The Medical Model

extends to the school and the classroom level as parent involvement and cooperation can ensure that the learner with ADHD obtains the correct medical treatment and therapy.

(d) Macro-system

The macro-system is viewed by Bronfenbrenner (1989) as the overarching ideology and organisation of social institutions that are found in a culture, i.e. the ways of people.

Cultural contexts would include socioeconomic status, poverty, and ethnicity. In the educational context the macro-system could include the community where the school is situated, education specialists and the Department of Education. According to this theory the systems are intrinsically intertwined which implies that alterations occurring on one level have the potential to affect the entire system. Therefore, both the teacher and ADHD learner’s development and growth are dependent on the interaction between the systems and the relationships that develop between them.

The ecological theory is one among the many different theories related to human development. It emphasises environmental factors as playing the major role in development. This theory, however, varies from culture to culture.

“maladjustment,” and thus as a function of psychopathology which requires the learner to be removed and placed in a “treatment environment” (Jones 2003). Schools seek to resolve problems of disruptive behaviour by referring learners to a more appropriate environment for therapy by trained psychiatrists, paediatricians and general practitioners (Cooper et al., 1994). It is argued that behavioural problems, by their very nature, disrupt the “normality”

of the environment in the mainstream classroom and that the school has the right and duty to create an environment for quality learning, even if it has to exclude these learners from the classroom.

Thus, the premise of the medical model is that learners who display negative or disruptive behaviour do so because of a mental illness or brain dysfunction which compels them to be referred to health practitioners for treatment and rehabilitation. This implies that the solutions to problems arising from disruptive behaviour are to be found in medical psychology, which is associated with psychiatry and paediatrics and is informed primarily by psychoanalytical thinking (Jones 2003). In summary, the fact that the majority of behaviours associated with ADHD is considered a medical disorder conveys the expectation to parents, learners, and teachers that behaviour should be unchanging, constant, and improved by medicine only. In many ways, the diagnosis creates an expectation that manifests in the very symptoms it sets out to describe. In contrast to the medical model, the educational model firmly asserts that the school is sufficiently equipped to manage learners with difficult behaviour without the need for medical intervention (Jones 2003). This critique of the medical model, particularly by the proponents of the educational model, purports to discredit the dominance of mental illness that originated in the Freudian paradigm and empower the rehabilitation of disruptive learners by the school, rather than through health agencies (Jones 2003). Jones (2003) furthermore points out that Educational Sociologists indicate that the vested interests of mental health agencies lead to practices that stigmatise and discriminate against learners who, for various reasons, are regarded as difficult in the classroom and at school. Research findings indicate that as a result of this discrimination, the medical model effectively marginalises the role of both teachers and school practitioners. Since behavioural psychology emphasises the fact that behaviour is learned, teachers are well-equipped to assist ADHD learners with behavioural problems to learn new and more appropriate behaviour (Singh 2012). I believe that teachers play a pivotal role in

observing and identifying learners who display ADHD associated behaviours in their classrooms. They should also employ the various management strategies and use the school’s code of conduct and special needs policies to address ADHD learners’ behavioural disorders and academic barriers. This is in line with the “inclusive education principle” which asserts firmly that every learner, irrespective of his or her disabilities, handicap or disruptive behaviour, has the right to be educated alongside his or her peers in a normal school environment (Singh 2012). The inclusion of learners with severe behavioural and learning barriers in the mainstream classroom, previously described as unsuitable for the education of such learners, raises the profile of behavioural psychology in the behaviour modification of the child. “Difficult” learners working alongside high achievers can benefit from this positive association by studying together, sharing class notes and working on assignments together, thus getting encouragement from their more capable counterparts to focus more on academic achievement and less on disruptive behaviour (Shaffer & Kipp, 2010).

All these models have valid theoretical foundations and assist greatly in understanding ADHD. The following table presents a summary of the main tenets of each model:

Table 2.1: Summary of models discussed

Model Characteristics

Conceptual Model  ADHD results as a primary deficit in the working memory

 Learners cannot manipulate, construct and maintain information

 Learners will avoid tasks which place demands on working memory such as solving problems and organizing information

 Deficit in working memory can cause learners to redirect their attention to negative stimuli

Barkley’s Model  Primary deficit of ADHD is the lack of

self-regulation and inhibition

 Motivation of the ADHD learner is weak

 Learner cannot sustain goal-directed behaviour

Brown’s Model  Postulates impaired cognitive executive functions in ADHD learners

 ADHD is not a behavioural disorder

 ADHD learners will experience impairments in the management system of the brain

 Learners cannot manage daily tasks such as time management, sustaining and shifting focus, sustaining effort, managing emotions and recalling information from short term memory

Cognitive-Energetic Model  Efficiency of information processing is determined by the interaction of three levels

 ADHD learners have a deficiency in one of these levels

 Apart from behavioural inhibition deficits, the energetic state of the learner is important

Bronfenbrenners’ Ecological Theory

 Development is influenced by interaction of environmental systems

 The influences from these systems and their relationships will determine human development

 How ADHD learners experience the classroom, will influence their behaviour and academical achievement

Medical Model  ADHD is a brain dysfunction

 ADHD must be treated with medication

 Disruptive behaviour is understood as a maladjustment

 The ADHD learner must be referred to health practitioners

As a mother of an ADHD child and a teacher, I believe that both Brown’s Model of ADHD and Bronfenbrenner’s Systems Theory can be helpful to teachers in understanding the behaviour of the ADHD learner and managing it. Brown’s Model of ADHD can explain academic problems, thereby guiding the teacher in managing these learners as well as helping them to perform optimally. As good relationships between the teacher, the learner and their parents are important, I am of the opinion that Bronfenbrenner’s Ecological Theory can provide valuable guidance and understanding to both parents and teachers regarding their attitude and actions towards these learners. The Medical Model might pose the risk of teachers feeling that ADHD can only be controlled with medication, and they may as a consequence make no effort to assist these learners.

Apart from the discussed theories and models, various other models of ADHD and ADHD behaviour have been explored in order to understand the disorder and its impact on the learner and the teacher. According to the biopsychosocial model, research reveals a moderate degree of heritability for delinquency, disruptive and antisocial behaviour from childhood to adulthood (Dodge & Pettit 2003). Furthermore, the educational model states that emotional and behavioural difficulties such as ADHD behaviour is the domain of teachers who can make profitable use of systemic insights and particular intervention techniques to modify the behaviour of disruptive learners (Jones 2003). The teaching pyramid model concurs with the educational model in that it proposes a three-tiered model of classroom management strategies for promoting the social-emotional development of all learners, including learners with ADHD (Fox, Dunlap, Hemmeter, Joseph & Strain 2003). The action research model of consultation and collaboration posits that all stakeholders of the school system are involved in the learner’s rehabilitation. This model suggests that

behavioural consultation and collaboration among all stakeholders of the school system (administrators, teachers, parents, school staff, human service professionals, mental health consultants, school psychologists and other community stakeholders) is an essential process in the attempt to guide and develop learners with AHDH (Conwill, 2003). It becomes clear from various educational and ADHD models that various interventions can be implemented to improve the development of ADHD learners on all levels of their lives.