱ childȱ instead.ȱ ȱ NonȬcompliantȱ behaviour,ȱ theȱ kindȱ investigatedȱ byȱ ADHDȱ diagnosticȱquestionnairesȱ suchȱ asȱ theȱConnor’sȱ TeacherȱRatingȱ Scaleȱ orȱ theȱ BehaviourȱRatingȱ Inventoryȱ ofȱExecutiveȱFunctionȱ(BRIEF),ȱisȱperceivedȱpurelyȱasȱ“deviance”ȱemanatingȱfromȱwithinȱtheȱaberrantȱchildȱfromȱaȱquestionableȱfamilyȱ(Slee,ȱ1995).ȱȱProblematically,ȱatȱnoȱtimeȱdoesȱthisȱteacherȱconsider,ȱdespiteȱhavingȱ‘5ȱotherȱchildrenȱwithȱbehaviourȱproblems’ȱ(Hodges,ȱ1990,ȱp.ȱ1)ȱinȱherȱclass,ȱthatȱtheȱproblemȱ couldȱ haveȱ anythingȱ toȱ doȱwithȱ herȱ choiceȱ ofȱ pedagogy,ȱ interpretationȱ ofȱ curriculaȱ orȱabilityȱ toȱ engageȱ herȱ studentsȱ inȱ learning.ȱ ȱ Norȱ itȱ appears,ȱ isȱ sheȱ requiredȱ toȱ questionȱ whatȱstructural,ȱpedagogicalȱorȱenvironmentalȱfactorsȱmayȱbeȱ influencingȱtheȱbehaviourȱofȱtheȱchildrenȱinȱherȱclass.ȱ

Conclusionȱ

Itȱappearsȱthatȱtheȱresidualȱnotionȱofȱ“aȱmainstream”ȱmeansȱthatȱteachersȱandȱschoolsȱcanȱstickȱtoȱoneȬsizeȬfitsȬallȱ approaches,ȱ deviatingȱ onlyȱ slightlyȱ whenȱ metȱ byȱ “deviance”.ȱ ȱ Howeverȱconveniently,ȱ “deviance”ȱ remainsȱ theȱ domainȱ ofȱ theȱ humanȱ sciencesȱ andȱ theȱ structuralȱarrangementsȱ ofȱ traditionalȱ schoolingȱ encouragesȱ teachersȱ toȱ siphonȱ offȱ theirȱ “problematic”ȱstudentsȱ toȱ theȱ “experts”ȱ ofȱ abnormality;ȱ guidanceȱ officers,ȱ withdrawalȬmodeȱ behaviourȱmodificationȱ programs,ȱ alternativeȬsiteȱ placementȱ centres,ȱ psychologists,ȱ doctors,ȱ paediatriciansȱandȱpsychiatrists.ȱȱInȱthisȱway,ȱAttentionȱDeficitȱHyperactivityȱDisorderȱactsȱasȱanȱescapeȱclauseȱforȱschoolsȱandȱteachersȱ–ȱaȱmeansȱtoȱmaintainȱwhatȱSleeȱcallsȱ“institutionalȱequilibrium”ȱ(Slee,ȱ2000).ȱȱThisȱproblemȱisȱcompoundedȱwhenȱtheȱmajorityȱofȱeducationalȱliteratureȱengagingȱwithȱtheȱconceptȱofȱADHD,ȱdoesȱsoȱinȱaȱwayȱthatȱreinforcesȱnormativeȱnotionsȱofȱmainstream,ȱgeneralȱorȱtraditionalȱschooling.ȱȱȱ

ȱ Despiteȱpayingȱ lipȱserviceȱ toȱ theȱ ‘eraȱofȱ inclusiveȱeducation’ȱ (StormontȬSpurgin,ȱ1997,ȱp.ȱ270),ȱthisȱisȱnotȱinclusive.ȱȱInȱthisȱguise,ȱ“inclusiveȱschooling”ȱisȱsubsumedȱwithinȱwhatȱSleeȱ(1996,ȱp.ȱ3)ȱcallsȱ theȱ ‘rearticulationȱ ofȱ specialȱ education’,ȱwhereȱ theȱ ‘voiceȱ ofȱ inclusionȱ [becomes]ȱ anȱ actȱ ofȱspecialȱeducationȱventriloquism’ȱ(Slee,ȱ2001,ȱp.ȱ395).ȱȱThroughȱaȱdiscursiveȱsleightȱofȱhand,ȱinclusiveȱeducationȱ ‘failsȱ toȱmoveȱbeyondȱ technicalȱadjustmentsȱ toȱ theȱ formȱofȱschooling’ȱandȱ thus,ȱ failsȱ toȱachieveȱequityȱandȱjusticeȱforȱkidsȱinȱschools.ȱȱInȱresponseȱSleeȱ(1996,ȱp.6)ȱargues,ȱasȱdoȱI,ȱthatȱ‘theȱpoliticalȱeconomyȱofȱschoolingȱrevealsȱconsiderableȱinstitutionalȱandȱculturalȱimpairmentȱinȱneedȱofȱremedialȱintervention’ȱandȱpointsȱtowardsȱtheȱcontrollingȱ‘graspȱofȱtheȱresourcesȱequations’ȱ(p.ȱ7)ȱasȱaȱmediatingȱ factor.ȱ ȱTheȱ influenceȱ thatȱ theseȱequationsȱbringȱ toȱbearȱuponȱ theȱpathologisationȱofȱchildrenȱ needsȱ furtherȱ interrogationȱ (seeȱ Graham,ȱ 2006a),ȱ especiallyȱ whatȱ influenceȱ suchȱarrangementsȱmayȱhaveȱuponȱ teacherȱdecisionsȱ toȱreferȱchildrenȱforȱassessment.ȱ ȱCouldȱ itȱbeȱ thatȱ

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theȱ chronicȱ underȬfundingȱ ofȱ schoolsȱ andȱ bureaucraticȱ redȬtapeȱ tyingȱ resourcesȱ andȱ classroomȱsupportȱ forȱunderpaidȱandȱoverworkedȱ teachersȱ toȱdisabilityȱcategoryȱcriteriaȱ isȱ influencingȱhowȱteachersȱdescribeȱandȱ referȱ theȱchildrenȱ inȱ theirȱclasses?ȱ ȱ Inȱ theȱend,ȱperhapsȱ theȱmostȱ importantȱbreakthroughȱ withȱ regardsȱ toȱ researchingȱ theȱ “ADHD”ȱ phenomenonȱ isȱ thatȱ theȱ notionȱ mayȱactuallyȱhelpȱ toȱelucidateȱ theȱpathologiesȱwithinȱschooling;ȱhighlightingȱschoolsȱandȱsystemsȱ thatȱsubscribeȱtoȱtheȱnotionȱofȱbeingȱinclusive,ȱyetȱinȱrealityȱengageȱinȱpracticesȱthatȱareȱanythingȱbut.ȱ

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