[What combination of symptoms according to parents and teachers would be more reliable for the diagnosis of ADHD?]. / ¿Cuál es la combinación de síntomas según padres y maestros más fiable para el diagnóstico de TDAH?

INTRODUCTION: The polythetic method used in the DSM is the one proposed traditionally for the diagnosis of Attention Disorders with or without Hyperactivity (ADHD). However, it is possible that the approach which aggregates any combination of 6 items won't be the optimal method to establish a diagnosis of ADHD, and that the different combinations may not be the same as regards to their ability to predict ADHD. AIM: Determine which combinations of items of DuPaul's inattention and hyperactivity-impulsivity scales (from parent and teacher versions), are the most effective to predict or rule out a diagnosis of ADHD. RESULTS: Not every combination of items from parents and teachers obtained the same predictive value. All of them offered high levels of specificity, but had low sensivity; that is to say, the combinations were more effective and reliable for ruling out the disorder than predicting it. CONCLUSIONS: Data show that not every combination of ADHD items has the same predictive value and, therefore, the well-known polythetic method is disputable. The highest predictive value combinations, limitations of the study, and future lines of investigation are analyzed.

[A study of primary school teachers' knowledge of attention deficit hyperactivity disorder]. / Estudio de los conocimientos de los maestros de educacion primaria sobre el trastorno por deficit de atencion/hiperactividad.

INTRODUCTION: The high prevalence of attention deficit hyperactivity disorder (ADHD), with at least one pupil per classroom, poses a challenge for all the professionals in contact with them, especially for teachers. AIM: To examine how much primary school teachers know about ADHD in three areas (general information, symptoms and diagnosis, and treatment). SUBJECTS AND METHODS: 125 primary school teachers from different communities answered the Knowledge of Attention Deficit Hyperactivity Disorder Scale (KADDS). RESULTS: The teachers answered fewer than half the items correctly, the symptoms and diagnosis subscale being the one where they were seen to be most knowledgeable. Teachers who had had children with ADHD in class displayed greater knowledge in the areas of general information and treatment, but less on the symptoms and diagnosis subscale. 32.8% of the teachers reported feeling somewhat or totally unable to teach children with ADHD in an effective way and recommend special education as a better educational style. Teachers with specific training in ADHD obtained better scores than those who had not received such instruction. CONCLUSION: Teachers with training in ADHD are more knowledgeable and more confident about their abilities when it comes to teaching children with ADHD.

TITLE: Estudio de los conocimientos de los maestros de educacion primaria sobre el trastorno por deficit de atencion/hiperactividad.Introduccion. La alta prevalencia del trastorno por deficit de atencion/hiperactividad (TDAH), con al menos un alumno por aula, supone un reto para todos los profesionales que estan en contacto con ellos, en especial para los maestros. Objetivo. Examinar los conocimientos de los maestros de educacion primaria sobre el TDAH en tres areas (informacion general, sintomas y diagnostico, y tratamiento). Sujetos y metodos. Un total de 125 maestros de educacion primaria de varias comunidades cumplimentaron la Knowledge of Attention Deficit Hyperactivity Disorder Scale (KADDS). Resultados. Los maestros contestaron de forma correcta a menos de la mitad de los items, y la subescala de sintomas y diagnostico es donde mas conocimientos demostraron. Los maestros que habian tenido niños con TDAH en clase mostraron mas conocimientos en las areas de informacion general y tratamiento, pero no en la subescala de sintomas y diagnostico. Un 32,8% de los maestros describe sentirse poco o nada capaz de enseñar eficazmente a niños con TDAH y recomienda la educacion especial como mejor estilo educativo. Los maestros con formacion especifica en TDAH obtuvieron mejores resultados en la KADDS en comparacion con los maestros sin formacion. Conclusion. Los maestros formados en TDAH demuestran un mayor grado de conocimiento y aumenta su confianza para llevar a cabo la labor educativa de los niños con TDAH.

[ADHD Rating Scale-IV in a sample of Spanish schoolchildren: normative data and internal consistency for teachers and parents]. / ADHD Rating Scale-IV en una muestra escolar española: datos normativos y consistencia interna para maestros, padres y madres.

INTRODUCTION: The ADHD Rating Scale-IV (ADHD RS-IV) is one of the most use scales for attention deficit hyperactivity disorder (ADHD), because has cut-off point regarding age, gender and setting, but the normalization data is based on American school samples. AIM: Evaluation of cut-off point of ADHD-RS-IV for parents and teachers in a Spanish sample. SUBJECTS AND METHODS: The study used the score of ADHD-RS-IV from a prevalence study of ADHD in school children of 6-12 years. Using an intrasubject design between the three evaluators (parents and teachers) and the results of each subscale (IN, H/I, and TOT) according to gender and age factors. Then, we analyzed the reliability and internal consistency for each subscale and evaluator. RESULTS: There are no significant differences between the father and the mother; but there are between teachers, and father and/or mother scores. In relation to gender factor, boys' score is higher on inattention and hyperactivity-impulsivity than girls'. Our results show a reversal tendency in comparison with the American samples, in our case parents' scores were significantly higher than teachers'. CONCLUSION: The use and normalization of the ADHD RS-IV will need to account not only for age, gender and setting but also for socio-cultural aspects.

[Estimation of the prevalence of attention deficit hyperactivity disorder among the standard population on the island of Majorca]. / Estimación de la prevalencia del trastorno por déficit de atención e hiperactividad en población normal de la isla de Mallorca.

AIM: To determine the rate of prevalence of attention-deficit/ hyperactivity disorder (ADHD) in children of school age (6-11 years) in the Island of Mallorca. SUBJECTS AND METHODS: The epidemiological study was conducted using a community sample extracted by means of multi-stage stratified sampling according to areas (rural, city and touristy) and schooling (public, private and concerted) and consisted in 1,509 children of both sexes. The ADHD Rating Scales-IV (ADHD RS-IV) for home and school setting were used to collect data. The optimal approach to do a diagnostic evaluation, according with the literature, was using a cut-off point of 90 centil. RESULTS: The estimated prevalence of ADHD was 4.57% (CI at 99%: 3.0-5.8%) and we also obtained 1.26% for the hyperactive subtype, 1.06% for the disattentional subtype, and 2.25% for the combined subtype. Contrary to what was expected, prevalence was higher for females but no statistically significant. There were no statistically significant differences between levels, schools or areas. CONCLUSIONS: The estimates for prevalence found in this study are consistent with those reported in the literature (between 3-5%). Using the ADHD rating scale which has different cut-off point regarding age, sex and setting and the fact that it was a poblational based study could explain the higher prevalence in the females. We propose a normalization of the scales in our area in other to confirm our findings.

[Current state of the attention deficit hyperactivity disorder approach in neuropediatrics]. / Estado actual del enfoque del trastorno por deficit de atencion/hiperactividad en neuropediatria.

AIM: To know the current state of the approach of attention deficit hyperactivity disorder (ADHD) in neuropediatricians. SUBJECTS AND METHODS: A telematic survey was carried out to collect preliminary information on the interest, difficulties in the management and treatment of ADHD to the 437 fellowship of the Neuropediactric Spanish Society (SENEP). RESULTS: Only 32.49% of the sent questionnaires were answered, with important geographic variability. 97.89% stated that 50% of their consultations were children with learning disabilities and ADHD. Regarding who started treatment for ADHD in their area, the majority answered that the neuropediatrician (57.97%), followed by the child psychiatrist (34.78%) and the primary care pediatrician (5.31%). The lack of a psycho-pedagogical study by the school (49.79%), followed by the lack of time in the consultation (29.11%), was cited as the greatest difficulty in the initial assessment of children with suspected ADHD. Concerning the difficulties in the follow-up, the biggest complaint was the lack of coordination between professionals, the school and parents. And, lastly, regarding the type of treatment use, most patients were on prolonged-release methylphenidate, a stable percentage using immediate release methylphenidate as a single or combined treatment, and in a lower range was the use of clonidine and atomoxetine, and an incipient use of lisdexamphetamine were observed. 80% of the patient showed adherence to pharmacological treatment after one year. CONCLUSIONS: It is necessary to advance in the training and continuous education of our neuropediatric specialists in ADHD and to homogenize the clinical practice and coordination with education system in the Spanish territory.

TITLE: Estado actual del enfoque del trastorno por deficit de atencion/hiperactividad en neuropediatria.Objetivo. Conocer el estado actual del enfoque del trastorno por deficit de atencion/hiperactividad (TDAH) entre los neuropediatras. Sujetos y metodos. Se realizo una encuesta telematica que recogia informacion preliminar sobre el interes, las dificultades en el manejo y el tratamiento del TDAH a los 437 socios de la Sociedad Española de Neurologia Pediatrica. Resultados. Respondio un 32,49% de los cuestionarios enviados, con una importante variabilidad geografica. El 97,89% afirmo que el 50% de sus consultas eran niños con trastornos de aprendizaje y TDAH. Respecto a quien iniciaba el tratamiento para el TDAH en su area, la mayoria contesto que el neuropediatra (57,97%), seguido del psiquiatra infantil (34,78%) y del pediatra de atencion primaria (5,31%). Respecto a las mayores dificultades para la valoracion inicial de los niños con sospecha de TDAH, se citaron la falta de un estudio psicopedagogico por parte de la escuela (49,79%), seguido de la falta de tiempo en la consulta (29,11%). Sobre las dificultades en el seguimiento, la mayor queja se produjo por la falta de coordinacion entre los profesionales, la escuela y los padres. Respecto a la medicacion, la mayoria de los pacientes se encontraba en tratamiento con algun tipo de metilfenidato de liberacion prolongada, un porcentaje estable utilizaba metilfenidato de liberacion inmediata como tratamiento unico o combinado, y se observo en un rango inferior el uso de clonidina y atomoxetina, y un incipiente uso de lisdexanfetamina. La adhesion al tratamiento farmacologico al año fue alrededor del 80%. Conclusiones. Es necesario avanzar en la capacitacion y educacion continua de nuestros especialistas neuropediatricos en el manejo del TDAH, y en homogeneizar la practica clinica y la coordinacion con educacion en el territorio español.

[Methylphenidate in the treatment of attention-deficit/hyperactivity disorder: are we achieving an adequate clinical practice?]. / Metilfenidato en el tratamiento del trastorno por déficit de atención e hiperactividad: realizamos una práctica clínica adecuada?

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is the most frequent behavioural disorder in infancy and methylphenidate is the most widely used medication. AIM. To analyze if the use of methylphenidate allows a good clinical practice in ADHD in terms of efficacy, effectiveness, efficiency and safety. MATERIALS AND METHODS: Systematic review of the articles about therapeutic management of ADHD with methylphenidate published in secondary and primary publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. RESULTS: The main secondary information is found in the Cochrane Library, but we also detect relevant articles in Pubmed, mainly published in Journal of the American Academy of Child and Adolescent Psychiatry and Pediatrics. There are many randomized clinical trials with methylphenidate (immediate-release and extended-release methylphenidate) and some systematic review and/or meta-analysis, but these trials have some limitations (in relation to patients, interventions and outcomes) and publication bias. CONCLUSIONS: From the evidence-based analysis (and from the experience) we detect good scientific evidence that methylphenidate improve target outcomes in ADHD in the short and half-term in children (mainly 6-12 years). The treatment algorithm advises to start with methylphenidate (immediate or extended-release methylphenidate, in relation to cost-benefit parameters); when there is not response (between 10-30% of patients) or evidence of relevant secondary effects, we could consider the use of atomoxetine. There are many questions to solve based on better clinical trials: the efficacy and safety of methylphenidate in very young children and adolescents, long-term effects and the duration of the treatment.

Evaluation of hyperhomocysteinaemia in children with stroke.

Hyperhomocysteinaemia is associated with an increased risk of arterial vascular disease and thrombosis in adults. Our aim was to study the association of hyperhomocysteinaemia and stroke in children. Since some patients who had suffered a stroke developed seizures and received treatment with anti-epileptic (antifolate) drugs, we also examined the possible interaction between anti-epileptic drugs and hyperhomocysteinaemia. Plasma total homocysteine was measured in 68 children with stroke (23 of the 68 were taking anti-epileptic drugs) and 100 children undergoing anti-epileptic treatment but without history of stroke, and we compared the values with our reference values for similar ages (n = 195). Total homocysteine was determined by high profile liquid chromatography with fluorescence detection. Hyperhomocysteinaemia was defined as a homocysteine concentration above the 95th percentile for the reference values. Significant differences were found in total homocysteine values of children with stroke and those taking anti-epileptic drugs compared with our reference values for similar ages, except for the adolescent group. Total homocysteine values above the 95th percentile for the reference values were found in 36% of patients with stroke and 28% of children on anti-epileptic treatment. Total homocysteine concentrations in the 23 patients with both stroke and anti-epileptic drug treatment were similar to those of untreated patients with stroke in all age groups. In summary, systematic screening for hyperhomocysteinaemia should be included in the protocol to investigate the aetiology of stroke, even in paediatrics. Anti-epileptic treatment in children with stroke may be responsible for the mild hyperhomocysteinaemia observed in some of them. A dietary supplement of folate may be of benefit in children with stroke and in patients taking anti-epileptic drugs.

Anti-epileptic drug treatment in children: hyperhomocysteinaemia, B-vitamins and the 677C-->T mutation of the methylenetetrahydrofolate reductase gene.

The aim of the study was to observe the influence of carbamazepine and valproic acid on plasma total homocysteine and B-vitamin status and the gene-drug interaction with the 677C-->T mutation of the methylenetetrahydrofolate reductase (MTHFR) gene. Plasma total homocysteine concentrations were determined in 136 epileptic children taking anti-epileptic drugs as monotherapy. Nutritional (folate, B12 and B6 vitamins) and genetic (MTHFR 677 C-->T) determinants of plasma homocysteine were studied in a random sample of 59 of the 136 epileptic children. Total homocysteine concentrations were significantly increased (p < 0.05) and folate and vitamin B6 levels were significantly decreased (p < 0.01) in the children taking anti-epileptic drugs compared with our reference ranges. In the carbamazepine-treated group, significantly positive correlation was found between duration of treatment and homocysteine concentration (p < 0.01). Homocysteine concentrations showed a significantly negative correlation with vitamin levels (folate: p = 0.002, and vitamin B12: p = 0.017) only in the carbamazepine treated group. In children treated with carbamazepine up to 3 years, total homocysteine concentration correlated negatively only with folate (p = 0.003), while in patients treated for more than 3 years, total homocysteine correlated negatively only with vitamin B12 values (p = 0.007). The lowering action of carbamazepine treatment on folate levels seems to be associated with hyperhomocysteinaemia, which seems to be related to the homozygous condition for the MTHFR 677C-->T mutation. Valproic acid treatment, although also associated with hyperhomocysteinaemia, only shows a lowering effect on vitamin B6 levels, which seems to be independent of the MTHFR genotype.

Children with stroke: polymorphism of the MTHFR gene, mild hyperhomocysteinemia, and vitamin status.

The aim of this study was to investigate a possible association among the thermolabile polymorphism, nucleotide 677 cytosine to thymidine point mutation (677 C-->T) of the methylenetetrahydrofolate reductase (MTHFR) gene, hyperhomocysteinemia, serum folate, vitamins B12 and B6, and stroke in children. Allele and genotype frequencies for the 677 C-->T polymorphism in 21 children with stroke and 28 healthy children of the same age were studied. No differences in allelic frequency were detected between the two populations. However, the prevalence of homozygous 677 C-->T was doubled in the stroke population (28.6%) compared to the healthy group (14.3%). Total plasma homocysteine (tHcy) levels were significantly increased in children aged 2 months to 15 years with stroke compared to reference values. No association was observed between the homozygous genotype (T/T) and hyperhomocysteinemia, nor between the T/T genotype and low folate levels (below the 95th percentile) in this group of patients. Vitamin concentrations in patients were not significantly different from reference values. Significant negative correlations were found between tHcy and folate and between tHcy and cobalamin, but not between tHcy and B6 concentrations. In summary, a higher prevalence of hyperhomocysteinemia and the 677 C-->T polymorphism were observed in children with stroke, but were not always associated. The systematic study of both abnormalities in children with stroke is recommended, so that hyperhomocysteinemia of any genetic origin can be corrected with vitamin supplementation. Moreover, the 677 C-->T genotype is a strong factor for predisposition to hyperhomocysteinemia and recurrent risk of stroke that might also be prevented with folate supplementation.

Levels of hexachlorobenzene and other organochlorine compounds in cord blood: exposure across placenta.

Hexachlorobenzene (HCB) is an organochlorine compound widespread in the environment, highly lipophilic, that accumulates in biological systems. It has been suggested that it should be classified as a dioxin-like compound. Newborns are exposed to organochlorine compounds across the placenta and through breastfeeding. Although HCB is one of the most common organochlorine compounds, the transplacental transference of HCB from mother to fetus during pregnancy has been scarcely documented. This study reports the levels of HCB, dichlorodiphenyl trichloroethane (DDT) and its metabolite p,p'DDE, polychlorinated biphenyls (PCBs), and beta-hexachlorocyclohexane (beta-HCH) in 72 maternal blood samples at delivery and in 69 cord blood samples, from which 62 corresponded to mother infant pairs born between May 1997 and September 1999 in a rural area highly exposed to HCB. Results show that all newborns presented detectable levels of HCB, PCBs, and p,p'DDE, and, to a lesser extent, of beta-HCH, the HCB levels being the highest. The geometric mean of HCB was 1.1 ng/ml, ranging from 0.3 to 5.7 ng/ml. Concentrations of HCB levels in cord blood (log ng/ml) were positively associated with concentrations in maternal blood (log ng/ml) (coefficient = 0.45, P < 0.01). Gestational age was not associated with the transplacental transfer of HCB. Maternal p,p'DDE and beta-HCH levels were also associated with newborn levels, but levels of PCBs were not. We conclude that HCB, similar to other organochlorinated compounds, has a transplacental transfer.

[The role of resistance to C active protein (R-APC) in a pediatric stroke]. / Papel de la resistencia a la proteína C activada (R-PCA) en el ictus pediátrico.

INTRODUCTION: Activated protein C resistance is a recently identified thrombophylic state which results from a mutation in the factor V gene and has been shown to be an important risk factor for peripheral venous thrombosis. We report a case of paediatric stroke in whom we have identified APC resistance. CLINICAL CASE: A boy presented acutely at the age of 6 years with a severe right sided headache, vomiting, unsteadiness and drowsiness which worsened over a period of 40 hours. Prior to this episode, he was neurologically and developmentally normal except for occasional headaches. CT showed low attenuation in the left cerebellar hemisphere, and occipital lobe associated with acute hydrocephalus. Excision biopsy of the left cerebellar cortex revealed inflammation and possible infarction. Although he remained in a 'locked-in' state with a flaccid quadriparesis for six months, he improved and was left with a left side hemiplegia, multiple cranial nerve palsies and a visual field defect. He represented at the age of thirteen years with transient ischaemic attacks and was found be heterozygous for the factor V Leiden mutation. Since he has been warfarinised, his symptoms have improved. CONCLUSIONS: Although cerebellar stroke in childhood is rare, it has been underdiagnosed in the past. As recurrence is common, patients should be fully investigated and followed up long term. Screening for new factor such as APC-resistance is recommended.

[Risk factors in cerebrovascular disease in childhood]. / Factores de riesgo en la enfermedad cerebrovascular en la infancia.

INTRODUCTION: The etiopathogenesis of cerebrovascular diseases in paediatrics is little known and very varied. Review of the literature gives little practical information about how to investigate a paediatric patient who presents with an acute cerebrovascular illness. OBJECTIVES: To identify the risk factors for cerebrovascular accidents in the paediatric age group in our setting and establish guidelines as to how best to act. PATIENTS AND METHODS: A retrospective study was made of the patients admitted to the Hospital San Joan de Deú in Barcelona between January 1984 and December 1995 with the diagnosis of ischemic or hemorrhagic cerebral infarct. RESULTS: A total of 141 cases were identified. Sixty specific causes (43.7%) were detected, of which cardiopathies made up the biggest etiological group. Risk factors for cerebrovascular disease were found in 66% of the cases. The risk factors most often identified were association with non-specific (22) and specific (varicella: 7 cases) viral infections; moderate dehydration (10); mild head injuries (10) and situations of stress (9). There were prethrombotic factors in 32.8% of the patients and anaemia in 29%. The high percentage of the anti Cytomegalovirus (67.1%) was of doubtful significance, and the percentage rose to 82.8% in the patients who died (29/35). In this study the role of hyperhomo-cysteinemia and resistance to C activated protein could not be assessed. CONCLUSIONS: In this study we identified the risk factors for cerebrovascular disease in the paediatric age group of our population. Stroke in the paediatric age group is probably due to a combination of several risk factors which will need structured protocols for identification. It is important to recognize these causes so as to plan strategies for action during the acute phase and to prevent recurrence, as are currently available to the adult population.

[Attention deficit disorder and hyperactivity: a pattern of evolution?]. / Trastorno por déficit de atención/hiperactividad: un patrón evolutivo?

INTRODUCTION: When the frequency of a gene in the general population exceeds 1%, is not considered a random mutation but a mutation that has been positively selected during evolution. The high prevalence of attention deficit/hyperactivity disorder (ADHD) from 5-10% and its association with the seven-repeat allele of DRD4, which is positively selected in evolution, raising the possibility that ADHD increases the reproductive fitness of the individual and/or group. One of the main characteristics of ADHD is its diversity and is a well recognized fact that diversity confers many benefits to a population (eg. immunity). DEVELOPMENT: This article discusses the various studies that support this hypothesis and offers further explanations on the prevalence, age distribution and sex distribution of the severity and heterogeneity of ADHD. CONCLUSION: It is possible that the presence of altered gene combinations, as in ADHD, can bring concrete benefits to society but are detrimental to the individual.

[Oppositional defiant disorder: aspects related to sex differences and informant]. / Trastorno negativista desafiante: aspectos relacionados con el sexo y el evaluador.

INTRODUCTION: Oppositional defiant disorder (ODD) is one of the most common externalizing disorders in childhood. ODD prevalence global rates vary from 2% to 16%. Along with conduct disorder and attention deficit disorder, ODD is one of the leading reasons for referral to neuropediatric and psychiatric services. Even though ODD has recognized clinical importance, key aspects of its conceptualization and prevalence in childhood and adolescence remain uncertain. DEVELOPMENT: We examine previous research findings of ODD prevalence and analyze sex differences and differences according to informants. CONCLUSIONS: ODD prevalence rates present high variability. A number of studies suggest that ODD is more common in boys than in girls. Nevertheless, some authors point that this sex differences may be due to methodological bias. We recommend the validation of an ODD scale that has into consideration the following aspects: level of the subject's development (age), gender and environment.

[Attention deficit hyperactivity disorder: the state of the matter and further research approaches]. / Trastorno por déficit de atención/hiperactividad:estado de la cuestión y futuras líneas de investigación.

AIM: This paper is a review on the state of affairs of attention deficit hyperactivity disorder. DEVELOPMENT: In the first section, the authors review the limitations and controversies in the fields of the prevalence, etiology, diagnostic criteria and comorbidities. In the second part, there is an update of the latest findings in the field of the neurobiological bases, the genetic etiology, the relevance of the evaluation of the executive functions and the effectiveness of drug therapies, behavioral and others alternatives therapies. The authors have selected the most relevant recently published bibliography and addressed in a schematic way, disputes or outstanding issues with a greater emphasis on the lines of research more relevant in the near future.

[Soft neurological signs: are they of any value in the assessment and diagnosis of attention deficit hyperactivity disorder?]. / Signos neurológicos blandos:¿tienen alguna utilidad en la evaluación y diagnósticodel trastorno por déficit de atención/hiperactividad?

INTRODUCTION: The association between difficulties on motor skills, visual-hand coordination and excess motor activity was described previously of being established the attention-deficit/hyperactivity disorder (ADHD) as a diagnostic category. These disorders have been grouped under different terminologies, being one of them the soft neurological signs (SNS). Traditionally, the European scientific community has put more attention on the SNS than the American one. However, nowadays there are a lot of neuropediatrician and community pediatrician that continue to think that those deficits, together with inattention and hyperactivity, form part of the same disorder. DEVELOPMENT: In this article we have tried to do a neurobiological revision of the movement and the possible relationship between motor problems and cognitive processes from different points of view: neuroanatomical, findings on different clinical examination tests and neuropsychological experimental models. CONCLUSION: Most of the revised articles conclude that the SNS prevalence is greater in ADHD children compared with control. Therefore we recommend to include the SNS in the evaluation and diagnosis protocols of these disorders in order to improve the sensitivity and specificity of the diagnosis and to be able to evaluate the real needs of the ADHD patients.

[The predictive value of DSM-IV criteria in the diagnosis of attention deficit hyperactivity disorder and its cultural differences]. / Valor predictivo de los criterios del DSM-IV en el diagnóstico del trastorno por déficit de atención/hiperactividad y sus diferencias culturales.

INTRODUCTION: The most common method used to diagnose attention deficit/hyperactivity disorder (ADHD) is based on the Diagnostic and statistic manual of mental disorders, 4th edition (DSM-IV) criteria. Nevertheless, it is more likely that the categorical system postulated by DSM-IV is not the most appropriate method as it does not consider the possible differences between the diagnostic capacity of the 18 proposed criteria. AIM. To analyze the predictive power of each DSM-IV diagnostic symptoms/criteria for ADHD using DuPaul's ADHD Parent and Teacher Rating Scales. PATIENTS AND METHODS: In a prospective, poblational study to evaluate the prevalence of ADHD the positive predictive power of each item was analyzed for each subtype and informant. A kappa index was applied for positive predictive power to correct the number of accurate predictions based on chance factors, and a ranking of items was established to determinate which ones offered the highest predictive power, comparing parent and teacher ratings. RESULTS: The results suggest that not all DSM-IV criteria are equal with regard to their ability to predict ADHD. The predictive power varies as a function of the informant. Parent and teachers agreed more on hyperactivity and impulsivity items, and showed more significant differences with regard to the American sample. CONCLUSIONS: The approach that aggregates any combination of items will not be the more effective strategy for ruling in a diagnosis of ADHD. To improve the clinical value of these scales making item combinations is recommended, the ones that will have attached a higher clinical weight for ruling in a diagnosis of ADHD.

[Prenatal cerebrovascular accidents: their incidence, pathogenesis and risk factors]. / Accidentes cerebrovasculares prenatales: incidencia, patogénesis y factores de riesgo.

INTRODUCTION: Prenatal stroke appears to have different risk factors, clinical characteristics, and outcomes than other perinatal or childhood stroke syndromes. DEVELOPMENT: Fetal stroke is defined as any cerebrovacular episode that occurs between 14 weeks of gestation and the onset of labor resulting in delivery, has been associated with postnatal epilepsy, mental retardation, and cerebral palsy. The entity is caused by antenatal ischemic, thrombotic, or hemorrhagic injury. A better understanding of those risk factors predisposing a fetus to cerebral infarction may provide a basis for future intervention for prevention and therapy. We will review the incidence, definition, pathogenesis, and risk factor of this entity that is more and more recognized. CONCLUSION: The analysis of this data will allow us to compare different method of evaluation and to draw conclusion of possible screening method and early detection.

[The prevalence of attention deficit hyperactivity disorder]. / Prevalencia del trastorno de déficit de atención e hiperactividad.

INTRODUCTION: Hyperactivity is a common, genetically-based disorder in childhood in which a number of neurological and psychological factors that give rise to attentional disorders, impulsiveness and motor overactivity are involved. DEVELOPMENT: The prevalence rate of attention deficit hyperactivity disorder (ADHD) is a controversial matter. Although the DSM-IV gives an interval of between 3 and 5%, which is probably the value that is most widely accepted by the scientific community, there is in fact a very high degree of variability. According to different authors, an interval of 2-30% is obtained in the general population. In Anglo-Saxon countries the most commonly accepted prevalence of this entity is 5%, but few studies have been conducted in our country. In an epidemiological study with a community-based sample extracted by multistage, stratified sampling in school-age children on the island of Majorca, the estimated prevalence of ADHD was 4.7%. The authors consider aspects concerning the prevalence of ADHD and subtypes by ages, sex, in both the clinical and community environments. CONCLUSIONS: The analysis of these data will enable us to compare the different evaluation methods used and to draw conclusions about screening and early detection methods.