When the
complaint is Attention Deficit Hyperactivity Disorder
Quando a queixa é Transtorno de Déficit de
Atenção e Hiperatividade
Cuando la queja
es Trastorno por Déficit de Atención e Hiperactividad
Maria Lidia
Sica Szymanski[i]
Western Paraná State University
Cascavel, Brazil
https://orcid.org/0000-0003-1641-8527
Andrise Teixeira[ii]
Western
Paraná State University
Cascavel, Brazil
https://orcid.org/0000-0001-6135-453X
The authors contributed
equally to the elaboration of the manuscript.
Received in:
09/30/2021
Accepted in:
02/17/2022
Published in: 02/23/2022
Linhas Críticas | Journal edited by the Faculty of Education of the University of
Brasília, Brazil
ISSN: 1516-4896 | e-ISSN: 1981-0431
Volume 28, 2022 (jan-dec).
http://periodicos.unb.br/index.php/linhascriticas
Full reference (APA):
Szymanski, M. L. S., & Teixeira, A.
(2022). When the complaint is Attention
Deficit Hyperactivity Disorder. Linhas Críticas, 28, e40200.
https://doi.org/10.26512/lc28202240200
Alternative link:
https://periodicos.unb.br/index.php/linhascriticas/article/view/40200
Creative
Commons license CC BY 4.0.
Abstract: The Attention Deficit Hyperactivity Disorder (ADHD)
emerges as a justification for problems in schooling, often resulting from a
quick and superficial evaluation. The variation in the number of ADHD reports
between 2015 and 2020 in public schools was investigated, showing an increase
of 594%. The biologizing conception of ADHD is questioned, the consequence of
which is medicalization. It proposes the development of attention and voluntary
control of behavior in the set of psychological functions. The importance of
planning based on the cultural-historical conception is pointed out, as well as
the urgency of public investment in teacher qualification.
Keywords: Teaching and
learning processes. Medicalization. Attention Deficit Hyperactivity Disorder. Special Education.
Resumo: O Transtorno do Déficit de Atenção e
Hiperatividade (TDAH) emerge como justificativa para problemas na
escolarização, sendo muitas vezes resultado de uma avaliação rápida e
superficial. Diante disso, neste estudo, investigou-se a variação no número de
laudos de TDAH, entre 2015 e 2020, em escolas públicas, constatando-se um
aumento de 594%. Questiona-se a concepção biologizante do TDAH, cuja
consequência é a medicalização. Propõe-se o desenvolvimento da atenção e do controle
voluntário do comportamento no conjunto das funções psicológicas. Aponta-se a
importância de um planejamento fundamentado na concepção histórico-cultural e a
premência de investimento público na qualificação docente.
Palavras-chave: Processos de ensino e de aprendizagem. Medicalização. Transtorno
de Déficit de Atenção e Hiperatividade. Educação Especial.
Resumen: El Trastorno por Déficit de Atención con Hiperactividad
(TDAH) surge como justificación de los problemas en la escolarización, siendo
muchas veces el resultado de una evaluación rápida y superficial. Se investigó
la variación en el número de reportes de TDAH, entre 2015 y 2020, en escuelas
públicas, observándose un aumento del 594%. Se cuestiona la concepción
biológica del TDAH, cuya consecuencia es la medicalización. Se propone el
desarrollo de la atención y el control voluntario de la conducta en el conjunto
de funciones psicológicas. Se destaca la importancia de la planificación basada
en la teoría histórico-cultural, así como la urgencia de la inversión pública
en la formación docente.
Palabras
clave: Procesos de enseñanza y aprendizaje. Medicalización. Trastorno por
Déficit de Atención e Hiperactividad. Educación especial.
The constant
complaints from teachers regarding attention and indiscipline in elementary and
high school reveal that it is common for teachers to refer students to medical
services, describing behaviors such as excessive agitation, inability to
maintain attention, and difficulty in self-regulation. These referrals result,
in most cases, in reports of Attention Deficit
Hyperactivity Disorder (ADHD; in portuguese
language, Transtorno do Déficit
de Atenção e Hiperatividade
- TDAH).
However, this
diagnosis has been made and described ignoring the cultural and social barriers
that permeate the regulation of attention, disregarding the development of the
individual and his higher psychological functions (HPF; in portuguese language Funções
Psicológicas Superiores
- FPSs) in their entirety (Caliman, 2008). And what
until the last decade of the twentieth century was, with rare exceptions,
considered a passing, childhood disorder, is now classified as ADHD, a
psychiatric disorder that may constitute a lifetime label (Caliman
& Domitrovic, 2013).
There are
controversies in the analysis of this issue, which are based on the conception
of man, the world, and the society that supports them. Therefore, it highlights
the importance of reflections and research on this issue, which, in addition to
its pedagogical consequences, brings social and economic impacts.
The education of
people with disabilities in Brazil was marked, until the twentieth century, by
the denial of access to any form of systematized school education and,
subsequently, by the assistentialist service in
segregated services, organized as a substitute for common education (Capellini
& Mendes, 2007). The overcoming of this excluding schooling process, which
hurt the constitutional precepts, occurred from the struggle against
traditional hegemonic conceptions, based on the understanding of psychic
development with emphasis on the biological aspect.
From the nineties
of the last century, following the international movement for inclusion, which
"[...] has as its precepts the right of everyone to attend regular school
and the appreciation of diversity" (Alves & Guareschi,
2012, p. 33), the concern with inclusive practices began to take shape in
Brazil (Mendes et al., 2011). At the same time, the neurological interpretation
of the disorder became widely accepted and the world witnessed an explosion of
publicity about ADHD and its medicalization (Eidt
& Tuleski, 2010), as well as the exacerbation of
this type of teacher complaint.
Against this
perspective, studies based on the Cultural-Historical Theory sought to question
the neurobiological perspective, anchored in the understanding that social and
historical laws are more determinant in human development than biological laws,
given the plasticity of the neurological system and the way the learning
process occurs, which determines this development (Leontiev,
1978).
At the threshold
of the third decade of the 21st century, about four decades have passed since
the ADHD publicity explosion. Many studies have been developed, sometimes
defending the neurobiological perspective, sometimes criticizing it, and
proposing a primarily pedagogical understanding of the issue[3].
From the legal
point of view, the Operational Guidelines for Specialized
Education Care (SEC; in portuguese language Atendimento
Educacional Especializado
- AEE) at the national level were regulated by Resolution No. 04/2009
(Brazil, 2009, p. 1), which assigns as its purpose, "[...] complement or
supplement the student's education through the provision of services,
accessibility resources, and strategies that eliminate barriers to their full
participation in society and development of their learning.
It should be
noted that Article 4 of Resolution No. 04/2009 (Brazil, 2009) excludes students
diagnosed with specific functional disorders, among them ADHD and others,
previously considered by Resolution No. 02/2001 (Brazil, 2001) as subjects
entitled to SEC. However, in the State of Paraná, Deliberation No. 02/2016
(Paraná, 2016) and Instruction No. 09/2018 (Paraná, 2018a) set standards for
serving public students in Special Education, including students diagnosed with
ADHD, in Multifunctional Resource Rooms (MRR; portuguese language Sala de Recurso
Multifuncional - SRM). The “[…] literature
points out that the teacher's role is to help diagnose possible disorders that
interfere with learning, one of them being ADHD” (Santos, 2019, p. 9). As a
hypothesis, it is assumed that if the teacher refers students for evaluation
with a suspicion of ADHD, it is because he expects clinical help to deal with
this situation, most often medication, given the explosion in sales of drugs
with methylphenidate as a basic component. The survey conducted in drugstores
in Brazil, from 2007 to 2012, “[…] proved that the growth was 50% in sales in
four years, between September 2007 and October 2008 were sold 1,238,064 boxes,
and between September 2011 and October 2012 1,853,930 boxes” (Andrade et al.,
2018, p. 109).
On the other hand, if the emphasis is placed on the
clinical aspect, it means that the pedagogical aspect is not being given the
necessary importance in dealing with this issue. Thus, this research is
justified to reflect on the current alternatives for the understanding of this
disorder. From this intention, two objectives are derived: 1- To quantify the
variation in the number of enrollments of students diagnosed with ADHD in the
state public school system, from 2015 to 2020, through the analysis of data
from the School Registration System (SRS-PR; in portuguese
language Sistema de Registro Escolar – SERE-PR).
2- To investigate which material the Special Education teacher uses to plan and
organize his work with students with ADHD.
Initially, we will briefly present the biologizing
conception that often underlies the complaint of ADHD and then question it
based on the Cultural-Historical Theory.
Next, we present data from field research to verify to
what extent the teacher complaint about ADHD still exists and to investigate
how the enrollment of students with this condition has evolved in the last five
years.
Research is then presented analyzing, from the
individual assessment and the guidance provided by the specialized pedagogical
team that works in the Regional Teaching Center of Cascavel
(PR), regarding the students indicated by the teacher with suspected ADHD, how
this assessment has been received by teachers in the state public network and
to what extent the teacher uses it to organize his planning and consequently
the pedagogical work.
We conclude by reflecting, considering the results of
the field research, on the pedagogical consequences of the analyzed
conceptions, resuming the initial problematization, i.e., which of the two
conceptions that circulate in the school and academia has been the basis of the
teacher's teaching activity.
Theoretical divergences: the naturalizing conception
In the naturalizing conception ADHD, like other disorders, is understood
as a mental disorder whose causes would have biological origin and would
manifest as early as Kindergarten, and as a disorder requires a psychiatric
approach, and may last throughout life. According to the DSM-5 (American
Psychiatric Association, 2014, p. 32, emphasis added):
ADHD is a neurodevelopmental disorder defined by impairing levels of
inattention, disorganization, and/or hyperactivity-impulsivity. Inattention and
disorganization involve inability to stay on task, appearance of not
listening, and loss of materials at levels inconsistent with age or
developmental level. Hyperactivity-impulsivity involve excessive activity,
restlessness, inability to remain seated, intrusion into the activities
of others, and inability to wait-symptoms that are excessive for
age or developmental level. In childhood, ADHD often overlaps with disorders
generally considered "externalizing" such as oppositional defiant disorder
and conduct disorder. ADHD often persists into adulthood, resulting in
impairments in social, academic, and occupational functioning.
This definition presents a description of observable symptoms. The term
disability is mentioned several times, and the electronic dictionary of the
Portuguese language puts capacity as a synonym for: propensity, predisposition,
tendency, inclination, aptitude, vocation, terms that suggest something a
priori of birth (Dicionário Online de Português, 2022).
According to this conception, a child who presents unwanted behaviors,
such as marked restlessness and/or inattention, would have a disorder, since it
would be normal for the child to follow the teaching guidelines at school.
Thus, the complaint involving such disorders would justify the referral to
specialized centers of pediatric psychology and neurology.
It is also interesting to check the DSM-5 guidance on
"diagnosis" (American Psychiatric Association, 2014, p. 22, emphasis
added):
A mental disorder is a syndrome characterized
by clinically significant disturbance in an individual's cognition, emotional
regulation, or behavior that reflects a dysfunction in the psychological,
biological, or developmental processes underlying mental functioning. Mental
disorders are often associated with significant suffering or disability that
affects social, occupational, or other important activities. An expected or
culturally approved response to a common stressor or loss, such as the death of
a loved one, does not constitute mental disorder. Social deviance in behavior
(e.g., of a political, religious, or sexual nature) and conflicts that are
primarily concerned with the individual and society are not mental disorders
unless the deviance or conflict is the result of a dysfunction in the
individual as described.
The definition of disorder, from the medical perspective, according to
the DSM-5 guideline makes it clear that conflicts that are primarily concerned
with the individual and society are not considered mental disorders. Therefore,
only those behaviors whose cause is biological are considered.
This perspective is understood as idealistic, since it involves an
abstract understanding of the human psyche, apart from social and economic
determinations. In this premise, what is out of the norm, or the hegemonic
conception of normality, is understood as individual dysfunction, resulting from
organic malfunction, that is, the attention is diverted from the historical and
social problems that interfere with the schooling process. Consequently, it is
believed that drugs can solve these problems.
In this innatist conception, human development
is understood as organic maturation that occurs "[...] regardless of the
context, the social environment, and the relationships in which the child is
inserted, [which] is radically opposed to the conception of development and
learning in the approach of Cultural-Historical Psychology" (Eidt & Tuleski, 2010, p.
139).
In the school context, ADHD has been used as a justification for
problems such as grade repetition and school failure which, in fact, reveal
difficulties in the appropriation of scientific concepts for numerous possible
causes. The individual is stigmatized, pointing him or her as abnormal, and,
furthermore, it is sought through justifications that disregard the social, to
affirm the pathology, which consequently leads to medicalization.
Moysés and Collares (2010)
introduce the term pathologization, as a
neologism derived from pathos, i.e., disease. It refers to transforming
into a physical, biological disease something that has a social origin. As a
"sick person," the student needs to be medicated.
Medicalization is the clinical resource for an alleged remission of the
symptom.
The professionals who medicate are unaware of the school context and do
not understand how failure or success in the learning process are determined by
institutional and political mechanisms, and one can add even by issues
involving the teacher-student-classroom relationship itself (Eidt & Tuleski, 2010). The
conceptions of childhood, psychism development and learning, with emphasis on
the biological and innate aspect, lead teachers to resort to health services to
seek medical diagnoses requiring the control of student behavior through
medication, without seeking to understand "[...] the social plots that
corrupt and dehumanize childhood" (Luengo, 2010,
p. 58).
The cultural-historical
conception: attention and regulation of behavior as higher psychological
functions
The Cultural-Historical Theory, whose main representatives are Lev Semionovitch Vygotsky (1896-1934), Alexander Romanovich Luria (1902-1977), and Alexei Leontiev (1903-1979), in opposition to the inatist conception, understands that man is constituted in
his social relations, that is, man is not born human.
The production process of this man does not occur genetically or
hereditarily, although it is based on a biological basis. It is a dialectical
relationship that goes through the appropriation of knowledge that enables
human beings, by appropriating culture, to be produced by it and to produce
their own history. It is a process that depends fundamentally on another human
being that teaches, and on the possibilities arising from social relations:
The psychism is determined by people's real life, that is, by their
activity within a given social class, in a specific historical time. Social
relations are structured, organized, and maintained on the basis of relations
of production and reproduction of the material conditions of existence. (Eidt & Tuleski, 2010, p.
131).
In other words, according to the conditions and social relations
experienced, each man appropriates the ways of using the material instruments
that circulate in his context, as he performs the necessary activities that
constitute his life. Also, in this process, each man gradually appropriates
concepts, that is, the words that mediate these procedures. These signs that
man appropriates, called psychological instruments, constitute his vocabulary,
and will allow him not only to express his ideas, but also to communicate and
think about distant objects and situations in time and space (Vygotsky, 1995)
and, consequently, to self-regulate his behavior.
Thus, children's possibilities of representing the world in thought
depend on the concepts - signs and meanings - that the child appropriates. And
in this process, by mastering the knowledge and techniques that humanity has
historically produced, the child becomes humanized. That is, the child
internalizes the material ways to develop the activities that circulate in his
context, regulating his behavior. As someone teaches him, he learns how to do
the activities of his social group.
As these mediators - the signs - are appropriated, acquiring a meaning
for the child, his language develops and his thought is formed, directly
assisting in the formation of higher psychological functions that are eminently
human, because the language will act as a mediator in the man's relationship
with objects and with other people, allowing him greater awareness and
expanding his possibilities of planning and self-regulation.
It is of fundamental importance to understand that the child
internalizes what circulates him/her, because it is in the social relationship,
in the collective, that his/her subjectivity is constituted, that is, the
higher psychological functions only become intrapsychic from interpsychic
relationships. What and how to pay attention, therefore, is a learned process,
not in an isolated way, but articulated to what the being perceives of the
world, what he memorizes, what and how he expresses himself, and what he
thinks, based on the information and concepts he has appropriated in his
relations. In this way, this child, in social interactions, appropriates
culture and gradually humanizes itself.
The self-regulation of attention is a psychological function that stems
from the development of consciousness, which corresponds to the verification of
the result of actions and operations that the activity involves, according to
their needs and goals, and the production of necessary corrections and
deviations. For Silva and Loos-Sant'Ana (2017, p.
476), this psychological function:
[...] undergoes a long and irregular process of transformation, in which
external (cultural/symbolic) support structures become internal structures and
psychological functioning; language (a culturally and socially constructed set
of signs) acquires a central role in the development of self-regulatory
capacities; changes depend on a developmental process deeply rooted in the
relations between individual history and social history.
Because it is the result of a complex social-historical process, guided
by interaction with others in different activities, the development of
self-regulation requires the important contribution of the schooling process,
which pedagogically organizes learning, therefore, promotes child development,
since the child is developing when learning.
In this way, the teacher's fundamental role in the student appropriation
of cultural behaviors and scientific concepts taught at school is highlighted.
This understanding is crucial, because it enables the confrontation of
naturalistic and biologizing conceptions, which, when faced with problems or
difficulties in learning school content, place the emphasis on neuronal aspects
and propose solutions that legitimize the pathologizing and medicalization at
school.
Therefore, for the Cultural-Historical Theory, which opposes the
idealistic conception of human development, the SPFs, which include the
voluntary control of behavior and attention, are not endogenous processes that
happen internally and spontaneously, but depend fundamentally on the
appropriation of cultural signs, made possible by the constant mediation of
other men.
Thus, when it is understood that the humanization process occurs in the
child's participatory relationship in its historical and cultural context,
through the appropriation of objectivations historically produced by humanity
(instruments and signs) and depend more on these than on their genetic heritage
to develop, it is necessary to redefine the concept of attention. Consequently,
the ADHD phenomenon nowadays needs to be reconfigured, requiring new studies,
analysis, and understanding.
As Eidt and Tuleski
(2010) alert, it is necessary to understand the ADHD phenomenon, not from
elementary psychological functions, common to humans and animals, but from HPF,
which are developed by the appropriation of human culture. At this point, the
teacher has a fundamental role, because it is mainly through him and his
performance as a mediating agent that this appropriation occurs.
Therefore, there are conceptual differences between the two positions
presented: the biologizing conception and the conception proposed by the
Cultural-Historical Theory. And the number of diagnosed and consequently
medicated children depends on which of the two presented conceptions guides the
teaching work.
The dissemination of ADHD Diagnoses
Even in the face of so many disagreements around the topic, Eidt and Ferracioli (2007, p. 95)
stated: "[...] research shows the unbridled growth in the number of
supposed carriers of the condition in question [...]", as well as Eidt and Tuleski (2010, p. 130)
pointed out that ADHD diagnoses were reaching "epidemic proportions".
After another decade, this research is presented, aiming to reflect on
the impacts of the advances of academic discussions based on the
cultural-historical conception on the weaknesses in the concept of ADHD, from
the investigation about the variation in the number of students with ADHD
reports, as well as the SEC teacher's procedure for planning their work.
To answer these questions, we developed a field research study,
presented below, based on Cascavel (PR),
understanding that by analyzing what happens in a city, we will have data from
a significant part of the whole, which represents part of the reality of Paraná
and perhaps of Brazil.
Methodology
The field
research was submitted to the Ethics Committee on Research with Human Beings of
the State University of Western Paraná (Universidade
Estadual do Oeste do Paraná - Unioeste)
and approved under number 3.359. 602, qualitative and exploratory, aimed to
answer two questions: (ii) quantify the variation in the number of enrollments
of students diagnosed with ADHD in the state public school network from 2015 to
2020, through the analysis of SRS-PR data; (ii) investigate which material the
Special Education teacher relies on to plan and organize his work with students
with ADHD.
Initially,
through online consultation in SRS-PR, we identified the students enrolled in
SEC in each educational institution in the Cascavel
Regional Center, which covers 18 municipalities in 2020. However, this report
did not specify the complaint related to each student. Thus, it was necessary
to consult the student's individual enrollment history, in which we considered
as subjects those in which there were indications of ADHD, in addition to
identifying from which year the student started attending the SEC. The data
collected were tabulated, quantifying the number of enrollments in the years
2015 to 2020.
The remaining
data were collected through semi-structured interviews, with audio recording
and de-recording of the content, involving 27% of schools in the city of Cascavel in the state public network, with Special
Education teachers working in SEC. Ten state schools were selected, two from
each region of the city of Cascavel (PR), being the
one with the highest and the one with the lowest scores on the Basic Education Development Index (BEDI; in portuguese language Índice
de Desenvovlimento da Educação
Básica - IDEB).
The script for
the semi-structured interview involved initial questions about the teacher's
background, time of performance, and professional experience in other levels of
education, and questions about the pedagogical process involving students with
ADHD. The question selected for this article referred to the teaching procedure
for planning, asking teachers to describe how they work with these students.
It is noteworthy
that the 11 Special Education teachers who participated in the study had
different backgrounds: 55% graduated in Pedagogy and the others graduated in
Literature (9%), History (9%) Mathematics (9%), Biological Sciences (18%), all
with graduate courses in specific areas of Special Education (Brazil, 2001). As
for the length of time they had been teaching, it was observed that they were
experienced teachers since 90.7% had more than five years of teaching
experience.
Results
Chart 1 summarizes the data found:
Chart 1
Number of students enrolled in the AEE in the Cascavel state network with ADHD reports from 2015 to 2020
in the state network or in the Regional Education Center
Source: Elaborated from data collected by the
authors.
It can be considered
that, from the publication of Deliberation No. 02/2016 (Paraná, 2016), in 2016,
there is an increase of 75% in the number of enrollments of students with ADHD
reports, compared to 2015. The curve remained upward and growing until the year
2019, which if compared to 2016 showed a difference in the number of these
enrollments of 594%. Until the date of data collection, five students who
attended the service in the Resource Room in 2019, still did not have their
enrollments effective in 2020 for this service, however, because of the
pandemic, the enrollments were suspended.
The data collected shows
that the path of school pathologizing is still widely used to justify the
problems in learning school content, which is evidenced by the significant
increase in the number of students enrolled in the SEC with ADHD diagnosis.
Given the sharp increase in the number of students enrolled in the SEC, we
questioned how the special education teachers who participated in the study
conducted their pedagogical work with students in the SEC.
Since 2003, the Regional
Education Center, which coordinates the pedagogical actions of public schools
in the state network of Paraná, in a geographical area involving 18
municipalities, has a sector responsible for receiving teaching complaints
related to ADHD, among others, called Regional Center
for Specialized Pedagogical Support (RCSPS; in portuguese language Centro Regional de Apoio Pedagógico Especializado - CRAPE).
Initially, the RCSPS
evaluated students with problems in the schooling process, classifying them
according to their psychological and pedagogical functioning, based on the
clinical model (Pelizzetti & Carvalho, 2007).
However, throughout its history, this evaluation process has undergone
significant changes. Currently, it starts in the school context, an
indispensable step to the role of RCSPS, which has as one of the functions the
complementation of the evaluation process in the school context with the
participation of a multidisciplinary team composed of specialist teachers in
Special Education and Psychologists.
At the end of this
evaluation, this team sends it to the teachers who work in the schools and had
referred their students, along with guidelines to help them prepare the Specialized Education Attendance Plans (SEAP; in portuguese language Atendimento
Educacional Especializado
- PAEE) for each student.
To analyze how the
Special Education teachers who participated in the study conduct the
pedagogical work with students in SEC, we took as a basis the procedure they
use to guide the teaching process, from the return of the psychoeducational
evaluation conducted by RCSPS, since the intentionality in the pedagogical
process is considered of fundamental importance from the perspective of the
Cultural-Historical Theory.
The results are shown in
Chart 2, below:
Chart 2
Methodological strategies adopted in working with
students with ADHD
Source:
Elaborated from data collected by the authors.
It was found that 40% of teachers rely on the SEAP to guide the teaching
process, which they prepare based on the information they have about the
student and the information provided by RCSPS, involving the actions and
resources necessary for the learning process of students with ADHD.
Many Special Education teachers (40%) stated that they plan their work
based on the learning gaps and difficulties in school content that are
recurrent in students in general. It is understood that this is an approach
more focused on fulfilling the task of working with the content since these
teachers are not considering the diagnostic work used in the evaluation in the
school context.
It was also verified that 20% of the teachers support the pedagogical
process with differentiated resources such as games and coloring activities.
Their answers, detached from the pedagogical aspects and the objectives of the
teaching work, seem to reveal a lack of commitment to the basic function of the
school, which would be the transmission of scientific knowledge.
Analysis and discussion
of the results
The teachers (40%) who reported developing their teaching activities
based on the PAEE, listed in this document the methodological approaches that
enable the development of attention, which derive from this process of pedagogical
assessment, in which the students' needs are evident, essential elements for
the preparation of the SEAP, guiding the efficiency of the work to be performed
in the SEC.
It is understood, in the light of the Cultural-Historical Theory, that
attention is a psychological function, resulting from the process of human
development, and thus depends circumstantially on the quality of the
educational process, i.e., the planning of specific tasks directed to this end.
Given this, it is understood the relevance of the SEAP as a tool to guide the
work with students with ADHD.
It is imperative to consider that the school and teachers must enable
conditions for students to develop "[...] increasingly awareness and
control of their behavior, so that they can propose, intentionally and
deliberately, to focus attention on the process of appropriation of school
content" (Meira, 2019, p. 230).
In this sense, in an interview, one of the teachers pointed out:
"[...] when we receive the feedback that he needs the Resource Room, we
first assess this student, get to know, and make the individual service plan,
where we have to check what the content gaps are, what he needs" (MRRT-01[4]).
This idea is reinforced in other statements of specialist professionals
who work in the Resource Room: "[...] in this care plan I always address
[...] the content to be worked during the school year according to the
pedagogical report of the student's assessment and according to the analysis
that we do" (MRRT-02); "[...] first is to know the documentary part,
go to the secretariat to know what there is of the student's document,
assessments, medical reports, so we can build his care plan [...]"
(MRRT-05).
The preparation of the PAEE is one of the assignments inherent to the
Special Education teacher and guides their actions according to Instruction No.
09/2018 (Paraná, 2018a), assuming the participation of everyone involved with
the student: regular education and Special Education teachers, school teaching
staff and clinical professionals. It contains information about the student,
specifies the student's needs for curricular flexibility, and organizes
collaborative work.
The evaluation and the collaborative work among professionals are the
essential elements that make it possible to plan and replan pedagogical actions
(Paraná, 2018a; 2018b). In this sense, the specialist teachers comment:
"[...] we do all the work based on this work plan, which over time and during
the year we reorganize according to the need" (MRRT-02); "everything
in this plan changes according to the year, suddenly this student is overcoming
we are advancing or suddenly we have to resume" (MRRT-01).
In Class Councils, Special Education teachers present the results
obtained about the objectives proposed in the PAEE, and based on the
suggestions presented, the necessary actions for the next school period are
replanned (Paraná, 2018a; 2018b).
Special Education teachers (40%) were found to plan their work based on
the learning gaps and difficulties in school content that they observe in the
student. However, they did not report discussing, with other teachers who serve
the student, the systematized planning of activities that would be developed in
SEC. The articulation between the teaching professionals who serve the student
with disabilities/ special educational needs in SEC is considered essential (Honnef, 2018; Szymanski & Teixeira, 2021) because only
in this collective occurs the strengthening of the work aimed at the
psycho-intellectual development of this student.
Another aspect detected in the work with students with ADHD indications
relies on differentiated resources such as games and coloring activities (20%),
as one of the teachers’ states: "we play some game, [...] any game that
helps them I do. I give them two activities, crossword puzzles, all different
things [sic] from the classroom, [...] I make them color drawings"
(MRRT-06).
The activities developed by those who think like MRRT-06, reveal
weaknesses in the educational work, which hinder the development of SPF of
students "clinically diagnosed" with ADHD. The educational act
requires intentionality, planning, systematization, verification of the real
needs presented by the students, as well as the fusion with the scientific
knowledge being worked on in regular education. In the report of this group of
teachers, it was not evident that the procedures adopted are planned and described
in the students' SEAP. The teachers' discourse seems to reveal that these
referrals are improvised, proposed at the moment of the class.
Also concerning data analysis, it was observed that 60% of the
interviewed teachers did not mention the SEAP as a formal part of the process
of serving students who attend the SEC. Therefore, we may ask: Has the SEAP
been materialized in these schools as an indispensable tool to work with
students with disabilities or ADHD?
Finally, considering that schooling is essential for the development of
higher psychic functions - including attention and will, which are the focus of
this article - and that the learning process of scientific concepts promotes
this development, it is assumed that the teacher intentionally plans his or her
actions for this purpose. These actions, mediated by instruments and signs,
enhance the development of human functions, activating a whole group of
processes that could not be developed without the learning of school contents.
However, without a plan that supports it, the pedagogical process is adrift, as
well as its result.
Conclusions
Some authors and specialists consider ADHD a chronic mental disorder
that manifests itself in early childhood education and evolves throughout life,
which is why more and more children are referred to pediatric neurology and
psychology centers. In this sense, many students are diagnosed by health
professionals, or labeled by their teachers as having this disorder, without a
more thorough evaluation.
It is necessary to emphasize that not every agitated child should be
labeled as hyperactive. Although the first evidence of hyperactivity, according
to some authors can be observed in infants and are more prominent in children
in the preschool or school phase, inattention and agitation are characteristics
that are part of child behavior. Excessive restlessness can result from several
situations in the child's life, as well as other behavioral problems.
However, in the school context ADHD is still being used as a teacher's
justification for problems in students' schooling, as we can see a 594%
increase in the number of students enrolled with ADHD reports in the last five
years in the studied city. By not establishing a difference between ADHD and
the need for behavior regulation, the referral of children to health services,
directed by teachers, continues to be increasingly frequent, blaming them for
not learning and exempting them from the analysis of the school and social
contexts.
Against this procedure, it is understood that psychoeducational research
must start from the analysis of the students' schooling process, in an
explanatory way, focused on pedagogical aspects, understanding that the
self-control of attention and behavior is learned and can only be learned if they
are taught.
From the perspective of the Cultural-Historical Theory, as the child
appropriates the culture and scientific concepts that surround him/her, he/she
develops his/her HPF and thus his/her conscience, expanding the ability to
self-regulate, learning to channel his/her agitation and attention to the
learning activities he/she develops at school.
In this sense, according to the legal and guiding documents, the PAEE is
a fundamental tool to guide the practice of teachers working in SEC. In the
state of Paraná, the production of the SEAP is regulated in accordance with the
national legislation and guiding documents prepared by the State Department of
Education and the Department of Special Education (Paraná, 2018a; 2018b). It is
reiterated that legal and guiding documents, both in the national and state
sphere, highlight the preparation of the SEAP as one of the duties inherent to
the function of the Special Education teacher, who works in the MRR.
It should also be considered that the psychoeducational assessment in
the school context should constantly focus on the quality of mediation offered,
the different resources used, as well as the methodological diversity of the
teacher. However, for the evaluation to play this role, its constant
articulation with the planning of the teaching work is necessary.
Based on these precepts, the evaluation becomes an essential element to
the SEAP, since it guides the intentional organization of the pedagogical
process, essential for the possible overcoming of schooling problems for all
students. Certainly, random interventions that do not start from the
educational needs of the students, not based on an organization of the teaching
activity that is the result of reflection and systematization from the
perspective of pedagogical praxis, will hardly reach the expected results.
Considering that voluntary attention is constituted throughout the
individual's development process, as the student appropriates scientific
knowledge and develops his psychological functions as an integrated bundle,
requires caution in the superficial observation of behaviors considered
inattentive. It requires that we stop linking them to neurological problems as
a principle, since such behaviors may occur more frequently due to the quality
of the mediations to which the individual has had access, than due to brain
dysfunctions. Therefore, it is important to consider the mediations in which
this student participates, both in and out of school.
The development of these functions does not occur spontaneously, just
because the child is growing from the chronological point of view. It is a
learning process that results from collaborative work - intentionally planned
in the face of hyperactivity, distraction, or other difficulties in the
learning process of school content, which promotes, through the appropriation
of scientific, artistic, and technical concepts that constitute the knowledge
historically developed by men, the development of the bundle of functions
specific to the human gender, among which is the children's self-regulation.
When the school does not fulfill its social function of transmitting
scientific content, which enables learning and human development, it creates
new demands (problems) that are taken as health services (Meira, 2019), resulting
in the search for medical diagnoses and solutions to explain these problems
that are of social order.
It was found that, in the school space, medicalization has often
replaced the teaching and learning processes, consolidating the idea that the
problems in the schooling process (learning difficulties) and behavior are
linked to disorders or disabilities that students may have. This biologizing
conception results in the referral of this public, which presents inadequate
behavior according to the school, to health services for diagnosis and
treatment, thus characterizing the medicalization of and in education.
Therefore, public policies that promote a state process of continued
teacher education are recommended, which understands man as a being that is
constituted in social relations, so that the teacher can gradually take
possession of the understanding of attention as a function that needs to be
developed in the pedagogical process.
The research showed that understanding ADHD in the biological conception,
as proposed in the DSM-5, leads to a limitation in the pedagogical work. When
ADHD is understood as a disorder, a biological disability, the emphasis is
shifted to the solution of the problems the student is facing, to medicine, to
medicalization, instead of reviewing the pedagogical process in its different
aspects. The development of the student's self-regulation is inhibited since it
is suggested that the solution would be in medicine.
We conclude by emphasizing Education's commitment to the cultural
development of people with or without special educational needs. Expanding the
possibilities of greater awareness, allows the unveiling of the apparent, and
favors a social insertion that contributes to humanization, so that each
student can apprehend the world and intervene in it towards greater social
justice.
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[ii] Master in Education from the Western Paraná State University
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