Agitated children in France, Chile and Brazil: comparative perspectives

Agitation problems, learning difficulties and behavioural disorders are the three central concerns in child mental health today. This phenomenon has major social impacts, because of its short- and long-term social, educational and health consequences. The rate of diagnosis increases in various national contexts; yet he definition, treatment and regulation of these problems generate intense public debate. Families suspect them to be fake disorders. As scientific and professional practices diverge, the management of these problems remains uncertain. The use of medication is under scrutiny; is it efficient? does it respect the children’s rights?

Although the phenomenon is observed worldwide, it affects societies in different ways from an epidemiological point of view. The highest prevalence of “attention deficit hyperactivity disorder” (ADHD) is observed in South America. In Chile, the prevalence of ADHD among children between 4 and 11 years is three times higher than the world average (16% vs 5%). In 2010, Brazil ranked second in terms of psychostimulant use among children, according to the Brazilian Institute for Drug Consumer Advocacy. In recent years, the increase in methylphenidate consumption led to organize the “Forum on the Medicalization of Education and Society” in November 2010. Its aims were to help the community take action against the medicalization of education and behavior practices. As a result, the Department of Health published several recommendations to prevent children and teenagers overmedication in 2015. Although the prevalence of ADHD is much lower in Europe, heated debates occur as well. Both in France and Sweden, the medicalization of children’s behaviour generates controversies among families, professionals, as well as media and civil society organizations.

These debates arise in different social and economical contexts: France and Sweden have a strong state and social welfare network, while Brazil and Chile share deep inequalities and a highly vulnerable population. Such a convergence exemplifies how social and health problems are now produced and regulated in the context of globalization, defined as the circulation of categories, technologies, practices and politics.

It is however also possible to identify, in each context, a specific framework of beliefs, ideas, values and social norms which shape the perception, experience, qualification and treatment of the children’s distress. Influential factors range from parenting styles, educational systems, health professionals knowledge, to media and civil society. They affect the attention to children’s behaviours and symptoms, as well as the social acceptance of health diagnoses and practices (e. g. the use of methylphenidate, or coercion practices in schools or families).

Several research programs have been conducted Europe and Latin America by collaborating social science research teams (SAGE, Lapsos, LICCHS…). Starting in 2014, empirical research was carried out in Paris and Lille in France, Stockholm in Sweden, Santos and Campinas in Brazil, Santiago in Chile) with children who are considered “agitated”, yet whose diagnosis is contentious (hyperactivity, hyperkinesia, behavior disorders, ADHD…).

The network “Agitated children, troubled trajectories” is currently developing a comparative perspective along four axes :

• Public policies, professional services (health, education and social welfare), institutional and legal regulations
• An ethnographic approach on health and educational institutions
• Trajectories of agitated children
• Doing research with children: methodological issues