Submitted by Rosangela Silva (rosangela.silva3@unioeste.br) on 2018-05-15T18:52:22Z No. of bitstreams: 2 Camila Borges Villas Boas.pdf: 1194832 bytes, checksum: 0d293fa14c23d9d546fc5cd44cffa2b6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-05-15T18:52:22Z (GMT). No. of bitstreams: 2 Camila Borges Villas Boas.pdf: 1194832 bytes, checksum: 0d293fa14c23d9d546fc5cd44cffa2b6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-03-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Attention Deficit Hyperactivity Disorder (ADHD) is defined as a persistent condition of inattention and/or hyperactivity/impulsivity which promotes interference in the development of the subject. It is estimated that between 65 and 89% of adult ADHD patients suffer from one or more life-long psychiatric disorders. This high percentage of comorbidities is also similar in the child population, where ADHD may be associated with other disorders in 60-100% of cases. One of the often associated disorders is anxiety, which reaches rates close to 25% in many samples of patients with ADHD. Therapies considered first-line for the treatment of ADHD and for Anxiety Disorder (ANX) alone are relatively well established through use of stimulants and cognitive-behavioral therapy, respectively. However, evidence for the most appropriate treatment when both disorders are present is quite controversial. Objectives: Perform systematic review about pharmacological options used to treat ADHD associated with ANX in order to generate evidence about the most effective, safe and tolerable therapeutic option. Methods: Systematic review was performed following the methodological standards recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) in the PubMed, Scopus and Directory of Open Access Journals databases in August 2016 and by manual search. Randomized, double-blind, parallel-design trials evaluating efficacy, safety and/or tolerability outcomes were considered. The methodological quality and risk of bias of included studies were assessed using the Jadad Scale and the Cochrane Collaboration tool. Relevant data from all included studies were collected using a previously developed form. At this stage, pertinent information from each study, according to the objective of the study, was extracted and analyzed. Results: A total of 1590 articles were found from databases searched, 218 were evaluated in full text for eligibility and finally 5 studies met all inclusion criteria and were included in the systematic review. Two of the included studies used atomoxetine compared to placebo, in which one population was composed of adult patients and the other was pediatric. Desipramine was also one of the medications used, which was studied to treat children from 6 to 17 years old. The others two studies included methylphenidate as pharmacological treatment for pediatric patients, but in one of them fluvoxamine was combined with methylphenidate. Regarding the methodological quality, studies obtained scores of 3, 4 and 5 on the Jadad scale, being considered of moderate to high quality, respectively. The bias risk analysis found that 60% of the articles were supported by the pharmaceutical industry and therefore classified as having a high bias risk in the "Other bias" domain. All studies in the domains "Blinding of participants and professionals" and "Blinding of outcome assessors" presented low risk of bias. Regarding the domain "Incomplete outcomes", 80% obtained low and 20% high risk of bias. The "Random Sequence Generation", "Allocation Concealment" and "Selective outcome reporting" obtained the following proportions of low vs uncertain risk of bias: 60% vs 40%, 20% vs 80% and 60% vs 40%. Due to the high heterogeneity of eligible studies, it was not possible to combine the results for generation of meta-analyzes. This was mainly due to the diversity of drugs studied and the disparity between the outcomes measures employed. Conclusion: Although few studies have been found, the results obtained through this systematic review point to a more expressive benefit of atomoxetine in the treatment of ADHD with ANX, because it was studied in a wider age group and the studies evaluated atomoxetine through more specific scales for both disorders. It is not possible to say that atomoxetine is superior to the other pharmacological options and only larger clinical trials and with sufficiently fed populations will be able to answer this question. / O Transtorno do Déficit de Atenção com Hiperatividade (TDAH) é definido como um quadro persistente de desatenção e/ou hiperatividade/impulsividade que promove interferências no desenvolvimento do indivíduo. Estima-se que entre 65 a 89% dos pacientes adultos com TDAH sofram um ou mais transtornos psiquiátricos ao longo da vida. Esta alta porcentagem de comorbidades também é semelhante na população infantil, onde o TDAH pode estar associado com outros distúrbios em 60-100% dos casos. Um dos transtornos frequentemente associados é a ansiedade, a qual atinge taxas próximas a 25% em muitas amostras de pacientes com TDAH. As terapias consideradas de primeira linha para o tratamento do TDAH e para o Transtorno de ansiedade (TA) de forma isolada estão relativamente bem estabelecidas, por meio da utilização de estimulantes e terapia cognitivo-comportamental, respectivamente. Porém, as evidências sobre o tratamento mais apropriado para quando ambos os transtornos estão presentes são bastante controversas. Objetivos: Realizar revisão sistemática de literatura sobre as opções farmacológicas utilizadas no tratamento do TDAH associado ao TA com o intuito de gerar evidências sobre a opção terapêutica mais eficaz, segura e tolerável. Metodologia: A revisão sistemática foi realizada seguindo padrões metodológicos recomendados pelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) nas bases de dados PubMed, Scopus e Directory of Open Access Journals em agosto de 2016 e por busca manual. Ensaios clínicos randomizados, duplo-cego com design paralelo que avaliavam desfechos de eficácia, segurança e/ou tolerabilidade foram considerados. A qualidade metodológica e o risco de viés dos estudos incluídos foram avaliados por meio da Escala de Jadad e pela ferramenta da Colaboração Cochrane. Dados relevantes de todos os estudos incluídos foram coletados utilizando formulário previamente elaborado. Nesta etapa, as informações pertinentes de cada estudo, segundo o objetivo do trabalho, foram extraídas e analisadas. Resultados: Um total de 1590 artigos foi encontrado nas bases de dados pesquisadas, 218 foram avaliados em texto completo para elegibilidade e, por fim, cinco estudos preencheram todos os critérios de inclusão e foram incluídos na revisão sistemática. Dois dos estudos incluídos utilizaram a atomoxetina comparada ao placebo, sendo que em um deles a população era composta por pacientes adultos e no outro pediátrica. A desipramina foi também um dos medicamentos utilizados, a qual foi estudada para tratar crianças de 6 a 17 anos. Os outros dois trabalhos incluídos utilizaram o metilfenidato como tratamento farmacológico de pacientes pediátricos, porém, em um deles, a fluvoxamina foi combinada ao metilfenidato. Em relação à qualidade metodológica, os estudos obtiveram pontuações de 3, 4 e 5 na escala de Jadad, sendo considerados de qualidade moderada a elevada, respectivamente. A análise do risco de viés verificou que 60% dos artigos receberam suporte da indústria farmacêutica e, por isso, foram classificados com um alto risco de viés no domínio “Outros vieses”. Todos os estudos nos domínios “Cegamento dos participantes e profissionais” e “Cegamento dos avaliadores do desfecho” apresentaram baixo risco de viés. Em relação ao domínio “Desfechos incompletos”,80% obtiveram baixo e 20% alto risco de viés. A “Geração da sequência aleatória”, “Ocultação da alocação” e “Relato de desfecho seletivo” obtiveram as seguintes proporções de baixo vs incerto risco de viés: 60% vs 40%, 20% vs 80% e 60% vs 40%. Devido à alta heterogeneidade dos estudos elegíveis, não foi possível combinar os resultados para geração de meta-análises. Isso ocorreu principalmente pela diversidade de medicamentos estudados e pela disparidade entre as medidas de desfecho empregadas. Conclusões: Embora poucos estudos tenham sido encontrados, os resultados obtidos por meio desta revisão sistemática apontam para um benefício mais expressivo da atomoxetina no tratamento do TDAH com TA, tanto por ter sido estudada em faixa etária mais abrangente bem como por escalas mais específicas de avaliação para ambos os transtornos terem sido utilizadas. Não é possível afirmar que a atomoxetina é superior às demais opções farmacológicas e apenas ensaios clínicos maiores poderão responder a esta questão.

Made available in DSpace on 2016-03-15T19:39:35Z (GMT). No. of bitstreams: 1 Bruna Tonietti Trevisan.pdf: 1049312 bytes, checksum: 721c1c576134d816f03fa62c08223a83 (MD5) Previous issue date: 2010-12-10 / Fundação de Amparo a Pesquisa do Estado de São Paulo / Executive functions (EF) are characterized by a set of cognitive and metacognitive processes that allow individuals to regulate their behavior, allowing their engagement in direct actions to goals. During development, children gradually become more able to control their thoughts and actions. This change has been linked to the development of EF, because they are especially important in new situations, as in the learning process, and is therefore considered crucial in preschool. In addition, changes in these processes have been documented in several cases, such as Attention Deficit Hyperactivity Disorder (ADHD). Thus, the purpose of this study was to evaluate attention and inhibitory control in preschool children, specifically: to verify the relationship between signs of inattention and hyperactivity and EF, verifying if the performances in the tests differ between groups of children with and without signs of inattention and hyperactivity, and the relation between EF and development of preschool children, examining if the abilities of attention and inhibitory control increase with the progression school grades. A total of 139 preschool children, aged between 4 and 7 years old, 65 males, from two public schools in a town in Sao Paulo state, were assessed with Trial Making Test, Cancellation Attention Test, Stroop Test for Preschoolers, Semantic Generation Test, Go/No-Go Task, Simon Task, Columbia Mental Maturity Scale, Scale for Attention Deficit Hyperactivity Disorder and SNAP-IV. Nonparametric analysis of Mann-Whitney test revealed, in general, differences between extreme groups with and without inattention and hyperactivity indicators for measuring instruments in all of EF, especially for groups in the inattention domain. Spearman correlation analysis also revealed significant correlations between indicators and performance in EF, with changes in the patterns of correlation throughout the school grades, showing relation with more basic cognitive abilities in the initial grades and with more complex skills in the lasted grades. Through MANOVAS and Kruskal-Wallis were observed developmental trends of the skills of attention and inhibitory control over the school grades. / As funções executivas (FE) são caracterizadas por um conjunto de processos cognitivos e metacognitivos que permitem ao indivíduo regular seu comportamento, possibilitando seu engajamento em ações direcionadas a metas. Durante o desenvolvimento, crianças se tornam gradualmente mais hábeis para controlar seus pensamentos e ações. Esta mudança tem sido associada ao desenvolvimento das FE, isto porque elas são especialmente importantes em situações novas, como no processo de aprendizagem, sendo, portanto, consideradas cruciais na idade pré-escolar. Além disso, alterações nestes processos têm sido documentadas em diversos casos, como no Transtorno do Déficit de Atenção e Hiperatividade (TDAH). Assim, o objetivo deste estudo foi avaliar atenção e controle inibitório em crianças pré-escolares, mais especificamente: analisar a relação entre indicadores de desatenção e hiperatividade e FE, verificando se os desempenhos nos testes diferem entre os grupos de crianças com e sem sinais de desatenção e hiperatividade; e analisar a relação entre as FE e o desenvolvimento de crianças pré-escolares, verificando se as habilidades de atenção e controle inibitório aumentaram com a progressão séries escolares. Participaram 139 crianças pré-escolares, com idades entre 4 e 7 anos, sendo 65 do sexo masculino, de duas escolas municipais de uma cidade do interior de São Paulo. Foram utilizados: Teste de Trilhas, Teste de Atenção por Cancelamento, Teste de Stroop para Pré-escolares, Teste de Geração Semântica, Go/no-Go Task, Simon Task, Escala de Maturidade Mental Colúmbia, Escala de Transtorno de Déficit de Atenção e Hiperatividade e SNAP-IV. Análise não paramétrica de Mann-Whitney revelou, de modo geral, efeito entre os grupos extremos com e sem indicadores de desatenção e hiperatividade para medidas em todos os instrumentos de FE, especialmente para os grupos no domínio de desatenção. Análises de correlação de Spearman também revelaram correlações significativas entre os indicadores e os desempenhos em FE, com mudanças nos padrões de correlação ao longo das séries, verificando relação com habilidades cognitivas mais básicas na série inicial e com habilidades mais complexas nas séries posteriores. Por meio de MANOVAS e teste de Kruskal-Wallis foram verificadas tendências desenvolvimentais das habilidades de atenção e controle inibitório ao longo das séries escolares.

Made available in DSpace on 2016-03-15T19:39:56Z (GMT). No. of bitstreams: 1 Geraldo Henrique Lemos Barbosa.pdf: 744647 bytes, checksum: a447200460fcb4cfbb7a563e03f92252 (MD5) Previous issue date: 2012-08-16 / Fundo Mackenzie de Pesquisa / Epilepsy is a multifactorial disease, multi-faceted, featuring different variations in severity from person to person, characterized by the emergence of spontaneous seizures due to neuronal hyperactivity. Among the epilepsies, temporal lobe epilepsy (TLE) is a very serious and common, comprising about 40% of all cases, often refractory to medication with a substantial impact on cognitive processes and behavior of the affected person. The ELT is characterized by the presence of complex partial seizures with onset in limbic structures, partially attributed to more frequent primary neuropathology, hippocampal sclerosis. This crisis can cause behavioral and cognitive impairments associated with psychiatric disorders, which Disorder Attention Deficit Hyperactivity Disorder (ADHD). In order to evaluate the locomotor activity and exploration in young rats subjected to status epilepticus. Male Wistar rats aged 25 days postnatal, received intraperitoneal injection of pilocarpine (350mg/kg). Control animals received saline. The model induced by pilocarpine was used in this study, given that their histological, biochemical, electrophysiological and behavioral reliably reproduce those found in human TLE. After induction by pilocarpine SE animals underwent behavioral tests that began five days after SE and were completed in 15 days. They were: the open field and elevated plus maze. The present study showed evidence that young animals subjected to status epilepticus exhibit moderate hyperactivity with increased emotionality in a threatening context. Hyperactivity was observed over time, when the animals were reintroduced to an environment with neutral context (open field) or immediately when exposed to a threatening environment (LCE). The results of this study argue for the simultaneous presence of ADHD in the model of TLE. Evidence shows that behavioral changes are manifested early, even before the installation of behavioral seizures. In this respect, it opens a window of opportunity to get early interventions that may minimize the deleterious consequences of seizures. / A epilepsia é uma doença multifatorial, multifacetada, que apresenta diferentes variações de gravidade de pessoa para pessoa, caracterizada pelo surgimento de crises espontâneas devido à hiperatividade neural. Dentre as epilepsias, a epilepsia do lobo temporal (ELT) é uma forma muito grave e comum, que compreende cerca de 40% de todos os casos, comumente refratária à medicação com um impacto substancial no processo cognitivo e no comportamento da pessoa afetada. A ELT é caracterizada pela presença de crises parciais complexas com início nas estruturas límbicas, parcialmente atribuídas à neuropatologia primária mais frequente, a esclerose hipocampal. Essa crise pode causar prejuízos cognitivos e comportamentais, associados a transtornos psiquiátricos, os quais o Transtorno do Déficit de Atenção e Hiperatividade (TDAH). Com objetivo de avaliar a atividade locomotora e exploratória em ratos jovens submetidos ao status epilepticus. Ratos Wistar machos com idade de 25 dias pós-natal, receberam injeção intraperitoneal de pilocarpina (350mg/kg). Animais controle receberam solução salina. O modelo de indução por pilocarpina foi utilizado nessa pesquisa, tendo em vista que suas características histológicas, bioquímicas, eletrofisiológicas e comportamentais reproduzem de forma fidedigna as encontradas na ELT em humanos. Após a indução ao SE por pilocarpina os animais foram submetidos a testes comportamentais que tiveram início 5 dias após o SE e foram concluídos em 15 dias. Foram eles: o campo aberto e o labirinto em cruz elevado. O presente trabalho mostrou evidências que animais jovens submetidos ao status epilepticus apresentam hiperatividade moderada com aumento da emocionalidade em um contexto ameaçador. A hiperatividade foi observada ao longo do tempo, quando os animais foram reapresentados a um ambiente com contexto neutro (campo aberto) ou imediatamente, quando expostos a um ambiente ameaçador (LCE). Os resultados observados neste estudo argumentam a favor da presença concomitante de TDHA no modelo de ELT. Mostra evidências que as alterações comportamentais se manifestam precocemente, antes mesmo da instalação das crises epilépticas comportamentais. Neste aspecto, abre-se uma janela de oportunidades para se buscar intervenções precoces que possam minimizar as consequências deletérias das crises convulsivas.

O objetivo deste trabalho é analisar os sentidos e significações atribuídos por professores de escolas particulares (de elite) ao Transtorno de Déficit de Atenção e Hiperatividade (TDAH). Muito já foi escrito a respeito da psicopatologização das questões escolares sob o nome de TDAH. Entretanto, poucas são as pesquisas e os estudos dirigidos especificamente à repercussão deste fato na prática dos professores e menos ainda dos professores de escolas de elite do Ensino Fundamental 1 e à compreensão dos sentidos conferidos por eles a este fenômeno. O modelo utilizado é o da pesquisa qualitativa em Psicanálise, e o trabalho está dividido em dois momentos: revisão bibliográfica sobre o tema, discutida criticamente, e a pesquisa de campo por meio de entrevistas semidirigidas. A condução das entrevistas e a análise dos resultados foram psicanaliticamente orientadas pelo referencial teórico freudlacaniano. Primeiramente, levantamos elementos do espaço social e epistêmico que revestem este controverso diagnóstico e quais seus efeitos sobre a subjetividade das crianças. Discutimos a diversidade clínica envolvida nesta nomenclatura, que reduz manifestações subjetivas e sociais à categoria de transtorno. Trouxemos uma reflexão do trajeto organicista do quadro de TDAH e apresentamos um contraponto entre a noção de transtorno e o entendimento de sintoma para Psicanálise como tratamento ao real da angústia. Num segundo momento, analisamos as entrevistas com as professoras e as dividimos em categorias. Constatamos que o discurso do capitalista, aliado ao cientificismo do discurso da ciência, vem trazendo uma série de consequências ao sujeito, entre as quais: transforma a educação em mais uma mercadoria a ser consumida, legitima a transferência da responsabilidade de certos valores educativos próprios às famílias para as mãos da escola, desresponsabiliza aqueles envolvidos com a educação da criança, inclusive ela própria, e subjuga o mal-estar do sujeito a alterações neuroquímicas. Analisando esses aspectos, o trabalho busca evidenciar a permeabilidade do discurso pedagógico ao discurso médico científico hegemônico. Observamos que essa epidemia de TDAH acaba sendo, em grande parte, engendrada por uma sociedade capitalista, calcada no consumo e no lucro e tendo como representante o poder da indústria farmacêutica. Em uma perspectiva contrária às regularidades discursivas dos ditos especialistas, as professoras entrevistadas apresentam particularidades nas condições de enfrentamento dos impasses escolares, inventando, dia após dia, estratégias para lidar com seus alunos. Assim, este trabalho pretende, também, contribuir com um espaço de reflexão ética, visando propiciar práticas educacionais mais críticas / The objective of this work is to analyze the senses and the significances assigned by teachers in private schools (elite group) to Attention Deficit Hyperactivity Disorder (ADHD). Much has been written about the issues of school psychopathology under the name of ADHD, however, there are few researches and studies directed specifically to the impact of this fact on teachers practice - and even less on elite schools teachers of elementary school and the insight of the meanings conferred by them to this phenomenon. The model used is the qualitative research in psychoanalysis and the work is divided into two stages: bibliographic review on the subject, critically discussed, and field research through semi-structured interviews. The conduct of the interviews and analysis of the results were psychoanalytically oriented through Freud-Lacan theoretical framework. First, we raised elements of social and epistemic space lining this controversial diagnosis and its effects on children subjectivity. We discussed the clinical diversity involved in that nomenclature which reduces subjective and social events to the category of a disorder. We have brought a reflection of the organicist path box ADHD and present a counterpoint between the notion of disorder and the understanding of symptom for Psychoanalysis as a treatment to the real of the angst. In a second stage, we analyzed the interviews with the teachers and divided them into categories. We noticed that the capitalist discourse, allied to the scientificism of the science discourse has brought a number of consequences to the subject including: turned education into a commodity to be consumed, legitimized the transfer of responsibility for certain families own educational values to the hands of the school, didnt blame those involved with the child\'s education, including herself, and subdued the malaise of the subject to neurochemical changes. Analyzing these aspects, this work seeks to demonstrate the permeability of pedagogic discourse to the hegemonic scientific medical discourse. We observed that this \"epidemy of ADHD\" ends up being largely engendered by a capitalist society grounded in consumption and income, having for major elective representantive the power of the pharmaceutical industry. On a counter perspective to the discursive regularities of said experts, the teachers who were interviewed show some particularities in terms of confrontation school impasses, \"inventing\" day after day, strategies for dealing with their students. This study also aims to contribute to an area of ethical reflection to provide more critical educational practices

Trata-se de um trabalho que apresenta elaborações teóricas e pesquisa de campo, na modalidade de pesquisa qualitativa, e que teve como objetivo investigar os sentidos e significados atribuídos ao diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade (TDAH) por adultos clinicamente avaliados como portadores do transtorno na infância. Utilizou-se na pesquisa de campo o instrumento de entrevistas semi-dirigidas, ao qual se buscou engajar o espectro da história oral como suporte para esse instrumental. A condução das entrevistas e posterior análise dos resultados foram psicanaliticamente orientadas através do referencial teórico freud-lacaniano. Com o estudo teórico e a revisão da literatura, analisamos as configurações psíquicas que tais fenômenos, como o TDAH, suscitam e seus efeitos no estabelecimento do laço social. Constatou-se, também, que os modos de organização da vida social na atualidade, evidenciam determinadas formas de pensar e agir, dentre as quais se incluem fenômenos como a desatenção, a hiperatividade e a impulsividade. Na pesquisa de campo, dispôs-se um espaço de encontro com os entrevistados, convocando-os a falar sobre o conjunto de sintomas agenciado pelo transtorno, destacando-se suas implicações nos âmbitos da vida familiar, afetiva, do trabalho e na construção da identidade subjetiva. Buscou-se, também, reforçar a pertinência da psicanálise nos casos que colocam em perspectiva certos impasses no processo de alteridade e identidade e que revelam a ação (acting) como forma privilegiada de expressão do mal-estar. Através do ato psicanalítico, torna-se possível propiciar ao sujeito um momento de subversão que possibilita a ruptura com o ponto de apoio que estabelece com o saber construído a seu respeito, para que então se crie algo novo, abrindo espaço para aquilo que escapa à realidade biológica e faz emergir a dimensão simbólica dos processos psíquicos e corporais, a partir da forma singular com que o sujeito pode, então, nomear aquilo que lhe afeta / It is a work that presents theoretical elaborations and a qualitative field research, aimed to investigate the meanings attributed to the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) by adults clinically assessed as carriers of the disorder in childhood. In the field research, it was used the instrument of the semi-directed interviews, which engaged the spectrum of oral history as support for this instrumental. Interviews conduction and subsequent result analysis were psychoanalytically oriented through the Freudian-Lacanian theoretical framework. With the theoretical study and the literature review , we analyze the psychic configurations such phenomena, as ADHD, raise and their effects on establishment of social ties. It was found that modes of organization of social life nowadays highlight certain ways of acting and thinking including phenomena such as inattention, hyperactivity and impulsivity. In the field research, interviewees were stimulated to talk about symptoms intermediated by the disorder, highlighting its implications in the areas of family, love life, work and the construction of subjective identity. It was also sought to strengthen the relevance of psychoanalysis in cases that put into perspective some of the impasses of otherness and identity process and show the action (acting) as a privileged form of malaise expression. Through the psychoanalytic act, it becomes possible to provide the subject a subversion moment that allows the break with the foothold established with the knowledge built about him, so he can create something new, making room for what escapes biological and brings out the symbolic dimension of psychic and bodily processes, from the singular way in which the subject can, then, nominate what affects himself

O Transtorno do Déficit de Atenção e Hiperatividade (TDAH) é um transtorno neurobiológico amplamente estudado e o que mais acomete a população infantil em idade escolar. No entanto, pesquisas relacionando o contexto familiar destas crianças e adolescentes com a moralidade são escassas. Este estudo teve por objetivo mapear o contexto familiar deste público no que diz respeito às concepções educativas morais, a legitimidade da autoridade parental e as representações de si dessas mães. MÉTODO: Participaram da pesquisa 17 mães e 5 avós (responsáveis legais) de crianças e adolescentes com diagnóstico de TDAH atendidos por uma instituição filantrópica especializada localizada na cidade de São João da Boa Vista, interior do estado de São Paulo. Para a coleta de dados, os instrumentos utilizados foram: Escala de Concepções Educativas Morais ECEM, Questionário de legitimidade da autoridade parental e Representações de si de mães de crianças e adolescentes com TDAH. RESULTADOS: Os resultados apontaram para mães que priorizam o respeito unilateral, a justiça retributiva com o uso de sanções expiatórias, o desejo pela obediência e baixa autonomia. Além disso, as mães legitimam a autoridade parental em todos os domínios, sendo as regras de domínio pessoal menos legitimadas que as demais. O uso de punições físicas está muito presente no discurso dessas mães. As representações de si como pessoa dessas mães estão voltadas para a maternidade como valor central e para um olhar positivo sobre si mesmas. Como mães, essas mulheres tem representações de si positivas e positivas morais com ênfase no cuidado. A maior parte das mães percebem diferenças entre educar crianças com TDAH e sem o transtorno. Elas também apresentam representações de si positivas, quando questionadas sobre como o filho, os familiares, os professores e os profissionais da saúde que atendem o filho com TDAH as veem como mães. Em relação às apresentações do TDAH, podemos destacar que as mães de crianças com apresentação predominantemente hiperativa/impulsiva apresentam a menor média para o construto autonomia e as maiores médias para o construto obediência e para as regras de domínio pessoal. As mães de crianças com apresentação predominantemente desatenta utilizam mais regras e apresentam maior legitimidade da autoridade parental, exceto quando se trata das regras de domínio pessoal. As mães de crianças com apresentação combinada apresentam as menores médias em todos os domínios, o que aponta para menor legitimidade da autoridade parental e menor expectativa de obediência. CONCLUSÃO: O contexto familiar dessa amostra não favorece o desenvolvimento moral. As participantes deste estudo desejam filhos obedientes e utilizam sanções expiatórias para garantir a obediência. Para as participantes, ser boa mãe está relacionado ao cuidado e o sacrifício pelos filhos / Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder that is widely studied and which affects the school-age children. However, research relating the family context of these children and adolescents with morality is scarce. This study aimed to map the family context of this public with regard to moral educational conceptions, the legitimacy of parental authority and the self-representations of these mothers. METHODS: 17 mothers and 5 grandmothers (legal guardians) of children and adolescents diagnosed with ADHD attended by a specialized philanthropic institution located in the city of São João da Boa Vista, in the state of São Paulo, participated in the study. For the data collection, the instruments used were: Moral Educational Conceptions Scale - ECEM, Questionnaire of legitimacy of parental authority and Self-representations of mothers of children and adolescents with ADHD. RESULTS: The results pointed to mothers who prioritize unilateral respect, retributive justice with the use of expiatory sanctions, the desire for obedience and low autonomy. In addition, mothers legitimize parental authority in all domains, with rules of personal dominance less legitimized than the others. The use of physical punishments is very present in the discourse of these mothers. The self-representations as a person of these mothers are focused on motherhood as a central value and a positive image at themselves. As mothers, these women have positive and positive moral self-representations with an emphasis on care. Most mothers perceive differences between educating children with ADHD and without the disorder. They also present positive self-representations when questioned about how the child, family members, teachers, and health professionals who treat the child with ADHD see them as mothers. Regarding the presentations of ADHD, we can highlight that the mothers of children with predominantly hyperactive / impulsive presentation present the lowest mean for the autonomy construct and the highest averages for the obedience construct and the rules of personal dominance. Mothers of children with predominantly inattentive presentation use more rules and have greater legitimacy of parental authority, except when it comes to rules of personal domain. Mothers of children with a combined presentation have the lowest averages in all domains, which points to a lower legitimacy of parental authority and lower expectation of obedience. CONCLUSION: The family context of this sample does not favor moral development. Participants in this study desire obedient children and use expiatory sanctions to ensure obedience. For the participants, being a good mother is related to the care and sacrifice for the children

Orientador: Maria Lygia Quartim de Moraes / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciências Humanas / Made available in DSpace on 2018-08-19T01:13:53Z (GMT). No. of bitstreams: 1 Barbarini_TatianaAndrade_M.pdf: 1839081 bytes, checksum: 7b2de3ce818598665618aef8fcd37332 (MD5) Previous issue date: 2011 / Resumo: O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é um transtorno mental infantil que tem ganhado evidência nos ambulatórios e consultórios médicos, escolas e mídia. Não parar, parecer estar no "mundo da lua" e não obedecer às ordens dos adultos são alguns indícios, entre tantos outros, de que a criança é uma potencial portadora de TDAH. Ao considerar-se que o TDAH tem origem em disfunções genéticas e neurológicas, encerra-se o problema no corpo individual, em sua constituição biológica, o que dá autoridade aos médicos psiquiatras para diagnosticar e propor tratamentos - sendo o uso de medicamentos psicoestimulantes o método mais utilizado - e deixam-se de lado questões sociais, históricas, culturais, econômicas e políticas importantes. Assim, nesta dissertação pretende-se analisar e interpretar o TDAH, seu diagnóstico e seu tratamento médico (psiquiátrico) e medicamentoso designados a crianças, a fim de desnaturalizá-los e desvendar suas relações com a sociedade contemporânea. Nesse sentido, são explorados temas como a definição clínica do transtorno, os processos de medicalização social, patologização e estigmatização de comportamentos infantis e as imagens da criança com TDAH, estabelecendo o diálogo entre TDAH, sociedade e infância. A metodologia escolhida engloba uma pesquisa qualitativa etnográfica, dispondo de métodos e técnicas de observação participativa no Ambulatório de Psiquiatria Infantil do Hospital das Clínicas da Universidade Estadual de Campinas; de entrevistas semiestruturadas com profissionais de saúde atuantes no referido ambulatório, crianças, entre seis e doze anos de idade, diagnosticadas como portadoras do TDAH e atendidas no local, e seus pais ou representantes legais; e de produção e interpretação de desenhos infantis. Portanto, a partir das pesquisas bibliográfica e de campo, entende-se que o TDAH e seu tratamento psiquiátrico e medicamentoso definem-se como fenômenos complexos que ultrapassam os limites do campo da biologia e medicina por possuírem raízes sociais, históricas e culturais ligadas a uma sociedade que valoriza as crianças como vir-a-ser, como seres em formação para a vida adulta ativa, e que as enquadra em normas e regras socialmente definidas sobre comportamentos adequados. A partir dessa conformação, além de se fornecer pouco espaço à expressão infantil, classificam-se, punem-se e tenta-se corrigir as crianças que se desviam, entre elas, as crianças com TDAH. Portanto, é possível entender o TDAH e seu tratamento (especialmente o medicamentoso) como mecanismos de biopoder / Abstract: Attention Deficit/Hyperactive Disorder (ADHD) is a child mental disorder which has been increasingly drawing attention from medical clinics, schools and media. Being in constant active, seeming aloof and not obeying adults' orders are some signs, along with so many others, that indicate a child is a potential ADHD bearer. When it is considered that ADHD has a genetic neurological dysfunction cause, the problem becomes restricted to the individual, in his/her biological constitution. This gives psychiatrists authority to diagnose and prescribe treatments - the use of psycho stimulant drugs being the main one. However this approach disregards important social, historical, cultural, economical, and political questions. Therefore, in this dissertation I aim to analyze and understand ADHD, its diagnosis, its drugs and the medical (psychiatric) treatment given to children in order to denaturalize them and reveal their relations with contemporary society. In this way, some themes are investigated, such as the disorder clinical definition, the processes of social medicalization and the pathologization and stigmatization of some children's behaviors, and these children's images, establishing the dialogue among ADHD, society, and childhood. The methodology chosen covers an ethnographic qualitative research, with methods and techniques of participative observation at "Ambulatório de Psiquiatria Infantil do Hospital das Clínicas da Universidade Estadual de Campinas"; semi-structured interviews with health professionals from the above-mentioned clinic, children from six to twelve years old diagnosed as ADHD bearers and treated there, and their parents or legal guardians; as well as by interpreting children's drawings. Thus, from bibliographic and field research, it is understood that ADHD and its medicamental and psychiatric treatment are complex phenomena which surpass Biology and Medicine field limits because of their social, historical, and cultural roots. They are connected to a society which values the child as a developing human being into an active adult life, and conforms them to socially defined principles and rules about proper behaviors. This conformation gives little room to child expression and, moreover, label, punish, and try to correct deviant children, among them, children with ADHD. Hence, it is possible to understand ADHD and its treatment (especially medicamental one) as mechanisms of bio-power / Mestrado / Sociologia / Mestre em Sociologia

M.A. (Psychology) / Attention Deficit Hyperactivity Disorder (ADHD) is now recognised as the most common neurobehavioral disorder of childhood, affecting children from their earliest infancy through school and into adult life. (Shaywitz and Shaywitz 1991). It is prevalent in both clinical and normal populations and consensus ofopinion seems to be that approximately 3% to 5% of the childhood population has ADHD.( Barkley 1990) The impact that this disorder has on the child and his immediate world cannot be underestimated, nor can the reciprocal basis to these behaviours be ignored. While the basic contention of this paper is that ADHD has a strong biological/hereditary basis to its development, nevertheless account must be taken ofthe impact of the child's behaviour on his surrounding world, and the impact again in turn ofthat world on the child's behaviour. In this reciprocal interaction between the child and the world, definitional problems arise wherein those diagnosed with ADHD do not consistently show hyperactivity.

M.A. / ADD is a term used to describe a group of individuals who have certain common problems. Most have learning difficulties that may interfere with school and social activities. Many are hyperactive and/or easily distracted with short spans of attention. The exact causes of ADD are not known, but there is widespread acceptance that the disorder is often inherited. ADD is presently managed, but not cured. Effective management requires understanding. It is essential that all those involved develop a commonsense understanding of the associated problems. The aim of this study is to describe the behaviour of ADD children and their parents in order to establish whether similarities exist between the two. This will assist in understanding this complex disorder. The literature review served as a theoretical basis for the research. It also aided in the design of additional questionnaires which were used to gather demographic information on the children and parents involved. The objectives of the study were firstly to describe the behaviour of ADD children using the Behaviour Rating Scale for Hyper-children (BRASH). By analyzing data gathered from this instrument, high scores in the areas of intensity, persistence, sensitivity, perceptiveness, energy and extroversion, were identified. Secondly, the Assessment Scale for Hyperpersons (ASH) was administered in order to collect data concerning the behaviour of parents involved. Areas that received high scores included: intensity, perceptiveness, sensitivity, energy and extroversion. The next objective was to establish possible similarities in the behaviour of ADD children and their parents. The behaviour patterns were compared, and similarities identified. Both groups scored highest in the areas of intensity, perceptiveness, sensitivity, energy and extroversion. The results emphasize ADD as a family issue, rather than an individual one.

Do you think we can concentrate in noisy situations? I bet most of us would spontaneously answer “no” to this apparent simple question. Although we admit it is intuitively the best answer to give, this thesis aims to evidence that it is not always true and that, under certain circumstances, noise can be beneficial.<p><p>To appropriately discuss this question, it is necessary to answer others, such as: what is concentrating, paying attention? And, what is noise? Everyone has an idea of what attention is, and can give examples of situations in which it is required: school, work, driving, listening to our parents’ requests and so forth. But who could say that we can fully control attention like if we had a button to press, switching on and off according to the context? When we were little, my father used to say to my brothers and me: “Ok, you did not do this on purpose, but, please, pay attention to your attention”. Well, I can say now that it is not that easy and certainly not for everyone. In the population, around five percent of children and adults meet serious difficulties to pay attention. These people, more than others, often express their deficit with excessive distraction and/or hyperactivity as well as impulsivity. These multiple symptoms, for the individual who lives these behavioral excesses, represent an issue for his/her everyday-life: at school, at work, driving, trying to listen to his/her parents’ requests, etc.<p><p>Such symptoms refer to a syndrome called attention-deficit/hyperactivity disorder (ADHD). Although the definition of this syndrome has changed across the course of History, the first descriptions of ADHD go back to 1798. Since, a lot has been written about this disorder, which we do not fully understand yet. Beyond these simple words, “inattention, impulsivity, hyperactivity”, a consequent number of etiologies (environmental, genetic, psychosocial), subtypes, comorbidities, and outcomes reflect the enormous heterogeneity of the phenotypes that are found in this syndrome. The main treatment offered to individuals with ADHD is a psychostimulant drug called methylphenidate. This medication, acting mainly on dopaminergic brain functioning, has proven efficacy regarding ADHD symptoms. However, it has several limitations. For instance, its use remains controversial in the society; it causes side effects and around 30% of individuals with ADHD do not respond to this treatment. These mentioned limitations, among others, highlight the necessity to find alternative ways to reduce ADHD symptoms.<p><p>This is the main objective of this thesis. To do so, we will investigate a counterintuitive phenomenon. In certain situations, what can be called noise might improve cognition and, consequently, potentially reduce the symptoms associated with ADHD. As mentioned in the beginning of this preamble, one could think that everything unnecessary in our direct environment is a potential distraction. Intuitively, a sensible person would suggest that individuals prone to distraction, as those with ADHD, would benefit from a stimulation- free environment to improve attention and reduce impulsivity as well as hyperactivity. However, already in the 1970’s, authors such as Zentall (1975) developed a theory supported by empirical data, i.e. the optimal stimulation theory, showing that adding stimulation in the environment (with pictures, posters, music, colors, etc.) might improve symptoms of children with ADHD. Successively, many theories and findings were developed and related to the observation that the environmental context affects attention, hyperactivity and impulsivity. For instance, the delay aversion theory (Sonuga-Barke, Taylor, Sembi, & Smith, 1992) suggests that, as children with ADHD are motivated to discount delay, the inattentive, overactive and impulsive behaviors are the expression of such aversion when they cannot avoid the delay. Related to this theory, adding stimulation in the environment has evidenced hyperactivity and impulsive choice reduction (Antrop, Roeyers, Van Oost, & Buysse, 2000; Antrop et al. 2006). Another theory advocates that the ADHD-related symptoms are explained in terms of energetic dysfunction (Sergeant, 2000). For instance, children with ADHD would meet difficulties to adjust their internal state (e.g. their arousal) required for a task. Accordingly, Sergeant (2000) suggested that performance is influenced not only by cognitive capacity but also by environmentally determined levels of arousal and showed the extent to which variations in these energetic factors can be managed to ensure optimal performance. A recent theory, called the Moderate Brain Arousal model (Sikstrom & Soderlund, 2007), particularly caught our interest. This theory postulates that white noise has beneficial effect on cognition. The first study of these authors (Soderlund, Sikstrom, & Smart, 2007) supported their hypothesis, showing that children with ADHD improved their episodic memory performance when they were exposed to white noise. This is, to our knowledge, the first study that evidenced such improvement with white noise, considered as extra-task stimulation, in children with ADHD.<p><p>The objective of this thesis is to investigate the potential beneficial effect of noise in individuals with and without ADHD regarding attentional and executive functioning. We will first review, in the first chapter of this Introduction, the general aspects of ADHD: definition criteria, prevalence, etiologies, treatments and outcomes. In the second chapter, we will present the main theories and findings related to this syndrome and to our main objective.<p>After the Introduction, we will describe the different experimental studies that we have carried out in the context of this thesis. Hereunder, we propose a short overview of these studies.<p>The first study of this thesis is a pilot study, aimed to validate the relevance to use event- related potentials (ERPs) in children with and without ADHD to further investigate noise effect. Accordingly, the second study investigated noise effect on behavioral and ERPs aspects in children with and without ADHD. To do so, children performed a visual cued Go/Nogo. They were also submitted to a neuropsychological assessment. Afterwards, in a third study, we used the same paradigm in adults with and without ADHD. Here, we also added a music condition to investigate another stimulation than noise.<p><p>In the fourth study, we decided to explore the effect of noise in a more ecological environment. To do so, we used a virtual reality tool that allowed to immerse the children in a virtual classroom environment. Children with and without ADHD were then assessed, being immersed in a classroom, with a continuous performance task (CPT) presented on the blackboard while several auditory and visual realistic distracters emerged during the test. Children performed the task with and without white noise exposure as well as a neuropsychological assessment. In the fifth study, we used the virtual classroom to investigate noise effect on interference control. Children with and without ADHD were submitted to a bimodal virtual reality Stroop (with auditory and visual target stimuli) and to a neuropsychological assessment. Finally, in a last study, we explored the effect of noise in consecutive young adults. Immersed in the virtual classroom, they were submitted to the CPT task with and without white noise. ADHD questionnaires and a neuropsychological assessment were also undertaken.<p><p>To end this thesis, we will discuss to what extent our studies allowed going one step further in the investigation of “on what, with whom, when and where” noise can be beneficial. We will discuss all our studies and results in the light of the theories and findings exposed in the Introduction. Finally, we will comment the clinical validation of these results.<p><p><p> / Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished