Estrategia metodológica inclusiva para la enseñanza-aprendizaje del fútbol, en estudiantes con trastorno por déficit de atención con hiperactividad, en la clase de Cultura Física

Es bien sabido que la forma más común de reducir los efectos del trastorno por déficit de atención con hiperactividad ha sido históricamente a través de productos farmacológicos. Sin embargo, es irrefutable que la influencia del ejercicio físico ha evitado indeseables efectos secundarios y ha logrado cambios favorables significativos en los pacientes. Esta actividad física fue implementada básicamente de forma preventiva, principalmente bajo condiciones médicas, crónicas y discapacidades, también para contribuir a la esfera cognitiva y comportamental. El objetivo de este trabajo consistió en proponer un grupo de recomendaciones metodológicas en la clase de Educación Física para mejorar las condiciones de vida de niños con trastorno por déficit de atención con hiperactividad en la Unidad Educativa Fiscomisional Sagrado Corazón de Esmeraldas, Ecuador. Los métodos empíricos que se utilizaron fueron la observación científica, la encuesta aplicada a estudiantes y la entrevista dirigida a profesores; también se emplea, una vez implementadas estas recomendaciones, una encuesta a ambos componentes del proceso para obtener una valoración preliminar sobre el efecto de esta propuesta, debido a que resultó ser una ayuda metodológica de alto valor para preparar los profesores y estudiantes en sus influencias como orientador en el caso del profesor y como colectivo social académico en el caso del grupo de estudiantes.

É bem sabido que a forma mais comum de reduzir os efeitos do transtorno de déficit de atenção e hiperatividade tem sido historicamente por meio de produtos farmacológicos. Contudo, é irrefutável que a influência do exercício físico evitou efeitos colaterais indesejáveis e alcançou mudanças favoráveis significativas nos pacientes. Essa atividade física foi implementada basicamente de forma preventiva, principalmente em condições médicas, crônicas e deficiências, também para contribuir na esfera cognitiva e comportamental. O objetivo deste trabalho foi propor um conjunto de recomendações metodológicas nas aulas de Educação Física para melhorar as condições de vida de crianças com transtorno de déficit de atenção e hiperatividade na Unidade Educacional Fiscomisional Sagrado Corazón de Esmeraldas, Equador. Os métodos empíricos utilizados foram a observação científica, o inquérito aplicado aos alunos e a entrevista dirigida aos professores; Uma vez implementadas estas recomendações, recorre-se também a um levantamento de ambas as componentes do processo para obter uma avaliação preliminar do efeito desta proposta, porque se revelou uma ajuda metodológica de elevado valor para preparar professores e alunos nas suas influências. como conselheiro no caso do professor e como coletivo social acadêmico no caso do grupo de alunos.

It is well known that the most common way to reduce the effects of Inclusive methodological strategy for teaching - learning football in students with attention deficit hyperactivity disorder in the physical culture class (ADHD) has historically been through pharmacological products. However, it is irrefutable that the influence of physical exercise has avoided undesirable side effects and has achieved significant favorable changes in patients. This physical activity was basically implemented preventively, mainly under medical, chronic conditions and disabilities, also to contribute to the cognitive and behavioral sphere. The objective of this work consisted of proposing a group of methodological recommendations in the Physical Education class to improve the living conditions of children with ADHD in the Sagrado Corazón Fiscomisional Educational Unit of Esmeraldas, Ecuador. The empirical methods used were scientific observation, the survey applied to students and the interview directed to teachers. Once these recommendations were implemented, a survey of both components of the process was also used to obtain a preliminary assessment of the effect of this proposal, because it turned out to be a methodological aid of high value to prepare teachers and students in their influences as a counselor in the case of the teacher and as an academic social collective in the case of the group of students.

A Randomized，Double-blind，Multi-center Clinical Trial of Tengfu Jiangya Tablets Combined with Valsartan/Amlodipine in Treatment of Grade 2 Hypertension with Hyperactivity of Liver Yang / 中国实验方剂学杂志

ObjectiveTo observe the clinical efficacy and safety of Tengfu Jiangya tablets combined with valsartan/amlodipine in the treatment of grade 2 hypertension with liver Yang hyperactivity syndrome. MethodAccording to a randomized，double-blind，and placebo parallel control method，288 patients with grade 2 hypertension with liver Yang hyperactivity from 7 subcenters were included. They were randomly divided into an observation group （144 cases） and a control group （144 cases），and then treated with Tengfu Jiangya tablets combined with valsartan/amlodipine and placebo combined with valsartan/amlodipine，respectively. The efficacy was evaluated after four weeks of intervention. During the experiment，the safety indicators and adverse reaction events of the subjects were recorded for safety evaluation，and the efficacy indicators and TCM syndrome scores were recorded for effectiveness evaluation. Sensitivity analysis was also conducted on the statistical results of the main efficacy indicators such as blood pressure （BP） compliance rate to ensure the accuracy of the analysis results. 88 groups of blood samples from each of the treatment and control groups were included as test subjects. Fasting blood samples were collected from the patients in the clinical trial on the day before and after medication，and enzyme linked immunosorbent assay （ELISA） was performed on the treated serum. The levels of arachidonic acid （AA），thromboxane B2 （TXB2），and prostaglandin E2 （PGE2） in the serum of the patients before and after treatment were measured to explore the regulation of inflammatory factors in the body by Tengfu Jiangya tablets. ResultA total of 271 patients （133 in the observation group and 138 in the control group） completed the trial. There was no statistically significant difference before and after treatment in such safety indicators as the blood routine （white blood cells，red blood cells，and platelets），urine routine （urinary protein and urinary red blood cells），alanine aminotransferase，aspartate aminotransferase，creatinine，urea，and abnormal electrocardiogram，and no serious adverse reactions were observed. After four weeks，the systolic blood pressure （SBP） difference and diastolic blood pressure （DBP） difference of patients in the observation group were greater than those in the control group（P<0.01）. According to the criteria for determining the antihypertensive effect，the overall response rate in the observation group［89.47%（119/133）］ was higher than that in the control group［57.97%（80/138）］ （Z=2.593，P<0.01）. The SBP compliance rate was 61.65%（82/133） and 37.68%（52/138） in the observation group and control group， respectively. The DBP compliance rate in the observation group was 78.20%（104/133），while in the control group it was 55.07%（76/138）. The overall BP compliance rate in the observation group was 48.12%（64/133），while in the control group it was 23.19%（32/138）. The BP compliance rates in the observation group were all significantly higher than those in the control group（χ2=15.571，16.236，18.404，P<0.01）. According to the criteria for evaluating the therapeutic effect of TCM syndrome integration，the overall response rate of the observation group［57.89%（77/133）］ was higher than that of the control group［38.41%（53/133）］ （Z=-3.172，P<0.01）.Compared with those before treatment， the levels of serum AA and TXB2 in the two groups were significantly decreased after treatment （P<0.01）， and the level of PGE2 in the observation group was significantly increased （P<0.01）. Compared with those of the control group after treatment， the levels of AA and TXB2 in the observation group were significantly decreased， while the level of PGE2 was significantly increased （P<0.01）. The results suggest that Tengfu Jiangya tablets can effectively reduce inflammatory factors，reduce the production of inflammatory mediators，and thus prevent the occurrence of inflammatory reactions in the treatment of patients with grade 2 hypertension. ConclusionTengfu Jiangya tablets can more effectively reduce patients' SBP and DBP，improve their BP compliance rates，and improve their TCM syndromes in the treatment of grade 2 hypertension with liver Yang hyperactivity. Its clinical application is safe. Tengfu Jiangya tablets has outstanding clinical efficacy and can be used as an effective intervention method for the treatment of grade 2 hypertension with liver Yang hyperactivity syndrome.

Characteristics and relationship between the development of gross motor skills and executive function in children with attention deficit hyperactivity disorder / 中国康复理论与实践

ObjectiveTo investigate the developmental characteristics of gross motor skills and executive functions, and the correlation between them in school-age children with attention deficit hyperactivity disorder (ADHD). MethodsFrom November, 2020 to May, 2021, 90 children with ADHD were recruited from Peking University Sixth Hospital and Beijing Haidian Wanquan Primary School, and other 90 children with normal development from this primary school were recruited matched their age and gender. Gross motor skills were assessed with the Test of Gross Motor Development in Children, Third Edition (TGMD-3), and inhibitory control, working memory, and cognitive flexibility were assessed with Stroop Color Words Test (SCWT), Rey-Osterrich Complex Figure Test (ROCFT) and Trail Making Test (TMT), respectively. ResultsThe TGMD-3 score was significantly lower in children with ADHD than in normal children (t = -6.275, P < 0.001), while the test results of SCWT, ROCFT and TMT were worse (|t| ≥ 1.986, P ≤ 0.05). The TGMD-3 score of children with ADHD was negatively correlated with the word sense reaction time (r = -0.261), the number of word sense errors (r = -0.404) and the number of color errors (r = -0.326) (P < 0.05), positively correlated with the delayed structural memory scores (r = 0.228) (P < 0.05), and negatively correlated with the TMT-A reaction time (r = -0.255), the number of TMT-A errors (r = -0.329), TMT-B reaction time (r = -0.214) and the number of TMT-B errors (r = -0.474) (P < 0.05). Stratified linear regression analyses showed that the TGMD-3 score of children with ADHD was significant only in predicting test results for inhibitory control and cognitive flexibility (P < 0.05), with explanations of 8.7% and 22.5%, respectively. ConclusionDevelopments of both gross motor skills and executive function delay in children with ADHD, and there is a relation between them, especially the level of gross motor skills relating to the developments of inhibitory control and cognitive flexibility.

Association of attention deficit hyperactivity disorder symptoms and bullying behavior in children / 中国学校卫生

Objective@#The association between school bullying and attention deficit hyperactivity disorder (ADHD) symptoms among students in primary schools and the moderating role of gender was explored to provide scientific evidence for the prevention and control of school bullying.@*Methods@#A total of 4 764 students from 2 primary schools in Wuhan were selected using the convenience sampling method in March 2023. The Olweus Bully/Victim Questionnaire and Strengths and Difficulties Questionnaire were used. A Pearson χ 2 test was used to compare differences in school bullying rates among children with and without ADHD symptoms. Pearson correlation analysis and Process 3.3 were used to analyse the association between ADHD symptoms, and school bullying behaviour and the moderating role of gender.@*Results@#The reported rate of bullying victims in primary schools was 24.2% and the rate of bullying perpetration was 3.8%. The rate of ADHD symptom detection among primary school students was 5.9%. ADHD symptoms were positively associated with bullying and bullying victim behaviour ( r =0.16, 0.27, P <0.01). Specifically, the association between ADHD symptoms and bullying behavior tended to be stronger among boys than girls ( β boy =0.17, t =11.13; β girl =0.07, t =4.11, P <0.01).@*Conclusions@#ADHD symptoms are an important factor influencing school bullying behaviors in students, and gender moderates the association. In the process of preventing and controlling school bullying, ADHD symptoms and gender differences should be emphasized and comprehensive interventions should be implemented.

A tomada de decisão no tratamento de crianças com indicadores de TDAH / Toma de decisiones en el tratamiento de niños con indicadores de TDAH / Decision making in the treatment of children with ADHD indicators

RESUMO O diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade - TDAH é bastante complexo, podendo ser influenciado por fatores contextuais, e seu tratamento pode envolver diferentes intervenções. A participação dos usuários nas decisões a respeito do tratamento vem sendo promovida por instituições de diversos países e, no Brasil, é prevista pelas legislações do Sistema Único de Saúde. Este estudo investigou o processo de tomada de decisão no tratamento de crianças com indicadores de TDAH a partir da percepção de oito profissionais de serviços públicos de saúde mental, que foram entrevistados individualmente. Os dados foram examinados através da análise temática, revelando desafios relativos ao excesso de demanda nos serviços e à complexidade do processo diagnóstico. O envolvimento de usuários e familiares nas decisões foi percebido como parcial, ocorrendo geralmente após a elaboração do plano terapêutico pelas equipes, e envolvendo dificuldades na comunicação entre profissionais e pacientes e divergências de interesses entre as crianças e seus familiares. Esses aspectos poderão ser abordados em futuros estudos e intervenções a fim de facilitar e melhorar a qualidade da tomada de decisão nesse contexto.

RESUMEN El diagnóstico del trastorno por déficit de atención con hiperactividad - TDAH es bastante complejo y puede verse influenciado por factores contextuales, y su tratamiento puede implicar diferentes intervenciones. La participación de los usuarios en las decisiones sobre tratamiento ha sido promovida por instituciones de diferentes países y, en Brasil, está prevista por las leyes del Sistema Único de Salud. Este estudio investigó el proceso de toma de decisiones en el tratamiento de niños con indicadores TDAH desde la percepción de 8 profesionales de la salud mental pública, que fueron entrevistados individualmente. Los datos fueron examinados a través del análisis temático, revelando desafíos relacionados con el exceso de demanda en los servicios y la complejidad del proceso de diagnóstico. La implicación de los usuarios y familiares en las decisiones se percibió como parcial, ocurriendo generalmente después de la elaboración del plan terapéutico por los equipos, y implicando dificultades en la comunicación entre profesionales y pacientes y divergencias de intereses entre los niños y sus familias. Estos aspectos pueden abordarse en futuros estudios e intervenciones con el fin de facilitar y mejorar la calidad de la toma de decisiones en este contexto.

ABSTRACT The diagnosis of Attention Deficit Hyperactivity Disorder - ADHD is quite complex. Contextual factors may influence it, and its treatment may involve different interventions. Institutions in several countries have promoted the participation of users in treatment decisions. In Brazil, it is provided by the Unified Health System. This study investigated the decision-making process in treating children with ADHD indicators from the perception of 8 public mental health services professionals interviewed individually. Data were examined through thematic analysis, revealing challenges related to excessive demand for services and the complexity of the diagnostic process. The involvement of users and family members in the decisions was perceived as partial, generally occurring after elaborating the therapeutic plan by the teams, and involving difficulties in communication between professionals and patients and differences of interests between children and their families. These aspects may be addressed in future studies and interventions to facilitate and improve the quality of the decision-making process in this context.

Self-reported attention and hyperactivity symptoms among adults with epilepsy / Sintomas de desatenção e hiperatividade autorrelatados entre adultos com epilepsia

Abstract Background Patients with epilepsy (PWE) frequently have comorbid psychiatric disorders, the most common of which are depression and anxiety. Attention deficit disorder with hyperactivity (ADHD) is also more frequent among PWE, though that condition has been scarcely studied among the adult PWE population. Objective This study aimed to compare the presence of ADHD symptoms between adult PWE and the general population. Methods This was an observational case-control study. Ninety-five adult PWE from a tertiary center in southern Brazil were compared with 100 healthy controls. All subjects were submitted to three structured scales: 1) the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS); 2) the Hospital Anxiety and Depression Scale (HADS); and 3) the Adverse Events Profile (AEP). Dichotomic variables were analyzed through chi-square test and Fisher's exact test, as appropriate, and non-parametric variables were analyzed through the Mann-Whitney U test. Results Medians and interquartile ranges (IR) were: 1) ASRS: 26.00 (IR: 18 to 38) among PWE versus 17.00 (IR: 11 to 24) among controls, p< 0.001; 2) HADS: 14.00 (IR: 8 to 21) among PWE versus 11.00 (IR: 8 to 16) among controls, p= 0.007; 3) AEP: 3800 (IR: 31 to 49) among PWE versus 33.00 (IR: 23 to 43) among controls, p= 0.001. Conclusion PWE showed a higher burden of symptoms of ADHD, depression, and anxiety when compared with controls, which replicates in the Brazilian population the findings of current literature that point toward a higher prevalence of such disorders among PWE.

Resumo Antecedentes Pacientes com epilepsia (PCE) frequentemente apresentam comorbidades psiquiátricas, principalmente depressão e ansiedade. O transtorno do déficit de atenção e hiperatividade (TDAH) também é mais frequente nos PCE, porém foi pouco estudado na população adulta de PCE. Objetivo Comparar a presença de sintomas de TDAH entre PCE adultos e a população geral. Métodos Noventa e cinco PCE adultos de um centro terciário no Sul do Brasil foram comparados a 100 controles saudáveis. Todos os sujeitos foram submetidos a três escalas estruturadas: 1) a Escala Autorrelatada de TDAH em Adultos da Organização Mundial da Saúde, versão 1.1 (ASRS); 2) a Escala Hospitalar de Ansiedade e Depressão (HADS); e 3) o Perfil de Eventos Adversos (AEP). Variáveis dicotômicas foram analisadas através dos testes chi-quadrado e exato de Fisher, conforme apropriado, e as variáveis não paramétricas foram analisadas através do teste U de Mann-Whitney. Resultados As medianas e os intervalos interquartis (IIQ) foram: 1) ASRS: 26.00 (IIQ: 18 a 38) em PCE versus 17.00 (IIQ: 11 a 24) nos controles, p< 0,001; 2) HADS: 14.00 (IIQ: 8 a 21) em PCE versus 11.00 (IIQ: 8 a 16) nos controles, p= 0,007; 3) AEP: 38.00 (IIQ: 31 a 49) em PCE versus 33.00 (IIQ: 23 a 43) nos controles, p= 0,001. Conclusão PCE apresentaram uma maior carga de sintomas de TDAH, depressão e ansiedade quando comparados aos controles, o que replica na população brasileira os achados da literatura atual, que apontam para uma maior prevalência de tais transtornos entre PCE.

Evaluation of ocular surface in children with attention deficit hyperactivity disorder with respect to methylphenidate treatment / Avaliação da superfície ocular em crianças com transtorno de déficit de atenção com hiperatividade em relação ao tratamento com metilfenidato

ABSTRACT Purpose: This study aimed to screen the ocular surface of children with attention deficit hyperactivity disorder and identify the adverse effects of methylphenidate related to dry eye disease. Methods: This cross-sectional study included children with attention deficit hyperactivity disorder and healthy children (all aged 5-18 years). They were randomized into Group A (without methylphenidate treatment), Group B (with methylphenidate treatment), and Group C (healthy children). Tear film break-up time, Ocular Surface Disease Index questionnaire, tear meniscus height, tear meniscus area, and Schirmer test results were evaluated. Furthermore, symptom severity in attention deficit hyperactivity disorder was assessed by Turgay DSM-IV-based Child and Adolescent Behavioral Disorders Screening and Rating Scale and Conners Parent Rating Scale-48. Results: Groups A, B, and C consisted of 34, 40, and 60 individuals (n=34, 40, and 60 eyes; age=11.44 ± 2.79, 11.70 ± 2.83, and 11.96 ± 3.63 years, median age=12, 12, and 11.5 years), respectively. Tear film break-up time, Ocular Surface Disease Index, tear meniscus height, tear meniscus area, and Schirmer test results were not significantly different between Groups A and C (p=0.964, 0.336, 0.445, 0.439, and 0.759, respectively). However, Group B showed a significant decrease in tear film break-up time (10.50 ± 3.39 vs. 12.52 ± 2.46 s; p=0.005), tear meniscus height (307.40 ± 5.53 vs. 310.82 ± 7.30 µm; p=0.025), tear meniscus area (0.024 ± 0.0037 vs. 0.026 ± 0.0046 mm2; p=0.010) and Schirmer test (12.75 ± 3.96 vs. 15.41 ± 3.75 mm; p=0.004) results compared with Group A. Conclusion: Compared with healthy children, children with attention deficit hyperactivity disorder showed ocular surface parameters suggestive of dry eye disease despite taking methylphenidate. Thus, they require close ophthalmologic follow-up to prevent sight-threatening dry eye complications.

RESUMO Objetivos: Este estudo teve como objetivo examinar a superfície ocular de crianças com transtorno de déficit de atenção com hiperatividade e identificar os efeitos adversos do metilfenidato relacionados à síndrome do olho seco. Métodos: Este estudo transversal incluiu crianças com transtorno de déficit de atenção e hiperatividade e crianças saudáveis (todas entre 5-18 anos de idade). Elas foram randomizadas no Grupo A (sem tratamento com metilfenidato), Grupo B (com tratamento com metilfenidato) e Grupo C (crianças saudáveis). Foram avaliados o tempo de ruptura do filme lacrimal, questionário sobre Índice de Doenças de Superfície Ocular (IDSO), altura do menisco lacrimal, área do menisco lacrimal e os resultados do teste de Schirmer. Além disso, a gravidade dos sintomas no transtorno de déficit de atenção com hiperatividade foi avaliada usando a Turgay DSM-IV-based Child and Adolescent Behavioral Disorders Screening and Rating Scale com base na escala de Conners Parent Rating Scale-48. Resultados: Os Grupos A, B e C consistiram de 34, 40 e 60 indivíduos (n=34, 40 e 60 olhos; idade=11,44 ± 2,79, 11,70 ± 2,83 e 11,96 ± 3,63 anos, idade média=12, 123 e 11,5 anos), respectivamente. O tempo de ruptura do filme lacrimal, o Índice de Doença da Superfície Ocular, as altura do menisco lacrimal, a área do menisco lacrimal e o teste de Schirmer não foram significativamente diferentes entre os Grupo A e C (p=0,964, 0,336, 0,445, 0,439 e 0,759, respectivamente). Entretanto, o Grupo B mostrou uma redução significativa no tempo de ruptura do filme lacrimal (10,50 ± 3,39 vs 12,52 ± 2,46 seg; p=0,005), altura do menisco lacrimal (307,40 ± 5,53 vs 310,82 ± 7,30 µm; p= 0,025), área do menisco lacrimal (0,024 ± 0,0037 vs 0,026 ± 0,0046 mm2; p=0,010) e teste de Schirmer (12,75 ± 3,96 vs 15,41 ± 3,75 mm; p=0,004), resultados com0arados com o Grupo A. Conclusão: Em comparação com crianças saudáveis, crianças com transtorno de déficit de atenção com hiperatividade apresentaram parâmetros de superfície ocular sugestivos de olho seco, apesar do uso de metilfenidato. Assim, elas requerem um acompanhamento oftalmológico próximo para evitar complicações oculares de olho seco que ameaçam a visão.

Modelo de orientación familiar en la prevención del trastorno por déficit de atención e hiperactividad

El presente trabajo está dirigido a exponer elementos inherentes de un modelo de orientación familiar en la prevención del trastorno por déficit de atención/hiperactividad en la primera infancia. Deriva de una investigación que se ejecuta en la especialidad de Rehabilitación en Salud, adscrita a la Universidad de Ciencias Médicas de Camagüey. Se emplearon métodos teóricos como: el análisis y síntesis, inductivo-deductivo y el método sistémico estructural funcional para fundamentar el carácter de sistema del modelo y su diseño. Se concluye con el establecimiento de un modelo estructurado por dos subsistemas. Las relaciones de coordinación y complementariedad establecidas posibilitaron la extrapolación cognitiva para la orientación familiar en la prevención del trastorno referido.

The present work is aimed at exposing inherent elements of a family counseling model in the prevention of attention deficit/hyperactivity disorder in early childhood. It derives from research carried out in the specialty of Health Rehabilitation, attached to the University of Medical Sciences of Camagüey. Theoretical methods such as: analysis and synthesis, inductive-deductive and the structural-functional systemic method were used to substantiate the system character of the model and its design. It concludes with the establishment of a model structured by two subsystems. The established coordination and complementarity relationships enabled cognitive extrapolation for family guidance in the prevention of the aforementioned disorder.

Déficit de atención con hiperactividad: farmacoterapia a través de la vida / Attention deficit hyperactivity: pharmacotherapy through life

Resumen El Trastorno por déficit de atención con hiperactivi dad (TDAH) es un trastorno del neurodesarrollo de ori gen biológico con una base genética del 70 al 80%, que afecta al 5% de niños y adolescentes y a un 2.5% de los adultos, cuyos síntomas principales son la inatención, hiperactividad e impulsividad. Por muchos años se pensó que afectaba solo a los niños; actualmente en el DSM 5 se acepta que se puede diagnosticar en adolescentes y adultos. El tratamiento debe ser individualizado, los objetivos principales son mejorar los síntomas centrales de las personas con TDAH, y su calidad de vida. El abordaje terapéutico es psicológico, conductual y farmacológico. Los medicamentos se clasifican en estimulantes y no estimulantes, siendo los de primera línea los estimu lantes tales como el metilfenidato, lisdexanfetamina y dexanfetamina. Entre los no estimulantes se cuentan a la guanfacina y atomoxetina. El tratamiento es funda mental porque mejora la calidad de vida de la persona a nivel familiar, educativo, laboral y social.

Abstract Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder of biological origin with a 70 to 80% genetic basis, which affects 5% of children and adolescents and 2.5% of adults, whose main symptoms are inattention, hyperactivity, and impulsivity. For many years it was thought that it only affected children; currently in the DSM 5 it is accepted that it can be diagnosed in adolescents and adults. Treatment must be individualized, the main objec tives are to improve the core symptoms of people with ADHD, and their quality of life. The therapeutic approach is psychological, behavioral, and pharmacological. Medications are classified as stimulants and non-stimulants, with stimulants such as methylphenidate, lisdexamfetamine, and dexamphetamine being the first line. Non-stimulants include guanfacine and atomox etine. Treatment is essential because it improves the qual ity of life of the person at the family, educational, work, and social levels.

Enfermedades sin diagnostico y enfermedades raras: avances en neurodesarrollo / Rare diseases and undiagnosed diseases: advances in neurodevelopment

Resumen Las enfermedades raras y enfermedades sin diag nóstico se han posicionado en los últimos años como condiciones clínicas que han permitido avanzar el en tendimiento de las funciones de los genes y el im pacto en el desarrollo del individuo. En esta revisión, presentamos como los esfuerzos individuales hechos por muchos años para entender la fisiopatología de en fermedades comunes, enfermedades raras y otras aún más raras, como las enfermedades sin diagnóstico, que se unen hoy para, de manera cooperativa, avanzar en el conocimiento científico. Estos avances en el conoci miento permiten aplicar los avances obtenidos en un grupo de condiciones clínicas a otras con características fenotípicas similares o viceversa. El trabajo conjunto de equipos multidisciplinarios y la comunicación entre clínicos e investigadores proporcionarán oportunidades para proveer mejores oportunidades de tratamiento para pacientes y familias a lo largo de múltiples diagnósticos comunes o raros.

Abstract Rare diseases and undiagnosed diseases have re cently positioned themselves as clinical entities that provide important opportunities to advance our under standing of gene functions and the impact of them in the individual development. In this review, we present how efforts made over years to understand common diseases, rare diseases and even undiagnosed diseases come together today to cooperatively advances scientific knowledge. These advance in science and new acquired knowledge, make possible to apply the advances ob tained in a group of clinical conditions to others with similar phenotypic characteristics or vice versa. The cooperative work of multidisciplinary teams and the communication between clinicians and researchers have and will provide opportunities for better treatments for patients and families across multiple common and rare diseases.

Bidirectional associations between hyperopia, myopia, astigmatism, and strabismus, and attention-deficit/hyperactivity disorder in children: a national population-based cohort study

Objectives: The present study analyzed the reciprocal relationships between four common pediatric ophthalmic diseases (i.e., hyperopia, myopia, astigmatism, and strabismus) and attention‐deficit/hyperactivity disorder (ADHD) in children. Methods: This study enrolled 86,028 children with ADHD and 1,798,673 children without ADHD in the Taiwan Maternal and Child Health Database who were born at any time from 2004 to 2017. Cox proportional hazards regression models were used to estimate the bidirectional relationships of the four ophthalmic diseases with ADHD in children after adjusting for age, sex, and gestational age at birth. Survival curves for time-to-event variables were estimated using the Kaplan-Meier method, and the log-rank test was used to compare the curves. Results: The results indicated that ADHD significantly predicted the occurrence of hyperopia, myopia, astigmatism, and strabismus. Furthermore, hyperopia, myopia, astigmatism, and strabismus significantly predicted the occurrence of ADHD. The time between enrollment and ADHD diagnosis was shorter for patients with ophthalmic diseases than for the control group, and the time between enrollment and ophthalmic disease diagnosis was also shorter for ADHD patients than for the control group. Sex differences were found in the associations between ADHD and ophthalmic diseases. Conclusion: Clinicians should monitor children with ADHD for hyperopia, myopia, astigmatism, and strabismus to ensure appropriate treatment, and vice versa.

Mercurio y trastornos del neurodesarrollo en niños: una revisión sistemática / Mercury and neurodevelopmental disorders in children: A systematic review

El mercurio es un metal tóxico que puede atravesar la placenta y la barrera hematoencefálica, y causar la interrupción de varios procesos celulares. Estudios han investigado la exposición al mercurio y trastornos en el neurodesarrollo, por lo que se requiere un análisis crítico y riguroso de esta evidencia. El objetivo de esta revisión fue evaluar la evidencia científica disponible sobre los efectos de la exposición al mercurio durante las etapas prenatal y posnatal, y su relación con el desarrollo de trastornos neuroconductuales. Se realizó una búsqueda sistemática en las bases de datos MEDLINE y ScienceDirect; los resultados se presentaron a través de tablas y síntesis narrativa. Solo 31 estudios cumplieron los criterios de elegibilidad. En general, la evidencia es limitada sobre los efectos de la exposición al mercurio y trastornos del neurodesarrollo en niños. Entre los posibles efectos reportados, se hallan problemas en el aprendizaje, autismo y trastorno por déficit de atención e hiperactividad.

Mercury is a toxic metal which can cross the placenta and the blood-brain barrier and cause the disruption of various cellular processes. Studies have investigated mercury exposure and neurodevelopmental disorders; therefore, a critical and rigorous analysis of this evidence is required. The objective of this review was to evaluate the available scientific evidence on the effects of mercury exposure during the prenatal and postnatal periods and its relationship with the development of neurobehavioral disorders. A systematic search of the MEDLINE and ScienceDirect databases was conducted; the results were presented in tables and narrative synthesis. Only 31 studies met the eligibility criteria. Overall, the evidence on the effects of mercury exposure and neurodevelopmental disorders in children is limited. Learning disabilities, autism, and attention deficit hyperactivity disorder were some of the reported potential effects.

Psychopathological Risk in Siblings of Subjects with Attention-Deficit/Hyperactivity Disorder: A cross-Sectional Study

Objective: We aim to determine the prevalence of mental disorders in siblings of children with attention deficit hyperactivity disorder (ADHD), and to determine how psychosocial adversity factors relate to this psychopathology, in a low-middle income country (Colombia). Methods: We evaluated subjects with ADHD diagnosed according to the DSM-5 criteria, one of their parents and one of their siblings (ages 8-19). We used the ADHD rating scale and a set of instruments to assess the presence of mental disorders as well as psychosocial adversity. Results: We evaluated 74 trios formed by the index case with ADHD, one sibling and one of the parents. We found that 24.3% of the participating siblings also met the criteria for ADHD and another 24.3% for other psychiatric disorders. The risk of these siblings having ADHD increased further when one of the parents reported a history of ADHD. We also found that 28.3% of the families faced high levels of psychosocial adversity as per their scores in the Rutter Adversity Index. Conclusions: Siblings of subjects with ADHD showed a significant risk for ADHD and other mental disorders. That risk increased if a parent reported a history of ADHD and also when two or more psychosocial adversity factors were present. This study supports the importance of early detection in efforts to decrease the risk for other siblings.

Objetivo: Nuestro objetivo es determinar la prevalencia de trastornos mentales en hermanos de casos con TDAH y cómo los factores de adversidad psicosocial se relacionan con esta psicopatología en un país de ingresos bajos-medios (Colombia). Métodos: Se evaluó a sujetos con TDAH diagnosticado según los criterios del DSM-5, uno de sus padres y uno de sus hermanos (edades, 8-19 anos). Mediante la escala de calificación del TDAH y un conjunto de otros instrumentos se evaluó la presencia de trastornos mentales y adversidad psicosocial. Resultados: Se evaluó a 74 tríos formados por el caso índice con TDAH, un hermano y uno de los padres. Se halló que un 24,3% de los hermanos participantes también cumplían los criterios de TDAH y otro 24,3%, otros trastornos psiquiátricos. El riesgo de que estos hermanos tuvieran TDAH aumentó aún más cuando uno de los padres informó antecedentes de TDAH. También, que el 28,3% de las familias se enfrentaron a altos niveles de adversidad psicosocial según sus puntuaciones en el Índice de Adversidad de Rutter. Conclusiones: Los hermanos de sujetos con TDAH mostraron un significativo riesgo de TDAH y otros trastornos mentales. Ese riesgo aumenta si uno de los padres reporta antecedentes de TDAH y también cuando se presentan 2 o más factores de adversidad psicosocial. Este estudio respalda la importancia de la detección temprana con el fin de disminuir el riesgo para otros hermanos.

Evolución de menores diagnosticados con trastorno de déficit de atención e hiperactividad. Estudio de seguimiento en una muestra española / Evolution of children diagnosed with attention deficit/hyperactivity disorder. Follow-up study in a Spanish sample

Resumen Antecedentes: El trastorno de déficit de atención e hiperactividad (TDAH) constituye una condición crónica con riesgos asociados a largo plazo. Objetivo: Analizar el estado clínico, la ocupación y las dificultades de la vida diaria de dos cohortes de niños con diagnóstico de TDAH (2004 y 2009) después cinco y 10 años. Material y método: Estudio descriptivo y longitudinal de la base de datos WOMI correspondiente a Oviedo, Asturias, España. Se incluyeron niños detectados con TDAH por su pediatra de atención primaria. Se solicitó una entrevista telefónica voluntaria de seguimiento. Las variables de resultado fueron estado clínico y ocupacional al momento de la entrevista, síntomas de TDAH según SNAP-IV y Cuestionario de Fortalezas y Dificultades (SDQ). Resultados: La muestra entrevistada estuvo formada por 95 sujetos, de los cuales 71 respondieron a los cuestionarios SNAP-IV y SDQ; 60.7 % de la muestra no recibía tratamiento en el momento del seguimiento, 4.7 % no tenía ninguna ocupación, 25.4 % mantenía síntomas globales de TDAH en nivel superior al punto de corte clínico y 66.2 % presentaba dificultades con interferencia moderada. Conclusiones: Los síntomas del TDAH disminuyen conforme las personas crecen. Las comorbilidades de salud mental y el abandono académico no se confirmaron en la muestra.

Abstract Background: Attention deficit/hyperactivity disorder (ADHD) is a chronic condition with long-term associated risks. Objective: To analyze the clinical status, occupation, and daily life difficulties of two cohorts of children diagnosed with ADHD (2004 and 2009) after five and 10 years. Material and method: Descriptive, longitudinal study using the WOMI database corresponding to Oviedo, Asturias, Spain. Children with ADHD detected by their primary care pediatrician were included. A voluntary follow-up telephone interview was requested. Outcome variables were current clinical and occupational status, ADHD symptoms according to SNAP-IV, and Strengths and Difficulties Questionnaire (SDQ). Results: The interviewed sample consisted of 95 subjects, out of whom 71 answered the SNAP-IV and SDQ questionnaires; 60.70% of the sample did not receive treatment at the time of follow-up, 4.7% had no occupation, 25.40% still had ADHD global symptoms above the clinical cutoff point, and 66.2% had difficulties with moderate interference. Conclusions: ADHD symptoms decline as people grow up. Mental health comorbidities and academic dropout were not confirmed in the sample.

Estudios neurofisiológicos en los trastornos del neurodesarrollo: potenciales evocados cognitivos / Neurophysiological studies in neurodevelopmental disorders: event related potentials

Resumen El trastorno por déficit de atención con hiperactividad (TDAH) y el trastorno del espectro autista (TEA) son trastornos del neurodesarrollo cuyo diagnóstico es clínico y con gran variabilidad en la presentación clínica. La posibilidad de identificar y validar biomarcadores en estos trastornos del neurodesarrollo ayudaría no sólo en su diagnóstico sino también a la hora de implementar tratamientos personalizados y mo nitorizar la respuesta al tratamiento. Exploraciones neurofisiológicas como los potenciales evocados cognitivos (PEC), son una de las herramientas más utilizadas para evaluar de forma objetiva y con una alta resolución temporal las funciones cognitivas y proporcionan información sobre los mecanismos neurobiológicos subyacen tes, por lo que constituyen una herramienta de gran utilidad para valorar las alteraciones cognitivas asociadas a los trastornos del neurodesarrollo. Se han utilizado diferentes componentes de los PEC para el estudio de los trastornos del neurodesarrollo, como el componente P300, N400 o el componente N170 como biomarcador de la disfunción social en TEA. Revisamos los principales componentes de los PEC que se han estudiado como herramientas complementarias en el diagnóstico y en la monitorización de los tratamientos en los trastornos del neurodesarrollo.

Abstract Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevel opmental disorders whose diagnosis is clinical and with great variability in clinical presentation. The possibility of identifying and validating biomarkers in these neurodevelopmental disorders would help not only in their diagnosis, but also when implementing personalized treatments and monitori ng the response to treatment. Neurophysiologi cal examinations such as event related potentials (ERP) are one of the most widely used tools to objectively assess cognitive functions with high temporal resolution and provide information on the underlying neurobiological mechanisms, making them a very useful tool to assess cognitive alterations associated with neurodevelopmental disorders. Different components of the ERP have been used for the study of neurodevelopmental disorders, such as the P300, N400 component or the N170 component as a biomarker of social dysfunction in ASD. We review the main components of ERP that have been studied as complementary tools in the diagnosis and monitoring of treatments in neurodevelopmental disorders.

Trastornos de la infancia y características sociodemográficas asociadas a la depresión en adultos en una ciudad de Colombia / Childhood disorders and sociodemographic characteristics associated with depression in adults from a Colombian city / Transtornos da infância e características sócio-demográficas associadas à depressão em adultos de uma cidade colombiana

Introducción: Los trastornos emocionales y del comportamiento que se inician en la infancia llevan a cambios que se extienden hasta la edad adulta, con consecuencias sociales. Objetivo: Determinar la asociación de la depresión en la adultez con trastornos mentales de inicio en la infancia y otras condiciones, en Envigado, 2017. Materiales y métodos: Estudio con enfoque cuantitativo, tipo observacional, transversal con intención analítica. El tamaño de la muestra fue de 737 individuos, entre 18 y 65 años. Se aplicó el instrumento CIDI - CAPI de la OMS. El procesamiento y análisis se llevó a cabo en SPSS v. 21 de la Universidad CES y Epidat 4.2. Resultados: La proporción de depresión en la adultez es de 10,8%, en la población de estudio que tuvo antecedente de trastorno por déficit de atención e hiperactividad (TDAH) fue aproximadamente 5,6 veces más que en aquellos que no tenían este antecedente (OR= 6,62; IC95% 1,92-22,7). Conclusiones: El TDAH en la infancia incrementa la probabilidad de presentar depresión en la adultez en la población de Envigado, lo cual soporta la importancia de promover acciones de salud mental en la niñez, para prevenir la depresión en la edad adulta.

Introduction: Emotional and behavioral disorders that begin in childhood lead to adult changes, which have social consequences. Objective: To determine the association of adult depression with childhood onset of mental disorders and other factors in Envigado (Colombia). Materials and methods: A quantitative observational and cross-sectional study was carried out. The sample size was 737 individuals aged between 18 to 65 years. The CIDI-CAPI instrument of the WHO was used. Data processing and analysis was conducted through SPSS v. 21 software from the CES University and Epidat 4.2. Results: The percentage of depression in adults was 10.8%. This figure was 5.6 times greater in the study population that had history of attention deficit hyperactivity disorder (ADHD) compared to individuals who did not have this disorder (OR= 6.62; 95% CI 1.92-22.7). Conclusions: Childhood ADHD increases the probability of depression in the adult population of Envigado, which supports the importance of promoting mental health programs in children in order to prevent adulthood depression.

Introdução: Os transtornos emocionais e comportamentais que se iniciam na infância levam a alterações que se estendem até a idade adulta, com consequências sociais. Objetivo: Determinar a associação da depressão na idade adulta com transtornos mentais de início na infância e outras condições, em Envigado, 2017. Materiais e métodos: um estudo foi realizado com abordagem quantitativa, observacional, transversal e com intenção analítica. O tamanho da amostra foi de 737 indivíduos, entre 18 e 65 anos de idade. Foi aplicado o instrumento CIDI - CAPI da OMS. O processamento e análise foram realizados no SPSS v. 21 da Universidad CES e Epidat 4.2. Resultados: A proporção de depressão na idade adulta é de 10,8%, na população estudada que tinha histórico de transtorno de déficit de atenção e hiperatividade (TDAH) foi aproximadamente 5,6 vezes maior do que naquelas sem esse histórico (OR= 6,62; 95 % CI 1,92-22,7). Conclusões: O TDAH na infância aumenta a probabilidade de apresentar depressão na idade adulta na população de Envigado, o que reforça a importância de promover ações de saúde mental na infância, para prevenir a depressão na idade adulta.

The role of psychosocial adversity in the aetiology and course of attention deficit hyperactivity disorder

Introduction: Attention deficit/hyperactivity disorder (ADHD) has genetic and environmental aetiological factors. There are few publications on the environmental factors. The objective of this review is to present the role of psychosocial adversity in the aetiology and course of ADHD. Methods: A search was carried out in the following databases: PubMed, ScienceDirect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA and PsycNET. English and Spanish were selected without being limited by type of study or year of publication. Finally, a qualitative synthesis was conducted. Results: ADHD development could be related to exposure to adverse factors in the family, school or social environment. It has been proposed as an explanatory mechanism that adversity interacts with genetic variants and leads to neurobiological changes. There may also be a gene-environment correlation whereby individual hereditary characteristics increase the risk of exposure to adversity, and indirectly increase the probability of developing ADHD. Research on psychosocial adversity represents a big challenge, not only due to the complexity of its construct, but also to the effect of subjective perception of a given event. Conclusions: ADHD aetiology is complex and involves the interaction of both genetic and environmental factors, in which these factors correlate and cause the disorder. The study of the role of psychosocial adversity in ADHD is fundamental, but it remains a task that entails great difficulties.

Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) tiene factores etiológicos genéticos y ambientales. Hay pocas publicaciones acerca de los factores ambientales. El objetivo de esta revisión es presentar el papel de la adversidad psicosocial en la etiología y el curso del TDAH. Métodos: Se llevó a cabo una búsqueda en las siguientes bases de datos: PubMed, ScienceDi-rect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA y PsycNET. Se seleccionaron artículos en inglés y español sin limitar por tipo de estudio o año de publicación. Finalmente, se hizo una síntesis cualitativa. Resultados: El desarrollo del TDAH podría estar relacionado con la exposición a factores adversos en el entorno familiar, escolar o social. Se ha propuesto como mecanismo explicativo que la adversidad interactúa con variantes genéticas y conduce a cambios neurobiológicos. También puede haber una correlación entre gen y ambiente, en la que las características hereditarias individuales aumentan el riesgo de exposición a la adversidad e indirectamente aumentan la probabilidad de sufrir TDAH. La investigación sobre la adversidad psicosocial representa un gran desafío no solo por la complejidad de su constructo, sino también por el efecto de la percepción subjetiva sobre un evento determinado. Conclusiones: La etiología del TDAH es compleja y factores genéticos y ambientales presentan una interacción en la que estos factores se correlacionan y originan el trastorno. El estudio del papel de la adversidad psicosocial en el TDAH es fundamental, pero sigue siendo una tarea que conlleva grandes dificultades.

Effects of cloperastine, a non-narcotic antitussive, on the expression of GIRK channels in the brain of methamphetamine-induced hyperactive mice

Objectives: Centrally-acting antitussives with inhibitory effects on G protein-coupled inwardly rectifying potassium (GIRK) channels have been shown to also inhibit methamphetamine-induced hyperactivity in mice. In this study, we examined if cloperastine, which is the most potent inhibitor of the GIRK channels among antitussives, is sensitive to the expression levels of GIRK channels in the brain of methamphetaminetreated mice. Materials and Methods: The brain tissues have been removed and the total RNA has been extracted from tissues. The mRNA levels were evaluated using semiquantitative reverse transcription-polymerase chain reaction. Results: The concentration levels of the mRNA of GIRK channels within the ventral midbrain of methamphetamine-treated mice increased as compared with that in control and cloperastine reduced an upregulation in GIRK2, one of the subunits of the GIRK channels, by the injection of methamphetamine. Conclusion: These findings suggest that cloperastine might ameliorate hyperactivity by inhibiting the GIRK channels in the brain.

The relationship between fine motor skills and executive function in boys with attention deficit hyperactivity disorder / 中国学校卫生

Objective@#To investigate the relationship between fine motor skills and executive function in school aged boys with attention deficit hyperactivity disorder (ADHD) aged 6-10 years, so as to provide a reference for promoting executive function.@*Methods@#From November 2022 to May 2021,65 boys with ADHD were recruited from a tertiary hospital in Beijing and a public elementary school in Beijing, and 65 boys with typical development according to age and sex were recruited as controls. Children s fine motor skills were assessed using the movement assessment battery for children, second version (MABC-2), and children s inhibitory control, working memory, and cognitive flexibility were assessed using the Stroop color word test (SCWT), Rey osterrich complex figure test (ROCFT) and trail making test (TMT), respectively. Independent samples t-tests were used to analyze the differences between the two groups, and Pearson correlation analysis and stratified regression analysis were used to explore the relationship between fine motor skills and executive functioning in boys with ADHD.@*Results@#In the fine motor skills test, boys with ADHD scored significantly lower (8.68±3.62) than control boys (11.22±2.27)( t =4.80, P <0.05); in the executive function test, the results of SCWT, ROCFT, and TMT tests were significantly worse in boys with ADHD than in normal boys ( t =-4.53-4.42, P < 0.05). Correlation analysis showed that the fine motor skill scores of boys with ADHD were negatively correlated with the number of word sense errors ( r =-0.35) and color errors ( r =-0.42), and positively correlated with memory scores for delayed structure ( r =0.30) and detail ( r =0.25), which were negatively correlated with TMT-A ( r =-0.34),TMT-B reaction time ( r =-0.26), number of errors ( r =-0.43) ( P <0.05). Stratified regression analysis showed that fine motor skill scores of boys with ADHD were predictive of test results for inhibitory control, working memory and cognitive flexibility, with explanatory rates of 15%, 7%, and 19%, respectively.@*Conclusion@#Fine motor skills in boys with ADHD are correlated with executive functions, and fine motor skills could predict inhibitory control, working memory and cognitive flexibility to some extent. The development of fine motor skills in boy with ADHD could promote their executive functions.

Association of deficits in prepotent response inhibition with attention deficit and impulsive behavior among children with attention deficit hyperactivity disorder / 预防医学

Objective@#To investigate the associations of deficits in prepotent response inhibition with attention deficit and impulsive behavior in children with attention deficit hyperactivity disorder (ADHD), so as to provide insights into response inhibition training in ADHD to relieve clinical symptoms. @*Methods@# From March to December 2022, 57 children with ADHD were selected from the clinical psychology department of a tertiary hospital in Hangzhou City as the ADHD group, and 55 normal children matched by age and gender were selected from a primary school as the control group. Prepotent response inhibition, attention deficit and impulsive behavior were assessed by inhibition conflict task, visual continuous performance test (CPT) and matching familiar figures test (MFFT), respectively. The associations of deficits in prepotent response inhibition with attention deficit and impulsive behavior were analyzed using multiple linear regression model, and the predictive value of deficits in prepotent response inhibition on ADHD was evaluated using receiver operating characteristic (ROC) curve.@*Results@# The children included in the ADHD group had a mean age of (8.77±1.60) years and 44 males (77.19%), and the children included in the control group had a mean age of (9.20±1.77) years and 42 males (76.36%). The error rate of inhibition conflict task, missing report rate of visual CPT and the number of MFFT errors were higher in the ADHD group than in the control group [22.50% (12.50%) vs. 8.75% (7.00%), 24.00% (30.00%) vs. 7.50% (7.00%), 8.67±3.32 vs. 4.47±3.16; all P<0.05]. Multiple linear regression model showed that the error rate of inhibition conflict task was positively associated with the missing report rate of visual CPT (R2=0.135, β=0.091, P<0.001) and the number of MFFT errors (R2=0.092, β=0.009, P<0.001). The area under the ROC curve was 0.891, the sensitivity was 93.00%, the specificity was 80.00%, and the cut-off was 13.13%.@* Conclusions @#The deficits in prepotent response inhibition are positively associated with attention deficit and impulsive behavior.