[The clinical semiology of attention deficit hyperactivity disorder according to age, and the effectiveness of treatments at different ages]. / Semiología clínica del trastorno por déficit de atención con hiperactividad en función de la edad y eficacia de los tratamientos en las distintas edades

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is the most important cause of poor academic performance and is also usually associated with behavioural, emotional and sociability disorders. AIM: To analyse the different clinical features and the response to psychostimulant therapy, according to the age. SUBJECTS AND METHODS: We reviewed the cases of 152 children referred to Neuropaediatrics owing to suspected ADHD over a 6-year period. Diagnosis and comorbidity were investigated by the looking at their case history, by examination and observation, as well as by interviewing the parents (DSM-IV criteria), and by applying Conners' Rating Scale for parents and teachers, in addition to neuropsychological tests. In order to improve data processing, we established four groups according to the patient's age at diagnosis and when treatment was started: G1: 3-5; G2: 6-8; G3: 9-11; and G4: 12-15 years. RESULTS: ADHD was diagnosed in 102 of the 152 children; 53% had the combined type, 26% were of the inattentional type, and 20% were hyperactive/impulsive. Poor school performance increased with age and reached 75% in G4. The same occurred with conduct disorders: at 6 years of age, 23% were found to have oppositional defiant disorder, and from the age of 9 onwards over 60% of them had conduct disorders. Up until 12 years of age they showed some improvement with psychostimulants and later the rate of dropouts from medical clinical controls and from treatment was over 40%. CONCLUSIONS: The older patients are and the later ADHD is attended, the more problems they have. If successful preventive measures are to be implemented, it would be advisable to begin treatment even before children start primary education (5 years old), so as to try and avoid the pedagogical and behavioural repercussions observed in these children at the age of 6.

[Neuromagnetic correlates of dyslexia]. / Correlatos neuromagnéticos de la dislexia.

Dyslexia was first described over a century ago and since then many theories have been put forward to explain it, but we still do not have one single unified theory that explains the problem. Furthermore, over the years a great deal of research work has also been carried out that relates dyslexia with disorders in different brain structures, and yet we still do not have a clear idea of exactly which neurophysiological mechanisms are involved. It has been claimed, however, that the disorder may be caused by specific deficits in the left frontotemporal region or atypical asymmetries in the left perisylvian regions. Lastly, neuroimaging techniques, such as functional magnetic resonance or mapping of the electrical activity in the brain, have helped to further studies into dyslexia over the last decade. Recently, the introduction of magnetoencephalography in the study of the brain has opened up a whole new range of possibilities that will allow most of the controversial points raised by research into dyslexia using neuroimaging techniques to be resolved empirically.

Semiología clínica del trastorno por déficit de atención con hiperactividad en función de la edad y eficacia de los tratamientos en las distintas edades / The clinical semiology of attention déficit hyperactivity disorder according to age, and the effectiveness of treatments at different ages

Introduction. Attention deficit hyperactivity disorder (ADHD) is the most important cause of poor academic performance and is also usually associated with behavioural, emotional and sociability disorders. Aim. To analyse the different clinical features and the response to psychostimulant therapy, according to the age. Subjects and methods.We reviewed the cases of 152 children referred to Neuropaediatrics owing to suspected ADHD over a 6-year period. Diagnosis and comorbidity were investigated by the looking at their case history, by examination and observation, as well as by interviewing the parents (DSM-IV criteria), and by applying Conners’ Rating Scale for parents and teachers, in addition to neuropsychological tests. In order to improve data processing, we established four groups according to the patient's age at diagnosis and when treatment was started: G1: 3-5; G2: 6-8; G3: 9-11; and G4: 12-15 years. Results. ADHD was diagnosed in 102 of the 152 children; 53% had the combined type, 26% were of the inattentional type, and 20% were hyperactive/impulsive. Poor school performance increased with age and reached 75% in G4. The same occurred with conduct disorders: at 6 years of age, 23% were found to have oppositional defiant disorder, and from the age of 9 onwards over 60% of them had conduct disorders. Up until 12 years of age they showed some improvement with psychostimulants and later the rate of dropouts from medical clinical controls and from treatment was over 40%. Conclusions. The older patients are and the later ADHD is attended, the more problems they have. If successful preventive measures are to be implemented, it would be advisable to begin treatment even before children start primary education (5 years old), so as to try and avoid the pedagogical and behavioural repercussions observed in these children at the age of 6 (AU)

Introducción. El trastorno por déficit de atención con hiperactividad (TDAH) es la causa más importante de fracaso escolar, y suele asociarse además a trastornos de conducta, emocionales y de sociabilidad. Objetivo. Analizar las distintas manifestaciones clínicas y la respuesta al tratamiento con psicoestimulantes, en función de la edad. Sujetos y métodos. Se revisan 152 niños remitidos a Neuropediatría por sospecha de TDAH en 6 años. El diagnóstico y la comorbilidad se investiga mediante anamnesis, exploración y observación, entrevista a padres (criterios DSM-IV), cuestionario de Conners para padres y profesores, y pruebas neuropsicológicas. Para mejor tratamiento de los datos, realizamos cuatro grupos según la edad al diagnóstico e inicio del tratamiento: G1: 3-5; G2: 6-8; G3: 9-11 y G4: 12-15 años. Resultados. De los 152 niños, se diagnosticó TDAH en 102; el 53% fueron de tipo combinado, el 26% inatencional, y el 20% hiperactivo/impulsivo. El mal rendimiento escolar aumenta con la edad, y un 75% es en el G4. Lo mismo sucede con los trastornos de conducta: a los 6 años ya encontramos un 23% de trastorno negativista desafiante, y a partir de los 9 años más de un 60% presentan trastornos de conducta. Mejoran con psicoestimulantes un 70% hasta los 12 años, y, después, el índice de abandono del control clínico médico y del tratamiento es de más de un 40%. Conclusiones. Cuanto mayores y más tarde se atienden los TDAH, más problemas tienen. La prevención hace conveniente empezar el tratamiento incluso antes de iniciar la educación primaria (5 años), en un intento de evitar las repercusiones pedagógicas y conductuales observadas ya a los 6 años en estos niños (AU)

Correlatos neuromagnéticos de la dislexia / Neuromagnetic correlates of dyslexia

Hace más de un siglo que se describió la dislexia y, en esee tiempo, han sido muchas las teorías que se han escrito, sin que tengamos todavía una teoría única y unificada sobra la misma. Por otro lado, a lo largo de este tiempo también han sido muchos los trabajos de investigación que han relacionado la dislexia con alteraciones en diferentes estructuras cerebrales, sin que, hasta el momento, tengamos tampoco una idea clara de cuáles son los mecanismos neurofisiológicos implicados en la misma, aunque se apuntan como causa déficit específicos frontotemporales izquierdos o con asimetrías atípicas en las regiones perisilvianas izquierdas. Por último, las técnicas de neuroimagen, como la resonancia magnética funcional o la cartografía de la actividad eléctrica cerebral, han contribuido en la última década a profundizar en el estudio de la dislexia. Recientemente, la introducción de la magnetoencefalografía en el estudio del cerebro abre un panorama inédito para la resolución empírica de buena parte de las controversias suscitadas por la investigación con las técnicas de neuroimagen en la dislexia (AU)

Dyslexia was first described over a century ago and since then many theories have been put forward to explain it, but we still do not have one single unified theory that explains the problem. Furthermore, over the years a great deal of research work has also been carried out that relates dyslexia with disorders in different brain structures, and yet we still do not have a clear idea of exactly which neurophysiological mechanisms are involved. It has been claimed, however, that the disorder may be caused by specific deficits in the left frontotemporal region or atypical asymmetries in the left perisylvian regions. Lastly, neuroimaging techniques, such as functional magnetic resonance or mapping of the electrical activity in the brain, have helped to further studies into dyslexia over the last decade. Recently, the introduction of magnetoencephalography in the study of the brain has opened up a whole new range of possibilities that will allow most of the controversial points raised by research into dyslexia using neuroimaging techniques to be resolved empirically (AU)