Prosocial behavior in children involved in peer violence.

INTRODUCTION: Peer violence is a serious type of school violence that is associated with emotional and behavioral problems. OBJECTIVE: To analyze violence between peers associated with students' social skills. METHODS: We used a cross sectional survey nested in a cluster randomized controlled trial to evaluate peer violence among elementary school students and its association with prosocial behaviors and mental problems. Teachers answered an adapted version of the Revised Olweus Bully/Victim Questionnaire and the Brazilian adaptation of the Teacher Observation of Classroom Adaptation-Checklist (TOCA-C) scale for each student. Children completed a sociodemographic questionnaire. The participants were 1,152 5-14-year-old children from Brazilian public schools; 79.70% reported being involved in violent situations. RESULTS: Children who had both committed and suffered violence were less likely to exhibit prosocial behaviors. Children who committed and suffered violence and those who only committed were more likely to experience concentration problems and disruptive behaviors. DISCUSSION: This study suggests that peer violence is associated with lower prosocial behaviors and more behavioral problems. Thus, more specialized mental health care is required for children involved in peer violence, in addition to the possibility of implementing and maintaining programs to prevent and reduce violence and to develop prosocial behaviors in schools.

Personal and Environmental Predictors of Aggression in Adolescence.

This study aims to find causal factors of aggression in a group of Latino adolescents to achieve a greater understanding of human nature, taking into account personal and contextual variables. The fundamental hypothesis is that moral disengagement, personality traits, self-esteem, values, parenting, sex, and socioeconomic situation can function as possible casual factors of aggression in adolescents. The study examined the variables using the structural equations model (SEM) to determine causal factors of aggression in a sample of 827 adolescents (54% men and 46% women) between 11 and 16 years of age. According to the scientific literature review, sociodemographic, personal, and familiar variables were included in the causal model. The influence of the variables occurred in two ways: one that inhibits aggression and the other that reinforces it. The results are discussed based on identifying protective and risk factors against aggression: biological sex and values of conformity and transcendence as aggression's inhibitors and, on the other hand, openness, moral disengagement, and leadership values as the most important predictors of aggression.

Rasgos de personalidad, bienestar y malestar psicológico en usuarios de redes sociales que presentan conductas disruptivas online / Personality traits, well-being and psychological distress in users who present online disruptive behavior

Resumen El presente estudio se propuso investigar perfiles de usuarios de redes sociales que presentan conductas disruptivas online. Para tal fin se diseñó un índice que permite evaluar el nivel en el que se presentan dichas conductas y se analizó la relación entre la intensidad de la conducta disruptiva online con variables sociodemográficas, motivos de usos de redes, variables de personalidad (normales, patológicas y rasgos vinculados a tríada oscura), bienestar y malestar psicológico. Participaron 858 adultos (421 hombres y 437 mujeres) que tenían en promedio 39.16 años (DE = 14.14). Para la recolección de datos se administraron: Dark Triad Scale, Big Five Inventory, Inventario para Trastornos de la Personalidad para el DSM-5, Mental Health Continuum . Depression, Anxiety and Stress Scale, y se diseñaron dos escalas: Índice de Conductas Disruptivas Online y Motivos de Utilización de Redes Sociales. En cuanto a las variables sociodemográficas, se halló que los más jóvenes de sexo masculino y que no trabajaban eran quienes presentaban un mayor nivel de comportamientos disruptivos online. En cuanto a los motivos de uso de redes, se observó que preferían usarlas con fines meramente exhibicionistas, de ocio o para iniciar nuevas relaciones. Por otro lado, en relación con rasgos de personalidad, aquellos que diferenciaban los perfiles en cuanto a la intensidad de las conductas disruptivas fueron: bajos niveles de responsabilidad y altos niveles de desinhibición, narcisismo y maquiavelismo. Por último, se demostró que presentar este tipo de conductas se asocia con mayor nivel de estrés y menor de bienestar social.

Abstract The present study focused on the analysis of online disruptive behavior that usually occurs among social network users. Individuals who perpetrate such behavior are commonly known as trolls or haters (Cheng, Danescu-Niculescu-Mitzil, & Leskovec, 2015). In general, they post comments, photos or provocative videos that do not pursue any purpose other than annoying or obtaining pleasure or fun (Brandel, 2007; Phillips, 2011). Recent studies have shown that certain personality traits are associated with the presence of such disruptive behavior. In this research, we studied normal personality traits, psychopathological traits, and dark personality traits in relation to disruptive behavior. The normal personality traits were considered from the classic Five Factor Model (FFM) - Openness to experience, Conscientiousness, Extraversion, Agreeableness, Neuroticism (Costa, & McCrae, 1985); the psychopathological traits, from the latest version of the DSM - Negative Effect, Detachment, Antagonism, Disinhibition and Psychoticism (DSM-5, American Psychiatric Association, 2013); and the dark personality traits from the so-called Dark Triad model - Narcissism, Machiavellianism and Psychopathy (Palthus, & Williams, 2002). This latter model has a growing interest in the international literature, related to dysfunctional Internet use, particularly to social networks. Therefore, the present study aimed to analyze profiles of social network users who present online disruptive behavior. For this purpose, an index was designed to assess the level of occurrence of such behaviors. First, the relationship between the intensity of online disruptive behavior and sociodemographic variables (i. e., sex, age, studies, occupation and nationality) and motives for social network use (i. e., Relationship maintenance; Passing time and Exhibitionism; Relationship Initiation and Search for companionship) were assessed. Then, the relationships among personality variables (i. e., normal, psychopathological and traits related to the dark triad); well-being (i. e., emotional, social and personal) and psychological distress (i. e., anxiety, stress and depression) were analyzed. The sample consisted of 858 adults (421 men, 49.1 % and 437 women, 50.9 %) with a mean age of 39.16 years (SD = 14.14). The majority (67.9 %; n = 583) lived in Buenos Aires, Argentina). For data collection, the following questionnaires were used: Dark Triad Scale (DTS), Big Five Inventory (BFI), Personality Disorder Inventory (PID-5-BF), the Mental Health Continuum (MHC-SF), and the Depression, Anxiety and Stress Scale (DASS-21). Additionally, two scales were designed: Online Disruptive Behavior Index, and Motives for Social Networks Use. The SPPS 24.0 statistical package was used for data analysis. Overall, the results are consistent with those reported in the international literature. Regarding sociodemographic variables, it was found that male, younger and unemployed individuals are those who presented higher level of online disruptive behavior. Considering motives for social network use, it was observed that individuals who tend to behave in a dysfunctional manner, preferred to use social networks purely for exhibitionism, pastime or relationships initiation. Regarding personality traits, those who differentiated profiles in terms of intensity of disruptive behaviors were: low levels of responsibility and high levels of disinhibition, narcissism and Machiavellianism. Thus, it might be concluded that the overall personality profile tends to be dysfunctional in terms of its characteristics. Finally, it was shown that presenting this type of behavior is associated with higher levels of stress and lower levels of social wellbeing. Therefore, it might be interpreted that although individuals who behave disruptively tend to obtain gratification from injury and deceit to others, this behavior does not result in positive results for them, but rather results in feelings of discomfort from a personal and social point of view.

Gender, Anxiety, and Legitimation of Violence in Adolescents Facing Simulated Physical Aggression at School.

We analyzed gender and anxiety differences in middle school students facing a physical peer aggression situation. The participants were 1147 adolescents aged between 12 and 18 years (male: n = 479; female: n = 668) who watched a 12 s animation representing the situation and filled out a questionnaire to analyze the legitimation of violent behaviors and anxiety levels. We registered their decisions to solve the situation using a categorical scale that included assertive, avoidant, aggressive, submissive, and supportive behaviors. Gender was not associated with the adolescent's behaviors in facing a simulated peer aggression situation. However, male teenagers tended to perceive adults as sanctioners and neutrals; those who used the diffusion of responsibility and dehumanization to justify their behavior also showed a higher state of anxiety. Female teenagers who expected legitimation from their peers, presented higher anxiety as well. Educational interventions may use these results, helping adolescents to understand that their acts have substantial implications in the lives of others. It is essential to develop group interventions that modify how adolescents manage their conflicts and change gender stereotypes that significantly impact health. We highlight the need for linking families in educational programs facing the challenges of transforming the legitimization of violence in parental practices.

Parent-teacher report reliability on the fourth edition of the Swanson, Nolan and Pelham scale in a Brazilian clinical sample of children and adolescents with attention-deficit/hyperactivity disorder

Abstract Background Parents and teachers can be valuable sources of information for characterizing children's ADHD-related impairments in different environments. However, evidence indicated that those categories of informants often provide conflicting responses in formal assessment scales, which may challenge diagnostic decisions regarding the condition. Objective: We aimed to investigate reliability rates between parents and teachers of children and adolescents with and without ADHD using SNAP IV. Methods 199 children and adolescents aged 6 to 17 years were evaluated for ADHD symptoms using parent-rated and teacher-rated SNAP IV scales. Intraclass correlation coefficients were analyzed for ADHD domains (inattention and hyperactivity/impulsivity), as well as for defiant-oppositional behavior. Results Reports from parents and teachers showed low reliability for all ADHD domains. Parents' scores on the SNAP IV were higher than those of teachers. Parents and teachers provided highly discrepant responses concerning to the presence and severity of ADHD in children and adolescents, which might result from intrinsic aspects related to their daily functioning in different settings. Discussion Clinicians should consider those trends in parental and teachers' responses when interpreting results from informant-based instruments for detecting ADHD.

A Parenting Program to Reduce Disruptive Behavior in Hispanic Children with Acquired Brain Injury: A Randomized Controlled Trial Conducted in Mexico.

Children with acquired brain injury (ABI) are at risk of impairments in self-regulation and disruptive behavior. We aimed to investigate the effectiveness of the Signposts program to reduce disruptive behavior and improve self-regulation in Hispanic children with ABI, and reduce parental stress and improve parenting practices. Using a randomized controlled trial design, we assigned children (n = 71) and their parents to Signposts or generic telephone support. Blinded assessors conducted assessments at pre-intervention, immediately post-intervention, and at 3 months post-intervention. Signposts was effective in reducing dysfunctional parenting practices. Further, when analyzing participants at risk of behavioral disturbance (n = 46), Signposts was effective in reducing child disruptive behavior in the home environment and emotional self-regulation. No differences were found for parental stress, parent sense of competence, child disruptive behaviors at school, and child cognitive and behavioral self-regulation. The reduction in disruptive behavior was associated with the implementation of authoritative parenting practices (external regulation), and not associated with child self-regulation.

Relationships between childhood maltreatment, impairment in executive functions and disruptive behavior disorders in a community sample of children.

Evidence points to an independent relationship among childhood maltreatment, impairments in executive functions (EF) and disruptive behavior disorders (DBD). However, it is still not fully understood how these three factors are interrelated. This study evaluated the association between childhood maltreatment and DBD testing the role of EF performance as a mediator or moderator. We studied a probabilistic school-based sample of 2016 children from 6 to 12 years. Mental disorders were assessed using the Development and Well-Being Assessment with parents and children. Children answered questions about exposure to child maltreatment and were evaluated with a set of cognitive tasks addressing inhibitory control, working memory, cognitive flexibility and planning. Childhood maltreatment was strongly associated with DBD (OR = 7.7, CI 95% 4.5-12.9). No association was found between childhood maltreatment and EF performance. Children with DBD showed worse performance in cognitive flexibility, which was not identified as a mediator or moderator of the association between childhood maltreatment and DBD. Results indicate that the association between maltreatment and disruptive behavior occurs regardless of performance in executive function in a community sample. Future studies are essential to confirm these findings and elucidate the cognitive mechanisms involved in this association.

Realizing Relational Preferences Through Transforming Interpersonal Patterns.

Family therapy has often been conceptualized as a conversational process whereby therapists and clients generate new meanings. Based on a 3-year study of conversational practices observable in successful family therapy processes of Chilean families with a child/adolescent who is engaged in disruptive behaviors, we looked for clinical examples of Transforming Interpersonal Patterns (TIPs). TIPs are a key aspect of the IPscope, a framework we used to explore the meaning-making processes in family therapy. TIPs constitute a novel approach to explore therapeutic processes by identifying empirically traceable conversational practices involved in generating "new meanings." TIPs are involved in bringing forth and discursively articulating ("talking-into-being") clients' preferred ways of relating and living (i.e., relational preferences or RPs). We analyze conversational data from successful family therapy sessions/treatments, and present an emergent model of five categories of conversational practices making up TIPs, namely: Preparatory TIPs, Identifier TIPs, Tracker TIPs, Transformer TIPs, and Consolidator TIPs. We have called them "realizers" because these conversational practices help families talk-into-being (or "make real") particular relational preferences. We also offer user-friendly descriptors of realizers' subcategories (e.g., Measuring TIPs) which may help practitioners to recognize, learn, and perform these conversational invitations. Theoretical consequences and future lines of research are discussed.

La terapia familiar generalmente se ha conceptualizado como un proceso conversacional por medio del cual los terapeutas y los pacientes generan nuevos significados. Basándose en un estudio de tres años de prácticas conversacionales observables en procesos satisfactorios de terapia familiar de familias chilenas con un niño/adolescente que tiene comportamientos disruptivos, buscamos ejemplos clínicos de patrones interpersonales transformadores (PIT). Estos patrones son un aspecto clave del "IPscope" o instrumento de evaluación de los patrones interpersonales (Tomm, St. George, Wulff, & Strong, 2014), un marco que usamos para analizar los procesos de creación de significado en la terapia familiar. Los patrones interpersonales transformadores constituyen un enfoque innovador para analizar los procesos terapéuticos mediante el reconocimiento de prácticas conversacionales fáciles de seguir empíricamente que participan en la generación de "significados nuevos". Los patrones interpersonales transformadores intervienen en la presentación y la articulación discursiva ("convencer de crear") de las manersa preferidas de los pacientes de relacionarse y vivir (p. ej.: preferencias relacionales o PR). Analizamos datos conversacionales de sesiones/tratamientos satisfactorios de terapia familiar y presentamos un modelo emergente de cinco categorías de prácticas conversacionales que constituyen patrones interpersonales transformadores, por ejemplo: PIT preparatorios, PIT identificadores, PIT localizadores, PIT transformadores y PIT consolidadores. Los hemos llamado "realizadores" porque estas prácticas conversacionales ayudan a las familias a convencerlas de crear (o a "hacer realidad") preferencias relacionales particulares. También ofrecemos descriptores fáciles de usar de las subcategorías de los realizadores (p. ej.: PIT de medición) que pueden ayudar a los profesionales a reconocer, aprender y llevar a cabo estas invitaciones conversacionales. Se debaten las consecuencias teóricas y las futuras líneas de investigación.

Implementing a community-based parent training behavioral intervention for autism spectrum disorder / Capacitação parental para manejo de comportamentos disruptivos para tea em intervenção comportamental / Tea: capacitación de padres para manejo de conductas problemáticas

The autism spectrum disorder (ASD) affects developmental areas early in life and on families exert significant burden both emotionally and economically. This paper is a non-controlled, multicenter study to train caregivers of ASD individuals displaying disruptive behavior and deficit of communication, based on Applied Behavior Analysis. Results showed a reduction in the disruptive behavior measured by the Aberrant Behavior Checklist (ABC) and also the caregivers' depression and anxiety symptoms assessed by the Hamilton Scale. Group interventions may be an alternative for reaching a higher share of the population.

O transtorno do espectro do autismo (TEA) afeta precocemente áreas de desenvolvimento e resulta em uma sobrecarga significativa para as famílias, tanto emocional quanto economicamente. Este é um estudo não controlado, multicêntrico, com o objetivo de capacitar, com base na Análise Aplicada do Comportamento, cuidadores de indivíduos com TEA que apresentam comportamento disruptivo e deficit de comunicação. Os resultados mostraram redução nos comportamentos disruptivos, medidos pelo Aberrant Behavior Checklist (ABC), e também nos sintomas de depressão e ansiedade dos cuidadores, avaliados pela Escala de Hamilton. As intervenções em grupo podem ser uma alternativa viável para atingir uma parcela maior da população.

O transtorno do espectro do autismo (TEA) afeta precocemente áreas de desenvolvimento e resulta em uma sobrecarga significativa para as famílias, tanto emocional quanto economicamente. Este é um estudo não controlado, multicêntrico, com o objetivo de capacitar, com base na Análise Aplicada do Comportamento, cuidadores de indivíduos com TEA que apresentam comportamento disruptivo e deficit de comunicação. Os resultados mostraram redução nos comportamentos disruptivos, medidos pelo Aberrant Behavior Checklist (ABC), e também nos sintomas de depressão e ansiedade dos cuidadores, avaliados pela Escala de Hamilton. As intervenções em grupo podem ser uma alternativa viável para atingir uma parcela maior da população.

Irritabilidad como síntoma transdiagnóstico / Irritability as a transdiagnostic Symptom

Resumen. La irritabilidad es un síntoma transdiagnóstico que atraviesa la barrera de las patologías internalizantes y externalizantes. Se define como un umbral bajo para experimentar la ira en respuesta a la frustración y es uno de los síntomas más comunes en niños y adolescentes. Las conductas relacionadas con la ira apropiadas para el desarrollo tienden a reflejar frustración en contextos esperados, mientras que la irritabilidad crónica es inapropiada para la situación. La presentación de la irritabilidad, crónica o episódica, es crucial para comprender su significado psicopatológico, en particular porque las estructuras de la irritabilidad episódica y crónica son separables y permanecen estables a lo largo del tiempo. Existen varios estudios acerca de la irritabilidad en patologías como trastorno afectivo bipolar y trastorno de desregulación disruptiva del estado del ánimo, en ambos casos es importante plantearse como punto de partida la identificación de la episodicidad. La irritabilidad también se encuentra presente en el trastorno de personalidad límite observándose dentro de una inestabilidad afectiva debida a una reactividad notable del estado de ánimo. Estas emociones tienen un correlato anatómico relacionado con deficiencias de los circuitos frontolímbicos. Para el manejo de la irritabilidad en las distintas patologías, la evidencia del tratamiento incluye terapia cognitivo conductual, intervención de los padres, mindfulness, pero existe una necesidad apremiante de investigación sobre el tratamiento farmacológico complementario.

Irritability is a transdiagnostic symptom that crosses the barrier between internalizing and externalizing pathologies. It is defined as a low threshold to experience anger in response to frustration and it is one of the most common symptoms in children and adolescents. Behaviors related to appropriate developmental anger tend to reflect frustration in expected contexts, while chronic irritability is inappropriate to the situation. The presentation of irritability, chronic or episodic, is crucial to understanding its psychopathological meaning, particularly because the structures of episodic and chronic irritability are separable and remain stable over time. There are several studies about irritability in pathologies such as bipolar affective disorder and disruptive mood dysregulation disorder, in both cases it is important to consider the identification of episodicity as a starting point. Irritability is also present in borderline personality disorder, where it is expressed as an affective instability due to a remarkable reactivity of the state of mind. These emotions have been anatomically related to deficiencies of the frontolimbic circuits. For the management of irritability in different patholo-gies, the evidence includes cognitive behavioral therapy, parental intervention, mindfulness, but there still is a pressing need for research on complementary pharmacological treatment.

Trastorno negativista desafiante: una puesta al día para pediatras y psiquiatras infantiles

El Trastorno Negativista Desafiante será diagnosticado en un niño que presenta un comportamiento disruptivo para su edad y cultura, caracterizado por un patrón persistente de mal humor o irritabilidad, que discute o presenta comportamientos desafiantes y/o vengativos por lo menos durante los últimos 6 meses. Este trastorno no sólo afecta al niño, sino que es un problema de salud pública, que alcanza a la familia, a los maestros y a los pares. Cuando no se atiende adecuadamente, el trastorno negativista desafiante puede evolucionar a un problema de conducta mayor como el trastorno disocial o a la generación de una personalidad antisocial. Con el fin de ayudar a pediatras y a psiquiatras infantiles en el reconocimiento y manejo de estos "niños problemáticos", este artículo de revisión tiene el objetivo de presentar una puesta al día del concepto, etiopatogenia, clínica, diagnóstico y modalidades terapéuticas para este desafiante grupo de pacientes.

Oppositional Defiant Disorder is diagnosed in a child who exhibits a disruptive behavior for their age and culture, characterized by a persistent pattern of an angry mood or irritability, and who presents oppositional and / or vindictive behavior for at least the last 6 months. This disorder not only affects the child, but is a public health problem that affects the child's family, teachers and peers. When not addressed properly, oppositional defiant disorder can evolve into a significant behavioral problem, such as conduct disorder or antisocial personality disorder. In order to help pediatricians and child psychiatrists in the recognition and management of these "problematic children", this review article aims to present an update of the definition, pathogenesis, clinical presentation, diagnosis and therapeutic modalities for this challenging group of patients.

Parental warmth and psychiatric disorders among Puerto Rican children in two different socio-cultural contexts.

BACKGROUND: Parental warmth (PW) has a strong influence on child development and may precede the onset of psychiatric disorders in children. PW is interconnected with other family processes (e.g., coercive discipline) that may also influence the development of psychiatric disorders in children. We prospectively examined the association between PW and child psychiatric disorders (anxiety, major depression disorder, ADHD, disruptive behavior disorders) over the course of three years among Puerto Rican youth, above and beyond the influence of other family factors. METHODS: Boricua Youth Study participants, Puerto Rican children 5 to 13 years of age at Wave 1 living in the South Bronx (New York) (SB) and San Juan and Canguas (PR) (n = 2,491), were followed for three consecutive years. Youth psychiatric disorders were measured by the Diagnostic Interview Schedule for Children-IV (DISC-IV). Generalized Linear Mixed models tested the association between PW (Wave 1) and psychiatric disorders in the next two years adjusting for demographic characteristics and family processes. RESULTS: Higher levels of PW were related to lower odds of child anxiety and major depressive disorder over time (OR = 0.69[0.60; 0.79]; 0.49[0.41; 0.58], respectively). The strength of the association between PW and ADHD and disruptive behavior disorder declined over time, although it was still significant in the last assessment (OR = 0.44[0.37; 0.52]; 0.46[0.39; 0.54], respectively). PW had a unique influence on psychiatric disorders beyond the influence of other parenting and family processes. Stronger associations were observed among girls for depression and ADHD. CONCLUSIONS: Incorporating PW behaviors such as acceptance, support, and comforting into interventions focused on parenting skills may help prevent child psychiatric disorders.

Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents.

BACKGROUND: The literature on the prevalence of mental disorders affecting children and adolescents has expanded significantly over the last three decades around the world. Despite the field having matured significantly, there has been no meta-analysis to calculate a worldwide-pooled prevalence and to empirically assess the sources of heterogeneity of estimates. METHODS: We conducted a systematic review of the literature searching in PubMed, PsycINFO, and EMBASE for prevalence studies of mental disorders investigating probabilistic community samples of children and adolescents with standardized assessments methods that derive diagnoses according to the DSM or ICD. Meta-analytical techniques were used to estimate the prevalence rates of any mental disorder and individual diagnostic groups. A meta-regression analysis was performed to estimate the effect of population and sample characteristics, study methods, assessment procedures, and case definition in determining the heterogeneity of estimates. RESULTS: We included 41 studies conducted in 27 countries from every world region. The worldwide-pooled prevalence of mental disorders was 13.4% (CI 95% 11.3-15.9). The worldwide prevalence of any anxiety disorder was 6.5% (CI 95% 4.7-9.1), any depressive disorder was 2.6% (CI 95% 1.7-3.9), attention-deficit hyperactivity disorder was 3.4% (CI 95% 2.6-4.5), and any disruptive disorder was 5.7% (CI 95% 4.0-8.1). Significant heterogeneity was detected for all pooled estimates. The multivariate metaregression analyses indicated that sample representativeness, sample frame, and diagnostic interview were significant moderators of prevalence estimates. Estimates did not vary as a function of geographic location of studies and year of data collection. The multivariate model explained 88.89% of prevalence heterogeneity, but residual heterogeneity was still significant. Additional meta-analysis detected significant pooled difference in prevalence rates according to requirement of funcional impairment for the diagnosis of mental disorders. CONCLUSIONS: Our findings suggest that mental disorders affect a significant number of children and adolescents worldwide. The pooled prevalence estimates and the identification of sources of heterogeneity have important implications to service, training, and research planning around the world.

Refinando o diagnóstico de Transtorno de Oposição e Desafio na infância e adolescência: validação e caracterização da dimensão irritável / Refining Oppositional Defiant Disorder diagnosis in children and adolescents: validation and characterization of the irritable dimension

O Transtorno de Oposição e Desafio (TOD) é definido por um padrão recorrente de comportamento desafiante, desobediente e hostil com início na infância e adolescência e caracteriza-se por uma alta taxa de comorbidades. Estudos longitudinais apontam o TOD na infância como um dos principais preditores de psicopatologia na idade adulta. Uma possível explicação para a grande heterogeneidade de comorbidades e trajetórias longitudinais é de que o diagnóstico de TOD abrange distintas dimensões de sintomas, cada qual com seu desfecho. O primeiro objetivo desta tese foi a validação das distintas dimensões do TOD em uma amostra comunitária Brasileira composta de 2512 sujeitos. Através de análise fatorial confirmatória, demonstramos que o modelo que melhor representa a heterogeneidade do TOD é composto por três dimensões: a dimensão "argumentative/defiant" que está associada com transtorno de déficit de atenção/hiperatividade (TDAH); a dimensão "vindictiveness" que possui associação com transtorno de conduta (TC); e a dimensão "angry/irritable mood" onde predominam as associações com transtornos depressivos e de ansiedade. O objetivo seguinte foi investigar o papel da dimensão irritável na classificação nosológica dos transtornos mentais na infância e adolescência. A apresentação da irritabilidade é um aspecto crucial: irritabilidade crônica caracterizada por baixa tolerância à frustração e frequentes explosões de raiva, que é distinta da apresentação episódica, associada ao diagnóstico Transtorno de Humor Bipolar (TB). "Severe mood dysregulation", "disruptive mood dysregulation disorder", ou dimensão irritável do TOD são formas distintas de classificar o fenótipo de irritabilidade crônica. Entretanto, independente da classificação utilizada, a alta taxa de comorbidades é invariavelmente o denominador comum em estudos sobre irritabilidade. Neste sentido, examinamos o impacto da irritabilidade como uma dimensão subjacente a vários transtornos. Para tanto, avaliamos o...

The Oppositional Defiant Disorder (ODD) is defined as a pattern of disobedient, hostile and defiant behavior beginning in childhood or adolescence and often accompanied by a wide range of comorbidities. Longitudinal studies support ODD as a predictor of psychopathology in adulthood. A potential explanation for such heterogeneity of comorbidities and longitudinal trajectories is that ODD diagnosis encompasses distinct clusters of symptoms, each with its outcome. The first aim of this work was the validation of ODD dimensions in a Brazilian community sample of 2512 subjects. Confirmatory factorial analysis showed that the best model for ODD comprised three dimensions: an "argumentative/defiant" dimension, which associates with attention deficit/hyperactivity disorder (ADHD); a "vindictiveness" dimension, which associates with conduct disorder (CD); and an "angry/irritable" dimension where emotional disorders such as depression and anxiety are the most common associations. The next step was the investigation of the role of the irritable dimension of oppositionality in diagnostic classifications of childhood mental disorders. The pattern of irritability is a crucial point: its chronic presentation as easy annoyance and frequent temper outbursts should be differentiated from the episodic course of irritability associated with the specific diagnosis of Bipolar Disorder (BD). "Severe mood dysregulation", "disruptive mood dysregulation disorder", and the irritable dimension of oppositionality are different ways to classify the chronic irritability phenotype. However, regardless of the classification, the high rate of comorbidities is invariably the common denominator in studies of irritability. Therefore, we examined the impact of irritability as a dimension cutting across multiple settings: individuals without any diagnosis, subjects with ADHD, and also those with emotional disorders. For that we used two samples, one from Brazil, with 2.512 subjects, and one...

Irritability in children and adolescents: past concepts, current debates, and future opportunities

Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.

Transtorno do déficit de atenção e hiperatividade na escola: mediação psicopedagógica / Attention deficit/hyperactivity disorder at school: mediation psychopedagogical

O estudo apresenta um caso de mediação psicopedagógica para diagnóstico de Transtorno do Déficit de Atenção/Hiperatividade (TDAH), tratamento, orientação na escola, família, e com a criança. A criança foi encaminhada pela psicopedagoga para avaliação interdisciplinar dos aspectos psicopedagógicos, neuropsicológico, neuropediátrico, psiquiátrico e familiar. A queixa da escola e da mãe era de que a criança estava agressiva, opositora, recusava-se a fazer as atividades, provocava confusões em casa e na sala de aula, era desorganizada, sem cuidado com seus pertences pessoais, não conseguia manter amizades e não demonstrava interesse pelas lições. Foi tratada com medicação metilfenidato, com melhora imediata da impulsividade e desatenção. Foram aplicados testes neuropsicológicos, psicopedagógicos, escalas de comportamento, antes e após o tratamento medicamentoso. Após o tratamento e as intervenções, foi verificada grande melhora no comportamento, na aprendizagem e nas relações pessoais. Os resultados nos testes foram para melhor; em relação à aprendizagem, foi possível verificar uma dificuldade fonológica do processo de alfabetização, que antes não foi constatado devido a sua recusa. A psicopedagoga fez orientação na escola e soube na ocasião que a criança frequentava o reforço escolar na escola, com conteúdo mais relacionado à matéria atual, assim foi realizada orientação para que fosse trabalhado o processo de alfabetização com ênfase nos aspectos fonológicos devido às dificuldades apresentadas na escrita e na leitura. A relação Saúde e Educação trouxe perspectivas e intervenções importantes na vida escolar, demonstrando que é possível mudar o comportamento e a qualidade da aprendizagem de crianças com diagnóstico de TDAH.(AU)

The study presents a case of psycho-pedagogical mediation to the Attention Deficit/Hyperactivity Disorder diagnoses, treatment, and school/family/child guidance. The child was referred by the psycho-pedagogue to the interdisciplinary evaluation of the psycho-pedagogical, neuropsychological, neuropediatrician, psychiatric and familiar aspects. The school and mother's complain was that the child was aggressive, objector, declining to do the activities, troublemaker at home and at school, disorganized, careless with his/her personal belongs, difficulty in keeping friends and not interested in classes. The child was treated with methylphenidate, with a prompt impulsivity and neglect improvement. Neuropsychological and psychiatric tests have been applied, behavior scales, before and after the drug treatment. After the treatment and the interventions, a great behavior improvement was verified, as in the learning process and in the social relations. The tests results were for better, concerning to the learning process, it was possible to realize a phonologic difficulty, which was not identified previously due to the refusal. During the scholar guidance, the psycho-pedagogue noted that the child was taking tutoring classes at school, with a content related to the current subject, and so it was advised that the literacy ability should be worked with a focus on the phonologic aspects due to the difficulties showed in the writing and reading skills. The Health-Education relation brought out important prospects and interventions in the scholar life, showing that it is possible to change the behavior and the quality of learning in children with ADHD.(AU)

Avaliação de crianças pré-escolares: relação entre testes de funções executivas e indicadores de desatenção e hiperatividade / Assessment of preschool children: relation between executive functions tests and inattention and hyperactivity indicators

Funções executivas (FE) referem-se às habilidades necessárias para planejar, iniciar, realizar e monitorar comportamentos intencionais. Incluem inibição, memória de trabalho, flexibilidade cognitiva, atenção seletiva, planejamento e organização e, de forma geral, são habilidades fundamentais à aprendizagem e ao comportamento autorregulado. As FE podem estar comprometidas em alguns distúrbios do desenvolvimento, como o Transtorno de Déficit de Atenção e Hiperatividade. Perante esse panorama e pautando-se na crescente ênfase da literatura sobre a importância da avaliação precoce, esta pesquisa investigou as relações entre desempenho em testes de funções executivas e indicadores de desatenção e hiperatividade em crianças pré-escolares de amostra não-clínica. Participaram 85 crianças de uma escola municipal de Educação Infantil da Grande SP, com idades entre quatro e seis anos, avaliadas no Teste de Trilhas para pré-escolares (TT-PE) e no Teste de Atenção por Cancelamento (TAC). Pais e professores responderam à SNAP-IV. As crianças com maiores índices de desatenção e hiperatividade, conforme relato dos pais, tenderam a apresentar piores desempenhos no TAC e aquelas com maiores índices de desatenção e hiperatividade, conforme relato dos professores, tenderam a apresentar piores desempenhos em diversas medidas do TAC e TT-PE. As relações entre desempenho nos testes e indicadores desatenção e hiperatividade tenderam a ser mais consistentes quando consideradas as respostas dos professores do que as dos pais. O estudo evidenciou que as relações entre desempenho em testes de FE e indicadores de desatenção e hiperatividade podem ser observadas desde idades precoces, em amostras não-clínicas, contribuindo para a discussão sobre avaliação e identificação precoce.(AU)

Executive functions (EF) refer to the skills needed to plan, initiate, implement and monitor intentional conduct. They include inhibition, working memory, cognitive flexibility, selective attention, planning and organization and, in general, are fundamental skills to learning and self-regulated behavior. EF may be compromised in some developmental disorders, such as Attention Deficit Disorder and Hyperactivity. Before this background and based on the increasing emphasis in the literature on the importance of early evaluation, this study investigated the relationship between performance in executive functions tests and inattention and hyperactivity indicators in preschool children of a non-clinical sample. A total of 85 children of a kindergarten public school from the state of SP, aged four and six years, were assessed at Trial Making Test for Preschoolers (TT-PE) and Attention Test for Cancellation (TAC). Parents and teachers were asked to answer SNAP-IV. Children with higher levels of inattention and hyperactivity, as reported by their parents, tended to have worse performance in TAC, and those with higher levels of inattention and hyperactivity, as reported teachers, tended to have worse performance on several measures of TAC and TT-PE. The relationship between test performance and indicators inattention and hyperactivity tended to be more consistent when considering the responses of teachers, instead of the parents' ones. The study showed that the relationship between performance on EF tests and indicators of inattention and hyperactivity can be observed from early ages, in nonclinical samples, contributing to the discussion on assessment and early identification.(AU)

Avaliação de crianças pré-escolares: relação entre testes de funções executivas e indicadores de desatenção e hiperatividade / Assessment of preschool children: relation between executive functions tests and inattention and hyperactivity indicators

Funções executivas (FE) referem-se às habilidades necessárias para planejar, iniciar, realizar e monitorar comportamentos intencionais. Incluem inibição, memória de trabalho, flexibilidade cognitiva, atenção seletiva, planejamento e organização e, de forma geral, são habilidades fundamentais à aprendizagem e ao comportamento autorregulado. As FE podem estar comprometidas em alguns distúrbios do desenvolvimento, como o Transtorno de Déficit de Atenção e Hiperatividade. Perante esse panorama e pautando-se na crescente ênfase da literatura sobre a importância da avaliação precoce, esta pesquisa investigou as relações entre desempenho em testes de funções executivas e indicadores de desatenção e hiperatividade em crianças pré-escolares de amostra não-clínica. Participaram 85 crianças de uma escola municipal de Educação Infantil da Grande SP, com idades entre quatro e seis anos, avaliadas no Teste de Trilhas para pré-escolares (TT-PE) e no Teste de Atenção por Cancelamento (TAC). Pais e professores responderam à SNAP-IV. As crianças com maiores índices de desatenção e hiperatividade, conforme relato dos pais, tenderam a apresentar piores desempenhos no TAC e aquelas com maiores índices de desatenção e hiperatividade, conforme relato dos professores, tenderam a apresentar piores desempenhos em diversas medidas do TAC e TT-PE. As relações entre desempenho nos testes e indicadores desatenção e hiperatividade tenderam a ser mais consistentes quando consideradas as respostas dos professores do que as dos pais. O estudo evidenciou que as relações entre desempenho em testes de FE e indicadores de desatenção e hiperatividade podem ser observadas desde idades precoces, em amostras não-clínicas, contribuindo para a discussão sobre avaliação e identificação precoce.(AU)

Executive functions (EF) refer to the skills needed to plan, initiate, implement and monitor intentional conduct. They include inhibition, working memory, cognitive flexibility, selective attention, planning and organization and, in general, are fundamental skills to learning and self-regulated behavior. EF may be compromised in some developmental disorders, such as Attention Deficit Disorder and Hyperactivity. Before this background and based on the increasing emphasis in the literature on the importance of early evaluation, this study investigated the relationship between performance in executive functions tests and inattention and hyperactivity indicators in preschool children of a non-clinical sample. A total of 85 children of a kindergarten public school from the state of SP, aged four and six years, were assessed at Trial Making Test for Preschoolers (TT-PE) and Attention Test for Cancellation (TAC). Parents and teachers were asked to answer SNAP-IV. Children with higher levels of inattention and hyperactivity, as reported by their parents, tended to have worse performance in TAC, and those with higher levels of inattention and hyperactivity, as reported teachers, tended to have worse performance on several measures of TAC and TT-PE. The relationship between test performance and indicators inattention and hyperactivity tended to be more consistent when considering the responses of teachers, instead of the parents' ones. The study showed that the relationship between performance on EF tests and indicators of inattention and hyperactivity can be observed from early ages, in nonclinical samples, contributing to the discussion on assessment and early identification.(AU)

Transtorno do déficit de atenção e hiperatividade na escola: mediação psicopedagógica / Attention deficit/hyperactivity disorder at school: mediation psychopedagogical

O estudo apresenta um caso de mediação psicopedagógica para diagnóstico de Transtorno do Déficit de Atenção/Hiperatividade (TDAH), tratamento, orientação na escola, família, e com a criança. A criança foi encaminhada pela psicopedagoga para avaliação interdisciplinar dos aspectos psicopedagógicos, neuropsicológico, neuropediátrico, psiquiátrico e familiar. A queixa da escola e da mãe era de que a criança estava agressiva, opositora, recusava-se a fazer as atividades, provocava confusões em casa e na sala de aula, era desorganizada, sem cuidado com seus pertences pessoais, não conseguia manter amizades e não demonstrava interesse pelas lições. Foi tratada com medicação metilfenidato, com melhora imediata da impulsividade e desatenção. Foram aplicados testes neuropsicológicos, psicopedagógicos, escalas de comportamento, antes e após o tratamento medicamentoso. Após o tratamento e as intervenções, foi verificada grande melhora no comportamento, na aprendizagem e nas relações pessoais. Os resultados nos testes foram para melhor; em relação à aprendizagem, foi possível verificar uma dificuldade fonológica do processo de alfabetização, que antes não foi constatado devido a sua recusa. A psicopedagoga fez orientação na escola e soube na ocasião que a criança frequentava o reforço escolar na escola, com conteúdo mais relacionado à matéria atual, assim foi realizada orientação para que fosse trabalhado o processo de alfabetização com ênfase nos aspectos fonológicos devido às dificuldades apresentadas na escrita e na leitura. A relação Saúde e Educação trouxe perspectivas e intervenções importantes na vida escolar, demonstrando que é possível mudar o comportamento e a qualidade da aprendizagem de crianças com diagnóstico de TDAH.(AU)

The study presents a case of psycho-pedagogical mediation to the Attention Deficit/Hyperactivity Disorder diagnoses, treatment, and school/family/child guidance. The child was referred by the psycho-pedagogue to the interdisciplinary evaluation of the psycho-pedagogical, neuropsychological, neuropediatrician, psychiatric and familiar aspects. The school and mother's complain was that the child was aggressive, objector, declining to do the activities, troublemaker at home and at school, disorganized, careless with his/her personal belongs, difficulty in keeping friends and not interested in classes. The child was treated with methylphenidate, with a prompt impulsivity and neglect improvement. Neuropsychological and psychiatric tests have been applied, behavior scales, before and after the drug treatment. After the treatment and the interventions, a great behavior improvement was verified, as in the learning process and in the social relations. The tests results were for better, concerning to the learning process, it was possible to realize a phonologic difficulty, which was not identified previously due to the refusal. During the scholar guidance, the psycho-pedagogue noted that the child was taking tutoring classes at school, with a content related to the current subject, and so it was advised that the literacy ability should be worked with a focus on the phonologic aspects due to the difficulties showed in the writing and reading skills. The Health-Education relation brought out important prospects and interventions in the scholar life, showing that it is possible to change the behavior and the quality of learning in children with ADHD.(AU)

Avaliação de crianças pré-escolares: relação entre testes de funções executivas e indicadores de desatenção e hiperatividade / Assessment of preschool children: relation between executive functions tests and inattention and hyperactivity indicators

Funções executivas (FE) referem-se às habilidades necessárias para planejar, iniciar, realizar e monitorar comportamentos intencionais. Incluem inibição, memória de trabalho, flexibilidade cognitiva, atenção seletiva, planejamento e organização e, de forma geral, são habilidades fundamentais à aprendizagem e ao comportamento autorregulado. As FE podem estar comprometidas em alguns distúrbios do desenvolvimento, como o Transtorno de Déficit de Atenção e Hiperatividade. Perante esse panorama e pautando-se na crescente ênfase da literatura sobre a importância da avaliação precoce, esta pesquisa investigou as relações entre desempenho em testes de funções executivas e indicadores de desatenção e hiperatividade em crianças pré-escolares de amostra não-clínica. Participaram 85 crianças de uma escola municipal de Educação Infantil da Grande SP, com idades entre quatro e seis anos, avaliadas no Teste de Trilhas para pré-escolares (TT-PE) e no Teste de Atenção por Cancelamento (TAC). Pais e professores responderam à SNAP-IV. As crianças com maiores índices de desatenção e hiperatividade, conforme relato dos pais, tenderam a apresentar piores desempenhos no TAC e aquelas com maiores índices de desatenção e hiperatividade, conforme relato dos professores, tenderam a apresentar piores desempenhos em diversas medidas do TAC e TT-PE. As relações entre desempenho nos testes e indicadores desatenção e hiperatividade tenderam a ser mais consistentes quando consideradas as respostas dos professores do que as dos pais. O estudo evidenciou que as relações entre desempenho em testes de FE e indicadores de desatenção e hiperatividade podem ser observadas desde idades precoces, em amostras não-clínicas, contribuindo para a discussão sobre avaliação e identificação precoce...

Executive functions (EF) refer to the skills needed to plan, initiate, implement and monitor intentional conduct. They include inhibition, working memory, cognitive flexibility, selective attention, planning and organization and, in general, are fundamental skills to learning and self-regulated behavior. EF may be compromised in some developmental disorders, such as Attention Deficit Disorder and Hyperactivity. Before this background and based on the increasing emphasis in the literature on the importance of early evaluation, this study investigated the relationship between performance in executive functions tests and inattention and hyperactivity indicators in preschool children of a non-clinical sample. A total of 85 children of a kindergarten public school from the state of SP, aged four and six years, were assessed at Trial Making Test for Preschoolers (TT-PE) and Attention Test for Cancellation (TAC). Parents and teachers were asked to answer SNAP-IV. Children with higher levels of inattention and hyperactivity, as reported by their parents, tended to have worse performance in TAC, and those with higher levels of inattention and hyperactivity, as reported teachers, tended to have worse performance on several measures of TAC and TT-PE. The relationship between test performance and indicators inattention and hyperactivity tended to be more consistent when considering the responses of teachers, instead of the parents' ones. The study showed that the relationship between performance on EF tests and indicators of inattention and hyperactivity can be observed from early ages, in nonclinical samples, contributing to the discussion on assessment and early identification...