The ADHD explosion in Sweden and its consequences for child welfare

ADHD (Attention deficit hyperactivity disorder) is the fastest growing psychiatric diagnosis among young people in Sweden and probably in the world. Drug treatment is common among those with a diagnosis, but little is known... [ view full abstract ]

ADHD (Attention deficit hyperactivity disorder) is the fastest growing psychiatric diagnosis among young people in Sweden and probably in the world. Drug treatment is common among those with a diagnosis, but little is known about the long term effects, positive and negative of such a treatment. Large geographic differences in prevalence of diagnoses and drug prescription on national and international level is a well-known phenomenon. Children within the child welfare system are however heavily over-represented, both with regard to diagnoses and drug treatment.

Objectives: The aim of the presentation is (1) to discuss geographic patterns in Swedish drug prescription for adhd and analyze factors that explain differences in this respect, (2) to present data on prescription rates among the child welfare population and to discuss the significance of these findings for social work with children and youth.

Method: Data on prescription rates in the Swedish municipalities (n=289) from the Swedish National Register of Prescribed Drugs and municipal data on child/youth factors, structural factors and economic factors are used in the analysis of geographic patterns (linear regression models). Data from the Swedish Board of Health and Welfare are deployed to discuss differences in description rates between children in different types of out of home care and the Swedish population (< 18 years). Findings from international research are used to place the Swedish case in context.

Results: The ADHD explosion (i.e. a fast growth of diagnoses as well as drug prescriptions) is an international phenomenon in the general population as well as in the child welfare population. Disadvantaged children (i.e. children to lonely mothers, children in poor families etc) are more affected than others. As for geographic differences in Sweden, results from regression analysis shows that factors on the local municipal/level can explain some of the variance, but the most important factor seems to be diverse types of professional practices on the regional level (Swedish health care is organized on the regional level). As for the differences between children in out of home care compared to the other children in Sweden differences are huge. For example, for girls in foster care the odds of being prescribed medicine for ADHD is six times as high compared to girls in the normal population. For boys in secure units (locked residential care units) the odds are ten times as high compared to children in the normal population.

Conclusion: The ADHD explosion might be understood as a case of medicalization of social problems. ADHD is not a stable and clear-cut diagnosis and social systems such as schools, the pharmaceutical industry, pressure groups and (in Sweden particularly) health care seems to be of great importance in explaining differences on international, national, regional and local level. This calls for more social science research on how the differences can be understood. Furthermore, there is an urgent need for more research on what diagnoses and medicalization means for children in general and for children in the child welfare system in particular. As for social work a number of ethical as well as practice oriented questions are raised, for example: To what degree and in what manner should social workers act when they identify children that might be diagnosed (this is of special importance as diagnoses often are made when children are in out of home care)? From an ethical perspective questions on different actors (children, parents schools etc) interests can be raised. From a practical perspective: how shall prescription drugs be handled in residential care units where up to 30 percent of the children use ADHD medicine.