Perfiles de Personalidad en adolescentes con Trastornos por Ansiedad en Población General y Clínica / Personality Profiles in Adolescents with Anxiety Disorders in General and Clinical population

La personalidad es el trasfondo que determina la forma de pensar, sentir y comportarse e influye en la psicopatología. En este contexto, resulta relevante el estudio de la relación entre personalidad y ansiedad en la adolescencia. El principal objetivo de nuestro estudio es analizar las diferencias entre casos con Trastornos por Ansiedad (TA) y una muestra de población general (PG) en los diferentes perfiles / prototipos de personalidad (PRP) derivados del el Inventario clínico para adolescentes de Millon (MACI). Un segundo objetivo fue estudiar el modelo más parsimonioso de PRP capaz de predecir TA. Para responder a estos objetivos se utilizó un diseño observacional analítico y se realizó un muestreo aleatorio de adolescentes en PG (n = 461) y consecutivo de pacientes con TA, valorados según criterios DSM-5 (n = 77). Los instrumentos de medida utilizados fueron el MACI y Adolescent Symptom Inventory. Los PRP Introvertidos, Inhibidos, Pesimistas, Sumisos, Oposicionistas, Autopunitivos y Límites presentan una media significativamente mayor en TA y los PRP Histriónico y Egocéntrico en PG. El modelo más parsimonioso de PRP que mejor predice TA está conformado por tener mayor edad y los PRP más límite y menos rebelde. El estudio ofrece una imagen novedosa de los PRP en casos de TA que invitan a su estudio clínico, favoreciendo nuevos caminos de investigación que incluyan la personalidad en la heterogeneidad del trastorno. (AU)

Personality is the background that determines the way we think, feel and behave and influences psychopathology. In this context, the study of the relationship between personality and anxiety in adolescence is important. The main objective of our study is to analyse the differences between cases with Anxiety Disorders (AD) and a sample of general population (GP) in the different personality profiles / prototypes (PRP) derived from the Millon Adolescent Clinical Inventory (MACI). Secondary objective: to study the most parsimonious predictive model of PRP to predict AD. To respond to these objectives, an observational analytical design was used and a random sampling of adolescents in GP (n = 461) and consecutive sampling of patients with AD, assessed according to DSM-5 criteria (n = 77) was performed. The measurement instruments used were the MACI and the Adolescent Symptom Inventory. Introverted, Inhibited, Doleful, Submissive, Oppositional, Self-demeaning and Borderline PRPs present a significantly higher mean in AD and the Dramatizing and Egotistic PRPs in GP. The most parsimonious PRP model that best predicts AD is shaped by having older age and the most Borderline and least Unruly PRPs. The study offers a novel picture of PRPs in AD cases that invite their clinical study, favoring new paths of research that include personality in the heterogeneity of the disorder. (AU)

Insight into ADHD diagnosis with deep learning on Actimetry: Quantitative interpretation of occlusion maps in age and gender subgroups.

Attention Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood that often persists into adulthood. Objectively diagnosing ADHD can be challenging due to the reliance on subjective questionnaires in clinical assessment. Fortunately, recent advancements in artificial intelligence (AI) have shown promise in providing objective diagnoses through the analysis of medical images or activity recordings. These AI-based techniques have demonstrated accurate ADHD diagnosis; however, the growing complexity of deep learning models has introduced a lack of interpretability. These models often function as black boxes, unable to offer meaningful insights into the data patterns that characterize ADHD. OBJECTIVE: This paper proposes a methodology to interpret the output of an AI-based diagnosis system for combined ADHD in age and gender-stratified populations. METHODS: Our system is based on the analysis of 24 hour-long activity records using Convolutional Neural Networks (CNNs) to classify spectrograms of activity windows. These windows are interpreted using occlusion maps to highlight the time-frequency patterns explaining ADHD activity. RESULTS: Significant differences in the frequency patterns between ADHD and controls both in diurnal and nocturnal activity were found for all the populations. Temporal dispersion also presented differences in the male population. CONCLUSION: The proposed interpretation techniques for CNNs highlighted gender- and age-related differences between ADHD patients and controls. Leveraging these differences could potentially lead to improved diagnostic accuracy, especially if a larger and more balanced dataset is utilized. SIGNIFICANCE: Our findings pave the way for the development of an AI-based diagnosis system for ADHD that offers interpretability, thereby providing valuable insights into the underlying etiology of the disease.

Personalidad en adolescentes en muestra general y clínica / Personality in adolescents in a general and clinical sample

El objetivo principal del estudio fue analizar las diferencias entre muestra general y clínica en los prototipos de personalidad (PRP) del “Inventario clínico para adolescentes de Millón” (MACI). La metodología incluyó un diseño observacional y analítico, utilizando un muestreo de participantes (13-17 años) aleatorio polietápico, estratificado y proporcional por conglomerados en muestra general (n= 461) y un muestreo consecutivo en muestra clínica (n= 219). Encontramos que los PRP introvertido, inhibido, pesimista, rudo, oposicionista, autopunitivo y límite presentan una media significativamente mayor en muestra clínica y los PRP histriónico y conformista en muestra general. Se observa ausencia de diferencias significativas en los PRP egocéntrico, sumiso y rebelde. En la variable sexo observamos más diferencias significativas de PRP en muestra clínica que en la general y en la variable edad encontramos una tendencia lineal significativa descendente en los PRP sumiso o conformista y ascendente en los PRP rebelde y rudo en muestra general. El clínico debe estar alerta ante la interpretación de los PRP del MACI que no diferencian entre muestra general y clínica. (AU)

The main objective of the study was to analyze the differences between samples from general and clinical sample in personality prototypes (PRP), derived from the Millon Adolescent Clinical Inventory (MACI). The methodology included an analytical and observational design with a random, multi-stage, stratified and proportional cluster sampling in general sample (n= 461) and consecutive sampling of clinical sample (n= 219), in adolescents between 13 and 17 years of age. We found introvert, inhibited, doleful, forceful, oppositional, self-demeaning and borderline PRP in the clinical sample and dramatizing and conforming PRP in the general sample present a significantly higher mean. There is a relevant absence of significant differences in egotistic, submissive and unruly PRP. By sex, more significant differences in PRP are observed in the clinical sample. By age, a significant downward linear trend in the submissive and conforming PRP is observed, as well as an upward trend in the unruly and forceful PRP in the general sample. The clinician must be alert in the interpretation of the MACI PRP that do not differentiate between general and clinical samples. (AU)

Calidad de vida relacionada con la salud en casos de trastorno por déficit de atención con hiperactividad con/sin tratamiento farmacológico / Health-related quality of life in cases of attention deficit hyperactivity disorder with and without pharmacological treatment

Introducción: La calidad de vida relacionada con la salud (CVRS) es un marcador relevante para valorar los efectos de una intervención terapéutica. El objetivo del estudio es analizar la CVRS comparando casos con trastorno por déficit de atención con hiperactividad (TDAH) tratados farmacológicamente con metilfenidato (TDAH-T), casos no tratados (TDAH-N) y controles. Material y métodos: Muestra de 228 participantes entre 8 y 14 años (114 controles, 57 TDAH-T y 57 TDAH-N). Muestreo consecutivo de TDAH según DSM-IV (ADHD Rating Scales IV) y muestreo aleatorio de controles emparejados por sexo y edad. Evaluación de CVRS mediante KIDSCREEN-52 versión padres. Resultados: La intensidad de síntomas de TDAH es significativamente menor en TDAH-T que en TDAH-N y se observa correlación significativa moderada entre mayor intensidad de síntomas de TDAH y peor CVRS. Los casos de TDAH tienen significativamente peor CVRS que los controles en bienestar psíquico, estado de ánimo, relación con padres, relación con amigos, entorno escolar y aceptación social. Los casos de TDAH-T presentan significativamente mejor CVRS que TDAH-N en la dimensión escolar, pero no se diferencian significativamente en otras dimensiones del KIDSCREEN-52. Conclusiones: Sería recomendable que el tratamiento del TDAH integrase modelos terapéuticos multidimensionales que mejoren los síntomas básicos del trastorno y la CVRS

Introduction: The health-related quality of life (HRQoL) questionnaire is important in order to assess the effects of therapeutic intervention. The aim of this study is to analyse HRQoL, comparing cases of attention deficit hyperactivity disorder (ADHD) treated with methylphenidate (ADHD-T), untreated cases (ADHD-N), and controls. Material and methods: The study included a sample of 228 participants between 8 and 14 years old (114 controls, 57 ADHD-T, and 57 ADHD-N). Consecutive sampling was used in ADHD according to DSM-IV criteria (ADHD Rating Scales IV), and random sampling of controls matched by gender and age. The evaluation of HRQoL was made by using KIDSCREEN-52 parent version. Results: The intensity of ADHD symptoms is significantly lower in ADHD-T than in ADHD-N. There is a moderate significant correlation between greater intensity of ADHD symptoms and worse HRQoL. ADHD cases have significantly worse HRQoL than controls on psychic well-being, mood, relationship with parents and friends, school environment, and social acceptance. The cases of ADHD-T have significantly better HRQoL than ADHD-N in the school dimension, but do not differ significantly in other dimensions of KIDSCREEN-52. Conclusions: It would be advisable that the treatment of ADHD integrates multi-dimensional therapeutic models that improve the basic symptoms of the disorder, as well as the HRQoL

[Health-related quality of life in cases of attention deficit hyperactivity disorder with and without pharmacological treatment]. / Calidad de vida relacionada con la salud en casos de trastorno por déficit de atención con hiperactividad con/sin tratamiento farmacológico.

INTRODUCTION: The health-related quality of life (HRQoL) questionnaire is important in order to assess the effects of therapeutic intervention. The aim of this study is to analyse HRQoL, comparing cases of attention deficit hyperactivity disorder (ADHD) treated with methylphenidate (ADHD-T), untreated cases (ADHD-N), and controls. MATERIAL AND METHODS: The study included a sample of 228 participants between 8 and 14 years old (114 controls, 57 ADHD-T, and 57 ADHD-N). Consecutive sampling was used in ADHD according to DSM-IV criteria (ADHD Rating Scales IV), and random sampling of controls matched by gender and age. The evaluation of HRQoL was made by using KIDSCREEN-52 parent version. RESULTS: The intensity of ADHD symptoms is significantly lower in ADHD-T than in ADHD-N. There is a moderate significant correlation between greater intensity of ADHD symptoms and worse HRQoL. ADHD cases have significantly worse HRQoL than controls on psychic well-being, mood, relationship with parents and friends, school environment, and social acceptance. The cases of ADHD-T have significantly better HRQoL than ADHD-N in the school dimension, but do not differ significantly in other dimensions of KIDSCREEN-52. CONCLUSIONS: It would be advisable that the treatment of ADHD integrates multi-dimensional therapeutic models that improve the basic symptoms of the disorder, as well as the HRQoL.

Criterion validity and clinical usefulness of Attention Deficit Hyperactivity Disorder Rating Scale IV in attention deficit hyperactivity disorder (ADHD) as a function of method and age / Validez de criterio y utilidad clínica del Attention Deficit Hiperactivity Disorder Rating Scales IV en el Trastorno por Déficit de Atención con Hiperactividad en función del método y la edad

BACKGROUND: The aim of this research is to analyze Attention Deficit Hyperactivity Disorder Rating Scales IV (ADHD RS-IV) criteria validity and its clinical usefulness for the assessment of Attention Deficit Hyperactivity Disorder (ADHD) as a function of assessment method and age. METHODOLOGY: A sample was obtained from an epidemiological study (n = 1095, 6-16 years). Clinical cases of ADHD (ADHD-CL) were selected by dimensional ADHD RS-IV and later by clinical interview (DSM-IV). ADHD-CL cases were compared with four categorical results of ADHD RS-IV provided by parents (CATPA), teachers (CATPR), either parents or teachers (CATPAOPR) and both parents and teachers (CATPA&PR). Criterion validity and clinical usefulness of the answer modalities to ADHD RS-IV were studied. RESULTS: ADHD-CL rate was 6.9% in childhood, 6.2% in preadolescence and 6.9% in adolescence. Alternative methods to the clinical interview led to increased numbers of ADHD cases in all age groups analyzed, in the following sequence: CATPAOPR> CATPRO> CATPA> CATPA&PR> ADHD-CL. CATPA&PR was the procedure with the greatest validity, specificity and clinical usefulness in all three age groups, particularly in the childhood. CONCLUSIONS: Isolated use of ADHD RS-IV leads to an increase in ADHD cases compared to clinical interview, and varies depending on the procedure used

ANTECEDENTES: se estudia la validez de criterio y utilidad clínica del Attention Deficit Hiperactivity Disorder Rating Scales IV (ADHD RS-IV) en el Trastorno por Déficit de Atención con Hiperactividad (TDAH) en función del método y edad. MÉTODO: muestra extraída de un estudio epidemiológico (n = 1095, 6-16 años). Los casos de TDAH clínico (TDAH-CL) fueron seleccionados mediante ADHD RS-IV dimensional y entrevista clínica (DSM-IV) y fueron comparados con cuatro modalidades categoriales de respuesta al ADHD RS-IV implementado por padres (CATPA), profesores (CATPR), padres o profesores indistintamente (CATPAOPR) y/o conjuntamente (CATPAYPR). Se estudió la validez de criterio y utilidad clínica de las modalidades de respuesta. RESULTADOS: la tasa de TDAHCL es 6,9% en infancia, 6,2% en preadolescencia y 6,9% en adolescencia. Los procedimientos alternativos a la entrevista clínica aumentan los casos de TDAH en los tres grupos de edad, siguiendo la sucesión CATPAOPR > CATPRO > CATPA > CATPAYPR > TDAH-CL. El procedimiento con mayor índice de validez, especifidad, utilidad clínica y capacidad predictiva de TDAH fue CATPAYPR. CONCLUSIONES: la utilización de una versión categorial del ADHD RS-IV produce un incremento de casos de TDAH respecto a la entrevista clínica que varía en función del método utilizado

Longitudinal Study of Cognitive Variables in Women with Schizophrenia: 31-Year Follow-Up Study.

OBJECTIVE: To longitudinally analyze the course of cognitive dimensions in schizophrenic women over a period of 31 years. METHOD: Accidental sampling. Developmental longitudinal design. Diagnosis according to the ICD-10. Thirty institutionalized women were evaluated using the WAIS on three separate occasions (in 1981, 1997, and 2012). The data were analyzed using a repeated measures split-plot method. RESULTS: Patients scored one to two standard deviations below the average on the WAIS. At all three evaluation times, they scored consistently, significantly worse on Performance IQ scales than on Verbal IQ in the following sequence: Processing Speed (PS) < Perceptual Organization (PO) < Working Memory (WM) < Verbal Comprehension (VC). Longitudinally, there was a significant, linear average trend that was stable between the first and second assessments, with a significant drop in scores at the third evaluation on Performance IQ (η2 = .586) and Verbal IQ scales (η2 = .299). The same trend was observed in PS (η2 = .655) and WM (η2 = .438), while PO decreased across the three evaluations (η2 = .509) and no difference in VC was found (η2 = .126). CONCLUSION: Patients with schizophrenia presented with a low cognitive level. Longitudinally, they had a stable, differential profile of WAIS factors until late life, when performance dropped significantly.

Longitudinal study of cognitive variables in women with schizophrenia: 31-year follow-up study

Objective: To longitudinally analyze the course of cognitive dimensions in schizophrenic women over a period of 31 years. Method: Accidental sampling. Developmental longitudinal design. Diagnosis according to the ICD-10. Thirty institutionalized women were evaluated using the WAIS on three separate occasions (in 1981, 1997, and 2012). The data were analyzed using a repeated measures split-plot method. Results: Patients scored one to two standard deviations below the average on the WAIS. At all three evaluation times, they scored consistently, significantly worse on Performance IQ scales than on Verbal IQ in the following sequence: Processing Speed (PS) < Perceptual Organization (PO) < Working Memory (WM) < Verbal Comprehension (VC). Longitudinally, there was a significant, linear average trend that was stable between the first and second assessments, with a significant drop in scores at the third evaluation on Performance IQ (η2 = .586) and Verbal IQ scales (η2 = .299). The same trend was observed in PS (η2 = .655) and WM (η2 = .438), while PO decreased across the three evaluations (η2 = .509) and no difference in VC was found (η2 = .126). Conclusion: Patients with schizophrenia presented with a low cognitive level. Longitudinally, they had a stable, differential profile of WAIS factors until late life, when performance dropped significantly (AU)

No disponible

Validez de un modelo reducido de items del DSM-IV según respuesta de padres y profesores en el diagnóstico del Trastorno por Déficit de Atención con Hiperactividad Combinado / Validity of a reduced model of items of DSM-IV criteria according to the parents’ and teachers’ responses in the diagnostic of the Attention Deficit Hyperactivity Disorder (Combined Type

Objetivo: Buscar un modelo reducido de síntomas del Trastorno por Déficit de Atención con Hiperactividad Combinado (TDAH-C), que presente adecuada validez de criterio para el diagnóstico del trastorno. Metodología: Contexto de estudio epidemiológico. Muestra de 1095 casos entre 6 y 16 años [4.38 % TDAH-C]. Selección de casos con primera fase psicométrica de sospecha TDAH-C que requiere que ADHD RS-IV, implementado por padres (PA) y profesores (PR), supere el PC 90. Segunda fase: Los casos seleccionados se evalúan mediante entrevista clínica modelo DISC-IV (DSM-IV) para confirmar TDAH-C. Se implementa regresión logística para buscar modelo parsimonioso de ítems que permita predecir TDAH-C. Resultados: El modelo de ítems que permite predecir TDAH-C contiene 8 de 36 ítems del ADHD RS-IV contestados por PA y PR. Considerando odss ratio del modelo de regresión logística, los ítems del ADHD RS-IV presentan un ranking de 15PR > 1PA > 16PR > 12PA > 17PA > 10PA > 14PA > 4PR. El modelo presenta validez de criterio para TDAH-C clínico (sensibilidad: 97.9 %. Especifidad: 93.8%. Razón de verosimilitud: 16.02). Conclusiones: Es posible reducir la lista de síntomas de TDAH-C con buena validez de criterio, manteniendo los que proporcionan mayor discriminación entre TDAH-C y población general

Main Objective: To look for a reduced model of symptoms of the attention deficit hyperactivity disorder combined type (ADHD-C), that shows suitable levels of criterion validity for the diagnostic of the disease. Methods: Epidemiological study. Sample of 1095 children between 6 and 16 years. First stage: psicometric study using ADHD RS-IV answered by parents (P) and teachers (T). ADHD is suspected when both questionnaires are over 90th percentile. Second stage: Clinical interview DISC-IV (DSM-IV) only in those selected cases to confirm ADHD-C. Logistic regression is implemented to find the most parsimonious model to predict ADHD-C. Results: The model that predicts clinical ADHD-C consists of 8 of the 36 items of the ADHD RS-IV answered by P and T. If we consider the Odds Ratio obtained by regression, the items present a ranking of: 15 T> 1 P> 16 T> 12 P> 17 P> 10 P> 14 P> 4 T. The model has criterion validity for symptomatic ADHD-C (sensitivity: 97.9%. Specificity: 93.8%. Likelihood ratio: 16.02). Conclusions: It is possible to reduce the list of symptoms of ADHD-C with good criterion validity, removing redundant items and keeping those that provide greater discrimination between ADHD-C and the general population

Prevalencia del trastorno negativista desafiante en España / Prevalence of oppositional defiant disorder in Spain

Introducción: El trastorno negativista desafiante (TND) se caracteriza por un patrón de comportamiento negativista, desafiante, desobediente y hostil, dirigido a las figuras de autoridad. El TND es uno de los motivos más frecuentes de consulta clínica en salud mental durante la infancia y adolescencia. Presenta gran morbilidad y disfuncionalidad, mostrando repercusiones futuras si no es tratado de forma temprana. Objetivo: Determinar la tasa de prevalencia de TND en escolares de 6-16 años de Castilla y León (España). Material y métodos: Estudio epidemiológico poblacional, con diseño muestral polietápico estratificado, proporcional y por conglomerados. Muestra analizada: 1.049 sujetos. Casos definidos según criterios DSM-IV. Resultados: La prevalencia de TND es 5,6% (IC 95%: 4,2-7%). Prevalencia género masculino = 6,8%; femenino = 4,3%. Prevalencia educación secundaria = 6,2%; educación primaria = 5,3%. No existen diferencias significativas en función del sexo, edad, tipo de centro, ni por zona sociodemográfica. La prevalencia de TND sin considerar deterioro funcional aumentaría al 7,4%. Los casos de TND presentan significativamente peores resultados académicos (resultados académicos globales, lectura, matemáticas y expresión escrita) y peor conducta en clase (relación con compañeros, respeto a las normas, destrezas de organización, realización de tareas académicas e interrupción de la clase). Conclusiones: Castilla y León presenta una tasa de prevalencia de TND levemente superior a la observada en publicaciones internacionales. En función de su distribución por edad, morbilidad y repercusión clínica disfuncional, parece necesaria una planificación sanitaria que incida en un diagnóstico temprano e intervención preventiva (AU)

Introduction: Oppositional defiant disorder (ODD) is characterized by a pattern of negative, defiant, disobedient and hostile behavior toward authority figures. ODD is one of the most frequent reasons for clinical consultation on mental health during childhood and adolescence. ODD has a high morbidity and dysfunction, and has important implications for the future if not treated early. Objective: To determine the prevalence of ODD in schoolchildren aged 6-16 years in Castile and Leon (Spain). Material and methods: Population study with a stratified multistage sample, and a proportional cluster design. Sample analyzed: 1,049. Cases were defined according to DSM-IV criteria. Results: An overall prevalence rate of 5.6% was found (95% CI: 4.2%---7%). Male gender prevalence = 6.8%; female = 4.3%. Prevalence in secondary education = 6.2%; primary education = 5.3%. No significant differences by gender, age, grade, type of school, or demographic area were found. ODD prevalence without considering functional impairment, such as is performed in some research, would increase the prevalence to 7.4%. ODD cases have significantly worse academic outcomes (overall academic performance, reading, maths and writing), and worse classroom behavior (relationship with peers, respect for rules, organizational skills, academic tasks, and disruption of the class). Conclusions: Castile and Leon has a prevalence rate of ODD slightly higher to that observed in international publications. Depending on the distribution by age, morbidity and clinical dysfunctional impact, an early diagnosis and a preventive intervention are required for health planning (AU)

Prevalence of oppositional defiant disorder in Spain.

INTRODUCTION: Oppositional defiant disorder (ODD) is characterized by a pattern of negative, defiant, disobedient and hostile behavior toward authority figures. ODD is one of the most frequent reasons for clinical consultation on mental health during childhood and adolescence. ODD has a high morbidity and dysfunction, and has important implications for the future if not treated early. OBJECTIVE: To determine the prevalence of ODD in schoolchildren aged 6-16 years in Castile and Leon (Spain). MATERIAL AND METHODS: Population study with a stratified multistage sample, and a proportional cluster design. Sample analyzed: 1,049. Cases were defined according to DSM-IV criteria. RESULTS: An overall prevalence rate of 5.6% was found (95% CI: 4.2%-7%). Male gender prevalence=6.8%; female=4.3%. Prevalence in secondary education=6.2%; primary education=5.3%. No significant differences by gender, age, grade, type of school, or demographic area were found. ODD prevalence without considering functional impairment, such as is performed in some research, would increase the prevalence to 7.4%. ODD cases have significantly worse academic outcomes (overall academic performance, reading, maths and writing), and worse classroom behavior (relationship with peers, respect for rules, organizational skills, academic tasks, and disruption of the class). CONCLUSIONS: Castile and Leon has a prevalence rate of ODD slightly higher to that observed in international publications. Depending on the distribution by age, morbidity and clinical dysfunctional impact, an early diagnosis and a preventive intervention are required for health planning.

Automatic diagnosis of ADHD based on multichannel nonlinear analysis of actimetry registries.

Attention-Deficit Hyperactivity Disorder (ADHD) is the most common mental health problem in childhood and adolescence. It is commonly diagnosed by means of subjective methods which tend to overestimate the severity of the pathology. A number of objective methods also exist, but they are either expensive or time-consuming. Some recent proposals based on nonlinear processing of activity registries have deserved special attention. Since they rely on actigraphy measurements, they are both inexpensive and non-invasive. Among these methods, those shown to have higher reliability are based on single-channel complexity assessment of the activity patterns. This way, potentially useful information related to the interaction between the different channels is discarded. In this paper we propose a new methodology for ADHD diagnosis based on joint complexity assessment of multichannel activity registries. Results on real data show that the proposed method constitute a useful diagnostic aid tool reaching 87:10% sensitivity and 84.38% specificity. The combination of ADHD indicators extracted with the proposed method with single-channel complexity-based indices previously proposed lead to sensitivity and specifity values above 90%.

Utilidad de un modelo estadístico de estilos cognitivos en el trastorno por déficit de atención con hiperactividad / Utility of a statistical model of cognitive styles in attention deficit hyperactivity disorder

El objetivo de este estudio fue buscar el mejor modelo estadístico de estilos cognitivos, basado en las pruebas MFFT-20, CEFT y STROOP para predecir el trastorno por déficit de atención con hiperactividad (TDAH), analizando la validez del modelo para el diagnóstico del trastorno. Se estudió una muestra de 100 casos de TDAH (criterios DSM-IV) y 100 controles entre 7 y 11 años. Los controles fueron reclutados de forma aleatoria y emparejados según edad, sexo y zona sociodemográfica con los casos. Los casos presentaron en promedio mayor impulsividad (d: 1,28), menor flexibilidad cognitiva (d: ,91) y más dependencia de campo (d: 1,62) que los controles. El modelo de regresión logística que mejor predice TDAH está formado por las variables edad, CEFT, MFFT-20 y STROOP, y la fórmula derivada del modelo presenta una sensibilidad del 85% y especifidad del 85% para TDAH, tomando como prueba de referencia criterios DSM-IV. El modelo estadístico de estilos cognitivos presenta indicadores de adecuada validez diagnóstica en TDAH, contribuyendo a incrementar la objetividad en su análisis (AU)

The purpose of this study was to determine the best statistical model of cognitive styles, based on the MFFT-20, CEFT and Stroop tests to predict attention deficit hyperactivity disorder (ADHD), analyzing the validity of the model for the diagnosis of the disease. We studied 100 ADHD cases (DSM-IV criteria) and 100 controls, age ranging between 7 and 11 years. Controls were randomly recruited and matched in age, gender and sociodemographic area with ADHD cases. On average, ADHD cases showed more impulsiveness (d: 1.28), less cognitive flexibility (d: 0.91) and more field dependence (d: 1.62) than controls. The logistic regression model that predicts ADHD best is made up of age, CEFT, MFFT-20 and Stroop tests and the formula derived from the model shows 85% sensitivity and 85% specificity for ADHD, regarding the DSM-IV criteria as the standard. The statistical model of cognitive styles presents valid indicators to diagnose ADHD, contributing to an increase in the objectivity of its analysis (AU)

[Utility of a statistical model of cognitive styles in attention deficit hyperactivity disorder]. / Utilidad de un modelo estadístico de estilos cognitivos en el trastorno por déficit de atención con hiperactividad.

The purpose of this study was to determine the best statistical model of cognitive styles, based on the MFFT-20, CEFT and Stroop tests to predict attention deficit hyperactivity disorder (ADHD), analyzing the validity of the model for the diagnosis of the disease. We studied 100 ADHD cases (DSM-IV criteria) and 100 controls, age ranging between 7 and 11 years. Controls were randomly recruited and matched in age, gender and sociodemographic area with ADHD cases. On average, ADHD cases showed more impulsiveness (d: 1.28), less cognitive flexibility (d: 0.91) and more field dependence (d: 1.62) than controls. The logistic regression model that predicts ADHD best is made up of age, CEFT, MFFT-20 and Stroop tests and the formula derived from the model shows 85% sensitivity and 85% specificity for ADHD, regarding the DSM-IV criteria as the standard. The statistical model of cognitive styles presents valid indicators to diagnose ADHD, contributing to an increase in the objectivity of its analysis.

Validez de los criterios DSM-IV según respuesta de los padres en el diagnóstico del trastorno por déficit de atención con hiperactividad / Validity of the DSM-IV criteria according to the parents´ response in the diagnosis of the attention deficit hyperactivity disorder

Introducción. Objetivos: Estudiar la validez para el diagnóstico del trastorno por déficit de atención con hiperactividad (TDAH), de cada uno de los ítems DSM-IV y buscar un modelo reducido de ítems que ayude a detectar casos de niños con TDAH. Sujetos y método. Se utilizan los datos de un estudio epidemiológico sobre TDAH con una muestra de 1095 casos. El 6.6% son TDAH. Casos de TDAH definidos según ADHD RS-IV y criterios clínicos DSM-IV. Controles definidos por exclusión. Resultados. El modelo de regresión logística que mejor predice el fenotipo inatento está compuesto por los ítems del ADHD RS-IV (versión padres) 1, 3, 9, 15 y 17 (Se: 96.7%, Es: 81.5%); el fenotipo hiperactivo/impulsivo por los ítems 2, 4, 10, 12, 14 y 16 (Se: 96.6%, Es: 81%) y el fenotipo combinado por los ítems 9, 10, 12, 14 y 15 (Se: 100 %, Es: 82.6%). Existe una reducción del 66% de los ítems en el fenotipo combinado. Conclusiones. Es posible reducir la lista de síntomas de TDAH con unos niveles de validez adecuados y determinados ítems parecen tener mayor capacidad para determinar decisiones diagnósticas (AU)

Introduction. Objective: To study the validity of each of the items DSM-IV for the diagnosis of the Attention Deficit Hyperactivity Disorder (ADHD), and to look for a reduced model of items that allows predicting ADHD. Subjects and methods: We use the information of an epidemiological study on ADHD with a sample of 1095 children. 6.6 % are ADHD cases. ADHD cases are defined according to ADHD RS-IV and clinical criteria DSM-IV. Controls are defined by exclusion. Results: The model of logistic regression that better predicts the inattentive phenotype is composed by the items of the ADHD RS-IV (parents’ version) 1, 3, 9, 15 and 17 (Sensitivity: 96.7%, Specificity: 81.5%); the hyperactive / impulsive phenotype by the items 2, 4, 10, 12, 14 and 16 (Sensitivity: 96.6%, Specificity: 81%) and the combined phenotype by the items 9, 10, 12, 14 and 15 (Sensitivity: 100%, Specificity: 82.6%). A reduction of 66 % of the items in the combined phenotype is detected. Conclusions: It is possible to reduce the list of ADHD symptoms with suitable levels of validity and all the items should not have the same weight at the moment of making diagnostic decisions (AU)

Validez de los Criterios DSM-IV según Respuesta de los Profesores en el Diagnóstico del Trastorno por Déficit de Atención con Hiperactividad / No disponible

Objetivos: Estudiar la validez para el diagnóstico del trastorno por déficit de atención con hiperactividad (TDAH), de cada uno de los ítems DSM-IV y buscar un modelo reducido de ítems que permita predecir TDAH. Método: Se utilizan los datos de un estudio epidemiológico sobre TDAH con una muestra de 1095 casos. El 6.6% son TDAH. Casos de TDAH definidos según ADHD RS-IV y criterios clínicos DSM-IV. Controles definidos por exclusión. Resultados: El modelo de regresión logística que mejor predice el fenotipo inatento está compuesto por los ítems del ADHD RS-IV (versión profesores) 5, 7, 13, 15 y 17 (Sensibilidad: 88.7%, Especifidad: 84.2%); el fenotipo hiperactivo/impulsivo por los ítems 2, 4, 8 y 16 (Sensibilidad: 86.4%, Especifidad: 83.7%) y el fenotipo combinado por los ítems 2, 6, 15, 16 y 17 (Sensibilidad: 91.6 %, Especifidad: 84.4%). Existe una reducción del 72.2% de los ítems en el fenotipo combinado. Conclusiones: Es posible reducir la lista de síntomas de TDAH con unos niveles de validez adecuados y los ítems no deberían tener el mismo peso a la hora de tomar decisiones diagnósticas (AU)

Objective: To study the validity of each of the DSM-IV items for the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), and to look for a reduced model of items that would allow prediction of ADHD. Method: We use the information from an epidemiological study of ADHD with a sample of 1095 children. Of these, 6.6 % are ADHD cases. ADHD cases are defined according to ADHD RS-IV and DSM-IV clinical criteria. Controls are defined by exclusion. Results: The model of logistic regression that best predicts the inattentive phenotype is composed of the ADHD RS-IV (teachers? version) items 5, 7, 13, 15 and 17 (Sensitivity: 88.7%, Specificity: 84.2%); the hyperactive / impulsive phenotype by the items 2, 4, 8 and 16 (Sensitivity: 86.4%, Specificity: 83.7%) and the combined phenotype by the items 2, 6, 15, 16 and 17 (Sensitivity: 91.6%, Specificity: 84.4%). A reduction of 72.2 % of the items in the combined phenotype is detected. Conclusions: It is possible to reduce the list of ADHD symptoms with satisfactory levels of validity and not all the items should have the same weight when making diagnostic decisions (AU)

[Usefulness of the Stroop test in attention deficit hyperactivity disorder]. / Utilidad del test de Stroop en el trastorno por déficit de atencion/hiperactividad.

AIMS: The aim of this study is to analyse the differences in the Stroop effect between cases with attention deficit hyper-activity disorder (ADHD) and controls. It also seeks to find the best model based on the third task of the colours and words test (Stroop-CW) for predicting ADHD and to analyse the validity of the Stroop-CW test for diagnosing the disorder. SUBJECTS AND METHODS: The sample studied consisted of 100 cases of ADHD -according to Diagnostic and statistical manual of mental disorders (DSM-IV) criteria- and 100 controls, between 7 and 11 years of age, who were evaluated using the Stroop test. The controls were recruited at random and paired by age, sex and sociodemographic area with the cases. RESULTS: The cases present a mean cognitive style that is significantly less flexible (d = -1.06) and they also display a lower capacity to inhibit or control automatic responses than the controls at all ages (7 years: d = 1.67; 8 years: d = 1.02; 9 years: d = 1.32; 10 years: d = 2.04; 11 years: d = 0.89). The model of logistic regression analysis that best predicts ADHD is made up of age and Stroop-CW. The formulation derived from the model offers a sensitivity of 81% and a specificity of 72%, taking the criteria of the DSM-IV for ADHD as the reference test. CONCLUSIONS: The Stroop-CW test presents usefulness and complementary criteria validity for the diagnosis of ADHD.

Utilidad del Children's Embedded Figures Test en el Trastorno por Déficit de Atención con Hiperactividad / Utility of Children’s Embedded Figures Tests in Attention Deficit Hyperactivity Disorder

El estudio analiza diferencias entre casos de Trastorno por Déficit de Atención con Hiperactividad (TDAH) y controles en su modo global / analítico de procesar la información, buscando el mejor modelo basado en el Children’s Embedded Figures Test (CEFT) que permita predecir TDAH y analizando la validez de la prueba para el diagnóstico del trastorno. Se estudia una muestra de 100 casos de TDAH (criterios DSM-IV) y 100 controles, entre 7 y 11 años, evaluados mediante el CEFT. Los controles fueron reclutados de forma aleatoria y emparejados según edad, sexo y zona sociodemográfica con los casos. Los casos presentan un estilo cognitivo medio significativamente mas dependiente de campo (d = 1.36), reflejando un modo de procesamiento mas global que los controles en todas las edades. El modelo de regresión logística que mejor predice TDAH está formado por edad, sexo y CEFT. La formulación derivada del modelo presenta sensibilidad del 80% y especifidad del 84%, tomando como prueba de referencia criterios DSM-IV para TDAH. Concluimos valorando que el CEFTpresenta utilidad y adecuada validez de criterio para TDAH (AU)

Objectives: To assess the differences among patients with Attention Deficit Hyperactivity Disorder (ADHD) and control subjects, in relation to their global/analytical way of processing information and to find the best model based in Children´s Embedded Figures Test (CEFT) which permits prediction and diagnosis of ADHD, and analyzing the validity of the test for the diagnostic of the disease. Method: We study 100 ADHD cases (DSM-IV criteria) and 100 controls, ranging between 7 and 11 years of age, analyzed with CEFT. Controls were randomly recruited and matched by age, gender and sociodemography area with cases. Results: Cases show an average cognitive style significantly more field dependent (d = 1.36), reflecting a more global way of processing information than controls at all ages. The logistic regression model that best predicts ADHD is constituted by age, gender and CEFT direct marks and the derived formula from the model shows an 80% of sensitivity and a 84% specificity for ADHD, taking as gold standard the DSM-IV criteria. Conclusion: CEFT test shows utility and of appropriate validity for diagnosing ADHD (AU)

[The freedom from distraction factor in the attention deficit hyperactivity disorder: a short model]. / Factor de independencia a la distracción en el trastorno por déficit de atención con hiperactividad: un modelo abreviado.

Attention deficit hyperactivity disorder (ADHD) usually presents a profile in which the freedom from distraction factor of the WISC-R (FDF) is affected to a greater extent than the verbal comprehension factor (VCF) and the perceptual organisation factor (POF). The formulation FDF< (VCF + POF)/2 has good sensitivity for ADHD. The aim of this study was to reduce the number of tests needed for the formulation FDF< (VCF + POF)/2, maintaining the sensitivity for ADHD and concordance with the complete formulation. A clinical sample of 167 children with ADHD is analysed (6-16 years). The cases of ADHD were defined according to DSM-IV criteria and they were assessed with WISC-R, Child Symptom Inventory and Social and Occupational Activity Assessment Scale. Lineal regression method was used to reduce the number of tests. The results showed that the short formulation reduces the number of tests by half and it has 83% sensitivity for ADHD. This formulation presents a good concordance with the complete version. The FDF is significantly lower than the VCF, POF and intellectual quotient in cases of ADHD. Comorbidity, social or school activity do not have a significant influence on the probability that FDF< (VCF + POF)/2.

Factor de independencia a la distracción en el trastorno por déficit de atención con hiperactividad: un modelo abreviado / The freedom from distraction factor in the attention deficit hyperactivity disorder: A short model

El factor independencia a la distracción (FID) del WISC-R presenta frecuentemente resultados inferiores al factor organización perceptiva (FOP) y comprensión verbal (FCV) en casos de Trastorno por Déficit de Atención con Hiperactividad (TDAH). La formulación FID< (FCV + FOP)/2 tiene buena sensibilidad para TDAH. El objetivo principal de este estudio ha sido reducir el número de pruebas necesarias para implementar la formulación FID < (FOP + FCV)/2, conservando sensibilidad para el trastorno y manteniendo buena concordancia con la fórmula completa. Se utilizó un diseño de investigación seccional, descriptivo y retrospectivo con 167 casos de TDAH, entre 6 y 16 años. Los casos fueron definidos según criterios DSM-IV y la evaluación se realizó mediante Child Symptom Inventory, Escala de Evaluación de Actividad Social y Laboral y WISC-R. Los resultados mostraron que la formulación abreviada reduce a la mitad el número de pruebas y tiene sensibilidad para TDAH del 83%, presentando concordancia casi perfecta con la versión íntegra. Mediante esta formulación el FID es significativamente inferior a la media del FCV, FOP y CIT en TDAH y las dimensiones de comorbilidad clínica, social y académica no influyen significativamente en la probabilidad FID< (FCV + FOP)/2

Attention deficit hyperactivity disorder (ADHD) usually presents a profile in which the freedom from distraction factor of the WISC-R (FDF) is affected to a greater extent than the verbal comprehension factor (VCF) and the perceptual organisation factor (POF). The formulation FDF< (VCF + POF)/2 has good sensitivity for ADHD. The aim of this study was to reduce the number of tests needed for the formulation FDF< (VCF + POF)/2, maintaining the sensitivity for ADHD and concordance with the complete formulation. A clinical sample of 167 children with ADHD is analysed (6-16 years). The cases of ADHD were defined according to DSM-IV criteria and they were assessed with WISC-R, Child Symptom Inventory and Social and Occupational Activity Assessment Scale. Lineal regression method was used to reduce the number of tests. The results showed that the short formulation reduces the number of tests by half and it has 83% sensitivity for ADHD. This formulation presents a good concordance with the complete version. The FDF is significantly lower than the VCF, POF and intellectual quotient in cases of ADHD. Comorbidity, social or school activity do not have a significant influence on the probability that FDF< (VCF + POF)/2