Diabetes materna y trastornos del neurodesarrollo en los hijos / Maternal diabetes and neurodevelopmental disorders in offspring

Resumen La diabetes durante el embarazo se asocia a un mayor riesgo perinatológico para los niños. Este puede reducirse significativamente con un control glucémico adecuado en estadios tempranos de la gestación. En la última década nuevos estudios han mostrado los efectos deletéreos de la diabetes materna en la salud de los hijos a largo plazo, como las alteraciones del neurodesarrollo y los efectos sobre el pronóstico educacional y ocupacional. Las mismas pueden ser clasificadas, desde el punto de vista clínico-diagnóstico en tres grupos principales: trastornos del aprendizaje y del desarrollo intelectual, trastorno por déficit de atención e hiperactividad y trastornos del espectro autista. El presente trabajo tiene como objetivo realizar una actualización no sistemática de la evidencia más reciente en el tema y comprender los mecanismos subyacentes que provocan el daño, con el fin de desarrollar estrategias preventivas.

Abstract Diabetes during pregnancy is associated with adverse effects on offspring perinatal outcomes. These could be reduced significantly with an adequate glycemic control in early stages of gestation. In the last decade, new studies have shown the effects of maternal diabetes in the long-term health of the offspring, like impaired neurodevelopment and its impact on educational and occupational outcome. This can be classified, from the clinical and diagnostic perspective, in three main groups: learning and cognitive disorders, attention deficit hyperactivity disorder and autism spectrum disorders. This paper has the objective to give a non-systematic upgrade of the current evidence on the subject, and to understand the underlying mechanisms of adverse neurodevelopmental outcomes which in turn may lead to strategies for its prevention.

Características clínicas del trastorno de déficit atencional e hiperactividad en epilepsia / Clinical features of the attentional deficit and hyperactivity disorder in epilepsy

La epilepsia y el trastorno por déficit de atención e hiperactividad (TDAH) son condiciones frecuentes en pediatría y suelen presentarse asociadas en muchos pacientes. Su relación es compleja y comparten comorbilidad psiquiátrica. Los pacientes con ambas condiciones conjuntas, epilepsia y TDAH, se presentan con igual frecuencia en ambos géneros, predominando la presentación inatenta. El déficit cognitivo incrementa el riesgo de asociar TDAH en pacientes con epilepsia. No hay evidencia suficiente para otros factores de riesgo, sin embargo, se puede anticipar su presencia en pacientes con algunos tipos de epilepsia y con modelos neuropsicológicos que evidencian la disfunción de redes subyacentes. Se revisa la relación con el control de crisis, las alteraciones electroencefalográficas y los fármacos antiepilépticos (FAEs). Se describen las recomendaciones para reducir efectos adversos de FAEs. El diagnóstico de TDAH en pacientes con epilepsia debe partir por la sospecha, a través de instrumentos clínicos y valoraciones de funcionamiento cognitivo. El tratamiento multimodal es recomendado para pacientes con TDAH con y sin epilepsia. Los psicoestimulantes se pueden usar con seguridad. La calidad de vida se afecta en pacientes y sus familias, por lo que la educación, pesquisa precoz y referencia para rehabilitación, están encaminadas a resolver las dificultades de estos pacientes. En caso contrario, se generan consecuencias negativas escolares, sociales y emocionales, que pueden ser relevantes y persistentes.

Epilepsy and attention deficit and hyperactivity disorder (ADHD) are frequent conditions in pediatrics. Their association is frequent and complex, often sharing psychiatric comorbidity. Patients who present epilepsy and ADHD, show equal frequency in both genders, with the inattentive type, as predominant presentation. Cognitive deficit increases the risk of associating ADHD in patients with epilepsy. There is not enough evidence for other risk factors, however there is enough information that allows to ant icipate its presence in some types of epilepsy, with neuropsychological models that evidence the underlying network dysfunction. The relationship with frequency and seizure control, electroencephalographic alterations and antiepileptic drugs (AEDs) is also reviewed. Recommendations to reduce adverse effects of AEDs are described. The diagnosis must therefore be based on suspicion, through clinical instruments and assessments of cognitive functioning. Multimodal treatment is also recommended in patients with ADHD with and without epilepsy. Psych stimulants can be used safely. The quality of life of the patients and their families is affected, so it is advisable for them to be supported by a specialized team that could provide education, early assessment and therapy. If they are omitted, the consequences can be negative at school, social environment and emotional development, which could be relevant and become persistent.

Tyrosinemia type iii: a case report of siblings and literature review / Tirosinemia tipo iii: descrição de caso clínico em irmãos e revisão da literatura

ABSTRACT Objective: Tyrosinemia type III (HT III) is the rarest form of tyrosinemia, and the full clinical spectrum of this disorder is still unknown. The neurological involvement varies, including intellectual impairment and attention deficit disorder with hyperactivity (ADHD). We report the case of two siblings diagnosed with HT III at different ages. Case description: The index case was diagnosed by newborn screening for endocrine and metabolic disorders, starting a low-protein diet immediately, with a consistent decrease in tyrosine levels. By the age of three, the child displayed a hyperactive behavior, starting treatment for ADHD two years later. At seven years of age, he shows a slight improvement in terms of behavior and attention span and has a cognitive performance slightly lower than his peers, despite maintaining acceptable tyrosine levels. His sister, who had a history of ADHD since age five, was diagnosed with HT III after family screening at the age of eight. Despite initiating a dietetic treatment, her behavior did not improve, and she has a mild intellectual impairment. Comments: This is the first case report describing siblings with HT III who underwent nutritional treatment with a low-protein diet in different phases of life, with a better neurological and behavioral evaluation in the patient who started treatment earlier.

RESUMO Objetivo: A tirosinemia tipo III (TT III) é a forma mais rara das tirosinemias e o espectro clínico desta entidade não está totalmente esclarecido. O envolvimento neurológico é variável, incluindo o atraso cognitivo ou transtorno do déficit de atenção com hiperatividade (TDAH). Descrevemos o caso de dois irmãos que foram diagnosticados com TT III em idades diferentes. Descrição dos casos: O caso índice foi diagnosticado no contexto do rastreio endócrino-metabólico neonatal, tendo iniciado imediatamente dieta hipoproteica, com redução consistente dos níveis de tirosina. Por volta dos três anos, foi detectado um comportamento hiperativo, tendo iniciado dois anos depois tratamento para o TDAH. Aos sete anos, apresenta leve melhora de comportamento e da atenção e avaliação cognitiva levemente inferior ou pouco abaixo quando comparado a crianças da mesma faixa etária, apesar de manter níveis aceitáveis de tirosina. A sua irmã, com história de TDAH desde os cinco anos, foi diagnosticada de TT III aos oito anos no contexto do rastreio de familiares. Apesar de iniciar tratamento dietético, nenhum efeito foi notado em termos de comportamento e a doente apresenta leve atraso cognitivo. Comentários: Este é o primeiro caso clínico descrito de irmãos com TT III que iniciaram terapêutica dietética com dieta hipoproteica em diferentes fases da vida, com melhor avaliação em termos neurológicos e comportamentais no doente que iniciou tratamento mais precocemente.

Factores de riesgo y bases genéticas: el caso del trastorno por déficit de atención e hiperactividad / Risk factors and genetic bases: the case of attention deficit hyperactivity disorder

RESUMEN El trastorno por déficit de atención e hiperactividad (TDAH) es el trastorno mental considerado más frecuente en la infancia. Si bien su diagnóstico en el manual de psiquiatría hoy más utilizado en el mundo, el Diagnostic and statistical manual of mental disorders (DSM-5), se basa en los comportamientos de desatención, hiperactividad e impulsividad, se encuentran numerosos intentos de describir las bases biológicas del trastorno para usarlos con fines de diagnóstico y como marcadores de riesgo. En este trabajo analizamos críticamente la validez de los estudios asociados a la búsqueda de marcadores genéticos para el TDAH. En primer lugar, se presenta la caracterización del TDAH en el manual DSM-5; luego, se desarrolla el vínculo entre el TDAH y los factores de riesgo y los marcadores genéticos; y, finalmente, se presentan algunas conclusiones en las que se señalan simplificaciones y omisiones que pueden tener consecuencias significativas.

ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is considered to be the most frequent mental disorder in childhood. Although its diagnosis in the most utilized handbook of psychiatry in the world today - the Diagnostic and statistical handbook of mental disorders (DSM-5) - is based on behaviors of inattention, hyperactivity and impulsivity, numerous attempts to describe the biological bases of the disorder can be found, to be used for and also as risk markers. In this paper, we will critically analyze the validity of studies associated with the search for genetic markers of ADHD. First, a characterization of ADHD by the DSM-5 handbook is presented. Subsequently, the link between ADHD, risk factors and genetic markers is developed. Finally, some conclusions are presented which highlight simplifications and omissions that could have significant consequences.

Caracterización, alcances y dificultades de las "bases biológicas" del Trastorno por Déficit de Atención e Hiperactividad (TDAH). Un enfoque desde la Filosofía de la Biología / Caracterização, alcances e dificuldades das "bases biológicas" do Transtorno do Déficit de Atenção e Hiperatividade (TDAH). Uma abordagem a partir da Filosofia da Biologia / Characterization, scope and difficulties of the "biological bases" of attention deficit hyperactivity disorder (ADHD). An approach from the Philosophy of Biology

Resumen El trastorno por déficit de atención e hiperactividad (TDAH) se encuentra entre los trastornos psiquiátricos infantiles más prevalentes en la actualidad y, desde áreas biomédicas y neurobiológicas, se considera que presenta una base biológica. En el presente trabajo se analizarán, desde una aproximación filosófica, los discursos que se despliegan desde dichas investigaciones con el objetivo de detectar y clarificar diversos aspectos fenoménicos, teóricos y ontológicos que le subyacen. En términos generales, hemos encontrado que la conceptualización del TDAH está atravesada por al menos cuatro niveles de organización diferentes: genético-molecular (genes y proteínas), tisular (partes del cerebro), órgano (cerebro como un todo) y el organísmico (individuo). Dichos niveles ocupan roles sumamente diferentes; ocupando los niveles inferiores de organización roles predominantes en lo explicativo así como presentando las entidades fundamentales en términos ontológicos. A su vez, el discurso neurocientífico presenta sesgos relacionados con la pérdida de consideración de la heterogeneidad, la omisión de los niveles superiores al organísmico y simplificaciones del ámbito genético-molecular y de la relación genotipo-fenotipo. Así, el tipo de indagación simplificante y que prepondera los niveles inferiores de la jerarquía biológica parece mostrar más dificultades que éxitos, y epistémicamente muestra grietas que no son saldadas.

Resumo O transtorno do déficit de atenção e hiperatividade (TDAH) encontra-se entre os transtornos psiquiátricos infantis mais prevalecentes na atualidade e considera-se, nas áreas biomédicas e neurobiológicas, que ele apresenta uma base biológica. No presente trabalho serão analisados, a partir de uma perspectiva filosófica, os discursos que se desdobram das pesquisas das áreas referidas, com o objetivo de detectar e esclarecer diversos aspectos fenomênicos, teóricos e ontológicos que lhes são subjacentes. Em termos gerais, encontramos que a conceitualização do TDAH está atravessada por pelo menos quatro níveis de organização diferentes: genético-molecular (genes e proteínas), tissular (partes do cérebro), órgão (cérebro como um todo) e o organismo (indivíduo). Esses níveis ocupam papéis sumamente diferentes, estando nos níveis inferiores de organização papéis predominantes no explicativo, assim como apresentam as entidades fundamentais em termos ontológicos. Por sua vez, o discurso neurocientífico contém um viés relacionado com a perda de consideração da heterogeneidade, a omissão dos níveis superiores ao organismo e simplificadores do âmbito genético-molecular e da relação genótipo-fenótipo. Assim, o tipo de indagação simplificadora e preponderante dos níveis inferiores da hierarquia biológica parece mostrar mais dificuldades que êxitos e epistemicamente mostra fissuras que não saldadas.

Abstract Attention deficit hyperactivity disorder (ADHD) is among the most prevalent psychiatric disorders in children at present and, from biomedical and neurobiological areas, it is considered to have a biological basis. In the present work we analyzed from a philosophical approach, the discourses deployed from these investigations in order to detect and clarify various phenomenal, theoretical and ontological aspects that underlie it. In general terms, we have found that the conceptualization of ADHD is traversed by at least four different organizational levels: genetic-molecular (genes and proteins), tissue (parts of the brain), organ (brain as a whole) and the organismic (individual). These levels occupy very different roles; lower levels of organization occupying predominant explanatory roles as well as presenting the fundamental entities in ontological terms. In turn, the neuroscientific discourse presents biases related to the loss of consideration of heterogeneity, the omission of levels superior to organismic and simplifications of the genetic-molecular domain and the genotype-phenotype relation. Thus, the type of simplifying inquiry in the lower levels of the biological hierarchy seems to show more difficulties than successes, and epistemically shows cracks that are not settled.

Hábitos tóxicos en adolescentes y jóvenes con problemas de aprendizaje, 2011-2013 / Toxic habits observed in adolescents and young people with learning difficulties, 2011-2013

Introducción: Los adolescentes y jóvenes con problemas de aprendizaje presentan comorbilidades con los hábitos tóxicos. Objetivos: Identificar la conducta de adolescentes y jóvenes con trastorno del aprendizaje ante el consumo de alcohol y tabaco. Métodos: Estudio epidemiológico de corte trasversal realizado en una muestra de 227 adolescentes y jóvenes, con edades entre los 15 y 23 años del Consejo Popular Cayo Hueso de Centro Habana. Se conformaron tres grupos. 1. Sujetos contrastorno por déficit de atención con hiperactividad, 2. Sujetos contrastorno de aprendizaje, 3. Sujetos conproblemas de aprendizaje inespecífico tomado como grupo control. Se aplicó un cuestionario para obtener los datos. Resultados: En el grupo con trastorno por déficit de atención con hiperactividad fue significativo fumar más de 10 cigarrillos al día, lo que representóser 3,7 veces más frecuente en estos jóvenes en comparación con el grupo control. En el grupo con trastorno de aprendizaje,las conductas más importante, sin significación estadística, pero representada por el 50 por ciento de los participantes o más fue consumir bebidas alcohólicas todos los fines de semana o más frecuentemente y fumar por primera vez antes de los 16 años. Conclusiones: Los adolescentes y jóvenes con trastornos específico del aprendizaje consumen alcohol y tabaco de forma cercanaa los que no tiene estos problemas; en los que tienen hiperactividad es marcado el consumo de tabaco y su inicio precoz. Estos hábitos tóxicos pudieran perdurar hasta la adultez, con la carga familiar y social que conllevan(AU)

Introduction: Adolescents and young people with learning disorders show comorbities with toxic habits. Objective: To identify the behavior of adolescents and young people with learning difficulties regarding alcohol consumption and smoking. Methods: A cross-sectional epidemiological study was conducted in a sample of 227 adolescents and young people aged 15 to 23 years-old from Cayo Hueso neighborhood in Centro Habana municipality. Three groups were formed. First: Subjects with attention deficit hyperactivity disorder, second: Subjects with learning disorder, and third: Subjects with unspecific learning problems taken as a control group. A questionnaire was given to them to collect data. Results: In the group with attention deficit hyperactivity disorder, the most significant problem was smoking more over 10 cigarettes a day, which was 3.7 times more frequent than in the control group. In the group with learning disorders, the most common behaviors, not statistically significant but represented by 50 percent of participants or over, were taking alcohol every weekend or more frequently and first smoking before being 16 years-old Conclusions: Alcohol intake and smoking in adolescents and young people with specific learning disorders are similar to those of their counterparts who do not face these problems. First smoking at early ages is remarkable in adolescents and young people with hyperactivity. These toxic habits may persist into adulthood, with all the family and social burden that these conditions entail(AU)

Impaired executive functions in experimental model of temporal lobe epilepsy / Prejuízo das funções executivas no modelo experimental de epilepsia do lobo temporal

ABSTRACT Objective The present study aimed to investigate cognitive and behavioural changes consistent with attention deficit hyperactivity disorder (ADHD -like behavior in male Wistar rats with temporal lobe epilepsy (TLE). Method Male Wistar rats at 25 day of age were submitted to animal model of TLE by pilocarpine injection (350 mg/kg, ip) and a control group received saline 0.9%. The animals were continuously video monitored up to the end of experiments. The behavioural tests (open field, elevated plus maze and operant conditioning box) started from 60 days postnatal. Results Animals with TLE exhibited elevated locomotor activity, reduced level of anxiety-related behavior, impulsivity and impaired visuospatial working memory. Conclusion Taken as a whole, we concluded that animals with TLE exhibited some cognitive and behavioural changes consistent with ADHD-like behavior.

RESUMO Objetivo O presente estudo teve como objetivo investigar as alterações cognitivas e comportamentais consistentes com o comportament de transtorno de deficit de atenção e hiperatividade (TDAH) -like em ratos Wistar machos com epilepsia do lobo temporal (ELT). Método Ratos Wistar machos com 25 dias de vida foram submetidos a modelo animal de ELT pela injeção de pilocarpina (350 mg / kg, ip) e grupo controle recebeu salina 0,9%. Os animais foram monitorados continuamente por vídeo até ao final dos experimentos. Os testes comportamentais (campo aberto, labirinto em cruz elevado e caixa de condicionamento operante) começaram a partir de 60 dias pós-natal. Resultados Os animais com ELT exibiram aumento da atividade locomotora, redução do comportamento relacionado com a ansiedade, impulsividade e prejuízo da memória de trabalho visuospatial. Conclusão Em conjunto, concluímos que os animais com ELT apresentaram algumas alterações cognitivas e comportamentais consistentes com o comportamento TDAH-like.

Patients with essential tremor can have manual dexterity and attention deficits with no impairments in other cognitive functions / Pacientes com tremor essencial podem apresentar prejuízo na destreza manual e déficit de atenção sem prejuízo em outras áreas da cognição

ABSTRACT Essential tremor (ET) was long believed to be a monosymptomatic disorder. However, studies have evidenced structural changes and attention is now being focused on non-motor symptoms. The objective of the study is to describe and compare ET patients with control groups according to their cognitive functions, and secondarily, to compare their sociodemographic characteristics and other clinical features. All participants were assessed using the Fahn-Tolosa-Marin Tremor Rating Scale for the severity of tremor; a neuropsychological assessment battery and a screening questionnaire for mood and anxiety symptoms. There were no significant age and gender differences between all groups. As for neuropsychological assessment results, a significant difference was found only in the Pegboard test. We also found a significant negative correlation between a poorer cognitive test results and disease severity and a significant differences regarding depression or anxiety symptoms in patients with ET. The study results suggest that patients with ET have impaired manual dexterity and attention.

RESUMO O tremor essencial (TE) era considerado como um transtorno monossintomático. Contudo estudos tem demonstrado alterações anatômicas despertando o interesse para sintomas não-motores.O objetivo do estudo é descrever e comparar pacientes com grupos controles segundo suas funções cognitivas, e secundariamente, comparar suas características demográficas e outros sintomas clínicos. Todos os participantes foram submetidos à escala de Fahn, Tolosa e Marin para avaliação da intensidade do tremor, a uma bateria neuropsicológica e a um questionário para detecção de transtorno de humor e ansiedade. Não houve diferença significativa na idade e gênero entre todos os grupos. Quanto ao resultado da avaliação neuropsicológica, foi encontrado uma diferença significativa apenas no Test Pegboard. Nós também encontramos uma correlação negativa no desempenho dos testes cognitivos e intensidade do tremor, presença de sintomas depressivos e ansiosos. Os resultados deste trabalho sugerem que pacientes com TE apresentem alteração na destreza manual e na atenção.

Dysfunctional family environments and childhood psychopathology: the role of psychiatric comorbidity / Ambientes de famílias disfuncionais e psicopatologia infantil: o papel da comorbidade psiquiátrica

Introduction: The study of the association between specific characteristics of family environments and different types of psychopathology may contribute to our understanding of these complex disorders and ultimately inform therapeutics. Objective: To compare the family characteristics of four groups: typically developing children; children with anxiety disorders only; children with externalizing disorders only; and children with both anxiety and externalizing disorders. Methods: This study enrolled 115 individuals from the community. Child psychiatrists made psychiatric diagnoses using a structured clinical interview. The Family Environment scale was used to evaluate six domains of family function. Results: The group with both anxiety and externalizing disorders had higher levels of conflict in family environment and lower levels of organization when compared with typically developing children. In addition, internalizing and externalizing symptoms were positively associated with conflict and negatively with organization. Maternal depressive and anxious symptoms were also associated with higher conflict and lower organization scores. Conclusion: An important between-group difference in comorbid cases of anxiety and behavioral disorders suggests that children with this comorbidity are potential candidates for family interventions to address family conflicts and organizational aspects (AU)

Introdução: O estudo da relação entre características específicas do ambiente familiar e os diferentes tipos de psicopatologias pode contribuir para o nosso entendimento desses complexos transtornos e possivelmente gerar informações para seu tratamento. Objetivo: Comparar as características familiares de quatro grupos: Crianças com desenvolvimento típico; crianças com transtornos de ansiedade apenas; crianças com transtornos de externalização apenas; e crianças com transtornos de ansiedade e de externalização. Métodos: Cento e quinze indivíduos foram recrutados na comunidade. Psiquiatras pediátricos usaram uma entrevista clínica estruturada para estabelecer os diagnósticos psiquiátricos. A Escala do Ambiente Familiar (Family Environment) foi usada para avaliar os seis domínios de funcionamento da família. Resultados: O grupo que apresentava tanto transtornos de ansiedade quanto de externalização apresentou níveis mais altos de conflito e níveis mais baixos de organização quando comparados com as crianças com desenvolvimento típico. Além disso, os sintomas de externalização e internalização estavam positivamente relacionados a conflitos e negativamente a organização. Sintomas depressivos e de ansiedade da mãe também se mostraram relacionados a resultados mais altos para conflito e mais baixos para organização. Conclusão: Uma importante diferença entre grupos em casos de comorbidades de transtornos de ansiedade e de comportamento sugerem que as crianças com esta comorbidades são candidatos em potencial para intervenções familiares que abordem conflitos familiares e aspectos organizacionais (AU)

Historical and diagnostic trajectory of attention deficit hyperactivity disorder (ADHD): a literature review / Trajetória histórica e diagnóstica do transtorno de déficit de atenção e hiperatividade (TDAH): uma revisão da literatura

The attention deficit hyperactivity disorder (ADHD), considered a common cause of disorders in children and adolescents, is a neurobiological condition characterized by inattention and disorganization, hyperactivity and impulsivity. The first reports emerged in the sixteenth century and since then a process that extends to the present time to establish the best nomenclature, process diagnosis, etiology and its clinical characteristics has started. As this is a long and fragmented process, it becomes necessary to conduct a review of the main topics related to the subject, including its historical context. The aim of this study is to present, through the literature review, an over­ view of the main historical aspects, diagnosis and clinical of ADHD. To do so, we conducted a search of the databases with the following keywords: "ADHD", "prevalence", "etiology", "diagnosis", "clinical manifestation" and "comorbidities", combined or not, in native and not native languages (English). The articles were selected according to the objectives of the study. As it is considered a complex and heterogeneous disorder, as well as for not having a well­defined etiological process, and for suffering diagnostic tendencies, more studies are needed

O transtorno de déficit de atenção e hiperatividade (TDAH), consi­derado uma causa comum de doenças em crianças e adolescentes, é uma condição neurobiológica caracterizada pela desatenção e desorganização, hiperatividade e impulsividade. Os primeiros relatos surgiram no século XVI, e desde então um processo que se estende até o presente momento para estabelecer a melhor nomenclatura, o diagnóstico de processos, a etiologia e suas características clínicas teve início. Como esse é um processo longo e fragmentado, torna­se necessário proceder com revisão dos principais temas relacionados ao assunto, incluindo seu contexto histórico. O objetivo deste estu­do é apresentar, por meio de revisão de literatura, uma visão geral dos principais aspectos histórico, diagnóstico e clínico de TDAH. Para isso, foi realizada uma pesquisa dos bancos de dados com as seguintes palavras­chave: "TDAH", "prevalência", "etiologia", "diagnóstico", "manifestações clínicas" e "comorbidades", combinadas ou não, em línguas nativas e não (inglês). Os artigos foram selecionados de acordo com os objetivos do estudo. Como ele é considerado um dis­túrbio complexo e heterogêneo, bem como por não ter um processo etiológico bem definido, e por sofrer tendências de diagnóstico, são necessários mais estudos

Funciones atencionales de pacientes pediátricos receptores de trasplante alogénico de células progenitoras hematopoyeticas / the function of attention in pediatric allogenic hematopoietic stem cell transplant recipients

Se incluyeron 28 pacientes, el 75% de sexo masculino, con una mediana de edad de 13 años (r 8-17). Se utilizaron las siguientes pruebas: Enfocar-Ejecutar: Stroop y Trail Making A; Sostener la Atención: D2; Codificar la Información (Memoria de Trabajo): Tomal; Capacidad de cambiar la atención adaptativamente: Trail Making B y Wisconsin. Se administró también un test de inteligencia abreviado (KBit). Los pacientes fueron evaluados antes del ingreso a la unidad de trasplante y un año después si se encontraban en seguimiento ambulatorio y en remisión de la enfermedad que motivo el TCPH. También fue estudiado un grupo control de niños y adolescentes sanos, sin trastornos de aprendizaje, de dos escuelas. Se compararon los resultados de los pacientes antes del TCPH con el grupo control y los resultados pre y post TCPH de los 17 que pudieron ser evaluados al año. Se utilizó la prueba t de Student y se consideró significativa una p< 0,05. En la evaluación previa al TCPH los pacientes presentaban resultados significativamente inferiores a los controles para las siguientes prueba: Wisconsin, Trail Making A y B, Stroop, D2 y K-Bit, lo que implicaría compromiso de las siguientes funciones cognitivas: Atención sostenida, Enfocar - ejecutar y Funciones ejecutivas respectivamente, debido a que tomamos el modelo de Misky en donde el cambio adaptativo de la atención está implicando a las funciones ejecutivas. En la evaluación posterior al TCPH se observaron pocas diferencias respecto a la evaluación inicial, que involucraron el sostén de la atención, la capacidad de cambiar el foco de la misma y las funciones ejecutivas. Conclusión: los pacientes llegan al TCPH con un compromiso previo de sus funciones atencionales que podría estar relacionado con las limitaciones para la actividad escolar, producto de la enfermedad y tratamientos previos. Esta situación podría afectar su rendimiento académico posterior y ser un factor de riesgo de fracaso escolar.

Developments and challenges in the diagnosis and treatment of ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, often associated with other psychiatric comorbidities, functional impairments, and poor long-term outcomes. The objective of this selected review is to describe current advances and challenges in the diagnosis and treatment of ADHD. The disorder is associated with neurobiological underpinnings and is highly heterogeneous in various aspects, such as symptom profiles, cognitive impairments, and neurobiological and genetic features. The efficacy and safety of short-term pharmacological treatments across the life cycle is well studied, but further research investigating long-term treatment, impact of treatment in preschoolers, and non-pharmacological interventions is needed. Future research is also needed to better characterize the neurodevelopmental pathways of the disorder, linking clinical and neurobiological information, less investigated populations, and new interventions.

Early Risk Factors for Depressive Symptoms among Korean Adolescents: A 6-to-8 Year Follow-up Study

Depression during adolescence is critical to the individual's own development. Hence, identifying individuals with high-risk depression at an early stage is necessary. This study aimed to identify childhood emotional and behavioral risk factors related to depressive symptoms in Korean adolescents through a longitudinal study. The first survey took place from 1998 to 2000, and a follow-up assessment conducted in 2006, as the original participants reached 13-15 yr of age. The first assessment used the Korean version of Child Behavior Checklist and a general questionnaire on family structure, parental education, and economic status to evaluate the participants. The follow-up assessment administered the Korean Children's Depression Inventory. Multiple regression analysis revealed that childhood attention problems predicted depressive symptoms during adolescence for both boys and girls. For boys, family structure also predicted adolescent depressive symptoms. This study suggests that adolescents with attention problems during childhood are more likely to experience depressive symptoms.

Is there an association between perinatal complications and ttention-deficit/hyperactivity disorder-inattentive type in children and adolescents? / Existe alguma associação entre complicações perinatais e transtorno de déficit de atenção/hiperatividade - subtipo desatento em crianças e adolescentes?

OBJECTIVE: The objective of the present study is to investigate the association between attention deficit/hyperactivity disorder (ADHD), predominantly inattentive type (ADHD-I) and prenatal, delivery and early postnatal complications (PDPC). METHOD: In a case-control design, we assessed a sample of 124 children and adolescents with ADHD-I and 124 non-ADHD controls (6-17 years old) from both a non-referred (n = 200) and a clinical sample (n = 48). Cases and controls, matched by gender and age, were systematically evaluated through structured diagnostic interviews. Prenatal, delivery and early postnatal complications (PDPC), as well as potential confounders were evaluated by direct interview with biological mothers. RESULTS: Conditional logistic regression analysis showed that children and adolescents whose mothers presented more PDPC had a significantly higher risk for ADHD-I (p = 0.005; OR = 1.25; CI 95%: 1.1-1.5). CONCLUSIONS: In a case-control study, we expanded to ADHD-I previous findings suggesting the association between perinatal factors and broadly defined ADHD. Due to the preventable nature of some of these PDPC, our results have clear impact in public mental health policies.

OBJETIVO: O objetivo desse estudo é investigar a associação entre complicações perinatais (complicações ocorridas nos períodos pré, peri e pós-natal imediato -CPPs) e transtorno de déficit de atenção/hiperatividade (TDAH) do subtipo desatento (TDAH-D). MÉTODO: Em um estudo de casos e controles, foram avaliadas 124 crianças e adolescentes (6-17 anos) com TDAH-D e 124 controles sem a doença, provenientes tanto de uma amostra populacional (n = 200), quanto de uma amostra clínica (n = 48). Casos e controles, pareados por gênero e idade, foram sistematicamente avaliados através de entrevistas diagnósticas estruturadas. Informações sobre as complicações ocorridas durante os períodos pré, peri e pós-natal imediato (CPPs), assim como sobre potencias confundidores, foram obtidas através de entrevistas realizadas diretamente com as mães biológicas. RESULTADOS:A análise de regressão logística condicional mostrou que para as crianças e adolescentes cujas mães apresentaram maior número de CPPs, o risco de TDAH-D foi significativamente mais elevado (p = 0.005; OR = 1.25; IC 95%: 1.1-1.5). CONCLUSÕES: Em um estudo de caso-controle, foi possível expandir, para o TDAH predominantemente desatento, os achados prévios que sugeriam a associação entre complicações perinatais e TDAH sem um subtipo específico. Em virtude da possibilidade de prevenção de algumas dessas complicações, nossos resultados podem exercer impacto sobre políticas públicas de saúde.

Efectos de la prematurez sobre el desarrollo cognitivo y la atención en etapa escolar / Effects of prematurity on cognitive development and attention at school age

Gracias a los avances tecnológicos, los niños prematuros con discapacidades físicas mayores han disminuido su prevalencia; actualmente, los defectos cognitivos son la secuela predominante. Se investigó el desarrollo cognitivo y la atención en escolares con antecedentes de haber sido recién nacidos prematuros, a través de un estudio descriptivo, de corte transversal, en que se realizaron evaluaciones neuropsicológicas mediante WISC-R y test de Gordon a niños escolares con antecedentes de prematurez (EG<33s y/o PN<1500g) y niños controles con antecedentes de ser recién nacidos de término. Se evaluó a 77 pacientes: 40 niños prematuros (EG: 30,5 s) y 37 de término, entre 6-7 años. Aunque ambos grupos obtuvieron un CIT dentro del rango normal, se observó diferencias significativas (p<0,03) en desmedro del grupo prematuro en comparación con controles. Las habilidades atencionales también fueron significativamente menores para los prematuros (p< 0,01). Los niños prematuros se encuentran en riesgo de presentar problemas cognitivos y/o de atención en la etapa escolar. Se sugiere incorporar instrumentos de pesquisa de estas dificultades durante el seguimiento, que permitan un reconocimiento precoz e intervención oportuna.

The prevalence of premature children with major physical disabilities has diminished over time mainly due to advances in technology. Cognitive disorders are currently the main sequels. In order to study cognitive and attentional functioning of extremely premature infants at school age, a cross sectional study was designed. Neuropsychological assessments were performed by WISC-R and Gordon test, in prematures and controls at school age. Seventy seven children, 40 preterm (GA: 30.5 w) and 37 term at birth, aged 6-7 years-old were assessed. Although both groups obtained an overall IQ within the normal range, prematures showed significantly lower scores than the control group (p< 0.03). Attentional skills were also significantly lower (p <0.01) in the premature children. Children with a history of extreme prematurity are at risk for cognitive and attention impairment at school age. We suggest to introduce screening tools during follow-up which allow early recognition and appropriate intervention.

Advances and considerations in attention-deficit/hyperactivity disorder pharmacotherapy

Attention-deficit/hyperactivity disorder [ADHD] is a highly heritable neuropsychiatric disorder associated with significant impairments in occupational, academic, neuropsychological, and social functioning. Central nervous system [CNS] stimulants are recommended as first-line medication therapy for children. CNS stimulants include formulations of methylphenidate and amphetamine derivatives and are available in a large variety of immediate-and extended-release preparations. Extended-release preparations are often preferred to limit drug administration during school or work and may help to limit side effects associated with rapid fluctuations in serum concentration. Stimulant medication is by far the most commonly used treatment in managing children with ADHD, 10-20% of those who take such medication do now show clinically significant improvements in their primary ADHD symptom. Even when a favorable response is obtained, some children experience side effects that are of sufficient occurrence and severity to prevent continued use of stimulant medication. In such instances or when families are unwilling to consider a stimulant, non-stimulant medications may be appealing. This review focuses on etiology, assessment and treatment of ADHD with various stimulant and non-stimulant agents

Meta Analysis of Variables Related to Attention Deficit Hyperactivity Disorder in School-Age Children

PURPOSE: The purpose of this study was to use meta-analysis to examine recent domestic articles related to attention deficit hyperactivity disorder (ADHD) in school-age children. METHODS: After reviewing 213 articles published between 1990 and 2009 from and cited in RISS, KISS, and DBpia, the researchers identified 24 studies with 440 research variables that had appropriate data for methodological study. SPSS 17.0 program was used. The outcome variables were divided into five types: Inattention, hyperactive impulsive, intrinsic, extrinsic, and academic ability variables. RESULTS: Effects size of overall core symptoms was 0.47 which is moderate level in terms of Cohen criteria and effects size of overall negative variables related ADHD was 0.27 which is small level. The most dominant variable related to ADHD was obtained from hyperactive-impulsive (0.70). Also academic ability (0.45), inattention (0.37), and intrinsic variables (0.29) had a small effect whereas extrinsic variables (0.13) had little effect on descriptive ADHD study. CONCLUSION: The results reveal that ADHD core symptoms have moderate effect size and peripheral negative variables related ADHD have small effect size. To improve the reliability of the meta-analysis results by minimizing publication bias, more intervention studies using appropriate study designs should be done.

Interacción de factores genéticos y ambientales en el trastorno por déficit de atención con hiperactividad: estudio de caso de gemelos / Interaction of genetic and environmental factors in attention deficit hyperactivity disorder: case study of twins

El Trastorno por Déficit de Atención con Hiperactividad (TDAH) es el trastorno neurocomportamental más común en la infancia, afecta aproximadamente del 3-5 por ciento de la población en edad escolar. Se caracteriza por déficit en la atención, baja regulación del nivel de actividad ante las demandas situacionales e impulsividad. Si bien se manifiesta en conductas consideradas habituales en la infancia, éstas se presentan con más frecuencia y mayor intensidad que lo observado en niños sin el diagnóstico. Las últimas investigaciones sobre el diagnóstico del TDAH avanzan en el conocimiento de los factores genéticos implicados en este trastorno. En el 70 - 80 por ciento de los niños los síntomas del trastorno persisten en la adolescencia, sumándose en los adolescentes las características propias de esta etapa; esto conlleva un aumento en las dificultades de conducta, de rendimiento académico y de relaciones interpersonales. El objetivo del presente trabajo es presentar el análisis de aspectos evolutivos, neuropsicológicos, académicos, familiares y sociales en un caso de gemelos varones adolescentes con diagnóstico de TDAH considerando la interacción de factores genéticos y ambientales que pudieran influenciar la expresión clínica del trastorno.

Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder in childhood, affects approximately 3-5 percent of school-age population. It is characterized by deficits in attention, down-regulation of the activity level to situational demands and impulsivity. Although it is manifested in what it is considered normal behavior in childhood, they occur more frequently and with greater intensity than seen in children without diagnosis. Recent research on the diagnosis of ADHD advances in knowledge of genetic factors involved in this disorder. In 70 to 80 percent of children, disorder symptoms persist into adolescence, joining those characteristics proper of this stage. This entails an increase in behavior difficulties, academic performance and interpersonal relationships. The aim of this paper is to present the analysis of evolutionary, neuropsychological, academic, social and family aspects in a case of twin boys diagnosed with ADHD considering the interaction of genetic and environmental factors that may influence the clinical expression of the disorder.

Tratamientos biológicos del autismo y dietas de eliminación / Biological treatments of autism, elimination diets: a critical review

This paper presents some critical considerations regarding the growing adoption, by families, of alternative treatments and diets for the treatment of various disorders like autism in children. Research does not seem to support such practices, with the exception of the relationship between timesoral and vaccines, neurological and cardiac disorders. Issues to consider are pointed out in the need to opt for biological treatments, and the need for families and research teams to work together for the purpose of clarifying such procedures.

El objetivo de este trabajo es presentar consideraciones críticas en relación a la creciente adopción, por parte de las familias de niños con trastornos del desarrollo, de tratamientos alternativos y dietas para reducir los síntomas de diversas alteraciones tales como el autismo, SDAH y otros. Las investigaciones no parecen apoyar tales prácticas, a excepción de la creciente evidencia de la relación entre el timerosal de las vacunas y afecciones cardíacas y neurológicas. Se señalan los elementos a tener en cuenta para optar por los tratamientos biológicos y dietas, junto con insistir en la necesidad de mancomunar esfuerzos entre familias y equipos de investigación para desarrollar estudios que clarifiquen los efectos de tales procedimientos.