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Medicine Goes to School: Teachers as Sickness Brokers for ADHD


Over the last twenty years, attention deficit hyperactivity disorder (ADHD) has emerged as a disorder of importance in childhood. Prescription of psychostimulants for ADHD escalated in many countries through the 1990s. Between 1990 and 1995, prescriptions of methylphenidate for young people increased 2.5-fold in the US [1], and 5-fold in Canada [2]. In New South Wales, Australia, rates of treatment for children in 2000 were nine times those in 1990 [3].

ADHD joins dyslexia and glue ear as disorders that are considered significant primarily because of their effects on educational performance. Medicalising educational performance can help children receive specialised medical and educational services; at the same time it can lead to them receiving medications or surgical therapies which may have short-term and long-term ill effects.

In the case of ADHD, there has been a complex, often heated debate in the public domain about the verity of the illness and the personal cost-benefit ratio of treatment with psychostimulant medication [4-6].

Much of the polemic for and against psychostimulants is concerned with the part played by doctors, the prescribers of medication, in diagnosing or discounting ADHD. ADHD is, however, a disorder of educational performance, and so teachers have a critical role in advocating for the illness, and its medical treatment.

This essay explores the roles of teachers as brokers for ADHD and its treatment, and the strategies used by the pharmaceutical industry to frame educators' responses to ADHD.


This open-access article explores some of the controversies surrounding the diagnosis and management of ADHD - particularly with respect to whether this condition is seen, and treated, primarily as a medical or an educational problem.

Similar controversies surround the diagnosis of other childhood developmental conditions affecting behaviour and/or learning, such as dyslexia, dyspraxia (Developmental Co-ordination Disorder) and Autism - not least because:

(1) although there is good evidence that these conditions have at least some biological basis, there are no reliable objective tests or biomarkers that can be used in their diagnosis

(2) the core defining symptoms of all of these conditions are found in milder form in the general population

However, only in the case of ADHD have any pharmacetical treatments been approved for the management of symptoms - making this diagnosis a particularly controversial one.