Prenatal and perinatal factors associated with ADHD risk in schoolchildren: EPINED epidemiological study.

The aim of this study is to assess the relationship between pre- and perinatal factors and ADHD in a sample of scholars exploring differences between ADHD presentations and spectrum of severity. A total of 6720 scholars (aged 3-4 and 10-11) participated in a double-phase epidemiologic cross-sectional study (Epidemiological Study of Neurodevelopmental Disorders, EPINED), and a sample of 646 scholars (ADHD risk, ASD risk and controls without risk) were individually assessed in the second phase of the study. The ADHD diagnosis, based on DSM-5 criteria, was performed with the Kiddie-Schedule for Affective Disorders & Schizophrenia, Present & Lifetime Version. Associations for the different ADHD presentations between prenatal, perinatal and postnatal factors and ADHD (n = 168), subclinical ADHD (n = 88) and non-ADHD (n = 310) were analysed. Logistic regression models showed that gestational diabetes (p = 0.012), instrumental delivery (p = 0.011), family history of psychopathology (p = 0.033) and maternal ADHD phenotype (p = 0.023) were associated with ADHD. These factors were related to the hyperactive-impulsive and combined presentations, but they were not related to the inattentive presentation. Maternal weight gain was associated with subclinical ADHD. In conclusion, metabolic disorder in the pregnancy, difficulties in childbirth and specific family phenotype were related to ADHD, specifically with hyperactive-impulsive presentation, but not in subclinical ADHD.

Prevalence and Epidemiological Characteristics of ADHD in Pre-School and School Age Children in the Province of Tarragona, Spain.

Objective: To report the ADHD estimated prevalence in Spain, considering differences in sex, age, presentation, and severity. Method: This study has a two-phase design and forms part of the Neurodevelopmental Disorders Epidemiological Research Project (EPINED). The ADHD screening was conducted through parent (N = 3,727) and teacher (N = 6,894). To perform ADHD diagnosis (DSM-5), screen positive and a subsample of the screen negative children and their parents were assessed using neuropsychological tests and a semi-structured psychiatric interview. Results: The ADHD overall estimate prevalence was 5.5% (7.7% in school-age children; 3.0% in pre-schoolers) and 3.5% for subclinical conditions. The combined presentation and mild severity were the most common, while 18.2% were highly impaired. Previous diagnoses were found in 12% of pre-schoolers and 41% school-aged. Conclusion: The prevalence found in Spain is higher than other European reports. The low ratio of prior-diagnoses indicates a need to provide resources for assessment in school and clinical settings.

Curso de formación online para la implementación de un nuevo modelo de atención a la depresión en atención primaria / An online training course for the implementation of a new clinical model for depression in primary care

INTRODUCCIÓN: En el marco de una estrategia para implementar un nuevo programa clínico para la depresión en atención primaria, desarrollamos un curso online con clases videograbadas dirigido a los médicos y enfermeras que van a introducir el programa en su práctica clínica. SUJETOS Y MÉTODOS: La evaluación del curso se realizó mediante un cuestionario estandarizado a los alumnos y un análisis temático de los contenidos de un foro de discusión. RESULTADOS: En la encuesta, los alumnos mostraron satisfacción respecto a sus expectativas, valorando positivamente el formato y el diseño general, los contenidos y su utilidad práctica, sin diferencias significativas según el perfil profesional. En el análisis cualitativo del foro se detectaron potencialidades del programa y del curso, destacando la percepción de que se abordaba una necesidad asistencial relevante. También se señalaron insuficiencias del curso y del programa, y obstáculos externos que pueden dificultar o impedir la implementación: falta de tiempo, inestabilidad en los equipos o exceso de trabajo y requerimientos en el día a día. CONCLUSIONES: Hemos ensayado un eficaz formato online para la formación de profesionales. La evaluación del curso ha sido satisfactoria. El feedback de los alumnos permitirá modelar y perfeccionar futuras ediciones del curso y el propio programa

INTRODUCTION: Within the framework of a strategy to implement a new clinical program for depression in primary care, we developed an online course with videotaped lectures targeted at doctors and nurses who will introduce the program into their clinical practice. SUBJECTS AND METHODS: The evaluation of the course was carried out by a standardized questionnaire for students and a thematic analysis of the contents of a discussion forum. RESULTS: In the survey, the students showed satisfaction regarding their expectations, positively valuing the format and the general design, the contents and their practical utility, without significant differences according to professional profile. In the qualitative analysis of the forum potentialities of the program and the course were detected, highlighting the perception that a relevant care need was addressed. There were also shortcomings of the course and the program, and external obstacles that may hinder or impede implementation: lack of time, instability in the staff, or excessive work and requirements on a day-to-day basis. CONCLUSIONS: We have tested an effective online format for the training of professionals. The evaluation of the course has been satisfactory. The feedback of the students will allow us to model and improve future editions of the course and the program itself

The effect of prenatal smoke exposure on child neuropsychological function: a prospective mother-child cohort study.

Objective: To study prospectively the effect of prenatal smoke exposure (PSE) on child neuropsychological function and intelligence quotient (IQ).Background: PSE has been associated with adverse effects on child neurodevelopment. However, some studies reported that these associations disappear after adjustment for potential confounders.Methods: A cohortof 248 mothers-child dyad was followed from the first trimester of pregnancy until children were 7.5 years old. PSE was recorded during pregnancy by questionnaire and plasma cotinine. The Wechsler Intelligence Scale for Children, the Neuropsychological Assessment of Executive Functions for Children (ENFEN) and the School Neuropsychological Maturity Questionnaire were administered at 7.5 years of age. The effect of PSE on child IQ and neuropsychological function was assessed with ANCOVA, adjusting for obstetric, neonatal and sociodemographic factors.Results: Children whose mothers smoked throughout pregnancy scored lower in interference (ENFEN) compared to unexposed children (F = 4.1; p = .008). The results showed no differences in other executive functions, verbal and visual memory and IQ between the PSE groups.Conclusion: PSE had little effect on child neuropsychological outcome and was limited to mental flexibility. Nevertheless, these findings support further efforts aimed at encouraging mothers to quit smoking in pregnancy.

Predictive value of child behavior checklist/6-18, Youth self-report and conners 3 adhd index for Adhd in school-aged children / Valor predictivo del Listado de comportamientos infantiles/6-18, el Autoinforme juvenil y el Índice de TDAH de Conners 3 para el TDAH en niños en edad escolar

The best predictors of attention deficit hyperactivity disorder (ADHD) were examined using Conners 3 ADHD Index (Conners 3 AI) (teacher and parent reports), Child Behaviour Checklist for ages 6-18 (CBCL/6-18) and Youth Self Report for ages 11-18 (YSR/11-18) in a sample of 350 schoolchildren from the Epidemiological Project on Neurodevelopmental Disorders (EPINED) (n = 2,818). The diagnosis was made on the basis of the DSM-5 criteria and the three presentations of ADHD were categorised as non-diagnosis (n = 175), subclinical (n = 56) or clinical (n = 118). Discriminant analyses showed that the CBCL attention problems scale was the best predictor, correctly classifying almost 80% of cases (78.4% unadjusted model; 79.2% model adjusted for IQ and socioeconomic level). The slow cognitive time scale was the best predictor of inattention presentation (68.7% unadjusted; 71.0% adjusted) and the DSM scale of attention problems was the best predictor of hyperactive-impulsive (71.1% unadjusted; 78.0% adjusted) and the combined (68% unadjusted; 71.0% adjusted) presentation. Predictors did not differ between models for two (nondiagnostic and clinical) or three diagnostic categories (non-diagnostic, subclinical and clinical)

Se examinaron los mejores predictores del trastorno de deficit de atencion e hiperactividad (TDAH) considerando el Indice de TDAH de Conners 3 (Conners 3 AI), el Listado de comportamientos infantiles/6-18 (CBCL/6-18) y el Autoinforme juvenil/11-18 (YSR/11-18) en 350 escolares. El diagnostico se realizó con base en los criterios DSM-5 y se consideraron las categorías de no-diagnostico (n = 175), subclinico (n = 56) y clínico (n = 118) con las tres presentaciones de TDAH. Los análisis discriminantes mostraron que la escala de problemas de atención del CBCL fue el mejor predictor, clasificando correctamente casi el 80% de los casos (78,4% modelo no ajustado; 79,2% modelo ajustado por el cociente intelectual y nivel socioeconomico). Para la presentación de inatención el mejor predictor fue la escala de tiempo cognitivo lento (68,7% no ajustado; 71,0% ajustado) y para las presentaciones hiperactivo-impulsivo (71,1% no ajustado; 78,0% ajustado) y combinada (68% no ajustado; 71,0% ajustado) la escala DSM de problemas de atención. Los predictores no difirieron entre los modelos para dos (no-diagnostico y clínico) o tres categorias diagnosticas (no-diagnostico, subclinico y clinico)

Moderately elevated preconception fasting plasma total homocysteine is a risk factor for psychological problems in childhood.

OBJECTIVE: We investigated the effect of maternal preconception fasting plasma total homocysteine (tHcy) on psychological problems in children aged 6 years from normal pregnancies. DESIGN: A longitudinal study was carried out from preconception, throughout each trimester of pregnancy, until 6 years of age in the offspring. Fasting blood samples at 2-10 weeks preconception and non-fasting samples at birth were collected. Parents completed the Child Behaviour Checklist (CBCL) and teachers the Inattention-Overactivity with Aggression (IOWA) scale for the 6-year-old children. SETTING: Elevated tHcy during pregnancy has been associated with several adverse outcomes and with neurodevelopmental impairment in the offspring.ParticipantsThe initial sample consisted of 139 healthy non-pregnant women who were planning on becoming pregnant. Eighty-one mother-child dyads were followed from preconception until 6 years of age. RESULTS: After adjusting for covariables, multiple linear regression models showed that higher preconception tHcy was associated with higher scores in internalizing dimension (ß=0·289; P=0.028), specifically in withdrawn behaviour (ß=0·349; P=0·009), anxiety/depression (ß=0·303; P=0·019) and social problems (ß=0·372; P=0·009). Aggressive behaviour in the school setting was higher in children whose mothers had higher preconception tHcy (ß=0·351; P=0·014). CONCLUSIONS: Moderately elevated preconception tHcy may increase the risk of psychological problems in offspring during childhood. These findings add to the evidence that maternal nutritional status, even before being pregnant, can affect later offspring health and may be important to consider when developing future public health policy.

Prevalence and Characteristics of Autism Spectrum Disorder Among Spanish School-Age Children.

The present study aims to assess the prevalence of autism spectrum disorder (ASD) in preschool and school-age children following a two-phase procedure. The screening phase was performed on a sample of 5555 children taking into account parent and teacher information. The individual assessment included the ADI-R, ADOS-2 and Wechsler scales. The estimated prevalence was 1.55% in preschoolers and 1.00% in school-age children. Between 1.84 and 2.59% of the children exhibited subclinical diagnosis. The male-to-female ratio was around 4:1. Most of the children exhibited mild and moderate nuclear symptoms, and the girls showed less severe communication problems. Previous diagnosis was found in 62-71% of the children. Prevalence estimates are close to the 1% international ratings and much higher than previous national reports suggested.

The Childhood Autism Spectrum Test (CAST): Spanish adaptation and validation.

The Childhood Autism Spectrum Test (CAST; Scott, Baron-Cohen, Bolton & Brayne, 2002) has proved to be a good test for screening autism spectrum disorders (ASD) and social communication problems. This study provides evidence on its psychometric properties, describe its validity for screening and provides data on its discriminative capabilities in a Spanish sample of 4-12 year-old children from community and clinical settings (N = 1460 and 36, respectively). Factorial and convergent validity is also assessed. The full Spanish version with a cut-off score of 15 presented a high sensitivity (83.9%) and specificity (92.5%), a positive predictive value (PPV) of .63 and an internal consistency (α) of .826. Some items showed low discriminating power and these results led us to propose a reduced version with 28 items and a cut-off score of 13, which presented a high sensitivity (85.7%) and specificity (91.16%), a PPV of .61 and an α of .839. Correlations were high between the Spanish full and reduced versions of the CAST, and ADI-R (Autism Diagnostic Interview Revised) and ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition). Like previous adaptation studies, a two-factor structure was found. The data show that the CAST can be a valid and reliable questionnaire for ASD screening in Spanish clinical and community populations. Autism Res 2017, 10: 1491-1498. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.