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1.
J Clin Psychiatry ; 81(3)2020 04 14.
Artículo en Inglés | MEDLINE | ID: mdl-32297719

RESUMEN

OBJECTIVE: To assess guanfacine extended-release (GXR) efficacy and safety in adults with attention-deficit/hyperactivity disorder (ADHD). METHODS: This phase 3, double-blind, placebo-controlled study (conducted between October 2016 and July 2017) included Japanese patients aged ≥ 18 years with ADHD (DSM-5). Patients received GXR (n = 101) or placebo (n = 100) titrated from 2 mg/d to 4-6 mg/d (dose-optimization; 5 weeks), followed by 4-6 mg/d (dose-maintenance; 5 weeks), then tapered doses to 2 mg/d (2 weeks). Primary endpoint was change from baseline in total score on the Japanese version of the ADHD-Rating Scale IV with adult prompts (ADHD-RS-IV) at week 10. Other measures were ADHD-RS-IV subscales, Clinical Global Impression-Improvement scale (CGI-I) and Patient Global Impression-Improvement scale (PGI-I) (percentage of patients very much improved/much improved), treatment-emergent adverse event (TEAE) incidences, and TEAEs leading to discontinuation. RESULTS: Compared with placebo, there was statistically significantly greater improvement in ADHD-RS-IV total score reduction with GXR (least squares mean ± SE: GXR vs placebo, -11.55 ± 1.10 vs -7.27 ± 1.07; P = .0005; effect size 0.52). There were significantly greater improvements in GXR for ADHD-RS-IV inattention (-7.39 ± 0.79 vs -4.89 ± 0.76; P = .0032) and hyperactivity-impulsivity (-3.84 ± 0.54 vs -2.10 ± 0.52; P = .0021) subscale scores, CGI-I scores (48.1% vs 22.6%; P = .0007), and PGI-I scores (25.3% vs 11.8%; P = .0283). More patients in the GXR versus the placebo group reported TEAEs (81.2% vs 62.0%) and discontinued due to TEAEs (19.8% vs 3.0%). The main TEAEs in the GXR group were somnolence, thirst, blood pressure decrease, nasopharyngitis, postural dizziness, and constipation; most TEAEs were mild to moderate in severity. CONCLUSIONS: In Japanese adults with ADHD, GXR improved ADHD symptoms without any major safety concerns. Trial Registration: Japan Primary Registries Network (https://rctportal.niph.go.jp/en): JapicCTI-163231


Asunto(s)
Agonistas de Receptores Adrenérgicos alfa 2/administración & dosificación , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Guanfacina/administración & dosificación , Administración Oral , Adolescente , Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Preparaciones de Acción Retardada , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Femenino , Estudios de Seguimiento , Guanfacina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Resultado del Tratamiento , Adulto Joven
4.
Medicina (B Aires) ; 80 Suppl 2: 67-71, 2020.
Artículo en Español | MEDLINE | ID: mdl-32150717

RESUMEN

Attention deficit disorder and hyperactivity (ADHD) is the main reason for consultation in most Pediatric Neurology units in Spain. The new technologies also associate benefits for both patients and professionals and the health system itself, which makes its rational implementation essential. Genetics, neuroimaging or virtual reality, for example, are clear exponents of the results that can be achieved by optimizing traditional processes. The different technologies that we collect in this article are fully operational and have thousands of experience in patients. The incorporation of them to the usual clinical practice is in our hands.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/terapia , Tecnología Biomédica/métodos , Tecnología Biomédica/tendencias , Humanos , Programas Informáticos , Terapia de Exposición Mediante Realidad Virtual/métodos
5.
Medicina (B Aires) ; 80 Suppl 2: 76-79, 2020.
Artículo en Español | MEDLINE | ID: mdl-32150719

RESUMEN

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental alteration of biological basis that started in childhood may persist during adolescence-youth and, despite what was believed until not many years ago, also in adulthood up to 50-60% of those affected, producing a significant clinical and psychosocial deterioration. In spite of being a syndrome easily identifiable by the triad: inattention, hyperactivity and impulsivity that characterizes it, in clinical practice there are different circumstances that hinder and complicate its diagnosis and treatment. One of the most significant is the presence, both in childhood and adulthood, of other comorbid mental disorders. It is from adolescence-youth when together with ADHD we can detect the presence of personality, mood and anxiety disorders and especially the use of several substances. The evidences existing until now show how the comorbidity of ADHD and substance use disorder influence the evolutionary course of both, complicating the approach, the treatment and, therefore, aggravating the final prognosis. The difficulties in their approach and the scarcity of treatment options make us underline the importance of preventive treatment in the infantile stage, starting from psychoeducation programs focused on the vulnerability of these patients to substances and the consequences associated with consumption.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastornos Relacionados con Sustancias/etiología , Adolescente , Adulto , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/terapia , Niño , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Factores de Riesgo , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/terapia , Adulto Joven
6.
Chemosphere ; 244: 125499, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32050328

RESUMEN

Thallium (Tl) is a highly toxic heavy metal that has been suggested to be responsible for oxidative stress and mitochondrial dysfunction. However, few studies have focused on the relationship of prenatal Tl exposure with children's neurobehavioural development. The purpose of our study was to investigate the association between prenatal Tl exposure and attention-deficit/hyperactivity disorder (ADHD) symptoms in 36-month-old children. We used data from 2851 mother-newborn pairs from the Ma'anshan Birth Cohort Study (MABC); serum Tl concentration was assessed in the first, second and third trimesters of pregnancy as well as in the umbilical cord blood. We assessed ADHD symptoms in the children using the Chinese version of the Conners abbreviated symptom questionnaire (C-ASQ). The adjusted odds ratio (OR) for the risk of ADHD symptoms was 2.00 [95% confidence interval (CI): 1.20, 3.32] and 2.08 (95% CI: 1.26, 3.43) for the third (60.25-75.21 ng/L) and fourth quartiles of serum Tl (>75.21 ng/L), respectively, in the second trimester of pregnancy, in comparison with the first quartile of serum Tl (<50.86 ng/L). The risk of ADHD symptoms was elevated among boys exposed to the fourth quartile of serum Tl in the second trimester of pregnancy (adjusted OR 2.08, 95% CI: 1.13, 3.83). Our results demonstrated that high levels of Tl exposure in the second trimester of pregnancy were related to a higher risk of ADHD symptoms in 36-month-old children, and the association of higher serum Tl exposure in the second trimester with ADHD symptoms was only found in boys.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/sangre , Efectos Tardíos de la Exposición Prenatal/sangre , Talio/sangre , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Preescolar , Estudios de Cohortes , Femenino , Sangre Fetal , Humanos , Recién Nacido , Masculino , Madres , Embarazo , Segundo Trimestre del Embarazo/sangre , Tercer Trimestre del Embarazo/sangre , Efectos Tardíos de la Exposición Prenatal/diagnóstico , Factores Sexuales , Talio/toxicidad
7.
Lancet ; 395(10222): 450-462, 2020 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-31982036

RESUMEN

Attention-deficit hyperactivity disorder (ADHD), like other psychiatric disorders, represents an evolving construct that has been refined and developed over the past several decades in response to research into its clinical nature and structure. The clinical presentation and course of the disorder have been extensively characterised. Efficacious medication-based treatments are available and widely used, often alongside complementary psychosocial approaches. However, their effectiveness has been questioned because they might not address the broader clinical needs of many individuals with ADHD, especially over the longer term. Non-pharmacological approaches to treatment have proven less effective than previously thought, whereas scientific and clinical studies are starting to fundamentally challenge current conceptions of the causes of ADHD in ways that might have the potential to alter clinical approaches in the future. In view of this, we first provide an account of the diagnosis, epidemiology, and treatment of ADHD from the perspective of both the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the eleventh edition of the International Classification of Diseases. Second, we review the progress in our understanding of the causes and pathophysiology of ADHD on the basis of science over the past decade or so. Finally, using these discoveries, we explore some of the key challenges to both the current models and the treatment of ADHD, and the ways in which these findings can promote new perspectives.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/etiología , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/terapia , Estimulantes del Sistema Nervioso Central/administración & dosificación , Estimulantes del Sistema Nervioso Central/efectos adversos , Humanos , Guías de Práctica Clínica como Asunto
8.
Proc Natl Acad Sci U S A ; 117(1): 641-649, 2020 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-31907309

RESUMEN

Early childhood deprivation is associated with higher rates of neurodevelopmental and mental disorders in adulthood. The impact of childhood deprivation on the adult brain and the extent to which structural changes underpin these effects are currently unknown. To investigate these questions, we utilized MRI data collected from young adults who were exposed to severe deprivation in early childhood in the Romanian orphanages of the Ceaușescu era and then, subsequently adopted by UK families; 67 Romanian adoptees (with between 3 and 41 mo of deprivation) were compared with 21 nondeprived UK adoptees. Romanian adoptees had substantially smaller total brain volumes (TBVs) than nondeprived adoptees (8.6% reduction), and TBV was strongly negatively associated with deprivation duration. This effect persisted after covarying for potential environmental and genetic confounds. In whole-brain analyses, deprived adoptees showed lower right inferior frontal surface area and volume but greater right inferior temporal lobe thickness, surface area, and volume than the nondeprived adoptees. Right medial prefrontal volume and surface area were positively associated with deprivation duration. No deprivation-related effects were observed in limbic regions. Global reductions in TBV statistically mediated the observed relationship between institutionalization and both lower intelligence quotient (IQ) and higher levels of attention deficit/hyperactivity disorder symptoms. The deprivation-related increase in right inferior temporal volume seemed to be compensatory, as it was associated with lower levels of attention deficit/hyperactivity disorder symptoms. We provide compelling evidence that time-limited severe deprivation in the first years of life is related to alterations in adult brain structure, despite extended enrichment in adoptive homes in the intervening years.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/patología , Encéfalo/patología , Desarrollo Infantil/fisiología , Niño Institucionalizado/psicología , Carencia Psicosocial , Adopción , Adulto , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/etiología , Encéfalo/diagnóstico por imagen , Encéfalo/crecimiento & desarrollo , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Inteligencia , Pruebas de Inteligencia , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Tamaño de los Órganos , Orfanatos , Estudios Prospectivos , Rumanía , Factores de Tiempo , Reino Unido , Adulto Joven
9.
Pediatrics ; 145(2)2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31964760

RESUMEN

Pediatricians regularly care for children who have experienced child maltreatment. Child maltreatment is a risk factor for a broad range of mental health problems. Issues specific to child maltreatment make addressing emotional and behavioral challenges among maltreated children difficult. This clinical report focuses on 2 key issues necessary for the care of maltreated children and adolescents in pediatric settings: trauma-informed assessments and the role of pharmacotherapy in maltreated children and adolescents. Specific to assessment, current or past involvement of the child in the child welfare system can hinder obtaining necessary information or access to appropriate treatments. Furthermore, trauma-informed assessments can help identify the need for specific interventions. Finally, it is important to take both child welfare system and trauma-informed assessment approaches into account when considering the use of psychotropic agents because there are critical diagnostic and systemic issues that affect the prescribing and discontinuing of psychiatric medications among children with a history of child maltreatment.


Asunto(s)
Maltrato a los Niños/psicología , Servicios de Protección Infantil , Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Adolescente , Ansiedad/etiología , Ansiedad/terapia , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/etiología , Trastorno por Déficit de Atención con Hiperactividad/terapia , Niño , Maltrato a los Niños/diagnóstico , Maltrato a los Niños/legislación & jurisprudencia , Servicios de Protección Infantil/legislación & jurisprudencia , Bases de Datos Factuales , Depresión/etiología , Depresión/terapia , Exposición a la Violencia/psicología , Encuestas Epidemiológicas , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/etiología , Pediatras , Resiliencia Psicológica , Trastornos del Sueño-Vigilia/etiología , Determinantes Sociales de la Salud , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/terapia , Privación de Tratamiento
10.
Psychiatr Hung ; 35(1): 30-36, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31854320

RESUMEN

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder. According to literature data, perinatal adversities might be associated with the occurrence of ADHD, but the results are inconclusive at the moment. The aim of the present study is to describe perinatal adversities in children with ADHD. METHODS: The data of children in County Fejér Pedagogical Service in three consecutive school years (2012-2015) was analyzed. In the present sample, 219 children with special education needs were diagnosed with ADHD (age: 9.0 years, SD: 3.1 years; 36 girls). The diagnosis was based on ICD-10 criteria. The present analysis is restricted to the presence of preterm birth, complicated/prolonged labor, intrauterine hypoxia and birth asphyxia in children with ADHD from different areas (central, urban or rural) of the county. Logistic regression analysis was performed to assess the effects of gender, age was used as a covariate. RESULTS: Within this sample, the presence of complicated/prolonged labor was significantly lower (OR: 0.378, p<0.039) in girls compared to boys. The other studied variables did not show significant differences regarding gender. Intrauterine hypoxia was registered in 28 cases, while birth asphyxia was registered in 15 cases. The presence of preterm birth was 8.7%, and showed distinctive differences according to living area (central: 3.6% vs rural: 11.3%). CONCLUSIONS: Our results indicate the importance of registering perinatal complications and long term follow up of these children in the direction of neurodevelopmental disorders, however a limitation of the present study is the lack of a control group.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/etiología , Complicaciones del Embarazo , Efectos Tardíos de la Exposición Prenatal , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Niño , Femenino , Humanos , Recién Nacido , Masculino , Perinatología , Embarazo
11.
Occup Ther Int ; 2019: 6891831, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31866801

RESUMEN

Background: Early identification of invisible comorbid neurodevelopmental disorders, such as specific learning disorders, attention deficit hyperactive disorders, and developmental coordination disorders, is crucial to improving children's daily functional deficits related to executive functions. However, a practical questionnaire to address parents' concerns is lacking. Aims: To develop a reliable and valid assessment tool that can identify young children at risk for invisible underrecognized neurodevelopmental disorders. This article describes the development and standardization of the Child Evaluation Checklist (CHECK). Methods and Procedures: Participants were 186 children aged 3 to 6 years: 91 with suspected invisible neurodevelopmental disorders, and 95 controls with typical development. Parents completed a demographic questionnaire, the CHECK, and the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Outcomes and Results: The CHECK's construct validity indicated high internal consistency for each part (Part A: α = .94; Part B: α = .90) and moderate-to-high consistency for each of Part A's four factors. Significant correlations, as well as significant group differences, were found between the CHECK factors and BRIEF-P scores. Conclusions and Implications: Use of the CHECK allows for timely identification of suspicious ("red flags") invisible neurodevelopmental disorders. It may support parents' sufficient awareness and knowledge to refer their children for comprehensive evaluation and intervention.


Asunto(s)
Lista de Verificación , Trastornos del Neurodesarrollo/diagnóstico , Encuestas y Cuestionarios/normas , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Masculino , Trastornos de la Destreza Motora/diagnóstico , Reproducibilidad de los Resultados
12.
Indian Pediatr ; 56(12): 1025-1028, 2019 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-31884432

RESUMEN

OBJECTIVE: To compare the Children's Color Trail Test scores in children with and without Attention Deficit Hyperactivity Disorder to assess its diagnostic performance in assessing attention-deficit. METHODS: 50 children with Attention Deficit Hyperactivity Disorder (diagnosed as per Diagnostic and Statistical Manual, 5th edition) and 50 age- and sex-matched children underwent Test 1 and Test 2 of the Children's Color Trail Test. A Receiver Operating Characteristics curve was constructed for the diagnostic accuracy of Children's Color Trail Test in Attention Deficit Hyperactivity Disorder. RESULTS: The Receiver Operating Characteristics curve showed a score ≤32 for Children's Color Trail Test 1 [AUC: 0.8 (0.71 to 0.87); P<0.001] and score ≤40 for Children's Color Trail Test 2 [AUC: 0.85 (0.77 to 0.92); P<0.001] as the best cut-off for diagnosing Attention Deficit Hyperactivity Disorder. CONCLUSIONS: Children's Color Trail Test is a promising tool for diagnosing attention deficit, and could be used in settings where parent or teacher reports are not available.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Prueba de Secuencia Alfanumérica , Adolescente , Atención/fisiología , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Niño , Humanos , Valor Predictivo de las Pruebas
13.
Codas ; 31(6): e20180197, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31778423

RESUMEN

PURPOSE: This study aimed to characterize and compare the use of typical story grammar elements and global coherence level in the oral narrative of children with Attention Deficit Hyperactivity Disorder with the narrative of children without the disorder and with typical development. METHODS: A total of 40 children of both sexes aged 5 to 10 years who attended elementary school participated in the study, 20 of whom were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD Group), and 20 with typical development (TD Group). Participants from each group were similar in sex, chronological age, schooling and socioeconomic status. The wordless picture book Frog, Where Are You? was used to elicit the oral narrative analyzed for the presence of the main typical elements of the story schema (character, theme/topic, event/plot and outcome), and afterwards their narration was classified according to four different levels of organization corresponding to the global story coherence level. RESULTS: The ADHD Group presented lower scores on the structural elements "theme/ topic" and "outcome" and a narrative with lower degree of coherence compared to the TD Group. CONCLUSION: The children with ADHD included in this study presented difficulties to use typical story grammar elements, mainly related to the maintenance of the central theme and outcome of the story. These elements are considered fundamental for construction of narrative coherence, which justifies the lower levels of global coherence found in the oral narrative of the ADHD Group.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastornos del Desarrollo del Lenguaje/fisiopatología , Narración , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Estudios de Casos y Controles , Niño , Lenguaje Infantil , Preescolar , Femenino , Humanos , Desarrollo del Lenguaje , Trastornos del Desarrollo del Lenguaje/diagnóstico , Lingüística , Masculino
14.
Rev. neurol. (Ed. impr.) ; 69(10): 423-432, 16 nov., 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-187108

RESUMEN

Introducción: El Attention Network Test (ANT) se ha aplicado en el estudio de las posibles alteraciones atencionales en diversas neuropatologías en los últimos años. Este test permite el análisis de diversas redes implicadas en el proceso atencional (alerta, orientación y sistema ejecutivo). Desarrollo: La aplicación particular del ANT en pacientes con trastorno por déficit de atención muestra que es posible encontrar diversas alteraciones de las tres redes atencionales según los estudios e incluso, en algunos casos, la ausencia de alteraciones en ellas. Las posibles causas de esta heterogeneidad pueden deberse a variaciones metodológicas en la aplicación del test, otras condiciones patológicas no consideradas de los pacientes y el análisis de redes sugerido por los creadores del modelo y que se ha demostrado en diversos estudios que puede llevar a interpretaciones erróneas. Conclusiones: A pesar de los resultados todavía poco concluyentes con la aplicación del ANT en el trastorno por déficit de atención, este test muestra múltiples aplicaciones que permitirán desentrañar los diversos déficits cognitivos que están presentes en los pacientes con trastorno por déficit de atención. Entre ellos, el test puede analizar diversos mecanismos que pueden estar afectados en estos pacientes (la alerta tónica y fásica, la expectativa temporal o espacial, el grado de interferencia de los estímulos distractores, el parpadeo atencional o la inhibición de retorno). El ANT puede ayudar a una mejor caracterización de los pacientes con trastorno por déficit de atención más allá de las formas clásicas consideradas hasta ahora (inatento o combinado)


Introduction: The Attention Network Test (ANT) has been applied to the study of potential attentional impairments in diverse neuropathologies in the last years. This test allows analyzing of different networks involved in attentional processing (alerting, orientation and executive system). Development: A specific application of ANT in ADHD patients shows that it is possible to find diverse impairments in the three attentional networks and even some studies revealed no alterations. Potential causes of this heterogeneity in the results could be based in methodological variations between studies, other pathological conditions in the participants and the network effects calculation that has been probed that could be wrongly interpreted. Conclusions: Despite the lack of conclusive results, this test shows multiple applications that would allow disentangling diverse cognitive impairments in ADHD patients. ANT could analyze diverse cognitive mechanisms that could be compromised in these patients (tonic and phasic alerting, temporal and spatial expectancy, degree of interference of the distractor stimuli, attentional blinking o inhibition of return). This test could help to perform a better characterization of ADHD patients further than the classical forms considered nowadays (unattended and combined)


Asunto(s)
Humanos , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Cognición , Alertas , Atención/fisiología , Señales (Psicología) , Neuropsicología
15.
Pediatrics ; 144(5)2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31582535

RESUMEN

OBJECTIVES: To evaluate the proportion of pediatric patients with concurrent diagnoses of hyperthyroidism and mental health conditions (MHCs) by using the Military Health System database. We hypothesized that the prevalence of mental health disorders would be higher in patients with hyperthyroidism compared with in the nonhyperthyroid population. METHODS: The prevalence of hyperthyroidism and MHCs was calculated by using data extracted from the Military Health System Data Repository on military beneficiaries between 10 and 18 years old who were eligible to receive care for at least 1 month during fiscal years 2008 through 2016. Prevalence ratios were used to compare MHC diagnoses in those with versus without a diagnosis of hyperthyroidism. RESULTS: There were 1894 female patients and 585 male patients diagnosed with hyperthyroidism during the study period. Prevalence ratios for MHCs in those with versus without hyperthyroidism ranged from 1.7 (attention-deficit/hyperactivity disorder [ADHD]) to 4.9 (bipolar disorder). Strikingly, suicidality was nearly 5 times more likely in patients diagnosed with hyperthyroidism than in patients who were never diagnosed with hyperthyroidism. For each of the MHCs examined, with the exception of suicidality, the MHC diagnosis was more commonly made before the diagnosis of hyperthyroidism, with the highest proportion of patients being diagnosed with ADHD before receiving a diagnosis of hyperthyroidism (68.3%). CONCLUSIONS: There is a clear association between hyperthyroidism and each of the following MHCs: ADHD, adjustment disorder, anxiety, bipolar disorder, depression, and suicidality. This study highlights the need to consider this association when evaluating patients with overlapping symptoms and for effective mental health screening tools and resources for clinicians.


Asunto(s)
Hipertiroidismo/psicología , Trastornos Mentales/complicaciones , Adolescente , Trastornos de Ansiedad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno Bipolar/complicaciones , Niño , Diagnóstico Tardío , Trastorno Depresivo/complicaciones , Femenino , Humanos , Hipertiroidismo/diagnóstico , Masculino , Trastornos Mentales/diagnóstico , Prevalencia , Ideación Suicida
16.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31570648

RESUMEN

Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/terapia , Adolescente , Factores de Edad , Algoritmos , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Estimulantes del Sistema Nervioso Central/efectos adversos , Estimulantes del Sistema Nervioso Central/uso terapéutico , Niño , Preescolar , Terapia Combinada/métodos , Accesibilidad a los Servicios de Salud , Humanos , Pediatría , Psicoterapia/métodos , Sociedades Médicas , Estados Unidos
17.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31570649

RESUMEN

Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral condition and the second most common chronic illness in children. The observance of specific behaviors in multiple settings have remained the most successful method for diagnosing the condition, and although there are differences in specific areas of the brain, and a high heritability estimate (∼76%), they are not diagnostically specific. Medications, and particularly stimulant medication, have undergone rigorous studies to document their efficacy dating back to the 1970s. Likewise, behavioral interventions in the form of parent training and classroom programs have demonstrated robust efficacy during the same time period. Both medication and behavioral interventions are symptomatic treatments. The availability of only symptomatic treatments places ADHD in the same category as other chronic conditions such as diabetes and asthma. Successful treatment of most individuals requires ongoing adherence to the therapy. Improved communication between patients and their families, primary and mental health providers, and school personnel is necessary for effective ADHD treatment. Further enhancement of electronic systems to facilitate family, school, and provider communication can improve monitoring of ADHD symptoms and functional performance. The American Academy of Pediatrics ADHD guidelines were initially developed to help primary care clinicians address the needs of their patients with ADHD and were further refined with the second revision in 2019.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/terapia , Estimulantes del Sistema Nervioso Central/uso terapéutico , Niño , Conducta Infantil , Sistemas de Apoyo a Decisiones Clínicas , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Responsabilidad Parental , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad , Calidad de la Atención de Salud , Programas Informáticos , Transición a la Atención de Adultos
18.
BMC Health Serv Res ; 19(1): 673, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533711

RESUMEN

BACKGROUND: To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers. METHODS: Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013-2017 were analyzed. RESULTS: The sample comprised 2262 children and adolescents aged 5-17 years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177 days (range 66-375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path. CONCLUSIONS: To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Tiempo de Tratamiento/normas , Adolescente , Análisis de Varianza , Niño , Preescolar , Comorbilidad , Femenino , Humanos , Italia , Masculino , Derivación y Consulta , Sistema de Registros , Tiempo de Tratamiento/estadística & datos numéricos , Listas de Espera
19.
Stud Health Technol Inform ; 267: 3-8, 2019 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-31483248

RESUMEN

Differential item functioning (DIF) indicates differential response probabilities of items for different subgroups. While there is a vast amount of research and literature on DIF in the field of educational screening and career assessment, DIF analysis has hardly been applied in the field of clinical assessment. This paper aims at analyzing the presence of gender related DIF in a cross-sectional survey of children assessed by a structured questionnaire containing items on attention deficit and hyperactivity. A total of 1449 children (mean age: 1.94 ± 0.14 years; 51.2% male) were included. Almost no significant variations in parameters were found between boys and girls. Results based on a Partial Credit Model indicate an absence of DIF in eight out of nine items. Consistent with other studies in attention deficit hyperactivity disorder (ADHD) our results imply that the same level of rating for a symptom has the same meaning for boys and girls.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Encuestas y Cuestionarios
20.
Niger J Clin Pract ; 22(9): 1241-1251, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31489861

RESUMEN

Background: One of the most common neurodevelopmental problems affecting behavior of children all over the world is attention deficit hyperactivity disorder (ADHD). Studies on ADHD prevalence in Africa used either parents' or teachers' disruptive behavioral disorder rating scale (DBDRS) to diagnose ADHD, but this study diagnose ADHD using both parents and teachers DBDRS simultaneously among primary school pupils in Ile-Ife. Materials and Methods: The study was conducted among 1,385 primary school pupils in Ile-Ife using multistage random sampling. The parents' and teachers' DBDRS were used simultaneously to screen children who had ADHD. Results: Sixty-five (4.7%) of the pupils had ADHD. Among the 65 pupils with ADHD, 28 (43%) had the inattentive subtype, 25 (38.5%) had the combined subtype, whereas 12 (18.5%) had hyperactive/impulsive subtype. The prevalence of ADHD was significantly higher in the younger age group than the older age groups (χ2 = 7.153, P = 0.007). There was no significant association found between the prevalence of ADHD and the social class (χ2 = 3.852, P = 0.146). Conclusion: ADHD prevalence of 4.7% was found among the children in Ile-Ife. Assessment of children for ADHD was done by parents at home and teachers in the school with DBDRS. The inattentive subtype was the most common and the hyperactive subtype was the least seen in the study. Early diagnosis and treatment of this disorder will bring better outcome in the children.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Niño , Preescolar , Femenino , Humanos , Masculino , Nigeria/epidemiología , Padres , Prevalencia , Instituciones Académicas , Clase Social
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