Metodología en el diagnóstico del Trastorno por Déficit de Atención e Hiperactividad / Methodology in the diagnosis of Attention Deficit Hyper activity Disorder (ADHD)

Resumen Introducción : El objetivo del trabajo es evidenciar la necesidad de aplicar una metodología de evaluación en el Trastorno por Déficit de Atención e Hiperactividad (TDAH) por la falta de acuerdo entre padres y profesores en los criterios del Manual diagnóstico y estadístico de los trastornos mentales, quinta edición (DSM-5). Métodos : Se trata de un estudio descriptivo retros pectivo de tres años y diez meses. La muestra se extrajo de 640 sujetos evaluados y diagnosticados de TDAH, con edades comprendidas entre 8 y 16 años, y un Cociente Intelectual Total (CIT) entre 80 y 120. A los sujetos se les aplicó una evaluación neuropsicológica. Se tuvieron en cuenta determinadas escalas de los cuestionarios: Siste ma de Evaluación de Niños y Adolescentes (SENA) y Eva luación Conductual de la Función Ejecutiva-2 (BRIEF-2), ambos cumplimentados por padres, y los criterios del DSM-5 contestados por padres y profesores. Resultados : Como resultado se observa una baja con cordancia entre las observaciones obtenidas del DSM-5 entre padres y profesores.

Abstract Introduction : The aim of the study is to demonstrate the need to apply an assessment methodology in At tention Deficit Hyperactivity Disorder (ADHD) due to the lack of agreement between parents and teachers on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Methods : This is a retrospective descriptive study of three years and ten months. The sample was drawn from 640 subjects assessed and diagnosed with ADHD, aged between 8 and 16 years, and with a Total Intellectual Quotient (TQ) between 80 and 120. Subjects underwent a neuropsychological assessment. Certain scales of the questionnaires: Child and Adolescent Assessment Sys tem (SENA) and Behavioural Assessment of Executive Function-2 (BRIEF-2), both completed by parents, and the DSM-5 criteria answered by parents and teachers were taken into account. Results : As a result, a low concordance was observed between the observations obtained from the DSM-5 between parents and teachers.

Trastorno por Déficit de Atención/Hiperactividad (TDAH) y Trastorno de Tourette (TT): entre la comorbilidad y el diagnóstico diferencial / Attention deficit/hyperactivity disorder (ADHD) and To urette disorder (TD): between comorbidity and differential diagnosis

Resumen El Trastorno de Tourette (TT) y el Trastorno por déficit de atención / hiperactividad (TDAH) son entidades neu ropsiquiátricas que usualmente inician en la infancia. Esta revisión busca colaborar con los clínicos, quienes suelen confrontarse al dilema de saber si existe una comorbilidad o un diagnóstico diferencial, ya que esta pregunta cobra vital importancia en el momento de decidir el tratamiento. Invitamos al colega a revisar nuestros hallazgos, soportados por bases moleculares, fisiológicas y neuroanatómicas, además de los datos epidemiológicos. Al final, brindamos una propuesta de algoritmo diag nóstico que podrá utilizar cuando se encuentre ante síntomas compartidos entre los dos diagnósticos. El TDAH y el TT deben ser intervenidos tempranamente, para mejorar la calidad de vida y funcionalidad del paciente y prevenir secuelas, no solo en niños, niñas y adolescentes (NNA), también a lo largo de la vida.

Abstract Tourette Disorder (TD) and attention deficit hyperac tivity disorder (ADHD) are both major neuropsychiatric conditions that usually begin during infancy. This revision aims to collaborate with pediatricians, who are often confronted with the question of co-mor bidity or differential diagnosis between ADHD and TD. The question becomes urgent when the clinician must decide if he/she can start ADHD or TD treatment. We encourage our colleagues to revise our findings, based in bimolecular and neuroanatomic shared issues in ad dition to updated epidemiological findings. The clinician will find an original proposed algorithm that they can use when the shared symptoms are pres ent in a little patient. TD and ADHD must be intervened early, so we can get better outcomes. The consequences of letting the symptoms increase can generate sequels and handicaps, that can interfere with the quality of life and functionality not only during infancy and adoles cence but also in adult life.

Genética del TDAH en la práctica clínica / Genetics of ADHD in clinical practice

Resumen El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo desde una perspectiva causal, clínica y pro nóstica. La investigación refleja su carácter multifactorial con un papel destacado de los factores genéticos. Los estudios poblacionales han señalado históricamente la implicación de numerosas variantes genéticas de escaso tamaño de efecto, las cuales por sí mismas apenas incre mentan el riesgo de TDAH y difícilmente justifican su ele vada heredabilidad. Muchas de ellas están presentes en más del 60% de la población general, lo que sugiere su pa pel modulador más que causal. No obstante, gracias a la irrupción de nuevas técnicas genéticas en los últimos 15 años, se están identificando un mayor número de casos con trastornos genéticos (muchos de ellos monogénicos), cuyas variantes genéticas explican por sí mismas la presencia del TDAH. El estudio detallado de los antecedentes personales y familiares, así como una exploración física completa, puede ayudar a identificar algunos de ellos. La identificación de la causa en este conjunto de casos tiene un valor crucial en el asesoramiento clínico, el consejo genético-familiar y la anticipación pronóstica, así como en la realización o evitación de estudios complementarios y en el diseño del plan terapéutico.

Abstract Attention-deficit/hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disor der from a causal, clinical and prognostic perspective. Research reflects its multifactorial nature with a promi nent role of genetic factors. Population studies have historically pointed to the involvement of numerous genetic variants of small effect size, which hardly by themselves increase the risk of presenting the disorder and hardly justify its high heritability. Many of them are present in more than 60% of the general population, suggesting their modulatory rather than causal role. However, after the irruption of new genetic techniques in the last 15 years, a greater number of cases are be ing identified with genetic disorders (many of them monogenic), whose genetic variants alone explain the presence of ADHD. A detailed study of the personal and family history, as well as a complete physical examination, can help to identify some of them. The identification of the cause in this group of cases has a crucial value in clinical counseling, genetic-familial counseling and prognostic anticipation, as well as in the performance or avoidance of complementary stud ies and in the design of the intervention plan.

Trastornos del espectro autista, trastornos por déficit de atención hiperactividad y desregulación emocional: enmascaramiento y abordaje / Autistic spectrum disorders, attention deficit disorders, hyperactivity and emotional dysregulation: masking and approach

Resumen Los Trastornos del Espectro Autista (TEA) y los Tras tornos por Déficit de Atención Hiperactividad (TDAH) son Trastornos del Neurodesarrollo (TN) que coexisten frecuentemente y que tienen factores etiológicos, bio lógicos, clínicos en común. La comorbilidad de ambos TN se asocia a un retraso en el diagnóstico del TEA o un diagnóstico que nunca llegan a recibir y es frecuente el desarrollo de alteraciones perceptivas, emocionales, cognitivas y conductuales relacionadas con la Desregu lación Emocional (DE). Cuando ambos TN no son diag nosticados en infancia, frecuentemente reciben diag nósticos equivocados en edades más tardías, siendo el más frecuente el Trastorno Límite de Personalidad (TLP). Se analiza la presentación clínica de la asociación del TEA y el TDAH, la asociación con DE, diferenciación del TLP y evaluación e intervención. La comorbilidad TEA, TDAH, DE, es un trastorno más severo, asociado a poli farmacología y a ingresos hospi talarios.

Abstract Autism Spectrum Disorders (ASD) and Attention Defi cit Hyperactivity Disorders (ADHD) are Neurodevelop mental Disorders (ND) that frequently coexist together and have etiological, biological, and clinical factors in common. The comorbidity of both neurodevelopmental disorders is associated with a delay or lack of ASD di agnosis and the development of perceptual, emotional, cognitive and behavioral alterations related to Emotional Dysregulation (ED) is common. When both TN are not diagnosed in childhood, they frequently receive wrong diagnoses at later ages, the most frequent being Border line Personality Disorder (BPD). The clinical presentation of the association of ASD and ADHD, the association with ED, differentiation of BPD, and evaluation and intervention are here analyzed. The comorbidity ASD, ADHD, ED is a more severe disorder associated to polypharmacology and hospital admissions.

Impactos do TDAH à Adolescência: Revisão Sistemática de Literatura / Impacts of ADHD on Adolescence: Systematic Literature Review

RESUMO: Transtorno do Déficit de Atenção com Hiperatividade (TDAH) é um transtorno do neurodesenvolvimento caracterizado por níveis prejudiciais de desatenção e/ou hiperatividade-impulsividade. Foram investigados resultados obtidos em pesquisas sobre impactos do TDAH ao adolescente e foi utilizada a recomendação PRISMA 2020. As bases de dados consultadas foram: APA PsycNet, Lilacs, Medline, PubMed Central, Scorpus, SciELO, a partir dos seguintes descritores: Transtorno do Déficit de Atenção e Hiperatividade, TDAH, Attention Deficit Hyperactivity Disorder, ADHD e Adolescente, Adolescentes, Adolescência, Adolescent, Teenager e Adolescence. Os critérios de inclusão foram: artigos publicados em periódicos entre janeiro de 2001 e janeiro de 2021, em português e inglês, completos e disponíveis online, estudos empíricos, revisados por pares, terem adolescentes como participantes e apresentarem no título, resumo ou corpo do texto os descritores referidos. Os dados foram tratados e organizados conforme check list (recomendação PRISMA 2020). Análises estatísticas descritivas foram realizadas com o Excel 2019. Para apresentar os resultados, utilizaram-se o fluxograma PRISMA, quadro e figuras. Incluíram-se 68 artigos que apontaram variedade de impactos negativos ao desenvolvimento do adolescente nas áreas sociais/relacionais, comportamentais, biológicas, neurológicas, cognitivas, psicológicas e psicopatológicas. Possível limitação desta revisão pode ser a não inclusão de artigos em outros idiomas, além do inglês e português. Os resultados sugerem multidimensionalidade dos impactos do TDAH ao adolescente, requerendo abordagem pluridimensional para evitar cronicidade, reduzindo seus efeitos ao desenvolvimento.

ABSTRACT: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by harmful levels of inattention and/or hyperactivity-impulsivity. Results obtained from research on the impact of ADHD on adolescents were investigated and the PRISMA 2020 recommendation was used. The databases consulted: were APA PsycNet, Lilacs, Medline, PubMed Central, Scorpus, SciELO, from the following descriptors: Transtorno do Déficit de Atenção e Hiperatividade, TDAH, Attention Deficit Hyperactivity Disorder, ADHD and Adolescente, Adolescentes, Adolescência, Adolescent, Teenager and Adolescence. The inclusion criteria were: articles published in journals between January 2001 and January 2021, in Portuguese and English, complete and available online, empirical studies, peer reviewed, with adolescents as participants and presenting in the title, abstract or body of the text the referred descriptors. The data were processed and organized according to the check list (PRISMA 2020 recommendation). Descriptive statistical analyzes were performed using Excel 2019. The PRISMA flowchart, table and figures were used to present the results. Sixty-eight articles were included that pointed to a variety of negative impacts on adolescent development in the social/relational, behavioral, biological, neurological, cognitive, psychological and psychopathological areas. A possible limitation of this review may be the non-inclusion of articles in languages other than English and Portuguese. The results suggest the multidimensionality of the impacts of ADHD on adolescents, requiring a multidimensional approach to avoid chronicity, reducing its effects on development.

Serious Games to Improve Attention in Boys and Girls with Attention Deficit Hyperactivity Disorder (ADHD): A Pilot Study

Background: The objective of this study was to test a treatment program in Serious Games (SG) format to improve attention in children from Catalonia, Spain, with Attention Deficit Hyperactivity Disorder (ADHD). The activities adapted to the SG format consisted of (1) stimulus selection, (2) mark equal drawings, (3) eight differences, (4) hidden figures, (5) compare texts, (6) compare measures and shapes, (7) put model keys, (8) labyrinths and (9) memorization of drawings. Method: A pretest-posttest design was used with a cohort of 30 children between 8 and 10 years old diagnosed with ADHD, with 20% girls (n = 6) and 80% boys (n = 24) with a mean age of 9.4 years (SD = 0.63; range of 8 to 10 years). Four schools and a clinical center from Catalonia, Spain participated in the sample composition. Half of the sample participated in an attention improvement program for nine sessions of 30-45 minutes each in Serious Games format. They were presented with a series of game challenges with various virtual scenarios through a monitor. The other half did the same attention improvement program in pencil and paper format. Results: The children in the Serious Games group progressed and improved more during treatment, as shown by the average number of errors of commission (p =.02) than those in the pencil and paper group. Both groups also improved in the total score and concentration scale of the D2 test (p < .001). Conclusions: Attentional training through programs in Serious Games format seems to have a more significant effect on commission errors than attentional training in pencil and paper format.

Antecedentes: El objetivo del presente estudio ha sido poner a prueba un programa de tratamiento en formato Serious Games (SG) para mejorar la atención en niños de Cataluña, España, con Trastorno por Déficit de Atención/Hiperactividad (TDAH). Las actividades adaptadas al formato SG consistieron en (1) selección de estímulos, (2) marcar dibujos iguales, (3) ocho diferencias, (4) figuras ocultas, (5) comparar textos, (6) comparar medidas y formas, (7) poner llaves modelo, (8) laberintos y (9) memorización de dibujos. Método: Se utilizó un diseño pretest-postest con una cohorte de 30 niños entre 8 y 10 años con diagnóstico de TDAH, con un 20% de niñas (n = 6) y un 80% de niños (n = 24) con una edad media de 9.4 años (DE = 0.63; rango de 8 a 10 años). La mitad de la muestra participó en un programa de mejora de la atención durante 9 sesiones de entre 30-45 minutos cada una en formato de Serious Games. Se les presentó una serie de desafios de juego con varios escenarios virtuales a través de un monitor. La otra mitad de la muestra hizo el mismo programa de mejora de la atención, pero en formato lápiz y papel. Resultados: Los niños del grupo de Serious Games progresaron y mejoraron más durante el tratamiento, como lo demuestra el promedio de errores de comisión (p = .02), en comparación con los niños del grupo de lápiz y papel. Ambos grupos también mejoraron en la puntuación total y en la escala de concentración de la prueba D2 (ambos p < .001). Conclusiones: El entrenamiento atencional a través de programas en formato Serious Games parece tener un mayor efecto que el entrenamiento atencional en formato lápiz y papel sobre los errores de comisión.

El rol de la retroalimentación en la toma de decisiones bajo riesgo en niños/as y adolescentes con Trastorno por Déficit de Atención e Hiperactividad

Los estudios en niños/as y adolescentes con Trastorno por Déficit de Atención e Hiperactividad (TDAH) suelen evidenciar dificultades en la toma de decisiones, vinculadas con comportamientos más riesgosos. El objetivo del presente estudio fue analizar y comparar el proceso de Toma de Decisiones Bajo Riesgo (TDBR) en niños/as y adolescentes con TDAH, considerando los tipos de retroalimentaciones utilizadas. Los tipos de retroalimentaciones se refieren al procesamiento de las consecuencias de las decisiones de los ensayos previos y a su influencia en las elecciones presentes y futuras. Se realizó un estudio descriptivo comparativo con un diseño ex post facto retrospectivo con dos grupos. La muestra estuvo compuesta por 100 niños/as y adolescentes de 8 a 15 años (68 niños y niñas de 8 a 11 años y 32 adolescentes de 12 a 16 años), divididos en grupo clínico y grupo control, pareados por sexo y edad. Para evaluar la TDBR se administró el Test de los Dados (The Game of Dice Task, GDT), la cual es una prueba informatizada en la que se deben tomar decisiones apostando para ganar puntos. Para analizar los tipos de retroalimentación se consideraron ocho tipos posibles. Los resultados evidenciaron un comportamiento con una tendencia a elegir opciones de riesgo en la población con TDAH, tanto en el tipo de elecciones realizadas como en la forma en que utilizan la retroalimentación al ganar o al perder, no vinculándose necesariamente con decisiones desfavorables. Estos hallazgos podrían contribuir al desarrollo de programas de intervención destinados a disminuir las dificultades en la toma de decisiones en personas con diagnóstico de TDAH.

Studies on children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) often show difficulties in decision-making, linked to riskier behaviors. The aim of the present study was to analyze and compare the process of Decision Making Under Risk (DMUR) in children and adolescents with ADHD considering the types of feedback used. Feedback types refer to processing the consequences of previous trial decisions and their influence on present and future choices. A comparative descriptive study was carried out with a retrospective ex post facto type design with two groups. The sample consisted of 100 boys, girls and adolescents from 8 to 15 years old, (68 boys and girls from 8 to 11 years old and 32 adolescents from 12 to 16 years old), divided into a clinical group and a control group paired by sex and age. To evaluate the DMUR, the Game of Dice Task (GDT) was administered, which is a computerized test in which betting decisions must be made to earn points. And to analyze the types of feedback, eight possible types were considered. The results showed a behavior with a tendency to choose risky options in the population with ADHD, both in the type of choices made and in the way, they use feedback when winning or losing, not necessarily linked to unfavorable decisions. These findings could contribute to the development of intervention programs aimed at reducing the difficulties in decision-making in people diagnosed with ADHD.

When should a university student be allowed academic accommodations for attention-deficit/hyperactivity disorder? A position statement for a unified procedure for use in Brazil

In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria.

Prevalence and correlates of social networking addiction and its association with adult ADHD and stress among students of a medical college

Introduction: Repeated use of social network is said to cause addiction. Attention deficit hyperactivity disorder (ADHD) is disorder found in childhood. Studies have shown that such children continue to have the symptoms of ADHD as adults. The aim of this study was to find the prevalence of social networking addiction and Internet addiction and their relationship with ADHD. Also, to assess the relationship between perceived stress and sociodemographic factors with social networking and internet addiction. Material and Methods: A cross-sectional study was conducted among 150 undergraduate and postgraduate students of BMCRI after ethical clearance. Medical students who gave consent were included through stratified random sampling. Those who were taking treatment for psychiatric illness were excluded. Scales like the Young Internet addiction test (IAT); Bergen’s Facebook Reporting Scale, ADHD Self-Reporting Scale, and Wender Utah Brief Rating Scale for ADHD, and Cohen Perceived Stress Scale (PSS) for perceived stress have been used. Results: The mean age was found to be 21.56 ± 3 years. 62.6% were males and 37.33% of were females. The prevalence of Internet addiction was found to be 23.3% (n = 35), with 2% (n = 3) were having severe addiction, 6.6% (n = 10) were having moderate Internet and 14.6% (n = 22) having mild internet addiction according to modified Young’s criteria (2011). The prevalence of social networking addiction as per the Bergen Facebook Addiction Scale (BFAS) score was 4.66% and adult ADHD was 15%. There was a strong positive correlation (0.76) between Internet Addiction and Facebook addiction scores and between BFAS score and IAT score. A moderate positive correlation (0.46 and 0.47) between Internet addiction and Facebook addiction with perceived stress and ADHD and IAT score with PSS score and ASRS score, weak positive correlation with PSS score and ASRS score was observed. Conclusion: A significant proportion of medical students develop Internet addiction and minority develops social network addiction. Furthermore, perceived stress and ADHD scores are positively correlated with internet and social networking addiction.

Velocidad de procesamiento en escolares chilenos con y sin Trastorno por Déficit de Atención con Hiperactividad (TDAH) / Processing Speed in Chilean Schoolchildren With and Without Attention Deficit Hyperactivity Disorder (ADHD) / Velocidade de processamento em estudantes chilenos com e sem Transtorno de Déficit de Atenção e Hiperatividade (TDAH)

El TDAH es el trastorno del neurodesarrollo más diagnosticado en escolares. La evidencia indica que las funciones ejecutivas, como es el caso de la velocidad de procesamiento y la memoria de trabajo, están afectadas en estudiantes con TDAH, aunque no existe un acuerdo definitivo sobre su presencia sistemática en este trastorno. Esta investigación pretende determinar si la velocidad de procesamiento y la memoria de trabajo corresponden a variables cognitivas en el TDAH. Participaron 138 estudiantes de 10 a 17 años. Se determinó TDAH con la escala VADTRS; se evaluó velocidad de procesamiento con una tarea de rapidez grafomotora y memoria de trabajo con una tarea de dígitos. Se utilizó un diseño transversal, univariante e intersujeto para el análisis de los datos. El VADTRS detectó un grupo con TDAH (N = 97) y otro sin TDAH (N = 41). A ambos grupos se aplicaron tareas de velocidad de procesamiento y memoria de trabajo; los análisis permitieron detectar diferencias significativas en estas variables entre los grupos con y sin TDAH. El grupo con TDAH fue dividido según su presentación; no se detectaron diferencias significativas en velocidad de procesamiento; la memoria de trabajo mostró un rendimiento significativa- mente menor en las presentaciones de TDAH inatenta y combinada. La velocidad de procesamiento y la memoria de trabajo parecen distinguir entre sujetos con y sin TDAH, la velocidad de procesamiento no parece distinguir entre presentaciones y la memoria de trabajo aparece alterada en aquellas presentaciones en que el componente atencional es definitorio

ADHD is the most commonly diagnosed neurodevelopmental disorder in schoolchildren. Evidence indicates that executive functions, such as processing speed and working memory, are affected in students with ADHD, although there is no definitive agreement on their sys- tematic presence in this disorder. This research aims to determine whether processing speed and working memory correspond to cognitive variables in ADHD. A total of 138 students aged 10 to 17 years participated. ADHD was determined with the VADTRS scale; processing speed was assessed with a graphomotor speed task and working memory with a digit task. A cross-sectional, univariate, intersubject design was used for data analy- sis. The VADTRS detected one group with ADHD (N = 97) and one without ADHD (N = 41). Processing speed and working memory tasks were applied to both groups; analyses detected significant differences in these variables between the ADHD and non- ADHD groups. The ADHD group was divided according to presentation; no significant differences were detected in processing speed; working memory showed significantly lower performance in the inattentive and combined ADHD presentations. Processing speed and working memory appear to distinguish between subjects with and without ADHD, processing speed does not appear to distinguish between presentations, and working memory appears impaired in those presentations in which the attentional component is defining.

O TDAH é o distúrbio de desenvolvimento neurológico mais frequentemente diagnosticado em crianças em idade escolar. As provas indicam que as funções executivas, tais como a velocidade de processamento e a memória de trabalho, são afectadas nos estudantes com TDAH, embora não haja um acordo definitivo sobre a sua presença sistemática nesta doença. Esta investiga- ção visa determinar se a velocidade de processamento e a memória de trabalho correspondem a variáveis cognitivas na TDAH. Um total de 138 estudantes com idades compreendidas entre os 10 e os 17 anos participaram. A TDAH foi determinada com a escala VADTRS; a velocidade de processamento foi avaliada com uma tarefa de velocidade grafomotora e a memória de trabalho com uma tarefa de dígitos. Foi utilizado um desenho transversal, univariado e intersubjecto para análise de dados. O VADTRS detectou um grupo com ADHD (N = 97) e um grupo sem ADHD (N = 41). Ambos os grupos foram administrados com velocidade de processamento e tarefas de memória de trabalho; as análises detectaram diferenças significativas nestas variáveis entre os grupos com ADHD e sem ADHD. O grupo TDAH foi dividido de acordo com a apresentação; não foram detectadas diferenças significativas na velocidade de processamento; a memória de trabalho mostrou um desempenho significativamente inferior nas apresentações de TDAH desatenta e combinada. A velocidade de processamento e a memória de trabalho parecem distinguir entre assuntos com e sem TDAH; a velocidade de processamento não parece distinguir entre apresentações e memória de trabalho parece prejudicada nas apresentações em que a componente atencional está a definir

Percepción de la ansiedad y de las dificultades de aprendizaje según los criterios de la familia y de los profesores de niños con Trastorno por Déficit de Atención e Hiperactividad / Perception of anxiety and learning difficulties according to the criteria of the family and eachers of children with Attention Deficit Hyperactivity Disorder

Resumen Tanto el Trastorno por Déficit de Atención e Hiperactividad (TDAH) como la ansiedad son dos de los trastornos que más se evidencian en la población infanto-juvenil existiendo una correlación entre ambos tal y como se recoge en numerosos estudios. La combinación de ambos trastornos afecta a los procesos de enseñanza-aprendizaje del niño provocando dificultades de aprendizaje (DA) en el mismo. Los objetivos del presente trabajo se basaron en valorar los criterios que evidencian padres y profesores en niños con TDAH para caracterizar el grado de adecuación de la percepción y evaluar si esta se ajusta a la realidad o es insuficiente, si existen diferencias en dicha percepción entre padres y docentes; analizar la conciencia que tienen sobre las posibles DA que puedan presentar, para así aportar orientaciones adecuadas que permitan una favorable inter vención y evolución. La muestra se compone de 137 sujetos con edades comprendidas entre 9 y 15 años con un Coeficiente Intelectual Total (CIT) de entre 80 y 120. Los instrumentos que se utilizaron fueron: la escala de inteligencia de Wechsler para niños-V (WISC-V), el Cuestionario de Ansiedad Estado-Rasgo en Niños(STAI-C), el Sistema de Evaluación de Niños y Adolescentes(SENA) y el Inventario de Problemas en la Escuela (IPE). Como resultado se observa que la ansiedad percibida por estos niños no está relacionada con la que aprecian padres y profesores, sin embargo, estos últimos sí que coinciden en su apreciación.

Abstract Both Attention Deficit Hyperactivity Disorder (ADHD) and anxiety are two of the disorders that are most evident in the infant-juvenile population and there is a correlation between the two, as shown in numerous studies. The combination of both disorders affects the child's teaching-learning processes, causing learning difficulties (LD). The aims of the present study were based on assessing the criteria evidenced by parents and teachers in children with ADHD to characterize the degree of adequacy of perception and to evaluate whether this is in line with real ity or insufficient, whether there are differences in this perception between parents and teachers, and to analyze their awareness of the possible AD they may present, in order to provide appropriate guidelines for favourable intervention and evolution. The sample consisted of 137 subjects aged between 9 and 15 years with a Total IQ (TIQ) between 80 and 120. The instruments used were: the Wechsler Intelligence Scale for Children-V (WISC-V), the State-Trait Anxiety Questionnaire for Children (STAI-C), the Child and Adolescent Assessment System (SENA) and the Inventory of Problems at School (IPE). As a result, it is observed that the anxiety perceived by these children is not related to the anxiety perceived by parents and teachers, although the latter do coincide in their assessment.

El impacto del TDAH sobre la lectura / The impact of ADHD on reading

Resumen Más allá de la frecuente coexistencia del trastorno por déficit de atención con hiperactividad (TDAH) y el trastorno específico del aprendizaje de la lectura, la presente revisión pretende examinar la evidencia empírica disponible sobre cómo el TDAH impacta negativamente sobre el aprendizaje de la lectura. Los datos existentes apuntan a que la presencia del trastorno (especialmente los síntomas de falta de atención), puede afectar a i) la correcta adquisición de lectura, ya sea de manera directa o a través de su influencia sobre los precursores de la lectura; ii) las propias habilidades de decodificación (precisión y fluidez lectora), tanto de manera directa como indirecta a través de su influencia sobre procesos cognitivos como la distracción o las funciones ejecutivas; y ii) la comprensión lectora, probablemente de manera indirecta por las dificultades eje cutivas y en la memoria de trabajo verbal características del TDAH. Estas conclusiones presentan importantes implicaciones para caracterizar e intervenir mejor sobre las dificultades lectoras en el TDAH, ya sean clínicas o subclínicas.

Abstract Beyond the frequent coexistence of attention deficit hyperactivity disorder (ADHD) and reading dis order (dyslexia), the present review aims to examine the available empirical evidence on how ADHD negatively impacts on learning to read. Existing data suggest that the presence of the disorder (especially inattention symp toms), may affect i) the correct acquisition of reading, either directly or through its influence on the precursors to reading; ii) decoding skills themselves (reading accuracy and fluency), both directly and indirectly through its influence on cognitive processes such as distractibility or executive functions; and iii) reading comprehension, probably indirectly through the executive and verbal memory difficulties characteristic of ADHD. These findings have important implications for better characterizing and intervening on reading difficulties in ADHD, whether clinical or subclinical.

Factores asociados a la adherencia al tratamiento farmacológico del trastorno por déficit de atención e hiperactividad (TDAH): revisión preliminar / Factors associated with adherence to pharmacological treatment of attention deficit hyperactivity disorder (ADHD): preliminary review

Resumen Introducción: El tratamiento del TDAH es seguro y eficaz, pero con frecuencia existen bajos niveles de adherencia al tratamiento. En este artículo describimos factores asociados a la adherencia des critos en la literatura disponible. Métodos: Realizamos una búsqueda bibliográfica no sistemática sobre artículos recientes sobre la adherencia a la medicación en niños y adolescentes con TDAH. Resultados: Hay factores asociados al propio trastorno, al paciente, al sistema de salud, factores socio-económicos, a la medicación y al entorno que pueden reducir o aumentar la adherencia a la medicación. Algunos factores que mejoran la adhe rencia incluyen: el conocimiento sobre el TDAH, la medicación y sus beneficios y efectos adversos potenciales. Regímenes de medicación sencillos, una vez al día y de liberación prolongada. Edad del paciente menor de 12 años y sexo femenino. Menos barreras de acceso al sistema de salud. Actitud positiva y proactiva de los padres respecto al TDAH y el uso de medicación. Discusión: Se podría optimizar la adherencia y por lo tanto mejorar el pronóstico a largo plazo del TDAH reforzando estos factores que aumentan la adherencia, y reduciendo los sesgos y desconocimiento sobre el TDAH.

Abstract Introduction: ADHD treatment is safe and effective, but often, adherence to t reatment is suboptimal. We studied factors associated to adherence to treatment in ADHD described in the literature. Methods: We conducted a non-systematic bibliographic search on recent articles on medication adherence in children and adolescents with ADHD. Results: There are factors associated with the disorder itself, the patient, the health system, socio-economic factors, the medication and the environment that can reduce/improve medication adherence. Some factors that improve adherence include: knowledge about ADHD, medication and its benefits and potential adverse effects. Simple, once-daily, extended-release medication regimens. Age of the patient less than 12 years and female sex. Fewer barriers to access the health system. Positive and proactive attitude of parents regarding ADHD and the use of medication. Discussion: Adherence could be optimized and therefore the long-term prognosis of ADHD improved by reinforcingfactors that increase adherence, and reducing biases and ignorance about ADHD.

Advances in intestinal flora and attention deficit hyperactivity disorder / 国际儿科学杂志

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children, which can be characterized by hyperactivity and(or)impulsivity, inattention, or a combination.The etiology and pathophysiological mechanism of ADHD have not been clarified yet.More and more studies have shown ADHD has intestinal flora disorder, which may affect the occurrence and development of ADHD through microbiome-gut-brain axis (MGBA). Treatment strategies targeting gut microbiota, including probiotics and dietary therapies, are considered to be a novel and effective method for the prevention or treatment of ADHD.This article reviews the changes of intestinal flora and the progress of diet and probiotics in ADHD children, in order to provide new ideas for treatment of ADHD children.

Association between attention deficit hyperactivity disorder (ADHD) and migraine: a review of observational studies / Associação entre transtorno de déficit de atenção e hiperatividade (TDAH) e enxaqueca: uma revisão de estudos observacionais

Introduction: Attention deficit hyperactivity disorder (ADHD) has been related to the presence of primary headaches. Among them, migraine presents a wide range of comorbidities shared with ADHD, both from other psychiatric disorders and somatic conditions. Objective:This review proposes to describe the association between ADHD and migraine. Methods:Based on literature research in the major medical databases and using as descriptors "Migraine Disorders" and "Attention Deficit Disorder with Hyperactivity". Observational studies that addressed the relationship between migraine and ADHD and written only in English were included. Of the 49 articles found, only 6 met the inclusion criteria and were analyzed. Results:A total of 35,684 patients were included, 22.36% were children. Of these, 1,829 (5.12%) had ADHD. The association between ADHD and migraine was identified in 528 patients (1.47%), representing 28.86% of patients with ADHD. A bilateral relationship was observed between the two diagnoses, having in the presence of ADHD, an almost 3 times greater risk of the presence of migraine. Furthermore, individuals with isolated migraine had significantly higher symptoms of hyperactivity/impulsivity and inattention than healthy individuals. Conclusion:This review shows a possible sharing of symptoms between migraine and ADHD, requiring further studies to investigate this relationship.

Introdução: O transtorno de déficit de atenção e hiperatividade (TDAH) tem sido relacionado à presença de cefaleias primárias. Dentre elas, a enxaqueca apresenta uma ampla gama de comorbidades compartilhadas com o TDAH, tanto de outros transtornos psiquiátricos quanto de condições somáticas. Objetivo:Esta revisão propõe descrever a associação entre TDAH e enxaqueca. Métodos:Baseado em pesquisa bibliográfica nas principais bases de dados médicas e utilizando como descritores "Transtornos de Enxaqueca" e "Transtorno de Déficit de Atenção com Hiperatividade". Foram incluídos estudos observacionais que abordassem a relação entre enxaqueca e TDAH e escritos apenas em inglês. Dos 49 artigos encontrados, apenas 6 atenderam aos critérios de inclusão e foram analisados. Resultados: Foram incluídos 35.684 pacientes, 22,36% eram crianças. Destes, 1.829 (5,12%) tinham TDAH. A associação entre TDAH e enxaqueca foi identificada em 528 pacientes (1,47%), representando 28,86% dos pacientes com TDAH. Foi observada uma relação bilateral entre os dois diagnósticos, tendo na presença de TDAH, um risco quase 3 vezes maior de presença de enxaqueca. Além disso, indivíduos com enxaqueca isolada apresentaram sintomas significativamente mais elevados de hiperatividade/impulsividade e desatenção do que indivíduos saudáveis. Conclusão:Esta revisão mostra um possível compartilhamento de sintomas entre enxaqueca e TDAH, necessitando de mais estudos para investigar essa relação.

ASD and ADHD in children: a preliminary study / TEA e TDAH em crianças: um estudo preliminar / TEA y TDAH en niños: un estudio preliminar

Early detection of ADHD symptoms in autistic children can significantly impact the course and prognosis of the disorder. The present study aimed to screen the symptoms of ADHD in autistic children using the Brazilian version of Swanson, Nolan and Pelham rating scale ­ 4th (SNAP-IV) applied to 72 parents of children diagnosed with ASD, as well as to assess whether there was a significant difference between children who used words to communicate of those who did not speak any words. The findings revealed a significant frequency in the pre-sentation of symptoms of inattention and of hyperactivity and / or impulsivity, when comparing children who had diagnosis of ASD, but who did not have the symptoms of ADHD. Regarding language, no significant differences were found in this preliminary study. In general, this finding can be considered clinically worrying, especially when considering that the subclinical symptoms of ADHD may overlap in possible interventions

A detecção precoce dos sintomas de TDAH em crianças com autismo pode impactar significativamente o curso e o prognóstico do transtorno. O presente estudo teve como objetivo rastrear os sintomas de TDAH em crianças autistas usando a versão brasileira do Questionário de Swanson, Nolan e Pelham versão IV (SNAP-IV) aplicada em 72 pais de crianças com diagnóstico de TEA, bem como avaliar se havia diferença significativa entre as crianças que usavam palavras para se comunicar daqueles que não falavam palavra alguma. Os achados revelaram alta frequência na apresentação dos sintomas de desatenção e de hiperatividade e/ou impulsividade, ao comparar crianças que tinham diagnóstico de TEA, mas que não apresentavam os sintomas de TDAH. Em relação à linguagem, não foram encontradas diferenças significativas neste estudo preliminar. Em geral, a alta frequência dos sintomas do TDAH clinicamente preocupante, principalmente quando se considera que os sintomas subclínicos do TDAH podem se sobrepor em possíveis intervenções

La detección temprana de los síntomas del TDAH en niños con autismo puede afectar significativamente el curso y el pronóstico del trastorno. El presente estudio tuvo como objetivo evaluar los síntomas del TDAH en niños con autismo utilizando la escala SNAP-IV de la versión brasileña aplicada a 72 padres de niños diagnosticados con TEA, así como evaluar si había una diferencia significativa entre los niños que usaban palabras para comunicarse los que no dijeron ninguna palabra. Los hallazgos revelaron frecuencia significativa en la presentación de síntomas de inatención y de hiperactividad y/o impulsividad, al comparar niños que tenían el diagnóstico del TEA, pero que no presentaba los síntomas del TDAH. En cuanto al lenguaje, no se encontraron diferencias significativas. En general, este hallazgo puede considerarse clínicamente preocupante, especialmente si se considera que los síntomas subclínicos del TDAH pueden superponerse en posibles intervenciones

Impacto de la rehabilitación neuropsicológica computarizada en un paciente con anemia de células falciformes y TDAH. Estudio experimental de caso único

Introducción: La anemia de células falciformes (ACF) es una enfermedad genética que provoca una malformación en el glóbulo rojo, volviéndolo más frágil y desencadenando su lisis. Por su forma anómala predispone a eventos oclusivos en vasos de menor tamaño, incluyendo aquellos en el sistema nervioso central. La literatura documenta presencia de infartos cerebrales silentes y no silentes asociados a ACF, con sus respectivas alteraciones cognitivas. En los últimos años se ha reportado que existe compromiso cognitivo y mayor presencia de trastornos del neurodesarrollo, como el trastorno por déficit de atención e hiperactividad (TDAH) en aquellos niños con ACF que aún no han tenido eventos cerebrales isquémicos. Método: Se llevó a cabo un estudio experimental y prospectivo de caso único, que consistió en un programa de rehabilitación por medio de la plataforma de entrenamiento cognitivo para la atención y concentración de CogniFit. Durante 45 sesiones, se realizaron mediciones de respuestas en atención y control inhibitorio, utilizando la Batería de Evaluación Cognitiva para la Atención (CAB-AT). Resultados: Se observó que la intervención tuvo un impacto significativo en el componente de atención, el cual se mantuvo por encima de la línea de base, incluso después de suspender la intervención. Sin embargo, no se encontró un impacto importante en el control inhibitorio. Conclusión: Aunque la intervención mejoró la atención, no lo hizo con el control inhibitorio. Se recomienda complementar la rehabilitación con manejo farmacológico y diseñar nuevos estudios con poblaciones heterogéneas.

Introduction: Sickle cell anemia (SCA) is a genetic disease that causes a malformation in red blood cells, making them more fragile and leading to their lysis. Due to their abnormal shape, they predispose to occlusive events in smaller blood vessels, including those in the central nervous system. Literature documents the presence of silent and non-silent cerebral infarctions associated with SCA, along with respective cognitive impairments. In recent years, cognitive impairment and a higher prevalence of neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) have been reported in children with SCA who have not experienced ischemic brain events. Method: An experimental and prospective single-case study was conducted, consisting of a rehabilitation program using the CogniFit platform for cognitive training in attention and concentration. Measurements of attention and inhibitory control responses were taken during 45 sessions, using the Cognitive Assessment Battery for Attention (CAB-AT). Results: It was observed that the intervention had a significant impact on the attention component, which remained above the baseline even after discontinuing the intervention. However, no significant impact was found on inhibitory control. Conclusion: Although the intervention improved attention, it did not have the same effect on inhibitory control. Complementing rehabilitation with pharmacological management and designing new studies involving heterogeneous populations are recommended.

Mudanças na alimentação de estudantes de uma Universidade Pública, durante a pandemia de COVID-19 / Changes in the diet of students at a public university during the COVID-19 pandemic

A pandemia de Covid-19 teve implicações diretas na qualidade de vida, saúde e renda da população mundial. Grande parte dos brasileiros passou a ficar mais tempo em casa e a rotina dos estudantes universitários foi afetada pelo fechamento dos sistemas educacionais. O presente estudo buscou investigar se houve mudanças no consumo alimentar de estudantes universitários de uma universidade pública do Estado do Rio de Janeiro no primeiro ano da pandemia de Covid-19, e possíveis fatores associados. Os ingressantes na Universidade do Estado do Rio de Janeiro (UERJ) no ano de 2019 foi a população alvo. Os dados foram coletados através de questionário on-line, entre agosto de 2020 e março de 2021. Do total de 3.973 ingressantes com email, 771 responderam ao questionário (19,4%). Foram investigadas variáveis demográficas, socioeconômicas e de consumo alimentar. Mudanças no consumo alimentar de 29 itens: ovos, doces, bolos, chá, café, queijo, sucos naturais, legumes, frutas, pães, raízes, pipoca, verduras, arroz, refrigerantes, leite, biscoitos doces, macarrão, alimentos prontos para consumo, sucos industrializados, carnes, iogurte, feijão, enlatados, biscoitos salgados, oleaginosas, refrigerantes diet/zero, salgadinhos de pacote e bebidas alcoólicas, foram avaliadas pela frequência de aumento ou redução. Associações entre essas mudanças e sexo, status de peso, raça/cor de pele e alteração na renda familiar foram avaliadas por regressão logística ajustada por idade. As análises foram ponderadas considerando a taxa de resposta por curso e sexo. Ocorreram grandes mudanças na alimentação, sendo as principais, o aumento no consumo de doces (52,3%), ovos (49,3%) e bolos (44,0%) e a redução no consumo de bebidas alcoólicas (36,9%), salgadinhos de pacote (33,3%) e biscoitos doces (28,9%). Universitários com excesso de peso apresentaram menor chance de aumentar o consumo de sucos naturais (OR:0,6; IC:0,5-0,9) em relação aos sem excesso de peso. Universitários negros apresentaram maior chance de aumentar o consumo de sucos naturais (OR=1,3; IC:1,1-1,7) e leite (OR=1,4; IC:1,1-2,0) em relação aos brancos. Com exceção para poucos alimentos, não houve mudança associada aos fatores avaliados e, no geral, a alimentação parece ter melhorado com redução de um terço para bebidas alcoólicas, salgadinhos de pacote e biscoitos doces. AU.

The Covid-19 pandemic had direct implications for the quality of life, health and income of the world's population. Most Brazilians stayed home longer and the routine of college students was affected by the closure of educational systems. The present study evaluated changes in food consumption of college students in the first year of the Covid-19 pandemic, and possible associated factors. Freshman from the State University of Rio de Janeiro (UERJ) in the year 2019, was the target population. Data were collected through an online questionnaire from August 2020 to March 2021 including demographic, socioeconomic and food consumption variables. Of the total of 3,973 email entrants, 771 completed the questionnaire (19.4%). Demographic, socioeconomic, and food consumption variables were investigated. Changes in food consumption of 29 items: eggs, sweets, cakes, tea, coffee, cheese, natural juices, vegetables, fruits, breads, roots, popcorn, greens, rice, soft drinks, milk, sweet cookies, noodles, ready-to-eat foods, processed juices, meats, yogurt, beans, canned food, salty cookies, oilseeds, diet/zero sodas, packaged snacks and alcoholic beverages, were assessed by the increase or decrease in the daily frequency. Associations between dietary changes with sex, weight status, race/skin color, and change in household income were assessed using age-adjusted logistic regression. All analyses were weighted considering the response rate by course and sex. Major changes in diet were the increased consumption of sweets (52.3%), eggs (49.3%), and cakes (44.0%) and decreased consumption of alcoholic beverages (36.9%), packaged snacks (33.3%), and sweet cookies (28.9%). Overweight students did not increase their consumption of fruit juices (OR:0.6; CI:0.5-0.9) compared to those without overweight. Black students had higher odds to increase consumption of juice (OR=1.3; CI:1.1-1.7) and milk (OR=1.4; CI:1.1-2.0) compared to white students. Except for these few food groups, the factors studied were not associated with dietary changes, and overall, the diet improved with a one-third reduction for alcoholic beverages, packaged snacks and sweet cookies. AU

TDAH e Complexo Médico-Industrial: revisão narrativa sobre uma epidemia lucrativa / ADHD and Medical-Industrial Complex: narrative review about a profitable epidemic

O emprego de diagnósticos psiquiátricos alcançou uma importância social tamanha que o atual cenário aponta para um risco constante de epidemias diversas de transtornos mentais. Por essa razão, este estudo teve como objetivo compreender a complexa dinâmica de forças que edificam o caminho para uma condição da vida se tornar um problema médico e, a posteriori, um quadro epidêmico. Para tanto, através de uma revisão narrativa, esta pesquisa reconheceu os múltiplos aspectos da medicalização da vida; da dinâmica de um Complexo Médico-Industrial e Financeiro; e da epidemia de diagnósticos psiquiátricos. O estudo igualmente apreciou a evolução histórico-social do Transtorno do Déficit de Atenção com Hiperatividade (TDAH), como um meio para identificar as interinfluências envolvidas na consolidação de seu diagnóstico, o qual se tornou exponencialmente mais recorrente na atualidade. Além disso, o estudo examinou, em bases como SciELO, PubMed, MEDLINE, MeSH e Google Acadêmico, trabalhos que façam referência à evolução da produção e do consumo dos principais fármacos prescritos para seu tratamento, de modo a averiguar as possíveis repercussões socioeconômicas da inflação diagnóstica do TDAH. Com isso, este trabalho constatou que a alternância do protagonismo entre os atores que compõem o campo da saúde é atualmente definida pelo mercado, e, associada à fluidez dos diagnósticos psiquiátricos, as influências de tais forças passaram a ser determinantes no modo como um distúrbio é introduzido, modificado e/ou ampliado no meio social. Outrossim, a pesquisa mostrou que os transtornos psiquiátricos se tornaram cada vez mais passíveis de se transformarem em condições epidêmicas, especialmente em razão: das sucessivas alterações de seus critérios, o que permitiu ampliar o público-alvo dos diagnósticos; da cronificação das práticas em saúde mental, influenciadas pelo forte movimento reducionista do sofrimento humano à lógica biomédica; e da primazia da farmacoterapia, perpetuada por meio de um modelo de atenção gerenciada que preza pela redução dos custos e aumento dos lucros com a assistência. AU

The use of psychiatric diagnoses has reached such a social importance that the current scenario points to a constant risk of various epidemics of mental disorders. Hence, this study aimed to understand the complex dynamics of forces that build the path for a condition of life to become a medical problem and, subsequently, an epidemic. For this purpose, through a narrative review, this research recognized the multiple aspects of the medicalization of life; the dynamics of a Medical-Industrial and Financial Complex; and the epidemic of psychiatric diagnoses. The study also looked at the historical-social evolution of Attention Deficit Hyperactivity Disorder (ADHD) as a means to identify the inter-influences involved in the consolidation of its diagnosis, which has become exponentially more recurrent nowadays. In addition, the study examined SciELO, PubMed, MEDLINE, MeSH, and Google Scholar databases to determine the evolution of the production and consumption of the main drugs prescribed for the treatment of ADHD, in order to investigate the possible socioeconomic repercussions of ADHD diagnostic inflation. With this, this work has found that the alternation of the protagonism among the actors that compose the health field is currently defined by the market, and, associated with the fluidity of psychiatric diagnoses, the influences of such forces have become determinant in the way a disorder is introduced, modified and/or expanded in the social environment. Moreover, the research showed that psychiatric disorders have become increasingly likely to become epidemic conditions, especially for the following reasons: the successive changes in their criteria, which allowed the expansion of the target audience of the diagnoses; the chronification of mental health practices, influenced by the strong reductionist movement of human suffering to biomedical logic; and the primacy of pharmacotherapy, perpetuated through a model of managed care that focuses on ​​cost reduction and increasing profits with the care. AU

Práticas cotidianas constituindo múltiplas versões da criança com comportamentos externalizantes: um estudo de caso / Prácticas cotidianas constituyendo múltiples versiones del niño con comportamientos externalizantes: un estudio de caso / Everyday practices constituting multiple versions of children with externalizing behaviors: a case study

Resumo Visando compreender as múltiplas versões de realidade produzidas nas práticas cotidianas da rede relacional de uma criança à qual se referem problemas de comportamentos externalizantes, no campo da saúde mental, este artigo relata um estudo de caso, realizado em 2017, a partir das abordagens da Teoria Ator-Rede e das Práticas Discursivas e Produção de Sentidos no Cotidiano. O referente empírico da pesquisa é um menino com hipótese diagnóstica de TDAH e TOD, articulado com actantes humanos e não humanos em dimensões diversas de suas relações. Os resultados expõem as interatuações cotidianas, atravessadas por conflitos intergeracionais, produzindo realidades e sentidos heterogêneos, no trânsito entre ideias aparentemente antagônicas (angelical-diabólico/criança-adulto). A criança, com seus comportamentos diversos, tal qual os adultos, atua e é atuada em relações de poder, numa coprodução fluida de conflitos e entendimentos que expressam versões sempre incertas e localizadas do que seria "a criança com comportamentos externalizantes".

Resumen Con el objetivo de comprender las múltiples versiones de la realidad que se producen en las prácticas cotidianas de la red relacional de un niño a la que se refieren los problemas de comportamiento externalizante, en el campo de la salud mental, este artículo relata un estudio de caso, realizado en 2017, a partir de los enfoques de la Teoría Actor-Red y Prácticas Discursivas y Producción de Sentidos en la Vida Cotidiana. El referente empírico de la investigación es un niño con hipótesis diagnóstica de TDAH y TND, articulado con actantes humanos y no humanos en diferentes dimensiones de sus relaciones. Los resultados exponen las interacciones cotidianas, atravesadas por conflictos intergeneracionales, produciendo realidades y significados heterogéneos, en el tránsito entre ideas aparentemente antagónicas (angelical-diabólica/niño-adulto). Los niños, con sus diferentes conductas, al igual que los adultos, actúan y son actuados en relaciones de poder, en una fluida coproducción de conflictos y entendimientos que expresan versiones siempre inciertas y localizadas de lo que sería "el niño con conductas externalizantes".

Abstract Aiming to understand the multiple versions of reality produced in the daily practices of a child's relational network to which externalizing behavior problems refer, in the field of mental health, this article reports a case study, carried out in 2017, based on the approaches of the Actor-Network and Discursive Practices and Production of Meanings in Everyday Life. The empirical referent of the research is a boy with a diagnostic hypothesis of ADHD and ODD, articulated with human and non-human actants in different dimensions of their relationships. The results expose everyday interactions, crossed by intergenerational conflicts, producing heterogeneous realities and meanings, in the transit between apparently antagonistic ideas (angelic-diabolical/child-adult). Children, with ir different behaviors, just like adults, acts and are acted upon in power relations, in a fluid co-production of conflicts and understandings that express always uncertain and localized versions of what would be "the child with externalizing behaviors".