Brain Fog in Hypothyroidism: Understanding the Patient's Perspective.

OBJECTIVE: Patient-centered studies have shown that several patients on thyroid hormone replacement therapy for hypothyroidism exhibit persistent symptoms, including "brain fog." Here, we aimed to determine which of these specific symptoms are associated with brain fog, identify patient-reported factors that modify these symptoms, and identify patient concerns related to brain fog not included in thyroid-specific questionnaires. METHODS: A survey on brain fog symptoms adapted from thyroid-specific patient-reported outcome was distributed online. Textual data analysis was performed to identify common areas of concern from open-ended survey responses. RESULTS: A total of 5170 participants reporting brain fog while being treated for hypothyroidism were included in the analysis. Of these, 2409 (46.6%) participants reported symptom onset prior to the diagnosis of hypothyroidism, and 4096 (79.2%) participants experienced brain fog symptoms frequently. Of the symptoms listed, participants associated fatigue and forgetfulness most frequently with brain fog. More rest was the most common factor provided for improving symptoms. The textual data analysis identified areas of concern that are not often included in thyroid-specific quality of life questionnaires, including a focus on the diagnosis of hypothyroidism, the types and doses of medications, and the patient-doctor relationship. CONCLUSION: Brain fog in patients treated for hypothyroidism was associated most frequently with fatigue and cognitive symptoms. Several additional areas of patient concern were found to be associated with brain fog, which are not typically addressed in thyroid-specific questionnaires.

Association between attention, nonverbal intelligence and school performance of school-age children with Autism Spectrum Disorder from a public health context in Brazil.

BACKGROUND: Autism Spectrum Disorder (ASD) is characterized by impairments in social interaction, restricted and repetitive behaviour, interests or activities. Difficulties in a broad spectrum of cognitive skills is often present, including attentional processes and nonverbal intelligence, which might be related to academic difficulties. AIMS: In this study, the association between attentional skills and nonverbal intelligence to school performance of children with ASD was assessed. METHODS AND PROCEDURES: 32 children/adolescents between 8-14 years old, who attended a treatment unit linked to the public health system of São Paulo-Brazil participated in the study. The following instruments were utilized: Cancellation Attention Test; Raven's Coloured Progressive Matrices; and School Performance Test. OUTCOMES AND RESULTS: After correlation analysis, statistically significant associations were found between attention and nonverbal intelligence with school performance. Regression analysis showed that attention drives school performance irrespective of nonverbal intelligence. CONCLUSIONS AND IMPLICATIONS: Results evidence the link between attention and school performance in ASD, suggesting that attentional mechanisms may be a promising route to follow in the design of interventions for school improvement of children and adolescents with ASD.

Attention training in children with autism spectrum disorder improves academic performance: A double-blind pilot application of the computerized progressive attentional training program.

Atypical attention has been reported in individuals with autism spectrum disorder (ASD) with studies pointing to an increase in attention deficit and hyperactivity disorder-like symptomatology. Individuals with ASD may also present academic difficulties and it is possible that they face a double-barrier for academic attainment from both core ASD symptomatology and from attention atypicalities, which are directly linked to academic performance. This raises the possibility that academic difficulties in ASD may benefit from cognitive training targeting attention. To test this possibility, we used the computerized progressive attentional training (CPAT) intervention in a double-blind, active control with follow-up intervention study in Brazil. The CPAT is a computerized attention training program that was recently piloted with schoolchildren with ASD in the UK. Twenty-six participants (8-14 years) with ASD in the São Paulo's ASD Reference Unit were assigned to either the CPAT (n = 14) or active control group (n = 12), which were matched at baseline. Two 45-min intervention sessions per week were conducted over a 2-month period. School performance, attention, fluid intelligence, and behavior were assessed before, immediately after and 3 months following the intervention. Significant group by time interactions show improvements in math, reading, writing and attention that were maintained at follow-up for the CPAT (but not the active control) group, while parents of children from both groups tended to report behavioral improvements. We conclude that attention training has the potential to reduce obstacles for academic attainment in ASD. Combined with the previous pilot study, the current results point to the generality of the approach, which leads to similar outcomes in different cultural and social contexts. LAY ABSTRACT: Attention difficulties tend to occur in ASD and are linked to academic performance. In this study, we demonstrate that school performance in math, reading and writing in children with ASD can improve following an intervention that trains basic attention skills (the CPAT intervention). The improvements we report are stable and were maintained 3-months following the intervention. This study, which was conducted in a public-health setting in Brazil, extends previous research in schools in the UK pointing to the cross-cultural and cross-settings efficacy of the intervention.

Word loss trajectory in autism spectrum disorder: analysis of home videos / Perda de palavras no transtorno do espectro autista: análise de vídeos caseiros / Pérdida del vocabulario en el trastorno del espectro autista: análisis de videos caseros

The regression of previously acquired skills has been highlighted as a potential early indicator of Autism Spectrum Disorder (ASD). The aims of the study were to validate parental reports regarding the occurrence of word loss and to investigate the characteristics of the words and other skills in a child aged 42 months with ASD over a 10-month period. It is a longitudinal and exploratory case study using systematic observation. Ten home videos showing the child's behavior between 13 and 23 months of age were analyzed according to the home video observation protocol and PROTEA-R. A total of 171 episodes involving the investigated behaviors were identified, which included the use of 51 words (the majority being nouns). Word loss and loss of other skills (play and social abilities) were observed. Word loss was the first or primary motive for parental concern, reinforcing that this phenomenon constitutes a potential early indicator of ASD.

A regressão de habilidades previamente adquiridas tem sido destacada como um potencial indicador precoce do Transtorno do Espectro Autista (TEA). Os objetivos do estudo de caso longitudinal e exploratório, utilizando observação sistemática foram validar os relatos dos pais sobre a perda de palavras, investigar suas características e outras habilidades em uma criança de 42 meses com TEA ao longo de um período de 10 meses. Foram analisados dez vídeos mostrando o comportamento da criança entre 13 e 23 meses de idade de acordo com um protocolo de observação de vídeos caseiros e do PROTEA-R. Analisamos 171 episódios envolvendo os comportamentos investigados, incluindo o uso de 51 palavras (a maioria substantivos). Observamos perda de palavras e perda de outras habilidades (de brincar e habilidades sociais). A perda de palavras foi o primeiro ou principal motivo de preocupação dos pais, reforçando que esse fenômeno constitui um indicador precoce potencial de TEA.

La regresión de habilidades previamente adquiridas es destacada como un potencial indicador precoz del Trastorno del Espectro del Autismo (TEA). Los objetivos del estudio de caso longitudinal y exploratorio, utilizando observación sistemática, fueron validar relatos de los padres sobre pérdida de vocabulario, investigar sus características y otras habilidades en un niño de 42 meses con TEA en un período de 10 meses. Se analizaron diez vídeos mostrando la conducta del niño entre 13 y 23 meses de edad de acuerdo con un protocolo de observación de vídeos caseros y el PROTEA-R. Analizamos 171 episodios que involucra los comportamientos investigados, incluyendo el uso de 51 palabras (la mayoría de ellos sustantivos). Observamos pérdida de vocabulario y pérdida de otras habilidades (jugar y habilidades sociales). La pérdida de vocabulario fue el primer o principal motivo de preocupación de los padres, reforzando que ese fenómeno constituye un indicador precoz potencial de TEA.

Effects of a behavioral intervention in a school setting on hyperactivity and inattention / Efeitos de intervenção comportamental em contexto escolar sobre desatenção e hiperatividade / Efectos de intervención conductual en ambiente escolar sobre desatención e hiperactividad

The clinical characteristics of Attention Deficit Hyperactivity Disorder (ADHD) can be a model to identify and manage behaviors of inattention, hyperactivity, and impulsivity of students without the disorder in the classroom. The objectives of the study were to verify the effects of implementing behavioral management guidelines to reduce these behaviors in a mainstream class. A total of 29 second-year students aged between 6 and 8 years were enrolled in the Experimental Group (EG), in which the guide was used, and a Control Group that kept their usual activities. Behavioral profiles were assessed by parents (CBCL/6-18) and teachers (TRF/6-18) before and after the intervention, in addition to an observation protocol filled by teachers. The results, according to teachers' responses, showed reduction in the frequency of inattention and hyperactivity behaviors in the EG. It can be concluded that the guide was effective in the classroom, with the potential for use in school practice.

As características clínicas do Transtorno do Déficit de Atenção/Hiperatividade (TDAH) podem ser modelos para identificar e manejar comportamentos de desatenção, hiperatividade e impulsividade de alunos sem o transtorno em sala de aula. Os objetivos do estudo foram verificar efeitos da implementação de um guia de manejo para redução desses comportamentos em uma classe regular. Foram acompanhados 29 alunos do 2º ano com idades entre 6 e 8 anos, separados em Grupo Experimental (GE), no qual foi implementado o guia, e Grupo Controle, que manteve atividades regulares. O perfil comportamental foi avaliado por pais (CBCL/6-18) e professores (TRF/6-18) antes e após a intervenção, juntamente a um protocolo de observação para o professor. Como resultados, verificaram-se, pelas respostas dos professores, a redução da frequência de comportamentos de desatenção e a hiperatividade no GE. Concluiu-se que a utilização do guia foi eficaz na classe regular, indicando seu potencial de uso na prática escolar.

Las características clínicas del Trastorno del Déficit de Atención/Hiperactividad (TDAH) pueden ser modelo para identificar y manejar conductas de desatención, hiperactividad e impulsividad de alumnos sin lo trastorno en clases escolares. Los objetivos del estudio fueron verificar los efectos de la implementación de una guía de manejo para reducir estas conductas en una clase. Fueron acompañados 29 alumnos de 2º año, entre 6 y 8 años separados en Grupo Experimental (GE), en el cual se implementó la guía, y un Grupo de Control que continuó con actividades regulares. El perfil conductual fue evaluado por padres (CBCL/6-18) y profesores (TRF/6-18) antes y después de la intervención con protocolo de observación para el profesor. Por las respuestas de los profesores, verificamos reducción de frecuencia de conductas de desatención e hiperactividad en el GE. Se concluye que la utilización de la guía fue eficaz en la clase, indicando su uso potencial en la práctica escolar.

Child Behavior Checklist (CBCL),Youth Self-Report (YSR) and Teacher's Report Form(TRF): an overview of the development of the original and Brazilian versions.

The Achenbach System of Empirically Based Assessment (ASEBA) for school-age children includes three instruments for assessing emotional and/or behavioral problems: Child Behavior Checklist (CBCL), completed by parents, Youth Self-Report (YSR), completed by adolescents and Teacher's Report Form (TRF), completed by teachers. This review article gives detailed information on the development of these forms in the United States and Brazil, describing the main changes to the items, scales and score cut-off points in original versions between 1991 and 2001, as well as the process involved in the translation, back-translation and cultural adaptation of the original questionnaires to develop the current official Brazilian versions of the CBCL, YSR and TRF. The utility of these tools for research and clinical practice is highlighted, mentioning epidemiological studies and evaluation of interventions conducted in Brazil. Researchers' and clinicians' doubts regarding the correct use of the current official Brazilian versions are answered, giving examples of frequently asked questions relevant to the Brazilian context.

Child Behavior Checklist (CBCL),Youth Self-Report (YSR) and Teacher's Report Form(TRF): an overview of the development of the original and Brazilian versions / Child Behavior Checklist (CBCL), Youth Self-Report (YSR) e Teacher's Report Form (TRF): uma visão geral sobre o desenvolvimento das versões originais e brasileiras / Child Behavior Checklist (CBCL), Youth Self- Report (YSR) y Teacher's Report Form (TRF): una visión general sobre el desarrollo de las versiones originales y brasileñas

The Achenbach System of Empirically Based Assessment (ASEBA) for school-age children includes three instruments for assessing emotional and/or behavioral problems: Child Behavior Checklist (CBCL), completed by parents, Youth Self-Report (YSR), completed by adolescents and Teacher's Report Form (TRF), completed by teachers. This review article gives detailed information on the development of these forms in the United States and Brazil, describing the main changes to the items, scales and score cut-off points in original versions between 1991 and 2001, as well as the process involved in the translation, back-translation and cultural adaptation of the original questionnaires to develop the current official Brazilian versions of the CBCL, YSR and TRF. The utility of these tools for research and clinical practice is highlighted, mentioning epidemiological studies and evaluation of interventions conducted in Brazil. Researchers' and clinicians' doubts regarding the correct use of the current official Brazilian versions are answered, giving examples of frequently asked questions relevant to the Brazilian context.

O Sistema de Avaliação de Base Empírica de Achenbach para crianças/adolescentes em idade escolar inclui três instrumentos para avaliar problemas emocionais e/ou comportamentais: Child Behavior Checklist (CBCL) [pais], Youth Self-Report (YSR) [adolescentes] e Teacher's Report Form (TRF) [professores]. Este artigo de revisão fornece informações detalhadas sobre o desenvolvimento desses instrumentos nos Estados Unidos e no Brasil, descrevendo as principais alterações em itens, escalas e pontos de corte na pontuação, ocorridas nas versões originais de 1991 a 2001, e o processo de tradução, retrotradução e adaptação cultural dos questionários originais para desenvolver as atuais versões brasileiras oficiais do CBCL, YSR e TRF. A utilidade desses instrumentos em pesquisa e na prática clínica é salientada, mencionando estudos epidemiológicos e de avaliação de intervenções conduzidos no Brasil. Pesquisadores e clínicos são instruídos a respeito do uso correto das atuais versões brasileiras oficiais, dando exemplos de perguntas frequentes, relevantes para o contexto brasileiro.

El sistema de evaluación de base empírica de Achenbach para niños/adolescentes en edad escolar incluye tres instrumentos para evaluar problemas emocionales y/o de comportamiento: Child Behavior Checklist (CBCL) [padres], Youth Self-Report (YSR) [adolescentes] y Teacher's Report Form (TRF) [profesores]. Este artículo de revisión proporciona información detallada sobre el desarrollo de estos instrumentos en los Estados Unidos y en Brasil, describiendo las principales alteraciones en ítems, escalas y puntos de corte en la puntuación, que se realizaron en las versiones originales de 1991 a 2001, y el proceso de traducción, retrotraducción y adaptación cultural de los cuestionarios originales, con el fin de desarrollar las actuales versiones brasileñas oficiales del CBCL, YSR y TRF. La utilidad de estos instrumentos en investigación y en la práctica clínica se resalta mencionando estudios epidemiológicos y de evaluación de intervenciones, llevados a cabo en Brasil. Investigadores y personal clínico son instruidos en lo que se refiere al uso correcto de las actuales versiones brasileñas oficiales, dando ejemplos de preguntas frecuentes y relevantes para el contexto brasileño.

Mothers of children with cerebral palsy with or without epilepsy: a quality of life perspective.

PURPOSE: Disability in a child affects not only the child's life but also the family's life. The aim of our study is to verify the quality of life (QOL) of mothers of disabled children with cerebral palsy (CP) with epilepsy compared with non-epilepsy children evaluated in a Brazilian center. METHODS: Thirty mothers of disabled children participated in the study. The control group comprised of 18 healthy mothers of children without disabilities. All mothers agreed to participate in the study. They completed the evaluation forms of the SF-36 health survey, a well-documented, self-administered QOL scoring system. RESULTS: The results of our study support the premise that mothers of children with CP, as a group, have poorer QOL than mothers of not disabled children. CONCLUSIONS: We also observed that mothers of children with CP and epilepsy have poorer QOL than mothers of children with CP without epilepsy.

Fenótipo comportamental de crianças e adolescentes com síndrome de Prader-Willi / Behavioral phenotype of children and adolescents with Prader-Willi syndrome

OBJETIVO: Identificar, em um grupo de crianças e adolescentes com síndrome de Prader-Willi, as principais características do fenótipo comportamental. MÉTODOS: A amostra foi composta por 11 crianças e adolescentes com diagnóstico clínico e citogenético-molecular da síndrome de Prader-Willi. A técnica de coleta de dados foi o Inventário dos Comportamentos de Crianças e Adolescentes entre 6 e 18 anos (CBCL/6-18). A análise de correlação bivariada, com nível de significância p<0,05, foi usada para testar a associação entre as variáveis analisadas. RESULTADOS: Os principais resultados mostraram um perfil comportamental considerado como clínico em várias das escalas do CBCL/6-18. Observou-se um padrão comportamental com alta frequência de respostas de agressão, quebra de regras e oposição. Identificaram-se correlações estatisticamente significativas entre problemas de atenção e sociais e problemas de pensamento e comportamento de quebrar as regras. CONCLUSÕES: Os pacientes investigados representam um grupo com risco psiquiátrico e alterações de comportamento que, em longo prazo, poderão evoluir para transtornos de 2009humor, do déficit de atenção e hiperatividade e transtorno desafiador e de oposição, dentre outros.

OBJECTIVE: To identify the main characteristics of the behavioral phenotype of children and adolescents with Prader-Willi syndrome. METHODS: Eleven children and adolescents with clinical and cytogenetic-molecular diagnosis of Prader-Willi syndrome were studied. Data collection was obtained by the Child Behavior Checklist for Ages 6-18 (CBCL/6-18). Bivariate correlations were used to test the association between the analyzed variables, being significant p<0.05. RESULTS: The behavioral profile obtained was considered as clinical in different scales of the CBCL/6-18 tool. A behavioral pattern with high frequency of aggression, rule breaking and opposition was observed. Statistically significant correlations between attention and social problems and between thought problems and breaking rules were identified. CONCLUSIONS: The studied patients represent a group of psychiatric risk, with behavioral changes that, in the long-term, can lead to mood disorders, attention deficit hyperactivity disorder and oppositional defiant behavior, among other disorders.

Adolescência, trabalho e estudo: análise comparativa das representações sociais de adolescentes trabalhadores e não trabalhadores / Adolescence, work and study: a comparative analysis of the social representations of adolescents engaged and not engaged in work

Ao trabalhar, os adolescentes comprometem, às vezes, a sua escolarização e desenvolvimento. Objetiva-se analisar a estrutura da representação social de estudantes sobre o trabalho e comparar as representações sociais de adolescentes trabalhadores e não trabalhadores sobre o trabalho e o trabalho associado ao estudo. O referencial teórico-metodológico foi a abordagem estrutural das Representações Sociais. O lócus da pesquisa, realizada em 2002, foi uma escola de ensino médio da região oeste de São Paulo, abrangendo 724 alunos. A coleta de dados baseou-se na técnica de evocações livres a dois termos indutores, trabalho e trabalhar e estudar. O tratamento dos dados utilizou o software Evoc 2000. São resultados: para trabalho predominam significados positivos, relacionados a benefícios financeiros e desenvolvimento psicossocial e moral; e diferentemente, o termo trabalhar e estudar exprimiu aspectos negativos vinculados à dupla jornada. Conclui-se que o senso comum dos adolescentes em relação ao assunto não difere dos conceitos científicos que explicitam as dificuldades da dupla jornada.