[A study of primary school teachers' knowledge of attention deficit hyperactivity disorder]. / Estudio de los conocimientos de los maestros de educacion primaria sobre el trastorno por deficit de atencion/hiperactividad.

INTRODUCTION: The high prevalence of attention deficit hyperactivity disorder (ADHD), with at least one pupil per classroom, poses a challenge for all the professionals in contact with them, especially for teachers. AIM: To examine how much primary school teachers know about ADHD in three areas (general information, symptoms and diagnosis, and treatment). SUBJECTS AND METHODS: 125 primary school teachers from different communities answered the Knowledge of Attention Deficit Hyperactivity Disorder Scale (KADDS). RESULTS: The teachers answered fewer than half the items correctly, the symptoms and diagnosis subscale being the one where they were seen to be most knowledgeable. Teachers who had had children with ADHD in class displayed greater knowledge in the areas of general information and treatment, but less on the symptoms and diagnosis subscale. 32.8% of the teachers reported feeling somewhat or totally unable to teach children with ADHD in an effective way and recommend special education as a better educational style. Teachers with specific training in ADHD obtained better scores than those who had not received such instruction. CONCLUSION: Teachers with training in ADHD are more knowledgeable and more confident about their abilities when it comes to teaching children with ADHD.

TITLE: Estudio de los conocimientos de los maestros de educacion primaria sobre el trastorno por deficit de atencion/hiperactividad.Introduccion. La alta prevalencia del trastorno por deficit de atencion/hiperactividad (TDAH), con al menos un alumno por aula, supone un reto para todos los profesionales que estan en contacto con ellos, en especial para los maestros. Objetivo. Examinar los conocimientos de los maestros de educacion primaria sobre el TDAH en tres areas (informacion general, sintomas y diagnostico, y tratamiento). Sujetos y metodos. Un total de 125 maestros de educacion primaria de varias comunidades cumplimentaron la Knowledge of Attention Deficit Hyperactivity Disorder Scale (KADDS). Resultados. Los maestros contestaron de forma correcta a menos de la mitad de los items, y la subescala de sintomas y diagnostico es donde mas conocimientos demostraron. Los maestros que habian tenido niños con TDAH en clase mostraron mas conocimientos en las areas de informacion general y tratamiento, pero no en la subescala de sintomas y diagnostico. Un 32,8% de los maestros describe sentirse poco o nada capaz de enseñar eficazmente a niños con TDAH y recomienda la educacion especial como mejor estilo educativo. Los maestros con formacion especifica en TDAH obtuvieron mejores resultados en la KADDS en comparacion con los maestros sin formacion. Conclusion. Los maestros formados en TDAH demuestran un mayor grado de conocimiento y aumenta su confianza para llevar a cabo la labor educativa de los niños con TDAH.

[Current state of the attention deficit hyperactivity disorder approach in neuropediatrics]. / Estado actual del enfoque del trastorno por deficit de atencion/hiperactividad en neuropediatria.

AIM: To know the current state of the approach of attention deficit hyperactivity disorder (ADHD) in neuropediatricians. SUBJECTS AND METHODS: A telematic survey was carried out to collect preliminary information on the interest, difficulties in the management and treatment of ADHD to the 437 fellowship of the Neuropediactric Spanish Society (SENEP). RESULTS: Only 32.49% of the sent questionnaires were answered, with important geographic variability. 97.89% stated that 50% of their consultations were children with learning disabilities and ADHD. Regarding who started treatment for ADHD in their area, the majority answered that the neuropediatrician (57.97%), followed by the child psychiatrist (34.78%) and the primary care pediatrician (5.31%). The lack of a psycho-pedagogical study by the school (49.79%), followed by the lack of time in the consultation (29.11%), was cited as the greatest difficulty in the initial assessment of children with suspected ADHD. Concerning the difficulties in the follow-up, the biggest complaint was the lack of coordination between professionals, the school and parents. And, lastly, regarding the type of treatment use, most patients were on prolonged-release methylphenidate, a stable percentage using immediate release methylphenidate as a single or combined treatment, and in a lower range was the use of clonidine and atomoxetine, and an incipient use of lisdexamphetamine were observed. 80% of the patient showed adherence to pharmacological treatment after one year. CONCLUSIONS: It is necessary to advance in the training and continuous education of our neuropediatric specialists in ADHD and to homogenize the clinical practice and coordination with education system in the Spanish territory.

TITLE: Estado actual del enfoque del trastorno por deficit de atencion/hiperactividad en neuropediatria.Objetivo. Conocer el estado actual del enfoque del trastorno por deficit de atencion/hiperactividad (TDAH) entre los neuropediatras. Sujetos y metodos. Se realizo una encuesta telematica que recogia informacion preliminar sobre el interes, las dificultades en el manejo y el tratamiento del TDAH a los 437 socios de la Sociedad Española de Neurologia Pediatrica. Resultados. Respondio un 32,49% de los cuestionarios enviados, con una importante variabilidad geografica. El 97,89% afirmo que el 50% de sus consultas eran niños con trastornos de aprendizaje y TDAH. Respecto a quien iniciaba el tratamiento para el TDAH en su area, la mayoria contesto que el neuropediatra (57,97%), seguido del psiquiatra infantil (34,78%) y del pediatra de atencion primaria (5,31%). Respecto a las mayores dificultades para la valoracion inicial de los niños con sospecha de TDAH, se citaron la falta de un estudio psicopedagogico por parte de la escuela (49,79%), seguido de la falta de tiempo en la consulta (29,11%). Sobre las dificultades en el seguimiento, la mayor queja se produjo por la falta de coordinacion entre los profesionales, la escuela y los padres. Respecto a la medicacion, la mayoria de los pacientes se encontraba en tratamiento con algun tipo de metilfenidato de liberacion prolongada, un porcentaje estable utilizaba metilfenidato de liberacion inmediata como tratamiento unico o combinado, y se observo en un rango inferior el uso de clonidina y atomoxetina, y un incipiente uso de lisdexanfetamina. La adhesion al tratamiento farmacologico al año fue alrededor del 80%. Conclusiones. Es necesario avanzar en la capacitacion y educacion continua de nuestros especialistas neuropediatricos en el manejo del TDAH, y en homogeneizar la practica clinica y la coordinacion con educacion en el territorio español.

[Attention deficit disorder and hyperactivity: a pattern of evolution?]. / Trastorno por déficit de atención/hiperactividad: un patrón evolutivo?

INTRODUCTION: When the frequency of a gene in the general population exceeds 1%, is not considered a random mutation but a mutation that has been positively selected during evolution. The high prevalence of attention deficit/hyperactivity disorder (ADHD) from 5-10% and its association with the seven-repeat allele of DRD4, which is positively selected in evolution, raising the possibility that ADHD increases the reproductive fitness of the individual and/or group. One of the main characteristics of ADHD is its diversity and is a well recognized fact that diversity confers many benefits to a population (eg. immunity). DEVELOPMENT: This article discusses the various studies that support this hypothesis and offers further explanations on the prevalence, age distribution and sex distribution of the severity and heterogeneity of ADHD. CONCLUSION: It is possible that the presence of altered gene combinations, as in ADHD, can bring concrete benefits to society but are detrimental to the individual.

¿Cuál es la combinación de síntomas según padres y maestros más fiable para el diagnóstico de TDAH? / What combination of symptoms according to parents and teachers would be more reliable for the diagnosis of ADHD?

Introducción: El método politético, recogido en el Manual Diagnóstico y Estadístico de los Trastornos Mentales-IV, es el que se plantea tradicionalmente para el diagnóstico de los trastornos por déficit de atención e hiperactividad (TDAH). Sin embargo, es probable que este procedimiento, que conlleva establecer cualquier combinación de 6 ítems, no sea el más adecuado para establecer un diagnóstico de TDAH y que las diferentes combinaciones de ítems tengan desigual peso. Objetivo: Determinar qué combinaciones de ítems de las escalas de inatención e hiperactividad-impulsividad de DuPaul, para padres y maestros, son las más efectivas a la hora de diagnosticar o descartar un TDAH. Resultados: No todas las combinaciones de ítems de padres y maestros obtuvieron el mismo valor predictivo. Todas ellas ofrecieron altos grados de especificidad, pero bajos grados de sensibilidad; es decir, las combinaciones resultaron más efectivas y confiables para descartar este tipo de trastornos que a la hora de diagnosticarlos. Discusión: El método que implica establecer combinaciones de los ítems mejores predictores del TDAH ofreció superiores resultados que los del método politético. No obstante, se requieren futuros estudios con muestras que posean tasas base más elevadas para obtener datos más fiables. Asimismo, sería conveniente emplear un método alternativo para la selección de los sujetos participantes que permita comprobar, posteriormente, la eficacia diagnóstica pura de los diferentes ítems de las escalas de clasificación de los TDAH (AU)

Introduction: The polythetic method used in the DSM is the one proposed traditionally for the diagnosis of Attention Disorders with or without Hyperactivity (ADHD). However, it is possible that the approach which aggregates any combination of 6 items won’t be the optimal method to establish a diagnosis of ADHD, and that the different combinations may not be the same as regards to their ability to predict ADHD. Aim: Determine which combinations of items of DuPaul's inattention and hyperactivity-impulsivity scales (from parent and teacher versions), are the most effective to predict or rule out a diagnosis of ADHD. Results: Not every combination of items from parents and teachers obtained the same predictive value. All of them offered high levels of specificity, but had low sensivity; that is to say, the combinations were more effective and reliable for ruling out the disorder than predicting it. Conclusions: Data show that not every combination of ADHD items has the same predictive value and, therefore, the well-known polythetic method is disputable. The highest predictive value combinations, limitations of the study, and future lines of investigation are analyzed (AU)

[What combination of symptoms according to parents and teachers would be more reliable for the diagnosis of ADHD?]. / ¿Cuál es la combinación de síntomas según padres y maestros más fiable para el diagnóstico de TDAH?

INTRODUCTION: The polythetic method used in the DSM is the one proposed traditionally for the diagnosis of Attention Disorders with or without Hyperactivity (ADHD). However, it is possible that the approach which aggregates any combination of 6 items won't be the optimal method to establish a diagnosis of ADHD, and that the different combinations may not be the same as regards to their ability to predict ADHD. AIM: Determine which combinations of items of DuPaul's inattention and hyperactivity-impulsivity scales (from parent and teacher versions), are the most effective to predict or rule out a diagnosis of ADHD. RESULTS: Not every combination of items from parents and teachers obtained the same predictive value. All of them offered high levels of specificity, but had low sensivity; that is to say, the combinations were more effective and reliable for ruling out the disorder than predicting it. CONCLUSIONS: Data show that not every combination of ADHD items has the same predictive value and, therefore, the well-known polythetic method is disputable. The highest predictive value combinations, limitations of the study, and future lines of investigation are analyzed.

[Oppositional defiant disorder: aspects related to sex differences and informant]. / Trastorno negativista desafiante: aspectos relacionados con el sexo y el evaluador.

INTRODUCTION: Oppositional defiant disorder (ODD) is one of the most common externalizing disorders in childhood. ODD prevalence global rates vary from 2% to 16%. Along with conduct disorder and attention deficit disorder, ODD is one of the leading reasons for referral to neuropediatric and psychiatric services. Even though ODD has recognized clinical importance, key aspects of its conceptualization and prevalence in childhood and adolescence remain uncertain. DEVELOPMENT: We examine previous research findings of ODD prevalence and analyze sex differences and differences according to informants. CONCLUSIONS: ODD prevalence rates present high variability. A number of studies suggest that ODD is more common in boys than in girls. Nevertheless, some authors point that this sex differences may be due to methodological bias. We recommend the validation of an ODD scale that has into consideration the following aspects: level of the subject's development (age), gender and environment.

Trastorno negativista desafiante: aspectos relacionados con el sexo y el evaluador / Oppositional deflant disorder: aspects related to sex differences and informant

Introducción. El trastorno negativista desafiante (TND) es uno de los trastornos externalizantes más prevalentes, con una tasa global del 2-16%. El TND, junto con el déficit de atención/hiperactividad y el trastorno de conducta, es una de las causas principales de derivación a los servicios especializados de neuropediatría y psiquiatría infantil. Aunque el trastorno tiene una relevancia clínica considerable, existe cierta incertidumbre con relación a los aspectos clave de su conceptualización y prevalencia tanto en la niñez como en la adolescencia. Desarrollo. Se revisan los estudios realizados sobre la prevalencia del TND y se analizan los aspectos relacionados con las diferencias según el sexo y en función del evaluador, debido a que en la actualidad los datos disponibles con relación a estos factores son escasos e inconsistentes. Conclusiones. Los índices de prevalencia del TND presentan una gran variabilidad dependiendo de la metodología utilizada y del evaluador (padres frente a maestros). La mayoría de estudios sugieren que el TND es más común en niños que en niñas, aunque algunos autores señalan que esto puede deberse a ciertos sesgos metodológicos. Se propone validar una escala de TND que tenga en cuenta el nivel de desarrollo del sujeto (edad), sexo y ambiente (AU)

Introduction. Oppositional defiant disorder (ODD) is one of the most common externalizing disorders in childhood. ODD prevalence global rates vary from 2% to 16%. Along with conduct disorder and attention deficit disorder, ODD is one of the leading reasons for referral to neuropediatric and psychiatric services. Even though ODD has recognized clinical importance, key aspects of its conceptualization and prevalence in childhood and adolescence remain uncertain. Development. We examine previous research findings of ODD prevalence and analyze sex differences and differences according to informants. Conclusions. ODD prevalence rates present high variability. A number of studies suggest that ODD is more common in boys than in girls. Nevertheless, some authors point that this sex differences may be due to methodological bias. We recommend the validation of an ODD scale that has into consideration the following aspects: level of the subject’s development (age), gender and environment. (AU)

[Soft neurological signs: are they of any value in the assessment and diagnosis of attention deficit hyperactivity disorder?]. / Signos neurológicos blandos:¿tienen alguna utilidad en la evaluación y diagnósticodel trastorno por déficit de atención/hiperactividad?

INTRODUCTION: The association between difficulties on motor skills, visual-hand coordination and excess motor activity was described previously of being established the attention-deficit/hyperactivity disorder (ADHD) as a diagnostic category. These disorders have been grouped under different terminologies, being one of them the soft neurological signs (SNS). Traditionally, the European scientific community has put more attention on the SNS than the American one. However, nowadays there are a lot of neuropediatrician and community pediatrician that continue to think that those deficits, together with inattention and hyperactivity, form part of the same disorder. DEVELOPMENT: In this article we have tried to do a neurobiological revision of the movement and the possible relationship between motor problems and cognitive processes from different points of view: neuroanatomical, findings on different clinical examination tests and neuropsychological experimental models. CONCLUSION: Most of the revised articles conclude that the SNS prevalence is greater in ADHD children compared with control. Therefore we recommend to include the SNS in the evaluation and diagnosis protocols of these disorders in order to improve the sensitivity and specificity of the diagnosis and to be able to evaluate the real needs of the ADHD patients.

[Attention deficit hyperactivity disorder: the state of the matter and further research approaches]. / Trastorno por déficit de atención/hiperactividad:estado de la cuestión y futuras líneas de investigación.

AIM: This paper is a review on the state of affairs of attention deficit hyperactivity disorder. DEVELOPMENT: In the first section, the authors review the limitations and controversies in the fields of the prevalence, etiology, diagnostic criteria and comorbidities. In the second part, there is an update of the latest findings in the field of the neurobiological bases, the genetic etiology, the relevance of the evaluation of the executive functions and the effectiveness of drug therapies, behavioral and others alternatives therapies. The authors have selected the most relevant recently published bibliography and addressed in a schematic way, disputes or outstanding issues with a greater emphasis on the lines of research more relevant in the near future.

Trastorno por déficit de atención/hiperactividad: estado de la cuestión y futuras líneas de investigación / Attention deficit hyperactivity disorder the state of the matter and further research approaches

El presente trabajo es una revisión sobre el estado de la cuestión del trastorno por déficit de atención/hiperactividad. Desarrollo. En el primer apartado, se revisan las limitaciones y controversias en los campos de la prevalencia, la etiología, los criterios diagnósticos y la comorbilidad. En el segundo apartado, se revisan los avances desde el punto de vista de los fundamentos neurobiológicos, la etiología genética, la relevancia de la evaluación de las funciones ejecutivas y la eficacia de los tratamientos farmacológicos, conductuales y otros alternativos. En todos los casos se hace una selección de la bibliografía más relevante publicada recientemente, se abordan de manera esquemática las controversias o las cuestiones pendientes y se hace especial hincapié en destacar aquellas líneas de investigación que parece que serán más relevantes en un futuro inmediato

This paper is a review on the state of affairs of attention deficit hyperactivity disorder. Development. In the first section, the authors review the limitations and controversies in the fields of the prevalence, etiology, diagnostic criteria and comorbidities. In the second part, there is an update of the latest findings in the field of the neurobiological bases, the genetic etiology, the relevance of the evaluation of the executive functions and the effectiveness of drug therapies, behavioral and others alternatives therapies. The authors have selected the most relevant recently published bibliography and addressed in a schematic way, disputes or outstanding issues with a greater emphasis on the lines of research more relevant in the near future

Signos neurológicos blandos: ¿tienen alguna utilidad en la evaluación y diagnóstico del trastorno por déficit de atención/hiperactividad? / Soft neurological signs: are they of any value in the assessment and diagnosis of attention déficit hyperactivity disorder?

Introducción. La asociación entre dificultades en las habilidades motoras, la coordinación visuomanual y el comportamiento sobreactivo fue descrita mucho antes de que se estableciera como categoría diagnóstica el trastorno por déficit de atención/hiperactividad (TDAH). Estas alteraciones se han intentado agrupar bajo diferentes terminologías, siendo una de ellas los signos neurológicos blandos (SNB). Tradicionalmente se ha prestado más atención a los llamados SNB entre la comunidad científica europea que en la americana. En la actualidad, muchos neuropediatras y pediatras del desarrollo continúan considerando que estos déficit, junto con la inatención y la hiperactividad, forman parte de un mismo trastorno. Desarrollo. En este artículo se intenta realizar una revisión neurobiológica del movimiento, de la posible relación entre las alteraciones motoras y los procesos cognitivos desde diferentes perspectivas: neuroanatómica, hallazgos en diferentes test de exploración clínica y modelos experimentales neuropsicológicos. Conclusión. La mayoría de los artículos revisados concluyen que la prevalencia de los SNB es muy superior en los niños con TDAH respecto a los controles, por lo que se recomienda su inclusión en los protocolos de evaluación y diagnóstico de estos trastornos, no sólo para mejorar la sensibilidad y especificidad en el diagnóstico, sino también para poder evaluar cuáles son las necesidades reales de los pacientes con TDAH (AU)

Introduction. The association between difficulties on motor skills, visual-hand coordination and excess motor activity was described previously of being established the attention-deficit/hyperactivity disorder (ADHD) as a diagnostic category. These disorders have been grouped under different terminologies, being one of them the soft neurological signs (SNS). Traditionally, the European scientific community has put more attention on the SNS than the American one. However, nowadays there are a lot of neuropediatrician and community pediatrician that continue to think that those deficits, together with inattention and hyperactivity, form part of the same disorder. Development. In this article we have tried to do a neurobiological revision of the movement and the possible relationship between motor problems and cognitive processes from different points of view: neuroanatomical, findings on different clinical examination tests and neuropsychological experimental models. Conclusion. Most of the revised articles conclude that the SNS prevalence is greater in ADHD children compared with control. Therefore we recommend to include the SNS in the evaluation and diagnosis protocols of these disorders in order to improve the sensitivity and specificity of the diagnosis and to be able to evaluate the real needs of the ADHD patients (AU)

[ADHD Rating Scale-IV in a sample of Spanish schoolchildren: normative data and internal consistency for teachers and parents]. / ADHD Rating Scale-IV en una muestra escolar española: datos normativos y consistencia interna para maestros, padres y madres.

INTRODUCTION: The ADHD Rating Scale-IV (ADHD RS-IV) is one of the most use scales for attention deficit hyperactivity disorder (ADHD), because has cut-off point regarding age, gender and setting, but the normalization data is based on American school samples. AIM: Evaluation of cut-off point of ADHD-RS-IV for parents and teachers in a Spanish sample. SUBJECTS AND METHODS: The study used the score of ADHD-RS-IV from a prevalence study of ADHD in school children of 6-12 years. Using an intrasubject design between the three evaluators (parents and teachers) and the results of each subscale (IN, H/I, and TOT) according to gender and age factors. Then, we analyzed the reliability and internal consistency for each subscale and evaluator. RESULTS: There are no significant differences between the father and the mother; but there are between teachers, and father and/or mother scores. In relation to gender factor, boys' score is higher on inattention and hyperactivity-impulsivity than girls'. Our results show a reversal tendency in comparison with the American samples, in our case parents' scores were significantly higher than teachers'. CONCLUSION: The use and normalization of the ADHD RS-IV will need to account not only for age, gender and setting but also for socio-cultural aspects.

ADHD Rating Scale-IV en una muestra escolar española: datos normativos y consistencia interna para maestros, padres y madres / ADHD rting scale-IV in a sample of Spanish school children: Normative data and internal consistency for teachers and parents

Las ADHD Rating Scale -IV (ADHD RS-IV) son unas de las escalas más utilizadas en evaluación deltrastorno por déficit de atención/hiperactividad (TDAH), al presentar puntos de corte por edad, género y ambiente; sin embargo, están normalizadas en población estadounidense. Objetivo. Realizar la normalización de las ADHD RS-IV para maestros y padres en una muestra española. Sujetos y métodos. Se utilizan las escalas ADHS RS-IV de maestros y padres de un estudioepidemiológico de prevalencia del TDAH en escolares de 6-12 años y se analizan las diferencias a través de un diseño intrasujetos entre los tres evaluadores (maestros, padres y madres) y en cada una de las tres subescalas (IN, H/I y TOT), en función de los factores género y edad. Mediante un diseño intersujetos, se analizan las diferencias que se dan en cada evaluadoren las tres subescalas en función de los factores ‘género y edad’. Por último, se analiza la fiabilidad por consistencia interna de cada subescala y para cada evaluador. Resultados. No existe diferencia significativa entre padres y madres, pero sí entre maestros frente a padres y/o madres. En el factor género, se considera a los niños más inatentos y más hiperactivos/impulsivos que las niñas. Los resultados han seguido una tendencia a la inversa a la muestra estadounidense, ya que en nuestro caso los padres han puntuado de modo significativamente superior con respecto a los maestros. Conclusión. El uso y la normalización de las ADHD RS-IV requiere no sólo contemplar aspectos de edad, género o tipo de evaluador, sino también aspectos socioculturales

The ADHD Rating Scale-IV (ADHD RS-IV) is one of the most use scales for attention deficit hyperactivity disorder (ADHD), because has cut-off point regarding age, gender and setting, but the normalization data isbased on American school samples. Aim. Evaluation of cut-off point of ADHD-RS-IV for parents and teachers in a Spanish sample. Subjects and methods. The study used the score of ADHD-RS-IV from a prevalence study of ADHD in school children of 6-12 years. Using an intrasubject design between the three evaluators (parents and teachers) and the results of eachsubscale (IN, H/I, and TOT) according to gender and age factors. Then, we analyzed the reliability and internal consistency for each subscale and evaluator. Results. There are no significant differences between the father and the mother; but there are between teachers, and father and/or mother scores. In relation to gender factor, boys’ score is higher on inattention andhyperactivity-impulsivity than girls’. Our results show a reversal tendency in comparison with the American samples, in our case parents’ scores were significantly higher than teachers’. Conclusion. The use and normalization of the ADHD RS-IV will need to account not only for age, gender and setting but also for socio-cultural aspect

[The predictive value of DSM-IV criteria in the diagnosis of attention deficit hyperactivity disorder and its cultural differences]. / Valor predictivo de los criterios del DSM-IV en el diagnóstico del trastorno por déficit de atención/hiperactividad y sus diferencias culturales.

INTRODUCTION: The most common method used to diagnose attention deficit/hyperactivity disorder (ADHD) is based on the Diagnostic and statistic manual of mental disorders, 4th edition (DSM-IV) criteria. Nevertheless, it is more likely that the categorical system postulated by DSM-IV is not the most appropriate method as it does not consider the possible differences between the diagnostic capacity of the 18 proposed criteria. AIM. To analyze the predictive power of each DSM-IV diagnostic symptoms/criteria for ADHD using DuPaul's ADHD Parent and Teacher Rating Scales. PATIENTS AND METHODS: In a prospective, poblational study to evaluate the prevalence of ADHD the positive predictive power of each item was analyzed for each subtype and informant. A kappa index was applied for positive predictive power to correct the number of accurate predictions based on chance factors, and a ranking of items was established to determinate which ones offered the highest predictive power, comparing parent and teacher ratings. RESULTS: The results suggest that not all DSM-IV criteria are equal with regard to their ability to predict ADHD. The predictive power varies as a function of the informant. Parent and teachers agreed more on hyperactivity and impulsivity items, and showed more significant differences with regard to the American sample. CONCLUSIONS: The approach that aggregates any combination of items will not be the more effective strategy for ruling in a diagnosis of ADHD. To improve the clinical value of these scales making item combinations is recommended, the ones that will have attached a higher clinical weight for ruling in a diagnosis of ADHD.

Valor predictivo de los criterios del DSM-IV en el diagnóstico del trastorno por déficit de atención/hiperactividad y sus diferencias culturales / The predictive value of DSM-IV criteria in the diagnosis of attention deficit hyperactivity disorder and its cultural differences

Introducción. Para el diagnóstico del trastorno por déficit de atención/hiperactividad (TDAH), el método más utilizado se basa en los criterios del Manual diagnóstico y estadístico de los trastornos mentales, 4.ª edición (DSM-IV). Sin embargo, es probable que el sistema categorial postulado por el DSM-IV no sea el más apropiado al no plantear que puede haber diferencias en la capacidad diagnóstica de los 18 criterios propuestos. Objetivo. Analizar el poder predictivo de cada uno de los síntomas/criterios diagnósticos del DSM-IV para el TDAH a través de las escalas comportamentales de DuPaul para maestros y padres. Pacientes y métodos. En un estudio poblacional prospectivo para evaluar la prevalencia del TDAH, se analizó el valor predictivo positivo de cada ítem para cada subtipo y evaluador. El valor predictivo positivo se corrigió a través del índice de congruencia kappa y se estableció un ranking entre ítems para determinar cuáles son los que ofrecen un mayor poder predictivo al comparar entre maestros y padres. Resultados. Los resultados sugieren que no todos los criterios del DSM-IV tienen la misma capacidad predictiva. El poder predictivo de los ítems varía según el evaluador. Los padres y profesores coincidían más en los ítems de hiperactividad e impulsividad, y mostraban mayores diferencias con la muestra americana. Conclusiones. El enfoque de agregar cualquier combinación de ítems no será el más acertado al efectuar diagnósticos. Para mejorar el valor clínico de las escalas, se recomienda realizar combinaciones de ítems a las que se les pueda acabar concediendo un peso clínico mayor en la detección y diagnóstico de niños con TDAH

Introduction. The most common method used to diagnose attention deficit/hyperactivity disorder (ADHD) is based on the Diagnostic and statistic manual of mental disorders, 4th edition (DSM-IV) criteria. Nevertheless, it is more likely that the categorical system postulated by DSM-IV is not the most appropriate method as it does not consider the possible differences between the diagnostic capacity of the 18 proposed criteria. Aim. To analyze the predictive power of each DSM-IV diagnostic symptoms/criteria for ADHD using DuPaul’s ADHD Parent and Teacher Rating Scales. Patients and methods. In a prospective, poblational study to evaluate the prevalence of ADHD the positive predictive power of each item was analyzed for each subtype and informant. A kappa index was applied for positive predictive power to correct the number of accurate predictions based on chance factors, and a ranking of items was established to determinate which ones offered the highest predictive power, comparing parent and teacher ratings. Results. The results suggest that not all DSM-IV criteria are equal with regard to their ability to predict ADHD. The predictive power varies as a function of the informant. Parent and teachers agreed more on hyperactivity and impulsivity items, and showed more significant differences with regard to the American sample. Conclusions. The approach that aggregates any combination of items will not be the more effective strategy for ruling in a diagnosis of ADHD. To improve the clinical value of these scales making item combinations is recommended, the ones that will have attached a higher clinical weight for ruling in a diagnosis of ADHD

[Estimation of the prevalence of attention deficit hyperactivity disorder among the standard population on the island of Majorca]. / Estimación de la prevalencia del trastorno por déficit de atención e hiperactividad en población normal de la isla de Mallorca.

AIM: To determine the rate of prevalence of attention-deficit/ hyperactivity disorder (ADHD) in children of school age (6-11 years) in the Island of Mallorca. SUBJECTS AND METHODS: The epidemiological study was conducted using a community sample extracted by means of multi-stage stratified sampling according to areas (rural, city and touristy) and schooling (public, private and concerted) and consisted in 1,509 children of both sexes. The ADHD Rating Scales-IV (ADHD RS-IV) for home and school setting were used to collect data. The optimal approach to do a diagnostic evaluation, according with the literature, was using a cut-off point of 90 centil. RESULTS: The estimated prevalence of ADHD was 4.57% (CI at 99%: 3.0-5.8%) and we also obtained 1.26% for the hyperactive subtype, 1.06% for the disattentional subtype, and 2.25% for the combined subtype. Contrary to what was expected, prevalence was higher for females but no statistically significant. There were no statistically significant differences between levels, schools or areas. CONCLUSIONS: The estimates for prevalence found in this study are consistent with those reported in the literature (between 3-5%). Using the ADHD rating scale which has different cut-off point regarding age, sex and setting and the fact that it was a poblational based study could explain the higher prevalence in the females. We propose a normalization of the scales in our area in other to confirm our findings.

Estimación de la prevalencia del trastorno por déficit de atención e hiperactividad en población normal de la isla de Mallorca / Estimation of the prevalence of attention deficit/hyperactivity disorder among the standard population on the island of Majorca

Objetivo. Determinar la tasa de prevalencia del trastorno por déficit de atención con o sin hiperactividad (TDAH) en escolares de 6 a 11 años de la isla de Mallorca. Sujetos y métodos. Estudio poblacional en el que se aplicó diseño de la muestra polietápico estratificado (por cursos), proporcional (para el tipo de centro y por zonas sociodemográficas) por conglomerados (número de vías por curso en cada centro). A partir de una población diana de aproximadamente 30.000 sujetos se obtuvo una muestra de 1.509 niños. Se utilizaron las Attention-Deficit/Hiperactivity Disorder Rating Scales IV (ADHD RS-IV) para padres y maestros. Los casos se definieron a partir del percentil 90 en las escalas de inatención, hiperactividad/impulsividad y total de maestros y padres. Resultados. Indican una tasa global de prevalencia en el nivel esperado el 4,6% (intervalo de confianza al 99%: 3,0-5,8%), de los cuales el 1,26% fueron del subtipo hiperactivo, el 1,06% del subtipo inatento y el 2,25% del subtipo combinado. Contrariamente a lo esperado la incidencia fue ligeramente superior en niñas. No aparecen diferencias significativas ni por sexo, ni por cursos, ni por tipo de centro, ni por zona. Conclusiones. Las ADHD RS-IV han demostrado ser útiles en una población no anglosajona para estimar la prevalencia del TDAH en los valores esperados; sus puntos de corte diferenciados inciden en que desaparezcan las diferencias por sexo. Se propone normalizar la escala con muestras de nuestro entorno para poder confirmar los datos hallados

Aim. To determine the rate of prevalence of attention-deficit/hyperactivity disorder (ADHD) in children of school age (6-11 years) in the Island of Mallorca. Subjects and methods. The epidemiological study was conducted using a community sample extracted by means of multi-stage stratified sampling according to areas (rural, city and touristy) and schooling (public, private and concerted) and consisted in 1,509 children of both sexes. The ADHD Rating Scales-IV (ADHD RS-IV) for home and school setting were used to collect data. The optimal approach to do a diagnostic evaluation, according with the literature, was using a cut-off point of 90 centil. Results. The estimated prevalence of ADHD was 4.57% (confidence interval at 99%: 3.0-5.8%) and we also obtained 1.26% for the hyperactive subtype, 1.06% for the disattentional subtype, and 2.25% for the combined subtype. Contrary to what was expected, prevalence was higher for females but no statistically significant. There were no statistically significant differences between levels, schools or areas. Conclusions. The estimates for prevalence found in this study are consistent with those reported in the literature (between 3-5%). Using the ADHD RS-IV which has different cut-off point regarding age, sex and setting and the fact that it was a poblational based study could explain the higher prevalence in the females. We propose a normalization of the scales in our area in other to confirm our findings

[Methylphenidate in the treatment of attention-deficit/hyperactivity disorder: are we achieving an adequate clinical practice?]. / Metilfenidato en el tratamiento del trastorno por déficit de atención e hiperactividad: realizamos una práctica clínica adecuada?

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is the most frequent behavioural disorder in infancy and methylphenidate is the most widely used medication. AIM. To analyze if the use of methylphenidate allows a good clinical practice in ADHD in terms of efficacy, effectiveness, efficiency and safety. MATERIALS AND METHODS: Systematic review of the articles about therapeutic management of ADHD with methylphenidate published in secondary and primary publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. RESULTS: The main secondary information is found in the Cochrane Library, but we also detect relevant articles in Pubmed, mainly published in Journal of the American Academy of Child and Adolescent Psychiatry and Pediatrics. There are many randomized clinical trials with methylphenidate (immediate-release and extended-release methylphenidate) and some systematic review and/or meta-analysis, but these trials have some limitations (in relation to patients, interventions and outcomes) and publication bias. CONCLUSIONS: From the evidence-based analysis (and from the experience) we detect good scientific evidence that methylphenidate improve target outcomes in ADHD in the short and half-term in children (mainly 6-12 years). The treatment algorithm advises to start with methylphenidate (immediate or extended-release methylphenidate, in relation to cost-benefit parameters); when there is not response (between 10-30% of patients) or evidence of relevant secondary effects, we could consider the use of atomoxetine. There are many questions to solve based on better clinical trials: the efficacy and safety of methylphenidate in very young children and adolescents, long-term effects and the duration of the treatment.

Metilfenidato en el tratamiento del trastorno por déficit de atención e hiperactividad: ¿realizamos una práctica clínica adecuada? / Methylphenidate in the treatment of attention-deficit/hyperactivity disorder: are we doing a good clinical practice?

Introducción. El trastorno por déficit de atención e hiperactividad(TDAH) es el trastorno de conducta más frecuente enla infancia y el metilfenidato es el fármaco más utilizado en su tratamiento.Objetivo. Analizar si el uso del metilfenidato permiteuna práctica clínica adecuada en el TDAH, en relación con su eficacia,efectividad, eficiencia y seguridad. Materiales y métodos.Revisión sistemática de los artículos sobre el metilfenidato en elTDAH publicados en fuentes de información secundaria y primaria,y valoración crítica por medio de la metodología del Evidence-Based Medicine Working Group. Resultados. Detectamos laprincipal información secundaria en la Cochrane Library, perotambién encontramos relevantes artículos en Pubmed, principalmentepublicados en Journal of the American Academy of Child and Adolescent Psychiatry y en Pediatrics. Hay muchos ensayosclínicos con metilfenidato (de liberación rápida y liberación prolongada)y algunas revisiones sistemáticas o metanálisis, pero estosensayos clínicos tienen limitaciones (relacionadas con los pacientes,las intervenciones y los resultados) y sesgo de publicación.Conclusiones. La evidencia (y la experiencia) científica confirmaque existen robustas pruebas científicas de que el metilfenidatomejora los síntomas clave del TDAH a corto y medio plazo enescolares (6-12 años). El algoritmo terapéutico aconseja empezarcon metilfenidato (de liberación inmediata o prolongada en funciónde la relación de los posibles beneficios, perjuicios y costes);si éste no funciona (entre el 10-30% de los pacientes) o el niño notolera los efectos adversos, deberá plantearse el uso de atomoxetina.Quedan cuestiones por resolver con mejores ensayos clínicos:utilidad del metilfenidato en preescolares y en adolescentes, efectosa largo plazo y duración del tratamiento

Introduction. Attention-deficit/hyperactivity disorder (ADHD) is the most frequent behavioural disorder in infancyand methylphenidate is the most widely used medication. Aim. To analyze if the use of methylphenidate allows a good clinicalpractice in ADHD in terms of efficacy, effectiveness, efficiency and safety. Materials and methods. Systematic review of thearticles about therapeutic management of ADHD with methylphenidate published in secondary and primary publications andcritical appraisal by means of methodology of the Evidence-Based Medicine Working Group. Results. The main secondaryinformation is found in the Cochrane Library, but we also detect relevant articles in Pubmed, mainly published in Journal of theAmerican Academy of Child and Adolescent Psychiatry and Pediatrics. There are many randomized clinical trials with methylphenidate(immediate-release and extended-release methylphenidate) and some systematic review and/or meta-analysis, butthese trials have some limitations (in relation to patients, interventions and outcomes) and publication bias. Conclusions. Fromthe evidence-based analysis (and from the experience) we detect good scientific evidence that methylphenidate improve targetoutcomes in ADHD in the short and half-term in children (mainly 6-12 years). The treatment algorithm advises to start withmethylphenidate (immediate or extended-release methylphenidate, in relation to cost-benefit parameters); when there is notresponse (between 10-30% of patients) or evidence of relevant secondary effects, we could consider the use of atomoxetine. Thereare many questions to solve based on better clinical trials: the efficacy and safety of methylphenidate in very young children andadolescents, long-term effects and the duration of the treatment

[Prenatal cerebrovascular accidents: their incidence, pathogenesis and risk factors]. / Accidentes cerebrovasculares prenatales: incidencia, patogénesis y factores de riesgo.

INTRODUCTION: Prenatal stroke appears to have different risk factors, clinical characteristics, and outcomes than other perinatal or childhood stroke syndromes. DEVELOPMENT: Fetal stroke is defined as any cerebrovacular episode that occurs between 14 weeks of gestation and the onset of labor resulting in delivery, has been associated with postnatal epilepsy, mental retardation, and cerebral palsy. The entity is caused by antenatal ischemic, thrombotic, or hemorrhagic injury. A better understanding of those risk factors predisposing a fetus to cerebral infarction may provide a basis for future intervention for prevention and therapy. We will review the incidence, definition, pathogenesis, and risk factor of this entity that is more and more recognized. CONCLUSION: The analysis of this data will allow us to compare different method of evaluation and to draw conclusion of possible screening method and early detection.