RESUMEN
Los déficit de las funciones ejecutivas (FE) suelen estar presentes en el Trastorno por Déficit de Atención e Hiperactividad (TDAH). Distintos trabajos mostraron algunas falencias vinculadas a la medición de las FE, como la participación de otros procesos que no constituyen objeto de la evaluación. En el trabajo que se informa se analizaron las diferencias existentes en las FE de niños con y sin diagnóstico de TDAH y se buscó identificar y establecer aquellas variables con mayor poder discriminante para la probabilidad de pertenencia a ambos grupos. Se utilizaron las tareas de la batería denominada Tareas de Autorregulación Cognitiva (TAC), diseñadas ad-hoc para evaluar específica y relativamente en forma independiente cada FE. Se trabajó con una muestra de 49 niños escolarizados de 7 a 12 años de edad, de ambos géneros, divididos en dos grupos, uno clínico de 19 niños con diagnóstico de TDAH, con una media de edad igual a 9.84 años (DE = 1.83) y uno control de 30 niños sin diagnóstico de TDAH con una media de edad igual a 10.27 años (DE = .82), equiparados por género, edad, niveles socioeconómico y educacional. Los resultados mostraron que el análisis discriminante permitió clasificar correctamente al 98% de los participantes. Las tareas mejor discriminadas fueron la de Flexibilidad cognitiva y Control inhibitorio comportamental, con un 98.9% y 97.8%, respectivamente, de casos correctos. Esto muestra que la TAC constituye una batería con adecuada sensibilidad y especificidad para discriminar y detectar casos de TDAH con un elevado nivel de confiabilidad y porcentaje de correctos clasificados.
The executive functions (EF) multidimensional approaches state that EFs consist of a set of processes with relative autonomy and independence: working memory (WM), cognitive flexibility (CF), and inhibition. Regarding the inhibitory operation, three dimensions are distinguished, each with distinct operative features: perceptual, cognitive, and behavioral inhibition. Perceptual inhibition is the process that allows the focus on relevant environmental stimuli through the attenuation of the interference generated by other stimuli present in the context. Cognitive inhibition is involved in the decreased level of activation of the prepotent mental representations of intrusive and irrelevant to the achievement of current goals. Finally, behavioral inhibition handles suppress or cancel behaviors and strong, prepotent and un suitable behaviors. While this last type contributes to the inhibitory control of behavior, the other two processes (cognitive and perceptual inhibition) apply to cognition, as involved in regulating the perceptions and representations. Regarding executive operation in general, empirical evidence suggests that these dimensions are involved in such diverse fields as psychopathology, personality, emotion, attentional control and cognitive development. It has been found that deficits in EFs are usually present in the Attention Deficit Hyper activity Disorder (ADHD). The common practice of treating children with ADHD as an undifferentiated group of participants in behavioral and neuropsychological research may have adverse methodological consequences. Relying on group averaging in comparing the performance of ADHD and control groups may produce misleading results, as it conceals possible effects that may characterize some but not all ADHD participants. According to the previous assumptions, the objectives of this work were (1) analyzing the EF performance in children with or without diagnosed ADHD and (2) identifying and setting the variables with greater discriminant power between the normal and clinical groups. Battery tasks called Tareas de Autorregulación Cognitiva (TAC) ad-hoc and designed to assess EFs operation specifically and with relative independence with each other were used. The sample consisted of 49 school-attending children, aged 7-12 years, of both sexes, divided into two groups: (1) a clinical group of 19 children diagnosed with ADHD combined subtype (M age = 9.84 years, SD =1.83), and (2) a control group of 30 children without ADHD diagnosis (M age = 10.27 years, SD = .82), matched by gender, age, socioeconomic and educational level. By analyzing the results, significant differences were found between verbal and visuospatial WM, CF, behavioral and perceptual inhibition indices. Then, a discriminant analysis was made in order to use the index values with significant differences and make predictions about the probability of a subject to be a member of a certain criteria variable value (clinical or control group condition). Results show that discriminant analysis allows to correctly classifying 98% of the participants. The results indicated that the average RT of the mixed block (Cognitive Flexibility) and the Stop Signal RT (Behavioral Inhibition) are the indices with better sensitivity and specificity for detecting the presence of ADHD in this sample. Considering that the area under the curve indicates the probability to classify correctly a couple of healthy and ill individuals randomly selected, then it is possible to conclude that the values of Cognitive Flexibility and Behavioral Inhibitory control tasks had better discriminant power, as they correctly classified 98.9% and 97.8% of the total cases, respectively. This result shows that the TAC Battery presents adequate sensitivity and specificity to discriminate and detect ADHD with a high level of reliability and classification accuracy. Summarizing, we highlight the importance of having an assessment battery such as the totally computerized TAC, which allows the assessment of EFs independently, with an attractive design and straightforward administering and scoring procedures.