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Resumen Más allá de la frecuente coexistencia del trastorno por déficit de atención con hiperactividad (TDAH) y el trastorno específico del aprendizaje de la lectura, la presente revisión pretende examinar la evidencia empírica disponible sobre cómo el TDAH impacta negativamente sobre el aprendizaje de la lectura. Los datos existentes apuntan a que la presencia del trastorno (especialmente los síntomas de falta de atención), puede afectar a i) la correcta adquisición de lectura, ya sea de manera directa o a través de su influencia sobre los precursores de la lectura; ii) las propias habilidades de decodificación (precisión y fluidez lectora), tanto de manera directa como indirecta a través de su influencia sobre procesos cognitivos como la distracción o las funciones ejecutivas; y ii) la comprensión lectora, probablemente de manera indirecta por las dificultades eje cutivas y en la memoria de trabajo verbal características del TDAH. Estas conclusiones presentan importantes implicaciones para caracterizar e intervenir mejor sobre las dificultades lectoras en el TDAH, ya sean clínicas o subclínicas.
Abstract Beyond the frequent coexistence of attention deficit hyperactivity disorder (ADHD) and reading dis order (dyslexia), the present review aims to examine the available empirical evidence on how ADHD negatively impacts on learning to read. Existing data suggest that the presence of the disorder (especially inattention symp toms), may affect i) the correct acquisition of reading, either directly or through its influence on the precursors to reading; ii) decoding skills themselves (reading accuracy and fluency), both directly and indirectly through its influence on cognitive processes such as distractibility or executive functions; and iii) reading comprehension, probably indirectly through the executive and verbal memory difficulties characteristic of ADHD. These findings have important implications for better characterizing and intervening on reading difficulties in ADHD, whether clinical or subclinical.
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Few reports have yet investigated adequate cognitive rehabilitation for patients with chronic cognitive disorder. In this report, we describe a case of cognitive rehabilitation 10 months after onset of cerebral infarction in the right middle cerebral artery region, resulting in a good outcome. The patient was a 44-year-old right-handed male, with primary symptoms of inattention and left hemispatial neglect. The patient had not undergone any neuropsychological evaluations or cognitive rehabilitation until 10 months after disease onset. After 30 days of both direct attention training and metacognitive strategy training, including time pressure management, improvement of his cognitive disorder was achieved. The teaching of internal methods to improve metacognition with a high level of evidence was effective even 10 months after onset. Furthermore, it is important for therapists who provide cognitive rehabilitation using metacognitive strategy training to understand patients' remaining functions based on neuropsychological assessment, and to consider and teach compensatory methods so that they can be effectively used by patients in situations of daily life.
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Few reports have yet investigated adequate cognitive rehabilitation for patients with chronic cognitive disorder. In this report, we describe a case of cognitive rehabilitation 10 months after onset of cerebral infarction in the right middle cerebral artery region, resulting in a good outcome. The patient was a 44-year-old right-handed male, with primary symptoms of inattention and left hemispatial neglect. The patient had not undergone any neuropsychological evaluations or cognitive rehabilitation until 10 months after disease onset. After 30 days of both direct attention training and metacognitive strategy training, including time pressure management, improvement of his cognitive disorder was achieved. The teaching of internal methods to improve metacognition with a high level of evidence was effective even 10 months after onset. Furthermore, it is important for therapists who provide cognitive rehabilitation using metacognitive strategy training to understand patients' remaining functions based on neuropsychological assessment, and to consider and teach compensatory methods so that they can be effectively used by patients in situations of daily life.
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O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) se caracteriza pela desatenção, hiperatividade e impulsividade, que podem ser observadas já no início da infância. O TDAH afeta diretamente as Funções Executivas (FE), responsáveis pela regulação de comportamentos sociais e habilidades cognitivas, reduzindo o desempenho escolar e gerando problemas pessoais. Sendo assim, pesquisas relacionadas ao tema mostram-se importantes do aspecto clínico e educacional, podendo contribuir para a melhora da qualidade de vida dos indivíduos afetados. Portanto, neste estudo de revisão sistemática, buscou-se quantificar e explorar artigos com pesquisas empíricas que relacionam o TDAH e as FE. Foram utilizadas as bases de dados: Periódicos CAPES, LILACS, SciELO, PePSIC e SIBiUSP. Os critérios de inclusão foram o ano de publicação (2009-2019), língua portuguesa e artigos relacionados apenas à infância e à adolescência. No total foram encontrados 112 artigos, dos quais seis foram analisados. Os critérios examinados incluíram neuroanatomia, instrumentos de avaliação utilizados para a detecção do transtorno, entrevistas realizadas, gênero e nível escolar dos participantes. Foi observado que os instrumentos mais utilizados, nos artigos analisados, foram o SNAP IV, o WASI, o Teste de Trilhas, o Teste dos Cinco Pontos, o Teste de Atenção por Cancelamento e o subteste Go-no-Go do Neupsilin Infantil. A atual pesquisa permitiu mostrar o que há de mais recente sobre o assunto. Porém, apesar de sua importância, notou-se que existe uma escassez de estudos nacionais que correlacionam estes temas. Logo, são necessários mais estudos empíricos brasileiros que se dediquem a contribuir para estas áreas do conhecimento.
Attention Deficit Hyperactivity Disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity, which can be observed as early as childhood. The disorder directly affects Executive Functions (FE), those responsible for controlling social performance and cognitive skills, school performance, and the management of personal problems. Thus, research related to the theme shows important clinical and educational aspects and may contribute to improve the quality of life of affected individuals. Therefore, look through this systematic review study, quantify and explore articles with empirical research related to ADHD and EF. CAPES, LILACS, SciELO, PePSIC and SIBiUSP were used as Periodic databases. The inclusion requests were the year of publication (2009-2019), Portuguese language and articles related only to childhood and adolescence. We found 112 articles, of which six were analyzed. The tests examined include neuroanatomy, the assessment tools used to detect disorders, interviews, gender, and school level of the survey participants. It was observed that the most used instruments in the analyzed articles were the SNAP IV, the WASI, the Trail Test, the Five Point Test, the Attention for Cancellation Test and the Go-no-Go subtest Neupsilin childish. The current research shows the latest on the subject. However, despite their importance, there is no shortage of national studies that correlate these themes. Therefore, more Brazilian empirical studies are needed to dedicate the contribution to these areas of knowledge.
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El trastorno por déficit de atención e hiperactividad constituye un modelo persistente o continuo de inatención y/o hiperactividad e impulsividad, que impide las actividades diarias o el desarrollo típico, pues provoca dificultades para mantener la atención, la función ejecutiva y la memoria de trabajo. Por su repercusión tanto en niños como en adultos, en la actualidad resulta un tema de gran interés sobre el cual se efectúan muchos estudios a nivel mundial. En este artículo se abordan aspectos importantes relacionados con la etiopatogenia de dicho síndrome y los diferentes tratamientos empleados para paliarlo; asimismo se ofrece información acerca de las morbilidades asociadas y los enfoques conceptuales que se evidencian en los sistemas de clasificación internacionales.
The disorder due to lack of attention and hyperactivity constitutes a persistent or continuous model of inattention and/or hyperactivity and impulsiveness that hinders the daily activities or the typical development, because it causes difficulties to keep the attention, the executive function and the work memory. For their repercussion either in children or in adults, at the present time it is a topic of great interest on which many studies are made worldwide. In this work important aspects related to the etiopathogenesis of this syndrome are approached and the different treatments used to palliate it; also some information about the associated morbidities and the conceptual approaches that are evidenced in the international classification systems are offered.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Child , Impulsive BehaviorABSTRACT
Abstract Content validity of the 18-item Investigator-Rated Attention-Deficit Hyperactivity Disorder (ADHD) Rating Scale IV (I-ADHD RS-IV) with adult prompts was investigated using qualitative interviews of US clinicians who had prior experience rating adults with phenylketonuria (PKU) using the I-ADHD RS-IV. Fourteen qualitative interviews were conducted to obtain key symptom experiences of adults with PKU and assessed the relevance, clarity, and administration of the I-ADHD RS-IV. Participants (n = 13, 92.9%) endorsed the inattention symptoms as key experiences by adults with PKU and endorsed the instrument as fit for purpose for adults with PKU. Participants generally reported low frequencies of occurrence for the 9 I-ADHD RS-IV hyperactivity/impulsivity items. Despite some clinicians' concerns for the lack of patient self-awareness, the participants reported no difficulty selecting a rating on these items. This in-depth study of the content validity of the I-ADHD RS-IV provides evidence that this clinician-reported instrument captures the severity of important inattention symptoms in adults with PKU.
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This study aimed to investigate if an executive functions (EF) intervention could promote these skills in individuals with attention deficit and hyperactivity disorder (ADHD). Eighteen children and adolescents, 7-13 years old, divided into experimental (EG, N = 8) and control (CG, N = 10) groups, were assessed in the Block Design and Vocabulary subtests of the WISC III and seven tests of EF. Parents answered two scales, measuring EF and inattention and hyperactivity signs. EG children participated in a program to promote EF in twice-weekly group sessions of one hour each. After 8 months of intervention, groups were assessed again. ANCOVA, controlling for age, intelligence quotient and pretest performance, revealed gains in attention/inhibition and auditory working memory measures for the EG. No effect was found for scales or measures of more complex EF. Results are not conclusive, but they illustrate some promising data about EF interventions in children and adolescents with ADHD.
Este estudo investigou se uma intervenção para funções executivas (FE) pode promover essas habilidades em indivíduos com transtorno do déficit de atenção e hiperatividade (TDAH). Participaram 18 crianças e adolescentes, 7-13 anos, divididos em Grupo Experimental (GE, N = 8) e Controle (GC, N = 10), avaliados nos subtestes Blocos e Vocabulário do WISC III e sete testes de FE. Pais responderam a duas escalas mensurando FE e sintomas de desatenção e hiperatividade. As crianças do GE participaram de um programa de promoção de FE, em sessões de grupo de uma hora cada, duas vezes por semana. Após intervenção de oito meses, os grupos foram reavaliados. ANCOVA, controlando idade, QI e desempenho no pré-teste, revelou ganhos da intervenção em medidas de atenção/inibição e memória de trabalho auditiva para o GE. Nenhum efeito foi encontrado para as escalas ou medidas de FE mais complexas. Os resultados não são conclusivos, mas ilustram tendências promissoras sobre intervenções em FE em crianças e adolescentes com TDAH.
Subject(s)
Humans , Organ Sparing Treatments , Prostatectomy/methods , UrethraABSTRACT
Objective To investigate the effects of sensory cueing (SC) on unilateral spatial neglect after stroke.Methods Five stroke survivors with unilateral spatial neglect underwent a tailored sensory cueing treatment (wearing a sensory cueing device 3 hours a day, 5 days a week for 2 weeks) in addition to their conventional rehabilitation.Two weeks before and one day before the treatment, and then one day, two weeks and 4 weeks after the treatment, all five patients were assessed using the Hong Kong edition of the behavioral inattention test (BIT-C).Results No significant changes were identified in the average BIT-C ratings at the two time point before the intervention.However, the average score had increased significantly only one day after the start of the intervention, with further significant improvement at each of the succeeding 2 week intervals.The greatest improvement was in finishing cancellation tasks, and the most severely affected patient showed the greatest improvement.Conclusion Sensory cueing treatment may be useful and feasible in reducing unilateral spatial neglect for stroke survivors.However, randomized and controlled trials with larger samples are needed to further verify its effects.
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OBJECTIVE: Quantitative electroencephalography (qEEG) has been increasingly used to evaluate patients with attention deficit hyperactivity disorder (ADHD). The aim of this study was to assess the correlation between qEEG data and symptom severity in patients with ADHD. METHODS: Fifteen patients with ADHD and 20 healthy controls (HCs) were recruited. Electroencephalography was assessed in the resting-state, and qEEG data were obtained in the eyes-closed state. The Korean version of the ADHD Rating Scale (K-ARS) and continuous performance tests (CPTs) were used to assess all participants. RESULTS: Theta-band (4-7 Hz) power across the brain was significantly positively correlated with inattention scores on the K-ARS, reaction times and commission errors on the CPTs in ADHD patients. Gamma-band (31-50 Hz) power was significantly positively correlated with the results of the auditory CPTs in ADHD patients. The theta/alpha (8-12 Hz) and theta/beta (13-30 Hz) ratios were significantly negatively correlated with commission and omission errors on auditory CPTs in ADHD patients. No significant correlations between qEEG relative power and K-ARS and CPT scores were observed in HCs. CONCLUSION: Our results suggest that qEEG may be a useful adjunctive tool in patients with ADHD.
Subject(s)
Humans , Male , Attention Deficit Disorder with Hyperactivity , Brain , Electroencephalography , Reaction TimeABSTRACT
Objective: Fluid intelligence and the behavioral problems of attention-deficit/hyperactivity disorder (ADHD) are related to academic performance, but how this association occurs is unclear. This study aimed to assess mediation and moderation models that test possible pathways of influence between these factors. Methods: Sixty-two children with ADHD and 33 age-matched, typically developing students were evaluated with Raven's Colored Progressive Matrices and the spelling and arithmetic subtests of the Brazilian School Achievement Test. Dimensional ADHD symptomatology was reported by parents. Results: Our findings suggest that fluid intelligence has a significant impact on academic tests through inattention. The inattentive dimension was the principal behavioral source of influence, also accounting for the association of hyperactive-impulsive manifestations with school achievement. This cognitive-to-behavioral influence path seems to be independent of diagnosis related group, and gender, but lower socioeconomic status might increase its strength. Conclusion: Fluid intelligence is a relevant factor in the influence of ADHD behavioral symptoms on academic performance, but its impact is indirect. Therefore, early identification of both fluid intelligence and inattentive symptoms is of the utmost importance to prevent impaired academic performance and future difficulties in functioning. .
Subject(s)
Adolescent , Child , Female , Humans , Male , Attention Deficit Disorder with Hyperactivity/physiopathology , Child Behavior Disorders/physiopathology , Cognition/physiology , Intelligence/physiology , Models, Psychological , Students/psychology , Behavior/physiology , Brazil , Cognition Disorders/physiopathology , Intelligence Tests , Socioeconomic FactorsABSTRACT
Objective To determine frequency of motor alterations in children with attention deficit hyperactivity disorder (ADHD). Method We evaluated 19 children aged 7-12 years with ADHD classified in three sub-types: Combined (ADHD-C), with Inattention (ADHD-I), and with Hyperactivity (ADHD-H). Controls were age- and gender matched healthy children. We utilized Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) for measuring motor skills. Results We observed differences between children with ADHD and controls in BOTMP general score and in static coordination, dynamic general- and hand- coordination, and in synkinetic movements. We also found differences in dynamic hand coordination between controls and children with ADHD-C; in dynamic general coordination between controls and children with ADHD-H; and in frequency of synkinetic movements between controls and children with ADHD-H. Conclusion Children with ADHD with a major degree of hyperactivity showed greater frequency of motor alterations. .
Objetivo Determinar la frecuencia de alteraciones motoras en niños con trastorno por déficit de atención-hiperactividad (TDAH). Método Evaluamos 19 niños de 7-12 años de edad con TDAH clasificados en tres subtipos: Combinado (TDAH-C), con Inatención (TDAH-I) y con Hiperactividad (TDAH-H). Los controles fueron niños sanos pareados por edad y género. Utilizamos la Prueba de eficiencia motora de Bruininks-Oseretsky (PEMBO). Resultados Observamos diferencias entre los grupos de niños con TDAH en la calificación general de la PEMBO y en: coordinación estática, coordinación dinámica general, coordinación manual y en movimientos sincinéticos. También encontramos diferencias en la coordinación manual entre los controles y los niños con TDAH-C; en la coordinación dinámica general entre los controles y los niños con TDAH-H; y en la frecuencia de movimientos sincinéticos entre los controles y los niños con TDAH-H. Conclusión Los niños con TDAH con una mayor grado de hiperactividad muestran una mayor frecuencia de alteraciones motoras y movimientos sincinéticos. .
Subject(s)
Child , Female , Humans , Male , Attention Deficit Disorder with Hyperactivity/physiopathology , Motor Skills Disorders/physiopathology , Analysis of Variance , Case-Control Studies , Intelligence Tests , Motor Skills/physiology , Neuropsychological Tests , Reference Values , Surveys and Questionnaires , Synkinesis/physiopathologyABSTRACT
O transtorno de déficit de atenção e hiperatividade é a síndrome neurocomportamental mais estudada na infância e adolescência. Trata-se de um problema de saúde pública, pois afeta cerca de 5,8% da população mundial. O diagnóstico é clínico, através de uma anamnese cuidadosa, não existindo nenhum marcador biológico que o determine. O autor pretende desmistificar a patologia, estudando sua epidemiologia, quadro clínico, comorbidades e tratamento.
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A Síndrome de Williams (SW) é uma doença genética e neurocomportamental causada por uma deleção hemizigótica de múltiplos genes na região cromossômica 7q11-23. Caracteriza-se por alterações cognitivas e comportamentais que interferem no ajustamento psicossocial. O objetivo do estudo foi verificar indicadores comportamentais de habilidades nas áreas social, escolar e de realização de atividades de um grupo de crianças e adolescentes com SW e sinais de desatenção e hiperatividade. A amostra foi composta por 22 crianças e adolescentes com diagnóstico clínico e genético de SW entre sete e 18 anos, média de idade 11,6 (desvio padrão 3,7) e suas respectivas mães. Os instrumentos de coleta de dados foram a Escala de Inteligência Wechsler para Crianças, o Inventário dos Comportamentos de Crianças e Adolescentes de seis a 18 anos e um Questionário que avaliou presença de sinais de desatenção e hiperatividade baseado nos critérios clínicos para Transtorno de Déficit de Atenção e Hiperatividade do Manual de Classificação Estatística dos Transtornos Mentais da Associação Americana de Psiquiatria. Os principais resultados apontaram para um elevado número de sinais de desatenção e hiperatividade (90% do total da amostra pontuaram positivamente nesses sinais). Também foram verificados prejuízos graves nas habilidades e competências de desempenho escolar do grupo, diferentemente dos resultados positivos obtidos nas escalas de socialização e prática de esportes. Conclui-se que os resultados positivos encontrados na área social podem agir como fatores protetores para o desenvolvimento de problemas afetivos como isolamento, tristeza, sentimentos de solidão e baixa autoestima.
Williams Syndrome (WS) is a genetic and neurobehavioral disease caused by a hemizygous deletion of multiples genes in the chromosome region 7q11-23. It is characterized by cognitive and behavioral changes that interfere in psychosocial adjustment. The objective of the study was to verify behavioral indicators of competence in social, educational and performance activities in a group of children and adolescents with WS and signs of inattention and hyperactivity. The sample was composed of 22 children and adolescents with WS clinical and genetic diagnoses between 7 and 18 years, average age 11.6 (standard deviation 3.7) and their mothers. The data collection instruments were the Wechsler Intelligence Scale for Children, the Child Behavior Checklist for Children and Adolescents between 6 and 18 years (CBCL/6-18) and a questionnaire that assessed signs of inattention and hyperactivity based on clinical criteria for Attention Deficit Hyperactivity Disorder of the Manual of Classification of Mental Disorders of the American Psychiatric Association. The main results showed a high number of signs of inattention and hyperactivity (90% of the group scored positively). Severe underachievement in academic skills were also observed, as opposed to positive results in socialization and sports scales. In conclusion, positive results in social areas can be inhibiting factors for the development of emotional problems such as withdrawal, loneliness and low self-esteem.
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OBJECTIVES: The purpose of this study was to investigate clinical characteristics of children and adolescents with autism spectrum disorders (ASDs) using methylphenidate (MPH). METHODS: Retrospective review of the charts of 79 children and adolescents with ASDs, who visited the Department of Child and Adolescent Psychiatry of Seoul National Hospital, from July 2010 to July 2011, was conducted. Changes in illness severity and improvement were measured using the Clinical Global Impression-Severity of illness (CGI-S) and Clinical Global Impression-Improvement (CGI-I) Scales. RESULTS: We found that MPH was prescribed in 23 (29.1%) children and adolescents. Of the 23 patients on MPH, 4 patients (17.4%) were on MPH monotherapy and 18 patients (78.3%) were using risperidone concomitantly. MPH was prescribed primarily for symptoms of hyperactivity and impulsivity in ASDs patients. The mean dosage of MPH was 26.2+/-11.1mg/day and mean duration of treatment was 31.9+/-28.7 months. Mean CGI-S score improved significantly from baseline to endpoint (from 5.4+/-0.6 to 4.1+/-0.9 ; p<.01). MPH was reported to be effective in 17 patients (17/23, 73.9%), and 10 patients (10/23, 43.5%) reported side effects. Side effects included decreased appetite (4/23, 17.4%), tic (2/23, 8.6%), sleep disturbances (2/23, 8.6%), headache (1/23, 4.3%) and irritability (1/23, 4.3%). CONCLUSION: The results of this study demonstrate that MPH may be used effectively and safely in children and adolescents with ASDs with hyperactivity and impulsivity. Future controlled trials are needed to confirm these findings.
Subject(s)
Adolescent , Child , Humans , Adolescent Psychiatry , Appetite , Autistic Disorder , Autism Spectrum Disorder , Headache , Methylphenidate , Phenazines , Retrospective Studies , Risperidone , TicsABSTRACT
El propósito de esta investigación de tipo tecnológica psicométrica, fue construir y validar un instrumento que hiciera parte del proceso exploratorio del trastorno por déficit de atención con hiperactividad (TDAH) llamada Escala del Trastorno por Déficit de Atención con Hiperactividad (ETDAH). La muestra estuvo conformada por padres y maestros de 315 niños de 7 a 10 años de seis colegios de Tunja. El instrumento comprendió una escala para padres con una confiabilidad de 0,93, una validez de constructo de 0,96 y en la escala para maestros de .97 y .97 respectivamente. El análisis factorial sugirió tres factores en la escala de padres y dos factores en la escala de docentes. Las comparaciones por grupos demostraron la pertinencia de realizar baremos de interpretación según edad y género.
The purpose of this investigation of psychometric technology type, was to construct and validate an instrument that is part of the exploratory process of attention deficit hyperactivity disorder (ADHD) called Scale of t Attention Deficit Hyperactivity Disorder (ETDAH). The sample consisted of parents and teachers of 315 children from 7 to 10 years in six schools in Tunja. The instrument included a parent scale with a reliability of 0.93, construct validity of 0.96 and teacher scale of .97 and .97 respectively.Factor analysis suggested three factors in the scale of parents and two factors in the scale of teachers. The group comparisons showed the relevance of performing scales of interpretation according to age and gender.
Subject(s)
Psychometrics , Attention Deficit Disorder with Hyperactivity , Reproducibility of Results , Factor Analysis, Statistical , Integrated Management of Childhood Illness , Child , HyperkinesisABSTRACT
OBJECTIVES: This study was done in adolescents with a high risk of substance or internet addiction in order to confirm the assumption that insecure attachment formation and impulsivity-inattention problems are major risk factors in adolescent addictive behavior. METHODS: 2,188 middle and high school students including a nicotine dependent treatment group were assessed using self-reporting scales : Adolescent Drinking Index (ADI), Fagerstrom Tolerance Questionnaire, Young Internet Addiction Scale, Revised Adult Attachment Scale (RAAS), and the Conner and Well's Self-reporting Scale for ADHD (CASS) were used. Subjects were classified into risk groups including substance addiction, internet addiction, as well as a combined group. RESULTS: Significant correlations were found between attachment formation and internet addiction tendencies, with respect to dependence, anxiety, and closeness (r=-0.185, r=0.248, r=-0.147, p<0.01, respectively). Impulsivity-inattention problems had positive correlations with internet addiction, alcohol addiction and nicotine addiction groups (r=0.345, r=0.211, r=0.187, p<0.01). With regard to attachment formation, the four groups showed significant differences regarding dependence (F=19.427, p<0.01), anxiety (F=28.926, p<0.01), and closeness (F=12.853, p<0.01). In addition, the four groups showed significant difference with respect to impulsivity-inattention problems (F=83.857, p<0.01), of which the combined risk group showed the highest scores, and the non-addicted group had the lowest scores. CONCLUSION: Insecure attachment formation and impulsivity-inattention problems were major risk factors for adolescent addictive behavior including internet addiction.
Subject(s)
Adolescent , Adult , Humans , Anxiety , Behavior, Addictive , Drinking , Internet , Nicotine , Surveys and Questionnaires , Risk Factors , Substance-Related Disorders , Weights and MeasuresABSTRACT
El trastorno por déficit de atención/hiperactividad (TDAH) de tipo inatento es una de las alteraciones neurocomportamentales más comunes de la niñez y una de las causas de consulta más frecuentes en la edad escolar. Se caracteriza por alteraciones básicas en las funciones ejecutivas e inhibición de la conducta. Objetivo: describir las características neuropsicológicas y sociodemográficas de un grupo de niños varones con déficit de atención/hiperactividad de predominio inatento. Pacientes y métodos: se seleccionaron 16 varones entre 7 y 11 años, de acuerdo con la lista de síntomas del DSM IV como TDAH de tipo inatento. Se consideraron las siguientes variables: edad, estrato socioeconómico, motivo de consulta, escolaridad, antecedentes personales, familiares y de desarrollo, tipología familiar y signos neurológicos blandos. Las características neuropsicológicas se evaluaron mediante una batería de pruebas psicométricas tales como la Escala de inteligencia de Wechsler para niños (WISC-R) con mediciones que permiten obtener un Coeficiente estimativo (CI). La Prueba de atención de la batería de Luria-DNA (diagnóstico neuropsicológico de adultos), para evaluar la vigilancia y el control mental. El Test de clasificación de tarjetas de Wisconsin (WCST) para medir la función ejecutiva. La Prueba de Stroop para inhibición de la conducta. Las subpruebas Pareo Visual y Tachar que evalúan la velocidad de procesamiento y focalización selectiva. Y las de Análisis, Síntesis y Formación de Conceptos que evalúan la función ejecutiva; estas cuatro subpruebas pertenecen a la Batería de Habilidad Cognitiva Woodcock-Muñoz. La Prueba de K-ABC utilizando las subpruebas Movimientos de manos, que evalúa la secuenciación, y la de Orden de palabras para medir el control de interferencia. Resultados. En la subprueba Pareo Visual WM se halló que 37,5% de los niños estaban en riesgo y que 18,8% eran clínicamente significativos; en el WCST el indicador Aprender a aprender mostró un mayor compromiso con un 37,5% en riesgo y clínicamente significativo. Conclusión. En general, de acuerdo con las pruebas WISC-R, Woodcock Muñoz, Wisconsin y K- ABC, se puede decir que la mayoría de nuestros pacientes se encontraban en las categorías promedio y favorable; las pruebas que identificaron más situaciones de riesgo y clínicamente significativas fueron el Woodcock Muñoz y el Wisconsin, que evalúan la velocidad de procesamiento, la focalización selectiva de la atención y la función ejecutiva.
Attention-deficit hyperactivity disorder (ADHD) with predominance of inattention is one of the most common neurobehavioral disorders during childhood, and a frequent reason for consultation. It is characterized by basic alterations in the executive functions and by behavioral inhibition. Objective: to describe the neuropsychological and sociodemographic characteristics of a group of predominantly-inattentive boys with ADHD, in Medellín, Colombia. Patients and methods: 16 boys, aged 7 to 11, were selected on the basis of the DSM IV checklist for the inattentive type of ADHD. The following variables were taken into account: age, socioeconomic stratum, reason for consultation, schooling, personal and familial background, development, family typology, and soft neurological signs. The neuropsychological characteristics were evaluated with a battery of psychometric tests that included: the Wechsler´s Intelligence Scale for children (WISC-R) with measurements to determine the Estimated Intellectual Coefficient (IC). The Attention test of the Luria-DNA battery in order to evaluate attention and mental control. The Wisconsin Card Sorting Test (WCST) to measure the executive function. The Stroop test for behavioral inhibition. The Woodcock Munoz (WM) cognitive hability battery subtests Visual Matching, and Cross out, to evaluate the speed of processing and selective focalization; also the Analysis-Synthesis and Concept formation that evaluate the executive function. Two subtests of KABC test were also included, namely: Hand movements to evaluate sequential processing, and Word order to measure interference control. Results: in the Visual matching subtest of the WM battery, we found that 6 out of the 16 boys (37.5%) were at risk and that 3 (18.8%) were clinically significative. In the dimension Learn to learn of the WCST, 6 boys (37.5%) were at risk and clinically significative. Conclusion: in general, according to the results obtained in the WISC-R, Woodcock-Munoz, Wisconsin and K-ABC, most of our patients were in the average and favorable categories. The tests that identified more at risk and clinically significant situations were those of Woodcock-Munoz and Wisconsin, that evaluate the speed of processing, selective focalization and executive function.
Subject(s)
Neurology , Child , Psychology , Attention Deficit Disorder with HyperactivityABSTRACT
OBJECTIVES: The purpose of this study was to compare two subtypes of attention-deficit hyperactivity disorder (ADHD) and controls in their attention using ADHD diagnostic system(ADS), a kind of continuous performance test. METHODS: Subjects of this study were 8 children with ADHD-predominantly inattentive type, 28 children with ADHDcombined type and 20 control children. Ages ranged from 5 to 14 years. The Korean Educational Development Institute version of the Wechsler Intelligence Scale for Children(KEDI-WISC) and the ADS were administered to all subjects to provide measures of intelligence and attention. RESULTS: Significant differences were found in the ADS variables for the three groups. When compared with controls, the ADHD-predominantly inattentive type children scored significantly higher on the omission error at middle stage and later stage and ADHD-combined type children scored significantly higher on the omission error and reaction time at later stage. When compared with the other two groups, the ADHD-combined type children scored significantly higher on the commission error at all three stages. CONCLUSION: Our results suggest that the two subtypes of ADHD have different features in attention deficit. And there was a possibility that commission error is available variable to show cognitive characteristics of ADHD-combined type than any other ADS variables. Further studies are needed to evaluate this finding.
Subject(s)
Child , Humans , Intelligence , Reaction TimeABSTRACT
El trastorno por déficit de atención/hiperactivad (TDA/H) presenta síntomas heterogéneos y con diversos grados de intensidad. El análisis de conglomerados de clases latentes (ACCL) puede clasificar a los niños a partir de los datos directos provenientes de cualquier instrumento que muestre estos síntomas, sin un diagnóstico de patrón de oro previo. Se utilizó un instrumento tipo lista de chequeo para los síntomas de TDA/H y otro para las comorbilidades del TDA/H. ACCLs fueron aplicados para los datos de cada instrumento en una muestra aleatoria y representativa de 540 niños y adolescentes escolarizados de 4 a 17 años, de la ciudad de Manizales. Un análisis de correspondencias simples (ACS) fue usado para determinar la relación o concordancia de los grupos derivados de los ACCLs. Se encontraron seis clases para la lista de chequeo de síntomas de TDA/H y cinco para el instrumento de las comorbilidades de TDA/H. El ACS mostró cuatro grupos independientes, derivados de las concordancias entre las clases obtenidas de los dos instrumentos. Estos hallazgos sugieren que el ACCL y el ACS pueden ser usados como procedimientos taxométricos precisos para la clasificación de las psicopatologías por externalización.
Attention deficit/hyperactivity disorder (ADHD) has heterogeneous symptoms with diverse grades of severity. Latentclass cluster analysis (LCCA) can be used to classify children, using direct data from any instrument that reports these symptoms, without previous gold standard diagnosis. One ADHD symptoms checklist, and one ADHD comorbidities questionnaire were used. LCCAs were developed for each instrument, which were administered to a sample of 540 children and adolescents, aged 4-17 years, from the regular school of Manizales-Colombia. A simple correspondence analysis (SCA) was done to determine the relationships between the groups classified from both LCCAs. Six clusters were obtained from ADHD checklist and five from the ADHD comorbidities questionnaire. SCA found four independent groups, derived from the concordances between the 11 clusters obtained by the LCCAs from both instruments. These findings suggest that LCCA and SCA can be use as accurate taxometric procedures to classify externalizing psychopathologies.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Cluster AnalysisABSTRACT
O transtorno de déficit de atenção/hiperatividade (TDAH) é um transtorno mental freqüentemente encontrado entre as patologias neuropsiquiátricas mais comuns na atualidade. Sua prevalência varia entre 3 a 5 por cento das crianças em idade escolar, e aproximadamente 4 por cento da população adulta. Sua etiologia ainda não está totalmente esclarecida, mas vários estudos sustentam que o TDAH parece ter causas multifatoriais, que abrangem desde aspectos bioquímicos e neurológicos, até psicológicos e sócio-ambientais. O diagnóstico do TDAH fundamenta-se em critérios clínico-comportamentais, dependendo da história clínica do paciente, informe dos pais e da escola e uso de questionários formais. O DSM-IV reconhece três subtipos de TDAH, o subtipo desatento, subtipo hiperativo/impulsivo e o subtipo combinado. Mais de 70 por cento dos pacientes com este transtorno que procuram ambulatórios especializados apresentam alguma comorbidade, dentre elas, destacam-se o distúrbio de conduta, comportamento desafiador opositivo, dislexia, distúrbios da linguagem e ansiedade. Os tratamentos para o TDAH podem ser por meio de diversos tipos de fármacos, dentre eles destacam-se as anfetaminas. Abordagens psicossociais, psicoeducacionais, cognitivo-comportamental e tratamentos combinados (terapia medicamentosa e não medicamentosa) são outras modalidades de tratamento. Os resultados apontam uma eficácia na redução dos sintomas do transtorno por ambas formas de intervenção. O tratamento combinado é o mais recomendado para o portador do transtorno por conseguir contemplar uma maior quantidade de variáveis possivelmente envolvidas com a aquisição e/ou manutenção dos sintomas relacionados ao TDAH. Este trabalho retrata de forma sucinta e objetiva questões referentes ao conceito, diagnóstico, etiologia, tratamentos farmacológicos, não farmacológicos e combinados para o TDAH.
Attention Deficit Hyperactivity Disorder (ADHD) is a mental disorder found between the most commonneuropsychiatry pathologies nowadays. Its occurrence varies between 3% and 5% of the children in scholaryears, and approximately 4% of the adult population. ADHD etiology is not yet completely clarified, but alot of researches support that this disease seems to have multifactor causes, that range since biochemical andneurological aspects to psychological and socio-environmental ones. ADHD diagnosis bases itself in clinical-behavioral criterions, depending on the patient's clinical history, parental and school informing and formalquestionnaire usage. The DSM-IV recognizes three ADHD subtypes, the absent-minded subtype, hyperactive/impulsive subtype and combined subtype. More than 70% of the ADHD patients that look for specializedambulatories present some comorbidity, among them, outstands behavior disturb, oppositional defiantdisorder, dislexy, language disturb and anxiety. Among the different types of medicines for the ADHDtreatment are distinguished the amphetamines. Other approaches of treatments can be as following:psychosocial, psychoeducational, cognitive-behavioral therapy and combined treatments (medical and nonmedical therapy). The results indicate a effectiveness in the reduction of the symptoms of the disorder forboth forms of intervention. The combined treatment is the most effective one for ADHD since it contemplatethe larger number of variables associated with the acquisition and/or maintenance of the symptoms relatedwith the ADHD. This paper shows briefly and objectively the issues related with the concepts, diagnosis,etiology, pharmacologic and non pharmacologic treatments and also combined treatments for ADHD