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

Abstract Attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorder (DBD) are two very common and co-occurring psychiatric disorders among children and adolescents. They are among the leading reasons for clinical referrals to child and adolescent mental health facilities worldwide and have many unfavorable consequences with a high cost to society. In this thesis, the potential early risk factors associated with ADHD and/or DBD were examined, the current well-being of the adolescent with ADHD and/or DBD was evaluated and the later education and the psychiatric morbidity of the adolescent were researched. The study population in this thesis is based on a subsample of the Northern Finland Birth Cohort 1986 (NFBC 1986) containing 457 study subjects, of which 91 (19.9%) were diagnosed with ADHD, 44 (9.6%) with DBD, 72 (15.6%) with comorbid ADHD and DBD and 250 (54.7%) with neither of these disorders. Confirmatory factor analysis, Kaplan-Meier survival analysis, Kruskal-Wallis one-way analysis of variance and several regression analyses were carried out in the study. This thesis contains four original publications. The results in the first publication indicated that there are different risk factors in childhood associating with different behavioral problems in adolescence. The differences between behavioral problems were also visible in the results of the second publication, where those adolescents who were diagnosed with both ADHD and DBD had more severe conduct disorder symptoms and had increased risks for many psychiatric disorders. The results from the third publication suggested that those adolescents who were diagnosed with both ADHD and DBD fared worse in school at the end of ninth grade and were later less likely to achieve higher than basic education. Finally, the fourth publication showed that the adolescents diagnosed with DBD (both with and without ADHD) seemed to have an increased risk for admittance to the psychiatric inpatient hospital. This thesis underlines the differences between children and adolescents diagnosed with ADHD and/or DBD and emphasizes the role of comorbidity between these disorders as an indicator of poorer outcomes later in life. / Tiivistelmä Tarkkaavaisuus- ja ylivilkkaushäiriö (attention deficit hyperactivity disorder, ADHD) sekä käytös- ja uhmakkuushäiriöt (disruptive behavior disorder, DBD) ovat hyvin yleisiä – ja usein yhtä aikaa ilmeneviä – lasten ja nuorten psyykkisiä häiriöitä. Nämä häiriöt ovat hyvin usein syynä lasten ja nuorten psykiatristen terveyspalveluiden käyttöön. Niillä on myös todettu olevan useita epätoivottuja seurauksia, joiden hoitaminen puolestaan nostaa yhteiskunnan kuluja. Tämä väitöskirjatyö tutkii mahdollisia varhaisia riskitekijöitä, jotka assosioituivat ADHD- ja/tai DBD-häiriöiden kanssa, arvioi näillä häiriöillä diagnosoitujen nuorten sen hetkistä hyvinvointia ja tutkii näiden nuorten kouluttautumista sekä muuta psykiatrista sairastavuutta. Tutkimusaineisto koostuu Pohjois-Suomen syntymäkohortti 1986 (Northern Finland Birth Cohort 1986, NFBC 1986) -aineiston osaotoksesta, johon kuuluu 457 henkilöä. Osaotoksesta 91:llä (19,9 %) oli diagnosoitu ADHD, 44:llä (9,6 %) DBD ja 72:lla (15,6 %) komorbidi ADHD ja DBD. 250 henkilöllä (54,7 %) osaotoksesta ei ollut diagnosoitu kumpaakaan diagnoosia. Aineiston analysoinnissa käytettiin konfirmatorista faktorianalyysiä, Kaplan-Meierin elossaolomenetelmää, Kruskal-Wallisin yksisuuntaista varianssianalyysiä ja useita regressioanalyysejä. Tämä väitöskirja koostuu neljästä osajulkaisusta. Ensimmäisen osajulkaisun tulokset osoittivat, että eri riskitekijät lapsuudessa assosioituivat eri käytösongelmiin nuoruudessa. Eri käytösongelmien eroavaisuudet olivat myös nähtävillä toisessa osajulkaisussa: niillä nuorilla, joilla oli diagnosoitu komorbidi ADHD ja DBD, todettiin olevan vakavampia käytöshäiriöiden oireita sekä kohonnut riski useisiin muihin psykiatrisiin sairauksiin. Kolmannen osajulkaisun tulokset viittasivat näiden nuorien, jotka oli diagnosoitu komorbidillä ADHD:lla ja DBD:llä, pärjäävän huonommin koulussa ja valmistuvan muita todennäköisemmin vain peruskoulusta. Lopuksi neljännessä osajulkaisussa todettiin, että DBD diagnoosin nuorena saaneilla (riippumatta ADHD diagnoosista) näytti olevan kohonnut riski psykiatriseen osastohoitoon joutumiselle. Tämä väitöskirjatyö alleviivaa tarkkaavaisuus- ja ylivilkkaushäiriöllä sekä käytös- ja uhmakkuushäiriöillä diagnosoitujen lasten ja nuorten eroavaisuuksia ja korostaa kyseisten häiriöiden komorbidin ilmenemisen roolia huonon lopputuloksen ennustetekijänä myöhemmin nuoren elämässä.

AFRIKAANS: In hierdie navorsing is deur aksienavorsing ondersoek ingestel na strategieë wat vir opvoeders bruikbaar is in die hantering van leerders met emosionele en gedragsbehoeftes binne die opset van insluitende onderwys. Leerders in Suid-Afrikaanse skole en klaskamers openbaar ʼn wye verskeidenheid emosionele en gedragsbehoeftes, en hierdie behoeftes word as een van die vernaamste knelpunte deur alle belanghebbendes in die land se onderwys uitgesonder. Anders as in die verlede word daar nou van opvoeders verwag om die primêre hulpverleners te wees van leerders met behoeftes in die konteks van die insluitende klaskamer. In die lig hiervan benodig opvoeders bemagtiging om die leerders te hanteer deur ’n verskeidenheid strategieë te kan gebruik. Die navorsing het deur verskeie fases verloop waar die aanvanklike behoeftes van die opvoeders bepaal is, asook die stand van sake voor die intervensie. Op grond hiervan is ʼn implementeringsprogram saamgestel wat gefokus het op die ontwikkeling van strategieë vir opvoeders van die twee skole, die toepassing daarvan in hul klasse/skool en die effek wat dit op die klasse/skool gehad het. Die implementering is op verskeie sistemiese vlakke gemoniteer – deur die opvoeders in hul eie klasse, maar ook deur eksterne waarnemers en die navorser. Gedurende die fases is die intervensie voortdurend aangepas namate nuwe behoeftes bekend geraak het. Die deelnemers het ook insette gelewer ten opsigte van strategieë en hoe dit aangepas kon word. Nuwe gemeenskaplike kennis van strategieë het tydens die intervensie ontstaan. Na afloop van die program het opvoeders die strategieë vir die hantering van leerders met emosionele en gedragsbehoeftes kwantitatief beoordeel, op grond van die bruikbaarheid daarvan in die skool- en klasopset. Uit my bevindinge het dit geblyk dat opvoeders bemagtiging benodig om met leerders met emosionele en gedragsbehoeftes te werk. Die indiensopleidings-program waaraan 47 opvoeders van twee skole deelgeneem het, het daartoe bygedra dat die opvoeders se ingesteldheid teenoor leerders verander het. Na die opleiding was hulle bekend met meer strategieë om leerdergedrag te hanteer en het ‘n gevoel van sukses beleef in die klas, wat bygedra het tot ‘n positiewe belewenis van die klassituasie. Van die strategieë wat as die bruikbaarste beoordeel is, het gehandel oor klaskamerpraktyke en strategieë om taakgerigtheid te bevorder. Ander strategieë het aspekte rondom skoolbestuur en ondersteuning aan ouers ingesluit. Enkele opvoeders het ook meer gevorderde strategieë, soos kognitiewe en gedragstegnieke gebruik. Opvoeders het positiewe reaksie aangemeld van leerders waar die strategieë toegepas is. Hierdie studie is deur ‘n proses van aksienavorsing uitgevoer en kwalitatiewe en kwantitatiewe navorsingsmetodes is gebruik. Die resultate is van toepassing binne hierdie bepaalde konteks. Volgens die navorser kan hierdie opleidingsprogram aangepas word om aan die behoefte vir indiensopleiding vir opvoeders te voorsien. Opleiding kan moontlik fokus op ʼn kleiner aantal strategieë wat deeglik ingeoefen en vasgelê kan word. Dit is verkieslik dat al die personeel van ‘n skool, insluitend die skoolbestuurspan, aan die opleiding moet deelneem om dit ‘n skoolontwikkelingsprojek te maak. Deur twee skole op verskillende vlakke van implementering saam op te lei, kan opvoeders mekaar stimuleer en kan die toepassing van idees bevorder word. ENGLISH: Learners who exhibit emotional and behavioural needs (e.g. ADHD and depression conduct disorder) seem to present a major challenge for educators in the inclusive mainstream class and educators feel that they are not adequately prepared and trained for these challenges. Action research was chosen as research method. The purpose of this research was to useful strategies which educators could implement in supporting and managing these learners, in the inclusive classroom environment. Learners with emotional and behavioural needs exhibit a wide variety of behaviours at school. In the inclusive education environment educators are expected to be the primary supporters of learners with needs. Although this expectation exists, up till now educators have received little or no training on how to support learners with needs. The research process conducted in this study followed different phases. Firstly, a needs analysis was conducted to determine the current state of affairs, the needs of educators, and strategies currently in use. Information that became evident through the needs analysis and literature research prescribed the format and aspects to be included in the initial intervention programme. During the execution of this programme, current strategies were adapted and new ones developed. Needs that came to the fore during the implementation were recognised and incorporated. The implementation was monitored on different levels, for example by teachers who implemented the strategies in their classrooms and provided feedback, by the researcher, and also by external observers. The focus was not only on the strategies, but also on processes. Changes that were observed in the different systems were assessed. During the final step of the implementation phase, educators, based on their practical experience, were required to rate the usefulness of all the different strategies that were either part of the initial presentation or were generated during the course of implementation. The qualitative as well as quantitative findings indicated that the educators became more capable of supporting these learners and implemented a wide variety of strategies. Classroom management strategies and strategies to support task behaviour were found to be the most helpful. Educators also gained more than merely knowledge. Changes in the relationship between educators and these learners were noticeable and they became aware of feelings of personal achievement and competency. Changes also occurred at other systemic levels, such as in the learners, the school, the community and even in the broader education system. This study was undertaken on a small group of educators in a particular context. Whilst the findings cannot be generalised, it is suggested that this programme may also be beneficial for educators to support learners with emotional and behavioural needs in other environments. / Thesis (DPhil)--University of Pretoria, 2010. / Psychology / unrestricted