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The diagnosis of attention deficit–­ hyperactivity disorder (ADHD) was shrouded in controversy before the current term was defined in the fourth edition of the Diagnostic and Statistical Manual of ­ Mental Disorders (DSM-­IV) of the American Psychiatric Association (APA) (APA 1994). The classification of ADHD by the APA raised doubts in professional and academic communities about ­ whether it constituted a real disease or simply emerged as a social construct in response to a supposed demand for the medicalization of child and adolescent be­ hav­ iors. In the absence of clear bound­ aries for the pathology, the main claim put forward by ­ those who argue that such a condition does not exist is that its main symptoms (attention deficit, hyperactivity, and impulsivity) fall within the range of be­ hav­ iors expected in childhood and adolescence. In Brazil, only physicians can diagnose ADHD and provide pharmacotherapy for it. Pharmacological treatments are frequently combined with psychosocial treatments such as behavioral therapy and lifestyle changes, which are facilitated mostly by psychologists, teachers and other educational professionals, and parents. Still, it is difficult to ascertain ­whether and when both types of interventions are being provided in each par­tic­u­lar case. ADHD is diagnosed in Brazil on the basis of the ICD-10 (WHO 2008), which is the main disease classification system in use in the country. The DSM is used only for research purposes. 10 Academic and Professional Tensions and Debates around ADHD in Brazil Francisco Ortega Rafaela Zorzanelli Valéria Portugal Gonçalves Tensions and Debates around ADHD in Brazil   187­ After de­ cades of debate, the issues have been hotly contested and several documents have been published defending vari­ ous positions; the controversy, however , remains. In Brazil, the debate is polarized around movements that reject the legitimacy of research into the diagnosis of ADHD and its psychopharmacological treatment, and ­ those that support the description and classification of ADHD based on the countless scientific studies published on the topic (Fórum 2011; Mattos, Rohde, and Polanczyk 2012; ABP 2014; ABRASME 2014). In this chapter, we provide an overview of the vari­ ous discourses that circulate in Brazil about ADHD. First, we pres­ ent the findings of the main research groups involved in both investigating the prevalence of ADHD and in making psychological tests for its diagnosis—­ either cultural adaptations of existing tests or new versions. Next, we introduce data from the Brazilian sanitation regulatory agency Agência Nacional de Vigilância Sanitária (ANVISA) about the control of methylphenidate prescription and the construction of a medical discourse about ADHD in the country. ANVISA is responsible for monitoring drug prices and medical devices, for inspecting tobacco products, and for controlling technical support in the granting of patents by the Instituto Nacional de Propriedade Industrial (INPI). It also exercises control over the production and marketing of products and ser­ vices that are subject to sanitary surveillance, and it controls ports, airports, and borders. It is linked to both the Brazilian Ministério de Saúde and the Brazilian Ministério de Relações Exteriores. Fi­ nally, we pres­ ent some controversies and opposing discourses about ADHD from Brazil’s professional and academic fields, the stances taken by the movements involved in the debate about ADHD’s medicalization, and the competing discourses about ADHD in the country. Epidemiological Data on ADHD in Brazil The lit­ er­ a­ ture on ADHD reports a wide range of prevalence estimates for the disorder. For example, the prevalence in Colombia is estimated to be 20.4% (Pineda et al. 1999; Cornejo et al. 2005); in Spain it is 3.1% to 6.8% (Pino and Mojarro-­ Praxedes 2001; Catalá-­López et al. 2012); in the United Kingdom it is 2% to 5% (Polanczyk et al. 2007; Polanczyk and Jensen 2008); and vari­ ous studies in Australia indicate a range from 2.4% to 9.9% (Gomez et al. 1999). Vari­ ous epidemiological studies in Brazil have found a 3.6% to 5% prevalence of ADHD among school-­ age ­ children (Barbosa and Gouveia 1993). With the use of DSM-­IV criteria, one study found a prevalence of 5.8% in a sample of teen­agers (Rohde, Biederman, and Busnello 1999). Another study, which evaluated students 188   Global Perspectives on ADHD at four public schools in southeastern Brazil, found a prevalence of 13% (Fontana et al. 2007); yet in the same region of the country, a dif­fer­ ent study found a prevalence of 17.1% (Vasconcelos et al. 2003...


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