A medicalização da educação: implicações para a constituição do sujeito/aprendiz

Resumo O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) gera controvérsias entre os pesquisadores da área da saúde. A corrente organicista defende que o transtorno seria decorrente de uma desordem neurobiológica, de origem genética. Contrariando o paradigma hegemônico, pesquisadores alinhados à vertente sócio-histórica entendem o TDAH como parte de um fenômeno denominado medicalização da educação. Este estudo pretende refletir sobre a construção social do TDAH (da entrada na escola ao diagnóstico médico) e suas implicações para a subjetividade, socialização e aprendizagem do aluno considerado resistente ao que a escola propõe. Esta pesquisa se constitui em análise de caso, pesquisa de campo, qualitativa, do tipo transversal, inserida em um paradigma teórico-metodológico de cunho sócio-histórico (BAKHTIN, 2006; VYGOTSKY, 2010). Para análise da história de uma criança de 10 anos de idade e com diagnóstico de TDAH, foram realizadas entrevistas com professores, com a mãe e com a criança, observação em sala de aula, avaliação fonoaudiológica e pesquisa documental (material pedagógico, pareceres avaliativos das escolas frequentadas pela criança, pareceres de profissionais de saúde etc.). Os resultados apontam que, quando se investiga em profundidade a qualidade das interações sociais em que a criança esteve/está inserida, é possível que se compreendam as bases socioeducacionais que constituem o suposto transtorno

Association between relative age at school and persistence of attention-deficit hyperactivity disorder in prospective studies: an individual participant data meta-analysis SIMBA study group

Background The youngest children in a school class are more likely than the oldest to be diagnosed with ADHD, but this relative age effect is less frequent in older than in younger school-grade children. However, no study has explored the association between relative age and the persistence of ADHD diagnosis at older ages. We aimed to quantify the association between relative age and persistence of ADHD at older ages. Methods For this meta-analysis, we searched MEDLINE, Embase, CINAHL, PsycINFO, and PubPsych up to April 1, 2022, with terms related to “cohort” and “ADHD” with no date, publication type, or language restrictions. We gathered individual participant data from prospective cohorts that included at least ten children identified with ADHD before age 10 years. ADHD was defined by either a clinical diagnosis or symptoms exceeding clinical cutoffs. Relative age was recorded as the month of birth in relation to the school-entry cutoff date. Study authors were invited to share raw data or to apply a script to analyse data locally and generate anonymised results. Our outcome was ADHD status at a diagnostic reassessment, conducted at least 4 years after the initial assessment and after age 10 years. No information on sex, gender, or ethnicity was collected. We did a two-stage random-effects individual participant data meta-analysis to assess the association of relative age with persistence of ADHD at follow-up. This study was registered with PROSPERO, CRD42020212650. Findings Of 33 119 studies generated by our search, we identified 130 eligible unique studies and were able to gather individual participant data from 57 prospective studies following up 6504 children with ADHD. After exclusion of 16 studies in regions with a flexible school entry system that did not allow confident linkage of birthdate to relative age, the primary analysis included 41 studies in 15 countries following up 4708 children for a period of 4 to 33 years. We found that younger relative age was not statistically significantly associated with ADHD persistence at follow-up (odds ratio 1·02, 95% CI 0·99–1·06; p=0·19). We observed statistically significant heterogeneity in our model (Q=75·82, p=0·0011, I2=45%). Participant-level sensitivity analyses showed similar results in cohorts with a robust relative age effect at baseline and when restricting to cohorts involving children with a clinical diagnosis of ADHD or with a follow-up duration of more than 10 years. Interpretation The diagnosis of ADHD in younger children in a class is no more likely to be disconfirmed over time than that of older children in the class. One interpretation is that the relative age effect decreases the likelihood of children of older relative age receiving a diagnosis of ADHD, and another is that assigning a diagnostic label of ADHD leads to unexplored carryover effects of the initial diagnosis that persist over time. Future studies should be conducted to explore these interpretations further.publishedVersio