[Deconstructing Kanner]. / Deconstruyendo a Kanner.

Kanner, in 1943, and Asperger, in 1944, published papers that have been considered the first descriptions of autism. Kanner is acknowledged as having been the first to recognise this condition, while Asperger is attributed with the identification of a milder form of autism which has been denominated Asperger's syndrome. Kanner's paper played an important role in the development of the conceptualisation of autism due to its being published in the United States, where it became popular in the field of child psychiatry. In contrast, Asperger's work, written in German during the period dominated by Nazism, was practically ignored until almost four decades later. A review of the historical data, mostly collected by Silberman, reveals that Kanner had first-hand knowledge of the work on autism that Asperger had begun ten years earlier. Moreover, on re-reading and analysing the pioneering publications it becomes clear that the contributions made by Asperger are still fully valid today, to the point of having intuited a complex polygenic aetiology and that it would fit in perfectly with autism spectrum disorder in the DSM-5.

TITLE: Deconstruyendo a Kanner.Kanner, en 1943, y Asperger, en 1944, publicaron sendos articulos que se han considerado las primeras descripciones del autismo. A Kanner se le atribuye el merito de haber sido el primero en reconocer dicha entidad y a Asperger se le asigna la identificacion de una forma de autismo, mas leve, que se ha denominado sindrome de Asperger. La publicacion de Kanner tuvo una relevancia importante en el desarrollo de la conceptualizacion del autismo por el hecho de haberse editado en Estados Unidos, donde alcanzo una gran difusion en el campo de la psiquiatria infantil. Por el contrario, el trabajo de Asperger, escrito en aleman durante la epoca del nazismo, fue practicamente ignorado hasta pasadas casi cuatro decadas. La recopilacion de datos historicos, en gran parte recogidos por Silberman, revela que Kanner conocia de primera mano el trabajo sobre el autismo que Asperger habia iniciado diez años antes. Por otro lado, una relectura y analisis de las publicaciones pioneras pone en evidencia que las aportaciones de Asperger son plenamente vigentes, hasta el punto de haber intuido una etiologia poligenica compleja y de encajar plenamente con el trastorno del espectro autista del DSM-5.

[Vulnerability to self-harm in autism]. / Vulnerabilidad a la autolesion en el autismo.

INTRODUCTION: The reasons underlying self-harm in persons with autism do not appear to have a single, straightforward and simple explanation. Biological predisposition, certain psychological states involving stress, atypical sensory processing, communication disorders, medical problems, and limited emotional regulation, among others, can lead persons with autism to harm themselves. AIMS: In this article a distinction is drawn, first of all, between self-harm related to neurodevelopmental disorders, such as autism, and self-harm linked to other psychiatric conditions. Second, a preliminary approach to an integrated model for the understanding of self-harm in autism is proposed. DEVELOPMENT: Some of the hypotheses put forward to account for self-harm in autism are focused on atypical sensory processing, on communication disorders and medical problems, and on emotional dysregulation. CONCLUSIONS: The limited number of studies conducted in this area and the inconsistency of the data resulting from them have led to great efforts being made to separate the facts from the suppositions in this subject. This modest initial proposal makes it possible to draw up a roadmap to guide and help persons with autism, their families and professionals in the process of reducing or eliminating this behaviour. It is suggested that self-harm should no longer be considered a disruptive behaviour and that it should be interpreted instead as an (inadequate) self-regulatory response to stress.

TITLE: Vulnerabilidad a la autolesion en el autismo.Introduccion. El porque de la autolesion en las personas con autismo no parece tener una explicacion simple, sencilla y unica. La predisposicion biologica, determinados estados psicologicos de estres, un procesamiento sensorial atipico, alteraciones en la comunicacion, problemas medicos, limitaciones en la regulacion emocional, entre otros, pueden llevan a la persona con autismo a dañarse. Objetivo. En este articulo se diferencia, en primer lugar, la autolesion relacionada con alteraciones del neurodesarrollo, como el autismo y la autolesion vinculada a otras condiciones psiquiatricas; y en segundo lugar, se propone una primera aproximacion a un modelo integral de comprension de la autolesion en el autismo. Desarrollo. Algunas de las hipotesis explicativas de la autolesion en el autismo estan centradas en el procesamiento sensorial atipico, en alteraciones de la comunicacion y problemas medicos, y en la desregulacion emocional. Conclusiones. La limitada investigacion al respecto y la confusion de los datos que se arrojan ha generado un especial esfuerzo por separar los hechos de las suposiciones en todo lo relativo a este tema. Esta modesta propuesta inicial permite elaborar una hoja de ruta que oriente y ayude a las personas con autismo, a sus familias y a los profesionales en el proceso de disminuir o eliminar este comportamiento. Se sugiere dejar de hablar de la autolesion como comportamiento disruptivo y mas bien interpretarla como una (inadecuada) respuesta autorregulatoria al estres.

[Autisms that 'cure themselves']. / Autismos que se 'curan'.

INTRODUCTION: Research into autism, based mainly on the categorical model in the Diagnostic and statistical manual of mental disorders, has focused above all on the epidemiology, clinical manifestations, cognitive mechanisms and the biological-environmental determining factors. Yet, little attention has been paid to the developmental trajectories, which play a decisive role when it comes to establishing a medium- and long-term prognosis. AIMS: The purpose of this study is to review the developmental course of children diagnosed with autism who, despite preserving behavioural traits consistent with the initial profile in the medium- and long-term, accomplish a satisfactory social and occupational adaptation, and additionally no longer meet the criteria that gave rise to the initial diagnosis. DEVELOPMENT: A review was conducted of the bibliography on autism focused on the analysis of the development of the clinical manifestations and their repercussions from the earliest ages to adulthood. Likewise, we have also taken into consideration conceptual aspects about autism that facilitate the comprehension and the meaning of the developmental patterns. CONCLUSIONS: Around 20% of the children diagnosed with autism cease to meet the criteria on which their diagnosis was based and, furthermore, achieve a satisfactory social and occupational adjustment. The following were identified as favouring factors: normal intelligence, good level of language and low incidence of 'comorbidities'; conversely, in the series that were reported, early and intensive therapeutic interventions were not shown to be determining factors. Lastly, mention is made of the concept of neurodiversity, where recovery is centred on the optimal development of each individual's capacities within a facilitating environment.

TITLE: Autismos que se 'curan'.Introduccion. La investigacion sobre el autismo, basada principalmente en el modelo categorico del Manual diagnostico y estadistico de los trastornos mentales, se ha centrado de forma preferente en la epidemiologia, las manifestaciones clinicas, los mecanismos cognitivos y los determinantes biologicos y ambientales; sin embargo, se ha prestado escaso interes a las trayectorias evolutivas, las cuales son decisivas de cara al pronostico a medio y largo plazo. Objetivo. Revisar el curso evolutivo de niños diagnosticados de autismo que, aun conservando a medio o largo plazo rasgos conductuales acordes con el perfil inicial, alcanzan una adaptacion social y laboral satisfactorias, y ademas dejan de cumplir los criterios que dieron lugar al diagnostico inicial. Desarrollo. Se ha revisado la bibliografia sobre el autismo centrada en el analisis de la evolucion de las manifestaciones clinicas y de su repercusion desde las primeras edades hasta la edad adulta. Asimismo, se han tomado en consideracion aspectos conceptuales sobre el autismo que facilitan la comprension y el significado de los patrones evolutivos. Conclusiones. Alrededor del 20% de los niños diagnosticados dejan de cumplir los criterios en los que se baso el diagnostico y, ademas, alcanzan un ajuste social y laboral satisfactorio. Como factores favorecedores se identifica: inteligencia normal, buen nivel de lenguaje y baja incidencia de 'comorbilidades'; por el contrario, en las series notificadas no se señalan como factores determinantes las intervenciones terapeuticas precoces e intensivas. Por ultimo, se menciona el concepto de neurodiversidad, donde la recuperacion se centra en el desarrollo optimo de las capacidades de cada individuo en un entorno facilitador.

[Autism and vaccinations: the end?]. / Autismo y vacunas: punto final?

INTRODUCTION: Of the different theories explaining the aetiology of autism, one that has achieved widespread popularity among the general public is the involvement of the MMR vaccine as the causation of autism. The connection between vaccines and autism rests upon two theories. On the one hand, the anti-measles fraction of the vaccine is attributed with the development of an enteropathy due to malabsorption, which would facilitate the absorption of toxic neuropeptides and the effects of this process on the brain would favour the appearance of autism. The other theory involves thimerosal (a combination of ethylmercury and thiosalicylate), which is used as a preservative in some vaccines, including the MMR. The data in favour of these hypotheses have led to a great amount of social alarm, especially in certain areas that are more inclined to accept 'alternative' therapies and hypotheses. DEVELOPMENT AND CONCLUSIONS: This article analyses the data on which the involvement of the MMR vaccine in autism is based. It also underlines the weakness of the anti-vaccine arguments, as well as the forceful, convincing response, based on experimental and epidemiological work, that has been generated following the notable social unrest. Running parallel to the scientific debate, there has also been a legal discussion, which has arisen as a consequence of the more than 5,000 lawsuits filed in the United States, and in which the claims for financial compensation together amount to two thousand million dollars. On 12th February 2009, following a court hearing in which the specific case of a girl called Michelle Cedillo was taken as an example, the court ruled that the overall weight of the evidence was overwhelmingly opposed to the theories put forward by the plaintiffs.

Modelos cognitivos en el trastorno por déficit de atención/hiperactividad / Cognitive models in attention deficit hyperactivity disorder

Resumen. Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) es una entidad cuya identidad actualmente de sustenta, casi exclusivamente, en la concomitancia de un conjunto de síntomas que tienden a coincidir con una cierta homogeneidad en un elevado número de pacientes. Sin embargo, para avanzar en la consolidación de un modelo de TDAH, basado en el soporte genético, neurofuncional y cognitivo, se requiere una comprensión de los síntomas como resultado de un o unos déficit nucleares. Desarrollo. El presente trabajo revisa las propuestas más relevantes y recientes orientadas a la comprensión cognitiva del TDAH. Si bien actualmente está muy generalizada la aceptación de la implicación de las funciones ejecutivas, no existe unanimidad respecto a la exclusividad de éstas como factor único, ni en la posible interacción de las funciones ejecutivas con otros déficit cognitivos. Se describen las propuestas de déficit único: déficit en el control inhibitorio, regulación del estado y aversión a la demora; y los modelos de déficit múltiple: modelo cognitivo energético, modelo de Sonuga- Barke y modelos basados en la comorbilidad con la dislexia y con el autismo. Conclusiones. Los avances en la genética y en el funcionamiento neurológico están aportando datos muy valiosos que, sin duda, contribuirán a configurar el o los modelos cognitivos que subyacen en el TDAH. Por último, se apunta hacia una mayor comprensión del efecto de los fármacos. Más allá de la mejora sintomática, los fármacos inciden sobre los mecanismos cognitivos. De acuerdo con esta premisa, se está estudiando, con resultados muy prometedores, la indicación del metilfenidato en la dislexia y autismo comórbidos con TDAH (AU)

Summary. Introduction. Attention deficit hyperactivity disorder (ADHD) is a condition that is currently identified almost exclusively by the simultaneous presence of a set of symptoms that tend to coincide in a more or less homogenous manner in a large number of patients. Yet, to be able to advance in the consolidation of a model of ADHD, based on genetic, neurofunctional and cognitive features, the symptoms need to be understood as being the result of one or more nuclear deficiencies. Development. This work reviews the most significant and up-to-date proposals put forward with the aim of providing a cognitive understanding of ADHD. Although the involvement of the executive functions is widely accepted today, it is not unanimously agreed that they are the only exclusive factor at play or that there is a possible interaction between the executive functions and other cognitive impairments. The study outlines the single deficit proposals, that is to say, deficient inhibitory control, regulation of the status and aversion to delay. The multiple deficit models are also discussed: the energetic cognitive model, the Sonuga-Barke model and models based on comorbidity with dyslexia and with autism. Conclusions. Advances in genetics and in neurological functioning are offering very valuable data that will undoubtedly help to shape the cognitive model or models underlying ADHD. Lastly, a greater understanding of the effects of pharmacological agents is also needed. Apart from improving the symptoms, the pharmacological agents employed also have an effect on cognitive mechanisms. In line with this assumption, very promising research is being carried out on the indication of methylphenidate in dyslexia and autism that are comorbid with ADHD (AU)

[Cognitive models in attention deficit hyperactivity disorder]. / Modelos cognitivos en el trastorno por déficit de atención/hiperactividad.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a condition that is currently identified almost exclusively by the simultaneous presence of a set of symptoms that tend to coincide in a more or less homogenous manner in a large number of patients. Yet, to be able to advance in the consolidation of a model of ADHD, based on genetic, neurofunctional and cognitive features, the symptoms need to be understood as being the result of one or more nuclear deficiencies. DEVELOPMENT: This work reviews the most significant and up-to-date proposals put forward with the aim of providing a cognitive understanding of ADHD. Although the involvement of the executive functions is widely accepted today, it is not unanimously agreed that they are the only exclusive factor at play or that there is a possible interaction between the executive functions and other cognitive impairments. The study outlines the single deficit proposals, that is to say, deficient inhibitory control, regulation of the status and aversion to delay. The multiple deficit models are also discussed: the energetic cognitive model, the Sonuga-Barke model and models based on comorbidity with dyslexia and with autism. CONCLUSIONS: Advances in genetics and in neurological functioning are offering very valuable data that will undoubtedly help to shape the cognitive model or models underlying ADHD. Lastly, a greater understanding of the effects of pharmacological agents is also needed. Apart from improving the symptoms, the pharmacological agents employed also have an effect on cognitive mechanisms. In line with this assumption, very promising research is being carried out on the indication of methylphenidate in dyslexia and autism that are comorbid with ADHD.

[Pharmacological treatment of dyslexia]. / Tratamiento farmacológico de la dislexia.

INTRODUCTION: Pharmacological approaches aimed at improving dyslexia are almost inexistent. AIM: To analyse, based on the current theories of dyslexia, the possibility of applying some pharmacological measure. DEVELOPMENT: The different theories on dyslexia are discussed. The multiple deficit model is then outlined, in opposition to the classical single dysfunction model. The model described provides a coherent explanation for several conceptual dilemmas that arise from the analysis of the comorbidity of dyslexia. The few pharmacological interventions that have been proposed to date are also analysed; with the exception of stimulants, however, they are not supported by any solid theoretical base about dyslexia. Lastly, we use the multiple deficit model as an aid to analyse the current data referring to the effect of stimulants on nuclear mechanisms in dyslexia. CONCLUSIONS: It is suggested that it would be wise to monitor the response in reading skills in children with dyslexia and attention deficit hyperactivity disorder (ADHD) who are being treated with stimulants. We also recommend taking into consideration the comorbidity between dyslexia and ADHD as an argument in favour of pharmacological intervention in patients with apparently mild symptoms of ADHD. In any case, today, pharmacological intervention cannot be expected to go beyond its having a complementary and synergic effect on traditional methods of treatment.

Tratamiento farmacológico de la dislexia / Pharmacological treatment of dyslexia

Introducción. Se constata una ausencia casi absoluta de abordajes farmacológicos orientados a mejorar la dislexia. Objetivo. Analizar, en base a las teorías actuales de la dislexia, la opción de aplicar alguna medida farmacológica. Desarrollo. Se discuten las distintas teorías sobre la dislexia. Se expone a continuación el modelo de déficit múltiple, en contraposición al modelo clásico de disfunción única. El modelo expuesto aporta una explicación coherente a diversos dilemas conceptuales planteados a partir del análisis de la comorbilidad de la dislexia. Igualmente se analizan las escasas intervenciones farmacológicas planteadas hasta el presente, las cuales, con excepción de los estimulantes, no están respaldadas por una base teórica sólida sobre la dislexia. Por último, tomando como soporte el modelo de déficit múltiple, se analizan los datos actuales referentes al efecto de los estimulantes sobre mecanismos nucleares de la dislexia. Conclusiones. Se sugiere la conveniencia de monitorizar la respuesta en las habilidades lectoras en niños con dislexia y trastorno por déficit de atención/hiperactividad (TDAH) tratados con estimulantes. También se recomienda considerar la comorbilidad entre dislexia y TDAH como un argumento a favor de la intervención farmacológica en pacientes con sintomatología de TDAH aparentemente leve. De todos modos, en el momento actual, las expectativas farmacológicas no pueden pretender ir más allá de una acción complementaria y sinérgica con los métodos tradicionales (AU)

Introduction. Pharmacological approaches aimed at improving dyslexia are almost inexistent. Aim. To analyse, based on the current theories of dyslexia, the possibility of applying some pharmacological measure. Development. The different theories on dyslexia are discussed. The multiple deficit model is then outlined, in opposition to the classical single dysfunction model. The model described provides a coherent explanation for several conceptual dilemmas that arise from the analysis of the comorbidity of dyslexia. The few pharmacological interventions that have been proposed to date are also analysed; with the exception of stimulants, however, they are not supported by any solid theoretical base about dyslexia. Lastly, we use the multiple deficit model as an aid to analyse the current data referring to the effect of stimulants on nuclear mechanisms in dyslexia. Conclusions. It is suggested that it would be wise to monitor the response in reading skills in children with dyslexia and attention deficit hyperactivity disorder (ADHD) who are being treated with stimulants. We also recommend taking into consideration the comorbidity between dyslexia and ADHD as an argument in favour of pharmacological intervention in patients with apparently mild symptoms of ADHD. In any case, today, pharmacological intervention cannot be expected to go beyond its having a complementary and synergic effect on traditional methods of treatment (AU)

[Dyslexia: a disease, a disorder or something else?]. / Dislexia: enfermedad, trastorno o algo distinto.

INTRODUCTION AND DEVELOPMENT: Although dyslexia is widely diagnosed and affects a very important portion of the childhood population, a conceptual definition of the condition is still lacking. This paper analyses different contributions from molecular genetics, neurocognitive research and evolutionary psychology so as to provide a series of reflections that may further our understanding of the nature of dyslexia and make it easier to categorise. Genetics has shown that dyslexia is linked to quantitative, pleiotropic genes. Moreover, dyslexia is not linked to a single gene, but is polygenic. Another genetic characteristic is its heterogeneity, that is to say, dyslexia may be due to a variety of different genetic combinations. This model, which has recently been put forward to make sense of and lend coherence to the data provided by genetics and neurocognitive research, has been called the multiple deficit model. Writing, on the other hand, is seen as a cultural technique that was invented only recently, if we compare it with whole process of human evolution. In order to learn to read and write successfully, the brain has had to adapt structures that were designed by the process of natural selection to perform functions that are typical of our species and have absolutely nothing to do with reading. CONCLUSIONS: Taking the multiple deficit model as its starting point, this article analyses the therapeutic response to stimulant medication as a way of improving nuclear aspects of dyslexia, when dyslexia and attention deficit hyperactivity disorder coincide.

Dislexia: enfermedad, trastorno o algo distinto / Dyslexia: A disease a disorder or somethig else?

Introducción y desarrollo. A pesar de que la dislexia es un diagnóstico ampliamente usado y que afecta a una parte muy importante de la población infantil, adolece de una falta de definición conceptual. Este artículo analiza aportaciones de la genética molecular, de la investigación neurocognitiva y de la psicología evolucionista, con el fin de ofrecer una reflexión que aporte una comprensión sobre la naturaleza de la dislexia y facilite una ubicación categórica. La genética ha mostrado que la dislexia está vinculada a genes cuantitativos y pleiotrópicos. Además, la dislexia no está vinculada a un solo gen, sino que es poligénica. Otra característica genética es la heterogeneidad, es decir, que las combinaciones genéticas que generan la dislexia pueden ser diversas. El modelo, propuesto recientemente para dar sentido y coherencia a los datos aportados por la genética y la investigación neurocognitiva, se ha denominado modelo de déficit múltiple. Por otra parte, se contempla la escritura como una técnica cultural de invención muy reciente, al tomar en consideración el proceso evolutivo humano. Para afrontar con éxito el aprendizaje de la lectura y la escritura, el cerebro debe adaptar estructuras que fueron diseñadas por el proceso de selección natural para ejercer funciones propias de la especie totalmente ajenas a la lectura. Conclusión. Sobre la base del modelo de déficit múltiple, se analiza la respuesta terapéutica a la medicación estimulante como intervención para mejorar los aspectos nucleares de la dislexia, cuando coinciden dislexia y trastorno por déficit de atención/hiperactividad (AU)

Introduction and development. Although dyslexia is widely diagnosed and affects a very important portion of the childhood population, a conceptual definition of the condition is still lacking. This paper analyses different contributions from molecular genetics, neurocognitive research and evolutionary psychology so as to provide a series of reflections that may further our understanding of the nature of dyslexia and make it easier to categorise. Genetics has shown that dyslexia is linked to quantitative, pleiotropic genes. Moreover, dyslexia is not linked to a single gene, but is polygenic. Another genetic characteristic is its heterogeneity, that is to say, dyslexia may be due to a variety of different genetic combinations. This model, which has recently been put forward to make sense of and lend coherence to the data provided by genetics and neurocognitive research, has been called the multiple deficit model. Writing, on the other hand, is seen as a cultural technique that was invented only recently, if we compare it with whole process of human evolution. In order to learn to read and write successfully, the brain has had to adapt structures that were designed by the process of natural selection to perform functions that are typical of our species and have absolutely nothing to do with reading. Conclusions. Taking the multiple deficit model as its starting point, this article analyses the therapeutic response to stimulant medication as a way of improving nuclear aspects of dyslexia, when dyslexia and attention deficit hyperactivity disorder coincide (AU)

[The relation between borderline intellectual capacity and neurodevelopmental disorders]. / Relación entre capacidad de inteligencia límite y trastornos del neurodesarrollo.

INTRODUCTION: Individuals with borderline intellectual capacity (BIC) have educational, social and occupational limitations that are similar to those of the mental retarded (MR), although to a lower degree. The condition that defines BIC is the detection of an intelligence quotient between 71 and 84. Unlike MR, patients with BIC have received little attention in medical journals and hence the cognitive characteristics of this group are still poorly defined. AIMS; The purpose of this study was to assess the different neurodevelopmental disorders associated with BIC. PATIENTS AND METHODS: A group of 87 patients who had been diagnosed with BIC were selected, together with a control group. The clinical diagnoses were analysed and the results of the CBCL/6-18 survey from the two groups were compared. RESULTS: The group of patients was found to have a high prevalence of neurocognitive disorders, such as attention deficit hyperactivity disorder (ADHD), learning difficulties and pervasive developmental disorders. The most frequent medical diagnosis was the effects of alcohol on the foetus. The results of the CBCL/6-18 in the group that was studied showed a behavioural profile that was very close to that described in patients with ADHD. CONCLUSIONS: Neurodevelopmental disorders, especially ADHD, exert a marked influence on intellectual capacity. Early detection and intervention could prevent many cases of BIC by lessening the sustained impact of a poor working memory linked to ADHD.

Relación entre capacidad de inteligencia límite y trastornos del neurodesarrollo / The relation between borderline intellectual capacity and neurodevelopmental disorders

Introducción. Los individuos con capacidad de inteligencia límite (CIL) presentan unas limitaciones escolares, sociales y laborales similares a las del retraso mental (RM), aunque de menor grado. La condición que define la CIL es la detección de un cociente intelectual comprendido entre 71 y 84. A diferencia del RM, el colectivo de pacientes con CIL ha merecido poca atención en las publicaciones médicas, por lo que están poco definidas las características cognitivas de este grupo. Objetivo. Valorar los diversos trastornos del neurodesarrollo que se asocian a CIL. Pacientes y métodos. Se seleccionaron un grupo de 87 pacientes diagnosticados de CIL y un grupo control. Se analizaron los diagnósticos clínicos y se compararon los resultados del cuestionario CBCL/6-18 entre los dos grupos. Resultados. Se detectó en el grupo de pacientes una elevada prevalencia de trastornos neurocognitivos: trastorno por déficit de atención/hiperactividad (TDAH), trastornos del aprendizaje y trastornos generalizados del desarrollo. El diagnóstico médico más frecuente fue los efectos fetales del alcohol. Los resultados del CBCL/6-18 del grupo estudiado mostraron un perfil conductual muy próximo al que se describe en los pacientes con TDAH. Conclusiones. Los trastornos del neurodesarrollo, especialmente el TDAH, tienen una influencia marcada sobre la capacidad intelectual. Una detección precoz y una intervención sobre ellos, posiblemente evitarían muchos casos de CIL, al paliar el impacto sostenido de una poca memoria de trabajo vinculada al TDAH

Introduction. Individuals with borderline intellectual capacity (BIC) have educational, social and occupational limitations that are similar to those of the mental retarded (MR), although to a lower degree. The condition that defines BIC is the detection of an intelligence quotient between 71 and 84. Unlike MR, patients with BIC have received little attention in medical journals and hence the cognitive characteristics of this group are still poorly defined. Aims. The purpose of this study was to assess the different neurodevelopmental disorders associated with BIC. Patients and methods. A group of 87 patients who had been diagnosed with BIC were selected, together with a control group. The clinical diagnoses were analysed and the results of the CBCL/6-18 survey from the two groups were compared. Results. The group of patients was found to have a high prevalence of neurocognitive disorders, such as attention deficit hyperactivity disorder (ADHD), learning difficulties and pervasive developmental disorders. The most frequent medical diagnosis was the effects of alcohol on the foetus. The results of the CBCL/6-18 in the group that was studied showed a behavioural profile that was very close to that described in patients with ADHD. Conclusions. Neurodevelopmental disorders, especially ADHD, exert a marked influence on intellectual capacity. Early detection and intervention could prevent many cases of BIC by lessening the sustained impact of a poor working memory linked to ADHD

[Early care of neurodevelopmental disorders. Advantages of early intervention in neurodevelopmental disorders Early care of neurodevelopmental disorders. Advantages of early intervention in neurodevelopmental disorders]. / Atención precoz de los trastornos del neurodesarrollo. A favor de la intervención precoz de los trastornos del neurodesarrollo.

INTRODUCTION: The model of early assistance implemented in our country is defined and developed in the White Paper on Early Intervention (Libro Blanco de Atencion Temprana). This model refers to a set of interventions aimed at children with neurodevelopmental problems between 0 and 6 years of age. Aims and development. The aim of this review is to explain the biological foundations underlying the theoretical arguments in favour of intervention and to analyse the different techniques that are applied to optimise the development of children with different kinds of disabilities. CONCLUSIONS: Although strong theoretical arguments have been put forward to defend early intervention, no solid conclusions can be drawn as far as its effectiveness is concerned because of the diversity of intervention techniques, the lack of homogeneity in treatments and the variety of problems that are included under the concept of neurodevelopmental disorders.

Atención precoz de los trastornos del neurodesarrollo. A favor de la intervención precoz de los trastornos del neurodesarrollo / Early care of neurodevelopmental disorders. Advantages of early intervention in neurodevelopmental disorders

Introducción. El modelo de intervención precoz implantado en nuestro país viene definido y desarrollado en el Libro Blanco de Atención Temprana. Dicho modelo hace referencia al conjunto de intervenciones, dirigidas a la población infantil de 0-6 años con problemas del neurodesarrollo. Objetivo y desarrollo. El objetivo de esta revisión es explicar las bases biológicas sobre las que se sustentan los argumentos teóricos a favor de la intervención, y analizar las distintas técnicas que se aplican con el fin de optimizar el desarrollo de los niños afectados de distintos tipos de discapacidad. Conclusiones. Si bien existen fuertes argumentos teóricos a favor de la intervención temprana, no es posible llegar a conclusiones sólidas sobre su eficacia, dada la dispersión de técnicas de intervención, la falta de homogeneidad de los tratamientos y la diversidad de problemas que se engloban bajo el concepto de trastornos del neurodesarrollo (AU)

Introduction. The model of early assistance implemented in our country is defined and developed in the White Paper on Early Intervention (Libro Blanco de Atención Temprana). This model refers to a set of interventions aimed at children with neurodevelopmental problems between 0 and 6 years of age. Aims and development. The aim of this review is to explain the biological foundations underlying the theoretical arguments in favour of intervention and to analyse the different techniques that are applied to optimise the development of children with different kinds of disabilities. Conclusions. Although strong theoretical arguments have been put forward to defend early intervention, no solid conclusions can be drawn as far as its effectiveness is concerned because of the diversity of intervention techniques, the lack of homogeneity in treatments and the variety of problems that are included under the concept of neurodevelopmental disorders (AU)

[Borderline intellectual capacity and executive dysfunction]. / Capacidad de inteligencia límite y disfunción ejecutiva.

INTRODUCTION: Borderline intellectual capacity (BIC) is defined by the detection of an intelligence quotient of between 71 and 84. In most cases, the diagnosis of BIC only represents the appreciation of one characteristic measured by intelligence tests. Thus, in most patients with BIC there is an underlying disorder that has helped to configure an intelligence quotient within the borderline range. The executive functions themselves, in addition to playing a role in the cognitive foundations of the disorders associated with BIC, also exert an effect on the degree of intelligence. AIM: To evaluate the impact of executive dysfunction in a group of patients with BIC. PATIENTS AND METHODS: A group of 87 patients who had been diagnosed with BIC were selected and their clinical diagnoses were analysed. The scores from the BRIEF questionnaire for evaluating the executive functions were obtained for 51 of the patients. These results were compared with those from a sample of patients with attention deficit hyperactivity disorder (ADHD). RESULTS: Prevalence of neurocognitive disorders (ADHD, learning difficulties and pervasive developmental disorders) was high in the group of patients. Moreover, an important degree of executive function involvement was also observed. CONCLUSIONS: Neurodevelopmental disorders, and more particularly ADHD, exert a strong influence on intellectual capacity. Early detection and intervention in those disorders may prevent many cases of BIC by lessening the sustained impact of a poor working memory.

Capacidad de inteligencia límite y disfunción ejecutiva / Borderline intellectual capacity and executive dysfunction

Introducción. La capacidad de inteligencia límite (CIL) viene definida por la detección de un cociente de inteligencia entre 71 y 84. En la mayoría de casos, el diagnóstico de CIL sólo representa la apreciación de una característica medida por los tests de inteligencia. Por ello, en la mayoría de pacientes con CIL existe un trastorno subyacente que ha contribuido a configurar un cociente de inteligencia en el rango límite. Las funciones ejecutivas, además de participar en las bases cognitivas de los trastornos asociados a la CIL, influyen por sí mismas en el grado de inteligencia. Objetivo. Valorar el impacto de la disfunción ejecutiva en un grupo de pacientes con CIL. Pacientes y métodos. Se seleccionó un grupo de 87 pacientes diagnosticados de CIL y se analizaron los diagnósticos clínicos. En 51 de los pacientes se obtuvo el resultado del cuestionario BRIEF para la valoración de funciones ejecutivas. Dichos resultados se compararon con una muestra de pacientes con trastorno por déficit de atención/ hiperactividad (TDAH). Resultados. El grupo de pacientes mostró una elevada prevalencia de trastornos neurocognitivos (TDAH, trastornos del aprendizaje y trastornos generalizados del desarrollo). Además, se observo una importante afectación de las funciones ejecutivas. Conclusiones. Los trastornos del neurodesarrollo, especialmente el TDAH, ejercen una marcada influencia sobre la capacidad intelectual. Una detección precoz y una intervención sobre esos trastornos posiblemente evitará muchos casos de CIL, al paliar el impacto sostenido de una baja memoria de trabajo

Introduction. Borderline intellectual capacity (BIC) is defined by the detection of an intelligence quotient of between 71 and 84. In most cases, the diagnosis of BIC only represents the appreciation of one characteristic measured by intelligence tests. Thus, in most patients with BIC there is an underlying disorder that has helped to configure an intelligence quotient within the borderline range. The executive functions themselves, in addition to playing a role in the cognitive foundations of the disorders associated with BIC, also exert an effect on the degree of intelligence. Aim. To evaluate the impact of executive dysfunction in a group of patients with BIC. Patients and methods. A group of 87 patients who had been diagnosed with BIC were selected and their clinical diagnoses were analysed. The scores from the BRIEF questionnaire for evaluating the executive functions were obtained for 51 of the patients. These results were compared with those from a sample of patients with attention deficit hyperactivity disorder (ADHD). Results. Prevalence of neurocognitive disorders (ADHD, learning difficulties and pervasive developmental disorders) was high in the group of patients. Moreover, an important degree of executive function involvement was also observed. Conclusions. Neurodevelopmental disorders, and more particularly ADHD, exert a strong influence on intellectual capacity. Early detection and intervention in those disorders may prevent many cases of BIC by lessening the sustained impact of a poor working memory

El trastorno de déficit de atención/hiperactividad en la consulta del pediatra. Algunas sugerencias / No disponible

El trastorno de déficit de atención/hiperactividad (TDAH) es un problema de elevadaprevalencia y gran trascendencia para el futuro de los niños que lo padecen. En este artículose destaca el papel que puede asumir el pediatra en el manejo del TDAH. Se destaca lafalta de profesionales y equipos diagnosticoterapéuticos capaces de asumir integralmenteesta problemática. La implicación del pediatra en la salud integral del niño comporta queéste deba atender a un número considerable de pacientes con TDAH. Por dicho motivo, debeconocer a fondo las características y la trascendencia del TDAH con el fin de orientaradecuadamente las familias de niños con este problema. El papel del pediatra se inicia conla sospecha del diagnóstico. A partir de este momento, es necesario que el pediatra asumael control y el desarrollo del proceso colaborando con otros especialistas implicados. Puestoque muchos niños con TDAH reciben medicación, independientemente de que ésta hayasido prescrita o no por el pediatra, es necesario que éste conozca bien el manejo y losefectos secundarios de los fármacos usados en el manejo del TDAH

Attention deficit hyperactivity disorder (ADH/D) is a highly prevalent problem with agreat impact on the future of the children affected. In this article, we stress the role thatthe paediatrician can assume in the management of ADH/D. We wish to emphasise on the lackof professionals and diagnostic-therapeutic teams able to fully assume this type of problem.The participation of paediatricians in children’s general health implies attending a largenumber of patients with ADH/D. The paediatricians must therefore know the characteristicsand transcendence of ADH/D in depth, in order to correctly orientate the families ofthe children affected with this problem. Their role starts with a diagnostic suspicion. Fromthen on, they must assume the control and development of the process, collaborating withthe other specialists implied. Paediatricians must also have a great knowledge of the drugsadministered for ADH/D, since many children with this disorder are taking medication,whether prescribed by the paediatrician or another physician

[Good practice guidelines for the treatment of autistic spectrum disorders]. / Guia de buena practica para el tratamiento de los trastornos del espectro autista.

INTRODUCTION: Due to the inexistence of an aetiology-based intervention for autistic spectrum disorders (ASD) families and professionals are exposed to diverse and sometimes conflictive recommendations when they have to decide the most adequate alternative for treatment. AIM: To elaborate treatment guidelines agreed by consensus at the ASD Study Group of the (National) Institute of Health Carlos III. DEVELOPMENT: Information about treatment of ASD was searched and gathered through available evidence based medical (EBM) databases. The data generated was complemented with practice parameters published elsewhere, reports from prestigious international institutions, focus oriented searches in PubMed and, finally, the opinion and experience of a multidisciplinary Study Group with extensive experience in treating ASD in Spain. Most popular treatment methods were reviewed as well as the common elements to be considered in successful support programs. CONCLUSION: No simple treatment algorithm can be produced at this time, and the level of available evidence based recommendations are in the weaker degrees of EBM classifications. Nevertheless, there is widespread agreement to stress that education, with special incidence in the development of communication and social competence, with the addition of community support are the main means of treatment. They can be complemented, depending on individual needs, with medication, behavioural approaches and cognitive-behavioural therapy for associated psychological problems in persons with higher cognitive level. Support to families and community empowerment are essential elements for the quality of life of persons with ASD.

Perfil neurocognitivo del trastorno de aprendizaje no verbal / The neurocognitive profile of non-verbal learning disorder

Introduction. Non-verbal learning disorder is a specific type of learning disorder that is characterised bydifficulties in social skills, in visuospatial and visual-constructional capabilities, and in motor skills. Aim. To observe thecognitive profile characterising these children. Patients and methods. We evaluated the intelligence, memory, visuospatialfunctions, instrumental and executive functions of 13 children between 8 and 14 years of age diagnosed with non-verballearning disorder. Results. All the children displayed an overall intelligence quotient within a range considered to be normal,with a marked difference between the verbal and manipulative intelligence quotients. They all had a good verbal memory. Incontrast, they had difficulties in any tasks requiring spatial organisation and sequencing. Spontaneous language was fluentand aprosodic, with poor non-verbal communication. Conclusions. Good verbal skills and marked deficits in visuospatialskills are the characteristic pattern that has been described in the literature and this coincides with the observations made inthe 13 children under study

Introducción. El trastorno de aprendizaje no verbal esun tipo específico de trastorno del aprendizaje caracterizado pordificultades en las habilidades sociales, en las capacidades visuoespacialesy visuoconstructivas y en las habilidades motoras.Objetivo. Observar el perfil cognitivo característico de estos niños.Pacientes y métodos. Se han evaluado la inteligencia, la memoria ylas funciones visuoespaciales, instrumentales y ejecutivas de 13niños diagnosticados de trastorno de aprendizaje no verbal, deedades comprendidas entre los 8 y los 14 años. Resultados. Todoslos niños mostraron un cociente de inteligencia total dentro de loslímites de la normalidad, con una diferencia marcada entre el cocientede inteligencia verbal y el manipulativo. Todos presentabanuna buena memoria verbal. Por el contrario, evidenciaban dificultadesen todas aquellas tareas que requieren una organización espacialy una secuenciación. El lenguaje espontáneo era fluido yaprosódico, con una pobre comunicación no verbal. Conclusiones.Las habilidades verbales buenas y los déficit marcados en las habilidadesvisuoespaciales son el patrón característico que se ha descritoen la bibliografía y que se ha podido observar en los 13 niñosevaluados

[The neurocognitive profile of non-verbal learning disorder]. / Perfil neurocognitivo del trastorno de aprendizaje no verbal.

INTRODUCTION: Non-verbal learning disorder is a specific type of learning disorder that is characterised by difficulties in social skills, in visuospatial and visual-constructional capabilities, and in motor skills. AIM: To observe the cognitive profile characterising these children. PATIENTS AND METHODS: We evaluated the intelligence, memory, visuospatial functions, instrumental and executive functions of 13 children between 8 and 14 years of age diagnosed with non-verbal learning disorder. RESULTS: All the children displayed an overall intelligence quotient within a range considered to be normal, with a marked difference between the verbal and manipulative intelligence quotients. They all had a good verbal memory. In contrast, they had difficulties in any tasks requiring spatial organisation and sequencing. Spontaneous language was fluent and aprosodic, with poor non-verbal communication. CONCLUSIONS: Good verbal skills and marked deficits in visuospatial skills are the characteristic pattern that has been described in the literature and this coincides with the observations made in the 13 children under study.