Negotiating medicalisation: the clinical practice of ADHD in paediatric psychiatry
Fan-Tzu Tseng (Academia Sinica)
Paper short abstract:
This study explores the clinical practices of childhood ADHD, and focuses on how psychiatrists react to the related medical and social controversies. Whilst considering back and forth between psychiatry as an imperfect science and as a contentious aid, practitioners manage to negotiate competing concerns in a constantly medicalising society.
Paper long abstract:
While the rate of diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) has been growing rapidly since the turn of the twenty-first century in Taiwan, the public debate around the over-diagnosis and over-medication treatment in children has prevailed throughout this decade, and has been challenging the authority and credibility of child psychiatry as a latecomer to the local field of medical specialties. Based upon analyses of interview data collected from seventeen psychiatrists, this study explores how every day clinical practices react to social controversies, and how psychiatrists, very aware of the marked skepticism surrounds ADHD, negotiate the standardised label of disorder and clinical practice guideline while considering the characteristics of the child and his/her situations. This study finds that psychiatrists interviewed put more emphasis on the clinical logic -- whether this case is “treatable”—than the ambivalent nature of ADHD as a “real” disorder (on constructed). Although psychiatrists understand children with a biopsychosocial framework, it is usually the child, rather than the environment itself, that become the prior object of medical interventions given capacity and resource limitations. However, psychiatrists try to interpret these interventions as means of empowering the suffering child to develop his ability to manage himself and his social relationships. This study unveils that the process the clinical practitioners negotiate back and forth between psychiatry as an imperfect science and as a contentious aid, and will contribute the literature of medicalisation, diagnosis and the social control of childhood behavior.
Health professionals' adaptation to societal and economic uncertainties, intensifying demands and growing challenges to healthcare provision