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BACKGROUND: In Mexico, this pioneering research was undertaken to assess the accessibility of timely diagnosis of Dyads [Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and their primary caregivers] at specialized mental health services. The study was conducted in two phases. The first phase involved designing an "Access Pathway" aimed to identify barriers and facilitators for ADHD diagnosis; several barriers, with only the teacher being identified as a facilitator. In the second phase, the study aimed to determine the time taken for dyads, to obtain a timely diagnosis at each stage of the Access Pathway. As well as identify any disparities based on gender and socioeconomic factors that might affect the age at which children can access a timely diagnosis. METHOD: In a retrospective cohort study, 177 dyads participated. To collect data, the Acceda Survey was used, based on the robust Conceptual Model Levesque, 2013. The survey consisted of 48 questions that were both dichotomous and polytomous allowing the creation of an Access Pathway that included five stages: the age of perception, the age of search, the age of first contact with a mental health professional, the age of arrival at the host hospital, and the age of diagnosis. The data was meticulously analyzed using a comprehensive descriptive approach and a nonparametric multivariate approach by sex, followed by post-hoc Mann-Whitney's U tests. Demographic factors were evaluated using univariable and multivariable Cox regression analyses. RESULTS: 71% of dyads experienced a late, significantly late, or highly late diagnosis of ADHD. Girls were detected one year later than boys. Both boys and girls took a year to seek specialized mental health care and an additional year to receive a formal specialized diagnosis. Children with more siblings had longer delays in diagnosis, while caregivers with formal employment were found to help obtain timely diagnoses. CONCLUSIONS: Our findings suggest starting the Access Pathway where signs and symptoms of ADHD are detected, particularly at school, to prevent children from suffering consequences. Mental health school-based service models have been successfully tested in other latitudes, making them a viable option to shorten the time to obtain a timely diagnosis.
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Transtorno do Deficit de Atenção com Hiperatividade , Diagnóstico Precoce , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Mental , Humanos , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Criança , Masculino , Feminino , México/epidemiologia , Adolescente , Estudos Retrospectivos , Serviços de Saúde Mental/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
Resumen El Trastorno de Tourette (TT) y el Trastorno por déficit de atención / hiperactividad (TDAH) son entidades neu ropsiquiátricas que usualmente inician en la infancia. Esta revisión busca colaborar con los clínicos, quienes suelen confrontarse al dilema de saber si existe una comorbilidad o un diagnóstico diferencial, ya que esta pregunta cobra vital importancia en el momento de decidir el tratamiento. Invitamos al colega a revisar nuestros hallazgos, soportados por bases moleculares, fisiológicas y neuroanatómicas, además de los datos epidemiológicos. Al final, brindamos una propuesta de algoritmo diag nóstico que podrá utilizar cuando se encuentre ante síntomas compartidos entre los dos diagnósticos. El TDAH y el TT deben ser intervenidos tempranamente, para mejorar la calidad de vida y funcionalidad del paciente y prevenir secuelas, no solo en niños, niñas y adolescentes (NNA), también a lo largo de la vida.
Abstract Tourette Disorder (TD) and attention deficit hyperac tivity disorder (ADHD) are both major neuropsychiatric conditions that usually begin during infancy. This revision aims to collaborate with pediatricians, who are often confronted with the question of co-mor bidity or differential diagnosis between ADHD and TD. The question becomes urgent when the clinician must decide if he/she can start ADHD or TD treatment. We encourage our colleagues to revise our findings, based in bimolecular and neuroanatomic shared issues in ad dition to updated epidemiological findings. The clinician will find an original proposed algorithm that they can use when the shared symptoms are pres ent in a little patient. TD and ADHD must be intervened early, so we can get better outcomes. The consequences of letting the symptoms increase can generate sequels and handicaps, that can interfere with the quality of life and functionality not only during infancy and adoles cence but also in adult life.
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Tourette Disorder (TD) and attention deficit hyperactivity disorder (ADHD) are both major neuropsychiatric conditions that usually begin during infancy This revision aims to collaborate with pediatricians, who are often confronted with the question of co-morbidity or differential diagnosis between ADHD and TD. The question becomes urgent when the clinician must decide if he/she can start ADHD or TD treatment. We encourage our colleagues to revise our findings, based in bimolecular and neuroanatomic shared issues in addition to updated epidemiological findings. The clinician will find an original proposed algorithm that they can use when the shared symptoms are present in a little patient. TD and ADHD must be intervened early, so we can get better outcomes. The consequences of letting the symptoms increase can generate sequels and handicaps, that can interfere with the quality of life and functionality not only during infancy and adolescence but also in adult life.
El Trastorno de Tourette (TT) y el Trastorno por déficit de atención / hiperactividad (TDAH) son entidades neuropsiquiátricas que usualmente inician en la infancia. Esta revisión busca colaborar con los clínicos, quienes suelen confrontarse al dilema de saber si existe una comorbilidad o un diagnóstico diferencial, ya que esta pregunta cobra vital importancia en el momento de decidir el tratamiento. Invitamos al colega a revisar nuestros hallazgos, soportados por bases moleculares, fisiológicas y neuroanatómicas, además de los datos epidemiológicos. Al final, brindamos una propuesta de algoritmo diagnóstico que podrá utilizar cuando se encuentre ante síntomas compartidos entre los dos diagnósticos. El TDAH y el TT deben ser intervenidos tempranamente, para mejorar la calidad de vida y funcionalidad del paciente y prevenir secuelas, no solo en niños, niñas y adolescentes (NNA), también a lo largo de la vida.
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Transtorno do Deficit de Atenção com Hiperatividade , Síndrome de Tourette , Adulto , Feminino , Adolescente , Humanos , Síndrome de Tourette/diagnóstico , Síndrome de Tourette/epidemiologia , Síndrome de Tourette/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Diagnóstico Diferencial , Qualidade de Vida , ComorbidadeRESUMO
Methylphenidate hydrochloride is used to treat children, adolescents, and adults with attention deficit/hyperactivity disorder (ADHD). Multiphasic release formulation has been used to control drug levels, mainly during children's school period. This study aimed to evaluate the bioequivalence between two methylphenidate hydrochloride extended-release tablets to meet regulatory requirements for registration in Brazil. Two independent studies (under fasting and fed conditions) designed as open-label, randomized, single-dose, two-period, two-way crossover trials were conducted in healthy subjects of both genders. Subjects were enrolled and randomly received a single dose of the test formulation methylphenidate hydrochloride 54 mg extended-release tablet (Consiv®, Adium S.A., São Paulo, Brazil) or the reference formulation (Concerta®, Janssen-Cilag Farmacêutica Ltd., São Paulo, Brazil), in each period, with a 7-day washout interval. Serial blood samples were collected up to 24 h post dose and methylphenidate plasma concentrations were obtained using a validated LC-MS/MS method. A total of 96 healthy subjects were enrolled in the fasting study, of which 80 completed the study. For the fed study, 52 healthy subjects were enrolled, and 46 subjects completed it. In both studies, 90% confidence intervals for Cmax, AUC0-t, AUC0-inf, and partial AUCs were within the acceptable limits of 80.00 to 125.00%. Thus, according to regulatory requirements, the test formulation (Consiv®) was considered to be bioequivalent to the reference formulation (Concerta®) in both conditions (fasting and fed) and, therefore, it can be considered interchangeable in clinical practice. Both formulations were safe and well tolerated in single-dose administration.
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Background: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent psychiatric disorders among school-age children and is characterized by varying degrees of inattention, hyperactivity, and impulsivity. Diagnosis, which currently relies on the DSM-V criteria, is complex. This research proposes an integrated procedure for ADHD diagnosis in children, improving the diagnostic process and scientific research on etiopathology. Materials and methods: We conducted a clinical report on ADHD diagnosis in children (n = 92) between the ages of 8 and 13, based on the results of the application of different scales to parents of school-age children in Chile. The children were divided into two groups, those with an ADHD diagnosis (n = 44) and those without (n = 48) (24% females). Results: The results revealed statistically significant differences between groups for scales EDAH y SDQ-Cas, Conners Comprehensive Behavior Scale, Conners Parent Scale and the criteria according to the DSM-V and its dimensions, with the exception of inattention. Conclusion: The findings indicate the importance of appropriate criteria and procedures to establish a diagnosis and implement effective interventions in ADHD.
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As a neurodevelopmental pathology, Attention Deficit Hyperactivity Disorder (ADHD) mainly arises during childhood. Persistent patterns of generalized inattention, impulsivity, or hyperactivity characterize ADHD that may persist into adulthood. The conventional diagnosis relies on clinical observational processes yielding high rates of overdiagnosis due to varying interpretations among specialists or missing information. Although several studies have designed objective behavioral features to overcome such an issue, they lack significance. Despite electroencephalography (EEG) analyses extracting alternative biomarkers using signal processing techniques, the nonlinearity and nonstationarity of EEG signals restrain performance and generalization of hand-crafted features. This work proposes a methodology to support ADHD diagnosis by characterizing EEG signals from hidden Markov models (HMM), classifying subjects based on similarity measures for probability functions, and spatially interpreting the results using graphic embeddings of stochastic dynamic models. The methodology learns a single HMM for EEG signal from each patient, so favoring the inter-subject variability. Then, the Probability Product Kernel, specifically developed for assessing the similarity between HMMs, fed a support vector machine that classifies subjects according to their stochastic dynamics. Lastly, the kernel variant of Principal Component Analysis provided a means to visualize the EEG transitions in a two-dimensional space, evidencing dynamic differences between ADHD and Healthy Control children. From the electrophysiological perspective, we recorded EEG under the Stop Signal Task modified with reward levels, which considers cognitive features of interest as insufficient motivational circuits recruitment. The methodology compares the supported diagnosis in two EEG channel setups (whole channel set and channels of interest in frontocentral area) and four frequency bands (Theta, Alpha, Beta rhythms, and a wideband). Results evidence an accuracy rate of 97.0% in the Beta band and in the channels where previous works found error-related negativity events. Such accuracy rate strongly supports the dual pathway hypothesis and motivational deficit concerning the pathophysiology of ADHD. It also demonstrates the utility of joining inhibitory and motivational paradigms with dynamic EEG analysis into a noninvasive and affordable diagnostic tool for ADHD patients.
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Transtorno do Deficit de Atenção com Hiperatividade , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Ritmo beta/fisiologia , Criança , Eletroencefalografia/métodos , Humanos , Processamento de Sinais Assistido por Computador , Máquina de Vetores de SuporteRESUMO
OBJECTIVE: To evaluate perspectives of youth regarding diverted stimulant use among a contemporary sample of adolescents and young adults. STUDY DESIGN: This study used MyVoice, a longitudinal national text message survey of American youth. In February 2019, 1228 MyVoice youth were asked 4 open-ended questions to elicit their perspectives on diverted stimulant use. Responses were assessed using thematic analysis, and quantitative results were summarized using descriptive statistics. RESULTS: Of 1228 youth, 906 responded to at least one survey question (relative risk, 74%). Respondents' ages ranged from 14 to 24 years with a mean age of 18.8 ± 2.9 years, 57% were female, and 66% identified as White. Peer pressure and coping were commonly perceived reasons for diversion, and respondents believed that many youth misuse stimulants. Many were aware of health risks of misuse, but few mentioned potential legal consequences. Youth thought stimulants could be obtained from peers, people with a prescription, dealers, and family, and some mentioned access through unnecessary prescriptions. CONCLUSIONS: The perspectives of a national sample of youth suggest that stimulant diversion continues to be a significant problem among American youth, with many noting that diverted stimulants are easy to obtain and are used to self-treat mental health issues. Standardized interventions at schools and in healthcare settings, as well as universal screening for diversion and mental health conditions, may combat this public health concern.
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Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Uso Indevido de Medicamentos sob Prescrição/psicologia , Adolescente , Adulto , Estimulantes do Sistema Nervoso Central/efeitos adversos , Feminino , Humanos , Estudos Longitudinais , Masculino , Influência dos Pares , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Medição de Risco , Inquéritos e Questionários , Envio de Mensagens de Texto , Estados Unidos , Adulto JovemRESUMO
Shared difficulties with cognitive control may play a role in co-occurring mental health problems frequently observed in autistic children. We investigated how different cognitive control processes (inhibitory control, conflict resolution, cognitive flexibility) associated with traits of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and anxiety in 7-year-old children at elevated (n = 44) and typical (n = 37) familial likelihood for ASD. Poor inhibitory control was associated with higher ADHD traits. Better inhibitory control and poorer cognitive flexibility predicted higher anxiety traits. Cognitive control processes were not associated dimensionally with autistic traits, though better conflict resolution predicted greater likelihood of meeting diagnostic criteria for ASD in categorical analysis. These findings suggest that different cognitive control alterations are associated with ASD, ADHD and anxiety.
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Transtornos de Ansiedade/psicologia , Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Espectro Autista/psicologia , Função Executiva/fisiologia , Ansiedade/complicações , Transtornos de Ansiedade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Espectro Autista/complicações , Criança , Cognição , Feminino , Humanos , Masculino , Fatores de RiscoRESUMO
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder of childhood. Although abnormalities in several brain regions and disturbances of the catecholaminergic pathway have been demonstrated, the pathophysiology of ADHD is not completely understood, but as a multifactorial disorder, has been associated with an increase in oxidative stress and neuroinflammation. This review presents an overview of factors that increase oxidative stress and neuroinflammation. The imbalance between oxidants and antioxidants and also the treatment with medications are two factors that can increase oxidative damage, whereas the comorbidity between ADHD and inflammatory disorders, altered immune response, genetic and environmental associations, and polymorphisms in inflammatory-related genes can increase neuroinflammation. Evidence of an association with these factors has become valuable for research on ADHD. Such evidence opens up new intervention routes for the use of natural products as antioxidants that could have potential as a treatment against oxidative stress and neuroinflammation in ADHD.
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BACKGROUND: Exposure to fluoride has been linked with increased prevalence of attention deficit hyperactivity disorder (ADHD) in the United States and symptoms of inattention in Mexican children. We examined the association between fluoride exposure and attention outcomes among youth living in Canada. METHOD: We used cross-sectional data collected from youth 6 to 17â¯years of age from the Canadian Health Measures Survey (Cycles 2 and 3). Urinary fluoride concentration adjusted for specific gravity (UFSG) was available for 1877 participants. Water fluoride concentration measured in tap water samples was available for 980 participants. Community water fluoridation (CWF) status was determined by viewing reports on each city's website or contacting the water treatment plant. We used logistic regression to test the association between the three measures of fluoride exposure and ADHD diagnosis. Linear regression was used to examine the relationship between the three measures of fluoride exposure and the hyperactivity/inattention score on the Strengths and Difficulties Questionnaire (SDQ). RESULTS: UFSG did not significantly predict ADHD diagnosis or hyperactive/inattentive symptoms. A 1â¯mg/L increase in tap water fluoride level was associated with a 6.1 times higher odds of an ADHD diagnosis (95% CIâ¯=â¯1.60, 22.8). A significant interaction between age and tap water fluoride level (pâ¯=â¯.03) indicated a stronger association between tap water fluoride and hyperactivity/inattention symptoms among older youth. A 1â¯mg/L increase in water fluoride level was associated with a 1.5 SDQ score increase (95% CI: 0.23, 2.68, pâ¯=â¯.02) for youth at the 75th percentile of age (14â¯years old). Similarly, there was a significant interaction between age and CWF. At the 75th percentile of age (14â¯years old), those living in a fluoridated region had a 0.7-point higher SDQ score (95% CIâ¯=â¯0.34, 1.06, pâ¯<â¯.01) and the predicted odds of an ADHD diagnosis was 2.8 times greater compared with youth in a non-fluoridated region (aORâ¯=â¯2.84, 95% CI: 1.40, 5.76, pâ¯<â¯.01). DISCUSSION: Exposure to higher levels of fluoride in tap water is associated with an increased risk of ADHD symptoms and diagnosis of ADHD among Canadian youth, particularly among adolescents. Prospective studies are needed to confirm these results.
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Transtorno do Deficit de Atenção com Hiperatividade/induzido quimicamente , Fluoretos/análise , Água/química , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Canadá/epidemiologia , Criança , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , México , Estudos Prospectivos , Estados UnidosRESUMO
Abstract Objectives The aim of the present study was to evaluate the associations of parental bonding and adolescents' Internet addiction symptoms with depression and anxiety in parents of adolescents with attention deficit/hyperactivity disorder (ADHD). Methods Parental depression and anxiety symptoms, parental bonding, and adolescents' Internet addiction symptoms were assessed in 46 parent-child dyads using the Center for Epidemiological Studies Depression Scale, State-Trait Anxiety Inventory, Parental Bonding Instrument (PBI), and Chen Internet Addiction Scale, respectively. Forward stepwise multiple regression analysis was used to examine the associations of parental bonding and adolescents' Internet addiction symptoms with parental depression and anxiety. Results Low care/affection on the PBI was significantly associated with parental depression, and overprotection on the PBI and adolescents' Internet addiction were significantly associated with parental anxiety. Discussion Parental bonding and adolescents' Internet addiction are related to depression and anxiety in parents of adolescents with ADHD.
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Humanos , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Ansiedade/complicações , Comportamento Aditivo/etiologia , Depressão/complicações , Relações Familiares/psicologia , Ansiedade/diagnóstico , Pais/psicologia , Escalas de Graduação Psiquiátrica , Transtorno do Deficit de Atenção com Hiperatividade , Internet , Depressão/diagnósticoRESUMO
Abstract Background Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups - mainly on trained tasks. Conclusions This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.
Resumo Introdução O treinamento cognitivo tem recebido atenção especial como abordagem não medicamentosa para o tratamento do transtorno de déficit de atenção/hiperatividade (TDAH) em crianças e adolescentes. Poucos estudos avaliaram o treinamento cognitivo como abordagem complementar à medicação em ensaios clínicos randomizados controlados por placebo. O objetivo deste estudo foi explorar a viabilidade para a implementação de um programa de treinamento cognitivo computadorizado, descrever suas características principais e potencial eficácia em um pequeno estudo piloto. Métodos Seis pacientes com TDAH entre 10-12 anos de idade, em uso de psicoestimulantes e apresentando sintomas residuais, foram recrutados e randomizados para um dos dois grupos (treinamento cognitivo ou placebo) por 12 semanas. O desfecho principal foram os sintomas nucleares do TDAH avaliados através do Questionário de Swanson, Nolan e Pelham (SNAP-IV). Resultados Encontramos maior resistência do que a esperada no recrutamento dos pacientes em função de problemas logísticos para atender às sessões presenciais no hospital assim como para preencherem os critérios de status medicamentoso e ausência de algumas comorbidades. Ambos os grupos apresentaram diminuição nos escores dos sintomas de TDAH reportados pelos pais, mas sem diferença estatística entre eles. Além disso, foi observada melhora nos testes neuropsicológicos em ambos os grupos - principalmente nas tarefas treinadas pelo programa. Conclusão Este protocolo revelou a necessidade de novas estratégias para melhor avaliar a eficácia do treinamento cognitivo tal como a necessidade de implementar a intervenção no ambiente escolar a fim de obter uma avaliação com maior validade externa. Devido ao pequeno tamanho amostral deste estudo, conclusões definitivas sobre os efeitos do treinamento cognitivo como abordagem complementar aos psicoestimulantes seriam prematuras.
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Humanos , Masculino , Feminino , Criança , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapia Assistida por Computador , Estimulantes do Sistema Nervoso Central/uso terapêutico , Psicotrópicos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico por imagem , Encéfalo/fisiopatologia , Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Comorbidade , Método Simples-Cego , Projetos Piloto , Protocolos Clínicos , Estudos de Viabilidade , Seguimentos , Resultado do Tratamento , Terapia Combinada , Seleção de Pacientes , Remediação Cognitiva/métodos , Testes NeuropsicológicosRESUMO
Studies investigating the possible benefits of transcranial direct current stimulation on left dorsolateral prefrontal cortex in children and adolescents with attention-deficit hyperactivity disorder (ADHD) have not been performed. This study assesses the effect of transcranial direct current stimulation in children and adolescents with ADHD on neuropsychological tests of visual attention, visual and verbal working memory, and inhibitory control. An auto-matched clinical trial was performed involving transcranial direct current stimulation in children and adolescents with ADHD, using SNAP-IV and subtests Vocabulary and Cubes of the Wechsler Intelligence Scale for Children III (WISC-III). Subjects were assessed before and after transcranial direct current stimulation sessions with the Digit Span subtest of the WISC-III, inhibitory control subtest of the NEPSY-II, Corsi cubes, and the Visual Attention Test (TAVIS-3). There were 9 individuals with ADHD according to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. There was statistically significant difference in some aspects of TAVIS-3 tests and the inhibitory control subtest of NEPSY-II. Transcranial direct current stimulation can be related to a more efficient processing speed, improved detection of stimuli, and improved ability to switch between an ongoing activity and a new one.
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Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estimulação Transcraniana por Corrente Contínua , Adolescente , Atenção/fisiologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Função Executiva/fisiologia , Feminino , Humanos , Testes de Inteligência , Masculino , Memória de Curto Prazo/fisiologia , Atividade Motora/fisiologia , Testes Neuropsicológicos , Projetos Piloto , Córtex Pré-Frontal/fisiopatologia , Percepção da Fala/fisiologia , Percepção Visual/fisiologiaRESUMO
El artículo analiza críticamente el aumento de los niños diagnosticados y tratados por el Trastorno de Déficit de Atención e Hiperactividad (TDAH). Los análisis vinculan este creciente fenómeno con las estrategias de la industria farmacéutica para reposicionarse en el liderazgo de la conceptualización del proceso salud-enfermedad-atención y en el mercado de salud. Utilizamos métodos analítico-interpretativos para estudiar datos primarios y secundarios, y realizar una extensa revisión bibliográfica. A la luz del concepto de biomedicalización analizamos los mecanismos subjetivo-ideológicos que facilitaron que este discurso se instituya como una nueva verdad sobre este trastorno y sea legitimado por los organismos gubernamentales y las organizaciones de la sociedad civil. La biomedicalización del sufrimiento infantil dificulta que se pongan en evidencia los profundos cambios socioeconómicos, políticos e ideológico-culturales que han transformado radicalmente nuestras sociedades en las últimas décadas.
The article critically analyzes the increasing number of children diagnosed with and treated for Attention Deficit Hyperactivity Disorder (ADHD). The analysis links this growing phenomenon with the strategies of the pharmaceutical industry to attain leadership in the health-illness-care process as well as in the health market. We utilized analytical and interpretive methods to study primary and secondary data and conducted an extensive literature review. In light to the concept of biomedicalization, we analyzed the ideological and subjective mechanisms that facilitated the institutionalization of this discourse as a new truth concerning this disease as well as its legitimization by governmental and civic organizations. The biomedicalization of children's suffering facilitates the concealment of deeply rooted socio-economic, political, ideological and cultural changes that have radically transformed our societies over the past few decades.
O artigo analisa criticamente o aumento das crianças diagnosticadas e tratadas por Transtorno de Déficit de Atenção de Hiperatividade (TDAH). As análises vinculam este crescente fenômeno às estratégias da indústria farmacêutica para se reposicionarem na liderança da conceituação do processo saúde-doença-atenção e no mercado de saúde. Utilizamos métodos analítico-interpretativos para estudar dados primários e secundários, e realizar uma extensa revisão bibliográfica. À luz do conceito da biomedicalização, analisamos os mecanismos subjetivo-ideológicos que facilitaram que este discurso se institua como uma nova verdade sobre este transtorno e seja legitimado pelos organismos governamentais e organizações da sociedade civil. A biomedicalização do sofrimento infantil dificulta que se revelem as profundas mudanças socioeconômicas, políticas e ideológico-culturais que têm transformado radicalmente nossas sociedades nas últimas décadas.
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Humanos , Pré-Escolar , Criança , Transtorno do Deficit de Atenção com Hiperatividade , Uso de MedicamentosRESUMO
Introducción. En la presente investigación se describe el desempeño neuropsicológico de una muestra de niños y niñas escolarizados, entre 6 y 14 años con diagnóstico de Trastorno por Déficit de Atención/Hiperactividad (TDAH), y se comparan los resultados obtenidos con el desempeño neuropsicológico de un grupo Control. Objetivo. Comparar las características del desempeño neuropsicológico de una muestra de niños y niñas con TDAH-C y TDAH-I y de un grupo Control de la ciudad de Manizales. Materiales y métodos. El artículo se originó de una investigación de tipo no experimental de corte transversal. Se realizó un análisis de varianza de tres grupos: TDAH Combinado (TDAH-C), TDAH Inatento (TDAH-I) y grupo Control. Las variables neuropsicológicas fueron las variables respuesta, y cada uno de los niños afectados se pareo con un control. Resultados. Se establecieron diferencias en el desempeño en una tarea de ejecución continua (cancelación de dibujos) entre ambos subtipos de TDAH (P<0,001), teniendo el grupo de TDAH-C, una media menor que el subtipo TDAH-I (P<0,001); así mismo, se encontraron diferencias estadísticamente significativas a nivel del lenguaje, en relación con las habilidades metalingüísticas, específicamente, en la tarea de conteo de sonidos (P<0,001), entre la estimación de la media en el grupo TDAH-I y el grupo Control (P<0,001). Conclusiones. Los hallazgos de la presente investigación confirman la presencia de algunas diferencias en el desempeño neuropsicológico entre niños y niñas con TDAH y grupos Control. Así mismo, se evidencia la necesidad de seguir avanzando en el empleo de la Batería de Evaluación Neuropsicológica (ENI) en ejercicios investigativos con poblaciones clínicas, para revisar la validez y el comportamiento de la prueba en la evaluación de niños y niñas con TDAH y en la de otros grupos clínicos de interés.
Introduction. The present investigation describes the neuropsychological performance of a sample of school children between 6 and 14 years old diagnosed with ttention Deficit Disorder/Hyperactivity Disorder (ADHD) and compares the results with the neuropsychological performance of a Control group. Objective. To compare the neuropsychological performance characteristics of a sample of children diagnosed with ADHD-C and ADHD-I and a Control group in the city of Manizales. Materials and Methods. This article originated from a cross section non-experimental research. A variance analysis was made using the following treatments: ADHD combined (ADHD-C) and Control group, ADHD inattentive (ADHD-I) and Control group, the neuropsychological variables were the response variables, and each of the affected children was paired with a control child. Results. Differences in a continuous performance task (cancellation of drawings) were established between the two subtypes of ADHD (P<0.001), having the ADHD-C, group lesser measure than the ADHD-I (P<0.001) subtype. Similarly, statistically significant differences at the language level in relation to metalinguistic skills was found, specifically in the task of counting sounds (P<0.001) between the mean estimate in group ADHD-I and the Control group (P<0.001). Conclusions. The findings of this study confirm the presence of some differences in neuropsychological performance among children with ADHD and Control groups. Also, it highlights the need for further progress in the use of the Neuropsychological Assessment Battery (IPD) in research exercises with clinical populations to verify the validity and performance of the test in the evaluation of children with ADHD and in that of other clinical groups of interest.
RESUMO
O Transtorno de Déficit de Atenção/Hiperatividade é um distúrbio neurocomportamental com prevalência em crianças e adolescentes, trazendo consequências no aprendizado na fase de aquisição e desenvolvimento, causando dificuldades emocionais e sociais. Fatores ambientais e genéticos estão relacionados ao transtorno e o diagnóstico precoce é uma das formas de tratamento. A questão fundamental que nos leva a estudar este tema está vinculada na prática pedagógica, onde percebemos que existem fatores que podem influenciar e prejudicar o desempenho dos educandos, incluindo diversos problemas tanto de ordem familiar, social e principalmente os que afetam a atenção. Assim, nossos objetivos visam a compreender esse transtorno, identificar os sintomas, causas, e propor estratégias de intervenções, para manejar melhor os conhecimentos e favorecer uma melhor atenção e amparo educacional a essas crianças. Realizamos pesquisas bibliográficas em diversas fontes como: Scientific Electronic Library Online (SciELO), PubMed, entre outras, buscando informações para compreender os diferentes aspectos associados (comportamento e relacionamento da criança hiperativa), possibilitando alternativas para um melhor atendimento na área educacional.
Attention-Deficit Hyperactivity Disorder is a developmental disorder, largely neurological in nature, with prevalence in children and adolescents, which brings consequences in learning, in the cognitive acquisition and development phase, causes emotional and social difficulties. The environmental and genetic factors are directly related to the disorder and so the precocious diagnosis is one way of ADHD treatment. The fundamental subject that leads us to study this theme is linked to the pedagogic practice, where we notice the existence of factors which can influence and harm the students acting, as much as the problems of family, social order and, mainly, the ones that affect the attention. Thereby, our purposes seek to understand this disorder, to identify the symptoms, the causes and consequences, to propose interventions to articulate the knowledge better and to dedicate larger attention and education help to those children. We accomplished bibliographical researches in several sources, such as: Scientific Electronic Library Online (SciELO), PubMed, among others, looking for information to understand the different aspects of the hyperactivity (the behavior and the relationship of the hyperactive child), making possible alternatives for a better service in the education area.
Assuntos
Criança , Adolescente , Adolescente , Aprendizagem , Criança , Transtorno do Deficit de Atenção com Hiperatividade , EducaçãoRESUMO
A estratégia de auto-instruções tem vindo a ser reconhecida como uma relevante forma de regulação cognitivo-comportamental no incremento das capacidades atencionais, nomeadamente em sujeitos com Transtorno do Deficit de Atenção com Hiperatividade (TDAH). Neste artigo foi avaliada a atenção seletiva e a atenção sustentada em 2 grupos, ambos formados por pessoas com e sem TDAH, sendo que a um deles foi solicitada a realização de auto-instrução, com o objetivo de verificar se o uso desta estratégia promove as capacidades da atenção. Os resultados demonstraram que os sujeitos que realizam a estratégia de auto-instruções, quer apresentem ou não TDAH, manifestam melhores resultados do que os sujeitos que não a realizaram.(AU)
Self-instruction strategy has been recognized as a relevant strategy in cognitive and behavioural regulation as a way of improving attention skills, namely in subjects with Attention Deficit Hyperactivity Disorder (ADHD). This paper aims at demonstrating the effectiveness of this strategy regarding this disorder in subjects with and without ADHD as a mean of promoting attention skills, particularly selective and sustained attention. The results showed that subjects who performed the verbal self-instruction strategy presented better results in both attention processes assessed, than those who did not do it.(AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estratégias de Saúde , Atenção , Instruções Programadas como AssuntoRESUMO
A estratégia de auto-instruções tem vindo a ser reconhecida como uma relevante forma de regulação cognitivo-comportamental no incremento das capacidades atencionais, nomeadamente em sujeitos com Transtorno do Deficit de Atenção com Hiperatividade (TDAH). Neste artigo foi avaliada a atenção seletiva e a atenção sustentada em 2 grupos, ambos formados por pessoas com e sem TDAH, sendo que a um deles foi solicitada a realização de auto-instrução, com o objetivo de verificar se o uso desta estratégia promove as capacidades da atenção. Os resultados demonstraram que os sujeitos que realizam a estratégia de auto-instruções, quer apresentem ou não TDAH, manifestam melhores resultados do que os sujeitos que não a realizaram.
Self-instruction strategy has been recognized as a relevant strategy in cognitive and behavioural regulation as a way of improving attention skills, namely in subjects with Attention Deficit Hyperactivity Disorder (ADHD). This paper aims at demonstrating the effectiveness of this strategy regarding this disorder in subjects with and without ADHD as a mean of promoting attention skills, particularly selective and sustained attention. The results showed that subjects who performed the verbal self-instruction strategy presented better results in both attention processes assessed, than those who did not do it.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Atenção , Estratégias de Saúde , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Instruções Programadas como AssuntoRESUMO
O presente artigo revisa criticamente o amplo escopo da literatura relacionada aos critérios diagnósticos, bases etiológicas e tratamentos farmacológico e comportamental do transtorno do déficit de atenção e hiperatividade (TDAH) em crianças. Foram consultadas as bases eletrônicas MedLine, Lilacs, PsycINFO e PubMed nas últimas três décadas. Os resultados dessa revisão apontam para uma predominância do critério diagnóstico baseado no Manual Diagnóstico e Estatístico das Doenças Mentais, bem como a necessidade de uma maior interação entre variáveis biológicas e comportamentais na compreensão das bases etiológicas e de tratamento deste transtorno. Sugestões para maximizar a eficácia desta interação são apresentadas e discutidas.
This article critically reviews the broad scope of literature related to diagnostic criteria, the etiological basis as well as the pharmacological and behavioral treatments of the Attention Deficit Hyperactivity Disorder (ADHD) in children. The electronic databases Medline, LILACS, PsycINFO and PubMed of the last three decades were consulted. The results of this review indicated a predominance of diagnostic criteria based on the Diagnostic and Statistical Manual of Mental Disorders, and the necessity of an increased interaction between biological and behavioral variables in understanding the etiological basis and treatment of this disorder. Suggestions to maximize the effectiveness of this interaction are presented and discussed.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapiaRESUMO
O presente artigo revisa criticamente o amplo escopo da literatura relacionada aos critérios diagnósticos, bases etiológicas e tratamentos farmacológico e comportamental do transtorno do déficit de atenção e hiperatividade (TDAH) em crianças. Foram consultadas as bases eletrônicas MedLine, Lilacs, PsycINFO e PubMed nas últimas três décadas. Os resultados dessa revisão apontam para uma predominância do critério diagnóstico baseado no Manual Diagnóstico e Estatístico das Doenças Mentais, bem como a necessidade de uma maior interação entre variáveis biológicas e comportamentais na compreensão das bases etiológicas e de tratamento deste transtorno. Sugestões para maximizar a eficácia desta interação são apresentadas e discutidas.(AU)
This article critically reviews the broad scope of literature related to diagnostic criteria, the etiological basis as well as the pharmacological and behavioral treatments of the Attention Deficit Hyperactivity Disorder (ADHD) in children. The electronic databases Medline, LILACS, PsycINFO and PubMed of the last three decades were consulted. The results of this review indicated a predominance of diagnostic criteria based on the Diagnostic and Statistical Manual of Mental Disorders, and the necessity of an increased interaction between biological and behavioral variables in understanding the etiological basis and treatment of this disorder. Suggestions to maximize the effectiveness of this interaction are presented and discussed.(AU)