RESUMO
OBJECTIVE: Eighteen extended multigenerational families were recruited from the genetically isolated Paisa community in Colombia to conduct genetic studies of attention-deficit/hyperactivity disorder (ADHD). This report describes the inclusion strategy and clinical features of participants to facilitate comparisons with other data sets. METHOD: Families were selected through a fixed-sampling scheme beginning with child probands referred for clinical evaluation for ADHD. Direct structured psychiatric interviews were conducted with 433 informative individuals, including 92 children aged 4 to 11, 57 adolescents aged 12 to 17, and 284 adults. Best estimate ADHD diagnoses were established for each informative pedigree member. RESULTS: These families contained a high proportion of individuals affected with ADHD (32.8%), which was highly comorbid with conduct disorder (50%; odds ratio 11.5, 95% confidence interval = 6.4-20.9), oppositional defiant disorder (25.4%; odds ratio 2.7, confidence interval = 1.5-4.8), and associated conditions including nicotine dependence and alcohol abuse and/or dependence. CONCLUSIONS: ADHD in these extended Paisa families is highly comorbid with conduct and oppositional defiant disorders. This pattern of comorbidity, as well as the large dense pedigrees of the sample, suggests that it will be particularly useful for molecular genetic studies that are currently under way.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/etnologia , Transtorno do Deficit de Atenção com Hiperatividade/genética , Relação entre Gerações , Idoso , Alcoolismo/diagnóstico , Alcoolismo/etnologia , Alcoolismo/genética , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/diagnóstico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/etnologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/genética , Área Programática de Saúde , Colômbia/epidemiologia , Comorbidade , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Estudos de Amostragem , Tabagismo/diagnóstico , Tabagismo/etnologia , Tabagismo/genéticaRESUMO
The aim of this article was to analyze the prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) in Colombian "Paisa" children and adolescents. A randomized sample of 4- to 17-year-old children and adolescents--176 males and 154 females--was selected from schools in Manizales, Colombia. The diagnosis of ADHD was obtained using a semistructured psychiatric and neurological interview, medical histories revision, and neurological or psychiatric evaluations. Several rating scales and a neuropsychological assessment were administered in order to confirm the diagnosis. Children with Full Scale Intelligence Quotient (FSIQ) between 71 and 84 were recorded as having Borderline Intellectual Functioning (BIF), and those with a history of mild motor retardation, and/or Performance Intelligence Quotient (PIQ) lower than 71, were recorded as having a Developmental Coordination disorder (DCD), after confirmation by neurological and neuropsychological examinations. BIF and DCD children were excluded from the ADHD group. Total prevalence of ADHD adjusted by sex was 16.4% (males 19.8% and females 12.3%). Prevalence of clean ADHD cases was 11.5%, distributed as follows: combined type, 6.4%; inattentive, 4.8%; and hyperactive-impulsive, 0.3%. Distribution by sex was as follows: males, 14.8%; and females, 7.7%; with an odds ratio of 2.1 (95% CI: 1-4.5, chi 2 = 4.0, p < .05). Clean prevalence of ADHD adjusted by equal sex distribution was 11.3%. Prevalence of BIF was 5.8%, DCD 3.0%, and mild mental retardation 3.9%. Prevalence of ADHD did not show differences by socioeconomic status (SES), in contrast to mild mental retardation in which BIF and DCD were significantly more frequent in the lower SES.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos Cognitivos/epidemiologia , Transtorno da Conduta/epidemiologia , Transtornos Psicomotores/epidemiologia , Adolescente , Área Programática de Saúde , Criança , Pré-Escolar , Transtornos Cognitivos/diagnóstico , Colômbia/epidemiologia , Comorbidade , Transtorno da Conduta/diagnóstico , Diagnóstico Diferencial , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Prevalência , Transtornos Psicomotores/diagnóstico , Índice de Gravidade de DoençaRESUMO
La prevalencia del trastorno por déficit de atención, cuando se utilizan instrumentos de diagnóstico epidemiológico y de aplicación a padres de niños paìsas, puede llegar al 16.1-18/100; estas cifras han sido criticadas por apoyarse en una sola fuente de información. El objetivo del estudio fue establecer la prevalencia del trastorno en una comunidad paisa usando multiples métodos para su diagnóstico. Se seleccionó de manera aleatoria una muestra de 341 niños y adolescentes de 4 a 17 años, 184 niños y 157 niñas de los colegios de la ciudad de Manizales. Se estratificaron en dos niveles socioeconómicos. Para el diagnóstico se utilizaron diversos cuestionarios, destinados a padres y maestros para la evaluación de la conducta de los niños y los adolescentes, previamente estandarizados en la población paisa. El diagnóstico se confirmó mediante una entrevista neurológica y psiquiátrica semiestructurada, se revisaron las historicas clínicas y se hizo una evaluación clínica neurológica y psiquiátrica cuando fue necesario. El análisis preliminar de los datos obtenidos, muestra que la prevalencia de la enfermedad y de acuerdo a los criterios de DSM IV, fue del 17.1/100. La distribución según tipos fue: combinado, inatento e hiperactivo-impulsivo. La prevalencia de la enfermedad en la comunidad paisa, según estos estudios es más alta que la informada en estudios de otras poblaciones