Haur eta nerabeek «eskura dituzten lau drogei» buruzko liburua kaleratu du Iñaki Redinek, eta drogarik gabe hezteko drogetan hezteko beharra nabarmendu. ADHNaren atalak polemika piztu du. Gehiegi diagnostikatzen delako ustea nahiko zabaldua da, eta batzuk botikaren aurka agertu dira, haurrendako egokia ez delakoan.
Origen: Drogen zurrunbiloan nahasirik | Berria.eus
2017-05-11 / Iker Tubia
Kalapita sortu du liburuak kaleratu eta berehala. Irakurtzeko astirik ere izan gabe, sare sozialetan irainak eta mehatxuak idatzi dizkiote Redini. Liburuan lau droga aipatzen dira —metilfenidatoa, alkohola, tabakoa eta kalamua—, baina bakarrak sortu du samina: ADHNa diagnostikaturik duten haur eta nerabeei ematen zaienak, hain zuzen ere. Eztabaida handia sortzen du afera horrek; ADHNa botikaz tratatatzea defendatzen dute batzuek, harekin kritiko dira beste batzuk.
Redinek argi du: murrizketek eragin dute hainbeste ikasleri ADHNa diagnostikatzea. Izan ere, arreta falta edo hiperaktibitatea duen ikasleari ezin zaio arreta bereziturik eman edo bestelako arretarik eskaini eskolen ratioak zabaldu eta irakasleen lan baldintzak okertzen diren garaiotan. «Dagoeneko ez dugu hezkuntza sistema aldatzeko beharraz hitz egiten, nahiz eta hankaz gora egon. Hegaldirako moduan uzten ditugu haurrak, eta, horrela, eskola eman dezakegu ratio horiekin», kexu da Redin.
Lehen, adin edo heldutasun faltagatik zailtasunak zituzten ikasleekin curriculum egokitzapenak egiten ziren, talde txikiagoak egiten ziren beste molde batez lan egiteko, gutxieneko edukiak aplikatzen ziren, birprogramatzen zen, arratsaldeetan joaten ziren… «Horrek oso ongi funtzionatzen zuen. Baina, horretarako, irakasleak behar dira. Murrizketen ondorioz, irakasleak eman beharrean pastillak eman dizkigute», salatu du irakasleak.
«Arazoa da oso tristea dela ikustea ikasleek sabaiari so ematen dutela DBH guzia». Haren ustez, ADHN ez da existitzen. «Ondorio batera ailegatu naiz: ADHNa marka bat da, interes zehatz batengatik jartzen dutena, eta interes hori ez da medikoa, ez baita gaixotasuntzat hartzen. Tamalgarria da». Zalantzak sortzen dira ADHNaz mintzatzean, ez baita ongi zehazturiko nahasmendua. «Mito gisa ikus daiteke, oso muga lauso eta ezaugarri ondo definitu gabeak dituen saski-naski gisa agertzen zaigulako», azaldu du Virginia Belategi mindfulness eta ADHNan adituak. Haren aburuz, badira egungo hezkuntza esparruan ongi egokitzen ez diren ikasleak, baina, oraingoz, haien jokabidea egungo esparrura doitzen saiatzen dira.
Belategiren ustez, ezjakintasun handia dago, eta berak ere gaiari buruzko iritzia aldatu du denbora joan ahala. Erdian kokatzen du bere burua: «Oinarri biologikoa egozten dioten ikerketa gehienak farmazia industriak babestutakoak dira, emaitza kontraesanezkoekin, edo lagin txikietan oinarrituak. Gaitza asmakizuna dela esaten dutenek bizipen pertsonalak hartzen dituzte oinarri». ADHNaren atzean egon daitezkeen interesak ere izan ditu hizpide: «Gaitzak kronifikatzeko interes handiak ere badaude, pazienteen menpekotasuna eta diru iturriak bermatzeko».
Euskal Herriko Unibertsitateko doktore da Wendy Davila psikologoa. Hark ere zalantza handiak ditu ADHNari buruz, baina ez luke esanen asmakizuna denik. «Zaila egiten zait esatea ADHNa soilik genetikoa dela eta kimikagatik sortzen dela, giroaren inolako eraginik gabe. Baina zaila egiten zait esatea ez dela afera biologikoa ere, eta guk sortzen dugula». Haren aburuz, ADHNa ezin da azaldu soilik arrazoi biologikoekin, pertsonen inguruak ere eragina du. Arretarik ez jartzea izan daiteke etxeko egoera txarra delako, adibidez. «Eskolan ezohiko ezinegon motor eta inpultsibo bat ageri duen haurra sailkatzeko modu oso orokor bat da ADHNa». Horregatik, diagnostikoa egiteko tresnekin «oso fin» ibili behar dela uste du psikologoak. «Haur hori mugitua izan daiteke hainbat kausarengatik, eta zaila izaten da jakitea zein gailentzen den».
Hain zuzen ere, diagnostikoa egiteko modua da zalantza askoren iturburu. Snap IV testaren bidez egiten da, baina test hori ez da bera Euskal Herria osoan. Iparraldean zailagoa da, eta hori emaitzetan antzematen da. Iparraldeko testak askoz ere kasu gutxiago diagnostikatzen ditu Hegoaldekoak baino. «ADHN kode genetiko kontu bat baino posta kode kontua da, zure bizitokiak eragina du diagnostikoan», esan du Redinek, ironiaz.
«Ez da ikusteko erraza den patroi bat. Pertsona bakoitza ezberdina da, eta ADHNa modu ezberdinean azaleratu dezake», azaldu du Davilak. Nahasmendu horri aurre egiteko erabiltzen den botikak ere eztabaida piztu ohi du. Batzuetan, oso gaztetik hartzen hasten baitira metilfenidatoa. Gehiegi diagnostikatzen dela uste dute askok. «Ikasgelak lasaiak diren pertsonentzat daude eginak, denbora luzez eserita egon daitezkeenentzat. Askotan botika ematen da, aringarri gisa, haur hori ikasgelan geldirik egon dadin. Bestelako ikasgela eskainita, agian, ez luke botikarik beharko, berak adierazten duena beste modu batera lantzeko aukera izanen zenukeelako».
Botikarekin bueltaka
Basurtuko ospitalean ongi ezagutzen dituzte ADHNa diagnostikatutako ikasleak. Iñaki Kerexeta psikiatra da, haur eta nerabeen unitatean. Hark ere arazo bat dagoela uste du. «Gehiegi diagnostikatzen dela esaten da, baina nik uste dut gaizki diagnostikatuta dagoela», azaldu du. «Ez dut esaten gaitz hori existitzen ez denik, badu jatorri biologiko bat, baina ehuneko baten kasua da, eta ehunekoa aldatzen da kontsultaren arabera. Kontsulta batzuetan, denek dute ADHN, eta, nirean, badirudi inork ez duela». Azaldu duenez, pertsonek sozialki ongi egokitzeko beharra dute, eta gaitasun hori garunaren eremu prefrontalak ematen du. Egiazko ADHN kasuetan, gaitasun hori moteldu egiten da. Metilfenidatoa pizgarria da, eta oso adi egoteko aukera eskaintzen du.
Nahasmenduaren diagnostikoa item batzuen gehikuntzaren emaitza da. Sintoma zehatz batzuk agertuz gero, pertsona horri ADHNa duela egotziko zaio. Baina item horiek nahiko arruntak direla uste du Kerexetak, beste gaitz batzuek ere eragiten ahal dituztela, alegia. Beraz, sintomak ez ezik, sintoma horiek zerk sortzen dituen ere ongi zehaztu eta ikertu beharra dagoela uste du Basurtuko psikiatrak. Izan ere, haurrak etxean edo eskolan dituen egoerek ere eragin ditzakete ADHNan positibo emanen luketen sintomak. «Oso irizpide eskasak dira. Badaude irakasleei pasatzen zaizkien conner eskalak, ikuspuntu zabalagoa dutenak, baina horrek ez du esan nahi haurrak hiperaktibitatea duenik. Ume depresibo batek edo elikadura arazoak dituen nerabe batek ere hori izan dezake».
Davilak uste du psikiatriak eta psikologiak mugak dituztela horrelako kasuetan, ez dutelako zerbait zuzenean neurtzen. «Orain tresna hobeak daude, baina ezin da lortu erabateko zehaztasunik». Gainera, ingurua ere tartean sartuta, are zailagoa da zorrotz-zorrotza izatea: «Nik uste dut arrazoi biologikoak eta kulturalak nahasten direla ADHNan. Gizartea asko aldatu da, eta, teknologia berriengatik, ADHNa gehiago diagnostikatzen da, aspertzea edo jarduera bakarra egitea askoz ere zailago egiten zaielako haurrei gaur egun».
Botikarekin kezkatuta daude hainbat; uste dute metilfenidatoa aise ematen dietela haurrei. Redinek gogor kritikatu du botika hori: «Merke-zurreko speeda banatzen ari dira, mundu guztiari, inor bereizi gabe, eta diagnostikoak irrigarriak dira. Orain, Nafarroan, 5.000 haurrek baino gehiagok dute ADHN». Belategik ere nahiago du albo kalterik eragiten ez duten bideak jorratzea, baina onartu du konponbide zaila duela. Are, kasu larrietan, ulergarri zaio botikaren aldeko hautua egitea. Berak bi bide aipatu ditu: batetik, elikadura hobetzea; bestetik, urduria denari anfetaminak eman bainoago, arnasa sakon harraraztea eta meditazio ariketak eginaraztea. «Arlo horietan trebatzea oso baliagarria da pazientearentzat».
Kerexetak, berriz, diagnostikoa ongi egitearen beharra nabarmendu du berriz ere. «Ongi baloratu behar da, botika hasieratik jarri beharrean». Batzuetan, ez du botikarik agintzen, eta, kasu batzuetan, arazoa gurasoek izan dezakete. Baina egoera horiek kudeatzea zaila da.
Askotan, gurasoak joaten dira psikiatrarengana «pastilla magikoaren» eske. Kerexetak hori ikusi du hainbatetan. Redin ez da horrekin harritu. Berak uste du hezkuntza sistemak ADHNa saritu egiten duela, ikasle horiei erraztasunak ematen zaizkielako gainditzeko, baina ez edukiak ongi barneratzeko. Davilak argi du aldaketak behar direla ADHNaren aferan, baina aldaketa horiek maila guzietan egin behar direla aldi berean: instituzioetan, osasunean, hezkuntzan, zuzenbidean… «Ikasgelan beste modu batera egonen den haurra izateko baliabide gehiago behar dira».
Bestelako drogak
Redinen liburuak beste hiru droga aipatzen ditu: alkohola, tabakoa eta kalamua. Kasu horietan, drogarik gabe heztea ez ezik, drogetan heztea ere oso garrantzitsutzat du: «Informazioa ematea ezinbestekoa da, informazioa boterea da». Hala ere, gaitzetsi egin du drogak deabruaren pare jartzeko joera. «Drogei buruz hitz eginda indartsu eginen dira. Drogak oso txarrak direla esatea, baina, hezkuntzaren kontrakoa da. Heztea ezagutza ematea da».
Autoritatearen arazoa ere aipatu du. Nola esan seme-alabari ez erretzeko, zigarroa eskuan, edo ez edateko, konbinatuari eragiten ari zaion bitartean? «Holakoetan, arindu egiten dira drogen eraginak, ohitura bat dela esaten duzu, batzuetan hartzen duzula soilik». Horrek gazteak droga horietara hurbilarazten ahal dituela uste du. Beraz, DBHko irakasleak argi utzi du irakaspena liburuan: drogarik gabe hezi, baina drogetan ere hezi.
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