Longitudinal associations between positive attributes and psychopathology and their interactive effects on educational outcomes.

Psychopathology is associated with impaired learning and early termination of schooling, whereas positive attributes are associated with better educational outcomes. However, it is important to understand if and how psychopathology and positive attributes longitudinally impact each other so we could shed light on where to intervene to promote educational outcomes through these constructs. A large prospective school-based community cohort of youths (5-15 years of age, 45% female) were assessed and followed up for 3 years (n = 2010; 80% retention). We assessed the longitudinal impact of positive attributes (Youth Strength Inventory) and psychopathology (bifactor model of Strengths and Difficulties Questionnaire) using a cross-lagged panel model. We also used generalized mixed effects models to investigate how these both constructs predict school dropout and literacy, adjusting for confounders and testing their interaction. Positive attributes negatively predicted, and were negatively predicted by, the general factor of psychopathology and conduct problems in the cross-lagged panel model. Positive attributes (OR = 0.57, 95% CI [0.44, 0.73], p < 0.001) and specific conduct symptoms (OR = 2.33, 95% CI [1.64, 3.33], p < 0.001) predicted school dropout, whereas the general factor of psychopathology predicted lower literacy ability (ß = - 0.08, 95% CI [- 0.11, - 0.05], p < 0.001). However, the protective association of positive attributes on school dropout decreases as the general factor of psychopathology increases. These findings provide new evidence that positive attributes and psychopathology mutually influence each other over development and have interactive effects on educational outcomes.

Association between preterm infant size at 1 year and ADHD later in life: data from 1993 and 2004 Pelotas Birth Cohorts.

The objective of this study is to examine the association between preterm infants' size at 1 year and attention-deficit/hyperactivity disorder (ADHD) assessed categorically and dimensionally in childhood and adolescence. We studied infants born < 37 weeks' gestation from two Brazilian birth cohorts (n = 653). ADHD was evaluated using the Development and Well-Being Assessment (DAWBA) interview at the age of 6 years in one cohort and by a structured interview according to DSM-5 criteria at 18 years in the other one. The presence of child attention difficulties was measured by the Strengths and Difficulties Questionnaire (SDQ) at 6 and 11 years in the 2004 and 1993 cohorts, respectively. We estimated associations of weight, length, head circumference, and BMI z-scores at 1-year chronological age with ADHD using Poisson Regression Model; and with attention difficulties using Linear Regression, adjusting for covariates. Mean birth weight was 2500 g and gestational age was 34.5 weeks. The aggregated ADHD prevalence in the two cohorts was 2.7%, and the median score for attention difficulties was 3.0. We found that increased head circumference at 1 year was associated with a lower risk of ADHD diagnosis (RR = 0.7, 95% CI 0.4, 0.9; p = 0.04 per standard deviation difference) and with fewer dimensional attention symptoms. In sensitivity analysis with other mental disorders, head circumference was associated with depression, but not with anxiety. Our findings emphasize poor head growth in the first year of life as a potential determinant of attentional difficulties in the preterm infant population.

Attention-based classification pattern, a research domain criteria framework, in youths with bipolar disorder and attention-deficit/hyperactivity disorder.

OBJECTIVE: The National Institute of Mental Health has initiated the Research Domain Criteria (RDoC) project. Instead of using disorder categories as the basis for grouping individuals, the RDoC suggests finding relevant dimensions that can cut across traditional disorders. Our aim was to use the RDoC's framework to study patterns of attention deficit based on results of Conners' Continuous Performance Test (CPT II) in youths diagnosed with bipolar disorder (BD), attention-deficit/hyperactivity disorder (ADHD), BD+ADHD and controls. METHOD: Eighteen healthy controls, 23 patients with ADHD, 10 with BD and 33 BD+ADHD aged 12-17 years old were assessed. Pattern recognition was used to partition subjects into clusters based simultaneously on their performance in all CPT II variables. A Fisher's linear discriminant analysis was used to build a classifier. RESULTS: Using cluster analysis, the entire sample set was best clustered into two new groups, A and B, independently of the original diagnoses. ADHD and BD+ADHD were divided almost 50% in each subgroup, and there was an agglomeration of controls and BD in group B. Group A presented a greater impairment with higher means in all CPT II variables and lower Children's Global Assessment Scale. We found a high cross-validated classification accuracy for groups A and B: 95.2%. Variability of response time was the strongest CPT II measure in the discriminative pattern between groups A and B. CONCLUSION: Our classificatory exercise supports the concept behind new approaches, such as the RDoC framework, for child and adolescent psychiatry. Our approach was able to define clinical subgroups that could be used in future pathophysiological and treatment studies.

Correlation between Peripheral Levels of Brain-Derived Neurotrophic Factor and Hippocampal Volume in Children and Adolescents with Bipolar Disorder.

Pediatric bipolar disorder (PBD) is a serious mental disorder that affects the development and emotional growth of affected patients. The brain derived neurotrophic factor (BDNF) is recognized as one of the possible markers of the framework and its evolution. Abnormalities in BDNF signaling in the hippocampus could explain the cognitive decline seen in patients with TB. Our aim with this study was to evaluate possible changes in hippocampal volume in children and adolescents with BD and associate them to serum BDNF. Subjects included 30 patients aged seven to seventeen years from the ProCAB (Program for Children and Adolescents with Bipolar Disorder). We observed mean right and left hippocampal volumes of 41910.55 and 41747.96 mm(3), respectively. No statistically significant correlations between peripheral BDNF levels and hippocampal volumes were found. We believe that the lack of correlation observed in this study is due to the short time of evolution of BD in children and adolescents. Besides studies with larger sample sizes to confirm the present findings and longitudinal assessments, addressing brain development versus a control group and including drug-naive patients in different mood states may help clarify the role of BDNF in the brain changes consequent upon BD.

Baseline brain volume predicts home-based transcranial direct current stimulation effects on inattention in adults with attention-deficit/hyperactivity disorder.

BACKGROUND: Home-based transcranial direct current stimulation (Hb-tDCS) is a non-invasive brain stimulation technique that utilizes low-intensity electric currents delivered via scalp electrodes to modulate brain activity. It holds significant promise for addressing inattention in adults with attention-deficit/hyperactivity disorder (ADHD). However, its effectiveness varies among individuals, and predicting outcomes remains uncertain, partially due to the influence of individual differences in ADHD-related brain anatomy. METHODS: We analyzed data from a subsample, composed by twenty-nine adult patients with ADHD, of the Treatment of Inattention Symptoms in Adult Patients with ADHD (TUNED) trial. Fourteen patients underwent active anodal right cathodal left dorsolateral prefrontal cortex (DLPFC) Hb-tDCS for 4 weeks and fifteen received sham-related tDCS intervention. Inattention outcome was evaluated at both baseline and endpoint (4th week). Baseline structural measures of the DLPFC, anterior cingulate cortex (ACC) and subcortical structures, previously associated with ADHD, were quantified. Several linear mixed models, with a three-way interaction between the fixed predictors brain volume or thickness, time, and treatment were calculated. Multiple comparison corrections were applied using the Benjamini-Hochberg method. RESULTS: Baseline volume of the left DLPFC regions middle frontal gyrus (t (25) = 3.33, p-adjusted = 0.045, Cohen's d = 1.33, 95% CI = [0.45, 2.19]), inferior frontal gyrus (orbital part) (t (25) = 3.10, p-adjusted = 0.045, Cohen's d = 1.24, 95% CI = [0.37, 2.08]), and of the left ACC supragenual (t (25) = 3.15, p-adjusted = 0.045, Cohen's d = 1.26, 95% CI = [0.39, 2.11]) presented significant association with the inattentive score improvement only in the active tDCS group. More specifically, the smaller these regions were, the more the symptoms improved following anodal right cathodal left DLPFC Hb-tDCS. CONCLUSION: Hb-tDCS was associated with greater improvement in brain areas related to attention regulation. Brain MRI can be potentially used to predict clinical response to tDCS in ADHD adults.

Computerized Cognitive Training for ADHD as an Add-On Treatment to Stimulants: A Randomized Clinical Trial.

Objective: Computerized cognitive training (CCT) as add-on treatment to stimulants for ADHD core symptoms is scarcely investigated. The purpose of this study is to assess the effect of CCT in a randomized controlled clinical trial for ADHD in children and adolescents treated with stimulants. Method: Fifty-three participants aged 6 to 13 years receiving stimulant treatment and presenting ADHD residual symptoms were randomized either to a CCT (n = 29) or to a controlled nonactive condition (n = 24) for four sessions/week during 12 weeks. The main outcome measure was inattentive symptoms assessed using the Swanson, Nolan, and Pelham-IV (SNAP-IV) Scale. Secondary outcomes include, among others, hyperactive/impulsive symptoms and cognitive tests. Results: There were neither significant group differences on ADHD-inattentive symptoms after the intervention nor on both ADHD-hyperactivity/impulsivity symptoms and cognitive measures. Conclusion: Our study does not provide evidence for the benefits of cognitive training over nonactive training on core ADHD symptoms in medicated ADHD children and adolescents.

Methylphenidate Alters Functional Connectivity of Default Mode Network in Drug-Naive Male Adults With ADHD.

Objective: This study evaluated the hypothesis that methylphenidate immediate release (MPH-IR) treatment would improve Default Mode Network (DMN) within-connectivity. Method: Resting-state functional connectivity of the main nodes of DMN was evaluated in a highly homogeneous sample of 18 drug-naive male adult participants with ADHD. Results: Comparing resting-state functional connectivity functional magnetic resonance imaging (R-fMRI) scans before and after MPH treatment focusing exclusively on within-DMN connectivity, we evidenced the strengthening of functional connectivity between two nodes of the DMN: posterior cingulate cortex (PCC) and left lateral parietal cortex (LLP). Conclusion: Our results contribute to the further understanding on how MPH affects functional connectivity within DMN of male adults with ADHD and corroborate the hypothesis of ADHD being a delayed neurodevelopmental disorder.

The prevalence of psychopathology in offspring of bipolar women from a Brazilian tertiary center.

OBJECTIVE: No previous study has assessed the occurrence of psychopathology in offspring of bipolar women from South America. The objective of this study was to assess the prevalence of psychopathology in offspring of bipolar mothers from Brazil compared with two control groups. METHOD: Children and adolescents aged 6 to 18 years of bipolar disorders mothers (n = 43), mothers with other mild to moderate mental disorders (n = 53) and mothers without any psychiatric disorder (n = 53) were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version, the Child Behavior Checklist and the Youth Self-Report. Raters were blind to the mothers' diagnoses, who were interviewed by means of the Structured Clinical Interview. RESULTS: Bipolar offspring had twice the chance of having one or more lifetime Axis I diagnoses [prevalence ratio = 2.11 (95% CI: 1.30-3.42) and p = 0.003] and 2.8 higher risk of having a lifetime anxiety disorder [prevalence ratio = 2.83 (95% CI: 1.39-5.78) e p = 0.004] than the offspring of mothers with no mental disorder. In addition, significantly higher scores on Child Behavior Checklist thought problems and Youth Self-Report social problems, as well as anxiety/depression and internalizing problems were observed. CONCLUSION: Our results confirm previous findings suggesting higher psychiatric problems in offspring of bipolar mothers and extend them to the Brazilian society.

Long-Term Efficacy of Methylphenidate Immediate-Release for the Treatment of Childhood ADHD.

OBJECTIVE: To evaluate the long-term effects of methylphenidate imediate-release (MPH-IR), and to confirm the efficacy established in previous meta-analyses of short-term studies. METHOD: Published and unpublished studies in which participants were treated with MPH-IR for 12 weeks or more were searched. Pooled effect sizes from these studies were computed with the DerSimonian and Laird random-effect model. Meta-regression analysis was conducted to estimate covariates associated with treatment effects. RESULTS: Seven studies were included. Pooled parents ratings for inattention and hyperactivity/impulsivity resulted in standardized mean difference (SMD) = 0.96 (95% confidence interval [CI] = [0.60, 1.32]) and SMD = 1.12 (95% CI = [0.85, 1.39]), respectively; pooled teachers ratings showed SMD = 0.98 (95% CI = [0.09, 1.86]) for inattention and SMD = 1.25 (95% CI = [0.7, 1.81]) for hyperactivity/impulsivity. No evidence of association of any covariates with treatment effect was detected in the meta-regression. CONCLUSION: MPH-IR is efficacious for childhood ADHD for periods longer than 12 weeks.

Computerized cognitive training in children and adolescents with attention deficit/hyperactivity disorder as add-on treatment to stimulants: feasibility study and protocol description.

Background: Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods: Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results: We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups - mainly on trained tasks. Conclusions: This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.

Desempenho em aritmética de estudantes com e sem sintomas de TDAH / Arithmetic performance in students with and without ADHD symptoms / Desempeño en aritmética de estudiantes con y sin síntomas de TDAH

O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) é um transtorno que frequentemente acarreta prejuízos ao desempenho acadêmico. O presente estudo teve como objetivo verificar a extensão desses prejuízos no desempenho aritmético, comparando estudantes com sintomas de TDAH com o de seus pares sem TDAH. O desempenho aritmético de 93 estudantes com sintomas de TDAH e 447 estudantes sem TDAH, entre 7 e 16 anos, de escolas públicas de Porto Alegre (3º a 9º ano), foi avaliado pelo Subteste de Aritmética do TDE. Estudantes com sintomas de TDAH apresentaram escores mais baixos e uma quantidade maior de erros de procedimento do que os estudantes sem o transtorno. Os resultados sugerem que sintomas frequentes de TDAH têm relação com maior ocorrência de erros no desempenho em aritmética dos estudantes avaliados neste estudo. (AU)

Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent disorder that often impairs academic performance. The present study aimed to verify the extent of these impairments in arithmetic performance by comparing the performance of students with and without ADHD symptoms. The arithmetic performance of 93 students with ADHD symptoms and 447 students without ADHD was evaluated by the Arithmetical Subtest of the School Performance Test. Participants were attending public elementary schools in the municipality of Porto Alegre (3rd to 9th grades) and their age range was 7 to 16 years old. Those with ADHD symptoms had lower scores and a higher number of procedural errors than those without ADHD. The results suggest that frequent symptoms of ADHD are related to a higher frequency of errors in the arithmetic performance of the students assessed in this study. (AU)

El Trastorno por Déficit de Atención/Hiperactividad (TDAH) es un trastorno que frecuentemente acarrea perjuicios al desempeño académico. El presente estudio tuvo como objetivo verificar la extensión de las deficiencias en el desempeño aritmético, comparando el rendimiento de estudiantes con y sin síntomas de TDAH. El desempeño aritmético de 93 estudiantes con síntomas de TDAH y 447 estudiantes sin TDAH provenientes de escuelas públicas de Porto Alegre (del 3º al 9º año) y con edades entre los 7 y los 16 años, fueron evaluados por el Subtest de Aritmética del Test de Rendimiento Escolar. Los estudiantes con síntomas de TDAH presentaron puntuaciones más bajas y una mayor cantidad de errores de procedimiento que los estudiantes sin el trastorno. Los resultados sugieren que, en los estudiantes evaluados en este estudio, los síntomas frecuentes del TDAH se relacionan con una mayor frecuencia de errores en el desempeño en aritmética. (AU)

Transcranial direct current stimulation improves short-term memory in an animal model of attention-deficit/hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is characterized by impairing levels of hyperactivity, impulsivity and inattention. However, different meta-analyses have reported disruptions in short and long-term memory in ADHD patients. Previous studies indicate that mnemonic dysfunctions might be the result of deficits in attentional circuits, probably due to ineffective dopaminergic modulation of hippocampal synaptic plasticity. In this study we aimed to evaluate the potential therapeutic effects of a neuromodulatory technique, transcranial direct current stimulation (tDCS), in short-term memory (STM) deficits presented by the spontaneous hypertensive rats (SHR), the most widely used animal model of ADHD. Adult male SHR and Wistar Kyoto rats (WKY) were subjected to a constant electrical current of 0.5 mA intensity applied on the frontal cortex for 20 min/day during 8 days. STM was evaluated with an object recognition test conducted in an open field. Exploration time and locomotion were recorded, and brain regions were dissected to determine dopamine and BDNF levels. SHR spent less time exploring the new object when compared to WKY, and tDCS improved object recognition deficits in SHR without affecting WKY performance. Locomotor activity was higher in SHR and it was not affected by tDCS. After stimulation, dopamine levels were increased in the hippocampus and striatum of both strains, while BDNF levels were increased only in the striatum of WKY. These findings suggest that tDCS on the frontal cortex might be able to improve STM deficits present in SHR, which is potentially related to dopaminergic neurotransmission in the hippocampus and striatum of those animals.

[Translation and adaptation of the Motorcycle Rider Behavior Questionnaire: a Brazilian version]. / Tradução e adaptação da escala Motorcycle Rider Behavior Questionnaire: versão brasileira.

Traffic accidents are a leading cause of death in young adults. In Brazil, traffic accidents are proportionally more prevalent among motorcyclists as compared to automobile drivers. Although numerous data indicate that individual characteristics are involved in traffic accident risk, there is no instrument in Brazil to assess motorcyclists' traffic behavior. The authors thus proposed to perform translation and cultural adaptation of the Motorcycle Rider Behavior Questionnaire (MRBQ) into Brazilian Portuguese. The translation process consisted of: two independent translations into Brazilian Portuguese; unification of the translations; back-translation into English; formal assessment of semantic equivalence; application of a summary version in a convenience sample of motorcyclists; generation of a final version; and back-translation and submission to the original author, who approved this version. The Brazilian version maintained its semantic equivalence and was accepted by the convenience sample, an important characteristic for a self-completed instrument. Further studies are necessary to evaluate the questionnaire's psychometric properties in the Brazilian cultural context.

Computerized cognitive training in children and adolescents with attention deficit/hyperactivity disorder as add-on treatment to stimulants: feasibility study and protocol description / Treinamento cognitivo para crianças e adolescentes com transtorno de déficit de atenção/hiperatividade como tratamento complementar aos psicoestimulantes: estudo de viabilidade e descrição de protocolo

Abstract Background Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups - mainly on trained tasks. Conclusions This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.

Resumo Introdução O treinamento cognitivo tem recebido atenção especial como abordagem não medicamentosa para o tratamento do transtorno de déficit de atenção/hiperatividade (TDAH) em crianças e adolescentes. Poucos estudos avaliaram o treinamento cognitivo como abordagem complementar à medicação em ensaios clínicos randomizados controlados por placebo. O objetivo deste estudo foi explorar a viabilidade para a implementação de um programa de treinamento cognitivo computadorizado, descrever suas características principais e potencial eficácia em um pequeno estudo piloto. Métodos Seis pacientes com TDAH entre 10-12 anos de idade, em uso de psicoestimulantes e apresentando sintomas residuais, foram recrutados e randomizados para um dos dois grupos (treinamento cognitivo ou placebo) por 12 semanas. O desfecho principal foram os sintomas nucleares do TDAH avaliados através do Questionário de Swanson, Nolan e Pelham (SNAP-IV). Resultados Encontramos maior resistência do que a esperada no recrutamento dos pacientes em função de problemas logísticos para atender às sessões presenciais no hospital assim como para preencherem os critérios de status medicamentoso e ausência de algumas comorbidades. Ambos os grupos apresentaram diminuição nos escores dos sintomas de TDAH reportados pelos pais, mas sem diferença estatística entre eles. Além disso, foi observada melhora nos testes neuropsicológicos em ambos os grupos - principalmente nas tarefas treinadas pelo programa. Conclusão Este protocolo revelou a necessidade de novas estratégias para melhor avaliar a eficácia do treinamento cognitivo tal como a necessidade de implementar a intervenção no ambiente escolar a fim de obter uma avaliação com maior validade externa. Devido ao pequeno tamanho amostral deste estudo, conclusões definitivas sobre os efeitos do treinamento cognitivo como abordagem complementar aos psicoestimulantes seriam prematuras.

Stress and coping in a sample of medical students in Brazil

Background Medical training is a stressing situation, making medical students vulnerable to psychiatric disorders, such as depression and anxiety. Objective The study aimed to assess the prevalence of stress and coping in students of a public medical school in Brazil, comparing the groups from the first and sixth years of training. Methods Through a cross-sectional, observational study, a sample of 232 first and sixth-year regularly registered medical students has been evaluated. Students filled a socio-demographic questionnaire, the Lipp Inventory of Stress Symptoms (ISSL), and the Coping Strategies Inventory (CSI). Results From the total sample of 232 students, 110 were first-year students and 122 sixth-year students. Stress symptoms were significantly higher in first-year students (49.1%) than in the sixth-year group (33.6%; p = 0.018). Variables significantly associated with stress were: year of the training (1st year > 6th year), income (lower > higher income), satisfaction with the training (dissatisfied > satisfied) and the use of escape/avoidance copying strategy (positive association). Discussion Considering the higher stress symptoms among first-year medical students and the positive association of the escape/avoidance copying strategy with stress, strategies must be developed to enable students starting medical school to be better at coping with this stressful situations.

Impacto do DSM-5 no diagnóstico de transtornos de aprendizagem em crianças e adolescentes com TDAH: um estudo de prevalência / The impact of DSM-5 on the diagnosis of learningdisorder in ADHD children and adolescents: a prevalence study

Estudos de prevalência de Transtornos de Aprendizagem (TA) em crianças e adolescentes com TDAH apresentam resultados não conclusivos, apesar da frequente comorbidade entre as síndromes. Esse artigo descreve e analisa a prevalência de TA em uma amostra referida de 270 crianças e adolescentes com TDAH atendidas no Programa de Transtornos de Déficit de Atenção/Hiperatividade/Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul (ProDAH/HCPA-UFRGS), de acordo com os critérios diagnósticos do Manual Diagnóstico e Estatístico de Transtornos Mentais IV - versão revisada (DSM-IV-TR). Verificou-se que 46,7% dos estudantes apresentam, pelo menos, um TA, sendo o Transtorno da Expressão Escrita o mais frequente (32,6%). Discutiu-se o potencial impacto das mudanças nos critérios diagnósticos para os TA, propostas pelo DSM-5 na prevalência desses transtornos. Embora seja possível afirmar que ocorrerão alterações nas taxas de prevalência de TA, o impacto do DSM-5 sobre a prevalência, especificidade e comorbidade do TA permanece incerto, já que há mudanças que ampliarão a abrangência dos critérios de inclusão e outras que a reduzirão. (AU)

Prevalence studies on learning disabilities (LD) in children and adolescents with Attention Deficit and Hyperactivity Disorder (ADHD) show inconclusive results, despite the frequent comorbidity between these syndromes. This article describes and analyzes the prevalence of LD in a referred sample of 270 children and adolescents with ADHD treated at Disorders Program of Attention Deficit / Hyperactivity / Hospital de Clínicas de Porto Alegre - Federal University of Rio Grande do Sul (PRODAH/HCPA-UFRGS), according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The prevalence of LD among the sample was of 46.7%. In that group, the most common LD was the Written Expression Disorder (32.6%). The impact of the changes in the diagnostic criteria for LD proposed by the DSM-5 in the prevalence of these disorders is discussed. Although changes will occur in the rates of LD prevalence, the impact of the DSM-5 on the prevalence, specificity and comorbidity of LD remains uncertain, as there are some proposed changes that will broaden the scope of the criteria and others that will reduce it. (AU)

Socio-demographic and clinical characteristics of pregnant and puerperal crack-cocaine using women: preliminary data

BACKGROUND The literature provides several studies on the effects of cocaine when exposed to the fetus. However, the majority of these data comes from animal models. OBJECTIVE The objective of this study is to present socio-demographic and clinical data in crack-cocaine using pregnant women and their babies, as compared to non-users. METHODS Cross-sectional study, comprised by 56 dyads of crack-cocaine using mothers-babies and 89 control dyads. In addition to the socio-demographic data and the babies’ information, data collection was based on ABIPEMI for socioeconomic level, WAIS for IQ, MINI for psychopathology and ASSIST for drug use. RESULTS Most crack users, in comparison to non-users, did not have a partner (10.52% vs 4.4%, P = 0.001) and presented lower IQ (78.15, +/-8.07 vs 84.27 +/- 9.87; P = 0.002). The prevalence of antisocial personality disorder and suicide risk in users was higher than in non-users (24.44% vs none, P < 0.001; 28.26% vs 10.46% P = 0.01). Most of the users did not participate in prenatal care (75%). The babies that the crack-cocaine using mothers gave birth to weighed significantly less than the controls (2.858 g vs 3.240 g, P = 0.002). DISCUSSION Users had a higher degree of psychopathology and lower attendance in prenatal care. There was an overlap of adverse factors, both for exposed mothers and babies. The sum of these vulnerabilities could result in significant harm to the developing infant. .

The prevalence of psychopathology in offspring of bipolar women from a Brazilian tertiary center / Prevalência de psicopatologia em filhos de mulheres bipolares de um centro terciário brasileiro

OBJECTIVE: No previous study has assessed the occurrence of psychopathology in offspring of bipolar women from South America. The objective of this study was to assess the prevalence of psychopathology in offspring of bipolar mothers from Brazil compared with two control groups. METHOD: Children and adolescents aged 6 to 18 years of bipolar disorders mothers (n = 43), mothers with other mild to moderate mental disorders (n = 53) and mothers without any psychiatric disorder (n = 53) were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version, the Child Behavior Checklist and the Youth Self-Report. Raters were blind to the mothers' diagnoses, who were interviewed by means of the Structured Clinical Interview. RESULTS: Bipolar offspring had twice the chance of having one or more lifetime Axis I diagnoses [prevalence ratio = 2.11 (95 percent CI: 1.30-3.42) and p = 0.003] and 2.8 higher risk of having a lifetime anxiety disorder [prevalence ratio = 2.83 (95 percent CI: 1.39-5.78) e p = 0.004] than the offspring of mothers with no mental disorder. In addition, significantly higher scores on Child Behavior Checklist thought problems and Youth Self-Report social problems, as well as anxiety/depression and internalizing problems were observed. CONCLUSION: Our results confirm previous findings suggesting higher psychiatric problems in offspring of bipolar mothers and extend them to the Brazilian society

OBJETIVO: Considerando-se a inexistência de estudos avaliando a ocorrência de psicopatologia em filhos de mães bipolares na América do Sul, este se propõe a avaliar a prevalência de psicopatologia em filhos de mulheres bipolares comparado com dois grupos-controle. MÉTODO: Crianças e adolescentes de 6 a 18 anos de idade, filhos de mães com transtorno bipolar (n = 43), filhos de mães com outros transtornos psiquiátricos leve a moderados (n = 53) e filhos de mães sem nenhum diagnóstico psiquiátrico (n = 53) foram avaliados usando o Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version, o Child Behavior Checklist e o Youth Self-Report por entrevistadores cegos ao diagnóstico das mães, as quais foram entrevistadas por meio do Structured Clinical Interview. RESULTADOS: Os filhos de mães bipolares tiveram duas vezes mais chance de ter um ou mais diagnósticos de Eixo I [Razão de Prevalência = 2,11 (95 por cento IC: 1,30-3,42) e p = 0,003] e 2,8 vezes maior risco de ter transtornos de ansiedade [Razão de prevalência = 2,83 (95 por cento IC: 1,39-5,78) e p = 0,004] ao longo da vida do que os filhos de mulheres sem transtorno mental, além de maiores escores na subescala de problemas de pensamento do Child Behavior Checklist e nas subescalas de problemas sociais, ansiedade/depressão e problemas de internalização do Youth Self-Report. CONCLUSÃO: Nossos resultados confirmam os achados prévios da literatura internacional que sugerem mais problemas psiquiátricos em filhos de mães bipolares e os estendem para a cultura brasileira

TDAH: remissão na adolescência e preditores de persistência em adultos / ADHD: Remission in adolescence and predictors of persistence into adulthood

Embora no passado se acreditasse que o TDAH persistia somente até a adolescência, atualmente jß hß um corpo sólido de conhecimento científico evidenciando que o TDAH freqüentemente persiste em adultos que foram diagnosticados como tendo TDAH na infância. São poucos os relatos na literatura sobre o padrão dessa evolução dos sintomas e, principalmente, sobre os fatores que predizem esse desfecho. O objetivo deste artigo é revisar a literatura científica sobre o TDAH, com foco específico em dados sobre remissão dos sintomas na adolescência e preditores de persistência do transtorno até a vida adulta. São apresentados dados de prevalência na adolescência e idade adulta, fatores relacionados à variabilidade de resultados entre os estudos, potenciais fatores de risco de persistência e o único estudo delineado especificamente com o objetivo de avaliar um conjunto abrangente de preditores do transtorno da infância à idade adulta.

Although in the past it was thought that ADHD did not continue beyond adolescence, nowadays there is a consistent body of scientific knowledge showing that ADHD often persists in adults who had been diagnosed as having ADHD in childhood. There are very few studies in the literature on the pattern of the evolution of the symptoms and mainly on the factors that predict this outcome in adulthood. The aim of this paper is to review the scientific literature on ADHD with specific focus on data about symptom remission during adolescence and predictors of the disorder persistence into adulthood. The authors present data on prevalence in adolescence and adulthood, factors associated to results variability among studies, potential risk factors of persistence, and the only study delineated specifically with the objective of assessing a comprehensive set of predictors of the disorder from childhood up to adulthood.

Associação entre trauma por perda na infância e depressão na vida adulta / Association between childhood loss trauma and depression in adulthood

Observações clínicas efetuadas por psicanalistas sugerem que psicopatologias da idade adulta podem ter sido originadas na infância. Estudos publicados na última década identificaram associaçäo entre trauma na infância e depressäo na vida adulta. Vivências traumáticas na infância, como a perda de vínculos afetivos devido à morte de pais ou de irmäos ou, ainda, a privaçäo de um ou de ambos os pais por separaçäo ou abandono constituem importantes fatores associados à depressäo na vida adulta. O objetivo do presente artigo é revisar a literatura dos últimos dez anos, considerando os fatores associados à depressäo, particularmente aqueles relacionados aos estressores presentes na infância. A metodologia utilizada foi de busca on-line nas bases de dados Medline, PsycINFO, Cochrane e Lilacs, referentes ao período de maio de 1991 a maio de 2001. A maioria dos estudos incluídos nesta revisäo encontrou uma associaçäo significativa entre trauma por perdas na infância e depressäo na vida adulta, com variaçäo na intensidade das associaçöes observadas