ADHD: new understanding but old issues remain

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The Lancet have published a report (30th September) that provides evidence that ADHD may not be a simple social construct, as many have thought, but has some biological, genetic origins.

It has been interesting, this morning, to hear a round up of interviews and articles via Radio 4 and on the web. There are some, who profess this will advance the cause of a medical response, through such interventions as Ritalin, at the expense of a need to address pyschological, behavoural and social deficits. There are others who herald this, almost, as the dawn of a new age of understanding.

I have listened with interest, and as someone, not of a medical background, but with an educational background, and some awareness and knowledge acquired over the years, in particular facets of special educational need.

I have a disquiet about the apparent ease that children, as young as five or six years old, may be heavily medicated, through prescription drugs (Ritalin by far and away the most common) over long periods of time, with little real or effective monitoring and communication between health and education professionals.

We have a great and increasing dissonance, between those professionals who diagnose and prescribe, and those professionals who witness the impact, or consequences of those decisions. The mantra of joined up services, and Local Authorites headed by health professionals, rather than education professionals, really has yet to make any impact on real communication, at the table, between the two camps, if ever it will.

Ritalin, and ADHD, has become the elephant in the room. It is a problem so profuse in our classrooms, that it in danger of being taken out of the equation altogether, pushed aside, neglected, ignored, despite the very real difficulties that young people may experience over many, if not all, of the formative years of their life.

In my consultation with schools, concerns I have raised, over and above the school’s own concerns, often focus on those young people whose behaviour, demeanour, social exclusion, or severe antipathy to school, present as priority needs to address. It is a simple humanist philosophy. Where resources are scarce and finite, who is most in need of our attention, our support?

On many occasions I am advised, by the school’s SENCo, Head Teacher, Inclusion Manager… that this young person is fine because they are on medication and they have a diagnosis of ADHD, (and the parents have been booted off to parent classes). In our everyday parlance, End Of.

The over-riding message is that time and resources are not to be wasted here.

The needs of the young person that are so apparent, in the classroom, may be tolerated, where medication is seen as the stop-gap, the solution to all ills, however temporary, transitory that may be.

Our multiplicity of need, however, generates a different response altogether. It is not uncommon to see the problems of ADHD, accompanied by the prescribed Ritalin, and the proferring of parenting classes, follow along a very sorry, haphazard path of  ‘healthy neglect’ until the destructive forces of ADHD become too vast to ignore. At that time, the drawing in of other professional from education (behaviour management, anger management, social inclusion) or health elicit a very different outcome.

ADHD juggles along very nicely with ASD. The multitude of joint-diagnosis, in my own Local Authority, is staggering. It is a recent, and alarming trend. 

So, the poor cousin, ADHD, meets up with the more affluent, and highly regarded cousin, ASD, and we have a golden ticket to provision, resources, funding and advice. It is the way of our times: joint medical diagnosis equates to money.

Sadly, for many young people with ADHD, that golden ticket may never be on offer. For those with parents who are just getting by, who are not tuned into the system, who do not make demands and make them loudly, their children suffer.

 The long relentless years of medication, so often sold as ‘pills to make you clever’ run on and on. And often, no one really knows, or seems to care, what else may be at stake here, what is really going on.

One young man of 11 years, medicated with Ritalin for ADHD since the age of 7, had a series of altercations at home and in school. He was at risk of permaent exclusion prior to secondary transfer. His home life was a horrendous tale of neglect, of change, of being paraded before different relatives, all of whom washed their hands of him and his behaviour.

In one incident, this young man commented that it was much easier for him to keep taking his tablets, because then nobody had to do anything about the awful things that were happening to him. His credibility, the evidence he gave of abuse at home, was judged not to be sound, as a young person with a mental health difficulty.   

Some young people, this young man in particular, have no relentless advocate who champions their cause, who considers their well-being above all else.

I welcome the attention The Lancet research has given to this much maligned, poor cousin of SEN, ADHD. I welcome it because there is an opportunity for many to comment, to lay their concerns firmly in the public arena, and make some difference to how we regard young people with ADHD.

The Lancet research gives a new understanding, but without debate and consideration, our old issues will remain with us still.   

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61109-9/fulltext (subscription based service to the on-line journal).

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About HMStack

Independent Education Consultant (SEND) delivering local, regional and national services to providers within the public, private and third sector. Passionate about creating the context for positive change working with and on behalf of children, young people and their families, the conference and public policy sector and training organisations. An eclectic mix of clients includes schools and other educational settings, museums and heritage, service children and British Armed Forces support organisations and providers across the public, private and third sector. Educational writer, blogger and philosopher and aspiring screenwriter, inspired by drama and literary adaptations.

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