兒童過動症的在地興起與專業技能網絡的變遷

ADHD and its Changing Network of Expertise in Taiwan

曾凡慈(Fan-Tzu Tseng)

《科技醫療與社會》 21期 (2015/10) Pp. 15-75

https://doi.org/10.6464/TJSSTM.201510_(21).0001

摘要

在台灣，過動症不但占據兒童青少年心理衛生門診的最高求診比例，發生率也呈現出顯著的長期成長趨勢。相較於傳統醫療化取向將新興疾病的出現與診斷擴張解釋為醫療專業（profession）的擴權行動，本研究採取多軸線交織的視角，以專業技能網絡（network of expertise）取向來探問：在什麼樣的條件下，「過動症」能夠被大規模的指認、診斷與治療？而這個診治兒童過動狀態的專業技能網絡，又是如何經歷不同階段與模式而裝配起來？本研究追索幾道編織這個網絡的軸線，包括：兒童青少年精神醫療社群的興起與專業取向的演變、不同專業之間的互動關係、診斷類別與治療技術的發展、藥廠與家長團體的活動、以及支撐治療實作的社會經濟組織方式。隨著這個專業技能網絡的動態發展，兒童精神醫學的知識與技術，成為認識與處置兒童行為問題的優勢取向，對於過動狀態的診治，則是日益趨向生物醫療化實作，削弱了過去強調多專業合作的生物心理社會模式，也使得藥物取得主要的治療地位。

關鍵字

過動症 ； （生物）醫療化 ； 兒童精神醫學 ； 專業技能網絡 ； 藥物治療

並列摘要

For the past twenty years, Attention Deficit Hyperactivity Disorder (ADHD) has been among the most commonly diagnosed psychiatric conditions for children in Taiwan, with the number of diagnoses significantly increasing annually. Instead of pursuing a classic medicalization perspective by viewing this phenomenon as a result of medical professionalism, this study takes a ＂network of expertise＂ approach to elucidate (1) the arrangements and conditions necessary for identification, diagnosis and treatment of ADHD; and (2) how this network of expertise, which links various medical professionals, activist parent groups, and drug industries, as well as knowledge, techniques, institutional arrangement, and the national health insurance system, has been assembled in different stages and in different ways. The data used in this study were obtained from archives, participant observation, and interviews with seven (child) psychiatrists, two special educators, and one parental activist. This study traces the dynamic development of this network of expertise in handling children's perceived over-activity, and examines the process by which child psychiatric knowledge and techniques have become the prevalent framework for understanding and treating children's behavioral problems in Taiwan. The model for ADHD diagnosis and treatment has gradually shifted from a more comprehensive biopsychosocial approach to a focus on biomedical clinical practices reliant on stimulant medications as the main therapy for children with ADHD.

並列關鍵字

ADHD ； (bio) medicalization ； child psychiatry ； network of expertise ； medication therapy

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