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

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

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

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

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

Neuropsicologia do transtorno de déficit de atenção/hiperatividade: modelos neuropsicológicos e resultados de estudos empíricos / Neuropsychology of attention-deficit/hyperactivity disorder: neuropsychological models and results of empirical studies / Neuropsicología del trastorno de déficit de atención/hiperactividad: modelos neuropsicológicos y resultados de estudios empíricos

Diferentes modelos teóricos foram propostos para explicar os déficits neuropsicológicos e seu impacto no comportamento de indivíduos com Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Os objetivos deste artigo serão apresentar os principais modelos neuropsicológicos do TDAH e possibilitar uma atualização acerca dos principais achados relacionados ao funcionamento neuropsicológico de pacientes com esse diagnóstico. Revisões e meta-análises sobre funcionamento executivo, aversão à resposta tardia, processamento temporal e variações intraindividuais no tempo de reação são apresentadas. O perfil neuropsicológico de pacientes com TDAH é heterogêneo e testes neuropsicológicos não são suficientemente sensíveis e específicos para realização do diagnóstico, embora sejam muito importantes na identificação do perfil cognitivo para estabelecimento de um plano de tratamento mais abrangente e adequado às necessidades especificas de cada paciente.

Different theoretical models have been proposed to explain the neuropsychological deficits and their impact on the behavior of individuals with Attention-Deficit/ Hyperactivity Disorder (ADHD). The aims of this article will be to present the main neuropsychological models of ADHD and an update on the main findings related to neuropsychological functioning of patients with this diagnosis. Reviews and meta-analyzes on executive functioning, delay aversion, temporal processing and intra-individual variability in reaction time are presented. The neuropsychological profile of patients with ADHD is heterogeneous and neuropsychological tests are not sufficiently sensitive and specific for correct diagnosis, although they are very important to identify the cognitive profile and establish a more comprehensive and appropriate treatment plan according to the characteristics of each patient.

Diferentes modelos teóricos han sido propuestos para explicar el déficit neuropsicológico y su impacto en el comportamiento de personas con Trastorno por Déficit de Atención/Hiperactividad (TDAH). Los objetivos de este artículo han sido presentar los principales modelos neuropsicológicos de TDAH y posibilitar una actualización sobre los principales resultados relacionados al funcionamiento neuropsicológico de pacientes con ese diagnóstico. Revisiones y meta- análisis sobre funcionamiento ejecutivo, aversión a la respuesta tardía, procesamiento temporal y variaciones interindividuales, en el tiempo de reacción se presentan. El perfil neuropsicológico de pacientes con TDAH es heterogéneo y los tests neuropsicológicos no son suficientemente sensibles y específicos para la realización del diagnóstico, aunque sean muy importantes para identificar el perfil cognitivo y establecer un plan de tratamiento más integral y adecuado a las necesidades específicas de cada paciente.

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

Análise fatorial confirmatória da escala de inteligência Wechsler abreviada: versão português brasileiro / Confirmatory factor analysis of Wechsler Abbreviated Scale of Intelligence: Brazilian Portuguese Version / Análisis factorial confirmatorio de la escala de inteligencia Wechsler abreviada: versión portuguesa-brasileña

A escala de inteligência Wechsler abreviada (WASI) é um instrumento desenvolvido para avaliar a inteligência de forma rápida. Fornece, além do QI total, os QIs verbal e de execução. O presente estudo visa a investigar se os dados de parte da amostra de normatização da versão brasileira do instrumento se ajustam ao modelo de dois fatores. Foi realizada uma análise fatorial confirmatória com dados de 534 participantes, idade média de 28,78 anos (DP=22,07), com 51,5% do sexo feminino. As análises consideraram as amostras total, de crianças/adolescentes e de adultos. Os resultados indicaram que o modelo de dois fatores se ajusta à amostra analisada. Considerações acerca da validade interna e da proposta conceitual do instrumento são realizadas...

The Wechsler abbreviated scale of intelligence (WASI) was developed to rapidly assess intelligence, providing Verbal, Performance, and Full Scale IQ scores. This study aimed to investigate whether part of the standardization sample data from the Brazilian version of the instrument fits the two-factor model. Confirmatory factor analysis was conducted with data from 534 participants, average age 28.78 years (SD=22.07), and 51.5% female. The analyses were performed considering the total sample, the children and adolescents sample and the adult sample. Results indicate that the two-factor model fits the analyzed sample. Considerations are presented regarding the internal validity and conceptual proposal of the instrument...

La escala de inteligencia Wechsler abreviada (WASI) es un instrumento desarrollado para evaluar la inteligencia de forma rápida que aporta además del CI total, los CIs Verbal y de Ejecución. Este estudio pretende investigar si los datos de parte de la muestra de normalización de la versión Brasileña se ajustan a un modelo de dos factores. Se realizó un análisis factorial confirmatorio con datos de 534 participantes, con media de edad de 28,78 años (SD=22,07), siendo 51,5% del sexo femenino. El análisis fue realizado considerándose la muestra total de niños/adolescentes y adultos. Los resultados indicaron que el modelo de dos factores se ajusta a la muestra analisado. Se hacen consideraciones sobre la validez interna y la propuesta conceptual...

Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD?

Objective: To assess differences in executive functioning between children and adolescents with attention-deficit/hyperactivity disorder (ADHD) comorbid or not with bipolar disorder (BD), and to study the neuropsychological profile of subjects with the comorbidity in a clinical sample from a developing country. Method: Case-control study comparing 23 participants with BD + ADHD and 85 ADHD-only subjects aged 6 to 17 years old. Both groups were drug-free. Executive function domains were assessed with the Stroop Test, the Wisconsin Card Sorting Test, and the Continuous Performance Test II. Results: The group with juvenile BD + ADHD showed a significantly worse performance on the Stroop task, including time in color (p = 0.002), time in color-word (p < 0.001), interference, number or errors in color and color-word (p = 0.001), and number of errors in word cards (p = 0.028). No between-group differences were found in other tests. Conclusions: Our findings suggest that ADHD-only and ADHD + BD do not show differences in inhibitory control and set-shifting domains. However, children and adolescents with BD and comorbid ADHD show greater impairment in processing speed and interference control. This suggests a potentially higher impairment in the dorsolateral prefrontal cortex and may be a potential neuropsychological signature of juvenile BD comorbid with ADHD. .

A systematic review of validity procedures used in neuropsychological batteries

This study presents a systematic review of validity evidence for neuropsychological batteries. Studies published in international databases between 2005 and 2012 were examined. Considering the specificity of neuropsychological batteries, the aim of the study was to review the statistical analyses and procedures that have been used to validate these instruments. A total of 1,218 abstracts were read, of which 147 involved studies of neuropsychological batteries or tests that evaluated at least three cognitive processes. The full text of each article was analyzed according to publication year, focal instrument of the study, sample type, sample age range, characterization of the participants, and procedures and analyses used to provide evidence of validity. The results showed that the studies primarily analyzed patterns of convergence and divergence by correlating the instruments with other tests. Measures of reliability, such as internal consistency and test-retest reliability, were also frequently employed. To provide evidence of relationships between test scores and external criteria, the most common procedures were evaluations of sensitivity and specificity, and comparisons were made between contrasting groups. The statistical analyses frequently used were Receiver Operating Characteristic analysis, Pearson correlation, and Cronbach's alpha. We discuss the necessity of incorporating both classic and modern psychometric procedures and presenting a broader scope of validity evidence, which would represent progress in this field. Finally, we hope our findings will help researchers better plan the validation process for new neuropsychological instruments and batteries...

Viabilidade da estimativa de QI a partir dos subtestes Vocabulário e Cubos da WAIS-III / Viability of IQ estimates based on Vocabulary and Block Design WAIS III subtests

Objetivou-se avaliar a viabilidade de estimar o Quociente de Inteligência (QI) de adultos por meio de duas estratégias que utilizam uma forma curta constituída pelos subtestes Vocabulário e Cubos da Escala Wechsler de Inteligência para Adultos (WAIS-III). Participaram do estudo 77 homens e mulheres, com idade média de 39,1 anos (dp=13,4). Foi aplicada a WAIS-III e questionários para cumprir os critérios de inclusão dos participantes sem prejuízos neurológicos e psiquiátricos. Para avaliar a concordância entre as duas estratégias de estimar o QI, utilizou-se o método estatístico proposto por Bland e Altman. Como resultado, encontrou-se que as estimativas de QI geradas pelas duas estratégias apresentam concordância com a medida do QI realizada pela aplicação da escala completa apenas em alguns dos casos avaliados. Sugere-se cautela na utilização dessas estratégias para estimar o QI de adultos.

The aim of this study was to evaluate the feasibility of estimating the Intelligence Quotient (IQ) in adults based on two strategies that use Vocabulary and Block Design subtests of Wechsler Adult Intelligence Scale (WAIS-III). Seventy-seven men and women participated of the study, with mean age of 39.1 (sd=13.4). WAIS-III subtests were administered and questionnaires were used to verify inclusion criteria for participants without neurological or psychiatric impairments. A statistical method proposed by Bland and Altman was used to evaluate the agreement between both strategies to estimate IQ. Results suggest that IQ estimates derived from both strategies only agree with the IQ derived from the full battery in a few cases of the sample. Considering these findings, caution is suggested when using these strategies to estimate adults' IQ.

Concepções de policiais sobre crianças em situação de rua: um estudo sobre preconceito / Police officer's conceptions about street children: a study about prejudice

O objetivo deste estudo foi investigar a concepção que policiais militares têm das crianças em situação de rua. Pela técnica da inserção ecológica, doze policiais homens foram selecionados ao acaso e entrevistados nas ruas perante um roteiro pré-estabelecido. Foi realizada uma análise qualitativa do conteúdo das entrevistas e de diários de campo dos pesquisadores. Os critérios utilizados pelos policiais para definir a criança em situação de rua foram a aparência, as atividades desenvolvidas na rua, o comportamento, a freqüência com que as crianças estão na rua, o local de permanência e a relação da criança com a família. Para todos os critérios houve uma tendência à valoração negativa, no entanto, percebeu-se uma relativização do conceito criado. O estudo destacou a importância da qualificação profissional no enfrentamento deste problema social, sobretudo num caráter educativo que revele melhor a dinâmica de vida das crianças em situação de rua.