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2.
Medicina (B Aires) ; 80 Suppl 2: 67-71, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32150717

RESUMO

Attention deficit disorder and hyperactivity (ADHD) is the main reason for consultation in most Pediatric Neurology units in Spain. The new technologies also associate benefits for both patients and professionals and the health system itself, which makes its rational implementation essential. Genetics, neuroimaging or virtual reality, for example, are clear exponents of the results that can be achieved by optimizing traditional processes. The different technologies that we collect in this article are fully operational and have thousands of experience in patients. The incorporation of them to the usual clinical practice is in our hands.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Tecnologia Biomédica/métodos , Tecnologia Biomédica/tendências , Humanos , Software , Terapia de Exposição à Realidade Virtual/métodos
3.
Medicina (B Aires) ; 80 Suppl 2: 76-79, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32150719

RESUMO

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental alteration of biological basis that started in childhood may persist during adolescence-youth and, despite what was believed until not many years ago, also in adulthood up to 50-60% of those affected, producing a significant clinical and psychosocial deterioration. In spite of being a syndrome easily identifiable by the triad: inattention, hyperactivity and impulsivity that characterizes it, in clinical practice there are different circumstances that hinder and complicate its diagnosis and treatment. One of the most significant is the presence, both in childhood and adulthood, of other comorbid mental disorders. It is from adolescence-youth when together with ADHD we can detect the presence of personality, mood and anxiety disorders and especially the use of several substances. The evidences existing until now show how the comorbidity of ADHD and substance use disorder influence the evolutionary course of both, complicating the approach, the treatment and, therefore, aggravating the final prognosis. The difficulties in their approach and the scarcity of treatment options make us underline the importance of preventive treatment in the infantile stage, starting from psychoeducation programs focused on the vulnerability of these patients to substances and the consequences associated with consumption.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtornos Relacionados ao Uso de Substâncias/etiologia , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto Jovem
4.
N C Med J ; 81(2): 122-125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32132257

RESUMO

At present, data suggests that attention-deficit/hyperactivity disorder may be more prevalent in North Carolina than other states, but whether we are properly identifying and treating cases, in childhood and adulthood, is murky. Much innovative work to this end is being done in North Carolina, but more is needed.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Adulto , Criança , Previsões , Humanos , North Carolina/epidemiologia , Prevalência
5.
Brain Nerve ; 72(3): 215-225, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32152255

RESUMO

This article examines how the characteristics of ADHD (attention-deficit hyperactivity disorder) affect self-formation and what kind of supporter's involvement is desirable for the person's self-formation. For those with ADHD, prevention of over-adaptation and resilience after failure are important, and it is desirable for them to utilize the characteristics of ADHD in society while preventing secondary obstacles in their social life. In addition, this article introduces International Classification of Living Function model by World Health Organization, which states that "the state of health and the level of disability change depending on the environment," and the importance of family support based on this model.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Avaliação da Deficiência , Qualidade de Vida , Família , Humanos , Desenvolvimento da Personalidade , Apoio Social , Organização Mundial da Saúde
6.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31964760

RESUMO

Pediatricians regularly care for children who have experienced child maltreatment. Child maltreatment is a risk factor for a broad range of mental health problems. Issues specific to child maltreatment make addressing emotional and behavioral challenges among maltreated children difficult. This clinical report focuses on 2 key issues necessary for the care of maltreated children and adolescents in pediatric settings: trauma-informed assessments and the role of pharmacotherapy in maltreated children and adolescents. Specific to assessment, current or past involvement of the child in the child welfare system can hinder obtaining necessary information or access to appropriate treatments. Furthermore, trauma-informed assessments can help identify the need for specific interventions. Finally, it is important to take both child welfare system and trauma-informed assessment approaches into account when considering the use of psychotropic agents because there are critical diagnostic and systemic issues that affect the prescribing and discontinuing of psychiatric medications among children with a history of child maltreatment.


Assuntos
Maus-Tratos Infantis/psicologia , Serviços de Proteção Infantil , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Adolescente , Ansiedade/etiologia , Ansiedade/terapia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/legislação & jurisprudência , Serviços de Proteção Infantil/legislação & jurisprudência , Bases de Dados Factuais , Depressão/etiologia , Depressão/terapia , Exposição à Violência/psicologia , Inquéritos Epidemiológicos , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/etiologia , Pediatras , Resiliência Psicológica , Transtornos do Sono-Vigília/etiologia , Determinantes Sociais da Saúde , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Suspensão de Tratamento
7.
PLoS One ; 15(1): e0228049, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31951639

RESUMO

BACKGROUND: Non-compliance to, or drop-out from treatment for childhood ADHD, result in suboptimal outcome. Non-compliance and drop-out may be due to mismatches between patients' care needs and treatments provided. This study investigated unmet care needs in ADHD patients. Unmet needs were assessed in two different treatment settings (general outpatient setting versus youth-ACT). Youth-ACT treatment is an intensive outreach-oriented treatment for patients with severe psychiatric and psychosocial problems. Comparison of a general outpatient sample with a youth-ACT sample enabled us to assess the influence of severity of psychiatric and psychosocial problems on perceived care needs. METHODS: Self-reported unmet care needs were assessed among 105 ADHD patients between 6 and 17 years of age in a general outpatient (n = 52) and a youth-ACT setting (n = 53). RESULTS: ADHD patients most frequently reported unmet needs regarding mental health problems, information on diagnosis/treatment, and future prospects. Outpatients differed from youth-ACT patients with respect to 30% of the unmet care needs that were investigated. Outpatients perceived more unmet needs regarding information on diagnosis/treatment (p = 0.014). Youth-ACT patients perceived more unmet needs concerning medication side effects (p = 0.038), quality and/or quantity of food (p = 0.016), self-care abilities (p = 0.016), regular/suitable school or other daytime activities (p = 0.013), making and/or keeping friends (p = 0.049), and future prospects (p = 0.045). CONCLUSIONS: Focusing treatment of ADHD patients on unmet needs may reduce non-compliance and drop-out. In clinical practice, systematic assessment of unmet care needs in all ADHD patients may be warranted, e.g. using the CANSAS questionnaire during the screening/intake phase.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Necessidades e Demandas de Serviços de Saúde , Qualidade de Vida , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Cooperação do Paciente , Pacientes Desistentes do Tratamento , Autorrelato
8.
Lancet ; 395(10222): 450-462, 2020 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-31982036

RESUMO

Attention-deficit hyperactivity disorder (ADHD), like other psychiatric disorders, represents an evolving construct that has been refined and developed over the past several decades in response to research into its clinical nature and structure. The clinical presentation and course of the disorder have been extensively characterised. Efficacious medication-based treatments are available and widely used, often alongside complementary psychosocial approaches. However, their effectiveness has been questioned because they might not address the broader clinical needs of many individuals with ADHD, especially over the longer term. Non-pharmacological approaches to treatment have proven less effective than previously thought, whereas scientific and clinical studies are starting to fundamentally challenge current conceptions of the causes of ADHD in ways that might have the potential to alter clinical approaches in the future. In view of this, we first provide an account of the diagnosis, epidemiology, and treatment of ADHD from the perspective of both the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the eleventh edition of the International Classification of Diseases. Second, we review the progress in our understanding of the causes and pathophysiology of ADHD on the basis of science over the past decade or so. Finally, using these discoveries, we explore some of the key challenges to both the current models and the treatment of ADHD, and the ways in which these findings can promote new perspectives.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/efeitos adversos , Humanos , Guias de Prática Clínica como Assunto
9.
J Altern Complement Med ; 26(3): 239-246, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31934771

RESUMO

Background: Attention deficit/hyperactivity disorder (ADHD), characterized by inattention, hyperactivity, and impulsivity, is currently one of the most common diagnoses given to children. Children with ADHD have a unique cognitive profile that involves difficulties in executive functions (EFs) and in the self-management system of the brain, and are at higher risk for educational failure, social and emotional difficulties, and high risk behavior. Objectives: The purpose of this study was to examine the effectiveness of self-management intervention for attention and executive functions using equine-assisted occupational therapy (STABLE-OT) for school-aged children with ADHD. Design: A pre-post design was used in the intervention. Setting/location: The study was conducted at two riding school stables is Israel. Subjects: Twenty-five 6-14-year-old children (3 girls, 22 boys, age: 7.8-12.3 years, M = 9.41 ± 1.75) diagnosed with ADHD participated in a therapeutic equestrian riding intervention. Intervention: The intervention included structured 45-min sessions for 12 weeks, while integrating child- and family-centered strategy acquisition and immediate feedback principles. Outcome measures: Their EF and occupational performance were evaluated pre- and post-intervention, using The Behavior Rating Inventory of Executive Function (BRIEF) and the Canadian Occupational Performance Measure (COPM). Results: Results showed a significant improvement in EF, as reflected by statistically significant decreases in the Global Executive Composite (GEC; t = 2.801; p = 0.01), metacognitive index (t = 3.873; p = 0.001), working memory (t = 2.476; p = 0.021), monitor (t = 2.359; p = 0.027), and initiation (t = 3.204; p = 0.004) subscales of the BRIEF questionnaire. A statistically (p < 0.001) and clinically significant improvement was also found in the COPM performance and satisfaction scales. Conclusions: This study provides key preliminary evidence supporting the effectiveness of an individual equine-assisted OT intervention for children with ADHD. It constitutes an initial step toward clinical implementation of such therapeutic approaches, and is expected to spark further research in this area.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapia Assistida por Cavalos/métodos , Função Executiva/fisiologia , Terapia Ocupacional/métodos , Autogestão/métodos , Adolescente , Animais , Atenção/fisiologia , Criança , Feminino , Cavalos , Humanos , Masculino
10.
Medicine (Baltimore) ; 98(46): e17980, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725664

RESUMO

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) which is characterized by developmentally inappropriate levels of attention, hyperactivity and impulsivity, is considered as the most common neurodevelopmental disorder in childhood. Physical exercise has shown to have several benefits in the improvement of children with ADHD. In this meta-analysis, we aimed to systematically show, with evidence, the impact of physical exercise on children with ADHD. METHODS: Web of Science, MEDLINE, EMBASE, Google Scholar, Cochrane Central and http://www.ClinicalTrials.gov were the searched sources for studies which were based on the impact of physical exercise on children with ADHD. Relevant endpoints were assessed. This evidence based meta-analysis was carried out by the most relevant RevMan 5.3 software. Due to the involvement of continuous data (mean and standard deviation), weight mean difference (WMD) with 95% confidence intervals (CI) were used to represent the final analysis. A significant level of P ≤ .05 was set and a fixed statistical effect model was used throughout the analysis. RESULTS: Fourteen studies with a total number of 574 participants with ADHD were included in this evidenced based meta-analysis. Two hundred and seventy six (276) participants were assigned to the physical activity group whereas 298 participants were assigned to the control group. Results of this analysis showed that anxiety and depression were significantly improved with physical activity in these children with ADHD (WMD: -1.84; 95% CI: [-2.65 - (-1.03)], P = .00001). Hyperactive/impulsive symptoms (WMD: -0.01; 95% CI: [-0.32 - 0.29], P = .93) and inattention symptoms (WMD: -0.22; 95% CI: [-0.51 - 0.08], P = .15) were also improved with physical exercise but the results were not statistically significant. This evidence based analysis showed thought problems (WMD: -3.49; 95% CI: [-5.51 - (-1.47)], P = .0007), social problems (WMD: -5.08; 95% CI: [-7.34 - (-2.82)], P = .0001), and aggressive behaviors (WMD: -3.90; 95% CI: [-7.10 - (-0.70)], P = .02) to have significantly been improved in participants with ADHD who were assigned to physical activity group. CONCLUSIONS: This current meta-analysis showed with evidence, that physical exercise has a major contribution owing to significant improvement in anxiety and depression, aggressive behaviors, thought and social problems among children suffering from ADHD. Therefore, physical exercise should be incorporated in the daily life of children with ADHD. Further future research should be able to confirm this hypothesis.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Exercício Físico/fisiologia , Agressão/fisiologia , Ansiedade/etiologia , Ansiedade/terapia , Atenção/fisiologia , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Criança , Depressão/etiologia , Depressão/terapia , Humanos , Relações Interpessoais , Saúde Mental
11.
Nurs Clin North Am ; 54(4): 517-532, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703777

RESUMO

Management of attention-deficit/hyperactivity disorders require provider skill, rapport, and referral acumen to treat patients across the life span. Incidence and prevalence have increased in the United States and globally. There are innovative models of evidence-informed screening techniques, treatment strategies to help providers work with patients and their families. Diplomatic management of highly charged treatment controversies, drug diversion, and risk factor reduction helps to ethically address this growing public health phenomenon. This article examines risk factors and treatment considerations in the United States for evidence-informed care, with a focus on affordable and readily accessible treatment in primary care settings.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/genética , Predisposição Genética para Doença , Farmacogenética , Atenção Primária à Saúde , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Humanos , Prevalência , Fatores de Risco , Estados Unidos
12.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31570648

RESUMO

Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Adolescente , Fatores Etários , Algoritmos , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estimulantes do Sistema Nervoso Central/efeitos adversos , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada/métodos , Acesso aos Serviços de Saúde , Humanos , Pediatria , Psicoterapia/métodos , Sociedades Médicas , Estados Unidos
13.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31570649

RESUMO

Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral condition and the second most common chronic illness in children. The observance of specific behaviors in multiple settings have remained the most successful method for diagnosing the condition, and although there are differences in specific areas of the brain, and a high heritability estimate (∼76%), they are not diagnostically specific. Medications, and particularly stimulant medication, have undergone rigorous studies to document their efficacy dating back to the 1970s. Likewise, behavioral interventions in the form of parent training and classroom programs have demonstrated robust efficacy during the same time period. Both medication and behavioral interventions are symptomatic treatments. The availability of only symptomatic treatments places ADHD in the same category as other chronic conditions such as diabetes and asthma. Successful treatment of most individuals requires ongoing adherence to the therapy. Improved communication between patients and their families, primary and mental health providers, and school personnel is necessary for effective ADHD treatment. Further enhancement of electronic systems to facilitate family, school, and provider communication can improve monitoring of ADHD symptoms and functional performance. The American Academy of Pediatrics ADHD guidelines were initially developed to help primary care clinicians address the needs of their patients with ADHD and were further refined with the second revision in 2019.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Comportamento Infantil , Sistemas de Apoio a Decisões Clínicas , Manual Diagnóstico e Estatístico de Transtornos Mentais , História do Século XX , História do Século XXI , Humanos , Poder Familiar , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Software , Transição para Assistência do Adulto
14.
Psychiatr Danub ; 31(Suppl 3): 265-275, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488739

RESUMO

BACKGROUND: Neurostimulation techniques are potential methods of treating ADHD, involving stimulation of brain areas showing abnormal activity in ADHD. They are associated with benefits that last longer with fewer side effects. This literature review will evaluate the effectiveness of these methods. SUBJECTS AND METHODS: A literature search using scientific databases including PubMed and the Cochrane Library, using "ADHD" and "Attention Deficit Hyperactivity Disorder" combined with "Transcranial Magnetic Stimulation", "TMS", "Transcranial Direct Current Stimulation", "tDCS", "Vagus Nerve Stimulation", "VNS", "Trigeminal Nerve Stimulation", "TNS", "Deep Brain Stimulation", "DBS", "Electroconvulsive Therapy", "ECT", "Ultrasound stimulation" as keywords was conducted, yielding 417 references, 30 of which are used in this paper. RESULTS: Mixed results have been found in the effectiveness of neurostimulatory methods in treating ADHD. CONCLUSIONS: Neurostimulation techniques have potential in treating ADHD, with some studies having positive results. More research using greater sample sizes and standardised outcome measures could be done to verify the results of previous studies.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Estimulação Encefálica Profunda , Eletroconvulsoterapia , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Estimulação do Nervo Vago , Humanos
15.
Bull Menninger Clin ; 83(3): 278-300, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31502874

RESUMO

Youth with autism spectrum disorder (ASD) present with deficits in both social cognition and executive functioning (EF), which contribute to social impairment. Autistic youth are also frequently diagnosed with comorbid attention-deficit/hyperactivity disorder (ADHD), a disorder that, like ASD, includes impaired EF and social functioning. The comorbidity of ASD and ADHD may result in compounded social impairment, but prior research has not sufficiently evaluated the extent to which this comorbidity profile responds to evidence-based intervention targeting social deficits. It is conceivable that dually targeting EF and social cognition impairment will be more impactful than direct social skills training alone. The authors present an integrative model for intervention programming that examines pathways to social impairment in order to more effectively improve social skills and thereby impact both proximal (e.g., emotion expression, current peer relationships) and more distal outcomes (e.g., depression, self-esteem) in youth with ASD and other neurodevelopmental disorders.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Espectro Autista/terapia , Disfunção Cognitiva/terapia , Função Executiva , Psicoterapia , Percepção Social , Habilidades Sociais , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Espectro Autista/complicações , Criança , Disfunção Cognitiva/etiologia , Humanos
16.
Tijdschr Psychiatr ; 61(7): 477-487, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31372969

RESUMO

BACKGROUND: Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur in adults. Together, they complicate diagnosis and can negatively influence treatment outcome.
AIM: To develop a practical guide to assist professionals with the screening, diagnosis and treatment of adult patients with SUD and ADHD.
METHOD: A literature search and a consensus procedure between several international scientific and clinical experts. This manuscript is an adapted and summarized Dutch version of the International consensus statement on screening, diagnosis and treatment of patients with SUD and comorbid ADHD.
RESULTS: The routine use of adequate screening tools enables ADHD to be detected earlier in adults with SUD. The diagnostic process for ADHD should be initiated as soon as possible in patients with SUD. Integrated treatment, involving a combination of pharmacotherapy and psychotherapy, is preferred. Long-acting stimulants with up-titration to higher dosages may be considered.
CONCLUSION: Early detection of ADHD in patients with SUD is essential for adequate diagnosis and more effective treatment and follow-up for these patients.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Comorbidade , Consenso , Humanos , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
17.
Psychiatr Prax ; 46(6): 317-323, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31408892

RESUMO

OBJECTIVE: Data on the quality and structure of outpatient care for adults with ADHD in Germany are scarce. The study describes the reality of care and identifies possible measures for improvement. METHOD: A complete survey of adults ≥ 18 years of age with a diagnosis of ADHD (ICD-Code F90.0) covered by statutory health insurance was carried out in the outpatient setting in the German Free State of Bavaria in 2012. RESULTS: The analysis revealed a diagnostic prevalence of ADHD in adults in Bavaria of 0.1 %, which was lower than expected based on ADHD prevalence estimates in the general population (about 3 %). Patients were diagnosed by specialists for CNS disorders and by general practitioners. About 30 % of patients received a medication approved for the treatment of ADHD, and these were in approx. 75 % of cases prescribed by specialists for CNS disorders. About 50 % of the patients received psychotherapy. CONCLUSION: General practitioners play an important role for medical care of adult patients with ADHD. Continuous medical education programmes and collaboration between general practitioners and specialists is an urgent imperative for improving outpatient care of ADHD in adults.


Assuntos
Assistência Ambulatorial/normas , Transtorno do Deficit de Atenção com Hiperatividade , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Análise de Dados , Alemanha , Humanos , Qualidade da Assistência à Saúde , Estudos Retrospectivos
18.
Cyberpsychol Behav Soc Netw ; 22(9): 588-596, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31441667

RESUMO

This study examined both children with attention deficit hyperactivity disorder (ADHD) and typically developing students in dynamic measures of intelligence through the use of a virtual avatar. Three conditions were compared: in the first condition, the avatar simply gave the instructions; in the second condition, the avatar presented the instructions and gave feedback on the attention of the learner; in the third condition, the avatar was not presented. Results indicated that ADHD subtypes do not differ in problem solving and the interactive avatar improved the performance of groups with ADHD in the dynamic intelligence test. Overall, these results support the hypothesis that the function of regulation and feedback of the avatar improve the attention process and, consequently, boosts performance.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Retroalimentação , Testes de Inteligência , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Humanos
19.
Psychiatr Pol ; 53(2): 419-432, 2019 Apr 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-31317967

RESUMO

OBJECTIVES: The assessment of changes in the general health, sense of coherence and stress coping styles in parents of children and adolescents with ADHD, participating in 12-week Workshops for Parents of Hyperactive Children. METHODS: The experimental group included 186 mothers and 139 fathers (parents of 199 children); the reference group included 23 mothers and 19 fathers (parents of 24 children), attending 1-2 standard medical visits within a 12-week period (treatment as usual). Parents from both groups were assessed twice using (1) the General Health Questionnaire (GHQ), (2) the Life Orientation Questionnaire (SOC-29), and (3) the Coping Inventory for Stressful Situations (CISS). RESULTS: (1) The experimental group showed a significant improvement in the severity of somatic symptoms and anxiety/insomnia in mothers and the general well-being of mothers and fathers. We observed the influence of workshops on manageability and reduction of the emotion-oriented coping in mothers; (2) the participation in the workshops was associated with a statistically significant effect (mostly moderate) in relation to general health of mothers, while TAU was mostly associated with a low or insignificant effect. CONCLUSIONS: The assessed form of interventions improves the functioning of parents of children with ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Relações Pais-Filho , Poder Familiar/psicologia , Pais/psicologia , Senso de Coerência , Adaptação Psicológica , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Feminino , Humanos , Masculino , Apoio Social , Inquéritos e Questionários
20.
Postgrad Med ; 131(7): 461-472, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31340712

RESUMO

Objective: This study examined adult attention-deficit/hyperactivity disorder (ADHD) screening and management patterns among healthcare provider (HCP) subgroups. Methods: An online survey of US-based HCPs (neurologists, n = 200; nurse practitioners [NPs], n = 100; psychiatrists, n = 201; primary care physicians [PCPs], n = 201) was conducted from May to June 2017. The survey assessed issues relating to adult ADHD screening and management and HCP perceptions of factors influencing patient choice of pharmacotherapy. Participants were required to be experienced in diagnosing and/or treating ADHD in adults (≥5 patients/month for neurologists and NPs; ≥10 patients/month for psychiatrists and PCPs). Results: Significantly greater percentages of psychiatrists than non-psychiatrists were confident in diagnosing ADHD (P < 0.001) and screened/evaluated for ADHD in patients with depression/anxiety disorders (P < 0.001). Significantly greater percentages of psychiatrists versus non-psychiatrists prescribed once-daily long-acting (LA) stimulants (71.6% vs 62.2%; P = 0.023) or short-acting (SA) stimulants more than once daily (40.3% vs 29.7%; P = 0.009) as first-line therapy. In contrast, a significantly greater percentage of non-psychiatrists than psychiatrists prescribed once-daily SA stimulants (32.9% vs 17.4%; P < 0.001). Psychiatrist and non-psychiatrist HCPs viewed insurance coverage/treatment costs (79.9%), perceived duration of effect (72.2%), and side effects (66.5%) as important factors to patients when choosing treatment. HCPs reported that the greatest mean ± SD percentages of patients changed their treatment regimen in the past 6 months because of perceptions of insufficient duration of effect (35.4% ± 22.1%) and lack of efficacy (30.3% ± 21.0%). Conclusion: Compared with psychiatrists, non-psychiatrists exhibited less confidence in diagnosing adult ADHD and experienced greater difficulty determining optimal treatment regimens.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Atitude do Pessoal de Saúde , Estimulantes do Sistema Nervoso Central/uso terapêutico , Psicoterapia , Adulto , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Neurologistas , Profissionais de Enfermagem , Médicos de Atenção Primária , Padrões de Prática Médica , Psiquiatria
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