• Presentation - Concepts, trajectories, and approaches to “agitation” and “non-conforming children”: social and cultural experiences in Brazil, Chile and France Dossier

    Cottet, Pablo; Béliard, Aude; Nakamura, Eunice
  • Problematic, disturbing and non-conforming children’s behaviors: the concepts and care demands related to agitation in children in Santos and Campinas, Brazil Dossier

    Nakamura, Eunice; Barbarini, Tatiana

    Abstract in Portuguese:

    Resumo Este artigo se inicia com um questionamento sobre as consequências sociais da impossibilidade de delimitar o conceito de transtorno mental, o qual parece ser um termo “vago”, sem definições satisfatórias, sobretudo quando associado a comportamentos infantis. Argumenta-se que, para pensar os comportamentos infantis problemáticos, perturbadores ou não conformes, é necessário entender quais são os conceitos relacionados às categorias classificatórias dos comportamentos infantis e apresentados como demandas de cuidado, tanto no discurso do senso comum quanto no discurso biomédico. Os dados foram coletados a partir de pesquisas qualitativas desenvolvidas em três diferentes serviços de saúde mental infantil, um em Santos (2012) e dois em Campinas (2009-2010 e 2017-2018). Baseado no que parece ser uma relação entre disfunção biológico-psicológica e expectativa ou resposta sociocultural, toma-se como ponto de partida a agitação como uma categoria multidimensional e vaga, apresentando-se uma descrição e reflexão teórica sobre os vários conceitos relativos à agitação. A análise é centrada nos diferentes usos dos conceitos de agitação, os atores sociais e instituições envolvidos nas demandas de cuidado e as formas como eles estão interdependentemente conectados. Por fim, revela, a partir de uma perspectiva sociocultural, as implicações de classificar e definir o comportamento infantil com base em uma categoria vaga.

    Abstract in English:

    Abstract This article discusses the social consequences of the impossibility of specifically defining the boundaries of the concept of mental disorder, which seems to be a “vague” term with no satisfactory definition, especially when referred to children’s behaviors. We argue that when discussing children’s problematic, disturbing or non-conforming behaviors it is necessary to understand how these concepts are related to the classificatory categories of children’s behaviors and presented as care demands, whether in common sense or in biomedical discourses. Data were collected in qualitative research developed in three different child mental health services (CMHS), one in Santos (2012) and two in Campinas (2009-2010; 2017-2018), Brazil. Based on what seems to be a relation between biological-psychological dysfunction and social-cultural expectation or response, our starting point is that agitation is also a multidimensional and vague category, presenting a description and theoretical reflection about the various concepts regarding agitation. The analysis focuses on the different uses of the concepts of agitation; the social actors and institutions involved in care demands and how they are interdependently connected; then revealing, from a sociocultural perspective, the implications of classifying and defining children’s behavior from this vague category.
  • Against the tide: psychodynamic approaches to agitated childhood in France, between crisis and resistance Dossier

    Borelle, Céline; Eideliman, Jean-Sébastien; Fansten, Maïa; Planche, Maëlle; Turlais, Amélie

    Abstract in French:

    Résumé La psychanalyse est-elle en crise ? Ce thème s’est avéré récurrent dans les propos des professionnels travaillant selon une orientation psychanalytique que nous avons croisés lors d’une enquête collective sur les trajectoires des enfants considérés comme agités en France. Durant cette recherche, nous avons mené des entretiens avec des enfants et leur entourage, avec des professionnels travaillant dans des centres de soin, des écoles et des Maisons départementales des personnes handicapées ; nous avons également conduit des observations et recueilli des données dans des centres de soin. Dans ces lieux, nous avons observé une diversité de pratiques, mais dont une nette majorité se revendiquait de manière plus ou moins stricte de la psychanalyse, ou plus largement d’approches psychodynamiques. Après avoir présenté quelques principes qui fondent l’approche psychodynamique de l’agitation, l’article revient sur le sentiment de crise que manifestent les professionnels rencontrés et sur les raisons qui peuvent en être à l’origine. Un détour par une analyse réflexive de nos relations d’enquête permet de mieux mettre en lumière les conséquences de ce climat sur le travail quotidien en général et sur les relations avec les partenaires institutionnels en particulier.

    Abstract in English:

    Abstract Is psychoanalysis in crisis? This theme turned out to be recurrent in the comments of professionals working with a psychoanalytical orientation that we encountered during a collective survey on the trajectories of children considered as agitated in France. During this research, we conducted interviews with children and their families, with professionals working in care centres, schools and public administration; we also conducted observations and collected data in care centres. In these places, we observed a diversity of practices, but a clear majority of which claimed to be more or less strictly psychoanalytical or more broadly psychodynamic approaches. After presenting some principles that underlie the psychodynamic approach of agitation, the article discusses the crisis feeling expressed by the professionals met and the reasons that may have caused it. A detour through a reflective analysis of our investigative relationships helps to shed more light on the consequences of this climate on daily work in general and on relations with institutional partners in particular.
  • Rethinking medicalization: discursive positions of children and their caregivers on the diagnosis and treatment of ADHD in Chile Dossier

    Reyes, Pablo; Cottet, Pablo; Jimenez, Alvaro; Jauregui, Gabriela

    Abstract in Spanish:

    Resumen Los debates en torno al diagnóstico y tratamiento farmacológico del Trastorno de Déficit Atencional e Hiperactividad (TDAH) han sido tradicionalmente abordados desde la perspectiva de los “procesos de medicalización” del comportamiento infantil. Sin embargo, esta perspectiva tiende a pasar por alto los sentidos y significaciones del diagnóstico y tratamiento del TDAH para los niños y sus cuidadores. El objetivo de este artículo es describir las posiciones discursivas de niños y de sus cuidadores sobre el diagnóstico y tratamiento farmacológico del TDAH. Se realizaron entrevistas en profundidad a siete niños chilenos y a sus cuidadores. El material fue analizado siguiendo los procedimientos del análisis estructural del discurso. Se identificó una estructura discursiva que configura cuatro realidades emergentes: el mito de origen de los problemas de comportamiento y de aprendizaje del niño; las ambivalencias en/de la medicalización; el proceso de (des)estabilización identitaria bajo el diagnóstico y tratamiento; y la subversión de la medicalización. Se observa que la experiencia subjetiva del diagnóstico y tratamiento del TDAH no es homogénea, dado que se encuentra atravesada por distintas posiciones discursivas, comprensiones familiares e institucionales que entran en conflicto. Las experiencias del diagnóstico y tratamiento del TDAH se encuentran modeladas por estructuras discursivas que condicionan las posibilidades de dar sentido a dicha experiencia. El proceso de medicalización no es unívoco, sino que puede asumir formas diferentes y tener consecuencias diversas sobre las experiencias y trayectorias sociales de niños y niñas.

    Abstract in English:

    Abstract The debates around the diagnosis and pharmacological treatment of Attention Deficit and Hyperactivity Disorder (ADHD) have traditionally been approached from the perspective of the “medicalization processes” of children’s behaviour. However, this perspective tends to overlook the meanings of diagnosis and treatment of ADHD for children and their caregivers. The purpose of this article is to describe the discursive positions of children and their caregivers on the diagnosis and treatment of ADHD. In-depth interviews were conducted with seven Chilean children and their caregivers. The material was analysed following the procedures of the discourse structure analysis. A discursive structure was identified that configures four emerging realities: the myth of origin of the child’s behaviour and learning problems; the ambivalences in/of medicalization; the process of identity (dis)stabilization under diagnosis and treatment; and the subversion of medicalization. It is observed that the subjective experience of the diagnosis and treatment of ADHD is not homogeneous, since different discursive positions, family and institutional understandings that enter into conflict cross it. The experiences of ADHD are shaped by discursive structures that condition the meanings of this experience. The medicalization process is not univocal, but can take different forms and have consequences on children’s experiences and social trajectories.
  • The multiple meanings of ADHD: between deficit, disruption and hidden potential Dossier

    Béliard, Aude; Jiménez-Molina, Álvaro; Díaz-Valdés, Javiera; Goff, Alice Le; Mougel, Sarra; Sir, Hugo

    Abstract in Portuguese:

    Resumo O objetivo deste artigo é descrever a experiência subjetiva do diagnóstico de Transtorno do Déficit de Atenção com Hiperatividade (TDAH) e os significados culturais que moldam essa experiência. Com base em entrevistas e grupos de discussão com pessoas diagnosticadas e suas famílias no Chile e na França, este artigo demonstra que diversos significados podem ser atribuídos ao TDAH. A partir de análise temática, foram identificados três registros ou modos de viver e pensar TDAH. No registro déficit, o transtorno é vivenciado primariamente como falha de certas habilidades. No registro distúrbio, o transtorno é vivenciado como uma perturbação da vida pessoal, personalidade e interações que necessita ser normalizada. No registro de potencial oculto, foco deste artigo, TDAH é considerado simultaneamente condição difícil e valiosa, fonte de capacidades excepcionais que estão habitualmente ocultas no andamento comum da vida social. Portanto, propõe-se refletir e identificar os fatores de mobilização e não mobilização do registro de potencial oculto, com particular ênfase não só nas configurações relacionais, variáveis socioeconômicas e de gênero, mas também no contexto institucional e político de cada país.

    Abstract in English:

    Abstract The purpose of this article is to describe the subjective experience of the diagnosis of Attention Deficit and Hyperactivity Disorder (ADHD) and the cultural meanings that shape this experience. Based on interviews and discussion groups with diagnosed people and their families in Chile and France, this article show that ADHD can acquire multiple meanings. From a thematic analysis, we identified three registers or ways of living and thinking about ADHD. In the deficit register, the disorder is experienced primarily as a failure of certain abilities. In the disruption register, the disorder is experienced as disrupting the person’s life, personality and interactions, which must then be normalized. In the register of hidden potential, on which this article focuses, ADHD is simultaneously thought of as a difficult and valuable condition, a source of exceptional capacities that are often hidden in the ordinary functioning of social life. We therefore invite reflection that identifies the factors of mobilization or non-mobilization of the hidden potential register, with particular emphasis not only on relational configurations, socio-economic variables, and the gender variable, but also on the institutional and political context of each country.
  • ADHD and Gender: subjective experiences of children in Chile Dossier

    Uribe, Pía; Abarca-Brown, Gabriel; Radiszcz, Esteban; López-Contreras, Eleonora

    Abstract in Spanish:

    Resumen Si bien las investigaciones sobre TDA-H han tendido a dejar los aspectos diferenciales de género en un lugar secundario, recientes contribuciones emanadas principalmente desde la epidemiología han revelado que esta categoría diagnóstica parece estar fuertemente relacionada con el reparto de los géneros. Sin embargo, dichas contribuciones parecen limitar sus alcances al estudio de la sintomatología y funcionamiento cognitivo, afectivo y social de los(as) niños(as), dejando de lado aspectos subjetivos asociados a las prácticas de diagnóstico y tratamiento de TDA-H. De este modo, el objetivo de este artículo es explorar cómo la dimensión de género configura la experiencia subjetiva de niños(as) diagnosticados(as) con TDA-H. A partir de la realización de entrevistas abiertas realizadas a niños entre 7 y 13 años, damos cuenta de tendencias generales que articulan género y características asociadas al diagnóstico de TDA-H, a la vez que, con experiencias infantiles que dislocan tales tendencias. Los resultados se agruparon en función de cuatro dimensiones emergentes del material producido en las entrevistas: (1) localizaciones; (2) habilidades; (3) abordajes; (4) interacciones. Así, mostraremos cómo la experiencia de niños y niñas es múltiple en relación al diagnóstico y no es posible reducirla a una perspectiva binaria en torno al género.

    Abstract in English:

    Abstract Although research on ADHD has tended to ignore gender differentials, recent contributions produced mainly from epidemiology have revealed that this diagnostic category seems to be strongly related to gender. However, these contributions seem to limit their scope to the study of the symptoms as well as cognitive, affective and social functioning of children, leaving aside subjective aspects associated with the ADHD practices of diagnosis and treatment. Thus, this article aims to explore how the gender dimension crosses the subjective experience of children diagnosed with ADHD. Based on open interviews conducted with children between the ages of 7 and 13, we show general trends that articulate gender and characteristics associated with the ADHD diagnosis, while at the same time, with children’s experiences that dislocate such trends. The findings were grouped according to four emerging axes: (1) locations, (2) abilities, (3) approches, (4) interactions. Thus, we will show how the experience of boys and girls is multiple in relation to the diagnosis and it is not possible to be reduced to a gender binary perspective.
Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. SP - Brazil
E-mail: saudesoc@usp.br