[Models of intervention in children with autism]. / Modelos de intervención en niños con autismo.

INTRODUCTION: Autism spectrum disorders make up a group of neurodevelopmental disorders that globally affect different higher brain functions in the individual, such as intelligence, the capacity to use language and social interaction. Today, although there is still no curative treatment for autism, there are a number of non pharmacological interventions that can modify the poor prognosis that is generally associated to this type of disorders. AIM: To briefly review the different approaches to the neuro rehabilitation of patients suffering from autism spectrum disorders, which are usually known as methods of intervention. DEVELOPMENT: From the categorical point of view, three types of methods of intervention can be distinguished, depending on whether the orientation is psychodynamic, biomedical or psycho educational. It is difficult to compare the results of the different methods of intervention, but researchers have identified several common elements that they should have if they are to be effective. At present, the psycho educational methods are preferred, since they are the only ones that, to date, have proved to be effective in research studies. CONCLUSIONS: Early intervention by diagnostic and early care centres, with the use of mixed models of psycho educational intervention that nevertheless also include an important percentage of behavioural elements, has proved to be capable of modifying the course of patients with autism spectrum disorders and is currently the most suitable approach.

Modelos de intervención en niños con autismo / Introduction. Autism spectrum disorders make up a group of neurodevelopmental disorders that globally affect different

Introducción. Los trastornos del espectro autista constituyen un grupo de alteraciones del neurodesarrollo que afectan de manera global distintas funciones cerebrales superiores del individuo, como la inteligencia, la capacidad del lenguaje y la interacción social. Aunque no existe hoy día ningún tratamiento curativo del autismo, sí hay diversas intervenciones no farmacológicas que pueden modificar el mal pronóstico generalmente asociado a este tipo de trastornos. Objetivo. Revisar de manera sucinta las diferentes aproximaciones para la neurorrehabilitación de los pacientes afectados de trastornos del espectro autista, lo que se conoce habitualmente como métodos de intervención.Desarrollo. Desde un punto de vista categórico, se pueden distinguir tres tipos de métodos de intervención, según que la orientación sea psicodinámica, biomédica o psicoeducativa. Existen dificultades para comparar los resultados de los distintos métodos de intervención, pero se han identificado unos elementos comunes que deberían tener para resultar eficaces. Actualmente se prefieren los métodos psicoeducativos, pues son los únicos que han demostrado eficacia en losestudios de investigación. Conclusiones. La intervención precoz, en el contexto de los centros de diagnóstico y atención temprana, dentro de modelosde intervención psicoeducativa mixtos, aunque con gran presencia de elementos conductuales, ha demostrado podermodificar la evolución de los pacientes con trastornos del espectro autista y constituye hoy día el abordaje más indicado (AU)

Introduction. Autism spectrum disorders make up a group of neurodevelopmental disorders that globally affect differenthigher brain functions in the individual, such as intelligence, the capacity to use language and social interaction. Today,although there is still no curative treatment for autism, there are a number of non pharmacological interventions that can modify the poor prognosis that is generally associated to this type of disorders. Aim. To briefly review the different approaches to the neuro rehabilitation of patients suffering from autism spectrum disorders, which are usually known as methods of intervention. Development. From the categorical point of view, three types of methods of intervention can be distinguished, dependingon whether the orientation is psychodynamic, biomedical or psycho educational. It is difficult to compare the results of the different methods of intervention, but researchers have identified several common elements that they should have if they are to be effective. At present, the psycho educational methods are preferred, since they are the only ones that, to date,have proved to be effective in research studies. Conclusions. Early intervention by diagnostic and early care centres, with the use of mixed models of psycho educational intervention that nevertheless also include an important percentage of behavioural elements, has proved to be capable of modifying the course of patients with autism spectrum disorders and is currently the most suitable approach (AU)

[The advantages of neuropsychological examination batteries in attention deficit hyperactivity disorder]. / Ventajas de las baterías de exploración neuropsicológica en el trastorno por déficit de atención/hiperactividad.

INTRODUCTION: The neuropsychological assessment of the functions of attention and the executive functions in patients with clinical features compatible with a diagnosis of attention deficit hyperactivity disorder (ADHD) is considered a priority study to be able to offer a basic study. It is also necessary to be able to carry out a short- and long-term developmental follow-up of patients. DEVELOPMENT: An algorithm for diagnosing ADHD is proposed that includes both traditional and computerised tests for assessing the functions of attention and the executive functions. The development of new neuropsychological batteries for this purpose involves the use of several tests in computerised form that offer technical and methodological advantages as regards their use and the later treatment of the data obtained. CONCLUSIONS: The advantages of computerised assessment include management of answer times, minimum expression of the effect exerted by the researcher, savings in time, accurate and fast scoring, statistical management of new scores, and greater proximity to research programmes.

Ventajas de las baterías de exploración neuropsicológica en el trastorno por déficit de atención/hiperactividad / The advantages of neuropsychological examination batteries in attention deficit hyperactivity disorder

Introducción. La evaluación neuropsicológica de las funciones de atención y de las funciones ejecutivas en pacientes con una sintomatología compatible con el diagnóstico de trastorno por déficit de atención/hiperactividad (TDAH) supone un estudio prioritario para poder ofrecer un estudio básico, así como para poder llevar a cabo un seguimiento evolutivo a corto y a largo plazo de los pacientes. Desarrollo. Se plantea un algoritmo diagnóstico del TDAH, en el que se incluyen pruebas tradicionales e informatizadas para evaluar las funciones de atención y las funciones ejecutivas. El desarrollo de nuevas baterías neuropsicológicas con esta finalidad supone el empleo informatizado de diversos test que demuestran ventajas técnicas y metodológicas en cuanto a su empleo y en referencia al manejo posterior de los datos obtenidos. Conclusiones. Entre las ventajas de la evaluación informatizada destacan el manejo temporal de las respuestas, la mínima expresión del efecto experimentador, el ahorro de tiempo, la precisión y rapidez de las puntuaciones, el tratamiento estadístico de nuevas puntuaciones y la mayor cercanía respecto a los programas de investigación (AU)

Introduction. The neuropsychological assessment of the functions of attention and the executive functions in patients with clinical features compatible with a diagnosis of attention deficit hyperactivity disorder (ADHD) is considered a priority study to be able to offer a basic study. It is also necessary to be able to carry out a short- and long-term developmental followup of patients. Development. An algorithm for diagnosing ADHD is proposed that includes both traditional and computerised tests for assessing the functions of attention and the executive functions. The development of new neuropsychological batteries for this purpose involves the use of several tests in computerised form that offer technical and methodological advantages as regards their use and the later treatment of the data obtained. Conclusions. The advantages of computerised assessment include management of answer times, minimum expression of the effect exerted by the researcher, savings in time, accurate and fast scoring, statistical management of new scores, and greater proximity to research programmes (AU)

[Asperger's syndrome, little teachers: special skills]. / Síndrome de Asperger, los pequeños profesores: habilidades especiales.

INTRODUCTION: Asperger's syndrome (AS) is characterised by its effects on reciprocal social interaction, verbal and non-verbal communication, difficulty in accepting changes, inflexible thinking and reduced fields of interest, but also by the presentation of special skills. DEVELOPMENT: On the occasion of the centenary of the birth of Hans Asperger, we briefly review the history of this researcher and offer a short description of the clinical features of the condition, including social interaction, communication, limited concerns and interests, routines and inflexibility, which are key points when it comes to reaching a diagnosis. Later, we also focus on Savant syndrome, which is a very common subgroup within AS and which is characterised by the patient's outstanding ability is certain special skills, such as hypermnesia, hyperlexia and hypercalculia, in mental feats concerning the perpetual calendar and in several branches of the arts, such as drawing, painting, sculpture and music. We discuss several famous cases of savants and explain some of the theories about its pathophysiology. CONCLUSIONS: Having special skills is a distinguishing mark of AS and identifying and facilitating them would provide us with a potential tool with which to accomplish suitable job opportunities.

[Neuropsychological disorders in teenagers with attention deficit hyperactivity disorder]. / Trastornos neuropsicológicos de los adolescentes afectos de trastorno por déficit de atención con hiperactividad.

AIMS: The aim of this study is to report on the neuropsychological aspects of teenage patients with attention deficit hyperactivity disorder (ADHD), namely disorders affecting attention, memory, the executive functions and language. We also discuss how to perform neuropsychological and functional evaluation of the systems involved in attention, by means of haemodynamic (functional magnetic resonance imaging) and neurophysiological (magnetoencephalography) techniques. The comorbidities that most frequently occur in teenage patients with ADHD are also described. DEVELOPMENT: The fundamental symptoms, that is to say, inattention, hyperactivity and impulsiveness, continue to be present in the teenager with ADHD, although with mild variations, and are probably dependent on each individual's own genetic load. The disorders most commonly associated with ADHD are oppositional defiant disorder (33%), conduct disorders (25%), anxiety (25%), learning disabilities (22%) and depression (22%). CONCLUSIONS: During adolescence, patients with ADHD usually suffer disorders that are secondary to their inability to process information efficiently due to the inadequate development of the executive functions. The lack of inhibitory control and a poor capacity to learn from their own mistakes facilitate the appearance of comorbid neuropsychiatric disorders.

[Language and neurodevelopmental disorders. A review of their clinical characteristics]. / El lenguaje y los trastornos del neurodesarrollo. Revisión de las características clínicas.

INTRODUCTION: Language is a keystone in the normal social and cognitive development of any group of children and early, fitting interventions can largely reduce the repercussions that the deficit has in this area. The article analyses the definition of language as 'the result of a complex nervous activity that allows individuals to communicate mental states by the production of multi-modal signs that symbolise these states in accordance with a linguistic community's own convention'. Other language-related terms are also dealt with. DEVELOPMENT: Different classifications of language disorders are also discussed and we analyse its characteristics in different neurological disorders, such as motor disorders with a central origin, autistic spectrum, learning disorders, mental retardation, and attention deficit and disruptive behaviour disorders. CONCLUSIONS: Disorders affecting language clearly display semiological heterogeneity, and therefore it is advisable to take into account the classifications and terms related to it. It is also necessary to be familiar with the specific features of each alteration in the different neurological disorders so as to be able to reach an accurate diagnosis that allows the implementation of suitable lines of behaviour and interventions. Additionally, this will also allow timely measures to be taken in order to avoid later complications.

[Learning disabilities in epileptic children]. / Dificultades del aprendizaje en los niños epilépticos.

AIMS: To analyse the association between neuropsychological disorders and epilepsy in infancy by searching for the origin in the pathophysiology of epilepsy as a neurological disease and based on the adaptive plasticity of the brain. DEVELOPMENT: The existence of electrical discharges, both in the presence and the absence of clinical seizures, is linked to problems involving attention, recent memory, limitations in the linguistic, visuospatial and executive capabilities, with slowed psychomotor functioning, and this leads to learning difficulties. The early age of onset of epilepsy, the secondary causation, the fact it is refractory to treatment and therefore requires polytherapy, and the negative experience of the disease all have an effect on the association of neuropsychological disorders. The type of epilepsy that can determine the involvement of specific functions, such as memory, is affected in partial epilepsies of the temporal lobe and in generalised epilepsies attention is affected. CONCLUSIONS: Epileptic seizures are not the only manifestation of epilepsy, and children display associated symptoms that make it necessary to carry out a comprehensive neuropsychological evaluation that must include hemisphere-specific examinations of the brain functions.

[Techniques for the functional evaluation of neurodevelopmental disorders]. / Técnicas de evaluación funcionalde los trastornos del neurodesarrollo.

AIM: To review the evaluation of neuropsychological functions by using non-invasive functional neuroimaging methods. DEVELOPMENT: Non-invasive functional neuroimaging methods can be sorted into two broad categories: the first includes those that make use of electromagnetic techniques, such as event-related potentials and magnetoencephalography (MEG), and the second consists of those involving haemodynamic techniques, such as positron emission tomography and functional magnetic resonance imaging. These methods have been employed in particular to evaluate the following functions: attention, perception, imagination, language, working memory, semantic retrieval, episodic memory, episodic memory retrieval, priming and procedural memory. The capacity of MEG, both for analysis and for organising the information it receives, is so large that it takes only a few milliseconds to evaluate brain activity and to create functional maps of the brain in which the brain structure is set out in blocks of cubic centimetres or even millimetres. This makes it possible to generate functional maps of brain activity that are capable of being organised and represented in terms of both time and space. It also enables us to obtain images that result from the signalling activity of sets of nerve cells (especially from the dendritic currents) and the electromagnetic signal that carries this information to the outer surface of the head, where the magnetic flow can be recorded. CONCLUSIONS: With the findings from these studies it has become possible to establish a topographic correlation between the functions and the basic brain processes involved in each paradigm. A growing body of clinical evidence proves the value of using them (especially MEG) with cases of epilepsy, language, dyslexia, autism and attention deficit hyperactivity disorder.

Técnicas de evaluación funcional de los trastornos del neurodesarrollo / Techniques for the functional evaluation of neurodevelopmental disorders

Objetivo. Revisar la evaluación de las funciones neuropsicológicasmediante los métodos de neuroimagen funcional noinvasivos. Desarrollo. Los métodos de neuroimagen funcional no invasivospueden clasificarse en dos grandes grupos: el primero deellos en relación con las técnicas electromagnéticas, como los potencialesrelacionados a eventos y la magnetoencefalografía (MEG),y el segundo en relación con técnicas hemodinámicas, como la tomografíapor emisión de positrones y la resonancia magnética funcional.Con estos métodos se han evaluado especialmente las siguientesfunciones: atención, percepción, imaginación, lenguaje, memoriade trabajo, recuperación semántica, memoria episódica, recuperaciónde la memoria episódica, priming y memoria de procedimiento.La capacidad de la MEG, tanto en análisis como en organizaciónde la información recibida, es tan grande que permite valoraren milisegundos la actividad cerebral y organizar mapas funcionalescerebrales con delimitación de la estructura cerebral en espaciode pequeños centímetros e incluso milímetros cúbicos. Esto permitegenerar mapas funcionales de la actividad cerebral capaces deser organizados y representados temporal y espacialmente, y obtenerimágenes que surgen de la actividad señalizadora de conjuntosde células nerviosas (en particular de las corrientes dendríticas) y laseñal electromagnética que porta esta información hasta el exteriorde la cabeza, donde puede registrase el flujo magnético. Conclusiones.Con los hallazgos de estos estudios se han podido correlacionartopográficamente las funciones y los procesos cerebrales básicosinvolucrados en cada paradigma. Especialmente con la MEG existenevidencias clínicas de su empleo en relación con la epilepsia, ellenguaje, la dislexia, el autismo y el trastorno por déficit de atencióncon hiperactividad

Aim. To review the evaluation of neuropsychological functions by using non-invasive functional neuroimaging methods.Development. Non-invasive functional neuroimaging methods can be sorted into two broad categories: the first includes thosethat make use of electromagnetic techniques, such as event-related potentials and magnetoencephalography (MEG), and thesecond consists of those involving haemodynamic techniques, such as positron emission tomography and functional magneticresonance imaging. These methods have been employed in particular to evaluate the following functions: attention, perception,imagination, language, working memory, semantic retrieval, episodic memory, episodic memory retrieval, priming andprocedural memory. The capacity of MEG, both for analysis and for organising the information it receives, is so large that it takesonly a few milliseconds to evaluate brain activity and to create functional maps of the brain in which the brain structure is set outin blocks of cubic centimetres or even millimetres. This makes it possible to generate functional maps of brain activity that arecapable of being organised and represented in terms of both time and space. It also enables us to obtain images that result fromthe signalling activity of sets of nerve cells (especially from the dendritic currents) and the electromagnetic signal that carries thisinformation to the outer surface of the head, where the magnetic flow can be recorded. Conclusions. With the findings from thesestudies it has become possible to establish a topographic correlation between the functions and the basic brain processesinvolved in each paradigm. A growing body of clinical evidence proves the value of using them (especially MEG) with cases ofepilepsy, language, dyslexia, autism and attention deficit hyperactivity disorder

El lenguaje y los trastornos del neurodesarrollo. Revisión de las características clínicas / Language and neurodevelopmental disorders. A review of their clinical characteristics

Introducción. El lenguaje es una piedra fundamental enel desarrollo social y cognitivo normal de cualquier grupo de niños,y las intervenciones tempranas y adecuadas pueden reducir engran escala las repercusiones del déficit en esta área. Se analiza ladefinición del lenguaje como ‘resultado de una actividad nerviosacompleja que permite la comunicación interindividual de estadospsíquicos a través de la materialización de signos multimodalesque simbolizan estos estados de acuerdo con una convención propiade una comunidad lingüística’ y se hace referencia a otros términosrelacionados con el lenguaje. Desarrollo. Se comentan distintasclasificaciones de las alteraciones del lenguaje y se analizanlas características de éste en los diferentes trastornos neurológicos,como los trastornos motores de origen central, espectro autista,alteraciones del aprendizaje, retraso mental y trastornos pordéficit de atención y comportamiento perturbador. Conclusiones.Se pone en evidencia la heterogeneidad semiológica de los trastornosdel lenguaje, por lo que es adecuado tener en cuenta las clasificacionesy términos relacionados con éste, además de conocer lascaracterísticas puntuales de cada alteración en los diferentes trastornosneurológicos a fin de llegar a un diagnóstico preciso quepermita implementar conductas e intervenciones apropiadas y, además,en el momento oportuno, evitar complicaciones posteriores

Introduction. Language is a keystone in the normal social and cognitive development of any group of children andearly, fitting interventions can largely reduce the repercussions that the deficit has in this area. The article analyses thedefinition of language as ‘the result of a complex nervous activity that allows individuals to communicate mental states by theproduction of multi-modal signs that symbolise these states in accordance with a linguistic community’s own convention’.Other language-related terms are also dealt with. Development. Different classifications of language disorders are alsodiscussed and we analyse its characteristics in different neurological disorders, such as motor disorders with a central origin,autistic spectrum, learning disorders, mental retardation, and attention deficit and disruptive behaviour disorders.Conclusions. Disorders affecting language clearly display semiological heterogeneity, and therefore it is advisable to take intoaccount the classifications and terms related to it. It is also necessary to be familiar with the specific features of each alterationin the different neurological disorders so as to be able to reach an accurate diagnosis that allows the implementation of suitablelines of behaviour and interventions. Additionally, this will also allow timely measures to be taken in order to avoid latercomplications

Dificultades del aprendizaje en los niños epilépticos / Learning disabilities in epileptic children

Objetivos. Analizar la asociación de las alteracionesneuropsicológicas a la epilepsia en la infancia buscando el origenen la fisiopatología de la epilepsia como enfermedad neurológica yen las bases de la plasticidad cerebral adaptativa. Desarrollo. Laexistencia de descargas eléctricas, en ausencia o presencia de crisisclínicas, se relaciona con problemas atencionales, de memoriareciente, limitación en las capacidades lingüísticas, visuoespacialesy ejecutivas, con lentitud psicomotora, y determina dificultadesde aprendizaje. La edad temprana de comienzo de la epilepsia, laetiología secundaria, la refractariedad al tratamiento que condicionala necesidad de una politerapia y la vivencia negativa de laenfermedad, influyen en la asociación de alteraciones neuropsicológicas.El tipo de epilepsia que puede determinar la afectación defunciones específicas, como la memoria, se ve afectada en las epilepsiasparciales del lóbulo temporal, y la atención en las epilepsiasgeneralizadas. Conclusiones. La epilepsia no sólo se manifiestacon crisis epilépticas, y los niños presentan síntomas asociadosque hacen necesaria una valoración neuropsicológica completaque debe incluir exploraciones de funciones cerebrales y específicasdel hemisferio

Aims. To analyse the association between neuropsychological disorders and epilepsy in infancy by searching forthe origin in the pathophysiology of epilepsy as a neurological disease and based on the adaptive plasticity of the brain.Development. The existence of electrical discharges, both in the presence and the absence of clinical seizures, is linked toproblems involving attention, recent memory, limitations in the linguistic, visuospatial and executive capabilities, with slowedpsychomotor functioning, and this leads to learning difficulties. The early age of onset of epilepsy, the secondary causation,the fact it is refractory to treatment and therefore requires polytherapy, and the negative experience of the disease all have aneffect on the association of neuropsychological disorders. The type of epilepsy that can determine the involvement of specificfunctions, such as memory, is affected in partial epilepsies of the temporal lobe and in generalised epilepsies attention isaffected. Conclusions. Epileptic seizures are not the only manifestation of epilepsy, and children display associated symptomsthat make it necessary to carry out a comprehensive neuropsychological evaluation that must include hemisphere-specificexaminations of the brain functions

Bases neurobiológicas del desarrollo del lenguaje / No disponible

Introducción. La estructura citoarquitectonica del lóbulo temporal y las conexiones intralobares temporales y extralobares,así como la competencia bihemsiférica son necesarias para la habilitación de procesos del habla y del lenguaje.Existen áreas cerebrales bien diferenciadas en cuanto a su estructura primaria (celularidad) y a la complejidad de las conexiones.Por ejemplo, la pars opercularis y la pars triangularis de la circunvolución frontal inferior izquierda son esencialespara la producción y comprensión del habla humana. Desarrollo. Se reconocen tres líneas citoarquitectónicas paralelas dellóbulo temporal las que a su vez presentan cuatro subdivisiones diferentes en sentido rostrocaudal: a) La root-line ocupa lalocalización periinsular (contiene fisiológicamente el área auditiva secundaria AAII y posee fuertes conexiones con el núcleosuprageniculado y la porción magnocelular del núcleo geniculado medial); b) La core-line ocupa la localización medial entrelas otras dos líneas citoarquitectónicas (contiene fisiológicamente el área auditiva primaria AAI y posee fuertes conexionescon la porción parvocelular del núcleo geniculado medial y pocas conexiones con los núcleos suprageniculado y pulvinar); yc) La belt-line ocupa la localización externa de la circunvolución temporal superior (contiene fisiológicamente el área auditivaterciaria AAIII y tiene su principal aferencia y eferencia con los núcleos pulvinar, mediodorsal e intralaminares del tálamo).Conclusión. Las conexiones asociativas del lóbulo frontal están dirigidas a áreas asociativas posrolándicas y límbicas.Las estructuras paralímbica y límbica desempeñan un papel en relacionar la información sensorial con los estados emocionaly motivacional

Bases neurobiológicas de los trastornos específicos de la comunicación (espectro autista) / No disponible

Desarrollo. Se analizan los factores neurobiológicos de los trastornos de la comunicación relacionados con el espectroautista, en base a las evidencias científicas por los hallazgos neuroanatomopatológicos, de neuroimagen, neurobioquímicosy neurofisiológicos descritos. Se ponen de manifiesto los distintos sistemas implicados en esta patología, que conllevasu variabilidad clínica y la dificultad en la orientación terapéutica. Conclusión. El análisis de los factores descritos y la comparaciónde hallazgos de los distintos casos clínicos con estas patologías puede permitir una aproximación para una mejorcompresión de estos trastornos

Funciones ejecutivas y autismo / No disponible

Sin duda, la característica más relevante del espectro autista lo constituye la invarianza o, dicho de otra manera,la tremenda rigidez cognitiva que presentan estos pacientes. La hipótesis de la disfunción ejecutiva en el autismo se basa enla llamada ‘metáfora frontal’, que estudia las similitudes existentes entre los pacientes que han sufrido lesiones en los lóbulosfrontales y las personas autistas. Las múltiples conexiones de las regiones prefrontales con casi todas las estructuras corticalesy subcorticales permiten explicar que no todo mal rendimiento en pruebas consideradas ejecutivas es la consecuencia delesiones frontales ni todas las lesiones frontales producen pobres resultados en los tests ejecutivos. La explicación ‘disejecutiva’intenta comprender determinados síntomas presentes en las personas con autismo tratando de integrar datos neurobiológicos,cognitivos y conductuales. La función ejecutiva se evalúa a menudo usando tareas neuropsicológicas formales, comoel test de clasificación de tarjetas de Wisconsin, una medición de la inhibición y la flexibilidad, o la torre de Londres, un testde planificación. Muchos estudios han mostrado que individuos con autismo se desempeñan pobremente en esta tareas.Pacientes con síndrome de Asperger, que logran resolver correctamente las tareas mentales de segundo orden, las cualesrequieren un pensamiento recursivo sobre los estados mentales (predecir lo que una persona piensa acerca del pensamientode otra), no superaban las pruebas de función ejecutiva

[Cytoarchitectural structure of the areas of language]. / Estructura citoarquitectónica de las areas del lenguaje.

INTRODUCTION AND DEVELOPMENT: There is a correlation between the higher brain functions and the degree of development of the associated cortices, but their efficiency depends on the patterns of cytoarchitectural organisation. Specialised areas can be distinguished in the neocortex and in the thalamus. Portions of the pars opercularis and triangularis of the inferior frontal gyrus (Broca's area) together with the posterior temporal region (Wernicke's area) are essential for the production and understanding of human speech, these being more developed in the left hemisphere of humans. The frontal lobe in front of Brodmann's areas numbers 6 and 8 represents a late phylogenetic acquisition, which is only developed in primates and in humans, that acts to sustain highly discriminating activities linked to the planning, execution and control of tasks that require the selection of programmes and flexibility for them to be applied. In its anterolateral sector, the temporal lobe has areas that are only shared with primates (such as area 20) or which are exclusive to humans (area 38), and which are important when it comes to assessing the vital significance of intellectually captured events. CONCLUSIONS: The three fundamental features of the human cerebral cortex are considerable folding, stratification and pillarisation, and its scant thickness. The rationale behind this work was to present the complex and sophisticated biological substrate for the development of speech and language in human beings and the connections within the temporal lobe and outside them, as well as the bi-hemispheric competence needed to enable the higher tutoring processes.

[Working memory in basic learning processes]. / Memoria de trabajo en los procesos básicos del aprendizaje.

INTRODUCTION AND DEVELOPMENT: Working or operative memory is considered to be a distinctive element of executive functioning. Nowadays, thanks to neuroimaging studies, it is known that the dorsolateral prefrontal cortex plays a crucial role in working memory. It has been observed that during the intervals when information is being retained, intense and persistent activity is going on in the region, as shown by the delayed response times. Working memory is fundamental for the analysis and synthesis of information, the retention of data needed to perform a particular mental process, carrying out priming (impression in memory of something that has been experienced, such as words, objects or events, for example), carrying out pre-functional tutoring activities and post-functional monitoring. CONCLUSIONS: Disorders affecting the fundamental mechanisms of working memory will give rise to a dysfunction that will exert an influence on innumerable formal academic learning processes such as difficulty in focusing attention, difficulty in inhibiting irrelevant stimuli, difficulty in recognising priority patterns, inability to recognise hierarchies and the meaning of stimuli (analysis and synthesis), problems in establishing an intention, and difficulty in recognising and selecting the goals that are best suited to solving a problem. It will also involve the impossibility to establish a plan to achieve goals, inability to analyse the activities required to accomplish an objective and difficulties in carrying out a plan, since it becomes impossible to monitor or modify the task to fit the original plans.

[The neuropaediatric and pathogenic clinical bases of autistic spectrum disorder]. / Bases clinicas neuropediatricas y patogenicas del trastorno del espectro autista.

INTRODUCTION: The dimension of the autistic spectrum embraces a considerable degree of clinical complexity which is, in turn, an expression of the numerous systems involved in the functioning of the central nervous system. Every day different biological factors are revealed which put in doubt other factors that, in a more objective way, appear to be involved in a particular aetiology. DEVELOPMENT AND CONCLUSIONS: It is clear that exactly what causes autistic spectrum disorder is still unknown and it may be useful to analyse cases with a known aetiology and correlate them with other similar cases, as it is likely to be this association between findings and studies in the future that will probably enable us to better define the bases and the underlying causes of the complex and manifold origin of the autistic spectrum. This will enable a more efficient therapeutic approach to be developed, which, when all is said and done, is what is primarily sought in the management of children with autistic spectrum disorder.

[Cognitive flexibility, an additional symptom of attention deficit hyperactivity disorder. Is it a therapeutically predictive element?]. / Flexibilidad cognitiva, sintoma adicional del trastorno por deficit de atencion con hiperactividad. ¿Elemento predictor terapeutico?

INTRODUCTION: Cognitive flexibility is a capability acquired during infancy that can be evaluated from the age of 8 onwards. This executive function can affect patients with dorsolateral frontal lesions. Involvement of this function in some children with attention deficit hyperactivity disorder (ADHD) would point to an additional disorder. AIMS: The objective of this study was to report on the involvement of cognitive flexibility in patients with ADHD from the age of 8 years onwards, to establish a correlation with the progressive phenomenon in its development, and to relate the findings from the study of cognitive flexibility with those of the attentional function. PATIENTS AND METHODS: A group of 50 children diagnosed as suffering from ADHD (8 21 years old) and 50 normal children were evaluated. The same subjects were submitted to a study of their attentional functions, their inhibitory control mechanisms as well as their cognitive flexibility. RESULTS: At least 38% of the patients studied showed involvement of cognitive flexibility. No statistically significant relation was observed when data were linked to the age variable, which could point to the absence of the maturation factor, unlike the results observed in the case of sustained attention. Patients with poor cognitive flexibility also present disorders involving attentional discrimination, the control of impulses and interference control. CONCLUSIONS: The group with cognitive rigidity as a symptom added to the attentional disorder could correspond to a complex subtype that does not respond so successfully to stimulants. Consequently, cognitive flexibility studies could reflect an indicator for selecting the type of pharmacological treatment to be employed.

[Experimental bases for evaluating attention in attention deficit hyperactivity disorder]. / Bases experimentales para la evaluacion de la atencion en el trastorno de deficit de atencion con hiperactividad.

INTRODUCTION: The experimental evaluation of the time variable in attention enables us to distinguish between what can be considered as its normal and its pathological behaviour. It has proved to be useful in evaluating the population suffering from attention disorders (attention deficit hyperactivity disorder, frontal lesions, etc.) as a means of defining the extent to which the patient is affected by the disorder and also in designing a training programme for later use. DEVELOPMENT: The most notable attentional paradigms are attentional blink (AB), repetition blindness, change detection, psychological refractory period, task switching, and negative and positive priming. Patients with ADHD showed a poor capacity for identification of target stimuli (T1) in attentional blink tests; they also displayed a significantly higher attentional blink than that observed in the control group, especially for time intervals between 300 and 600 ms after the first target letter (T1). CONCLUSIONS: Attention is a complex, dynamic concept derived from the interaction of different neuroanatomical systems. There are several different theories to explain disorders affecting the attentional skills. One of the explanations comes into being as a result of linking sustained attentional disorder with impulsiveness and hyperactive behaviour. Another is related to selective attention disorders. This distinction allows us to discern the involvement of two systems that will give rise to different clinical symptoms and hence the presence of attentional subtypes. Thus, for example, it is possible to find a first group with disorders affecting attention, impulsiveness and disinhibition, and a second group with slow reactions and in a state of confusion and/or inattention as regards the events taking place around them (but they do not have impulsiveness or disinhibition).