Effects of Dual Task Training and Transcranial Direct Current Stimulation in Children with Spastic Cerebral Palsy: A Pilot Randomized Control Trial.

OBJECTIVE: Compare the effectiveness of active and sham transcranial direct current stimulation (tDCS) during the training of a dual task in children with spastic cerebral palsy (CP). METHODS: Thirty children with CP were submitted to ten sessions of either active (n = 15) or sham (n = 15) tDCS over the motor cortex for 20 minutes during the training of a dual task. Pre-intervention, post-intervention and follow-up evaluations involved measures of functional performance, intellectual performance, functional mobility and cortical excitability. RESULTS: The combination of active tDCS and dual task training led to improvements in functional mobility as well as functional and intellectual performances one month after the end of the intervention. CONCLUSION: The combination of active tDCS and dual task training demonstrated promising effects for children with spastic CP.

DNA methylation epi-signature and biological age in attention deficit hyperactivity disorder patients.

OBJECTIVE: Attention Deficit/Hyperactivity Disorder (ADHD) is a common behavioral syndrome that begins in childhood and affects 3.4% of children worldwide. Due to its etiological complexity, there are no consistent biomarkers for ADHD, however the high heritability presented by the disorder indicates a genetic/epigenetic influence. The main epigenetic mechanism is DNA methylation, a process with an important role in gene expression and in many psychiatric disorders. Thus, our study sought to identify epi-signatures biomarkers in 29 children clinically diagnosed with ADHD. METHODS: After DNA extraction and bisulfite conversion, we performed methylation array experiment for differential methylation, ontological and biological age analysis. RESULTS: The biological response in ADHD patients was not sufficient to determine a conclusive epi-signature in our study. However, our results highlighted the interaction of energy metabolism and oxidative stress pathways in ADHD patients detected by differential methylation patterns. Furthermore, we were able to identify a marginal association between the DNAmAge and ADHD. CONCLUSION: Our study present new methylation biomarkers findings associated with energy metabolism and oxidative stress pathways, in addition to DNAmAge in ADHD patients. However, we propose that further multiethnic studies, with larger cohorts and including maternal conditions, are necessary to demonstrate a definitive association between ADHD and these methylation biomarkers.

Numerical cognition in children with cerebral palsy.

Children with Cerebral Palsy (CP) often perform poorly in mathematics. It is not yet clear to what extent mathematics difficulties in this clinical condition are similar to those observed in developmental dyscalculia. To better elucidate this issue, we conducted an exploratory cross-sectional study with a sample of children and adolescents with congenital brain injuries and educational history of problems in Mathematics. Fifty students aged 7-15 years, of both genders (28 males) participated in the study, 31 with typical development (TD) and 19 of whom diagnosed with spastic CP. Nine had hemiplegia and ten diplegia. Assessment procedures included a neuropsychological battery covering numerical cognition (ZAREKI-R) and working memory (AWMA) skills, and a computerized task for comparing non-symbolic magnitudes as a measure of number sense. Despite average intelligence coefficient, participants with CP underperformed the TD in five of the 12 ZAREKI-R subtests, as well as in the number sense and working memory tasks. scores were lower among hemiplegic children compared to diplegic, numerical cognition was impaired in all CP group, unveiling a dyscalculia secondary to neurodevelopmental impairments. Therefore, we can consider that mathematical learning difficulties in CP as being heterogeneous and associated with the immaturity of neuropsychological functions, with consequences for the development of numerical cognition.

Revisão integrativa sobre métodos e estratégias para promoção de habilidades socioemocionais / Integrative review on methods and strategies to promote socio-emotional skills

Competências socioemocionais são um conjunto de habilidades fundamentais para o desenvolvimento integral dos indivíduos, bem como para seu sucesso nas interações sociais. Estudos longitudinais apontam o impacto dessas habilidades em relação à saúde mental e física, aprendizagem, relações afetivas e profissionais. Neste sentido, pesquisas recentes têm alertado para a importância de promover tais habilidades a partir da primeira infância. Sendo assim, o presente estudo teve como objetivo realizar uma revisão de literatura no recorte de 2008-2019, em busca de estudos que apresentem métodos e estratégias para a promoção de habilidades socioemocionais na infância e na adolescência. Foram utilizadas as bases de dados SciELO, LILACS e PePSIC. Após empregados os critérios de elegibilidade, oito estudos entraram para a revisão. Em todos os estudos, os resultados do pós-teste indicaram diminuição de comportamentos antissociais e aumento de comportamentos pró-sociais. Contudo, foi possível observar que ainda são poucas as pesquisas que visam a investigar a eficácia de programas e estratégias de intervenção e promoção de competências socioemocionais.

Socio-emotional competencies are a set of skills fundamental to the integral development of individuals, as well as to their success in social interactions. Longitudinal studies point out the impact of these skills in relation to mental and physical health, learning, affective and professional relationships. In this sense, recent research has warned of the importance of promoting such skills from early childhood. Thus, the present study aimed to carry out a review of the literature in the 2008-2019 study, in search of studies that present methods and strategies to promote socioemotional skills in childhood and adolescence. The SciELO, LILACS, and PePSIC databases were used. After employing the eligibility criteria 8 studies entered for review. In all studies, post-test results indicated a decrease in antisocial behaviors and increased pro-social behaviors. However, it was possible to observe that there are still few researches that aim to investigate the effectiveness of intervention programs and strategies and the promotion of socio-emotional competences.

Segurança e tolerabilidade da estimulação transcraniana por corrente contínua anódica em crianças e adolescentes com paralisia cerebral / Safety and tolerability of anodic transcranial direct current stimulation in children and adolescents with cerebral palsy tDCS safety in children with cerebral palsy

O foco deste estudo é investigar a segurança e tolerabilidade da ETCC anódica em crianças e adolescentes com paralisia cerebral (PC). Participaram desse estudo dez crianças e adolescentes com PC do tipo hemiplégica e diplégica, com idade entre oito e 17 anos (média = 11,40, dp = 2,83). Os sujeitos participaram de cinco sessões de ETCC anódica no córtex parietal posterior (CPP) direito, com o cátodo posicionado no músculo deltoide esquerdo. Após cada sessão de estimulação foi aplicado um questionário padronizado para avaliação de efeitos adversos. Os resultados revelaram os seguintes efeitos adversos: as taxas de prurido (62%), sensação de queimação (16%) e formigamento (23%). A maior parte dos efeitos foi classificada como de intensidade leve pelos participantes, demonstrando a alta tolerabilidade e segurança da ETCC em crianças e adolescentes com PC.

The focus of this study is to investigate the safety and tolerability of anodic tDCS in children and adolescents with cerebral palsy (CP). Ten children and adolescents with hemiplegic and diplegic PCs, aged eight to 17 years (mean = 11.40, dp = 2.83) participated in this study. The subjects participated in five sessions of anodic tDCS in the right posterior parietal córtex (PPC), with the cathode positioned in the left deltoid muscle. After each stimulation session, a standardized questionnaire was used to assess adverse effects. Results: the results showed the following adverse effects: pruritus rates (62%), burning sensation (16%) and tingling (23%). Most of the effects were classified as mild intensity by the participants, thus demonstrating the high tolerability and safety of tDCS in children and adolescents with CP.

A systematic review of transcranial direct current stimulation effects in attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) stands out as the most prevalent neurodevelopmental disorder of childhood, with global prevalence ranging from 3.4% to 7•2%. Its cognitive symptoms result from the combination of complex etiological processes encompassing genetic and environmental components. Available therapeutic approaches are associated with significant challenges such as modest efficacy or side effects. Transcranial direct current stimulation (tDCS) is a promising tool for enhancing cognitive performance in neuropsychiatric disorders. Trials investigating its applicability in ADHD have showed propitious, however, still preliminary findings. METHODS: We performed a systemic review by searching on Medline, Cochrane Library, Web of Science, ScienceDirect and Embase using the descriptors: "attention-deficit/hyperactivity disorder" or "ADHD"; and "transcranial direct current stimulation" or "tDCS"; following PRISMA guidelines. RESULTS: A total of 383 articles were identified. After removing duplicates, 45 studies were assessed for eligibility, and after careful review, 11 manuscripts applying tDCS in ADHD were included. Significant improvements in attention, inhibitory control and working memory were reported, in addition to increased brain connectivity following use of active tDCS. LIMITATIONS: The main limitation was the small number of trials investigating use of tDCS in ADHD. Study methods and outcome measures were quite variable, and generally did not include long-term follow-up. CONCLUSIONS: Although the extent literature indicates promising findings, the available data remains highly preliminary. Further trials evaluating the efficacy of tDCS for ADHD, with longer follow-up, are necessary. These studies will be needed to determine the optimal protocol for clinical efficacy.

Relação entre índice de motivação escolar e desempenho acadêmico de crianças com transtorno de déficit de atenção/hiperatividade e grupo controle / Relation between the academic motivation index and the academic performance of children with attention deficit hyperactivity disorder and control group

INTRODUÇÃO: Transtorno do Déficit de Atenção e Hiperatividade (TDAH) é um transtorno do neurodesenvolvimento caracterizado por padrões persistentes de desatenção e/ou hiperatividade e impulsividade, que causam prejuízos no funcionamento e no desenvolvimento do indivíduo. Um dos prejuízos marcantes nessa população está relacionado à habilidade de motivação. OBJETIVO: Neste sentido, o presente estudo teve como objetivo analisar a relação entre índices de motivação escolar e desempenho acadêmico em crianças com TDAH comparadas com grupo de desenvolvimento típico. MÉTODO: Participaram 60 crianças com idade entre 6 e 12 anos, de ambos os sexos, pertencentes a escolas da rede pública e privada, sendo 30 com TDAH e 30 com desenvolvimento típico. Para avaliação da motivação escolar, foi utilizada a Escala para Avaliação da Motivação Escolar Infantojuvenil (EAME-IJ) e para avaliação do desempenho acadêmico utilizou-se o Teste de Desempenho Escolar (TDE). RESULTADOS: Nos resultados referentes ao desempenho acadêmico, as crianças com TDAH apresentaram desempenho significativamente inferior em todas as tarefas em relação às crianças do grupo com desenvolvimento típico. Na motivação escolar o grupo com TDAH apresentou menor índice de motivação intrínseca. Os resultados revelaram também correlação negativa de magnitude moderada entre motivação extrínseca e desempenho escolar. CONCLUSÃO: Os achados sugerem que as crianças com TDAH têm dificuldades para modular e autorregular seus níveis de motivação, especialmente o de motivação intrínseca, o que pode implicar em maior necessidade de recompensas externas, principalmente durante a execução de tarefas que demandam maior esforço cognitivo, como é o caso das tarefas escolares.

INTRODUCTION: Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that consists of persistent patterns of inattention and/or hyperactivity and impulsiveness, which impair an individual's behavior and development. A major impairment undergone by this population has to do with motivation. OBJECTIVE: Thus, this study had the objective of analyzing the relation between academic motivation and performance indexes in children with ADHD as compared to results from a control group that exhibits typical development patterns. METHODS: A total of 60 children of both sexes, aged 6-12 years and studying in both private and public schools participated in this study. Half of the participants (30 children) has ADHD and the other half (30 children) exhibits typical development. In order to evaluate their academic motivation, we used the Rating Scale of School Motivation (EAME - IJ) and also academic performance was tested with the Academic Achievement Test (TDE). RESULTS: Regarding academic performance, children with ADHD showed significantly lower performance in all tasks when contrasted with the typical development group. As for academic motivation, the ADHD group also showed a lower level of intrinsic motivation. Results also had shown negative correlation with low magnitude between extrinsic motivation and scholar performance. CONCLUSION: The findings suggest that children with ADHD have difficulty modulating and self-regulating their motivation levels, especially intrinsically, which may suggest a greater need for external rewards, mainly during the execution of tasks that demand greater cognitive effort, such as schoolwork.

Aspectos neurocientíficos da aprendizagem matemática: explorando as estruturas cognitivas inatas do cérebro / Neuroscientific aspects of mathematics learning: exploring the innate cognitive structures of the brain

Muitos estudos têm sido realizados sobre o modo como o cérebro lida com a informação matemática. Essas pesquisas têm concordado com a tese de que possuímos um módulo cerebral para o processamento de números e quantidades, na literatura referido como senso numérico. A expansão desse módulo, porém, depende de como e quanto conhecimento matemático adquirimos da cultura em que vivemos através da aprendizagem. Desta forma, esse artigo tem por objetivo discutir aspectos relacionados à aprendizagem matemática sob a ótica das neurociências, destacando achados de pesquisas relacionadas a este tema, como os modelos postulados para explicar a relação entre o cérebro e o processamento numérico, nomeadamente, Sistema Numérico Aproximado (SNA) e Modelo do Triplo Código (MTC).

Many studies have been conducted about how the brain deals with mathematical information. These researches have agreed with the assertion that we have a brain module for processing of numbers and quantities, in the literature referred to as number sense. The expansion of this module, however, depends to how much mathematical knowledge acquired and the culture we live through learning. Thus, this article aims to discuss aspects related to mathematical learning about the perspective of neuroscience, highlighting research findings related to this issue, as the models postulated to explain the relationship between the brain and the numerical processing, namely Approximate Number System (SNA) and the Triple Code Model (TCM).

Temporal discounting and emotional self-regulation in children with attention-deficit/hyperactivity disorder.

Temporal Discounting (TD) reflects a tendency to discount a reward more deeply the longer its delivery is delayed. TD tasks and behavioral scales have been used to investigate 'hot' executive functions in ADHD. The present study analyzed TD task performance shown by ADHD and control groups for correlations with emotional self-regulation metrics from two scales, the Behavior Rating Inventory of Executive Functions (BRIEF) and the Child Behavior Checklist (CBCL). Children (ages 8-12) with ADHD (n=25) and controls (n=24) were assessed using material rewards (toys) for three types of task: Hypothetical (H); Hypothetical with temporal expectation (HTE); and Real (R). Between-group differences were found for the HTE task, on which the ADHD group showed a higher rate of discounting their favorite toy over time, especially at 10s and 20s. This was the only task on which performance significantly correlated with BRIEF metrics, thus suggesting associations between impulsivity and low emotional self-regulation, but no task was correlated with CBCL score. The conclusion is that tasks involving toys and HTE in particular may be used to investigate TD in children with ADHD and as a means of evaluating the interface between the reward system and emotional self-regulation.

Use of Cognitive Behavioral Therapy and Token Economy to Alleviate Dysfunctional Behavior in Children with Attention-Deficit Hyperactivity Disorder.

Medication has proved highly efficacious as a means of alleviating general symptoms of attention-deficit hyperactivity disorder (ADHD). However, many patients remain functionally impaired by inappropriate behavior. The present study analyzed the use of cognitive behavioral therapy (CBT) with the Token-Economy (TE) technique to alleviate problem behavior for 25 participants with ADHD, all children (19 boys, mean age 10.11) on long-term methylphenidate medication, who were given 20 CBT sessions with 10 weeks of TE introduced as of session 5. Their ten most acute problem behaviors were selected and written records kept. On weekdays, parents recorded each inappropriate behavior and provided a suitable model for their actions. At weekly sessions, problem behaviors were counted and incident-free participants rewarded with a token. To analyze improvement (less frequent problem behavior), a list of 11 behavioral categories was rated: inattention, impulsivity, hyperactivity, disorganization, disobeying rules and routines, poor self-care, verbal/physical aggression, low frustration tolerance, compulsive behavior, antisocial behavior, lacking in initiative and distraction. Two CBT specialists categorized behaviors and an ADHD specialist ruled on discrepancies. Statistical analyses used were Generalized Estimating Equations with Poisson distribution and autoregressive order correlation structure. In the course of the sessions, problematic behaviors decreased significantly in seven categories: impulsiveness, hyperactivity, disorganization, disobeying rules and routine, poor self-care, low frustration tolerance, compulsive behaviors, and antisocial behaviors. Caregiver attitudes to children's inappropriate behavior were discussed and reshaped. As functional improvement was observed on applying TE for 10 weeks, this type of intervention may be useful as an auxiliary strategy combined with medication.

Face Scanning in Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder: Human Versus Dog Face Scanning.

This study used eye tracking to explore attention allocation to human and dog faces in children and adolescents with autism spectrum disorder (ASD), attention deficit/hyperactivity disorder (ADHD), and typical development (TD). Significant differences were found among the three groups. TD participants looked longer at the eyes than ASD and ADHD ones, irrespective of the faces presented. In spite of this difference, groups were similar in that they looked more to the eyes than to the mouth areas of interest. The ADHD group gazed longer at the mouth region than the other groups. Furthermore, groups were also similar in that they looked more to the dog than to the human faces. The eye-tracking technology proved to be useful for behavioral investigation in different neurodevelopmental disorders.

Attentional Profiles and White Matter Correlates in Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type.

Attention-deficit/hyperactivity disorder (ADHD) is a widely studied neurodevelopmental disorder. It is a highly heterogeneous condition, encompassing different types of expression. The predominantly inattentive type is the most prevalent and the most stable over the lifetime, yet it is the least-studied presentation. To increase understanding of its cognitive profile, 29 children with attention-deficit/hyperactivity disorder of predominantly inattentive type (ADHD-I) and 29 matched controls, aged 7-15 years, had their attentional abilities assessed through the Conners' continuous performance test. Diffusion tensor imaging data were collected for all of the participants using a 3.0-T MRI system. Fractional anisotropy (FA) values were obtained for 20 fiber tracts, and brain-behavior correlations were calculated for 42 of the children. The ADHD-I children differed significantly from the typically developing (TD) children with respect to attentional measures, such as the ability to maintain response-time consistency throughout the task (Hit RT SE and Variability), vigilance (Hit RT ISI and Hit RT ISI SE), processing speed (Hit RT), selective attention (Omissions), sustained attention (Hit RT Block Change), error profile (Response Style), and inhibitory control (Perseverations). Evidence of significant differences between the ADHD-I and the TD participants was not found with respect to the mean FA values in the fiber tracts analyzed. Moderate and strong correlations between performance on the attention indicators and the tract-average FA values were found for the ADHD-I group. Our results contribute to a better characterization of the attentional profile of ADHD-I individuals and suggest that in children and adolescents with ADHD-I, attentional performance is mainly associated with the white matter structure of the long associative fibers that connect anterior-posterior brain areas.

Attention Deficit Hyperactivity Disorder in the Light of the Epigenetic Paradigm.

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder characterized by a definite behavioral pattern that might lead to performance problems in the social, educational, or work environments. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the symptoms of ADHD were restricted to those associated with cognitive (attention deficit) and behavioral (hyperactivity/impulsivity) deficits, while deficient emotional self-regulation, a relevant source of morbidity, was left out. The etiology of it is complex, as its exact causes have not yet been fully elucidated. ADHD seems to arise from a combination of various genetic and environmental factors that alter the developing brain, resulting in structural and functional abnormalities. The aim of this paper was to review epigenetics and ADHD focused on how multidimensional mechanisms influence the behavioral phenotype.

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.

Rede de apoio social na vida do indivíduo com transtorno de déficit de atenção e hiperatividade e seus cuidadores / Social support network in the life of individuals with attention deficit disorder and hyperactivity and their caregivers

Neste artigo, os autores discutem o papel das redes de apoio social no tratamento e acompanhamento de crianças e adolescentes com Transtorno de Déficit de Atenção e Hiperatividade.(AU)

In this article, the authors discuss the role of social support networks in the treatment and monitoring of children and adolescents with Attention Deficit Disorder and Hyperactivity.(AU)

Rede de apoio social na vida do indivíduo com transtorno de déficit de atenção e hiperatividade e seus cuidadores / Social support network in the life of individuals with attention deficit disorder and hyperactivity and their caregivers

Neste artigo, os autores discutem o papel das redes de apoio social no tratamento e acompanhamento de crianças e adolescentes com Transtorno de Déficit de Atenção e Hiperatividade.

In this article, the authors discuss the role of social support networks in the treatment and monitoring of children and adolescents with Attention Deficit Disorder and Hyperactivity.

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.