Rasgos de personalidad, bienestar y malestar psicológico en usuarios de redes sociales que presentan conductas disruptivas online / Personality traits, well-being and psychological distress in users who present online disruptive behavior

Resumen El presente estudio se propuso investigar perfiles de usuarios de redes sociales que presentan conductas disruptivas online. Para tal fin se diseñó un índice que permite evaluar el nivel en el que se presentan dichas conductas y se analizó la relación entre la intensidad de la conducta disruptiva online con variables sociodemográficas, motivos de usos de redes, variables de personalidad (normales, patológicas y rasgos vinculados a tríada oscura), bienestar y malestar psicológico. Participaron 858 adultos (421 hombres y 437 mujeres) que tenían en promedio 39.16 años (DE = 14.14). Para la recolección de datos se administraron: Dark Triad Scale, Big Five Inventory, Inventario para Trastornos de la Personalidad para el DSM-5, Mental Health Continuum . Depression, Anxiety and Stress Scale, y se diseñaron dos escalas: Índice de Conductas Disruptivas Online y Motivos de Utilización de Redes Sociales. En cuanto a las variables sociodemográficas, se halló que los más jóvenes de sexo masculino y que no trabajaban eran quienes presentaban un mayor nivel de comportamientos disruptivos online. En cuanto a los motivos de uso de redes, se observó que preferían usarlas con fines meramente exhibicionistas, de ocio o para iniciar nuevas relaciones. Por otro lado, en relación con rasgos de personalidad, aquellos que diferenciaban los perfiles en cuanto a la intensidad de las conductas disruptivas fueron: bajos niveles de responsabilidad y altos niveles de desinhibición, narcisismo y maquiavelismo. Por último, se demostró que presentar este tipo de conductas se asocia con mayor nivel de estrés y menor de bienestar social.

Abstract The present study focused on the analysis of online disruptive behavior that usually occurs among social network users. Individuals who perpetrate such behavior are commonly known as trolls or haters (Cheng, Danescu-Niculescu-Mitzil, & Leskovec, 2015). In general, they post comments, photos or provocative videos that do not pursue any purpose other than annoying or obtaining pleasure or fun (Brandel, 2007; Phillips, 2011). Recent studies have shown that certain personality traits are associated with the presence of such disruptive behavior. In this research, we studied normal personality traits, psychopathological traits, and dark personality traits in relation to disruptive behavior. The normal personality traits were considered from the classic Five Factor Model (FFM) - Openness to experience, Conscientiousness, Extraversion, Agreeableness, Neuroticism (Costa, & McCrae, 1985); the psychopathological traits, from the latest version of the DSM - Negative Effect, Detachment, Antagonism, Disinhibition and Psychoticism (DSM-5, American Psychiatric Association, 2013); and the dark personality traits from the so-called Dark Triad model - Narcissism, Machiavellianism and Psychopathy (Palthus, & Williams, 2002). This latter model has a growing interest in the international literature, related to dysfunctional Internet use, particularly to social networks. Therefore, the present study aimed to analyze profiles of social network users who present online disruptive behavior. For this purpose, an index was designed to assess the level of occurrence of such behaviors. First, the relationship between the intensity of online disruptive behavior and sociodemographic variables (i. e., sex, age, studies, occupation and nationality) and motives for social network use (i. e., Relationship maintenance; Passing time and Exhibitionism; Relationship Initiation and Search for companionship) were assessed. Then, the relationships among personality variables (i. e., normal, psychopathological and traits related to the dark triad); well-being (i. e., emotional, social and personal) and psychological distress (i. e., anxiety, stress and depression) were analyzed. The sample consisted of 858 adults (421 men, 49.1 % and 437 women, 50.9 %) with a mean age of 39.16 years (SD = 14.14). The majority (67.9 %; n = 583) lived in Buenos Aires, Argentina). For data collection, the following questionnaires were used: Dark Triad Scale (DTS), Big Five Inventory (BFI), Personality Disorder Inventory (PID-5-BF), the Mental Health Continuum (MHC-SF), and the Depression, Anxiety and Stress Scale (DASS-21). Additionally, two scales were designed: Online Disruptive Behavior Index, and Motives for Social Networks Use. The SPPS 24.0 statistical package was used for data analysis. Overall, the results are consistent with those reported in the international literature. Regarding sociodemographic variables, it was found that male, younger and unemployed individuals are those who presented higher level of online disruptive behavior. Considering motives for social network use, it was observed that individuals who tend to behave in a dysfunctional manner, preferred to use social networks purely for exhibitionism, pastime or relationships initiation. Regarding personality traits, those who differentiated profiles in terms of intensity of disruptive behaviors were: low levels of responsibility and high levels of disinhibition, narcissism and Machiavellianism. Thus, it might be concluded that the overall personality profile tends to be dysfunctional in terms of its characteristics. Finally, it was shown that presenting this type of behavior is associated with higher levels of stress and lower levels of social wellbeing. Therefore, it might be interpreted that although individuals who behave disruptively tend to obtain gratification from injury and deceit to others, this behavior does not result in positive results for them, but rather results in feelings of discomfort from a personal and social point of view.

Parent-teacher report reliability on the fourth edition of the Swanson, Nolan and Pelham scale in a Brazilian clinical sample of children and adolescents with attention-deficit/hyperactivity disorder

Abstract Background Parents and teachers can be valuable sources of information for characterizing children's ADHD-related impairments in different environments. However, evidence indicated that those categories of informants often provide conflicting responses in formal assessment scales, which may challenge diagnostic decisions regarding the condition. Objective: We aimed to investigate reliability rates between parents and teachers of children and adolescents with and without ADHD using SNAP IV. Methods 199 children and adolescents aged 6 to 17 years were evaluated for ADHD symptoms using parent-rated and teacher-rated SNAP IV scales. Intraclass correlation coefficients were analyzed for ADHD domains (inattention and hyperactivity/impulsivity), as well as for defiant-oppositional behavior. Results Reports from parents and teachers showed low reliability for all ADHD domains. Parents' scores on the SNAP IV were higher than those of teachers. Parents and teachers provided highly discrepant responses concerning to the presence and severity of ADHD in children and adolescents, which might result from intrinsic aspects related to their daily functioning in different settings. Discussion Clinicians should consider those trends in parental and teachers' responses when interpreting results from informant-based instruments for detecting ADHD.

Implementing a community-based parent training behavioral intervention for autism spectrum disorder / Capacitação parental para manejo de comportamentos disruptivos para tea em intervenção comportamental / Tea: capacitación de padres para manejo de conductas problemáticas

The autism spectrum disorder (ASD) affects developmental areas early in life and on families exert significant burden both emotionally and economically. This paper is a non-controlled, multicenter study to train caregivers of ASD individuals displaying disruptive behavior and deficit of communication, based on Applied Behavior Analysis. Results showed a reduction in the disruptive behavior measured by the Aberrant Behavior Checklist (ABC) and also the caregivers' depression and anxiety symptoms assessed by the Hamilton Scale. Group interventions may be an alternative for reaching a higher share of the population.

O transtorno do espectro do autismo (TEA) afeta precocemente áreas de desenvolvimento e resulta em uma sobrecarga significativa para as famílias, tanto emocional quanto economicamente. Este é um estudo não controlado, multicêntrico, com o objetivo de capacitar, com base na Análise Aplicada do Comportamento, cuidadores de indivíduos com TEA que apresentam comportamento disruptivo e deficit de comunicação. Os resultados mostraram redução nos comportamentos disruptivos, medidos pelo Aberrant Behavior Checklist (ABC), e também nos sintomas de depressão e ansiedade dos cuidadores, avaliados pela Escala de Hamilton. As intervenções em grupo podem ser uma alternativa viável para atingir uma parcela maior da população.

O transtorno do espectro do autismo (TEA) afeta precocemente áreas de desenvolvimento e resulta em uma sobrecarga significativa para as famílias, tanto emocional quanto economicamente. Este é um estudo não controlado, multicêntrico, com o objetivo de capacitar, com base na Análise Aplicada do Comportamento, cuidadores de indivíduos com TEA que apresentam comportamento disruptivo e deficit de comunicação. Os resultados mostraram redução nos comportamentos disruptivos, medidos pelo Aberrant Behavior Checklist (ABC), e também nos sintomas de depressão e ansiedade dos cuidadores, avaliados pela Escala de Hamilton. As intervenções em grupo podem ser uma alternativa viável para atingir uma parcela maior da população.

Irritabilidad como síntoma transdiagnóstico / Irritability as a transdiagnostic Symptom

Resumen. La irritabilidad es un síntoma transdiagnóstico que atraviesa la barrera de las patologías internalizantes y externalizantes. Se define como un umbral bajo para experimentar la ira en respuesta a la frustración y es uno de los síntomas más comunes en niños y adolescentes. Las conductas relacionadas con la ira apropiadas para el desarrollo tienden a reflejar frustración en contextos esperados, mientras que la irritabilidad crónica es inapropiada para la situación. La presentación de la irritabilidad, crónica o episódica, es crucial para comprender su significado psicopatológico, en particular porque las estructuras de la irritabilidad episódica y crónica son separables y permanecen estables a lo largo del tiempo. Existen varios estudios acerca de la irritabilidad en patologías como trastorno afectivo bipolar y trastorno de desregulación disruptiva del estado del ánimo, en ambos casos es importante plantearse como punto de partida la identificación de la episodicidad. La irritabilidad también se encuentra presente en el trastorno de personalidad límite observándose dentro de una inestabilidad afectiva debida a una reactividad notable del estado de ánimo. Estas emociones tienen un correlato anatómico relacionado con deficiencias de los circuitos frontolímbicos. Para el manejo de la irritabilidad en las distintas patologías, la evidencia del tratamiento incluye terapia cognitivo conductual, intervención de los padres, mindfulness, pero existe una necesidad apremiante de investigación sobre el tratamiento farmacológico complementario.

Irritability is a transdiagnostic symptom that crosses the barrier between internalizing and externalizing pathologies. It is defined as a low threshold to experience anger in response to frustration and it is one of the most common symptoms in children and adolescents. Behaviors related to appropriate developmental anger tend to reflect frustration in expected contexts, while chronic irritability is inappropriate to the situation. The presentation of irritability, chronic or episodic, is crucial to understanding its psychopathological meaning, particularly because the structures of episodic and chronic irritability are separable and remain stable over time. There are several studies about irritability in pathologies such as bipolar affective disorder and disruptive mood dysregulation disorder, in both cases it is important to consider the identification of episodicity as a starting point. Irritability is also present in borderline personality disorder, where it is expressed as an affective instability due to a remarkable reactivity of the state of mind. These emotions have been anatomically related to deficiencies of the frontolimbic circuits. For the management of irritability in different patholo-gies, the evidence includes cognitive behavioral therapy, parental intervention, mindfulness, but there still is a pressing need for research on complementary pharmacological treatment.

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.

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.

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.

Trastorno negativista desafiante: una puesta al día para pediatras y psiquiatras infantiles

El Trastorno Negativista Desafiante será diagnosticado en un niño que presenta un comportamiento disruptivo para su edad y cultura, caracterizado por un patrón persistente de mal humor o irritabilidad, que discute o presenta comportamientos desafiantes y/o vengativos por lo menos durante los últimos 6 meses. Este trastorno no sólo afecta al niño, sino que es un problema de salud pública, que alcanza a la familia, a los maestros y a los pares. Cuando no se atiende adecuadamente, el trastorno negativista desafiante puede evolucionar a un problema de conducta mayor como el trastorno disocial o a la generación de una personalidad antisocial. Con el fin de ayudar a pediatras y a psiquiatras infantiles en el reconocimiento y manejo de estos "niños problemáticos", este artículo de revisión tiene el objetivo de presentar una puesta al día del concepto, etiopatogenia, clínica, diagnóstico y modalidades terapéuticas para este desafiante grupo de pacientes.

Oppositional Defiant Disorder is diagnosed in a child who exhibits a disruptive behavior for their age and culture, characterized by a persistent pattern of an angry mood or irritability, and who presents oppositional and / or vindictive behavior for at least the last 6 months. This disorder not only affects the child, but is a public health problem that affects the child's family, teachers and peers. When not addressed properly, oppositional defiant disorder can evolve into a significant behavioral problem, such as conduct disorder or antisocial personality disorder. In order to help pediatricians and child psychiatrists in the recognition and management of these "problematic children", this review article aims to present an update of the definition, pathogenesis, clinical presentation, diagnosis and therapeutic modalities for this challenging group of patients.

Refinando o diagnóstico de Transtorno de Oposição e Desafio na infância e adolescência: validação e caracterização da dimensão irritável / Refining Oppositional Defiant Disorder diagnosis in children and adolescents: validation and characterization of the irritable dimension

O Transtorno de Oposição e Desafio (TOD) é definido por um padrão recorrente de comportamento desafiante, desobediente e hostil com início na infância e adolescência e caracteriza-se por uma alta taxa de comorbidades. Estudos longitudinais apontam o TOD na infância como um dos principais preditores de psicopatologia na idade adulta. Uma possível explicação para a grande heterogeneidade de comorbidades e trajetórias longitudinais é de que o diagnóstico de TOD abrange distintas dimensões de sintomas, cada qual com seu desfecho. O primeiro objetivo desta tese foi a validação das distintas dimensões do TOD em uma amostra comunitária Brasileira composta de 2512 sujeitos. Através de análise fatorial confirmatória, demonstramos que o modelo que melhor representa a heterogeneidade do TOD é composto por três dimensões: a dimensão "argumentative/defiant" que está associada com transtorno de déficit de atenção/hiperatividade (TDAH); a dimensão "vindictiveness" que possui associação com transtorno de conduta (TC); e a dimensão "angry/irritable mood" onde predominam as associações com transtornos depressivos e de ansiedade. O objetivo seguinte foi investigar o papel da dimensão irritável na classificação nosológica dos transtornos mentais na infância e adolescência. A apresentação da irritabilidade é um aspecto crucial: irritabilidade crônica caracterizada por baixa tolerância à frustração e frequentes explosões de raiva, que é distinta da apresentação episódica, associada ao diagnóstico Transtorno de Humor Bipolar (TB). "Severe mood dysregulation", "disruptive mood dysregulation disorder", ou dimensão irritável do TOD são formas distintas de classificar o fenótipo de irritabilidade crônica. Entretanto, independente da classificação utilizada, a alta taxa de comorbidades é invariavelmente o denominador comum em estudos sobre irritabilidade. Neste sentido, examinamos o impacto da irritabilidade como uma dimensão subjacente a vários transtornos. Para tanto, avaliamos o...

The Oppositional Defiant Disorder (ODD) is defined as a pattern of disobedient, hostile and defiant behavior beginning in childhood or adolescence and often accompanied by a wide range of comorbidities. Longitudinal studies support ODD as a predictor of psychopathology in adulthood. A potential explanation for such heterogeneity of comorbidities and longitudinal trajectories is that ODD diagnosis encompasses distinct clusters of symptoms, each with its outcome. The first aim of this work was the validation of ODD dimensions in a Brazilian community sample of 2512 subjects. Confirmatory factorial analysis showed that the best model for ODD comprised three dimensions: an "argumentative/defiant" dimension, which associates with attention deficit/hyperactivity disorder (ADHD); a "vindictiveness" dimension, which associates with conduct disorder (CD); and an "angry/irritable" dimension where emotional disorders such as depression and anxiety are the most common associations. The next step was the investigation of the role of the irritable dimension of oppositionality in diagnostic classifications of childhood mental disorders. The pattern of irritability is a crucial point: its chronic presentation as easy annoyance and frequent temper outbursts should be differentiated from the episodic course of irritability associated with the specific diagnosis of Bipolar Disorder (BD). "Severe mood dysregulation", "disruptive mood dysregulation disorder", and the irritable dimension of oppositionality are different ways to classify the chronic irritability phenotype. However, regardless of the classification, the high rate of comorbidities is invariably the common denominator in studies of irritability. Therefore, we examined the impact of irritability as a dimension cutting across multiple settings: individuals without any diagnosis, subjects with ADHD, and also those with emotional disorders. For that we used two samples, one from Brazil, with 2.512 subjects, and one...

Irritability in children and adolescents: past concepts, current debates, and future opportunities

Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.

Avaliação de crianças pré-escolares: relação entre testes de funções executivas e indicadores de desatenção e hiperatividade / Assessment of preschool children: relation between executive functions tests and inattention and hyperactivity indicators

Funções executivas (FE) referem-se às habilidades necessárias para planejar, iniciar, realizar e monitorar comportamentos intencionais. Incluem inibição, memória de trabalho, flexibilidade cognitiva, atenção seletiva, planejamento e organização e, de forma geral, são habilidades fundamentais à aprendizagem e ao comportamento autorregulado. As FE podem estar comprometidas em alguns distúrbios do desenvolvimento, como o Transtorno de Déficit de Atenção e Hiperatividade. Perante esse panorama e pautando-se na crescente ênfase da literatura sobre a importância da avaliação precoce, esta pesquisa investigou as relações entre desempenho em testes de funções executivas e indicadores de desatenção e hiperatividade em crianças pré-escolares de amostra não-clínica. Participaram 85 crianças de uma escola municipal de Educação Infantil da Grande SP, com idades entre quatro e seis anos, avaliadas no Teste de Trilhas para pré-escolares (TT-PE) e no Teste de Atenção por Cancelamento (TAC). Pais e professores responderam à SNAP-IV. As crianças com maiores índices de desatenção e hiperatividade, conforme relato dos pais, tenderam a apresentar piores desempenhos no TAC e aquelas com maiores índices de desatenção e hiperatividade, conforme relato dos professores, tenderam a apresentar piores desempenhos em diversas medidas do TAC e TT-PE. As relações entre desempenho nos testes e indicadores desatenção e hiperatividade tenderam a ser mais consistentes quando consideradas as respostas dos professores do que as dos pais. O estudo evidenciou que as relações entre desempenho em testes de FE e indicadores de desatenção e hiperatividade podem ser observadas desde idades precoces, em amostras não-clínicas, contribuindo para a discussão sobre avaliação e identificação precoce...

Executive functions (EF) refer to the skills needed to plan, initiate, implement and monitor intentional conduct. They include inhibition, working memory, cognitive flexibility, selective attention, planning and organization and, in general, are fundamental skills to learning and self-regulated behavior. EF may be compromised in some developmental disorders, such as Attention Deficit Disorder and Hyperactivity. Before this background and based on the increasing emphasis in the literature on the importance of early evaluation, this study investigated the relationship between performance in executive functions tests and inattention and hyperactivity indicators in preschool children of a non-clinical sample. A total of 85 children of a kindergarten public school from the state of SP, aged four and six years, were assessed at Trial Making Test for Preschoolers (TT-PE) and Attention Test for Cancellation (TAC). Parents and teachers were asked to answer SNAP-IV. Children with higher levels of inattention and hyperactivity, as reported by their parents, tended to have worse performance in TAC, and those with higher levels of inattention and hyperactivity, as reported teachers, tended to have worse performance on several measures of TAC and TT-PE. The relationship between test performance and indicators inattention and hyperactivity tended to be more consistent when considering the responses of teachers, instead of the parents' ones. The study showed that the relationship between performance on EF tests and indicators of inattention and hyperactivity can be observed from early ages, in nonclinical samples, contributing to the discussion on assessment and early identification...

Transtorno do déficit de atenção e hiperatividade na escola: mediação psicopedagógica / Attention deficit/hyperactivity disorder at school: mediation psychopedagogical

O estudo apresenta um caso de mediação psicopedagógica para diagnóstico de Transtorno do Déficit de Atenção/Hiperatividade (TDAH), tratamento, orientação na escola, família, e com a criança. A criança foi encaminhada pela psicopedagoga para avaliação interdisciplinar dos aspectos psicopedagógicos, neuropsicológico, neuropediátrico, psiquiátrico e familiar. A queixa da escola e da mãe era de que a criança estava agressiva, opositora, recusava-se a fazer as atividades, provocava confusões em casa e na sala de aula, era desorganizada, sem cuidado com seus pertences pessoais, não conseguia manter amizades e não demonstrava interesse pelas lições. Foi tratada com medicação metilfenidato, com melhora imediata da impulsividade e desatenção. Foram aplicados testes neuropsicológicos, psicopedagógicos, escalas de comportamento, antes e após o tratamento medicamentoso. Após o tratamento e as intervenções, foi verificada grande melhora no comportamento, na aprendizagem e nas relações pessoais. Os resultados nos testes foram para melhor; em relação à aprendizagem, foi possível verificar uma dificuldade fonológica do processo de alfabetização, que antes não foi constatado devido a sua recusa. A psicopedagoga fez orientação na escola e soube na ocasião que a criança frequentava o reforço escolar na escola, com conteúdo mais relacionado à matéria atual, assim foi realizada orientação para que fosse trabalhado o processo de alfabetização com ênfase nos aspectos fonológicos devido às dificuldades apresentadas na escrita e na leitura. A relação Saúde e Educação trouxe perspectivas e intervenções importantes na vida escolar, demonstrando que é possível mudar o comportamento e a qualidade da aprendizagem de crianças com diagnóstico de TDAH...

The study presents a case of psycho-pedagogical mediation to the Attention Deficit/Hyperactivity Disorder diagnoses, treatment, and school/family/child guidance. The child was referred by the psycho-pedagogue to the interdisciplinary evaluation of the psycho-pedagogical, neuropsychological, neuropediatrician, psychiatric and familiar aspects. The school and mother's complain was that the child was aggressive, objector, declining to do the activities, troublemaker at home and at school, disorganized, careless with his/her personal belongs, difficulty in keeping friends and not interested in classes. The child was treated with methylphenidate, with a prompt impulsivity and neglect improvement. Neuropsychological and psychiatric tests have been applied, behavior scales, before and after the drug treatment. After the treatment and the interventions, a great behavior improvement was verified, as in the learning process and in the social relations. The tests results were for better, concerning to the learning process, it was possible to realize a phonologic difficulty, which was not identified previously due to the refusal. During the scholar guidance, the psycho-pedagogue noted that the child was taking tutoring classes at school, with a content related to the current subject, and so it was advised that the literacy ability should be worked with a focus on the phonologic aspects due to the difficulties showed in the writing and reading skills. The Health-Education relation brought out important prospects and interventions in the scholar life, showing that it is possible to change the behavior and the quality of learning in children with ADHD...

Trastornos de la conducta disruptiva en la infancia y la adolescencia: diagnóstico y tratamiento / Disruptive behavior disorders in childhood and adolescence: diagnosis and treatment

Disruptive behavior disorders (DBD) in childhood and adolescence are among the most frequent reasons for consultation and counseling. In Oppositional Defiant Disorder (ODD), psychosocial management is the therapeutic intervention of choice. Training parents and caregivers in the behavioral management of the child or early adolescent (12 to 15 years) is the best interventions. Behavioral perspective needs to cover all contexts: family, school, and the child. The clinician must make an individualized treatment plan. The parents suggested interventions should be based on those with the greatest empirical evidence. The use of drugs may be useful as an addition to psychosocial interventions for symptomatic treatment and comorbid conditions. Severe and persistent ODD may require prolonged and intensive treatment. Brief interventions are usually ineffective. Conduct disorder (CD) is a mixed manifestation that needs biological, psychological and social therapeutic intervention. Psychopharmacological treatment alone is never enough. Studies with drugs for the treatment of CD may be grouped by type of drug used: mood stabilizers, antipsychotics and stimulants. The overall effect size of psychotropic agents in the treatment of aggression is 0.56. Currently only three psychosocial treatments have been adequately evaluated: A) Training for parents, B) Cognitive training in problem-solving skills and C) Multisystemic therapy. Conclusions ODD and CD are among the most frequent and severe mental disorders in childhood and adolescence. The treatment of these conditions must be multimodal or multisystemic, including pharmacological, psychoeducational and psychotherapy.

Los Trastornos de la Conducta Disruptiva (TCD) en la infancia y la adolescencia constituyen uno de los motivos más frecuente de consulta. En el Trastorno Negativista y Desafiante (TND) el tratamiento psicosocial es la intervención terapéutica de primera elección. Los programas de intervención desde una perspectiva conductual abarcan todos los contextos: familiar, escolar y del propio niño o adolescente. El clínico debe considerar importante cualquier información obtenida de otros informantes, vgr. maestros, para realizar un plan de tratamiento individualizado. Las intervenciones sugeridas a los padres deben basarse en las de mayor evidencia científica. El uso de medicamentos puede ser útil como tratamiento adjunto a las intervenciones psicosociales, para el tratamiento sintomático y el de las comorbilidades. Cuando el TND es intenso y persistente se pueden requerir tratamientos prolongados e intensivos. Las intervenciones cortas usualmente son inefectivas. El Trastorno Disocial (TD) es un fenómeno que por su naturaleza mixta, biológica, psicológica y social, requiere de una intervención terapéutica integral. La magnitud del efecto global de los fármacos en el tratamiento de la agresión es de 0.56. Actualmente sólo tres tratamientos psicosociales han sido adecuadamente evaluados: a) El entrenamiento para padres, b) el entrenamiento cognitivo en habilidades para resolver problemas y c) la terapia multisistémica. Conclusiones Los padecimientos externalizados como el TND y el TD; constituyen algunos de los problemas más frecuentes y graves dentro de los trastornos mentales de inicio en la infancia y la adolescencia. El tratamiento de estos padecimientos debe tener un enfoque multimodal o multisistémico que incorpore las aproximaciones farmacológicas, psicoeducativas y psicoterapéuticas necesarias.

Mau desempenho escolar: uma visão atual / Poor school performance: an updated review

Este estudo tem como objetivo uma revisão atualizada sobre o tema de mau desempenho escolar para profissionais da área de saúde e educação. Aborda aspectos atuais da educação, de aprendizagem e das principais condições envolvidas em mau desempenho escolar. Apresenta dados atualizados sobre os principais aspectos da neurobiologia, epidemiologia, etiologia, quadro clínico, comorbidades, diagnóstico, intervenção precoce e tratamento das principais patologias envolvidas. Trata-se de uma revisão abrangente, não sistemática da literatura sobre aprendizagem, desempenho escolar, transtorno de aprendizagem (dislexia, discalculia e disgrafia), transtorno de déficit de atenção/hiperatividade (TDA/H) e transtorno de desenvolvimento de coordenação (TDC). O mau desempenho escolar é um sintoma frequente em nossas crianças com graves repercussões emocionais, sociais e econômicas. Uma visão atualizada do tema facilita o raciocínio clínico, o diagnóstico correto e o tratamento adequado.

This study aims to develop a comprehensive review on the issue of poor school performance for professionals in both health and education areas. It discusses current aspects of education, learning and the main conditions involved in underachievement. It also presents updated data on key aspects of neurobiology, epidemiology, etiology, clinical presentation, comorbidities and diagnosis, early intervention and treatment of the major pathologies comprised. It is a comprehensive, non-systematic literature review on learning, school performance, learning disorders (dyslexia, dyscalculia and dysgraphia), attention deficit / hyperactivity disorder (ADHD) and developmental coordination disorder (DCD). Poor school performance is a frequent problem faced by our children, causing serious emotional, social and economic issues. An updated view of the subject facilitates clinical reasoning, accurate diagnosis and appropriate treatment.

Efectos de un programa combinado de técnicas de modificación conductual para la disminución de la conducta disruptiva y el aumento de la conducta prosocial en escolares chilenos / Effects of a combined program of behavior modification techniques for decreasing disruptive behavior and increasing prosocial behavior in Chilean school children / Efeitos de um programa combinado de técnicas de modificação de comportamento para reduzir o comportamento perturbador e aumentar o comportamento prosocial em escolares chilenos

El objetivo de la presente investigación fue evaluar la eficacia de un programa de intervención conductual en la disminución de la frecuencia de conductas disruptivas y en el aumento de la frecuencia de conductas prosociales en el contexto escolar. Con este objetivo se entrenó a una profesora en el empleo de una serie de técnicas de modificación conductual (instrucciones, alabanza verbal y economía de fichas) para que ella las aplicara a un curso de primer año de enseñanza secundaria que presentaba serios desajustes conductuales. Se utilizó un diseño de reversión ABAB con seguimiento para evaluar el desempeño de la profesora en las técnicas de modificación conductual enseñadas y su efecto en el grupo-curso. Los resultados indican que la profesora logró aplicar de manera apropiada las técnicas de modificación conductual produciendo los cambios deseados en el comportamiento de los alumnos del curso.

The objective of this research was to evaluate the effectiveness of a behavioral intervention program on the reduction of disruptive behavior, and the increase of prosocial behavior in a classroom context. In order to do so, the class teacher received training in the use of a series of behavior modification techniques (namely instructions, verbal praise and token economy). After training the teacher, she implemented the procedures in a first year class of secondary school that presented severe behavioral problems. A reversal design ABAB was used in order to evaluate the performance of the teacher in the implementation of the behavioral modification techniques taught and to evaluate the effect of these techniques on the group. Results indicated that the teacher was able to implement appropriately all the behavior modification techniques. The implemented procedures were in turn able to generate the desired changes in student behavior during class time.

Esta pesquisa avaliou a eficácia de um programa de intervenção comportamental para reduzir a freqüência de comportamentos perturbadores e aumentar os comportamentos prosociais no contexto escolar. Portanto, uma professora treinada no uso de uma série de técnicas de modificação do comportamento (instruções, louvor verbal e economia de fichas) as aplicou em um curso do primeiro ano do ensino secundário que tinha sérios desajustes comportamentais. Foi utilizado um desenho de reversão ABAB com seguimento para avaliar o desempenho da professora nas técnicas ensinadas de modificação comportamental e seu efeito no grupo-curso. Os resultados revelam a professora aplicou apropriadamente as técnicas de modificação comportamental produzindo os resultados esperados no comportamento dos alunos do curso.

Inattention, hyperactivity, oppositional-defiant symptoms and school failure / Desatenção, hiperatividade, sintomas de oposição e desafio e fracasso escolar

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is associated with school failure. Inattention has been mainly implicated for this association. Oppositional-defiant disorder's (ODD) impact on academic performance remains controversial, because of the high comorbidity between ODD and ADHD. OBJECTIVE: To understand the role of inattention (IN), hyperactivity (H/I) and ODD in school failure. METHOD: Parents and teachers filled out SNAP-IV questionnaires for 241 / 6th grade students. The associations of the scores of oppositional-defiant (OP), H/I and IN symptoms with school year failure were calculated. RESULTS: IN was strongly correlated with school failure. H/I and OP were not associated with school failure, when controlled for IN. CONCLUSION: OP and H/I symptoms do not play an important role in school failure, when controlled for IN symptoms. Our study supports the cross-cultural role of IN as a major predictor of school failure.

Transtorno do déficit de atenção e hiperatividade (TDAH) está fortemente correlacionado a fracasso escolar. Desatenção (DA) parece ser primordialmente responsável por essa associação. A influência de transtorno desafiador de oposicão (TDO) sobre o desempenho acadêmico continua a ser controversa, principalmente devido à alta comorbidade entre TDO e TDAH. OBJETIVO: Entender melhor o papel da DA, hiperatividade/impulsividade (H/I) e sintomas opositivo-desafiadores (OP) no fracasso escolar. MÉTODO: Duzentos e quarenta e um estudantes da 6ª série foram avaliados com os questionários de Swanson, Nolan e Pelham (SNAP-IV), preenchidos pelos pais e professores. As associações entre as sub-escalas de OP, H/I e DA, com o número de notas "I" ("insuficiente") e com reprovação escolar foram calculadas. RESULTADOS: Sintomas OP não foram correlacionados com o número de notas "I", após o controle para a sua associação com H/I e DA. DA se associou com fracasso escolar. H/I não se correlacionou com fracasso escolar, uma vez controlada a sua associação com DA. CONCLUSÃO: OP e H/I não exercem papel importante no fracasso escolar, uma vez controladas as suas associações com DA. Esse estudo ressalta, em amostra brasileira, o papel transcultural da DA como ameaça ao bom desempenho escolar. A associação entre transtornos do aprendizado e sintomas de DA precisa ser mais extensamente investigada.

Transtornos de déficit de atenção e do comportamento disruptivo: associação com abuso físico na infância: [relato de caso] / Attention-deficit and disruptive behavior disorders: association with physical abuse in childhood: [case report]

CONTEXTO: Muitos transtornos psiquiátricos, geralmente diagnosticados pela primeira vez na infância, estão associados a maus-tratos, entre eles o abuso físico, causando significativo impacto no desenvolvimento das crianças acometidas. OBJETIVOS: Avaliar a associação entre um diagnóstico psiquiátrico do grupo dos transtornos de déficit de atenção e do comportamento disruptivo (TDACD) em crianças e a história de abuso físico na infância. MÉTODOS: Em um estudo seccional, crianças de 3 a 12 anos, atendidas em um ambulatório de psiquiatria de um hospital universitário, foram avaliadas por meio do MINI KID (), tendo sido diagnosticadas de acordo com os critérios do DSM-IV. A avaliação de abuso físico e de outros eventos traumáticos foi realizada por um questionário específico, o LSC-R () e inclui diferentes tipos de maus-tratos. RESULTADOS: Encontrou-se uma razão de chance mais alta de exposição freqüente ao abuso físico (p = 0,02) no grupo de crianças diagnosticadas com TDACD. Não se encontrou associação entre transtornos de humor (p = 0,67) e de ansiedade (p = 0,57) com abuso físico. Evidenciou-se uma relação de temporalidade entre o grupo dos TDACD e abuso físico (66,6 por cento). Após ajuste de possíveis fatores de confundimento, meninos demonstraram índices significativamente mais elevados de abuso físico do que meninas (p = 0,001). CONCLUSÕES: Nossos achados documentaram associação entre um diagnóstico do grupo dos TDACD em crianças e abuso físico na infância.

BACKGROUND: Many psychiatric disorders diagnosed at the first time in childhood are associated with child abuse, like physical abuse. This disorders cause an important impact on the childhood development. OBJECTIVES: To investigate the association between children with attention-deficit and disruptive behavior disorders group (ADDBD) and physical abuse in childhood. METHODS: Cross-sectional study using the MINI KID (Mini International Neuropsychiatric Interview for Children and Adolescents) to evaluate children with and without the diagnostic of ADDBD group. Physical abuse was evaluated using the LSC-R (Life Stressor Checklist - Revised) and included others child abuses. RESULTS: We found a higher odds ratio for frequent exposure to physical abuse (p = 0,02) in the ADDBD group than in the group without this diagnostic. No association between mood (p = 0,67) and anxiety (p = 0,57) disorders and physical abuse. We found a temporal association (66,6 percent) between ADDBD group and physical abuse. After adjusting for potential confounding factors, we found significantly higher odds ratio to the association between boys and physical abuse than did girls (p = 0,001). DISCUSSION: Our findings document an association between ADDBD group and physical abuse in childhood period.

Association analysis of dopamine D4 receptor gene polymorphism and attention deficit hyperactivity disorder with/without disruptive behavior disorder / 北京大学学报(医学版)

Objective:To examine the role of dopamine D4 receptor gene(DRD4) in attention deficit hyperactivity disorder(ADHD) with/without disruptive behavior disorder(DBD) by focusing on a-521C/T SNP within the promoter region of this gene.Methods:A total of 401 DSM-Ⅳ ADHD children(including 284 trios) of Chinese Han descent were genotyped.Chi-square test and the transmission disequilibrium test(TDT) were used to test for associations in ADHD with and without DBD respectively.Results:In the comparison of ADHD with(n= 143) and without(n= 258) DBD,the-521T allele(?2 = 6.778,P= 0.009,OR= 1.485) and the TT genotype(?2 = 6.292,P= 0.012,OR= 1.729) showed higher frequency in children with ADHD and DBD simultaneously.For family based analysis,T allele of the-521C/T polymorphism was preferentially transmitted to ADHD children with comorbid DBD(n= 100,?2 = 3.868,P= 0.049),whereas no significant distortion was found in the transmission of the tested variant for ADHD without DBD(n= 184,?2 = 0.223,P= 0.637).Conclusion:Our findings suggest that the-521C/T SNP of DRD4 may contribute to the predisposition to ADHD with comorbid DBD.This study supports for the hypothesis that ADHD with comorbid DBD may be influenced by greater genetic effect compared to ADHD alone.

Association between serotonin 4 gene polymorphisms and attention deficit hyperactivity disorder comorbid or not comorbid disruptive behavioral disorder / 北京大学学报(医学版)

T were genotyped by restriction fragment length polymorphism analysis.Transmit/disequilibrium test and haplotype analysis were used to test the association of the three polymorphisms with ADHD comorbid or not comorbid DBD separately.Results:Haplotype T/G/T showed tendency of overtransmission(?2=3.470,P=0.062) to probands of ADHD with DBD, while haplotype C/G/T(?2=4.568,P=0.032) and C/G/C(?2=5.333,P=0.021) were undertransmitted to probands of ADHD without DBD,No biased transmissions of any allele were found in families with probands of ADHD with and without DBD.Conclusion:whether ADHD comorbid DBD or not comorbid DBD makes difference at the level of HTR4 gene polymrohisms.

Executive function characteristic in boys with attention deficit hyperactivity disorder comorbid disruptive behavior disorders / 北京大学学报(医学版)

Objective:To answer the question whether executive function(EF) deficits are specific to attention deficit hyperactivity disorder(ADHD) or whether such deficits are also associated with disruptive behavior disorders(DBD),including oppositional defiant disorder(ODD) and conductive disorder(CD).Methods:A total of 19 pure ADHD boys,19 ADHD + DBD boys and 19 normal controls(criteria of DSM-Ⅳ) were collected as our samples.The groups were matched by age(less than 6 months).The research instruments included Stroop color-word task,Rey complex figure test,digit span test, trail making test,tower of Hanoi and verbal fluency test.Results:The differences of IQs weren't significant among three groups.(1) Both pure ADHD group and ADHD+DBD group performed worse(P0.05).(2) Pure ADHD group also showed deficits in the aspects of errors of Stroop 2,time and errors of Stroop 3, word interference time;immediate memory structure score of Rey complex figure test;time and errors of number-letter part and shifting time of trail making test;total time and steps of completing tower of Hanoi.The differences were significant(P