Intervention for oral language comprehension skills in preschoolers with developmental language disorder.

BACKGROUND: There is a clear predominance of programmes aimed at improving aspects related to language production in pupils with developmental language disorder (DLD). However, programmes aimed at improving their receptive skills are limited. AIMS: The main aim was to assess the effectiveness of an intervention programme for oral language comprehension skills in preschoolers with typical development (TD) and pupils with DLD. METHODS & PROCEDURES: Participants were 99 five-year-old pupils, with and without DLD, divided into four groups: two control groups (TD-C = 25; DLD-C = 25) and two experimental groups (TD-T = 24; DLD-T = 25), from schools on the Spanish island of Tenerife. The study used, as pre- and post-measures, the receptive language subtests of the CELF-4-Spanish: Concepts and Following Directions, Word Classes-Receptive and Sentence Structure, as well as two tasks assessing comprehension of paragraphs and narratives. Due to the strong link between oral comprehension skills and executive functions, working memory and semantic fluency are included in this research. The Backward Digit Span subtest of the Wechsler Intelligence Scale for Children (WISC-IV) and Semantic Fluency subtest of the Controlled Oral Word Association Test (COWAT) were used to assess working memory and semantic fluency, respectively. The intervention programme followed a multitiered system of support (MTSS) model, with 95 sessions lasting 60 min each delivered jointly by teachers and speech and language therapists, and focused on lexical-semantic, morphological, syntactic and narrative skills; inferences; verbal working memory; and semantic fluency. OUTCOMES & RESULTS: The results showed, as expected, that pupils diagnosed with DLD initially performed worse on oral language comprehension and executive functions than pupils with TD. Further, the DLD-T and TD-T groups showed greater gains following the programme, especially in word classes-receptive, sentence structure, verbal working memory and semantic fluency. Finally, a significant positive correlation was found between the gains obtained by the participants in verbal working memory and semantic fluency, with the gains obtained in the three CELF-4-Spanish subtests. CONCLUSIONS & IMPLICATIONS: An intervention programme applied at an early age fosters oral language comprehension skills and executive functions in pupils with DLD and TD. The intervention organized at different levels of support, following an MTSS model, showed clear progress of the DLD and TD groups in oral language comprehension and executive functions. WHAT THIS PAPER ADDS: Pupils with DLD present deficits in linguistic comprehension and executive functions. There are many intervention programs focused on improving language production skills. It is also necessary to consider the skills underlying language problems in pupils with DLD. Oral language, inference, working memory and semantic fluency activities improve comprehension. A collaborative and inclusive intervention of teachers and speech language therapists. Psycholinguistic and neuropsychological skills training should become part of the academic curriculum as early as preschool age. What is already known on the subject Pupils with DLD show problems related to both comprehension and production language. However, there is a clear predominance of programs just aimed at improving aspects related to language production. Clinical implications of this study An intervention program applied at an early age fosters oral language comprehension skills and executive function in pupils with DLD. The intervention organized at different levels of support, following an adaptation of the Response Tier Intervention models, showed clear progress of the DLD in comprehension oral language and executive functions.

Overlapping in memory profiles in Spanish children with autism spectrum disorders, developmental language disorders, and attention deficit hyperactivity disorder.

Neurodevelopmental disorders do not have biological markers that allow for their identification. This means that in most cases, diagnosis is based on behavior. This approach implies that difficulties will exist in establishing the diagnostic boundaries of the different nosological entities, and it argues that neurodevelopmental disorders probably share neuropsychological deficits. Our main objective was to study whether neurodevelopmental disorders share a common endophenotype. We carried out a study of memory in children with Autism Spectrum Disorders (ASD), Developmental Language Disorders (DLD), and Attention Deficit Hyperactivity Disorder (ADHD). For this purpose, we administered an extensive neuropsychological battery to evaluate memory to 24(ASD), 25(DLD), and 25(ADHD) children. The results obtained by these three clinical groups were contrasted with those obtained by a group of 25 children of typical development (TD). TD group performed better in all memory tasks, except the recognition task than the clinical groups, and the clinical groups showed slight differences among themselves in their performance in memory tasks. These results show that memory deficits could represent a common endophenotype at least in these three neurodevelopmental disorders and emphasize the need to intervene in memory disorders in this population.

Intervention in Syntactic Skills in Pupils with Developmental Language Disorder / Intervención en Habilidades Sintácticas en Alumnos con Trastorno del Desarrollo del Lenguaje

BACKGROUND: The main objective of this research has been to verify the effectiveness of an intervention program on syntactic skills of pupils with typical development and with developmental language disorder. METHOD: A total of 99 five-year-old pupils from schools of Tenerife (Spain) participated. The CELF-4 Recalling Sentences, Formulated Sentences, and Sentence Structure subtests were used. The intervention program consisted of 40 sessions implemented by teachers and speech language therapists. Three levels of practice were organized: in the ordinary classroom (large group and small group) and in the support classroom. RESULTS: Pupils diagnosed with developmental language disorder initially performed worse on syntax than those with typical development. In addition, the goodness of an intervention program was verified especially for Recalling sentences, and, to a lesser extent, for Sentences Structure, which improves in the experimental group with typical development as well as in the control and experimental groups with language development disorder. CONCLUSIONS: A collaborative and inclusive intervention program that uses implicit techniques favors the improvement of certain aspects of the syntactic processing of pupils with developmental language disorder

ANTECEDENTES: el objetivo principal de esta investigación ha sido verificar la efectividad de un programa de intervención sobre las habilidades sintácticas de los alumnos con desarrollo típico y con trastorno del desarrollo del lenguaje. MÉTODO: participaron 99 alumnos de cinco años de colegios de Tenerife (España). Se utilizaron los subtests del CELF-4 Recordando oraciones, Formulación de oraciones y Estructura de oraciones. El programa de intervención consistió en 40 sesiones implementadas por profesores y logopedas. Se organizaron tres niveles de práctica: en el aula ordinaria (grupo grande y grupo pequeño) y en el aula de apoyo. RESULTADOS: los resultados indicaron que los alumnos diagnosticados con trastorno del desarrollo del lenguaje presentaron inicialmente un peor rendimiento en la sintaxis que aquellos con desarrollo típico. Además, se comprobó la bondad de un programa de intervención especialmente en Recordando oraciones, y en menor medida, para Estructura de oraciones, que mejora en el grupo experimental con desarrollo típico y en los grupos control y experimental con trastorno del desarrollo del lenguaje. CONCLUSIONES: un programa de intervención de naturaleza colaborativa e inclusiva que recurre a técnicas implícitas favorece la mejora de determinados aspectos del procesamiento sintáctico de alumnado con trastorno del desarrollo del lenguaje

Intervention in Syntactic Skills in Pupils with Developmental Language Disorder.

BACKGROUND: The main objective of this research has been to verify the effectiveness of an intervention program on syntactic skills of pupils with typical development and with developmental language disorder. METHOD: A total of 99 five-year-old pupils from schools of Tenerife (Spain) participated. The CELF-4 Recalling Sentences, Formulated Sentences, and Sentence Structure subtests were used. The intervention program consisted of 40 sessions implemented by teachers and speech language therapists. Three levels of practice were organized: in the ordinary classroom (large group and small group) and in the support classroom. RESULTS: Pupils diagnosed with developmental language disorder initially performed worse on syntax than those with typical development. In addition, the goodness of an intervention program was verified especially for Recalling sentences, and, to a lesser extent, for Sentences Structure, which improves in the experimental group with typical development as well as in the control and experimental groups with language development disorder. CONCLUSIONS: A collaborative and inclusive intervention program that uses implicit techniques favors the improvement of certain aspects of the syntactic processing of pupils with developmental language disorder.

Efficacy of a computer-based cognitive training program to enhance planning skills in 5 to 7-year-old normally-developing children.

We designed and evaluated the efficacy of a computer-based cognitive training program (Executive Function Enhancement Program [EFEP]) to stimulate executive functions through enhancing planning in normally-developing children. A total of 111 Colombian children participated in the study. Fifty-nine (53%) of the children were assigned to the experimental condition (application of the EFEP program) with two levels of planning performance, and fifty-two (47%) to the waiting list control condition with the same two levels of planning. The training program was applied three times a week over six weeks, with post-intervention assessment two weeks after the end of training. A follow-up assessment was carried out three months later. Results showed that the intervention program was particularly effective in the children with lower pre-intervention performance in planning, demonstrating that the program is an efficient therapeutic instrument for enhancing the executive function of planning in children between 5 and 7 years old.

A comparative study of language phenotypes in autism spectrum disorder and specific language impairment / Estudio comparativo de los fenotipos lingüísticos en el Trastorno del Espectro Autista y en el Trastorno Específico del Lenguaje

BACKGROUND: Problems with communication and language are among the main characteristics of both Autism Spectrum Disorder (ASD) and Specific Language Impairment (SLI). The main objective of the present study was to analyze whether the two disorders have similar formal language profiles. METHOD: The study involved three groups of 20 students each, divided into ASD, SLI, and Control, of similar ages and IQ. The CELF-4 standardized test was administered to assess their language skills. RESULTS: No significant differences in language were found between the SLI and ASD groups, with no effect sizes. Differences were observed between the SLI and ASD groups when they were compared separately with the Control group, with a large effect size. CONCLUSIONS: There is an overlap in the linguistic profiles of children with SLI and children with ASD. Similarity is thus confirmed in comprehensive and expressive language, as well as in morphosyntactic and lexical-semantic production

ANTECEDENTES: los problemas de comunicación y lenguaje constituyen una de las características principales tanto del Trastorno del Espectro Autista (TEA) como del Trastorno Específico del Lenguaje (TEL). El objetivo principal del presente estudio ha sido analizar si ambos trastornos presentan perfiles de lenguaje formal similares. MÉTODO: en el estudio participaron tres grupos de 20 alumnos cada uno, divididos en TEA, TEL y Control, equiparados en las variables edad y CI. A todos los participantes se les administró el test estandarizado CELF-4 para evaluar sus habilidades lingüísticas. RESULTADOS: no existen diferencias significativas en lenguaje entre los grupos TEL y TEA, con tamaños del efecto prácticamente nulos. Las diferencias se establecen entre los grupos TEL y TEA cuando se les compara por separado con el grupo Control, obteniéndose un tamaño del efecto grande. CONCLUSIONES: se produce un solapamiento en los perfiles lingüísticos entre niños con TEL y TEA. En consecuencia, se confirma la similitud en lenguaje comprensivo y expresivo, así como en la producción morfosintáctica y léxico-semántica

Differential long-term medication impact on executive function and delay aversion in ADHD.

The objective was to compare long-term effects of methylphenidate (MPH) and atomoxetine (ATX) on executive functions (EF) and delay aversion (DAv) in ADHD. A randomized controlled trial was conducted. A comprehensive neuropsychological battery was administered at three moments (Naive, Post-1, Post-2). ADHD participants who showed deficits in the naive evaluation (n = 26) were randomized to receive either MPH (n = 13; Mage = 11 ± 1, MIQ 96 ± 8) or ATX (n = 13; Mage = 10 ± 1, MIQ 106 ± 16.5) optimal dosages. Parallel test forms were administered after three (Post-1) and six months (Post-2) of treatment. A control group (n = 19; Mage = 11 ± 1; MIQ = 106 ± 16.5) performed the neuropsychological battery similarly. Both MPH and ATX significantly improved scores in verbal working memory (vWM) (Naive: p < 0.0001, d = 0.75; Post-1: p = 0.71, d = 0.12), spatial working memory (sWM) (Naive p < 0.0001, d = 0.63; Post-2 p = 0.44; d = 0.03), planning (Naive p < 0.0001, d = 0.54; Post-2 p = 0.6, d = 0.18), decision making (Naive p < 0.001 d = 0.28; Post-1 = 0.06 d = 0.12) and inhibition (Naive <0.0001, d = 0.66; Post-2 p = 0.08, d = 0.00), reaching an improved treatment response after three months of treatment in vWM and after six months in sWM, planning, and inhibition. No beneficial effect on DAv and risk taking was found with MPH and neither with ATX. Long-term treatment in range of optimal clinical dosages with either MPH or ATX improves EF, but not DAv in children with ADHD.

Correlatos electrofisiológicos de la lectura en niños con trastorno por déficit de atención/hiperactividad / Electrophysiological correlates of reading in children with attention deficit hyperactivity disorder

Objetivos. Investigar si los déficits en las funciones ejecutivas en el trastorno por déficit de atención/hiperactividad (TDAH) afectan a su compresión lectora e identificar un potencial marcador biológico de este endofenotipo neuropsicológico a través de potenciales relacionados con eventos. Específicamente, hipotetizar si las diferencias en memoria de trabajo e inhibición mantienen una asociación fenotípica con la comprensión lectora en el TDAH. Sujetos y métodos. La muestra estuvo constituida por 52 niños con TDAH (8-13 años) divididos en dos grupos según la presencia (TDAH-; n = 27; percentil < 30) o ausencia (TDAH+; n = 25; percentil > 50) de déficit en compresión lectora y un grupo control (n = 27). Se evaluaron las funciones ejecutivas y se realizó un experimento de potenciales relacionados con eventos en el que se presentaron oraciones anafóricas de diferentes longitudes, y se registraron los potenciales relacionados con eventos en el último adjetivo de la oración que requiere acuerdo de género. Resultados. Se encontró una relación entre memoria de trabajo e inhibición con el rendimiento en compresión lectora. Mientras que los grupos de TDAH+ y control mostraron signos de detección de no concordancia sintáctica a los 100 ms, el grupo de TDAH no activó la memoria de trabajo hasta los 250 ms. Conclusiones. La lentitud en la puesta en marcha de los mecanismos de memoria de trabajo nos ayuda a entender los déficits en comprensión lectora del grupo de TDAH (AU)

Aims. To investigate whether or not the deficits in executive functions in the attention deficit hyperactivity disorder (ADHD) affect reading comprehension and identify a potential biological marker of this neuropsychological endophenotype through event-related potentials (ERP). The phenotypic association between reading comprehension and the specific functions of inhibition and working memory is studied. Subjects and methods. The sample consisted of 52 children with ADHD (8-13 years) divided in two groups according to the presence (TDAH-; n = 27; percentile < 30) or the absence (TDAH+; n = 25; percentile > 50) of reading comprehension deficits and a control group (n = 27). The executive functions were evaluated. The ERPs were assessed during a task in which anaphoric sentences of different lengths were presented, recording the ERP in the last adjective of the sentence that required a gender agreement. Results. Working memory and inhibition were associated to reading comprehension performance. The ADHD+ group and the control group seem to detect the disagreement at 100 ms, while the ADHD - group does not activate its working memory until 250 ms. Conclusions. The delay in the implementation of the working memory mechanisms helps us to understand the deficits in reading comprehension of the ADHD - group (AU)

Funciones ejecutivas y trastornos del lenguaje: implicaciones para la evaluación y la intervención / Executive Functions and Language Disorders: implications for Evaluation and Intervention

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[Neuropsychological profile in opsoclonus-myoclonus-ataxia syndrome presenting as neuroblastic tumours]. / Perfil neuropsicologico en el sindrome opsoclono-mioclono-ataxia como forma de presentacion de tumores neuroblasticos.

INTRODUCTION: Sociosanitary improvements experienced in western society have significantly increased the survival of patients with opsoclonus-myoclonus-ataxia syndrome (OMAS). However, several studies have reported neurological, cognitive-behavioral and development persistent deficits in 70-80% of these patients. PATIENTS AND METHODS: We reviewed cases of neuroblastic tumors diagnosed in a total period of 13 years and six months (from January 2000 to May 2013) and its association with OMAS in the pediatric service of a general hospital of a third level. Furthermore, it conducts a full neuropsychological study in three children diagnosed with OMAS. RESULTS: We objectified deficits in intelligence, attention, processing speed, memory, language, visuospatial and visuoconstructive skills, fine motor skills and executive functions. In addition, we found alterations in the psychological profile. CONCLUSIONS: Data emphasize the role of the cerebellum in complex cognitive processing in child population probably linked to neurodevelopmental deficits in this structure caused by deficiencies of the immune system. The results are interpreted in the framework of child neuropsychology and their interest in studying the brain-behavior relationships in the dynamic context of brain development.

TITLE: Perfil neuropsicologico en el sindrome opsoclono-mioclono-ataxia como forma de presentacion de tumores neuroblasticos.Introduccion. Las mejoras sociosanitarias experimentadas en la sociedad occidental han incrementado de forma significativa la supervivencia de los pacientes con el sindrome opsoclono-mioclono-ataxia (SOMA). Sin embargo, diversos estudios han informado de deficits neurologicos, cognitivo-conductuales y de desarrollo persistentes en el 70-80% de estos pacientes. Pacientes y metodos. Se revisan los casos de tumores neuroblasticos diagnosticados en un periodo total de 13 años y seis meses (desde enero de 2000 a mayo de 2013) y su asociacion a SOMA en el servicio de pediatria de un hospital general de tercer nivel. Ademas, se lleva a cabo la evaluacion neuropsicologica exhaustiva de tres niños diagnosticados de SOMA. Resultados. Hemos objetivado deficits en inteligencia, atencion, velocidad de procesamiento, memoria, lenguaje, habilidades visuoespaciales y visuoconstructivas, motricidad fina y funciones ejecutivas. Ademas, hemos comprobado alteraciones en el perfil psicologico. Conclusiones. Se aportan datos que enfatizan el papel del cerebelo en el procesamiento cognitivo complejo en poblacion infantil, probablemente vinculado a alteraciones neuromadurativas de esta estructura motivadas por deficiencias del sistema inmunologico. Los resultados encontrados son interpretados en el marco conceptual de la neuropsicologia Infantil y su interes por estudiar las relaciones cerebro-conducta en el contexto dinamico del desarrollo cerebral.

Perfil neuropsicológico en el síndrome opsoclono-mioclono-ataxia como forma de presentación de tumores neuroblásticos / Neuropsychological profile in opsoclonus-myoclonus-ataxia syndrome presenting as neuroblastic tumours

Introducción. Las mejoras sociosanitarias experimentadas en la sociedad occidental han incrementado de forma significativa la supervivencia de los pacientes con el síndrome opsoclono-mioclono-ataxia (SOMA). Sin embargo, diversos estudios han informado de déficits neurológicos, cognitivo-conductuales y de desarrollo persistentes en el 70-80% de estos pacientes. Pacientes y métodos. Se revisan los casos de tumores neuroblásticos diagnosticados en un período total de 13 años y seis meses (desde enero de 2000 a mayo de 2013) y su asociación a SOMA en el servicio de pediatría de un hospital general de tercer nivel. Además, se lleva a cabo la evaluación neuropsicológica exhaustiva de tres niños diagnosticados de SOMA. Resultados. Hemos objetivado déficits en inteligencia, atención, velocidad de procesamiento, memoria, lenguaje, habilidades visuoespaciales y visuoconstructivas, motricidad fina y funciones ejecutivas. Además, hemos comprobado alteraciones en el perfil psicológico. Conclusiones. Se aportan datos que enfatizan el papel del cerebelo en el procesamiento cognitivo complejo en población infantil, probablemente vinculado a alteraciones neuromadurativas de esta estructura motivadas por deficiencias del sistema inmunológico. Los resultados encontrados son interpretados en el marco conceptual de la neuropsicología Infantil y su interés por estudiar las relaciones cerebro-conducta en el contexto dinámico del desarrollo cerebral (AU)

Introduction. Sociosanitary improvements experienced in western society have significantly increased the survival of patients with opsoclonus-myoclonus-ataxia syndrome (OMAS). However, several studies have reported neurological, cognitivebehavioral and development persistent deficits in 70-80% of these patients. Patients and methods. We reviewed cases of neuroblastic tumors diagnosed in a total period of 13 years and six months (from January 2000 to May 2013) and its association with OMAS in the pediatric service of a general hospital of a third level. Furthermore, it conducts a full neuropsychological study in three children diagnosed with OMAS. Results. We objectified deficits in intelligence, attention, processing speed, memory, language, visuospatial and visuoconstructive skills, fine motor skills and executive functions. In addition, we found alterations in the psychological profile. Conclusions. Data emphasize the role of the cerebellum in complex cognitive processing in child population probably linked to neurodevelopmental deficits in this structure caused by deficiencies of the immune system. The results are interpreted in the framework of child neuropsychology and their interest in studying the brain-behavior relationships in the dynamic context of brain development (AU)

Los niños con Trastorno del Espectro Autista tienen déficits en las Funciones Ejecutivas / Children with Autism Spectrum Disorder have Deficits in Executive Functions

Existe un creciente acuerdo científico sobre el hecho de que en personas con Trastorno del Espectro Autista (TEA) se identifican alteraciones neurológicas de considerable magnitud que tienen una base genética que se expresa en el desarrollo neuronal. Como consecuencia de esto se han identificado déficits en funciones cognitivas complejas en esta población, si bien los resultados hasta el momento son inconsistentes. El objetivo de nuestro trabajo ha sido la caracterización neuropsicológica de una población con TEA. Para ello, a una muestra de 18 niños diagnosticados con TEA, le hemos administrado una batería neuropsicológica amplia destinada a la evaluación de la atención y de las funciones ejecutivas. Los resultados obtenidos por el grupo experimental fueron contrastados con los alcanzados por una muestra de 18 niños con desarrollo típico. En ellos se muestra como el grupo con TEA tiene un déficit generalizado en atención y funciones ejecutivas, excepto en fluidez verbal con claves semánticas, planificación y flexibilidad cognitiva. Se requiere más investigación para clarificar la naturaleza de estos hallazgos

It exists a growing consensus about broad neurological abnormalities in people with Autism Spectrum Disorders (ASD) and its genetic origin, which has its expression during the neural development. As a consequence, there have been identified several impairments in high order cognitive functions in this population. However the results remain inconsistent. Our research is aimed at the neuropsychological characterization of children with ASD. To that end, we assessed a sample of 18 children diagnosed of ASD with a broad neuropsychological test battery in order to evaluate attention and executive functioning. The results obtained by this experimental group were compared with a sample of 18 typically developing children. The results show a comprehensive impairment in attention and executive functioning in the ASD group, with the exception of verbal fluency with semantic clues, planning and cognitive flexibility. Further research is needed in order to clarify the origin of these results

Uso de la estimulación cerebral no invasiva en los trastornos psiquiátricos de la infancia: nuevas oportunidades y retos diagnósticos y terapéuticos / The use of noninvasive brain stimulation in childhood psychiatric disorders: new diagnostic and therapeutic opportunities and challenges

La estimulación cerebral no invasiva constituye una herramienta prometedora para el desarrollo de nuevos abordajes diagnósticos y terapéuticos en los trastornos psiquiátricos de la infancia. En la actualidad existen dos técnicas de estimulación no invasiva disponibles: la estimulación magnética transcraneal y la estimulación transcraneal de corriente directa. Estas técnicas no invasivas de neuromodulación parecen actuar modulando la plasticidad cerebral, abriendo nuevas esperanzas en el tratamiento de los trastornos de la plasticidad y circuitos cerebrales. Dado que muchos trastornos psiquiátricos infantiles presentan alteraciones en la maduración o en los mecanismos de plasticidad de los circuitos frontoestriatales, y el cerebro en desarrollo presenta mayor capacidad de plasticidad cerebral, la estimulación cerebral no invasiva podría aportar mayores beneficios en esta población que los ya bien conocidos en adultos. Aunque su utilización sigue siendo limitada en niños, existe suficiente evidencia para su uso racional y seguro en esta población. En este trabajo se revisan los principios teóricos de la estimulación cerebral no invasiva y las aplicaciones diagnósticas y terapéuticas en los trastornos psiquiátricos de la infancia, con la finalidad de aportar evidencias para el desarrollo de estas técnicas como nuevos enfoques diagnósticos seguros y fiables, así como nuevas herramientas terapéuticas eficaces en psiquiatría infantil (AU)

Novel diagnostic and therapeutic approaches based on noninvasive brain stimulation offer some promise in the field of childhood psychiatric disorders. There are two primary methods of noninvasive brain stimulation currently available: transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Both noninvasive neuromodulation techniques appear to rely on modulating brain plasticity and thus open new hopes in the treatment of brain circuit and plasticity disorders. Since many childhood psychiatric disorders involve disturbances in the timing or mechanisms of plasticity within frontostriatal circuits, and the developing brain shows a greater capacity of brain plasticity, noninvasive brain stimulation might induce greater benefits in this population than in adults. Although the utilization of TMS and tDCS remains limited in children, there is enough evidence for their rational, safe use in this population. In this paper, we review the principles of noninvasive brain stimulation and the diagnostic and therapeutic applications in childhood psychiatric disorders in order to inform its development into safe and reliable diagnostic and effective therapeutic approaches in pediatric psychiatry (AU)

[The use of noninvasive brain stimulation in childhood psychiatric disorders: new diagnostic and therapeutic opportunities and challenges]. / Uso de la estimulación cerebral no invasiva en los trastornos psiquiátricos de la infancia: nuevas oportunidades y retos diagnósticos y terapéuticos.

Novel diagnostic and therapeutic approaches based on noninvasive brain stimulation offer some promise in the field of childhood psychiatric disorders. There are two primary methods of noninvasive brain stimulation currently available: transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Both noninvasive neuromodulation techniques appear to rely on modulating brain plasticity and thus open new hopes in the treatment of brain circuit and plasticity disorders. Since many childhood psychiatric disorders involve disturbances in the timing or mechanisms of plasticity within frontostriatal circuits, and the developing brain shows a greater capacity of brain plasticity, noninvasive brain stimulation might induce greater benefits in this population than in adults. Although the utilization of TMS and tDCS remains limited in children, there is enough evidence for their rational, safe use in this population. In this paper, we review the principles of noninvasive brain stimulation and the diagnostic and therapeutic applications in child-hood psychiatric disorders in order to inform its development into safe and reliable diagnostic and effective therapeutic approaches in pediatric psychiatry.

Alteraciones genéticas en el trastorno por déficit de atención con hiperactividad: relación con variables neuropsicológicas / Genetic variations in attention deficit hyperactivity disorder: relationship with neuropsychological variables

El Trastorno por Déficit de Atención con Hiperactividad (TDAH) es una patología frecuente de la infancia con una fuerte contribución genética. Tras unos años dedicados al estudio de los genes específicos que explicaban la sintomatología nuclear del trastorno (inatención, hiperactividad e impulsividad), en la actualidad el interés de los investigadores se ha ampliado, considerando la repercusión neuropsicológica que estas alteraciones genéticas tienen en los sujetos afectos de esta patología. En este trabajo revisamos la literatura existente sobre los correlatos genéticos de los déficits cognitivos del TDAH. Estas nuevas estrategias de investigación, necesariamente multidisciplinares, pretenden conseguir, además del incremento en la caracterización neurobiológica de esta patología, líneas de tratamiento alternativas a las existentes que respondan a la relación comentada entre genes y cognición en el TDAH

Attention Deficit/Hyperactivity Disorder (ADHD) is a frequent disorder in childhood with a strong genetic contribution. After a few years studying the specific genes that could explain the nuclear symptomatology of the disorder (inattention, hyperactivity, and impulsivity), actual research has been extended considering the neuropsychological repercussion that these genetic alterations have in subjects with ADHD. In this work we review the existing literature on the genetic basis of the cognitive deficits in ADHD. These new research strategies, necessarily multidisciplinary, try to explain a better neurobiological characterization of this pathology, plus alternative new lines of treatment based on the relationship between genes and cognition in ADHD

Epilepsia del lóbulo frontal en la infancia y memoria: una aproximación neuropsicológica / Frontal lobe epilepsy in childhood and memory: a neuropsychological approach

La epilepsia supone un problema sociosanitario de gran relevancia, al que se destina una enorme cantidad de recursos humanos y económicos. Constituye, por tanto, una necesidad conocer esta patología y sus implicaciones, para así poder dar una adecuada respuesta médica, psicológica, social y educativa a quienes presentan este trastorno. La evaluación neuropsicológica en la epilepsia se erige como una herramienta necesaria que nos ayuda a comprender el funcionamiento cognitivo de las personas con esta patología, para poder, de esta manera, desarrollar técnicas de intervención efectivas. Su importancia es doble en el caso de niños y adolescentes, en la medida en que están inmersos en un proceso de aprendizaje escolar y requieren de estrategias cognitivas eficaces para lograr el nivel exigido en cada curso. Tradicionalmente, la memoria se ha estudiado en la epilepsia del lóbulo temporal, pero ¿qué ocurre en otros tipos de epilepsia? Es objetivo central de este trabajo exponer los distintos resultados encontrados en la evaluación neuropsicológica de la memoria en la epilepsia del lóbulo frontal, de tal manera que permita dar a los profesionales una visión de conjunto de las implicaciones neuropsicológicas de este trastorno

Epilepsy is a health problem of great significance to which devotes a tremendous amount of human and financial resources. Therefore, it is a need to know this disease and its implications in order to give an adequate medical, psychological, social and educational response to those who have this disorder. Neuropsychological assessment in epilepsy is emerging as a necessary tool to help us to understand the cognitive functioning of people with this condition, and effective intervention techniques could be developed thanks to that. Its importance is double in the case of children and adolescents, as they are involved in a learning process and require effective cognitive strategies to achieve the level required in each grade. Traditionally, memory has been studied in temporal lobe epilepsy, but it is little known what happens in other epilepsies. The core objective in this work is to show the different results found in the neuropsychological assessment of memory in frontal lobe epilepsy so a broad view of the neuropsychological implications of this disease could be given

Caracterización neuropsicológica de la memoria en prematuros / Neuropsychological characterization of memory in preterm children

La salud de la mayor parte del mundo desarrollado ha mejorado de forma significativa en años recientes gracias a los avances médicos y sociales, incluyendo mejoras diagnósticas y terapéuticas. Sin embargo, en este mismo mundo desarrollado un problema importante de salud pública no sólo no disminuye, sino al contrario, se incrementa. Se trata de la prematuridad. En efecto, la prematuridad representa un problema sociosanitario de primer orden, probablemente debido a las elevadas tasas de prevalencia que se registran actualmente (10% en España). Según el Instituto Nacional de Estadística (INE), en el año 2008 nacieron en España 519.779 niños, de los cuales 40.501 lo hicieron de forma prematura. Las causas de la prematuridad son multifactoriales y complejas, incluyendo infecciones, inflamaciones, enfermedad vascular, estrés y embarazos múltiples espontáneos o derivados de la reproducción asistida. A éstas hemos de añadirles factores de naturaleza socioeconómica (acceso a los cuidados prenatales), conducta materna durante la gestación (consumo de drogas y/o alcohol), e interacciones genética-ambiente. Dilucidar los mecanismos subyacentes que conducen a la prematuridad es una tarea ardua en la que están inmersos en la actualidad un número importante de investigadores de diversas disciplinas a nivel mundial. No obstante, la relación prematuridad-alteraciones neurológicas-repercusiones cognitivoconductuales a largo plazo dista de estar establecida de forma consistente. En este contexto, la Neuropsicología se muestra como un acercamiento válido y fiable para el estudio de los déficits cognitivos, así como del sustrato anatomopatológico generalmente identificado en la prematuridad

The health of most of the developed world has improved significantly in recent years thanks to medical advances and social changes including improvements in diagnostic and therapeutic methods. However, in developed countries a major public health problem does not decrease, but increases: prematurity. In fact, prematurity is a first class health problem to which significant human and material resources are devoted, probably due to high prevalence rates that are recorded (10% in Spain). According to the Spanish National Statistics Institute (INE), 519,779 children were born in 2008 in Spain, of which 40,501 did so prematurely. The causes of prematurity are multifactorial and complex, including infection, inflammation, vascular disease, stress and multiple pregnancies, spontaneous or resulting from assisted reproduction. Besides, new factors should be added like socio-economic factors (as access to prenatal care), maternal behavior during pregnancy (drug and/or alcohol abuse) and genetical-environmental interactions. To elucidate the underlying mechanisms that lead to prematurity is an arduous work in which a number of researchers from different disciplines worldwide are currently involved. However, the connection between prematurity, neurological disorders, and cognitive-behavioral effects in the long term is far from being consistently established. In this context, the Neuropsychology is shown as a valid and reliable approach for the study of cognitive deficits and pathological substrate usually identified in prematurity

Neurobiología del autismo / Neurobiology of autism

El autismo es un trastorno del neurodesarrollo con debut en la infancia cuyo incremento en la prevalencia ha supuesto que haya dejado de ser considerado una enfermedad rara. Motivado posiblemente por alteraciones de naturaleza genética, diversas estructuras tanto corticales como subcorticales experimentan un desarrollo inadecuado. Estas alteraciones anatomofuncionales incluyen cada vez más a un mayor número de regiones cerebrales, pudiendo el autismo ser considerado como ejemplo de alteración cerebral difusa. Si bien no podemos hablar de un perfil neuropsicológico del autismo, las funciones psicológicas complejas deficitarias con mayor frecuencia en esta población son: atención, memoria, lenguaje y funciones ejecutivas. Este conjunto de déficits neuropsicológicos es compatible con el sustrato anatomopatológico identificado en esta población. Se realiza una revisión de la literatura científica más reciente respecto a las características neurobiológicas y neuropsicológicas del trastorno. Se aboga en última instancia por una profundización en el estudio neuropsicológico del autismo como medio de mejorar los acercamientos terapéuticos a estos pacientes. Todo el trabajo que se presenta se enmarca en la disciplina científica de la Neuropsicología del Desarrollo y su interés por estudiar las relaciones entre el cerebro y la conducta en el contexto dinámico del desarrollo cerebral

Autism is a neurodevelopmental disorder which begins in childhood. The prevalence has increased in the last years so is no longer considered a rare disease. It is probably motivated by genetic alterations and affects both cortical and subcortical structures which undergo inappropriate development. These anatomic changes include a great number of brain regions so autism can be considered as an example of diffuse brain disorder. While we do not know a neuropsychological profile of autism, complex psychological functions displayed a deficit like: attention, memory, language and executive functions. This set of neuropsychological deficits is consistent with the pathogenetic mechanisms identified in this population. This is a review of recent scientific literature on the neurobiological and neuropsychological characteristics of the disorder. We propose a deeper neuropsychological study of autism to improve therapeutic approaches for these patients. All work presented is part of the scientific discipline of Developmental Neuropsychology and their interest in exploring the relationships between brain and behavior in the dynamic context of brain development

Locus and nature of perceptual phonological deficit in Spanish children with reading disabilities.

The aims of this study were (a) to determine whether Spanish children with reading disabilities (RD) show a speech perception deficit and (b) to explore the locus and nature of this perceptive deficit. A group of 29 children with RD, 41 chronological age-matched controls, and 27 reading ability-matched younger controls were tested on tasks of speech perception. The effect of linguistic unit (word vs. syllable) and type of phonetic contrast (voicing, place and manner of articulation) were analyzed in terms of the number of errors and the response time. The results revealed a speech perception deficit in Spanish children with RD that was independent of the type of phonetic contrast and of linguistic unit.