Transtorno do Espectro Autista e Transtorno Desafiante de Oposição: Dificuldades no diagnostico / Transtorno del Espectro Autista y Trastorno Negativista Desafiante: Dificultades en el diagnóstico / Autism Spectrum Disorder and Oppositional Defiant Disorder: Difficulties in diagnosis

Introdução: O Transtorno do Espectro Autista e Transtorno Desafiante de Oposição, são desordens comumente diagnosticadas em indivíduos ainda na infância. Objetivo: Identificar possíveis fatores dificultadores no diagnóstico diferencial dos referidos transtornos. Metodologia: Foi realizada uma revisão integrativa da literatura, a qual selecionou artigos nas bases de dados Biblioteca Virtual de Saúde, periódico Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e Periódicos Eletrônicos de Psicologia entre os meses de setembro e outubro de 2021. Para tanto, foram utilizadas as palavras chaves Transtorno do Espectro Autista, autismo, Transtorno Desafiante de Oposição, Transtorno Opositor Desafiador, diagnóstico, comorbidades, comportamentos disruptivos e dificuldades diagnósticas. Resultados: Oito artigos foram selecionados para extração de dados. O diagnóstico correto desses transtornos pode ser desafiador devido à sobreposição de sinais com outros transtornos e comorbidades, bem como à diversidade presente no espectro autista e à variedade de manifestações dos transtornos disruptivos. Além disso, a maioria dos estudos destacam os prejuízos na área da comunicação, o comprometimento na área social e os graus de severidade, como sendo características semelhantes entre os dois transtornos, podendo serem possíveis fatores que podem dificultar no diagnóstico do Transtorno do Espectro Autista e Transtorno Desafiante de Oposição, de maneira diferencial ou concomitante. Conclusões: O número de pesquisas relacionadas aos transtornos citados acima é inferior ao que se faz necessário para melhor conhecimento sobre o tema. No que diz respeito as pesquisas de materiais científicos, foram encontradas dificuldades para obtenção de estudos que estivessem de acordo com a nossa pesquisa. Com isso, faz-se necessário mais pesquisas que tentem investigar e compreender o porquê da escassez de material que estudem tais diagnósticos de maneira concomitante (AU).

Introduction: Autism Spectrum Disorder and Oppositional Defiant Disorderare disorders commonly diagnosed in individuals in childhood. Objective:Identify possible factors that hinder the differential diagnosis of these disorders. Methodology:An integrative review of the literature was carried out, which selected articles from the Virtual Health Library databases, Coordination for the Improvement of Higher Education Personnel journal and Electronic Psychology Journalsdatabases between the months of September and October 2021. To this end, the keywords Autistic Spectrum Disorder, autism, Disorder Defiant Disorder, Opposition, Oppositional Defiant Disorder, diagnosis, comorbidities, disruptive behaviors and diagnostic difficulties.Results:Eight articles were selected for data extraction. Correctly diagnosing these disorders can be challenging due to overlapping signs with other disorders and comorbidities, as well as the diversity present in the autism spectrum and the variety of manifestations of disruptive disorders. Furthermore, most studies highlight losses in the area of communication, impairment in the social area and degrees of severity, as being similar characteristics between the two disorders, and may be possible factors that can make it difficult to diagnose Autism Spectrum Disorder and Oppositional Defiant Disorder, differentially or concomitantly. Conclusions:The number of studies related to the disorders mentioned above is lower than what is needed for a better understanding of the subject. With regard to research on scientific materials, difficulties were encountered in obtaining studies that were in accordance with our research. With this, more research is needed to try to investigate and understand the reason for the scarcity of material that studies such diagnoses concomitantly (AU).

Introducción: El Trastorno del Espectro Autista y el Trastorno Negativista Desafiante son trastornos comúnmente diagnosticados en individuos en la infancia. Objetivo: Identificar posibles factores que puedan dificultar el diagnóstico diferencial de los trastornos antes mencionados.Metodología:Se realizó una revisión integrativa de la literatura, que seleccionó artículos en las bases de datos Biblioteca Virtual en Salud, revista Coordinación para el Perfeccionamiento del Personal de Educación Superior y Revistas Electrónicas de Psicología entre septiembre y octubre de 2021. Para ello, se utilizaron las palabras clave Trastorno del espectro autista, autismo, Trastorno negativista desafiante, Trastorno negativista desafiante, diagnóstico, comorbilidades, conductas disruptivas y dificultades diagnósticas. Resultados: Se seleccionaron ocho artículos para la extracción de datos. El diagnóstico correcto de estos trastornos puede ser un desafío debido a la superposición de síntomas con otros trastornos y comorbilidades, así como a la diversidad presente en el espectro del autismo y la variedad de manifestaciones de los trastornos disruptivos. Además, la mayoría de los estudios destacan las deficiencias en el área de la comunicación, la deficiencia en el área social y los grados de gravedad, como características similares entre ambos trastornos, que pueden ser posibles factores que dificulten el diagnóstico del Trastorno del Espectro Autista y Trastorno de Oposición Desafiante, ya sea de forma diferencial o concomitante. Conclusiones: El número de estudios relacionados con los trastornos antes mencionados es inferior al necesario para una mejor comprensión del tema. En cuanto a la investigación sobre materiales científicos, se encontraron dificultades para obtener estudios que estuvieran de acuerdo con nuestra investigación. Con esto, se necesita más investigación para tratar de investigar y comprender la razón de la escasez de material que estudie dichos diagnósticos de forma concomitante (AU).

Enseñanza de deportes de colaboración y oposición: análisis comparativo entre metodologías comprensivas y modelo tradicional / Collaborative and opposition sports teaching: comparative analysis between comprehensive methodologies and the traditional model / Ensino colaborativo e de oposição do esporte: análise comparativa entre metodologias integrais e o modelo tradicional

El propósito del estudio fue determinar el efecto que produce la aplicación de una unidad de enseñanza de los deportes de colaboración y oposición diseñada en base a dos propuestas del modelo pedagógico comprensivo: el Teaching Games for Understanding y la Didáctica Cognitiva, en comparación a un modelo tradicional de enseñanza. La muestra estuvo conformada por alumnos(as) de 5° a 8° básicos (12 a 14 años). Mediante metodología observacional, fueron evaluadas las principales acciones de juego eficientes en las dimensiones de ataque y defensa, en momentos de test y retest, a un grupo control (GC) y otro experimental (GE). El análisis de varianza (MANOVA) y las comparaciones por pares con corrección de Bonferroni aplicadas con un alfa de 0.05, evidenciaron diferencias significativas entre ambos grupos, de las acciones motoras de lanzamiento en zona eficaz (GE: 74,3% GC: -16,7%) y Pase simple (GE: -27,1% - GC: -3,1%). Mientras que, mediante el análisis descriptivo de las tasas de ocurrencia, se encontraron diferencias de las acciones motoras de Anticipación (GE:211,1% - GC:20%), marcación eficiente (GE: 330,8% - GC: -7,1%) y desmarcación (GE: 400% - GC: 0%). Los hallazgos de ambos análisis muestran que la aplicación de metodologías comprensivas en la enseñanza de los deportes de colaboración y oposición en el contexto de educación física escolar, mejoran la calidad de las acciones de juego, en comparación a un modelo tradicional de enseñanza.

The purpose of the study was to determine the effect produced by the application of a teaching unit for collaborative and oppositional sports designed on the basis of two proposals of the comprehensive pedagogical model: Teaching Games for Understanding and Cognitive Didactics, compared to a traditional teaching model. The sample consisted of students from 5th to 8th grade (12 to 14 years old). By means of observational methodology, the main efficient game actions in the dimensions of attack and defense were evaluated, in test and retest moments, to a control group (CG) and an experimental group (EG). The analysis of variance (MANOVA) and pairwise comparisons with Bonferroni correction applied with an alpha of 0. 05, showed significant differences between both groups in the motor actions of throwing in the effective zone (EG: 74.3% - CG: -16.7%) and simple passing (EG: -27.1% - CG: -3.1%), while descriptive analysis of the occurrence rates showed differences in the anticipation motor actions (EG: 211.1% - CG: 20%), efficient tackling (EG: 330.8% - CG: -7.1%) and untacking (EG: 400% - CG: 0%). The findings of both analyses show that the application of comprehensive methodologies in the teaching of collaborative and oppositional sports in the context of school physical education improves the quality of the game actions, compared to a traditional teaching model.

O objetivo do estudo foi determinar o efeito produzido pela aplicação de uma unidade de ensino de esportes colaborativos e opostos projetada com base em 2 propostas do modelo pedagógico integral: Jogos de ensino para a compreensão e didática cognitiva, em comparação com um modelo de ensino tradicional. A amostra foi composta por alunos da 5ª à 8ª série (12 a 14 anos). Por meio de metodologia observacional, foram avaliadas as principais ações de jogo eficientes nas dimensões de ataque e defesa, nos momentos de teste e reteste, em um grupo controle (GC) e um grupo experimental (GE). A análise de variância (MANOVA) e as comparações por pares com correção de Bonferroni aplicada com alfa de 0,05, mostraram diferenças significativas entre ambos os grupos, das ações motoras de lançamento na zona efetiva (GE: 74,3% GC: -16,7% ) e passe simples (GE: -27,1% - GC: -3,1%). Já pela análise descritiva das taxas de ocorrência, foram encontradas diferenças nas ações motoras de Antecipação (GE: 211,1% - GC: 20%), marcação eficiente (GE: 330,8% - GC: -7,1%) e desmarcação (GE: 400% - GC: 0%). Os resultados de ambas as análises mostram que a aplicação de metodologias abrangentes no ensino de esportes colaborativos e de oposição no contexto da educação física escolar melhora a qualidade das ações de jogo, em comparação com um modelo de ensino tradicional.

Contribuições da Terapia Cognitivo-Comportamental no treinamento parental de crianças com Transtorno de Oposição Desafiante / Contributions of Cognitive-Behavioral Therapy in parental training of children with Oppositional Defiant Disorder

O Transtorno de Oposição Desafiante (TOD) caracteriza-se por um padrão frequente e persistente, de humor irritável, comportamento desafiador ou índole vingativa. Diferentes estratégias de prevenção e tratamento são propostas, como é o caso do treinamento parental. Nesse contexto, destacam-se as intervenções baseadas na Terapia Cognitivo-Comportamental (TCC), as quais, apesar de apresentarem resultados promissores, ainda carecem de sistematização de suas contribuições em contexto brasileiro. Em função disso, este estudo teve como objetivo apresentar as contribuições da TCC no Treinamento de Pais de crianças com TOD. Para tanto, foi realizada uma revisão narrativa literatura. Os resultados apontaram que o treinamento parental baseado na TCC faz uso de distintas variáveis (ex. estilos ou práticas parentais, estresse e competência parental) e estratégias (ex: role-play, resolução de problemas, treino de habilidades sociais educativas e reestruturação cognitiva). Conclui-se que o TOD e seu sintomas trazem consequências negativas no contexto familiar e o treinamento parental é um recurso eficaz para prevenção e tratamento desse transtorno, uma vez que possibilita a melhoria da relação entre pais e filhos. Entretanto, estudos acerca do tema ainda precisam ser ampliados em contexto brasileiro.(AU)

The Oppositional Defiant Disorder (ODD) is characterized by a frequent and persistent pattern of irritable mood, defiant behavior or vengeful nature. Different strategies of prevention and treatment are proposed, as is the case of parental training. In this context, the interventions based on Cognitive-Behavioral Therapy (CBT) stand out, which, despite presenting promising results, still need to systematize their contributions in the brazilian context. As a result, this study aimed to present the contributions of CBT in Parents' Training of children with ODD. For this, a literature review was performed. The results showed that parental training based on Cognitive-Behavioral Therapy makes use of different variables (e.g., parenting styles or practices, stress and parental competence) and strategies (e.g., role-play, problem solving, training of educational social skills and cognitive restructuring). It is concluded that ODD and its symptoms bring negative consequences in the family context and parental training is an effective resource for prevention and treatment of this disorder, since it allows the improvement of the relationship between parents and children. However, it is suggested that studies on the subject be expanded in the brazilian context.(AU)

El trastorno de oposición desafiante (TOD) se caracteriza por un patrón frecuente y persistente de estado de ánimo irritable, comportamento desafiante o la naturaleza vengativa. Se proponen diferentes estrategias de prevención y tratamiento, como el entrenamiento de los padres. En este contexto, destacamos las intervenciones basadas en la Terapia Cognitivo-Conductual (TCC), que, a pesar de presentar resultados prometedores, todavía carecen de sistematización de sus contribuciones en el contexto brasileño. Como resultado, este estudio tenía como objetivo presentar las contribuciones de cbt en el entrenamiento de los padres de los niños con OD. Para ello, se llevó a cabo una revisión narrativa literaria. Los resultados mostraron que el entrenamiento de los padres basado en la TCC hace uso de diferentes variables (por ejemplo, estilos o prácticas de crianza, estrés y competencia parental) y estrategias (por ejemplo, juego de roles, resolución de problemas, entrenamiento de habilidades sociales educativas y reestructuración cognitiva). Se concluye que el TOD y sus síntomas traen consecuencias negativas en el contexto familiar y el entrenamiento parental es un recurso eficaz para la prevención y tratamiento de este trastorno, ya que permite la mejora de la relación entre padres e hijos. Sin embargo, se sugiere ampliar los estudios sobre el tema en el contexto brasileño.(AU)

Changes of gray matter volume and brain functional connectivity in children with attention deficit hyperactivity disorder comorbid with oppositional defiant disorder / 中华行为医学与脑科学杂志

Objective:To analyze the changes of gray matter volume and resting-state functional connectivity in children with attention deficit hyperactivity disorder (ADHD) comorbid with oppositional defiant disorder (ODD).Methods:A total of 22 ADHD comorbid with ODD children (ADHD-ODD group, n=22) were selected from a public-assess resting-state fMRI ADHD cohort, namely, ADHD-200.Meanwhile, 22 age- and sex- matched ADHD children without ODD (ADHD group, n=22) and 22 healthy children(control group, n=22) were also included.T1-weighted MRI and resting-state fMRI scans were performed on all of the participants.The voxel-based morphometric (VBM) method was used to compare the volume of gray matter in three groups.The gray matter with aberrant volume was set as the region of interest(ROI) for mapping the functional connectivity of the whole brain.For comparison of gray matter volumes, one-way ANOVA and two-sample t-test analysis were applied, while two-sample t-test analysis was used for comparison of functional connectivity. Results:Compared with the control group, ADHD-ODD group showed decreased gray matter volume in the left cerebellum anterior lobe (MNI coordinate: x, y, z=-19.5, -42, -18) and right cerebellum anterior lobe (MNI coordinate: x, y, z=19.5, -39, -21). The left cerebellum anterior lobe showed increased functional connectivity with left superior frontal gyrus, left middle frontal gyrus (MNI coordinate: x, y, z=-24, 19, 43), right superior frontal gyrus, right middle frontal gyrus (MNI coordinate: x, y, z=30, 9, 45) and bilateral precuneus, posterior cingulate gyrus(MNI coordinate: x, y, z=-6, -35, 24). Compared with the ADHD group, ADHD-ODD group showed decreased gray matter volume in the right cerebellum anterior lobe (MNI coordinate: x, y, z=19.5, -37.5, -22.5). The right cerebellum anterior lobe showed increased functional connectivity with bilateral superior frontal gyrus, bilateral middle frontal gyrus, bilateral medial frontal gyrus, anterior cingulate gyrus and posterior cingulate gyrus(MNI coordinate: x, y, z=18, -12, 42), bilateral cuneus, bilateral lingual gyrus(MNI coordinate: x, y, z=9, -87, 27).Conclusion:ADHD comorbid with ODD children show decreased cerebellum volume and excessive functional connectivity with several brain regions of the cerebral hemispheres, which may be one of the neuropathological bases of cognitive, emotional, and behavioral disorders.

Sandplay therapy in the treatment of children with Oppositional Defiant Disorder and Conduct Disorder / A terapia de sandplay no tratamento de crianças com Transtorno Opositivo-Desafiador e Transtorno de Conduta

The study aimed at assessing the effectiveness of sandplay therapy in the treatment of children with symptoms of oppositional defiant disorder and/or conduct disorder. The intervention consisted of twelve weekly sessions of sandplay therapy. The Child Behavior Checklist 6-18 was used to assess symptoms before and after the intervention. Participants were 41 children of both sexes, randomly divided into two groups. The control group remained on hold while experimental group 1 underwent the intervention. After three months, control group participants who still met the inclusion criteria were placed in experimental group 2. Results were analyzed statistically, in order to compare the control group and experimental group 1, as well as to assess the evolution of the total experimental group, which included experimental groups 1 and 2. Results pointed to the effectiveness of sandplay therapy in reducing symptoms of oppositional defiant disorder and conduct disorder.

O estudo visou avaliar a efetividade da terapia de sandplay no tratamento de crianças com sintomas de Transtorno Opositivo-Desafiador e/ou Transtorno de Conduta. A intervenção consistiu de 12 sessões semanais de terapia de sandplay. O Child Behavior Checklist 6-18 foi o instrumento utilizado para avaliar os sintomas antes e após a intervenção. Participaram do estudo 41 crianças de ambos os sexos, divididas randomicamente em dois grupos. O grupo controle permaneceu em espera enquanto o grupo experimental 1 passava pela intervenção. Após três meses de intervenção, os participantes do grupo controle que ainda atendiam aos critérios de inclusão formaram o grupo experimental 2. Os resultados obtidos foram analisados estatisticamente, de modo a comparar o grupo controle e o grupo experimental 1 bem como avaliar a evolução do grupo experimental total, que incluiu os grupos experimentais 1 e 2. Os resultados indicam que a terapia de sandplay foi eficiente na redução dos sintomas dos transtornos em questão.

Revisão da literatura sobre Transtorno Opositivo Desafiador e Transtorno de Conduta: causas/proteção, estratégia escolar e relação com a criminalidade / Literature review about Oppositional Defiant Disorder and Conduct Disorder: causes / protection, teaching school and relationship with crime

De acordo com variados estudos científicos, nas idades escolares os estudantes podem apresentar diferentes distúrbios comportamentais. Assim, este artigo tem como objetivo apresentar uma revisão da literatura sobre o Transtorno Opositivo Desafiador (TOD) e o Transtorno de Conduta (TC) de modo a favorecer o diagnóstico e intervenções escolares. Para isso, realizou-se busca por descritores no Portal da Capes e no Google Acadêmico em que foram selecionados trabalhos mais recentes escritos em português e inglês que continham no título dos manuscritos os termos da busca e os conteúdos destes foram divididos em categorias, tais como, fatores de causa/proteção; estratégias de trabalho com alunos acometidos de TOD e TC e a relação que os distúrbios podem apresentar com o cometimento de atos infracionais. Verificou-se que os autores abordam que ambos os distúrbios podem desenvolver-se pela influência do ambiente social das crianças e adolescentes, e que o professor pode exercer influência sobre o comportamento e rendimento escolar destes estudantes. O presente estudo contribui, portanto para a compreensão dos distúrbios a partir da exposição do debate de diversos autores o que pode auxiliar professores, alunos e pais no trabalho com pessoas acometidas de TOD e TC.

According to several scientific studies, at school age, students may have different behavioral disorders. Thus, this article aims to present a literature review on Oppositional Defiant Disorder (ODD) and Conduct Disorder (CT) to favourdiagnosis and school interventions. A search for descriptors in Capes Portal and Google Scholar was carried out, in which more recent works written in Portuguese and English that contained the search terms in the title of the manuscripts and their contents were divided into categories, such as causative/protective factors; work strategies with students suffering from ODD and CT, and the relationship that the disorders can present with infractions. We found that the authors state that both disorders can develop under the influence of the children's and adolescents' social environment and that the teacher can influence their behavior and academic performance. Therefore, the present study contributes to the understanding of disorders from the discussion of several authors' debates, which can help teachers, students, and parents work with people with ODD and CT.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP)

Objective: This was the first national epidemiological study on oppositional defiant disorder (ODD) in Iran, which provided new information about the prevalence, comorbidities, and sociodemographic predictors of ODD. Methods: Data from a face-to-face household survey of 30,532 children and adolescents aged 6-18 years were collected from across all 31 provinces of Iran using a multistage cluster sampling design. The Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) was used in this study. Results: The lifetime prevalence of ODD was found to be 3.9%. ODD was significantly more common in boys than girls and appeared in late adolescence more frequently than in childhood. A lower prevalence of ODD was found among participants who lived in rural areas. ODD is highly likely to co-occur with attention deficit hyperactivity disorder, separation anxiety disorder, generalized anxiety disorder, and depressive disorders. Conclusions: The findings of this national population-based study confirm and extend previous findings on the prevalence, comorbidities, and sociodemographic predictors of ODD.

Parent SNAP-IV rating of attention-deficit/hyperactivity disorder: accuracy in a clinical sample of ADHD, validity, and reliability in a Brazilian sample, / Avaliação do instrumento SNAP-IV pelos pais no transtorno de déficit de atenção/hiperatividade: acurácia em uma amostra clínica de TDAH, validade e confiabilidade em uma amostra brasileira,

ABSTRACT Objective: To investigate the psychometric properties of the short or multimodal treatment study version of the Swanson, Nolan, and Pelham, Version IV (SNAP-IV) scale, which measures attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms. Methods: Participants were 765 parents of children from 4 to 16 years old (641 non-attention-deficit/hyperactivity disorder and 124 attention-deficit/hyperactivity disorder children) from Belo Horizonte, Brazil, who reported sociodemographic characteristics and answered the SNAP-IV. Parents of the clinical sample also underwent the K-SADS-PL interview. Results: Age was significantly associated with SNAP-IV hyperactivity-impulsivity problems (r = −0.14), but not with inattention or oppositional defiant disorder. Sex was a significant influence on attention-deficit/hyperactivity disorder and oppositional defiant disorder severity (all p < 0.001), with boys showing higher scores in the full sample, but not within the attention-deficit/hyperactivity disorder group. Exploratory and confirmatory factor analysis supports a three-factor structure of the SNAP-IV scale. Moderate-to-strong correlations were found between SNAP-IV and K-SADS-PL measures. All SNAP-IV scales showed very high internal consistency coefficients (all above 0.91). SNAP-IV inattention scores were the most predictive of attention-deficit/hyperactivity disorder diagnosis (AUC: 0.877 for the averaging rating method and the raw sum method, and 0.874 for the symptom presence/absence method). Conclusion: The parent SNAP-IV showed good psychometric properties in a Brazilian school and clinical sample.

RESUMO Objetivo: Investigar as propriedades psicométricas da versão curta ou MTA da escala Swanson, Nolan e Pelham, versão IV (SNAP-IV), que mede os sintomas do transtorno de déficit de atenção/hiperatividade e transtorno desafiador de oposição. Métodos: Os participantes incluíram 765 pais de crianças de 4 a 16 anos (641 crianças sem transtorno de déficit de atenção/hiperatividade e 124 com transtorno de déficit de atenção/hiperatividade) de Belo Horizonte, Brasil, que relataram características sociodemográficas e responderam o SNAP-IV. Os pais da amostra clínica também foram submetidos à entrevista com K-SADS-PL. Resultados: A idade foi significativamente associada aos problemas de hiperatividade-impulsividade no SNAP-IV (r = −0,14), mas não à desatenção ou aos transtornos desafiadores de oposição. O sexo foi uma influência significativa na gravidade do transtorno de déficit de atenção/hiperatividade e transtorno desafiador de oposição (todos os p < 0,001), os meninos apresentaram escores mais altos na amostra completa, mas não no grupo de transtorno de déficit de atenção/hiperatividade. A análise fatorial exploratória e confirmatória apoia uma estrutura de três fatores da escala SNAP-IV. Foram encontradas correlações moderadas a fortes entre as medidas dos instrumentos SNAP-IV e K-SADS-PL. Todas as escalas do SNAP-IV mostraram coeficientes de consistência interna muito altos (todos acima de 0,91). Os escores de desatenção do SNAP-IV foram os mais preditivos do diagnóstico de transtorno de déficit de atenção/hiperatividade (AUC - área sob a curva ROC: 0,877 para o método de classificação da média e o método da soma bruta e 0,874 para o método de presença ou ausência de sintomas). Conclusão: A avaliação do SNAP-IV pelos pais apresentou boas propriedades psicométricas em uma escola brasileira e amostra clínica.

Prevalence of attention deficit hyperactivity disorder, gender difference and its co morbidity among urban school children in a city of southern Rajasthan, India

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed disorders of childhood (3-5%). The main characteristics of attention deficit hyperactivity disorder are inattention, hyperactivity, and impulsivity. 'The Objective of this study was to study prevalence of ADHD in school aged children.Methods: A cross sectional descriptive school-based study was conducted in a private school of Udaipur from January 2017 to September 2018.' All eligible students were included. Total 1200 students were enrolled. They were assessed for the presence of ADHD using INCLEN diagnostic tool and those found positive were further assessed for the presence of co-morbid conditions using child behavior checklist (CBCL).Results: In present study out of total 1200 students 730(60.83%) were male and 470(39.17%) were female. 76 (6.3%) students out of 1200 were ADHD Positive. ADHD was more common in male students (73.7%), urban locality (57.89%), in age group 6 to 9 years (44.7%) and higher economic class (46.1%). Hyperactivity-Impulsivity type was most common type (51.32%). Male students had predominance of hyperactivity (60.7%) whereas in female student's inattention type was predominant (45%). Aggressive Behavior (19.6%) and rule breaking behavior (80.4%) was more common in male. Somatic complaints were more common in females (60%). Oppositional defiant disorder was observed in male (21.4%) and female (10%) students. 15.8% of ADHD students had learning disorder.Conclusions: Present study shows 6.3% prevalence of ADHD. Hyperactivity type of ADHD was more common in boys, while Inattention type was more common in girls. Among associated co morbid conditions - aggressive behavior, rule breaking behavior and oppositional defiant disorder (ODD) was found to be more prevalent in boys while anxious behavior, somatic complaints and social problems were more commonly found in girls. Thought problems, learning disorders and conduct disorders are also observed in ADHD students.

Study on socioeconomic status and psychological characteristics of children with oppositional defiant disorder / 中华实用儿科临床杂志

Objective To explore the socioeconomic status and psychological characteristics of the children with oppositional defiant disorder(ODD),and to provide evidence for revealing the pathogenesis of ODD.Methods General Conditions Questionnaire and Achenbach Children's Behavior Checklist Scale (CBCL) were used to evaluate 44 cases of ODD children aged 8 to 14 years old who were first referred to the Eighth People's Hospital of Zhengzhou City from August 2016 to January 2017,and 50 healthy children were randomly selected according to their grades from a primary school in Zhengzhou.Chi-square test and independent sample t test were used to analyze data.Results The father's and mother's education levels and family per capita income in ODD group were lower than those in healthy control group,and their academic achievements in ODD group were worse than those in healthy control group,and the differences were statistically significant(all P =0.000).The scores of schizoid (2.32 ± 2.73),depression(4.48 _± 6.12),social problems (3.09 ± 3.34),compulsion (4.05 ± 5.60),social withdrawal (2.39 ± 3.20),hyperactivity (4.95 ±4.37),aggressive behavior(7.59 ± 7.62) and rule-breaking(2.91 ± 3.85) in ODD children were higher than those of the healthy control group(1.04 ± 1.37,1.48 ± 2.06,0.68 ± 1.13,0.78 ± 1.46,0.60 ± 1.16,1.70 _± 1.98,2.48 ±3.28,0.62 ± 1.58),and the differences were statistically significant (all P ＜ 0.05).The scores of social problems (2.85 ± 3.33),compulsion (3.96 ± 5.11),social withdrawal (2.63 ±3.16),hyperactivity (5.44 _± 4.50) in male ODD children were higher than those in the male healthy children (0.80 ± 1.05,1.30 ± 1.92,0.95 ± 1.50,2.15 ±1.56),and the differences were statistically significant (all P ＜ 0.05).Compared with the female children (0.83 ±1.22,1.10 ±1.84,0.60 ± 1.18,0.43 ±0.92,0.53 ± 1.09,0.37 ±0.80,1.40 ±2.17,1.87 ±2.14,0.30 ±0.78),the scores of schizoid (2.24 _± 2.64),depression (4.65 ± 4.93),social problems (3.47 ± 3.37),compulsion (4.18 ±6.38),somatic complaints (2.12 ± 3.65),social withdrawal (2.00 ± 3.26),hyperactivity (4.18 ± 4.12),aggressive behavior (8.24 ± 7.26) and rule-breaking(3.76 ± 4.85) in female ODD children were significantly higher,and the differences were statistically significant(all P ＜ 0.05).There was no significant gender difference in the score of CBCL scale in ODD group(all P ＞ 0.05).Conclusions There are significant emotional and behavioral problems in ODD children whose family socioeconomic status is lower,and their psychological characteristics vary with gender differences.

Study on socioeconomic status and psychological characteristics of children with oppositional defiant disorder / 中华实用儿科临床杂志

Objective@#To explore the socioeconomic status and psychological characteristics of the children with oppositional defiant disorder(ODD), and to provide evidence for revealing the pathogenesis of ODD.@*Methods@#General Conditions Questionnaire and Achenbach Children′s Behavior Checklist Scale (CBCL) were used to evaluate 44 cases of ODD children aged 8 to 14 years old who were first referred to the Eighth People′s Hospital of Zhengzhou City from August 2016 to January 2017, and 50 healthy children were randomly selected according to their grades from a primary school in Zhengzhou.Chi-square test and independent sample t test were used to analyze data.@*Results@#The father′s and mother′s education levels and family per capita income in ODD group were lower than those in healthy control group, and their academic achievements in ODD group were worse than those in healthy control group, and the diffe-rences were statistically significant(all P=0.000). The scores of schizoid (2.32±2.73), depression(4.48±6.12), social problems(3.09±3.34), compulsion(4.05±5.60), social withdrawal(2.39±3.20), hyperactivity(4.95±4.37), aggressive behavior(7.59±7.62) and rule-breaking(2.91±3.85) in ODD children were higher than those of the healthy control group(1.04±1.37, 1.48±2.06, 0.68±1.13, 0.78±1.46, 0.60±1.16, 1.70±1.98, 2.48±3.28, 0.62±1.58), and the differences were statistically significant(all P<0.05). The scores of social problems(2.85±3.33), compulsion(3.96±5.11), social withdrawal(2.63±3.16), hyperactivity(5.44±4.50) in male ODD children were higher than those in the male healthy children(0.80±1.05, 1.30±1.92, 0.95±1.50, 2.15±1.56), and the differences were statistically significant(all P<0.05). Compared with the female children(0.83±1.22, 1.10±1.84, 0.60±1.18, 0.43±0.92, 0.53±1.09, 0.37±0.80, 1.40±2.17, 1.87±2.14, 0.30±0.78), the scores of schizoid(2.24±2.64), depression(4.65±4.93), social problems(3.47±3.37), compulsion(4.18±6.38), somatic complaints(2.12±3.65), social withdrawal (2.00±3.26), hyperactivity(4.18±4.12), aggressive behavior (8.24±7.26) and rule-breaking(3.76±4.85) in female ODD children were significantly higher, and the differences were statistically significant(all P<0.05). There was no significant gender difference in the score of CBCL scale in ODD group(all P>0.05).@*Conclusions@#There are significant emotional and behavioral problems in ODD children whose family socioeconomic status is lower, and their psychological characteristics vary with gender differences.

Parents' Executive Functions, Parenting Styles, and Oppositional Defiant Disorder Symptoms: A Relational Model / Funciones ejecutivas de los padres, estilos de crianza y síntomas del Trastorno Oposicionista Desafiante: un modelo relacional

Abstract The present study examined the role of mother's and father's executive functions (EF), warmth and harsh parenting, and child oppositional defiant disorder symptoms (ODD). A total of 100 families with preschool children participated. The mothers answered three questionnaires: EMBU, ECI-4, and the BRIEF; the fathers answered only the BRIEF. The analysis was done by testing two structural equation models (SEM). The results showed that both models had an excellent fit and presented a significant path from mother's EF toward harsh parenting; the second model presented a significant path from harsh parenting to ODD symptoms. Our findings are concluded in light of the importance of addressing parenting interventions to prevent further conduct/disruptive disorders.

Resumen El siguiente estudio analizó el papel de las FE de la madre y del padre, el estilo de crianza y la sintomatología del TOD en los niños. Un total de 100 familias con niños en edades preescolares participaron en este estudio. La madre contestó tres cuestionarios: el EMBU, el ECI-4, y el BRIEF, mientras que el padre solo contestó su propio BRIEF. El análisis se realizó con el modelo de ecuaciones estructurales. Los resultados muestran que hay una trayectoria significativa de las FE de la madre hacia un estilo de crianza duro y severo, y esta relación continua significativa hacia la sintomatología de TOD. Nuestros resultados aluden a la importancia de las intervenciones en los estilos de crianza para prevenir el desarrollo de trastornos de conducta.

Trastorno negativista desafiante: una puesta al día para pediatras y psiquiatras infantiles

El Trastorno Negativista Desafiante será diagnosticado en un niño que presenta un comportamiento disruptivo para su edad y cultura, caracterizado por un patrón persistente de mal humor o irritabilidad, que discute o presenta comportamientos desafiantes y/o vengativos por lo menos durante los últimos 6 meses. Este trastorno no sólo afecta al niño, sino que es un problema de salud pública, que alcanza a la familia, a los maestros y a los pares. Cuando no se atiende adecuadamente, el trastorno negativista desafiante puede evolucionar a un problema de conducta mayor como el trastorno disocial o a la generación de una personalidad antisocial. Con el fin de ayudar a pediatras y a psiquiatras infantiles en el reconocimiento y manejo de estos "niños problemáticos", este artículo de revisión tiene el objetivo de presentar una puesta al día del concepto, etiopatogenia, clínica, diagnóstico y modalidades terapéuticas para este desafiante grupo de pacientes.

Oppositional Defiant Disorder is diagnosed in a child who exhibits a disruptive behavior for their age and culture, characterized by a persistent pattern of an angry mood or irritability, and who presents oppositional and / or vindictive behavior for at least the last 6 months. This disorder not only affects the child, but is a public health problem that affects the child's family, teachers and peers. When not addressed properly, oppositional defiant disorder can evolve into a significant behavioral problem, such as conduct disorder or antisocial personality disorder. In order to help pediatricians and child psychiatrists in the recognition and management of these "problematic children", this review article aims to present an update of the definition, pathogenesis, clinical presentation, diagnosis and therapeutic modalities for this challenging group of patients.

Estrategias de intervención dirigidas a niños con trastorno negativista desafiante, una revisión de la literatura / Intervention Strategies Used in the Treatment of Children with Oppositional Defiant Disorder, a Review of Literature / Estratégias de intervenção dirigidas a crianças com transtorno desafiador opositivo, uma revisão da literatura

Objetivo: identificar las estrategias que se utilizan en el tratamiento de niños con trastorno oposicional desafiante. Materiales y métodos: se trata de una revisión de la literatura sobre las estrategias de intervención que se reportan para la intervención de niños con trastorno negativista desafiante, la cual se realiza en seis bases de datos: ProQuest, PubMed, Science Direct, Ebsco, Scopus y Scielo. Los criterios de inclusión fueron población infantil, publicaciones en el periodo 2007-2015, idioma español e inglés, que explicaran estrategias de intervención en niños con trastorno negativista desafiante, artículos completos y disponibles. Los criterios de exclusión fueron artículos que mencionan desórdenes cognitivos, intervenciones farmacológicas y tratamiento solo para déficit de atención con hiperactividad. El método de registro y análisis de resultados se realiza en una rejilla en Excel en la que se incluye el número de artículos por base de datos, año, país de publicación, disciplina, herramientas de evaluación, población y estrategia de intervención sugerida. Se revisaron un total de 50 artículos que se ajustaban al objetivo del estudio. Resultados: el 50% de las publicaciones se encontraron en Pubmed, el 16% en Scopus, el 14% en Science Direct, el 10% en Proquest, el 6% en Ebsco y en Scielo 4%. Estados Unidos es el país con mayor evidencia respecto al tema con un 60% de publicaciones. El 50% de las búsquedas reportan que las estrategias para el tratamiento del trastorno oposicional desafiante son desarrolladas de manera interdisciplinar y están dirigidas a la población infantil. Conclusiones: las estrategias de intervención se plantean desde un enfoque clínico y pocas involucran estrategias pedagógicas

Objective: To identify the strategies used in the treatment of children with oppositional defiant disorder. Materials and methods: This is a review of literature on intervention strategies that are reported for the intervention of children with oppositional defiant disorder, which was performed in six databases: ProQuest, PubMed, Science Direct, Ebsco, Scopus and Scielo. Inclusion criteria were child population, publications in the period 2007-2015 in Spanish and English, articles that explained intervention strategies in children with oppositional defiant disorder, complete and available items. Exclusion criteria: articles that mentioned cognitive disorders, pharmacological interventions and only treatment for attention deficit hyperactivity disorder. The method of recording and analysis of the results is carried out on a grid in Excel in which the number of items per database, year, country of publication, discipline, assessment tools, and population strategy suggested intervention is included. A total of 50 items that fit the purpose of the study were revised. Results: 50% of the publications were found in PubMed, in Scopus 16%, 14% in Science Direct, 10% in the Proquest, 6% in Ebsco and 4% Scielo. United States is the country with more evidence on the issue with 60% of publications. 50% of the researches reported that strategies for treating oppositional defiant disorder are developed in an interdisciplinary way and are aimed at children. Conclusions: Intervention strategies arise from a clinical approach and few involve teaching strategies

Objetivo: Identificar as estratégias que se utilizam no tratamento de crianças com transtorno desafiador opositivo. Materiais e métodos: Trata-se de uma revisão da literatura sobre as estratégias de intervenção que se reportam para a intervenção de crianças com transtorno desafiador opositivo, a qual realiza-se em seis bases de dados: ProQuest, PubMed, Science Direct, Ebsco, Scopus e Scielo. Os critérios de inclusão foram população infantil, publicações no período 2007-2015, língua espanhola e inglesa, que explicaram estratégias de intervenção em crianças com transtorno negativista desafiador opositivo, artigos completos e disponíveis. Os critérios de exclusão foram artigos que mencionam desordens cognitivos, intervenções farmacológicas e tratamento só para déficit de atenção com hiperatividade. O método de registro e análise de resultados se realiza em uma grade em Excel na que se inclui o número de artigos por base de dados, ano, país de publicação, disciplina, ferramentas de avaliação, população e estratégia de intervenção sugerida. Revisaram-se um total de 50 artigos que se ajustavam o objetivo do estudo. Resultados: O 50% das publicações encontraram-se em Pubmed, o 16% em Scopus, o 14% em Science Direct, o 10% em Proquest, o 6% em Ebsco e em Scielo 4%. Os Estados Unidos é o país com maior evidência respeito ao tema com um 60% de publicações. O 50% das buscas reportam que as estratégias para o tratamento do transtorno desafiador opositivo são desenvolvidas de maneira interdisciplinar e estão dirigidas à população infantil. Conclusões: As estratégias de intervenção apresentam-se desde um enfoque clínico e poucas envolvem estratégias pedagógicas

Serviço Social: um enfant terrible na institucionalidade burguesa? / Social work: an enfant terrible in the bourgeois institutionality?

Resumo: Esta é uma reflexão que, aproveitando-se do ensejo comemorativo dos oitenta anos do Serviço Social no Brasil, faz um retrospecto da performance desta profissão na ordem burguesa, partindo dos países capitalistas que lhes serviram de berço. Esse périplo, no entanto, pretendeu realçar um denominador comum no Serviço Social mundializado, que é a sua propensão a remar, em qualquer contexto, contra os ditames do sistema que o engendrou. E com essa tendência - que não é unânime, mas historicamente persistente - ele tem sido um profícuo "ponto fora da curva" das profissões sucumbentes ao conservadorismo.

Abstract: This is a reflection that, taking advantage of the commemorative occasion of the eighty years of Social Work in Brazil, does a retrospect of the performance of this profession, in the bourgeois order, starting with the capitalist countries that served as its birthplace. This tour, however, intended to highlight a common denominator in the globalized Social Work, which is its tendency to row, in any context, against the system dictates that engendered it. And with this trend - which is not unanimous, but historically persistent - it has been a fruitful "point off the curve" of the rendered professions to conservatism.

Analysis of psychological behavior features of different sexual children with oppositional defiant disorder / 中华实用儿科临床杂志

Objective To explore the psychological behavior features between different sexual children with oppositional defiant disorder(ODD).Methods The subjects were sampled from grade 1 to 5 in a primary school in Ji-nan,Shandong Province.According to the diagnosed criteria,42 pupils were diagnosed ODD,which was the study group,and 556 pupils without ODD became the control group.The pupils and their families were investigated and as-sessed by using Achenbach Child Behavior Checklist (CBCL).Results According to CBCL,there was extremely sig-nificantly higher score of depression,obsessive -compulsive,hyperactive,aggressive,interpersonal behaviors in ODD boys [(5.00 ±3.73)scores,(4.88 ±3.65)scores,(5.21 ±3.49)scores,(1 0.1 0 ±6.85)scores,(2.88 ±1 .99) scores]than those in healthy control group [(1 .65 ±2.61 )scores,(1 .91 ±2.65)scores,(2.46 ±2.63)scores, (3.95 ±4.52)scores,(1 .34 ±1 .61 )scores](t =4.31 ,3.90,4.76,4.33,4.40;P =0.000,0.000,0.001 ,0.000, 0.000).There was significantly higher score of symptoms of somatization,indiscipline,schizoid -like behaviors in ODD boys with [(2.38 ±2.50)scores,(2.63 ±2.70)scores,(3.1 7 ±2.35)scores]than those in healthy control group [(0.85 ±1 .63)scores,(0.1 3 ±1 .76)scores,(1 .51 ±1 .72)scores](t =2.94,2.85,3.37;P =0.007,0.009, 0.002).There was extremely significantly higher score of depression,communication disorder behaviors in ODD girls [(5.44 ±4.1 2)scores,(3.1 1 ±2.93)scores]than those in healthy control group with [(2.50 ±3.34)scores, (1 .36 ±2.08)scores](t =3.57,3.38;P =0.000,0.001 ).A significantly higher score of hyperactive,aggression, cruelty behaviors in ODD girls [(4.67 ±4.41 )scores,(9.33 ±7.82)scores,(1 .1 7 ±1 .79)scores]than those in healthy control group [(1 .87 ±2.38)scores,(3.1 9 ±4.08)scores,(0.24 ±0.66)scores](t =2.67,3.30,2.1 8;P =0.01 6,0.004,0.043).Conclusions According to CBCL,there were more psychological behavior problems in ODD children than healthy children.A significantly higher difference was found in different gender.

Social Conduct Scale (SCS): a psychometric investigation

Abstract The social conduct of an individual comprises all the interpersonal behaviors that he or she exhibits in the social contexts he or she is exposed to. The Social Conduct Scale (SCS) is a self-report instrument developed to provide researchers and clinicians with information on prosocial, antisocial and oppositional-defiant tendencies of Portuguese-speaking children and adolescents. In the present study, we conducted an analysis of the criterion validity of the SCS by comparing the scores obtained from a large population-based sample (N= 1,172) against an offender (N= 129), a scholar (N= 31), and a clinic-referred (N= 24) sample of adolescents with marked previous conduct problems. As expected, antisocial youths had significantly higher means on antisocial behaviors and lower means on prosocial tendencies when compared to the population-based sample. Overall, findings supported the hypothesized criterion validity of the SCS. The instrument might play a role as a helpful resource for researchers, clinicians and practitioners interested in assessing the social conduct of Brazilian children and adolescents. (AU)

Emotional Regulation and Executive Function Deficits in Unmedicated Chinese Children with Oppositional Defiant Disorder

OBJECTIVE: This study aims to explore the feature of emotional regulation and executive functions in oppositional defiant disorder (ODD) children. METHODS: The emotional regulation and executive functions of adolescents with ODD, as well as the relationship between the two factors were analyzed using tools including Adolescent Daily Emotional Regulation Questionnaire (ADERQ), Wisconsin Card Sorting Test (WCST) and Cambridge Neuropsychological Test Automated Battery (CANTAB), in comparison with attention deficit hyperactivity disorder (ADHD) children without behavioral problem and healthy children; the ADERQ assessed emotional regulation ability and others were used to assess executive function. RESULTS: Compared to normal children, the ODD group displayed significant differences in the scores of cognitive reappraisal, rumination, expressive suppression, and revealing of negative emotions, as well as in the score of cognitive reappraisal of positive emotions. WCST perseverative errors were well correlated with rumination of negative emotions (r=0.47). Logistic regression revealed that the minimum number of moves in the Stocking of Cambridge (SOC) test (one test in CANTAB) and negative emotion revealing, were strongly associated with ODD diagnosis. CONCLUSION: Children with ODD showed emotion dysregulation, with negative emotion dysregulation as the main feature. Emotion dysregulation and the lack of ability to plan lead to executive function deficits. The executive function deficits may guide us to understand the deep mechanism under ODD.

Behavior and initial sandtray characters of children with oppositional defiant disorders / 中华行为医学与脑科学杂志

Objective To explore the behavior and initial sandtray characters of the children with oppositional defiant disorders (ODD) in order to provide psychological and behavioral intervention as early as possible.Methods The differences of the Conners parent symptom questionnaire (PSQ) and initial sandtrays between 24 children with ODD and 24 normal children were compared.Results PSQ indicated that children with ODD had higher scores of conduct proble((1.31 ± 0.53),(0.36 ± 0.31)),learning problem ((2.01 ± 0.66),(0.57 ±0.5)),hyperactivity-impulsion ((1.60 ± 0.77),(0.35 ± 0.41)),anxiety ((0.60 ± 0.50),(0.27 ± 0.25)) and hyperactivity index((1.12 ± 0.31),(0.78 ± 0.28)) than normal children.On the use of toys,the experimental group was significantly higher in armament and transports and lower in plants and stones(P＜0.05).On the theme of sandtrays,the ODD group was significantly higher in disorder,neglect,injury,threat and lower in integration and energy (P ＜ 0.05).Conclusion The results show that the children with ODD have more anxiety experience than normal children and this may be associated with oppositional conduct.Children with ODD use more aggressive toys and wounded themes,revealing their attack and conflict.Psychological intervention can be provided according to the characters of behavior scale and initial sandtray.

Qué es la hiperactividad y cómo ven el problema los padres? Análisis de los motivos de consulta y las estrategias de afrontamiento del TDAH en una muestra de estratos socioeconómicos altos de Bogotá D. C / What is Hyperactivity and How do Parents View The Problem? Analysis of Chief Complaints and Coping Strategies of Adhd in a Sample of High Socioeconomic Status in Bogotá

Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) es el diagnóstico Más frecuente en la consulta Psiquiátrica infantil en distintas sociedades. Clásicamente, la Triada de hiperactividad, déficit de atención e impulsividad es el núcleo y el objetivo de las Diferentes estrategias terapéuticas. Sin embargo, son múltiples los motivos de consulta que Los pacientes y sus familias establecen, debido al impacto de los síntomas en las dinámicas Escolares y de convivencia. Objetivo: Conocer cómo se expresan los motivos de consulta en un medio como el de Bogotá (Colombia). Métodos: Se analizaron 366 encuestas de padres De niños con TDAH, quienes asisten a la reunión mensual de la escuela para padres HIDEA, Especializada en TDAH, en la que relatan sus motivos de consulta y las estrategias con las Cuales tratan de mejorar estas dificultades. Resultados: Las quejas más frecuentes son La rebeldía, el desacato a la autoridad y el bajo rendimiento escolar. Para ayudar al niño, Recurren ante todo a la terapia ocupacional, de acuerdo con la recomendación del colegio. Conclusiones: Para los padres la problemática sentida no se relaciona directamente con Los rasgos clínicos principales del TDAH, sino con sus consecuencias desadaptativas en el medio escolar. Paradójicamente, también se hace evidente una relativa debilidad de las estrategias de afrontamiento que implican cambios profundos en los patrones de crianza y convivencia...

Introduction: The most frequent clinical diagnosis in psychiatric child services in different societies is attention deficit hyperactivity disorder (ADHD). Classically, the core symptoms and the main objective of different therapeutic strategies are the triad hyperactivity, attention deficit, and impulsivity. However, the chief complaints those patients and families states are diverse due to the relevant impact of the symptoms on school and social dynamics. Objective: To learn how the chief complaints are expressed in the context of Bogotá (Colombia). Methods: 366 surveys of parents of children with ADHD were analyzed. They participated in the monthly meeting of the “HIDEA Parent´s School”, which specializes in ADHD. Surveys summarized the complaints and confrontation strategies used to improve these inconveniences. Results: The most frequent complaints were disobedience, defying authority, and low school performance. To help the children the parents turned mainly to occupational therapy as suggested by the school. Conclusions: We observed that parents perceived the problem as linked to social annoyance consequences instead of clinical symptoms of ADHD. Paradoxically a relative weakness of confrontation approaches was also evident, involving deep changes in child rearing patterns and social interactions...