Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD.

Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.

Attention deficit hyperactivity disorder, self-esteem and the impact of treatments.

OBJECTIVES: Children with attention deficit hyperactivity disorder (ADHD) experience repetitive failures in their school and social life and often receive negative feedback from their environment, endangering the development of their self-esteem. Self-esteem is a forecasting factor for social, psychological, professional and familial well-being. Poor self-esteem is a risk factor for the development of depression, anxiety disorder, and personality disorder. The aim of this article is to evaluate the child's self-esteem at the initial time of ADHD diagnosis, describe self-esteem evolution after diagnosis and identify clinical and therapeutic factors associated with improved self-esteem. METHODS: In a longitudinal descriptive study, 6-12-year-old patients with ADHD underwent a multidisciplinary evaluation including a diagnostic interview (Kiddie Schedule for Affective Disorders and Schizophrenia Present/Lifetime version: K-SADS), a symptoms severity assessment with parent questionnaires (Attention Deficit Hyperactivity Disorder Rating Scale: ADHD-RS), a neurocognitive testing of attention and IQ, and a self-esteem interview (Self-Esteem Inventory of Coopersmith: SEI). The follow-up assessment included a K-SADS-PL, ADHD-RS and SEI assessments and recorded treatment history. We compared the score of self-esteem between these two assessments. RESULTS: Among the 108 screened patients, we obtained complete data from 55 patients at the second assessment. At first evaluation, two-thirds of children with ADHD had low self-esteem scores. At the second evaluation, our results indicate a significant improvement of global, personal, and social self-esteem score (SEI) and symptoms severity score (K-SADS-PL and ADHD-RS). CONCLUSIONS: Self-esteem improved in patients with ADHD after specific treatments.

Relationship between hair cortisol concentrations and cognitive functioning in adolescents with ADHD.

Background: Our study aimed to explore whether the hair cortisol concentration (HCC), a measure of long-term cortisol output, is associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD). We further aimed to test the potential moderating effects of sex and childhood maltreatment.Methods: In this cross-sectional study, fifty-three adolescents with ADHD were studied. The ADHD Rating Scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory and executive functioning) were identified by confirmatory factor analysis. A 3-cm hair sample from the posterior vertex region of the head was obtained. HCCs were determined by a high-sensitivity enzyme immunoassay kit. Multiple linear regression analyses were used to explore the association between HCCs and either cognitive performance or ADHD severity while adjusting for sex, childhood maltreatment and the ADHD-RS total score.Results: Sex moderated the relationship between HCCs and attention/memory confirmatory factor analysis (CFA) scores, with better performance in boys with higher HCCs. HCCs were not associated with executive functioning or ADHD symptoms. Childhood maltreatment was associated with inattention symptoms in adolescents with ADHD.Conclusions: Our study suggests that HCCs are positively associated with attention and memory performance in adolescents with ADHD, with a moderating effect of sex (the relationship is strongest in boys).

We studied the relationship between cortisol and cognition in adolescents with ADHD.Hair cortisol concentrations (HCCs) were determined.We explored the moderating effects of sex and childhood trauma.Sex moderated the relationship between HCCs and attention and memory.Childhood trauma did not moderate the relationship between HCCs and cognition.

Teoría de la mente en niños con trastorno por déficit de atención/hiperactividad / Theory of mind in children with attention deficit hyperactivity disorder

Introducción: La teoría de la mente (TM) está involucrada en la cognición social, ya que evalúa nuestra capacidad para atribuir estados mentales a los demás con el fin de predecir y explicar el comportamiento. En la bibliografía, se ha observado que los niños con trastorno por déficit de atención/hiperactividad (TDAH) muestran algunas alteraciones en la TM en comparación con los niños sin problemas de neurodesarrollo. Nuestro objetivo en este estudio fue comparar la TM en dos grupos: niños en edad escolar con desarrollo normal y niños en edad escolar con TDAH. Sujetos y métodos: Se reclutó a 35 niños con edades comprendidas entre los 6 y los 12 años: 17 con TDAH y 18 sin problemas de neurodesarrollo. La TM se evaluó utilizando un método de evaluación validado para la población portuguesa: Tortuga en la Isla-Batería de Evaluación de Funciones Ejecutivas en Niños. Resultados: Obtuvimos dos grupos comparables en cuanto a datos sociodemográficos. No hubo diferencias significativas entre los dos grupos en cuanto a la TM. Conclusiones: La evaluación de la TM en niños portugueses no reveló alteraciones significativas en esta habilidad cognitiva en niños con TDAH.(AU)

Introduction: Theory of mind (TM) is involved in social cognition, as it evaluates our ability to impute our mental states to the others in order to predict and explain behaviour. In the literature, it has been noticed that children with attention deficit hyperactivity disorder (ADHD) show some impairments of TM when compared with children not neurodevelopmental impaired. Our goal in this study was to compare the TM in two groups: schooler children with normal development and schooler children with ADHD. Subjects and methods: A total of 35 children, aged between 6 and 12 years, were recruited: 17 with ADHD and 18 not neurodevelopmental impaired. TM was evaluated using an assessment method validated for the Portuguese population: Turtle on the Island-Battery of Assessment of Executive Functions in Children. Results: We obtained two comparable groups concerning sociodemographic data. There were no significant differences between the two groups regarding TM. Conclusion: The TM assessment in Portuguese children did not reveal significant impairment regarding this cognitive skill in children with ADHD.(AU)

Serious Games to Improve Attention in Boys and Girls with Attention Deficit Hyperactivity Disorder (ADHD): A Pilot Study

Background: The objective of this study was to test a treatment program in Serious Games (SG) format to improve attention in children from Catalonia, Spain, with Attention Deficit Hyperactivity Disorder (ADHD). The activities adapted to the SG format consisted of (1) stimulus selection, (2) mark equal drawings, (3) eight differences, (4) hidden figures, (5) compare texts, (6) compare measures and shapes, (7) put model keys, (8) labyrinths and (9) memorization of drawings. Method: A pretest-posttest design was used with a cohort of 30 children between 8 and 10 years old diagnosed with ADHD, with 20% girls (n = 6) and 80% boys (n = 24) with a mean age of 9.4 years (SD = 0.63; range of 8 to 10 years). Four schools and a clinical center from Catalonia, Spain participated in the sample composition. Half of the sample participated in an attention improvement program for nine sessions of 30-45 minutes each in Serious Games format. They were presented with a series of game challenges with various virtual scenarios through a monitor. The other half did the same attention improvement program in pencil and paper format. Results: The children in the Serious Games group progressed and improved more during treatment, as shown by the average number of errors of commission (p =.02) than those in the pencil and paper group. Both groups also improved in the total score and concentration scale of the D2 test (p < .001). Conclusions: Attentional training through programs in Serious Games format seems to have a more significant effect on commission errors than attentional training in pencil and paper format.

Antecedentes: El objetivo del presente estudio ha sido poner a prueba un programa de tratamiento en formato Serious Games (SG) para mejorar la atención en niños de Cataluña, España, con Trastorno por Déficit de Atención/Hiperactividad (TDAH). Las actividades adaptadas al formato SG consistieron en (1) selección de estímulos, (2) marcar dibujos iguales, (3) ocho diferencias, (4) figuras ocultas, (5) comparar textos, (6) comparar medidas y formas, (7) poner llaves modelo, (8) laberintos y (9) memorización de dibujos. Método: Se utilizó un diseño pretest-postest con una cohorte de 30 niños entre 8 y 10 años con diagnóstico de TDAH, con un 20% de niñas (n = 6) y un 80% de niños (n = 24) con una edad media de 9.4 años (DE = 0.63; rango de 8 a 10 años). La mitad de la muestra participó en un programa de mejora de la atención durante 9 sesiones de entre 30-45 minutos cada una en formato de Serious Games. Se les presentó una serie de desafios de juego con varios escenarios virtuales a través de un monitor. La otra mitad de la muestra hizo el mismo programa de mejora de la atención, pero en formato lápiz y papel. Resultados: Los niños del grupo de Serious Games progresaron y mejoraron más durante el tratamiento, como lo demuestra el promedio de errores de comisión (p = .02), en comparación con los niños del grupo de lápiz y papel. Ambos grupos también mejoraron en la puntuación total y en la escala de concentración de la prueba D2 (ambos p < .001). Conclusiones: El entrenamiento atencional a través de programas en formato Serious Games parece tener un mayor efecto que el entrenamiento atencional en formato lápiz y papel sobre los errores de comisión.

El rol de la retroalimentación en la toma de decisiones bajo riesgo en niños/as y adolescentes con Trastorno por Déficit de Atención e Hiperactividad

Los estudios en niños/as y adolescentes con Trastorno por Déficit de Atención e Hiperactividad (TDAH) suelen evidenciar dificultades en la toma de decisiones, vinculadas con comportamientos más riesgosos. El objetivo del presente estudio fue analizar y comparar el proceso de Toma de Decisiones Bajo Riesgo (TDBR) en niños/as y adolescentes con TDAH, considerando los tipos de retroalimentaciones utilizadas. Los tipos de retroalimentaciones se refieren al procesamiento de las consecuencias de las decisiones de los ensayos previos y a su influencia en las elecciones presentes y futuras. Se realizó un estudio descriptivo comparativo con un diseño ex post facto retrospectivo con dos grupos. La muestra estuvo compuesta por 100 niños/as y adolescentes de 8 a 15 años (68 niños y niñas de 8 a 11 años y 32 adolescentes de 12 a 16 años), divididos en grupo clínico y grupo control, pareados por sexo y edad. Para evaluar la TDBR se administró el Test de los Dados (The Game of Dice Task, GDT), la cual es una prueba informatizada en la que se deben tomar decisiones apostando para ganar puntos. Para analizar los tipos de retroalimentación se consideraron ocho tipos posibles. Los resultados evidenciaron un comportamiento con una tendencia a elegir opciones de riesgo en la población con TDAH, tanto en el tipo de elecciones realizadas como en la forma en que utilizan la retroalimentación al ganar o al perder, no vinculándose necesariamente con decisiones desfavorables. Estos hallazgos podrían contribuir al desarrollo de programas de intervención destinados a disminuir las dificultades en la toma de decisiones en personas con diagnóstico de TDAH.

Studies on children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) often show difficulties in decision-making, linked to riskier behaviors. The aim of the present study was to analyze and compare the process of Decision Making Under Risk (DMUR) in children and adolescents with ADHD considering the types of feedback used. Feedback types refer to processing the consequences of previous trial decisions and their influence on present and future choices. A comparative descriptive study was carried out with a retrospective ex post facto type design with two groups. The sample consisted of 100 boys, girls and adolescents from 8 to 15 years old, (68 boys and girls from 8 to 11 years old and 32 adolescents from 12 to 16 years old), divided into a clinical group and a control group paired by sex and age. To evaluate the DMUR, the Game of Dice Task (GDT) was administered, which is a computerized test in which betting decisions must be made to earn points. And to analyze the types of feedback, eight possible types were considered. The results showed a behavior with a tendency to choose risky options in the population with ADHD, both in the type of choices made and in the way, they use feedback when winning or losing, not necessarily linked to unfavorable decisions. These findings could contribute to the development of intervention programs aimed at reducing the difficulties in decision-making in people diagnosed with ADHD.

Healthcare pathways and practitioners' knowledge about ADHD in children.

INTRODUCTION: Access to care for children and adolescents affected by ADHD in France remains below the levels attained in most industrialised countries. To contribute to improving ADHD care in France, we assessed existing ADHD knowledge among medical doctors (MDs) and described associated care pathways in two large French regions in 2021. We produced tools to evaluate the regional impact of implementing a stepped-care pathway for ADHD. METHODS: A SurveyMonkey® study was sent to professionals from two regions in France accounting for 14 million inhabitants, allowing them to describe their role in child/adolescent ADHD, as well as their representations and knowledge about the disorder. RESULTS: Around 9.4% of all MDs potentially involved with children took part in the study; 34.9% considered themselves untrained, 40.5% were involved in ADHD care at a first-tier level, and 19.6% at a second-tier level. Access to a second or third-tier service for ADHD was associated with mean waiting times of 5.7 and 8.5 months, respectively. Initiation of stimulant therapy remained mainly restricted to second or third-tier MDs, and adaptation of dosage or change in the galenic formulation was rarely performed by first-tier MDs (27.2% and 18%, respectively). Training in neurodevelopmental disorders and tier-level were the strongest determinants of knowledge, attitudes and self-assessed expertise about ADHD. CONCLUSIONS: This study provides insight into training needs for MDs regarding healthcare pathways in ADHD and should support the implementation of health policies, such as a stepped healthcare access for ADHD. The study design and dissemination have been validated and will be available in France and other countries facing similar obstacles in care pathways for ADHD. Official recommendations on ADHD in children and adults are being updated in France, and our data and the survey design will be a starting point for their implementation.

Assessment of sustained attention in high-performance and attention deficit/hyperactivity disorder (ADHD) children with a vigilance task / Evaluación de la atención sostenida en niños de alto rendimiento y con trastorno por déficit de atención e hiperactividad (TDAH) en una tarea de vigilancia

El objetivo principal de este estudio fue comparar a niños se-leccionados en un contexto comunitario con TDAH, alto rendimiento, y desarrollo normotípico, en una tarea de atención sostenida. Se selecciona-ron tres grupos de niños: TDAH (n= 42), alto rendimiento (n= 20) y desarrollo normotípico (n= 28). Se aplicó una tarea breve de vigilancia computarizada (CSAT-R) para comparar la capacidad deatención y el tiempo de reacción. Para analizar la validez clínica, los participantes se divi-dieron en aquellos con "disfunción atencional" y aquellos con "atención normal”. Los niños con alto rendimiento se diferenciaron claramente de los otros dos grupos, con tamaños del efecto grandes. Las diferencias entre los grupos normotípico y TDAH solo fueron significativas en los errores y en un índice no paramétrico de capacidad de atención, pero con tamaños del efecto pequeños. La CSAT-R mostró una buena especificidad y un valor predictivo positivo aceptable, pero niveles bajos de sensibilidad y un pobre valor predictivo negativo. Por tanto, la atención sostenida podría ser un mecanismo destacado en niños con altas capacidades. La CSAT-R (y pro-bablemente la mayoría de las tareas de atención) sería moderadamente útil en entornos comunitarios para el diagnóstico del TDAH, pero no para des-cartarlo.(AU)

The main objective of this study was to compare children select-ed in a community setting with ADHD, high-performance, and normo-typical development on a sustained attention task. Three groups of chil-dren were selected: ADHD (n= 42), high-performance (n= 20), and nor-mo-typical development (n= 28). A brief computerized vigilance task (CSAT-R) was applied to compare attentional capacity and reaction time. The participants were divided into those with “attentional dysfunction” and those with “normal attention” to analyze clinical validity. Children with high-performance were clearly differentiated from the other two groups, with large effect sizes. The differences between normo-typical and ADHD groups were only significant in the errors and in a nonparametric index of attentional capacity, but with small effect sizes. The CSAT-R showed good specificity and an acceptable positive predictive value, but low levels of sensitivity, and a poor negative predictive value. Therefore, sustained attention could be a prominent mechanism in children with high capacities. The CSAT-R (and probably most of attentional tasks) would be moderately useful in community settings for ADHD diagnosis, but not to rule it out.(AU)

Validation and reliability of The Childhood Executive Function Inventory (CHEXI) in Spanish primary school students / Validación y fiabilidad del Inventario de Función Ejecutiva Infantil (CHEXI) en alumnos españoles de primaria

Given the enormous influence of executive functions in school and life success, it is necessary to identify EF levels and address them in a reliable way with tools accessible to practitioners. Two studies were conducted. In study 1, the psychometric properties of the Spanish version Children’s Executive Functioning Inventory (CHEXI) in a representative sample of 1230 primary school students from 9 to 12 years old was investigated. According to Barkley’s hybrid model, CHEXI showed good fit indices on the two subscales: working memory and inhibition (Χ² =949.32, p < 0.001, CFI = 0.98, TLI = 0.98, SRMR = 0.06, RMSEA = 0.05), as well as excellent internal consistency (ω ≥ 0.84–0.91; α ≥ 0.84–0.91). In study 2, the efficacy of the CHEXI for the observation of EF deficits related to ADHD symptoms in children was analysed. Significant differences in parent-reported scores were observed between typically developing students and students diagnosed with ADHD (p = < 0.001, η2partial = 0.09 – 0.10). The results showed that the CHEXI is a reliable instrument for measuring EF in Spanish children, and, it could be a useful tool for the identification of ADHD in these ages. (AU)

Dada la enorme influencia de las funciones ejecutivas (FE) en el bienestar y el éxito escolar del alumnado de Educación Primaria, resulta necesario utilizar instrumentos que midan talesvariables que sean accesibles para todos los profesionales de la educación. Se realizaron dos estudios. En el estudio 1, se investigó las propiedades psicométricas de la versión española del Inventario de Funcionamiento Ejecutivo Infantil (CHEXI) en una muestra representativa de 1230 alumnos de primaria de 8 a 12 años. Siguiendo el modelo híbrido de Barkley, el CHEXI mostró unos buenos índices de ajuste en las dos subescalas: memoria de trabajo e inhibición (Χ ²=949.32, p < 0.001, CFI = 0.98, TLI = 0.98, SRMR = 0.06, RMSEA = 0.05), así como una excelente consistencia interna (ω ≥ 0.84–0.91; α ≥ 0.84–0.91). En el estudio 2, se analizó la eficacia del CHEXI para la observación de los déficits de EF relacionados con los síntomas del TDAH. Se observaron diferencias significativas en las puntuaciones informadas por los padres entre los estudiantes con desarrollo típico y los estudiantes diagnosticados con TDAH (p = < 0.001, η2partial = 0.09 – 0.10). Los resultados mostraron que el CHEXI es un instrumento fiable para medir las FEs en niños españoles, y podría ser una herramienta útil para la identificación del TDAH en estas edades. (AU)

Velocidad de procesamiento en escolares chilenos con y sin Trastorno por Déficit de Atención con Hiperactividad (TDAH) / Processing Speed in Chilean Schoolchildren With and Without Attention Deficit Hyperactivity Disorder (ADHD) / Velocidade de processamento em estudantes chilenos com e sem Transtorno de Déficit de Atenção e Hiperatividade (TDAH)

El TDAH es el trastorno del neurodesarrollo más diagnosticado en escolares. La evidencia indica que las funciones ejecutivas, como es el caso de la velocidad de procesamiento y la memoria de trabajo, están afectadas en estudiantes con TDAH, aunque no existe un acuerdo definitivo sobre su presencia sistemática en este trastorno. Esta investigación pretende determinar si la velocidad de procesamiento y la memoria de trabajo corresponden a variables cognitivas en el TDAH. Participaron 138 estudiantes de 10 a 17 años. Se determinó TDAH con la escala VADTRS; se evaluó velocidad de procesamiento con una tarea de rapidez grafomotora y memoria de trabajo con una tarea de dígitos. Se utilizó un diseño transversal, univariante e intersujeto para el análisis de los datos. El VADTRS detectó un grupo con TDAH (N = 97) y otro sin TDAH (N = 41). A ambos grupos se aplicaron tareas de velocidad de procesamiento y memoria de trabajo; los análisis permitieron detectar diferencias significativas en estas variables entre los grupos con y sin TDAH. El grupo con TDAH fue dividido según su presentación; no se detectaron diferencias significativas en velocidad de procesamiento; la memoria de trabajo mostró un rendimiento significativa- mente menor en las presentaciones de TDAH inatenta y combinada. La velocidad de procesamiento y la memoria de trabajo parecen distinguir entre sujetos con y sin TDAH, la velocidad de procesamiento no parece distinguir entre presentaciones y la memoria de trabajo aparece alterada en aquellas presentaciones en que el componente atencional es definitorio

ADHD is the most commonly diagnosed neurodevelopmental disorder in schoolchildren. Evidence indicates that executive functions, such as processing speed and working memory, are affected in students with ADHD, although there is no definitive agreement on their sys- tematic presence in this disorder. This research aims to determine whether processing speed and working memory correspond to cognitive variables in ADHD. A total of 138 students aged 10 to 17 years participated. ADHD was determined with the VADTRS scale; processing speed was assessed with a graphomotor speed task and working memory with a digit task. A cross-sectional, univariate, intersubject design was used for data analy- sis. The VADTRS detected one group with ADHD (N = 97) and one without ADHD (N = 41). Processing speed and working memory tasks were applied to both groups; analyses detected significant differences in these variables between the ADHD and non- ADHD groups. The ADHD group was divided according to presentation; no significant differences were detected in processing speed; working memory showed significantly lower performance in the inattentive and combined ADHD presentations. Processing speed and working memory appear to distinguish between subjects with and without ADHD, processing speed does not appear to distinguish between presentations, and working memory appears impaired in those presentations in which the attentional component is defining.

O TDAH é o distúrbio de desenvolvimento neurológico mais frequentemente diagnosticado em crianças em idade escolar. As provas indicam que as funções executivas, tais como a velocidade de processamento e a memória de trabalho, são afectadas nos estudantes com TDAH, embora não haja um acordo definitivo sobre a sua presença sistemática nesta doença. Esta investiga- ção visa determinar se a velocidade de processamento e a memória de trabalho correspondem a variáveis cognitivas na TDAH. Um total de 138 estudantes com idades compreendidas entre os 10 e os 17 anos participaram. A TDAH foi determinada com a escala VADTRS; a velocidade de processamento foi avaliada com uma tarefa de velocidade grafomotora e a memória de trabalho com uma tarefa de dígitos. Foi utilizado um desenho transversal, univariado e intersubjecto para análise de dados. O VADTRS detectou um grupo com ADHD (N = 97) e um grupo sem ADHD (N = 41). Ambos os grupos foram administrados com velocidade de processamento e tarefas de memória de trabalho; as análises detectaram diferenças significativas nestas variáveis entre os grupos com ADHD e sem ADHD. O grupo TDAH foi dividido de acordo com a apresentação; não foram detectadas diferenças significativas na velocidade de processamento; a memória de trabalho mostrou um desempenho significativamente inferior nas apresentações de TDAH desatenta e combinada. A velocidade de processamento e a memória de trabalho parecem distinguir entre assuntos com e sem TDAH; a velocidade de processamento não parece distinguir entre apresentações e memória de trabalho parece prejudicada nas apresentações em que a componente atencional está a definir

Percepción de la ansiedad y de las dificultades de aprendizaje según los criterios de la familia y de los profesores de niños con Trastorno por Déficit de Atención e Hiperactividad / Perception of anxiety and learning difficulties according to the criteria of the family and eachers of children with Attention Deficit Hyperactivity Disorder

Resumen Tanto el Trastorno por Déficit de Atención e Hiperactividad (TDAH) como la ansiedad son dos de los trastornos que más se evidencian en la población infanto-juvenil existiendo una correlación entre ambos tal y como se recoge en numerosos estudios. La combinación de ambos trastornos afecta a los procesos de enseñanza-aprendizaje del niño provocando dificultades de aprendizaje (DA) en el mismo. Los objetivos del presente trabajo se basaron en valorar los criterios que evidencian padres y profesores en niños con TDAH para caracterizar el grado de adecuación de la percepción y evaluar si esta se ajusta a la realidad o es insuficiente, si existen diferencias en dicha percepción entre padres y docentes; analizar la conciencia que tienen sobre las posibles DA que puedan presentar, para así aportar orientaciones adecuadas que permitan una favorable inter vención y evolución. La muestra se compone de 137 sujetos con edades comprendidas entre 9 y 15 años con un Coeficiente Intelectual Total (CIT) de entre 80 y 120. Los instrumentos que se utilizaron fueron: la escala de inteligencia de Wechsler para niños-V (WISC-V), el Cuestionario de Ansiedad Estado-Rasgo en Niños(STAI-C), el Sistema de Evaluación de Niños y Adolescentes(SENA) y el Inventario de Problemas en la Escuela (IPE). Como resultado se observa que la ansiedad percibida por estos niños no está relacionada con la que aprecian padres y profesores, sin embargo, estos últimos sí que coinciden en su apreciación.

Abstract Both Attention Deficit Hyperactivity Disorder (ADHD) and anxiety are two of the disorders that are most evident in the infant-juvenile population and there is a correlation between the two, as shown in numerous studies. The combination of both disorders affects the child's teaching-learning processes, causing learning difficulties (LD). The aims of the present study were based on assessing the criteria evidenced by parents and teachers in children with ADHD to characterize the degree of adequacy of perception and to evaluate whether this is in line with real ity or insufficient, whether there are differences in this perception between parents and teachers, and to analyze their awareness of the possible AD they may present, in order to provide appropriate guidelines for favourable intervention and evolution. The sample consisted of 137 subjects aged between 9 and 15 years with a Total IQ (TIQ) between 80 and 120. The instruments used were: the Wechsler Intelligence Scale for Children-V (WISC-V), the State-Trait Anxiety Questionnaire for Children (STAI-C), the Child and Adolescent Assessment System (SENA) and the Inventory of Problems at School (IPE). As a result, it is observed that the anxiety perceived by these children is not related to the anxiety perceived by parents and teachers, although the latter do coincide in their assessment.

El impacto del TDAH sobre la lectura / The impact of ADHD on reading

Resumen Más allá de la frecuente coexistencia del trastorno por déficit de atención con hiperactividad (TDAH) y el trastorno específico del aprendizaje de la lectura, la presente revisión pretende examinar la evidencia empírica disponible sobre cómo el TDAH impacta negativamente sobre el aprendizaje de la lectura. Los datos existentes apuntan a que la presencia del trastorno (especialmente los síntomas de falta de atención), puede afectar a i) la correcta adquisición de lectura, ya sea de manera directa o a través de su influencia sobre los precursores de la lectura; ii) las propias habilidades de decodificación (precisión y fluidez lectora), tanto de manera directa como indirecta a través de su influencia sobre procesos cognitivos como la distracción o las funciones ejecutivas; y ii) la comprensión lectora, probablemente de manera indirecta por las dificultades eje cutivas y en la memoria de trabajo verbal características del TDAH. Estas conclusiones presentan importantes implicaciones para caracterizar e intervenir mejor sobre las dificultades lectoras en el TDAH, ya sean clínicas o subclínicas.

Abstract Beyond the frequent coexistence of attention deficit hyperactivity disorder (ADHD) and reading dis order (dyslexia), the present review aims to examine the available empirical evidence on how ADHD negatively impacts on learning to read. Existing data suggest that the presence of the disorder (especially inattention symp toms), may affect i) the correct acquisition of reading, either directly or through its influence on the precursors to reading; ii) decoding skills themselves (reading accuracy and fluency), both directly and indirectly through its influence on cognitive processes such as distractibility or executive functions; and iii) reading comprehension, probably indirectly through the executive and verbal memory difficulties characteristic of ADHD. These findings have important implications for better characterizing and intervening on reading difficulties in ADHD, whether clinical or subclinical.

Factores asociados a la adherencia al tratamiento farmacológico del trastorno por déficit de atención e hiperactividad (TDAH): revisión preliminar / Factors associated with adherence to pharmacological treatment of attention deficit hyperactivity disorder (ADHD): preliminary review

Resumen Introducción: El tratamiento del TDAH es seguro y eficaz, pero con frecuencia existen bajos niveles de adherencia al tratamiento. En este artículo describimos factores asociados a la adherencia des critos en la literatura disponible. Métodos: Realizamos una búsqueda bibliográfica no sistemática sobre artículos recientes sobre la adherencia a la medicación en niños y adolescentes con TDAH. Resultados: Hay factores asociados al propio trastorno, al paciente, al sistema de salud, factores socio-económicos, a la medicación y al entorno que pueden reducir o aumentar la adherencia a la medicación. Algunos factores que mejoran la adhe rencia incluyen: el conocimiento sobre el TDAH, la medicación y sus beneficios y efectos adversos potenciales. Regímenes de medicación sencillos, una vez al día y de liberación prolongada. Edad del paciente menor de 12 años y sexo femenino. Menos barreras de acceso al sistema de salud. Actitud positiva y proactiva de los padres respecto al TDAH y el uso de medicación. Discusión: Se podría optimizar la adherencia y por lo tanto mejorar el pronóstico a largo plazo del TDAH reforzando estos factores que aumentan la adherencia, y reduciendo los sesgos y desconocimiento sobre el TDAH.

Abstract Introduction: ADHD treatment is safe and effective, but often, adherence to t reatment is suboptimal. We studied factors associated to adherence to treatment in ADHD described in the literature. Methods: We conducted a non-systematic bibliographic search on recent articles on medication adherence in children and adolescents with ADHD. Results: There are factors associated with the disorder itself, the patient, the health system, socio-economic factors, the medication and the environment that can reduce/improve medication adherence. Some factors that improve adherence include: knowledge about ADHD, medication and its benefits and potential adverse effects. Simple, once-daily, extended-release medication regimens. Age of the patient less than 12 years and female sex. Fewer barriers to access the health system. Positive and proactive attitude of parents regarding ADHD and the use of medication. Discussion: Adherence could be optimized and therefore the long-term prognosis of ADHD improved by reinforcingfactors that increase adherence, and reducing biases and ignorance about ADHD.

Retrospective diagnosis of childhood ADHD using the Wender Utah Rating Scale.

OBJECTIVE: An external validation of the Wender Utah Rating Scale (WURS) against a clinical assessment is lacking, especially for French-speaking populations. METHOD: Participants completed three subsets of the WURS-61 and were assessed for ADHD using the DIVA 2.0 semi-structured interview. Exploratory factor analyses were performed. Logistic regression models and Receiver-Operating Curves were used to determine the cut-off scores that predicted childhood ADHD with best accuracy. RESULTS: One hundred three adults were included. Three factors were extracted for the WURS-25 and WURS-K, and four for the WURS-29. Cut-off scores are 44, 24 and 42, respectively. When considering DSM-5 rather than DSM-IV criteria, these values changed to 44, 36 and 44, respectively. More than 83% of the participants had been correctly classified. CONCLUSION: All three subsets of the WURS-61 retrospectively predict the presence of ADHD in childhood. This result might prove to be useful in screening and research procedures.

ADHD and addictive behavior in crack-cocaine users.

BACKGROUND: Crack consumption is a major public health issue in Martinique with a poor prognosis. A preliminary study has found a high prevalence of history of childhood ADHD (C-ADHD) in crack users. OBJECTIVE: To determine the prevalence of C-ADHD and adult ADHD (A-ADHD) in crack users and their potential associations with substance use behavior. METHODS: All consecutive patients consulting in the public academic hospital covering 376,000 inhabitants were included in the present study and received a comprehensive battery measuring addictive behavior, psychiatric and somatic comorbidities. C-ADHD groups and A-ADHD groups were defined with the Wender-Utah Rating Scale-25 and the Brown ADD Rating Scale, respectively. Impulsivity was evaluated with the Barratt Impulsiveness Scale (BIS-11). FINDINGS: In total, 111 participants were evaluated. Among them, 50 (45%) were classified in the C-ADHD group and 20 (18%) in the A-ADHD group. Compared to the patients without ADHD, those with ADHD were found to have higher impulsivity (C-ADHD: BIS total score 67.90 (10.1) vs. 63.28 (10.5), P=0.021, BIS attentional score 17.5 (3.6) vs. 15.3 (3.4), P=0.002, A-ADHD: BIS total score 75.1 (11.3) vs. 63.4 (9.2), P<0.001, BIS motor impulsivity 26.9 (5.3) vs. 22.6 (4.3), P<0.001, BIS attentional score 19.3 (3.3) vs. 15.6 (3.5), P<0.001, BIS planification 28.9 (5.7) vs. 25.10 (4.7), P=0.003). Fifty percent of A-ADHD patients were found with high impulsivity vs. 15% of patients without A-ADHD (P<0.001). However, ADHD was not associated with more severe addictive behavior or history of legal consequences. INTERPRETATION: ADHD prevalence is high in cocaine-crack users and associated with increased impulsivity. However, neither ADHD nor impulsivity explains addictive behaviors or legal consequences.

Self-Perceived Bullying Victimization in Pre-Adolescent Schoolchildren With ADHD / Victimización por Acoso Autopercibida en Escolares Preadolescentes con TDAH

Background: Bullying is highly prevalent among children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). This study investigates self-perceived bullying victimization and related sociodemographic, psychopathological, cognitive, and academic characteristics in pre-adolescents with ADHD compared to controls. Method: The participants were 424 pre-adolescents, 138 of whom had ADHD. Self-perceived bullying victimization was assessed with the Bullying and School Violence questionnaire. This study is part of a larger double-phase epidemiologic cross-sectional study. Results: A total of 35% of the ADHD pre-adolescents self-reported bullying victimization. ADHD-combined presentation showed the highest prevalence of co-occurring self-perceived bullying victimization. After the effects of socioeconomic level, gender, place of birth, intelligence quotient and autism had been controlled, we observed that presenting ADHD increased the likelihood of self-perceived bullying victimization almost 3-fold. Having ADHD and self-perceived bullying victimization were significantly associated with higher rates of the co-occurrence of internalizing and externalizing psychological problems. Comorbidity with ASD was higher in ADHD + bullying cases. Pre-adolescents with ADHD had lower cognitive scores and worse academic outcomes regardless of whether they were being bullied or not. Conclusions: In bullying prevention and intervention, special attention should be paid to ADHD as a vulnerability factor for self-perceived victimization, with negative consequences for emotional well-being and behavior.(AU)

Antecedentes: El acoso escolar es altamente prevalente entre niños/adolescentes con TDAH. Se estudió la victimización por acoso escolar autopercibida y las características sociodemográficas, psicopatológicas, cognitivas y académicas relacionadas en preadolescentes con TDAH en comparación con un grupo control. Método: Participaron 424 preadolescentes, 138 con TDAH. La victimización por acoso autopercibida se evaluó con el cuestionario de Acoso y Violencia Escolar. Este trabajo forma parte de un estudio epidemiológico transversal en doble fase más amplio. Resultados: El 35% de los preadolescentes con TDAH reportaron haber sido víctimas de acoso escolar. El TDAHpresentación combinada mostró la mayor coocurrencia de victimización por acoso autopercibida. Controlados los efectos del nivel socioeconómico, sexo, lugar de nacimiento, coeficiente intelectual y autismo, esta presentación aumentaba casi 3-veces la probabilidad de victimización por acoso autopercibida. El TDAH y la percepción de victimización se asociaron significativamente con altas tasas de coocurrencia de problemas psicológicos internalizantes/externalizantes. La comorbilidad con TEA fue mayor en el TDAH + acoso. Los preadolescentes TDAH tenían puntuaciones cognitivas más bajas y peores resultados académicos, independientemente de si estaban siendo acosados. Conclusiones: En prevención e intervención del bullyingdebe prestarse especial atención al TDAH como factor de vulnerabilidad, con consecuencias negativas para el bienestar emocional y comportamiento.(AU)

Impacto de la rehabilitación neuropsicológica computarizada en un paciente con anemia de células falciformes y TDAH. Estudio experimental de caso único

Introducción: La anemia de células falciformes (ACF) es una enfermedad genética que provoca una malformación en el glóbulo rojo, volviéndolo más frágil y desencadenando su lisis. Por su forma anómala predispone a eventos oclusivos en vasos de menor tamaño, incluyendo aquellos en el sistema nervioso central. La literatura documenta presencia de infartos cerebrales silentes y no silentes asociados a ACF, con sus respectivas alteraciones cognitivas. En los últimos años se ha reportado que existe compromiso cognitivo y mayor presencia de trastornos del neurodesarrollo, como el trastorno por déficit de atención e hiperactividad (TDAH) en aquellos niños con ACF que aún no han tenido eventos cerebrales isquémicos. Método: Se llevó a cabo un estudio experimental y prospectivo de caso único, que consistió en un programa de rehabilitación por medio de la plataforma de entrenamiento cognitivo para la atención y concentración de CogniFit. Durante 45 sesiones, se realizaron mediciones de respuestas en atención y control inhibitorio, utilizando la Batería de Evaluación Cognitiva para la Atención (CAB-AT). Resultados: Se observó que la intervención tuvo un impacto significativo en el componente de atención, el cual se mantuvo por encima de la línea de base, incluso después de suspender la intervención. Sin embargo, no se encontró un impacto importante en el control inhibitorio. Conclusión: Aunque la intervención mejoró la atención, no lo hizo con el control inhibitorio. Se recomienda complementar la rehabilitación con manejo farmacológico y diseñar nuevos estudios con poblaciones heterogéneas.

Introduction: Sickle cell anemia (SCA) is a genetic disease that causes a malformation in red blood cells, making them more fragile and leading to their lysis. Due to their abnormal shape, they predispose to occlusive events in smaller blood vessels, including those in the central nervous system. Literature documents the presence of silent and non-silent cerebral infarctions associated with SCA, along with respective cognitive impairments. In recent years, cognitive impairment and a higher prevalence of neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) have been reported in children with SCA who have not experienced ischemic brain events. Method: An experimental and prospective single-case study was conducted, consisting of a rehabilitation program using the CogniFit platform for cognitive training in attention and concentration. Measurements of attention and inhibitory control responses were taken during 45 sessions, using the Cognitive Assessment Battery for Attention (CAB-AT). Results: It was observed that the intervention had a significant impact on the attention component, which remained above the baseline even after discontinuing the intervention. However, no significant impact was found on inhibitory control. Conclusion: Although the intervention improved attention, it did not have the same effect on inhibitory control. Complementing rehabilitation with pharmacological management and designing new studies involving heterogeneous populations are recommended.

ASD and ADHD in children: a preliminary study / TEA e TDAH em crianças: um estudo preliminar / TEA y TDAH en niños: un estudio preliminar

Early detection of ADHD symptoms in autistic children can significantly impact the course and prognosis of the disorder. The present study aimed to screen the symptoms of ADHD in autistic children using the Brazilian version of Swanson, Nolan and Pelham rating scale ­ 4th (SNAP-IV) applied to 72 parents of children diagnosed with ASD, as well as to assess whether there was a significant difference between children who used words to communicate of those who did not speak any words. The findings revealed a significant frequency in the pre-sentation of symptoms of inattention and of hyperactivity and / or impulsivity, when comparing children who had diagnosis of ASD, but who did not have the symptoms of ADHD. Regarding language, no significant differences were found in this preliminary study. In general, this finding can be considered clinically worrying, especially when considering that the subclinical symptoms of ADHD may overlap in possible interventions

A detecção precoce dos sintomas de TDAH em crianças com autismo pode impactar significativamente o curso e o prognóstico do transtorno. O presente estudo teve como objetivo rastrear os sintomas de TDAH em crianças autistas usando a versão brasileira do Questionário de Swanson, Nolan e Pelham versão IV (SNAP-IV) aplicada em 72 pais de crianças com diagnóstico de TEA, bem como avaliar se havia diferença significativa entre as crianças que usavam palavras para se comunicar daqueles que não falavam palavra alguma. Os achados revelaram alta frequência na apresentação dos sintomas de desatenção e de hiperatividade e/ou impulsividade, ao comparar crianças que tinham diagnóstico de TEA, mas que não apresentavam os sintomas de TDAH. Em relação à linguagem, não foram encontradas diferenças significativas neste estudo preliminar. Em geral, a alta frequência dos sintomas do TDAH clinicamente preocupante, principalmente quando se considera que os sintomas subclínicos do TDAH podem se sobrepor em possíveis intervenções

La detección temprana de los síntomas del TDAH en niños con autismo puede afectar significativamente el curso y el pronóstico del trastorno. El presente estudio tuvo como objetivo evaluar los síntomas del TDAH en niños con autismo utilizando la escala SNAP-IV de la versión brasileña aplicada a 72 padres de niños diagnosticados con TEA, así como evaluar si había una diferencia significativa entre los niños que usaban palabras para comunicarse los que no dijeron ninguna palabra. Los hallazgos revelaron frecuencia significativa en la presentación de síntomas de inatención y de hiperactividad y/o impulsividad, al comparar niños que tenían el diagnóstico del TEA, pero que no presentaba los síntomas del TDAH. En cuanto al lenguaje, no se encontraron diferencias significativas. En general, este hallazgo puede considerarse clínicamente preocupante, especialmente si se considera que los síntomas subclínicos del TDAH pueden superponerse en posibles intervenciones

Association between attention deficit hyperactivity disorder (ADHD) and migraine: a review of observational studies / Associação entre transtorno de déficit de atenção e hiperatividade (TDAH) e enxaqueca: uma revisão de estudos observacionais

Introduction: Attention deficit hyperactivity disorder (ADHD) has been related to the presence of primary headaches. Among them, migraine presents a wide range of comorbidities shared with ADHD, both from other psychiatric disorders and somatic conditions. Objective:This review proposes to describe the association between ADHD and migraine. Methods:Based on literature research in the major medical databases and using as descriptors "Migraine Disorders" and "Attention Deficit Disorder with Hyperactivity". Observational studies that addressed the relationship between migraine and ADHD and written only in English were included. Of the 49 articles found, only 6 met the inclusion criteria and were analyzed. Results:A total of 35,684 patients were included, 22.36% were children. Of these, 1,829 (5.12%) had ADHD. The association between ADHD and migraine was identified in 528 patients (1.47%), representing 28.86% of patients with ADHD. A bilateral relationship was observed between the two diagnoses, having in the presence of ADHD, an almost 3 times greater risk of the presence of migraine. Furthermore, individuals with isolated migraine had significantly higher symptoms of hyperactivity/impulsivity and inattention than healthy individuals. Conclusion:This review shows a possible sharing of symptoms between migraine and ADHD, requiring further studies to investigate this relationship.

Introdução: O transtorno de déficit de atenção e hiperatividade (TDAH) tem sido relacionado à presença de cefaleias primárias. Dentre elas, a enxaqueca apresenta uma ampla gama de comorbidades compartilhadas com o TDAH, tanto de outros transtornos psiquiátricos quanto de condições somáticas. Objetivo:Esta revisão propõe descrever a associação entre TDAH e enxaqueca. Métodos:Baseado em pesquisa bibliográfica nas principais bases de dados médicas e utilizando como descritores "Transtornos de Enxaqueca" e "Transtorno de Déficit de Atenção com Hiperatividade". Foram incluídos estudos observacionais que abordassem a relação entre enxaqueca e TDAH e escritos apenas em inglês. Dos 49 artigos encontrados, apenas 6 atenderam aos critérios de inclusão e foram analisados. Resultados: Foram incluídos 35.684 pacientes, 22,36% eram crianças. Destes, 1.829 (5,12%) tinham TDAH. A associação entre TDAH e enxaqueca foi identificada em 528 pacientes (1,47%), representando 28,86% dos pacientes com TDAH. Foi observada uma relação bilateral entre os dois diagnósticos, tendo na presença de TDAH, um risco quase 3 vezes maior de presença de enxaqueca. Além disso, indivíduos com enxaqueca isolada apresentaram sintomas significativamente mais elevados de hiperatividade/impulsividade e desatenção do que indivíduos saudáveis. Conclusão:Esta revisão mostra um possível compartilhamento de sintomas entre enxaqueca e TDAH, necessitando de mais estudos para investigar essa relação.

Mudanças na alimentação de estudantes de uma Universidade Pública, durante a pandemia de COVID-19 / Changes in the diet of students at a public university during the COVID-19 pandemic

A pandemia de Covid-19 teve implicações diretas na qualidade de vida, saúde e renda da população mundial. Grande parte dos brasileiros passou a ficar mais tempo em casa e a rotina dos estudantes universitários foi afetada pelo fechamento dos sistemas educacionais. O presente estudo buscou investigar se houve mudanças no consumo alimentar de estudantes universitários de uma universidade pública do Estado do Rio de Janeiro no primeiro ano da pandemia de Covid-19, e possíveis fatores associados. Os ingressantes na Universidade do Estado do Rio de Janeiro (UERJ) no ano de 2019 foi a população alvo. Os dados foram coletados através de questionário on-line, entre agosto de 2020 e março de 2021. Do total de 3.973 ingressantes com email, 771 responderam ao questionário (19,4%). Foram investigadas variáveis demográficas, socioeconômicas e de consumo alimentar. Mudanças no consumo alimentar de 29 itens: ovos, doces, bolos, chá, café, queijo, sucos naturais, legumes, frutas, pães, raízes, pipoca, verduras, arroz, refrigerantes, leite, biscoitos doces, macarrão, alimentos prontos para consumo, sucos industrializados, carnes, iogurte, feijão, enlatados, biscoitos salgados, oleaginosas, refrigerantes diet/zero, salgadinhos de pacote e bebidas alcoólicas, foram avaliadas pela frequência de aumento ou redução. Associações entre essas mudanças e sexo, status de peso, raça/cor de pele e alteração na renda familiar foram avaliadas por regressão logística ajustada por idade. As análises foram ponderadas considerando a taxa de resposta por curso e sexo. Ocorreram grandes mudanças na alimentação, sendo as principais, o aumento no consumo de doces (52,3%), ovos (49,3%) e bolos (44,0%) e a redução no consumo de bebidas alcoólicas (36,9%), salgadinhos de pacote (33,3%) e biscoitos doces (28,9%). Universitários com excesso de peso apresentaram menor chance de aumentar o consumo de sucos naturais (OR:0,6; IC:0,5-0,9) em relação aos sem excesso de peso. Universitários negros apresentaram maior chance de aumentar o consumo de sucos naturais (OR=1,3; IC:1,1-1,7) e leite (OR=1,4; IC:1,1-2,0) em relação aos brancos. Com exceção para poucos alimentos, não houve mudança associada aos fatores avaliados e, no geral, a alimentação parece ter melhorado com redução de um terço para bebidas alcoólicas, salgadinhos de pacote e biscoitos doces. AU.

The Covid-19 pandemic had direct implications for the quality of life, health and income of the world's population. Most Brazilians stayed home longer and the routine of college students was affected by the closure of educational systems. The present study evaluated changes in food consumption of college students in the first year of the Covid-19 pandemic, and possible associated factors. Freshman from the State University of Rio de Janeiro (UERJ) in the year 2019, was the target population. Data were collected through an online questionnaire from August 2020 to March 2021 including demographic, socioeconomic and food consumption variables. Of the total of 3,973 email entrants, 771 completed the questionnaire (19.4%). Demographic, socioeconomic, and food consumption variables were investigated. Changes in food consumption of 29 items: eggs, sweets, cakes, tea, coffee, cheese, natural juices, vegetables, fruits, breads, roots, popcorn, greens, rice, soft drinks, milk, sweet cookies, noodles, ready-to-eat foods, processed juices, meats, yogurt, beans, canned food, salty cookies, oilseeds, diet/zero sodas, packaged snacks and alcoholic beverages, were assessed by the increase or decrease in the daily frequency. Associations between dietary changes with sex, weight status, race/skin color, and change in household income were assessed using age-adjusted logistic regression. All analyses were weighted considering the response rate by course and sex. Major changes in diet were the increased consumption of sweets (52.3%), eggs (49.3%), and cakes (44.0%) and decreased consumption of alcoholic beverages (36.9%), packaged snacks (33.3%), and sweet cookies (28.9%). Overweight students did not increase their consumption of fruit juices (OR:0.6; CI:0.5-0.9) compared to those without overweight. Black students had higher odds to increase consumption of juice (OR=1.3; CI:1.1-1.7) and milk (OR=1.4; CI:1.1-2.0) compared to white students. Except for these few food groups, the factors studied were not associated with dietary changes, and overall, the diet improved with a one-third reduction for alcoholic beverages, packaged snacks and sweet cookies. AU