常民的被醫療化與抗醫療化：以注意力不足過動症兒童的父母親為例

Abstract

研究背景與動機：注意力不足過動症(Attention Deficit / Hyperactivity Disorder，以下簡稱ADHD) 在臺灣的盛行率範圍約為5%至12%，高於已開發國家。過動特質從原先的偏差行為而後轉變成一項診斷類別，並且開始藉由醫療介入控制，這個過程便是醫療化(Medicalization)所探討的。回顧現有文獻主要探討在醫療化的框架下醫療專業如何驅動，卻很難了解常民如何看待醫療化過程，特別是對於此過程中發生的順應與抗拒。 研究方法：本研究為質性研究，並且從2011年11月至2012年6月以深度訪談方法進行資料收集。訪談對象為家中有確診為ADHD兒童之父親或母親，主要經由滾雪球方式從病友團體、機構、協會或周遭親友等多元管道接觸訪談對象。 研究結果：主要結果有：(1)在醫療化孩童過動的偏差行為過程中，老師扮演關鍵角色，包括是偏差發現者、就醫資訊提供者、治療策略建議者，以及孩子言行的監測者。(2)家長，特別是母親，最初願意接受醫療化是為求舒緩當下混亂狀況。然而確診後，抗拒醫療化行為除了更改藥物劑量與時間的不遵循醫囑情形，還有嘗試使用其他行為介入或替代方式，並非全然拒絕醫療才是所謂的抗醫療化行為。(3)對於母親而言，照顧過程中缺乏的社會資源，包括有家庭與社會的支持與互助、照顧者職場的彈性與經濟補助、孩子所處學校環境的改革，以及改善醫療資源間的連結性與可近性。 結論與建議：對於擁有ADHD孩童且接受醫療介入的母親而言，藉由醫療改善孩子偏差行為，其實是一個讓孩子「正常化」的過程。過程中不僅使母親舒緩壓力，更幫助孩子早日適應現今學校環境。然而，結果顯示學校與老師擁有左右診斷與治療的顯著影響力，這是值得關注的現象。因此，未來應建構一個將家庭、學校與醫療照護體系緊密連結的照顧與支持計畫，並且發展各種社會福利以解決本研究探討的ADHD議題，或其他孩童成長過程中會遇到的問題。

Background: In Taiwan, the prevalence of Attention Deficit / Hyperactivity Disorder (ADHD) ranges from 5% to 12%, broader than those in most of the developed countries. Viewed from a deviant behavior to a diagnostic category, this problem has been controlled under the power of medical interventions, a process designated as “medicalization.” While ADHD has been discussed under the rubric of mediclization which has been driven by the medical professions, hardly has it been examined from lay perspective, particularly lay acceptance and defense against this process of medicalization. Method: This study mainly applies a qualitative research design. Data were collected by means of in-depth interview from the parents of 20 ADHD children, mainly their mothers, from November 2011 to June 2012. The participants have been recruited through snowballing or referred by various institutions. Result: The important findings of this study were: (1) School teacher played critical roles in the process of medicalizing children’s state of ‘deviance,” from as deviance discoverers, medical information providers, medical strategy initiators, to behavioral performance monitors. (2) Parents especially mothers’ willingness to pro-medicalization was intending to control chaos. However, once diagnosis was confirmed, “anti-medicalization” surfaced, either non-adhering to medicinal treatment in dosage and intake schedule or additionally adopting alternative strategies such as other “behavioral interventions” without totally rejecting medical intervention, (3) As far as mothers concerned, what they needed most were social resources, including family and social support, assistance from workplace, and school accommodations, and improve connections and reciprocity between schools and health care system. Conclusion and suggestion: The best expectation from the mothers who had ADHA children and who accepted medical interventions was to pursue 'normalization' through which not only to release their pressure but also to help their children to adapt nowadays school environments. However, it has to be noted that the school and the teachers have become a predominant force in the process of diagnosis and the subsequent treatment of these children. A comprehensive assistance program that links family, school, health care system, and social welfare should be developed to tackle an increasingly prevalent childhood problem like ADHD.