Abordaje de los trastornos del sueño en los trastornos del neurodesarrollo / Treatment of sleep disorders in neurodevelopmental disorders

Resumen Los trastornos del sueño son frecuentes en niños y afectan al desarrollo neurológico, con importante repercusión cognitiva, emocional y conductual. Existe una alta prevalencia de trastornos del sueño (TS) en los trastornos del neurodesarrollo (TND), como trastorno del espectro autista (TEA) y trastorno por déficit de atención con hiperactividad (TDAH). Los TS en población pediá trica tienen una prevalencia del 6-25%, mientras que en los niños con TND esta cifra asciende al 50-80%. En los TND se observa un incremento de las dificultades para conciliar el sueño, de los despertares nocturnos y de la somnolencia diurna. Así mismo, presentan alteracio nes del ritmo circadiano y trastornos respiratorios del sueño. Como consecuencia se produce una reducción de la alerta para las actividades diarias con incremento de trastornos conductuales, problemas emocionales y dificultades académicas asociadas a disfunciones eje cutivas y de memoria. La evaluación del sueño debe formar parte sistemática en la valoración clínica de los niños con TND, con el fin de realizar un diagnóstico y un tratamiento adecuados a cada caso, permitiendo mejorar la calidad de vida del niño y de su familia.

Abstract Sleep disorders are common in children and affect neurological development with important cognitive, emotional and behavioral repercussions. There is a high prevalence of sleep disorders (SD) in neurodevelop mental disorders (NDD) such as autism spectrum dis order (ASD) and attention-deficit hyperactivity disorder (ADHD). Sleep disorders in pediatric population have a prevalence of 6-25%, while in children with NDD this number rises to 50-80%. In NDDs, higher rates of dif ficulties in falling asleep, nocturnal awakenings and daytime sleepiness are observed. Disturbances in the circadian rhythm as well as respiratory sleep disorders are also observed. Consequently, there is a decrease in alertness for daytime activities with increased be havioral disorders, emotional problems and academic difficulties associated with executive and memory dys functions. Sleep assessment has to be a systemic part in the clinical evaluation of children with NDDs, so as to give a convenient diagnosis and treatment in each case, allowing to improve the quality of life of children and their families.

Trastorno por Déficit de Atención/Hiperactividad (TDAH) y Trastorno de Tourette (TT): entre la comorbilidad y el diagnóstico diferencial / Attention deficit/hyperactivity disorder (ADHD) and To urette disorder (TD): between comorbidity and differential diagnosis

Resumen El Trastorno de Tourette (TT) y el Trastorno por déficit de atención / hiperactividad (TDAH) son entidades neu ropsiquiátricas que usualmente inician en la infancia. Esta revisión busca colaborar con los clínicos, quienes suelen confrontarse al dilema de saber si existe una comorbilidad o un diagnóstico diferencial, ya que esta pregunta cobra vital importancia en el momento de decidir el tratamiento. Invitamos al colega a revisar nuestros hallazgos, soportados por bases moleculares, fisiológicas y neuroanatómicas, además de los datos epidemiológicos. Al final, brindamos una propuesta de algoritmo diag nóstico que podrá utilizar cuando se encuentre ante síntomas compartidos entre los dos diagnósticos. El TDAH y el TT deben ser intervenidos tempranamente, para mejorar la calidad de vida y funcionalidad del paciente y prevenir secuelas, no solo en niños, niñas y adolescentes (NNA), también a lo largo de la vida.

Abstract Tourette Disorder (TD) and attention deficit hyperac tivity disorder (ADHD) are both major neuropsychiatric conditions that usually begin during infancy. This revision aims to collaborate with pediatricians, who are often confronted with the question of co-mor bidity or differential diagnosis between ADHD and TD. The question becomes urgent when the clinician must decide if he/she can start ADHD or TD treatment. We encourage our colleagues to revise our findings, based in bimolecular and neuroanatomic shared issues in ad dition to updated epidemiological findings. The clinician will find an original proposed algorithm that they can use when the shared symptoms are pres ent in a little patient. TD and ADHD must be intervened early, so we can get better outcomes. The consequences of letting the symptoms increase can generate sequels and handicaps, that can interfere with the quality of life and functionality not only during infancy and adoles cence but also in adult life.

Trastorno por déficit de atención e hiperactividad: perfil neuropsicológico y estudio de su impacto en las funciones ejecutivas y académicas / Attention deficit hyperactivity disorder: Neuropsychological profile and study of its impact on executive functions and academic performance

Introducción: El objetivo del presente estudio es describir el perfil neuropsicológico de los pacientes con trastorno por déficit de atención con hiperactividad (TDAH) y su impacto en las funciones ejecutivas y académicas. Pacientes y métodos: Se realizó un estudio analítico, observacional y retrospectivo. La muestra estuvo compuesta por 24 sujetos con diagnóstico de TDAH (6-15 años) sin tratamiento farmacológico y 24 controles (7-15 años) sin TDAH. Se realizó una evaluación neuropsicológica completa que abarcase los principales dominios cognitivos, así como la evaluación mediante cuestionarios a padres y profesores del funcionamiento ejecutivo y sintomatología psicopatológica. Resultados: El perfil cognitivo del grupo con TDAH se caracteriza por presentar puntuaciones globales (incluidas funciones ejecutivas y habilidades académicas) dentro del rango de la normalidad (puntuaciones z entre −1 y 1), aunque significativamente menores que las del grupo. Más de la mitad de los sujetos (58%) con TDAH presentan trastornos específicos de aprendizaje de manera comórbida. Por otro lado, los profesores tienden a informar de más dificultades de tipo ejecutivo cuando los sujetos son varones. Conclusiones: En nuestro grupo de estudio los pacientes diagnosticados con TDAH se caracterizan por presentar un rendimiento cognitivo dentro de la normalidad, aunque con menores puntuaciones que los controles. Los cuestionarios de conducta proporcionan información muy valiosa sobre el funcionamiento en entornos fuera de la consulta, pero pueden presentar sesgos al predominar los síntomas externalizantes. La evaluación neuropsicológica es una herramienta útil que puede facilitar el diagnóstico del TDAH y dar una respuesta eficaz a las características y a las necesidades de los pacientes y sus familias.(AU)

Introduction: The aim of the study was to describe the neuropsychological profile of patients with attention deficit hyperactivity disorder (ADHD) and the impact of the disorder on executive functioning and academic performance. Patients and methods: We conducted a retrospective observational and analytical study. The sample consisted of 24 children with a diagnosis of ADHD (aged 6-15 years) without pharmacological treatment and 24 controls without ADHD (aged 7-15 years). A comprehensive neuropsychological evaluation was carried out, encompassing major cognitive domains, in addition to assessment of executive functioning and psychopathological symptoms through the administration of questionnaires to parents and teachers. Results: The cognitive profile of the ADHD group was characterized by overall scores (including executive functions and academic abilities) in the normal range (z scores between −1 and 1), although significantly lower compared to the control group. Over half of the patients with ADHD (58%) had associated specific learning disorders. Furthermore, teachers tended to report executive function difficulties more frequently in male students. Conclusions: In the study sample, the group of patients with ADHD exhibited cognitive performance within the normal range, although with lower scores compared to controls. Behavioural rating scales provide valuable information about functioning outside the clinic, but may yield biased results on account of the focus on externalising symptoms. The neuropsychological evaluation is a useful tool that can facilitate the diagnosis of ADHD and an effective response to the needs and characteristics of patients and families.(AU)

Attention deficit hyperactivity disorder: Neuropsychological profile and study of its impact on executive functions and academic performance.

INTRODUCTION: The aim of the study was to describe the neuropsychological profile of patients with attention deficit hyperactivity disorder (ADHD) and the impact of the disorder on executive functioning and academic performance. PATIENTS AND METHODS: We conducted a retrospective observational and analytical study. The sample consisted of 24 children with a diagnosis of ADHD (aged 6-15 years) without pharmacological treatment and 24 controls without ADHD (aged 7-15 years). A comprehensive neuropsychological evaluation was carried out, encompassing major cognitive domains, in addition to assessment of executive functioning and psychopathological symptoms through the administration of questionnaires to parents and teachers. RESULTS: The cognitive profile of the ADHD group was characterized by overall scores (including executive functions and academic abilities) in the normal range (z scores between -1 and 1), although significantly lower compared to the control group. Over half of the patients with ADHD (58%) had associated specific learning disorders. Furthermore, teachers tended to report executive function difficulties more frequently in male students. CONCLUSIONS: In the study sample, the group of patients with ADHD exhibited cognitive performance within the normal range, although with lower scores compared to controls. Behavioural rating scales provide valuable information about functioning outside the clinic, but may yield biased results on account of the focus on externalising symptoms. The neuropsychological evaluation is a useful tool that can facilitate the diagnosis of ADHD and an effective response to the needs and characteristics of patients and families.

A tomada de decisão no tratamento de crianças com indicadores de TDAH / Toma de decisiones en el tratamiento de niños con indicadores de TDAH / Decision making in the treatment of children with ADHD indicators

RESUMO O diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade - TDAH é bastante complexo, podendo ser influenciado por fatores contextuais, e seu tratamento pode envolver diferentes intervenções. A participação dos usuários nas decisões a respeito do tratamento vem sendo promovida por instituições de diversos países e, no Brasil, é prevista pelas legislações do Sistema Único de Saúde. Este estudo investigou o processo de tomada de decisão no tratamento de crianças com indicadores de TDAH a partir da percepção de oito profissionais de serviços públicos de saúde mental, que foram entrevistados individualmente. Os dados foram examinados através da análise temática, revelando desafios relativos ao excesso de demanda nos serviços e à complexidade do processo diagnóstico. O envolvimento de usuários e familiares nas decisões foi percebido como parcial, ocorrendo geralmente após a elaboração do plano terapêutico pelas equipes, e envolvendo dificuldades na comunicação entre profissionais e pacientes e divergências de interesses entre as crianças e seus familiares. Esses aspectos poderão ser abordados em futuros estudos e intervenções a fim de facilitar e melhorar a qualidade da tomada de decisão nesse contexto.

RESUMEN El diagnóstico del trastorno por déficit de atención con hiperactividad - TDAH es bastante complejo y puede verse influenciado por factores contextuales, y su tratamiento puede implicar diferentes intervenciones. La participación de los usuarios en las decisiones sobre tratamiento ha sido promovida por instituciones de diferentes países y, en Brasil, está prevista por las leyes del Sistema Único de Salud. Este estudio investigó el proceso de toma de decisiones en el tratamiento de niños con indicadores TDAH desde la percepción de 8 profesionales de la salud mental pública, que fueron entrevistados individualmente. Los datos fueron examinados a través del análisis temático, revelando desafíos relacionados con el exceso de demanda en los servicios y la complejidad del proceso de diagnóstico. La implicación de los usuarios y familiares en las decisiones se percibió como parcial, ocurriendo generalmente después de la elaboración del plan terapéutico por los equipos, y implicando dificultades en la comunicación entre profesionales y pacientes y divergencias de intereses entre los niños y sus familias. Estos aspectos pueden abordarse en futuros estudios e intervenciones con el fin de facilitar y mejorar la calidad de la toma de decisiones en este contexto.

ABSTRACT The diagnosis of Attention Deficit Hyperactivity Disorder - ADHD is quite complex. Contextual factors may influence it, and its treatment may involve different interventions. Institutions in several countries have promoted the participation of users in treatment decisions. In Brazil, it is provided by the Unified Health System. This study investigated the decision-making process in treating children with ADHD indicators from the perception of 8 public mental health services professionals interviewed individually. Data were examined through thematic analysis, revealing challenges related to excessive demand for services and the complexity of the diagnostic process. The involvement of users and family members in the decisions was perceived as partial, generally occurring after elaborating the therapeutic plan by the teams, and involving difficulties in communication between professionals and patients and differences of interests between children and their families. These aspects may be addressed in future studies and interventions to facilitate and improve the quality of the decision-making process in this context.

Modelo de orientación familiar en la prevención del trastorno por déficit de atención e hiperactividad

El presente trabajo está dirigido a exponer elementos inherentes de un modelo de orientación familiar en la prevención del trastorno por déficit de atención/hiperactividad en la primera infancia. Deriva de una investigación que se ejecuta en la especialidad de Rehabilitación en Salud, adscrita a la Universidad de Ciencias Médicas de Camagüey. Se emplearon métodos teóricos como: el análisis y síntesis, inductivo-deductivo y el método sistémico estructural funcional para fundamentar el carácter de sistema del modelo y su diseño. Se concluye con el establecimiento de un modelo estructurado por dos subsistemas. Las relaciones de coordinación y complementariedad establecidas posibilitaron la extrapolación cognitiva para la orientación familiar en la prevención del trastorno referido.

The present work is aimed at exposing inherent elements of a family counseling model in the prevention of attention deficit/hyperactivity disorder in early childhood. It derives from research carried out in the specialty of Health Rehabilitation, attached to the University of Medical Sciences of Camagüey. Theoretical methods such as: analysis and synthesis, inductive-deductive and the structural-functional systemic method were used to substantiate the system character of the model and its design. It concludes with the establishment of a model structured by two subsystems. The established coordination and complementarity relationships enabled cognitive extrapolation for family guidance in the prevention of the aforementioned disorder.

Psychopathological Risk in Siblings of Subjects with Attention-Deficit/Hyperactivity Disorder: A cross-Sectional Study.

OBJECTIVE: We aim to determine the prevalence of mental disorders in siblings of children with attention deficit hyperactivity disorder (ADHD), and to determine how psychosocial adversity factors relate to this psychopathology, in a low-middle income country (Colombia). METHODS: We evaluated subjects with ADHD diagnosed according to the DSM-5 criteria, one of their parents and one of their siblings (ages 8-19). We used the ADHD rating scale and a set of instruments to assess the presence of mental disorders as well as psychosocial adversity. RESULTS: We evaluated 74 trios formed by the index case with ADHD, one sibling and one of the parents. We found that 24.3% of the participating siblings also met the criteria for ADHD and another 24.3% for other psychiatric disorders. The risk of these siblings having ADHD increased further when one of the parents reported a history of ADHD. We also found that 28.3% of the families faced high levels of psychosocial adversity as per their scores in the Rutter Adversity Index. CONCLUSIONS: Siblings of subjects with ADHD showed a significant risk for ADHD and other mental disorders. That risk increased if a parent reported a history of ADHD and also when two or more psychosocial adversity factors were present. This study supports the importance of early detection in efforts to decrease the risk for other siblings.

Enfermedades sin diagnostico y enfermedades raras: avances en neurodesarrollo / Rare diseases and undiagnosed diseases: advances in neurodevelopment

Resumen Las enfermedades raras y enfermedades sin diag nóstico se han posicionado en los últimos años como condiciones clínicas que han permitido avanzar el en tendimiento de las funciones de los genes y el im pacto en el desarrollo del individuo. En esta revisión, presentamos como los esfuerzos individuales hechos por muchos años para entender la fisiopatología de en fermedades comunes, enfermedades raras y otras aún más raras, como las enfermedades sin diagnóstico, que se unen hoy para, de manera cooperativa, avanzar en el conocimiento científico. Estos avances en el conoci miento permiten aplicar los avances obtenidos en un grupo de condiciones clínicas a otras con características fenotípicas similares o viceversa. El trabajo conjunto de equipos multidisciplinarios y la comunicación entre clínicos e investigadores proporcionarán oportunidades para proveer mejores oportunidades de tratamiento para pacientes y familias a lo largo de múltiples diagnósticos comunes o raros.

Abstract Rare diseases and undiagnosed diseases have re cently positioned themselves as clinical entities that provide important opportunities to advance our under standing of gene functions and the impact of them in the individual development. In this review, we present how efforts made over years to understand common diseases, rare diseases and even undiagnosed diseases come together today to cooperatively advances scientific knowledge. These advance in science and new acquired knowledge, make possible to apply the advances ob tained in a group of clinical conditions to others with similar phenotypic characteristics or vice versa. The cooperative work of multidisciplinary teams and the communication between clinicians and researchers have and will provide opportunities for better treatments for patients and families across multiple common and rare diseases.

Mercurio y trastornos del neurodesarrollo en niños: una revisión sistemática / Mercury and neurodevelopmental disorders in children: A systematic review

El mercurio es un metal tóxico que puede atravesar la placenta y la barrera hematoencefálica, y causar la interrupción de varios procesos celulares. Estudios han investigado la exposición al mercurio y trastornos en el neurodesarrollo, por lo que se requiere un análisis crítico y riguroso de esta evidencia. El objetivo de esta revisión fue evaluar la evidencia científica disponible sobre los efectos de la exposición al mercurio durante las etapas prenatal y posnatal, y su relación con el desarrollo de trastornos neuroconductuales. Se realizó una búsqueda sistemática en las bases de datos MEDLINE y ScienceDirect; los resultados se presentaron a través de tablas y síntesis narrativa. Solo 31 estudios cumplieron los criterios de elegibilidad. En general, la evidencia es limitada sobre los efectos de la exposición al mercurio y trastornos del neurodesarrollo en niños. Entre los posibles efectos reportados, se hallan problemas en el aprendizaje, autismo y trastorno por déficit de atención e hiperactividad.

Mercury is a toxic metal which can cross the placenta and the blood-brain barrier and cause the disruption of various cellular processes. Studies have investigated mercury exposure and neurodevelopmental disorders; therefore, a critical and rigorous analysis of this evidence is required. The objective of this review was to evaluate the available scientific evidence on the effects of mercury exposure during the prenatal and postnatal periods and its relationship with the development of neurobehavioral disorders. A systematic search of the MEDLINE and ScienceDirect databases was conducted; the results were presented in tables and narrative synthesis. Only 31 studies met the eligibility criteria. Overall, the evidence on the effects of mercury exposure and neurodevelopmental disorders in children is limited. Learning disabilities, autism, and attention deficit hyperactivity disorder were some of the reported potential effects.

Psychopathological Risk in Siblings of Subjects with Attention-Deficit/Hyperactivity Disorder: A cross-Sectional Study

Objective: We aim to determine the prevalence of mental disorders in siblings of children with attention deficit hyperactivity disorder (ADHD), and to determine how psychosocial adversity factors relate to this psychopathology, in a low-middle income country (Colombia). Methods: We evaluated subjects with ADHD diagnosed according to the DSM-5 criteria, one of their parents and one of their siblings (ages 8-19). We used the ADHD rating scale and a set of instruments to assess the presence of mental disorders as well as psychosocial adversity. Results: We evaluated 74 trios formed by the index case with ADHD, one sibling and one of the parents. We found that 24.3% of the participating siblings also met the criteria for ADHD and another 24.3% for other psychiatric disorders. The risk of these siblings having ADHD increased further when one of the parents reported a history of ADHD. We also found that 28.3% of the families faced high levels of psychosocial adversity as per their scores in the Rutter Adversity Index. Conclusions: Siblings of subjects with ADHD showed a significant risk for ADHD and other mental disorders. That risk increased if a parent reported a history of ADHD and also when two or more psychosocial adversity factors were present. This study supports the importance of early detection in efforts to decrease the risk for other siblings.

Objetivo: Nuestro objetivo es determinar la prevalencia de trastornos mentales en hermanos de casos con TDAH y cómo los factores de adversidad psicosocial se relacionan con esta psicopatología en un país de ingresos bajos-medios (Colombia). Métodos: Se evaluó a sujetos con TDAH diagnosticado según los criterios del DSM-5, uno de sus padres y uno de sus hermanos (edades, 8-19 anos). Mediante la escala de calificación del TDAH y un conjunto de otros instrumentos se evaluó la presencia de trastornos mentales y adversidad psicosocial. Resultados: Se evaluó a 74 tríos formados por el caso índice con TDAH, un hermano y uno de los padres. Se halló que un 24,3% de los hermanos participantes también cumplían los criterios de TDAH y otro 24,3%, otros trastornos psiquiátricos. El riesgo de que estos hermanos tuvieran TDAH aumentó aún más cuando uno de los padres informó antecedentes de TDAH. También, que el 28,3% de las familias se enfrentaron a altos niveles de adversidad psicosocial según sus puntuaciones en el Índice de Adversidad de Rutter. Conclusiones: Los hermanos de sujetos con TDAH mostraron un significativo riesgo de TDAH y otros trastornos mentales. Ese riesgo aumenta si uno de los padres reporta antecedentes de TDAH y también cuando se presentan 2 o más factores de adversidad psicosocial. Este estudio respalda la importancia de la detección temprana con el fin de disminuir el riesgo para otros hermanos.

Evolution of children diagnosed with attention deficit/hyperactivity disorder. Follow-up study in a Spanish simple.

BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) is a chronic condition with long-term associated risks. OBJECTIVE: To analyze the clinical status, occupation, and daily life difficulties of two cohorts of children diagnosed with ADHD (2004 and 2009) after five and 10 years. MATERIAL AND METHOD: Descriptive, longitudinal study using the WOMI database corresponding to Oviedo, Asturias, Spain. Children with ADHD detected by their primary care pediatrician were included. A voluntary follow-up telephone interview was requested. Outcome variables were current clinical and occupational status, ADHD symptoms according to SNAP-IV, and Strengths and Difficulties Questionnaire (SDQ). RESULTS: The interviewed sample consisted of 95 subjects, out of whom 71 answered the SNAP-IV and SDQ questionnaires; 60.70% of the sample did not receive treatment at the time of follow-up, 4.7% had no occupation, 25.40% still had ADHD global symptoms above the clinical cutoff point, and 66.2% had difficulties with moderate interference. CONCLUSIONS: ADHD symptoms decline as people grow up. Mental health comorbidities and academic dropout were not confirmed in the sample.

ANTECEDENTES: El trastorno de déficit de atención e hiperactividad (TDAH) constituye una condición crónica con riesgos asociados a largo plazo. OBJETIVO: Analizar el estado clínico, la ocupación y las dificultades de la vida diaria de dos cohortes de niños con diagnóstico de TDAH (2004 y 2009) después cinco y 10 años. MATERIAL Y MÉTODO: Estudio descriptivo y longitudinal de la base de datos WOMI correspondiente a Oviedo, Asturias, España. Se incluyeron niños detectados con TDAH por su pediatra de atención primaria. Se solicitó una entrevista telefónica voluntaria de seguimiento. Las variables de resultado fueron estado clínico y ocupacional al momento de la entrevista, síntomas de TDAH según SNAP-IV y Cuestionario de Fortalezas y Dificultades (SDQ). RESULTADOS: La muestra entrevistada estuvo formada por 95 sujetos, de los cuales 71 respondieron a los cuestionarios SNAP-IV y SDQ; 60.7 % de la muestra no recibía tratamiento en el momento del seguimiento, 4.7 % no tenía ninguna ocupación, 25.4 % mantenía síntomas globales de TDAH en nivel superior al punto de corte clínico y 66.2 % presentaba dificultades con interferencia moderada. CONCLUSIONES: Los síntomas del TDAH disminuyen conforme las personas crecen. Las comorbilidades de salud mental y el abandono académico no se confirmaron en la muestra.

Evolución de menores diagnosticados con trastorno de déficit de atención e hiperactividad. Estudio de seguimiento en una muestra española / Evolution of children diagnosed with attention deficit/hyperactivity disorder. Follow-up study in a Spanish sample

Resumen Antecedentes: El trastorno de déficit de atención e hiperactividad (TDAH) constituye una condición crónica con riesgos asociados a largo plazo. Objetivo: Analizar el estado clínico, la ocupación y las dificultades de la vida diaria de dos cohortes de niños con diagnóstico de TDAH (2004 y 2009) después cinco y 10 años. Material y método: Estudio descriptivo y longitudinal de la base de datos WOMI correspondiente a Oviedo, Asturias, España. Se incluyeron niños detectados con TDAH por su pediatra de atención primaria. Se solicitó una entrevista telefónica voluntaria de seguimiento. Las variables de resultado fueron estado clínico y ocupacional al momento de la entrevista, síntomas de TDAH según SNAP-IV y Cuestionario de Fortalezas y Dificultades (SDQ). Resultados: La muestra entrevistada estuvo formada por 95 sujetos, de los cuales 71 respondieron a los cuestionarios SNAP-IV y SDQ; 60.7 % de la muestra no recibía tratamiento en el momento del seguimiento, 4.7 % no tenía ninguna ocupación, 25.4 % mantenía síntomas globales de TDAH en nivel superior al punto de corte clínico y 66.2 % presentaba dificultades con interferencia moderada. Conclusiones: Los síntomas del TDAH disminuyen conforme las personas crecen. Las comorbilidades de salud mental y el abandono académico no se confirmaron en la muestra.

Abstract Background: Attention deficit/hyperactivity disorder (ADHD) is a chronic condition with long-term associated risks. Objective: To analyze the clinical status, occupation, and daily life difficulties of two cohorts of children diagnosed with ADHD (2004 and 2009) after five and 10 years. Material and method: Descriptive, longitudinal study using the WOMI database corresponding to Oviedo, Asturias, Spain. Children with ADHD detected by their primary care pediatrician were included. A voluntary follow-up telephone interview was requested. Outcome variables were current clinical and occupational status, ADHD symptoms according to SNAP-IV, and Strengths and Difficulties Questionnaire (SDQ). Results: The interviewed sample consisted of 95 subjects, out of whom 71 answered the SNAP-IV and SDQ questionnaires; 60.70% of the sample did not receive treatment at the time of follow-up, 4.7% had no occupation, 25.40% still had ADHD global symptoms above the clinical cutoff point, and 66.2% had difficulties with moderate interference. Conclusions: ADHD symptoms decline as people grow up. Mental health comorbidities and academic dropout were not confirmed in the sample.

Rasgos de personalidad en adolescentes con trastorno por déficit de atención con hiperactividad / Personality traits in adolescents with Attention Deficit Hyperactivity Disorder

Antecedentes: Existen pocos estudios que relacionen personalidad y trastorno por déficit de atención con hiperactividad (TDAH) en adolescentes. Objetivo: estudiar diferencias entre casos con TDAH y población general en prototipos de personalidad (PRP) derivados del Inventario clínico para adolescentes de Millon (MACI). Material y Método: Diseño observacional analítico. Muestreo aleatorio en población general (n = 461) y consecutivo de pacientes con TDAH valorados según criterios DSM-5 (n = 85), en adolescentes entre 13 y 17 años. Instrumentos de medida: MACI y Adolescent Symptom Inventory. Resultados: los PRP Pesimista, Rudo, Rebelde, Oposicionista, Autopunitivo y Límite presentan una media significativamente mayor en TDAH y los PRP Sumiso y Conformista, en población general. El modelo de PRP que mejor prediceTDAH está conformado por tener sexo masculino y los PRP Rudo, Límite, Sumiso y Autopunitivo, clasificando el 82.4% de los casos. Conclusión: Los casos de TDAH tienen PRP diferenciales con la población general que invitan a su estudio clínico e intervención terapéutica. El estudio ofrece una imagen novedosa de los PRP en casos de TDAH y abre nuevos caminos de investigación que incluyan la personalidad al explicar la heterogeneidad del trastorno. (AU)

Background: There are few studies linking personality and Attention Deficit Hyperactivity Disorder (ADHD) in adolescents. Research objective: to study differences between cases with ADHD and the general population in personality prototypes (PRP) derived from the Millon Clinical Inventory for Adolescents (MACI). Material and Method: Analytical observational design. Random sampling in the general population (n = 461) and consecutive of patients with ADHD evaluated according to DSM-5 criteria (n = 85), in adolescents between 13 and 17 years old. Measurement instruments: MACI and Adolescent Symptom Inventory. Results: ADHD presents a significantly higher mean in Doleful, Forceful, Unruly, Oppositional, Self-demeaning and Borderline PRP and the general population in Submissive and Conforming PRP. The PRP model that best predicts ADHD includes male sex and the Forceful, Borderline, Submissive and Self-demeaning PRP. The model classifies 82.4% of the cases. Conclusion. ADHD cases have differential PRP in comparison with the general population, which invites their clinical study and therapeutic intervention. The study offers a novel image of PRP in ADHD and opens new lines of research that include personality when explaining the heterogeneity of the disorder. (AU)

Asociación entre el consumo de alimentos ultraprocesados y el déficit de atención en escolares de 6 a 12 años de instituciones educativas privadas de Lima Metropolitana y Arequipa, 2022 / Association between the consumption of ultra-processed foods and attention deficit in students aged 6 to 12 years old from private educational institutions in Metropolitan Lima and Arequipa, 2022

Fundamentos: Es importante destacar el fácil acceso que tienen hoy en día los escolares a productos ultraprocesados, y la prevalencia del déficit de atención con hiperactividad (TDAH) también ha ido en aumento en este grupo de edad. El objetivo del presente estudio fue determinar la asociación entre el consumo de alimentos ultraprocesados y el déficit de atención en escolares de 6 a 12 años en instituciones educativas privadas de las ciudades de Lima y Arequipa de Perú en el 2022. Métodos: Estudio tipo analítico transversal. Se realizó un muestreo de tipo no probabilístico, por conveniencia, la muestra recolectada fue de 217 escolares en 4 instituciones educativas privadas de las ciudades de Lima y Arequipa de Perú en el 2022. Resultados: Del total de participantes el 57,1% eran mujeres, el 52,1% tenían TDAH, el 87,1% presentaron un mayor consumo de alimentos ultraprocesados. No se encontró asociación entre las principales características del TDAH y el consumo de alimentos ultraprocesados en los escolares evaluados (p>0,05), pero si existe asociación entre el consumo de piqueos y el TDAH (p<0,05). Asimismo, se encontró que ser hombre brinda un 34% más probabilidades de tener TDAH, no tener antecedentes en los padres representa un 37% menos probabilidad de presentar TDAH, y usar aparatos tecnológicos durante 3-4 horas representa un 42% más probabilidades de tener TDAH. Conclusiones: Existe asociación entre el consumo de piqueos y TDAH en escolares de 6 a 12 años de instituciones educativas privadas de Lima Metropolitana y Arequipa, en el año 2022. (AU)

Background: It is important to highlight the easy access that schoolchildren have today to ultra-processed products, and the prevalence of attention deficit has also been increasing in this age group. The objective of this study was to determine the association between the consumption of ultra-processed foods and attention deficit in schoolchildren from 6 to 12 years of age in private educational institutions in the cities of Lima and Arequipa in Peru in 2022. Methods: Cross-sectional analytical study. A non-probabilistic sampling was carried out, for convenience, the sample collected was 217 schoolchildren in 4 private educational institutions in the cities of Lima and Arequipa in Peru in 2022. Results: Of the total number of participants, 57.1% were women, 52.1% had ADHD, and 87.1% had a higher consumption of ultra-processed foods. No association was found between the main characteristics of ADHD and the consumption of ultra-processed foods in the evaluated schoolchildren (p>0.05), but there is an association between the consumption of snacks and ADHD (p<0.05). Likewise, it was found that being a man provides 34% more probabilities of having ADHD, not having a history in the parents represents a 37% less probability of presenting ADHD, and using technological devices for 3-4 hours represents 42% more probabilities of having ADHD. Conclusions: There is an association between the consumption of snacks and ADHD in schoolchildren from 6 to 12 years of age from private educational institutions in Metropolitan Lima and Arequipa, in the year 2022. (AU)

The role of psychosocial adversity in the aetiology and course of attention deficit hyperactivity disorder.

INTRODUCTION: Attention deficit/hyperactivity disorder (ADHD) has genetic and environmental aetiological factors. There are few publications on the environmental factors. The objective of this review is to present the role of psychosocial adversity in the aetiology and course of ADHD. METHODS: A search was carried out in the following databases: PubMed, ScienceDirect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA and PsycNET. English and Spanish were selected without being limited by type of study or year of publication. Finally, a qualitative synthesis was conducted. RESULTS: ADHD development could be related to exposure to adverse factors in the family, school or social environment. It has been proposed as an explanatory mechanism that adversity interacts with genetic variants and leads to neurobiological changes. There may also be a gene-environment correlation whereby individual hereditary characteristics increase the risk of exposure to adversity, and indirectly increase the probability of developing ADHD. Research on psychosocial adversity represents a big challenge, not only due to the complexity of its construct, but also to the effect of subjective perception of a given event. CONCLUSIONS: ADHD aetiology is complex and involves the interaction of both genetic and environmental factors, in which these factors correlate and cause the disorder. The study of the role of psychosocial adversity in ADHD is fundamental, but it remains a task that entails great difficulties.

Estudios neurofisiológicos en los trastornos del neurodesarrollo: potenciales evocados cognitivos / Neurophysiological studies in neurodevelopmental disorders: event related potentials

Resumen El trastorno por déficit de atención con hiperactividad (TDAH) y el trastorno del espectro autista (TEA) son trastornos del neurodesarrollo cuyo diagnóstico es clínico y con gran variabilidad en la presentación clínica. La posibilidad de identificar y validar biomarcadores en estos trastornos del neurodesarrollo ayudaría no sólo en su diagnóstico sino también a la hora de implementar tratamientos personalizados y mo nitorizar la respuesta al tratamiento. Exploraciones neurofisiológicas como los potenciales evocados cognitivos (PEC), son una de las herramientas más utilizadas para evaluar de forma objetiva y con una alta resolución temporal las funciones cognitivas y proporcionan información sobre los mecanismos neurobiológicos subyacen tes, por lo que constituyen una herramienta de gran utilidad para valorar las alteraciones cognitivas asociadas a los trastornos del neurodesarrollo. Se han utilizado diferentes componentes de los PEC para el estudio de los trastornos del neurodesarrollo, como el componente P300, N400 o el componente N170 como biomarcador de la disfunción social en TEA. Revisamos los principales componentes de los PEC que se han estudiado como herramientas complementarias en el diagnóstico y en la monitorización de los tratamientos en los trastornos del neurodesarrollo.

Abstract Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevel opmental disorders whose diagnosis is clinical and with great variability in clinical presentation. The possibility of identifying and validating biomarkers in these neurodevelopmental disorders would help not only in their diagnosis, but also when implementing personalized treatments and monitori ng the response to treatment. Neurophysiologi cal examinations such as event related potentials (ERP) are one of the most widely used tools to objectively assess cognitive functions with high temporal resolution and provide information on the underlying neurobiological mechanisms, making them a very useful tool to assess cognitive alterations associated with neurodevelopmental disorders. Different components of the ERP have been used for the study of neurodevelopmental disorders, such as the P300, N400 component or the N170 component as a biomarker of social dysfunction in ASD. We review the main components of ERP that have been studied as complementary tools in the diagnosis and monitoring of treatments in neurodevelopmental disorders.

Trastornos de la infancia y características sociodemográficas asociadas a la depresión en adultos en una ciudad de Colombia / Childhood disorders and sociodemographic characteristics associated with depression in adults from a Colombian city / Transtornos da infância e características sócio-demográficas associadas à depressão em adultos de uma cidade colombiana

Introducción: Los trastornos emocionales y del comportamiento que se inician en la infancia llevan a cambios que se extienden hasta la edad adulta, con consecuencias sociales. Objetivo: Determinar la asociación de la depresión en la adultez con trastornos mentales de inicio en la infancia y otras condiciones, en Envigado, 2017. Materiales y métodos: Estudio con enfoque cuantitativo, tipo observacional, transversal con intención analítica. El tamaño de la muestra fue de 737 individuos, entre 18 y 65 años. Se aplicó el instrumento CIDI - CAPI de la OMS. El procesamiento y análisis se llevó a cabo en SPSS v. 21 de la Universidad CES y Epidat 4.2. Resultados: La proporción de depresión en la adultez es de 10,8%, en la población de estudio que tuvo antecedente de trastorno por déficit de atención e hiperactividad (TDAH) fue aproximadamente 5,6 veces más que en aquellos que no tenían este antecedente (OR= 6,62; IC95% 1,92-22,7). Conclusiones: El TDAH en la infancia incrementa la probabilidad de presentar depresión en la adultez en la población de Envigado, lo cual soporta la importancia de promover acciones de salud mental en la niñez, para prevenir la depresión en la edad adulta.

Introduction: Emotional and behavioral disorders that begin in childhood lead to adult changes, which have social consequences. Objective: To determine the association of adult depression with childhood onset of mental disorders and other factors in Envigado (Colombia). Materials and methods: A quantitative observational and cross-sectional study was carried out. The sample size was 737 individuals aged between 18 to 65 years. The CIDI-CAPI instrument of the WHO was used. Data processing and analysis was conducted through SPSS v. 21 software from the CES University and Epidat 4.2. Results: The percentage of depression in adults was 10.8%. This figure was 5.6 times greater in the study population that had history of attention deficit hyperactivity disorder (ADHD) compared to individuals who did not have this disorder (OR= 6.62; 95% CI 1.92-22.7). Conclusions: Childhood ADHD increases the probability of depression in the adult population of Envigado, which supports the importance of promoting mental health programs in children in order to prevent adulthood depression.

Introdução: Os transtornos emocionais e comportamentais que se iniciam na infância levam a alterações que se estendem até a idade adulta, com consequências sociais. Objetivo: Determinar a associação da depressão na idade adulta com transtornos mentais de início na infância e outras condições, em Envigado, 2017. Materiais e métodos: um estudo foi realizado com abordagem quantitativa, observacional, transversal e com intenção analítica. O tamanho da amostra foi de 737 indivíduos, entre 18 e 65 anos de idade. Foi aplicado o instrumento CIDI - CAPI da OMS. O processamento e análise foram realizados no SPSS v. 21 da Universidad CES e Epidat 4.2. Resultados: A proporção de depressão na idade adulta é de 10,8%, na população estudada que tinha histórico de transtorno de déficit de atenção e hiperatividade (TDAH) foi aproximadamente 5,6 vezes maior do que naquelas sem esse histórico (OR= 6,62; 95 % CI 1,92-22,7). Conclusões: O TDAH na infância aumenta a probabilidade de apresentar depressão na idade adulta na população de Envigado, o que reforça a importância de promover ações de saúde mental na infância, para prevenir a depressão na idade adulta.

Relación entre los síntomas de déficit de atención/hiperactividad y el sueño en preescolares / Association between attention-deficit/hyperactivity symptoms and sleep in preschoolers

Introducción: Los problemas de sueño son frecuentes en niños con trastorno por déficit de atención/hiperactividad (TDAH). Algunos autores han tratado de caracterizar los hábitos de sueño pediátricos en Portugal, pero ninguno se ha centrado en los niños en edad preescolar ni ha intentado correlacionarlos con el TDAH. El objetivo fue evaluar la prevalencia de los síntomas del TDAH en niños en edad preescolar y estudiar su asociación con los hábitos de sueño. Material y métodos: Estudio transversal mediante la administración de un cuestionario a una muestra aleatoria de cuidadores de niños matriculados en guarderías en Oporto. Se recogieron datos de características sociodemográficas, consumo de televisión y actividades al aire libre. Los síntomas del TDAH y los hábitos de sueño fueron evaluados mediante las versiones portuguesas del Conners’ Parents Rating Scale-Revised y el Children's Sleep Habits Questionnaire (CSHQ-PT), respectivamente. Resultados: El estudio incluyó 381 preescolares (50,90% varones). Se encontraron niveles altos de síntomas de TDAH en el 13,10%, con una prevalencia mayor en las niñas (14,40% vs. 11,85%; p=0,276). El 45,70% tenían una puntuación total en el CSQH-PT superior a 48, que es el punto de corte establecido para el cribado de los trastornos del sueño en la población portuguesa. Se encontró una asociación significativa entre niveles altos de síntomas de TDAH y un nivel educativo materno más bajo (p<0,001), una menor duración del sueño (p=0,049) y mayores puntuaciones en las subescalas de parasomnias (p=0,019) y de trastornos respiratorios del sueño (p=0,002). (AU)

Introduction: Sleep problems are frequent in children with attention-deficit/hyperactivity disorder (ADHD). Some authors have tried to characterize paediatric sleep habits in Portugal, but none has focused on preschool-age children nor attempted to establish their association with ADHD. We aimed to assess the prevalence of ADHD symptoms in preschool-age children and to study their association with sleep habits. Material and methods: We conducted a cross-sectional study. We distributed questionnaires to a random sample of caregivers of children enrolled in early childhood education centres in Porto. We collected data on sociodemographic characteristics, television watching and outdoor activities. We assessed ADHD symptoms and sleep habits with the Portuguese versions of the Conners’ Parents Rating Scale, Revised and the Children's Sleep Habits Questionnaire (CSHQ-PT), respectively. Results: The study included 381 preschoolers (50.90% male). We found high scores for ADHD symptoms in 13.10%, with a higher prevalence in girls (14.40% vs. 11.85%; P=.276). In the CSHQ-PT, 45.70% of participants had a mean total score greater than 48, which is the cut-off point applied in the screening of sleep disturbances in the Portuguese population. There was a significant association between high scores for ADHD symptoms and a lower maternal education level (P<.001), a shorter sleep duration (P=.049), and higher scores on parasomnias (P=.019) and sleep disordered breathing (P=.002) in CSHQ-PT subscales. (AU)

Association between attention-deficit/hyperactivity symptoms and sleep in preschoolers.

INTRODUCTION: Sleep problems are frequent in children with attention-deficit/hyperactivity disorder (ADHD). Some authors have tried to characterize paediatric sleep habits in Portugal, but none has focused on preschool-age children nor attempted to establish their association with ADHD. We aimed to assess the prevalence of ADHD symptoms in preschool-age children and to study their association with sleep habits. MATERIAL AND METHODS: We conducted a cross-sectional study. We distributed questionnaires to a random sample of caregivers of children enrolled in early childhood education centres in Porto. We collected data on sociodemographic characteristics, television watching and outdoor activities. We assessed ADHD symptoms and sleep habits with the Portuguese versions of the Conners' Parents Rating Scale, Revised and the Children's Sleep Habits Questionnaire (CSHQ-PT), respectively. RESULTS: The study included 381 preschoolers (50.90% male). We found high scores for ADHD symptoms in 13.10%, with a higher prevalence in girls (14.40% vs. 11.85%; P = 0.276). In the CSHQ-PT, 45.70% of participants had a mean total score greater than 48, which is the cut-off point applied in the screening of sleep disturbances in the Portuguese population. There was a significant association between high scores for ADHD symptoms and a lower maternal education level (P < 0.001), a shorter sleep duration (P = 0.049), and higher scores on parasomnias (P = 0.019) and sleep disordered breathing (P = 0.002) in CSHQ-PT subscales. CONCLUSIONS: ADHD and sleep disorders are common in preschoolers, in Porto, and this study suggests some clinical correlations between them. Since these interactions are complex and far from being elucidated, further studies are paramount to provide guidance for prevention and managing strategies in younger children at risk for ADHD.

The role of psychosocial adversity in the aetiology and course of attention deficit hyperactivity disorder

Introduction: Attention deficit/hyperactivity disorder (ADHD) has genetic and environmental aetiological factors. There are few publications on the environmental factors. The objective of this review is to present the role of psychosocial adversity in the aetiology and course of ADHD. Methods: A search was carried out in the following databases: PubMed, ScienceDirect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA and PsycNET. English and Spanish were selected without being limited by type of study or year of publication. Finally, a qualitative synthesis was conducted. Results: ADHD development could be related to exposure to adverse factors in the family, school or social environment. It has been proposed as an explanatory mechanism that adversity interacts with genetic variants and leads to neurobiological changes. There may also be a gene-environment correlation whereby individual hereditary characteristics increase the risk of exposure to adversity, and indirectly increase the probability of developing ADHD. Research on psychosocial adversity represents a big challenge, not only due to the complexity of its construct, but also to the effect of subjective perception of a given event. Conclusions: ADHD aetiology is complex and involves the interaction of both genetic and environmental factors, in which these factors correlate and cause the disorder. The study of the role of psychosocial adversity in ADHD is fundamental, but it remains a task that entails great difficulties.

Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) tiene factores etiológicos genéticos y ambientales. Hay pocas publicaciones acerca de los factores ambientales. El objetivo de esta revisión es presentar el papel de la adversidad psicosocial en la etiología y el curso del TDAH. Métodos: Se llevó a cabo una búsqueda en las siguientes bases de datos: PubMed, ScienceDi-rect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA y PsycNET. Se seleccionaron artículos en inglés y español sin limitar por tipo de estudio o año de publicación. Finalmente, se hizo una síntesis cualitativa. Resultados: El desarrollo del TDAH podría estar relacionado con la exposición a factores adversos en el entorno familiar, escolar o social. Se ha propuesto como mecanismo explicativo que la adversidad interactúa con variantes genéticas y conduce a cambios neurobiológicos. También puede haber una correlación entre gen y ambiente, en la que las características hereditarias individuales aumentan el riesgo de exposición a la adversidad e indirectamente aumentan la probabilidad de sufrir TDAH. La investigación sobre la adversidad psicosocial representa un gran desafío no solo por la complejidad de su constructo, sino también por el efecto de la percepción subjetiva sobre un evento determinado. Conclusiones: La etiología del TDAH es compleja y factores genéticos y ambientales presentan una interacción en la que estos factores se correlacionan y originan el trastorno. El estudio del papel de la adversidad psicosocial en el TDAH es fundamental, pero sigue siendo una tarea que conlleva grandes dificultades.