児童養護施設の養育形態と「ADHD」の診断を受け薬物療法に進む子どもたち―児童養護施設における子どもの医療的ケアに関する全国調査を手がかりに―

抄録

From the perspective of medicalization theory in medical sociology, this paper examines the increasing number of children in residential care facilities diagnosed with “ADHD.” Previous discussions on the medicalization of these children have focused on the assignment of psychotherapy staff and psychiatric interventions, highlighting the growing number receiving medical diagnoses and pharmacotherapy. Meanwhile, it has also been noted that these issues relate to challenges associated with communal living. However, in addition to large-scale facilities that primarily adopt a communal living arrangement, some facilities provide more “family-like” care, such as small-group homes and unit-based systems. Past research on medicalization has paid little attention to differences in forms of care environment and the likelihood of children receiving medical diagnoses and pharmacotherapy. This study analyzes data from a questionnaire survey conducted at approximately 600 children’s residential care facilities nationwide to examine the relationship between forms of care environment, the prevalence of “ADHD,” and the prescription rates of psychotropic medication.

The analysis confirmed that many facilities have children diagnosed with “ADHD” who proceed to pharmacotherapy. Examining the characteristics of children receiving medical diagnoses and pharmacotherapy by form of care environment, such children were present in significant numbers across all care arrangements. However, they were more prevalent in facilities adopting unit-based or small-group home systems, which are closer to a “family” environment, than in large-scale facilities based on communal living. This paper discusses why children diagnosed with “ADHD” and proceeding to pharmacotherapy are more commonly found in facilities adopting a “family-like” care environment, which is generally considered to reduce stress from communal living and provide a more stable living situation.