Combining neuropsychological tests to improve the assessment of arithmetic difficulties in children with ADHD / Combinando testes neuropsicológicos para melhorar a avaliação de dificuldades aritméticas em crianças com TDAH

Abstract Objective: To compare the ways of evaluating arithmetic skills in Brazilian children with ADHD by combining three validated neuropsychological tests and determining whether they are sensitive to the methylphenidate treatment. Methods: Forty-two children (9‒12 years old) participated in the present study: 20 were children with ADHD (DSM-IV) and 22 were age-matched controls. A classification criterion was used for each test separately and one, for their combination to detect the presence of arithmetic difficulties at two time points: baseline (time 1); and when children with ADHD were taking 0.3‒0.5 mg/kg of methylphenidate (time 2). The study also assessed children's subtraction performance, combining parts of these tests. Results: Separately, the tests were only sensitive to differences between groups without medication. However, by combining the three neuropsychological tests, we observed a difference and detected a reduction in arithmetic difficulties associated with the methylphenidate treatment. The same effects were found in subtraction exercises, which require a borrowing procedure. Conclusions: The present study detected arithmetic difficulties in Brazilian children with ADHD and the effects of methylphenidate. Given this improvement in sensitivity, combining tests could be a promising alternative when working with limited samples.

Resumo Objetivo: Comparar as formas de avaliar as habilidades aritméticas em crianças brasileiras com TDAH, combinando três testes neuropsicológicos validados, e verificar se são sensíveis ao tratamento com metilfenidato. Métodos: Quarenta e duas crianças (9‒12 anos) participaram deste estudo: 20 eram crianças com TDAH (DSM-IV) e 22 eram controles pareados por idade. Usamos um critério de classificação para cada teste separadamente e outro para a combinação entre eles, visando detectar a presença de dificuldades aritméticas em dois momentos: início (tempo 1) e quando as crianças com TDAH estavam tomando 0,3‒0,5 mg/kg de metilfenidato (tempo 2). O estudo também avaliou o desempenho dessas crianças em operações de subtração, combinando partes desses testes. Resultados: Separadamente, os testes foram sensíveis apenas às diferenças entre os grupos sem medicação. Entretanto, ao combinar os três testes neuropsicológicos, foi possível observar uma diferença e detectar uma redução das dificuldades aritméticas associadas ao tratamento com metilfenidato. Os mesmos efeitos foram encontrados em exercícios de subtração que exigem o procedimento de empréstimo. Conclusões: O estudo foi capaz de detectar dificuldades aritméticas em crianças brasileiras com TDAH e os efeitos do metilfenidato. Dada essa melhora na sensibilidade, combinar testes poderia ser uma alternativa promissora ao trabalhar com amostras limitadas.

Combining neuropsychological tests to improve the assessment of arithmetic difficulties in children with ADHD.

OBJECTIVE: To compare the ways of evaluating arithmetic skills in Brazilian children with ADHD by combining three validated neuropsychological tests and determining whether they are sensitive to the methylphenidate treatment. METHODS: Forty-two children (9‒12 years old) participated in the present study: 20 were children with ADHD (DSM-IV) and 22 were age-matched controls. A classification criterion was used for each test separately and one, for their combination to detect the presence of arithmetic difficulties at two time points: baseline (time 1); and when children with ADHD were taking 0.3‒0.5 mg/kg of methylphenidate (time 2). The study also assessed children's subtraction performance, combining parts of these tests. RESULTS: Separately, the tests were only sensitive to differences between groups without medication. However, by combining the three neuropsychological tests, we observed a difference and detected a reduction in arithmetic difficulties associated with the methylphenidate treatment. The same effects were found in subtraction exercises, which require a borrowing procedure. CONCLUSIONS: The present study detected arithmetic difficulties in Brazilian children with ADHD and the effects of methylphenidate. Given this improvement in sensitivity, combining tests could be a promising alternative when working with limited samples.

Assessment of motor skills and school performance in children diagnosed with attention deficit hyperactivity disorder

Abstract This study was designed to analyze the association between motor skills and school performance in elementary school children with attention deficit hyperactivity disorder (ADHD). Two groups of children were evaluated. The experimental group contained 55 students of both sexes, age 7 to 10, who had been clinically diagnosed with ADHD; the control group consisted of 55 children with typical motor development. The results showed no association between motor skills and school performance in the experimental group, although there was a statistically significant difference between manual dexterity and writing performance in the control group. Although we found no relationship between motor skills and school performance in children with ADHD, we believe that having specialized professionals monitor these children may be beneficial. Early diagnosis of impaired motor skills and poor school performance may lead to better developmental opportunities and a better quality of life.

Methylphenidate use in children with attention deficit hyperactivity disorder.

A Brazilian Health Technology Assessment Bulletin (BRATS) article regarding scientific evidence of the efficacy and safety of methylphenidate for treating attention deficit hyperactivity disorder (ADHD) has caused much controversy about its methods. Considering the relevance of BRATS for public health in Brazil, we critically reviewed this article by remaking the BRATS search and discussing its methods and results. Two questions were answered: did BRATS include all references available in the literature? Do the conclusions reflect the reviewed articles? The results indicate that BRATS did not include all the references from the literature on this subject and also that the proposed conclusions are different from the results of the articles chosen by the BRATS authors themselves. The articles selected by the BRATS authors showed that using methylphenidate is safe and effective. However, the BRATS final conclusion does not reflect the aforementioned and should not be used to support decisions on the use of methylphenidate.

Methylphenidate use in children with attention deficit hyperactivity disorder / Uso de metilfenidato em crianças com transtorno de déficit de atenção e hiperatividade

A Brazilian Health Technology Assessment Bulletin (BRATS) article regarding scientific evidence of the efficacy and safety of methylphenidate for treating attention deficit hyperactivity disorder (ADHD) has caused much controversy about its methods. Considering the relevance of BRATS for public health in Brazil, we critically reviewed this article by remaking the BRATS search and discussing its methods and results. Two questions were answered: did BRATS include all references available in the literature? Do the conclusions reflect the reviewed articles? The results indicate that BRATS did not include all the references from the literature on this subject and also that the proposed conclusions are different from the results of the articles chosen by the BRATS authors themselves. The articles selected by the BRATS authors showed that using methylphenidate is safe and effective. However, the BRATS final conclusion does not reflect the aforementioned and should not be used to support decisions on the use of methylphenidate.

O Boletim Brasileiro de Avaliação de Tecnologias em Saúde (BRATS), em matéria sobre as evidências científicas da eficácia e segurança do metilfenidato para o transtorno de déficit de atenção e hiperatividade (TDAH), gerou controvérsias sobre sua metodologia. Considerando a relevância do BRATS para a saúde pública no Brasil, realizou-se análise crítica dessa matéria ao refazer a busca do BRATS e discutir sua metodologia e achados. Foram respondidas duas perguntas:o BRATS incluiu todas as referências disponíveis na literatura? As conclusões refletiram os textos revisados? Identificou-se que o BRATS não incluiu todas as referências da literatura sobre o tema e que as conclusões propostas estão diferentes dos resultados dos artigos escolhidos pelos próprios autores do BRATS. Os artigos selecionados pelos autores do BRATS apontam para a eficácia e segurança do uso do metilfenidato. Entretanto, a conclusão final dos autores não reflete isso e não deveria ser usada como referência para orientar decisões sobre o uso do metilfenidato.

Health-related physical fitness children with severe and moderate developmental coordination disorder.

The present study aims to examine physical fitness among children with developmental coordination disorder (DCD) with varying degrees of severity (moderate and severe - mDCD, sDCD), and a group of children without DCD (wDCD), in the city of Manaus, Brazil. Initially, 180 children aged 6-10 years old participated in this study. After being diagnosed according to the DSM-IV-TR, 63 children were then divided into three groups (21 in each group). Health-related physical fitness was measured by means of the Fitnessgram, which included several core components, namely, body composition, muscle strength and endurance, flexibility, and cardiorespiratory resistance. The results showed no statistically significant differences between both groups in any of the assessed components. However, when analyzing the results of each component according to the criteria of the Fitnessgram, we observed that, regardless of the classification group, less than half of the children achieved scores that, according to the motor tests, would classify them as having a healthy fitness. Children with sDCD, mDCD and wDCD presented similar levels of health-related physical fitness, with an unsatisfactory performance for the component strength and muscular endurance. We therefore emphasize the importance of further research in this area, more particularly when it comes to following the development of motor skills and physical fitness in children with DCD, as well as the observation of the interactions between these variables over time.

[Attention deficit disorder and hyperactivity: does the treatment affect the statural growth?]. / Hiperatividade e déficit de atenção: o tratamento prejudica o crescimento estatural?

The current study evaluated the influence of stimulant drugs used for attention deficit and hyperactivity (ADH) on statural growth. The authors conducted a literature review collecting published articles on attention deficit hyperactivity disorder and its relationship with short stature. The source of information was the PubMed database where the following terms were researched: "Growth and Methylphenidate"/"Attention deficit and hyperactivity versus short stature"/"Methylphenidate and growth disorders". ADH are difficult clinical situations that interfere with the patient's well-being and social and school performance. Once the diagnosis is attained stimulant medications such as methylphenidate have a key role in the treatment but there are concerns regarding their interference in growth and weight gain. We reviewed many publications regarding these side effects and there is no consensus on them; however, even when they happen to occur their intensity is not sufficient to preclude the use of the medication. We have to take into consideration the cost/benefit relationship, remembering that improvement in school and social performance are very welcome to the child and family. Careful monitoring of the growth chart can detect worsening of growth and its intensity will determine if the drug shall or shall not be interrupted.

Reaction time assessment in children with ADHD.

UNLABELLED: Attention deficit, impulsivity and hyperactivity are the cardinal features of attention deficit hyperactivity disorder (ADHD) but executive function (EF) disorders, as problems with inhibitory control, working memory and reaction time, besides others EFs, may underlie many of the disturbs associated with the disorder. OBJECTIVE: To examine the reaction time in a computerized test in children with ADHD and normal controls. METHOD: Twenty-three boys (aged 9 to 12) with ADHD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 2000 (DSM-IV) criteria clinical, without comorbidities, Intelligence Quotient (IQ) > or = 89, never treated with stimulant and fifteen normal controls, age matched were investigated during performance on a voluntary attention psychophysical test. RESULTS: Children with ADHD showed reaction time higher than normal controls. CONCLUSION: A slower reaction time occurred in our patients with ADHD. This findings may be related to problems with the attentional system, that could not maintain an adequate capacity of perceptual input processes and/or in motor output processes, to respond consistently during continuous or repetitive activity.

Reaction time assessment in children with ADHD / Avaliação do tempo de reação em crianças portadoras do transtorno do déficit de atenção/hiperatividade (TDAH)

Attention deficit, impulsivity and hyperactivity are the cardinal features of attention deficit hyperactivity disorder (ADHD) but executive function (EF) disorders, as problems with inhibitory control, working memory and reaction time, besides others EFs, may underlie many of the disturbs associated with the disorder. OBJECTIVE: To examine the reaction time in a computerized test in children with ADHD and normal controls. METHOD: Twenty-three boys (aged 9 to 12) with ADHD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 2000 (DSM-IV) criteria clinical, without comorbidities, Intelligence Quotient (IQ) >89, never treated with stimulant and fifteen normal controls, age matched were investigated during performance on a voluntary attention psychophysical test. RESULTS: Children with ADHD showed reaction time higher than normal controls. CONCLUSION: A slower reaction time occurred in our patients with ADHD. This findings may be related to problems with the attentional system, that could not maintain an adequate capacity of perceptual input processes and/or in motor output processes, to respond consistently during continuous or repetitive activity.

Déficit de atenção, impulsividade e hiperatividade são os pontos cardinais do transtorno do déficit de atenção/hiperatividade (TDAH), mas as desordens da função executiva (FE) tais como os problemas no controle inibitório, memória operacional e tempo de reação, dentre outras funções executivas (FEs) podem estar subjacentes a muitos distúrbios associados a esta desordem. OBJETIVO: Avaliar o tempo de reação em meninos portadores do TDAH. MÉTODO: Participaram 23 pacientes do sexo masculino, de idade entre 9 a 12 anos de idade, com diagnóstico de TDAH sem co-morbidades, estabelecido segundo os critérios do Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), com Quoeficiente Intelectual (QI) >89, que não tivessem sido medicados para o TDAH. Grupo controle, seguindo os mesmos critérios em relação ao sexo, idade, QI. O teste utilizado foi o teste psicofísico da atenção voluntária (TPAV). RESULTADOS: Os pacientes do TDAH apresentaram maior tempo de reação na execução do teste em relação aos controles. CONCLUSÃO: O tempo de reação apresentou-se mais lento em nossos pacientes portadores de TDAH. Estes achados podem estar relacionados aos problemas do sistema atencional; este grupo não pôde manter uma adequada capacidade de percepção de dados processados e/ou, em responder regularmente durante atividades contínuas ou repetitivas.

Hiperatividade e déficit de atenção: o tratamento prejudica o crescimento estatural? / Attention deficit disorder and hyperactivity: does the treatment affect the statural growth?

O presente estudo avaliou a influência de drogas estimulantes usadas no déficit de atenção e hiperatividade no crescimento estatural. Os autores procederam a uma revisão de literatura coletando artigos publicados sobre déficit de atenção e hiperatividade e sua relação com a baixa estatura. A fonte consultada foi o PubMed e o tópico levantado foi "Crescimento e Metilfenidato"/"Déficit de atenção e hiperatividade versus baixa estatura"/"Metilfenidato e distúrbios de crescimento". Os transtornos de atenção e hiperatividade constituem-se em situações clínicas difíceis, por interferir no bem-estar da criança e no seu relacionamento social, com prejuízos de seu desenvolvimento escolar. Uma vez feito o diagnóstico, as medicações estimulantes como o metilfenidato têm papel primordial no tratamento, mas muito se teme com relação a certos efeitos colaterais, particularmente a perda de peso e a perda estatural. Revisou-se uma série de publicações a respeito e pôde-se verificar que não há consenso sobre tais efeitos colaterais, mas que, mesmo quando ocorrem, não são suficientemente intensos para impedir o tratamento. Um julgamento da relação custo-benefício da medicação é sempre apropriado, mas os benefícios obtidos com a medicação e com a melhora do rendimento escolar e das relações sociais da criança não devem ser esquecidos. Uma cuidadosa monitorização da curva pondoestatural permite que o médico vigie com segurança o tratamento prescrito e possa tomar decisões se julgar que o prejuízo estatural compromete o bem-estar do paciente.

The current study evaluated the influence of stimulant drugs used for attention deficit and hyperactivity (ADH) on statural growth. The authors conducted a literature review collecting published articles on attention deficit hyperactivity disorder and its relationship with short stature. The source of information was the PubMed database where the following terms were researched: "Growth and Methylphenidate"/"Attention deficit and hyperactivity versus short stature"/"Methylphenidate and growth disorders". ADH are difficult clinical situations that interfere with the patient's well-being and social and school performance. Once the diagnosis is attained stimulant medications such as methylphenidate have a key role in the treatment but there are concerns regarding their interference in growth and weight gain. We reviewed many publications regarding these side effects and there is no consensus on them; however, even when they happen to occur their intensity is not sufficient to preclude the use of the medication. We have to take into consideration the cost/benefit relationship, remembering that improvement in school and social performance are very welcome to the child and family. Careful monitoring of the growth chart can detect worsening of growth and its intensity will determine if the drug shall or shall not be interrupted.

Avaliaçäo e acompanhamento audiológico após meningite bacteriana / Audiological assessment and follow-up post bacterial meningitis

A deficiência auditiva é uma das sequelas da meningite bacteriana que ocorre com maior frequência em crianças. Este estudo descreve o perfil audiológico (periférico e central) de crianças internadas com diagnóstico de meningite bacteriana. Nas 89 crianças que compareceram ao seguimento audiológico após a alta hospitalar e foram submetidas aos testes audiológicos, os resultados evidenciaram que 85,4 por cento apresentaram acuidade auditiva normal em ambas orelhas, 10,1 por cento apresentaram deficiência auditiva neurossensorial bilateral e 4,5 por cento apresentaram deficiência auditiva neurossensorial unilateral. Nos testes que avaliaram as habilidades de processamento auditivo, os resultados mostraram que 10 por cento dessas crianças apresentaram alterações no desempenho de localização auditiva e de reconhecimento de sentenças com mensagem competitiva ipsilateral.