Monday, October 8, 2012

Day 58: Education Fraud Part 19 – Medicalization of the Education System Part 7 - Professionals involved in the medicalizing process.

This blog is a continuation from:

If you have a moment I suggest read the following article:

From it I have taken the following points, from which I will be walking Self-Forgiveness:

- ADD/ADHD is medicalized through educators, medical practitioners and members of the
 psy sector, the complex of social work, psychological,psychiatric and helping professionals that handle mental health and psycho-logical issues within a given culture (Donzelot, 1997).

 - Medicalization is not always complete, but occurs in varying degrees, depending on whether competing definitions of the problem exist (as is the case withADD/ADHD), and on the relationship between professionals who are involved in the medicalizing process (Conrad, 1992). With ADD/ADHD,there are gaps in the medicalization process at both the conceptual level and the institutional level.

 - the medicalization of ADD/ADHD was, at the time of the study, far more entrenched in Canada than in the UK in both professional and lay circles.It is not surprising, then, that mothers describe a high preparedness of teachers in Canada to accept the ADD/ADHD label when compared withdescriptions of UK educators.

 - It has been argued that, in the United States, educators have come to embrace ADD/ADHD and drug therapy as a result of decreased access to the useof traditional educational social controls of physical discipline and student expulsion or suspension (Kiger, 1985)

 - As western society has become less tolerant of difference, and as medical,educational and psychiatric professions have developed, the range of behaviors identified or perceived of as pathological has grown (Porter,1987). This decreased tolerance and increased psychiatric surveillance over a broad range of behaviors and signs that once were accepted as part of the continuum of human possibility, but that now have become problems to be resolved through expert practice, has been termed the ‘psychiatriza-tion of difference’ (Castel et al., 1982)

 - the behaviors to be measured by parents and teachers on assessment instruments relate primarily to the classroom, and indeed, most parents in both sites noted that their children’s problems began or escalated once they entered the school system.

 - Researchers have tied ADD/ADHD’s legitimacy to aggressive pharmaceutical marketing strategies and middle-class parent support groups seeking a medical label for their children’s behavioral problems (Conrad and Schneider, 1980). Others relate its rise to reductions in educational funding and restricted classroom discipline policies (Kiger,1985), or as part of a general increase in the psychiatric labeling of children (Armstrong, 1993). Still others note that ADD/ADHD as a diagnostic category is connected to the rise of the relatively new fields of special education and educational psychology, through which an increasingly broad array of assessment tools have been employed in classifying and identifying differences in children (Slee, 1994).

 - Canada, influenced by its proximity to the United States, is strongly immersed in the legacy of developmental and behavioral psychology, where tests, measures and classification systems have emerged to organize and regulate populations (Armstrong, 1983; Rose, 1985, 1990; Burman, 1994). Thus, in Canada, mothers with children who are ‘different’ will typically encounter an educational or developmental psychologist and undergo behavioral and pencil-and-paper testing with an aim to categorizing and 'labeling' the child.

 - The difference in diagnostic tools and psy sector cultures has material effects, resulting in different degrees of medicalization, as evidenced by rates of diagnosis and treatment in the UK and Canada. British Parliamentary Office of Science and Technology figures indicate that in 1995 only 6000 (or 0.03%) UK schoolchildren were being treated with any psycho-stimulant (Kewley, 1998). In 1995 in Alberta, approximately 2.5 percent of school-aged children were prescribed Ritalin alone, representing a four-fold increase since 1987 when record keeping began (Alberta College of Physicians and Surgeons, 1999). Thus, we can expect that British mothers’stories reflect a context where ADD/ADHD remains a partially or perhaps even non-medicalized phenomenon, while Canadian mothers’ stories reflect a context where ADD is highly legitimated as a medical diagnosis.

 - There are two stages in the ADD/ADHD labeling process: identification and assessment. In Canada, teachers were the prime identifiers of children who ultimately became labeled as having ADD. Of 17 Canadian children in the study, only two children had already been identified and tentatively diagnosed prior to attending primary school. Mothers of the remaining 15 reported that, although their child had always been in many ways ‘different’during infancy and early childhood, it was really only once the child went to school that these differences came to be identified as problematic enough that the child was identified for formal intervention. Canadian teachers who identified these children as problematic were often quite directive in their suggestions, in many cases going so far as to tell mothers that they should consider ADD as a diagnosis and Ritalin as a treatment.

 - even when evidence of classroom abuse was not present, the constant pressure of phone calls, meetings and questions about medication left the parents feeling they should at least give medication a trial. Thus, although Canadian teachers were not qualified to perform a diagnosis or prescribe treatment legitimately, they were able to exercise considerable influence in having mothers push physicians and psychologists for a label and medicalization.

 - Additionally, the reported demands teachers made of Canadian mothers to consider drug therapy for their children may reflect the relative lack of alternative forms of social control that Canadian educators have availableto them in managing disruptive classroom behavior.

 - Again and again, mothers described working through oneavenue of treatment after another, never having a name for what they andtheir children were struggling with, because the name itself was problem-atic to educators and helping professions.

 - In 2000, the British government estimated the average initial assessment for any child in Britain would cost the school approximately £480 (NICE, 2000: 10) and often, once a child is assessed,schools risk losing any transfer moneys into their budgets because the Statemented child (to be diagnosed) is often moved to a specialized setting. Thus, the initiating school bears the cost, while the receiving school enjoys the benefits.

 - Canadian mothers rarely described teachers who seemed willing or able to implement appropriate educational strategies for the ADD identified children in their classroom. Again and again, mothers described providing medical and psy sector information to teachers about their child specifically, and about ADD children in general, only to be ignored.

 Self-Forgiveness to follow...


 Malacrida C, "Medicalization, Ambivalence and Social Control: Mothers’ Descriptions of Educators and ADD/ADHD." Publication Date: Jan 1, 2004. Accessed on 8 Oct 2012.

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