A intervenção farmacológica e não farmacológica na PHDA: A perspetiva dos profissionais de saúde
Palavras-chave:
PHDA, Crianças e Adolescentes, Diagnóstico, Intervenção psicossocial, Intervenção psicofarmacológicaResumo
É controversa a tendência de aumento da PHDA na infância/adolescência, mas inegável o incremento das taxas de prescrição farmacológica. Dado o papel dos profissionais de saúde neste processo, pretendeu-se indagar a sua perspetiva sobre o diagnóstico e intervenção nesta perturbação. Assim, realizaram-se entrevistas semiestruturadas a oito médicos e oito psicólogos, selecionados por métodos de amostragem não probabilísticos. Da análise de conteúdo, concluiu-se que o espectro de terapêuticas recomendadas para a PHDA é conhecido e mobilizado pelos profissionais de acordo com critérios de adequação e eficácia, numa análise ponderada custo-benefício. Este processo tem ainda outros intervenientes, responsáveis pela sinalização e encaminhamento dos casos (família e escola) que, acedendo facilmente aos serviços, depositam nos clínicos as expetativas de resolução rápida e eficaz, configurando um processo de pressão social para a prescrição farmacológica. Às terapêuticas não farmacológicas reconhece-se um papel eficaz, mas continuam a observar-se dificuldades de acesso e oferta oportuna e suficiente.
Downloads
Referências
American Psychiatric Association (2014). Manual de Diagnóstico e Estatística das Perturbações Mentais (5ª ed.). Climepsi Editores.
APA Working Group on Psychoactive Medications for Children and Adolescents (APA) (2006). Report of the Working Group on Psychoactive Medications for Children and Adolescents. Psychopharmacological, psychosocial, and combined interventions for childhood disorders: Evidence base, contextual factors, and future directions. American Psychological Association.
Bardin, L. (2009). Análise de conteúdo. Edições 70.
Busardò, F.P., Kyriakou, C., Cipolloni, L., Zaami, S., & Frati, P. (2016). From clinical application to cognitive enhancement: the example of methylphenidate. Current Neuropharmacology, 14(1), 17-27. https://doi.org/10.2174/1570159x13666150407225902
Bussing, R., & Winterstein, A. G. (2012). Polypharmacy in attention deficit hyperactivity disorder treatment: current status, challenges and next steps. Current Psychiatry Reports, 14(5), 447-449. https://doi.org/10.1007/s11920-012-0295-6
Caye, A., Spadini, A. V., Karam, R. G., Grevet, E. H., Rovaris, D. L., Bau, C. H., Rohde, A. V., & Kieling, C. (2016). Predictors of persistence of ADHD into adulthood: A systematic review of the literature and meta-analysis. European Child & Adolescent Psychiatry, 25(11), 1151-1159. https://doi.org/10.1007/s00787-016-0831-8
Conrad, P. (2017). Identifying Hyperactive Children. The Medicalization of Deviant Behavior (expanded edition). Ashgate.
Cortese, S., Adamo, N., del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Caruci, S., Atkinson, L., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H-C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. Lancet Psychiatry, 5, 727-738. https://doi.org/10.1016/S2215-0366(18)30269-4
Direção-Geral da Saúde (2017). Programa Nacional para a Saúde Mental. DGS. https://www.dgs.pt/em-destaque/relatorio-do-programa-nacional-para-a-saude-mental-2017.aspx
Daley, D., Oord, S. V. D., Ferrin, M., Cortese, S., Danckaerts, M., Doepfner, M., Hoofdakker, B. J., Coghill, D., Thompson, M., Philip, A., Banaschewski, T., Brandeis, D., Buitelaar, J., Dittmann, R. W., Hollis, C., Holtmann, M., Konofal, E., Lecendreux, M., Rothenberger, A., … Sonuga-Barke, E. J. (2018). Practitioner review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder. Journal of Child Psychology and Psychiatry, 59(9), 932-947. https://doi.org/10.1111/jcpp.12825
Döpfner, M., Breuer, D., Wille, N., Erhart, M., Ravens-Sieberer, U., & the BELLA Study Group (2008). How often do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder? Parent-based prevalence rates in a national sample— results of the BELLA study. European Child & Adolescent Psychiatry, 17, 59-70. https://doi.org/10.1007/s00787-008-1007-y
Erlandsson, S., & Punzi, E. (2017). A biased ADHD discourse ignores human uniqueness. International Journal of Qualitative Studies on Health and Well-being. 12(1), 1319584. https://doi.org/10.1080/17482631.2017.1319584
Evans, S., Owens, J., Wymbs, B., & Ray, A. (2018). Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 47(2), 157-198. https://doi.org/10.1080/15374416.2017.1390757
Friedman, L. M., & Pfiffner, L. J. (2020). Behavioral interventions. In M. M. Martel (Ed.), The Clinical Guide to Assessment and Treatment of Childhood Learning and Attention Problems (pp. 149-169). Academic Press. https://doi.org/10.1016/B978-0-12-815755-8.00007-1
Hinshaw, S. P., & Scheffler, R. M. (2014). The ADHD explosion: Myths, medication, money, and today's push for performance. Oxford University Press.
Hinshaw, S. P., Arnold, L. E., & MTA Cooperative Group. (2015). Attention‐deficit hyperactivity disorder, multimodal treatment, and longitudinal outcome: Evidence, paradox, and challenge. Wiley Interdisciplinary Reviews: Cognitive Science, 6(1), 39-52. https://doi.org/10.1002/wcs.1324
Infarmed (2015). Medicamentos para a Hiperatividade com Défice de Atenção. Infarmed. https://www.infarmed.pt/documents/15786/2713015/Relatorio_ADHD.pdf/d6043d87-561e-4534-a6b1-4969dff93b78?version=1.0
Krull, R. K., Augustyn, M., & Torchia M., M. (2020, maio). Attention deficit hyperactivity disorder in children and adolescents: Treatment with medications. UpToDate. https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-treatment-with-medications/print
Lima, J. Á. (2013). Por uma análise de conteúdo mais fiável. Revista Portuguesa de Pedagogia, 47(1), 7-29. https://doi.org/10.14195/1647-8614_47-1_1
Marques, C. (2009). A saúde mental infantil e juvenil nos cuidados de saúde primários – avaliação e referenciação. Revista Portuguesa de Medicina Geral e Familiar, 25(5), 569-75. http://dx.doi.org/10.32385/rpmgf.v25i5.10674
Meerman, S., Batstra, L., Grietens, H., & Frances, A. (2017). ADHD: A critical update for educational professionals. International Journal of Qualitative Studies on Health and Well-Being, 12(S1), 1298267. https://doi.org/10.1080/17482631.2017.1298267
Moore, D., Richardson, M., Gwernan-Jones, R., Thompson-Coon, J., Stein, K., Rogers, M., Garside, R., Logan, S., & Ford, T. (2015). Non-pharmacological interventions for ADHD in school settings: An overarching synthesis of systematic reviews. Journal of Attention Disorders, 23(3), 1-14. https://doi.org/10.1177/1087054715573994
Moreno-García, I., Meneres-Sancho, S.,Camacho-Vara de Rey, C., & Servera-Barceló, M. (2017). A randomized controlled trial to examine the posttreatment efficacy of neurofeedback, behavior therapy, and pharmacology on ADHD measures. Journal of Attention Disorders, 23(4), 374-383. https://doi.org/10.1177/1087054717693371
National Institute for Health and Care Excellence (NICE) (2008). Attention deficit hyperactivity activity disorder: diagnosis and management. NICE Guidelines. https://doi.org/978-1-4731-1674-0
National Institute for Health and Care Excellence (NICE) (2019). Attention deficit hyperactivity activity disorder: Diagnosis and management. NICE Guidelines. https://www.nice.org.uk/guidance/ng87
OECD (2019). Education at a Glance 2019: OECD Indicators. OECD Publishing. https://doi.org/10.1787/f8d7880d-en
Oliveira, L., Pereira, M., Medeiros, M., & Serrano, A. (2015). PHDA: O que há de novo no DSM ‑5?. Revista Portuguesa de Pedagogia, 49(2), 75-94. https://doi.org/10.14195/1647
Palumbo, D., Sallee, F., Pelham, W., Bukstein, O., McDermott, M., & The CAT Study Group. (2005, October). Clonidine in attention treatment: Primary outcomes [Poster]. Annual meeting of the American Academy of Child & Adolescent Psychiatry, Toronto, Canada.
Pereira, S., Ferreira, A., Azevedo, A., Barroso, C., & Monteiro, V. (2018). Illicit use of Methylphenidate: the other side of the medical prescription. Birth and Growth Medical Journal, 27(2), 98-104. https://doi.org/10.25753/BirthGrowthMJ.v27.i2.13022
Pelham, W. E., Burrows-MacLean, L., Gnagy, E. M., Fabiano, G. A., Coles, E. K., Wymbs, B. T., Chacko, A., Walker, K. S., Wymbs, F., Garefino, A., Hoffman, M. T., Waxmonsky, J. G., & Waschbusck D. A. (2014). A dose-ranging study of behavioral and pharmacological treatment in social settings for children with ADHD. Journal of Abnormal Child Psychology, 42(6), 1019-1031. https://doi.org/10.1371/journal.pone.0180355
Pfiffner, L., J., & Haack, L., M. (2015). Nonpharmacologic treatments for childhood attention-defici/hyperactivity disorder and their combination with medication. In P. E. Nathan & L. J. Pfiffner (Ed.), A guide to treatments that work (pp. 55-84). Oxford University Press.
Polanczyk, G., Willcutt, E., Salum, G., Kieling, C., & Rohde, L. (2014). ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. International Journal of Epidemiology, 43(2), 434-442. https://doi.org/10.1093/ije/dyt261
Safer, D., & Zito, J. (2000). Pharmacoepidemiology of methylphenidate and other stimulants for the treatment of attention-deficit/hyperactivity disorder. In L. Greenhill & B. Osman (Eds.), Ritalin: Theory and practice (2nd ed., pp. 7-26). Mary Ann Liebert.
Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2017). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2), 175-186. https://doi.org/10.1016/S2215-0366(17)30167-0
Sax, L., & Kautz, K. J. (2003). Who first suggest the diagnosis of attention-deficit/hyperactivity disorder? Annals of Family Medicine, 1(3), 171-174. https://doi.org/10.1370/afm.3
Spencer, T. J., Brown, A., Seidman, L. J., Valera, E. M., Makris, N., Lomedico, A., Faraone, S.V., & Biederman, J. (2013). Effect of psychostimulants on brain structure and function in ADHD: A qualitative literature review of MRI-based neuroimaging studies. The Journal of Clinical Psychiatry, 74(9), 902-917. https://doi.org/10.4088/JCP.12r08287
Stockl, K., Hughes, T., Jarrar, M., Secnik, K., & Perwien, A. (2003). Physician Perceptions of the Use of Medications for Attention Deficit Hyperactivity Disorder. Journal of Managed Care Pharmacy, 9(5), 416-23. https://doi.org/10.18553/jmcp.2003.9.5.416
Triguero Veloz Teixeira, M. C., de Freitas Marino, R. L., & Rodrigues Carreiro, L. R. (2015). Associations between inadequate parenting practices and behavioral problems in children and adolescents with attention deficit hyperactivity disorder. The Scientific World Journal, 2015, 1-6. http://dx.doi.org/10.1155/2015/683062
Timimi, S., & Taylor, E. (2004). ADHD is best understood as a cultural construct. British Journal of Psychiatry, 184(1), 8-9. http://doi.org/ 10.1192/bjp.184.1.8
Thomas, R., Mitchell, G. K., & Batstra, L. (2013) Attention-deficit/hyperactivity disorder: Are we helping or harming? Bmj, 347, f6172. https://doi.org/10.1136/bmj.f6172
Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics, 135(4), e994-e1001. https://doi.org/10.1542/peds.2014-3482
Walter, H. J., Gouze, K., & Lim, K. G. (2006). Teachers’ beliefs about mental health needs in inner city elementary schools. Journal of the American Academy of Child & Adolescent Psychiatry, 45(1), 61–68. https://doi.org/10.1097/01.chi.0000187243.17824.6c
Wilens, T. (2009). Straight talk about psychiatric medications for kids. The Guildford Press.
Young, S., & Amarasinghe, J. (2010). Practitioner review: non-pharmacological treatments for ADHD: A lifespan approach. Journal of Child Psychology and Psychiatry and Allied Disciplines, 51, 116–133. https://doi.org/10.1111/j.1469-7610.2009.02191.x
Zhou, Z., Betts, K. A., Bocharova, I., Kinrich, D., & Spalding, W. M. (2020). Concomitant use of psychotropic medication with stimulants for the treatment of ADHD in children and adolescents: A retrospective insurance claims study in the United States. Journal of Attention Disorders, 24(2), 336-347. https://doi.org/10.1177/1087054718784668
