RESUMEN
El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo, de carácter crónico, de etiología multifactorial, principalmente debida a factores genéticos y ambientales. Realizamos un estudio analítico retrospectivo del tratamiento de niños diagnosticados de TDAH. Se estudió una muestra de 82 niños diagnosticados de TDAH (74.4% niños y 25.6% niñas). El 96.3% de los casos presentaba algún trastorno asociado. El tratamiento farmacológico fue el tratamiento de elección (90.2%). El 46.0% recibía metilfenidato de liberación inmediata, un 51.4% metilfenidato de liberación sostenida y la atomoxetina solo se recetó en un 2.7% de los casos. El 20.3% de la muestra abandonó en algún momento el tratamiento farmacológico. El tratamiento farmacológico fue la opción más utilizada en nuestra muestra, y el metilfenidato de liberación inmediata el fármaco de elección para inicio del tratamiento. Se utilizan poco las alternativas a los estimulantes. No se encontraron diferencias significativas entre el tipo de tratamiento y el subtipo de TDAH o el género, aunque sí en cuanto a la edad de inicio del tratamiento.
Attention deficit hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disorder, of a chronic nature, of multifactorial etiology, mainly due to genetic and environmental factors. We conducted a retrospective analytical study of the t herapeutic management of children diagnosed with ADHD. A sample of 82 children diagnosed with ADHD (74.4% children and 25.6% girls) was studied. 96.3% of the cases presented some associated disorder. Pharmacological treatment was the treatment of choice (90.2%). 46.0% received immediate release methylphenidate, 51.4% sustained release methylphenidate and atomoxetine was only prescribed in 2.7% of patients. 20.3% of the sample abandoned pharmacological treatment at some point. Pharmacological treatment was the most frequent option in our sample, and methylphenidate immediate release the drug of choice for treatment initiation. The alternatives to stimulants are used in very low percentage of the patient. No significant differences were found between the type of treatment regarding the subtype of ADHD or gender, but we found significant difference in relation with the age of onset of treatment.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Inhibidores de Captación Adrenérgica/uso terapéutico , Clorhidrato de Atomoxetina/uso terapéutico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Metilfenidato/uso terapéutico , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Psicoterapia , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/terapia , Estudios Retrospectivos , Distribución por Sexo , Distribución por EdadRESUMEN
Attention deficit hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disorder, of a chronic nature, of multifactorial etiology, mainly due to genetic and environmental factors. We conducted a retrospective analytical study of the t herapeutic management of children diagnosed with ADHD. A sample of 82 children diagnosed with ADHD (74.4% children and 25.6% girls) was studied. 96.3% of the cases presented some associated disorder. Pharmacological treatment was the treatment of choice (90.2%). 46.0% received immediate release methylphenidate, 51.4% sustained release methylphenidate and atomoxetine was only prescribed in 2.7% of patients. 20.3% of the sample abandoned pharmacological treatment at some point. Pharmacological treatment was the most frequent option in our sample, and methylphenidate immediate release the drug of choice for treatment initiation. The alternatives to stimulants are used in very low percentage of the patient. No significant differences were found between the type of treatment regarding the subtype of ADHD or gender, but we found significant difference in relation with the age of onset of treatment.
El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo, de carácter crónico, de etiología multifactorial, principalmente debida a factores genéticos y ambientales. Realizamos un estudio analítico retrospectivo del tratamiento de niños diagnosticados de TDAH. Se estudió una muestra de 82 niños diagnosticados de TDAH (74.4% niños y 25.6% niñas). El 96.3% de los casos presentaba algún trastorno asociado. El tratamiento farmacológico fue el tratamiento de elección (90.2%). El 46.0% recibía metilfenidato de liberación inmediata, un 51.4% metilfenidato de liberación sostenida y la atomoxetina solo se recetó en un 2.7% de los casos. El 20.3% de la muestra abandonó en algún momento el tratamiento farmacológico. El tratamiento farmacológico fue la opción más utilizada en nuestra muestra, y el metilfenidato de liberación inmediata el fármaco de elección para inicio del tratamiento. Se utilizan poco las alternativas a los estimulantes. No se encontraron diferencias significativas entre el tipo de tratamiento y el subtipo de TDAH o el género, aunque sí en cuanto a la edad de inicio del tratamiento.
Asunto(s)
Inhibidores de Captación Adrenérgica/uso terapéutico , Clorhidrato de Atomoxetina/uso terapéutico , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Metilfenidato/uso terapéutico , Adolescente , Distribución por Edad , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/terapia , Niño , Femenino , Humanos , Masculino , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Psicoterapia , Estudios Retrospectivos , Distribución por SexoRESUMEN
El Trastorno por Déficit de Atención e Hiperactividad (TDAH) es un trastorno neurobiológico frecuente asociado a un importante impacto funcional, personal y social. Posee un fuerte componente genético, con múltiples genes involucrados, que interactúan con factores ambientales y neurobiológicos, aumentando la susceptibilidad genética y heterogeneidad del cuadro clínico. Los hallazgos más consistentes apuntan a una dismorfología, disfunción y baja conectividad de múltiples redes, fronto-estriatal, fronto-parietal y fronto-cerebelar, lo que refleja los distintos dominios cognitivos afectados en TDAH, como inhibición, atención, percepción del tiempo y aversión a la demora. Contrario a lo que se pensaba el TDAH no se resuelve en la adolescencia, pero cambian sus manifestaciones, su complejidad y potencial de daño. El diagnóstico de TDAH es complejo dada su alta heterogeneidad clínica y la ausencia de un marcador biológico. En esta revisión se describen las conductas propias del adolescente y los desafíos que plantea en este contexto el diagnóstico de TDAH y su tratamiento.
Attention Deficit/Hyperactivity Disorder is a frequent neurobiological condition with significant personal and social functional impairments. It has a strong genetic component, involving multiple genes which interact with environmental and neurobiological factors, thus increasing genetic susceptibility and clinical heterogeneity. The most consistent findings point towards a dismorphology, dysfunction and underconnectivity of multiple fronto-striatal, fronto-parietal and fronto-cerebellar networks reflecting the different cognitive domains involved in ADHD, such as inhibition, attention, time perception and aversion to delay. Contrary to earlier beliefs, ADHD is not resolved in adolescence, but there is a change in its manifestations, complexity and potential harm. The diagnosis of ADHD is complex due to his high clinical heterogenecity and the absence of a biological marker. In this review there is a description of the normal specific behavior of the adolescent and, in this context, of the challenges of the diagnosis and treatment of ADHD.
Asunto(s)
Humanos , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/terapiaRESUMEN
INTRODUCTION: In July 2013, the US Food and Drug Administration approved the use of NEBA as the first device for the complementary evaluation of attention deficit hyperactivity disorder (ADHD). It is based on quantitative electroencephalogram (qEEG) and includes the standardised theta/beta ratio, the results of which were consistent with both the medical and psychological clinical evaluation. Likewise, it has proved to be a useful tool for determining whether the ADHD is primary, secondary or comorbid to another pathology. Yet, to date no publications have specified whether it is a total theta/beta ratio or theta/beta-1 and theta/beta-2. Additionally, no data are provided to be able to discriminate between diagnostic subtypes of ADHD. AIMS: To quantify the theta/beta ratios, by means of qEEG, in a sample of patients from the Rio de la Plata area with a main confirmed diagnosis of ADHD, in order to compare the neurophysiological patterns according to the diagnostic subtypes. PATIENTS AND METHODS: We used a randomised stratified sample of 62 subjects of both sexes, with ages between 8 and 17 years, distributed into two groups, depending on the diagnostic subtype: attention deficit subtype of ADHD (n = 31) and the combined subtype of ADHD (n = 31). RESULTS: High theta/beta-1 and theta/beta-2 ratios were confirmed in the Cz region, being higher than the ratios in the C3 and C4 areas. Moderate and statistically significant differences were found between the two subtypes only in the beta-1 band in the occipital regions. The analysis of the interhemispheric coherence suggests an association of the power peak crossed with the diagnostic subtype, which is the fastest peak (10 Hz) for the combined subtype. No important differences are found on analysing the phase spectra or the theta/beta ratios. CONCLUSIONS: Although the scientific literature, especially the NEBA system, highlights the importance of the theta/beta ratio in the differential diagnosis of ADHD in control samples and other neurodevelopmental disorders, a distinction must be made between beta-1 and beta-2.
TITLE: Cociente theta/beta (NEBA) en el diagnostico del trastorno por deficit de atencion/hiperactividad.Introduccion. En julio del año 2013, la Food and Drug Administration estadounidense aprobo el NEBA como el primer dispositivo para la evaluacion complementaria del trastorno por deficit de atencion/hiperactividad (TDAH), basado en el electroencefalograma cuantificado (EEGq) e incluyendo la relacion theta/beta estandarizada, cuyos resultados fueron consistentes con la evaluacion clinica, tanto medica como psicologica, y es una herramienta util para determinar si el TDAH es primario, secundario o comorbido a otro trastorno. Sin embargo, ninguna de las publicaciones, hasta la fecha, especifica si se trata de un cociente theta/beta total, o theta/beta-1 y theta/beta-2, como tampoco se aportan datos para discriminar entre subtipos diagnosticos del TDAH. Objetivo. Cuantificar los cocientes theta/beta, a traves del EEGq, en una muestra de pacientes rioplatenses con diagnostico principal confirmado de TDAH, para comparar el patron neurofisiologico segun el subtipo diagnostico. Pacientes y metodos. Muestra aleatoria estratificada de 62 sujetos de ambos sexos, de 8 a 17 años, distribuidos en dos grupos segun subtipo diagnostico, TDAH subtipo deficit de atencion (n = 31) y TDAH subtipo combinado (n = 31). Resultados. Se confirman cocientes altos theta/beta-1 y theta/beta-2 en la region Cz, mayores a los cocientes en las areas C3 y C4. Se encontraron diferencias moderadas y estadisticamente significativas entre los dos subtipos solo en la banda beta-1 en las regiones occipitales. El analisis de la coherencia interhemisferica sugiere una asociacion del pico de potencia cruzada con el subtipo diagnostico, que para el subtipo combinado es el pico mas rapido (10 Hz). No se encuentran diferencias importantes al analizar los espectros de fase, ni los cocientes theta/alfa. Conclusiones. Si bien la bibliografia cientifica, especificamente el sistema NEBA, plantea la importancia del cociente theta/beta en el diagnostico diferencial del TDAH de muestras controles y otros trastornos del neurodesarrollo, es necesario discriminar entre beta-1 y beta-2.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Ritmo beta , Ritmo Teta , Adolescente , Algoritmos , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Niño , Dominancia Cerebral , Femenino , Humanos , Masculino , Distribución Aleatoria , MuestreoRESUMEN
BACKGROUND: Taxometric and behavioral genetic studies suggest that attention deficit hyperactivity disorder (ADHD) is best modeled as a dimension rather than a category. We extended these analyses by testing for the existence of putative ADHD-related deficits in basic information processing (BIP) and inhibitory-based executive function (IB-EF) in individuals in the subclinical and full clinical ranges. Consistent with the dimensional model, we predicted that ADHD-related deficits would be expressed across the full spectrum, with the degree of deficit linearly related to the severity of the clinical presentation. METHOD: A total of 1547 children (aged 6-12 years) participated in the study. The Development and Well-Being Assessment (DAWBA) was used to classify children into groups according to levels of inattention and hyperactivity independently: (1) asymptomatic, (2) subthreshold minimal, (3) subthreshold moderate and (4) clinical ADHD. Neurocognitive performance was evaluated using a two-choice reaction time task (2C-RT) and a conflict control task (CCT). BIP and IB-EF measures were derived using a diffusion model (DM) for decomposition of reaction time (RT) and error data. RESULTS: Deficient BIP was found in subjects with minimal, moderate and full ADHD defined in terms of inattention (in both tasks) and hyperactivity/impulsivity dimensions (in the 2C-RT). The size of the deficit increased in a linear manner across increasingly severe presentations of ADHD. IB-EF was unrelated to ADHD. CONCLUSIONS: Deficits in BIP operate at subclinical and clinical levels of ADHD. The linear nature of this relationship provides support for a dimensional model of ADHD in which diagnostic thresholds are defined in terms of clinical and societal burden rather than representing discrete pathophysiological states.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/clasificación , Cognición/fisiología , Función Ejecutiva/fisiología , Inhibición Psicológica , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Brasil/epidemiología , Niño , Femenino , Humanos , Masculino , Índice de Severidad de la EnfermedadRESUMEN
The diagnostic criteria for the attention deficit/hyperactivity disorder (ADHD) were defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fourth version. ADHD is a neuro-psychiatric disorder associated with impairments in everyday life and behavioral dysregulation (i.e. inattention, hyper-activity and impulsivity), and it has showed empirical evidence from clinical, pharmacological, and psychometric studies. Nevertheless, the role of neurobiological impairments in the presentation of the symptoms remains unclear. For this paper, the authors reviewed Spanish and English literature that support the neurobiological validity of the disorder, aimed to present evidence associated with its cognitive and behavioral phenotype (e.g. in: neuropsychology, electrophysiology, structural and functional magnetic resonance imaging, neurochemistry and genetics). Additionally, an integrative theoretical clinical and scientific proposal is presented. Finally, the introduction of neurobiological marker as part of the definitive diagnosis is suggested, as a started point for the identification of therapeutic targets.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Atención , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Encéfalo/patología , Encéfalo/fisiopatología , Mapeo Encefálico , Cognición , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Electrofisiología , Potenciales Evocados , Predisposición Genética a la Enfermedad , Humanos , Conducta Impulsiva , Imagen por Resonancia Magnética , Metilfenidato/uso terapéutico , Modelos Neurológicos , Motivación , Neurobiología , Pruebas Neuropsicológicas , Neurotransmisores/fisiología , Fenotipo , Carácter Cuantitativo Heredable , Refuerzo en PsicologíaRESUMEN
The objective of the current study was to evaluate a proposed restrictive inattentive type of Attention Deficit Hyperactivity Disorder (ADHD) by comparing clinical correlates among youths with ADHD inattentive type (ADHD-I) as a function of the number of hyperactivity symptoms presented (none vs. 3 or less) and controls (individuals without ADHD). The sample for this community-based study was comprised of youths aged 6 to 18 years from 12 public schools in Porto Alegre, Brazil. ADHD-I groups had lower levels of adaptive functioning (p < .001) and a higher occurrence of familial ADHD (p < .001) when compared with the controls. There was no significant difference between the two ADHD-I groups. Also, both ADHD-I groups had higher rates of oppositional defiant disorder than controls (p < .001) without significant difference between them. For generalized anxiety disorder and social phobia, only the ADHD-I without HI group showed significant differences compared to controls.
Asunto(s)
Adaptación Psicológica , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Familia/psicología , Agitación Psicomotora/diagnóstico , Adolescente , Trastornos de Ansiedad/psicología , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Déficit de la Atención y Trastornos de Conducta Disruptiva/clasificación , Déficit de la Atención y Trastornos de Conducta Disruptiva/diagnóstico , Brasil/epidemiología , Niño , Comorbilidad , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Trastornos Fóbicos/diagnóstico , Trastornos Fóbicos/epidemiología , Agitación Psicomotora/psicología , MuestreoRESUMEN
Objetivo: Diseñar, validar y determinar confiabilidad de un instrumento para evaluar limitaciones en actividad y restricciones en participación de niños con TDAH a nivel escolar. Procedimiento: Se determino validez de contenido y apariencia por juicio de expertos y consistencia interna mediante alfa de Cronbach. Muestra de 37 profesores de niños de 6 a 12 años con TDAH combinado escolarizados. Resultados: Se diseño el cuestionario CLARP-TDAH profesores con 6 dominios y 37 Items con buena validez de apariencia y contenido, consistencia interna por alfa de Cronbach de 0.96 para el cuestionario completo, y para cada dominio valores por encima de 0.7. Conclusiones: El uso de la CIF para evaluar limitaciones y restricciones trasciende los signos y síntomas a otras alteraciones en los niños con TDAH. El cuestionario tiene una confiabilidad suficiente para su uso y aplicación clínica. Es necesario continuar procesos de validación y confiabilidad del cuestionario.
Objetive: To design, validate and determine the reliability of an instrument to evaluate activity limitations and participation restrictions involving children with ADHD at scholar level. Procedure: Content validity and appearance was determined by experts and internal consistency by Cronbach alpha. Sample of 37 teachers of scholarized children between the ages of 6 to 12 with ADHD combined. Results: The questionnaire CLARP-TDAH professor was designed with 6 dominions and 37 items with good appearance validity and content. Internal consistency by Cronbach alpha of 0.96 for the completed questionnaire and for each domain values above 0.7. Conclusions: The use of CIF to evaluate limitations and restrictions transcend the signs and symptoms to other alterations in children with ADHD. The questionnaire has enough reliability for its use and clinical application. However, it is necessary to continue with the processes of validation and reliability of the questionnaire.
Asunto(s)
Humanos , Niño , Encuestas y Cuestionarios , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/psicología , Chile , Comunicación , Evaluación de la Discapacidad , Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud , Relaciones Interpersonales , Aprendizaje , Reproducibilidad de los Resultados , Factores Socioeconómicos , Trastorno por Déficit de Atención con Hiperactividad/clasificaciónRESUMEN
OBJECTIVE: To better understand the familial transmission of attention deficit hyperactivity disorder (ADHD), a highly heritable disorder, the effects of paternal and maternal ADHD status on probands' ADHD symptoms and subtypes were investigated. STUDY DESIGN: In 323 trios with ADHD, data from a structured interview and a self-report scale (score of >21) were used to determine ADHD probands' diagnostic status and parental ADHD status, respectively. Parental ADHD status on proband ADHD severity and subtypes was investigated. RESULTS: ADHD criteria were endorsed by 23% of fathers and 27% of mothers, and by at least one parent in 41% of the cases. ADHD severity was higher for children whose parents had ADHD versus those whose parents were without it. Paternal ADHD was associated with an increased likelihood of ADHD combined subtype (odds ratio = 3.56) and a decreased likelihood of the inattentive subtype (odds ratio = 0.34) in male children. CONCLUSIONS: Parental ADHD status appears to confer different risks for the severity of hyperactive-impulsive and inattentive symptoms depending on parental sex; however, parental ADHD self-report scale score has low to negligible correlation with proband's ADHD severity. Biparental ADHD does not appear to have an additive or synergistic effect on the proband's ADHD severity.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/genética , Padres , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Niño , Femenino , Estado de Salud , Humanos , Masculino , Índice de Severidad de la EnfermedadRESUMEN
There is much controversy about the importance of the electroencephalogram (EEG) in assessing the attention-deficit/hyperactivity disorder (ADHD). The objective of this study was to assess the use of EEG and quantitative EEG (qEEG) in ADHD children. Thirty ADHD children and 30 sex- and age-matched controls with no neurological or psychiatric problems were studied. The EEG was recorded from 15 electrode sites during an eyes-closed resting condition. Epileptiform activity was assessed, as were the absolute and relative powers in the classical bands after application of the Fast Fourier transform. Epileptiform activity was found in 3 (10%) ADHD children. As compared to the controls, the ADHD group showed significantly greater absolute delta and theta powers in a diffuse way, and also greater absolute beta power and smaller relative alpha 1 and beta powers at some electrodes. A logistic multiple regression model, allowed for 83.3% sensibility and specificity in diagnosing ADHD.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Electroencefalografía , Epilepsia/diagnóstico , Distribución por Edad , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Estudios de Casos y Controles , Niño , Electrodos , Femenino , Humanos , Modelos Logísticos , Masculino , Distribución por SexoRESUMEN
There is much controversy about the importance of the electroencephalogram (EEG) in assessing the attention-deficit/hyperactivity disorder (ADHD). The objective of this study was to assess the use of EEG and quantitative EEG (qEEG) in ADHD children. Thirty ADHD children and 30 sex- and age-matched controls with no neurological or psychiatric problems were studied. The EEG was recorded from 15 electrode sites during an eyes-closed resting condition. Epileptiform activity was assessed, as were the absolute and relative powers in the classical bands after application of the Fast Fourier transform. Epileptiform activity was found in 3 (10 percent) ADHD children. As compared to the controls, the ADHD group showed significantly greater absolute delta and theta powers in a diffuse way, and also greater absolute beta power and smaller relative alpha 1 and beta powers at some electrodes. A logistic multiple regression model, allowed for 83.3 percent sensibility and specificity in diagnosing ADHD.
Há controvérsias sobre a importância do eletrencefalogama (EEG) na avaliação do transtorno de déficit de atenção/hiperatividade (TDAH). O objetivo deste estudo foi avaliar, em crianças com TDAH, o EEG digital e quantitativo. Foram estudadas 30 crianças com TDAH e 30 sadias, sem evidências de problemas neurológicos ou psiquiátricos e pareadas por idade e gênero. Foi registrado o EEG em 15 posições de eletrodos, durante repouso e olhos fechados. Foi realizada pesquisa de atividade epileptiforme e feita análise de freqüências nas faixas clássicas, após aplicação da transformada rápida de Fourier. Foi encontrada atividade epileptiforme em 3 (10 por cento) crianças com TDAH. O grupo TDAH teve, em relação ao grupo controle, significativamente, maior potência absoluta delta e teta, de modo difuso, assim como maior potência absoluta beta e menor potência relativa alfa 1 e beta, em alguns eletrodos. Um modelo de regressão múltipla logística possibilitou sensibilidade e especificidade de 83,3 por cento no diagnóstico de TDAH.
Asunto(s)
Niño , Femenino , Humanos , Masculino , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Electroencefalografía , Epilepsia/diagnóstico , Distribución por Edad , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Estudios de Casos y Controles , Electrodos , Modelos Logísticos , Distribución por SexoRESUMEN
OBJECTIVE: To examine whether symptoms of attention-deficit/hyperactivity disorder (ADHD) during childhood are associated with child maltreatment. STUDY DESIGN: The study sample consisted of 14 322 participants in the National Longitudinal Study of Adolescent Health. We used logistic regression and propensity score matching to examine the relationship, adjusting for demographic, socioeconomic, and familial risk factors for child maltreatment. RESULTS: Inattentive type, by criteria of Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, was significantly associated with the likelihood of supervision neglect (odds ratio [OR]: 1.6; 95% confidence interval [CI]: 1.2-2.2), physical neglect (OR: 2.1; 95% CI: 1.4-3.1), physical abuse (OR: 1.6; 95% CI: 1.1-2.3), and contact sexual abuse (OR: 2.6; 95% CI: 1.5-4.5). To a lesser extent, hyperactive type was associated with the likelihood of supervision neglect (OR: 1.5; 95% CI: 1.1-2.0) and physical abuse (OR: 1.3; 95% CI: 1.0-1.6). The association between hyperactive type and physical neglect or contact sexual abuse was not significant. The results from the propensity score matching were similar. CONCLUSIONS: Childhood ADHD symptoms were associated with self-reported child maltreatment. Health care providers should be alert to the potential for child maltreatment among children with ADHD symptoms, especially those with inattentive symptoms.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/etiología , Maltrato a los Niños/clasificación , Familia , Vigilancia de la Población/métodos , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Factores de Confusión Epidemiológicos , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Estados UnidosRESUMEN
An association between ADRA2A -1291 C > G polymorphism and response to methylphenidate in inattentive symptoms was previously suggested in children with ADHD. No investigation specifically assessed this association in ADHD-inattentive type (ADHD-I). In this naturalistic pharmacogenetic study, 59 subjects with ADHD-I from a non-referred sample were treated with short-acting methylphenidate and genotyped for ADRA2A -1291 C > G polymorphism. The primary outcome measure was the inattentive subscale of the SNAP-IV applied by a child psychiatrist blinded to genotype at baseline and first month of treatment. Children and adolescents with the G allele showed significantly lower inattentive scores with MPH treatment at the first month of treatment than subjects without the G allele (n = 59; F = 6.14; p = 0.016). We extended to ADHD-I previous findings suggesting the influence of the G allele at the ADRA2A -1291 C > G polymorphism on the improvement of inattentive symptoms with methylphenidate in children with all ADHD subtypes.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/genética , Estimulantes del Sistema Nervioso Central/uso terapéutico , Metilfenidato/uso terapéutico , Farmacogenética , Receptores Adrenérgicos alfa 2/genética , Adolescente , Alelos , Análisis de Varianza , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Niño , Femenino , Frecuencia de los Genes , Humanos , Masculino , Polimorfismo de Nucleótido Simple/genéticaAsunto(s)
Humanos , Niño , Adolescente , Adulto , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/terapia , Conferencias de Consenso como Asunto , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/etiologíaRESUMEN
BACKGROUND: Previous investigations have demonstrated that an MspI polymorphism at the adrenergic alpha2A receptor gene (ADRA2A) is associated with severity of attention-deficit/hyperactivity disorder (ADHD) inattentive symptoms in clinical samples composed mainly of subjects with ADHD, combined type. This study aimed to investigate the association between this ADRA2A polymorphism and attention-deficit/hyperactivity disorder-inattentive type (ADHD-I) in a nonreferred sample. METHODS: In a case-control study, we assessed a sample of 100 children and adolescents with ADHD-I and 100 non-ADHD controls. Cases and controls were matched by gender and age and were screened by using teacher reports in a revised version of the Swanson, Nolan, and Pelham rating scale at 12 schools. Psychiatric diagnoses were derived through structured diagnostic interviews. RESULTS: Homozygous subjects for the G allele at the ADRA2A had significantly higher odds ratio (OR) for ADHD-I than did those with other genotypes (CC + CG genotypes), even after adjusting for potential confounders (p = .02; OR = 3.78; 95% confidence interval = 1.23-11.62). In family-based analyses, no significant associations were detected. CONCLUSIONS: Our results suggest that the ADRA2A may be associated with ADHD-I, replicating previous findings from clinical samples that have suggested the importance of this gene for the dimension of inattention. In addition, these results support the role of the noradrenergic system in ADHD.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/genética , Predisposición Genética a la Enfermedad , Polimorfismo Genético , Receptores Adrenérgicos alfa 2/genética , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Estudios de Casos y Controles , Niño , Femenino , Frecuencia de los Genes , Genotipo , Humanos , Masculino , Oportunidad Relativa , Escalas de Valoración Psiquiátrica , Índice de Severidad de la EnfermedadRESUMEN
The aim of the present study is to verify if gender modifies the clinical, adaptative and psychological outcomes of adult attention-deficit/hyperactivity disorder (ADHD) subtypes. We evaluated 219 clinically referred adult patients. The interviews followed the DSM-IV criteria,using the K-SADS-E for ADHD and oppositional defiant disorder and SCID-IV for comorbidities. Regression models were used to analyze gender and subtype main effects and interactions in psychiatric outcomes. In the initial sample, 117 patients (53.5%) were of the combined subtype, 88 (40%) were inattentives and 14 (6.5%) hyperactives. There were no significant interactions between gender and subtype in any variable assessed. Men and women did not differ in the relative frequency of each subtype. Patients of the combined subtype in both genders presented a higher severity and increased rates of conduct and ODD disorders than inattentives. The main effects of gender and subtype in this sample are similar to those previously reported in other countries, suggesting the cross-cultural equivalence of the phenotype. The absence of significant interactions between gender and subtype suggests that, at least in clinical-based samples, DSM-IV adult ADHD subtypes present cross-gender validity.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Adulto , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Comorbilidad , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Factores SexualesRESUMEN
There is still some debate in the literature whether Attention-Deficit Disorder/Hyperactivity (ADHD) is best conceptualized as a biological disorder or if it is best understood as a cultural construct. This review aims to contribute to disentangle this issue assessing clinical and research data on ADHD in a complete diverse culture from a developing country. We performed a systematic computerized review of the literature on ADHD in Brazil. All investigations were included if dealing with ADHD prevalence, etiology, symptomatological construct, or treatment. Findings were compared to those from studies in developed countries. The prevalence rates of ADHD (5.8% using DSM-IV criteria, 1.5% using ICD-10), the bi-dimensional factor construct extracted from factor analyses (inattention and hyperactivity/impulsivity), the pattern of ADHD comorbidity in clinical samples, the family genetic data suggesting a 39% family transmission in clinical samples and the role of some potential candidate genes in dopaminergic and noradrenergic systems, as well as data on the efficacy of methylphenidate in the disorder are all very similar to findings from developed countries. Taken together, these findings suggest that ADHD is not a cultural construct, reinforcing the importance of applying similar research methodology in different cultures to make findings comparable.
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Trastorno por Déficit de Atención con Hiperactividad/etnología , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Cultura , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/genética , Comorbilidad , Comparación Transcultural , Salud de la Familia , Humanos , Biología Molecular , PrevalenciaRESUMEN
BACKGROUND: The aim of this investigation was to examine the construct validity and distinctiveness of the inattentive type (IT) and combined type (CT) of Attention-Deficit/Hyperactivity Disorder (ADHD) in a Latino/Hispanic sample. METHOD: A comprehensive assessment was conducted with a clinically diagnosed school-based sample of 98 children aged 6 to 11 (CT=44; IT=25; control group=29). RESULTS: Both ADHD groups were impaired on academic achievement measures, presented more ADHD-type behaviors during math and vigilance tasks, and exhibited greater internalizing symptoms. The IT group had a later onset of inattention symptoms, presented more sluggish cognitive tempo symptoms, was less prone to initiate social interactions or to be assertive and more self-controlled in social interchanges, was less likely to have externalizing behaviors, had mothers who reported less child-related family stress, and was less impaired in their adaptive functioning. CONCLUSIONS: Findings supported the construct validity of ADHD in this culturally different sample and suggested that the CT and IT represent distinct disorders.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Niño , Escolaridad , Femenino , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Pruebas Psicológicas , Puerto Rico/epidemiología , Reproducibilidad de los Resultados , Ajuste SocialRESUMEN
AIMS: This study reports the findings of a research project aimed at determining the rate of prevalence of attention deficit hyperactivity disorder (ADHD) in school aged children. PATIENTS AND METHODS: Different behavioural and cognitive measures were administered to a sample of children between 3 and 13 years of age obtained by means of a multistage sampling procedure that was stratified by socioeconomic and educational level. The sample was made up of 394 children; 33.25% (n = 131) were females and the remaining 66.75% (n = 263) males. The mean age of the sample was 7.64 years old (SD: 2.33). The assessment battery included the Conners Rating Scales adapted for parents and teachers, the abbreviated version of the Wechsler Intelligence Scale for Children (WISC III) and for Preschool children Revised (WPPSI R), several academic achievement scales, development history and DISC IV. RESULTS: The estimated prevalence of ADHD was 10.15%, and a figure of 2.03% was obtained for the hyperactive type, 0.51% for the inattentive subtype, and 7.61% for the combined subtype. Prevalence was higher for males, the ratio being 3:1. Subjects performance in the cognitive and academic measures was within the average interval. CONCLUSIONS: The prevalence of ADHD in our population oscillates around the average figures reported in other countries. This study confirms the prevalence of ADHD in the population of Venezuela, with a distribution of subtypes and in terms of gender similar to those reported in the literature.