ABSTRACT
El diagnóstico de trastorno del espectro autista (TEA) en mujeres presenta importantes complejidades, desafíos y particularidades. Históricamente se ha planteado que este trastorno es más frecuente en hombres, existiendo, además, un sesgo hacia el género masculino en el screening y criterios diagnósticos. Objetivo: Presentar un caso clínico a fin de revisar las dificultades y particularidades asociadas al proceso diagnóstico de TEA en mujeres. Discusión: Las investigaciones a la fecha han planteado que muchas niñas no encajan en el perfil tradicional de TEA. Se han descrito características específicas del cuadro clínico en el sexo femenino, varias de las cuales se evidencian en el caso clínico presentado. Por otro lado, existen altas tasas de comorbilidades, tanto con patologías médicas como psiquiátricas, las cuales son siempre relevantes de evaluar. Conclusiones: Como en muchos otros aspectos, las mujeres también han sido invisibilizadas en lo que respecta al TEA. Es relevante que se continúe estudiando el tema para lograr un diagnóstico e intervención precoces en esta población.
The diagnosis of autism spectrum disorder (ASD) in women presents with significant complexities and challenges. It has been mentioned that the disorder is more prevalent in males, and there is also a bias towards the male gender in screening and diagnostic criteria. Objectives: To present a clinical case in order to review difficulties and peculiarities associated with the diagnostic process of ASD in women. Discussion: It has been suggested that many girls do not fit the traditional profile of ASD. Specific characteristics of the female gender phenotype have been described, several of which are illustrated in the clinical case presented. On the other hand, there are high rates of comorbidities, both with medical and psychiatric conditions, which are always relevant to assess and recognize. Conclusions: As in various other aspects, women have also been unrecognized and misdiagnosed when it comes to ASD. It is relevant that we keep understanding this issue, in order to achieve an early diagnosis and provide proper interventions to this population.
Subject(s)
Humans , Female , Adolescent , Autism Spectrum Disorder/diagnosis , Attention Deficit Disorder with Hyperactivity/diagnosis , Depression/diagnosisABSTRACT
El Trastorno por déficit atencional con hiperactividad (TDAH) es un trastorno crónico, del neurodesarrollo con una prevalencia de 5,29% en la población pediátrica. Las manifestaciones clínicas incluyen síntomas de hiperactividad, impulsividad y desatención que conducen a un deterioro funcional en el desarrollo social, familiar y escolar. Si bien en los últimos años ha habido un aumento en su reconocimiento, la heterogeneidad clínica y la alta comorbilidad pueden obstaculizar su diagnóstico. En el presente trabajo se revisarán diferentes aspectos de la presentación clínica y del abordaje terapéutico de este trastorno
The attention hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with a prevalence of 5.24% in pediatric population. The clinical presentation includes symptoms of hyperactivity, impulsivity and inattention with a functional impairment in social, family and scholar development. Even though in the last years it has been well recognized, its clinical heterogeneity and high comorbidity hampers its diagnosis. In this article different aspects of the clinical presentation and therapeutic approach of this disorder will be reviewed
Subject(s)
Humans , Child , Adolescent , Attention Deficit Disorder with Hyperactivity/psychology , Child Health , Adolescent Health , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapyABSTRACT
OBJECTIVE: The relationship between mental health and contextual factors has been increasingly investigated in the scientific literature to identify elements that may configure themselves as protective. The present study aimed to identify what resources (activities, family outings, toys, material elements, and learning) were offered in the daily lives of children with mental disorders, and from this, verify whether the offer of such resources in the family was associated with areas of greatest damage relative to mental health problems. METHODS: Thirty-three caregivers of/people responsible for children between 6 and 12 years of age with most frequent diagnoses in attention-deficit hyperactivity disorder and autism spectrum disorder seen at a general hospital participated. We used the Strengths and Difficulties Questionnaire (SDQ parents version) and Family Environment Resources Inventory (RAF). RESULTS: From a descriptive and correlational analysis, it was revealed that the more the mental health problems were present in children, the lower the family resources offer. CONCLUSIONS: The environmental resources offer proved to be protective for child development. Such findings are relevant to aid in outlining strategies for promoting mental health among children.
OBJETIVO: As relações entre saúde mental e fatores contextuais têm sido cada vez mais investigadas na literatura científica no sentido de identificar elementos que possam se configurar como protetivos. Este estudo teve por objetivo identificar quais recursos (atividades, passeios com a família, brinquedos, elementos materiais e de aprendizagem) eram oferecidos no cotidiano das crianças que apresentam transtornos mentais e, a partir disso, verificar se há associações entre a oferta de tais recursos no ambiente familiar e as áreas de maior prejuízo em relação a problemas de saúde mental. MÉTODOS: Participaram 33 cuidadores/responsáveis de/por crianças entre 6 e 12 anos de idade com diagnósticos mais frequentes de transtorno do déficit de atenção e hiperatividade e transtorno do espectro autista acompanhadas em um hospital geral. Foram utilizados: Questionário de Capacidades e Dificuldades (SDQ versão pais) e Inventário de Recursos do Ambiente Familiar (RAF). RESULTADOS: A partir de uma análise descritiva e correlacional, revelou-se que quanto mais problemas de saúde mental estão presentes nas crianças, menor é a oferta de recursos no ambiente familiar. CONCLUSÃO: A oferta de recursos ambientais mostrou-se protetiva para o desenvolvimento infantil. Tais achados são relevantes para auxiliar no delineamento de estratégias para a promoção de saúde mental destinada ao público infantil.
Subject(s)
Humans , Child , Attention Deficit Disorder with Hyperactivity/diagnosis , Caregivers/psychology , Family Relations/psychology , Autism Spectrum Disorder/diagnosis , Mental Disorders/psychology , Child Development , Cross-Sectional Studies , Surveys and Questionnaires/standards , Protective FactorsABSTRACT
OBJECTIVES@#To study the clinical value of attention time combined with behavior scale in the screening of attention deficit hyperactivity disorder (ADHD) in preschool children.@*METHODS@#A total of 200 preschool children with ADHD diagnosed in Fujian Maternal and Child Health Hospital from February 2019 to March 2020 were enrolled as the ADHD group. A total of 200 children who underwent physical examination in the hospital or kindergartens during the same period were enrolled as the control group. Attention time was recorded. Chinese Version of Swanson Nolan and Pelham, Version IV Scale-Parent Form (SNAP-IV) scale was used to evaluate symptoms. With clinical diagnosis as the gold standard, the decision tree analysis was used to evaluate the clinical value of attention time combined with behavior scale in the screening of ADHD.@*RESULTS@#Compared with the control group, the ADHD group had significantly higher scores of SNAP-IV items 1, 4, 7, 8, 10, 11, 14, 15, 16, 18, 20, 21, and 22 (P<0.05) and a significantly shorter attention time (P<0.05). The variables with statistically significant differences between the two groups in univariate analysis were used as independent variables to establish a decision tree model. The accuracy of the model in predicting ADHD was 81%, that in predicting non-ADHD was 69%, and the overall accuracy was 75%, with an area under the ROC curve of 0.816 (95% CI: 0.774-0.857, P<0.001).@*CONCLUSIONS@#The decision tree model for screening ADHD in preschool children based on attention time and assessment results of behavior scale has a high accuracy and can be used for rapid screening of ADHD among children in clinical practice.
Subject(s)
Child, Preschool , Humans , Asian People , Attention Deficit Disorder with Hyperactivity/diagnosis , Decision Trees , Mass Screening , Prospective StudiesABSTRACT
Resumen Objetivo. Describir los estudios actuales sobre calidad de vida en adultos jóvenes con TDAH diagnosticados por primera vez en la adultez o que no recibieron ningún tipo de tratamiento para dicho trastorno. Método. Se realizó una meta-síntesis en investigaciones que reportan evidencias teóricas, metodológicas y concluyentes sobre el objeto de estudio, siguiendo recomendaciones de la red Cochrane y la declaración PRISMA. Resultados. Seis documentos seleccionados y analizados de 418 encontrados arrojaron que el TDAH afecta negativamente el bienestar personal, emocional, físico y material del adulto joven sin diagnóstico ni tratamiento durante la etapa infanto-juvenil. La gran mayoría de los adultos jóvenes con TDAH, principalmente aquellos con trastornos comórbidos, tienen una pobre valoración de su calidad de vida.
Abstract. Objective. Describe current studies on quality of life of young adults with ADHD diagnosed for the first time in adulthood, or who did not receive any type of treatment for this disorder. Method. a meta-synthesis was carried out investigations that report theoretical, methodological, and conclusive evidence of the object of study, following the recommendations on the Cochrane and PRISMA. Results. Six documents selected and analyzed out of 418 found showed that ADHD negatively affects the personal, emotional, physical, and material well-being of the young adult without diagnosis or treatment during the infant-adolescent stage. The vast majority of young adults with ADHD, mainly those with comorbid disorders, have a poor perception of their quality of life.
Subject(s)
Humans , Adult , Middle Aged , Quality of Life/psychology , Attention Deficit Disorder with Hyperactivity/diagnosisABSTRACT
Objective: To investigate the association of sluggish cognitive tempo (SCT) with autistic traits (ATs) and anxiety disorder symptoms among children with attention-deficit/hyperactivity disorder (ADHD). Methods: A total of 195 children with a DSM-5 diagnosis of ADHD were included. The Barkley Sluggish Cognitive Tempo Scale (BSCTS) was used to measure SCT symptoms. Other study measures included the Autism Spectrum Quotient (AQ), Screen for Child Anxiety and Related Disorders (SCARED), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners' Teacher Rating Scale (CTRS-R). Results: The frequency of SCT was 30.3% (n=59) in the whole group. Those with SCT had higher total AQ and SCARED scores. Significant associations and correlations were also found between SCT and certain subscores of AQ and SCARED. According to the linear regression model, the total score and social skills, attention switching, and imagination scores of AQ, as well as generalized anxiety and panic/somatic scores of SCARED and the total and inattention scores of parent T-DSM-IV, were predictive of SCT total score (p < 0.05). Conclusions: SCT is associated with ATs and anxiety disorders. Children with ADHD and SCT symptoms should be screened for such conditions.
Subject(s)
Humans , Child , Attention Deficit Disorder with Hyperactivity/diagnosis , Autistic Disorder/diagnosis , Anxiety Disorders/diagnosis , Cognition , Attention Deficit and Disruptive Behavior DisordersABSTRACT
Objective: Studies to reduce the heterogeneity of attention-deficit/hyperactivity disorder (ADHD) have increased interest in the concept of sluggish cognitive tempo (SCT). The aim of this study was to investigate if the prevalence of two variable-number tandem repeats (VNTRs) located within the 3′-untranslated region of the DAT1 gene and in exon 3 of the dopamine D4 receptor (DRD4) gene differ among four groups (31 subjects with SCT but no ADHD, 146 individuals with ADHD but no SCT, 67 subjects with SCT + ADHD, and 92 healthy controls). Methods: We compared the sociodemographic profiles, neurocognitive domains, and prevalence of two VNTRs in SCT and ADHD subjects versus typically developing (TD) controls. Results: The SCT without ADHD group had a higher proportion of females and lower parental educational attainment. Subjects in this group performed worse on neuropsychological tests, except for psychomotor speed and commission errors, compared to controls. However, the ADHD without SCT group performed significantly worse on all neuropsychological domains than controls. We found that 4R homozygosity for the DRD4 gene was most prevalent in the ADHD without SCT group. The SCT without ADHD group had the highest 7R allele frequency, differing significantly from the ADHD without SCT group. Conclusion: The 7R allele of DRD4 gene was found to be significantly more prevalent in SCT cases than in ADHD cases. No substantial neuropsychological differences were found between SCT and ADHD subjects.
Subject(s)
Humans , Female , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/genetics , Cognition , Minisatellite Repeats/genetics , Receptors, Dopamine D4/genetics , GenotypeABSTRACT
Objective: To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD). Methods: Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups. Results: BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale - Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decision-making and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity. Conclusion: Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.
Subject(s)
Humans , Male , Female , Adult , Attention/physiology , Suicide/psychology , Borderline Personality Disorder/diagnosis , Cognition Disorders/diagnosis , Dissociative Disorders/diagnosis , Impulsive Behavior , Personality Inventory/statistics & numerical data , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/psychology , Borderline Personality Disorder/psychology , Case-Control Studies , Mental Status and Dementia Tests , Neuropsychological Tests/statistics & numerical dataABSTRACT
El trastorno por déficit de atención e hiperactividad afecta al 5 % de los niños en edad escolar. Se presenta una serie de 82 niños con este trastorno no asociado a enfermedades neurológicas ni a discapacidad intelectual o trastorno del espectro autista, atendidos durante un período de 8 meses en Neuropediatría: 57 casos de tipo combinado, 23 de tipo inatento y 2 de predominio hiperactivo. Tiempo medio de seguimiento: 7 ± 2,8 años (rango: 4-14,6). Compartían seguimiento con Psiquiatría 16 pacientes. Nunca recibieron tratamiento por decisión parental 12 pacientes. De los 70 que recibieron, en 20, hubo demora en el inicio del tratamiento. Tiempo medio de demora: 20 meses ± 1,6 años (rango: 1 mes y 6 años). Tiempo medio de tratamiento: 44 meses ± 2,6 años (rango: 1 mes y 10,5 años). El 90 % de los pacientes (63) que iniciaron tratamiento continuaban tomándolo en la última revisión
Attention deficit disorder with hyperactivity has a high prevalence affecting 5 % of school-age children. We present a case series of 82 children with said disorder not associated with neurological diseases or intellectual disability or autism spectrum disorder, treated during a period of 8 months in a neuropediatrics clinic: 57 cases of combined type, 23 of inattentive type and 2 of overactive predominance. Average follow-up time: 7 ± 2.8 years (range: 4-14.6); 16 patients shared follow-up with Psychiatry; 12 patients never received treatment by parental decision. Of the 70 who received it, in 20 there was a delay in the start of treatment. Average delay time: 20 months ± 1.6 years (range: 1 month and 6 years). Average treatment time: 44 months ± 2.6 years (range: 1 month and 10.5 years); 90 % of the patients (63) who started treatment were under treatment at the last control
Subject(s)
Humans , Male , Female , Child , Adolescent , Attention Deficit Disorder with Hyperactivity/diagnosis , Pediatrics , Attention Deficit Disorder with Hyperactivity/therapy , Epidemiology, Descriptive , Retrospective Studies , Tics , Learning Disabilities , NeurologyABSTRACT
El trastorno por déficit de atención e hiperactividad (TDAH) es el principal motivo de consulta en la mayoría de las unidades de Neurología Pediátrica en España. Las nuevas tecnologías asocian además beneficios tanto para los pacientes como para los profesionales y el propio sistema sanitario. Se hace imprescindible su implementación racional. La genética, la neuroimagen o la realidad virtual por ejemplo, son claros exponentes de los resultados que se pueden conseguir al optimizar los procesos tradicionales. Las diferentes tecnologías que recogemos en este artículo están completamente operativas y cuentan con miles de pacientes de experiencia. La incorporación de las mismas a la práctica clínica habitual está en nuestras manos.
Attention deficit disorder and hyperactivity (ADHD) is the main reason for consultation in most Pediatric Neurology units in Spain. The new technologies also associate benefits for both patients and professionals and the health system itself, which makes its rational implementation essential. Genetics, neuroimaging or virtual reality, for example, are clear exponents of the results that can be achieved by optimizing traditional processes. The different technologies that we collect in this article are fully operational and have thousands of experience in patients. The incorporation of them to the usual clinical practice is in our hands.
Subject(s)
Humans , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Biomedical Technology/methods , Software , Biomedical Technology/trends , Virtual Reality Exposure Therapy/methodsABSTRACT
El trastorno por déficit de atención con hiperactividad (TDAH) es una alteración del neurodesarrollo de base biológica que iniciado en la infancia puede persistir durante la adolescencia-juventud y, a pesar de lo que se pensaba hasta hace no muchos años, también en la edad adulta hasta en un 50-60% de los afectados, produciendo un notable deterioro clínico y psicosocial. A pesar de tratarse de un síndrome fácilmente identificable por la triada: desatención, hiperactividad e impulsividad que le caracteriza, en la práctica clínica existen diferentes circunstancias que dificultan y complican su diagnóstico y tratamiento. Una de las más significativas es la presencia, tanto en la infancia como en la edad adulta, de otros trastornos mentales comórbidos. Es a partir de la adolescencia-juventud cuando junto al TDAH podemos detectar la presencia de trastornos de la personalidad, trastornos del estado de ánimo, trastornos de ansiedad y muy especialmente trastornos por uso de sustancias. Las evidencias existentes hasta el presente muestran como la comorbilidad del TDAH y el trastorno por uso de sustancias influyen en el curso evolutivo de ambos, complicando el abordaje, el tratamiento y consecuentemente agravando el pronóstico final. Las dificultades en su abordaje y la escasez de opciones de tratamiento nos hacen subrayar la importancia del tratamiento preventivo en la etapa infantil a partir de programas de psicoeducación centrados en la vulnerabilidad de estos pacientes a las sustancias y las consecuencias asociadas al consumo.
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental alteration of biological basis that started in childhood may persist during adolescence-youth and, despite what was believed until not many years ago, also in adulthood up to 50-60% of those affected, producing a significant clinical and psychosocial deterioration. In spite of being a syndrome easily identifiable by the triad: inattention, hyperactivity and impulsivity that characterizes it, in clinical practice there are different circumstances that hinder and complicate its diagnosis and treatment. One of the most significant is the presence, both in childhood and adulthood, of other comorbid mental disorders. It is from adolescence-youth when together with ADHD we can detect the presence of personality, mood and anxiety disorders and especially the use of several substances. The evidences existing until now show how the comorbidity of ADHD and substance use disorder influence the evolutionary course of both, complicating the approach, the treatment and, therefore, aggravating the final prognosis. The difficulties in their approach and the scarcity of treatment options make us underline the importance of preventive treatment in the infantile stage, starting from psychoeducation programs focused on the vulnerability of these patients to substances and the consequences associated with consumption.
Subject(s)
Humans , Child , Adolescent , Adult , Young Adult , Attention Deficit Disorder with Hyperactivity/complications , Substance-Related Disorders/etiology , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Risk Factors , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapy , Diagnostic and Statistical Manual of Mental DisordersABSTRACT
Resumen: Objetivo: Evaluar el acceso al diagnóstico oportuno del trastorno por déficit de atención e hiperactividad (TDAH) e identificar sus barreras mediante una trayectoria de hechos que va desde percibir los síntomas hasta obtener el diagnóstico formal. Material y métodos: Se empleó un modelo conceptual integral (basado en cuatro dimensiones: percibir, buscar, llegar y usar) y centrado en el paciente. Ello permitió trazar una trayectoria de hechos vividos por las diadas (paciente y su cuidador primario), a partir de la cual se diseñó una cédula compuesta por 143 preguntas dicotómicas o politómicas, y cinco preguntas abiertas. Participaron 177 diadas. Resultados: Se identificaron numerosas barreras para acceder al diagnóstico oportuno; la falta de percepción del TDAH resultó clave como obstáculo para el acceso inicial. Conclusión: La barrera de la falta de percepción podría evitarse brindando información a los cuidadores para que perciban los síntomas nucleares del TDAH como problemas potenciales de salud mental.
Abstract: Objective: To evaluate the access of an early diagnosis of the ADHD and to identify its barriers by means of a trajectory of facts from perceiving the symptoms until obtaining the formal diagnosis. Materials and methods: An integral conceptual model has been used - based on four dimensions (perceive, search, arrive and use) - and centered on the patient; this has allowed to trace a trajectory of facts lived by the dyads (patient and their primary caregiver). The survey was composed of five open and 143 dichotomous or polytomous questions. 177 dyads participated. Results: Numerous barriers were identified to access the early diagnosis; the lack of perception of ADHD was key to initiate access. Conclusion: The lack of perception could be avoided with information to the caregivers so that they perceive the nuclear symptoms of ADHD as potential mental health problems.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Attention Deficit Disorder with Hyperactivity/diagnosis , Caregivers , Symptom Assessment , Health Services Accessibility , Surveys and Questionnaires , Caregivers/statistics & numerical data , Sample Size , Early Diagnosis , School Teachers , Academic Performance/statistics & numerical data , Health Services Needs and Demand , Mothers/statistics & numerical dataABSTRACT
A perturbação de hiperatividade e déficit de atenção (PHDA) é considerada um dos problemas de comportamento e neurodesenvolvimento mais frequentes nas crianças e adolescentes em idade escolar, tanto em Portugal como a nível mundial. Além disso, a categorização diagnóstica da PHDA e a prescrição de psicoestimulantes como tratamento de primeira linha têm sido não só objeto de pesquisa científica e validação clínica, mas também alvo de polêmica e crítica social, sobretudo à luz do conceito de medicalização. Apesar do seu aspecto midiático e relevância em domínios tão diversos quanto os da educação, do medicamento, da saúde mental e dos apoios psicossociais, existe uma lacuna profunda na caracterização das dimensões históricas, socioéticas e institucionais da PHDA em Portugal. Aliando dados historiográficos e etnográficos à análise documental e da mídia, este artigo procura responder a esse desafio, traçando a trajetória social da PHDA neste país - desde a emergência da "hiperatividade" nos anos 1970/1980 ao debate público e político sobre a prescrição de psicoestimulantes. Dessa perspectiva interdisciplinar e por meio do estudo do caso português, procura contextualizar-se a definição, validação e ampliação da PHDA como parte de um processo dinâmico e socialmente situado na interseção de sistemas diagnósticos e farmacêuticos globais, contingências institucionais e socioeconômicas e, ainda, políticas públicas e especificidades locais. Discute-se, por fim, a forma como o caso da PHDA em Portugal contribui para o desenvolvimento de novas linhas de reflexão e de pesquisa interdisciplinar que permitem repensar o escopo social da saúde mental e da saúde global.
Attention deficit and hyperactivity disorder (ADHD) is considered one of the most frequent behavioral and neurodevelopmental problems in school-age children and adolescents, both in Portugal and worldwide. The diagnostic categorization of ADHD and the prescription of psychostimulants as its first-line treatment have been the object not only of scientific research and clinical validation, but also of controversy and social critique, especially in light of the concept of medicalization. Despite its high profile and salience in such diverse fields as education, pharmaceuticals, mental health, and public policy, a significant gap remains in the characterization of social-historical, ethical, and institutional dimensions of ADHD outside English-speaking countries. Combining historical and ethnographic research with document and media analysis, the article addresses that challenge by tracing the social trajectory of ADHD in Portugal, from the emergence of "hyperactivity" in the 1970s and 1980s to the current public and political debates on psychostimulant treatments and prescribing trends. From this interdisciplinary perspective and based on the Portuguese case study, the aim of this article is to contextualize the definition, validation, and expansion of ADHD as part of a dynamic and socially situated process in which global diagnostic and pharmaceutical systems intersect with institutional and socioeconomic contingencies, as well as local specificities and needs. More broadly, the article discusses how the case study of ADHD contributes to the development of interdisciplinary research that helps rethinking the social scope of mental health across local and global health contexts.
El trastorno de hiperactividad y déficit de atención (THDA) está considerado uno de los problemas de comportamiento y neurodesarrollo más frecuentes en niños y adolescentes en edad escolar, tanto en Portugal, como a nivel mundial. Asimismo, la categorización diagnóstica del THDA y la prescripción de psicoestimulantes como tratamiento de primera línea ha sido no sólo objeto de investigación científica y validación clínica, sino también objeto de polémica y crítica social, sobre todo a la luz del concepto de medicalización. A pesar de su cariz mediático y relevancia en dominios tan diversos como son los de la educación, del medicamento, de la salud mental y de los apoyos psicosociales, existe una laguna profunda en la caracterización de las dimensiones históricas, socio-éticas e institucionales del THDA en Portugal. Aunando datos historiográficos y etnográficos y al análisis documental, y de los medios de comunicación, este artículo procura responder a este desafío, trazando la trayectoria social del THDA en este país - desde la emergencia de la "hiperactividad" en los años 1970/1980 al debate público y político sobre la prescripción de psicoestimulantes. Desde esta perspectiva interdisciplinar, y a través del estudio del caso portugués, se intenta contextualizar la definición, validación y ampliación del THDA como parte de un proceso dinámico y socialmente situado, que atraviesa sistemas diagnósticos y farmacéuticos globales, contingencias institucionales y socioeconómicas e, incluso, políticas públicas y especificidades locales. Se discute, finalmente, la forma en la que el caso del THDA en Portugal contribuye al desarrollo de nuevas líneas de reflexión y de investigación interdisciplinaria que permiten repensar el campo social de la salud mental y de la salud global.
Subject(s)
Humans , Child , Adolescent , Portugal , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/drug therapy , Global Health , Brazil , Mental HealthABSTRACT
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.
Subject(s)
Humans , Male , Child , Adolescent , Parents , Attention Deficit Disorder with Hyperactivity/diagnosis , Parent-Child Relations , Psychometrics , Students , Brazil , Surveys and Questionnaires , Reproducibility of Results , Factor Analysis, StatisticalABSTRACT
Introducción. La neuropsicología es el estudio de los procesos cognoscitivos comportamentales y sus alteraciones cuando se encuentra presente un daño o disfunción cerebral. En el caso de la neuropsicología infantil, esta busca evaluar e intervenir los procesos cognitivos relacionados con el aprendizaje que influyen en el desempeño académico, social, familiar y adaptativo. Objetivo. Caracterización clínica de niños y adolescentes que consultaron en la unidad de neuropsicología del Instituto Neurológico de Colombia entre los años 2013 - 2018. Métodos. Investigación observacional, descriptiva y transversal para una sola muestra de pacientes. Se extrajeron 17.623 registros de pacientes menores de 18 años que consultaron al servicio de neuropsicología del Instituto Neurológico de Colombia. Se analizaron las variables de edad, sexo y diagnóstico, mediante análisis univariados y bivariados. Se empleó la Clasificación internacional de Enfermedades (CIE-10). Resultados. Los principales diagnósticos de la población infantil fueron perturbación de la actividad y de la atención (31.9%), trastorno mixto de las habilidades escolares (2.6%) y retraso mental leve: deterioro del comportamiento significativo que requiere atención o tratamiento (2.6%). Conclusiones. Estos resultados muestran los principales tipos de trastornos neuropsicológicos de la población perteneciente al departamento de Antioquia que consulta para valoración e intervención cognitiva, lo que favorece la implementación mecanismos de prevención, diagnóstico y tratamiento para la población infantil con alteraciones en el neurodesarrollo y sus familias, mejorando su funcionamiento social y escolar.
Introduction. Neuropsychology is the study of behavioral cognitive processes and their alterations when brain damage or dysfunction is present. In the case of childhood neuropsychology, it seeks to evaluate cognitive processes related to learning that influence academic, social, family and adaptive performance. Objective. Clinical characterization of children and adolescents who consulted in the neuropsychology unit of a Colombian Neurological Institute, between 2013 - 2018. Methods. Observational, descriptive and cross-sectional research for a single sample of patients. 17,623 records were extracted from patients under 18 who consulted the neuropsychology service of a neurological institute in the city. The variables of age, sex and diagnosis were analyzed, using univariate and bivariate analyses. The International Classification of Diseases (ICD-10) was used. Results. The main diagnoses of the child population were activity and attention disturbance (31.9%), a mixed disorder of school skills (2.6%), mild mental retardation: the significant decline of the behavior that requires attention or treatment. Conclusions. These results show the most frequent neuropsychologic diagnosis of the Antioquia department residents that consult for cognitive attention and treatment, this benefits the implementation of prevention, diagnosis and treatment mechanism for the infant population with neurodevelopment disturbance and their families, improving their social and school functioning.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Neurodevelopmental Disorders/diagnosis , Neurodevelopmental Disorders/epidemiology , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Autistic Disorder/diagnosis , Autistic Disorder/epidemiology , Cross-Sectional Studies , Colombia , Age and Sex Distribution , Intellectual Disability/diagnosis , Intellectual Disability/epidemiology , NeuropsychologyABSTRACT
Abstract Introduction There are only a few instruments available to assess behavioral problems in school-age children based on reports of physical education teachers. The Motor Behavior Checklist (MBC) was designed to be completed by this professional in free play-situations or during physical education classes to rate students' motor-related behavior using 5-point Likert scales. The MBC comprises 59 items distributed into two broadband factors (externalizing and internalizing) and seven behavior problem scales: rule breaking, hyperactivity/impulsivity, lack of attention, low energy, stereotyped behaviors, lack of social interaction, and lack of self-regulation. The objective of this study was to describe the translation and cross-cultural adaptation processes of the MBC into Brazilian Portuguese. Method The following procedures were conducted: forward translation of the original instrument, production of a synthesized version, back-translation, literal and semantic comparison, back-translator's evaluation of divergent items, synthesized version with back-translator's suggestions, clarity assessment of the synthesized version by professionals (physical education teachers), focus group to assess clarity indicators of the instrument, evaluation of adjustments by the author of the instrument, and production of the final version. Results The results indicated a satisfactory level of agreement between the original and the back-translated versions, with 68% of exact equivalence between the translated items and 16% of terms requiring minor adjustments. In the draft version, 84% of the items were evaluated as clear by physical education teachers. Conclusion The translated version has compatible content with the original version. Future studies should be conducted to assess the psychometric properties of the Brazilian Portuguese version of the MBC.
Resumo Introdução Existem poucos instrumentos disponíveis para avaliar problemas de comportamento em crianças em idade escolar com base no relato de professores de educação física. O Motor Behavior Checklist (MBC) foi criado para ser usado por este profissional observando a criança em uma situação de brincadeira livre ou nas aulas de educação física utilizando escalas Likert de 5 pontos. O MBC compreende 59 itens distribuídos em duas categorias (externalizantes e internalizantes) e sete escalas de problemas de comportamento: quebra de regras, hiperatividade/impulsividade, falta de atenção, baixa energia, comportamentos estereotipados, falta de interação social e falta de autorregulação. O objetivo deste estudo foi descrever o processo de tradução e adaptação transcultural do MBC para o português do Brasil. Método Os procedimentos foram: tradução do instrumento original, produção de uma versão sintetizada, retrotradução, comparação literal e semântica, parecer do retrotradutor sobre itens divergentes, versão síntese com as sugestões do retrotradutor, avaliação da clareza da versão síntese por profissionais (professores de educação física), grupo focal para avaliar indicadores de clareza do instrumento, avaliação dos ajustes pelo autor do instrumento e produção da versão final. Resultados Os resultados indicaram um nível satisfatório de concordância entre as versões originais e retrotraduzidas, com 68% de itens iguais e 16% de itens com poucas alterações. A versão síntese teve 84% dos itens avaliados como claros por professores de educação física. Conclusão A versão traduzida possui conteúdo compatível com a versão original. Estudos futuros deverão ser conduzidos para a verificação das propriedades psicométricas da versão em português brasileiro do MBC.
Subject(s)
Humans , Male , Female , Child , Attention Deficit Disorder with Hyperactivity/diagnosis , Impulsive Behavior/physiology , Interpersonal Relations , Motor Activity/physiology , Psychometrics , Attention Deficit Disorder with Hyperactivity/physiopathology , Translations , Brazil , Checklist , School TeachersABSTRACT
Abstract Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by neurodevelopmental delays. Physical activity (PA) may influence many of the same neurocognitive systems affected by ADHD. Therefore, PA may be a potential tool in treatment and management plans. This review synthesizes findings from studies investigating PA, fitness, and motor coordination. Studies of PA in youth on the spectrum for ADHD were considered in this paper. Main results include: a) cross-sectional studies: children with ADHD evidence PA levels higher than children that seem to be healthy. Childhood coincides with opportunities to free play; however, this advantage dissipates by adolescence, as PA programs become increasingly structured and less inclusive. In adulthood, individuals with ADHD are more likely to be obese and less likely to meet healthy lifestyle guidelines; b) longitudinal studies: PA at earlier stages predicts symptom severity in subsequent stages; and c) further studies: moderate PA activity of limited duration offers neurocognitive benefits. Multi-week intervention studies have tested diverse formats with results that differ based upon the chosen outcome and comparison group utilized. PA interventions that challenge cognition and fundamental movement skills in childhood provide benefits to children with ADHD. They also encourage children and adolescents to participate in structured programs, meet PA guidelines, and include short-term AF as part of daily routines.
Resumen El trastorno por déficit de atención e hiperactividad (TDAH) está caracterizado por retrasos en el desarrollo neurobiológico. La actividad física (AF) puede influir en varios de los mecanismos neurocognitivos que también son afectados por el TDAH; por lo tanto, puede considerarse parte de su tratamiento y manejo. Esta revisión sobre el trastorno resumirá estudios que evaluaron AF, aptitud física y coordinación motora. Fueron incluidos artículos sobre AF en la niñez en el espectro de TDAH. Entre los resultados se encuentran a) estudios transversales: los niños con TDAH presentan niveles de AF más altos que aquellos niños aparentemente saludables. La niñez coincide con oportunidades para participar en juego libre, pero esta ventaja es reducida durante la adolescencia, en la cual la AF es estructurada y menos inclusiva. Durante la adultez, las personas con TDAH están más propensas a ser obesas y a no adoptar las recomendaciones de estilos de vida saludables; b) estudios longitudinales: AF durante etapas tempranas predice la severidad de los síntomas del TDAH en etapas subsecuentes y c) otros estudios: la AF moderada de corta duración brinda beneficios neurocognitivos. Los resultados sobre intervenciones de varias semanas difieren según la variable de interés y el grupo con el cual es comparada la intervención. Las intervenciones de AF que retan las habilidades cognitivas y destrezas de movimientos brindan beneficios a los niños con TDAH. Además, estimulan a niños, niñas y adolescentes a participar en AF estructurada, a cumplir con la recomendación de AF y a incluir AF de corta duración como parte de las rutinas diarias.
Resumo O transtorno do déficit de atenção com hiperatividade (TDAH) caracteriza-se por retardo no desenvolvimento neurobiológico. A atividade física (AF) pode influenciar em vários dos mecanismos neurocognitivos que também são afetados pelo TDAH, portanto, pode ser considerada como parte de seu tratamento e manejo. Esta revisão sobre o transtorno resumirá os estudos que avaliaram a AF, a aptidão física e a coordenação motora. Artigos sobre AF infantil foram incluídos no espectro de TDAH. Entre os resultados estão a) estudos transversais: crianças com TDAH têm níveis mais altos de AF do que aquelas aparentemente saudáveis. A infância coincide com as oportunidades de participar de jogos livres, mas essa vantagem é reduzida durante a adolescência, na qual a AF é estruturada e menos inclusiva. Durante a idade adulta, as pessoas com TDAH são mais propensas a serem obesas e a não adotar as recomendações para terem estilos de vida saudáveis; b) Estudos longitudinais: A fase inicial de AF prediz a gravidade dos sintomas de TDAH nos estágios subsequentes e c) Outros estudos: A AF moderada de curta duração proporciona benefícios neurocognitivos. Os resultados em intervenções de várias semanas diferem segundo a variável de interesse e o grupo com o qual a intervenção é comparada. As intervenções de AF que desafiam habilidades cognitivas e habilidades de movimento proporcionam benefícios às crianças com TDAH. Além disso, estimulam crianças e adolescentes a participarem de AF estruturada, a cumprir a recomendação de AF e a incluir AF de curta duração como parte das rotinas diárias.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Attention Deficit Disorder with Hyperactivity/diagnosis , Exercise/psychology , Child Development , Mental Health , Motor SkillsABSTRACT
Abstract The debates around the diagnosis and pharmacological treatment of Attention Deficit and Hyperactivity Disorder (ADHD) have traditionally been approached from the perspective of the "medicalization processes" of children's behaviour. However, this perspective tends to overlook the meanings of diagnosis and treatment of ADHD for children and their caregivers. The purpose of this article is to describe the discursive positions of children and their caregivers on the diagnosis and treatment of ADHD. In-depth interviews were conducted with seven Chilean children and their caregivers. The material was analysed following the procedures of the discourse structure analysis. A discursive structure was identified that configures four emerging realities: the myth of origin of the child's behaviour and learning problems; the ambivalences in/of medicalization; the process of identity (dis)stabilization under diagnosis and treatment; and the subversion of medicalization. It is observed that the subjective experience of the diagnosis and treatment of ADHD is not homogeneous, since different discursive positions, family and institutional understandings that enter into conflict cross it. The experiences of ADHD are shaped by discursive structures that condition the meanings of this experience. The medicalization process is not univocal, but can take different forms and have consequences on children's experiences and social trajectories.
Resumen Los debates en torno al diagnóstico y tratamiento farmacológico del Trastorno de Déficit Atencional e Hiperactividad (TDAH) han sido tradicionalmente abordados desde la perspectiva de los "procesos de medicalización" del comportamiento infantil. Sin embargo, esta perspectiva tiende a pasar por alto los sentidos y significaciones del diagnóstico y tratamiento del TDAH para los niños y sus cuidadores. El objetivo de este artículo es describir las posiciones discursivas de niños y de sus cuidadores sobre el diagnóstico y tratamiento farmacológico del TDAH. Se realizaron entrevistas en profundidad a siete niños chilenos y a sus cuidadores. El material fue analizado siguiendo los procedimientos del análisis estructural del discurso. Se identificó una estructura discursiva que configura cuatro realidades emergentes: el mito de origen de los problemas de comportamiento y de aprendizaje del niño; las ambivalencias en/de la medicalización; el proceso de (des)estabilización identitaria bajo el diagnóstico y tratamiento; y la subversión de la medicalización. Se observa que la experiencia subjetiva del diagnóstico y tratamiento del TDAH no es homogénea, dado que se encuentra atravesada por distintas posiciones discursivas, comprensiones familiares e institucionales que entran en conflicto. Las experiencias del diagnóstico y tratamiento del TDAH se encuentran modeladas por estructuras discursivas que condicionan las posibilidades de dar sentido a dicha experiencia. El proceso de medicalización no es unívoco, sino que puede asumir formas diferentes y tener consecuencias diversas sobre las experiencias y trayectorias sociales de niños y niñas.
Subject(s)
Humans , Male , Female , Child , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/therapy , Chile , Medicalization , Language ArtsABSTRACT
Abstract Although research on ADHD has tended to ignore gender differentials, recent contributions produced mainly from epidemiology have revealed that this diagnostic category seems to be strongly related to gender. However, these contributions seem to limit their scope to the study of the symptoms as well as cognitive, affective and social functioning of children, leaving aside subjective aspects associated with the ADHD practices of diagnosis and treatment. Thus, this article aims to explore how the gender dimension crosses the subjective experience of children diagnosed with ADHD. Based on open interviews conducted with children between the ages of 7 and 13, we show general trends that articulate gender and characteristics associated with the ADHD diagnosis, while at the same time, with children's experiences that dislocate such trends. The findings were grouped according to four emerging axes: (1) locations, (2) abilities, (3) approches, (4) interactions. Thus, we will show how the experience of boys and girls is multiple in relation to the diagnosis and it is not possible to be reduced to a gender binary perspective.
Resumen Si bien las investigaciones sobre TDA-H han tendido a dejar los aspectos diferenciales de género en un lugar secundario, recientes contribuciones emanadas principalmente desde la epidemiología han revelado que esta categoría diagnóstica parece estar fuertemente relacionada con el reparto de los géneros. Sin embargo, dichas contribuciones parecen limitar sus alcances al estudio de la sintomatología y funcionamiento cognitivo, afectivo y social de los(as) niños(as), dejando de lado aspectos subjetivos asociados a las prácticas de diagnóstico y tratamiento de TDA-H. De este modo, el objetivo de este artículo es explorar cómo la dimensión de género configura la experiencia subjetiva de niños(as) diagnosticados(as) con TDA-H. A partir de la realización de entrevistas abiertas realizadas a niños entre 7 y 13 años, damos cuenta de tendencias generales que articulan género y características asociadas al diagnóstico de TDA-H, a la vez que, con experiencias infantiles que dislocan tales tendencias. Los resultados se agruparon en función de cuatro dimensiones emergentes del material producido en las entrevistas: (1) localizaciones; (2) habilidades; (3) abordajes; (4) interacciones. Así, mostraremos cómo la experiencia de niños y niñas es múltiple en relación al diagnóstico y no es posible reducirla a una perspectiva binaria en torno al género.
Subject(s)
Humans , Male , Female , Child , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Chile , Gender IdentityABSTRACT
Abstract The purpose of this article is to describe the subjective experience of the diagnosis of Attention Deficit and Hyperactivity Disorder (ADHD) and the cultural meanings that shape this experience. Based on interviews and discussion groups with diagnosed people and their families in Chile and France, this article show that ADHD can acquire multiple meanings. From a thematic analysis, we identified three registers or ways of living and thinking about ADHD. In the deficit register, the disorder is experienced primarily as a failure of certain abilities. In the disruption register, the disorder is experienced as disrupting the person's life, personality and interactions, which must then be normalized. In the register of hidden potential, on which this article focuses, ADHD is simultaneously thought of as a difficult and valuable condition, a source of exceptional capacities that are often hidden in the ordinary functioning of social life. We therefore invite reflection that identifies the factors of mobilization or non-mobilization of the hidden potential register, with particular emphasis not only on relational configurations, socio-economic variables, and the gender variable, but also on the institutional and political context of each country.
Resumo O objetivo deste artigo é descrever a experiência subjetiva do diagnóstico de Transtorno do Déficit de Atenção com Hiperatividade (TDAH) e os significados culturais que moldam essa experiência. Com base em entrevistas e grupos de discussão com pessoas diagnosticadas e suas famílias no Chile e na França, este artigo demonstra que diversos significados podem ser atribuídos ao TDAH. A partir de análise temática, foram identificados três registros ou modos de viver e pensar TDAH. No registro déficit, o transtorno é vivenciado primariamente como falha de certas habilidades. No registro distúrbio, o transtorno é vivenciado como uma perturbação da vida pessoal, personalidade e interações que necessita ser normalizada. No registro de potencial oculto, foco deste artigo, TDAH é considerado simultaneamente condição difícil e valiosa, fonte de capacidades excepcionais que estão habitualmente ocultas no andamento comum da vida social. Portanto, propõe-se refletir e identificar os fatores de mobilização e não mobilização do registro de potencial oculto, com particular ênfase não só nas configurações relacionais, variáveis socioeconômicas e de gênero, mas também no contexto institucional e político de cada país.