[Attention deficit hyperactivity behavioral phenotype dimensions of adults from Antioquian families using the Wender-Utah Scale -Spanish version]. / Dimensiones del fenotipo conductual del trastorno por déficit de atención/hiperactividad en adultos de familias antioqueñas utilizando la escala Wender-Utah en Español.

INTRODUCTION: The Wender-Utah Rating Scale (WURS) has been used for retrospective screening of attention deficit hyperactivity disorders (ADHD) symptoms and its comorbidities. AIM: To establish the ADHD behavioral phenotype dimensions of adults from 140 Antioquian families with genetic segregation for ADHD diagnosis, using the WURS -Spanish version. SUBJECTS AND METHODS: 392 adults from both genders, belonging to nuclear and multigenerational families with one or more ADHD affected members were selected. The Composite International Diagnostic Interview (CIDI) for mental disorder was administered to establish the gold standard diagnosis of ADHD through the long life. All participants fulfill the WURS. Exploratory and confirmatory factor analyses were done to determine the behavioral dimensions of the ADHD phenotype. RESULTS: A factor structure of four dimensions was derived, measuring behavioral decontrol, hyperactivity, inattention and anxiety, and which explained the 60% of the total variance. CONCLUSIONS: The behavioral adult ADHD phenotype in the Antioquian families was conformed by four dimensions, which could be used in heritability and linkage future studies.

[Attention and executive function tests components in attention deficit/hyperactivity children]. / Componentes de las pruebas de atención y función ejecutiva en niños con trastorno por déficit de atención/hiperactividad.

INTRODUCTION: It has been suggested that children with attention deficit/hyperactivity disorder (ADHD) have problems in attention and executive functions. A factor analysis showed that ADHD children had a different factor structure of the executive functions when they were compared with controls. AIM. To determine the factor structure of attention and executive functions in a group of ADHD children compared with a group of controls. SUBJECTS AND METHODS: 249 ADHD children and 372 controls of both genders, aged 6 to 11 years old, and from the different socio economic strata of Medellín city, were selected. Attention --Mental Control and Auditory Continuous Performance Test (ACPT)-- and executive functions --Phonologic and Semantic Verbal Fluency (FAS)--, and a shortened version of the Wisconsin Card Sorting Test (WCST) were assessed in both groups. Factor analyses were developed with principal components procedure were developed for each group and the total sample, using principal component procedure with orthogonal rotation. RESULTS: Stable factor structures were found for each group and for the total sample. The general factor structure was constituted by three independent factors: 1- Categorization, 2- Verbal fluency and verbal sustained attention, and 3- Cognitive flexibility. This factor structure explained 74.9% of the variance. CONCLUSION: The factor structures suggested that the components of attention and executive functions are similar for ADHD and control groups. The differences between groups would be quantitative.

[Instruments for evaluating behavioural disorders]. / Instrumentos para evaluar las alteraciones de la conducta.

AIMS: This review considers, from a theoretical clinical point of view, several interview based instruments used in the areas of neuropsychology, psychology and psychiatry that have been designed to evaluate the associated symptoms in several diagnostic categories or types in the different editions of the Diagnostic and statistical manual of mental disorders. DEVELOPMENT: The study of psychopathology, especially in children and adolescents, has one prior requisite: a thorough knowledge of how categorical disorders are organised by axes and the reason for the groups of symptoms and their variations located in each criterion. Consequently, in order to perform a diagnosis in child psychopathology, different criteria have to be fulfilled, according to the presence of the different disorders associated with a particular pathology, and the different evaluation tools provide a multiple approach that allows the behavioural problems to be evaluated. CONCLUSIONS: We currently have a series of diagnostic instruments available that are recommended for individual clinical study and can be applied both by parents and by teachers. The need then arises to research into whether the symptoms reported by parents and teachers have similar characteristics or whether, to the contrary, there are differences in the behaviour observed in distinct contexts, which would require a further analysis of the contextual particularities the patient moves in.

[Perinatal factors associated with attention deficit/hyperactivity diagnosis in Colombian Paisa children]. / Factores perinatales asociados con la aparición del trastorno por deficiencia de atención en niños de la comunidad colombiana 'paisa'.

INTRODUCTION: Some perinatal factors have been associated with attention d ficit/hyperactivity disorder (ADHD). OBJECTIVE: To estimate the association between perinatal factor and ADHD diagnosis in school, aged 6 to 11 years, children from Medell n city (Colombia). PATIENTS AND METHODS: A randomized sample of 200 cases, 6 to 11 year old, with standardized ADHD diagnosis was selected. A randomized sample of 200 control children, 6 to 11 year old, was selected from a data base of 70 schools of Medell n city. The same diagnostic protocol was administered to controls. A questionnaire with questions about pregnancy, delivery an neonatal period was given to the mothers. Data were analyzed using cross tabulation and stepwise logistic multiple regression analyses. RESULTS: Miscarriage symptoms, premature delivery symptoms, severe flu attacks (cold with fever, without virus confirmation), tobacco abuse, alcohol abuse (to become drunk), minor congenital malformations, neonatal seizures and hospitalizations during newborn period were factors associated with ADHD diagnosis (p< 0.05). However, stepwise logistic multiple regression analysis selected a block of variables formed by premature delivery symptoms, severe flu attacks and neonatal seizures as significant perinatal risk factors (p< 0.01) for ADHD diagnosis.

[Prevalence of mental retardation in teenagers with dissocial conduct disorder]. / Prevalencia del retarso mental en adolescentes con trastorno disocial de la conducta.

INTRODUCTION: Prevalence of adolescents with conduct disorder (CD) has been calculated between 4 y 10%. OBJECTIVE: To estimate the prevalence of mental retardation in Colombian adolescent offenders, using the Wechsler Intelligence Scales for Children Revised (WISC R). PATIENTS AND METHODS: 106 male adolescent offenders with CD, aged 12 to 16 years, and attending to institutions of re education in Medell n Colombia were selected in a randomized approach. WISC R Hispanic version was administered to the sample, using 4 verbal (information, vocabulary, similarities and arithmetic) and 4 performance (Picture completion, block design, picture arrangement, and digit symbol) subtests for calculating verbal, performance and full scale IQs (VIQ, PIQ, and FSIQ), according to the manual instructions. RESULTS: 43 participants (40.6%) obtained a FSIQ < 70, then they were categorized as mild mental retardation. 34 offenders (32.1%) had a FSIQ between 70 and 84, then they were classified as people with borderline intellectual functioning, only 29 participants (27.4%) obtained a FSIQ over 85. CONCLUSION: 72.7% of the institutionalized adolescents offenders had low intellectual functioning, which may be interfere with the re education programs.

[Prevalence of dissocial conduct disorder in adolescents using an epidemiological diagnostic questionnaire]. / Prevalencia del trastorno disocial de la conducta en adolescentes usando un cuestionario de diagnóstico epidemiológico.

INTRODUCTION: Prevalence of Conduct Disorder has been calculated between 4 to 10%. OBJECTIVE: To estimate the prevalence CD in Colombian adolescents, using a rating scale by self report. PATIENTS AND METHODS: 190 male adolescents from secondary school population, 12 to 16 year-old, were stratified and selected in a randomizing procedure, from Medellín, Colombia. A checklist including 14 diagnostic symptoms taken from the DSM-IV Criterion A for CD was constructed, with a scale of 0 = never to 3 = almost always (Reliability alpha coefficient: 0.86). Prevalences were calculated as follow: (1) codifying as 'Probable TDC' a T score over 60; (2) codifying as Adolescent Antisocial Behavior (AAB) having three or more answers qualified with 1 or more points, and (3) codifying as CD obtaining three or more answers qualified with 2 or 3 points. RESULTS: The most prevalent CD symptoms were 'staying out at night before 13 year-old' (10.5%), 'having been cruel to animals' (8.4%), 'having been cruel to people' (7.4%), 'having broken into someone else's house or car' (7.3%), and 'using weapon or other objects that can cause serious physical harm to others' (6.9%). The prevalence of 'Probable CD' was 13.7%; prevalence of AAB was 56.8% and prevalence of CD was 8.4%. It was not found significant differences between socioeconomic strata. CONCLUSION: The prevalence of CD in the studied sample was 8.4%, independent of the socioeconomic strata.

[A brief questionnaire for the diagnosis of maladaptive behavior disorders in adolescents aged between 12 and 16 years of age]. / Cuestionario breve para el diagnóstico del trastorno disocial de la conducta en adolescentes de 12 a 16 años.

OBJECTIVE: To standardize and to determine the structural validity of a conduct disorder self report questionnaire in adolescents. PATIENTS AND METHODS: One hundred ninety, 12 to 16 year old male participants from the different socioeconomic status were randomized selected from educational institutions of Medellin City, Colombia. A quantitative self report questionnaire, with a discrete (0-3) item scored scale, based upon the DSM-IV criteria A symptoms for conduct disorder was applied to the sample. Reliability analysis using alpha item/scale Cronbach's coefficient was calculated, and a factor analysis with a maximum likelihood method of extraction and VARIMAX rotation was developed. RESULTS: The standard obtained scores defined the presence and distribution of the symptoms of conduct disorder in an adolescent normal population. Reliability alpha Cronbach's coefficient for 14 items was 0.86. Three stable factors, which explained 53.9% of the variance, were found. First factor was serious violation of rules and explained 32.9% of variance, second factor was violence, which explained 10.9%, and the third factor was cruelty which explained 10.1% of the structure (Goodness-of-fit chi 2 = 34.6; df 25; p = 0.09). Conduct disorder questionnaire had a strong internal consistency and multidimensional structure, which would allow that it could be used in clinical and epidemiological researches with adolescent population.

Neurobehavioral characteristics of adolescents with behavioral dysregulation disorder.

BACKGROUND: There is growing recognition that violence and other forms of conduct problems increase during adolescence. The exact relationship between biological, psychological, and social variables has not been defined yet. OBJECTIVES: To analyze whether Intelligence Quotients (IQS), neurological history, child behavioral problems, executive functions, and soft neurological signs (SNS) can differentiate between undisciplined and unreliable adolescents (Behavioral Dysregulation Disorder subjects, BDD) and normal controls. METHOD: Twenty-five 13 to 16-year-olds, adolescents with BDD and 25 matched controls were used in this study. WISC-R, executive function assessment, neurological history, child behavioral problems, and SNS scores were analyzed using a Multivariate Analysis of Variance (MANOVA). A Multiple Regression Stepwise with Criteria Probability of F Analysis was used for predicting criteria variable variance. RESULTS: WISC-R Verbal IQ (VIQ), Information, Similarities, and Vocabulary subtests presented statistically significant differences between BDD and controls (p < .001). No Performance IQ (PIQ) variables established significant differences between both groups. Executive function scores did not detect significant differences between groups either. Prenatal, neonatal, and neurological history scores were similar between both groups. Two child behavioral problem variables were significantly different, with higher scores in BDD group: use of weapons and drug-use (p < .05). A Multiple Regression Stepwise (Criteria Probability of F < .05) model, entering the predictive variables in each domain (intelligence, executive function, neurological antecedents, child behavioral problems, and SNS), and using the score on the criteria variable as dependent variable, found two predictive models: (1) WISC-R Information (Ad-R-SQ = 0.172 F-Ch. = 11.176, p < .01); and (2) WISC-R Information and drug-use (R-SQ: 0.26; F-Ch = 9.605 p < .001). CONCLUSIONS: A verbal factor and drug-use predicted fairly 30% of the variance of the criteria variable used for classifying adolescents with BDD. These results would mean that a language underlying factor and an environmental drug-use factor would be related to the BDD in adolescents.

[Use of multidimensional scale for parents of children aged 6 to 11 for the diagnosis of attention deficit with hyperactivity]. / Uso de una escala multidimensional para padres de niños de 6 a 11 años en el diagnóstico de deficiencia atencional con hiperactividad.

INTRODUCTION: The BASC is a multidimensional approach to evaluate the child behavior and it has been validated on the diagnosis of ADD/+H in North American children. OBJECTIVE: Validating BASC-PRS 6-11 on the diagnosis of ADD/+H. PATIENTS AND METHODS: We selected 25 male DSM IV-ADD/+H (combined type), 6 to 11-years-old children, and 25 age, gender, and socioeconomic status matched controls. Mean ages of both groups 8.16 (1.5), schooling of controls 2.64 (1.4), and cases 2.6 (1.9). RESULTS: On the Clinical Scale ADD/+H children had significant (Anova p < 0.01) higher scores in hyperactivity, conduct problems, and attention problems. On the Adaptive Scale only significant differences on social skills and leadership were found, with lower score in the ADD/+H group. A crosstab analysis between group code and each rating variable transformed into categorical (0 and 1) variable, cut-off point = 85 percentile, found that the case children's parents qualified as clinically in higher risk the variables attention problems (OR = 24.4; 95% CI = 4.5-130), conduct problems (OR = 9.0; 95% CI = 1.7-46.9) and hyperactivity (OR = 6.8; 95% CI = 1.6-28.5) (p < 0.01). A discriminant analysis selected attention problems as discriminant function (p < 0.0001). Classification capability 84% for each group. CONCLUSION: Our results proved the validity of the BASC-PRS 6-11 questionnaire for the screening diagnosis of ADD/+H children in a Spanish speaking population.

[Discrimination between genetic factors in attention deficit]. / Discriminación de factores genéticos en el déficit de atención.

INTRODUCTION AND OBJECTIVE: In order to elucidate the genetic and environmental components involved in the susceptibility to develop attention deficit hyperactivity disorder (ADHD), a complex segregation analysis on nuclear families (n = 53) ascertained from affected probands belonging to Medellín, in the Antioquian State, Colombia, was performed. METHODS AND RESULTS: Models of cohort effect (non-inheritance), multifactorial, recessive major gene, non-major gene component and non-transmission of major gene were rejected. Contrarily, dominant and codominant major gene models and non-multifactorial component could not be rejected. Thus, the better model fitting the data was that of the major gene (dominant/codominant). This major gene explains more than 99.99% of the ADHD phenotypic variance (value of heritability in the mixed model equal to 0.007%), which permit to assume a low aport of the environmental component to the phenotype ADHD. Gene frequency of the major gene was 3% in the general population of Antioquia and its penetrance was closed to 30%. CONCLUSION: Some cautions and aspects related to the bias of the interview and diagnosis of the parents are discussed.

[A system of multidimensional behavior assessment. A scale for parents of children from 6 to 11 years of age. Colombian version]. / Sistema de evaluación multidimensional de la conducta. Escala para padres de niños de 6 a 11 años, versión colombiana.

INTRODUCTION: Behavioral Assessment System for Children (BASC) has demonstrated to be useful in the diagnosis of Attention Deficit Disorder (ADD). PATIENTS AND METHODS: A randomized sample of 120 children, 6 to 11-year-old, participants from the school of the city of Medellín, Colombia, was selected. The sample was stratified by sex and two socioeconomic status (SES). Parents were asked to answer the BASC Parent Rating Scale (PRS) 6-11, authorized Spanish version. RESULTS: Cronbach's alpha coefficient was 0.85 for the clinical scale (9 items). It was 0.75 for the Adaptive Scale (3 items). A scale designed with 4 items to assess ADD (hyperactivity, attention problems, aggression, and conduct problems) showed an alpha coefficient of 0.82. Male children scored significantly higher than female (ANOVA, p < 0.05) in hyperactivity, conduct problems, and atypicality. Children from low SES scored significantly higher than children of high SES on the most of clinical measures (p < 0.05) and lower on the three adaptive measures. Cluster analysis selecting six clusters found a prevalence of 61.6% for normal male children. In the total sample there were a 4% at risk of DDA type II (inattentive) and 14% at risk of DDA type I (combined). CONCLUSIONS: BASC PRS (6-11) showed reliability and validity to assessing the behavior in Spanish speaking Colombian children.

[The use of brief questionnaire in the diagnosis of attention deficit. Study group of the Manizales University Foundation]. / Uso de un cuestionario breve para el diagnóstico de deficiencia atencional. Grupo de Investigación de la Fundación Universidad de Manizales.

INTRODUCTION: American Psychiatric Association has defined the DSM-IV ADD diagnostic criteria and symptoms, however, there is not a quantitative instrument to evaluate them in Spanish speaker population. OBJECTIVE: To evaluate the utility of a ADD checklist in a Colombian schooling population. PATIENTS AND METHODS: A randomized and stratified by sex, age and socioeconomic level, 4 to 17-year old, sample of 540 schooling subjects was selected from Manizales City, Colombia. An ADD checklist was applied to the parents of these subjects. RESULTS: The reliability of the different dimensions of the questionnaire (18 total items, 9 items for inattention, 9 for hyperactivity-impulsivity, and 6 for hyperactivity) were strong in both sex and in all age groups (Cronbach's alpha coefficient 0.71-0.92). Only the impulsivity dimension formed by three variables showed fairly weak reliability (0.42-0.79 Cronbach's alpha). Some factorial analysis found two dimensions. In the male sample first dimension (inattention) explain around the 45% of the variance, and the second dimension (hyperactivity-impulsivity) explain around the 12 to 15% of the variance in the different age groups. In the female sample the first dimension was hyperactivity-impulsivity and the second dimension was inattention. A categorical (yes or not) scored questionnaire found a ADD estimated prevalence of 16.1, distributed in type I (combined) 3.3%, in type II (inattentive) 4.3%, and type III (hyperactive-impulsive) 8.5%. Male prevalence was 19.8% and female 12.4%. CONCLUSIONS: ADD checklist Spanish version showed a strong reliability. A bidimensional stable structured was found. A clinical related ADD prevalence was presented, it was much higher than the prevalence of the developed countries.