Parent-teacher report reliability on the fourth edition of the Swanson, Nolan and Pelham scale in a Brazilian clinical sample of children and adolescents with attention-deficit/hyperactivity disorder

Abstract Background Parents and teachers can be valuable sources of information for characterizing children's ADHD-related impairments in different environments. However, evidence indicated that those categories of informants often provide conflicting responses in formal assessment scales, which may challenge diagnostic decisions regarding the condition. Objective: We aimed to investigate reliability rates between parents and teachers of children and adolescents with and without ADHD using SNAP IV. Methods 199 children and adolescents aged 6 to 17 years were evaluated for ADHD symptoms using parent-rated and teacher-rated SNAP IV scales. Intraclass correlation coefficients were analyzed for ADHD domains (inattention and hyperactivity/impulsivity), as well as for defiant-oppositional behavior. Results Reports from parents and teachers showed low reliability for all ADHD domains. Parents' scores on the SNAP IV were higher than those of teachers. Parents and teachers provided highly discrepant responses concerning to the presence and severity of ADHD in children and adolescents, which might result from intrinsic aspects related to their daily functioning in different settings. Discussion Clinicians should consider those trends in parental and teachers' responses when interpreting results from informant-based instruments for detecting ADHD.

A Comparative Study on the Effectiveness of Individual and Group Play Therapy on Symptoms of Oppositional Defiant Disorder among Children / 가정의학회지

BACKGROUND: This research compared the effectiveness of play therapy provided individually or in groups for oppositional defiant disorder (ODD) symptoms among children. METHODS: This was a randomized controlled trial that used a multi-stage random sampling method. Participants included 45 children aged 6 to 10 years old with ODD, all of whom had been referred to medical consultation centers in Ahvaz, Iran in 2012. Experimental groups consisted of 15 children receiving individual play therapy and 15 receiving group play therapy, while the control group consisted of 15 randomly selected children. Data were collected using the child behavior checklist parent report form and teacher report form, along with clinical interviews with the parents. Play therapy took place weekly for eight total sessions; individual sessions lasted 45 minutes each, while group sessions were each 60 minutes in duration. Participants were assessed in three stages, including pre-intervention, post-intervention, and at 2-month follow-up. PASW SPSS ver. 18.0 software (SPSS Inc., Chicago, IL, USA) and analysis of covariance analysis methods were used to analyze data. RESULTS: Results showed meaningful decreases in ODD symptoms in the experimental groups in comparison with the control group, based on parent reporting (P≤0.001 and F=129.40) and the teacher reports additionally showed meaningful decreases in ODD symptoms in the experimental groups compared to the control group, (P≤0.001 and F=93.14). Furthermore, the effects were maintained after 2 months. CONCLUSION: This research supports the efficacy of individual and group play therapy for the treatment of ODD in children, as well as the consistency of the effects at 2-month follow-up.

Refinando o diagnóstico de Transtorno de Oposição e Desafio na infância e adolescência: validação e caracterização da dimensão irritável / Refining Oppositional Defiant Disorder diagnosis in children and adolescents: validation and characterization of the irritable dimension

O Transtorno de Oposição e Desafio (TOD) é definido por um padrão recorrente de comportamento desafiante, desobediente e hostil com início na infância e adolescência e caracteriza-se por uma alta taxa de comorbidades. Estudos longitudinais apontam o TOD na infância como um dos principais preditores de psicopatologia na idade adulta. Uma possível explicação para a grande heterogeneidade de comorbidades e trajetórias longitudinais é de que o diagnóstico de TOD abrange distintas dimensões de sintomas, cada qual com seu desfecho. O primeiro objetivo desta tese foi a validação das distintas dimensões do TOD em uma amostra comunitária Brasileira composta de 2512 sujeitos. Através de análise fatorial confirmatória, demonstramos que o modelo que melhor representa a heterogeneidade do TOD é composto por três dimensões: a dimensão "argumentative/defiant" que está associada com transtorno de déficit de atenção/hiperatividade (TDAH); a dimensão "vindictiveness" que possui associação com transtorno de conduta (TC); e a dimensão "angry/irritable mood" onde predominam as associações com transtornos depressivos e de ansiedade. O objetivo seguinte foi investigar o papel da dimensão irritável na classificação nosológica dos transtornos mentais na infância e adolescência. A apresentação da irritabilidade é um aspecto crucial: irritabilidade crônica caracterizada por baixa tolerância à frustração e frequentes explosões de raiva, que é distinta da apresentação episódica, associada ao diagnóstico Transtorno de Humor Bipolar (TB). "Severe mood dysregulation", "disruptive mood dysregulation disorder", ou dimensão irritável do TOD são formas distintas de classificar o fenótipo de irritabilidade crônica. Entretanto, independente da classificação utilizada, a alta taxa de comorbidades é invariavelmente o denominador comum em estudos sobre irritabilidade. Neste sentido, examinamos o impacto da irritabilidade como uma dimensão subjacente a vários transtornos. Para tanto, avaliamos o...

The Oppositional Defiant Disorder (ODD) is defined as a pattern of disobedient, hostile and defiant behavior beginning in childhood or adolescence and often accompanied by a wide range of comorbidities. Longitudinal studies support ODD as a predictor of psychopathology in adulthood. A potential explanation for such heterogeneity of comorbidities and longitudinal trajectories is that ODD diagnosis encompasses distinct clusters of symptoms, each with its outcome. The first aim of this work was the validation of ODD dimensions in a Brazilian community sample of 2512 subjects. Confirmatory factorial analysis showed that the best model for ODD comprised three dimensions: an "argumentative/defiant" dimension, which associates with attention deficit/hyperactivity disorder (ADHD); a "vindictiveness" dimension, which associates with conduct disorder (CD); and an "angry/irritable" dimension where emotional disorders such as depression and anxiety are the most common associations. The next step was the investigation of the role of the irritable dimension of oppositionality in diagnostic classifications of childhood mental disorders. The pattern of irritability is a crucial point: its chronic presentation as easy annoyance and frequent temper outbursts should be differentiated from the episodic course of irritability associated with the specific diagnosis of Bipolar Disorder (BD). "Severe mood dysregulation", "disruptive mood dysregulation disorder", and the irritable dimension of oppositionality are different ways to classify the chronic irritability phenotype. However, regardless of the classification, the high rate of comorbidities is invariably the common denominator in studies of irritability. Therefore, we examined the impact of irritability as a dimension cutting across multiple settings: individuals without any diagnosis, subjects with ADHD, and also those with emotional disorders. For that we used two samples, one from Brazil, with 2.512 subjects, and one...

Avaliação de crianças pré-escolares: relação entre testes de funções executivas e indicadores de desatenção e hiperatividade / Assessment of preschool children: relation between executive functions tests and inattention and hyperactivity indicators

Funções executivas (FE) referem-se às habilidades necessárias para planejar, iniciar, realizar e monitorar comportamentos intencionais. Incluem inibição, memória de trabalho, flexibilidade cognitiva, atenção seletiva, planejamento e organização e, de forma geral, são habilidades fundamentais à aprendizagem e ao comportamento autorregulado. As FE podem estar comprometidas em alguns distúrbios do desenvolvimento, como o Transtorno de Déficit de Atenção e Hiperatividade. Perante esse panorama e pautando-se na crescente ênfase da literatura sobre a importância da avaliação precoce, esta pesquisa investigou as relações entre desempenho em testes de funções executivas e indicadores de desatenção e hiperatividade em crianças pré-escolares de amostra não-clínica. Participaram 85 crianças de uma escola municipal de Educação Infantil da Grande SP, com idades entre quatro e seis anos, avaliadas no Teste de Trilhas para pré-escolares (TT-PE) e no Teste de Atenção por Cancelamento (TAC). Pais e professores responderam à SNAP-IV. As crianças com maiores índices de desatenção e hiperatividade, conforme relato dos pais, tenderam a apresentar piores desempenhos no TAC e aquelas com maiores índices de desatenção e hiperatividade, conforme relato dos professores, tenderam a apresentar piores desempenhos em diversas medidas do TAC e TT-PE. As relações entre desempenho nos testes e indicadores desatenção e hiperatividade tenderam a ser mais consistentes quando consideradas as respostas dos professores do que as dos pais. O estudo evidenciou que as relações entre desempenho em testes de FE e indicadores de desatenção e hiperatividade podem ser observadas desde idades precoces, em amostras não-clínicas, contribuindo para a discussão sobre avaliação e identificação precoce...

Executive functions (EF) refer to the skills needed to plan, initiate, implement and monitor intentional conduct. They include inhibition, working memory, cognitive flexibility, selective attention, planning and organization and, in general, are fundamental skills to learning and self-regulated behavior. EF may be compromised in some developmental disorders, such as Attention Deficit Disorder and Hyperactivity. Before this background and based on the increasing emphasis in the literature on the importance of early evaluation, this study investigated the relationship between performance in executive functions tests and inattention and hyperactivity indicators in preschool children of a non-clinical sample. A total of 85 children of a kindergarten public school from the state of SP, aged four and six years, were assessed at Trial Making Test for Preschoolers (TT-PE) and Attention Test for Cancellation (TAC). Parents and teachers were asked to answer SNAP-IV. Children with higher levels of inattention and hyperactivity, as reported by their parents, tended to have worse performance in TAC, and those with higher levels of inattention and hyperactivity, as reported teachers, tended to have worse performance on several measures of TAC and TT-PE. The relationship between test performance and indicators inattention and hyperactivity tended to be more consistent when considering the responses of teachers, instead of the parents' ones. The study showed that the relationship between performance on EF tests and indicators of inattention and hyperactivity can be observed from early ages, in nonclinical samples, contributing to the discussion on assessment and early identification...

Transtorno do déficit de atenção e hiperatividade na escola: mediação psicopedagógica / Attention deficit/hyperactivity disorder at school: mediation psychopedagogical

O estudo apresenta um caso de mediação psicopedagógica para diagnóstico de Transtorno do Déficit de Atenção/Hiperatividade (TDAH), tratamento, orientação na escola, família, e com a criança. A criança foi encaminhada pela psicopedagoga para avaliação interdisciplinar dos aspectos psicopedagógicos, neuropsicológico, neuropediátrico, psiquiátrico e familiar. A queixa da escola e da mãe era de que a criança estava agressiva, opositora, recusava-se a fazer as atividades, provocava confusões em casa e na sala de aula, era desorganizada, sem cuidado com seus pertences pessoais, não conseguia manter amizades e não demonstrava interesse pelas lições. Foi tratada com medicação metilfenidato, com melhora imediata da impulsividade e desatenção. Foram aplicados testes neuropsicológicos, psicopedagógicos, escalas de comportamento, antes e após o tratamento medicamentoso. Após o tratamento e as intervenções, foi verificada grande melhora no comportamento, na aprendizagem e nas relações pessoais. Os resultados nos testes foram para melhor; em relação à aprendizagem, foi possível verificar uma dificuldade fonológica do processo de alfabetização, que antes não foi constatado devido a sua recusa. A psicopedagoga fez orientação na escola e soube na ocasião que a criança frequentava o reforço escolar na escola, com conteúdo mais relacionado à matéria atual, assim foi realizada orientação para que fosse trabalhado o processo de alfabetização com ênfase nos aspectos fonológicos devido às dificuldades apresentadas na escrita e na leitura. A relação Saúde e Educação trouxe perspectivas e intervenções importantes na vida escolar, demonstrando que é possível mudar o comportamento e a qualidade da aprendizagem de crianças com diagnóstico de TDAH...

The study presents a case of psycho-pedagogical mediation to the Attention Deficit/Hyperactivity Disorder diagnoses, treatment, and school/family/child guidance. The child was referred by the psycho-pedagogue to the interdisciplinary evaluation of the psycho-pedagogical, neuropsychological, neuropediatrician, psychiatric and familiar aspects. The school and mother's complain was that the child was aggressive, objector, declining to do the activities, troublemaker at home and at school, disorganized, careless with his/her personal belongs, difficulty in keeping friends and not interested in classes. The child was treated with methylphenidate, with a prompt impulsivity and neglect improvement. Neuropsychological and psychiatric tests have been applied, behavior scales, before and after the drug treatment. After the treatment and the interventions, a great behavior improvement was verified, as in the learning process and in the social relations. The tests results were for better, concerning to the learning process, it was possible to realize a phonologic difficulty, which was not identified previously due to the refusal. During the scholar guidance, the psycho-pedagogue noted that the child was taking tutoring classes at school, with a content related to the current subject, and so it was advised that the literacy ability should be worked with a focus on the phonologic aspects due to the difficulties showed in the writing and reading skills. The Health-Education relation brought out important prospects and interventions in the scholar life, showing that it is possible to change the behavior and the quality of learning in children with ADHD...

Mau desempenho escolar: uma visão atual / Poor school performance: an updated review

Este estudo tem como objetivo uma revisão atualizada sobre o tema de mau desempenho escolar para profissionais da área de saúde e educação. Aborda aspectos atuais da educação, de aprendizagem e das principais condições envolvidas em mau desempenho escolar. Apresenta dados atualizados sobre os principais aspectos da neurobiologia, epidemiologia, etiologia, quadro clínico, comorbidades, diagnóstico, intervenção precoce e tratamento das principais patologias envolvidas. Trata-se de uma revisão abrangente, não sistemática da literatura sobre aprendizagem, desempenho escolar, transtorno de aprendizagem (dislexia, discalculia e disgrafia), transtorno de déficit de atenção/hiperatividade (TDA/H) e transtorno de desenvolvimento de coordenação (TDC). O mau desempenho escolar é um sintoma frequente em nossas crianças com graves repercussões emocionais, sociais e econômicas. Uma visão atualizada do tema facilita o raciocínio clínico, o diagnóstico correto e o tratamento adequado.

This study aims to develop a comprehensive review on the issue of poor school performance for professionals in both health and education areas. It discusses current aspects of education, learning and the main conditions involved in underachievement. It also presents updated data on key aspects of neurobiology, epidemiology, etiology, clinical presentation, comorbidities and diagnosis, early intervention and treatment of the major pathologies comprised. It is a comprehensive, non-systematic literature review on learning, school performance, learning disorders (dyslexia, dyscalculia and dysgraphia), attention deficit / hyperactivity disorder (ADHD) and developmental coordination disorder (DCD). Poor school performance is a frequent problem faced by our children, causing serious emotional, social and economic issues. An updated view of the subject facilitates clinical reasoning, accurate diagnosis and appropriate treatment.

Transtornos de déficit de atenção e do comportamento disruptivo: associação com abuso físico na infância: [relato de caso] / Attention-deficit and disruptive behavior disorders: association with physical abuse in childhood: [case report]

CONTEXTO: Muitos transtornos psiquiátricos, geralmente diagnosticados pela primeira vez na infância, estão associados a maus-tratos, entre eles o abuso físico, causando significativo impacto no desenvolvimento das crianças acometidas. OBJETIVOS: Avaliar a associação entre um diagnóstico psiquiátrico do grupo dos transtornos de déficit de atenção e do comportamento disruptivo (TDACD) em crianças e a história de abuso físico na infância. MÉTODOS: Em um estudo seccional, crianças de 3 a 12 anos, atendidas em um ambulatório de psiquiatria de um hospital universitário, foram avaliadas por meio do MINI KID (), tendo sido diagnosticadas de acordo com os critérios do DSM-IV. A avaliação de abuso físico e de outros eventos traumáticos foi realizada por um questionário específico, o LSC-R () e inclui diferentes tipos de maus-tratos. RESULTADOS: Encontrou-se uma razão de chance mais alta de exposição freqüente ao abuso físico (p = 0,02) no grupo de crianças diagnosticadas com TDACD. Não se encontrou associação entre transtornos de humor (p = 0,67) e de ansiedade (p = 0,57) com abuso físico. Evidenciou-se uma relação de temporalidade entre o grupo dos TDACD e abuso físico (66,6 por cento). Após ajuste de possíveis fatores de confundimento, meninos demonstraram índices significativamente mais elevados de abuso físico do que meninas (p = 0,001). CONCLUSÕES: Nossos achados documentaram associação entre um diagnóstico do grupo dos TDACD em crianças e abuso físico na infância.

BACKGROUND: Many psychiatric disorders diagnosed at the first time in childhood are associated with child abuse, like physical abuse. This disorders cause an important impact on the childhood development. OBJECTIVES: To investigate the association between children with attention-deficit and disruptive behavior disorders group (ADDBD) and physical abuse in childhood. METHODS: Cross-sectional study using the MINI KID (Mini International Neuropsychiatric Interview for Children and Adolescents) to evaluate children with and without the diagnostic of ADDBD group. Physical abuse was evaluated using the LSC-R (Life Stressor Checklist - Revised) and included others child abuses. RESULTS: We found a higher odds ratio for frequent exposure to physical abuse (p = 0,02) in the ADDBD group than in the group without this diagnostic. No association between mood (p = 0,67) and anxiety (p = 0,57) disorders and physical abuse. We found a temporal association (66,6 percent) between ADDBD group and physical abuse. After adjusting for potential confounding factors, we found significantly higher odds ratio to the association between boys and physical abuse than did girls (p = 0,001). DISCUSSION: Our findings document an association between ADDBD group and physical abuse in childhood period.

Association analysis of dopamine D4 receptor gene polymorphism and attention deficit hyperactivity disorder with/without disruptive behavior disorder / 北京大学学报(医学版)

Objective:To examine the role of dopamine D4 receptor gene(DRD4) in attention deficit hyperactivity disorder(ADHD) with/without disruptive behavior disorder(DBD) by focusing on a-521C/T SNP within the promoter region of this gene.Methods:A total of 401 DSM-Ⅳ ADHD children(including 284 trios) of Chinese Han descent were genotyped.Chi-square test and the transmission disequilibrium test(TDT) were used to test for associations in ADHD with and without DBD respectively.Results:In the comparison of ADHD with(n= 143) and without(n= 258) DBD,the-521T allele(?2 = 6.778,P= 0.009,OR= 1.485) and the TT genotype(?2 = 6.292,P= 0.012,OR= 1.729) showed higher frequency in children with ADHD and DBD simultaneously.For family based analysis,T allele of the-521C/T polymorphism was preferentially transmitted to ADHD children with comorbid DBD(n= 100,?2 = 3.868,P= 0.049),whereas no significant distortion was found in the transmission of the tested variant for ADHD without DBD(n= 184,?2 = 0.223,P= 0.637).Conclusion:Our findings suggest that the-521C/T SNP of DRD4 may contribute to the predisposition to ADHD with comorbid DBD.This study supports for the hypothesis that ADHD with comorbid DBD may be influenced by greater genetic effect compared to ADHD alone.

Association between serotonin 4 gene polymorphisms and attention deficit hyperactivity disorder comorbid or not comorbid disruptive behavioral disorder / 北京大学学报(医学版)

T were genotyped by restriction fragment length polymorphism analysis.Transmit/disequilibrium test and haplotype analysis were used to test the association of the three polymorphisms with ADHD comorbid or not comorbid DBD separately.Results:Haplotype T/G/T showed tendency of overtransmission(?2=3.470,P=0.062) to probands of ADHD with DBD, while haplotype C/G/T(?2=4.568,P=0.032) and C/G/C(?2=5.333,P=0.021) were undertransmitted to probands of ADHD without DBD,No biased transmissions of any allele were found in families with probands of ADHD with and without DBD.Conclusion:whether ADHD comorbid DBD or not comorbid DBD makes difference at the level of HTR4 gene polymrohisms.

Executive function characteristic in boys with attention deficit hyperactivity disorder comorbid disruptive behavior disorders / 北京大学学报(医学版)

Objective:To answer the question whether executive function(EF) deficits are specific to attention deficit hyperactivity disorder(ADHD) or whether such deficits are also associated with disruptive behavior disorders(DBD),including oppositional defiant disorder(ODD) and conductive disorder(CD).Methods:A total of 19 pure ADHD boys,19 ADHD + DBD boys and 19 normal controls(criteria of DSM-Ⅳ) were collected as our samples.The groups were matched by age(less than 6 months).The research instruments included Stroop color-word task,Rey complex figure test,digit span test, trail making test,tower of Hanoi and verbal fluency test.Results:The differences of IQs weren't significant among three groups.(1) Both pure ADHD group and ADHD+DBD group performed worse(P0.05).(2) Pure ADHD group also showed deficits in the aspects of errors of Stroop 2,time and errors of Stroop 3, word interference time;immediate memory structure score of Rey complex figure test;time and errors of number-letter part and shifting time of trail making test;total time and steps of completing tower of Hanoi.The differences were significant(P

Contribution of disruptive behavior disorder to balance function of children with attention deficit hyperactivity disorder / 北京大学学报(医学版)

Objective:To investigate whether the likelihood of balance impairment in children with attention deficit hyperactivity disorder(ADHD) increases with the presence of disruptive behavior disorder(DBD),and whether the likelihood of co-occurring diagnosis of DBD increases in ADHD children with severer balance deficit.Methods:Three groups of 20 children each,representing pure ADHD,ADHD+DBD,and typically developing control children,were included and group matched by age and gender.Balance functions were assessed with the Balance Master in different conditions.We compared the percentages of children in each group who swayed faster than 85% of the typical control children in all conditions.Results:In the conditions of firm surface with eyes open(FI/EO) and eyes closed(FI/EC),and foam surface with eyes open(FO/EO) and eyes closed(FO/EC),the sway velocities of ADHD only group(0.65?0.26 ?/s,0.65?0.30 ?/s,0.95?0.29 ?/s,and 1.70?0.49?/s,respectively) were significantly higher than those of the typical control group(0.47?0.18 ?/s,0.43?0.19 ?/s,0.76?0.21 ?/s,and 1.27?0.38 ?/s,respectively)(P

Alpha competitive structure in children with attention deficit hyperactivity disorder with/without oppositional defiant disorder / 北京大学学报(医学版)

0.05).(2) The entropy value of the ADHD with ODD group was significantly higher than that of the normal controls in the right frontal region,right central region,and bilateral occipital region(P

Risk factors of attention deficit hyperactivity disorder comorbid with oppositional defiant disorder in children / 北京大学学报(医学版)

Objective:To explore risk factors of attention deficit hyperactivity disorder(ADHD) comorbid with oppositional defiant disorder(ODD) in children.Methods:Parents of 43 pure ADHD+ODD children,and 43 pure ADHD children(criteria of DSM-Ⅳ;group matched by sex,age and ADHD subtypes) were asked to complete a set of investigation questionnaires including child and family information;family history;pregnancy,delivery and infancy complications;physical development and temperament;and predisposing factors and parents' or teachers' responses toward children's misbehaviors.Results:Probabilities of psychosis or schizophrenia of family members,long-term conflict between parents and parents' constant/stringent criticism to children in ADHD+ODD group were significantly higher than those in ADHD group(psychosis or schizophrenia of family members(16% vs 2%,P=0.058,OR=8.167);long-term conflict between parents(23% vs 7%,P=0.035,OR=4.040);parents' constant/stringent criticism to children(51% vs 28%,P=0.027,OR=2.706);probability of having anoxia at birth in ADHD group was significantly higher than that in ADHD+ODD group(12% vs 0,P=0.055,OR=0.469).Setting diagnosis of ADHD+ODD as dependent variable,and factors with significant difference between the two groups as independent variables,after 2 steps of regression analyses,one factor,i.e.parents' constant/stringent criticism to children was left in the model(P=0.054,OR=2.879).The regression formula had a sensitivity of 53.5%,a specificity of 83.7%,and total correction rate of 68.6%.Conclusion:Inappropriate parenting is a risk factor of ADHD comorbid with ODD,and long-term conflict between parents and positive family history of psychoses might have influence on ADHD comorbid with ODD.

An open trial on effectiveness of parent training in children with comorbid attention deficit hyperactivity disorder and oppositional defiant disorder / 北京大学学报(医学版)

Objective:To explore effectiveness of Russell Barkley's parent training in children with comorbid attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD),and to evaluate its applicability in mainland China.Methods:Parents of 30 DSM-Ⅳ ADHD+ODD children were given 10 weekly trainings.Results:Total numbers of symptoms,symptoms of ADHD,symptoms of inattention,hyperactivity/impulsivity and ODD declined significantly(P

Association between serotonin 1D gene polymorphisms and attention deficit hyperactivity disorder comorbid or not comorbid disruptive behavior disorder / 北京大学学报(医学版)

G. The current results indicate that ADHD with DBD has more heritable backgrounds when compared with ADHD without DBD.