Medicating schoolchildren

Medicating of schoolchildren II

Joar Tranøy



Joar Tranøy is a criminologist (MA), psychologist (BSc.), historian (BA) and School Counselling Advisor. Previously a researcher/research scholar at the University of Oslo and Senior Scientific Officer at the University College in Østfold.


This article was previously published in UKS-FORUM FOR CONTEMPORARY ART 2001. It is republished here with the kind consent of the author.





The central stimulating narcotic agent Ritalin (methylphenidate chloride) is an amphetamine-like material that, in the 1950s, was employed in psychiatry in order to control mild depressions and senile behaviour in adult persons. In 1961 there were warnings published in the medical journals against the abuse of Ritalin. In 1963 Ritalin was tested systematically for the first time on 81 children in an American treatment centre. The testing was financially supported by Ciba - Geigy, who naturally had a capital interest in a positive assessment.


The breakthrough for the use of Ritalin on children came in 1967 when the public health authorities in the USA decided in favour of trying the material directly on schoolchildren. The material was employed on Afro-American children in the ghetto schools of Baltimore. The unrest was quelled in the schools and Ritalin was hailed as a means of controlling disruptive behaviour. This was the beginning of a decisive breakthrough in the USA where at least 3 million children under the age of 18 years are currently legal users of Ritalin. The situation in Norway is not that dramatic, but the trends in the treatment and support apparatus are, nevertheless, disquieting. The medicating of behavioural problems in Norwegian schools is approaching epidemic conditions with regard to diagnosing and treating children with behavioural difficulties. This is particularly true of the diagnosis Attention Deficit Hyper-activity Disorder (ADHD) and Ritalin where at least 3000 schoolchildren are medicated by means of the central stimulating agent. The number is twice as large as in our neighbouring country Sweden, with twice our population.


Figures from the Norwegian Pharmaceuticals Depot show that the use of Ritalin in the period 1986-96 had quadrupled in Norway. The increase for Ritalin was 125 per cent from 1996 to year 2000. The head of the state nationwide expertise centre for ADHD, Tourette’s Syndrome and narcolepsy recommends that at least 10 000 Norwegian children need Ritalin. School-related behavioural problems have become a major individual clinical area of attention connected to regional and nationwide centres with psychiatrists, neurologists, psychologists and special pedagogues in a professional medical environment.


Behavioural problems are regarded as a functional disorder in the brain of a biochemical nature. Children are heavily medicated in order to achieve calm in the school. In this way the adults concerned are exempted from responsibility. Such a medical disciplining of disruptive and inattentive schoolchildren often leads to fundamental problem-creating system conditions. Alternative provision (such as alternative schooling) is precluded because the authorities wish to preserve the semblance of "integration of all" within a uniform school system.


The diagnostic basis for ADHD is extremely unclear. It is said that children are inattentive because they have ADHD and that they have ADHD because they are inattentive. On the form for diagnosing ADHD the question is asked, for example, whether the child has the following bad habits: Is it not attentive enough to details or does it make careless mistakes in its schoolwork? Does it fumble with its hands and feet, or sit restlessly on its chair. Does it have problems in sustaining attention in tasks or games. Does it often leave its place in the classroom or get up elsewhere, when he/she should be sitting still? Does it not appear to hear when being directly addressed. If the answer is ‘yes’ to these questions, the criteria for the diagnosis are, so to speak, met. The border between "sick" and normal is a fluid one.


The registration is undertaken at home by the parents and at school by teachers. When the reports from the teacher and the parents are contradictory, consideration is normally given to the teacher’s report since the latter possesses greater awareness of age-related norms. The symptoms are more easily registered in situations that require self-development, as in the classroom. The deviation may actually not be present in other situations.


The teacher’s assessment often appears to be the decisive one, and the School-councelling service as the expert instance normally follows up the school assessment of who is a "normal" child. It is not necessarily the case that it is the pupils that create the problems, but rather the school’s teaching and frameworks that create difficulties for the pupils.


The diagnosis of ADHD is highly subjective and is decided on the basis of culture-relative norms. In addition there are framework conditions and contexts such as, for example, the child’s daily pattern etc., that is not taken into consideration. Moreover the treatment level may vary considerably with a child. Even within the same family.


The incidence of ADHD shows itself to be proportional to the presence of, and influence by, behaviour diagnosticians, testers and therapists in the schools, not only in the USA but also in Norway.


Social conditions also exert an influence. For example there is the worsening of the physical and social environment in the schools with reduced opportunities for play and physical development. At the same time the pressure of theory has increased. Children can easily be run over in the school system with its behavioural experts, towards whom even the teachers and advisors feel powerless.


One example is the teenager Tore. There was disagreement as to whether Ritalin could help Tore. After a few months of medication the opinions were divided. The school’s advisor stated, for example: "I am now doubtful as to whether we have proceeded in the right way. Tore has been calmer during the lessons. But several of us are somewhat uneasy. We do not really recognise Tore now. His charm has almost disappeared. There is hardly ever a smile to be seen. His school performance is about the same as before. Purely egoistically one may say that he has become easier to have dealings with. But he is not entirely Tore any more."


Neither Tore’s parents nor the treating psychologist were willing to comment. But Tore’s friend expressed the following: "It has become calmer, yes. Most of those in the class are, perhaps, happy about that, but not me. Tore is not quite the same. I miss his funny and crazy things. Now there is nothing there. The worst time is in the breaks. He doesn’t join in with anything any more."


Tore himself did not wish to say very much. His face showed that he was not particularly satisfied: "I feel that I am no longer in control. My body takes over. I have to have the tablets in order to feel my body. I am no longer able to be aware of everything. I don’t really know what the other think about me. Not that it really makes any difference. I’m the one there is something wrong with."


Tore’s class tutor did not really wish to say anything. But he expressed himself in a very serious manner: "This is a very difficult and sad case. The classroom disturbances have been greatly reduced. It is clear that certain pupils have profited from it."


The employment of Ritalin appears to serve as a solution or an alternative to changing the school environment and the school system. Ritalin becomes a short-term aid. The child becomes easier to deal with without there being a documented effect on school performances and psychosocial functioning in the longer term. A particular difficulty is the danger of addiction. It is difficult to stop taking the material after long-term use. The problem is referred to as "Withdrawal syndrome", and involves a serious and sustained depression and suicide danger.


Follow-up examinations are subject to serious limitations. The observation time is seldom longer than a year. The assessment of the results are completely restricted to the actual symptoms, and do not include subjective reports regarding well being etc.


It is not necessarily the case that the absence of symptoms is synonymous with subjective well being and quality of life. Even in those cases where freedom from symptoms also involves subjective well-being, the Ritalin treatment is not necessarily ethically defensible if, in the longer term it contributes towards social invalidity. Ritalin and the label ADHD individualise social and moral problems. Social and ethical problems will, by means of the diagnosis, be constructed as a question of deficient individual adjustment. How are trouble-makers, disruptive elements, to be dealt with? The child is rendered ill and stigmatised. Other cultures look at such troublesome behaviour differently. An erstwhile neighbour from Sri Lanka explained that there are hyperactive children there, too, but that they are treated with respect and care because "something big always emerges from such children."


We adults save our own honour, but not that of the child. With the power and disciplining perspectives of Michel Foucault, we are able to regard the medicinal practice in respect of children as a kind of separating and excluding practice, where the treatment represents an extension of society’s excluding procedure, where children are subjected to a chemical control.


Those who determine normality possess power and it is groups of experts who possess this power through their social technology. The determination of the deviation concept becomes increasingly fine-meshed: classification of the deviation is subjected to constant new categorising and dividing lines. It is particularly children at whom the new diagnoses are directed. Among these are ODD (Oppositional Defiant Disorder), CD (Conduct Disorder) and OCD (Obsessive Compulsive Disorder). The diagnosis ODD applies to what is referred to as the defiance illness for children aged 5-6 years who are "egocentric and narcissistic." Since the 1950s the diagnoses in the two international psychiatric diagnosis systems have increased more than twofold. The Norwegian post-war era has also shown that there have occurred significant encroachments with psychiatry’s illness categories conditioned by the culture’s tolerance limit and moral standards. It is enough to mention the LSD treatment of homosexuals, transvestites and the sterilisation, castration and lobotomising of gypsies and the persecution of dissenters such as Knut Hamsun and Arnold Juklerød.


In conclusion: Do we wish to have a society comprising only well-controlled and pliant people - Are we about to realise Aldous Huxley’s frightening vision of the future in "Brave New World"?




Medicating of schoolchildren


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