Tratamiento del trastorno por déficit de atención con hiperactividad en la práctica clínica habitual: Estudio retrospectivo / Treatment of attention-deficit/hyperactivity disorder in clinical practice. A retrospective study

El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo, de carácter crónico, de etiología multifactorial, principalmente debida a factores genéticos y ambientales. Realizamos un estudio analítico retrospectivo del tratamiento de niños diagnosticados de TDAH. Se estudió una muestra de 82 niños diagnosticados de TDAH (74.4% niños y 25.6% niñas). El 96.3% de los casos presentaba algún trastorno asociado. El tratamiento farmacológico fue el tratamiento de elección (90.2%). El 46.0% recibía metilfenidato de liberación inmediata, un 51.4% metilfenidato de liberación sostenida y la atomoxetina solo se recetó en un 2.7% de los casos. El 20.3% de la muestra abandonó en algún momento el tratamiento farmacológico. El tratamiento farmacológico fue la opción más utilizada en nuestra muestra, y el metilfenidato de liberación inmediata el fármaco de elección para inicio del tratamiento. Se utilizan poco las alternativas a los estimulantes. No se encontraron diferencias significativas entre el tipo de tratamiento y el subtipo de TDAH o el género, aunque sí en cuanto a la edad de inicio del tratamiento.

Attention deficit hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disorder, of a chronic nature, of multifactorial etiology, mainly due to genetic and environmental factors. We conducted a retrospective analytical study of the t herapeutic management of children diagnosed with ADHD. A sample of 82 children diagnosed with ADHD (74.4% children and 25.6% girls) was studied. 96.3% of the cases presented some associated disorder. Pharmacological treatment was the treatment of choice (90.2%). 46.0% received immediate release methylphenidate, 51.4% sustained release methylphenidate and atomoxetine was only prescribed in 2.7% of patients. 20.3% of the sample abandoned pharmacological treatment at some point. Pharmacological treatment was the most frequent option in our sample, and methylphenidate immediate release the drug of choice for treatment initiation. The alternatives to stimulants are used in very low percentage of the patient. No significant differences were found between the type of treatment regarding the subtype of ADHD or gender, but we found significant difference in relation with the age of onset of treatment.

Iron deficiency in South African children and adolescents with attention deficit hyperactivity disorder

Objective: Iron deficiency may play a role in the pathophysiology of attention deficit hyperactivity disorder (ADHD) by causing dopamine dysfunction, but there is conflicting evidence in the literature regarding this relationship. This study investigates the possible correlation between iron deficiency and ADHD in children and adolescents attending a South African child and adolescent psychiatry outpatient service.Method: In this retrospective study, we gathered data from 245 outpatient children and adolescents who had their serum ferritin and/or iron levels tested between February 2011 and January 2016. Relevant statistical methods were used to test for correlations between ADHD and various demographic and clinical factors, including iron deficiency.Results: Out of 245 patients, 88 (35.9%) had iron deficiency, 156 (63.7%) had ADHD and 55 (22.4%) had both iron deficiency and ADHD. Variables found to be significantly correlated with ADHD included gender, age, and methylphenidate treatment, but there was no significant correlation between ADHD and iron deficiency.Conclusions: Our study emphasizes the great complexity involved in understanding ADHD. Comparisons between mentally-ill paediatric patients and matched healthy controls from the same communities are required to further explore the possible association between iron deficiency and ADHD

Trastorno por déficit de atención e hiperactividad (TDAH) en adolescentes / Attention deficit/hyperactivity disorder in adolescents

El Trastorno por Déficit de Atención e Hiperactividad (TDAH) es un trastorno neurobiológico frecuente asociado a un importante impacto funcional, personal y social. Posee un fuerte componente genético, con múltiples genes involucrados, que interactúan con factores ambientales y neurobiológicos, aumentando la susceptibilidad genética y heterogeneidad del cuadro clínico. Los hallazgos más consistentes apuntan a una dismorfología, disfunción y baja conectividad de múltiples redes, fronto-estriatal, fronto-parietal y fronto-cerebelar, lo que refleja los distintos dominios cognitivos afectados en TDAH, como inhibición, atención, percepción del tiempo y aversión a la demora. Contrario a lo que se pensaba el TDAH no se resuelve en la adolescencia, pero cambian sus manifestaciones, su complejidad y potencial de daño. El diagnóstico de TDAH es complejo dada su alta heterogeneidad clínica y la ausencia de un marcador biológico. En esta revisión se describen las conductas propias del adolescente y los desafíos que plantea en este contexto el diagnóstico de TDAH y su tratamiento.

Attention Deficit/Hyperactivity Disorder is a frequent neurobiological condition with significant personal and social functional impairments. It has a strong genetic component, involving multiple genes which interact with environmental and neurobiological factors, thus increasing genetic susceptibility and clinical heterogeneity. The most consistent findings point towards a dismorphology, dysfunction and underconnectivity of multiple fronto-striatal, fronto-parietal and fronto-cerebellar networks reflecting the different cognitive domains involved in ADHD, such as inhibition, attention, time perception and aversion to delay. Contrary to earlier beliefs, ADHD is not resolved in adolescence, but there is a change in its manifestations, complexity and potential harm. The diagnosis of ADHD is complex due to his high clinical heterogenecity and the absence of a biological marker. In this review there is a description of the normal specific behavior of the adolescent and, in this context, of the challenges of the diagnosis and treatment of ADHD.

Cuestionario para la evaluación de limitaciones en la actividad y restricciones en la participación en niños con TDA a nivel escolar / Questionnaire for the evaluation of activity limitations and participation restrictions involving children with attention-deficit/hyperactivity disorder at scholar level

Objetivo: Diseñar, validar y determinar confiabilidad de un instrumento para evaluar limitaciones en actividad y restricciones en participación de niños con TDAH a nivel escolar. Procedimiento: Se determino validez de contenido y apariencia por juicio de expertos y consistencia interna mediante alfa de Cronbach. Muestra de 37 profesores de niños de 6 a 12 años con TDAH combinado escolarizados. Resultados: Se diseño el cuestionario CLARP-TDAH profesores con 6 dominios y 37 Items con buena validez de apariencia y contenido, consistencia interna por alfa de Cronbach de 0.96 para el cuestionario completo, y para cada dominio valores por encima de 0.7. Conclusiones: El uso de la CIF para evaluar limitaciones y restricciones trasciende los signos y síntomas a otras alteraciones en los niños con TDAH. El cuestionario tiene una confiabilidad suficiente para su uso y aplicación clínica. Es necesario continuar procesos de validación y confiabilidad del cuestionario.

Objetive: To design, validate and determine the reliability of an instrument to evaluate activity limitations and participation restrictions involving children with ADHD at scholar level. Procedure: Content validity and appearance was determined by experts and internal consistency by Cronbach alpha. Sample of 37 teachers of scholarized children between the ages of 6 to 12 with ADHD combined. Results: The questionnaire CLARP-TDAH professor was designed with 6 dominions and 37 items with good appearance validity and content. Internal consistency by Cronbach alpha of 0.96 for the completed questionnaire and for each domain values above 0.7. Conclusions: The use of CIF to evaluate limitations and restrictions transcend the signs and symptoms to other alterations in children with ADHD. The questionnaire has enough reliability for its use and clinical application. However, it is necessary to continue with the processes of validation and reliability of the questionnaire.

Epileptiform abnormalities and quantitative EEG in children with attention-deficit / hyperactivity disorder / Atividade epileptiforme e eletrencefalograma quantitativo em crianças com transtorno de déficit de atenção/hiperatividade

There is much controversy about the importance of the electroencephalogram (EEG) in assessing the attention-deficit/hyperactivity disorder (ADHD). The objective of this study was to assess the use of EEG and quantitative EEG (qEEG) in ADHD children. Thirty ADHD children and 30 sex- and age-matched controls with no neurological or psychiatric problems were studied. The EEG was recorded from 15 electrode sites during an eyes-closed resting condition. Epileptiform activity was assessed, as were the absolute and relative powers in the classical bands after application of the Fast Fourier transform. Epileptiform activity was found in 3 (10 percent) ADHD children. As compared to the controls, the ADHD group showed significantly greater absolute delta and theta powers in a diffuse way, and also greater absolute beta power and smaller relative alpha 1 and beta powers at some electrodes. A logistic multiple regression model, allowed for 83.3 percent sensibility and specificity in diagnosing ADHD.

Há controvérsias sobre a importância do eletrencefalogama (EEG) na avaliação do transtorno de déficit de atenção/hiperatividade (TDAH). O objetivo deste estudo foi avaliar, em crianças com TDAH, o EEG digital e quantitativo. Foram estudadas 30 crianças com TDAH e 30 sadias, sem evidências de problemas neurológicos ou psiquiátricos e pareadas por idade e gênero. Foi registrado o EEG em 15 posições de eletrodos, durante repouso e olhos fechados. Foi realizada pesquisa de atividade epileptiforme e feita análise de freqüências nas faixas clássicas, após aplicação da transformada rápida de Fourier. Foi encontrada atividade epileptiforme em 3 (10 por cento) crianças com TDAH. O grupo TDAH teve, em relação ao grupo controle, significativamente, maior potência absoluta delta e teta, de modo difuso, assim como maior potência absoluta beta e menor potência relativa alfa 1 e beta, em alguns eletrodos. Um modelo de regressão múltipla logística possibilitou sensibilidade e especificidade de 83,3 por cento no diagnóstico de TDAH.

Psychiatric Comorbidity in Korean Children and Adolescents with Attention-Deficit Hyperactivity Disorder: Psychopathology According to Subtype

It is well-known that more than 50% of attention-deficit hyperactivity disorder (ADHD) cases also have comorbid psychiatric disorders. We evaluated the comorbid psychopathology of Korean children and adolescents with ADHD using a standardized diagnostic instrument. The Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-K) was administered and completed in 105 patients who had been referred to the outpatient and inpatient clinics at the Samsung Medical Center from March 2004 to May 2005. All of the cases were diagnosed as ADHD according to DSM-IV criteria. We analyzed their clinical characteristics and psychiatric comorbidities, and assessed the correlation of any comorbidity with gender, age and ADHD subtype. Among our 105 participants, 70 (66.7%) subjects were diagnosed with combined-type ADHD, 22 (21.0%) were the predominantly inattentive type, only 1 (1.0%) was determined to have the predominantly hyperactive-impulsive type of ADHD, and 12 (11.4%) were classified as not otherwise specified (NOS) ADHD. Eighty (76.2%) subjects had at least one comorbid disorder such as oppositional defiant disorder (n = 53, 50.5%), anxiety disorders (n = 35, 33.3%) and affective disorders (n = 15, 14.3%). Our patients ranged in age from five to 16 years. Among the factors including gender, age, and ADHD subtype, ADHD subtype was the only one significant to comorbidity in our study. The results of this study suggest that psychiatric comorbidity in Korean children with ADHD is similar to the results of previous studies in western countries. Out of all the ADHD subtypes, the combined-type group had a significantly higher ratio of comorbid disorders and psychopathologies.

Transtorno de déficit de atenção. Tratamento farmacológico e rendimento escolar / Attention Deficit Disorder. Pharmacologic Treatment and School Performance

O autor aborda os principais aspectos clínicos relacionados ao Transtorno de Déficit de Atenção (TDA), aprofundando a discussão sobre o tratamento farmacológico do TDA e sua repercussão sobre o rendimento, bem como, alguns questionamentos levantados pela literatura revisada sobre o assunto. Conclui, enfatizando a importância do tratamento farmacológico aliado a outras modalidades de tratamento numa abordagem dita multidisciplinar que atualmente vem sendo utilizada por boa parte dos pesquisadores sobre TDA

Tratamiento de la inquietud en niños

Se describe una experiencia de la consulta externa del Hospital Universitario Pediátrico de La Misericordia, en el tratamiento de la inquietud en 50 niños con retardo mental. La mayoría del grupo eran varones con promedio de diez años de edad y con inquietud de seis meses de evolución. La "inquietud" es un síndrome constituido por hiperactividad, agresividad y autoagresividad. Entre los factores que precipitaban la inquietud predominaron los ambientales. Se destacan, en particular, la ausencia de soporte social y un equilibrio económico precario. El protocolo de tratamiento incluye un psicotrópico y apoyo psiquiátrico a la madre. Con el tratamiento mejoraron 42 pacientes. Los factores cruciales para la mejoría son la sedación del paciente y el apoyo emocional de la madre.