Cognitive versus behavioral ADHD phenotype: what is it all about?

The ADHD PASS assessment is discussed. 100 combined and 50 inattentive ADHD patients with DSM IV - TR criteria, no comorbidity, and no previous treatment were enrolled. Those with SNAP-IV> or =2.5/1.8 (teacher/parents) [n=96] were randomly assigned to 1 of 3 treatment groups: Concerta, humanistic psychology, and Concerta+psychology. Those with SNAP-IV<2.5/1.8 [n=54] to 1 of 2 groups: Concerta and Concerta+psychology. All of them [n=150] we administered the SNAP-IV and cognitive DN:CAS battery at baseline and 6 and 12 months later. Cluster analysis and paired Student t-test were applied. The cluster analysis produced three cognitive profiles: one [n=96] with planning dysfunction and SNAP-IV> or =2.5/1.8, the majority [n=76] combined ADHD; another [n=38] with successive processing dysfunction and SNAP-IV<2.5/1.8, the majority [n=28] inattentive ADHD; and another [n=16] without cognitive dysfunction and with SNAP-IV<2.5/1.8, [n=8] combined and [n=8] inattentive. Only planning ameliorated at 12 months assessment. It was better in group 3 (p<0.1) than in group 1 (p<0.5), than in group 2 (p<0.4/0.3). Remission was parallel to planning improvement, group 3>group 1> group 2. PASS assessment in ADHD may be relevant.

Mecanismos cerebrales implicados en la toma de decisiones: ¿de qué se trata? / The brain mechanisms involved in making decisions: what exactly are we talking about?

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[Topiramate and epilepsy in the light of Das-Naglieri Cognitive Assessment System]. / Topiramato y epilepsia a la luz del Das-Naglieri Cognitive Assessment System.

INTRODUCTION: Cognitive side effect is a possible effect of topiramate. Cognitive function is not unanimously defined and a test measures according to the concept is based on. On the other hand, behavioral dysfunction is frequent in epileptics and the euthimic effect of topiramate on impulsive dysfunction is known. AIMS: To asses the cognitive effect of topiramate with a modern battery, Das-Naglieri Cognitive Assessment System (DN:CAS), which diagnoses mental programs, but not only achievement. Also, to test the influence of topiramate on behavior. PATIENTS AND METHODS: As a prospective study, 35 patients with idiopathic or cryptogenic epilepsies were administered DN:CAS battery, and, simultaneously, patients and parents were given behavioral questionnaires at baseline, and after 6 and 12 months on topiramate. Cognitive scores were compared to those of a group of healthy controls at baseline, and baseline scores were compared to 6 and 12 months follow-up scores within the patient group. t-Student was applied. RESULTS: Patient scores were lower in successive processing before treatment as compared to controls (p < 0.001). After 6 months no change was noted. After 12 months of treatment, patients scored significantly better in planning processing than before treatment (p = 0.04) and, moreover, improved behavioral scores were noted. CONCLUSIONS: The patients showed a successive processing dysfunction not related with topiramate. An improved planning processing and behavioral pattern were observed 12 months after treatment. According to the euthimic effect of topiramate and the neurocognitive-neuroimpulsive interaction, a positive effect of topiramate on DN:CAS cognition and behavior can be postulated.

Topiramato y epilepsia a la luz del Das-Naglieri Cognitive Assessment System / Topiramate and epilepsy in the light of Das-Naglieri Cognitive assessment system

Introducción. El efecto cognitivo indeseable es un posible efecto del topiramato (TPM). La definición de función cognitiva no es unánime, y una prueba mide según el concepto en que se basa. También son frecuentes las disfunciones de comportamiento en los epilépticos y se conoce el efecto eutímico del TPM sobre la disfunción impulsiva. Objetivo. Comprobar el efecto cognitivo del TPM con la moderna batería cognitiva DN:CAS (Das-Naglieri Cognitive Assessment System) de fundamento neurológico, que diagnostica programas mentales y no exclusivamente rendimiento. Asimismo, comprobar si el TPM influye en los comportamientos. Pacientes y métodos. Como estudio prospectivo, a 35 pacientes con epilepsia idiopática o criptogenética se les administró el DN: CASy a pacientes y padres cuestionarios de comportamientos antes del tratamiento y 6 y 12 meses después. Las puntuaciones de antes del tratamiento se compararon con un grupo control. Se aplicó la t de Student. Resultados. Antes del tratamiento, los epilépticos de la muestra, en comparación con los controles, puntuaron significativamente peor en secuencial (p < 0,001). Seis meses después, las puntuaciones no cambiaron significativamente. 12 meses después, los pacientes puntuaron significativamente mejor en planificación (p = 0,04) con respecto a antes del tratamiento. A los 12 meses, asimismo, mejoraron significativamente los comportamientos, según las escalas aplicadas. Conclusiones. Los epilépticos de la muestra presentaron una disfunción secuencial no atribuible al tratamiento. A los 12 meses, mostraron una mejor planificación DN:CAS y un mejor comportamiento. Se postula una posible explicación según el efecto eutímico del TPM y los conocimientos actuales de interacción entre los circuitos neurocognitivos y neuroimpulsivos (AU)

Introduction. Cognitive side effect is a possible effect of topiramate. Cognitive function is not unanimously defined and a test measures according to the concept is based on. On the other hand, behavioral dysfunction is frequent in epileptics and the euthimic effect of topiramate on impulsive dysfunction is known. Aims. To asses the cognitive effect of topiramate with a modern battery, Das-Naglieri Cognitive Assessment System (DN:CAS), which diagnoses mental programs, but not only achievement. Also, to test the influence of topiramate on behavior. Patients and methods. As a prospective study, 35 patients with idiopathic or cryptogenic epilepsies were administered DN:CAS battery, and, simultaneously, patients and parents were given behavioral questionnaires at baseline, and after 6 and 12 months on topiramate. Cognitive scores were compared to those of a group of healthy controls at baseline, and baseline scores were compared to 6 and 12 months follow-up scores within the patient group. t-Student was applied. Results. Patient scores were lower in successive processing before treatment as compared to controls (p < 0.001). After 6 months no change was noted. After 12 months of treatment, patients scored significantly better in planning processing than before treatment (p = 0.04) and, moreover, improved behavioral scores were noted. Conclusions. The patients showed a successive processing dysfunction not related with topiramate. An improved planning processing and behavioral pattern were observed 12 months after treatment. According to the euthimic effect of topiramate and the neurocognitive-neuroimpulsive interaction, a positive effect of topiramate on DN:CAS cognition and behavior can be postulated (AU)

La función intelectual: ¿de qué se trata? / Intellectual function: what is it about?

Introducción: La función intelectual no está claramente definida en términos neurológicos. Desde 1994, se dispone de una concepción basada en evidencias neurológicas, conocida como teoría PASS, acrónimo de los cuatro programas definidos: planificación, atención, simultáneo y secuencial. Objetivo: Comprobar si la batería WISC-R (Wechsler InteIligence Scale for Children-Revised) valora la función cognitiva PASS y, en particular, la planificación, el programa de mayor rendimiento intelectual y el más susceptible de ser tratado. Material y métodos: Se seleccionaron 60 pacientes, con una escolaridad normal, de edades comprendidas entre los 5 y 12 años: mitad niños y mitad niñas. Procedimiento: administración del WISC-R y DN:CAS (Das Naglieri: Cognitive Assessment System), batería traducida y validada para la valoración de los procesamientos PASS. Resultados: Mediante análisis factorial se verificó la discriminación de los cuatro procesamientos PASS (planificación, atención, secuencial y simultáneo) y, a la vez, su correspondencia con las pruebas del WISC-R. Las pruebas de este último se corresponden, sobre todo, con el procesamiento simultáneo y menos con el secuencial y la atención; ninguna prueba se corresponde con la planificación; y algunas pruebas lo hacen con un factor que no es procesamiento PASS. Discusión y conclusiones: Se explica el concepto PASS haciendo énfasis en la planificación y su relación con la denominada función ejecutiva. Se sostiene la ventaja, desde el punto de vista diagnóstico y terapéutico, que supone poder valorar la capacidad intelectual como mecanismo de producción neurológico, utilizando pruebas específicas no heterogéneas al alcance, incluso, de pediatras del desarrollo y pediatría social. Se insiste en la concepción dinámica de inteligencia y se sugiere una redefinición del retraso mental

Introduction. Intellectual function has not yet been clearly defined in neurological terms. In 1994, a conception was introduced based on neurological evidence, the theory known as PASS, which stands for four programs: planning, attention, simultaneous and successive. Objective. To determine whether the Wechsler Intelligence Scale for Children-Revised (WISC-R) cognitive battery assesses the cognitive PASS function, in particular, planning, the program involving the highest intellectual performance and that most susceptible to treatment, if necessary. Material and methods. Sixty children (30 boys and 30 girls aged 5 to 12 years) with a normal level of schooling were selected. The procedure consisted of administering the WISC-R and the Das-Naglieri Cognitive Assessment System (DN:CAS), a battery translated and validated for assessing PASS processing. Results. The discrimination of the four PASS processes, planning, attention, simultaneous and successive, was verified by factorial analysis. The correspondence between PASS processing and the WISC-R tests was also established. The WISC-R tests primarily assess PASS simultaneous processing and, to some extent, successive and attention. No WISC-R test identifies PASS planning processing. Some tests identify a factor that is not a PASS process. Discussion and conclusions. The PASS concept places particular emphasis on planning and its relationship to the so-called executive function. The advantage, from both the diagnostic and therapeutic points of view, is that it enables the assessment of intellectual capacity as a neurological mechanism of production by means of specific, non-heterogeneous tests that can be used by pediatricians in both the developmental and social areas. We insist on the dynamic conception of intelligence this knowledge implies, and suggest a redefinition of mental retardation

[Emotional behaviors as a neurological dysfunction]. / Conductas emocionales como disfunción neurológica.

INTRODUCTION: The hypothesis of the emotional component of behaviors can be explained by a specific neurological mechanism was stated. PATIENTS AND METHODS: A sample of 749 cases, all between 5 and 14 year old, with different behavioral and cognitive problems was selected from attendance to the Neuropediatric/Neuropsychopedagogic Unit from 1994 to 2000. A sub sample of 20 cases with PASS planning processing scoring less than 1SD was also selected. A design of mainly qualitative research according to case analysis was followed, behavioral data being provided by patients and their parents and analyzed with video recorder assistance. To avoid the study to be biased techniques as triangulation were applied. Quantitative cognitive data were obtained by using DN:CAS battery for diagnosis of PASS processing. A procedure for diagnosis and treatment of behaviors, previously reported, was followed. The cases of the sub sample were tested before and after emotional treatment without cognitive remediation, the results being tested by Student t. RESULTS: The responders were 82% according to not only the criterion of solution of the behavioral problem, for example, anorexia, psychosomatism, non neurological paroxysm an so on, but also, the sufficient amelioration assessed by the patients, their parents and the researchers. All cases, however, were required the disappearance of observable defensive behaviors in enough quantity to deduce an important maturation change. Significant difference was observed in planning. DISCUSSION: Defensive behaviors as masquerade behaviors are explained in the light of neurological reasons. The neurological processing of the sensibility of danger is emphasized according to the most recent knowledge. CONCLUSION: All behaviors can activate the neurological processing of danger feeling

Conductas emocionales como disfunción neurológica / Emotional behaviors as a neurological dysfunction

Introducción. Se plantea la hipótesis de si el componente emocional de las conductas puede explicarse por un mecanismo neurológico determinado. Pacientes y métodos. Se seleccionó una muestra de 749 casos, de edades entre 5 y 14 años, con diversos problemas conductuales y cognitivos atendidos en la Unidad de Neuropediatría/ Neuropsicopedagogía, entre 1994-2000, y una submuestra de 20 casos seleccionados por tener, además, el procesamiento cognitivo PASS planificación en valores de -1 DE. El diseño es de investigación preferentemente cualitativa de análisis de casos con el empleo de datos conductuales, aportados por pacientes y padres, analizados con registro audiovisual. Se emplearon técnicas consideradas adecuadas, como la triangulación, para obviar posibles sesgos. Los datos cognitivos fueron, fundamentalmente, los valores cuantitativos proporcionados por la batería DN:CAS para el diagnóstico PASS. Se aplicó un procedimiento de diagnóstico-intervención previamente publicado. Se practicó un estudio pretest-retest con la submuestra antes y después del tratamiento emocional sin tratamiento cognitivo, con la aplicación de la t de Student. Resultados. Los respondedores fueron 82 por ciento, y el criterio fue la curación del problema motivo de la consulta, anorexia, trastorno somatomorfo, paroxismo no neurológico, etc., o la mejora en un grado mínimamente suficiente según el/la paciente, los padres y los investigadores; se exigió, además, la desaparición de las conductas defensivas objetivables, en cantidad suficiente como para indicar un cambio madurativo importante. La planificación mejoró con significación estadística. Discusión. Se explican con detalle las conductas de defensa denominadas enmascaradoras y se hace hincapié en el procesamiento neurológico de la `sensibilidad' de peligro, según los conocimientos más actuales. Conclusión. Todas las conductas pueden activar el procesamiento neurológico del `sentir peligro' (AU)

[PASS neurocognitive dysfunction in attention deficit]. / Disfunción neurocognitiva PASS del déficit de atención.

INTRODUCTION: Attention deficit disorder shows both cognitive and behavioral patterns. OBJECTIVE: To determine a particular PASS (planning, attention, successive and simultaneous) pattern in order to early diagnosis and remediation according to PASS theory. PATIENTS AND METHODS: 80 patients were selected from the neuropediatric attendance, aged 6 to 12 years old, 55 boys and 25 girls. Inclusion criteria were inattention (80 cases) and inattention with hyperactive symptoms (40 cases) according to the Diagnostic and Statistical Manual (DSM-IV). Exclusion criteria were the criteria of phonologic awareness previously reported, considered useful to diagnose dyslexia. A control group of 300 individuals, aged 5 to 12 years old, was used, criteria above mentioned being controlled. DN:CAS (Das-Naglieri Cognitive Assessment System) battery, translated to native language, was given to assess PASS cognitive processes. Results were analyzed with cluster analysis and t-Student test. Statistical factor analysis of the control group had previously identified the four PASS processes: planning, attention, successive and simultaneous. RESULTS: The dendrogram of the cluster analysis discriminated three categories of attention deficit disorder: 1. The most frequent, with planning deficit; 2. Without planning deficit but with deficit in other processes, and 3. Just only a few cases, without cognitive processing deficit. Cognitive deficiency in terms of means of scores was statistically significant when compared to control group (p = 0.001). CONCLUSIONS: According to PASS pattern, planning deficiency is a relevant factor. Neurological planning is not exactly the same than neurological executive function. The behavioral pattern is mainly linked to planning deficiency, but also to other PASS processing deficits and even to no processing deficit.

Disfunción neurocognitiva PASS del déficit de atención / Neurocognitive dysfunction in attention deficit disorder

Introducción. El trastorno por déficit de atención implica un trastorno conductual y cognitivo. Objetivo. Comprobar si existe un patrón característico de procesamientos cognitivos PASS (planificación, atención, secuencial y simultáneo) para el diagnóstico precoz y la intervención cognitiva eficaz según la teoría PASS. Pacientes y métodos. Se seleccionaron 80 pacientes de las consultas de neuropediatría, de entre 6 y 12 años, 55 niños y 25 niñas. Los criterios de inclusión fueron inatención (80 casos) y, de ellos, 40 casos, además, presentaban hiperactividad/impulsividad, según el Manual estadístico y diagnóstico (DSM-IV). Los criterios de exclusión fueron criterios de conciencia fonológica, ya publicados, útiles para detectar la dislexia. Asimismo, contamos con un grupo control de 300 integrantes, de entre 5 y 12 años, sin los criterios de inclusión y exclusión mencionados. Se administró una traducción del Das-Naglieri Cognitive Assessment System (DN:CAS) para diagnosticar los procesamientos cognitivos PASS. Se practicó un análisis de grupo en el grupo de estudio y se compararon las medias, según la prueba de la t de Student, entre el grupo de estudio y el grupo control. Mediante un análisis factorial se verificó la discriminación de los cuatro procesamientos: planificación, atención, secuencial y simultáneo con el DN:CAS. Resultados. Discriminación de un dendrograma con tres grupos: 1. El mayoritario, con planificación deficiente; 2. Sin planificación deficiente pero con otros procesos deficientes, y 3. Minoritario, sin ningún proceso cognitivo deficiente. La deficiencia cognitiva, comparando medias con el grupo control, fue estadísticamente significativa (p= 0,001). Conclusiones. Según el perfil PASS, la planificación deficiente es un factor relevante. La planificación no es exactamente una función ejecutiva. El patrón conductual se relaciona con la planificación deficiente, pero también con otras deficiencias cognitivas e incluso puede darse sin deficiencia cognitiva conocida (AU)

[Dyslexia as a disfunction in successive processing]. / La dislexia como disfunción del procesamiento secuencial.

INTRODUCTION: We present a study on reading and writing difficulties after normal instruction during a year. OBJECTIVE: Verifying if these patients showed a specific pattern of PASS (Planning, Attention, Sequential and Simultaneous) cognitive processing; if so, it allows us a rapid diagnosis and a useful cognitive remediation according to the PASS theory of intelligence. PATIENTS AND METHODS: Thirty patients were selected from neuropediatric patients because of learning disability. They were selected according to their performance on several tests of phonological aware and a test of writing to discover errors in spelling. Patients with verbal language problems, as in dysphasia, and patients with learning difficulty not determined by reading or writing were ruled out. A control group of 300 scholars was used. The translated DN:CAS battery was administered to the study group and the control group for assessing the PASS cognitive processing. Statistical factorial analysis of the control group was performed as a validity confirmation to discriminate the four PASS cognitive processes. Cluster analysis of the study group was performed to discriminate its homogeneity. Differences between means were tested with the t-Student. RESULTS: The four PASS cognitive processes were identified in the control group. The study group scored less than minus 1 SD in successive processing, the rest of the processes being clearly higher than minus 1 SD, and the mean of study group was inferior to control group (p = 0.001). CONCLUSION: A kind of dyslexia may be defined by disfunction in PASS successive processing.

La dislexia como disfunción del procesamiento secuencial / Dyslexia as a disfunction in successive processing

Introducción. Presentamos un estudio sobre dificultades de lectoescritura en pacientes que habían recibido un año de enseñanza. Objetivo. Comprobar si estos sujetos presentaban un patrón característico de procesamientos cognitivos PASS (Planificación, Atención, Secuencial y Simultáneo); de ser así, ello permitiría un diagnóstico precoz y una intervención cognitiva eficaz según la teoría PASS de la inteligencia. Pacientes y métodos. Seleccionamos 30 pacientes de entre las consultas de Neuropediatría por problemas de aprendizaje y les aplicamos pruebas de lectura de `percatamiento fonológico', así como una prueba de escritura para detectar errores en la construcción secuencial de las palabras. Se excluyeron los casos con problemas de lenguaje oral, tipo disfasia, o con problemas de aprendizaje no mediados por la lectoescritura. El grupo control estaba formado por 300 escolares. Administramos el DN:CAS traducido a ambos grupos, para diagnosticar los procesamientos cognitivos PASS. Se practicó análisis factorial del grupo control para validar el DN:CAS; análisis de cluster en el grupo de estudio para comprobar homogeneidad; comparación de medias, según la t de Student, entre grupo de estudio y grupo control. Resultados. Los cuatro procesos se identificaron en el grupo control. El grupo de estudio puntuó en valores de menos 1 DE en procesamiento secuencial y el resto de procesos se situaba claramente por encima de menos 1 DE. Por otra parte, la puntuación media del grupo de estudio resultó ser inferior al grupo control (p= 0,001). Conclusión. Existe un tipo de paciente disléxico cuya disfunción neurológica central consiste en una alteración del procesamiento secuencial PASS, mientras que el resto de procesamientos permanecen indemnes (AU)

[Behavioral phenotypes: cognitive and emotional explanation]. / Fenotipos conductuales: explicación cognitiva y emocional.

INTRODUCTION: We present a series of Behavioural phenotypes treated with neurocognitive and neuroemotional procedure. PATIENTS AND METHODS: A sample of 26 cases were selected according to qualitative methodology from neuropediatric patients. The method was based on using the PASS theory of intelligence to approach the cognitive problem and the theory of masquerade behaviour as self-defence to solve the emotional problem. Both theories have neurological bases. DN:CAS battery was utilized for assessment of cognitive processes. On the other hand, analysis of cases was carried out doing data analysis with video recorder device. RESULTS: All cases were considered responder cases although in different degree. The responder was defined as the patient which reached better intellectual achievement with respect to cognitive function and which gave up, at least partially, masquerade Behaviour with respect to emotional function. DISCUSSION: The Behaviour of the Behavioural phenotypes has neurological rationale. The PASS theory and the planning, in particular, supported by prefrontal cortex justifies consistently some behaviours. The masquerade Behaviour theory is explained by the fear emotional response mechanism which means emotion is a cerebral processing with neurological rationale. CONCLUSIONS: The Behavioural phenotypes are Behaviours and every Behaviour can be explained by neurological reasons both cognitive and emotional reasons. So, they can be treated by a cognitive and emotional procedure understood in the light of the neurology.

[Language disorders in the light of K-ABC]. / Las dificultades de lenguaje a la luz del K-ABC.

OBJECTIVE: Problems of terminology have hampered the study of dysfunctional school age children, and a confusing array of labels has been applied to them. This is the case for speech and language disorders. The challenge to the pediatrician is to arrive at an integrated diagnosis that will lead to useful strategies for intervention. PATIENTS AND METHODS: The K-ABC test, as a new instrument in the light of a new conception of intelligence, has been used as a tool for assessing language disorders in a sample of 261 preschool children aged 3 to 6 years. The results were analyzed by the Chi-square test and the stratified Chi-square test of Mantel-Haenzel as a discriminator between two variables. RESULTS: Bilingualism, father's and mother's educational level and jobs, as sociocultural and/or socioeconomic factors, emerged as statistically significant. CONCLUSIONS: The main conclusions refer to the ability to discriminate between learning and language disabilities and the relationship between language disorders and the bilingual condition or sociocultural markers, such as profession and academic achievement, of the parents. This article highlights the value of pediatrician-psychologist collaborations.