The role of circadian rhythms in individuals with attention deficit hyperactivity disorder and obesity: A narrative review / El papel de los ritmos circadianos en personas con trastorno por déficit de atención con hiperactividad y obesidad: Una revisión narrativa

Abstract Background A relationship between attention deficit hyperactivity disorder (ADHD) and obesity has been consistently documented. Obesity and metabolic syndrome have been associated with misalignment between daily activities and circadian rhythm. ADHD patients have a high prevalence of delayed sleep phase syndrome, which is a circadian rhythm disorder. Understanding this relationship is important for the evaluation of obese population at risk. Objective The aim of this narrative review was to summarize the information updated until 2019 about the role of circadian rhythms in obese ADHD individuals. Method A search was performed in MEDLINE, EMBASE, and Google Scholar database. The terms ADHD, obesity, circadian rhythm, sleep disorders, adolescent, adult, Adolesc, circadian, attention deficit hyperactivity disorder, and child were combined with logical functions. Results A total of 132 articles were reviewed. Evidence showed that ADHD subjects have an increased risk to present obesity and circadian rhythms disorders. Some possible pathways for this relationship have been hypothesized including obesity as a risk factor, an underpinned common biological dysfunction, and behavioral and cognitive features of individuals with ADHD. As most of the articles are methodologically cross-sectional, it is not possible to establish causative associations. Discussion and conclusion This review points out the importance of early recognizing and treating circadian rhythms disorders and obesity in ADHD patients. Future studies must be carried out with a longitudinal design to establish the effect of each comorbidity in the treatment of individuals with ADHD.

Resumen Antecedentes La relación entre el trastorno por déficit de atención con hiperactividad (TDAH) y la obesidad se ha documentado consistentemente. Por otro lado, el síndrome metabólico y la obesidad se han asociado con un desfase del ritmo circadiano. En poblaciones clínicas con TDAH se han encontrado una alta prevalencia del trastorno de fase de sueño retrasada, el cual es un trastorno del ritmo circadiano. Entender la relación entre estos padecimientos es importante para evaluar la población en riesgo de obesidad. Objetivo Resumir la información actualizada hasta 2019 sobre el rol del ritmo circadiano en individuos obesos con TDAH. Método Se realizó una búsqueda de artículos en las bases de datos MEDLINE, EMBASE y Google Scholar. Los términos TDAH, obesidad, ritmos circadianos, trastornos del sueño, adolescentes, adultos y niños se combinaron con operadores lógicos. Resultados Se revisaron un total de 132 artículos. La evidencia demostró que los sujetos con TDAH tienen un alto riesgo de sufrir obesidad y ritmos circadianos alterados. Existen algunas hipótesis para establecer esta relación, incluyendo la obesidad como factor de riesgo para TDAH, la disfunción biológica común entre estos trastornos y las características conductuales y cognitivas de los individuos con TDAH. Sin embargo, como la mayoría de los artículos son transversales, no es posible establecer una asociación causal. Discusión y conclusión Esta revisión señala la importancia del reconocimiento temprano y tratamiento de los trastornos del ritmo circadiano y obesidad en pacientes con TDAH. Estudios futuros deben realizarse de manera longitudinal para establecer el efecto de estas comorbilidades en el tratamiento de los individuos con TDAH.

Validity and reliability of the kiddie schedule for affective disorders and schizophrenia present and lifetime version DSM-5 (K-SADS-PL-5) Spanish version.

BACKGROUND: There are various language adaptations of the Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL). In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation. METHODS: K-SADS-PL was adapted to correspond to DSM-5 categories. All clinicians received training, and a 90% agreement was reached. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters. Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients. RESULTS: A total of 74 subjects were included. The Factor Analysis yielded six factors (Depressive, Stress Hyperarousal, Disruptive Behavioral, Irritable Explosive, Obsessive Repetitive and Encopresis), representing 72% of the variance. Kappa values for inter-rater agreement were larger than 0.7 for over half of the disorders. CONCLUSIONS: The factor structure of diagnoses, made with the instrument was found to correspond to the DSM-5 disorder organization. The instrument showed good construct validity and inter-rater reliability, which makes it a useful tool for clinical research studies in children and adolescents.

Construct validity and parent-child agreement of the six new or modified disorders included in the Spanish version of the Kiddie Schedule for Affective Disorders and Schizophrenia present and Lifetime Version DSM-5 (K-SADS-PL-5).

Changes to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) incorporate the inclusion or modification of six disorders: Autism Spectrum Disorder, Social Anxiety Disorder, Intermittent Explosive Disorder, Disruptive Mood Dysregulation Disorder, Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder. The objectives of this study were to assess the construct validity and parent-child agreement of these six disorders in the Spanish language Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL-5) in a clinical population of children and adolescents from Latin America. The Spanish version of the K-SADS-PL was modified to integrate changes made to the DSM-5. Clinicians received training in the K-SADS-PL-5 and 90% agreement between raters was obtained. A total of 80 patients were recruited in four different countries in Latin America. All items from each of the six disorders were included in a factor analysis. Parent-child agreement was calculated for every item of the six disorders, including the effect of sex and age. The factor analysis revealed 6 factors separately grouping the items defining each of the new or modified disorders, with Eigenvalues greater than 2. Very good parent-child agreements (r>0.8) were found for the large majority of the items (93%), even when considering the sex or age of the patient. This independent grouping of disorders suggests that the manner in which the disorders were included into the K-SADS-PL-5 reflects robustly the DSM-5 constructs and displayed a significant inter-informant reliability. These findings support the use of K-SADS-PL-5 as a clinical and research tool to evaluate these new or modified diagnoses.

Validez del Trastorno por Déficit de Atención con Hiperactividad como un trastorno del neurodesarrollo / Validity of Attention Deficit Hyperactivity Disorder as a Neurodevelopmental Disorde

ADHD was included in the DSM-5 as part of neurodevelopmental disorders (NDD), which also include autism spectrum disorders, intellectual disability, among others. This review makes an analysis of the validity of the diagnosis of ADHD and its inclusion within the NDD from the perspective of the diagnostic validity criteria of Robins, Guze and Feighner: 1. Clinical description, 2. Demarcation with other disorders, 3. Genetic studies, 4. Neuropsychological imaging and laboratory studies, 5. Follow up studies and 6. Response to treatment. It analyzes in a rational way the scientific evidence for each of these six areas of diagnostic validity for ADHD and the dimension of NDD.Key words: attention deficit hyperactivity neurodevelopmental disorders.

El TDAH fue incluido dentro del DSM-5 como parte de los trastornos del neurodesarrollo (TND), donde además se encuentran los trastornos del espectro autista, la discapacidad intelectual, entre otros. Esta revisión realiza un análisis de la validez del diagnóstico del TDAH y de su inclusión dentro de los TND bajo la perspectiva de la validez diagnóstica de los criterios de Robins, Guze y Feighner: 1. Descripción clínica, 2. Delimitación con otros trastornos, 3. Estudios genéticos, 4. Estudios neuropsicológicos, de imagen y de laboratorio, 5. Estudios de seguimiento y 6. Respuesta al tratamiento. Se analiza de forma razonada la evidencia científica para cada una de estas seis áreas de validez diagnóstica para el TDAH y la dimensión de los TND. Palabras clave: déficit atención hiperactividad trastornos neurodesarrollo.