Sociologist: ADHD treatment in Poland different than in the US
In the US, drugs are more often used in the treatment of ADHD than in Poland. In Poland, there is more reluctance to treat children pharmacologically, which is why psychotherapy is recommended more often, says sociologist Dr. Michał Wróblewski.
ADHD (attention deficit hyperactivity disorder) is recognized as a mental disorder in various medical classifications. Sociologist Dr. Michał Wróblewski from the Nicolaus Copernicus University explains that ADHD consists of three types of symptoms: hyperactivity, impulsiveness and attention deficit. This disorder is generally associated with children, but it can also be diagnosed in adults.
In his book "Medykalizacja nadpobudliwości. Od globalnego standardu do peryferyjnych praktyk" ("Medicalization of hyperactivity. From the global standard to peripheral practices"), the scientist analysed the development of knowledge concerning ADHD and the way this problem is discussed by psychiatrists, psychologists, teachers, patient organizations, the media and parents of children diagnosed with ADHD - especially in Poland.
"I wanted to check how the fact that behaviours formerly associated with being unruly became a symptom of a mental disorder that can be treated - is reflected in the discourse" - says Dr. Wróblewski. He explains that this is a part of a wider phenomenon: medicalization. Medicalization means that certain spheres of life, which previously were of no interest to medicine, begin to be included in the framework of medical standards.
"My research on ADHD shows that the most common reason for interest in an unusual behaviour of a child are problems at school" - the sociologist says. He explains that ADHD has become a fashionable topic in psychiatry and psychology in the US in the 1950s, which was related to the educational system reform during that time. "People started to wonder what was wrong with the schools that they did not work well. One of the conclusions was that children had various types of barriers - including those related to mental health. More attention started to be paid to their behaviour and therapy started to be used" - says the scientist.
He adds that in Poland, knowledge about ADHD began to spread among psychologists, teachers and social workers only at the turn of the 21st century.
"In the 1970s, it was alleged that social relations could be among the causes of ADHD. This hypothesis turned out to be wrong. We already know that the causes of ADHD do not include a wrong parenting model, i.e. the parents unable to handle the child" - says Dr. Wróblewski.
He explains that specialists now consider ADHD to be a biological disorder associated with genes or neurophysiology. "But there is no convincing evidence that this is the case. There is no diagnostic test or identified gene responsible for ADHD" - says the sociologist, and adds that this is one of the reasons why ADHD causes so much controversy.
Part of the controversy associated with ADHD relates to treatment. "There are two types of intervention in the case of ADHD. The first path is pharmacological. The patients are given stimulants - chemicals that act on the central nervous system. They help the patient focus and calm down. The chemical composition of methylphenidate - the main agent administered to people with this disorder - resembles amphetamine" - says Dr. Michał Wróblewski. He notes that this drug does help children with ADHD improve their learning performance, but there are still doubts as to why this substance actually helps.
The second path of ADHD therapy is associated with psychosocial interventions including family therapy or cognitive-behavioural therapy.
The sociologist compares that in the US, patients with ADHD are treated primarily with pharmacological agents, and the consumption of drugs in this disorder is high. In Poland, however, the approach is more nuanced and multifactorial.
"According to my analysis, it seems that in our country, for various reasons, a mixed approach is common - combining a pharmacological approach with psychotherapy" - he says. He comments that this is in part due to the nature of psychiatry in Poland. "It is based not only on biological factors, but also has a strong humanistic component" - says the sociologist.
Another factor, due to which psychotherapy is more often used in the treatment of ADHD in Poland, is the taboo associated with medicating children. "We have a lot of social resistance against giving children psychopharmacological drugs. Parents are not willing to choose a pharmacological path" - the scientist concludes. He adds: "If we give children substances that work like amphetamines, it can cause controversy".
Dr. Wróblewski points out that in the ADHD discussion, the very existence of this disorder is sometimes negated. "Some people believe that this is a conspiracy of pharmaceutical concerns or an easy way taken by parents unable to properly raise their child. This thread returns every now and then" - he says.
"Parents are often misunderstood by schools. Teachers do not treat a child diagnosed with ADHD as someone who needs medical or psychological assistance, but rather someone who misbehaves, who should be better disciplined, someone badly raised by parents. In the long run, such approach is hurtful for both the child and the parents" - he says. But he concludes that there is now a lot of talk about ADHD, and teachers are becoming more aware of the problem.
"In my work, I wanted to show that ADHD is a complex problem that we should think about comprehensively, not in a crude way. Even if in medicine we do not understand all the mechanisms and notice some non-transparent processes, such as the influence of pharmaceutical companies, we should not automatically draw conclusions that all of medicine is unreliable" - he says.
He warns against falling into extremes in assessing the phenomenon of ADHD. "We should not say that everything is now known about the causes of ADHD, but neither should we think that this problem does not exist. It is not the case that the diagnosis of ADHD is due to the behind-the-scenes interests and profiteering of pharmaceutical companies" - says the sociologist. He adds that there are parents and children, for whom ADHD is the cause of really suffering.
PAP - Science in Poland, Ludwika Tomala
lt/ ekr/ kap/