Gaming como método de intervención en el trastorno por déficit de atención e hiperactividad / Gaming as a method of intervention in attention deficit hyperactivity disorder

El presente estudio tiene como objetivo realizar una intervención utilizando como base los videojuegos. Para el mismo, se ha utilizado un videojuego indie llamado GRIS. El estudio es de tipo cuasi-experimental, donde se ha evaluado a los niños/as antes y después de la intervención. La evaluación de la intervención se realizó ha realizado mediante el test de Toulouse, que se mide mediante el índice global de atención y percepción (IGAP), y una guía creada específicamente para este estudio. El grupo de participantes, seleccionado por conveniencia, se conformó por tres niños procedentes del centro DIVERTEA en Cáceres (España) que presentaban trastorno por déficit de atención e hiperactividad o déficit de atención como trastorno comórbido. La comparación de los resultados obtenidos en los test previo y posterior indican una mejora en la atención y en la percepción, con unos resultados entre el 80% y el 100 por ciento en el IGAP posterior a la intervención. Estos resultados refuerzan la idea de utilizar los videojuegos como método de intervención para el trastorno por déficit de atención e hiperactividad. Queda abierta la posibilidad de seguir investigando sobre la utilización de los videojuegos como método de intervención en otros tipos de patologías y trastornos.

The aim of this study was to deliver an intervention using videogames as a base. For this study, it was used an indie videogame called GRIS. This was a quasi-experimental study, where children were evaluated before and after the intervention. For the assessment, Toulouse test was used, which is measured by global index of attention and perception (GIAP) and a guide created specifically for this study. The group of participants, selected by convenience, was made up of three children from DIVERTEA in Caceres (Spain) which had attention deficit/hyperactivity disorder, or attention deficit as a co-morbid disorder. The results obtained with the pre.post testing were compared, suggesting an attention and perception improvement with result between 80 and 100 percent in GIAP post- intervention. This result reinforces the idea of using videogames as intervention method in attention deficit/hyperactivity disorder. The possibility of using videogames as an intervention method in other pathologies and disorders, is open to continue research.

Time estimation exposure modifies cognitive aspects and cortical activity of attention deficit hyperactivity disorder adults.

AIM: This study investigated whether time-estimation task exposure influences the severity of Attention Deficit Hyperactivity Disorder (ADHD), as well as theta band activity in the dorsolateral prefrontal cortex and ventrolateral prefrontal cortex. MATERIAL AND METHODS: Twenty-two patients with ADHD participated in a crossover experiment with a visual time-estimation task under control conditions (without exposure to time estimation tasks) and experimental (thirty days exposure to time-estimation tasks) in association with electroencephalographic analysis of theta band. RESULTS: ADHD patients with thirty days of time-estimation task exposure presented a worse performance of the time-estimation task, as revealed by the measurements of the absolute error and relative error (p ≤ 0.05). However, our findings show the improvement of self-reported symptoms of attention, impulsivity, and emotional control in patients after the time-estimation task exposure (p = 0.0001). Moreover, the theta band oscillations in the right dorsolateral prefrontal cortex and in the ventrolateral prefrontal increased with thirty days of time-estimation task exposure (p ≤ 0.05). CONCLUSION: We propose that the decrease in EEG theta power may indicate an efficient accumulation of temporal pulses, which could be responsible for the improvement in the patient cognitive aspects as demonstrated by the current study. Time-estimation task improves ADHD cognitive symptoms, with a substantial increase in cortical areas activity related to attention and memory, suggesting its use as a tool for cognitive timing function management and non-invasive therapeutic aid in ADHD.

Possible benefit of consolidation therapy with high-dose cytarabine on overall survival of adults with non-promyelocytic acute myeloid leukemia

In adults with non-promyelocytic acute myeloid leukemia (AML), high-dose cytarabine consolidation therapy has been shown to influence survival in selected patients, although the appropriate doses and schemes have not been defined. We evaluated survival after calculating the actual dose of cytarabine that patients received for consolidation therapy and divided them into 3 groups according to dose. We conducted a single-center, retrospective study involving 311 non-promyelocytic AML patients with a median age of 36 years (16-79 years) who received curative treatment between 1978 and 2007. The 131 patients who received cytarabine consolidation were assigned to study groups by their cytarabine dose protocol. Group 1 (n=69) received <1.5 g/m2 every 12 h on 3 alternate days for up to 4 cycles. The remaining patients received high-dose cytarabine (≥1.5 g/m2 every 12 h on 3 alternate days for up to 4 cycles). The actual dose received during the entire consolidation period in these patients was calculated, allowing us to divide these patients into 2 additional groups. Group 2 (n=27) received an intermediate-high-dose (<27 g/m2), and group 3 (n=35) received a very-high-dose (≥27 g/m2). Among the 311 patients receiving curative treatment, the 5-year survival rate was 20.2% (63 patients). The cytarabine consolidation dose was an independent determinant of survival in multivariate analysis; age, karyotype, induction protocol, French-American-British classification, and de novo leukemia were not. Comparisons showed that the risk of death was higher in the intermediate-high-dose group 2 (hazard ratio [HR]=4.51; 95% confidence interval [CI]: 1.81-11.21) and the low-dose group 1 (HR=4.43; 95% CI: 1.97-9.96) than in the very-high-dose group 3, with no significant difference between those two groups. Our findings indicated that very-high-dose cytarabine during consolidation in adults with non-promyelocytic AML may improve survival.

Tradução e adaptação do Pay Attention - um programa de treinamento dos processos da atenção para crianças / Translation and adaptation of Pay Attention- a children's attention process training program

Este estudo descreve o processo de tradução, adaptação e análise de aplicabilidade clínica do Programa Pay Attention! ao português do Brasil. O processo seguiu as etapas recomendadas internacionalmente para adequação de instrumentos a outros idiomas: tradução/adaptação baseado em normas que preservassem características originais bem como as da cultura; análise por juízes especialistas; estudos-piloto; análise de aplicabilidade clínica em um grupo de 10 crianças com TDAH. Os resultados dos estudos-piloto foram analisados qualitativamente na fase de tradução/adaptação. No grupo clínico, o programa foi aplicado em 20 sessões individuais analisando-se a evolução individual, conforme estabelecido no manual. Os resultados demonstraram que a versão em português do Pay Attention! está adequada, tornando-se um importante instrumento de intervenção nos Transtornos de Déficit de Atenção em crianças. (AU)

This research report describes the translation, adaptation and analysis of clinical applicability process related to the Pay Attention! Program to Brazilian Portuguese. The process followed all the steps internationally recommended to adequate instruments to other languages: translation/adaptation based on rules that preserve original features and cultural characteristics; analysis by expert judges; pilot studies, and analysis of clinical applicability in a group of 10 children with Attention Deficit and Hyperactivity Disorder (ADHD). Results of pilot studies were qualitatively analyzed in the phase of translation/adaptation. In the clinical group, the program was implemented in 20 individual sessions analyzing the individual evolution, as stated in the manual. Results showed that the Portuguese version of the Pay Attention! Program is appropriate, becoming an important tool for the interventions in attention deficits in children. (AU)

Rehabilitación neuropsicológica en un caso de TDAH con predominio impulsivo / Neuropsychological rehabilitation in a case of ADHD with impulsive predominance

En Trastorno por déficit de atención e hiperactividad (TDAH) el síntoma central desde la neuropsicología es el deficiente desarrollo de la organización de su conducta, específicamente de las formas de actividad consciente e intencionalmente orientada. Los niños presentan dificultades en la organización y autorregulación de la conducta y un comportamiento inapropiado respecto a lo que se espera para su edad y desarrollo intelectual, aunque el niño es capaz de formar un propósito para su actividad, no logra mantenerse en ella, es incapaz de planear y seguir una secuencia de acciones para alcanzar el objetivo que se había planteado, los estímulos auditivos y visuales externos lo distraen con facilidad desviándolo de su propósito. El objetivo de este artículo es mostrar un programa de intervención Neuropsicológica en un caso de un niño con TDH de predominio impulsivo fundamentado en la identificación de la falla en el mecanismo de regulación y control que afecta la función reguladora del lenguaje para lograr una actividad voluntaria y organizada, se muestran los resultados de la valoración pre, el programa de intervención, la valoración pos y un análisis comparativo. La discusión se establece a partir de la importancia de la función reguladora del Lenguaje para la organización de la actividad voluntaria...

In the Attention Deficit Hyperactivity Disorder (ADHD), the central symptoms from the neuropsychology aspect, is the poor development of the organization of the behavior, specifically for conscious and intentionally targeted activities. Children have difficulties in self-regulation and organization of their behavior as well as an inappropriate conduct in respect to what is expected for their age and intellectual development. Although the child is capable of developing a purpose for their activity, the child is unable to plan and follow a sequence of actions, and maintain the focus to achieve the objective established. External visual and/or acoustic stimulus can easily distract and deflect them from their activities. The aim of this paper is to show a Neuropsychological intervention program for a case of a child with ADHD with impulsive predominance, based on the identification of the fault in the regulation and control’s mechanism that affects the language regulatory function to achieve an organized and voluntary activity. This paper shows the results of the pre-assessment, intervention program, the post assessment and the comparative analyzes. The discussion is set as regards as the importance of the language regulatory function in organizing a voluntary activity...

Psychopharmacology and psychotherapy for the treatment of adults with ADHD-a systematic review of available meta-analyses.

UNLABELLED: OBJECTIVE/INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) in adult life is a prevalent condition. We systematically reviewed the literature available by searching for meta-analyses assessing pharmacological and psychosocial interventions for adults with ADHD. METHODS: Using wide-ranging search terms, we retrieved 191 titles from the PubMed and Cochrane databases. Two independent evaluators judged all abstracts. Only meta-analyses about the treatment of adults with ADHD were included. Information from meta-analyses found was systematically extracted by 3 independent evaluators. RESULTS: Eight meta-analyses were identified. Results from those meta-analyses suggest that stimulants are effective in decreasing ADHD symptoms on a short-term basis with a medium to large effect size (ES). Short-acting stimulants might be superior to long-acting stimulants, but no data on difference in adherence are available for the comparison of these two types of formulation. Bupropion is superior to placebo but less effective than stimulants. No conclusions about the impact of psychosocial interventions can be drawn based on meta-analyses so far. Discussion The efficacy of stimulants in reducing ADHD symptoms for adults is well documented in meta-analyses, but there is a concerning lack of meta-analysis about other treatment interventions. CONCLUSION: The available meta-analytic literature does not cover questions of essential clinical relevance for adults with ADHD.

Exercise improves behavioral, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder.

OBJECTIVE: To examine the effect of a single bout of moderate-intensity aerobic exercise on preadolescent children with attention-deficit/hyperactivity disorder (ADHD) using objective measures of attention, brain neurophysiology, and academic performance. STUDY DESIGN: Using a within-participants design, task performance and event-related brain potentials were assessed while participants performed an attentional-control task following a bout of exercise or seated reading during 2 separate, counterbalanced sessions. RESULTS: Following a single 20-minute bout of exercise, both children with ADHD and healthy match control children exhibited greater response accuracy and stimulus-related processing, with the children with ADHD also exhibiting selective enhancements in regulatory processes, compared with after a similar duration of seated reading. In addition, greater performance in the areas of reading and arithmetic were observed following exercise in both groups. CONCLUSION: These findings indicate that single bouts of moderately intense aerobic exercise may have positive implications for aspects of neurocognitive function and inhibitory control in children with ADHD.

[Attention deficit hyperactivity disorder (ADHD) should be addressed in early childhood public policy-making in Colombia]. / Trastorno por déficit de atención e hiperactividad (TDAH), una problemática a abordar en la política pública de primera infancia en Colombia.

The following document was aimed at offering reflection about the attention deficit hyperactivity disorder (ADHD) as a true public health problem in Colombian children, involving very large challenges for childhood policy regarding this problem. This (in addition to all treatment protocols advanced to date) should include approaches implicitly involving motricity since one of this pathology's comorbid disorders becomes manifest in motor difficulties in the first instance, integrally involving family and school for success in managing the event.

Trastorno por déficit de atención e hiperactividad (TDAH), una problemática a abordar en la política pública de primera infancia en Colombia / Attention deficit hyperactivity disorder (ADHD) should be addressed in early childhood public policy-making in Colombia

El siguiente documento tiene como propósito establecer una mirada reflexiva acerca del Trastorno por déficit de atención e hiperactividad (TDAH) como verdadero problema de salud pública en la población infantil de nuestro país, situación que implica unos retos muy grandes de la política de infancia sobre esta problemática y donde además de todos los protocolos de tratamiento realizados hasta el momento se deben incluir abordajes que tengan implícita la motricidad ya que una de las alteraciones comorbidas de esta patología se manifiesta en las dificultades motrices en primera instancia, y de manera integral involucrar a la familia y la escuela para el éxito en el manejo del evento.

The following document was aimed at offering reflection about the attention deficit hyperactivity disorder (ADHD) as a true public health problem in Colombian children, involving very large challenges for childhood policy regarding this problem. This (in addition to all treatment protocols advanced to date) should include approaches implicitly involving motricity since one of this pathology's comorbid disorders becomes manifest in motor difficulties in the first instance, integrally involving family and school for success in managing the event.

Low Apgar scores and risk of childhood attention deficit hyperactivity disorder.

OBJECTIVE: To examine whether low Apgar scores at 5 minutes are associated with increased risks of attention deficit hyperactivity disorder (ADHD). STUDY DESIGN: We conducted a nationwide population-based cohort study of all 980 902 singletons born in Denmark from 1988 to 2001. All children were monitored from 3 years of age until a first International Classification of Diseases diagnosis of hyperkinetic disorder, a first medication for ADHD, migration, death, or the end of 2006, whichever came first. We used Cox regression models to examine the association between Apgar scores at 5 minutes and ADHD. RESULTS: Apgar scores were inversely associated with risk of ADHD (hazard ratio 0.92; 95% CI: 0.88-0.96, P trend < .001). Compared with children with Apgar scores of 9 or 10 at 5 minutes, the risk for ADHD was 75% higher in children with Apgar scores of 1 to 4 (hazard ratio 1.75; 95% CI: 1.15 to 2.11) and 63% higher for those with Apgar scores of 5 to 6 (95% CI: 1.25 to 2.11). CONCLUSIONS: A low Apgar score was associated with an increased risk of ADHD in childhood. Low Apgar scores and ADHD may share common causes or a low Apgar score reflects at least one causal pathway leading to ADHD.

Análisis del desempeño ocupacional de un niño con trastorno por déficit de atención e hiperactividad / Analysis of the occupational performance of a child with attention deficit and hyperactive disorder

Este estudio tuvo como objetivo analizar el desempeño ocupacional de un niño con Trastorno por Déficit de Atención e Hiperactividad (TDAH) durante el ejercicio de sus tareas diarias. La metodología escogida fue el estudio de caso de un niño con diagnóstico clínico de TDAH de una ciudad al interior del estado de Sao Paulo, Brasil. La recolección y análisis de datos fue realizada mediante la observación y la aplicación de evaluaciones estandarizadas como Pediatric Evaluation of Disability Inventory (PEDI) traducida y avalada para la población brasilera, School Funtion Assessment (SFA), Questionário sobre o comportamento lúdico infantil (PFEIFER, 2006) y Roteiro de análise de habilidades sociais (ANHÃO, 2008). Estas evaluaciones fueron aplicadas con el fin de abarcar todas las áreas ocupacionales de los niños: juego, participación social, actividades de la vida diaria (AVD) y escolar. Los resultados mostraron que las alteraciones presentadas en el desempeño ocupacional están relacionadas con la calidad en la ejecución de tareas diarias y no con la independencia en la realización de las mismas. Por esta razón no existe ninguna restricción en la participación del niño en los contextos donde se desenvuelve.

The objective of this study was to analyze the occupational performance of the daily activities of children with the ADHD (Attention deficit and hyperactive disorder). The selected methodology was the case study of a boy with a clinical diagnose of ADHD in a city in the interior state of Sao Paulo, Brazil. The recollection and analysis of data were made by observation and the application of standard evaluations like Pediatric Evaluation of Disability Inventory (PEDI), translated and applied in Brazilian population, School function Assessment (SFA), Questionário sobre o comportamento lúdico infantil (PFEIFER, 2006) and Roteiro de análise de habilidades sociais (ANHÃO, 2008). This evaluation were applied with the objective of include all the occupational areas of children, play, social participation, daily activities and study. The results showed that the alteration presented in the occupational performance is related with the quality in the execution of daily tasks and not with the independence in the accomplishment of them. For this reason, there weren’t found any restriction in the participation of the child in his occupational contexts.

Conducta intencional en niños con trastornos por déficit de atención con hiperactividad: resultados preliminares / Volition in attention deficit hyperactivity disorder in childhood: preliminar results

La mayoría de los modelos teóricos que explican el trastorno por déficit de atención con hiperactividad coinciden en señalar la presencia de un déficit motivacional. Sin embargo, son pocos los estudios que se centran sobre la conducta intencional o volición en estos niños. El Modelo de la Ocupación Humana entiende que la volición es un elemento clave en la ocupación humana. El objetivo de este estudio es conocer cómo es la conducta intencional de los niños con trastorno por déficit de atención con hiperactividad para poder establecer objetivos y programas de tratamiento más eficaces con esta población. Método. La muestra está formada por 21 niños con edades comprendidas entre 7 y 11 años y todos ellos fueron evaluados a través del PediatricVolitional Questionaire (PVQ) en dos ocupaciones: actividades de la vida diaria y actividades escolares. Resultados. Los resultados indican que la conducta intencional es diferente en las actividades de la vida diaria y actividades escolares, mostrando una mayor complejidad en las actividades escolares. La conducta intencional es inferior en los niños del subtipo combinado que el grupo control e inatento. Conclusiones. Estos resultados podrían indicar un menor desarrollo del sentido de capacidad o competencia en los niños con el trastorno por déficit de atención con hiperactividad. Los tratamientos deberían fomentar el desarrollo de un sentido positivo de competencia y de identidad ocupacional.

Most of the theoretical models that explain Attention Deficit Hyperactivity Disorder suggest the presence of a motivational deficit. However, few studies that focuses on the intentional or volition in these children. The Model of Human Occupation understands that volition is a key element in the human occupation. The aim of this study is how the volition of children with Attention Deficit Hyperactivity Disorder in order to establish goals and treatment programs more effective with this population. Method. Twenty one children, between seven and eleven years old participated and were assessed through the Pediatric Volitional Questionnaire (PVQ) in two occupations: activities of daily living and school activities. Results. The results indicate that the volition is different in the activities of daily living and school activities, showing more complex school activities. The volition is lower in children in the combined subtype that the control group and inattentive subtype. Conclusions. These results could indicate a less developed sense of capacity or competence in children with attention deficit hyperactivity disorder. The future treatment should encourage the development of a positive sense of occupational identity and occupational competence.

Attention deficit hyperactivity disorder and substance use disorders.

Attention deficit hperactivity disorder (ADHD) is highly prevalent among adolescents who have substance use disorder (SUD). Several lines of evidence, although not conclusive, suggest that ADHD might have an independent effect on SUD liability. It is still to be determined, however, whether this association is mediated by conduct disorder. This article reviews ADHD and SUD.