At regular intervals, texts appear that problematize the increase in the number of ADHD diagnoses, now most recently in several chronicles and comments on news Ytring. This is often explained by practitioners who hastily make the diagnosis without considering other diagnoses or “normal” explanations such as stress. This view is also raised by most therapists, who unanimously agree that we should not make the normal sick, and that the increase in the number of people diagnosed with ADHD is cause for concern. My problem with these texts is the invisible premise that the cause is too casual handling of the diagnosis. What if something else explains the trend? All psychiatric diagnoses are influenced by non-psychological and non-biological factors such as poverty, racism, school structure or family system. As social conditions change, it is natural that the incidence of the diagnosis will also vary. A relevant social factor for the diagnosis of ADHD is the conditions at school. Children, especially the youngest, are dependent on external frameworks to be able to maintain focus and concentration. Moreover, they have a higher level of activity than older children and adults, while the normal variation is greater in the youngest. If the school has fewer teachers to provide follow-up during lessons to the individual child, or there are increased requirements for theory and less room for play and activity, more children will have difficulties with regulating activity and attention. They will perform worse. This is precisely the case in the Norwegian school, and has been a trend over time. Results show that after Reform 97 and the Knowledge Boost were introduced, there has been less emphasis on play and more on learning for the very youngest. The consequence is likely that more children will struggle and fit into the diagnostic criteria for ADHD. It may well be that therapists have too low a threshold for diagnosing ADHD, I simply don’t know enough about that. But the school system has, by all accounts, become more theory-heavy than before, and boys in particular are dropping out. Let children be children My point is that both the explanation and solution to the increase in ADHD diagnoses may lie at a political, not a clinical level. The school must be arranged so that children can be children – even those who are more active and less theoretically interested. Increased teacher density will also lead to better accommodation for children with additional needs – not through diagnosis, medication or environmental measures, but through a teacher or assistant who can see them and follow them up. This in turn will lead to fewer children exhibiting challenging behavior that can be explained by concentration difficulties or hyperactivity, with the consequences that can have socially, professionally and personally. Thus, fewer fit the diagnosis. As part of the diagnosis of ADHD, we include social factors in the assessment. One would, for example, be very careful about making an ADHD diagnosis in a child who lives at home with parents with active problematic drug use. At the same time, there is a social context we rarely count on – and that is the politically determined one. This is problematic, depending on how we look at it. On the one hand, we are overlooking an important factor that plays a role in the occurrence of psychiatric diagnoses, on the other, clinical everyday life would have been drowned in political issues, if we as practitioners were to point out this connection. The number of teachers, the teachers’ working conditions, academic content, testing and measurement, are all factors that are politically determined, and which will presumably have an impact on the quality of the psychosocial environment in the school, and by extension, in the children’s behavior and adaptation. At the same time, we would not consider that a child who qualified for ADHD did not receive the diagnosis, citing “inadequate school structure with too little emphasis on age-appropriate development, individual adaptation and follow-up. School reform is recommended to be tested before the diagnosis can be made.” The correct brake My point is not that school structure causes ADHD in itself, but if activity level and ability to concentrate are normally distributed, and the requirements for a lower level of activity and increased ability to concentrate increase, more people will fall outside the requirements. It makes no sense to talk about the true occurrence of a psychiatric diagnosis, as it can be changed with the stroke of a pen by changing the criteria and threshold for diagnostics. A change in requirements for activity and concentration in children will lead to an increase in the number of children who are correctly diagnosed with ADHD, if the diagnostic criteria are unchanged. I do not believe that we should abolish the diagnostic system because political decisions affect the incidence of depression, anxiety or ADHD, but when we assess the incidence, we must include the social factors that are politically determined. If we in mental health care do not dare to highlight this, we will have a narrow understanding of changes in incidence, and consequently, what is needed to change course. In order to overcome the number of children who struggle with the requirements for little activity and a lot of learning, rather than play and creative expression, we have to step on the brakes. But the correct brake is not necessarily the diagnosis brake, but the reform brake for school reforms that make inappropriate demands on schoolchildren. Then fewer children will be required to sit when they want to run, focus when they want to sense, and push when they want to unfold. FOLLOW THE DEBATE:
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Stepping on the right brake – Speech
