Limited Prosocial Emotions in a Clinical Population of Children and Adolescents: Proposal for Core and Ancillary Characteristics.

OBJECTIVE: Limited prosocial emotions (LPE) has been recently incorporated into international classifications as a specifier for conduct disorder in the DSM-5 and for all disruptive behavioural disorders in the ICD-11. The aims of the current work were to determine (a) the accuracy of each of the characteristics used to assess the LPE specifier and (b) whether the manner in which symptoms group together supports the idea of LPE having core characteristics. METHOD: Trained clinicians conducted interviews and determined LPE characteristics using responses from 74 parent/guardian and child/adolescent participants. RESULTS: The distribution of LPE characteristics among those participants with LPE (n = 13) was compared to those with only one LPE characteristic (n = 11). The proposal of callous lack of empathy (CLE) and shallow deficient affect (SDA) as core characteristics was supported by strong associations with the presence of the LPE specifier, larger specificity, and sensitivity indices than those for unconcerned about performance and lack of remorse or guilt, as well as by a robust aggregation in a latent class analysis. CONCLUSIONS: CLE and SDA could be considered as core characteristics of LPE in children and adolescents.

Sandplay therapy in the treatment of children with Oppositional Defiant Disorder and Conduct Disorder / A terapia de sandplay no tratamento de crianças com Transtorno Opositivo-Desafiador e Transtorno de Conduta

The study aimed at assessing the effectiveness of sandplay therapy in the treatment of children with symptoms of oppositional defiant disorder and/or conduct disorder. The intervention consisted of twelve weekly sessions of sandplay therapy. The Child Behavior Checklist 6-18 was used to assess symptoms before and after the intervention. Participants were 41 children of both sexes, randomly divided into two groups. The control group remained on hold while experimental group 1 underwent the intervention. After three months, control group participants who still met the inclusion criteria were placed in experimental group 2. Results were analyzed statistically, in order to compare the control group and experimental group 1, as well as to assess the evolution of the total experimental group, which included experimental groups 1 and 2. Results pointed to the effectiveness of sandplay therapy in reducing symptoms of oppositional defiant disorder and conduct disorder.

O estudo visou avaliar a efetividade da terapia de sandplay no tratamento de crianças com sintomas de Transtorno Opositivo-Desafiador e/ou Transtorno de Conduta. A intervenção consistiu de 12 sessões semanais de terapia de sandplay. O Child Behavior Checklist 6-18 foi o instrumento utilizado para avaliar os sintomas antes e após a intervenção. Participaram do estudo 41 crianças de ambos os sexos, divididas randomicamente em dois grupos. O grupo controle permaneceu em espera enquanto o grupo experimental 1 passava pela intervenção. Após três meses de intervenção, os participantes do grupo controle que ainda atendiam aos critérios de inclusão formaram o grupo experimental 2. Os resultados obtidos foram analisados estatisticamente, de modo a comparar o grupo controle e o grupo experimental 1 bem como avaliar a evolução do grupo experimental total, que incluiu os grupos experimentais 1 e 2. Os resultados indicam que a terapia de sandplay foi eficiente na redução dos sintomas dos transtornos em questão.

Revisão da literatura sobre Transtorno Opositivo Desafiador e Transtorno de Conduta: causas/proteção, estratégia escolar e relação com a criminalidade / Literature review about Oppositional Defiant Disorder and Conduct Disorder: causes / protection, teaching school and relationship with crime

De acordo com variados estudos científicos, nas idades escolares os estudantes podem apresentar diferentes distúrbios comportamentais. Assim, este artigo tem como objetivo apresentar uma revisão da literatura sobre o Transtorno Opositivo Desafiador (TOD) e o Transtorno de Conduta (TC) de modo a favorecer o diagnóstico e intervenções escolares. Para isso, realizou-se busca por descritores no Portal da Capes e no Google Acadêmico em que foram selecionados trabalhos mais recentes escritos em português e inglês que continham no título dos manuscritos os termos da busca e os conteúdos destes foram divididos em categorias, tais como, fatores de causa/proteção; estratégias de trabalho com alunos acometidos de TOD e TC e a relação que os distúrbios podem apresentar com o cometimento de atos infracionais. Verificou-se que os autores abordam que ambos os distúrbios podem desenvolver-se pela influência do ambiente social das crianças e adolescentes, e que o professor pode exercer influência sobre o comportamento e rendimento escolar destes estudantes. O presente estudo contribui, portanto para a compreensão dos distúrbios a partir da exposição do debate de diversos autores o que pode auxiliar professores, alunos e pais no trabalho com pessoas acometidas de TOD e TC.

According to several scientific studies, at school age, students may have different behavioral disorders. Thus, this article aims to present a literature review on Oppositional Defiant Disorder (ODD) and Conduct Disorder (CT) to favourdiagnosis and school interventions. A search for descriptors in Capes Portal and Google Scholar was carried out, in which more recent works written in Portuguese and English that contained the search terms in the title of the manuscripts and their contents were divided into categories, such as causative/protective factors; work strategies with students suffering from ODD and CT, and the relationship that the disorders can present with infractions. We found that the authors state that both disorders can develop under the influence of the children's and adolescents' social environment and that the teacher can influence their behavior and academic performance. Therefore, the present study contributes to the understanding of disorders from the discussion of several authors' debates, which can help teachers, students, and parents work with people with ODD and CT.

Implicit Attitudes Toward Violence in a Sample of Adolescent Offenders With Conduct Disorder.

Few studies have addressed attitudes toward violence in offender populations using implicit measures. The aim of this study is to test whether implicit attitudes toward two types of violence (physical and relational) differ between two groups of adolescent offenders: one group with conduct disorder (CD; n = 36) and the other group without this condition (No-CD; n = 26). We found that adolescent offenders with CD evidenced less negative implicit attitudes toward physical violence than the No-CD group. No differences between groups were observed in the case of relational violence. Our results suggest that CD modulates implicit attitudes toward violence in adolescent offenders and that the influence of CD is stronger in the case of physical rather than relational acts of violence.

Onset and Severity of Early Disruptive Behavioral Disorders in Treatment-Seeking Substance Use Disorder Patients with and without Attention-Deficit/Hyperactivity Disorder.

AIMS: This study addressed the age of onset of conduct disorder (CD) and oppositional defiant disorder (ODD) in treatment-seeking substance use disorder (SUD) patients with and without adult attention-deficit/hyperactivity disorder (ADHD) and its association with early onset of SUD. METHODS: We examined data from the 2nd International ADHD in Substance Use Disorders Prevalence Study, including 400 adults in SUD treatment from Puerto Rico, Hungary, and Australia. ADHD, SUD, and CD/ODD were assessed with the Conners Adult ADHD Diagnostic Interview for DSM-IV, the MINI International Neuropsychiatric Interview, and the K-SADS, respectively. Cox regression analyses modeled time to emergence of CD/ODD separately for SUD patients with and without adult ADHD. Linear regression models examined associations between age of onset of SUD and presence of ADHD and adjusted for sex, age, and country. To assess the mediating role of CD/ODD on the association of ADHD with onset of SUD, adjusted regression models were estimated. RESULTS: Treatment-seeking SUD patients with ADHD presented an earlier onset of CD/ODD compared with those without ADHD. CD/ODD symptom loads were higher among the SUD and ADHD group. Age of first substance use and SUD were significantly earlier in SUD patients with ADHD, and these findings remained significant after adjustment for demographics and coexisting CD/ODD. CONCLUSIONS: ADHD is associated with earlier onset of SUD as well as with an earlier onset of more frequent and more severe disruptive behavioral disorders. These findings may inform preventive interventions to mitigate adverse consequences of ADHD.

Gender differences in the association between theory of mind, empathy and conduct disorder: A cross-sectional study / Diferencias de género en la asociación entre teoría de la mente, empatía y trastorno de conducta: Un estudio transversal

Abstract The purpose of this research was to explore gender differences regarding theory of mind and empathy abilities in a sample of adolescents with conduct disorder (n=46; males=28 and females=18). Empathy (cognitive and emotional dimensions) and theory of mind (reading the mind through the eyes) were tested based on an observational method with a crosssectional design. Statistical analysis included: description of variables according to their type, assessment of quantitative correlations and logistic multivariate modelling for identifying variables that differentiate female from male patients. The results demonstrated significant gender differences in empathy and theory of mind evaluations. Particularly, women showed different scores for cognitive/emotional empathy and in the Reading the Mind through the Eyes test, with a lower number of behavioural symptoms. The results are discussed in light of the current empirical evidence, and some future directions in the study of conduct disorder are suggested.

Resumen El objetivo de este estudio fue explorar las diferencias de género en habilidades de teoría de la mente y empatía en una muestra de adolescentes con trastorno de conducta (n=46; 28 hombres y 18 mujeres). Se determinó un abordaje observacional con un diseño de corte transversal mediante el cual se evaluó la empatía (dimensiones cognitiva y afectiva) y teoría de la mente (lectura de la mirada). El análisis estadístico incluyó la descripción de las variables de acuerdo con su naturaleza, la evaluación de correlaciones cuantitativas, y el diseño de un modelo logístico multivariado para identificar las variables que diferencian los pacientes según su género. Los resultados indicaron diferencias significativas por género tanto en empatía como en teoría de la mente. Las mujeres presentaron de manera consistente diferencias en los niveles de empatía cognitiva/afectiva y test de la mirada, con un menor número de síntomas de conducta. Los resultados se discuten a la luz de la evidencia empírica actual y se sugieren algunas direcciones futuras en el estudio del trastorno de conducta.

Homicidal Ideation among Children and Adolescents: Evidence from the 2012-2016 Nationwide Emergency Department Sample.

OBJECTIVE: To assess the prevalence and behavioral, sociodemographic, and psychiatric/psychological correlates of homicidal ideation among a sample of children and adolescents. STUDY DESIGN: We employed descriptive and multivariate logit models of homicidal ideation using data from the 2012-2016 Nationwide Emergency Department Sample from the Healthcare Cost and Utilization Project. This study was conducted with data from emergency departments in the US, and we used a sample of (N = 17 041 346) children and adolescents between the ages of 5 and 17 years. RESULTS: Pediatric homicidal ideation is rare with a prevalence estimate of 0.09%; however, its prevalence increases substantially from age 5 years to age 15 years when it peaks, and then declines through the end of adolescence. Conduct disorders conferred 1483% increased odds, attention deficit hyperactivity disorder conferred 616% increased odds, and other behavioral and emotional disorders increased a 2-fold to nearly 4-fold increased liability for homicidal ideation net the effects of sex, age, urban residence, insurance status, and zip code median household income. CONCLUSION: In the wake of homicide tragedies, it is often the case that numerous behavioral and clinical red flags were present in the developmental history of the perpetrator, but these were overlooked. Identifying children and adolescents who present with homicidal ideation is a crucial pediatric and public health matter that can inform prevention and behavioral interventions that forestall lethal violence.

Behavior Disorders: knowledge and actions of health professionals and social work / Trastornos de la Conducta: conocimiento y acciones de los profesionales de la salud y asistencia social / Transtornos do Comportamento: conhecimentos e ações de profissionais de saúde e assistência social

ABSTRACT Objective: to identify the knowledge of professionals of mental health services and social work on Behavior Disorders (BD) in childhood and adolescence, and to analyze their actions in care for children and adolescents with such disorders. Method: a qualitative, descriptive-exploratory study with 13 professionals from two mental health services and two tutorial councils. The data were collected in interviews and submitted to thematic content analysis. Results: three categories emerged from the interviews: "Knowledge about behavior disorders", which defines BD as deviations from normality and lack of limits. "Integrated and group care", which explains the integrated, multidisciplinary and group actions. "Specialized and legal care", which explains the actions through specialized, medical and judicial care. Final considerations: the results point out weaknesses and knowledge gaps of professionals, causing potential harm in the programming of effective actions, such as identification, referral and therapeutic planning.

RESUMEN Objetivo: identificar los conocimientos de los profesionales de los servicios de salud mental y asistencia social en Trastornos de la Conducta (TC) en la infancia y la adolescencia, y analizar sus acciones en la atención a niños y adolescentes con tales trastornos. Método: estudio cualitativo, descriptivo-exploratorio con 13 profesionales de dos servicios de salud mental y dos consejos de tutoría. Los datos fueron recolectados en entrevistas y sometidos a análisis de contenido temático. Resultados: de las entrevistas surgieron tres categorías: "Conocimiento sobre trastornos de conducta", que define la TC como desviaciones de la normalidad y la falta de límites. "Atención integrada y grupal", que explica las acciones integradas, multidisciplinares y grupales. "Atención especializada y jurídica", que explica las acciones a través de la atención especializada, médica y judicial. Consideraciones finales: los resultados señalan las debilidades y las brechas de conocimiento de los profesionales, causando un daño potencial en la programación de acciones efectivas, como la identificación, la referencia y la planificación terapéutica.

RESUMO Objetivo: identificar o conhecimento dos profissionais de serviços de saúde mental e assistência social sobre os Transtornos de Comportamento (TC) na infância e adolescência, e analisar suas ações na atenção a crianças e adolescentes com tais transtornos. Método: estudo qualitativo, descritivo-exploratório com 13 profissionais de dois serviços de saúde mental e dois conselhos tutelares. Os dados foram coletados em entrevistas e submetidos à análise de conteúdo temático. Resultados: três categorias emergiram das entrevistas: "Conhecimentos acerca dos transtornos de comportamento", que define os TC como desvios da normalidade e falta de limites. "O cuidado integrado e em grupo", que explica as ações integradas, multidisciplinares e através de grupos. "O cuidado especializado e jurídico", que explica as ações através do cuidado especializado, medicamentoso e judicial. Considerações finais: os resultados apontam fragilidades e lacunas de conhecimento dos profissionais acarretando potenciais prejuízos na programação de ações eficazes, como identificação, encaminhamento e planejamento terapêutico.

Youth homicide: a study of homicide predictor factors in adolescent offenders in custody in the south of Brazil / Homicídio juvenil: fatores preditores em adolescentes privados de liberdade no sul do Brasil

Abstract Objectives To assess the sociodemographic, psychiatric and criminal profile of adolescent offenders complying with temporary custody for homicide/homicide attempt and to compare it to that of the population of adolescents in custody for other crimes. Methods This cross-sectional study was based on the review of the medical records of 74 juvenile offenders in temporary custody at socioeducational agency Fundação de Atendimento Sócio-Educativo do Rio Grande do Sul. For the analysis, variables that presented p < 0.2 were included in multivariate adjustment through logistic regression. Results The sample comprised males only, mostly with white skin color (55.6 vs. 57.9% for homicidal and non-homicidal, respectively) and with a high prevalence of school failure (77.8 vs. 91.2%). There was a high prevalence of family history of delinquency (88 vs. 81%). Only years of study and belonging or not to a criminal organization remained statistically significant in the multivariate model. Conclusion The results show that having fewer years of study and denying belonging to a criminal organization are predictive factors of homicidal behavior in adolescent offenders (both with statistical relevance). The other variables were not statistically significant for this outcome. The present study may serve as a basis for further research, which may improve our understanding of risk factors for juvenile homicide.

Resumo Objetivos Avaliar o perfil sociodemográfico, psiquiátrico e criminal de adolescentes infratores que cumprem internação provisória por homicídio ou tentativa de homicídio e compará-los aos adolescentes privados de liberdade por outros atos infracionais. Métodos Este estudo transversal baseou-se na revisão dos prontuários médicos de 74 adolescentes infratores em internação provisória na Fundação de Atendimento Sócio-Educativo do Rio Grande do Sul. Para a análise, variáveis que apresentaram p <0,2 foram incluídas no ajuste multivariado por meio de regressão logística. Resultados A amostra foi composta apenas por homens, a maioria de pele branca (55,6 versus 57,9% para homicidas e não-homicidas, respectivamente) e com alta prevalência de reprovações escolares (77,8 vs. 91,2%). Houve alta prevalência de antecedentes familiares de delinquência (88 versus 81%). Apenas anos de estudo e pertencimento ou não a uma organização criminosa permaneceram estatisticamente significantes no modelo multivariado. Conclusão Os resultados mostram que ter menos anos de estudo e negar pertencer a uma organização criminosa foram fatores preditivos de comportamento homicida em adolescentes infratores (ambos com relevância estatística). As demais variáveis não foram estatisticamente significativas para esse desfecho. O presente estudo pode servir como base para futuras pesquisas, o que pode melhorar nossa compreensão dos fatores de risco para o homicídio juvenil.

Reaction time variability and attention-deficit/hyperactivity disorder: is increased reaction time variability specific to attention-deficit/hyperactivity disorder? Testing predictions from the default-mode interference hypothesis.

Increased reaction time variability (RTV) is one of the most replicable behavioral correlates of attention-deficit/hyperactivity disorder (ADHD). However, this may not be specific to ADHD but a more general marker of psychopathology. Here we compare RT variability in individuals with ADHD and those with other childhood internalizing and externalizing conditions both in terms of standard (i.e., the standard deviation of reaction time) and alternative indices that capture low-frequency oscillatory patterns in RT variations over time thought to mark periodic lapses of attention in ADHD. A total of 667 participants (6-12 years old) were classified into non-overlapping diagnostic groups consisting of children with fear disorders (n = 91), distress disorders (n = 56), ADHD (n = 103), oppositional defiant or conduct disorder (ODD/CD; n = 40) and typically developing controls (TDC; n = 377). We used a simple two-choice reaction time task to measure reaction time. The strength of oscillations in RTs across the session was extracted using spectral analyses. Higher RTV was present in ADHD compared to all other disorder groups, effects that were equally strong across all frequency bands. Interestingly, we found that lower RTV to characterize ODD/CD relative to TDC, a finding that was more pronounced at lower frequencies. In general, our data support RTV as a specific marker of ADHD. RT variation across time in ADHD did not show periodicity in a specific frequency band, not supporting that ADHD RTV is the product of spontaneous periodic lapses of attention. Low-frequency oscillations may be particularly useful to differentiate ODD/CD from TDC.

Clozapine in the Treatment of Aggression in Conduct Disorder in Children and Adolescents: A Randomized, Double-blind, Controlled Trial.

OBJECTIVE: This study was conducted to compare the efficacy of clozapine vs. risperidone in the treatment of aggression in conduct disorder in children and adolescents. METHODS: Twenty-four children with conduct disorder aged 6 to 16 years were randomized in a prospective, double-blind trial into two groups to receive clozapine or risperidone for 16 weeks. The Modified Overt Aggression Scale score was used as the primary outcome of the study. Secondary outcomes were Child Behavior Checklist (CBCL) externalization (CBCL-E) and internalization factors; Aggression, Hyperactivity and Delinquency subscales of CBCL-E, Child Global Assessment Scale (CGAS), Barnes Akathisia Rating Scale, and Simpson-Angus Scale. RESULTS: Both antipsychotics were similarly effective in the primary outcome and in most of the secondary ones. Clozapine was more effective in CBCL-E, the delinquency subscale and the CGAS scores than risperidone (p =0.039, 0.010, and 0.021). Two subjects from the clozapine group were excluded due to a low neutrophil count at week four. CONCLUSION: Clozapine and risperidone are effective for short-term treatment of aggression in children and adolescents with conduct disorder. Clozapine was more effective than risperidone in conduct externalization factors, delinquency trait and global functioning in children and adolescents. Stronger efficacy of clozapine should be investigated in larger sample sizes using pharmacogenomic studies. White blood cell counts need to be monitored when prescribing clozapine.

Adult outcomes of childhood disruptive disorders in offspring of depressed and healthy parents.

BACKGROUND: Longitudinal studies of children with disruptive disorders (DDs) have shown high rates of antisocial personality disorder (ASPD) and substance use in adulthood, but few have examined the contribution of parental disorders. We examine child-/adulthood outcomes of DDs in offspring, whose biological parents did not have a history of ASPD, bipolar disorder, or substance use disorders. METHOD: Offspring (N = 267) of parents with or without major depression (MDD), but no ASPD or bipolar disorders were followed longitudinally over 33 years, and associations between DDs and psychiatric and functional outcomes were tested. RESULTS: Eighty-nine (33%) offspring had a DD. Those with, compared to without DDs, had higher rates of MDD (adjusted odds ratio, AOR = 3.42, p < 0.0001), bipolar disorder (AOR = 3.10, p = 0.03), and substance use disorders (AOR = 5.69, p < 0.0001) by age 18, as well as poorer school performance and global functioning. DDs continued to predict MDD and substance use outcomes in adulthood, even after accounting for presence of the corresponding disorder in childhood (MDD: hazards ratio, HR = 3.25, p < 0.0001; SUD, HR = 2.52, p < 0.0001). Associations were similar among the offspring of parents with and without major depression. DDs did not predict adulthood ASPD in either group. LIMITATIONS: Associations are largely accounted for by conduct disorder (CD), as there were few offspring with ADHD, and oppositional defiant disorder (ODD) was not diagnosed at the time this study began. CONCLUSION: If there is no familial risk for ASPD, bipolar disorder or substance use, childhood DDs do not lead to ASPD in adulthood; however, the children still have poorer prognosis into midlife. Early treatment of children with DD, particularly CD, while carefully considering familial risk for these disorders, may help mitigate later adversity.

Transtorno de Déficit de Atenção e Hiperatividade e Transtorno de Conduta em adolescentes concluintes do ensino fundamental de Caxias do Sul / Attention Deficit Hyperactivity Disorder and Behavioral Disorder in adolescents who completed elementary education in Caxias do Sul

O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é uma das comorbidades neuropsiquiátricas mais comuns entre crianças e adolescentes, e caracteriza-se por sintomas de desatenção, hiperatividade e impulsividade. O presente estudo tem por objetivo determinar a prevalência de TDAH em uma amostra de adolescentes na cidade de Caxias do Sul. Trata-se de um estudo transversal realizado com uma amostra de 272 escolares. Como instrumento para triagem do TDAH foi utilizada a versão brasileira do questionário Child Behavior Check List. A prevalência de TDAH foi de 3,7 %; nessa amostra também foi avaliada a prevalência do Transtorno de Conduta que foi de 6,2 %. O Transtorno de Conduta se mostrou mais prevalente em escolares com TDAH. (p=0,019). O presente estudo evidenciou que o TDAH é uma patologia comum entre os adolescentes, apresentando importante associação com Transtorno de Conduta.(AU)

Attention Deficit Hyperactivity Disorder (ADHD) is considered one of the most common neuropsychiatric disorders among children and adolescents and is characterized by symptoms of inattention, hyperactivity and impulsivity. The present study aims to determine the prevalence of ADHD in a sample of adolescents in Caxias do Sul. A cross-sectional study was conducted in a sample of 272 students. The instrument used for screening ADHD was the Brazilian version of the questionnaire Child Behavior Checklist. The prevalence of ADHD was 3.7%; in this sample we also evaluated the prevalence of Conduct Disorder that was 6.2%. Conduct Disorder was more common in students with ADHD. (p = 0.019). The present study evidenced that ADHD is a common comorbidity in adolescents, presenting an important association with Conduct Disorder.(AU)

Empathic skills and theory of mind in female adolescents with conduct disorder

Objective: Most studies on conduct disorder (CD) have focused on male adolescents, disregarding analysis of this psychopathology in women. The purpose of this study was to identify differences in empathy and theory of mind (ToM) in a group of adolescent women with CD and a control group. Method: Thirty-six adolescent women were selected from an initial sample of 239 adolescents (CD group = 18, control group = 18). Empathy and ToM were evaluated through objective instruments. Mean comparisons and multivariate analysis were performed to ascertain differences between cases and controls and to propose a prediction model based on clinical status. Results: Significant differences in empathic abilities and ToM were found between the groups. The model that differentiated both groups was composed of eye-reading ability, perspective taking, and personal distress. Conclusion: These findings are consistent with previous studies. Capacity to take the other's perspective and the recognition of emotions in the face are protective factors against CD in women.

Concepções e práticas de profissionais da saúde e assistência social acerca dos transtornos de comportamento em crianças e adolescentes / Conceptions and practices of health and social welfare professionals about behavior disorders in children and teenagers

Nesta dissertação, procuramos compreender os sentidos e significados que os profissionais de serviços de saúde e de assistência social de um município do interior paulista têm acerca dos transtornos de comportamento em crianças e adolescentes. Para tanto, foi realizado um estudo qualitativo em dois serviços de saúde e 2 conselhos tutelares de um município do interior paulista. Participaram do estudo 13 profissionais. A coleta de dados foi realizada através de uma entrevista semiestruturada realizada em local escolhido pelos participantes. Para a organização e tratamento dos dados foi utilizada a técnica de análise de conteúdo de Bardin, que nos permitiu construir três categorias temáticas: "Transtornos de comportamento: que comportamento é esse?" "Transtornos de comportamento: como se desenvolvem?" "Ações (des)articuladas entre os setores saúde e assistência no atendimento à crianças e adolescentes com transtorno de comportamento". Verificamos que o conhecimento acerca da aplicabilidade diagnóstica dos transtornos de comportamento não é clara para os profissionais de nosso estudo, o que acaba dificultando a identificação e o encaminhamento dessas crianças e adolescentes aos serviços de saúde mental e assistência social. Para os profissionais de nosso estudo, os principais fatores de risco atribuídos ao desenvolvimento dos transtornos de comportamento em crianças e adolescentes são aqueles que ocorrem nas relações entre as crianças e seus familiares, como a violência doméstica, a desestruturação familiar, a falta de afeto e as práticas educativas, fatores que podem inclusive potencializar ou não a predisposição genética da criança ou adolescente a desenvolver transtornos de comportamento. Já os fatores macrossociais, como as condições sociais e culturais, a ação do estado e as características da sociedade nas quais vivem as crianças e adolescentes são pormenorizados como colaboradores para o desenvolvimento de transtornos de comportamento pelos profissionais de nosso estudo. Por fim, constatamos que as ações de prevenção à violência juvenil e de atendimento à crianças e adolescentes com transtornos de comportamento dos profissionais de nosso estudo não atendem às diretrizes e normas estabelecidas pela OMS e pelas políticas nacionais de prevenção à violência no que diz respeito ao trabalho integrado e intersetorial, no desenvolvimento de ações preventivas, na consolidação do atendimento pré-hospitalar sistematizado, hierarquizado e subsidiado por práticas baseadas em evidências e na capacitação adequada dos recursos humanos

Nesta dissertação, procuramos compreender os sentidos e significados que os profissionais de serviços de saúde e de assistência social de um município do interior paulista têm acerca dos transtornos de comportamento em crianças e adolescentes. Para tanto, foi realizado um estudo qualitativo em dois serviços de saúde e 2 conselhos tutelares de um município do interior paulista. Participaram do estudo 13 profissionais. A coleta de dados foi realizada através de uma entrevista semiestruturada realizada em local escolhido pelos participantes. Para a organização e tratamento dos dados foi utilizada a técnica de análise de conteúdo de Bardin, que nos permitiu construir três categorias temáticas: "Transtornos de comportamento: que comportamento é esse?" "Transtornos de comportamento: como se desenvolvem?" "Ações (des)articuladas entre os setores saúde e assistência no atendimento à crianças e adolescentes com transtorno de comportamento". Verificamos que o conhecimento acerca da aplicabilidade diagnóstica dos transtornos de comportamento não é clara para os profissionais de nosso estudo, o que acaba dificultando a identificação e o encaminhamento dessas crianças e adolescentes aos serviços de saúde mental e assistência social. Para os profissionais de nosso estudo, os principais fatores de risco atribuídos ao desenvolvimento dos transtornos de comportamento em crianças e adolescentes são aqueles que ocorrem nas relações entre as crianças e seus familiares, como a violência doméstica, a desestruturação familiar, a falta de afeto e as práticas educativas, fatores que podem inclusive potencializar ou não a predisposição genética da criança ou adolescente a desenvolver transtornos de comportamento. Já os fatores macrossociais, como as condições sociais e culturais, a ação do estado e as características da sociedade nas quais vivem as crianças e adolescentes são pormenorizados como colaboradores para o desenvolvimento de transtornos de comportamento pelos profissionais de nosso estudo. Por fim, constatamos que as ações de prevenção à violência juvenil e de atendimento à crianças e adolescentes com transtornos de comportamento dos profissionais de nosso estudo não atendem às diretrizes e normas estabelecidas pela OMS e pelas políticas nacionais de prevenção à violência no que diz respeito ao trabalho integrado e intersetorial, no desenvolvimento de ações preventivas, na consolidação do atendimento pré-hospitalar sistematizado, hierarquizado e subsidiado por práticas baseadas em evidências e na capacitação adequada dos recursos humanos

Toma de decisiones en menores con factores de riesgo para el Trastorno Disocial de la Conducta / Decision making in minors with risk factor of dissocial behavior disorder

Introducción. Existe la hipótesis de que las emociones participan del proceso cognitivo de la toma de decisiones guiando la conducta y dotando a la experiencia de una cualidad positiva o negativa que permite la adaptación del individuo al medio social. Método: La muestra estuvo conformada por 81 menores de edad (48 que cumplían con uno o dos criterios del DSM-IV y 33 sin alteraciones de comportamiento). Se utilizó la Escala Muldimensional de la Conducta, el SNAP IV y el Check list para TDC como instrumentos de tamizaje para su selección, posteriormente se realizó la evaluación con la versión computarizada de la IGT (Iowa Gambling Task). Resultados: Se dan diferencias estadísticamente significativas entre el grupo estudio y de comparación para la selección de las barajas desventajosas B durante la ejecución de la tarea. Los menores en riesgo presentaron un desempeño menor para la prueba general de toma de decisiones. Discusión: Los resultados indican la presencia de alteraciones en los procesos de toma de decisiones de los menores que presentan uno o dos criterios clínicos para desarrollar el TDC.

Introduction: There is a hypothesis that proposes that emotions take part in the cognitive process related to decision-making behavior; such processes provide experience of a positive or negative quality that allows the adaptation of a human being to a social background. Methods: There were 81 minors participants (48 qualified with one or two standards of DSM-IV and 33 without conduct disorders). We used Multidimensional Scale of Conduct, SNAP IV, and checklist for CD as screening instruments for its selection, and later we performed the assessment with the online version of IGT (Iowa Gambling Task). Results: A statistically significant difference was present between study and control groups in the selection of unfavorable decks of cards. Those children affected by behavioral disorders presented lower results in the general decision-making test. Conclusions: Results suggest the presence of disorders in decision-making in minors that present one or two clinical criteria to develop CD. This could be due to difficulties in contingency processing for unfavorable decisions, which prevented them from generating somatic states based on the possible future consequences.

QEEG and LORETA in Teenagers With Conduct Disorder and Psychopathic Traits.

BACKGROUND: Few studies have investigated the impact of the psychopathic traits on the EEG of teenagers with conduct disorder (CD). To date, there is no other research studying low-resolution brain electromagnetic tomography (LORETA) technique using quantitative EEG (QEEG) analysis in adolescents with CD and psychopathic traits. OBJECTIVE: To find electrophysiological differences specifically related to the psychopathic traits. The current investigation compares the QEEG and the current source density measures between adolescents with CD and psychopathic traits and adolescents with CD without psychopathic traits. METHODS: The resting EEG activity and LORETA for the EEG fast spectral bands were evaluated in 42 teenagers with CD, 25 with and 17 without psychopathic traits according to the Antisocial Process Screening Device. All adolescents were assessed using the DSM-IV-TR criteria. The EEG visual inspection characteristics and the use of frequency domain quantitative analysis techniques (narrow band spectral parameters) are described. RESULTS: QEEG analysis showed a pattern of beta activity excess on the bilateral frontal-temporal regions and decreases of alpha band power on the left central-temporal and right frontal-central-temporal regions in the psychopathic traits group. Current source density calculated at 17.18 Hz showed an increase within fronto-temporo-striatal regions in the psychopathic relative to the nonpsychopathic traits group. CONCLUSIONS: These findings indicate that QEEG analysis and techniques of source localization may reveal differences in brain electrical activity among teenagers with CD and psychopathic traits, which was not obvious to visual inspection. Taken together, these results suggest that abnormalities in a fronto-temporo-striatal network play a relevant role in the neurobiological basis of psychopathic behavior.

Estudio de asociación del trastorno del desarrollo de la coordinación con los problemas de conducta en niños de la ciudad de Bucaramanga, Colombia / Cross-Sectional Study of Developmental Coordination Disorder with Behavior Problems in Children from Bucaramanga City, Colombia / Estudo de associação do trastorno do desenvolvimento da coordenação com os problemas de conduta em crianças da cidade de Bucaramanga, Colômbia

Introducción: el trastorno del desarrollo de la coordinación TDC en la infancia es una problemática importante desde la salud pública, ya que tiene repercusiones para el desarrollo infantil desde las dimensiones motora, cognitiva, psicosocial y emocional y, al mismo tiempo, son frecuentes sus comorbilidades con otros trastornos del desarrollo infantil. El presente estudio analiza la asociación de características de TDC con los problemas de conducta en niños de la ciudad de Bucaramanga, Colombia. Materiales y métodos: Estudio transversal, descriptivo y de asociación, en una muestra de 140 niños de 6 a 12 años de edad, aleatorizados en instituciones educativas. Se realizó entrevista estructurada y aplicación de cuestionarios para determinar la presencia de características de TDC y de problemas de conducta. Se realizó análisis descriptivo univariado para la caracterización sociodemográfica y pruebas de asociación con coeficiente de correlación de Spearman. Resultados: se encontró una prevalencia del 3,6% de características de TDC en la población estudiada, y una asociación de Rho = -0,263 con p valor = 0,002 entre características de TDC y problemas de conducta referidos por los padres. Discusión: la prevalencia de características de TDC para Bucaramanga fue menor en relación con la mayoría que se reporta a nivel internacional. La asociación entre características de TDC y problemas de conducta en esta ciudad es baja pero estadísticamente significativa.

Introduction: Developmental Coordination Disorder (DCD) in childhood is a major public health issue due to its consequences for child development from the motor, cognitive, psychosocial and emotional perspectives, and its comorbidities are common with other developmental disorders in children as well. This study characterizes the association of DCD features with behavior problems in children from Bucaramanga city, Colombia. Materials and methods: This cross-sectional study was conducted in a random sample of 140 children aged 6 to 12 years old that belonged to educational institutions. A structured interview and questionnaires were applied in order to determine the presence of DCD features and behavior problems. A univariate descriptive analysis led to a socio demographic characterization and a Spearman's rank correlation coefficient. Results: Results showed a prevalence of 3.6% of DCD features in the population, and a negative association of Rho = -0,263 with p value = 0,002 among DCD features and behavior problems reported by parents. Discussion: The prevalence of DCD features in Bucaramanga was lower concerning the prevalence reported internationally. The association among DCD features and behavior problems in this city is low but statistically significant.

Introdução: o transtorno do Desenvolvimento da Coordenação TDC na infância é uma problemática importante desde a saúde pública, já que tem repercussões para o desenvolvimento infantil desde as dimensões motoras, cognitiva, psicossocial e emocional, e ao mesmo tempo são frequentes suas comorbilidades com outros transtornos do desenvolvimento infantil. O presente estudo analisa a associação de características de TDC com os problemas de conduta em crianças da cidade de Bucaramanga, Colômbia. Materiais e métodos: estudo transversal, descritivo e de associação em uma amostra de 140 crianças de 6 a 12 anos, aleatorizados em instituições educativas. Se realizou entrevista estruturada e aplicação de questionários para determinar a presença de características de TDC e de problemas de conduta. Realizou-se análise descritiva univariada para a caracterização sociodemográfica e provas de associação com coeficiente de correlação de Spearman. Resultados: se encontrou uma prevalência do 3,6% de características de TDC na população estudada, e uma associação negativa de Rho = -0,263 com p valor = 0,002 entre características de TDC e problemas de conduta referidos pelos pais. Discussão: a prevalência de características de TDC para Bucaramanga foi menor em relação à maioria que se reporta ao nível internacional. A associação entre características de TDC e problemas de conduta nesta cidade é baixa, mas estatisticamente significativa.

Transtorno de conduta na adolescência: recortes de um caso clínico / Conduct disorder in adolescence: a clinical case

O presente trabalho teve por objetivo descrever recortes de um caso clínico de um adolescente com diagnóstico de transtorno de conduta, atendido no Centro de Referência de um Instituto de Hebiatria de uma faculdade de medicina. Tratou-se de um adolescente de 12 anos de idade, atendido por uma equipe multidisciplinar. Entendeu-se nesse estudo a importância do diagnóstico, pois nos casos de transtornos de conduta é sempre necessária uma análise mais aprofundada do adolescente e de seu meio social, uma vez que sempre haverá diferenças entre os sujeitos e, consequentemente, a intervenção psicológica deverá ser individualizada para cada paciente para que se possa ajudá-lo. (AU)

The aim of the present study was to describe the cut - offs of a clinical case of an adolescent with a diagnosis of conduct disorder, attended at the Reference Center of an Institute of Hebiatrics of a medical school. It was a 12-year-old adolescent, assisted by a multidisciplinary team. The importance of diagnosis is evident, because in the cases of conduct disorders a more in-depth analysis of the adolescent and his social environment is always necessary, since there will always be differences between the subjects and, consequently, the psychological interventions hould be specific for each patient so that they can be helped. (AU)

Risk of Suicide Attempt among Adolescents with Conduct Disorder: A Longitudinal Follow-up Study.

OBJECTIVE: To assess the independent or comorbid effect of conduct and mood disorders on the risk of suicide. STUDY DESIGN: The Taiwan National Health Insurance Research Database was used to derive data for 3711 adolescents aged 12-17 years with conduct disorder and 14 844 age- and sex-matched controls between 2001 and 2009. The participants were followed up to the end of 2011, and those who attempted suicide during the follow-up period were identified. RESULTS: Adolescents with conduct disorder had a higher incidence of suicide (0.9% vs 0.1%; P <.001) and attempted suicide at a younger age (17.38 ± 2.04 vs 20.52 ± 1.70 years of age) than did the controls. The Cox proportional hazards regression model, after adjustment for demographic data and psychiatric comorbidities, determined that conduct disorder was an independent risk factor for subsequent suicide attempts (hazard ratio, 5.17; 95% CI, 2.29-11.70). The sensitivity after those with other psychiatric comorbidities were excluded revealed a consistent finding (hazard ratio, 10.32; 95% CI, 3.71-28.71). DISCUSSION: Adolescents with conduct disorder had an increased risk of suicide attempts over the next decade. Future studies are required to clarify the underlying pathophysiology and elucidate whether prompt intervention for conduct disorder could reduce this risk.