04 SES 02 A, Rethinking the ADHD Paradigm from an Inclusive Perspective
The ADHD diagnosis has been debated to a large extent and even its existence has been questioned (Barkley et al, 2002; Harwood & Allan, 2014; Meerman et al., Timimi et al, 2004, Saul, 2014). Nevertheless, the number of ADHD diagnoses has skyrocketed in many countries (Hinshaw & Scheffler, 2014; Langager, 2014) and Sweden is no exception.
In the Swedish school system, a student shall receive special needs provision irrespective whether the student has a neuropsychiatric diagnosis or not (Swedish Education act, 2010:800). This legislation has not been obeyed by all municipalities (Swedish National Board of Health and Welfare). They must follow educational legislation but have a certain degree of freedom in interpreting state-governed policy.
Classes specifically designed for students with ADHD were found in a recent national survey (Malmqvist & Nilholm, 2016). This is contrary to the notion of inclusion and the Swedish national policy (Hjörne & Evaldsson, 2015). It was found that these ADHD special education classes were established in some municipalities but not in others. The present study presents results from a follow-up case-based interview study with ten pair-matched municipalities. Educational leaders representing their municipality’s policy and practice level were interviewed.
Research questions, Aim/objectives
The aim of this study is to examine and describe educational leaders’ mind-set types related to schooling of ADHD students in five municipalities which have established ADHD special education classes. Furthermore, their mind-sets are compared with mind-sets among educational leaders’ in five pair-matched municipalities without ADHD special education classes.
An objective is to investigate how the influence from the neuropsychiatric paradigm is perceived by municipal educational leaders regarding school policy and school practices.
- What characterises mind-sets among municipal educational leaders who represent their municipal’s educational policy level, in municipalities with and without ADHD classes, when it concerns the job of dealing with student behaviour and in teaching academic subjects?
- What characterises mind-sets among educational leaders who represent their municipal’s practice level, in municipalities with and without ADHD classes, when it concerns the job of dealing with student behaviour and in teaching academic subjects?
A theoretical framework was constructed to make it possible to compare mind-sets among educational leaders responsible for ADHD students’ schooling. It contains two dimensions of schooling, 1., ‘teaching’ and 2., ‘affecting behaviour’ and both dimensions have the character of being continuums. Two end-positions and one ‘in-between’ position is used for each dimension, which means that the framework consists of six positions:
- ‘Neuropsychiatry-based teaching’. Teaching that is based on individual ADHD students’ neurological deficiencies. The goal is to reduce primary symptoms to keep ADHD students on-task (Pfiffner & DuPaul, 2015).
- ‘Integration-based teaching’. Teaching where ADHD students must adjust to the main teaching strategies offered to all students. ADHD students are offered individual adaptations.
- ‘Inclusive education-based teaching’. The teaching is designed to cope with diversity and where teaching strategies are changed when students encounter difficulties.
- ‘Treating and controlling behaviour’. Classroom behaviour management is used. It is based on consequence-based strategies to treat secondary symptoms, such as aggression (Pfiffner & DuPaul, 2015). Other clinical interventions, such as child psychological therapies and medication are used in treating ADHD students.
- ‘Normalisation of behaviour in educational settings’. Inappropriate behaviours are handled in regular settings according to principles of ‘normalisation’ (Nirje, 2003).
- ‘Inclusive education-based approach’. Changes of teaching strategies are made when there are behavioural problems and challenges in the classroom. This means that the teachers reconsider the existing teaching and classroom procedures to remove barriers for social inclusion. In case this does not work, improvements of teacher competence and/or reinforcement of the number of staff or other contextual changes are done.
A purposeful sampling procedure was used (Creswell, 2013). Ten municipalities were selected based on the answers of the previously mentioned survey. The purpose was to have municipalities representing contrasting mind-sets about ADHD students’ schooling. Five municipalities with ADHD classes were pair-matched with municipalities without such classes. Several other criteria were used, such as municipality size and municipality type. The five municipalities with ADHD classes had 23 such classes and a total number of 189 000 inhabitants, whereas the five municipalities without ADHD classes had 190 000 inhabitants. Interview data was collected during one-day visits to the municipalities. Information about schools, psychiatry units and social services were collected from websites prior to the visits. The visits included school and classroom visits, visiting lessons and informal talks to staff. There are huge differences between municipalities in their way of organising the educational systems. Therefore, interviewees where chosen based on their knowledge and not on their municipal position. Two interviewee profiles, based on defining criteria, were made explicit to the municipalities. The policy level interviewee profile prescribed an educational leader high in rank in the municipality. This leader should be responsible for the whole special needs education area and have a thorough knowledge about organisational decisions and political arguments. The practice level profile prescribed an educational leader in charge of ADHD classes or schools with a large number of ADHD students. These leaders should possess a thorough knowledge about educational practices in classes with ADHD students. Semi-structured interviews (Kvale, 1997) were conducted. A total of 22 interviews were conducted with an average length of 63 minutes. All participants gave verbal consent to participate and they were provided information that the investigation was conducted according to Swedish ethical guidelines. All interviews were audio-recorded and transcribed verbatim. The step-wise analysis contained a first step aimed at receiving condensed descriptions from transcriptions while keeping original formulations (Kvale, 1997). In the second step, meaning units were divided into the two dimensions: ‘Teaching’ and ‘Affecting behaviour’. The third step contained a criteria-based analysis to establish whether meaning units were in accordance with mind-sets in the theoretical framework. In the fourth step, meaning units were positioned in summary tables which were based on the two dimensions in the theoretical framework (one table per municipality). Respondents’ mind-sets were positioned in a two-dimensional typology table in the fifth step. In this step, the analysis led to municipal profile-types.
The typology table showed that many respondents had mind-sets in line with the neuropsychiatric research paradigm when it concerns ADHD schooling. In some municipalities there was a congruence in mind-sets between the educational leaders, but not in others. The municipal leaders in one municipality had totally opposite mind-sets about ADHD schooling. When the educational leader with a neuropsychiatric mind-set left the municipality, the ADHD classes were closed down. This happened during the interview period. This municipality profile was called ‘Complete disagreement in a transformation phase’. Five other municipality profiles were found and they constitute a typology. The types were labelled: ‘Congruent neuropsychiatry based’, ‘Conflicting mind-sets dominated by neuropsychiatry’, ‘Conflicting mind-sets dominated by educational integration’, ‘Educational integration with an eclectic approach’ and ‘Striving towards inclusion’. A perceived neuropsychiatric influence was strong in municipalities with ADHD classes and in one of the other municipalities. The influence, according to the interviewees, came from ADHD centres and neuropsychiatry units and often ‘indirectly’ via parents. The influence in some municipalities seems to reflect the large regional differences in prevalence of ADHD diagnoses, (Swedish National Board of Health and Welfare, 2016). Another perceived influence was evaluations conducted by the School Inspectorate. One single inspection seemed to have been decisive for a decision to close down ADHD schools in one of the municipalities. Many interviewees expressed doubts about their way of educating students with ADHD and the descriptions showed that there was a dynamic and unstable situation in many municipalities. Implication The results are discussed in relation to the dominance of the neuropsychiatric research paradigm and the pedagogical implications for schooling. The scarcity of empirical ‘ADHD studies’ conducted by educational researchers is questioned. There is a need to examine, from an educational perspective, the long-term consequences of ADHD schooling based on the neuropsychiatric paradigm.
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