[Can ADHD have an adulthood onset?] / TDA/H, trouble de l'enfance ou de l'âge adulte ?

ADHD is the most common psychiatric disorder of childhood. It is considered to be a neurodevelopmental disorder that may persist from chilhood into adulthood. In childood it is associated with several outcomes such as inattention, hyperactivity and impulsivity. Symptoms may change as a person gets older with an increased risk of developing psychiatric comorbidities such as depression, anxiety and substance addiction. However, recent studies diverge from the traditional perspective. These authors hypothesized that ADHD may appear in adulthood, not as a continuation of child ADHD, but some limitations have to be considered. Firstly, ADHD often goes unrecognized throughout childhood. Secondly, families may help the children to develop compensation strategies and adaptative behaviors. The purpose of this report is to better investigate these different and innovative clinical results and understand if adult ADHD could really be considered as a distinct, different pathology, as a late-onset disorder. We conducted a brief review of literature and included the most recent scientific longitudinal follow-up cohort studies. We conclude that, while adult ADHD is still considered a continuation from childhood, many questions of late-onset ADHD remain and further research is necessary to better understand and explain the etiology, the development, the clinical impact, and the psychotherapeutic and pharmacologic treatment of this late-onset disorder.

[ADH/D and impulsiveness: Prevalence of impulse control disorders and other comorbidities, in 81 adults with attention deficit/hyperactivity disorder (ADH/D)]. / L'impulsivité dans le TDAH: prévalence des troubles du contrôle des impulsions et autres comorbidités, chez 81 adultes présentant un trouble déficit de l'attention/hyperactivité (TDA/H).

UNLABELLED: Attention deficit hyperactivity disorder (ADH/D) is a neuropsychological developmental disorder characterized by pervasive and impairing symptoms of inattention, hyperactivity, and impulsivity. Whereas it is well known in children, there is still little information about ADH/D in adults, including prevalence. Indeed, there are actually no epidemiological studies in France, despite the considerable impact of this disorder in a patient's professional and affective life. Moreover, ADH/D rarely stays isolated, and many comorbidities often complicate the diagnostic investigation. It is well known that the so-called ADH/D is composed of two main categories of symptoms (Attentional Disorder/Hyperactiviy Disorder), but Impulsiveness also remains a major symptom. OBJECTIVE: The aim of this study was to evaluate not only the prevalence of Impulse Control Disorders (ICD) but also psychological and addictive comorbidities among adult patients with ADH/D. A total of 100 patients from specialized consultations of adult ADH/D were evaluated in this study, but only 81 were included after presenting all the clinical criteria of ADH/D. METHOD: We used the DSM IV-T-R for ADH/D, the Minnesota Impulsive Disorders Interview a semi-structured clinical interview assessing impulse control disorders (ICD) (compulsive buying, trichotillomania, compulsive sexual behaviour, kleptomania, pyromania and intermittent explosive disorder), and the Mini International Neuropsychiatric Interview in order to evaluate psychiatric and addictive comorbidities. RESULTS: More than 90 % of the patients met the early apparition criteria of ADH/D (before 7years). More than half of the patients presented a mixed type of ADH/D (both inattentive and hyperactive-impulsive forms): 55.6 % vs 44.4 % for the inattentive type. The vast majority of patients showed a complete form (with a total of 6 or more symptoms out of 9, of inattentive and/or impulsive-hyperactivity category): 93.8 % and only 6.2 % presented a sub-syndromic form of ADH/D (with 3 symptoms at least of one and/or the other category). Regarding the ICDs, we found a proportion of 66 % of patients manifesting at least one, the most frequent ICD being the Intermittent Explosive Disorder (IED): 29.6 %, followed by Compulsive Buying (CB): 23.4 %, Pathological Gambling (PG): 7.4 %, Kleptomania and Compulsive Sexual Behaviour: 2.4 %, and Trichotillomania: 1.2 %. Among the psychiatric comorbidities evaluated, generalized anxiety disorder: 61.7 %, followed by dysthymia: 44.4 %, major depressive episode: 28.3 %, Agoraphobia: 22.2 %, panic disorder: 17.2 %, hypomanic episode: 16 %, social phobia: 11.1 %, bulimia nervosa: 8.6 %, and antisocial personality disorder and obsessive-compulsive disorder: 3.7 %. Regarding the addictive comorbidities, we found a prevalence of 14.8 % of substance abuse (non-alcohol), followed by 7.4 % of alcohol abuse, 6.1 % of substance dependence (non-alcohol), and 3.7 % of alcohol dependence. CONCLUSION: ADH/D in adults continues to be unrecognized in France. The aim of this study was to evaluate the prevalence of impulse control disorders, psychiatric and addictive comorbidities in adults with ADH/D. The results enable us to appreciate quantitative and qualitative data for 81 French adults with ADH/D. This disorder rarely remains isolated and is often associated with many others, especially anxiety and mood disorders. We also observed that impulsivity stays at the heart of the ADH/D, either through impulsive behaviours or addictive disorders. Considering the lack of studies with ADH/D adults, it is difficult to compare our data. The diagnosis of ADH/D is complex and stays controversial, moreover the strong prevalence of comorbidities points out the importance of differential diagnosis.

ADHD and Gender: subjective experiences of children in Chile / TDA-H y género: experiencias subjetivas de niños y niñas en Chile

Abstract Although research on ADHD has tended to ignore gender differentials, recent contributions produced mainly from epidemiology have revealed that this diagnostic category seems to be strongly related to gender. However, these contributions seem to limit their scope to the study of the symptoms as well as cognitive, affective and social functioning of children, leaving aside subjective aspects associated with the ADHD practices of diagnosis and treatment. Thus, this article aims to explore how the gender dimension crosses the subjective experience of children diagnosed with ADHD. Based on open interviews conducted with children between the ages of 7 and 13, we show general trends that articulate gender and characteristics associated with the ADHD diagnosis, while at the same time, with children's experiences that dislocate such trends. The findings were grouped according to four emerging axes: (1) locations, (2) abilities, (3) approches, (4) interactions. Thus, we will show how the experience of boys and girls is multiple in relation to the diagnosis and it is not possible to be reduced to a gender binary perspective.

Resumen Si bien las investigaciones sobre TDA-H han tendido a dejar los aspectos diferenciales de género en un lugar secundario, recientes contribuciones emanadas principalmente desde la epidemiología han revelado que esta categoría diagnóstica parece estar fuertemente relacionada con el reparto de los géneros. Sin embargo, dichas contribuciones parecen limitar sus alcances al estudio de la sintomatología y funcionamiento cognitivo, afectivo y social de los(as) niños(as), dejando de lado aspectos subjetivos asociados a las prácticas de diagnóstico y tratamiento de TDA-H. De este modo, el objetivo de este artículo es explorar cómo la dimensión de género configura la experiencia subjetiva de niños(as) diagnosticados(as) con TDA-H. A partir de la realización de entrevistas abiertas realizadas a niños entre 7 y 13 años, damos cuenta de tendencias generales que articulan género y características asociadas al diagnóstico de TDA-H, a la vez que, con experiencias infantiles que dislocan tales tendencias. Los resultados se agruparon en función de cuatro dimensiones emergentes del material producido en las entrevistas: (1) localizaciones; (2) habilidades; (3) abordajes; (4) interacciones. Así, mostraremos cómo la experiencia de niños y niñas es múltiple en relación al diagnóstico y no es posible reducirla a una perspectiva binaria en torno al género.

TDA/H – Análise documental sobre a produção do conceito / TDA / H - Documentary analysis on the concept of roduction / TDA/H - Análisis documental sobre la produción del concepto

Este artigo apresenta resultados de uma pesquisa desenvolvida para fins de doutoramento pela UFMS, sobre temática do TDA/H. Traz a análise do processo de construção do conceito de TDA/H em suas diversas vertentes teóricas a partir do estudo da produção científica sobre o tema publicada entre os anos de 2003 e 2007 e posteriormente atualizada até 2013, nas principais revistas científicas do ramo. Demonstra a conceituação hegemônica sobre o transtorno e as vertentes críticas desse posicionamento teórico. Conclui que não há consenso nas pesquisas apresentadas e que as nuanças desta temática estão estreitamente ligadas ao processo de construção do conceito, ou seja, a metodologia e as bases epistemológicas utilizadas pelos pesquisadores que estudam o transtorno influenciam e definem posições, opções de terapêuticas, condutas éticas e até mesmo a convicção da existência desse transtorno.

In this article we present some of a PhD research developed at University of Mato Groso do Sul on ADD / H. We offer an analysis of the construction of the concept of ADD / H in its various theoretical perspectives from the study of scientific production around the topic, published between the years 2003 to 2007 and later updated by 2013 in major journals branch .Our work demonstrates the hegemonic conceptualization of the disorder and the critical aspects of this theoretical position. We conclude that there is no consensus in the research presented and the nuances of this issue is closely linked to the process of construction of the concept, that is, the methodology and epistemological bases, used by researchers who lecture about the disorder, will influence and define positions, therapeutic options, ethical conduct and influences even the conviction of the existence of this disorder.

Este artículo presenta resultados de una investigación desarrollada para fines de doctoramiento por la UFMS, sobre temática del TDA/H. Trae el análisis del proceso de construcción del concepto de TDA/H en sus diversas vertientes teóricas a partir del estudio de la producción científica sobre el tema publicada entre los años de 2003 y 2007 y posteriormente actualizada hasta 2013, en las principales revistas científicas del ramo. Demuestra la conceptuación hegeménica sobre el trastorno y las vertientes críticas de ese posicionamiento teórico. Concluye que no hay consenso en las investigaciones presentadas y que las matices de esta temática están extremamente atadas al proceso de construcción del concepto, o sea, la metodología y las bases epistemológicas utilizadas por los investigadores que estudian la perturbación influencian y definen posiciones, opciones de terapéuticas, conductas éticas e incluso la convicción de la existencia de esa perturbación.

TDA/H e o Neurocentrismo: reflexões acerca dos sintomas de desatenção e hiperatividade e seu lugar no registro das bioidentidades / ADHD and the Neurocentrism: reflections on the symptoms of lack of attention and hyperactivity and their register in the bio identities / TDAH y Neurocentrismo: reflexiones sobre los síntomas de desatención y hiperactividad y su lugar em los registros bioidentidades

Apresenta-se uma notícia divulgada na mídia de circulação nacional acerca da exacerbação do consumo de cloridrato de metilfenidato no Brasil. Realiza-se uma análise crítica da clínica do TDA/H sustentada pela classificação DSM. Para isso, faz-se uma breve leitura da história do DSM, tendo como foco o surgimento do TDA/H em suas sucessivas revisões, visando discutir os fundamentos do manual que justificam a existência e a classificação desse transtorno. Conclui-se que o corpo se constitui no refúgio da razão diagnóstica sustentada pelo DSM e apresenta-se a proposta de uma clínica que valorize a escuta do sintoma da criança como forma de produção que é singular, em alternativa à medicalização das manifestações desatentas e hiperativas na infância...

We present an article on the exacerbation of the consumption of methylphenidate in Brazil, published by the national media. We carried out a critical analysis of the clinical practices concerning the ADHD supported by the DSM. In order to do so, we briefly read the history of DSM, focusing on the appearance of the ADHA and its successive revisions, aiming to discuss its bases which justify the existence of a classification for such disorder. We came to the conclusion that the body is consisted in the refuge of the diagnostic reason supported by the DMS, then we presented a proposal of a clinical practice, which gives value to listening to the child's symptom as a way of production that is unique, as an alternative to the medicalization of the lack of attention and hyperactive manifestations in the childhood...

Se presenta un informe de noticias en los medios de comunicación de circulación nacional sobre la exacerbación del consumo de clorhidrato de metilfenidato en Brasil. Se realiza un análisis crítico de la clínica TDAH, con el apoyo de la clasificación DSM. Para ello, se hace una breve lectura de la historia del DSM, que se centra en la aparición del TDAH en sus revisiones sucesivas a fin de discutir las bases del manual que justifica la existencia y la clasificación de este trastorno. Se concluye que el cuerpo es el refugio de la razón con el apoyo de diagnóstico DSM, y se presenta una propuesta para una clínica que valora la escucha del síntoma del niño como una forma de producción que es único, en lugar de la medicalización de las conductas de desatención e hiperactividad en la infancia...

Efeitos imaginários do diagnóstico de TDA/H na subjetividade da criança / Imaginary effects of the diagnostic of ADHD in children subjectivity

Neste artigo discute-se a avaliação diagnóstica de crianças com Transtorno de Déficit de Atenção e Hiperatividade. O discurso médico aponta a etiologia desse quadro como endógena e orgânica e, para efeito de diagnóstico, utiliza os critérios descritivos do DSM IV. A partir de um Estudo de Caso e, mediante a apresentação de fundamentos teóricos da psicanálise, o texto aqui apresentado propõe que o TDA/H é uma problemática nas funções da atenção, linguagem e motricidade, as quais estão articuladas e dependem da posição subjetiva do sujeito. Nessa visão, o TDA/H pode ser pensado como um sintoma que se endereça, como uma mensagem, ao Outro.

In this article it’s discussed the diagnostic evaluation of children with Attention-Deficit and Hyperactivity disorder. The medical speech points out the etiology of this condition as being both endogenous and organic. The DSM IV’s descriptive criterion is usually used for diagnostic purposes. Starting from a Case Study, based on the psychoanalysis’ theoretical fundaments, the author suggests that the ADHD is a disorder of the functionality of perception, language and mobility. These features are intertwined and rely on the subjective position of the individual. Thus the ADHD can be seen as a symptom that regards a sort of message to the Other.

Mecanismos de atenção selectiva na perturbação de hiperactividade com déficit de atenção / Selective attention mechanisms applied in attention deficit hyperactivity disorder

O déficit atencional é o factor primordial da Transtorno do Deficit de Atenção com ou sem Hiperactividade (TDA/H). Neste artigo procura-se comprovar as dificuldades na atenção selectiva dos sujeitos com TDA/H em comparação com os sujeitos sem TDA/H, procurando verificar quais os mecanismos deste processo da atenção que estão mais afectados nos sujeitos com TDA/H. Para isso, avaliou-se a atenção selectiva em sujeitos com e sem TDA/H, numa população de 183 sujeitos, em que 152 não apresentam e 31 apresentam TDA/H. Os resultados gerais comprovam que os sujeitos com TDA/H apresentam piores capacidades de atenção selectiva do que os sujeitos sem TDA/H, nomeadamente ao nível dos acertos, dos erros, da capacidade de concentração e do número de elementos processados.

The attention deficit is the major factor of Attention Deficit Hyperactivity Disorder (ADHD). This paper aims to demonstrate difficulties in selective attention of subjects with ADHD as compared to subjects without ADHD, attempting to verify which mechanisms of selective attention are more affected in subjects with ADHD. For this purpose, we evaluated selective attention in subjects with and without ADHD (152 without and 31 with ADHD), in a population of 183 subjects. The general results show that the subjects with ADHD present lower selective attention skills than the subjects without ADHD, specifically as far as rightness, errors, concentration and processed elements are concerned.

Taxometría de conglomerados del trastorno por déficit de atención/hiperactividad con análisis de clases latentes y de correspondencias / Cluster taxometry of attention deficit/hyperactivity disorder with latent class and correspondence analysis

El trastorno por déficit de atención/hiperactivad (TDA/H) presenta síntomas heterogéneos y con diversos grados de intensidad. El análisis de conglomerados de clases latentes (ACCL) puede clasificar a los niños a partir de los datos directos provenientes de cualquier instrumento que muestre estos síntomas, sin un diagnóstico de patrón de oro previo. Se utilizó un instrumento tipo lista de chequeo para los síntomas de TDA/H y otro para las comorbilidades del TDA/H. ACCLs fueron aplicados para los datos de cada instrumento en una muestra aleatoria y representativa de 540 niños y adolescentes escolarizados de 4 a 17 años, de la ciudad de Manizales. Un análisis de correspondencias simples (ACS) fue usado para determinar la relación o concordancia de los grupos derivados de los ACCLs. Se encontraron seis clases para la lista de chequeo de síntomas de TDA/H y cinco para el instrumento de las comorbilidades de TDA/H. El ACS mostró cuatro grupos independientes, derivados de las concordancias entre las clases obtenidas de los dos instrumentos. Estos hallazgos sugieren que el ACCL y el ACS pueden ser usados como procedimientos taxométricos precisos para la clasificación de las psicopatologías por externalización.

Attention deficit/hyperactivity disorder (ADHD) has heterogeneous symptoms with diverse grades of severity. Latentclass cluster analysis (LCCA) can be used to classify children, using direct data from any instrument that reports these symptoms, without previous gold standard diagnosis. One ADHD symptoms checklist, and one ADHD comorbidities questionnaire were used. LCCAs were developed for each instrument, which were administered to a sample of 540 children and adolescents, aged 4-17 years, from the regular school of Manizales-Colombia. A simple correspondence analysis (SCA) was done to determine the relationships between the groups classified from both LCCAs. Six clusters were obtained from ADHD checklist and five from the ADHD comorbidities questionnaire. SCA found four independent groups, derived from the concordances between the 11 clusters obtained by the LCCAs from both instruments. These findings suggest that LCCA and SCA can be use as accurate taxometric procedures to classify externalizing psychopathologies.

A educação dos filhos com transtorno de déficit de atenção e hiperatividade: o que fazer? / The education of children with attention deficit hyperactivity disorder: what to do?

Atualmente, o Transtorno de Déficit de Atenção/Hiperatividade(TDA/H) é um dos distúrbios mais comuns apresentados na infância. Na pesquisa sobre esse assunto, a grande maioria dos trabalhos encontrados se refere às dificuldades e ao estresse das famílias, pois o relacionamento entre pais e filhos apresenta-se de forma mais conflituosa que o comum. Este estudo se propôs a estudar os pais de crianças em idade escolar com o diagnóstico deTDA/H, com o objetivo de identificar os tipos de estratégias educativas das quais eles fazem uso e quais consideram mais eficazes na orientação e educação dos filhos, bem como as estratégias mais utilizadas. Para tal, foi realizada a técnica do grupo focal, e entrevistas individuais. No tratamento dos dados, foi utilizada a análise de conteúdo, conforme Olabuénega (1999), partindo dos seguintes eixos temáticos previamente estabelecidos a partir da literatura existente: descrição da parentalidade; dificuldades educativas dos TDA/H; estratégias educativas utilizadas; eficácia das estratégias. Os resultados mostraram que as estratégias utilizadas são: negociação, bater, castigo, chantagem e a tomada de consciência, como as mais usadas pelos pais.

Nowadays, Attention Deficit Hyperactivity Disorder (ADHD) is one of the commonest childhood disorders. Most research works on the subject refer to family stress and difficulties, as the relationship between those children and their parents generates more conflicts than usual. The aim of this article is to analyze the parents of school-age children with ADHD in order to identify what kind of educational strategies they use, and which ones they consider most effective to guide and educate their children, as well as to define the most commonly used ones. For such, the focal group technique and individual interviews were used. Data handling was based on content analysis, according to Olabuénega(1999), starting from the following thematic axes previously established by the literature: parenting description; educational difficulties of children with ADHD; adopted educational strategies; efficiency of strategies. Results showed strategies such as threat, beating, negotiation, punishment and awareness as the ones most used by parents.

Atención y actividad en el aula / Attentionand activity in the classroom

Examinamos la prevalencia de comportamientos característicos de los trastornos por déficit de atención/hiperactividad (TDA/H) y negativista desafiante (ND), grado de perjuicio y diferencias entre tipos de TDA/H en una muestra de tres escuelas municipales de la Ciudad de Buenos Aires. Los docentes completaron un inventario de comportamientos del DSM-IV para el TDA/H y ND de 732 alumnos de primero a quinto grado (edad media=8,1±1,5; 375 niñas), puntuados en una escala Likert (0-3 puntos, de “nunca” a “casi siempre”). Fue reportada también la habilidad más destacada de cada alumno. El perfil de atención y actividad reveló las mayores dificultades en: “distracciones por estímulos extraños”, “fracaso en completar tareas”, y “hablar excesivamente”. Las tasas de prevalencia de los comportamientos del TDA/H y ND fueron del 12,7% y 6%, respectivamente. Los síntomas de inatención y combinados fueron asociados a mayor perjuicio social y académico, con mayor prevalencia en los dos primeros grados.