Trastornos de la infancia y características sociodemográficas asociadas a la depresión en adultos en una ciudad de Colombia / Childhood disorders and sociodemographic characteristics associated with depression in adults from a Colombian city / Transtornos da infância e características sócio-demográficas associadas à depressão em adultos de uma cidade colombiana

Introducción: Los trastornos emocionales y del comportamiento que se inician en la infancia llevan a cambios que se extienden hasta la edad adulta, con consecuencias sociales. Objetivo: Determinar la asociación de la depresión en la adultez con trastornos mentales de inicio en la infancia y otras condiciones, en Envigado, 2017. Materiales y métodos: Estudio con enfoque cuantitativo, tipo observacional, transversal con intención analítica. El tamaño de la muestra fue de 737 individuos, entre 18 y 65 años. Se aplicó el instrumento CIDI - CAPI de la OMS. El procesamiento y análisis se llevó a cabo en SPSS v. 21 de la Universidad CES y Epidat 4.2. Resultados: La proporción de depresión en la adultez es de 10,8%, en la población de estudio que tuvo antecedente de trastorno por déficit de atención e hiperactividad (TDAH) fue aproximadamente 5,6 veces más que en aquellos que no tenían este antecedente (OR= 6,62; IC95% 1,92-22,7). Conclusiones: El TDAH en la infancia incrementa la probabilidad de presentar depresión en la adultez en la población de Envigado, lo cual soporta la importancia de promover acciones de salud mental en la niñez, para prevenir la depresión en la edad adulta.

Introduction: Emotional and behavioral disorders that begin in childhood lead to adult changes, which have social consequences. Objective: To determine the association of adult depression with childhood onset of mental disorders and other factors in Envigado (Colombia). Materials and methods: A quantitative observational and cross-sectional study was carried out. The sample size was 737 individuals aged between 18 to 65 years. The CIDI-CAPI instrument of the WHO was used. Data processing and analysis was conducted through SPSS v. 21 software from the CES University and Epidat 4.2. Results: The percentage of depression in adults was 10.8%. This figure was 5.6 times greater in the study population that had history of attention deficit hyperactivity disorder (ADHD) compared to individuals who did not have this disorder (OR= 6.62; 95% CI 1.92-22.7). Conclusions: Childhood ADHD increases the probability of depression in the adult population of Envigado, which supports the importance of promoting mental health programs in children in order to prevent adulthood depression.

Introdução: Os transtornos emocionais e comportamentais que se iniciam na infância levam a alterações que se estendem até a idade adulta, com consequências sociais. Objetivo: Determinar a associação da depressão na idade adulta com transtornos mentais de início na infância e outras condições, em Envigado, 2017. Materiais e métodos: um estudo foi realizado com abordagem quantitativa, observacional, transversal e com intenção analítica. O tamanho da amostra foi de 737 indivíduos, entre 18 e 65 anos de idade. Foi aplicado o instrumento CIDI - CAPI da OMS. O processamento e análise foram realizados no SPSS v. 21 da Universidad CES e Epidat 4.2. Resultados: A proporção de depressão na idade adulta é de 10,8%, na população estudada que tinha histórico de transtorno de déficit de atenção e hiperatividade (TDAH) foi aproximadamente 5,6 vezes maior do que naquelas sem esse histórico (OR= 6,62; 95 % CI 1,92-22,7). Conclusões: O TDAH na infância aumenta a probabilidade de apresentar depressão na idade adulta na população de Envigado, o que reforça a importância de promover ações de saúde mental na infância, para prevenir a depressão na idade adulta.

Dental Care Differences Among the Behavioral Health Population in an Accountable Care Organization: A Retrospective Cohort.

OBJECTIVE: To compare dental utilization and expenditures between children with and without behavioral health (BH) diagnoses in an accountable care organization. METHODS: This retrospective cohort study used enrollment and claims data of Medicaid-enrolled children in Ohio. Children with 7 years of continuous enrollment from 2013 to 2019 were included. We calculated 5 dental utilization outcomes: 1) Diagnostic only visits, 2) Preventive visits, 3) Treatment visits, 4) Treatment visits under general anesthesia (GA), and 5) Orthodontic visits. Total 7-year cumulative expenditures were calculated for each outcome. Multivariable logistic regression models were run for each outcome adjusting for demographics and medical comorbidities. RESULTS: Among 77,962 children, 23% had ≥1 BH diagnosis. No utilization differences were noted between children with and without BH for diagnostic only visits, treatment visits, and orthodontic visits. BH status modified the likelihood of having a preventive visit and dental GA visits based on medical comorbidity. For example, children with BH diagnoses had significantly lower odds of a preventive visit (eg, non-complex chronic comorbidity: odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.85-0.89), and significantly higher odds of a dental treatment under general anesthesia visit (eg, non-chronic comorbidity: OR = 3.69, 95% CI: 3.26-4.18). The total cumulative dental expenditures were $10.5M greater for children with BH. CONCLUSIONS: Children with BH diagnoses were significantly less likely to have preventive visits and more likely to have dental GA visits, which was expensive. Early identification and intervention could alter treatment approaches, improve care, reduce risk of harm, and achieve cost-savings within a pediatric accountable care organization.

The Effects of Young Children's Callous-Unemotional Traits on Behaviorally Observed Outcomes in Standard and Technology-Enhanced Behavioral Parent Training.

Behavioral Parent Training (BPT) remains the current standard of care for early onset behavior disorders (BD); however, problem behaviors characterized by relatively high callous unemotional (CU) traits are linked to poorer treatment outcomes, highlighting the need for novel interventions. This study examined the relation of baseline child CU traits to changes in observed parent and child (3 to 8 years old) behavior in 101 families with low-income randomized to either a standard (Helping the Noncompliant Child, HNC) or technology-enhanced BPT program (TE-HNC). Assessments occurred at baseline, post-intervention, and at a three-month follow-up. Treatment group moderated the relation between CU traits and observed parenting behaviors and child compliance. Specifically, higher levels of child CU traits at baseline predicted lower levels of positive parenting at post-intervention and follow-up, and lower levels of child compliance at follow-up but only in the standard program (HNC). This is the first intervention study to behaviorally assess the differential impact of CU traits in standard, relative to technology-enhanced, BPT and suggests the promise of a technology-enhanced treatment model.

Internal consistency of the Strengths and Difficulties Questionnaire in Amazonian children / Consistência interna do Questionário de Capacidades e Dificuldades em crianças amazônicas

ABSTRACT OBJECTIVE: To describe the frequency of behavioral problems and the internal consistency of the parent version of the Strengths and Difficulties Questionnaire (SDQ-P) in Amazonian preschool children during the covid-19 pandemic. METHODS: Data from the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) study, a population-based birth cohort in the Western Brazilian Amazon, were used. The SDQ-P was applied in 2021 at the five-year follow-up visit to parents or caregivers of 695 children (49.4% of which were girls). This instrument is a short behavioral screening questionnaire composed of 25 items reorganized into five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Cases of behavioral problems were defined according to the original SDQ cut-offs based on United Kingdom norms. Moreover, cut off points were estimated based on the SDQ-P percentile results of our study sample. Internal consistency was assessed by calculating Cronbach's alpha coefficient and McDonald's omega for each scale. RESULTS: According to the cut-offs based on our studied population distribution, 10% of all children had high or very high total difficulty scores, whereas it was almost twice when the original SDQ cut-offs based on United Kingdom norms, were applied (18%). Differences were also observed in the other scales. Compared to girls, boys showed higher means of externalizing problem and lower means of prosocial behavior. The five-factor model showed a moderate internal consistency of the items for all scales (0.60 ≤ α ≤ 0.40), except for total difficulty scores, which it considered substantial (α > 0.61). CONCLUSIONS: Our results support the usefulness of SDQ in our study population and reinforce the need for strategies and policy development for mental health care in early life in the Amazon.

RESUMO OBJETIVO: Descrever a frequência de problemas de comportamento e a consistência interna da versão para os pais do Questionário de Capacidades e Dificuldades (SDQ-P) em crianças pré-escolares da Amazônia durante a pandemia de covid-19. MÉTODOS: Foram utilizados dados do estudo de saúde e nutrição Materno-Infantil no Acre (MINA-Brasil), uma coorte de nascimentos de base populacional na Amazônia Ocidental Brasileira. O SDQ-P foi aplicado aos pais e cuidadores em 2021 na visita de acompanhamento de cinco anos de 695 crianças (49,4% das quais eram meninas). Esse instrumento é um breve questionário de rastreamento comportamental composto por 25 itens reorganizados em cinco subescalas: sintomas emocionais, problemas de conduta, hiperatividade/desatenção, problemas de relacionamento com colegas e comportamento pró-social. Os casos de problemas de comportamento foram definidos de acordo com os pontos de corte originais do SDQ, baseados nas normas do Reino Unido. Além disso, os pontos de corte foram estimados com base nos percentis dos resultados do SDQ-P da amostra do nosso estudo. A consistência interna foi avaliada pelo cálculo do coeficiente alfa de Cronbach e ômega de McDonald para cada escala. RESULTADOS: De acordo com os pontos de corte baseados na distribuição da população estudada, 10% de todas as crianças apresentaram escores totais de dificuldade elevados ou muito elevados, o que quase dobrou quando os pontos de corte originais do SDQ, baseados nas normas do Reino Unido, foram utilizados (18%). Este estudo também encontrou diferenças nas demais escalas. Comparados às meninas, os meninos apresentaram maiores médias de problemas de externalização e menores médias de comportamento pró-social. O modelo de cinco fatores apresentou consistência interna dos itens moderada para todas as escalas (0,60 ≤ α ≤ 0,40), exceto para a escala de pontuação total de dificuldades, a qual foi considerada substancial (α > 0,61). CONCLUSÕES: Nossos resultados apoiam a utilidade do SDQ em nossa população de estudo e reforçam a necessidade de estratégias e desenvolvimento de políticas para o cuidado em saúde mental no início da vida na Amazônia.

Práticas cotidianas constituindo múltiplas versões da criança com comportamentos externalizantes: um estudo de caso / Prácticas cotidianas constituyendo múltiples versiones del niño con comportamientos externalizantes: un estudio de caso / Everyday practices constituting multiple versions of children with externalizing behaviors: a case study

Resumo Visando compreender as múltiplas versões de realidade produzidas nas práticas cotidianas da rede relacional de uma criança à qual se referem problemas de comportamentos externalizantes, no campo da saúde mental, este artigo relata um estudo de caso, realizado em 2017, a partir das abordagens da Teoria Ator-Rede e das Práticas Discursivas e Produção de Sentidos no Cotidiano. O referente empírico da pesquisa é um menino com hipótese diagnóstica de TDAH e TOD, articulado com actantes humanos e não humanos em dimensões diversas de suas relações. Os resultados expõem as interatuações cotidianas, atravessadas por conflitos intergeracionais, produzindo realidades e sentidos heterogêneos, no trânsito entre ideias aparentemente antagônicas (angelical-diabólico/criança-adulto). A criança, com seus comportamentos diversos, tal qual os adultos, atua e é atuada em relações de poder, numa coprodução fluida de conflitos e entendimentos que expressam versões sempre incertas e localizadas do que seria "a criança com comportamentos externalizantes".

Resumen Con el objetivo de comprender las múltiples versiones de la realidad que se producen en las prácticas cotidianas de la red relacional de un niño a la que se refieren los problemas de comportamiento externalizante, en el campo de la salud mental, este artículo relata un estudio de caso, realizado en 2017, a partir de los enfoques de la Teoría Actor-Red y Prácticas Discursivas y Producción de Sentidos en la Vida Cotidiana. El referente empírico de la investigación es un niño con hipótesis diagnóstica de TDAH y TND, articulado con actantes humanos y no humanos en diferentes dimensiones de sus relaciones. Los resultados exponen las interacciones cotidianas, atravesadas por conflictos intergeneracionales, produciendo realidades y significados heterogéneos, en el tránsito entre ideas aparentemente antagónicas (angelical-diabólica/niño-adulto). Los niños, con sus diferentes conductas, al igual que los adultos, actúan y son actuados en relaciones de poder, en una fluida coproducción de conflictos y entendimientos que expresan versiones siempre inciertas y localizadas de lo que sería "el niño con conductas externalizantes".

Abstract Aiming to understand the multiple versions of reality produced in the daily practices of a child's relational network to which externalizing behavior problems refer, in the field of mental health, this article reports a case study, carried out in 2017, based on the approaches of the Actor-Network and Discursive Practices and Production of Meanings in Everyday Life. The empirical referent of the research is a boy with a diagnostic hypothesis of ADHD and ODD, articulated with human and non-human actants in different dimensions of their relationships. The results expose everyday interactions, crossed by intergenerational conflicts, producing heterogeneous realities and meanings, in the transit between apparently antagonistic ideas (angelic-diabolical/child-adult). Children, with ir different behaviors, just like adults, acts and are acted upon in power relations, in a fluid co-production of conflicts and understandings that express always uncertain and localized versions of what would be "the child with externalizing behaviors".

Attitudes and practices in the management of attention deficit hyperactivity disorder among Brazilian pediatric neurologists who responded to a national survey: a cross-sectional study

ABSTRACT BACKGROUND: Attention deficit hyperactivity disorder (ADHD) has a prevalence of 5.3% among children and adolescents. It is characterized by attention deficit, hyperactivity, and impulsivity. OBJECTIVE: We aimed to conduct a survey involving pediatric neurologists in the management of ADHD and compare the results with the current literature and guidelines. DESIGN AND SETTING: Descriptive analytical study of a virtual environment, was used Test of equality of proportions for comparison between two groups of pediatric neurologists (working as specialists for > 6 versus ≤ 6 years), with a significance level of P = 0.05. METHODS: This cross-sectional study used a virtual questionnaire covering the steps in the diagnosis and treatment of children with ADHD. The inclusion criteria were professionals who had completed their residency/specialization in pediatric neurology and clinical neurologists working in pediatric neurology. RESULTS: Among the 548 electronic invitations sent, 128 were considered valid. For all participants, the diagnosis was clinically based on the disease classification manuals. Combination treatment promotes improvement of symptoms (96.9%). Among psychostimulants, short-acting methylphenidate was the most commonly prescribed medication (85.2%). Headache was the most common side effect (77.3%). Altogether, 73.4% of the participants requested laboratory tests, 71.1% requested an electrocardiogram, and 42.2% requested an electroencephalogram. Pediatric neurologists working as specialists for ≤ 6 years had more frequent referrals to psycho-pedagogists for diagnosis (P = 0.03). CONCLUSIONS: The participants complied with clinical guidelines, emphasizing the relevance of diagnostic manuals and treatment guidelines for an eminently clinical situation and enabling uniformity in quality treatment.

Persistence of behavioral abnormalities following corticosteroid therapy in children with initial episode of idiopathic nephrotic syndrome: a prospective longitudinal observation / Persistência de anormalidades comportamentais após corticoterapia em crianças com episódio inicial de síndrome nefrótica idiopática: uma observação longitudinal prospectiva

Abstract Introduction: Treatment of nephrotic syndrome with corticosteroid can cause several side- effects including behavioral abnormalities. The objectives of the study were to observe the proportion of non-relapsers having persistence of behavioral abnormalities after completion of treatment of initial episode and compare the abnormalities with relapsers, and to determine risk factors for persistence. Methods: Seventy-five children with a first episode of idiopathic nephrotic syndrome and 60 normal children were rated by parents for behavioral problems using the Child Behavior Checklist. The Parenting Stress Index was also evaluated. The children were rated before treatment and 12 and 36 weeks after. Results: Both relapsers and non-relapsers showed abnormalities in internalizing and externalizing domains at 12 weeks of steroid therapy. Non-relapsers had abnormal scores in the internalizing domain in 63.5 % and externalizing domain in 48.1% of cases at 36 weeks. Relapsers had abnormal scores in all the three behavior domains, but a significantly higher proportion of relapsers had abnormal scores regarding total behavior (65.2% vs 28.8%, p<0.01) and child domains (100% vs 57.7%, p<0.001) of Parenting Stress Index in comparison to non-relapsers at 36 weeks. Occurrence of relapse increased the risk (odds ratio 5.76, 95% CI 1.35-10.76, p< 0.001) for persistence of abnormal total behavior at 36 weeks follow-up. Conclusion: Persistence of abnormalities was observed not only in relapsers but also in non-relapsers. Relapse was found to be a significant risk factor for persistence of abnormal behaviors in these patients.

Resumo Introdução: O tratamento da síndrome nefrótica com corticosteroide pode causar vários efeitos colaterais, incluindo anormalidades comportamentais. Os objetivos do estudo foram observar a proporção de não-recidivos com persistência de anormalidades comportamentais após conclusão do tratamento do episódio inicial, comparar as anormalidades com os recidivos, e determinar fatores de risco para persistência. Métodos: 75 crianças com primeiro episódio de síndrome nefrótica idiopática e 60 crianças normais foram avaliadas pelos pais por problemas comportamentais usando o Checklist de Comportamento Infantil. O Índice de Estresse Parental também foi avaliado. As crianças foram avaliadas antes do tratamento, 12 e 36 semanas após. Resultados: Tanto recidivos quanto não recidivos mostraram anormalidades nos domínios de internalização e externalização às 12 semanas de terapia com esteroides. Não-recidivos apresentaram pontuações anormais no domínio de internalização em 63,5%, e no domínio de externalização, em 48,1% dos casos em 36 semanas. Recidivos tiveram pontuações anormais em todos os três domínios de comportamento, mas uma proporção significativamente maior de recidivos apresentou pontuações anormais em relação ao comportamento total (65,2% vs 28,8%, p<0,01) e domínios infantis (100% vs 57,7%, p<0,001) do Índice de Estresse Parental em comparação com não recidivos às 36 semanas. A ocorrência de recidiva aumentou o risco (odds ratio 5,76, 95% IC 1,35-10,76, p< 0,001) de persistência de comportamento total anormal em 36 semanas de acompanhamento. Conclusão: A persistência de anormalidades foi observada não apenas em recidivos, mas também em não recidivos. A recidiva foi um fator de risco significativo para a persistência de comportamentos anormais nesses pacientes.

A randomized controlled trial of technology-enhanced behavioral parent training: sustained parent skill use and child outcomes at follow-up.

BACKGROUND: Early-onset (3-8 years old) disruptive behavior disorders (DBDs) have been linked to a range of psychosocial sequelae in adolescence and beyond, including delinquency, depression, and substance use. Given that low-income families are overrepresented in statistics on early-onset DBDs, prevention and early-intervention targeting this population is a public health imperative. The efficacy of Behavioral Parent Training (BPT) programs such as Helping the Noncompliant Child (HNC) has been called robust; however, given the additional societal and structural barriers faced by low-income families, family engagement and retention barriers can cause effects to wane with time. This study extends preliminary work by examining the potential for a Technology-Enhanced HNC (TE-HNC) program to improve and sustain parent skill proficiency and child outcomes among low-income families. METHODS: A randomized controlled trial with two parallel arms was the design for this study. A total of 101 children (3-8-years-old) with clinically significant problem behaviors from low-income households were randomized to HNC (n = 54) or TE-HNC (n = 47). Participants were assessed at pre-treatment, post-treatment, 3-month, and 6-month follow-ups. Primary outcomes were parent-reported and observed child behavior problems. Secondary outcomes included observed parenting skills use (ClinicalTrials.gov Identifier: NCT02191956). RESULTS: Primary analyses used latent curve modeling to examine treatment differences in the trajectory of change during treatment, maintenance of treatment gains, and levels of outcomes at the 6-month follow-up. Both programs yielded improvements in parenting skills and child problems at post-treatment. However, TE-HNC families evidenced greater maintenance of parent-reported and observed child behavior and observed positive parenting skills at the 6-month follow-up. CONCLUSIONS: Our findings contribute to an ongoing line of work suggesting that technology-enhanced treatment models hold promise for increasing markers of engagement in BPT and sustaining long-term outcomes among low-income families.

Relacionamento conjugal e suas relações com parentalidade, habilidades sociais e problemas de comportamento dos filhos / Marital relationship and its relationships with parenting, social skills and children's behavior problems / Relación matrimonial y sus relaciones con la paternidad, habilidades sociales y problemas de comportamento de los niños

O relacionamento conjugal satisfatório depende de múltiplas variáveis, incluindo a própria interação conjugal, parentalidade e comportamentos infantis. O estudo simultâneo dessas medidas ainda é escasso na literatura. Objetivou-se verificar a influência da parentalidade (positiva e negativa) e do repertório comportamental infantil (habilidades sociais e problemas de comportamento) na ocorrência do relacionamento conjugal positivo, negativo e na satisfação conjugal. Participaram 106 mães e suas crianças que responderam a instrumentos de relato sobre conjugalidade, parentalidade e comportamentos infantis, em um delineamento transversal de comparação de grupos. Considerando as comparações estatisticamente significativas, verificou-se que a parentalidade e os comportamentos infantis influenciaram no relacionamento conjugal positivo (práticas positivas, habilidades sociais infantis) e negativo (práticas negativas, problemas de comportamento), quanto aos comportamentos de definição do cônjuge, comunicação e comportamentos positivos e negativos. Comportamentos conjugais positivos foram mais frequentes entre os respondentes que relataram estar satisfeitos e os comportamentos conjugais negativos foram mais citados pelas pessoas insatisfeitas com o relacionamento conjugal. Ressalta-se a multideterminação do relacionamento conjugal que é influenciada pela parentalidade (positiva e negativa) e pelos comportamentos infantis (habilidades sociais e problemas de comportamento).

Satisfactory marital relationship depends on multiple variables, including the interaction between consorts, parenting and child behaviors. The simultaneous study of those several measures is still scarce in literature. The objective is to verify the influence of parenting (positive and negative) and children's behavioral repertoire (social skills and behavior problems) in the occurrence of positive, negative marital relationships and marital satisfaction.106 mothers and their children participated of this study and answered to report instruments about conjugality, parenting and child behavior, in a cross-sectional design of group comparison. Considering the statistically significant comparisons, it was found that parenting and children's behaviors influenced the positive (positive practices, children's social skills) and negative (negative practices, behavioral problems) marital relationships, regarding the spouse's definition, communication and positive and negative behaviors. Positive marital behaviors were more frequent among respondents who reported being satisfied and negative marital behaviors were more frequently cited by people dissatisfied with the marital relationship. Highlights is the multi-determination of the marital relationship is influenced by parenting (positive and negative) and by children's behaviors (social skills and behavior problems).

La relación matrimonial satisfactoria depende de múltiples variables, incluida la interacción matrimonial en sí, la conducta de los padres y los hijos. El estudio simultáneo de estas diversas medidas aún es escaso en la literatura. El objetivo es verificar la influencia de la crianza (positiva y negativa) y el repertorio conductual de los niños (habilidades sociales y problemas de conducta) en la ocurrencia de relaciones maritales positivas, negativas y satisfacción marital. Participaron 106 madres y sus hijos que respondieron a los instrumentos de denuncia sobre la conyugalidad, la paternidad y los comportamientos infantiles, em um diseño transversal de comparación de grupos. Considerando las comparaciones estadísticamente significativas, se encontró que la crianza y los comportamientos de los niños influyeron en las relaciones maritales positivas (prácticas positivas, habilidades sociales de los niños) y negativas (prácticas negativas, problemas de conducta), en cuanto a la definición del cónyuge, la comunicación y las conductas positivas y negativas. Los comportamientos matrimoniales positivos fueron más frecuentes entre los encuestados que informaron estar satisfechos y los comportamientos maritales negativos fueron citados con mayor frecuencia por personas insatisfechas con la relación matrimonial. Se destaca con la determinación múltiple de la relación matrimonial, que está influenciada por la paternidad (positiva y negativa) y por el comportamiento de los niños (habilidades sociales y problemas de conducta.

Periconceptional Maternal Diet Characterized by High Glycemic Loading Is Associated with Offspring Behavior in NEST.

Maternal periconceptional diets have known associations with proper offspring neurodevelopment. Mechanisms for such associations include improper energy/nutrient balances between mother and fetus, as well as altered offspring epigenetics during development due to maternal nutrient and inflammatory status. Using a comprehensive food frequency questionnaire and assessing offspring temperament with the Infant-Toddler Social and Emotional Assessment (n = 325, mean age = 13.9 months), we sought to test whether a maternal periconceptional diet characterized by high glycemic loading (MGL) would affect offspring temperament using adjusted ordinal regression. After limiting false discovery to 10%, offspring born to mothers in tertile 3 of glycemic loading (referent = tertile 1) were more likely to be in the next tertile of anxiety [OR (95% CI) = 4.51 (1.88-11.07)] and inhibition-related behaviors [OR (95% CI) = 3.42 (1.49-7.96)]. Male offspring were more likely to exhibit impulsive [OR (95% CI) = 5.55 (1.76-18.33)], anxiety [OR (95% CI) = 4.41 (1.33-15.30)], sleep dysregulation [OR (95% CI) = 4.14 (1.34-13.16)], empathy [6.68 (1.95-24.40)], and maladaptive behaviors [OR (95% CI) = 9.86 (2.81-37.18)], while females were more likely to exhibit increased anxiety-related behaviors [OR (95% CI) = 15.02 (3.14-84.27)]. These associations persisted when concurrently modeled with the maternal-Mediterranean dietary pattern. In a subset (n = 142), we also found MGL associated with increased mean methylation of the imprint control region of SGCE/PEG10. In conclusion, these findings highlight the importance of maternal dietary patterns on offspring neurodevelopment, offering avenues for prevention options for mothers.

Assessing ADHD symptoms in clinical public practice: Is a reliable final diagnosis possible? / Evaluando los síntomas del TDAH en la práctica clínica pública: ¿Es posible un diagnóstico final seguro?

Introduction: Attention deficit and hyperactivity disorder (ADHD) rates vary between 1% and 20% depending on the type of diagnosis guide used, the test used in the assessment, psychosocial factors, and professional in charge of the assessment. Goal: to describe and compare current clinical ADHD assessment processes in public health system in two cohorts and analyze variables related to final diagnosis. Design: Descriptive, multicenter, longitudinal (retrospective-prospective). Location: primary care (PC) centers in Oviedo, Asturias (Spain). Participants: a Spanish clinical ADHD symptomatic sample (n=134) from two cohorts (2004 and 2009). Variables: clinical professional in charge of ADHD assessment (PC, mental health professional [MH], neuropediatrician [NP]), type of test used in the assessment, confirmation/disconfirmation of ADHD diagnosis, and final diagnosis.Results: the use of symptoms checklists and the assessments in charge of primary care (PC) and neuropediatrician (NP) professionals show an upward trend from 2004 to 2009. ADHD final diagnosis shows low inter-professional (NP-MH) reliability (kappa=0.39). Final diagnoses for the same symptoms are different depending on the professional (NP or MH). Discussions: the professional in charge of the assessment appears to be a relevant variable for the final diagnosis. ADHD diagnosis criteria seem not to be clear. This data suggests that ADHD diagnosis must be used with caution to ensure good quality clinical standards when assessing and treating ADHD symptoms. Assessments supported by symptoms checklists and performed by NP or PC could be contributing factors to an ADHD over-diagnosis tendency.(AU)

Introducción: Las ratios del trastorno de déficit de atención e hiperactividad (TDAH) varían entre el 1 y el 20%, dependiendo del tipo de guía diagnóstica utilizada, del test usado en la evaluación, de los factores psicosociales y del profesional a cargo de la evaluación. Objetivo: Describir el proceso actual de evaluación del trastorno por déficit de atención e hiperactividad (TDAH) en la práctica clínica en el sistema público de salud y analizar las variables relacionadas con el diagnóstico final.Diseño: Estudio descriptivo y longitudinal (retrospectivo-prospectivo). Localización: Centros de atención primaria en Oviedo, Asturias (España). Participantes: Se analiza una muestra española de 134 casos clínicos en dos cohortes (2004 y 2009). Variables: Profesional a cargo de la evaluación, test empleados en la evaluación y diagnóstico final. Resultados: El empleo de listas de síntomas y las evaluaciones a cargo de profesionales de atención primaria (AP) y de neuropediatría (NP) muestran una tendencia al alza entre 2004 y 2009. El diagnóstico final de TDAH muestra una baja fiabilidad interprofesional (kappa = 0,39). Conclusiones: El profesional a cargo de la evaluación parece ser una variable relevante para establecer un diagnóstico final. Los criterios de diagnóstico de TDAH no parecen claros. Estos datos sugieren que el diagnóstico de TDAH debe usarse con precaución para garantizar una práctica clínica de calidad al evaluar y tratar los síntomas de TDAH. Las evaluaciones apoyadas por listas de síntomas y realizadas por NP o AP podrían ser factores que contribuyen a una tendencia de diagnóstico excesivo de TDAH.(AU)

Assessing ADHD symptoms in clinical public practice: Is a reliable final diagnosis possible?

INTRODUCTION: Attention deficit and hyperactivity disorder (ADHD) rates vary between 1% and 20% depending on the type of diagnosis guide used, the test used in the assessment, psychosocial factors, and professional in charge of the assessment. GOAL: to describe and compare current clinical ADHD assessment processes in public health system in two cohorts and analyze variables related to final diagnosis. DESIGN: Descriptive, multicenter, longitudinal (retrospective-prospective). LOCATION: primary care (PC) centers in Oviedo, Asturias (Spain). PARTICIPANTS: a Spanish clinical ADHD symptomatic sample (n=134) from two cohorts (2004 and 2009). VARIABLES: clinical professional in charge of ADHD assessment (PC, mental health professional [MH], neuropediatrician [NP]), type of test used in the assessment, confirmation/disconfirmation of ADHD diagnosis, and final diagnosis. RESULTS: the use of symptoms checklists and the assessments in charge of primary care (PC) and neuropediatrician (NP) professionals show an upward trend from 2004 to 2009. ADHD final diagnosis shows low inter-professional (NP-MH) reliability (kappa=0.39). Final diagnoses for the same symptoms are different depending on the professional (NP or MH). DISCUSSIONS: the professional in charge of the assessment appears to be a relevant variable for the final diagnosis. ADHD diagnosis criteria seem not to be clear. This data suggests that ADHD diagnosis must be used with caution to ensure good quality clinical standards when assessing and treating ADHD symptoms. Assessments supported by symptoms checklists and performed by NP or PC could be contributing factors to an ADHD over-diagnosis tendency.

El estudio de casos: método efectivo para el diagnóstico y manejo de trastornos de conducta / Case study: effective method in the diagnosis and treatment of behavioral disorders

RESUMEN Fundamento: los trastornos de conducta constituyen un problema de salud de intervención multidisciplinaria entre instituciones correspondientes a diferentes campos del saber. Su tratamiento a través del estudio de casos como método de indagación detallado, descriptivo y holístico permite su diagnóstico efectivo y orienta hacia una terapéutica integral para su solución. Objetivo: valorar la efectividad del método estudio de casos para el diagnóstico y manejo de los trastornos de conducta. Métodos: se realizó un estudio descriptivo en el municipio de Santa Clara durante febrero de 2018. Se emplearon métodos teóricos: análisis-síntesis, inductivo-deductivo e histórico-lógico; empíricos: análisis documental, historia de vida, observación participante y entrevista a informantes clave y familiares y el método estudio de casos. Resultados: los métodos empleados permitieron conformar un diagnóstico preventivo a partir del análisis minucioso de las características psicopedagógicas y psicosociales del menor, el cual se prescribió como portador de un trastorno de conducta disocial potenciado y generado por patrones, códigos y estilos antisociales asimilados desde sus círculos de amistad, cuyo pronóstico fue desfavorable. Conclusiones: se valoró la efectividad de la aplicación del método estudio de casos para el diagnóstico y manejo de los trastornos de conducta porque permitió la identificación de las potencialidades del entorno del sujeto para enfrentar esta problemática y las existentes en él y en su familia, y la elaboración de estrategias que coadyuvan al éxito de un comportamiento cívico a tono con el proyecto social cubano.

ABSTRACT Background: behavioral disorders are a health problem that requires multidisciplinary action between institutions from different fields of knowledge. Its treatment through the study of cases as a detailed, descriptive and holistic method of research enables the effective diagnosis of it and also it is a guide towards a comprehensive treatment for its solution. Objective: to evaluate the effectiveness of the case study method in the diagnosis and treatment for conduct disorders. Methods: a descriptive study was conducted in Santa Clara municipality during February 2018. Theoretical methods were used: analysis-synthesis method, inductive-deductive method and historical-logical method; empirical methods: documentary analysis method, life history method, participant observation method, key informant interview, family members interview and the case study method. Results: the methods we used made possible to obtain a preventive diagnosis from the detailed analysis of the psycho-pedagogical and psychosocial characteristics of the child, who was prescribed as sufferer of dissociative identity disorder enhanced and generated by patterns, codes and antisocial styles assumed from friendship circles, with an unfavorable prognosis. Conclusions: the effectiveness of the case study method in the diagnosis and treatment for conduct disorders was evaluated since it made possible to identify the potentialities of the subject's environment to face this problem and those inherent in him and his family, and the development of strategies that contribute to success in terms of civic behavior in accordance with the Cuban social project.

[Early onset anorexia nervosa]. / Anorexie mentale à début précoce.

Early onset anorexia nervosa. Anorexia nervosa is an eating disorder of multifactorial origin. It has a serious physical and psychological impact on the functioning of the individual and the highest risk of mortality from psychiatric disorders. It is defined according to international classifications by a refusal to maintain a normal minimum weight for his age and height, an intense fear of gaining weight and a disturbance of one's body image. This pathology most often affects adolescents but can be diagnosed from the age of 8 years. In this case, it is considered as "early onset anorexia nervosa" or called "prepubescent anorexia nervosa". Its prognosis is serious, and it requires emergency medical care. Multidisciplinary ambulatory care should be favored in the absence of criteria imposing full-time hospitalization. Patient monitoring should continue for several years.

Anorexie mentale à début précoce. L'anorexie mentale est un trouble du comportement alimentaire d'origine multifactorielle, grave du fait de son impact physique et psychologique sur le fonctionnement de l'individu et du risque de mortalité le plus élevé des troubles psychiatriques. Elle est définie selon les critères des classifications internationales par un refus de maintenir un poids minimum normal pour son âge et sa taille, une peur intense de prendre du poids et une perturbation de son image corporelle. Cette pathologie touche le plus souvent l'adolescent mais peut être diagnostiquée dès 8 ans. Elle est alors considérée comme survenant « à début précoce ¼ ou dite « anorexie mentale prépubère ¼. Son pronostic est grave et sa prise en charge est une urgence médicale. Une prise en charge multidisciplinaire ambulatoire est privilégiée en l'absence de critère imposant une hospitalisation à temps complet. Le suivi du patient se poursuivra plusieurs années.

Randomized open-label trial of docosahexaenoic acid-enriched fish oil and fish meal on cognitive and behavioral functioning in Omani children.

OBJECTIVE: This study aimed to examine the effect of docosahexaenoic acid (DHA)-enriched fish oil supplement and meal of grilled fish on cognitive and behavioral functioning manifested as attention-deficit/hyperactivity disorder in primary school students 9 to 10 y of age in Muscat, Oman. METHODS: This randomized open-label trial involved two types of interventions: fish oil supplement or one serving (100 g) of grilled fish per day (Sunday through Friday) for 12 weeks. Red cell total lipid DHA levels were assessed. The Verbal Fluency Test, Buschke Selective Reminding Test, and Trail Making Test were used to measure cognitive functioning. Behavioral functioning was assessed using a standardized Arabic version of the National Initiative for Children's Health Quality Vanderbilt Assessment Scales. All measurements were carried out before and after intervention. RESULTS: DHA levels increased by 72% and 64% in the fish oil (mean, 3.6%-6.2%) and fish-meal (mean, 3.4%-5.6%) groups, respectively (P = 0.000). The Trail Making Test was the only cognitive test that demonstrated marked differences between groups: Median interquartile range difference between pre- and postintervention in the Trail Making Part B score was 61.5 (SE, 19.3, 103.2) in the fish oil versus fish-meal group, 24.5 (SE, -15.2, 74.7, P = 0.005). The Vanderbilt Assessment Scales also showed significant differences between groups (P < 0.001). CONCLUSION: This study contributed to available evidence on the cognitive and behavioral benefits of DHA in healthy school children. Expanding the food fortification program with DHA-enriched fish oil should be considered as part of broader policy to improve child health.

Endocrine Disruptors and Autism Spectrum Disorder in Pregnancy: A Review and Evaluation of the Quality of the Epidemiological Evidence.

Exposure to environmental contaminants during pregnancy has been linked to adverse health outcomes later in life. Notable among these pollutants are the endocrine disruptors chemicals (EDCs), which are ubiquitously present in the environment and they have been measured and quantified in the fetus. In this systematic review, our objective was to summarize the epidemiological research on the potential association between prenatal exposure to EDCs and Autism Spectrum Disorder (ASD) published from 2005 to 2016. The Navigation Guide Systematic Review Methodology was applied. A total of 17 studies met the inclusion criteria for this review, including: five cohorts and 12 case-control. According to the definitions specified in the Navigation Guide, we rated the quality of evidence for a relationship between prenatal exposure to EDCs and ASD as "moderate". Although the studies generally showed a positive association between EDCs and ASD, after considering the strengths and limitations, we concluded that the overall strength of evidence supporting an association between prenatal exposure to EDCs and later ASD in humans remains "limited" and inconclusive. Further well-conducted prospective studies are warranted to clarify the role of EDCs on ASD development.

Periconceptional Maternal Mediterranean Diet Is Associated With Favorable Offspring Behaviors and Altered CpG Methylation of Imprinted Genes.

Background: Maternal diet during pregnancy has been shown to influence the child neuro-developmental outcomes. Studies examining effects of dietary patterns on offspring behavior are sparse. Objective: Determine if maternal adherence to a Mediterranean diet is associated with child behavioral outcomes assessed early in life, and to evaluate the role of differentially methylated regions (DMRs) regulating genomically imprinted genes in these associations. Methods: Among 325 mother/infant pairs, we used regression models to evaluate the association between tertiles of maternal periconceptional Mediterranean diet adherence (MDA) scores derived from a Food Frequency Questionnaire, and social and emotional scores derived from the Infant Toddler Social and Emotional Assessment (ITSEA) questionnaire in the second year of life. Methylation of nine genomically imprinted genes was measured to determine if MDA was associated with CpG methylation. Results: Child depression was inversely associated with maternal MDA (Bonferroni-corrected p = 0.041). While controlling for false-discovery, compared to offspring of women with the lowest MDA tertile, those with MDA scores in middle and high MDA tertiles had decreased odds for atypical behaviors [OR (95% CI) = 0.40 (0.20, 0.78) for middle and 0.40 (0.17, 0.92) for highest tertile], for maladaptive behaviors [0.37 (0.18, 0.72) for middle tertile and 0.42 (0.18, 0.95) for highest tertile] and for an index of autism spectrum disorder behaviors [0.46 (0.23, 0.90) for middle and 0.35 (0.15, 0.80) for highest tertile]. Offspring of women with the highest MDA tertile were less likely to exhibit depressive [OR = 0.28 (0.12, 0.64)] and anxiety [0.42 (0.18, 0.97)] behaviors and increased odds of social relatedness [2.31 (1.04, 5.19)] behaviors when compared to low MDA mothers. Some associations varied by sex. Perinatal MDA score was associated with methylation differences for imprinted control regions of PEG10/SGCE [females: Beta (95% CI) = 1.66 (0.52, 2.80) - Bonferroni-corrected p = 0.048; males: -0.56 (-1.13, -0.00)], as well as both MEG3 and IGF2 in males [0.97 (0.00, 1.94)] and -0.92 (-1.65, -0.19) respectively. Conclusion: In this ethnically diverse cohort, maternal adherence to a Mediterranean diet in early pregnancy was associated with favorable neurobehavioral outcomes in early childhood and with sex-dependent methylation differences of MEG3, IGF2, and SGCE/PEG10 DMRs.

Practical management of behavioral problems in mucopolysaccharidoses disorders.

The mucopolysaccharidosis (MPS) disorders are caused by deficiencies of specific lysosomal enzymes, resulting in progressive glycosaminoglycan (GAG) accumulation in cells and tissues throughout the body. Excessive GAG storage can lead to a variety of somatic manifestations as well as primary and secondary neurological symptoms. Behavioral problems (like hyperactivity, attention difficulties, and severe frustration) and sleeping problems are typical primary neurological symptoms of MPS caused by GAG accumulation in neurons, and are frequently observed in patients with MPS I, II, III, and VII. As these problems often place a significant burden on the family, proper management is important. This review summarizes current insights into behavioral and sleeping problems in MPS disorders and the most optimal management approaches, as presented and discussed during a meeting of an international group of experts with extensive experience in managing and treating MPS.

Psychiatric and Behavioural Problems in Children and Adolescents with Epilepsy.

OBJECTIVE: To investigate the psychiatric and behavioural symptoms in children and adolescents with epilepsy. METHODS: Patients with epilepsy and aged 4 to 16 years were recruited from a medical centre in Azerbaijan during January 2012 to December 2013. A community sample was drawn from 3 schools as the comparison group. The Strengths and Difficulties Questionnaire (SDQ) was administered to parents of both patients with epilepsy and children in the comparison group. The total difficulties score and the scores for each subscale were compared between the 2 groups. Additionally, scores between different groups of epileptic patients were compared. RESULTS: A total of 409 patients with epilepsy and 515 children in the comparison group were recruited. Those with epilepsy had a significantly higher mean total difficulties score and mean difficulties subscale scores (p < 0.001). In epileptic children with severe mental or physical disabilities, prosocial behaviour scores were significantly lower than those in the comparison group. The proportion of children with a total difficulties score in the abnormal range was higher in the epilepsy group than in the comparison group (53.1% vs. 15.7%; p < 0.001). Children with symptomatic epilepsy showed a higher total difficulties score than those with idiopathic epilepsy (p < 0.05). CONCLUSION: Children with epilepsy have a higher rate of psychiatric and behavioural symptoms. These rates are even higher in children with symptomatic epilepsy.

Trauma Exposure and Externalizing Disorders in Adolescents: Results From the National Comorbidity Survey Adolescent Supplement.

OBJECTIVE: Exposure to violence and other forms of potentially traumatic events (PTEs) are common among youths with externalizing psychopathology. These associations likely reflect both heightened risk for the onset of externalizing problems in youth exposed to PTEs and elevated risk for experiencing PTEs among youth with externalizing disorders. In this study, we disaggregate the associations between exposure to PTEs and externalizing disorder onset in a population-representative sample of adolescents. METHOD: We analyzed data from 13- to 18-year-old participants in the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A) (N = 6,379). Weighted survival models estimated hazard ratios (HRs) for onset of oppositional defiant disorder (ODD), conduct disorder (CD), and substance use disorders (SUDs) associated with PTEs, and for exposure to PTEs associated with prior-onset externalizing disorders. Multiplicative interaction terms tested for effect modification by sex, race/ethnicity, and household income. RESULTS: All types of PTEs were associated with higher risk for SUD (HRs = 1.29-2.21), whereas only interpersonal violence (HR = 2.49) was associated with onset of CD and only among females. No associations were observed for ODD. Conversely, ODD and CD were associated with elevated risk for later exposure to interpersonal violence and other/nondisclosed events (HRs = 1.45-1.75). CONCLUSION: Externalizing disorders that typically begin in adolescence, including SUDs and CD, are more likely to emerge in adolescents with prior trauma. ODD onset, in contrast, is unrelated to trauma exposure but is associated with elevated risk of experiencing trauma later in development. CD and interpersonal violence exposure exhibit reciprocal associations. These findings have implications for interventions targeting externalizing and trauma-related psychopathology.