Brenton Prosser

Changes in use of psychostimulant medication for ADHD in South Australia (1990–2006)

Objective: The aim of the present study was to undertake a retrospective analysis of archival data on psychostimulant prescriptions from South Australia for the periods 1990–2000 and 2001–2006 for 7849 youths aged from birth to 18 years. Method: A person-based data set was used to assess: (i) rate of new prescriptions by age group; (ii) demographic characteristics (age of psychostimulant start, male: female ratio); (iii) duration of psychostimulant use; and (iv) geographic variation in psychostimulant prescription. Results: Four major findings were observed: (i) the rate of new prescriptions was highly variable both for 1990–2000 and 2000–2006; (ii) demographic characteristics such as start age and male:female ratio declined over both periods; (iii) the duration of psychostimulant use was approximately 2.5 years for 1990–2000 and 2.0 years for 2000–2006; and (iv) there was geographic variation in both periods with a significant correlation between socioeconomic status and prescription rate per region. Conclusions: The patterns of psychostimulant use in Australia closely parallel the USA. Physicians’ prescribing practice may be extremely volatile. Duration of psychostimulant treatment should receive increased attention. There is pronounced geographic variability in prescription rates, which may be related to socioeconomic status.

Unsettling Deficit Views of Students and their Communities

In this paper we explore the possibilities for redesigning pedagogy in the middle years of schooling. We think that the middle schooling movement in Australia is unfinished because the pedagogical reforms promised have been patchy, not well researched and difficult to sustain. As well, middle schooling is a little exhausted because it has failed to respond to changing demographies and youth identities. As a response we argue for school change projects linked to mainstream curriculum change. From a range of conceptual resources we discuss the potential of using a “funds of knowledge” approach and a narrative approach to youth identity work.

Beyond ADHD: a consideration of attention deficit hyperactivity disorder and pedagogy in Australian Schools

A psycho‐medical discourse that explains behavioural dysfunction through neurological deficit has dominated debate about attention deficit hyperactivity disorder (ADHD). However, if only medical questions are asked, only medical answers will be found, resulting in more or less drug treatment. When behavioural dysfunction results in impairment within home, school and work settings, it is also important to include educational and sociological considerations of what defines these differences as deficit. This paper notes the influence of recent Australian education priorities on ADHD, traces the relationship between traditional pedagogies and ADHD diagnostic criteria, and documents research into the schooling experiences of secondary students diagnosed with ADHD. It does so to argue that current pedagogical practices around ADHD focus on integrating students rather than inclusive education. In response, the paper proposes possible pedagogical resources that might help educators move beyond asking why students are failing at school, to consider how schools may be failing an increasingly diverse generation of students.

I am smart and I am not joking: Aiming High in the Middle Years of Schooling

In this paper, we draw on accounts from students to inform a Middle Schooling movement that has been variously described as “arrested”, “unfinished” and “exhausted”. We propose that if the Middle Schooling movement is to understand the changing worlds of students and develop new approaches in the middle years of schooling, then it is important to draw on the insights that individual students can provide by conducting research with “students-as-informants”. The early adolescent informants to this paper report high hopes for their futures (despite their lower socioeconomic surroundings), which reinforces the importance of supporting successful learner identities and highlights the role of schooling in the decline of adolescent student aspirations. However, their insights did not stop at the individual learner, with students also identifying cultural and structural constraints to reform. As such, we argue that students may be both an important resource for inquiry into individual school reform and for the Middle Schooling movement internationally.

Revolution or backlash? The mediatisation of education policy in Australia

Recent scholarship has identified the emergence of a new modality of policy work: the mediatisation of policy. This paper provides an Australian case study which reports on the tactics of an Australian Federal Minister of Education and a media commentator who both engaged in public pedagogical work for the purpose of spinning education policy. In particular, we argue that this example of the mediatisation of education policy has worked to stifle pedagogical innovation as advocates of middle schooling reform struggle against what appears to be a backlash to the social-democratic reforms of the post-World War II era. Such backlash politics is understood in terms of a struggle to maintain the role of teachers as curriculum designers and not be merely technicians; to sustain critically reflective learning communities of colleagues and friends; and not succumb to pedagogies of resentment that are driven by a logic of deficit views of students and their communities.

Psychostimulant Use for Children with ADHD in Australia

There has been rapid growth in the use of medication for treatment of attention-deficit/hyperactivity disorder in the last decade. This growth has often been explained as the recognition of a condition that affects up to 5% of all young people. The purpose of this study is to compare past medication trends and current usage in Australia with that in the United States. We present country-wide data from Australia on psychostimulant production and prescription rates. We also analyze data from one city on the number of children receiving medication. Results suggest that medication use in Australia is increasing at a rate similar to that found in the United States and that in one city a relatively small proportion of practitioners accounted for the majority of prescriptions. Results also suggest that, in Australia, there may be differences in prescription rates by income and unemployment.

Devolution, Evolution, Revolution … Democracy? What's Really Happening to English Local Governance?

The Cities and Local Government Devolution Bill 2015–2016[HL] was introduced into the House of Lords as Bill No. 1 in the 2015–2016 parliamentary session. The Bill forms a critical element of the governments high-profile policy of devolving powers and responsibilities to local areas within England. The transition from first-generation ‘city deals’ to second-generation ‘devolution deals’ within five years provides a sense of the pace and development of the reform agenda but there is also a strong sense that something is missing. ‘Missing’ in the sense of an understanding of the specific type of devolution on offer, ‘missing’ in the sense of how an explosion of bilateral new ‘deals’ will be offset against the obvious risks of fragmentation and complexity, and ‘missing’—most importantly—in relation to the democratic roots that might be put in place to counterbalance the economic thrust and make the reform agenda sustainable. It is in exactly this context that this article argues that the full potential of the current devolution agenda will only be realised when the Conservative government fulfils its September 2014 commitment to wider civic engagement about how England is governed.

Unfinished but Not yet Exhausted: A Review of Australian Middle Schooling.

The state of Middle Schooling in many Western countries has been described as under threat, at a crossroads and like a wasteland. Within Australia, it has also been claimed that the past generation focus on Middle Schooling is unfinished and exhausted. But a Middle Schooling movement continues in Australia that provides examples of a way out of a state of arrested development. This article explores the Australian situation in the light of past literature and research, before detailing the potential contributions of a current Australian Research Council project in the area of Middle Schooling. The article argues that, while Middle Schooling may be down in many nations, it is far from down and out, and an Australian perspective has much to offer the Middle Schooling movement internationally.

Developing a public health policy-research nexus: An evaluation of Nurse Practitioner models in aged care

A frustration often expressed by researchers and policy-makers in public health is an apparent mismatch between respective priorities and expectations for research. Academics bemoan an oversimplification of their work, a reticence for independent critique and the constant pressure to pursue evaluation funding. Meanwhile, policy-makers look for research reports written in plain language with clear application, which are attuned to current policy settings and produced quickly. In a context where there are calls in western nations for evidence based policy with stronger links to academic research, such a mismatch can present significant challenges to policy program evaluation. The purpose of this paper is to present one attempt to overcome these challenges. Specifically, the paper describes the development of a conceptual framework for a large-scale, multifaceted evaluation of an Australian Government health initiative to expand Nurse Practitioner models of practice in aged care service delivery. In doing so, the paper provides a brief review of key points for the facilitation of a strong research-policy nexus in public health evaluations, as well as describes how this particular evaluation embodies these key points. As such, the paper presents an evaluation approach which may be adopted and adapted by others undertaking public health policy program evaluations.

The DSM-5 changes and ADHD: More than a tweak of terms

A recent commentary reignited discussion within this journal about the access by clinicians to the updated Australian National Guidelines on Attention Deficit Hyperactivity Disorder (ADHD) (The Royal Australian College of Physicians, 2009). We seek to extend this debate by noting that the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included a number of changes to the definition of ADHD. Given the reliance of these draft national guidelines on the DSM-IV, it can be expected that the DSM-5 changes will also have significant impact on the future form of guidelines, research and clinical practice (Al-Yagon et al., 2013). Further, the high prevalence of ADHD makes it important for clinicians to understand these recent changes and their implications for diagnosis and treatment (Bell, 2011). There are five major changes in the new DSM-5. First, a number of examples have been included to elaborate the types of behaviour that people with ADHD may exhibit across the lifespan. Second, the age before which symptoms must be manifested has been increased from 7 to 12 years. Third, the number of symptoms required for those over 17 years has been reduced from six to five. Fourth, the previous exclusion criterion for ADHD and autism has been removed. Finally, greater emphasis has been placed on the identification of symptoms across several settings. While the purpose of these changes is to more accurately incorporate the experience of adults affected by ADHD, possible knock-on effects to paediatrics have been suggested (Sibley et al., 2013). Estimated prevalence of ADHD in Australia is between 5 and 10% (The Royal Australian College of Physicians, 2009). Historically, changes to the DSM criteria have resulted in increases in ADHD diagnosis, at times as much as 15% (Bastra and Frances, 2012). The DSM-5 changes have the potential for similar increases in ADHD prevalence and concomitant psychostimulant treatment (Coghill and Seth, 2011; Sibley et al., 2013). However, it is pertinent to examine evidence-based critiques of the DSM-5 changes and their implications for clinical practice. The main critique of the above changes is that they have not been fully clinically tested (Coghill and Seth, 2011; Hebebrand and Buitelaar, 2011; Sibley et al., 2013). Questions have also been raised about the blurring of subtypes and the potential for confusion with comorbid conditions (Bastra and Frances, 2012). For some, this is a positive move that enables diagnostic practices to cater for individual diversity (Bell, 2011), while for others, it leaves the potential for greater misdiagnosis (Bastra and Frances, 2012). The increase of age onset from 7 to 12 years has also been subject to critique. Although it is acknowledged that there is no empirical evidence to support either age (Coghill and Seth, 2011), the lower age has been preferred in the past because it removes puberty and transition into secondary schooling as confounding variables that may influence behaviour (Bastra and Frances, 2012). The shift to the older age is intended to allow more accurate diagnosis of adolescents and adults (Bell, 2011). However, lifting the age of onset, combined with the requirement to show only symptoms in the past (rather than impairment), may increase levels of diagnosis (Sibley et al., 2013). A less controversial change is the greater emphasis on identifying difficulties across multiple settings and the need to rely on reports from third parties in each of these contexts. Those familiar with the DSM-IV might observe that this is little change from the previous requirements. And while Coghill and Seth (2011) argue that assessing across settings is commonplace in the UK, Epstein and colleagues (2009) have found that in North America less than 50% of diagnosticians go beyond parental reports of a child’s behaviour. There Commentaries