Family Factors and Communicative Skills in Children with Autism Without Intellectual Disability.

The primary objective of this study was to identify the profiles of families of children with autism spectrum disorder (ASD) without intellectual disability (ID) based on several risk indicators: sociodemographic and emotional indicators, parental stress, confidant social support, and coping strategies. A second aim was to determine the differences in communicative skills between children of family subtypes empirically established according to the aforementioned risk factors. Participants were 52 Spanish mothers and their children with ASD. Through cluster analysis, three subtypes of families were identified, classifying them as "high risk, moderate risk, and little risk". The "little risk" profile showed significantly less stress and greater use of coping strategies and confidant social support. Furthermore, the children's communication exhibited better development, compared to children from the other family environments.

Failure modes and effects analysis of total skin electron irradiation technique

Purpose. Total skin electron irradiation (TSEI) is a radiotherapy technique which consists of an homogeneous body surface irradiation by electrons. This treatment requires very strict technical and dosimetric conditions, requiring the implementation of multiple controls. Recently, the Task Group 100 report of the AAPM has recommended adapting the quality assurance program of the facility to the risks of their processes. Materials and methods. A multidisciplinary team evaluated the potential failure modes (FMs) of every process step, regardless of the management tools applied in the installation. For every FM, occurrence (O), severity (S) and detectability (D) by consensus was evaluated, which resulted in the risk priority number (RPN), which permitted the ranking of the FMs. Subsequently, all the management tools used, related to the TSEI process, were examined and the FMs were reevaluated, to analyze the effectiveness of these tools and to propose new management tools to cover the greater risk FMs. Results. 361 FMs were identified, 103 of which had RPN ≥80, initially, and 41 had S ≥ 8. Taking this into account the quality management tools FMs were reevaluated and only 30 FMs had RPN ≥80. The study of these 30 FMs emphasized that the FMs that involved greater risk were related to the diffuser screen placement and the patient’s position during treatment. Conclusions. The quality assurance program of the facility has been adapted to the risk of this treatment process, following the guidelines proposed by the TG-100. However, clinical experience continually reveals new FMs, so the need for periodic risk analysis is required (AU)

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Failure modes and effects analysis of total skin electron irradiation technique.

PURPOSE: Total skin electron irradiation (TSEI) is a radiotherapy technique which consists of an homogeneous body surface irradiation by electrons. This treatment requires very strict technical and dosimetric conditions, requiring the implementation of multiple controls. Recently, the Task Group 100 report of the AAPM has recommended adapting the quality assurance program of the facility to the risks of their processes. MATERIALS AND METHODS: A multidisciplinary team evaluated the potential failure modes (FMs) of every process step, regardless of the management tools applied in the installation. For every FM, occurrence (O), severity (S) and detectability (D) by consensus was evaluated, which resulted in the risk priority number (RPN), which permitted the ranking of the FMs. Subsequently, all the management tools used, related to the TSEI process, were examined and the FMs were reevaluated, to analyze the effectiveness of these tools and to propose new management tools to cover the greater risk FMs. RESULTS: 361 FMs were identified, 103 of which had RPN ≥80, initially, and 41 had S ≥ 8. Taking this into account the quality management tools FMs were reevaluated and only 30 FMs had RPN ≥80. The study of these 30 FMs emphasized that the FMs that involved greater risk were related to the diffuser screen placement and the patient's position during treatment. CONCLUSIONS: The quality assurance program of the facility has been adapted to the risk of this treatment process, following the guidelines proposed by the TG-100. However, clinical experience continually reveals new FMs, so the need for periodic risk analysis is required.

[Grounds for a multi-component programme for counselling families with children with attention deficit hyperactivity disorder]. / Fundamentación de un programa multicomponencialde asesoramiento a familias con hijos con trastornopor déficit de atención/hiperactividad.

AIM: To analyse the change of perspective in the approach used in counselling programmes for parents of children with attention deficit hyperactivity disorder (ADHD). DEVELOPMENT: Research focused on analysing the familial context of people with ADHD has shown that parents experience higher levels of tension and feelings of low degrees of competence. Furthermore, the stress that occurs in parenting is significantly related to the application of discipline techniques that are inefficient, too lenient or too strict. CONCLUSIONS: We present a parent counselling programme that was designed in accordance with the latest guidelines and includes procedures for managing stress and communicative skills, as well as behavioural modification training.

[Discipline styles in families with children with attention deficit hyperactivity disorder: their influence on the course of the disorder]. / Estilos de disciplina en familias con hijos con trastorno por déficit de atención/hiperactividad: influencia en la evolucion del trastorno.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is caused by hereditary factors but it can only really be understood using a model that takes into account the interaction between genes and the environment. Discipline styles stand out among the factors offered by the familial environment that can influence the course of ADHD. AIMS: To compare the discipline styles employed by mothers of children with and without ADHD and to analyse how the subtype of ADHD and the presence of oppositional defiant disorder influence the discipline styles utilised by mothers of children with ADHD. SUBJECTS AND METHODS: We divided 167 mothers into two groups, one consisting of those who had a child with ADHD (n = 114) and a control group (n = 53), and they were asked to answer a semi-structured interview and a questionnaire about discipline styles. RESULTS: The statistical analyses showed that mothers of children with ADHD used more severe discipline strategies, especially if the ADHD was associated with oppositional defiant disorder. CONCLUSIONS: Interventions must include family guidance focused on the dimensions of self-control and affective expression.

Estilos de disciplina en familias con hijos con trastorno por déficit de atención/hiperactividad: influencia en la evolución del trastorno / Discipline styles in families with children with attention deficit hyperactivity disorder: their influence on the course of the disorder

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) tiene un origen hereditario, pero su comprensión debe enmarcarse en un modelo que contemple la interacción genes/ambiente. Los estilos de disciplina destacan entre los factores del ambiente familiar que pueden influir en el curso del TDAH. Objetivos. Comparar los estilos de disciplina de madres de niños con TDAH y sin TDAH, y analizar la influencia del subtipo de TDAH y la presencia de trastorno oposicionista desafiante en los estilos de disciplina de las madres de niños con TDAH. Sujetos y métodos. 167 madres, divididas en dos grupos, grupo con un hijo con TDAH (n = 114) y grupo de control (n = 53), cumplimentaron una entrevista semiestructurada y un cuestionario de estilos de disciplina. Resultados. Los análisis estadísticos señalaron que las madres de niños con TDAH utilizaban más estrategias severas de disciplina, especialmente si el TDAH estaba asociado a un trastorno oposicionista desafiante. Conclusión. Las intervenciones deben incorporar un componente de asesoramiento familiar centrado en las dimensiones de autocontrol y de expresión afectiva

Introduction. Attention deficit hyperactivity disorder (ADHD) is caused by hereditary factors but it can only really be understood using a model that takes into account the interaction between genes and the environment. Discipline styles stand out among the factors offered by the familial environment that can influence the course of ADHD. Aims. To compare the discipline styles employed by mothers of children with and without ADHD and to analyse how the subtype of ADHD and the presence of oppositional defiant disorder influence the discipline styles utilised by mothers of children with ADHD. Subjects and methods. We divided 167 mothers into two groups, one consisting of those who had a child with ADHD (n = 114) and a control group (n = 53), and they were asked to answer a semi-structured interview and a questionnaire about discipline styles. Results. The statistical analyses showed that mothers of children with ADHD used more severe discipline strategies, especially if the ADHD was associated with oppositional defiant disorder. Conclusions. Interventions must include family guidance focused on the dimensions of self-control and affective expression

[Learning difficulties in mathematics in children with attention deficit hyperactivity disorder]. / Dificultades en el aprendizaje de matemáticas en niñoscon trastorno por déficit de atención e hiperactividad.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) and learning difficulties are two diagnostic categories of great social importance and impact, and which are associated in around 25-35% of cases. One explanation offered by researchers to account for this overlap is a deficit in executive functioning (EF). AIMS: 1) To compare EF and applied mathematical knowledge in children with ADHD, difficulties in learning mathematics (DLM) or ADHD + DLM, and to identify the deficiencies they experience. 2) To verify whether the phenotype hypothesis is fulfilled in the case of the ADHD + DLM condition. SUBJECTS AND METHODS: The study involved a quasi-experimental 2 x 2 design, with a sample made up of 78 participants (6-13 years old) who were divided into four groups: ADHD (n = 33), DLM (n = 15), ADHD + DLM (n = 15) and a control group (n = 15). Tests aimed at evaluating different cognitive processes as well as applied mathematical knowledge were administered: inhibitory control (go/no go); verbal working (backward digit-recall and counting memory task) and temporal-visual-spatial memory; short-term memory (direct digit-recall); attention (CPT); calculation speed (Canals) and real-life problems. RESULTS AND CONCLUSIONS: Taking the variables age, gender and intelligence quotient as covariables, results showed that the three groups with problems displayed a deficit of attention and in working memory; the DLM group stood out from the other owing to the presence of a specific deficiency affecting the ability to recall temporal-visual-spatial information. In contrast, deficits in inhibitory control were seen to be specific to ADHD. Finally, findings did not support the phenotype hypothesis, and it was therefore an accumulative profile.

Dificultades en el aprendizaje de matemáticas en niños con trastorno por déficit de atención e hiperactividad / Learning difficulties in mathematics in children with attention deficit hyperactivity disorder

Introducción. El trastorno por déficit de atención e hiperactividad(TDAH) y las dificultades del aprendizaje son dos categoríasdiagnósticas de gran relevancia e impacto social, que seencuentran asociadas en torno al 25-35%. Una explicación queofrece la investigación sobre este solapamiento es el déficit en elfuncionamiento ejecutivo (FE). Objetivos. 1) Comparar el FE y elconocimiento matemático aplicado en niños con TDAH, dificultadesdel aprendizaje de las matemáticas (DAM) o TDAH + DAM e identificarlos déficit que experimentan; 2) Comprobar si se cumple lahipótesis de la fenocopia en el caso de la condición TDAH + DAM.Sujetos y métodos. Se planteó un diseño casi experimental 2 × 2,cuya muestra estaba formada por 78 participantes (6-13 años)repartidos en cuatro grupos: TDAH (n = 33), DAM (n = 15), TDAH+ DAM (n = 15) y control (n = 15). Se administraron tests dirigidosa evaluar diferentes procesos cognitivos además del conocimientomatemático aplicado: control inhibitorio (go/no go); memoriade trabajo verbal (dígitos-recuerdo inverso y tarea de memoriade conteo) y temporovisuoespacial (MTVE); memoria a corto plazo(dígitos-recuerdo directo), atención (TEC); velocidad en cálculo(Canals) y problemas de la vida real. Resultados y conclusiones.Considerando las variables edad, género y cociente intelectual comocovariables, los resultados indicaron que los tres grupos conproblemas mostraron déficit de atención y en la memoria de trabajo,y destacaba el grupo con DAM al presentar un déficit específicoen el recuerdo de información temporovisuoespacial. En cambio, eldéficit en el control inhibitorio se mostró específico del TDAH. Finalmente,los resultados no apoyaron la hipótesis de la fenocopia,por lo que se trataba de un perfil acumulativo

Introduction. Attention deficit hyperactivity disorder (ADHD) and learning difficulties are two diagnostic categoriesof great social importance and impact, and which are associated in around 25-35% of cases. One explanation offered byresearchers to account for this overlap is a deficit in executive functioning (EF). Aims. 1) To compare EF and appliedmathematical knowledge in children with ADHD, difficulties in learning mathematics (DLM) or ADHD + DLM, and toidentify the deficiencies they experience. 2) To verify whether the phenotype hypothesis is fulfilled in the case of the ADHD +DLM condition. Subjects and methods. The study involved a quasi-experimental 2 × 2 design, with a sample made up of 78participants (6-13 years old) who were divided into four groups: ADHD (n = 33), DLM (n = 15), ADHD + DLM (n = 15) anda control group (n = 15). Tests aimed at evaluating different cognitive processes as well as applied mathematical knowledgewere administered: inhibitory control (go/no go); verbal working (backward digit-recall and counting memory task) andtemporal-visual-spatial memory; short-term memory (direct digit-recall); attention (CPT); calculation speed (Canals) and reallifeproblems. Results and conclusions. Taking the variables age, gender and intelligence quotient as covariables, resultsshowed that the three groups with problems displayed a deficit of attention and in working memory; the DLM group stood outfrom the other owing to the presence of a specific deficiency affecting the ability to recall temporal-visual-spatial information.In contrast, deficits in inhibitory control were seen to be specific to ADHD. Finally, findings did not support the phenotypehypothesis, and it was therefore an accumulative profile

[The evaluation of pragmatic difficulties. A case study]. / Evaluacion de las dificultades pragmaticas. Estudio de casos.

INTRODUCTION: Pragmatic skills are defined as the speaker's appropriate use of language to communicate in different contexts and with different interlocutors. Within the field of disorders affecting language and communication, research into this issue became particularly important when, in 1983, Rapin and Allen put forward the term semantic pragmatic disorder to describe the communicative behaviour of children who presented traits such as pathological talkativeness, deficient access to vocabulary and discourse comprehension, atypical choice of terms and inappropriate conversational skills. This pioneering proposal has led to a development from both a terminological perspective and as regards the entity itself and the differential validity of the disorder. DEVELOPMENT: In this work, our aim is to bring together the main procedures used to evaluate pragmatic skills in children; this will be illustrated with examples taken from our own clinical practice and experience involving children belonging to different clinical groups. These procedures include getting people who play significant roles in the child's life to answer scales and surveys, the use of standardised instruments and other tasks, and finally the qualitative analysis of their discourse and conversation.

Evaluación de las dificultades pragmáticas. Estudio de casos / The evaluation of pragmatic difficulties. A case study

Introducción. Las habilidades pragmáticas se definen como el uso apropiado que el hablante hace del lenguaje para comunicarse, en diferentes contextos y con distintos interlocutores. En el ámbito de las dificultades lingüísticas y de comunicación, la investigación sobre este tema cobró especial relevancia cuando en 1983, Rapin y Allen propusieron el término ‘trastorno semánticopragmático’ para describir la conducta comunicativa de niños que presentaban rasgos como verborrea, déficit en el acceso léxico y en la comprensión del discurso, elección atípica de términos y destrezas conversacionales inadecuadas. Desde esta propuesta pionera se ha producido una evolución tanto desde el punto de vista terminoló- gico como en lo relativo a la propia entidad y validez diferencial del trastorno. Desarrollo. En este trabajo, nos proponemos realizar una síntesis de los principales procedimientos de evaluación de las habilidades pragmáticas en el niño, ilustrada con ejemplos de nuestra experiencia y práctica clínica, que proceden de niños pertenecientes a distintos grupos clínicos. Estos procedimientos incluyen la cumplimentación de escalas y cuestionarios por personas significativas en la vida del niño, el uso de instrumentos estandarizados y otras tareas y, finalmente, el análisis cualitativo del discurso y la conversación (AU)

Pragmatic skills are defined as the speaker’s appropriate use of language to communicate in different contexts and with different interlocutors. Within the field of disorders affecting language and communication, research into this issue became particularly important when, in 1983, Rapin and Allen put forward the term semantic-pragmatic disorder to describe the communicative behaviour of children who presented traits such as pathological talkativeness, deficient access to vocabulary and discourse comprehension, atypical choice of terms and inappropriate conversational skills. This pioneering proposal has led to a development from both a terminological perspective and as regards the entity itself and the differential validity of the disorder. Development. In this work, our aim is to bring together the main procedures used to evaluate pragmatic skills in children; this will be illustrated with examples taken from our own clinical practice and experience involving children belonging to different clinical groups. These procedures include getting people who play significant roles in the child’s life to answer scales and surveys, the use of standardised instruments and other tasks, and finally the qualitative analysis of their discourse and conversation (AU)

[The role played by parents in the development and learning of children with attention deficit hyperactivity disorder]. / El papel de los padres en el desarrollo y aprendizaje de los niños con trastorno por déficit de atención con hiperactividad.

INTRODUCTION: The parents of children with attention deficit hyperactivity disorder (ADHD) undergo high levels of stress, frequent quarrels amongst themselves and limitations in their social life, which are factors that exert an influence on the progress of the disorder and constitute a high priority therapeutic goal. AIMS: 1. To analyse the impact ADHD has on family life: economy, the relations between parents and children and between brothers and sisters, social life, and the feelings and attitudes parents have towards their child. 2. To study possible changes in the use of behavioural modification techniques and in the attributions/expectations of the parents following a programme of counselling. SUBJECTS AND METHODS: In order to accomplish the first objective, 36 couples filled in a questionnaire about family impact, and percentage analyses were carried out. To achieve the second aim, 28 couples, who received counselling in small groups, filled in questionnaires before and after the programme, and comparative analyses were performed using the Wilcoxon interval test. RESULTS: 89% of parents suffer from stress, 64% feel uncomfortable about their child's behaviour, for 68% of them the psychoeducational cost of the child is higher, 50% have quarrels with their partner and 44% report that it makes it more difficult for their brothers and sisters to take part in activities. Significant changes have also been observed in the knowledge parents have about the nature of the disorder and the attributions/expectations they have about their child, together with improvements in the application of behavioural modification techniques. CONCLUSIONS: ADHD exerts a negative effect on the family system; parent counselling has proved to be effective in understanding the pathology and bringing about positive changes in expectations/attributions.

[Adopted children: risk factors and neuropsychological problems]. / Niños adoptados: factores de riesgo y problemática neuropsicológica.

In recent years there has been a striking increase in the number of transnational adoptions in our country, which follows the trend already observed in other developed European countries. Major contributing factors to this phenomenon have been the improvements in socioeconomic conditions in our country, the drop in the birth rate, with the corresponding decrease in the number of children available for adoption, and the disappearance of orphanages. This growing demand can be met by developing countries, in which the birth rate is still high and there are only limited chances of being able to maintain offspring. The children that are adopted come mainly from countries in Central and South America, Eastern Europe and Asia. Pathologies that can be expected in adopted children include general paediatric conditions, especially infections (which are often autochthonous ailments in their own country) and malnutrition, as well as neuropsychological and developmental disorders, such as psychomotor retardation, conduct and behavioural disorders, which sometimes stem from conflicts arising in the process of adaptation, communication problems, which occasionally reflect an autistic like disorder, and the problems deriving from the circumstances that condition the donation of the child for adoption (perinatal pathology, maternal drug addiction and withdrawal symptoms, maternal psychopathology.). The pathology, history and prognosis of the adopted child depend on several different factors that act in an accumulative fashion. The country of origin plays a decisive role in the type of pathology, according to the level of the health care system that exists there, the existence of adoption programmes that are regulated by law, etc. The child's age at adoption marks the difference in the optimisation of their development, if they have early access to a stable family unit. Having stayed in institutions and the length of time spent there is a risk factor for presenting a neuropsychological pathology. On many occasions the scarce information available about the child's medical history makes it more difficult to anticipate the appearance of certain problems. The existence of social risk factors in the biological families is a conditioning factor in increased morbidity. We describe a short series of adopted patients who were attended in our Neuropaediatric clinic, and we analyse the above mentioned conditioning variables and the most frequent pathologies.

El papel de los padres en el desarrollo y aprendizaje de los niños con trastorno por déficit de atención con hiperactividad / The role played by parents in the development and learning of children with attention deficit hyperactivity disorder

Introducción. Los padres de niños con trastorno por déficit de atención con hiperactividad (TDAH) experimentan altos niveles de estrés, frecuentes enfrentamientos de pareja y limitaciones en su vida social, factores que influyen en la evolución del trastorno y constituyen una meta terapéutica prioritaria. Objetivos. Analizar el impacto del TDAH en el ámbito familiar (economía, relaciones padre-hijo y entre hermanos, vida social y sentimientos y actitudes de los padres hacia su hijo) y estudiar posibles cambios en el uso de técnicas de modificación de conducta y en las atribuciones/expectativas de los padres, tras un programa de asesoramiento. Sujetos y métodos. Para el primer objetivo, 36 parejas rellenaron un cuestionario de impacto familiar, y se realizaron análisis porcentuales. Para el segundo objetivo, 28 parejas que recibieron asesoramiento en pequeños grupos, rellenaron dos cuestionarios antes y después del programa, y se realizaron análisis de comparación mediante la prueba de intervalos de Wilcoxon. Resultados: .Un 89 por ciento de padres experimentan estrés, al 64 por ciento les incomoda el comportamiento de su hijo, para el 68 por ciento el costo psicoeducativo del hijo es superior, el 50 por ciento tienen enfrentamientos de pareja y el 44 por ciento refieren que obstaculiza la participación de sus hermanos en actividades. Se han observado, además, cambios significativos en el conocimiento de los padres sobre la naturaleza del trastorno y en las atribuciones/expectativas que tienen sobre su hijo, junto a mejoras en la aplicación de técnicas de modificación de conducta. Conclusiones. El TDAH ejerce un impacto negativo en el sistema familiar; el asesoramiento a padres se revela eficaz para entender la patología y producir cambios positivos en las expectativas/atribuciones (AU)

Introduction. The parents of children with attention deficit hyperactivity disorder (ADHD) undergo high levels of stress, frequent quarrels amongst themselves and limitations in their social life, which are factors that exert an influence on the progress of the disorder and constitute a high-priority therapeutic goal. Aims. 1. To analyse the impact ADHD has on family life: economy, the relations between parents and children and between brothers and sisters, social life, and the feelings and attitudes parents have towards their child. 2. To study possible changes in the use of behavioural modification techniques and in the attributions/ expectations of the parents following a programme of counselling. Subjects and methods. In order to accomplish the first objective, 36 couples filled in a questionnaire about family impact, and percentage analyses were carried out. To achieve the second aim, 28 couples, who received counselling in small groups, filled in questionnaires before and after the programme, and comparative analyses were performed using the Wilcoxon interval test. Results. 89% of parents suffer from stress, 64% feel uncomfortable about their child’s behaviour, for 68% of them the psychoeducational cost of the child is higher, 50% have quarrels with their partner and 44% report that it makes it more difficult for their brothers and sisters to take part in activities. Significant changes have also been observed in the knowledge parents have about the nature of the disorder and the attributions/expectations they have about their child, together with improvements in the application of behavioural modification techniques. Conclusions. ADHD exerts a negative effect on the family system; parent counselling has proved to be effective in understanding the pathology and bringing about positive changes in expectations/attributions (AU)

Niños adoptados: factores de riesgo y problemática neuropsicológica / Adopted children: risk factors and neuropsychological problems

En los últimos años hemos asistido a un incremento llamativo en el número de adopciones transnacionales en nuestro país, que sigue las tendencias ya existentes en otros países desarrollados europeos. A este fenómeno ha contribuido la mejora en las condiciones socioeconómicas de nuestro país, el descenso de la natalidad, con una disminución en la oferta de niños en adopción, y la desaparición de los orfanatos. Esta demanda creciente tiene salida en los países en vías de desarrollo, en los que la natalidad es todavía elevada y las posibilidades de mantener a la descendencia muy limitadas. Los niños adoptados son originarios, principalmente, de países pertenecientes a Centroamérica, América de sur, Europa del este y Asia. La patología esperable en el niño adoptado comprende tanto problemas pediátricos generales, entre los que destacan las infecciones -amenudo autóctonas del país de origen- y la desnutrición, como trastornos neuropsicológicos y de desarrollo, como el retraso psicomotor, los trastornos de comportamiento y conducta -que en ocasionesresponden a conflictos adaptativos-, los problemas de comunicación -en ocasiones como expresión de un trastorno de características autistas- y los problemas derivados de las circunstancias que condicionaron la donación del niño en adopción (patología perinatal, drogadicción materna y síndrome de abstinencia, psicopatía materna, etc.). La patología, evolución y pronóstico del niño adoptado dependen de diversos factores que actúan de forma sumatoria. El país de origen es determinante del tipo de patología, en función del desarrollo del sistema sanitario, la existencia de programas de adopción regulados, etc. La edad del niño en el momento de su adopción marca la diferencia en la optimización de su desarrollo, si tiene acceso temprano a un núcleo familiar estable. La estancia previa en instituciones y su duración es un factor de riesgo para presentar patología neuropsicológica. La escasa información disponible en muchas ocasiones acerca de los antecedentes hace más difícil el anticiparse a la aparición de determinados problemas. Por último, la existencia de factores de riesgo social de las familias biológicas condiciona mayor morbilidad. Describimos una serie corta de pacientes adoptados atendidos en nuestra consulta de neuropediatría y analizamos las variables condicionantes citadas y las patologías más frecuentes (AU)

In recent years there has been a striking increase in the number of transnational adoptions in our country, which follows the trend already observed in other developed European countries. Major contributing factors to this phenomenon have been the improvements in socioeconomic conditions in our country, the drop in the birth rate, with the corresponding decrease in the number of children available for adoption, and the disappearance of orphanages. This growing demand can be met by developing countries, in which the birth rate is still high and there are only limited chances of being able to maintain offspring. The children that are adopted come mainly from countries in Central and South America, Eastern Europe and Asia. Pathologies that can be expected in adopted children include general paediatric conditions, especially infections (which are often autochthonous ailments in their own country) and malnutrition, as well as neuropsychological and developmental disorders, such as psychomotor retardation, conduct and behavioural disorders, which sometimes stem from conflicts arising in the process of adaptation, communication problems, which occasionally reflect an autistic-like disorder, and the problems deriving from the circumstances that condition the donation of the child for adoption (perinatal pathology, maternal drug-addiction and withdrawal symptoms, maternal psychopathology...). The pathology, history and prognosis of the adopted child depend on several different factors that act in an accumulative fashion. The country of origin plays a decisive role in the type of pathology, according to the level of the health care system that exists there, the existence of adoption programmes that are regulated by law, etc. The child’s age at adoption marks the difference in the optimisation of their development, if they have early access to a stable family unit. Having stayed in institutions and the length of time spent there is a risk factor for presenting a neuropsychological pathology. On many occasions the scarce information available about the child’s medical history makes it more difficult to anticipate the appearance of certain problems. The existence of social risk factors in the biological families is a conditioning factor in increased morbidity. We describe a short series of adopted patients who were attended in our Neuropaediatric clinic, and we analyse the above-mentioned conditioning variables and the most frequent pathologies (AU)

[The course of behaviour changes in children with attention deficit and hyperactivity after drug treatment]. / Evolución de las alteraciones conductuales en niños con trastorno por déficit de atencion con hiperactividad tras la intervención farmacológica.

INTRODUCTION: Several studies have reported differences in behaviour in patients with various subtypes of attention deficit with hyperactivity and the benefits of psychostimulant medication in the treatment of behaviour problems of patients with the attention deficit hyperactivity syndrome (TDAH). OBJECTIVES: 1. To determine possible differences in behaviour between patients with subtypes of the attention deficit hyperactivity disorder; 2. To analyze the efficacy of methylphenidate on behaviour in three subtypes of TDAH, evaluated on the opinions of patients and teachers. PATIENTS AND METHODS: A total of 90 children were studied: 39 children with TDAH-C; 36 with TDAH-1 and 15 with TDAH-H/I. All patients were given 0.5 mg/kg of methylphenidate for a period of three months, once in the morning and once in the afternoon. RESULTS: The results show that the children with the three subtypes of TDAH have significant differences in all the behaviour variables studied except for the variable timidity anxiety, in which no differences were observed between the subtypes of TDAH. Statistical analysis also showed that children with all three subtypes of TDAH improved significantly with regard to most of the aspects of behaviour studied after psychostimulant medication, in the opinions of parents and teachers. CONCLUSIONS: Our findings are similar to those of other studies and give fresh data on the behaviour and advantages of methylphenidate in the new subtype included in the DSM-1V, the predominantly hyperactive impulsive type.

[The effects of psychostimulants on the cognitive results and behaviour of children with the combined subtype of attention deficit with hyperactivity]. / Efectos de los psicoestimulantes en el desempeño cognitivo y conductual de los niños con un déficit de atención con hiperactividad subtipo combinado.

INTRODUCTION: Many studies have shown the efficacy of methylphenidate in treating children with attention deficit and hyperactivity to reduce the main symptoms of the disorder and problems of behaviour: behaviour which is disruptive, antisocial, negative and aggressive. OBJECTIVES: 1. Analyze the therapeutic effects of methylphenidate on the cognitive function of children with TDAH, combined subtype, evaluated by means of neuropsychological tests of attention and inhibitory control. 2. Determine the efficacy of methylphenidate in improving the basic symptoms of TDAH C according to the DSM 1V for parents and teachers, and their behaviour, evaluated by their teachers, in the combined subtype. PATIENTS AND METHODS: The sample was made up of 48 children with TDAH C. 24 of these had been referred by paediatricians and received drug treatment with methylphenidate, 0.5 mg/kg once in the morning and once after lunch (TDAH C/CTF). The other group of 24 children with TDAH C were referred from their teachers to a school psychologist so that they followed the usual guidelines for orientation but not a systematically developed treatment (TDAH C/C or control group). RESULTS. In relation to the first objective the results were good for the TDAH C/CTF compared with the TDAH C/C group regarding the proportion of children who improved their results on neuropsychological testing of planning inhibitory control and attention. The differences between the two groups were statistically significant in the latent period of the reflexive impulsive test (MFF), arithmetic, cancellation of rhomboids and cancellation of numbers. Regarding the second objective, the improvement in the TDAH C/CTF group according to the teachers opinions were statistically significant with respect to attention, hyperactivity and impulsiveness, as compared with the control group. However, according to the parents assessment, although improvement was greater in both dimensions, the differences between the two groups did not reach statistical significance. Finally, the teachers observed greater improvement in the medicated group as compared to the control group regarding three variables: learning problems, antisocial conduct and failure to adapt to school. CONCLUSIONS: Overall, our results coincide with those of other excellent reviews, which have shown the effectiveness of methylphenidate in the treatment of cognitive and behaviour disorders in this group.

Efectos de los psicoestimulantes en el desempeño cognitivo y conductual de los niños con déficit de atención e hiperactividadsubtipo combinado / The effects of psychostimulants on the cognitive results and behaviour of children with the combined subtype of attention deficit with hyperactivity

Introducción. Numerosos estudios han comprobado la eficacia del metilfenidato en la intervención de los niños con déficit de atención con hiperactividad, para disminuir los síntomas centrales del trastorno y los problemas de comportamiento: conductas disruptivas, antisociales, negativismo, agresividad. Objetivos. 1. Analizar los efectos terapéuticos del metilfenidato sobre el funcionamiento cognitivo de niños con TDAH, subtipo combinado, valorado mediante pruebas neuropsicológicas de atención y control inhibitorio; 2. Determinar la eficacia del metilfenidato para mejorar los síntomas esenciales del TDAH-C según el DSM-IV para padres y profesores, así como el funcionamiento conductual, valorado a partir de la estimación de profesores, en el subtipo combinado. Pacientes y métodos. La muestra la formaban un total de 48 niños con TDAH-C; 24 pertenecían al grupo de niños remitidos clínicamente por pediatras, que recibieron tratamiento farmacológico con metilfenidato con dosis de 0,5 mg/kg, una por la mañana y otra después de comer (TDAH-C/CTF), y el otro grupo de 24 niños con TDAH-C procedían de remisiones del profesor al psicólogo escolar, de tal manera que seguían las pautas habituales de orientación, pero no un tratamiento sistemáticamente desarrollado (TDAH-C/C o grupo control). Resultados. En relación con el primer objetivo, los resultados fueron ventajosos para el grupo TDAH-C/CTF respecto al grupo TDAH-C/C, en cuanto al porcentaje de niños que obtuvieron progresos en su rendimiento en las pruebas neuropsicológicas de planificación-control inhibitorio y de atención. Las diferencias entre los dos grupos fueron estadísticamente significativas en el tiempo de latencia de la prueba de reflexividad-impulsividad (MFF), aritmética, cancelación de rombos y cancelación de números. En relación al segundo objetivo, las mejoras del grupo TDAH-C/CTF, de acuerdo con la estimación de los profesores, fueron estadísticamente significativas en la dimensión de atención y en la de hiperactividad e impulsividad, respecto al otro grupo de comparación; sin embargo, según la valoración de los padres, aunque también fueron las mejoras superiores en ambas dimensiones, las diferencias entre los grupos no llegaron a ser significativas. Por último, los profesores observan mejoras superiores en el grupo con medicación respecto al control en tres variables: problemas de aprendizaje, conducta antisocial e inadaptación escolar. Conclusiones. Globalmente, nuestros resultados coinciden con los aportados por otras excelentes revisiones, que han puesto de manifiesto la efectividad del metilfenidato para el tratamiento de las alteraciones cognitivas y conductuales de este trastorno (AU)

[Pharmacological treatment with risperidone in children with behavior disorders]. / Tratamiento farmacológico con risperidona en niños con trastornos en el comportamiento.

INTRODUCTION: Behavior disorders are frequently seen in children attending a neuropaediatric clinic. The classical neuroleptic drugs are usually used for treatment. However response tends to be irregular with adverse effects at a cognitive level and extrapyramidal symptoms. PATIENTS AND METHODS: We started to use risperidone in children with serious behavior problems who had not responded to other drugs, and evaluated the clinical course and side effects. RESULTS: A total of 16 patients aged between 7 and 14 years were treated for diagnoses of: hyperactivity attention deficit disorder, mental retardation with non specific behavior disorder, Gilles de la Tourette disorder with hyperactivity attention deficit disorder and generalized disorder of development. The doses of risperidone varied between 0.01 and 0.05 mg/kg/day. In two cases the evolution could not be assessed, was good in 10 and no change was seen in 4. The group of patients with most improvement were those with mental retardation. The commonest adverse effect was weight gain. No patient had extrapyramidal symptoms. CONCLUSION: We consider risperidone to be a safe drug for the pharmacological treatment of children with behavior problems.

Tratamiento farmacológico con risperidonaen niños con trastornos en el comportamiento / Pharmacological treatment with risperidone in children with behavior disorders

Introducción. Los trastornos del comportamiento en los niños constituyen una patología frecuente en la consulta de neuropediatría. El tratamiento farmacológico se realiza generalmente con los neurolépticos clásicos, que provocan una respuesta irregular y efectos adversos relevantes en cuanto al nivel cognitivo y a síntomas extrapiramidales. Pacientes y métodos. Iniciamos el empleo de la risperidona en niños con problemas graves de comportamiento que no habían respondido a otros fármacos, y valoramos la evolución clínica y los efectos secundarios. Resultados. Se trataron un total de 16 pacientes entre los 7 y 14 años de edad con los diagnósticos de: trastorno de déficit de atención con hiperactividad (TDAH), retraso mental (RM) con trastorno del comportamiento perturbador no especificado, trastorno de Gilles de la Tourette con TDAH y trastorno generalizado del desarrollo. Las dosis de risperidona osciló entre 0,01 y 0,05 mg/kg/día. La evolución no se pudo valorar en dos casos, fue positiva en 10 y sin cambios en 4. El grupo de pacientes que más se benefició fue el afecto de RM. El efecto adverso más frecuente fue el incremento de peso. Ningún caso presentó sintomatología extrapiramidal. Conclusión. Consideramos a la risperidona un fármaco seguro para el tratamiento farmacológico de los niños con problemas en su comportamiento (AU)

[The evaluation of the effects of pharmacological treatment of children with attention deficit hyperactivity disorder]. / Valoración de los efectos del tratamiento farmacológico en niños con déficit de atención y trastornos de hiperactividad.

In this study we approach problems related to the dosage and specific action of methylphenidate, its effects at cognitive and social levels, possible side-effects and limitations to its usage, and methods for evaluation of the response to treatment in the school environment. We make special mention of the importance of both parents and teachers being familiar with these problems.