A research report submitted to the Faculty of Humanities University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts (Research Psychology), 2017 / ADHD is one of the most prevalent disorders in child psychiatry today. Whilst the phenomenon of ADHD is well researched in Europe and North America, there are limited studies available in South Africa that explore the link between ADHD and different forms of schooling. Furthermore, few studies focus on the children who have been socially positioned in this way. This study focused on the prevalence of ADHD with a particular aim to explore how gender, race and class play out in an unequal schooling system. The secondary aim was to contribute to the knowledge about adolescents’ own understandings and experiences of ADHD. The research was conducted in two distinct phases, Phase 1 included the administration of a demographic questionnaire to determine the prevalence of the disorder within four different Gauteng schools. Phase 2 of the project included semi-structured interviews to explore the understandings, perceptions and experiences of children living with this diagnosis. This study explored the prevalence of ADHD across four different schools in Gauteng. Results of the study propose that the diagnosis and prevalence of this phenomena is strongly influenced by gender, race and class, as the majority of children diagnosed are boys (65%), more than half are from upper class families (61%) and most of the children are white (71%). The adolescents who were interviewed indicated that teachers were mostly the initiators of their diagnosis due to deviations from classroom behaviour and academic performance. While the children claimed that the diagnosis and the medication had certain benefits, they also identified distinct disadvantages with the most notable adverse effects on mood and interactions with their peers. The predominant biomedical view of the disorder seemed to be internalised by the children which positioned them in a subordinate relationship with health care professionals. A strong theme of disempowerment emerged, with medical experts and mothers, identified as gatekeepers to their sense of agency. / XL2018

Syftet med studien var att beskriva arbetsterapeuters kliniska resonemang vid arbetet med vuxna klienter med ADHD. Genom ett ändamålsinriktat urval identifierades åtta arbetsterapeuter inom psykiatrisk öppenvård som hade erfarenhet av att arbeta med vuxna klienter med ADHD. Data samlades in genom narrativa intervjuer och analyserades därefter med stöd av en paradigmatisk narrativ metod. Analys av data resulterade i tre teman som benämndes: Att möta personen där den är och skapa delaktighet i processen; Att möta en mångfacetterad problematik kräver samverkan; Att coacha klienten att etablera effektiva vanor. Arbetsterapeuternas kliniska resonemang ger indikationer på att det vid arbetet med berörd klientgrupp är viktigt att ta samtalets betydelse, klientcentrering och teamarbete i beaktning. Den visar på hur samtalet kan vara en intervention i sig och hur arbetsterapeuterna genom sitt resonemang kan möjliggöra klientcentrering genom att sätta klienten i fokus både i teamet och i det enskilda arbetet med klienten. Studiens resultat anses kunna bidra med kunskap för arbetsterapeuter som arbetat med vuxna klienter med ADHD och resultatet bör även gå att appliceras på andra klientgrupper inom området psykiatri eftersom denna studie tyder på att klienterna ofta har en mångfacetterad problematik som bidrar till utmaningar i dagliga aktiviteter. / The aim of the study was to describe the clinical reasoning of occupational therapists when working with adult clients with ADHD. Through a purposeful selection, eight occupational therapists were identified in psychiatric outpatient care who had experience working with adult clients with ADHD. Data was collected by narrative interviews and then analysed using a paradigmatic narrative method. Analysis of data resulted in three themes called: To meet the client where he or she is and promote participation in the process; To meet a multifaceted problem requires collaboration; To coach the client to establish effective habits. The clinical reasoning of occupational therapists gives indications that when working with the affected client group it is important to take into consideration the importance of the conversation, client centeredness and teamwork. It shows how the conversation can be an intervention in itself and how the occupational therapists can, through their reasoning, enable client centeredness by putting the client in focus both in the team and in the individual work with the client. The study's results can be considered to contribute knowledge for occupational therapists who work with adult clients with ADHD, and the result should also be applicable to other client groups in the field of psychiatry, as this study suggests that the clients often have  multifaceted problems that contributes to challenges in everyday occupations.

O TDAH é um fenômeno de entendimento complexo e muitas vezes controverso, possuindo sintomas que, em certo grau, estão presentes em crianças de diferentes idades e contextos, reforçando a necessidade de pensar essa manifestação a partir de teorias que reflitam sobre o desenvolvimento da criança. Em estudo anterior (Folquitto, 2009), investigou-se o desenvolvimento de crianças diagnosticadas com TDAH. Os resultados sugeriram indícios de defasagens no desenvolvimento, e não foram observadas diferenças significantes no desempenho entre grupos de crianças com TDAH, fazendo ou não uso de medicamentos, durante a aplicação de provas piagetianas. Procurou-se, na presente pesquisa, elaborar estratégias de intervenção que possibilitem às crianças avançar em seu desenvolvimento, a partir da construção de novos procedimentos que conduzirão, progressivamente, a estruturações mais avançadas de pensamento. A hipótese foi verificar se é possível proporcionar, com base na teoria piagetiana, experiências facilitadoras para a construção de capacidades cognitivas e afetivas que favoreçam o desenvolvimento dessas crianças, bem como investigar suas crenças espontâneas sobre o tempo. Foi conduzido um estudo longitudinal, durante 12 meses, com intervenções utilizando jogos e situações problema, estimulando reflexões, aquisição de conhecimentos significativos, favorecendo a construção de procedimentos e consciência das ações. A mediação realizada pelos profissionais foi a principal estratégia de intervenção adotada, com o intuito de mobilizar processos de autorregulação nas crianças. Participaram da pesquisa 18 crianças, com idades entre 7 a 12 anos. Anteriormente, e posteriormente à intervenção, os participantes e seus pais foram entrevistados, para avaliação do desenvolvimento das noções operatórias, medidas neuropsicológicas e sintomas de TDAH. Foram utilizados os seguintes instrumentos: SNAP-IV, WISC-III (subtestes Vocabulário, Cubos, Código, Dígitos e Procurar Símbolos), Figura de Rey, e as seguintes provas piagetianas: Conservação das quantidades discretas, Mudança de critério/dicotomia, Noção de ponto e contínuo, O relacionamento das perspectivas, Sucessão dos Acontecimentos Percebidos, Simultaneidade e O tempo da ação própria e a duração interior. Perguntou-se também às crianças o que era o tempo, solicitando exemplos. Os participantes foram subdivididos em um grupo intervenção, que participou das atividades propostas (n=13), e grupo comparação (n=5). Foi escolhida a estratégia de composição dos grupos a partir de uma amostra definida por conveniência. Para o grupo intervenção, houve diferença estatisticamente significativa, na comparação entre as avaliações anterior e posterior à intervenção, em relação aos sintomas, QI, velocidade de processamento e funções executivas. Comparando-se os dois momentos, houve diferença significativa para as respostas das provas piagetianas como um todo (p=0,011), O relacionamento das perspectivas (p=0,024) e Simultaneidade (p=0,023). O grupo comparação não apresentou diferença estatisticamente significativa no desempenho nas avaliações, para as medidas analisadas. Sobre as crenças espontâneas sobre o tempo, constatou-se que a maioria das crianças conceituou o tempo como vinculado à própria ação, desconsiderando aspectos como a sucessão dos movimentos e a sensação de passagem do tempo. Os resultados indicam que as intervenções com jogos, em grupo e mediadas por profissionais, podem mobilizar o desenvolvimento de crianças com TDAH, diminuindo sintomas e melhorando suas funções executivas, e, principalmente, tais resultados demonstram que o método de intervenção realizado, pautado na utilização de jogos mediada por profissionais, foi efetivo para mobilizar processos de autorregulação e tomada de consciência por parte dos participantes, que assim puderam avançar em seu desenvolvimento, construindo procedimentos de melhor qualidade e estruturações cognitivas e afetivas mais adaptadas. Portanto, os resultados obtidos podem ser interpretados como um indício de que propostas de intervenções em longo prazo, envolvendo situações problema, reflexões sobre as ações e tomada de consciência, são fundamentais para que crianças com TDAH possam ter processos de aprendizagem e desenvolvimento mais significativos / ADHD is a complex disorder, whose understanding is often controversial. ADHD symptoms, to some degree, are present in children with different ages and backgrounds, reinforcing the need to study this phenomenon from a theoretical perspective that considers the development of children. In a previous study (Folquitto, 2009), it was investigated the development of children diagnosed with ADHD. They were also evaluated according to whether use psycho stimulant medications or not. Comparing subgroups, no significant differences were observed, indicating that the use of these medications has not contributed sufficiently to favour the development of ADHD children. In the present research, we aimed at developing intervention strategies that could enable children to enhance development, constructing new procedures who lead, progressively, to more advanced structures of thinking. The hypothesis of this work was to investigate if it is possible to provide, based on the Piagetian theory, experiences that facilitate the construction of cognitive and affective capacities that would favour the development of these children, as well as to investigate their spontaneous beliefs about time. This is a longitudinal study, performing interventions with games and problem-solving situations that stimulate children to analyse their activities and to acquire meaningful knowledge, favouring the construction of new procedures, awareness of actions and cognitive structuring. Participants were 18 children, aged 7-12 years old. Previously, and after the intervention, participants and their parents were interviewed to assess the development of operational notions, neuropsychological measures of Executive Functions and ADHD symptoms. We used the following instruments: SNAP-IV, WISC-III´s subtests \"Vocabulary\", \"Block Design\", \"Coding\", \"Digit Span\" and \"Symbol Search\", Rey Osterrieth Complex Figure (ROCF), and the Piagetian tasks Conservation of discrete quantities; Change of criteria - dichotomy; the tasks Three mountains, Succession of Events Perceived, The ideia of points and the ideia of continuity, Simultaneity, and The time of the action and the internal duration.Participants were divided into an experimental group, who took part in the intervention (n=13), and a control group (n=5), composed by ADHD children who did not take part in the intervention program. For the intervention group there were statistically significant differences when comparing the assessments before and after the intervention for symptoms, IQ, processing speed and executive functions. Comparing the two periods, there was significant difference in the responses of piagetian tasks as a whole (p=0.011), the Three mountains task (p=0.024) and Simultaneity (p=0.023). The comparison group showed no statistically significant difference in the performance evaluations for the measures analyzed. Regarding spontaneous beliefs about time, the majority of children conceptualized time as linked with action itself, not considering aspects like the succession of movements and sensation of time going by. Results indicate that interventions with games, mediated by professionals, can be useful tools to assist and enhance the development of children with ADHD, decreasing symptoms and improving executive functions. Specially, this results demonstrate that intervention method performed, based on use of games mediated by professionals, was effective in mobilizing self-regulation and awareness processes by participants. Thus, they were able to move forward in its development, building better procedures and affective and cognitive structuring more adapted. Results presented can be interpreted as an indication that long-term interventions, involving problem solving situations, reflections on the actions and awareness are fundamental to enable children with ADHD to have more meaningful learning processes and developing

INTRODUÇÃO: O transtorno de déficit de atenção / hiperatividade (TDAH) é observado em 30-40% das crianças e adolescentes com epilepsia. Estudos recentes relataram a segurança do metilfenidato em pacientes com epilepsia controlada, porém há uma carência de estudos em pacientes com epilepsia não controlada. OBJETIVO: Estudar a eficácia e segurança do metilfenidato em crianças e adolescentes com diagnóstico de TDAH e epilepsia não controlada. MÉTODOS: Avaliação prospectiva de 24 pacientes de 7 a 16 anos, com diagnóstico de epilepsia e TDAH, no Ambulatório de Especialidades da Universidade da Região de Joinville (Univille), que preencham os seguintes critérios: pacientes com diagnóstico de epilepsia que tenham tido pelo menos duas crises epilépticas nos últimos seis meses; diagnóstico de TDAH com base nos critérios definidos pelo DSM-IV; que não tivesse recebido tratamento prévio com metilfenidato. RESULTADOS: A amostra foi composta de 24 pacientes, classificados pelo subtipo do TDAH em 41,7% desatento, 37,5% combinado e 20,8% hiperativo/impulsivo. Os pacientes apresentaram epilepsia parcial em 58,3% e epilepsia generalizada em 41,7%. A dose média do metilfenidato utilizada foi 0,52 mg/kg/dia (22,3 mg/dia). Tempo de seguimento foi de seis meses para todos os pacientes. Em 70,8% houve melhora dos sintomas do TDAH após seis meses de tratamento, e em 22 dos 24 pacientes (91,6%) não houve aumento da freqüência de crises epilépticas. CONCLUSÕES: metilfenidato demonstrouse efetivo no tratamento dos sintomas do TDAH em pacientes com epilepsia não controlada, e nos primeiros seis meses de estudo, não houve aumento significativo da freqüência das crises epilépticas. / INTRODUCTION: Attention Deficit and Hyperactivity Disorder (ADHD) is observed in 30 to 40 % children and adolescents with epilepsy. Recent studies demonstrate the safety of methylphenidate (MPH) in patients with controlled epilepsy. There is a lack of studies of patients with uncontrolled epilepsy. OBJECTIVE: to study the efficacy and safety of MPH in children and adolescents diagnosed with ADHD and uncontrolled epilepsy. METHODS: We evaluated 24 patients with ages of 7 and 16 years, diagnosed with epilepsy and ADHD, outpacient speciality clinic which took place in the Ambulatório de Especialidades of the Universidade da Região de Joinville (Univille). Inclusions criterias: at least two seizures in the previous 6 months; the diagnosis of ADHD based on DSM-IV criteria. RESULTS: The results of 24 patients have been evaluated, classified according to subtype ADHD as the following: 41.7 % inattentive type, 37.5 % combined and 20.8% hyperactive/impulsive type. The sample was distributed as the following: parcial epilepsy 58.3 % and generalized epilepsy 41.7 %. An average dose of MPH was 0.52 mg/kg/daily (22.3 mg daily). This was given for a period of 6 months to all patients. In 70.8 % the patients showed signs of improvement from ADHD symptoms and there was not increase of frequency of epileptic seizure in 22 of the 24 patients (91.6%). CONCLUSIONS: MPH was effective in the treatment of ADHD in patients with uncontrolled epilepsy. In the first 6 months of this study there was no increase of epileptic seizures.

O Transtorno do Déficit de Atenção e Hiperatividade (TDAH), atualmente, é uma das desordens neuropsicobiológicas mais frequentemente diagnosticadas na infância. A presença de uma criança com tal transtorno afeta a dinâmica familiar, com aumento de perturbações na família, em especial no cuidador primário. O presente estudo tem por objetivo avaliar o estresse, a depressão, a qualidade de vida, a auto-percepção de estresse e de fatores estressantes em cuidadores primários de crianças com diagnóstico de TDAH, bem como investigar suas vivências emocionais no convívio com a criança. Para tanto, participaram do estudo 40 cuidadores primários de crianças com idades entre 6 e 12 anos, divididos em dois grupos que foram comparados: G1 - Grupo clínico - 20 cuidadores primários de crianças diagnosticadas com TDAH, em tratamento no serviço público de saúde, sem uso de medicação; G2 - Grupo de comparação - 20 cuidadores primários de crianças, sem histórico de doença ou atendimento psicológico, psiquiátrico ou neurológico. Os instrumentos utilizados foram: Questionário de Capacidades e Dificuldades (SDQ), Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Escala de Qualidade de Vida- versão abreviada (WHOQOL-Bref), Inventário de Depressão de Beck, Questionário de Auto-Percepção em relação ao estresse e Roteiro complementar. Os instrumentos foram codificados de acordo com suas proposições técnicas, e, procedeu-se tratamento estatístico não paramétrico, adotando-se valores de p<= 0,05. As questões abertas do Roteiro complementar foram analisadas segundo os preceitos da análise de conteúdo. Os resultados apontaram que, quanto ao estresse, o percentual de cuidadores com indicadores de estresse no Grupo clínico é significativamente maior do que o encontrado no Grupo de comparação (p=0,001). Os dados relativos aos domínios da qualidade de vida indicaram médias significativamente maiores em participantes do G2 quanto a satisfação com os domínios físico (p<0,001), psicológico (p=0,005) e social (p=0,027), quando comparados aos do G1. Quanto aos indicadores de depressão, o G1 apresentou médias significativamente superiores de sintomatologia depressiva quando comparado ao G2 (p=0,001). E, no G1, houve maior percepção de estresse no convívio com a criança (p<0,001), no cuidado com a criança (p<0,001) e, ainda, os cuidadores desse grupo perceberam manifestações frequentes de estresse (p=0,003) quando comparados ao G2. Os dados qualitativos foram agrupados em cinco temas principais: convívio com a criança, gravidez, enfrentamento, tratamentos e necessidades. A avaliação, através das técnicas, revelou altos níveis de perturbações nos cuidadores de crianças com TDAH, o que foi corroborado pela análise qualitativa do material. Os dados apontam que o cuidador apresenta dificuldades para acolher a criança, criando um ciclo que se retroalimenta com impactos negativos na qualidade de vida da família. Enfatiza-se a necessidade de políticas públicas que favoreçam a ampliação do cuidado à criança com TDAH e aos seus cuidadores, com elaboração e desenvolvimento de programas de intervenção que proporcione uma maior articulação entre os níveis primários e secundários da atenção em saúde, o que auxiliará os cuidadores no cuidado à criança, no manejo de situações estressantes vividas no cotidiano e na recuperação de sua qualidade de vida. (CAPES). / Attention deficit hyperactivity disorder (ADHD) is among today\'s most common diagnosed childhood neuropsychological disorders. When a child has ADHD, the family dynamics is affected, and more troubles occur, especially concerning the primary caregiver. The purpose of this study was to evaluate stress, depression, quality of life, and the self-perception of stress and stressing factors in primary caregivers of children diagnosed with ADHD, and to investigate their emotional experiences of living with that child. Participants were 40 primary caregivers of children of ages 6 to 12 years. Two groups were formed and compared, as follows: G1 - Clinical group - 20 primary caregivers of children diagnosed with ADHD, who were following treatment at a public health care center, without the use of medication; G2 - Comparison group - 20 primary caregivers of children without any history of psychological, psychiatric or neurological disorder or treatment. The instruments used were: The Strength and Difficulties Questionnaire (SDQ), Lipp\'s Inventory of Stress Symptoms in Adults (ISSL), Quality of Life Scale - abbreviated version (WHOQOL-Bref), Beck\'s Depression Inventory, Questionnaire on Self-Perception in relation to Stress and a Complementary Script. The instruments were coded according their technical propositions, and submitted to nonparametrical statistical analysis, considering values of p<= 0.05. The open questions of the Complementary Script were submitted to content analysis. Results showed that, regarding stress, the percentage of caregivers with stress indicators in the Clinical Group was significantly greater than that found for the Comparison Group (p=0.001). The data regarding the quality of life domains indicated significantly greater means in participants from G2 in terms of satisfaction with physical (p<0.001), psychological (p=0.005), and social (p=0.027) domains, compared to those of G1. As to depression indicators, G1 means were significantly greater for depressive symptoms compared to G2 (p=0.001). Also, in G1, there was a greater perception of stress living with the child (p<0.001), in providing care to the child (p<0.001), and, in addition, the caregivers of this group perceived themselves having more stress (p=0.003) compared to G2. The qualitative data were grouped according to five themes: living with the child, pregnancy, coping, treatments and needs. The evaluation, using the techniques, revealed high disturbance levels among caregivers of children with ADHD, which was confirmed by the qualitative analysis of the material. The data showed that caregivers face difficulties to embrace the child, creating a cycle that retro-feeds with negative impacts on the family\'s quality of life. There is a need to create public policies that help improve the care provided to children with ADHD and their caregivers, including the development of intervention programs that would provide a better cooperation between primary and secondary health care levels, which would eventually help the children\'s caregivers in their task, as well as to manage stressful everyday life situations and recover their quality of life. (CAPES).

Orientador: Jorge Luis Ferreira Abrão / Banca: Audrey Setton Lopes de Souza / Banca: Diana Pancini de Sá Antunes Ribeiro / Banca: Mary Yoko Okamoto / Banca: Viviana Carola Velasco Martinez / Resumo: Segundo o Fórum sobre Medicalização da Educação e da Sociedade, de 2005 a 2010 houve um aumento da compra do metilfenidato pelos órgãos públicos em torno de 1400%. Deste modo, contextualizar e compreender o crescente número de diagnósticos do Transtorno do Déficit de Atenção/Hiperatividade, bem como o aumento da venda de medicamentos para este transtorno, tem sido uma empreitada comum de muitos autores que se dedicam ao tema da infância. O presente trabalho visa compreender os significados e as peculiaridades da sintomatologia do TDAH, elucidando a polissemia imbricada na singularidade de cada caso particular. Os objetivos específicos foram: identificar as experiências singulares de crianças, pais e professores e entender os sentidos comunicados por suas queixas e dificuldades; apontar algumas correlações entre certos traços da nossa cultura e a atual proliferação de diagnósticos do referido transtorno. Para tanto, realizei um trabalho de psicodiagnóstico com crianças que foram encaminhadas para atendimento psicológico em uma cidade do interior paulista. Foram atendidos três casos de crianças diagnosticadas com TDAH, todas medicadas com metilfenidato e/ou outros medicamentos, as quais foram acompanhadas por médicos neuropediatras e psicólogos. Deste modo, optei por trabalhar com o método psicanalítico. Este se enquadra em um modelo de pesquisa qualitativa, visto que neste enquadre o conhecimento tem um caráter interpretativo, na medida em que é construído em um processo de atribuição de sentidos. Assim, partindo da bibliografia estudada, dos casos atendidos e do olhar psicanalítico, pude constatar que na contemporaneidade, tornou-se cada vez mais raro abster-se das tecnologias medicamentosas/biológicas para educar crianças e adolescentes. Foi frequente a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: According to the Forum of Education and Society Medicalization, from 2005 to 2010, there was an increase in the purchase of methylphenidate by public agencies, around 1400%. Thus, contextualizing and understanding the growing number of diagnoses of Attention Deficit Hyperactivity Disorder, as well as the increasing of sales of drugs for this disorder, it has been an ordinary venture of many authors who dedicate themselves to the theme of childhood. This study aims to understand the meanings and the peculiarities of the symptoms of ADHD, explaining the different meanings embedded in the uniqueness of each individual case. The specific objectives were: identifying the unique experiences of children, parentes, and teachers as well as understanding the meanings communicated by their complaints and difficulties; demonstrating some correlations between certain traits of our culture and the current proliferation of the diagnoses of the said disorder. Therefore, I performed a work of psychodiagnostic with children who were referred for psychological care in an inland city of São Paulo state. Three cases of children diagnosed with ADHD were seen, all of them medicated with methylphenidate and / or other drugs, which were accompanied by neuropediatricians and psychologists. Thus, I chose to work with the psychoanalytic method. This fits itself into a model of qualitative research, since knowledge has an interpretive character frame, as it is built on a process of assigning senses. Thus, based on the literature studied, the cases treated, and psychoanalytical study, I found out that, nowadays, it has become increasingly rare to abstain from drug/biologic technologies to educate children and teenagers. It was common the observation of lack of discrimination between parents‟ and children‟s places. The family dynamics... (Complete abstract click electronic access below) / Doutor

<div>Although some literature suggests that video games improve attention skills within the game-play, this study addressed translating this effect on attention in the real world. Research has shown video games can help people focus. Yet, there is lack of evidence displaying whether video games improve or diminish attention skills. The video game “The Inattentive Mind”, a game created for this study, used a method of overstimulation in the form of user interfaces, sound, and environmental interaction to try and help participants to empathize or improve their attention skills outside of the game. Using an experimental design of pre-test, video game intervention, and post-test, results were expected to show improved attention skills. These results did not show conclusive evidence of significant changes in attention skills. However, the results did show an increase in ADHD understanding.<br></div>

Attention Deficit Hyperactivity Disorder (ADHD) is a neuropsychiatric disability  characterised by difficulties in paying attention, excessive activity and actions without thinking about the consequenses. Symptoms vary among different individuals in how the disability expresses. Symptoms also vary among different age groups. The cause of ADHD is not yet known, but the main theory seems to be due to disturbed dopaminergic transmisson in the regions of the brain that controlls attention, activity control and impulses. Clinical studies show that there seems to be a connection between the etiology of the disability and genetic- and environmental factors. ADHD can’t be cured but a multimodal treatment has been proven to be effective in symptom reduction. The multimodal treatment consist of psychoeducation, psychotherapy and medical treatment. In Sweden methylphenidate is the first choise of drug and if it is not tolerated well by patients in terms of respons or side effects lisdexamfetamine or atomoxetin is choosen. The mechanism of action for these three substances is not completly known but in general they presume to block the reuptake of dopamine and norepinephrine in the presynaptic neurons. This leads to an enhanced transmission at the dopaminergic neurons that in turn stimulates the executive funtions that seem to be deficient in ADHD patients. The aim of this literature study is to investigate how the three substances methylphenidate, lisdexamfetamine and atomoxetine differ in therapeutic effects and side effects profile during long-term treatment for ADHD. Five scientific articles were choosen from the database Pubmed, which analysed the therapeutic effects and side effects of the above choosen drugs during a period of atleast 24 weeks. Participants in the selected studies had a definite diagnosis of ADHD and the participants included were children, adolescents and also adults. Therapeutic efficiency of selected drugs was measured by using different diagnostic scales such as ADHD-RS-IV, CAARS-Inv:SV, AISRS, CGI-S or CGI-I. Therapeutic efficiency was measured by the total reduction of the mean value in the rating scale from start to end of the study. Safety was measured at each follow up session by evaluating the side effects profile and measurements of vital parameters. These studies show statistically significant symptom reductions for all three selected drugs. The results also show differences in therapeutic effects among different drugs. Participants treated with lisdexamfetamine showed greater symptom reduction and thereby the greatest effect. There may be a difference in therapeutic effect between methylphenidate and atomoxetine but more studies are needed to conclude the results. The adverse effects were similar between lisdexamfetamine and methylphenidate but more serious effects were found during treatment with lisdexamfetamine.

L’hyperactivité du DSM est un dispositif anthropologique qui capture l’agitation de l’enfance pour naturaliser un effet de norme. Il s’agira dans un premier temps de démontrer le peu de scientificité du DSM et de la psychiatrie biologique dont il est l’instrument. L’hyperactivité est à ce propos paradigmatique ; son absence de consistance clinique en démontre la portée idéologique. La société, sous sa forme d’organisation néolibérale, tente de domestiquer l’humain à travers une normativité implacable ; la liberté de l’individu est réduite à celle d’un consentement à la norme. L’école, depuis qu’elle est obligatoire, est un des lieux stratégiques de normalisation des subjectivités. Quelles sont les caractéristiques de l’école qui relaie l’idéologie néolibérale ? Cette école est devenue école des performances ; elle produit des dispositifs pédagogiques soumis à l’idéologie de l’évaluation. Ce qui est visé là n’est plus un savoir à situer dans sa dimension sociale, mais la production de compétences/aptitudes individuelles. Ces nouveaux dispositifs pédagogiques opèrent un forçage sur la subjectivité des enfants en mécanisant le rapport au savoir. A ce forçage répond une protestation du sujet, qui peut engager le corps dans une agitation. Psychiatrie biologique et école des performances se connectent de nos jours via le paradigme du handicap, qui unifie ces deux champs, pour capter cette agitation dans les filets de l’hyperactivité. L’Autre que fait consister les dispositifs néolibéraux a un effet dé subjectivant ; il empêche le sujet de s’appuyer sur un symptôme pour trouver un appui dans la structure. Cet Autre projette le sujet du côté de la pulsion au point de ne pas pouvoir la traiter par l’opération de déchiffrement du savoir inconscient. L’agitation de l’enfant serait ainsi à situer entre symptôme et acting out. Mais reste toujours, via le transfert, à interroger la part du sujet qui est là convoqué dans son rapport à l’Autre et à la jouissance. / DSM hyperactivity is an anthropological device in so much that it captures the agitation of childhood in order to naturalize a normative effect. Hyperactivity is in this respect a paradigm of the scientisme of biological psychiatry of which DSM is the tool ; the absence of clinical substance is a testament to its ideological range. Society in its neo-liberal form has a tendency to domesticate humankind through implacable normality in which individual freedoms are reduced to normative consent. Since becoming mandatory, primary school has been one of the strategic sites of the normalisation of individual subjectivities. What are the distinctive features found in schooling that serve neo-liberal ideology ? Schooling has become the school of performances. It produces pedagogical devices subject to the ideology of evaluation. The target is no longer knowledge to be situated in a social dimension, but rather the production of individual skills and aptitudes. These new pedagogical devices force down on the subjectivity of children by making the link to knowledge a mechanical one. Such pressure meets with the subject’s protestation, which can lead to physical agitation. Today, biological psychiatry and performance led schooling connect through the paradigm of handicap, uniting the two fields and capturing agitation in the net of hyperactivity. The Other as the embodiment of neo-liberal devices has an effect on subjectivity : the subject can no longer gain support from a symptom in order to find his or her balance in the structure. Agitation in the child could therefore be situated between symptom and acting out. Nevertheless, there remains the ability to examine through transfer the part of the subject thus summoned in relation to the big Other and to jouissance.

O diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade (TDAH) apresentou um expressivo crescimento durante a última década (LEGNANI et al., 2006), tornando-se o mais frequente dos transtornos psiquiátricos tratados em jovens (ROHDE et al., 2007). Dados epidemiológicos apontam para prevalência mundial de 4% a 10% entre crianças. Os desdobramentos dessa epidemia diagnóstica não são sem efeitos para a criança e seu corpo. Temos, do lado da família e da escola, uma criança tida como insuportável, que não para e que ninguém consegue controlar; via de regra, esta última não é escutada, mas julgada a partir de seus comportamentos. O desejo tanto do lado da escola como do da família é silenciar a criança e sua agitação. E a resposta a essa demanda vai ser encontrada junto ao saber médico-científico que, consoante à lógica do discurso capitalista de mercados, que tende a simplificar para gerir, tem uma resposta clara e objetiva: trata-se de um transtorno neurobiológico que deve ser tratado via medicação e terapia cognitivo-comportamental. Essa pesquisa tem como objetivo debater de forma crítica a homogeneização da criança sob o diagnóstico de TDAH no discurso médico-científico, trazendo rigor e formalizando a discussão, tanto no âmbito clínico, em que há uma redução do sujeito e seu sofrimento a processos neuroquímicos, como no campo político, no qual a articulação entre saber e poder, evidenciada pela medicalização da existência, permanece oculta sob o véu do discurso da neutralidade científica. A partir de recortes da experiência da clínica psicanalítica de orientação lacaniana com crianças procurou-se restaurar a complexidade da leitura da produção sintomática de um sujeito, articulando-a a um modo de gozo e ao desejo do Outro. Nesse sentido foi possível formalizar que se trata de sujeitos que, de modo singular, renunciam ao seu espaço e à apropriação/subjetivação de seu corpo para gozar e servir ao gozo ao Outro. Quando consideramos o eixo político, podemos pensar a medicalização do desvio como uma construção social que evidencia um momento singular da evolução da cultura e da função social da medicina, em que o aumento do poder médico sobre a regulação de condutas e comportamentos passa a ter uma função de normalização psíquica, constituindo um novo sintoma no laço social / The diagnosis of attention-deficit hyperactivity disorder (ADHD) has showed a significant growth over the last decade (LEGNANI et al., 2006), making it the most common psychiatric disorder treated in young people (ROHDE et al., 2007). Epidemiological data indicate a global prevalence of 4 % to 10 % among children. The consequences of this epidemic of diagnosis are not without effects on the children and their body. We have, on the side of the family and school, a child seen as \"unbearable,\" unstoppable and uncontrollable. By and large, these children are not heard, but judged from their behaviour. That which the school and the family desire is to mute this children and \"their agitation.\" And the answer to this demand will be found in the medical-scientific discourse which, in line with the logic of capitalist market discourse, which tends to simplify to manage, has a clear and objective answer: it is a neurobiological disorder that should be treated via medication and cognitive behavioural therapy. The present research aims to critically discuss the homogenization of the child under the ADHD diagnosis in the medicalscientific discourse, bringing rigor and formalizing the discussion both in the clinical setting, where the subject and his suffering are reduced to neurochemical processes, and in the political field, in which the relationship between knowledge and power, as evidenced by the medicalization of existence, remains hidden under the veil of the discourse of scientific neutrality. Based on the experience of clippings of Lacanian psychoanalytic clinical guidance with children, we sought to restore the complexity of reading a symptomatic production of a subject, linking it to a mode of enjoyment and desire of the Other. In this sense, it was possible to formalize that these subjects who, in a unique way, give up their space and the appropriation/subjectivization of their body to enjoy and serve the jouissance of the Other. In relation to the political axis, we can consider the medicalization of deviance as a social construct that reflects a unique moment in the evolution of culture and the social function of medicine, in which the increased medical power over the regulation of conduct and behaviour acquires a function of psychic standardization, thereby creating a new symptom in the social bond