Métodos de avaliação cognitiva de pacientes com Síndrome de Apert e de Crouzon / Cognitive assessment methods of patients with Apert and Crouzon syndrome

A Craniossinostose Coronal bilateral implica em diminuição do Perímetro Craniano (PC) no eixo ântero-posterior (Braquicefalia) e frequentemente se associa ao aumento do eixo céfalo-caudal (vertical-altura) do crânio (Turricefalia), sendo um dos achados mais comuns nas Síndromes de Crouzon e Apert. Objetivo: Identificar, analisar e sintetizar os métodos de avaliação cognitiva apropriados para o acompanhamento da evolução de pacientes com cranioestenoses sindrômicas, em particular as síndromes de Apert e de Crouzon. Método: Trata-se de uma revisão de escopo. Para a formulação da pergunta norteadora da pesquisa e da estratégia de busca, foi utilizada a estratégia Population [((Apert OR Crouzon) AND (Disease OR Syndrom*))], Concept [((cognit* OR neurobehavioral OR neurocognit* OR neuropsyc*) AND (evaluation OR evaluations OR assessment OR "test" OR tests OR status OR development OR disorder OR disorders OR impairment OR impairments OR impaired OR function OR functions))] e Context (em qualquer contexto). Foram inclusos os artigos escritos em inglês, português e espanhol em qualquer período. A busca foi realizada nas bases de dados: Embase, Scopus, PubMed/MEDLINE e rede BVS Salud. Resultados:Inúmeros testes de avaliação cognitiva validados internacionalmente foram aplicados aos pacientes com Apert e Crouzon, mas não se observou uma padronização (protocolo) seguida pelas várias unidades de assistência. Dos 75 tipos de Testes Cognitivos aplicados houve o predomínio da Escala de Inteligência de Wechsler (e seus subtestes), 50%. Na população avaliada predominou duas faixas etárias: escolares e adolescentes. As crianças com Apert e Crouzon obtiveram escores piores nos transtornos de socialização, atenção e internalização quando comparadas com o grupo normativo, sendo os piores resultados encontrados em Apert. Fatores que interferem no desenvolvimento neuropsicomotor: pressão intracraniana, malformações encefálicas, genética, idade na correção cirúrgica (postergação da primeira cirurgia após um ano de idade associou-se a um quociente de inteligência mais baixo), institucionalização, ambiente familiar, escolaridade dos cuidadores e nível socioeconômico. Considerações finais: os resultados obtidos contribuíram para maior conhecimento do perfil cognitivo dos pacientes com estas síndromes. Somente conhecendo as habilidades e dificuldades neuropsicomotoras, cognitivas e psicossociais dos pacientes com Apert e Crouzon é que as equipes de saúde, da escola e de cuidadores poderão entender melhor a capacidade perceptiva destes no processo de aprendizado e estarão mais aptas em atender as necessidades especiais destes pacientes e poderão ofertar os estímulos mais adequados no momento mais oportuno (AU).

Bilateral Coronal Craniosynostosis implies a decrease in the Cranial Perimeter (CP) in the anteroposterior axis (Brachycephaly) and is frequently associated with an increase in the cephalocaudal (vertical height) axis of the skull (Turrycephaly); being one of the most common findings in Crouzon and Apert Syndromes (Syndromic Craniosynostosis). In this Scope Review study, among the Syndromic Craniosynostosis, Apert and Crouzon Syndromes will be of special interest. Objective: This study aimed to identify, analyze, and synthesize the appropriate cognitive assessment methods for monitoring the evolution of patients with syndromic craniosynostosis, in particular Apert's and Crouzon's syndromes. Method: This is a scope review. In order to formulate the research guiding question and the searching strategy, the Population [((Apert OR Crouzon) AND (Disease OR Syndrom*))], Concept [((cognit* OR neurobehavioral OR neurocognit* OR neuropsyc*) AND (evaluation OR evaluations OR assessment OR "test" OR tests OR status OR development OR disorder OR disorders OR impairment OR impairments OR impaired OR function OR functions))] and Context (in any context) strategy was used. The articles written in English, Portuguese, and Spanish in any period were included. The search was performed in the following databases: Embase, Scopus, National Library of Medicine (PubMed/MEDLINE), and in the BVS Salud network (PAHO, WHO, BIREME, LILACS). Results: many internationally validated cognitive assessment tests were applied to patients with Apert and Crouzon, but no standardization (protocol) was followed. Of the 75 types of Cognitive Tests applied, the Wechsler Intelligence Scale predominated, 50%. In the evaluated population, two age groups predominated: school children and adolescents. Children with Apert and Crouzon had worse scores on disorders of socialization, attention, and internalization when compared to the normative group, with the worst results found in Apert. Factors that interfere with cognitive development: intracranial pressure, brain malformations, genetics, age at surgical correction, institutionalization, family environment, caregiver education, and socioeconomic status. Conclusion: the results contributed to a better understanding of the cognitive profile of patients with these syndromes and only by knowing about the neuropsychomotor, cognitive, and psychosocial skills and difficulties of these patients with Apert and Crouzon that health, school, and caregiver teams will be able to understand the perceptive capacity in the learning process of these patients deeply and will be able to offer the most appropriate stimuli at the most opportune time. Keywords: Apert, Crouzon, Neuropsyc, Tests, Development (AU).

Contribuições da Terapia Cognitivo-Comportamental no treinamento parental de crianças com Transtorno de Oposição Desafiante / Contributions of Cognitive-Behavioral Therapy in parental training of children with Oppositional Defiant Disorder

O Transtorno de Oposição Desafiante (TOD) caracteriza-se por um padrão frequente e persistente, de humor irritável, comportamento desafiador ou índole vingativa. Diferentes estratégias de prevenção e tratamento são propostas, como é o caso do treinamento parental. Nesse contexto, destacam-se as intervenções baseadas na Terapia Cognitivo-Comportamental (TCC), as quais, apesar de apresentarem resultados promissores, ainda carecem de sistematização de suas contribuições em contexto brasileiro. Em função disso, este estudo teve como objetivo apresentar as contribuições da TCC no Treinamento de Pais de crianças com TOD. Para tanto, foi realizada uma revisão narrativa literatura. Os resultados apontaram que o treinamento parental baseado na TCC faz uso de distintas variáveis (ex. estilos ou práticas parentais, estresse e competência parental) e estratégias (ex: role-play, resolução de problemas, treino de habilidades sociais educativas e reestruturação cognitiva). Conclui-se que o TOD e seu sintomas trazem consequências negativas no contexto familiar e o treinamento parental é um recurso eficaz para prevenção e tratamento desse transtorno, uma vez que possibilita a melhoria da relação entre pais e filhos. Entretanto, estudos acerca do tema ainda precisam ser ampliados em contexto brasileiro.(AU)

The Oppositional Defiant Disorder (ODD) is characterized by a frequent and persistent pattern of irritable mood, defiant behavior or vengeful nature. Different strategies of prevention and treatment are proposed, as is the case of parental training. In this context, the interventions based on Cognitive-Behavioral Therapy (CBT) stand out, which, despite presenting promising results, still need to systematize their contributions in the brazilian context. As a result, this study aimed to present the contributions of CBT in Parents' Training of children with ODD. For this, a literature review was performed. The results showed that parental training based on Cognitive-Behavioral Therapy makes use of different variables (e.g., parenting styles or practices, stress and parental competence) and strategies (e.g., role-play, problem solving, training of educational social skills and cognitive restructuring). It is concluded that ODD and its symptoms bring negative consequences in the family context and parental training is an effective resource for prevention and treatment of this disorder, since it allows the improvement of the relationship between parents and children. However, it is suggested that studies on the subject be expanded in the brazilian context.(AU)

El trastorno de oposición desafiante (TOD) se caracteriza por un patrón frecuente y persistente de estado de ánimo irritable, comportamento desafiante o la naturaleza vengativa. Se proponen diferentes estrategias de prevención y tratamiento, como el entrenamiento de los padres. En este contexto, destacamos las intervenciones basadas en la Terapia Cognitivo-Conductual (TCC), que, a pesar de presentar resultados prometedores, todavía carecen de sistematización de sus contribuciones en el contexto brasileño. Como resultado, este estudio tenía como objetivo presentar las contribuciones de cbt en el entrenamiento de los padres de los niños con OD. Para ello, se llevó a cabo una revisión narrativa literaria. Los resultados mostraron que el entrenamiento de los padres basado en la TCC hace uso de diferentes variables (por ejemplo, estilos o prácticas de crianza, estrés y competencia parental) y estrategias (por ejemplo, juego de roles, resolución de problemas, entrenamiento de habilidades sociales educativas y reestructuración cognitiva). Se concluye que el TOD y sus síntomas traen consecuencias negativas en el contexto familiar y el entrenamiento parental es un recurso eficaz para la prevención y tratamiento de este trastorno, ya que permite la mejora de la relación entre padres e hijos. Sin embargo, se sugiere ampliar los estudios sobre el tema en el contexto brasileño.(AU)

Sandplay therapy in the treatment of children with Oppositional Defiant Disorder and Conduct Disorder / A terapia de sandplay no tratamento de crianças com Transtorno Opositivo-Desafiador e Transtorno de Conduta

The study aimed at assessing the effectiveness of sandplay therapy in the treatment of children with symptoms of oppositional defiant disorder and/or conduct disorder. The intervention consisted of twelve weekly sessions of sandplay therapy. The Child Behavior Checklist 6-18 was used to assess symptoms before and after the intervention. Participants were 41 children of both sexes, randomly divided into two groups. The control group remained on hold while experimental group 1 underwent the intervention. After three months, control group participants who still met the inclusion criteria were placed in experimental group 2. Results were analyzed statistically, in order to compare the control group and experimental group 1, as well as to assess the evolution of the total experimental group, which included experimental groups 1 and 2. Results pointed to the effectiveness of sandplay therapy in reducing symptoms of oppositional defiant disorder and conduct disorder.

O estudo visou avaliar a efetividade da terapia de sandplay no tratamento de crianças com sintomas de Transtorno Opositivo-Desafiador e/ou Transtorno de Conduta. A intervenção consistiu de 12 sessões semanais de terapia de sandplay. O Child Behavior Checklist 6-18 foi o instrumento utilizado para avaliar os sintomas antes e após a intervenção. Participaram do estudo 41 crianças de ambos os sexos, divididas randomicamente em dois grupos. O grupo controle permaneceu em espera enquanto o grupo experimental 1 passava pela intervenção. Após três meses de intervenção, os participantes do grupo controle que ainda atendiam aos critérios de inclusão formaram o grupo experimental 2. Os resultados obtidos foram analisados estatisticamente, de modo a comparar o grupo controle e o grupo experimental 1 bem como avaliar a evolução do grupo experimental total, que incluiu os grupos experimentais 1 e 2. Os resultados indicam que a terapia de sandplay foi eficiente na redução dos sintomas dos transtornos em questão.

Problemas de aprendizagem e comportamento no ciclo 1 do ensino fundamental / Learning difficulties and behavioral problems in elementary school / Problemas de aprendizaje y comportamiento en la educación primaria

As relações entre problemas comportamentais e dificuldades de aprendizagem ainda não estão claras na literatura. Essas variáveis representam, entretanto, importantes fatores de risco para o fracasso escolar e profissional, bem como para o desenvolvimento e a adaptação social. O objetivo desta pesquisa foi investigar as relações entre problemas comportamentais e dificuldades de aprendizagem em alunos de uma escola pública do ciclo I do ensino fundamental. Foram realizadas, também, análises dessas variáveis em função da série e do sexo dos alunos. A pesquisa seguiu um delineamento descritivo, de caráter transversal. Participaram do estudo 310 alunos do 1º ao 5º ano. Os instrumentos utilizados na coleta de dados foram o Questionário de Capacidades e Dificuldades, respondido pelos pais, e um questionário para a identificação do desempenho escolar, respondido pelas professoras. Os resultados indicam 12% de problemas comportamentais e 15% de dificuldades de aprendizagem na amostra estudada. Correlações negativas moderadas altamente significativas foram obtidas entre o desempenho escolar, as subescalas hiperatividade; problemas de conduta; e problemas de relacionamento entre pares, e o escore total do SDQ. Foram encontrados valores marginalmente significativos para a associação entre sexo e hiperatividade, indicando maior tendência de comportamentos hiperativos nos meninos. Os sintomas emocionais foram marginalmente mais frequentes nos alunos do 1º ano. Já os alunos do 2º ano apresentaram maior frequência de dificuldades de aprendizagem. Conclui-se que os dois primeiros anos do ensino fundamental podem ser considerados uma etapa crítica do percurso escolar, demandando intervenções focadas na prevenção de problemas comportamentais e de aprendizagem.(AU)

The relationships between behavioral problems and learning difficulties are still unclear in the literature. These variables represent, however, important risk factors for school and professional failures and for the development and social adaptation. This research aimed to investigate the relationships between behavioral problems and learning difficulties in the students in a public elementary school. These variables were also analyzed in relation to the school grade and gender of the students. The research followed a descriptive cross-sectional design. The sample comprised 310 students from 1st to 5th grade. The instruments used in data collection were the Strengths and Difficulties Questionnaire, answered by the parents, and a questionnaire to identify the students school performance, answered by the teachers. The results indicated 12% of behavioral problems and 15% of learning difficulties in the studied sample. Moderate highly significative negative correlations were obtained between school performance; the subscales hyperactivity, conduct problems and peer relationship problems; and the total questionnaire score . Marginally significant values were found for the association between gender and Hyperactivity, indicating a greater tendency for hyperactive behavior in boys. Emotional symptoms were marginally more frequent in 1st grade students. On the other hand, 2nd grade students had a higher frequency of learning difficulties. We concluded that the two first years of elementary school can be considered a critical phase of the school trajectory and it needs preventive interventions focused on behavioral and learning problems.(AU)

Las relaciones entre los problemas de conducta y las dificultades de aprendizaje aún no están claras en la literatura. Estas variables representan, sin embargo, importantes factores de riesgo para el fracaso escolar y profesional, así como para el desarrollo y la adaptación social. El objetivo de este estudio fue investigar las relaciones entre los problemas de conducta y las dificultades de aprendizaje en estudiantes de una escuela primaria pública. También se realizaron análisis de estas variables en función del grado y sexo de los alumnos. La investigación siguió un diseño descriptivo y transversal. Participaron del estudio 310 estudiantes de 1º a 5º grado. Los instrumentos utilizados fueron el Cuestionario de Habilidades y Dificultades, respondido por los padres, y un cuestionario para identificar el desempeño escolar, respondido por los docentes. Los resultados indican un 12% de problemas de conducta y un 15% de dificultades de aprendizaje en la muestra estudiada. Se obtuvieron correlaciones negativas altamente significativas entre el rendimiento escolar y la puntuación total y de las subescalas hiperactividad problemas de conducta y problemas de relación con los compañeros del cuestionario. Se encontró aún mayor tendencia a la conducta hiperactiva en los niños. Los "síntomas emocionales" fueron ligeramente más frecuentes en los estudiantes de primer año, mientras los estudiantes de segundo año tenían una mayor frecuencia de dificultades de aprendizaje. Se concluye que los dos primeros años de la escuela primaria pueden ser una fase crítica de la trayectoria escolar, lo que requiere intervenciones enfocadas en la prevención de problemas de conducta y aprendizaje.(AU)

Revisão da literatura sobre Transtorno Opositivo Desafiador e Transtorno de Conduta: causas/proteção, estratégia escolar e relação com a criminalidade / Literature review about Oppositional Defiant Disorder and Conduct Disorder: causes / protection, teaching school and relationship with crime

De acordo com variados estudos científicos, nas idades escolares os estudantes podem apresentar diferentes distúrbios comportamentais. Assim, este artigo tem como objetivo apresentar uma revisão da literatura sobre o Transtorno Opositivo Desafiador (TOD) e o Transtorno de Conduta (TC) de modo a favorecer o diagnóstico e intervenções escolares. Para isso, realizou-se busca por descritores no Portal da Capes e no Google Acadêmico em que foram selecionados trabalhos mais recentes escritos em português e inglês que continham no título dos manuscritos os termos da busca e os conteúdos destes foram divididos em categorias, tais como, fatores de causa/proteção; estratégias de trabalho com alunos acometidos de TOD e TC e a relação que os distúrbios podem apresentar com o cometimento de atos infracionais. Verificou-se que os autores abordam que ambos os distúrbios podem desenvolver-se pela influência do ambiente social das crianças e adolescentes, e que o professor pode exercer influência sobre o comportamento e rendimento escolar destes estudantes. O presente estudo contribui, portanto para a compreensão dos distúrbios a partir da exposição do debate de diversos autores o que pode auxiliar professores, alunos e pais no trabalho com pessoas acometidas de TOD e TC.

According to several scientific studies, at school age, students may have different behavioral disorders. Thus, this article aims to present a literature review on Oppositional Defiant Disorder (ODD) and Conduct Disorder (CT) to favourdiagnosis and school interventions. A search for descriptors in Capes Portal and Google Scholar was carried out, in which more recent works written in Portuguese and English that contained the search terms in the title of the manuscripts and their contents were divided into categories, such as causative/protective factors; work strategies with students suffering from ODD and CT, and the relationship that the disorders can present with infractions. We found that the authors state that both disorders can develop under the influence of the children's and adolescents' social environment and that the teacher can influence their behavior and academic performance. Therefore, the present study contributes to the understanding of disorders from the discussion of several authors' debates, which can help teachers, students, and parents work with people with ODD and CT.

Sluggish cognitive tempo is associated with autistic traits and anxiety disorder symptoms in children with attention-deficit/hyperactivity disorder

Objective: To investigate the association of sluggish cognitive tempo (SCT) with autistic traits (ATs) and anxiety disorder symptoms among children with attention-deficit/hyperactivity disorder (ADHD). Methods: A total of 195 children with a DSM-5 diagnosis of ADHD were included. The Barkley Sluggish Cognitive Tempo Scale (BSCTS) was used to measure SCT symptoms. Other study measures included the Autism Spectrum Quotient (AQ), Screen for Child Anxiety and Related Disorders (SCARED), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners' Teacher Rating Scale (CTRS-R). Results: The frequency of SCT was 30.3% (n=59) in the whole group. Those with SCT had higher total AQ and SCARED scores. Significant associations and correlations were also found between SCT and certain subscores of AQ and SCARED. According to the linear regression model, the total score and social skills, attention switching, and imagination scores of AQ, as well as generalized anxiety and panic/somatic scores of SCARED and the total and inattention scores of parent T-DSM-IV, were predictive of SCT total score (p < 0.05). Conclusions: SCT is associated with ATs and anxiety disorders. Children with ADHD and SCT symptoms should be screened for such conditions.

Differentiating irritable mood and disruptive behavior in adults

Abstract Introduction Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability. Methods The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators. Results Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior. Conclusions Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP)

Objective: This was the first national epidemiological study on oppositional defiant disorder (ODD) in Iran, which provided new information about the prevalence, comorbidities, and sociodemographic predictors of ODD. Methods: Data from a face-to-face household survey of 30,532 children and adolescents aged 6-18 years were collected from across all 31 provinces of Iran using a multistage cluster sampling design. The Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) was used in this study. Results: The lifetime prevalence of ODD was found to be 3.9%. ODD was significantly more common in boys than girls and appeared in late adolescence more frequently than in childhood. A lower prevalence of ODD was found among participants who lived in rural areas. ODD is highly likely to co-occur with attention deficit hyperactivity disorder, separation anxiety disorder, generalized anxiety disorder, and depressive disorders. Conclusions: The findings of this national population-based study confirm and extend previous findings on the prevalence, comorbidities, and sociodemographic predictors of ODD.

Conductas disruptivas infantiles y estilos de crianza / Child disruptive behaviors and parenting styles

Este estudio analiza los estilos de crianza parental y su relación con la aparición y mantenimiento de conductas disruptivas en escolares. El proceso de socialización en la familia es el primer y principal medio que provee y retroalimenta a nivel comportamental y emocional la conducta infantil, al vincular la práctica de actitudes, delimitación de normas-límites, valores, cumplimientos de funciones-roles y expresiones de comunicación-afecto. Se utilizó estudio de caso. Participaron seis progenitores de hijos 5 a 9 años de edad, a quienes se aplicó entrevistas psicológicas, escala de Funcionamiento Familiar (EFP) y cuestionario de Funcionamiento Familiar (FF-SI), a seis docentes se administró: Escala de Evaluación del Trastorno por Déficit de Atención con Hiperactividad e Inventario del Comportamiento de niños/as de 6-8 años para profesores/as. De las entrevistas clínicas se desprende que la mayoría de los niños muestran conductas disruptivas en los contextos: familiar y educativo, sus principales manifestaciones: irritaciones, confrontaciones, exigencias, búsqueda constante de atención, bajo rendimiento escolar, inquietud, desobediencia, no cumplen con tareas u obligaciones, desafiantes y manipuladores. Respecto a los estilos parentales y al funcionamiento familiar, los resultados encontrados muestran que las familias emplean estilos de crianza parental rígidos y permisivos. De ellas la mitad es moderadamente funcional y disfuncional. Por su parte, los docentes cumplimentan pruebas que indican la existencia de trastorno de conducta de riesgo elevado y moderado, con rango clínico. Estos resultados permiten concluir que los estilos de crianza parental se convierten en factores de protección o riesgo en la conducta de niños según la interacción que exista.

This study analyzes parenting styles and their relationship to the appearance and maintenance of disruptive behavior in school children. The process of socialization in the family is the first and main means that provides and provides feedback at a behavioral and emotional level for children's behavior, by linking the practice of attitudes, delimitation of norms-limits, values, fulfillment of functions-roles and expressions of communication -affection. A case study was used. Six parents of children from 5 to 9 years old participated, to whom psychological interviews, Family Functioning Scale (FFS) and Family Functioning Questionnaire (FF-SI) were applied, six teachers were administered: Attention Deficit Hyperactivity Disorder Assessment Scale and Behavior Inventory for 6-8 years old children for teachers. From the clinical interviews, it was found that most of the children showed disruptive behaviors in the following contexts: family and educational, their main manifestations: irritations, confrontations, demands, constant attention seeking, low school performance, restlessness, disobedience, failure to fulfill tasks or obligations, defiance and manipulation. Regarding parental styles and family functioning, the results found show that families employ rigid and permissive parenting styles. Half of them are moderately functional and dysfunctional. For their part, teacher's complete tests that indicate the existence of high- and moderate-risk behavioral disorders, with clinical range. These results allow us to conclude that parenting styles become protective or risk factors in children's behavior depending on the interaction that exists.

Salud mental infantil: una prioridad a considerar / Children's mental health: a priority to consider

Resumen: Objetivo: Identificar posibles cambios en la frecuencia de manifestaciones sindromáticas sugerentes de problemas de salud mental en población infantil mexicana empleando el Cuestionario Breve de Tamizaje y Diagnóstico (CBTD), a lo largo de 15 años. Material y métodos: Se analiza información de diferentes estudios en población general, escuelas y práctica médica. La estimación obtenida en la Ciudad de México fue utilizada como población de referencia para comparación. Resultados: Se apreciaron incrementos notables respecto a la prevalencia de síndromes como el déficit de atención e hiperactividad, y conducta oposicionista y explosiva, así como manifestaciones de ansiedad y depresivas. Estas últimas resultaron más frecuentes en la edad escolar tardía. Las alteraciones en el lenguaje y la epilepsia también mostraron incremento en diferentes grupos de edad. Conclusiones: Se discuten los hallazgos a la luz de estudios longitudinales en la literatura, así como de reportes de población adolescente en nuestro país.

Abstract: Objective: To identify possible changes in the frequency of psychopathological syndromes in Mexican children population over a 15-year period using the Brief Screening and Diagnostic Questionnaire (CBTD in Spanish). Materials and methods: Information gathered from different studies on the general population, schools and medical general practice are analyzed. Results from the Mexico City study were used as base rates for comparisons. Results: Higher prevalence of externalizing syndromes such as attention deficit and hyperactivity, oppositional and explosive conduct were very evident. Also, anxiety and depressive syndromes showed a notable increase. Prevalence of abnormal language and probable epilepsy were also increased on different age-groups. Conclusions: Findings are discussed in light of longitudinal reports in the literature as well as on reports in adolescent population in Mexico.

Riesgo de trastorno por déficit de atención e hiperactividad y otros trastornos psiquiátricos de los hermanos de pacientes con TDAH / Risk of Attention Deficit/Hyperactivity Disorder (ADHD) and Other Psychiatric Disorders in Siblings of ADHD Probands

RESUMEN Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) ocurre con mayor frecuencia en familiares de primer grado. Se cree que el riesgo no solo es específico de este trastorno, sino también de otras psicopatologías. Estudiar a los hermanos de pacientes con TDAH es un campo interesante porque comparten factores ambientales comunes. Métodos: Revisión narrativa de la literatura. Se realizó una búsqueda bibliográfica en las bases de datos PubMed y PsychNet, y se seleccionaron los artículos relacionados con el tema sin límites de fecha de publicación o diseño. Resultados: Los hermanos de pacientes con TDAH tienen mayor posibilidad de sufrir el mismo trastorno en comparación con controles, con odds ratio que varían entre 11,4 y 13,5. En estos hermanos la prevalencia de TDAH oscila entre el 26 y el 45,2%. Los hermanos con TDAH y aquellos sin TDAH están en mayor riesgo de sufrir otros trastornos, de los que el más frecuente es el trastorno de oposición desafiante (TOD). Conclusiones: Los hermanos de personas con TDAH tienen mayor riesgo de padecer el mismo trastorno. El riesgo de otro trastorno psiquiátrico aumenta marcadamente cuando el hermano también tiene TDAH; esto es aplicable especialmente al TOD, el trastorno por uso de sustancias y el trastorno bipolar.

ABSTRACT Introduction: Attention deficit and hyperactivity disorder (ADHD) occurs more frequently in first-degree relatives. It is believed that this risk is not specific to this disorder but also occurs with other psychopathologies. The study of siblings of ADHD probands is an interesting field since they share common environmental factors. Methods: This is a narrative literature review. A bibliographic search was performed on PubMed and PsychNet databases and topic-related publications were included without date of publication or study design limits. Results: Siblings of patients with ADHD have a higher likelihood of having this disorder when compared to controls, with odds ratios (OR) ranging between 11.4 and 13.5. Among these siblings, ADHD prevalence ranges between 26 and 45.2%. Siblings with ADHD and those without ADHD have an increased risk of having other disorders, the most frequent being oppositional defiant disorder (ODD). Conclusions: Siblings of people with ADHD have an increased risk of having the same disorder. The risk of having another psychiatric disorder markedly increases when the sibling also presents ADHD; this is especially true for ODD, substance use disorder and bipolar disorder.

Desarrollo cognitivo, psicoafectivo y del juego en niños y niñas con dificultades de aprendizaje que cursan primero, tercero y cuarto de primaria / Cognitive, psycho-affective, and game development in children with learning difficulties from first, third and fourth grade in elementary school

El desarrollo cognitivo, psicoafectivo y del juego han sido considerados como factores que influyen dentro del proceso de aprendizaje. En la presente investigación se pretende describir el desarrollo cognitivo, psicoafectivo y del juego en seis niños que presentan dificultades de aprendizaje y que cursan primero, tercero y cuarto de primaria en los departamentos del Valle del Cauca, Cauca y Meta en Colombia. Cabe resaltar que Elkonin será el principal autor, puesto que es el referente desde la Neuropsicología histórico-cultural para estudiar el desarrollo del juego por etapas y en su propuesta teórica plantea que el juego favorece procesos atencionales, de regulación de la conducta y el desarrollo de las neoformaciones psicológicas en el niño, necesarias para la escolarización y el aprendizaje de la lectura, la escritura y el cálculo. Como idea central, Elkonin y diversos exponentes han demostrado la relación entre el desarrollo del juego temático de roles y el desarrollo de la actividad voluntaria en el niño, crucial para la adaptación a la escuela primaria. En la investigación se utilizó un estudio de caso múltiple de corte no experimental con diseño transaccional, enfoque mixto donde el alcance de la investigación es descriptivo. Los instrumentos utilizados son la Batería Psicopedagógica Evalúa de García y González (2002), específicamente el Evalúa 0, 3 y 4, el Test del Dibujo de la Familia de Louis Corman, y se diseñó para la evaluación de las etapas del juego un Protocolo de exploración, un formato de entrevista y encuestas con padres y docentes. Los datos arrojan que los participantes presentan un desempeño bajo en cuanto al desarrollo cognitivo y las habilidades escolares, lo que contrasta significativamente con el adecuado desarrollo del juego. Los niños más pequeños y con mayores dificultades en la realización de las tareas del Evalúa, aún no alcanzan la etapa del juego temático de roles. A nivel emocional, se encontró que los niños presentan inseguridad y baja autoestima, que influyen en los niveles de adaptación.

Cognitive, psycho-affective, and game development have been considered as factors that influence the learning process. The following research describes the cognitive, psycho-affective, and game development in six children presenting learning difficulties and that are in first, third and fourth grade in elementary school in the departments Valle del Cauca, Cauca and Meta in Colombia. It is important to mention that Elkonin is the main author presented as he, from the historical-cultural neuropsychology, is a reference to study the development of the game and his theory presents that the game favors attention processes, behavior regulation and development of new psychological formation in children for schooling, literacy and mathematical awareness. As main idea, Elkonin and other authors have demonstrated the relationship between the development of role plays and the development of voluntary activity in children which is paramount for elementary school adaptation. For the research, a non-experimental multiple case study with a transactional design and mixed focus was used where the research goal is descriptive. The instruments implemented are García y González's (2002) Batería Psicopedagógica Evalúa, specifically Evalúa 0, 3 y 4, Louis Corman's Test del dibujo de la familia. A game stages exploratory protocol, an interview format and surveys for parents and teachers were designed as assessment. Data present that participants show low performance regarding cognitive development and school abilities, contrasting reatly with the proper game development. Younger children with greater difficulties solving Evalúa's tasks do not reach the role play game stage. Emotionally, it was found that the children present uncertainty and low self-steem, which influence adaptations levels.

Response inhibition and emotional responding in attention-deficit/hyperactivity disorder with comorbid disruptive, impulse-control, and conduct disorders / 南方医科大学学报

OBJECTIVE@#To characterize the traits of neuropsychological functioning deficits in patients with attention-deficit/ hyperactivity disorder (ADHD) with comorbid disruptive, impulse-control, and conduct disorders (DICCD).@*METHODS@#Twenty out-patients with ADHD, 20 with ADHD with comorbid DICCD, and 20 with DICCD, all aged 6-16 years, were enrolled in this study, with 20 healthy subjects matched for age, gender and IQ serving as the healthy controls. The patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-5). All the subjects were assessed with Golden Stroop test and emotional Stroop test to evaluate their response inhibition and emotional responding.@*RESULTS@#In Golden Stroop test, the interference scores (IGs) of errors and reaction time both differed significantly among the groups ( < 0.05), and were the highest in patients with ADHD only. In emotional Stroop test, the mean reaction time (MRT) showed significant differences among the groups ( < 0.05); the MRT of positive- congruent trials in ADHD with comorbid DICCD group was shorter than that in ADHD group but longer than that in group DICCD; the MRT in the 3 case groups were all longer than that in the control group. The MRT of both positive-incongruent trials and negative-congruent trials in ADHD with comorbid DICCD group and DICCD group was shorter than that in ADHD group but longer than that in the control group. The MRT of negative- incongruent trials in DICCD group was shorter than that in ADHD group and ADHD with comorbid DICCD group but longer than that in the control group.@*CONCLUSIONS@#The response inhibition deficit and abnormal emotional responding are the core symptoms of ADHD. Bias emotional stimuli may render response inhibitory dysfunction in patients with DICCD with callous-unemotional traits of emotional responding disorder, especially in dealing with negative emotional trials, while the comorbidity of ADHD and DICCD tends to have the emotional response trait of DICCD.

A Comparative Study on the Effectiveness of Individual and Group Play Therapy on Symptoms of Oppositional Defiant Disorder among Children / 가정의학회지

BACKGROUND: This research compared the effectiveness of play therapy provided individually or in groups for oppositional defiant disorder (ODD) symptoms among children. METHODS: This was a randomized controlled trial that used a multi-stage random sampling method. Participants included 45 children aged 6 to 10 years old with ODD, all of whom had been referred to medical consultation centers in Ahvaz, Iran in 2012. Experimental groups consisted of 15 children receiving individual play therapy and 15 receiving group play therapy, while the control group consisted of 15 randomly selected children. Data were collected using the child behavior checklist parent report form and teacher report form, along with clinical interviews with the parents. Play therapy took place weekly for eight total sessions; individual sessions lasted 45 minutes each, while group sessions were each 60 minutes in duration. Participants were assessed in three stages, including pre-intervention, post-intervention, and at 2-month follow-up. PASW SPSS ver. 18.0 software (SPSS Inc., Chicago, IL, USA) and analysis of covariance analysis methods were used to analyze data. RESULTS: Results showed meaningful decreases in ODD symptoms in the experimental groups in comparison with the control group, based on parent reporting (P≤0.001 and F=129.40) and the teacher reports additionally showed meaningful decreases in ODD symptoms in the experimental groups compared to the control group, (P≤0.001 and F=93.14). Furthermore, the effects were maintained after 2 months. CONCLUSION: This research supports the efficacy of individual and group play therapy for the treatment of ODD in children, as well as the consistency of the effects at 2-month follow-up.

Parents' Executive Functions, Parenting Styles, and Oppositional Defiant Disorder Symptoms: A Relational Model / Funciones ejecutivas de los padres, estilos de crianza y síntomas del Trastorno Oposicionista Desafiante: un modelo relacional

Abstract The present study examined the role of mother's and father's executive functions (EF), warmth and harsh parenting, and child oppositional defiant disorder symptoms (ODD). A total of 100 families with preschool children participated. The mothers answered three questionnaires: EMBU, ECI-4, and the BRIEF; the fathers answered only the BRIEF. The analysis was done by testing two structural equation models (SEM). The results showed that both models had an excellent fit and presented a significant path from mother's EF toward harsh parenting; the second model presented a significant path from harsh parenting to ODD symptoms. Our findings are concluded in light of the importance of addressing parenting interventions to prevent further conduct/disruptive disorders.

Resumen El siguiente estudio analizó el papel de las FE de la madre y del padre, el estilo de crianza y la sintomatología del TOD en los niños. Un total de 100 familias con niños en edades preescolares participaron en este estudio. La madre contestó tres cuestionarios: el EMBU, el ECI-4, y el BRIEF, mientras que el padre solo contestó su propio BRIEF. El análisis se realizó con el modelo de ecuaciones estructurales. Los resultados muestran que hay una trayectoria significativa de las FE de la madre hacia un estilo de crianza duro y severo, y esta relación continua significativa hacia la sintomatología de TOD. Nuestros resultados aluden a la importancia de las intervenciones en los estilos de crianza para prevenir el desarrollo de trastornos de conducta.

Dispositivos de segurança, psiquiatria e prevenção da criminalidade: o TOD e a noção de criança perigosa / Security devices, psychiatry and crime prevention: the TOD and the notion of a dangerous child

Resumo O artigo analisa a tendência crescente da multiplicação de diagnósticos psiquiátricos na infância, que encontra legitimidade no argumento que indica que se as patologias psiquiátricas da infância não forem devidamente tratadas, será altamente provável que, na vida adulta, surjam graves problemas psiquiátricos irreversíveis, assim como problemas associados à criminalidade e à delinquência. Analisa-se o exemplo do transtorno de oposição e desafio, conhecido como TOD, na medida em que, de acordo com o DSM-5, essa patologia supõe um alto risco para o desenvolvimento do transtorno de personalidade antissocial, patologia que apresenta conotações claramente jurídicas e criminológicas. Esses diagnósticos são analisados em perspectiva crítica a partir do conceito foucaultiano de "dispositivo de segurança".

Abstract The article analyzes the growing tendency to multiply psychiatric diagnoses in childhood, which finds legitimacy in the argument that, if childhood psychiatric disorders are not properly treated, it will be highly probable that in adult life there will be serious irreversible psychiatric problems, problems associated with crime and delinquency. The example of oppositional and defiant disorder, known as TOD, is analyzed insofar as, according to DSM-5, this pathology supposes a high risk for the development of antisocial personality disorder, a condition that presents clearly juridical connotations and criminological. These diagnoses are analyzed in a critical perspective from the Foucauldian concept of "safety device".

Dysfunctional Social Reinforcement Processing in Disruptive Behavior Disorders: An Functional Magnetic Resonance Imaging Study

OBJECTIVE: Prior functional magnetic resonance imaging (fMRI) work has revealed that children/adolescents with disruptive behavior disorders (DBDs) show dysfunctional reward/non-reward processing of non-social reinforcements in the context of instrumental learning tasks. Neural responsiveness to social reinforcements during instrumental learning, despite the importance of this for socialization, has not yet been previously investigated. METHODS: Twenty-nine healthy children/adolescents and 19 children/adolescents with DBDs performed the fMRI social/non-social reinforcement learning task. Participants responded to random fractal image stimuli and received social and non-social rewards/non-rewards according to their accuracy. RESULTS: Children/adolescents with DBDs showed significantly reduced responses within the caudate and posterior cingulate cortex (PCC) to non-social (financial) rewards and social non-rewards (the distress of others). Connectivity analyses revealed that children/adolescents with DBDs have decreased positive functional connectivity between the ventral striatum (VST) and the ventromedial prefrontal cortex (vmPFC) seeds and the lateral frontal cortex in response to reward relative to non-reward, irrespective of its sociality. In addition, they showed decreased positive connectivity between the vmPFC seed and the amygdala in response to non-reward relative to reward. CONCLUSION: These data indicate compromised reinforcement processing of both non-social rewards and social non-rewards in children/adolescents with DBDs within core regions for instrumental learning and reinforcement-based decision-making (caudate and PCC). In addition, children/adolescents with DBDs show dysfunctional interactions between the VST, vmPFC, and lateral frontal cortex in response to rewarded instrumental actions potentially reflecting disruptions in attention to rewarded stimuli.

The Mechanism of Cortico-Striato-Thalamo-Cortical Neurocircuitry in Response Inhibition and Emotional Responding in Attention Deficit Hyperactivity Disorder with Comorbid Disruptive Behavior Disorder / 神经科学通报·英文版

The neurocircuitries that constitute the cortico-striato-thalamo-cortical (CSTC) circuit provide a framework for bridging gaps between neuroscience and executive function in attention deficit hyperactivity disorder (ADHD), but it has been difficult to identify the mechanisms for regulating emotional problems from the understanding of ADHD comorbidity with disruptive behavior disorders (DBD). Research based on "cool" and "hot" executive functional theory and the dual pathway models, which are thought of as applied response inhibition and delay aversion, respectively, within the neuropsychological view of ADHD, has shed light on emotional responding before and after decontextualized stimuli, while CSTC circuit-related domains have been suggested to explain the different emotional symptoms of ADHD with or without comorbid DBD. This review discusses the role of abnormal connections in each CSTC circuit, especially in the emotion circuit, which may be responsible for targeted executive dysfunction at the neuroscience level. Thus, the two major domains - abstract thinking (cool) and emotional trait (hot) - trigger the mechanism of onset of ADHD.

Estrategias de intervención dirigidas a niños con trastorno negativista desafiante, una revisión de la literatura / Intervention Strategies Used in the Treatment of Children with Oppositional Defiant Disorder, a Review of Literature / Estratégias de intervenção dirigidas a crianças com transtorno desafiador opositivo, uma revisão da literatura

Objetivo: identificar las estrategias que se utilizan en el tratamiento de niños con trastorno oposicional desafiante. Materiales y métodos: se trata de una revisión de la literatura sobre las estrategias de intervención que se reportan para la intervención de niños con trastorno negativista desafiante, la cual se realiza en seis bases de datos: ProQuest, PubMed, Science Direct, Ebsco, Scopus y Scielo. Los criterios de inclusión fueron población infantil, publicaciones en el periodo 2007-2015, idioma español e inglés, que explicaran estrategias de intervención en niños con trastorno negativista desafiante, artículos completos y disponibles. Los criterios de exclusión fueron artículos que mencionan desórdenes cognitivos, intervenciones farmacológicas y tratamiento solo para déficit de atención con hiperactividad. El método de registro y análisis de resultados se realiza en una rejilla en Excel en la que se incluye el número de artículos por base de datos, año, país de publicación, disciplina, herramientas de evaluación, población y estrategia de intervención sugerida. Se revisaron un total de 50 artículos que se ajustaban al objetivo del estudio. Resultados: el 50% de las publicaciones se encontraron en Pubmed, el 16% en Scopus, el 14% en Science Direct, el 10% en Proquest, el 6% en Ebsco y en Scielo 4%. Estados Unidos es el país con mayor evidencia respecto al tema con un 60% de publicaciones. El 50% de las búsquedas reportan que las estrategias para el tratamiento del trastorno oposicional desafiante son desarrolladas de manera interdisciplinar y están dirigidas a la población infantil. Conclusiones: las estrategias de intervención se plantean desde un enfoque clínico y pocas involucran estrategias pedagógicas

Objective: To identify the strategies used in the treatment of children with oppositional defiant disorder. Materials and methods: This is a review of literature on intervention strategies that are reported for the intervention of children with oppositional defiant disorder, which was performed in six databases: ProQuest, PubMed, Science Direct, Ebsco, Scopus and Scielo. Inclusion criteria were child population, publications in the period 2007-2015 in Spanish and English, articles that explained intervention strategies in children with oppositional defiant disorder, complete and available items. Exclusion criteria: articles that mentioned cognitive disorders, pharmacological interventions and only treatment for attention deficit hyperactivity disorder. The method of recording and analysis of the results is carried out on a grid in Excel in which the number of items per database, year, country of publication, discipline, assessment tools, and population strategy suggested intervention is included. A total of 50 items that fit the purpose of the study were revised. Results: 50% of the publications were found in PubMed, in Scopus 16%, 14% in Science Direct, 10% in the Proquest, 6% in Ebsco and 4% Scielo. United States is the country with more evidence on the issue with 60% of publications. 50% of the researches reported that strategies for treating oppositional defiant disorder are developed in an interdisciplinary way and are aimed at children. Conclusions: Intervention strategies arise from a clinical approach and few involve teaching strategies

Objetivo: Identificar as estratégias que se utilizam no tratamento de crianças com transtorno desafiador opositivo. Materiais e métodos: Trata-se de uma revisão da literatura sobre as estratégias de intervenção que se reportam para a intervenção de crianças com transtorno desafiador opositivo, a qual realiza-se em seis bases de dados: ProQuest, PubMed, Science Direct, Ebsco, Scopus e Scielo. Os critérios de inclusão foram população infantil, publicações no período 2007-2015, língua espanhola e inglesa, que explicaram estratégias de intervenção em crianças com transtorno negativista desafiador opositivo, artigos completos e disponíveis. Os critérios de exclusão foram artigos que mencionam desordens cognitivos, intervenções farmacológicas e tratamento só para déficit de atenção com hiperatividade. O método de registro e análise de resultados se realiza em uma grade em Excel na que se inclui o número de artigos por base de dados, ano, país de publicação, disciplina, ferramentas de avaliação, população e estratégia de intervenção sugerida. Revisaram-se um total de 50 artigos que se ajustavam o objetivo do estudo. Resultados: O 50% das publicações encontraram-se em Pubmed, o 16% em Scopus, o 14% em Science Direct, o 10% em Proquest, o 6% em Ebsco e em Scielo 4%. Os Estados Unidos é o país com maior evidência respeito ao tema com um 60% de publicações. O 50% das buscas reportam que as estratégias para o tratamento do transtorno desafiador opositivo são desenvolvidas de maneira interdisciplinar e estão dirigidas à população infantil. Conclusões: As estratégias de intervenção apresentam-se desde um enfoque clínico e poucas envolvem estratégias pedagógicas