Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con trastorno por déficit de atención con hiperactividad y un diagnóstico comórbido de trastorno por uso de sustancias / Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use

La evidencia actual confirma la alta comorbilidad entre el trastorno por déficit de atención con hiperactividad (TDAH) y trastorno por uso de sustancias (TUS). Esta revisión resume las intervenciones farmacológicas y psicosociales que se han evaluado en pacientes con TDAH y TUS, y ofrece recomendaciones mediante el enfoque GRADE. Nuestros resultados sugieren: 1) En pacientes con TDAH y trastorno por uso de alcohol, la atomoxetina es recomendable para reducir los síntomas de TDAH (recomendación débil) y el craving de alcohol (recomendación débil). 2) En pacientes con TDAH y trastorno por uso de cannabis, la atomoxetina es recomendable para mejorar los síntomas de TDAH (recomendación débil), no para reducir el uso de cannabis (recomendación débil). 3) En pacientes con TDAH y trastorno por uso de cocaína, el metilfenidato no es recomendable para mejorar los síntomas de TDAH o para reducir el uso de cocaína (recomendación débil). 4) En pacientes con TDAH y trastorno por uso de nicotina, es recomendable el metilfenidato para mejorar los síntomas de TDAH (recomendación débil). Los psicoestimulantes, como metilfenidato o lisdexanfetamina, no son recomendables para reducir el uso de nicotina (recomendación débil). 5) Respecto de los pacientes con TDAH y cualquier TUS, el uso de los psicoestimulantes es recomendable para mejorar los síntomas de TDAH (recomendación débil), no para reducir el uso de sustancias (recomendación débil) o para mejorar la retención del tratamiento (recomendación fuerte).(AU)

Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). This review synthesizes the pharmacological and psychosocial interventions conducted in ADHD and SUDs, and provides clinical recommendations using the GRADE approach. Our results suggest: 1) In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms (weak recommendation) and alcohol craving (weak recommendation). 2) In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to reduce cannabis use (weak recommendation). 3) In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or to reduce cocaine use (weak recommendation). 4) In patients with ADHD and comorbid nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms (weak recommendation). Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation).(AU)

Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use. / Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con trastorno por déficit de atención con hiperactividad y un diagnóstico comórbido de trastorno por uso de sustancias.

Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). This review synthesizes the pharmacological and psychosocial interventions conducted in ADHD and SUDs, and provides clinical recommendations using the GRADE approach. Our results suggest: 1) In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms (weak recommendation) and alcohol craving (weak recommendation). 2) In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to reduce cannabis use (weak recommendation). 3) In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or to reduce cocaine use (weak recommendation). 4) In patients with ADHD and comorbid nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms (weak recommendation). Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation). In these patients, the use of atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to decrease substance use (weak recommendation) or to improve retention to treatment (strong recommendation). Atomoxetine and psychostimulants appear to be safe in patients with any SUD (strong recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite and conclusive evidence.

La evidencia actual confirma la alta comorbilidad entre el trastorno por déficit de atención con hiperactividad (TDAH) y trastorno por uso de sustancias (TUS). Esta revisión resume las intervenciones farmacológicas y psicosociales que se han evaluado en pacientes con TDAH y TUS, y ofrece recomendaciones mediante el enfoque GRADE. Nuestros resultados sugieren: 1) En pacientes con TDAH y trastorno por uso de alcohol, la atomoxetina es recomendable para reducir los síntomas de TDAH (recomendación débil) y el craving de alcohol (recomendación débil). 2) En pacientes con TDAH y trastorno por uso de cannabis, la atomoxetina es recomendable para mejorar los síntomas de TDAH (recomendación débil), no para reducir el uso de cannabis (recomendación débil). 3) En pacientes con TDAH y trastorno por uso de cocaína, el metilfenidato no es recomendable para mejorar los síntomas de TDAH o para reducir el uso de cocaína (recomendación débil). 4) En pacientes con TDAH y trastorno por uso de nicotina, es recomendable el metilfenidato para mejorar los síntomas de TDAH (recomendación débil). Los psicoestimulantes, como metilfenidato o lisdexanfetamina, no son recomendables para reducir el uso de nicotina (recomendación débil). 5) Respecto de los pacientes con TDAH y cualquier TUS, el uso de los psicoestimulantes es recomendable para mejorar los síntomas de TDAH (recomendación débil), no para reducir el uso de sustancias (recomendación débil) o para mejorar la retención del tratamiento (recomendación fuerte). En estos pacientes, el uso de atomexetina es recomendable para mejorar los síntomas de TDAH (recomendación débil), no para reducir el uso de sustancias (recomendación débil) o para mejorar la retención del tratamiento (recomendación fuerte). La atomoxetina y los psicoestimulantes parecen ser seguros en pacientes con cualquier TUS (recomendación fuerte). Nuestra revisión sugiere la necesidad de realizar más investigaciones en esta área y de estudios aleatorizados, multicéntricos y de mayor tamaño muestral para proporcionar más evidencia definitiva y concluyente.

Prevalencia del trastorno por déficit de atención con hiperactividad en niños de una localidad urbana / Prevalence of attention deficit disorder with hyperactivity in children from an urban area

Introducción: el objetivo es estimar la prevalencia del trastorno por déficit de atención con hiperactividad en la población infantil (6-14 años) asignada a un centro de salud. Como objetivo secundario, describir el motivo de la primera consulta, el especialista que diagnostica y realiza el seguimiento, los criterios diagnósticos, el tipo de tratamiento, efectos secundarios derivados y comorbilidad. Se intenta comprobar si la prevalencia de niños con TDAH está alrededor del 5%, como refleja la bibliografía consultada. Pacientes y métodos: se realiza un estudio descriptivo transversal mediante una revisión en conjunto, con cada pediatra responsable, de las historias clínicas de niños adscritos al centro de salud Cerro del Aire en Majadahonda (Madrid, España) (4747 niños). Resultados: se han encontrado 108 casos con trastorno por déficit de atención con hiperactividad (prevalencia del 2,28%), el 23,15% niñas y el 76,85% niños. La edad media de diagnóstico es 7,89 años. El motivo de consulta más frecuente son los problemas de aprendizaje (39,82%). El diagnóstico y seguimiento lo realizan neuropediatras en el 48,15 y 50% de los casos respectivamente. En el 64,8% de los casos el diagnóstico se realiza según los criterios del DSM-IV combinado con escalas y valoración psicopedagógica. El 63,89% recibe tratamiento farmacológico, además de psicopedagógico. El fármaco más utilizado (88,88%) es metilfenidato. El 25,25% presentaron efectos secundarios. Existe comorbilidad en un 45,37% (trastornos del aprendizaje 27,12%). Conclusiones: la prevalencia encontrada es baja, pero hay que tener en cuenta los sesgos y limitaciones del estudio. Es importante tener un protocolo de diagnóstico y tratamiento único, para registrar adecuadamente y evitar infra- o sobrediagnosticar. Un 28% de los pacientes es seguido por pediatras de Atención Primaria (AU)

Introduction: the primary objective waste assess the prevalence of attention deficit hyperactivity disorder in the paediatric population (ages 6-14 years) served by one primary care centre. The secondary objective waste describe the reasons for initial consultation, specialists that diagnosed and managed ADHD, the criteria used in diagnosis, the types of treatment and associated side effects, and the presence of comorbidities. We sought to determine whether the prevalence of ADHD in children was of approximately 5%, consistent with the reviewed literature. Patients and methods: we conducted a cross-sectional descriptive study through the review, in collaboration with the paediatrician in charge of each patient, of the health records of children in the catchment area or the Cerro del Aire primary care centre of Majadahonda (Madrid, Spain) (4747 children). Results: we identified 108 cases of attention deficit hyperactivity disorder (prevalence of 2.28%), 23.15% in girls and 76.85% in boys. The mean age at diagnosis was 7.89 years. Learning problems were the most frequent reason for consultation (39.82%). Paediatric neurologists diagnosed 48.15% of cases and managed 50% of them. In 64.8% of cases, the diagnosis was made based on the DSM-IV criteria combined with scales and a psychoeducational assessment. In 63.89% of patients, pharmacotherapy was used in combination with psychoeducational interventions. The most frequently used drug was methylphenidate (88.88%). Side effects were reported by 25.25%.There were comorbidities in 45.37% (learning disorders in 27.12%). Conclusion: we found a low prevalence of ADHD, but the biases and limitations of the study must be taken into account. The establishment of a standardised protocol for the diagnosis and management of ADHD would be important to ensure accurate documentation and avoid under- or over diagnosis. Twenty-eight percent of patients were followed up by primary care paediatricians (AU)

Processing speed can monitor stimulant-medication effects in adults with attention deficit disorder with hyperactivity.

BACKGROUND: Treatment responses to methylphenidate by adults with ADHD are generally monitored against DSM-IV/DSM-V symptomatology, rating scales or interviews during reviews. AIMS: To evaluate the use of single- and dual-dimension processing-speed and efficiency measures to monitor the effects of pharmacological treatment with methylphenidate after a short period off medication. METHODS: A Quick Test of Cognitive Speed (AQT) monitored the effects of immediate-release methylphenidate in 40 previously diagnosed and medicated adults with ADHD. Processing speed was evaluated with prior prescription medication, without medication after a 2-day period off ADHD medication, and with low-dose (10/20 mg) and high-dose (20/40 mg) methylphenidate hydrochloride (Medikinet IR). RESULTS: Thirty-three participants responded to the experimental treatments. One-way ANOVA with post-hoc analysis (Scheffe) indicated significant main effects for single dimension colour and form and dual-dimension colour-form naming. Post-hoc analysis indicated statistical differences between the no- and high-dose medication conditions for colour and form, measures of perceptual speed. For colour-form naming, a measure of cognitive speed, there was a significant difference between no- and low-dose medication and between no- and high-dose medications, but not between low- and high-dose medications. CONCLUSIONS: Results indicated that the AQT tests effectively monitored incremental effects of the methylphenidate dose on processing speed after a 2-day period off medication. Thus, perceptual (colour and form) and cognitive speed (two-dimensional colour-form naming) and processing efficiency (lowered shift costs) increased measurably with high-dose medication. These preliminary findings warrant validation with added measures of associated behavioural and cognitive changes.

College Adjustment as a Mediator Between Attention Deficit/Hyperactivity Disorder Symptoms and Work Self-Efficacy / Adaptação Acadêmica Como Mediadora Entre Sintomas do Transtorno do Déficit de Atenção/Hiperatividade e Autoeficácia Profissional / Adaptación Académica Como Mediadora Entre Síntomas del Trastorno por Déficit de Atención con Hiperactividad y Autoeficacia Profesional

Abstract Studies have addressed features of Attention Deficit/Hyperactivity Disorder (ADHD) in higher education, but the potential relationships between ADHD symptoms, dimensions of college adjustment and students' work self-efficacy remain scarcely explored. The aim of this study was to test a theoretical model in which the dimensions of college adjustment mediate the relationship between ADHD symptoms and work self-efficacy. Participants were 509 college students from two Brazilian public universities. Data were collected using questionnaires and analyzed using a path analysis model. The ADHD symptoms affected work self-efficacy exclusively through college adjustment problems. Improving students' well-being, social support networks, study habits, and feelings regarding their majors and the university may reduce the potential disadvantages in work self-efficacy caused by ADHD symptoms.(AU)

Resumo Pesquisas têm investigado aspectos do Transtorno do Déficit de Atenção/Hiperatividade (TDAH) no contexto universitário, mas permanecem pouco exploradas as relações entre os sintomas de TDAH, as dimensões da adaptação acadêmica e a autoeficácia profissional dos estudantes. O objetivo desse estudo foi testar um modelo teórico em que dimensões da adaptação acadêmica medeiam a relação entre sintomas do TDAH e autoeficácia profissional. Participaram do estudo 509 estudantes universitários de duas universidades públicas brasileiras. Os dados foram coletados por meio de questionários e analisados por meio de um modelo de path analysis. Os sintomas do TDAH interferiram na autoeficácia profissional exclusivamente por meio de problemas de adaptação acadêmica. O aumento do bem-estar, da rede de apoio social, dos hábitos de estudo e dos sentimentos frente ao curso e à universidade dos estudantes pode reduzir as potenciais desvantagens na autoeficácia profissional causadas pelos sintomas do TDAH.(AU)

Resumen Estudios han abordado características del Trastorno por Déficit de Atención con Hiperactividad (TDAH) en el contexto universitario, pero siguen poco exploradas las posibles relaciones entre los síntomas del TDAH, dimensiones de ajuste académico y la autoeficacia profesional de los estudiantes. El objetivo de este estudio fue testar un modelo teórico en que dimensiones de la adaptación académica medían la relación entre síntomas del TDAH y autoeficacia profesional. Participaron del estudio 509 estudiantes universitarios de dos universidades públicas brasileñas. Los datos fueron recolectados a través de cuestionarios y analizados mediante un modelo de path analysis. Los síntomas del TDAH interfirieron en la autoeficacia profesional exclusivamente por medio de problemas de adaptación académica. El aumento del bienestar, la red de apoyo social, los hábitos de estudio y los sentimientos ante la carrera y la universidad de los estudiantes pueden disminuir las potenciales desventajas en la autoeficacia profesional, causadas por los síntomas del TDAH.(AU)

College adjustment as a mediator between attention deficit/hyperactivity disorder symptoms and work self-efficacy / Adaptação acadêmica como mediadora entre sintomas do transtorno do déficit de atenção/hiperatividade e autoeficacia profissional / Adaptacion académica como mediadora entre síntomas del trastorno por déficit de atención con hiperactividad y autoeficacia profesional

Studies have addressed features of Attention Deficit/Hyperactivity Disorder (ADHD) in higher education, but the potential relationships between ADHD symptoms, dimensions of college adjustment and students' work self-efficacy remain scarcely explored. The aim of this study was to test a theoretical model in which the dimensions of college adjustment mediate the relationship between ADHD symptoms and work self-efficacy. Participants were 509 college students from two Brazilian public universities. Data were collected using questionnaires and analyzed using a path analysis model. The ADHD symptoms affected work self-efficacy exclusively through college adjustment problems. Improving students' well-being, social support networks, study habits, and feelings regarding their majors and the university may reduce the potential disadvantages in work self-efficacy caused by ADHD symptoms.

Pesquisas têm investigado aspectos do Transtorno do Déficit de Atenção/Hiperatividade (TDAH) no contexto universitário, mas permanecem pouco exploradas as relações entre os sintomas de TDAH, as dimensões da adaptação acadêmica e a autoeficácia profissional dos estudantes. O objetivo desse estudo foi testar um modelo teórico em que dimensões da adaptação acadêmica medeiam a relação entre sintomas do TDAH e autoeficácia profissional. Participaram do estudo 509 estudantes universitários de duas universidades públicas brasileiras. Os dados foram coletados por meio de questionários e analisados por meio de um modelo de path analysis. Os sintomas do TDAH interferiram na autoeficácia profissional exclusivamente por meio de problemas de adaptação acadêmica. O aumento do bem-estar, da rede de apoio social, dos hábitos de estudo e dos sentimentos frente ao curso e à universidade dos estudantes pode reduzir as potenciais desvantagens na autoeficácia profissional causadas pelos sintomas do TDAH.

Estudios han abordado características del Trastorno por Déficit de Atención con Hiperactividad (TDAH) en el contexto universitario, pero siguen poco exploradas las posibles relaciones entre los síntomas del TDAH, dimensiones de ajuste académico y la autoeficacia profesional de los estudiantes. El objetivo de este estudio fue testar un modelo teórico en que dimensiones de la adaptación académica medían la relación entre síntomas del TDAH y autoeficacia profesional. Participaron del estudio 509 estudiantes universitarios de dos universidades públicas brasileñas. Los datos fueron recolectados a través de cuestionarios y analizados mediante un modelo de path analysis. Los síntomas del TDAH interfirieron en la autoeficacia profesional exclusivamente por medio de problemas de adaptación académica. El aumento del bienestar, la red de apoyo social, los hábitos de estudio y los sentimientos ante la carrera y la universidad de los estudiantes pueden disminuir las potenciales desventajas en la autoeficacia profesional, causadas por los síntomas del TDAH.

Implicaciones forenses en adultos con trastorno por déficit de atención con hiperactividad / Forensic implications in adults with attention deficit hyperactivity disorder

En el ámbito forense abundan los diagnósticos de trastorno antisocial de la personalidad, trastorno límite de la personalidad y abuso de sustancias psicoactivas, que comparten algunos síntomas con el trastorno por déficit de atención con hiperactividad (TDAH) y frecuente comorbilidad. Las disfunciones ejecutivas, atencionales y, especialmente, las dificultades en el control de la impulsividad y de la autorregulación emocional, presentes en el TDAH, también son comunes en población forense. En este trabajo se revisan aspectos de estos síntomas susceptibles de producir problemas legales al sujeto. Por último, se plantean algunas cuestiones sobre la evaluación forense y sus futuros efectos sobre la valoración de la imputabilidad en personas con disfunciones neurofisiológicas y neuropsicológicas en los circuitos que regulan la atención y la impulsividad (AU)

In the forensic field, there are numerous diagnoses of antisocial personality disorder, borderline personality disorder and substance abuse, as we shall see, that share some symptoms with the attention deficit hyperactivity disorder (ADHD) and frequent comorbidity. Executive dysfunction, especially attentional difficulties in impulse control and emotional self-regulation in ADHD, are also common in forensic population. In this paper, aspects of these symptoms likely to cause legal problems the subject are reviewed. Finally, some questions arise about the forensic evaluation and its future effects on the assessment of responsibility in people with neurophysiological and neuropsychological dysfunction in circuits that regulate attention and impulsivity (AU)

Influence of the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and comorbid disorders on functioning in adulthood / Influencia de los síntomas del Trastorno por Déficit de Atención con Hiperactividad (TDAH) y trastornos comórbidos en el funcionamiento en la edad adulta

BACKGROUND: ADHD is a chronic disorder that generally has a negative effect on socio-personal adaptation. The objectives of the current study were to examine the adaptive functioning in the daily lives of adults with ADHD compared to adults without the disorder and to test the influence of ADHD symptoms and comorbid problems on different areas of adaptive functioning. METHOD: Seventy-seven adults between 17 and 24 years old, 40 with a clinical diagnosis of combined-subtype ADHD in childhood and 37 controls, filled out the Weiss Functional Impairment Scale, the Weiss Symptom Record and Conners' Adult ADHD Rating Scale. RESULTS: Significant differences were found between adults with and without ADHD in family and academic functioning. Moreover, the ADHD symptomatology as a whole predicted significant deficiencies in the family environment and self-concept, whereas inattention specifically predicted worse academic performance and life skills. The comorbidities mainly affected the family and risky activity domains (dangerous driving, illegal behaviors, substance misuse and sexually inappropriate behaviors). CONCLUSIONS: The results illustrate the importance of developing a multimodal approach to helping ADHD adults cope with associated comorbid disorders, offering them supportive coaching in organizing daily activities, and incorporating the family and/or partner in the treatment plan

ANTECEDENTES: el TDAH es un trastorno crónico que afecta la adaptación sociopersonal. Los objetivos de este estudio fueron comprobar el funcionamiento adaptativo de adultos con TDAH en comparación a adultos sin el trastorno y analizar la influencia de la inatención e hiperactividad/impulsividad y de los trastornos comórbidos en este funcionamiento. MÉTODO: la muestra incluyó 77 adultos entre 17 y 24 años, 40 con un diagnóstico de TDAH subtipo combinado y 37 controles que cumplimentaron el Weiss Functional Impairment Scale, el Weiss Symptom Record y el Conners' Adult ADHD Rating Scale. RESULTADOS: se encontraron diferencias significativas entre adultos con y sin TDAH en el funcionamiento familiar y académico. Además, la sintomatología de TDAH predijo déficits significativos en el ámbito familiar y en el autoconcepto y concretamente la inatención predijo un peor funcionamiento académico y de habilidades cotidianas. Las comorbilidades influyeron principalmente en los dominios familiar y de actividades de riego (conducción temeraria, conductas ilegales, abuso de sustancias y conductas sexuales inapropiadas). CONCLUSIONES: los resultados reflejan la importancia de desarrollar un enfoque multimodal en adultos con TDAH para tratar los trastornos comórbidos, ofreciéndoles entrenamiento para la organización de actividades diarias e incorporando a la familia y/o pareja en el plan de tratamiento

Prevalencia de síntomas de trastorno por déficit de atención con hiperactividad en adolescentes y adultos jóvenes con otros trastornos psiquiátricos refractarios a tratamientos previos / Prevalence of attention deficit/hyperactivity disorder symptoms in outpatient adolescents and young adults with other psychiatric disorders refractory to previous treatments

Introducción. El objetivo de este estudio fue evaluar la prevalencia de síntomas de trastorno por déficit de atención con hiperactividad (TDAH) en adolescentes y adultos jóvenes diagnosticados de otros trastornos psiquiátricos primarios que no habían respondido a tratamientos previos. Material y métodos. Se incluyeron 795 pacientes ambulatorios de 15-24 años. Se estudió la presencia de un TDAH según los criterios DSM-IV y la frecuencia de los síntomas utilizando la escala de valoración del TDAH de DuPaul de 18 ítems. Resultados. Se objetivó la presencia de un TDAH (criterios DSM-IV) en 48 pacientes (6%), ninguno de los cuales previamente había recibido este diagnóstico. Un total de 260 pacientes (32,7%) presentaron síntomas moderados de TDAH y en ellos la gravedad del trastorno psiquiátrico de base era mayor según la ICG-S (p = 0,007). Los factores de riesgo para tener síntomas moderados de TDAH fueron la presencia de trastornos por uso de sustancias (TUS) (odds ratio = 1,543; p = 0,01) y de trastorno límite de la personalidad (odds ratio = 2,173; p = 0,0001). Conclusiones. El TDAH no diagnosticado previamente estaba presente en el 6% de los pacientes, observándose asimismo una elevada frecuencia de síntomas moderados del trastorno (32,7%) en la muestra. Por estos motivos sería recomendable hacer un minucioso estudio del TDAH en los jóvenes refractarios al tratamiento del trastorno primario, principalmente en aquellos con trastornos por uso de sustancias, trastornos de conducta y de personalidad, debido a la elevada comorbilidad entre el TDAH y estos trastornos (AU)

Introduction. The aim of the current study was to assess the prevalence of symptoms of attention deficit/hyperactivity disorder (ADHD) in adolescents and young adults diagnosed with other primary psychiatric disorders, who had not responded to previous treatments. Material and methods. A total of 795 outpatients aged 15 to 24 years were included. The presence of ADHD was studied using DSM-IV criteria and the frequency of symptoms using the 18 item DuPaul ADHD Rating Scale. Results. ADHD (DSM-IV criteria) was present in 48 patients (6%), none of whom had previously received the diagnosis. A total of 260 patients (32.7%) met the criteria for moderate ADHD and between them, severity of primary psychiatric disorder was higher according to the CGI-S (P = .007). Risk factors for moderate ADHD symptoms were the presence of substance use disorders (SUD) (odds ratio = 1.543, P = .01) and borderline personality disorders (odds ratio = 2.173, p = .0001). Conclusion. Unrecognized ADHD was present in 6% of patients; moreover 32.7% of the sample also presented moderate symptoms of the disorder. Screening for ADHD in young patients with refractory response to primary disorder treatment, mainly those with substance use disorders, conduct and personality disorders is highly advisable, due to the high frequency of ADHD comorbidity in these psychiatric disorders (AU)

[Prevalence of attention deficit/hyperactivity disorder symptoms in outpatient adolescents and young adults with other psychiatric disorders refractory to previous treatments]. / Prevalencia de síntomas de trastorno por déficit de atención con hiperactividad en adolescentes y adultos jóvenes con otros trastornos psiquiátricos refractarios a tratamientos previos.

INTRODUCTION: The aim of the current study was to assess the prevalence of symptoms of attention deficit/hyperactivity disorder (ADHD) in adolescents and young adults diagnosed with other primary psychiatric disorders, who had not responded to previous treatments. MATERIAL AND METHODS: A total of 795 outpatients aged 15 to 24 years were included. The presence of ADHD was studied using DSM-IV criteria and the frequency of symptoms using the 18 item DuPaul ADHD Rating Scale. RESULTS: ADHD (DSM-IV criteria) was present in 48 patients (6%), none of whom had previously received the diagnosis. A total of 260 patients (32.7%) met the criteria for moderate ADHD and between them, severity of primary psychiatric disorder was higher according to the CGI-S (P=.007). Risk factors for moderate ADHD symptoms were the presence of substance use disorders (SUD) (odds ratio=1.543, P=.01) and borderline personality disorders (odds ratio =2.173, p=.0001). CONCLUSION: Unrecognized ADHD was present in 6% of patients; moreover 32.7% of the sample also presented moderate symptoms of the disorder. Screening for ADHD in young patients with refractory response to primary disorder treatment, mainly those with substance use disorders, conduct and personality disorders is highly advisable, due to the high frequency of ADHD comorbidity in these psychiatric disorders.

Função motora fina, sensorial e perceptiva de escolares com transtorno do déficit de atenção com hiperatividade / Fine motor, sensory and perceptive function of students with attention deficit disorder with hyperactivity

OBJETIVO: Caracterizar e comparar as funções motoras fina, sensorial e perceptiva de escolares com Transtorno do Déficit de Atenção com Hiperatividade (TDAH) e escolares com bom desempenho escolar sem alterações de comportamento. MÉTODOS: Participaram 22 escolares do ensino fundamental, de gênero masculino, distribuídos em: GI - 11 escolares com Transtorno do Déficit de Atenção com Hiperatividade; e GII - 11 escolares com bom desempenho acadêmico e sem alterações de comportamento. Os escolares foram submetidos à aplicação do Protocolo de Avaliação da Função Motora Fina, Sensorial e Perceptiva e da Escala de Disgrafia. RESULTADOS: Houve diferença nas tarefas de função motora fina, função sensorial e função perceptiva entre o GI e o GII, com desempenho inferior do GI. Todos os escolares de GI apresentaram disgrafia. CONCLUSÃO: Escolares com Transtorno do Déficit de Atenção com Hiperatividade apresentam desempenho inferior aos escolares com bom desempenho acadêmico em relação às funções motoras fina, sensorial e perceptiva. Tais dificuldades podem causar impacto significativo sobre o desempenho acadêmico, uma vez que comprometem o desenvolvimento da linguagem escrita, ocasionando disgrafia nesses escolares.

PURPOSE: To characterize and compare the fine motor, sensory and perceptive functions of students with Attention Deficit Disorder with Hyperactivity (ADHD) and students with good academic performance, without behavior alteration. METHODS: Participants were 22 male students from Elementary School distributed into: GI - 11 children with ADHD; and GII - 11 students with good academic performance and no behavior alteration. Students were submitted to the Protocol for Evaluation of Fine Motor, Sensory and Perceptual Function, and to the Dysgraphia Scale. RESULTS: There were differences between GI and GII in tasks concerning fine motor function, sensory function, and perceptual function, with lower performance from GI. All students in GI presented dysgraphia. CONCLUSION: Students with Attention Deficit Disorder with Hyperactivity present lower performance regarding fine motor, sensory and perception functions in relation to students with good academic performance. These difficulties can cause significant impact on academic performance, impairing the development of written language and causing dysgraphia in these students.

Desempenho cognitivo-linguístico e achados de neuroimagem de escolares com dislexia, transtorno do déficit de atenção com hiperatividade / Cognitive-linguistic performance and neuroimaging findings of students with dyslexia, attention deficit hyperactivity disorder

OBJETIVO: Este estudo buscou caracterizar e comparar os achados cognitivo-linguísticos e a neuroimagem de escolares disléxicos, com transtorno do déficit de atenção com hiperatividade e bom desempenho acadêmico. MÉTODOS: Participaram 53 escolares, divididos em GI, 17 escolares disléxicos; GII, 17 com transtorno do déficit de atenção com hiperatividade e GIII, 19 com bom desempenho acadêmico. Realizou-se o teste de desempenho cognitivo-linguístico e o exame de neuroimagem. RESULTADOS: Os resultados indicaram desempenho inferior de GI e GII em relação aos desempenhos cognitivo-linguísticos do GIII. Os resultados de neuroimagem indicaram hipoperfusão na porção mesial do lobo temporal-esquerdo para GI e no frontal-esquerdo para GII. CONCLUSÃO: O perfil cognitivo-linguístico dos escolares do GI e GII pode ser decorrente das alterações de fluxo sanguíneo em regiões do sistema nervoso central.

OBJECTIVE: This study aimed at characterizing and comparing the performance of students with dyslexia, attention deficit hyperactivity disorder, and good readers in cognitive-linguistic tests and neuroimaging. METHODS: This study included 53 students, divided into GI, 17 students with interdisciplinary diagnoses of dyslexia; GII, 17 with interdisciplinary diagnoses with attention deficit hyperactivity disorder; and GIII, 19 good readers. We applied the cognitive-linguistic performance test and neuroimaging exams (Single Photon Emission Computed Tomography). RESULTS: The results revealed that GI and GII showed low scores in the cognitive-linguistic performance test. The neuroimaging exams indicated predominance of hypoperfusion in the mesial portion of the left temporal lobe for GI and in the left frontal lobe for GII. CONCLUSION: The low performance of GI and GII are related with the cognitive-linguistic profile and may be due to changes in blood flow in some areas of the central nervous system.

Validez de los criterios DSM-IV según respuesta de los padres en el diagnóstico del trastorno por déficit de atención con hiperactividad / Validity of the DSM-IV criteria according to the parents´ response in the diagnosis of the attention deficit hyperactivity disorder

Introducción. Objetivos: Estudiar la validez para el diagnóstico del trastorno por déficit de atención con hiperactividad (TDAH), de cada uno de los ítems DSM-IV y buscar un modelo reducido de ítems que ayude a detectar casos de niños con TDAH. Sujetos y método. Se utilizan los datos de un estudio epidemiológico sobre TDAH con una muestra de 1095 casos. El 6.6% son TDAH. Casos de TDAH definidos según ADHD RS-IV y criterios clínicos DSM-IV. Controles definidos por exclusión. Resultados. El modelo de regresión logística que mejor predice el fenotipo inatento está compuesto por los ítems del ADHD RS-IV (versión padres) 1, 3, 9, 15 y 17 (Se: 96.7%, Es: 81.5%); el fenotipo hiperactivo/impulsivo por los ítems 2, 4, 10, 12, 14 y 16 (Se: 96.6%, Es: 81%) y el fenotipo combinado por los ítems 9, 10, 12, 14 y 15 (Se: 100 %, Es: 82.6%). Existe una reducción del 66% de los ítems en el fenotipo combinado. Conclusiones. Es posible reducir la lista de síntomas de TDAH con unos niveles de validez adecuados y determinados ítems parecen tener mayor capacidad para determinar decisiones diagnósticas (AU)

Introduction. Objective: To study the validity of each of the items DSM-IV for the diagnosis of the Attention Deficit Hyperactivity Disorder (ADHD), and to look for a reduced model of items that allows predicting ADHD. Subjects and methods: We use the information of an epidemiological study on ADHD with a sample of 1095 children. 6.6 % are ADHD cases. ADHD cases are defined according to ADHD RS-IV and clinical criteria DSM-IV. Controls are defined by exclusion. Results: The model of logistic regression that better predicts the inattentive phenotype is composed by the items of the ADHD RS-IV (parents’ version) 1, 3, 9, 15 and 17 (Sensitivity: 96.7%, Specificity: 81.5%); the hyperactive / impulsive phenotype by the items 2, 4, 10, 12, 14 and 16 (Sensitivity: 96.6%, Specificity: 81%) and the combined phenotype by the items 9, 10, 12, 14 and 15 (Sensitivity: 100%, Specificity: 82.6%). A reduction of 66 % of the items in the combined phenotype is detected. Conclusions: It is possible to reduce the list of ADHD symptoms with suitable levels of validity and all the items should not have the same weight at the moment of making diagnostic decisions (AU)

Fine motor, sensory and perceptive function of students with attention deficit disorder with hyperactivity.

PURPOSE: To characterize and compare the fine motor, sensory and perceptive functions of students with Attention Deficit Disorder with Hyperactivity (ADHD) and students with good academic performance, without behavior alteration. METHODS: Participants were 22 male students from Elementary School distributed into: GI - 11 children with ADHD; and GII - 11 students with good academic performance and no behavior alteration. Students were submitted to the Protocol for Evaluation of Fine Motor, Sensory and Perceptual Function, and to the Dysgraphia Scale. RESULTS: There were differences between GI and GII in tasks concerning fine motor function, sensory function, and perceptual function, with lower performance from GI. All students in GI presented dysgraphia. CONCLUSION: Students with Attention Deficit Disorder with Hyperactivity present lower performance regarding fine motor, sensory and perception functions in relation to students with good academic performance. These difficulties can cause significant impact on academic performance, impairing the development of written language and causing dysgraphia in these students.

Perfil social de los subtipos del trastorno por déficit de atención con hiperactividad / Social profile of the subtypes of attention-deficit hyperactivity disorder

Este estudio analiza la relación existente entre el trastorno por déficit de atención con hiperactividad y distintos perfiles sociales, tanto a nivel descriptivo como predictivo. Para ello, se han evaluado a 150 alumnos (10-16 años) y 14 profesores, seleccionados aleatoriamente de 14 centros escolares. Los resultados obtenidos han puesto de manifiesto que los niños con sintomatología hiperactiva difieren de los alumnos controles en todas las variables de socialización, excepto en ansiedad social y timidez. El autocontrol social constituye la principal variable implicada en la disminución de la sintomatología hiperactiva.Asimismo, negativismo y retraimiento social acentúan los síntomas hiperactivos en los subtipos TDAH diferenciados (Subtipo déficit atencional y Subtipo combinado). Por último, el grupo con sintomatología combinada muestra comparativamente un perfil de socialización más desajustado, con elevado negativismo y escasa consideración hacia los demás

This study analyzes the existing relation between attention-deficit hyperactivity disorder and different social profiles, as much at descriptive level as predictive. For it, 150 students (10-16 years) and 14 professors, selected randomly of 14 scholastic centershave evaluated themselves to. The obtained results have shown that the children withhyperactive symptoms differ from the students controls in all the variables of socialization,except in social anxiety and timidity. The social self-control constitutes the mainvariable implied in the diminution of the hyperactive symptoms. Also, oppositional andsocial retirement accentuate the hyperactive symptoms in differentiated ADHD subtypes (attention-deficit and combined Subtypes). Finally, the group with combined symptoms shows a misadjusted profile of socialization comparativily more, with high oppositional and little consideration with the others and little consideration with the others (AU)

Transtorno do déficit de atenção com hiperatividade bases neurológicas, diagnóstico, tratamento e aspectos evolutivos / Attention deficit with hyperativity disorder neurobilogical basis, diagnostic, treatment and evolutive aspects

Os autores apresentam atualização das bases neurobiológicas do transtorno do déficit de atenção com hiperatividade e problemas associados. Tecem considerações a respeito do TDAH no adulto.

[Neuropsychological disorders in teenagers with attention deficit hyperactivity disorder]. / Trastornos neuropsicológicos de los adolescentes afectos de trastorno por déficit de atención con hiperactividad.

AIMS: The aim of this study is to report on the neuropsychological aspects of teenage patients with attention deficit hyperactivity disorder (ADHD), namely disorders affecting attention, memory, the executive functions and language. We also discuss how to perform neuropsychological and functional evaluation of the systems involved in attention, by means of haemodynamic (functional magnetic resonance imaging) and neurophysiological (magnetoencephalography) techniques. The comorbidities that most frequently occur in teenage patients with ADHD are also described. DEVELOPMENT: The fundamental symptoms, that is to say, inattention, hyperactivity and impulsiveness, continue to be present in the teenager with ADHD, although with mild variations, and are probably dependent on each individual's own genetic load. The disorders most commonly associated with ADHD are oppositional defiant disorder (33%), conduct disorders (25%), anxiety (25%), learning disabilities (22%) and depression (22%). CONCLUSIONS: During adolescence, patients with ADHD usually suffer disorders that are secondary to their inability to process information efficiently due to the inadequate development of the executive functions. The lack of inhibitory control and a poor capacity to learn from their own mistakes facilitate the appearance of comorbid neuropsychiatric disorders.

Trastorno por déficit de atención con hiperactividad en adultos: caracterización clínica y terapéutica / Attention deficit hyperactivity disorder in adults: a clinical and therapeutic characterisation

Objetivo. Actualizar los conocimientos existentes sobreel trastorno por déficit de atención con hiperactividad (TDAH) enadultos, centrándose en aspectos relativos a la epidemiología, diagnóstico,evolución y tratamiento. Desarrollo. El reconocimiento dela persistencia del TDAH en la edad adulta es relativamente reciente.A pesar de ello, durante los últimos años se han aportadoevidencias que sustentan la validez del diagnóstico en adultos. Laprevalencia del TDAH en la población general adulta se estima entorno al 4%. Más del 50% de niños afectados continuarán presentandoel trastorno en la edad adulta. Los síntomas del TDAH puedenmanifestarse de diferente forma en los adultos, mostrandomenor hiperactividad y una leve disminución de la impulsividadpero manteniéndose los síntomas de inatención. El TDAH en laedad adulta se asocia a graves repercusiones económicas, laborales,académicas, familiares, así como a accidentes de tráfico y a lapresencia de otras patologías psiquiátricas (como drogodependencias,trastornos de personalidad y depresión). Conclusiones. Se disponede diferentes instrumentos psicométricos en español paraevaluar el TDAH en adultos. El empleo de entrevistas estructuradas,así como una evaluación sistematizada de los posibles trastornoscomórbidos, facilitarán el correcto diagnóstico diferencial. Eltratamiento farmacológico en adultos es esencialmente el mismoque en niños, pero adaptado al peso. Existen ensayos clínicos conpsicoestimulantes, destacando el metilfenidato por su eficacia y seguridad.Dentro del grupo de fármacos no estimulantes, la atomoxetinaes el mejor estudiado en adultos. Los tratamientos psicológicoscognitivoconductuales se han mostrado eficaces en adultoscon TDAH

Aim. To update the existing knowledge about attention deficit hyperactivity disorder (ADHD) in adults, withspecial interest given to aspects concerning epidemiology, diagnosis, progression and treatment. Development. Acknowledgingthe fact that ADHD can persist into adulthood is a relatively recent development. Nevertheless, over the last few yearsevidence has been put forward to support the validity of its diagnosis in adults. The prevalence of ADHD in the general adultpopulation is estimated to be around 4%. Over 50% of the children with the disorder will continue to have it as adults. Thesymptoms of ADHD can be different in adults, with less hyperactivity and a slight decrease in impulsiveness, but with thesame symptoms of inattention. ADHD in adulthood is linked to serious economic, occupational, academic and familialrepercussions, as well as to road accidents and to the presence of other psychiatric pathologies (such as drug addiction,personality disorders and depression). Conclusions. A number of different psychometric instruments are available in Spanishfor evaluating ADHD in adults. The use of structured interviews, together with a systemised evaluation of possible comorbiddisorders, makes it easier to reach a correct differential diagnostic. Pharmacological treatment in adults is essentially thesame as that used with children, but weight-adjusted. Clinical trials have been carried out with psychostimulants and resultsshow methylphenidate to be the most effective and the safest. Atomoxetine is the non-stimulating pharmaceutical that has beenmost widely studied in adults. Cognitive behavioural psychological treatments have proved to be effective in adults with ADHD

Impacto familiar de los niños con trastorno por déficit de atención con hiperactividad subtipo combinado: efecto de los problemas de conducta asociados / Familial impact of children with the combined subtype of attention deficit hyperactivity disorder: the effects of associated behavioural disorders

Aims. To determine the impact that children with ADHD-C (attention deficit hyperactivity disorder, combined subtype) have on their family by analysing their parents’ perceptions, and to examine whether the presence of associated behavioural disorders affect that impact. Subjects and methods. Participants in the study included one group made up of the parents of 27 children with ADHD-C and another group consisting of the parents of 27 children without ADHD. The parents in the ADHD-C group were divided into two subgroups according to whether or not their children had an oppositional defiant disorder and/or a co-morbid conduct disorder (10 and 17 families, respectively). Results and conclusions. The results of the analyses performed showed significant differences between the perceptions of the parents of the control children and those of the parents of children with ADHD-C in the following categories: feelings and attitudes, social life, matrimonial relationship, day-to-day relationships with peers and siblings, stress and difficulty in living with their child. Comparisons between the two subgroups of children with ADHD-C did not reveal any significant differences in any of the categories that were analysed, and showed ADHD-C to be the fundamental factor underlying the problems in the family context. Some items, however, suggested that the problem is more serious in the subtype with associated behavioural disorders (AU)

Objetivos. Conocer el impacto familiar que supone un niño con TDAH-C (trastorno por déficit de atención con hiperactividad, subtipo combinado), a partir del análisis de las percepciones de sus padres, y comprobar si los problemas de conducta asociados modulan dicho impacto. Sujetos y métodos. Participaron en el estudio un grupo formado por los padres de 27 niños con TDAH-C y otro por los padres de 27 niños sin TDAH. Los padres del grupo de TDAH-C se dividieron en dos subgrupos según la existencia o no de un trastorno negativista-desafiante y/o un trastorno disocial comórbidos (10 y 17 familias, respectivamente). Resultados y conclusiones. Los análisis realizados evidencian diferencias significativas entre las percepciones de los padres de niños controles y las de los padres de niños con TDAH-C en las categorías de sentimientos y actitudes, vida social, relación matrimonial, convivencia entre iguales y hermanos, estrés y dificultad de vivir con su hijo. Las comparaciones entre ambos subgrupos de niños con TDAH-C no arrojan diferencias significativas en ninguna de las categorías, y muestran el TDAH-C como el factor básico de los problemas en el contexto familiar. No obstante, algunos ítems apuntan una mayor gravedad en el subtipo con trastornos de conducta asociados (AU)

[Differences in the way parents and teachers identify the symptoms of attention deficit hyperactivity disorder in Mexican children]. / Diferencias entre padres y maestros en la identificación de síntomas del trastorno por déficit de atención con hiperactividad en niños mexicanos.

INTRODUCTION: Parents and teachers have been considered as reliable sources to identify attention deficit hyperactivity disorder (ADHD) symptoms in children, Conners scales have been useful for that purpose. AIM: To determine how parents and teachers attest ADHD behaviors in children, as well as to analyze if there are differences between them attending to school grade and/or genre. SUBJECTS AND METHODS: A total of 13 teachers (12 women and 1 man), that teach over the three first grades of elementary school and 139 mothers participated, their age ranged between 21 and 58 years old. All of them answered the Conners scales of 139 children; in an individual way with the mothers and in a grouped one with teachers. RESULTS AND CONCLUSIONS: Research results indicate that teachers so as mothers attest ADHD behaviors more in boys than in girls, especially on those of second grade, they also pointed out in a significantly way the hyperactivity and inattention behaviors more than behavior disturbances. Discrepancies between mothers and teachers were observed in respect the school grade of children.