Does ADHD worsen inhibitory control in preschool children born very premature and/or with very low birth weight?

Abstract Introduction Deficits in executive functioning, especially in inhibitory control, are present in children born very premature and/or with very low birth weight (VP/VLBW) and in children with attention-deficit/hyperactivity disorder (ADHD). Objective To evaluate whether ADHD imposes additional inhibitory control (IC) deficits in preschoolers born VP/VLBW. Methods 79 VP/VLBW (4 to 7 years) children were assessed for ADHD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL). IC was measured with Conners' Kiddie Continuous Performance Test (K-CPT 2) and the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P).Results: No significant differences were found between ADHD (n = 24) and non-ADHD children (n = 55) for any of the measures (p = 0.062 to p = 0.903). Both groups had deficits in most K-CPT 2 scores compared to normative samples, indicating poor IC and inconsistent reaction times. Conclusions ADHD does not aggravate IC deficits in VP/VLBW children. Either neuropsychological tasks and parent reports of executive functions (EFs) may not be sensitive enough to differentiate VP/VLBW preschoolers with and without ADHD, or these children's EFs are already so impaired that there is not much room for additional impairments imposed by ADHD.

Intragroup differences and similarities in performance on rapid automatized naming tasks in children with ADHD symptoms, children with reading disabilities, and controls

Abstract Introduction Rapid automatized naming (RAN) is the ability to name, as fast as possible, symbols such as letters, digits and figures. The present study aimed to investigate intragroup performance patterns on RAN tasks in children with attention deficit hyperactivity disorder (ADHD) symptoms alone, children with reading disability (RD) alone and controls with typical development. Methods A total of 216 Brazilian children between 8 to 11 years old were selected from public schools located in two Brazilian capitals, namely Porto Alegre and Belo Horizonte, to participate in the study. Mixed 3 (participant group: ADHD symptoms, RD or control group) × 3 (type of stimulus: letters, numbers or figures) ANOVAs were performed using response time and number of errors as dependent variables. Only intragroup comparisons are described in this paper. Results The groups with ADHD symptoms and RD showed similar performance results on naming speed. There were no differences between letters and numbers within each group, but we found slower responses in figure naming compared to the other tasks for both groups. Concerning accuracy, children with ADHD symptoms showed a similar number of errors in all three tasks. These patterns were distinct from the performance of the control group. Conclusion Results suggest a shared deficit in naming speed of alphanumeric stimuli in children with ADHD symptoms and those with RD, and impairments in naming digits correctly in children with ADHD symptoms.

Assessment of intraocular pressure, macular thickness, retinal nerve fiber layer, and ganglion cell layer thicknesses: ocular parameters and optical coherence tomography findings in attention-deficit/hyperactivity disorder

Objective: To compare intraocular pressure (IOP) and macular, retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL) thicknesses in treatment-naive children with attention-deficit/hyperactivity disorder (ADHD), children with ADHD on regular methylphenidate (MPH) treatment for at least 3 months, and healthy controls. Methods: A total of 58 treatment-naive children with ADHD, 45 children with ADHD on regular MPH treatment, and 44 healthy controls were enrolled in this study. All participants underwent a comprehensive eye examination. Optical coherence tomography (OCT) was used to assess global RNFL thickness, central macular thickness, and GCL thickness in both eyes. Results: Separate univariate analysis of covariance (ANCOVA) on the outcome variables revealed a significant difference among the research groups with respect to IOP in the left eye. Post-hoc univariate analyses indicated that left IOP was significantly higher in children with ADHD under MPH treatment than among healthy controls. However, global RNFL thickness, central macular thickness, and GCL thickness of both eyes, as well as IOP in the right eye, were not significantly different across groups. Conclusion: Further longitudinal follow-up studies are needed to determine whether MPH treatment has any effect on IOP or OCT findings.

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.

Valoración del cociente Theta/Beta en el electroencefalograma cuantificado de los trastornos por déficit de atención e hiperactividad / Measurement of the theta / beta ratio with the quantified electroencephalogram in attention-deficit hyperactivity disorders

El cociente Theta-Beta (T/B) del electroencefalograma cuantificado (EEGQ) de los pacientes con trastorno por déficit de atención e hiperactividad (TDAH) constituye una variable del EEG característica del trastorno primario con una precisión global del 89%. El objetivo de este estudio es medir el cociente T/B de una población de con TDAH y los efectos del tratamiento farmacológico con psicoestimulantes y no psicoestimulantes sobre el cociente T/B. La muestra estaba formada por 85 sujetos de entre 6 y los 18 años (68 niños y 17 niñas) con el diagnóstico de TDAH de subtipo inatento y combinado, según los criterios del DSM-V. Se les realizó un EEGQ con medición del cociente T/B antes y después de 6 meses de tratamiento con fármacos psicoestimulantes y no psicoestimulantes. Se compararon ambos grupos mediante la prueba de rangos con signo de Wilcoxon para muestras relacionadas. En el 86% de los casos el cociente T/B fue elevado respecto de los valores normales para la edad. La reducción en el cociente T/B fue significativa en el grupo tratado con psicoestimulantes aunque la reducción con los no psicoestimulantes no fue significativa. En conclusión, se confirma la elevación del cociente T/B en los pacientes con TDAH. Los fármacos psicoestimulantes disminuyen de forma significativa el cociente T/B elevado en los pacientes con TDAH tras 6 meses de tratamiento.

Theta-Beta (T / B) ratio of the quantified electroencephalogram (EEGQ) in patients with attention deficit hyperactivity disorder (ADHD) constitutes a characteristic EEG variable of the primary disorder with an overall accuracy of 89%. The objective of this study was to measure the T/B ratio in a sample of patients with ADHD and the effects of the treatment with psychostimulants and non-psychostimulants on the T/B ratio. The sample consisted of 85 children between 6 and 18 years (68 males and 17 females) with the diagnosis of the inattentive and combined subtype of ADHD, according to the criteria of the DSM-V. An EEGQ was performed with measurement of the T/B ratio before and after 6 months of treatment with psychostimulant and non-psychostimulant drugs. Both groups were compared using the Wilcoxon signed range test for related samples. The results showed that 86% of the cases had a T/B ratio above the normal values for the age of them. The reduction in the T/B ratio was statistically significant in the group of patients treated with psychostimulants. The reduction of non-psychostimulants was not significant. In conclusion, we confirmed the high T/B ratio in patients with ADHD. Psychostimulant drugs decrease the elevated T/B ratio in patients with ADHD after 6 months of treatment.

Progresión de los síntomas en niños con trastorno por déficit de atención e hiperactividad en tratamiento con metilfenidato / Progression of symptoms in children with attention deficit and hyperactivity disorder in treatment with methylphenidate

El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno neurobiológico frecuente en la infancia. Sus síntomas cardinales involucran a la atención y/o la impulsividad y/o la hiperactividad. Hay diferentes subtipos de TDAH según la expresividad clínica de esos tres síntomas. Hay distintas estrategias terapéuticas de alta efectividad. El metilfenidato, un estimulante que actúa en las vías dopaminérgicas y adrenérgicas, se utiliza con frecuencia en su tratamiento. El Cuestionario de Cualidades y Dificultades (SDQ) es un cuestionario de despistaje breve utilizado para la detección de problemas de salud mental en niños y adolescentes. Consta de 25 preguntas que se distribuyen en 5 escalas: sintomatología emocional, problemas de conducta, hiperactividad/inatención, problemas con los compañeros y conducta prosocial. Se recogió la puntuación del SDQ en una muestra de pacientes con TDAH con una edad situada entre los 7 y 12 años. Se comparó la puntuación obtenida antes de comenzar el tratamiento con metilfenidato y después de comenzar tratamiento, cada 3-6 meses y hasta un periodo de 2 años. Se realizó el procesamiento estadístico mediante R, que es un programa gratuito para análisis estadísticos y gráficos, y permite análisis temporales. Los resultados indican que la hiperactividad mejora a lo largo del primer año de tratamiento, la sintomatología emocional y los problemas de comportamiento mejoran durante los primeros 6 meses de tratamiento, la sintomatología prosocial mejora lentamente a lo largo de los 2 años y los problemas con compañeros no mejoran en el tiempo analizado.

Attention deficit and hyperactivity disorder (ADHD) is a neurobiological disorder frequent in childhood. The main symptoms are attention disorder and/or impulsivity and/or hyperactivity. There are different subtypes of ADHD according to the degree of presence of these three symptoms. There are different therapeutic approaches with high proved effectiveness. Methylphenidate, a stimulant that acts through the dopaminergic and adrenergic pathways, is commonly used for the treatment of ADHD. The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening instrument internationally used for the screening of mental health problems in children and adolescents. It consists in a 25 items questionnaire with 5 different scales: emotional symptoms, conduct problems, hyperactivity / inattention, peer relationship problems and prosocial behaviours. The SDQ score was collected in a sample of ADHD patients with an age between 7 and 12 years. The score obtained before starting treatment with methylphenidate was compared before and after starting treatment, every 3-6 months and up to a period of 2 years. Statistical processing was performed using R, which is a free program for statistical and graphical analysis, that allows temporary analysis. The results indicate that hyperactivity improves throughout the first year of treatment, emotional symptoms and behavioral problems improve during the first 6 months of treatment, pro-social symptoms slowly improve over 2 years. Problems with partners do not improve in the analyzed time.

Translation and cross-cultural adaptation of the Motor Behavior Checklist (MBC) into Brazilian Portuguese / Tradução e adaptação transcultural para o português do Brasil do Motor Behavior Checklist (MBC)

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.

El sueño del niño con trastornos del neurodesarrollo / The sleep in children with neurodevelopmental disorders

El sueño adecuado es necesario para el desarrollo sináptico y la maduración cerebral, un sueño de mala calidad tiene efectos perjudiciales en las funciones cognitivas, de atención, memoria y conducta de los niños. La preocupación sobre la alta prevalencia de los problemas del sueño es amplia en todo el mundo; las consecuencias de estos problemas son incluso más importantes en los niños portadores de trastornos del neurodesarrollo; estos niños a menudo tienen dificultades de inicio y mantenimiento del sueño y despertares nocturnos frecuentes que afectan a sus problemas de conducta. El propósito de este escrito es revisar el estado del arte de los problemas del sueño en los niños con trastornos del neurodesarrollo. En este punto, es importante tener en cuenta el ritmo circadiano, un reloj que genéticamente dirige los ritmos celulares de transcripción, traslación y metabolismos. Este reloj se combina con el ambiente diurno y nocturno coordinando estos mecanismos durante los ciclos luz/oscuridad, sueño/vigilia, frío/calor, ingesta/ayuno, tanto diariamente como en las diferentes estaciones. En conclusión, los problemas del sueño son un factor condicionante de la evolución y calidad de vida de los niños con trastornos del neurodesarrollo, que debe ser tenido en cuenta en todos los casos y ocupar un lugar preferente tanto en la etapa diagnóstica como en la terapéutica.

Adequate sleep is of critical need for a typical synaptic development and brain maturation, a poor quality sleep can have detrimental effects on children's' cognitive attention, memory, mood regulation, and behavior functions. Great concern has been voiced out regarding the high prevalence of poor sleep in children worldwide, the effects of poor sleep may be even more pronounced in children with neurodevelopmental disorders; these children often have difficulties with falling and staying asleep and with night awakenings, this has a strong association with daytime behavior problems. The purpose of this article is to provide an overview of the state of the science of sleep in children with a neurodevelopmental disorder. In this context, it is important to take the circadian cycle into account, a genetically encoded clock that drives cellular rhythms of transcription, translation and metabolism. The circadian clock interacts with the diurnal and nocturnal environment that also drives transcription and metabolism during light/dark, sleep/wake, hot/cold and feast/fast daily and seasonal cycles In conclusion, the sleep problems are a conditioning factor in the evolution and quality of life of children with neurodevelopmental disorders that must be taken into account in all cases and occupy a preferential place in both the diagnostic and the therapeutic stages.

Diferencias en procesamiento cerebral visual temprano en niños con trastorno del déficit de atención / Differences in early visual cerebral processing in children with attention deficit / hyperactivity disorders with predominance of no attention

Para evaluar los procesos atencionales a estímulos visuales que no requieren repuesta motora, se llevó a cabo un estudio con potenciales evocados a 17 niños con trastornos del déficit de atención/ hiperactividad (TDAH-I) con predominio inatento y a 15 controles de edades entre 7 y 11 años. Se analizó la latencia y localización de fuentes de los potenciales evocados visuales tempranos P100 y N100 durante la realización de una tarea oddball visual (20% rayas horizontales y 80% verticales) en que las rayas verticales no exigían respuesta motora. Los resultados indican que los niños con TDAH-I procesan la información visual que no requiere respuesta motora con un mayor aumento de la actividad cerebral y mediante la vía temporal ventral mientras que el grupo control lo hace mediante la vía parietal dorsal. Este proceso neurobiológico de procesamiento de la información visual vía temporal ventral de los niños con TDAH-I podría deberse a alteraciones en los procesos emocionales que influyen directamente en el reconocimiento visual o a un déficit en el control de los procesos atencionales por parte de la vía parietal dorsal.

To evaluate attentional processes to visual stimuli that do not require motor response, a study with evoked potentials was carried out on 17 children with attention deficit disorder predominantly inattentive (ADDH-I) and 15 controls between the ages of 7 and 11 years. The latency and localization of sources of the early visual evoked potentials P100 and N100 were analyzed during the performance of a visual oddball task (20% horizontal and 80% vertical lines) where the vertical lines did not require motor response. The results indicate that ADDH-I group process visual information that does not require motor response with a greater increase in brain activity and through the ventral temporal pathway, while the control group does so by means of the dorsal parietal stream. This neurobiological process of visual information processing by ventral temporal pathway of ADDH-I group could be due to alterations in emotional processes that directly influence visual recognition or as consequence of deficit in the control of attentional processes by the dorsal parietal pathway.

Craving for heroin: difference between methadone maintenance therapy patients with and without ADHD / Fissura por heroína: diferença entre pacientes em terapia de manutenção com metadona com e sem TDAH

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder persisting in adulthood in 40-60% of cases. Clinical and neuroimaging studies suggest that patients affected by both drug addiction and ADHD show higher rates of craving for drug than patients without ADHD. We designed a pilot open-label study to investigate the effects of ADHD on craving for heroin in methadone maintenance therapy patients. Method Patients were recruited from outpatient facilities in an addiction treatment unit in the municipality of Alba, Italy. They were assessed using the Structured Clinical Interview for DSM-5 (SCID-5), the SCID-5 for Personality Disorders (SCID-5-PD), the Diagnostic Interview for Adult ADHD, second edition (DIVA 2.0), and the Clinical Opiate Withdrawal Scale (COWS). Categorical variables were examined using the chi-square test, and continuous variables, the t-test and Mann-Whitney's U test for normally and non-normally distributed data, respectively. Data distribution was evaluated using Shapiro-Wilk's test. Significance was set at p=0.05. Bonferroni correction was applied (0.0063) to avoid type I error. Results A total of 104 patients were included in the study: 14 affected by ADHD (13.5%) and 90 were not affected (86.5%). Patients with ADHD showed higher intensity of craving for heroin than patients without ADHD in the absence of withdrawal symptoms. Conclusion Drug addiction and ADHD share various neurobiological mechanisms that mutually influence the evolution of both disorders. In particular, dopamine dysfunction within various brain circuits may influence impulsivity levels, motivation, inhibitory control, executive functions, and behavior and, consequently, the intensity of craving.

Resumo Introdução O transtorno de déficit de atenção e hiperatividade (TDAH) é um transtorno do neurodesenvolvimento que persiste na idade adulta em 40-60% dos casos. Estudos clínicos e de neuroimagem sugerem que pacientes afetados tanto por adição quanto por TDAH apresentam maiores índices de fissura (craving) por droga do que pacientes sem TDAH. Este estudo piloto aberto investigou os efeitos do TDAH sobre fissura por heroína em pacientes em terapia de manutenção com metadona. Método Os pacientes foram recrutados em serviços ambulatoriais em uma unidade de tratamento de adição na cidade de Alba, Itália. Eles foram avaliados usando os seguintes instrumentos: Structured Clinical Interview for DSM-5 (SCID-5), SCID-5 for Personality Disorders (SCID-5-PD), Diagnostic Interview for Adult TDAH, second edition (DIVA 2.0) e Clinical Opiate Withdrawal Scale (COWS). Variáveis categóricas foram examinadas utilizando o teste do qui-quadrado, e variáveis contínuas, o teste t e o teste U de Mann-Whitney para dados com distribuição normal e não normal, respectivamente. A distribuição dos dados foi avaliada usando o teste de Shapiro-Wilk. O nível de significância foi estabelecido em p=0,05. A correção de Bonferroni foi aplicada (0,0063) para evitar erro tipo I. Resultados Um total de 104 pacientes foram incluídos no estudo: 14 com TDAH (13,5%) e 90 sem (86,5%). Pacientes com TDAH mostraram maior intensidade de fissura por heroína do que pacientes sem TDAH na ausência de sintomas de abstinência. Conclusão Adição e TDAH compartilham mecanismos neurobiológicos que influenciam mutuamente a evolução dos dois transtornos. Em particular, a disfunção da dopamina em vários circuitos cerebrais pode influenciar os níveis de impulsividade, motivação, controle inibitório, funções executivas e comportamento, e, portanto, a intensidade da fissura.

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

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

Caracterización cognitiva del trastorno de Tourette con comorbilidad TDAH: un estudio de caso / Cognitive characterization of Tourette disorder with ADHD comorbidity: a case study

El trastorno de Tourette (TT) es un trastorno del neurodesarrollo que aparece en la primera infancia caracterizado por la presencia de tics fónicos y motores que dificultan la socialización y el proceso de aprendizaje escolar. El TT posee una variada comorbilidad que incluye el trastorno por déficit de atención con hiperactividad (TDAH), el trastorno obsesivo compulsivo (TOC), y dificultades de aprendizaje y del comportamiento. Presentamos el caso de un adolescente de 13 años diagnosticado con TT y con TDAH a los 6 y 10 años respectivamente. El paciente ha tenido una escolarización dificultosa y se encuentra con tratamiento médico de clozapina, aripiprazol, haloperidol y litio. Se aplica una batería neuropsicológica para evaluar la atención e inhibición, organización visuoespacial, memoria de trabajo, flexibilidad cognitiva, memoria verbal y memoria no-verbal, con el propósito de describir su perfil cognitivo de funciones ejecutivas y memoria. El estudio reveló que la atención está deteriorada pero que la inhibición se encuentra preservada; esto confirma el diagnóstico de TDAH y establece el subtipo de inatento para el caso en estudio. Las demás funciones ejecutivas evaluadas se encuentran severamente descendidas, situación que es coincidente con el perfil desarrollado por otros autores para el TT con comorbilidad TDAH. Sin embargo, no es claro si la disfuncionalidad ejecutiva se debe al TDAH que presenta, o a factores sociales y culturales derivados de las dificultades de escolarización causadas por el TT.

Tourette's disorder (TD) is a neurodevelopmental disorder that appears in early childhood characterized by the presence of phonic and motor tics that hinder socialization and the school learning process. TD has a varied comorbidity that includes attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), learning and behavioral difficulties. We present the case of a 13-year-old adolescent diagnosed with TD and with ADHD at 6 and 10 years old respectively. The patient has had a difficult schooling and is under medical treatment of clozapine, aripiprazole, haloperidol and lithium. A neuropsychological battery is applied to evaluate the attention and inhibition, visuospatial organization, working memory, cognitive flexibility, verbal memory and non-verbal memory, with the purpose of describing its cognitive profile of executive functions and memory. The study revealed that the attention is impaired but that the inhibition is preserved; This confirms the diagnosis of ADHD and establishes the inattentive subtype for the case under study. The other executive functions evaluated are severely descended, a situation that coincides with the profile developed by other authors for TD with comorbid ADHD. However, it is not clear if the executive dysfunctionality is due to the ADHD it presents, or to social and cultural factors derived from the difficulties of schooling caused by the TD.

Trastorno del desarrollo intelectual: Superposiciones con el trastorno del espectro autista y el trastorno por déficit de atención e hiperactividad / Intellectual developmental disability overlapping with autism spectrum disorder and attention deficit-hyperactivity disorder

Nunca dejará de ser interesante y relevante el tema de las discapacidades que abarcan la cognición y la adaptabilidad. La etiología genética tiene cada día más peso. La relación con otros trastornos del neurodesarrollo como el trastorno del espectro autista (TEA) y el trastorno por déficit de atención e hiperactividad (TDAH), es de importancia clínica, diagnóstica y terapéutica. Realizamos una revisión sobre el trastorno del desarrollo intelectual (TDI) y su implicación con el TEA y el TDAH. Desde Hipócrates hasta la actualidad los trastornos que afectan las habilidades de aprendizaje, conducta y socialización han sido sujeto de estudios y han variado sobre todo en la denominación como entidad y su percepción desde el punto de vista humano y social. La etiología del TDI en la mayoría de los casos es un enigma y los avances genéticos son la piedra angular para dilucidar el origen de este trastorno del neurodesarrollo, así como su relación con otros como el TEA y el TDAH. El trastorno del desarrollo intelectual, el más antiguo con respecto a definición, estudio y abordaje, aún presenta incógnitas sobre todo de origen etiológico. Su relación con otros trastornos del neurodesarrollo como el TEA y el TDAH es evidente por poseer áreas comunes de afectación, pudiendo ser diagnósticos coincidentes.

The subject of disabilities that include cognition and adaptability will never cease to be interesting and relevant. The genetic etiology has more weight every day. The relationship with other neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) is of clinical, diagnostic and therapeutic importance. The objective was to conduct a review of intellectual development disorder and its implication with ASD and ADHD. From Hippocrates to the present the disorders that affect learning, behavior and socialization skills have been the subject of studies and have varied, above all, in the denomination as an entity and its perception from the human and social point of view. The etiology of intellectual development disorders in most cases is an enigma and genetic advances are the cornerstone to elucidate the origin of this neurodevelopmental disorder, as well as its relationship with others such as ASD and ADHD. The disorder of intellectual development, the oldest one with respect to definition, study and approach, still presents mysteries above all of etiological origin. Its relationship with other neurodevelopmental disorders such as ASD and ADHD is evident by having common areas of involvement, which may be coincident diagnoses.

Los movimientos oculares como medida de control ejecutivo en niños con trastorno por déficit de atención con hiperactividad / Eye movements as a measure of executive control in children with Attention Deficit Hyperactivity Disorder

El Trastorno por Déficit de Atención con Hiperactividad (TDAH) está relacionado con dificultades a nivel de control ejecutivo. Nuevas formas de explorar este constructo contribuyen a la precisión diagnóstica, disminuir la prevalencia y la construcción de un consenso objetivo sobre los criterios del TDAH. El objetivo fue establecer las diferencias en el control ejecutivo de un grupo de niños con TDAH (N=22), con respecto al grupo control (N=15), de ambos géneros y de entre 7 y 12 años de edad, escolarizados de la ciudad de Medellín, Colombia. Se implementaron tres parámetros oculares: fijaciones, antisacadas y prosacadas, los cuales fueron registrados continuamente en un equipo de rastreo visual (Tobii T120). Los resultados indicaron un menor tiempo para el grupo con TDAH en fijaciones oculares (p<,001) que miden control de la interferencia. Un mayor número de errores de dirección en el parámetro antisacadas relacionados con el control inhibitorio. Respecto a las prosacadas, que miden la capacidad para iniciar una respuesta motora, no se encontraron diferencias significativas. Se concluyó que la población con TDAH presenta alteración en el control ejecutivo al utilizar el paradigma de rastreo ocular. Se propusieron, además, los movimientos oculares como posible marcador biológico para detectar una población en riesgo de padecer dicho trastorno.

Attention Deficit Hyperactivity Disorder (ADHD) is related to difficulties at the level of the executive control. New ways of exploring this construct contribute to diagnostic accuracy, decrease the prevalence and build an objective consensus on ADHD criteria. The aim of the study was to establish the differences in the executive control of a group of children with ADHD (N=22), with respect to the control group (N=15), of both genders and between 7 and 12 years old, attending school in the city of Medellin, Colombia. Three ocular parameters were implemented: fixings, antisaccade, and prosaccades, which were recorded continuously in a visual tracking equipment (Tobii T120). The results indicated a shorter time for the group with ADHD in ocular fixations (p<0.001) that measure interference control. A greater number of address errors in the antisaccade parameter related to inhibitory control. Regarding the prosaccades, which measure the capacity to initiate a motor response, no significant differences were found. It was concluded that the population with ADHD presents alteration in the executive control when using the eye tracking paradigm. Eye movements were also proposed as a possible biological marker to detect a population at risk of suffering from this disorder.

Effects of distractors on upright balance performance in school-aged children with attention deficit hyperactivity disorder, preliminary study / Efeitos de distrações sobre o desempenho do equilíbrio vertical em crianças em idade escolar com transtorno de déficit de atenção e hiperatividade - estudo preliminar

Abstract Introduction: Attention deficit hyperactivity disorder is a common impairing neuropsychiatric disorder with onset in early childhood. Almost half of the children with attention deficit hyperactivity disorder also experience a variety of motor-related dysfunctions ranging from fine/gross motor control problems to difficulties in maintaining balance. Objectives: The main purpose of this study was to investigate the effects of distractors two different auditory distractors namely, relaxing music and white noise on upright balance performance in children with attention deficit hyperactivity disorder. Methods: We compared upright balance performance and the involvement of different sensory systems in the presence of auditory distractors between school-aged children with attention deficit hyperactivity disorder (n = 26) and typically developing controls (n = 20). Neurocom SMART Balance Master Dynamic Posturography device was used for the sensory organization test. Sensory organization test was repeated three times for each participant in three different test environments. Results: The balance scores in the silence environment were lower in the attention deficit hyperactivity disorder group but the differences were not statistically significant. In addition to lower balance scores the visual and vestibular ratios were also lower. Auditory distractors affected the general balance performance positively for both groups. More challenging conditions, using an unstable platform with distorted somatosensory signals were more affected. Relaxing music was more effective in the control group, and white noise was more effective in the attention deficit hyperactivity disorder group and the positive effects of white noise became more apparent in challenging conditions. Conclusion: To the best of our knowledge, this is the first study evaluating balance performance in children with attention deficit hyperactivity disorder under the effects of auditory distractors. Although more studies are needed, our results indicate that auditory distractors may have enhancing effects on upright balance performance in children with attention deficit hyperactivity disorder.

Resumo Introdução: O transtorno do déficit de atenção e hiperatividade é um distúrbio neuropsiquiátrico comum que causa comprometimentos, com início na primeira infância. Quase metade das crianças com transtorno do déficit de atenção e hiperatividade também experimenta uma variedade de distúrbios relacionados às habilidades motoras, desde problemas de controle de habilidades motoras finas/grossas até dificuldades na manutenção do equilíbrio. Objetivos: O principal objetivo deste estudo foi investigar os efeitos de distrações, especificamente duas distrações auditivas diferentes, música relaxante e ruído branco, sobre o desempenho do equilíbrio vertical em crianças com transtorno de déficit de atenção e hiperatividade. Método: Comparamos o desempenho do equilíbrio vertical e o envolvimento de diferentes sistemas sensoriais na presença de distração auditiva entre crianças em idade escolar com transtorno do déficit de atenção e hiperatividade (n = 26) e controles com desenvolvimento típico (n = 20). O dispositivo Neurocom Smart Balance Master Dynamic Posturography foi utilizado para o teste de organização sensorial. O teste de organização sensorial foi repetido três vezes para cada participante em três ambientes de teste diferentes. Resultados: Os escores de equilíbrio no ambiente em silêncio foram menores no grupo com transtorno do déficit de atenção e hiperatividade, mas as diferenças não foram estatisticamente significativas. Além dos escores de equilíbrio mais baixos, as razões vestibulares e visuais também foram menores. As distrações auditivas afetaram positivamente o desempenho do equilíbrio geral para ambos os grupos. Condições mais desafiadoras, usando uma plataforma instável com sinais somatossensoriais distorcidos, foram mais afetados. Música relaxante foi mais eficaz no grupo de controle, e ruído branco foi mais eficaz no grupo de hiperatividade com déficit de atenção e os efeitos positivos do ruído branco se tornaram mais evidentes em condições desafiadoras. Conclusão: Que seja de nosso conhecimento, este é o primeiro estudo que avalia o desempenho do equilíbrio em crianças com transtorno do déficit de atenção e hiperatividade sob os efeitos de distrações auditivas. Embora mais estudos sejam necessários, os nossos resultados indicam que as distrações auditivas podem ter efeitos de aumento no desempenho do equilíbrio vertical em crianças com transtorno de déficit de atenção e hiperatividade.

Latent class analysis of attention and white matter correlation in children with attention-deficit/hyperactivity disorder

This study aimed to explore attentional patterns among children with inattentive attention-deficit/hyperactivity disorder (ADHD-I) and children with typical development (TD), using a latent class analysis (LCA). Patterns of brain connectivity were also explored. The sample comprised 29 ADHD-I and 29 TD matched children. An LCA was conducted to reclassify subjects according to their attentional performance, considering cognitive measures of attention and behavioral symptoms, regardless of group of origin. The new clusters were then compared in respect to brain white matter measurements (extracted from diffusion tensor imaging). Participants were rearranged in 2 new latent classes, according to their performance in an attention task and the results of behavioral scales, resulting in groups with more homogeneous attentional profiles. A comparison of the 2 new classes using the white matter measurements revealed increased fractional anisotropy in the left inferior fronto-occipital fasciculus and left inferior longitudinal fasciculus for the class composed by participants with a higher risk of attentional problems. The findings indicated that it was possible to observe variability regarding neuropsychological profile, accompanied by underpinning neurobiological differences, even among individuals with the same disorder subtype - inattentive ADHD. This specific data-driven clustering analysis may help to enhance understanding of the pathophysiology of the disorder's phenotypes.

Dental caries in schoolchildren: influence of inattention, hyperactivity and executive functions

Abstract Attention-deficit/hyperactivity disorder (ADHD) is characterized by inappropriate levels of hyperactivity, impulsivity, and/or inattention. Individuals with ADHD may present limitations with regard to executive functions and performing activities that involve planning and/or attention/concentration. The aim of the study was to investigate the association between dental caries and signs of ADHD in a representative sample of schoolchildren. A representative sample of 851 schoolchildren aged seven to 12 years was randomly selected from public and private schools. Data acquisition involved a clinical dental examination for cavitated permanent and deciduous teeth using the DMFT/dmft indices. Neuropsychological evaluations, including the assessment of intelligence (Raven's Colored Progressive Matrix Test) and executive functions (Corsi Tapping Blocks tests and Digit Span test) were also performed. Parents/caregivers and teachers answered the SNAP-IV Questionnaire for the investigation of signs of inattention and hyperactivity in the family and school environment. Parents/caregivers also answered questionnaires addressing socioeconomic and socio-demographic characteristics. Descriptive analysis of the variables and Poisson regression with robust variance were performed. Parental reports of signs of inattention (PR: 1.28; p < 0.05) and hyperactivity (PR: 1.15; p < 0.05) were associated with a greater occurrence of caries. A better performance on the backward order of the Corsi Tapping Blocks tests (PR: 0.94; p < 0.05) and higher level of mother's schooling were associated with a lower frequency of caries. A better performance on executive function tasks was a protective factor against dental caries, whereas children considered inattentive and/or hyperactive by their parents had a higher prevalence rate of dental caries.

Computerized cognitive training in children and adolescents with attention deficit/hyperactivity disorder as add-on treatment to stimulants: feasibility study and protocol description / Treinamento cognitivo para crianças e adolescentes com transtorno de déficit de atenção/hiperatividade como tratamento complementar aos psicoestimulantes: estudo de viabilidade e descrição de protocolo

Abstract Background Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups - mainly on trained tasks. Conclusions This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.

Resumo Introdução O treinamento cognitivo tem recebido atenção especial como abordagem não medicamentosa para o tratamento do transtorno de déficit de atenção/hiperatividade (TDAH) em crianças e adolescentes. Poucos estudos avaliaram o treinamento cognitivo como abordagem complementar à medicação em ensaios clínicos randomizados controlados por placebo. O objetivo deste estudo foi explorar a viabilidade para a implementação de um programa de treinamento cognitivo computadorizado, descrever suas características principais e potencial eficácia em um pequeno estudo piloto. Métodos Seis pacientes com TDAH entre 10-12 anos de idade, em uso de psicoestimulantes e apresentando sintomas residuais, foram recrutados e randomizados para um dos dois grupos (treinamento cognitivo ou placebo) por 12 semanas. O desfecho principal foram os sintomas nucleares do TDAH avaliados através do Questionário de Swanson, Nolan e Pelham (SNAP-IV). Resultados Encontramos maior resistência do que a esperada no recrutamento dos pacientes em função de problemas logísticos para atender às sessões presenciais no hospital assim como para preencherem os critérios de status medicamentoso e ausência de algumas comorbidades. Ambos os grupos apresentaram diminuição nos escores dos sintomas de TDAH reportados pelos pais, mas sem diferença estatística entre eles. Além disso, foi observada melhora nos testes neuropsicológicos em ambos os grupos - principalmente nas tarefas treinadas pelo programa. Conclusão Este protocolo revelou a necessidade de novas estratégias para melhor avaliar a eficácia do treinamento cognitivo tal como a necessidade de implementar a intervenção no ambiente escolar a fim de obter uma avaliação com maior validade externa. Devido ao pequeno tamanho amostral deste estudo, conclusões definitivas sobre os efeitos do treinamento cognitivo como abordagem complementar aos psicoestimulantes seriam prematuras.

Working memory and left medial temporal cortical thickness / Memória de trabalho e espessura cortical temporal medial esquerda

ABSTRACT Objective To perform a pilot study to investigate the association between working memory and cortical thickness in a sample of attention deficit/hyperactivity disorder (ADHD) children. Methods Seventeen children aged 7-10 years diagnosed with ADHD and 16 healthy children underwent a magnetic resonance scan for cortical thickness measurements. Data was correlated with working memory performance using the Backwards Digit Span subtest of the Wechsler Intelligence Scale for Children. Results Working memory impairment, evidenced by lower scores on the Backwards Digit Span, was observed in patients with ADHD compared to healthy controls. There was a direct correlation between working memory and cortical thickness of the left medial temporal lobe (Spearman’s correlation coefficient: 0.499; p < 0.005). Conclusions Our data suggests, for the first time, a correlation between working memory, evaluated by the Backwards Digit Span, and left medial temporal cortical thickness.

RESUMO Objetivo Realizar estudo piloto para investigar a associação entre memória de trabalho e espessura cortical em crianças com transtorno de défict de atenção e hiperatividade (TDAH). Métodos Dezessete crianças com TDAH, entre 7 e 10 anos, e dezesseis crianças saudáveis foram submetidas a ressonância magnética para aferição de espessura cortical. Os dados foram correlacionados com desempenho da memória de trabalho usando a ordem inversa do subteste Dígitos da Escala de Inteligência Wechsler para Crianças. Resultados Prejuízos na memória de trabalho, evidenciado pela menor pontuação na ordem inversa do subteste Dígitos, foram observados em pacientes com TDAH, em comparação com crianças saudáveis. Observou-se correlação direta entre memória de trabalho e espessura do lobo temporal médio à esquerda (coeficiente de correlação de Spearman: 0,499; p < 0,005). Conclusões Nossos dados sugerem, pela primeira vez, uma correlação entre memória de trabalho, avaliada através da pontuação na ordem inversa do subteste Dígitos, e espessura do córtex temporal medial à esquerda.