The New Medical Model and Beyond: A Response to Forness and Kavale.

Forness and Kavale (2001) have proposed it the time has come to add a new medical model to the practice of special education, a model that combines the benefits of the behavioral and psychopharmacologic approaches. They argue that when the old medical model was discredited, special educators struggling with the challenging behaviors of children with emotional and behavioral disorders (E/BD) came to rely on functional behavior analysis and positive behavior support as the sole strategies available for diagnosis and treatment. The new medical model adds to the classroom behavioral armamentarium a contemporary, largely biological, conceptual framework that emphasizes the role of psychopharmacology in the treatment of E/BD. Advocating that special educators accept, even embrace, the implications of this model is an important next step in the evolution of services for children with E/BD. Epidemiological data indicate that psychiatric disorders are endemic in the special education population, particularly among students identified as having E/BD. Furthermore, the data regarding the contribution of medicine to the treatment of E/BD are unassailable, and the rapidly advancing field of psychopharmacology holds considerable promise for the future. Forness and Kavale also provide a model for how educators and clinicians might proceed to make the best use of emerging knowledge. Parents and professionals associated with children with E/BD are too often the victims of an outdated conceptual framework and a woefully deficient knowledge base. This article illustrates the fundamental principle involved in the dissemination and implementation of best practices: Good decisions about effective education and treatment are dependent on thoughtful monitoring of the research literature. While access to research findings does not guarantee good intervention decisions, ignorance of the empirical literature is the equivalent of flying blind, and the social landscape is strewn with the casualties resulting from such ignorance. Limitations of the New Medical Model The primary question is whether Forness and Kavale's call to rethink the relationship between medicine and special education goes far enough. The authors appear to equate the old medical model with emphasis on "underlying psychodynamic conflicts, or, subsequently, minimal brain dysfunction" (p. 269), and they note that the fatal flaw of the old model was the assumption that "these [internal] factors had to be diagnosed and even treated before any meaningful school intervention could proceed" (p. 269). There is a danger that the new medical model may perpetuate the failings of the old, merely substituting neurobiological abnormalities as the point of focus. In this discussion of the model, the endorsement of the combination of behavioral and medical treatments and the call for collaboration between teachers and physicians are in peril of being lost amidst the enthusiastic recitation of drug treatment effects. By emphasizing the potential that medicine offers, there is a danger that teachers and principals may seize the new psychiatry as another excuse for failing to provide meaningful school intervention. Ready referral for psychiatric screening can become another way of removing troubling students from the classroom, barring their return until they have "stab ized." The practical implications of the new model also risk placing special educators in the limiting position of merely providing information to the physician. One of the dangers of the old medical model was its heavy reliance on the physician as expert. Similarly, the new model may place the burden of all treatment decision making on the physician, a burden that many physicians simply do not have the time, or in some cases the expertise, the motivation, or the will to shoulder. A more insidious consequence of this medicine-centered approach is that it perpetuates the powerlessness of those who spend the most time with the child (i. …