ADHD debate: the role of medication in ADHD treatment

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Medication can help children with ADHD, but it is crucial to understand how people experience the condition and its treatment

The story of medication for attention deficit hyperactive disorder (ADHD) is a complex one, but it does suggest some clear benefits for children with the condition. While medication is not a “cure” for ADHD, it helps to calm and focus children, giving them time to think through their actions and responses in order to perhaps make more appropriate choices and decisions. The way in which this occurs is outside the scope of this article, but the National Institute for Health and Clinical Excellence (NICE) clinical guideline 72 details appropriate care pathways, principles of treatment and care, the medications which are licensed for use with children and likely responses to them (NICE, September 2008).

Medication has a value in enabling relationships to develop more positively; however, any tendency to rely on medication as the only form of intervention can be criticised. There are also disadvantages of being treated with medication, particularly in relation to the child’s identity, which are not widely known about.

Numerous research studies have investigated ADHD from a clinical perspective, but studies which explore the realities of the condition within schools are less prevalent. This is perhaps understandable, given that the dominant perspective on ADHD has been highly medicalised, and alternative approaches are often regarded as in opposition to, or a challenge to, the validity of medical diagnosis. UK educational legislation is heavily influenced by the medical model of disability, which assumes that a child’s behaviour or their impairment is “the problem”. However, an increased understanding of the ways in which being diagnosed with ADHD impacts on children’s experiences of schooling might better facilitate the educational process, both for teachers and pupils alike. Offering holistic support to young people with ADHD might also help them to locate their educational needs in a broader context and positively influence processes of identity formation.

My research, involving seven children with a diagnosis of ADHD, found that difficulties at school featured in each child’s account of their life experiences. For parents and children, it is sometimes difficult to disentangle the effects of receiving a diagnosis of ADHD from the effects of the prescribed medication; the two are regarded as almost synonymous. Ross, aged twelve, illustrated how different his experience in class was before being diagnosed and treated, compared to afterwards:

This was when I didn’t know I had ADHD and the teacher used to always be saying “Please write this down in your folder” and then she’d say “OK, if you’ve finished you can leave and go to your next class” or whatever, and then I’d say “finished” when I wasn’t really finished, and I would just have written, oh, if it would have been about a bird I would have been writing about Mars, and so on. I wasn’t really paying attention, I would just be sitting there and worried about everything else…then I’d start fiddling round with my pencil, watching what those two girls over there were talking about, writing notes to my friend next to me, and everyone would have written it all down except for me, and then I’d be off!

Once Ross had been diagnosed and was taking methylphenidate he felt more able to concentrate, both at school and at home, and was more able to meet homework deadlines.

Children are generally pleased with their improved concentration and ability to attend to a task, but there are other less obvious effects of taking medication. Ross’s descriptions of his thought processes before and after medication are of relevance here.

Before: “You can’t control it, you say something and then keep on trying to say more about that thing, so I’m trying to stay on track, but another thought is coming in.”
After: “The bad thing about taking the tablet is that when I do take the tablet it’s really hard to start a conversation, because when you start a conversation you start on one subject and lead onto another, and another, but I can only concentrate on one subject, so it’s hard to go onto another.”

This may provide insight for teachers who are trying to understand the children in their care; response to medication is far from straight forward and is often more complex than any of the adults who are supporting that child realise.

The ways in which teachers relate to children are also imortant here. Chris, fifteen, told me his teacher exclaimed “I can’t manage you and a class full of children, so get out!”  He also put Chris “on report” for not doing his coursework, even though it was impossible for him to do it when he was constantly excluded from lessons. The fact that these comments were made in the presence of the wider group of children demonstates how some teachers can be said to collude in reinforcing the “otherness” of a young person who has a diagnosis of ADHD.

Within the school setting, children can also have difficluties trying to manage their medication regime as appropriate pastoral care is not always immediately available. Chris’s school eventually nominated a teacher to dispense his medication at the end of break-time, but there were logistical difficulties, which caused further problems for Chris, and these were factors in his later decision to stop taking medication.

So, it would seem that medication may have a role to play in ADHD treatment, yet there are disadvantages, in terms of both side effects and psychosocial factors. Health care professionals are often concerned to find that many school professionals have limited understanding of ADHD. As the number of children receiving the diagnosis and being prescribed medication has increased, so has the very real problem of lack of appropriate social, emotional, academic and medical support within schools.

Teachers and educationalists can play a key role in mediating stigma, marginalization and the social issues which accompany ADHD diagnosis. The ethos of a school is a powerful determinant of behaviour; by focusing on the educational setting, rather than just on individual children, we may be able to identify ways in which the contexts in which young people find themselves shape behaviour (Weare, 2005).

Adequate provision should be made to ensure that children can fully participate in school life. Children’s views and perspectives should be included in educational research and practice; they can provide insight and an opportunity to influence policy and practice within schools.

Dr Geraldine Brady

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