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Psicoeducação do Transtorno do Déficit de Atenção/Hiperatividade: O Que, Como e Para Quem Informar?

La Psicoeducación del Trastorno por Déficit de Atención/Hiperactividad: Qué, Cómo ya Quién Informar?

Resumo

O objetivo deste estudo foi caracterizar as publicações científicas sobre psicoeducação do Transtorno do Déficit de Atenção/Hiperatividade (TDAH). Foi realizada uma revisão sistemática da literatura em oito bases de dados nacionais e internacionais. Utilizou-se a combinação das palavras-chave TDAH e psicoeducação. No total, foram encontrados 504 trabalhos completos, mas apenas 29 preencheram os critérios de inclusão para análise na íntegra. As informações foram organizadas nas categorias: conceito de psicoeducação, público-alvo, foco da psicoeducação do TDAH, variáveis relacionadas à psicoeducação do TDAH, e características das intervenções em psicoeducação do TDAH. Verificou-se que nem todas as publicações apresentam claramente o conceito de psicoeducação utilizado. Em geral, a psicoeducação tem sido destinada a familiares de pessoas com TDAH, e conduzida em formato de sessões grupais, palestras e manuais. A psicoeducação do TDAH contribui para maior conhecimento sobre o transtorno, adesão ao tratamento, qualidade de vida e menor intensidade dos sintomas do TDAH.

Palavras-chave:
Transtorno da falta de atenção com hiperatividade; psicoeducação; revisão de literatura

Resumen

El objetivo de este estudio fue caracterizar las publicaciones científicas sobre la psicoeducación del Trastorno por Déficit de Atención/Hiperactividad (TDAH). Se realizó una revisión sistemática de la literatura en ocho bases de datos nacionales e internacionales con la combinación de palabras clave psicoeducación y TDAH. En total, fueran encontrados 504 estudios, pero sólo 29 cumplieron los criterios de inclusión para el análisis en su totalidad. La información se organiza en categorías: concepto de la psicoeducación, la audiencia, el enfoque de la psicoeducación del TDAH, las variables relacionadas con la psicoeducación del TDAH, y características de las intervenciones en la psicoeducación del TDAH. Se ha encontrado que no todas las publicaciones muestran claramente el concepto de psicoeducación utilizado. En general, la psicoeducación se ha diseñado para familiares de personas con TDAH, y llevado a cabo en el formato de sesiones de grupo, conferencias y manuales. La psicoeducación del TDAH contribuye a un mayor conocimiento sobre el trastorno, la adherencia al tratamiento, calidad de vida y menor intensidad de los síntomas del TDAH.

Palabras clave:
Trastorno por Déficit de Atención/Hiperactividad; psicoeducación; revisión de literatura

Abstract

The aim of this study was to review scientific publications about Attention Deficit/Hyperactivity Disorder (ADHD) psychoeducation. A systematic review of literature was performed in eight national and international databases (Scielo Brazil, Index Psi, Pepsic, Lilacs, ScienceDirect, PsycINFO, Medline, and Scopus) using the combination of ADHD and psychoeducation as keywords. In total, 504 studies were found, although only 29 met the inclusion criteria. Afterwards, the information was organized into categories: the concept of psychoeducation, target population, focus of ADHD psychoeducation, variables related to ADHD psychoeducation, and the characteristics of intervention on ADHD psychoeducation. Results show that not all studies present the concept of psychoeducation adopted by the authors. In general, psychoeducation has focused on the relatives of people with ADHD and carried out as group sessions, lectures, and manuals. ADHD psychoeducation contributes to a better understanding of the disorder, treatment adherence, quality of life, and decreased symptoms of ADHD.

Keywords:
Attention deficit disorder with hyperactivity; psychoeducation; literature review

O Transtorno do Déficit de Atenção/Hiperatividade (TDAH) é caracterizado por um padrão persistente de desatenção, hiperatividade e impulsividade (American Psychiatric Association [APA], 2013). Esses sintomas têm origem neurobiológica, e são decorrentes da incapacidade de inibir reações impulsivas e de considerar o futuro para guiar o comportamento (Barkley, Fischer, Smallish, & Fletcher, 2002Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology, 111(2),279-89. doi: http://dx.doi.org/10.1037/0021843X.111.2.279
http://dx.doi.org/10.1037/0021843X.111.2...
). Como consequência, pessoas diagnosticadas com esse transtorno tendem a apresentar prejuízos no âmbito acadêmico, profissional, familiar e social. O TDAH é crônico. Os sintomas iniciam antes dos 12 anos (APA, 2013American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 ed.). Arlington, VA: Author.) e tendem a permanecer ao longo da vida em aproximadamente 70% dos casos (Lara et al., 2009Lara, C., Fayyad, J., De Graaf, R., Kessler, R. C., Aguilar-Gaxiola, S., Angermeyer, M., ...Karam, E. G. (2009). Childhood predictors of adult attention-deficit/hyperactivity disorder: Results from the World Health Organization World Mental Health Survey Initiative. Biological Psychiatry, 65(1),46-54. doi: 10.1016/j.biopsych.2008.10.005
https://doi.org/10.1016/j.biopsych.2008....
). Os sintomas modificam-se conforme o período do desenvolvimento no qual o indivíduo se encontra. Na idade adulta, a desatenção pode se manifestar pela evitação de atividades que exijam manutenção da atenção, como assistir a filmes e ler; a hiperatividade, na forma de inquietação interna ou desconforto; e a impulsividade pode aparecer em decisões sem pensar nas consequências (Conners, 2009Conners, C. K. (2009). Diagnóstico e avaliação do TDAH. In C. K. Conners, Transtorno de déficit de Atenção/hiperatividade: As mais recentes estratégias de avaliação e tratamento. Porto Alegre, RS: Artmed.).

Independente da fase do desenvolvimento, o tratamento para pessoas que apresentam esse transtorno envolve a combinação de medicação (para minimizar os sintomas de desatenção, hiperatividade e impulsividade) e a adoção de intervenções psicológicas, a exemplo das propostas pela terapia cognitivo-comportamental (TCC), para desenvolver estratégias para lidar com os sintomas residuais (Mongia & Hechtman, 2016Mongia, M., & Hechtman, L. (2016). Attention-Deficit Hyperactivity Disorder across the lifespan: Review of literature on Cognitive Behavior Therapy. Current Developmental Disorders Reports, 3(1),7-14. doi: 10.1007/s40474-0160072-z
https://doi.org/10.1007/s40474-0160072-z...
; Sprich, Safren, Finkelstein, Remmert, & Hammerness, 2016Sprich, S. E., Safren, S. A. , Finkelstein, D., Remmert, J. E., & Hammerness, P. (2016). A randomized controlled trial of cognitive behavioral therapy for ADHD in medication-treated adolescents. Journal of Child Psychology and Psychiatry. doi: 10.1111/jcpp.12549
https://doi.org/10.1111/jcpp.12549...
). Contudo, a não adesão ao tratamento pode variar de 13,2% a 64,0% (Mc-Carthy, 2014McCarthy, S. (2014). Pharmacological interventions for ADHD: How do adolescent and adult patient beliefs and attitudes impact treatment adherence? Patient Preference & Adherence, 8, 1317-1327.) por fatores associados à falta de conhecimento sobre o TDAH, às características da medicação e aos objetivos propostos no tratamento (Charach & Fernandez, 2013Charach, A., & Fernandez, R. (2013). Enhancing ADHD medication adherence: Challenges and opportunities. Current Psychiatry Reports, 15(7),1-8. doi: 10.1007/s11920-013-0371-6
https://doi.org/10.1007/s11920-013-0371-...
). Portanto, o fornecimento de informações sobre esses aspectos para os pacientes e seus familiares pode ser fundamental para a busca e a manutenção do tratamento do TDAH.

O termo psicoeducação começou a ser utilizado na década de 80, referindo-se à transmissão de informações sobre os transtornos mentais para familiares e pacientes psicóticos. Na década de 90, a psicoeducação passou a ser desenvolvida junto a outros grupos que apresentavam outros transtornos mentais (como transtorno do humor bipolar, transtorno do estresse pós-trauma etc.; Bonsack, Rexhaj, & Favrod, 2015Bonsack, C., Rexhaj, S., & Favrod, J. (2015). Psychoéducation: définition, historique, intérêt et limites. Annales Médico-psychologiques, 173(1),79-84. doi: 10.1016/j.amp.2014.12.001
https://doi.org/10.1016/j.amp.2014.12.00...
). Atualmente, esse termo se refere tanto à oferta de informações relevantes aos pacientes sobre o transtorno (diagnóstico, etiologia, funcionamento), o tratamento e o prognóstico, quanto à busca por esclarecimento de dúvidas e correções de informações distorcidas. A psicoeducação tem por objetivo ampliar o conhecimento do paciente/familiar sobre seu problema (Menezes & Souza, 2012Menezes, S. L., & Souza, M. C. B. (2012). Implicações de um grupo de psicoeducação no cotidiano de portadores de transtorno afetivo bipolar. Revista da Escola de Enfermagem da USP, 46(1),124-131. doi: 10.1590/S0080-62342012000100017
https://doi.org/10.1590/S0080-6234201200...
; Swadi, Bobier, Price, & Craig, 2010Swadi, H., Bobier, C., Price, L., & Craig, B. (2010). Lessons from an audit of psycho-education at an older adolescent inpatient unit. Australasian Psychiatry, 18(1),53-58. doi: 10.1080/10398560902721580
https://doi.org/10.1080/1039856090272158...
) a fim de aumentar a compreensão da sua condição, auxiliar na tomada de decisões com base em informações confiáveis e promover maior adesão ao tratamento (Bégin, Bluteau, Arseneault, & Pronovost, 2012Bégin, J. Y., Bluteau, J., Arseneault, C., & Pronovost, J. (2012). Psychoeducation in Quebec: Past to Present. Ricerche di Pedagogia e Didattica . Journal of Theories and Research in Education, 7(1),1-16. doi: 10.6092/issn.1970-2221/2681
https://doi.org/10.6092/issn.1970-2221/2...
; Bonsack et al., 2015Bonsack, C., Rexhaj, S., & Favrod, J. (2015). Psychoéducation: définition, historique, intérêt et limites. Annales Médico-psychologiques, 173(1),79-84. doi: 10.1016/j.amp.2014.12.001
https://doi.org/10.1016/j.amp.2014.12.00...
; Swaminath, 2009Swaminath, G. (2009). Psychoeducation. Indian journal of psychiatry, 51(3),171-172. doi: 10.4103/0019-5545.55082
https://doi.org/10.4103/0019-5545.55082...
). Ela deve ocorrer de forma didática e em linguagem adequada ao público-alvo, que pode ser constituído por pacientes, familiares, educadores e profissionais da saúde. A transmissão desses conhecimentos assume diferentes formatos: individual ou grupal, palestras, rodas de conversas, manuais, vídeos ou biblioterapia (Bai, Wang, Yang, & Niu, 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
). Dentre os diversos benefícios da psicoeducação, destacam-se o aumento do conhecimento sobre o transtorno, da motivação para a mudança, da participação no tratamento, da satisfação com o tratamento psicológico, a maior adesão ao mesmo e a redução de recaídas (Burlingame, Ridge, Matasuno, Hwang, & Ernshaw, 2006Burlingame, G., Ridge, N., Matasuno, J., Hwang, A., & Ernshaw, D. (2006). Educational needs of inpatients with severe and persistent mental illnesses. Journal of Psychosocial Nursing, 44(1),39-43.; Knapp, 2004Knapp, P. (2004). Terapia Cognitivo-Comportamental na Prática Psiquiátrica. Porto Alegre, RS: Artmed.; Nussey, Pistrang, & Murphy, 2013Nussey, C., Pistrang, N., & Murphy, T. (2013). How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder. Child: Care, Health and Development, 39(5),617-627. doi: 10.1111/cch.12039
https://doi.org/10.1111/cch.12039...
).

Programas de psicoeducação são mais efetivos na redução dos sintomas do TDAH quando comparados ao tratamento medicamentoso isolado, o que indica a necessidade de considerar a psicoeducação como uma abordagem adicional válida para o tratamento do TDAH (Ferrin et al., 2016Ferrin, M. , Perez-Ayala, V. , El-Abd, S., Lax-Pericall, T., Jacobs, B., Bilbow, A., & Taylor, E. (2016). A randomized controlled trial evaluating the efficacy of a psychoeducation program for families of children and adolescents with ADHD in the United Kingdom: Results after a 6-month follow-up. Journal of Attention Disorders, 1-12. doi: 10.1177/1087054715626509
https://doi.org/10.1177/1087054715626509...
). Ademais, é possível que a identificação de informações relevantes para cada caso, como adequar a transmissão dessas informações de acordo com as características do público-alvo, e como verificar se a mensagem foi, de fato, compreendida contribuam para o engajamento do paciente no tratamento (Burlingame et al., 2006Burlingame, G., Ridge, N., Matasuno, J., Hwang, A., & Ernshaw, D. (2006). Educational needs of inpatients with severe and persistent mental illnesses. Journal of Psychosocial Nursing, 44(1),39-43.; Knapp, 2004Knapp, P. (2004). Terapia Cognitivo-Comportamental na Prática Psiquiátrica. Porto Alegre, RS: Artmed.). Por isso, o objetivo deste estudo foi caracterizar as publicações científicas sobre psicoeducação do TDAH. Em especial, buscou-se identificar o conceito de psicoeducação utilizado pelos pesquisadores, a quem a psicoeducação se destina, o foco da psicoeducação, variáveis relacionadas e intervenções em psicoeducação para o TDAH.

Método

Realizou-se uma revisão sistemática da literatura sobre psicoeducação do TDAH. A busca foi realizada nas bases de dados Scielo Brasil, Index Psi, Pepsic, Lilacs, ScienceDirect, PsycINFO, Medline, Scopus. Optou-se por essas bases de dados por oferecerem acesso ao texto completo de publicações nacionais (Scielo Brasil, Index Psi e Pepsic) e internacionais (Lilacs, ScienceDirect, PsycINFO, Medline e Scopus) no meio eletrônico. Foi utilizada a combinação entre os descritores TDAH/ADHD ou Transtorno do Déficit de Atenção/Hiperatividade/Attention Deficit/Hyperactivity Disorder de um lado e, de outro, psicoeducação/psychoeducation, biblioterapia/bibliotherapy ou intervenção psicoeducativa/psychoeducative interventions, no campo resumo/abstract. Essas palavras-chave foram escolhidas com base no objetivo do estudo.

No total, foram encontrados 504 trabalhos completos. As buscas nas bases de dados brasileiras identificaram apenas três trabalhos utilizando os descritores combinados. Destes, um foi incorporado na amostra final (Mesquita, Porto, Rangé, & Ventura, 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
), os outros dois estavam duplicados ou indisponíveis. Os 501 artigos restantes foram recuperados de bases internacionais. Os resumos das 504 publicações foram lidos por dois juízes a fim de delimitar a amostra de trabalhos a serem analisados na íntegra. Os critérios de inclusão dos artigos para participação na amostra final deste estudo foram: (a) abordar psicoeducação do TDAH, (b) ser redigido em Português, Inglês ou Espanhol, e (c) artigos originais publicados em periódicos científicos, ou seja, não foram incluídos livros, capítulos de livros, dissertações e teses. Nesta etapa de análise, foram excluídos 475 (figura 1). O índice de concordância entre juízes foi de 89,65. As discordâncias foram solucionadas pelo acesso às publicações na sua totalidade e reavaliação das mesmas de acordo com o primeiro critério de inclusão.

figura 1
Procedimento de triagem dos artigos recuperados

A amostra final foi constituída por 29 publicações internacionais, que foram avaliadas em quatro etapas: leitura exploratória, seletiva, analítica e interpretativa (Gil, 2006Gil, A. C. (2006). Métodos e técnicas de pesquisa social. São Paulo, SP: Atlas.). Na primeira, os textos foram lidos na sua totalidade. Na segunda, realizou-se uma leitura aprofundada do método, resultados e conclusões. Na terceira, as informações foram ordenadas de forma a identificar as principais características da psicoeducação (conceito, público-alvo, foco e variáveis relacionadas). Por fim, na última etapa, as informações foram agrupadas em categorias definidas a priori, com base no objetivo deste estudo:

  1. Conceito de psicoeducação,

  2. Público-alvo,

  3. Foco da psicoeducação do TDAH,

  4. Variáveis relacionadas à psicoeducação do TDAH,

  5. Características das intervenções em psicoeducação do TDAH.

Resultados e Discussão

Foram analisados 29 estudos internacionais. Destes, 14 apresentavam delineamento experimental (Aguiar et al., 2014Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
; Anderson & Guthery, 2015Anderson, S. B., & Guthery, A. M. (2015). Mindfulness- based psychoeducation for parents of children with Attention-Deficit/Hyperactivity Disorder: An applied clinical project. Journal of Child and Adolescent Psychiatric Nursing, 28(1),43-49. doi: 10.1111/jcap.12103
https://doi.org/10.1111/jcap.12103...
; Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Ferrin et al., 2014Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry, 23(8),637-647. doi: 10.1007/s00787-013-0494-7
https://doi.org/10.1007/s00787-013-0494-...
; Hirvikoski, Waaler, Lindström, Bölte, & Jokinen, 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Janssen et al., 2014Janssen, M., Wensing, M., van der Gaag, R. J., Cornelissen, I., van Deurzen, P., & Buitelaar, J. (2014). Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: A controlled before and after study. Implementation Science, 9(1),155-162. doi: 10.1186/s13012-014-0155-3
https://doi.org/10.1186/s13012-014-0155-...
; Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.; Korzeniowsk & Ison, 2008Korzeniowsk, C., & Ison, M. (2008). Estrategias psicoeducativas para padres y docentes de niños con TDAH. Revista Argentina de Clínica Psicológica, 18(1),65-71.; Long, Rickert, & Ashcraft, 1993Long, N., Rickert, V. I., & Ashcraft, E. W. (1993). Bibliotherapy as an adjunct to stimulant medication in the treatment of attention-deficit hyperactivity disorder. Journal of Pediatric Health Care, 7(2),82-88. doi: 10.1016/08915245(93)90078-V
https://doi.org/10.1016/08915245(93)9007...
; McCarty, Vander Stoep, Violette, & Myers, 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; McCleary & Ridley, 1999McCleary, L., & Ridley, T. (1999). Parenting adolescents with ADHD: Evaluation of a psychoeducation group. Patient Education and Counseling, 38(1),3-10. doi: 10.1016/S07383991(98)00110-4
https://doi.org/10.1016/S07383991(98)001...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
; Myers, Vander Stoep, Thompson, Zhou, & Unützer, 2010Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
), oito eram revisões de literatura (Asherson, 2012Asherson, P. (2012). ADHD across the lifespan. Medicine, 40(11),623-627. doi: http://dx.doi.org/10.1016/j.mpmed.2012.08.007
http://dx.doi.org/10.1016/j.mpmed.2012.0...
; Hernández & Gutiérrez 2014Hernández, P. R., & Gutiérrez, I. C. (2014). Plan de tratamiento multimodal del TDAH. Tratamiento psicoeducativo. Pediatría Integral, 18(9),624-633.; Hill, 2015Hill, P. (2015). Attention-deficit hyperactivity disorder in children and adolescents: Assessment and treatment. BJPsych Advances, 21(1),23-30. doi: 10.1192/apt.bp.114.013953
https://doi.org/10.1192/apt.bp.114.01395...
; Knouse, Cooper-Vince, Sprich, & Safren, 2008Knouse, L. E., Cooper-Vince, C., Sprich, S., & Safren, S. A. (2008). Recent developments in the psychosocial treatment of adult ADHD. Expert Review of Neurotherapeutics, 8(10),1537-1548. doi: 10.1586/14737175.8.10.1537
https://doi.org/10.1586/14737175.8.10.15...
; Montoya, Colom, & Ferrin, 2011Montoya, A., Colom, F., & Ferrin, M. (2011). Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. European Psychiatry, 26(3),166-175. doi: 10.1016/j.eurpsy.2010.10.005
https://doi.org/10.1016/j.eurpsy.2010.10...
; Murphy, 2005Murphy, K. (2005). Psychosocial treatments for ADHD in teens and adults: A practice-friendly review. Journal of Clinical Psychology, 61(5),607-619. doi: 10.1002/jclp.20123
https://doi.org/10.1002/jclp.20123...
; Nussey et al., 2013Nussey, C., Pistrang, N., & Murphy, T. (2013). How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder. Child: Care, Health and Development, 39(5),617-627. doi: 10.1111/cch.12039
https://doi.org/10.1111/cch.12039...
; Young, 1999Young, S. (1999). Psychological therapy for adults with attention deficit hyperactivity disorder. Counselling Psychology Quarterly, 12(2),183-190. doi: 10.1080/09515079908254088
https://doi.org/10.1080/0951507990825408...
), quat ro eram estudo de levantamento (Altin, Altin, & Semerci, 2016Altin, M., Altin, G. E., & Semerci, B. (2016). An online survey of Turkish psychiatrists' attitudes about and experiences of adult attention deficit hyperactivity disorder in clinical practice. Neuropsychiatric Disease and Treatment, 12,2455-2461. doi: 10.2147/NDT.S110720
https://doi.org/10.2147/NDT.S110720...
; Bussing et al., 2012Bussing, R., Zima, B. T., Mason, D. M., Meyer, J. M., White, K., & Garvan, C. W. (2012). ADHD knowledge, perceptions, and information sources: Perspectives from a community sample of adolescents and their parents. Journal of Adolescent Health, 51(6),593-600. doi: 10.1016/j.jadohealth.2012.03.004
https://doi.org/10.1016/j.jadohealth.201...
; Coletti et al., 2012Coletti, D. J., Pappadopulos, E., Katsiotas, N. J., Berest, A., Jensen, P. S., & Kafantaris, V. (2012). Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 22(3),226-237. doi: 10.1089/cap.2011.0090
https://doi.org/10.1089/cap.2011.0090...
; Palacios-Cruz et al., 2013Palacios-Cruz, L., de la Peña Olvera, F., Figueroa, G. V., Caballero, A. A., de la Rosa Muñoz, L., Pedroza, ...Flores, R. E. U. (2013). Knowledge and beliefs about attention deficit hyperactivity disorder in teachers from three Latin-American countries. Salud Mental, 36,257-262.) e três, estudos de caso (Hogue, Bobek, & Evans, 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Levine & Anshel, 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
). De modo geral, os estudos com delineamento experimental e estudos de caso consistem em intervenções de psicoeducação do TDAH destinadas a familiares de crianças/adolescentes com TDAH. As revisões de literatura referem-se à psicoeducação do TDAH para crianças, adolescentes, adultos, familiares, escola e profissionais na saúde. Por fim, os estudos de levantamento buscaram avaliar o conhecimento de adolescentes, genitores e professores sobre o TDAH. Informações sobre o conceito do psicoeducação adotado pelos pesquisadores, público-alvo, foco da psicoeducação e variáveis relacionadas estão descritas na Tabela 1.

Tabela 1
Características da Psicoeducação do TDAH nos Estudos Analisados

Conceito de Psicoeducação

A psicoeducação é resultado da integração de diversas teorias e modelos clínicos complementares, tais como teoria cognitivo-comportamental, teoria da aprendizagem, modelo de prática de grupos, modelo de estresse e enfrentamento, modelo do suporte social, entre outras (Lukens & McFarlane, 2004Lukens, E. P., & McFarlane, W. R. (2004). Psycho-education as evidence-based practice: Considerations for practice, research, and policy. Brief Treatment and Crisis Intervention, 4(3),205. doi: 10.1093/brief-treatment/mhh019
https://doi.org/10.1093/brief-treatment/...
). Por exemplo, a psicoeducação pode ser utilizada como intervenção cognitiva isolada (Bäuml, Froböse, Kraemer, Rentrop, & Pitschel-Walz, 2006Bäuml, J., Froböse, T., Kraemer, S., Rentrop, M., & Pitschel-Walz, G. (2006). Psychoeducation: A basic psychotherapeutic intervention for patients with schizophrenia and their families. Schizophrenia Bulletin, 32(1),51-59. doi: 10.1093/schbul/sbl017
https://doi.org/10.1093/schbul/sbl017...
) ou como estratégia na TCC para aumentar a compreensão do paciente sobre o que este apresenta e engajá-lo no tratamento (Knapp, 2004Knapp, P. (2004). Terapia Cognitivo-Comportamental na Prática Psiquiátrica. Porto Alegre, RS: Artmed.). Por isso, a definição do que os pesquisadores entendem por psicoeducação é relevante para facilitar a compreensão de profissionais interessados em utilizar os resultados dos estudos.

Alguns artigos analisados não apresentaram o conceito de psicoeducação utilizado (Aguiar et al., 2014Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
; Anderson & Guthery, 2015Anderson, S. B., & Guthery, A. M. (2015). Mindfulness- based psychoeducation for parents of children with Attention-Deficit/Hyperactivity Disorder: An applied clinical project. Journal of Child and Adolescent Psychiatric Nursing, 28(1),43-49. doi: 10.1111/jcap.12103
https://doi.org/10.1111/jcap.12103...
; Asherson, 2012Asherson, P. (2012). ADHD across the lifespan. Medicine, 40(11),623-627. doi: http://dx.doi.org/10.1016/j.mpmed.2012.08.007
http://dx.doi.org/10.1016/j.mpmed.2012.0...
; Coletti et al., 2012Coletti, D. J., Pappadopulos, E., Katsiotas, N. J., Berest, A., Jensen, P. S., & Kafantaris, V. (2012). Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 22(3),226-237. doi: 10.1089/cap.2011.0090
https://doi.org/10.1089/cap.2011.0090...
; Hill, 2015Hill, P. (2015). Attention-deficit hyperactivity disorder in children and adolescents: Assessment and treatment. BJPsych Advances, 21(1),23-30. doi: 10.1192/apt.bp.114.013953
https://doi.org/10.1192/apt.bp.114.01395...
; Janssen et al., 2014Janssen, M., Wensing, M., van der Gaag, R. J., Cornelissen, I., van Deurzen, P., & Buitelaar, J. (2014). Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: A controlled before and after study. Implementation Science, 9(1),155-162. doi: 10.1186/s13012-014-0155-3
https://doi.org/10.1186/s13012-014-0155-...
; Knouse et al., 2008Knouse, L. E., Cooper-Vince, C., Sprich, S., & Safren, S. A. (2008). Recent developments in the psychosocial treatment of adult ADHD. Expert Review of Neurotherapeutics, 8(10),1537-1548. doi: 10.1586/14737175.8.10.1537
https://doi.org/10.1586/14737175.8.10.15...
; Korzeniowsk & Ison, 2008Korzeniowsk, C., & Ison, M. (2008). Estrategias psicoeducativas para padres y docentes de niños con TDAH. Revista Argentina de Clínica Psicológica, 18(1),65-71.; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
; Myers et al., 2010Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
; Nussey et al., 2013Nussey, C., Pistrang, N., & Murphy, T. (2013). How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder. Child: Care, Health and Development, 39(5),617-627. doi: 10.1111/cch.12039
https://doi.org/10.1111/cch.12039...
; Palacios-Cruz et al., 2013Palacios-Cruz, L., de la Peña Olvera, F., Figueroa, G. V., Caballero, A. A., de la Rosa Muñoz, L., Pedroza, ...Flores, R. E. U. (2013). Knowledge and beliefs about attention deficit hyperactivity disorder in teachers from three Latin-American countries. Salud Mental, 36,257-262.). Um estudo (Murphy, 2005Murphy, K. (2005). Psychosocial treatments for ADHD in teens and adults: A practice-friendly review. Journal of Clinical Psychology, 61(5),607-619. doi: 10.1002/jclp.20123
https://doi.org/10.1002/jclp.20123...
) apresenta os benefícios de pacientes e familiares terem conhecimento sobre o TDAH, como identificar o que os prejudica e como desenvolver metas de tratamento realistas, mas não uma definição clara de psicoeducação.

Outros estudos analisados definiram psicoeducação como sendo uma forma de intervenção interativa entre profissional e paciente/familiares (Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Montoya et al., 2011Montoya, A., Colom, F., & Ferrin, M. (2011). Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. European Psychiatry, 26(3),166-175. doi: 10.1016/j.eurpsy.2010.10.005
https://doi.org/10.1016/j.eurpsy.2010.10...
). A intervenção psicoeducativa avalia percepções sobre o transtorno e o tratamento (Bussing et al., 2012Bussing, R., Zima, B. T., Mason, D. M., Meyer, J. M., White, K., & Garvan, C. W. (2012). ADHD knowledge, perceptions, and information sources: Perspectives from a community sample of adolescents and their parents. Journal of Adolescent Health, 51(6),593-600. doi: 10.1016/j.jadohealth.2012.03.004
https://doi.org/10.1016/j.jadohealth.201...
; Young, 1999Young, S. (1999). Psychological therapy for adults with attention deficit hyperactivity disorder. Counselling Psychology Quarterly, 12(2),183-190. doi: 10.1080/09515079908254088
https://doi.org/10.1080/0951507990825408...
) para, então, comunicar informações sobre o TDAH e as estratégias de enfrentamento de forma sistemática e didática (Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Ferrin, et al., 2014Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry, 23(8),637-647. doi: 10.1007/s00787-013-0494-7
https://doi.org/10.1007/s00787-013-0494-...
; Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Montoya et al., 2011Montoya, A., Colom, F., & Ferrin, M. (2011). Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. European Psychiatry, 26(3),166-175. doi: 10.1016/j.eurpsy.2010.10.005
https://doi.org/10.1016/j.eurpsy.2010.10...
). Tem o objetivo de auxiliar na compreensão do TDAH, das consequências do mesmo e dos objetivos do tratamento (Altin et al., 2016Altin, M., Altin, G. E., & Semerci, B. (2016). An online survey of Turkish psychiatrists' attitudes about and experiences of adult attention deficit hyperactivity disorder in clinical practice. Neuropsychiatric Disease and Treatment, 12,2455-2461. doi: 10.2147/NDT.S110720
https://doi.org/10.2147/NDT.S110720...
; Hernández & Gutiérrez 2014Hernández, P. R., & Gutiérrez, I. C. (2014). Plan de tratamiento multimodal del TDAH. Tratamiento psicoeducativo. Pediatría Integral, 18(9),624-633.; Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.; Levine & Anshel, 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
; McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
; Young, 1999Young, S. (1999). Psychological therapy for adults with attention deficit hyperactivity disorder. Counselling Psychology Quarterly, 12(2),183-190. doi: 10.1080/09515079908254088
https://doi.org/10.1080/0951507990825408...
), bem como empoderar pacientes e familiares (Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
) para melhorar suas habilidades para lidar com os problemas associados ao transtorno (Le-vine & Anshel, 2011; McCleary & Ridley, 1999McCleary, L., & Ridley, T. (1999). Parenting adolescents with ADHD: Evaluation of a psychoeducation group. Patient Education and Counseling, 38(1),3-10. doi: 10.1016/S07383991(98)00110-4
https://doi.org/10.1016/S07383991(98)001...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
). Pode-se fazer uso de biblioterapia, que consiste na leitura como técnica terapêutica, uma vez que manuais de autoajuda podem ser efetivos para uma variedade de problemas (Long et al., 1993Long, N., Rickert, V. I., & Ashcraft, E. W. (1993). Bibliotherapy as an adjunct to stimulant medication in the treatment of attention-deficit hyperactivity disorder. Journal of Pediatric Health Care, 7(2),82-88. doi: 10.1016/08915245(93)90078-V
https://doi.org/10.1016/08915245(93)9007...
).

Esses resultados mostram a necessidade de definir claramente o que os autores entendem por psicoeducação e como a mesma está sendo aplicada: como intervenção principal ou estratégia de tratamento mais abrangente. A especificação da forma como a mesma tem sido aplicada no contexto clínico e comunitário para diversos públicos-alvo também pode ser útil para clínicos e pesquisadores (Lukens & McFarlane, 2004Lukens, E. P., & McFarlane, W. R. (2004). Psycho-education as evidence-based practice: Considerations for practice, research, and policy. Brief Treatment and Crisis Intervention, 4(3),205. doi: 10.1093/brief-treatment/mhh019
https://doi.org/10.1093/brief-treatment/...
).

Foco da Psicoeducação do TDAH

O objetivo da psicoeducação é transmitir informações relevantes ao paciente ou interessados sobre determinado assunto (Menezes & Souza, 2012Menezes, S. L., & Souza, M. C. B. (2012). Implicações de um grupo de psicoeducação no cotidiano de portadores de transtorno afetivo bipolar. Revista da Escola de Enfermagem da USP, 46(1),124-131. doi: 10.1590/S0080-62342012000100017
https://doi.org/10.1590/S0080-6234201200...
; Swadi et al., 2010Swadi, H., Bobier, C., Price, L., & Craig, B. (2010). Lessons from an audit of psycho-education at an older adolescent inpatient unit. Australasian Psychiatry, 18(1),53-58. doi: 10.1080/10398560902721580
https://doi.org/10.1080/1039856090272158...
). Na amostra analisada, a psicoeducação do TDAH abordou o próprio transtorno e as opções de tratamento. Em especial, a psicoeducação do TDAH em si especificou os seguintes aspectos: (a) sintomas do transtorno (Aguiar et al., 2014Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
; Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Coletti et al., 2012Coletti, D. J., Pappadopulos, E., Katsiotas, N. J., Berest, A., Jensen, P. S., & Kafantaris, V. (2012). Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 22(3),226-237. doi: 10.1089/cap.2011.0090
https://doi.org/10.1089/cap.2011.0090...
; Hernández & Gutiérrez 2014Hernández, P. R., & Gutiérrez, I. C. (2014). Plan de tratamiento multimodal del TDAH. Tratamiento psicoeducativo. Pediatría Integral, 18(9),624-633.; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.; Levine & Anshel, 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
; Murphy, 2005Murphy, K. (2005). Psychosocial treatments for ADHD in teens and adults: A practice-friendly review. Journal of Clinical Psychology, 61(5),607-619. doi: 10.1002/jclp.20123
https://doi.org/10.1002/jclp.20123...
; Nussey et al., 2013Nussey, C., Pistrang, N., & Murphy, T. (2013). How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder. Child: Care, Health and Development, 39(5),617-627. doi: 10.1111/cch.12039
https://doi.org/10.1111/cch.12039...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
), (b) causas (Aguiar et al., 2014Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
; Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Hernández & Gutiérrez 2014Hernández, P. R., & Gutiérrez, I. C. (2014). Plan de tratamiento multimodal del TDAH. Tratamiento psicoeducativo. Pediatría Integral, 18(9),624-633.; Hill, 2015Hill, P. (2015). Attention-deficit hyperactivity disorder in children and adolescents: Assessment and treatment. BJPsych Advances, 21(1),23-30. doi: 10.1192/apt.bp.114.013953
https://doi.org/10.1192/apt.bp.114.01395...
; McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
; Myers et al., 2010Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
; Young, 1999Young, S. (1999). Psychological therapy for adults with attention deficit hyperactivity disorder. Counselling Psychology Quarterly, 12(2),183-190. doi: 10.1080/09515079908254088
https://doi.org/10.1080/0951507990825408...
), (c) prejuízos decorrentes do mesmo (Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Hill, 2015Hill, P. (2015). Attention-deficit hyperactivity disorder in children and adolescents: Assessment and treatment. BJPsych Advances, 21(1),23-30. doi: 10.1192/apt.bp.114.013953
https://doi.org/10.1192/apt.bp.114.01395...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.; McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; McCleary & Ridley, 1999McCleary, L., & Ridley, T. (1999). Parenting adolescents with ADHD: Evaluation of a psychoeducation group. Patient Education and Counseling, 38(1),3-10. doi: 10.1016/S07383991(98)00110-4
https://doi.org/10.1016/S07383991(98)001...
; Murphy, 2005Murphy, K. (2005). Psychosocial treatments for ADHD in teens and adults: A practice-friendly review. Journal of Clinical Psychology, 61(5),607-619. doi: 10.1002/jclp.20123
https://doi.org/10.1002/jclp.20123...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
) e (d) comorbidades existentes (Hill, 2015Hill, P. (2015). Attention-deficit hyperactivity disorder in children and adolescents: Assessment and treatment. BJPsych Advances, 21(1),23-30. doi: 10.1192/apt.bp.114.013953
https://doi.org/10.1192/apt.bp.114.01395...
; McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
; Montoya et al., 2011Montoya, A., Colom, F., & Ferrin, M. (2011). Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. European Psychiatry, 26(3),166-175. doi: 10.1016/j.eurpsy.2010.10.005
https://doi.org/10.1016/j.eurpsy.2010.10...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
).

A psicoeducação do tratamento do TDAH tratou de temas como a medicação (Asherson, 2012Asherson, P. (2012). ADHD across the lifespan. Medicine, 40(11),623-627. doi: http://dx.doi.org/10.1016/j.mpmed.2012.08.007
http://dx.doi.org/10.1016/j.mpmed.2012.0...
; Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Coletti et al., 2012Coletti, D. J., Pappadopulos, E., Katsiotas, N. J., Berest, A., Jensen, P. S., & Kafantaris, V. (2012). Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 22(3),226-237. doi: 10.1089/cap.2011.0090
https://doi.org/10.1089/cap.2011.0090...
; Hill, 2015Hill, P. (2015). Attention-deficit hyperactivity disorder in children and adolescents: Assessment and treatment. BJPsych Advances, 21(1),23-30. doi: 10.1192/apt.bp.114.013953
https://doi.org/10.1192/apt.bp.114.01395...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
) e as estratégias para manejo dos sintomas (Ferrin et al., 2014Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry, 23(8),637-647. doi: 10.1007/s00787-013-0494-7
https://doi.org/10.1007/s00787-013-0494-...
; Hernández & Gutiérrez 2014Hernández, P. R., & Gutiérrez, I. C. (2014). Plan de tratamiento multimodal del TDAH. Tratamiento psicoeducativo. Pediatría Integral, 18(9),624-633.; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; McCleary & Ridley, 1999McCleary, L., & Ridley, T. (1999). Parenting adolescents with ADHD: Evaluation of a psychoeducation group. Patient Education and Counseling, 38(1),3-10. doi: 10.1016/S07383991(98)00110-4
https://doi.org/10.1016/S07383991(98)001...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
; Myers et al., 2010Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
). Nos casos da psicoeducação de familiares de crianças/adolescentes com TDAH, foram tratadas também as habilidades parentais necessárias para se relacionar com o filho, manejar os sintomas do transtorno (Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.; Levine & Anshel, 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
; Long et al., 1993Long, N., Rickert, V. I., & Ashcraft, E. W. (1993). Bibliotherapy as an adjunct to stimulant medication in the treatment of attention-deficit hyperactivity disorder. Journal of Pediatric Health Care, 7(2),82-88. doi: 10.1016/08915245(93)90078-V
https://doi.org/10.1016/08915245(93)9007...
; McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; Montoya et al., 2011Montoya, A., Colom, F., & Ferrin, M. (2011). Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. European Psychiatry, 26(3),166-175. doi: 10.1016/j.eurpsy.2010.10.005
https://doi.org/10.1016/j.eurpsy.2010.10...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
).

Um dos estudos analisados não abordou psicoeducação propriamente dita, mas investigou os conhecimentos de adolescentes (com alto e baixo risco de apresentar TDAH) e genitores sobre o transtorno. Os participantes relataram informações incorretas sobre o tema (como o transtorno ser decorrente de elevado consumo de açúcar ou uso indevido de medicação) embora acreditassem estar familiarizados com o mesmo, o que evidencia a necessidade de ampliar o acesso a informações sobre o TDAH. Ademais, tanto adolescentes quanto os genitores costumam buscar informações sobre o tema na internet, redes sociais, e televisão, mas apenas os genitores procuram também informativos escritos e profissionais da saúde (Bussing et al., 2012Bussing, R., Zima, B. T., Mason, D. M., Meyer, J. M., White, K., & Garvan, C. W. (2012). ADHD knowledge, perceptions, and information sources: Perspectives from a community sample of adolescents and their parents. Journal of Adolescent Health, 51(6),593-600. doi: 10.1016/j.jadohealth.2012.03.004
https://doi.org/10.1016/j.jadohealth.201...
). Em outro estudo analisado, verificou-se que os genitores valorizam a tentativa do profissional de explicar o transtorno e o uso da medicação. Contudo, a preferência pela quantidade de informações e modalidade de transmissão destas variou entre os participantes: alguns pais preferiram informações detalhadas em forma de panfleto e/ou internet, enquanto outros, informações resumidas transmitidas de forma oral pelo profissional da saúde (Coletti et al., 2012Coletti, D. J., Pappadopulos, E., Katsiotas, N. J., Berest, A., Jensen, P. S., & Kafantaris, V. (2012). Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 22(3),226-237. doi: 10.1089/cap.2011.0090
https://doi.org/10.1089/cap.2011.0090...
). Esses resultados indicam as fontes que podem ser utilizadas para acessar o público-alvo na ocasião de psicoeducação do TDAH.

Outro estudo avaliou os conhecimentos e crenças de professores de escolas públicas e privadas sobre o TDAH. A maioria dos professores considerou o TDAH um transtorno mental (79,3%) e o psicólogo como o profissional competente para realizar o diagnóstico e tratamento do mesmo. Menos da metade (44,1%) dos professores acredita que o tratamento combinado é a opção ideal, e apenas 14,7% pensa que a medicação é o componente principal do tratamento. Mesmo assim, reconhecem os efeitos do tratamento no funcionamento social e acadêmico dos alunos com TDAH (Palacios-Cruz et al., 2013Palacios-Cruz, L., de la Peña Olvera, F., Figueroa, G. V., Caballero, A. A., de la Rosa Muñoz, L., Pedroza, ...Flores, R. E. U. (2013). Knowledge and beliefs about attention deficit hyperactivity disorder in teachers from three Latin-American countries. Salud Mental, 36,257-262.). Esses resultados indicam a necessidade de psicoeducar os professores sobre a etiologia do TDAH, bem como opções de tratamento e eficácia. Afinal, os professores convivem com os alunos diariamente e podem auxiliar na identificação e encaminhamento daqueles que podem apresentar o transtorno.

Público-Alvo

Um dos fatores que determinam o formato da psicoeducação é o público-alvo ao qual se destina. Na amostra analisada, a psicoeducação foi realizada para uma ou mais populações. A maioria dos estudos desenvolveu a psicoeducação destinada a familiares de crianças e adolescentes com TDAH (Anderson & Guthery, 2015Anderson, S. B., & Guthery, A. M. (2015). Mindfulness- based psychoeducation for parents of children with Attention-Deficit/Hyperactivity Disorder: An applied clinical project. Journal of Child and Adolescent Psychiatric Nursing, 28(1),43-49. doi: 10.1111/jcap.12103
https://doi.org/10.1111/jcap.12103...
; Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Coletti et al., 2012Coletti, D. J., Pappadopulos, E., Katsiotas, N. J., Berest, A., Jensen, P. S., & Kafantaris, V. (2012). Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 22(3),226-237. doi: 10.1089/cap.2011.0090
https://doi.org/10.1089/cap.2011.0090...
; Ferrin et al., 2014Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry, 23(8),637-647. doi: 10.1007/s00787-013-0494-7
https://doi.org/10.1007/s00787-013-0494-...
; Hernández & Gutiérrez 2014Hernández, P. R., & Gutiérrez, I. C. (2014). Plan de tratamiento multimodal del TDAH. Tratamiento psicoeducativo. Pediatría Integral, 18(9),624-633.; Hill, 2015Hill, P. (2015). Attention-deficit hyperactivity disorder in children and adolescents: Assessment and treatment. BJPsych Advances, 21(1),23-30. doi: 10.1192/apt.bp.114.013953
https://doi.org/10.1192/apt.bp.114.01395...
; Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Janssen et al., 2014Janssen, M., Wensing, M., van der Gaag, R. J., Cornelissen, I., van Deurzen, P., & Buitelaar, J. (2014). Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: A controlled before and after study. Implementation Science, 9(1),155-162. doi: 10.1186/s13012-014-0155-3
https://doi.org/10.1186/s13012-014-0155-...
; Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.; Korzeniowsk & Ison, 2008Korzeniowsk, C., & Ison, M. (2008). Estrategias psicoeducativas para padres y docentes de niños con TDAH. Revista Argentina de Clínica Psicológica, 18(1),65-71.; Levine & Anshel, 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
; Long et al., 1993Long, N., Rickert, V. I., & Ashcraft, E. W. (1993). Bibliotherapy as an adjunct to stimulant medication in the treatment of attention-deficit hyperactivity disorder. Journal of Pediatric Health Care, 7(2),82-88. doi: 10.1016/08915245(93)90078-V
https://doi.org/10.1016/08915245(93)9007...
; McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; McCleary & Ridley, 1999McCleary, L., & Ridley, T. (1999). Parenting adolescents with ADHD: Evaluation of a psychoeducation group. Patient Education and Counseling, 38(1),3-10. doi: 10.1016/S07383991(98)00110-4
https://doi.org/10.1016/S07383991(98)001...
; Montoya et al., 2011Montoya, A., Colom, F., & Ferrin, M. (2011). Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. European Psychiatry, 26(3),166-175. doi: 10.1016/j.eurpsy.2010.10.005
https://doi.org/10.1016/j.eurpsy.2010.10...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
; Myers et al., 2010Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
; Nussey et al., 2013Nussey, C., Pistrang, N., & Murphy, T. (2013). How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder. Child: Care, Health and Development, 39(5),617-627. doi: 10.1111/cch.12039
https://doi.org/10.1111/cch.12039...
) ou de adultos com TDAH (Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
). Um estudo foi realizado com crianças com TDAH (Levine & Anshel, 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
), quatro com adolescentes com TDAH (Asherson, 2012Asherson, P. (2012). ADHD across the lifespan. Medicine, 40(11),623-627. doi: http://dx.doi.org/10.1016/j.mpmed.2012.08.007
http://dx.doi.org/10.1016/j.mpmed.2012.0...
; Bussing et al., 2012Bussing, R., Zima, B. T., Mason, D. M., Meyer, J. M., White, K., & Garvan, C. W. (2012). ADHD knowledge, perceptions, and information sources: Perspectives from a community sample of adolescents and their parents. Journal of Adolescent Health, 51(6),593-600. doi: 10.1016/j.jadohealth.2012.03.004
https://doi.org/10.1016/j.jadohealth.201...
; Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Murphy, 2005Murphy, K. (2005). Psychosocial treatments for ADHD in teens and adults: A practice-friendly review. Journal of Clinical Psychology, 61(5),607-619. doi: 10.1002/jclp.20123
https://doi.org/10.1002/jclp.20123...
) e oito com adultos com TDAH (Altin et al., 2016Altin, M., Altin, G. E., & Semerci, B. (2016). An online survey of Turkish psychiatrists' attitudes about and experiences of adult attention deficit hyperactivity disorder in clinical practice. Neuropsychiatric Disease and Treatment, 12,2455-2461. doi: 10.2147/NDT.S110720
https://doi.org/10.2147/NDT.S110720...
; Asherson, 2012Asherson, P. (2012). ADHD across the lifespan. Medicine, 40(11),623-627. doi: http://dx.doi.org/10.1016/j.mpmed.2012.08.007
http://dx.doi.org/10.1016/j.mpmed.2012.0...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Knouse et al., 2008Knouse, L. E., Cooper-Vince, C., Sprich, S., & Safren, S. A. (2008). Recent developments in the psychosocial treatment of adult ADHD. Expert Review of Neurotherapeutics, 8(10),1537-1548. doi: 10.1586/14737175.8.10.1537
https://doi.org/10.1586/14737175.8.10.15...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
; Murphy, 2005Murphy, K. (2005). Psychosocial treatments for ADHD in teens and adults: A practice-friendly review. Journal of Clinical Psychology, 61(5),607-619. doi: 10.1002/jclp.20123
https://doi.org/10.1002/jclp.20123...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
; Young, 1999Young, S. (1999). Psychological therapy for adults with attention deficit hyperactivity disorder. Counselling Psychology Quarterly, 12(2),183-190. doi: 10.1080/09515079908254088
https://doi.org/10.1080/0951507990825408...
). Os demais estudos abordaram psicoeducação do TDAH para professores (Aguiar et al., 2014Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
; Hernández & Gutiérrez 2014Hernández, P. R., & Gutiérrez, I. C. (2014). Plan de tratamiento multimodal del TDAH. Tratamiento psicoeducativo. Pediatría Integral, 18(9),624-633.; Hill, 2015Hill, P. (2015). Attention-deficit hyperactivity disorder in children and adolescents: Assessment and treatment. BJPsych Advances, 21(1),23-30. doi: 10.1192/apt.bp.114.013953
https://doi.org/10.1192/apt.bp.114.01395...
; Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.; Korzeniowsk & Ison, 2008Korzeniowsk, C., & Ison, M. (2008). Estrategias psicoeducativas para padres y docentes de niños con TDAH. Revista Argentina de Clínica Psicológica, 18(1),65-71.; Montoya et al., 2011Montoya, A., Colom, F., & Ferrin, M. (2011). Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. European Psychiatry, 26(3),166-175. doi: 10.1016/j.eurpsy.2010.10.005
https://doi.org/10.1016/j.eurpsy.2010.10...
; Nussey et al., 2013Nussey, C., Pistrang, N., & Murphy, T. (2013). How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder. Child: Care, Health and Development, 39(5),617-627. doi: 10.1111/cch.12039
https://doi.org/10.1111/cch.12039...
; Palacios-Cruz et al., 2013Palacios-Cruz, L., de la Peña Olvera, F., Figueroa, G. V., Caballero, A. A., de la Rosa Muñoz, L., Pedroza, ...Flores, R. E. U. (2013). Knowledge and beliefs about attention deficit hyperactivity disorder in teachers from three Latin-American countries. Salud Mental, 36,257-262.) e para profissionais da saúde básica (Hill, 2015Hill, P. (2015). Attention-deficit hyperactivity disorder in children and adolescents: Assessment and treatment. BJPsych Advances, 21(1),23-30. doi: 10.1192/apt.bp.114.013953
https://doi.org/10.1192/apt.bp.114.01395...
).

Verifica-se uma maior preocupação dos pesquisadores em psicoeducar os familiares do que os próprios pacientes com TDAH. Há duas explicações possíveis para esse resultado. A primeira justificativa é que, historicamente, o TDAH era considerado um transtorno exclusivo da infância. Assim, a realização do tratamento do filho com TDAH dependia do engajamento dos genitores, o que justifica a necessidade de psicoeducar os familiares de crianças e adolescentes com o transtorno. As evidências de que o TDAH interfere na autoestima dos pacientes (APA, 2013) demonstraram a necessidade de adaptar a psicoeducação também para crianças, adolescentes e adultos em 2004 (Lukens & McFarlane, 2004Lukens, E. P., & McFarlane, W. R. (2004). Psycho-education as evidence-based practice: Considerations for practice, research, and policy. Brief Treatment and Crisis Intervention, 4(3),205. doi: 10.1093/brief-treatment/mhh019
https://doi.org/10.1093/brief-treatment/...
). Contudo, mais de 10 anos depois, a quantidade de relatos da psicoeducação do TDAH para esse público ainda é inferior aos destinados para seus familiares. A segunda explicação possível é que o TDAH em adultos começou a ser estudado apenas nos últimos anos, e foi inserido recentemente no Manual Diagnóstico e Estatístico dos Transtornos Mentais (DSM5; APA, 2013), o que pode justificar o menos número de estudos sobre psicoeducação para essa população. Apesar das lacunas identificadas nos relatos de psicoeducação para públicos diversos, recomenda-se psicoeducação da população em geral sobre o TDAH, visto que pode contribuir não só para identificação de casos não tratados, mas também para aumentar atitudes positivas frente às pessoas com esse transtorno (Nussey et al., 2013Nussey, C., Pistrang, N., & Murphy, T. (2013). How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder. Child: Care, Health and Development, 39(5),617-627. doi: 10.1111/cch.12039
https://doi.org/10.1111/cch.12039...
).

Variáveis Relacionadas à Psicoeducação do TDAH

A amostra analisada relacionou psicoeducação do TDAH com maior adesão ao tratamento por parte de pacientes e familiares (Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Coletti et al., 2012Coletti, D. J., Pappadopulos, E., Katsiotas, N. J., Berest, A., Jensen, P. S., & Kafantaris, V. (2012). Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 22(3),226-237. doi: 10.1089/cap.2011.0090
https://doi.org/10.1089/cap.2011.0090...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Janssen et al., 2014Janssen, M., Wensing, M., van der Gaag, R. J., Cornelissen, I., van Deurzen, P., & Buitelaar, J. (2014). Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: A controlled before and after study. Implementation Science, 9(1),155-162. doi: 10.1186/s13012-014-0155-3
https://doi.org/10.1186/s13012-014-0155-...
; McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
; Myers et al., 2010Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
; Young, 1999Young, S. (1999). Psychological therapy for adults with attention deficit hyperactivity disorder. Counselling Psychology Quarterly, 12(2),183-190. doi: 10.1080/09515079908254088
https://doi.org/10.1080/0951507990825408...
), menores níveis de estresse (Anderson & Guthery, 2015Anderson, S. B., & Guthery, A. M. (2015). Mindfulness- based psychoeducation for parents of children with Attention-Deficit/Hyperactivity Disorder: An applied clinical project. Journal of Child and Adolescent Psychiatric Nursing, 28(1),43-49. doi: 10.1111/jcap.12103
https://doi.org/10.1111/jcap.12103...
; Ferrin et al., 2014Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry, 23(8),637-647. doi: 10.1007/s00787-013-0494-7
https://doi.org/10.1007/s00787-013-0494-...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
), maiores níveis de autoestima (Young, 1999Young, S. (1999). Psychological therapy for adults with attention deficit hyperactivity disorder. Counselling Psychology Quarterly, 12(2),183-190. doi: 10.1080/09515079908254088
https://doi.org/10.1080/0951507990825408...
), maior conhecimento sobre o transtorno (Aguiar et al., 2014Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
; Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
), maiores índices de qualidade de vida (Ferrin et al., 2014Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry, 23(8),637-647. doi: 10.1007/s00787-013-0494-7
https://doi.org/10.1007/s00787-013-0494-...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Janssen et al., 2014Janssen, M., Wensing, M., van der Gaag, R. J., Cornelissen, I., van Deurzen, P., & Buitelaar, J. (2014). Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: A controlled before and after study. Implementation Science, 9(1),155-162. doi: 10.1186/s13012-014-0155-3
https://doi.org/10.1186/s13012-014-0155-...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
), menor presença de sintomas do TDAH e de outras psicopatologias (Ferrin et al., 2014Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry, 23(8),637-647. doi: 10.1007/s00787-013-0494-7
https://doi.org/10.1007/s00787-013-0494-...
; Janssen et al., 2014Janssen, M., Wensing, M., van der Gaag, R. J., Cornelissen, I., van Deurzen, P., & Buitelaar, J. (2014). Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: A controlled before and after study. Implementation Science, 9(1),155-162. doi: 10.1186/s13012-014-0155-3
https://doi.org/10.1186/s13012-014-0155-...
; Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.; Korzeniowsk & Ison, 2008Korzeniowsk, C., & Ison, M. (2008). Estrategias psicoeducativas para padres y docentes de niños con TDAH. Revista Argentina de Clínica Psicológica, 18(1),65-71.; Levine & Anshel, 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
; Long et al., 1993Long, N., Rickert, V. I., & Ashcraft, E. W. (1993). Bibliotherapy as an adjunct to stimulant medication in the treatment of attention-deficit hyperactivity disorder. Journal of Pediatric Health Care, 7(2),82-88. doi: 10.1016/08915245(93)90078-V
https://doi.org/10.1016/08915245(93)9007...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
; Myers et al., 2010Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
), maior colaboração entre os genitores e a escola, e maiores níveis de desempenho escolar (Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
).

As variáveis associadas com a psicoeducação do TDAH nos estudos analisados vão ao encontro das variáveis utilizadas para mensurar impacto nas intervenções em psicoeducação de maneira geral. Evidências sobre programas de psicoeducação em geral mostram que a mesma parece estar associada com a redução dos sintomas psicoeducados, a redução de sintomas associados a ansiedade e a depressão (independente do foco da psicoeducação), maior adesão e satisfação com o tratamento, maior conhecimento, autoestima, estratégias de enfrentamento e qualidade de vida (Lukens & McFarlane, 2004Lukens, E. P., & McFarlane, W. R. (2004). Psycho-education as evidence-based practice: Considerations for practice, research, and policy. Brief Treatment and Crisis Intervention, 4(3),205. doi: 10.1093/brief-treatment/mhh019
https://doi.org/10.1093/brief-treatment/...
).

Características das Intervenções em Psicoeducação do TDAH

Na amostra analisada, 17 estudos apresentaram intervenções psicoeducativas do TDAH para pessoas com diagnóstico ou traços do transtorno. O diagnóstico foi realizado pela triangulação de dados em cinco pesquisas (Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
; Ferrin et al., 2014Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry, 23(8),637-647. doi: 10.1007/s00787-013-0494-7
https://doi.org/10.1007/s00787-013-0494-...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Levine & Anshel 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
). De fato, o diagnóstico do TDAH é clínico e requer a coleta de informações em diferentes fontes, como escalas e entrevistas semiestruturadas baseadas nos critérios do DSM-5 com o paciente, coleta de informações com os familiares do indivíduo, identificação dos contextos em que os sintomas nucleares se mostram presentes, bem como o comprometimento funcional associado aos mesmos (Mattos et al., 2006Mattos, P., Palmini, A., Salgado, C. A., Segenreich, D., Grevet, E., Oliveira, I. R., ...Lima, P. P. (2006). Painel brasileiro de especialistas sobre o diagnóstico do Transtorno do Déficit de Atenção/Hiperatividade (TDAH) em adultos. Revista de Psiquiatria, 28(1),50-60.). Os demais estudos analisados basearam o diagnóstico apenas em critérios diagnósticos (Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
), escalas (McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
), entrevistas clínicas (Janssen et al., 2014Janssen, M., Wensing, M., van der Gaag, R. J., Cornelissen, I., van Deurzen, P., & Buitelaar, J. (2014). Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: A controlled before and after study. Implementation Science, 9(1),155-162. doi: 10.1186/s13012-014-0155-3
https://doi.org/10.1186/s13012-014-0155-...
; Long et al., 1993Long, N., Rickert, V. I., & Ashcraft, E. W. (1993). Bibliotherapy as an adjunct to stimulant medication in the treatment of attention-deficit hyperactivity disorder. Journal of Pediatric Health Care, 7(2),82-88. doi: 10.1016/08915245(93)90078-V
https://doi.org/10.1016/08915245(93)9007...
; McCleary & Ridley, 1999McCleary, L., & Ridley, T. (1999). Parenting adolescents with ADHD: Evaluation of a psychoeducation group. Patient Education and Counseling, 38(1),3-10. doi: 10.1016/S07383991(98)00110-4
https://doi.org/10.1016/S07383991(98)001...
; Myers et al., 2010Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
) ou confiança em diagnóstico prévio (Korzeniowsk & Ison, 2008Korzeniowsk, C., & Ison, M. (2008). Estrategias psicoeducativas para padres y docentes de niños con TDAH. Revista Argentina de Clínica Psicológica, 18(1),65-71.), o que pode levar a erros de diagnóstico devido aos sintomas do TDAH serem comuns a outros transtornos, como transtornos do humor e da ansiedade (Searight, Burke, & Rootnek, 2000Searight, H. R., Burke, J. M., & Rootnek, K. F. (2000). Adult ADHD: Evaluation and treatment in family medicine. American Family Physician, 62(9),2077-2086.).

A maioria das intervenções consistia em um conjunto de sessões interativas grupais (Ferrin et al., 2014Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry, 23(8),637-647. doi: 10.1007/s00787-013-0494-7
https://doi.org/10.1007/s00787-013-0494-...
; Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
; Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Korzeniowsk & Ison, 2008Korzeniowsk, C., & Ison, M. (2008). Estrategias psicoeducativas para padres y docentes de niños con TDAH. Revista Argentina de Clínica Psicológica, 18(1),65-71.; McCarty et al., 2015McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children's ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6),1735-1743. doi: 10.1007/s10826-014-9977-5
https://doi.org/10.1007/s10826-014-9977-...
; McCleary & Ridley, 1999McCleary, L., & Ridley, T. (1999). Parenting adolescents with ADHD: Evaluation of a psychoeducation group. Patient Education and Counseling, 38(1),3-10. doi: 10.1016/S07383991(98)00110-4
https://doi.org/10.1016/S07383991(98)001...
; Montoya et al., 2014Montoya, A. , Hervás, A., Fuentes, J., Cardo, E., Polavieja, P., Quintero, J., & Tannock, R. (2014). Cluster-randomized, controlled 12-month trial to evaluate the effect of a parental psychoeducation program on medication persistence in children with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 10, 1081-1092. doi: 10.2147/NDT.S62487
https://doi.org/10.2147/NDT.S62487...
; Vidal et al., 2013Vidal, R., Bosch, R., Nogueira, M., Gómez-Barros, N., Valero, S., Palomar, G., ...Ramos-Quiroga, J. A. (2013). Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: A randomized controlled pilot study. The Journal of Nervous and Mental Disease, 201(10),894-900. doi: 10.1097/NMD.0b013e3182a5c2c5
https://doi.org/10.1097/NMD.0b013e3182a5...
), enquanto as demais ocorreram em formato de palestras associadas a manual (Aguiar et al., 2014Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
; Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
), biblioterapia (Anderson & Guthery, 2015Anderson, S. B., & Guthery, A. M. (2015). Mindfulness- based psychoeducation for parents of children with Attention-Deficit/Hyperactivity Disorder: An applied clinical project. Journal of Child and Adolescent Psychiatric Nursing, 28(1),43-49. doi: 10.1111/jcap.12103
https://doi.org/10.1111/jcap.12103...
; Long et al., 1993Long, N., Rickert, V. I., & Ashcraft, E. W. (1993). Bibliotherapy as an adjunct to stimulant medication in the treatment of attention-deficit hyperactivity disorder. Journal of Pediatric Health Care, 7(2),82-88. doi: 10.1016/08915245(93)90078-V
https://doi.org/10.1016/08915245(93)9007...
) e encontros individuais com o público-alvo (Levine & Anshel, 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
; Mesquita et al., 2009Mesquita, C. M. D., Porto, P. R., Rangé, B. P., & Ventura, P. R. (2009). Terapia cognitivo-comportamental e o TDAH subtipo desatento: Uma área inexplorada. Revista Brasileira de Terapias Cognitivas, 5(1),35-45. doi: 10.5935/18085687.20090004
https://doi.org/10.5935/18085687.2009000...
). Dois estudos analisados apenas informaram quem recebeu psicoeducação, sem descrever como a mesma foi realizada (Janssen et al., 2014Janssen, M., Wensing, M., van der Gaag, R. J., Cornelissen, I., van Deurzen, P., & Buitelaar, J. (2014). Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: A controlled before and after study. Implementation Science, 9(1),155-162. doi: 10.1186/s13012-014-0155-3
https://doi.org/10.1186/s13012-014-0155-...
; Myers et al., 2010Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
). Outra pesquisa relata o acompanhamento de uma intervenção psicoeducativa mensal para pais e professores de crianças com TDAH após um e 10 anos, mas não descreveu como a psicoeducação foi realizazda (duração, individual ou grupal, local, equipe; Kądziela-Olech, 2012Kądziela-Olech, H. (2012). Attention-deficit/hyperactivity disorder in children - The role of psychoeducation in longitudinal study. Psychiatria i Psychologia Kliniczna, 12(3),149-156.).

Em todas as pesquisas, foram utilizados questionários e escalas para avaliação das variáveis descritas na categoria anterior em, pelo menos, dois tempos (pré e pós intervenção), com exceção de três estudos que realizaram avaliação qualitativa (Hogue et al., 2014Hogue, A., Bobek, M., & Evans, S. W. (2014). Changing Academic Support in the home for adolescents with Attention-Deficit/Hyperactivity Disorder: A family-based clinical protocol for improving school performance. Cognitive and Behavioral Practice, 23,14-30. doi: 10.1016/j.cbpra.2014.07.002
https://doi.org/10.1016/j.cbpra.2014.07....
; Korzeniowsk & Ison, 2008Korzeniowsk, C., & Ison, M. (2008). Estrategias psicoeducativas para padres y docentes de niños con TDAH. Revista Argentina de Clínica Psicológica, 18(1),65-71.; Levine & Anshel, 2011Levine, E. S., & Anshel, D. J. (2011). "Nothing works!" A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attentiondeficit/hyperactivity disorder. Psychology in the Schools, 48(3),297-306. doi: 10.1002/pits.20554
https://doi.org/10.1002/pits.20554...
). Constata-se que medidas de processo, tais como presença nas sessões, taxa de evasão, treinamento dos facilitadores, raramente foram avaliadas. O estudo de Aguiar et al. (2014)Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
descreveu o treinamento oferecido à equipe profissional que conduziu a intervenção e o de Myers et al. (2010)Myers, K. , Vander Stoep, A. , Thompson, K., Zhou, C., & Unützer, J. (2010). Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder. General Hospital Psychiatry, 32(6),612-614. doi: 10.1016/j.genhosppsych.2010.08.004
https://doi.org/10.1016/j.genhosppsych.2...
avaliou a presença dos pais nas sessões de intervenção.

Tabela 2
Características das Intervenções em Psicoeducação do TDAH

Os pacientes tendem a apreender apenas 50% das informações relevantes transmitidas pelo profissional (Swaminath, 2009Swaminath, G. (2009). Psychoeducation. Indian journal of psychiatry, 51(3),171-172. doi: 10.4103/0019-5545.55082
https://doi.org/10.4103/0019-5545.55082...
), o que sugere a necessidade de avaliar as informações absorvidas pelos pacientes. Apenas três estudos verificaram se as informações fornecidas na psicoeducação do TDAH foram, de fato, compreendidas por pacientes, familiares e professores. Bai et al. (2015)Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
utilizaram um questionário composto por 16 itens para avaliar o conhecimento dos genitores de crianças com TDAH. Cinco itens referiam-se ao TDAH (sintomas nucleares, causas, prejuízos, se é crônico) e 11, à medicação (tratamento combinado, diminuição dos sintomas do TDAH, possibilidade de dependência, efeitos colaterais). Após a intervenção, os participantes do grupo experimental demonstraram conhecimento significativamente maior que o grupo controle e maior tendência a aderir ao tratamento (Bai et al., 2015Bai, G. N., Wang, Y. F., Yang, L., & Niu, W. Y. (2015). Effectiveness of a focused, brief psycho-education program for parents of ADHD children: improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, 11,2721-2735. doi: 10.2147/NDT.S88625
https://doi.org/10.2147/NDT.S88625...
). Hirvikoski et al. (2015)Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
também avaliaram o conhecimento dos participantes por meio de um questionário. O ADHD 20 Questions é composto por 20 itens sobre início do TDAH, possibilidade de contágio, sintomas, possíveis prejuízos, comorbidades etc. (Bramham et al., 2009Bramham, J., Young, S., Bickerdike, A., Spain, D., McCartan, D., & Xenitidis, K. (2009). Evaluation of group cognitive behavioral therapy for adults with ADHD. Journal of Attention Disorders, 12(5),434-441. doi: 10.1177/1087054708314596
https://doi.org/10.1177/1087054708314596...
). A intervenção realizada resultou em maior conhecimento sobre o transtorno, bem-estar psicológico e qualidade do relacionamento entre adultos com TDAH e familiares (Hirvikoski et al., 2015Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2015). Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial. ADHD Attention Deficit and Hyperactivity Disorders, 7(1),89-99. doi: 10.1007/s12402-014-0141-2
https://doi.org/10.1007/s12402-014-0141-...
). Aguiar et al. (2014)Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
avaliaram o conhecimento de professores do Ensino Fundamental sobre o TDAH por meio de instrumento construídos pelos próprios pesquisadores baseado em itens da literatura. Como resultado, verificou-se uma redução no nível de crenças incorretas sobre o TDAH (Aguiar et al., 2014Aguiar, A. P., Kieling, R. R., Costa, A. C., Chardosim, N., Dorneles, B. V., Almeida, M. R., ...Rohde, L. A. (2014). Increasing teachers' knowledge about ADHD and learning disorders: An investigation on the role of a psychoeducational intervention. Journal of Attention Disorders, 18(8),691-698. doi: 10.1177/1087054712453171
https://doi.org/10.1177/1087054712453171...
). O uso de instrumentos como esses pode auxiliar na identificação de informações distorcidas a serem abordadas durante a psicoeducação, bem como servir como forma de avaliar o quanto a psicoeducação foi efetiva para o público-alvo.

Considerações finais

Este estudo apresenta as características da psicoeducação do TDAH a partir de publicações nacionais e internacionais. Após análise dos 29 estudos que satisfaziam os critérios de inclusão, constatou-se que nem todas as publicações apresentam claramente o conceito de psicoeducação utilizado, o que pode confundir os leitores dada a natureza teoricamente diversificada do constructo. A psicoeducação tem sido destinada, na maioria dos estudos, a familiares de pessoas com TDAH. Em geral, a psicoeducação deste transtorno parece contribuir para maior conhecimento sobre ele, maior adesão ao tratamento, menor intensidade dos sintomas, bem como maior qualidade de vida. Contudo, poucos estudos avaliaram o quanto as informações fornecidas na psicoeducação foram, de fato, apreendidas pelo público-alvo.

Destacam-se algumas limitações que podem interferir na interpretação dos resultados apresentados. A revisão de literatura foi realizada com a combinação de apenas cinco descritores e em apenas dois idiomas. É possível que outros artigos sobre o mesmo tema não tenham sido identificados e analisados. Logo, os resultados apresentados referem-se apenas à amostra de artigos selecionados para análise neste estudo.

A maior contribuição desta revisão sistemática foi oferecer um panorama da produção nacional e internacional sobre psicoeducação do TDAH a partir da busca em oito bases de dados, o que permitiu identificar aspectos que necessitam de maior atenção dos pesquisadores. Constatou-se ausência de relato de psicoeducação do transtorno para professores de nível superior e profissionais da saúde, o que sugere a necessidade de desenvolver adaptações da psicoeducação sobre o próprio transtorno e tratamento para esse público. Verificou-se também que já se sabe o conteúdo que deve ser transmitido em psicoeducação do TDAH, embora os profissionais pudessem investir em outros meios (internet, redes sociais, manuais) para atingir adolescentes e genitores, por exemplo.

  • Agradecemos ao Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) e Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS) pelo financiamento e à Karen Rech Braun pela colaboração como juíza.

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Datas de Publicação

  • Publicação nesta coleção
    Jan-Mar 2018

Histórico

  • Recebido
    23 Set 2016
  • Revisado
    23 Fev 2017
  • Aceito
    28 Fev 2017
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