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48 Seiten, Note: Distinction
ADHD according to the DSM-IV
Politics of ADHD
Latest developments for ADHD Guidelines
The link between colonisation and social disadvantage
Ethnographic account of ADHD
Inclusive classroom practice
Classroom instruction for students with challenging behaviour
CHAPTER 2: RESEARCH METHODOLOGIES
Chapter 3: DISCUSSION
Chapter 4: CONCLUSIONS
“If there is no valid test for ADHD, no data proving ADHD is a brain dysfunction, no long-term studies of the drugs’ effects, and if the drugs do not improve academic performance or social skills and the drugs can cause compulsive and mood disorders and can lead to illicit drug use, why in the world are millions of children, teenagers and adults… being labelled with ADHD and prescribed these drugs?”
Dr Mary Anne Block, Author of No More ADHD
An understanding of Aboriginal history, educational neuroscience and the practice of the Transcendental Meditation (TM) technique might reduce the rate at which Aboriginal children are being diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Currently, the incidence of ADHD increases with social disadvantage, especially for Aboriginal children (Isaacs 2006). Aboriginal Australians experience greater disadvantage than the rest of Australia; this is due in part to the impact of historical and contemporary racism (Paradies, Harris & Anderson 2008), colonisation and oppression imposed on Aboriginal people.
In Australia, ADHD has become a common childhood illness. Kindergarten and schoolteachers are now required to medically analyse children’s behaviour. If behaviour is deemed different to that of “normal” children, then a diagnosis may lead to ADHD and a prescription for stimulant medication. Such consultations require no objective proof. Therefore it is important to consider the context of the student’s environment, such as lifestyle, school and society at large.
In Chapter 1 the literature review investigates the link between colonisation, the dominant Western education system, and how this may influence the behaviour of Aboriginal students. In addition, a personal experience of ADHD will bring a parent’s perspective to the ADHD debate, which provides an ethnographic account of the hardship of a child being labelled then prescribed ADHD medication. An analysis of educational neuroscience suggests that brain-friendly classrooms help to prevent ADHD-type behaviour. Finally, a review of Transcendental Meditation describes the success of Consciousness-Based Education within an urban school in Melbourne. Chapter 2 involves a critical discussion of the research methodologies informing the research approach taken, and justifying the research strategy chosen, as well as evaluating its usefulness. Chapter 3 reports on the research findings at Maharishi School, Melbourne. Chapter 4 is an assessment, evaluation, analysis and synthesis of research findings, identifying implications and conclusions that link theoretical themes identified in the Literature Review to the case study findings. Finally, a summary of the key outcomes, the limitations of the study and potential areas for further research will be discussed.
The American Diagnostics and Statistical Manual of Mental Disorders (DSM-IV) states ADHD symptoms are represented by patterns of inattention, hyperactivity or impulsivity. Examples of student behaviour that constitutes ADHD under the manual’s definition include instances where a student fails to give close attention to details or makes careless mistakes in schoolwork or other tasks; work is often messy or careless; the student has difficulty sustaining attention in tasks or play activities; they find it hard to persist with tasks until completion; the child appears as if their mind is elsewhere or as if they are not listening; or a failure to complete schoolwork, chores or other duties (APA 1994).
Hyperactivity includes behaviours such as “often fidgets with hands or feet or squirms in seat. Often leaves seat in classroom or in other situations in which remaining seated is expected. Often runs about or climbs excessively in situations in which it is inappropriate. Often has difficulty playing or engaging in leisure activities quietly; is often on the go, often talks excessively. Impulsivity includes often blurts out answers before questions have been completed, has difficulty waiting their turn. Interrupts or intrudes on others (APA 1994). These behaviours may be due to excitement, enthusiasm or the nature of the child. Perhaps they are artistic, creative and enjoy being the centre of attention. The nature of these behaviours may arise due to boredom, or the curriculum being either too hard or too easy; students may not be engaged or may even be hungry. There may also be other factors such as stress or anxiety causing such behaviour.
Once a child is diagnosed with these behaviours they are usually prescribed stimulant drugs. According to the Citizens Commission on Human Rights (CCHR), children as young as two are being prescribed stimulant drugs for ADHD and, in Australia, 2406 children younger than six are on these drugs. An exponential increase in the rate of diagnosis and prescription of stimulant drugs has sparked concern in Australia.
For example, in April 2006, Australian authorities launched an immediate investigation into the safety of ADHD drugs following 400 adverse reactions involving children as young as three and four years old. Also, a five-year-old suffered a stroke and a seven-year-old suddenly died while on a stimulant drug. As a result, warnings have been strengthened for all ADHD drugs regarding cardiac problems and psychiatric episodes.
On the other hand, American psychiatrist Russell Barkley, author and advocate of ADHD, suggests that 1 to 20 per cent of those on ADHD drugs will experience an adverse reaction. Three times as many boys as girls are likely to be diagnosed with ADHD. Defenders like Russell Barkley attest that a diagnosis is preferable to their lives being dominated by behavioural problems (Fischer et al. 2005). Russell Barkley (in Baughman & Hovey 2006, p. 33) states, “although inattention, overactivity, and poor impulse control are the most common symptoms cited by others as primary in hyperactive children, my own work with these children suggests that noncompliance is also a primary problem.” He goes on to say, “…there is, in fact, something ‘wrong’ with these children.”
Staterra.com, a website of Lilly pharmaceuticals, states, “ADHD is a neurological brain disorder that manifests as a persistent pattern of inattention and/or hyperactivity – impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.”
For the first time in 10 years, the American Academy of Paediatrics (AAP) has revised its recommendations for ADHD children; among the biggest changes is the inclusion of preschoolers (four- to five-year-olds) and adolescents (13- to 18-year-olds). Previously, the guidelines focused only on children between the ages of six and 12. According to the US Centers for Disease Control and Prevention, ADHD affects some 5.4 million children in the United States — more than half of who are 11 years of age or younger. Of those, as many as two-thirds exhibit symptoms at or before the age of four, according to a study in the Journal of Developmental & Behavioral Pediatrics (2011) . Diagnosing ADHD in children that young is complex and somewhat controversial.
The AAP’s guidelines state that a diagnosis of ADHD should be based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which lists 18 symptoms for ADHD in children and adults: nine related to inattention, and nine related to hyperactivity and impulsivity. Only the latter – which includes frequent fidgeting, excessive running around or climbing, excessive talking, difficulty playing quietly, and tendency to interrupt or blurt out answers before questions have been asked – applies to preschool-age children.
<http://www.everydayhealth.com> reported, “When we’re talking about ADHD in preschool children, we’re not talking about the inattentive form,” explains Andrew Adesman, MD, (2011) chief of developmental and behavioural paediatrics at Schneider Children's Hospital in New Hyde Park, NY, and member of the advisory board for Children and Adults with Attention-Deficit/Hyperactivity Disorder. “We’re talking about children who are hyperactive and impulsive who may or may not have significant problems with distractibility.” Among the possible red flag, he says, are restlessness, difficulty sitting still, and trouble waiting for their turn.
The Netherlands Advertisement Code Commission has ruled that the country's Brain Foundation cannot claim that the controversial psychiatric condition ADHD is a neurobiological disease or brain dysfunction. The Advertisement Code Commission decision (2011) stated, “The information that the defendant presented gives no grounds for the definitive statement that ADHD is an inherent brain dysfunction… Under the circumstances, the defendant has not been careful enough and the advertisement is misleading.”
Even the DSM itself states (p. 88), “There are no laboratory tests, neurological assessments or intentional assessments that have been established as diagnostic in the clinical assessment of Attention Deficit/Hyperactivity Disorder.” This fact is rarely told to parents and teachers despite the DSM being the main manual used to diagnose ADHD in Australia, and many checklists used by teachers and parents to screen children for ADHD are based on this manual.
The Daily Mail (14 June 2011, p. 5) reported that Gwynedd Lloyd, an education researcher at Edinburgh University, has explained her doubts, “You can’t do a blood test to see if a child has ADHD. It is diagnosed by ticking a behaviour checklist –getting out of your seat and running about is an example. Half the kids in a school would qualify under these sorts of criteria.” Nonetheless, it is a psychiatric condition based on the American Diagnostic and Statistical Manual of Mental Disorders (APA), the “bible” of mental illness (2011).
Recently, Glasser (2005, p. 122) created his own non-medication-centred approach for teachers and parents (The Nurtured Heart Approach). He argued, “ADHD may be a neurological disorder but then there is also a great deal of compelling evidence that state it isn’t.” Dr Fred Baughman, a world renowned adult and child neurologist certified by the American Board of Psychiatry and Neurology and a Fellow of the American Academy of Neurology, built his whole argument on the fact that ADHD is not a brain disease, stating there is no evidence of its existence (Baughman & Hovey 2006). This type of hypothetical analysis is misleading and can be seen as medically socially constructed. Most diseases have verifiable evidence-based diagnoses such as diabetes, cancer and heart disease. Administering stimulant medication for an assumed disease that cannot be proven should be seen as a criminal act. All stimulants prescribed for ADHD are classified as Schedule 2 drugs by the Drug Enforcement Agency – a classification reserved for the most dangerous and addictive drugs that can be legally prescribed (Baughman & Hovey 2006, p. 31).
American drug companies are reported to be making huge revenues and enormous profits from ADHD drugs. Dr Healy (in Baughman & Hovey 2006, p. 57) points out that drug companies barely existed prior to World War II to become “…giant corporations and the darlings of Wall Street… a medico pharmaceutical complex that appears to have gradually shifted from discovering treatment for major diseases to medicalizing aspects of the human condition. We live in a Brave New World which is shaped not just by new drugs created in company laboratories, but by an almost Orwellian capacity to control the flow of information.”
Once diagnosed with ADHD, young children are often given an amphetamine-type drug like Ritalin. These drugs are a Schedule 2 controlled substance in the same category as cocaine, methadone and methamphetamine. While appreciating the benefits that pharmaceuticals can bring to many behavioural and mental conditions, it is justifiable to question the legitimacy of stimulant medication for young children that may mask other problems that would be better dealt with by way of better parenting and more inclusive educational approaches.
With the development of ADHD, it has inadvertently replicated colonial dynamics by imposing Western notions of self, childhood and family onto non-Western populations. This discussion looks at the way that history and the education system have treated Aboriginal people and also reflects on the negative impact of the Anglo-European invasion of Australia.
Charles Darwin’s scientific theory of evolution that contributed to policies that continue to affect Aboriginal people will be considered. Then a critique of difference and injustice will be the springboard to understanding the structural and systemic discrimination within the education system that can ultimately lead to a student being diagnosed with ADHD.
Aboriginal society is the oldest living culture in the world, and for approximately one hundred and twenty-five thousand years there was no intergenerational disadvantage or ADHD; in fact, this notion was non-existent. Aboriginal children were productively and successfully educated through complex systems integrating the natural landscape, all living beings and the universe as life itself. Aboriginal culture can claim to be the oldest continuous living culture on the planet.
The hallmark of Aboriginal culture is oneness with nature, and knowledge and education has been at the forefront of Aboriginal life – it can be seen today through Elders, family, community, art and the Australian landscape. Then, in 1788, Aboriginal life and Mother Earth experienced a catastrophic invasion that would negatively impact and change Aboriginal society and the Australian landscape forever.
Anglo-Europeans invaded Australia and declared the land belonged to no one. This gave onus to Anglo-Europeans’ possession and claims over Aboriginal land. Brendt & Brendt (1954) indicate that Aborigines were dispossessed of land that was always considered part of spirit, part of life, “lands that were associated spiritually with themselves and their tribal ancestors” (p. 22). When Aboriginal people resisted and tried to defend their rights and what was undeniably theirs, “they were shot and driven back” (p. 22). Moreton-Robinson (2005) argues, “the incarceration, removal and extermination of Indigenous People were validated by regimes of common law based on the assumption that terra nullius gave rise to white sovereignty” (p. 26). Of course, this was a complete farce but, sadly, a reality.
Brendt and Brendt (1954) comment that dispossession of land involved the forced removal of tribes herded like cattle into artificial surroundings (p. 138). The British eventually took over Australia in 1788 through policies and practices that suited their campaign of colonisation and domination. The publication of Charles Darwin’s book, On the Origin of Species by Means of Natural Selection, or the Preservation of Favored Races in the Struggle for Life (1859), gave rise to the scientific notion that Aboriginal Australians were in fact at the lowest end of man-kind, not far from apes. This book proposed a “struggle for life” among the different races of humanity, and the “fittest”, superior races were those that would ultimately adapt and survive. According to Darwin, the fittest and most superior were white Anglo-Europeans.
Once the news of the “noble savage” reached Britain, fervent European anthropologists and researchers eager to discover the origins of the human species rushed to Australia to conduct scientific, medical, biological and psychological experiments on Aborigines and collect artefacts, skeletons and, in particular, skulls. Since then, Aborigines have consequently featured as objects of research, investigation and case study for hordes of social theorists.
Social Darwinism ultimately defined Aboriginal people at the lower end of a humanities scale, the backward species of man. Aboriginal people were isolated from the influences, excesses and industrialisation of the Western world. It was believed that Aboriginal people had not evolved from an early form of humanity and were too primitive, inferior and unable to adapt to advanced European society, and nothing could be done to save the race from biological and cultural extinction. Elkin (1964) affirms the notion that it became comfortable for white society to rationalise the disappearance of the Aboriginal race as inevitably doomed to extinction, and all that could be done was to “Smooth the Dying Pillow” to justify the passing of a stone age people confronted by civilization” (p. 366). The beliefs of Social Darwinians authenticated and provided justification for colonisation by imperial powers. Europeans regarded colonisation as a natural and predestined process of humanity where civilisation, Christianity and technology would be brought to the people of the “new world”. Social Darwinism constituted Indigenous people as inferior, being weaker than whites. Those unfit and unable to adapt and survive in a civilised society would merely perish during the natural course of evolution. The strongest would adapt to the new social environment; would be absorbed into the dominant culture as the survival of the fittest.
Although the theory of the “noble savage” is not supported by most academics, in 1964, Elkin, Emeritus Professor of the University of Sydney, wrote, “we need skulls and other skeleton remains of the inhabitants of Australia in bygone millennia to enable us to determine whether they are alike, or different from, the Aborigines of today” (p. 21). This so-called scientific theory, along with economic gain, white supremacy, and religious beliefs, reflected the legislation of invasion.
Aboriginal people have endured and continue to endure intergenerational discrimination and racist policies and practices through the continuation of invasion, dispossession and the notion of Social Darwinism. Richard Broome (1994, p. 94) comments that “Social Darwinism” came to be widely accepted in Australia by the 1880s and “the survival of the fittest” seemed to explain what many white Australians already believed – that some races were better than others, and the weaker ones faded away. Episkenew (2009) emphasises that the dominant colonial society bestowed a set of privileges upon themselves that were not only ill-founded and fallacious but most often based on nation, class or religion which prompted him to conclude that the “colonial myth is a story of imagined White superiority” (p. 3).
Although many Australians believe this happened in the past and it is history, it continues today within the education system. Diagnosing and deciding how people should behave is informed by a dominant group of so-called experts. The only difference is students are being drugged to modify their behaviour to the expectation of white, middle class teachers, medical practitioners and bureaucrats. Malin (1990, p.9) argues, “school policy and programs are predominantly informed by the perceptions, life experience, priorities and processes of the dominant group.”
Many of the behavioural problems attributed to Aboriginal students may arise in the clash of cultures, ways of learning and expectations of schooling. To address the classroom behaviour it appears that many Aboriginal students are being over-diagnosed as having ADHD characteristics and then prescribed medication. Aboriginal students should not have to give up their cultural identity in order to succeed at school (Hughes 2008). Burbules (1997, p. 98) states, Such racist inequalities continue to be central in the lives of Aboriginal students. Disadvantage on this magnetite has sparked much debate and research. The United Nations (UN) pointed out that racism is systemic in Australia. In 2011, the UN Committee on the Elimination of Racial Discrimination condemned the ‘unacceptably high level of disadvantage and social dislocation’ of Aborigines (http://theangle.org). The wave of trying to deconstruct then construct Aboriginal people to reflect dominant society is a process that has failed to achieve social justice and it starts for young people in the education system.
Other government reports such as Bringing Them Home and the Royal Commission into Aboriginal Deaths in Custody have highlighted how past policies contribute to low school retention rates and low participation rates in education sectors. The NSW Public Education Inquiry Report (2002) and Kata Kulpa, a Commonwealth report from a Senate Committee inquiry into the effectiveness of education and training for Indigenous Australians, found that overall outcomes for Indigenous people in education and employment are still unacceptable. It appears that there has been more success in “Aboriginalising” the curriculum than improving educational outcomes. Commenting on an analysis of education statistics of OECD countries to determine whether Australian students are being developed to their fullest potential under the United Nations Convention on the Rights of the Child (CRC), to which Australia is a signatory. Redmond (2007) ranks Australia sixth on his scale and remarks that, generally, Australia performs well when compared to other rich counties and makes the statement that “overall our students are high performers” (p. 39).
However, he qualifies his comments by emphasising that there are disparities within the analysis and, although he regards inequalities “as a given” (p. 47), he nevertheless emphasises that one of the most striking disparities in the Australian analysis is the inequality of achievement between Indigenous and non-Indigenous students. He notes that the average score for Indigenous Australian students in 2006 (p. 48) was lower than the average for every OECD country except those of Turkey and Mexico and the vast disparities in scores have not diminished significantly over time. When the factor of remoteness is added to the theory to determine “fullest potential”, educational disadvantage in terms of access and equity of outcomes for Indigenous students is greatly exacerbated, and this group of students must surely be the most educationally disadvantaged group in any developed, wealthy country on the planet.
In a paper prepared by Helen Hughes (2008) on the state of Indigenous education in the Northern Territory, she questions the failings of state education when she remarks, “how can there be such appalling educational deprivation and inequalities in a compassionate country with one of the world’s most effective democracies?” (p. 19). The MCEETYA Taskforce on Indigenous Education (2000) states, “The scale of educational inequality remains vast for Australia’s Aboriginal and Torres Strait Islanders” (p. 8). In response, the review articulates a deep sense of frustration directed at both the failure of education systems to provide improved outcomes for Indigenous students – “educational inequality has persisted for so long” (p. 9) – and at the continuing institutional and societal mindsets that the gap in education attainment is considered “normal” – “there is a perception in some quarters of the Australian community that achieving educational equality for Indigenous people is too hard and not achievable, or if it is achievable, that it will take a very long time: if it was simple and quick, it would have been done already” (p. 9).
It is argued by Hickling-Hudson and Ahlquist (2003) that “educational systems in white dominated countries, and what is recognised as formal knowledge, are shaped by ‘whiteness’” (p. 1). They contend that in Australia the provision of Indigenous education is constructed and shaped by long-standing cultural, social and historical assumptions of racial supremacy emanating from the colonial experience. Embedded assumptions of dominance and dispossession underpin education policy and practice and serve to perpetuate and reinforce education inequality. The practice of dominance and conformity are very evident in school routines, policies and behavioural expectations imposed by white, middle class teachers and policy developers. The education systems have always tried to control Aboriginal children and it would appear that the diagnosis of ADHD is a medical strategy used to impose conformity of Western expectations of behaviour, conduct and values on Aboriginal students – merely another weapon of assimilation.
Access to quality education and equity of education outcomes for students, or lack of these fundamental human rights, is ultimately a political decision. To support this point, Cannella (2004) states, The lack of a robust debate and the narrow discourse through which education policies in Australia have evolved since white settlement serves to support a particular political agenda and represents the very narrow and dominant perspectives that have prevailed since the early days of colonization. As examples, the language of education has been one of deficit, marginal, other, inferior, blame and punishment rather than focusing on a discourse of equality of opportunity, equity of outcomes and social justice and the redressing of societal inequities.
On the other hand, McConaghy (2000) built her whole argument on the issue of culture, or the problem of Indigenous culture, or the problem of cultural difference. Often, cultural difference manifests itself in behaviour, manners and values. However, differences in cultures may be framed – the argument has deflected real understanding of the crisis of Indigenous education in this country where disproportionate numbers of Aboriginal students are leaving school before the compulsory leaving age and are being suspended and excluded in large numbers from education. And now the labelling of Aboriginal students as disruptive, abusive and disengaged through ADHD diagnosis further exacerbates the issues of lower than expected education achievement and marginalisation from education settings. It’s deflected us from doing the types of sophisticated sociological analysis of education that we’ve developed in other areas of educational research.
These issues are all linked through conditions of colonialism, post-colonialism, dispossession and a long history of neglect and exclusion and superficial inclusion, racialisation practices, ideologies of whiteness and so on. These conditions have reproduced within education and schooling by both radicals and conservatives through the influence and the prevalence of culturalism, which is in effect a form of racism and necessary for the continuation of colonial formations.
The government’s own words, contained in the MCEETYA Taskforce on Indigenous Education (2000) discussion paper, provide a very clear recognition of the powerful role that education has played in the process of assimilation: “For the past two hundred years, formal education has been not only Australian society’s tool for change but also the mechanism of domination and colonisation. No Indigenous student ever escapes this realization and all feel its pressure” (p. 1). Likewise, aboriginal people of Canada have endured a similar education policy. Smith (2004), in summarising Marie Batiste, claims that education has not been benign or beneficial for Aboriginal people. Rather, through ill-conceived Federal Government policies, Aboriginal people have been subjected to a combination of unquestionably powerful but profoundly debilitating forces of assimilation and colonisation.
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