El dilema del metilfenidato en el TDAH: estudio de caso / The dilema of methylphenidate in the ADHD: case of study

El Trastorno por Déficit de Atención con Hiperactividad (TDAH), es una de las alteraciones del neurodesarrollo de mayor prevalencia; su trinomio sintomático de desatención, hiperactividad e impulsividad, genera significativas dificultades en distintos contextos en donde se desenvuelve el niño. Este trabajo presenta el estudio de caso de un niño de 11 años, diagnosticado con TDAH con predominio de déficit de atención (TDAH-DA), medicado con metilfenidato (MFD) a 36 mg. Se buscó analizar y comparar las diferencias en el desempeño de atención y funciones ejecutivas, evaluadas a través de la batería neuropsicológica Monitoreo Cognitivo Computarizado, en relación a la presencia o ausencia de medicación. Los resultados permiten evidenciar como la suspensión de la mediación en este caso afectó el sistema pre-atencional, la atención sostenida y la flexibilidad cognitiva, y no así la atención selectiva, la fluencia de lectura, la capacidad de nominación y el output motor, en especial de la mano izquierda, los cuales incluso obtuvieron un mejor desempeño al suspenderla. Este estudio plantea los beneficios del MFD en el sistema pre-atencional y atención sostenida más que en la atención selectiva y su influencia en el detrimento de la velocidad de procesamiento.

The Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders. Its symptomatic trinomial of inattention, hyperactivity and impulsiveness generates significant difficulties within several contexts in which the child evolves. This work shows a case study of an 11-yearoldboy, diagnosed with ADHD subtype: inattentive, medicated with methylphenidate (MPH) 36mg. The aim of this study was to analyze and compare the differences regarding the development of attention and executive functions, assessed through the neuropsychological battery Cognitive Computerized Monitoring related with the presence or absence of medication. In this case, the results show how withdrawing the medication affects the pre-attentional system, sustained attention and cognitive flexibility. On the other hand, the results demonstrate that the cessation of medication does not affect selective attention, Reading fluency, naming capacity and motor output, especially the right hand’s motor output that even showed better performance when suspending medication. This study confirms the benefits of MPH in the pre-attentional system and sustained attention, more than selective attention and its influence in the detriment of processing speed.

Evaluating reading and metacognitive deficits in children and adolescents with attention deficit hyperactivity disorder.

The reading achievement of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) has scarcely been explored in research conducted in the Spanish language and when it has, the results have been contradictory. The focus of the present research is to analyze participants' reading competency and metacognitive strategies as they carry out reading comprehension tasks. The sample was comprised of 187 Argentine schoolchildren aged 9 to 13 years old. 94 constituted the control group and the clinical group consisted of 93 schoolchildren diagnosed with ADHD. The metacognitive assessment was made up of two metacognitive tests, the Reading Awareness Scale (ESCOLA; acronym in Spanish) and a Spanish adaptation of Metacognitive Awareness of Reading Strategies Inventory (MARSI), and one test of reading comprehension, the Evaluation of Reading Processes for Secondary Education Students (PROLEC-SE; acronym in Spanish). Students with ADHD had lower achievement on tests o reading comprehension compared to the control group. Nevertheless, our results suggest their difficulties did not stem from readin comprehension problems, but rather from alterations in their Executive Functions, because when subjects' reading comprehensio was equalized, students with ADHD still exhibited a lower level of Metacognition, particularly when it came to planning.

Evaluating reading and metacognitive deficits in children and adolescents with attention deficit hyperactivity disorder

The reading achievement of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) has scarcely been explored in research conducted in the Spanish language and when it has, the results have been contradictory. The focus of the present research is to analyze participants’ reading competency and metacognitive strategies as they carry out reading comprehension tasks. The sample was comprised of 187 Argentine schoolchildren aged 9 to 13 years old. 94 constituted the control group and the clinical group consisted of 93 schoolchildren diagnosed with ADHD. The metacognitive assessment was made up of two metacognitive tests, the Reading Awareness Scale (ESCOLA; acronym in Spanish) and a Spanish adaptation of Metacognitive Awareness of Reading Strategies Inventory (MARSI), and one test of reading comprehension, the Evaluation of Reading Processes for Secondary Education Students (PROLEC-SE; acronym in Spanish). Students with ADHD had lower achievement on tests of reading comprehension compared to the control group. Nevertheless, our results suggest their difficulties did not stem from reading comprehension problems, but rather from alterations in their Executive Functions, because when subjects’ reading comprehension was equalized, students with ADHD still exhibited a lower level of Metacognition, particularly when it came to planning (AU)

El rendimiento lector en relación con la metacognición en niños y adolescentes con trastorno por déficit de atención con hiperactividad (TDAH) ha sido escasamente explorado en el ámbito de habla hispana, y en aquellos casos que lo han abordado, los resultados son contradictorios. La presente investigación analiza las competencias y uso de estrategias metacognitivas durante la realización de tareas de comprensión lectora. La muestra estuvo compuesta por 187 escolares argentinos de edades comprendidas entre los 9 y los 13 años; 94 de ellos constituyeron el grupo control y otros 93 el grupo clínico formado por escolares diagnosticados con TDAH. La evaluación metacognitiva se realizó utilizando la escala de conciencia lectora (ESCOLA) y una adaptación al español del metacognitive awareness of reading strategies inventory (MARSI). Adicionalmente, para conocer el nivel de comprensión lectora se administraron varios textos seleccionados de la prueba de evaluación de procesos lectores (PROLEC-SE). Los TDAH mostraron un rendimiento inferior en los tests de comprensión lectora en comparación con el grupo control; no obstante, nuestros resultados sugieren que sus dificultades no se explican tanto como un problema de comprensión lectora sino como una alteración en su función ejecutiva, puesto que, igualando a los sujetos en comprensión lectora, los TDAH siguen mostrando un nivel inferior de metacognición, particularmente en lo que se refiere a los procesos de planificación (AU)