Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-28T13:21:45.049Z Has data issue: false hasContentIssue false
  • English
  • Français

‘I Bambini e le Droghe’: The Right to Ritalin vs the Right to Childhood in Italy

Published online by Cambridge University Press:  01 December 2007

Giovanni Frazzetto ,
Sinéad Keenan  and
Ilina Singh
Giovanni Frazzetto*
Affiliation:
BIOS, London School of Economics and Political Science, Houghton Street, London WC2A 2AEUK
Sinéad Keenan
Affiliation:
BIOS, London School of Economics and Political Science, Houghton Street, London WC2A 2AEUK
Ilina Singh
Affiliation:
BIOS, London School of Economics and Political Science, Houghton Street, London WC2A 2AEUK
*
*E-mail: g.frazzetto@lse.ac.uk
Get access

Abstract

Despite the widespread consumption of stimulant drugs such as Ritalin (methylphenidate) for the treatment of children with attention deficit/hyperactivity disorder (ADHD), understanding of the differing national realities of the ADHD/methylphenidate phenomenon is especially impoverished. In this article, we give an introductory description of the scientific-historical, cultural and ideological factors that have shaped the diagnosis of ADHD and its treatment in Italy. Qualitative empirical analysis of the national debate on the use of methylphenidate and of parents’ experiences with the drug reveals that, in the Italian context, the evolution of the ADHD/Ritalin phenomenon has been largely shaped by dynamics within the country’s psychiatric practices and health system, as well as by attitudes towards mental illness. We suggest that in Italy, the current dynamics in the regulation of methylphenidate inscribe ADHD diagnosis and stimulant drug treatment as moral choices. On both the political and the familial level, these choices are grounded in sometimes opposing conceptions of vital civil rights and national ideals: the ‘right to medication’, the ‘right to mental health care’ and the ‘right to childhood’. Our study illustrates that close analysis of specific cultural contexts can be useful in understanding how attitudes towards mental disorders and the use of psychotropic drugs can be shaped by the social practices and medical habits of a country.

Keywords

attention deficit/hyperactivity disorder (ADHD)childhoodItalyneuroethicsRitalinstigma
Type
Articles
Information
BioSocieties , Volume 2 , Issue 4 , December 2007 , pp. 393 - 412
Copyright
Copyright © London School of Economics and Political Science 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agency for Public Health (2002). Document from Agenzia di Sanità Pubblicà, Lazio regarding mental health interventions. URL (accessed October 2003): www.asplazio.it/asp_online/tut_soggetti_deb/files/files_sal_ment/TSMREE_2002.PDFGoogle Scholar
Barbaresi, W., Katusic, S., Colligan, R., Weaver, A., Pankratz, V., Mrazek, D. et al. (2004). How common is attention-deficit/hyperactivity disorder? Towards resolution of the controversy: results from a population study. Acta Pediatrica, 445, 55–59.CrossRefGoogle Scholar
Basaglia, F. (1982). Conversazione: a proposito della nuova legge 180. In F. Basaglia, (Ed.), Franco Basaglia, scritti, vol. 2, 1968–1980: dall’ apertura del manicomio alla nuova legge sull’ assistenza psichiatrica. Turin, Einaudi.Google Scholar
Berlim, M.T., Fleck, M.P.A., & Shorter, E. (2003). Notes on antipsychiatry. European Archives of Psychiatry and Clinical Neuroscience, 253, 61–67.CrossRefGoogle ScholarPubMed
Besana, D., Bonati, M., Calzone, C., Carpiniello, C., Cianchetti, C, Cornoldi, C. et al. (2006). Open Letter to the Ministry of Health dated 6 June 2006. URL (accessed October 2007): www.aifa.it/documenti/lettera_aperta_MDS.pdfGoogle Scholar
Bonati, M. (2005). The Italian saga of ADHD and its treatment. In Lloyd, G.Cohen, D. & Stead, J., (Eds) New Critical Perspectives on ADHD. London: Routledge.Google Scholar
Bonati, M., & Clavenna, A.(2005). The epidemiology of psychotropic drug use in children and adolescents. International Review of Psychiatry, 17, 181–188.CrossRefGoogle ScholarPubMed
Bonati, M., Impacciatore, P., & Pandolfini, C.(2001). Evidence and belief in attention deficit hyperactivity disorder: Reintroduction of methylphenidate in Italy needs careful monitoring. British Medical Journal, 322, 556.Google ScholarPubMed
Brock, D. (1998). Enhancements of human function: Some distinctions for policymakers. In Parens, E.,(Ed.), Enhancing human traits: Ethical and social implications. Washington, DC: Georgetown University Press.Google Scholar
Buitelaar, J., Danckaerts, M., Gillberg, C., Zuddas, A., Becker, K., Bouvard, M. et al. for the Atomoxetine International Study-Group (2004). A prospective, multicenter, open-label assessment of atomoxetine in non-North American children and adolescents with ADHD. European Child & Adolescent Psychiatry, 13, 249–257.CrossRefGoogle ScholarPubMed
Buitelaar, J., Barton, J., Danckaerts, M., Friedrichs, E., Gillberg, C., Hazell, P. et al. (2006). A comparison of North American versus non-North American ADHD study populations. European Child & Adolescent Psychiatry, 15, 177–181.CrossRefGoogle ScholarPubMed
Buitelaar, J., Michelson, D., Danckaerts, M., Gillberg, C., Spencer, T.J., Zuddas, A. et al. (2007). A randomised, double-blind study of continuation treatment for Attention-Deficit/Hyperactivity Disorder after 1 year. Biological Psychiatry, 61, 694–699.CrossRefGoogle ScholarPubMed
Camerini, G.B., Coccia, M., & Caffo, E. (1996). Il disturbo da deficit dell’ attenzione-iperattivita’: analisi della frequenza in una popolazione scolastica attraverso questionari agli insegnanti. Psichiatria dell’ infanzia e dell’ adolescenza, 63, 587–594.Google Scholar
Charach, A., Ickowitz, A., & Schachar, R. (2004). Stimulant treatment over five years: adherence, effectiveness and adverse effects. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 559–567.CrossRefGoogle ScholarPubMed
Clavenna, A., Rossi, E., Derosa, M., & Bonati, M. (2007). Use of psychotropic medications in Italian children and adolescents. European Journal of Pediatrics, 166, 339–347.CrossRefGoogle ScholarPubMed
Conrad, P. (1975). The discovery of hyperkinesis: Notes on the medicalisation of deviant behavior. Social Problems, 23, 12–21.CrossRefGoogle Scholar
Conrad, P. (1992). Medicalisation and social control. Annual Review of Sociology, 18, 209–232.Google Scholar
Conrad, P., & Potter, D.(2000). From hyperactive children to ADHD adults: Observations on the expansion of medical categories. Social Problems, 47, 559–582.CrossRefGoogle Scholar
Conrad, P., & Schneider, J.W. (1982). Deviance and medicalisation. Philadelphia, PA: Temple University Press.Google Scholar
Corbin, J., & Strauss, A. (1990). Grounded theory research: Procedures, canons and evaluative criteria. Qualitative Research, 13, 3–21.Google Scholar
Diller, L.H. (1998). Running on Ritalin. New York: Bantam Books.Google Scholar
Di Martino, A., Melis, G., Cianchetti, C., & Zuddas, A. (2004). Methylphenidate for pervasive developmental disorders: Safety and efficacy of acute single dose test and ongoing therapy: An open-pilot study. Journal of Child and Adolescent Psychopharmacology, 14, 207–218.CrossRefGoogle ScholarPubMed
Faraone, S.V., Biederman, J., Spencer, T., Michelson, D., Adler, L., Reimherr, F. et al. (2005). Efficacy of atomoxetine in adult attention-deficit/hyperactivity disorder: A drug–placebo response curve analysis. Behavioral and Brain Functions,1,16.CrossRefGoogle ScholarPubMed
FDA (Food and Drug Administration) (2003). FDA statement regarding the use of the antidepressant fluoxetine in the paediatric population. URL (accessed October 2007): www.fda.gov/bbs/topics/ANSWERS/2003/ANS01187.htmlGoogle Scholar
Frigerio, A., Vanzin, L., Pastore, V., Nobile, M., Giorda, R., Marino, C. et al. (2006). The Italian Preadolescent Mental Health Project (PrISMA): Rationale and methods. International Journal of Methods in Psychiatric Research, 15, 22–35.CrossRefGoogle ScholarPubMed
Gallucci, F., Bird, H.R., Berardi, C., Gallai, V., Pfanner, P., & Weinberg, A. (1993). Symptoms of Attention-Deficit Hyperactivity Disorder in an Italian school sample: Findings of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1051–1058.CrossRefGoogle Scholar
Gazzetta Ufficiale della Repubblica Italiana, No. 230, 3 October 2003.Google Scholar
Gostin, L.O.(2001). The human right to health: A right to the highest attainable standard of health. Hastings Center Report, March–April, 29–30.CrossRefGoogle Scholar
Greco, M.(2004). The politics of indeterminacy and the right to health. Theory, Culture & Society, 21, 16–22.CrossRefGoogle Scholar
Guareschi-Cazzullo, A., & Mazzini-Tomazzolli, C. (1971). La syndrome ipercinetica, contributo casistico alla sua validita’ nosografica. Neuropsichiatria Infantile Fasc, 118.Google Scholar
Hazell, P., Zhang, S., Wolanczyk, T., Barton, J., Johnson, M., Zuddas, A. et al. (2006). Comorbid oppositional defiant disorder and the risk of relapse during 9 months of atomoxetine treatment for attention-deficit/hyperactivity disorder. European Child and Adolescent Psychiatry, 15, 105–110.CrossRefGoogle ScholarPubMed
Hechman, L., & Greenfield, B. (2003). Long-term effects of stimulants in children with attention deficit hyperactivity disorder: Safety, efficacy and long-term outcome. Pediatric Drugs, 5, 787–794.CrossRefGoogle Scholar
Klasen, H.(2000). A name, what’s in a name? The medicalization of hyperactivity, revisited. Harvard Review of Psychiatry, 7, 334–344.CrossRefGoogle Scholar
Leary, V. (1994). The right to health in international human rights law. Health and Human Rights, 1, 25–56.CrossRefGoogle ScholarPubMed
Levi, G., & Penge, R. (1999). Un’esperienza italiana pilota nel campo della salute mentale. In Levi, G.,(Ed.), Una finestra sull’infanzia, 9–17. Roma: Borla.Google Scholar
Malacrida, C. (2004). Medicalisation, ambivalence and social control: Mothers’ descriptions of educatore and ADD/ADHD, Health, 8, 61–80.CrossRefGoogle Scholar
Marchini, L., Puzzo, F., Pirella, A., Pandolfini, C., Campi, R., Impicciatore, P. et al. (2000). Se non sta fermo solo in USA scatta la ricetta. Occhio Clinico Pediatria, 4, 12–14.Google Scholar
Marzocchi, G.M., & Cornoldi, C. (2000). Una scala di facile uso per la rilevazione dei comportamenti problematici dei bambini con Deficit di Attenzione e Iperattivitá. Psicologia Clinica dello Sviluppo,4, 43–63.Google Scholar
Michelson, D., Facies, D., Wernicke, J., Kelsey, D., Kendrick, K., Vallee, F.R. et al. (2001). Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: A randomised, placebo-controlled, dose-response study. Pediatrics , 108, E83.CrossRefGoogle ScholarPubMed
Michelson, D., Allen, A.J., Busner, J., Casat, C., Dunn, D., Kratochvil, C. et al. (2002). Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: A randomized, placebo-controlled study. American Journal of Psychiatry , 159, 1896–1901.CrossRefGoogle ScholarPubMed
Michelson, D., Buitelaar, J.K., Danckaerts, M., Gillberg, C., Spencer, T.J., Zuddas, A. et al. (2004). Relapse prevention in pediatric patients with ADHD treated with atomoxetine: A randomized, double-blind, placebo-controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 896–904.CrossRefGoogle ScholarPubMed
Migone, P. (1996). Brevi note sulla storia della psichiatria in Italia. Il ruolo terapeutico, 71, 32–36.Google Scholar
Migone, P.(1999). Sviluppi Italiani. In Pancheri, P.,and Pfanner, P.(Eds), Il punto su psicofarmacologia nei disturbi psichiatrici dell’ infanzia e dell’ adolescenza, 39–73. Florence: Scientific Press.Google Scholar
Moffitt, T., & Melchior, M. (2007). Why does the worldwide prevalence of childhood attention deficit hyperactivity disorder matter? American Journal of Psychiatry, 164, 856–858.Google Scholar
MTA Cooperative Group. (1999). A 14-month randomised clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073–1086.CrossRefGoogle Scholar
O’Leary, K.D., Vivian, D., & Cornoldi, C. (1984). Assessment and treatment of ‘hyperactivity’ in Italy and the United States’. Journal of Clinical Child Psychology, 13, 56–60.Google Scholar
O’Leary, K.D., Vivian, D., & Nisi, A. (1985). Hyperactivity in Italy. Journal of Abnormal Child Psychology, 4, 485–500.Google Scholar
Panei, P., Arcieri, R., Vella, S., Bonati, M., Martini, N., & Zuddas, A. (2004). Italian attention-deficit/hyperactivity disorder registry. Pediatrics, 114, 514.CrossRefGoogle ScholarPubMed
Parens, E.(Ed.) (1998). Enhancing human traits: Ethical and social implications. Washington, DC: Georgetown University Press.Google Scholar
Phillips, C. (2006). Medicine goes to school: Teachers as sickness brokers for ADHD. PLoS Medicine, 3, 433–435.Google Scholar
Ralston, S.J., & Lorenzo, M.J. ADORE Study Group (2004). ADORE—attention-deficit hyperactivity disorder observational research in Europe. European Child and Adolescent Psychiatry, 13, 136–142.CrossRefGoogle ScholarPubMed
Ronfani, L., MacalusoA., & A., &Tamburlini, G. (2005). Rapporto sulla salute del bambino in Italia: problemi e priorità. Milan: Burlo, Centro per la salute del bambino, Associazione Culturale Pediatri.Google Scholar
Rose, N. (2001). The politics of life itself. Theory, Culture & Society, 18, 1–30.CrossRefGoogle Scholar
Sabin, J., & Daniels, N. (1994). Determining medical necessity in mental health practice. Hastings Center Report, 24, 5–13.CrossRefGoogle ScholarPubMed
Sergeant, J., & Steinhausen, H.C.(1992). European perspectives on hyperkinetic disorder. European Child and Adolescent Psychiatry, 1, 34–41.CrossRefGoogle ScholarPubMed
Singh, I. (2004). Doing their jobs: Mothering with Ritalin in a culture of mother blame. Social Science and Medicine, 59, 1193–1205.CrossRefGoogle Scholar
Singh, I. (2005). Will the ‘real boy’ please behave: dosing dilemmas for parents of boys with ADHD. American Journal of Bioethics, 5, 34–57.Google Scholar
Sommerville, J. (1982 ). The rise and fall of childhood. London: SAGE.Google Scholar
Spencer, T.J., Newcorn, J.H., Kratochvil, C.J., Ruff, D., Michelson, D., & Biederman, J. (2005). Effects of atomoxetine on growth after 2-year treatment among pediatric patients with attention-deficit/hyperactivity disorder. Pediatrics, 116, 74–80.Google Scholar
Swanson, J.M., Sergeant, J.A., Taylor, E., Sonuga-Barke, E.J.S., Jensen, P.S., & Cantwell, D.P. (1998). Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet, 351, 429–433.Google Scholar
Tancredi, R., Picchi, L., Floriani, C., Seppia, P., & Muratori, F.(2002). Behavioral problems in pediatric primary care. Italian Journal of Pediatrics, 28, 377–382.Google Scholar
United Nations International Narcotics Control Board (UNINCB) (2005). Comments on reported Statistics, New York: United Nations.Google Scholar
Vezzoli, R., Archiati, L., Buizza, C., Pasqualetti, P., Rossi, G., & Pioli, R. (2001). Attitude towards psychiatric patients: a pilot study in a northern Italian town. European Psychiatry, 16, 451–458.Google Scholar
Volpe, M., Giurazza, R., Costantino, L. et al. (1987). Il Pregiudizio: ancora un’ inerzia nella pratica terapeutica ed assistenziale. In L’ albero dell’ Utopia. Napoli: Spazi della Mente.Google Scholar
Woodruff, T., Axelrad, D.A., Kyle, A.D., Nweke, O., Miller, G.G., & Hurley, B.J. (2004). Trends in environmentally related childhood illness. Pediatrics, 113, 1133–1140.Google Scholar
Zuddas, A., & Bonati, M. (2003). Conferenza Nazionale di Consenso. Indicazioni e strategie terapeutiche per i bambini e gli adolescenti con disturbo da deficit attentivo e iperattivita’. URL (accessed October 2007): www.aifa.it/articoli-ita.htmGoogle Scholar
Zuddas, A., Marzocchi, G.M., Oosterlaan, J., Cavolina, P., Ancilletta, B., & Sergeant, J. (2006). Factor structure and cultural factors of disruptive behaviour disorders symptoms in Italian children. European Psychiatry, 21, 410–418.CrossRefGoogle ScholarPubMed