Transtorno de déficit de atenção e hiperatividade (TDAH) e medicalização na infância: uma análise crítica das significações de trabalhadores da educação e da atenção básica em saúde

• Ano de defesa: 2017
• Autor(a) principal: Santos, Regina Célia dos [UNESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Estadual Paulista (Unesp)
• Palavras-chave em Português: Saúde coletiva; Educação; Infância; Medicalização; TDAH; Psicologia Histórico-Cultural; Collective health; Education; Childhood; Medicalization; ADHD; Cultural-historical Psychology
• Link de acesso: http://hdl.handle.net/11449/150123

In our study, we discuss the Medicalization of childhood, understood as a process that has been transforming questions that are historical-social in origin into merely biological questions. Due to the connection with the pharmaceutical industry and the biomedical field, different disorders are disseminated, concealing expressions of suffering and difficulties of going through life created by life conditions in capitalist society. The Attention Deficit Hyperactivity Disorder (ADHD) is among them, and is, according to the biomedical literature, more common throughout childhood, attributing a genetic cause in which the brain is reputed to be the origin of hiperactivity and inattention behavior. Even though this biomedical conception is hegemonic, there are studies showing the evolution of referrals from children schools to health units. These studies criticize the raise of diagnosis of this disorder during childhood, and point out that this phenomenon has a close link with the biomedical conception and the pharmaceutical industry, a relationship based on medication propagation and construction of diagnosis, resulting in the medicalization of childhood. In our study, we consider the ADHD phenomenon a health-illness process, questioning, thus, the subjacent conception of the disorder's biological determinism. According to the culturalhistorical psychology postulates adopted in our research, the biological-social relationship is defined as an inseparable unity in the development process, therefore, the attention and the human behavior are developed by the biological-social unity, in other words, the biologistic framework is dismounted. Our objective was to analyze the meanings about diagnosis and treatment in children allegedly bearer of ADHD, starting with the speeches of education workers and primary health care workers. And this way we aim to understand how these workers explain the determinations of this disorder and its expressions in the education and health fields that have been leading to the medicalization of the childhood. We conducted the research in two basic health units (BHU) and three public schools, from elementary school to secondary education. On the first phase of the research, a questionnaire was applied, participant observation was conducted, and collection of data, informations about the local of research and conversations with the participants, registered in a field journal, was performed. On the second phase, we conducted semi-structured interviews with three workers from the education sector and four workers from the health sector for the construction of the nuclei of meanings, which constitutes the methodological proposition of analysis of this research. The nuclei of meanings from education workers were delimited as: a) Rowdy and inattentive children that don't learn, children allegedly bearer of ADHD; b) Education: between work's liking and distress; c) The nature of pedagogical work traversed by the biomedical field; d) When the learning disability is not normal. And from the workers from the health sector emerged the following nuclei: a) ADHD characterizing children's behavior as learning deviations; b) From pre-diagnosis to diagnosis; c) From hyperactive and “unfocused” gaze to pharmacological treatment; d) The misbehaved child, that doesn't learn. The analysis of meanings indicates that the biomedical discourse penetrated the school space in order to explain the causes of learning difficulties and that 1) even though the education workers affirm their interest in the educational activity, there is an indicative that the conditions and intensification of work have been facilitating the institution of this discourse; 2) when the ADHD expressions in the education and health sectors were analyzed, the biological explanation was verified as preponderant, which attributes agitated, hyperactive and inattentive behavior to a brain flaw, disregarding the mediation relations of the act of educating. In other words, children that should be being educated are being medicalized. 3) Even though this discourse is preponderant, it was socially verified that in the education field this understanding of ADHD is vague and riddled with doubts, and in the health field there is no consensus about the diagnosis; they reveal that there is exclusivity of medical diagnosis, disregarding other fields and practices of knowledge on the treatment, like those of psychology and phonoaudiology. With this research, we conclude that there is a task to be performed regarding the act of educating and that it requires the understanding and overcoming of biological explanations of the development and learning processes, conceiving, thus, that attention and regulated behavior evolve through social mediation and not as a biologically determined phenomenon.