偏鄉地區ADHD兒童的生活處境研究：論診斷與藥物的「非生物醫學」功能

The Lived Experience of ADHD Children in the Remote Areas: On the “Non-Biomedical” Functions of Diagnosis and Drugs

本文旨在探究注意力缺失／過動症（ADHD）兒童於偏鄉的生活經驗，以揭露偏鄉ADHD盛行率偏高的原因、診斷路徑及意義，說明診斷為ADHD兒童的核心受苦經驗。本研究以詮釋現象學作為分析方法，以花蓮某偏鄉課輔班為核心研究場域，透過參與式觀察與訪談形成研究文本。研究結果顯示，ADHD診斷的取得與治療經常是為回應偏鄉兒童受苦處境的無奈，即便看見兒童在診斷之外有關愛、歸屬、心理照顧上的需求，卻不易在處境中獲得回應，故需透過ADHD作為一個正式的診斷而讓兒童的困境受到正視，因此藥物所治療的不僅僅是ADHD症狀，更是回應偏鄉處境中各角色的無力。然而，隨著ADHD診斷的盛行與普遍，一方面因其相對容易指稱、說明、介入，而形成視角的慣性，另一方面則因超出ADHD診斷標準外的脈絡經常不易爬梳與理解，且可能落入無法回應的窘境，導致診斷標準外的理解最終常常被擺在末位；ADHD兒童的生活處境，遂逐漸形成一種「藥／愛」的共存與共依性：孩子若要獲得關愛，藥往往必須在場，形成一種迂迴之照顧。最後，本研究指出，造成當前處境的關鍵背景可能在於，獨尊「城市／發展／中產階級」模式所帶來的匱乏心態，且最終往往落入無以為繼與流離失所的無奈，當努力追趕著同樣的模式時，ADHD的診斷與藥物使用成為偏鄉照顧的唯一路徑。

This study explores the lived experiences of ADHD children in remote areas, to reveal the reasons, diagnostic paths, and significance of the high prevalence of ADHD, aiming to explain the core suffering of children with ADHD diagnosis. This study adapts hermeneutic phenomenology as the analytic method and focuses on a tutoring class in a rural area in Hualien. The research text is collected and formed through participatory observation and semi-structural interviews. The study found that the core suffering beyond ADHD symptoms may be the need for care, belonging, and psychological care for children, which may vary for each child. However, the context beyond the ADHD diagnostic criteria is often difficult to sort out and understand, and may even lead to a situation where there is no response. Therefore, a coexistence and co-dependence of “medicine/love” gradually formed: medication must be present to sustain the care for ADHD children, forming circuitous care. Finally, this study found that the core of the current situation may lie in the mindset of “urban/development/ middle class” as the only path of development, which ultimately leads to a sense of lack and helplessness, and the diagnosis and medication of ADHD become the only route to provide care for the children in rural areas.