Antonio Carlos de Farias

Manganese in Children with Attention-Deficit/Hyperactivity Disorder: Relationship with Methylphenidate Exposure

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder that affects children worldwide. The etiology of ADHD is complex and not fully understood. Earlier studies associated elevated levels of manganese (Mn) with learning problems, attention deficits, and ADHD. Furthermore, it has also been shown that the dopamine (DA) system, the primary site of action of pharmacological ADHD treatments, is influenced by high levels of Mn. Recent studies have suggested that Mn accumulates in dopaminergic neurons via the presynaptic dopamine transporter (DAT). A role for altered functioning of the dopaminergic system in the etiology of ADHD has been well established through neurochemical, neurophysiological, imaging, and genetics studies. Methylphenidate (MPH) is a psychostimulant commonly used to manage ADHD symptoms. The pharmacotherapeutic effect of MPH occurs primarily through its action of inhibiting DAT, and thus increasing dopamine, as well as other catecholamines, at the synapse. We assessed a group of children with ADHD and matched control children without psychopathology attending public schools in a southern Brazilian city and reported elevated serum concentrations of Mn in treatment-naïve children with ADHD compared to normal controls. Interestingly, children with ADHD receiving concurrent MPH showed no difference in Mn serum levels versus controls. We then prospectively assessed the impact of naturalistic treatment with MPH and determined that Mn concentrations were significantly reduced from baseline values following MPH exposure.

Potential link between caffeine consumption and pediatric depression: a case-control study

BackgroundEarly-onset depressive disorders can have severe consequences both from developmental and functional aspects. The etiology of depressive disorders is complex and multi-factorial, with an intricate interaction among environmental factors and genetic predisposition. While data from studies on adults suggest that caffeine is fairly safe, effects of caffeine in children, who are in period of rapid brain development, are currently unknown. Furthermore, systematic research addressing the relationship between depressive symptoms in children and caffeine consumption is lacking.The present study examined the effects of caffeine consumption on depressed mood in children with depression and non-depressed participants.MethodsChildren and adolescents (n = 51) already enrolled in an ongoing longitudinal study, aged 9-12 years, were assessed for depressive symptoms with the Children Depressive Inventory (CDI). Psychopathological symptoms were assessed with the Child Behavioral Checklist (CBCL) and eating habits were assessed with the Nutrition-Behavior Inventory (NBI) [1]. The children were compared to control children without psychopathology attending public schools in a Southern Brazilian city.ResultsParticipants with CDI scores ≥ 15 (mean = 19; S.D. = 4) also had high NBI scores (mean = 52; S.D. = 19, p < 0.001) suggestive of a relationship between depressive symptoms and environmental factors, in this case nutrition/behavior. Additional linear regression adjusted statistical analysis, considering the factors of consumption of sweets and caffeine individually, showed that caffeine, but not sweets, was associated with depressive symptoms.ConclusionsThese findings indicate that depressed children consume more caffeinated drinks than non-depressed children. Nonetheless while a strong association between depressive symptoms and caffeine consumption among children was found, further research should investigate whether or not this association is due to a cause and effect relationship.

Co-Occurrence of ADHD and High IQ: A Case Series Empirical Study.

Objective: The validity of a diagnosis of ADHD in children with a high intelligence quotient (IQ) remains controversial. Using a multidisciplinary approach, rigorous diagnostic criteria, and worldwide-validated psychometric instruments, we identified a group of children attending public schools in southern Brazil for co-occurrence of high IQ and ADHD. Method: Students attending public schools, in the first to fifth grades, were referred to our Research Center for behavioral and/or learning difficulties. These children completed clinical, psychiatric, psychological, and pedagogical evaluations for assessment of IQ, ADHD, learning, and other emotional or behavioral disorders. Results: Fifteen of the participants were identified to have a full-scale IQ ≥ 120. Data show that 10 of these high-IQ children met the DSM-IV criteria diagnosis for ADHD combined type, 5 met criteria for current oppositional-defiant disorder, 2 had current major depression, and 2 had a learning disorder. Here we present the results as a case series. Conclusion: Our data support the hypothesis that ADHD is a valid diagnosis in children with high IQs.

Mood disorders in children and adolescents: update for pediatricians

OBJECTIVES To review epidemiological and etiologic aspects of diagnosis and treatment of mood disorders (MDs) in children and adolescents, with a focus on essential information for pediatricians. SOURCES A literature search on MEDLINE, a review of the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, fourth edition (text revision) (DSM-IV-TR), and a critical analysis of current diagnostic criteria and scientific evidence regarding the etiology of mood disorders were performed. SUMMARY OF THE FINDINGS We identified diverging opinions for and against the proposition of using the same criteria used for adults, as listed in the DSM-IV-TR, for diagnosing mood disorders in children and adolescents. Although there has been much debate in the literature on this topic in the last decade, there remains a concern that there may be a significant under-diagnosis of cases due to differing methods. Several epidemiological studies conducted in pediatric populations using different criteria and methods make it difficult to interpret the data currently published. Although the field of neurosciences has achieved major advances in understanding these pathologies, additional investigations are needed to gain a clearer picture of how genetic and environmental factors interact and influence the origin and severity of the disease and the patients response to treatment. CONCLUSIONS MDs have a high prevalence in childhood and adolescence and have major long-term impacts on sufferers lives. There is a need to improve diagnostic criteria, adapting them for the pediatric population, with the objective of making it simpler for clinicians, particularly pediatricians, to make diagnoses and initiate early intervention. Advances in the area of epigenetics may aid in the development of new preventative, diagnostic, and therapeutic approaches.

Transtornos do humor em crianças e adolescentes: atualização para pediatras

OBJETIVOS: Revisar aspectos epidemiologicos e etiologicos do diagnostico e tratamento dos transtornos do humor em criancas e adolescentes, com foco em conteudos essenciais para medicos pediatras. FONTES DOS DADOS: Revisao da literatura no banco de dados da MEDLINE. Utilizacao das recomendacoes da quarta edicao do texto revisado do Manual Diagnostico e Estatistico de Transtornos Mentais da Associacao Americana de Psiquiatria. Analise critica dos atuais criterios diagnosticos e teorias cientificas sobre etiologia dos transtornos do humor. SINTESE DOS DADOS: Foram identificadas opinioes discordantes e congruentes sobre a efetividade de se utilizar os mesmos criterios atualmente listados no Manual Diagnostico e Estatistico de Transtornos Mentais para diagnostico de transtornos do humor em adultos, adolescentes e criancas. Embora esse topico tenha sido muito debatido na literatura dos ultimos 10 anos, a percepcao e de que uma porcentagem significativa de casos continuam sendo subdiagnosticados devido a utilizacao dos mesmos criterios independente da faixa etaria. Os diversos estudos epidemiologicos realizados na populacao infantil fundamentam-se nesses criterios para calculos de prevalencia, o que tornam duvidosos os numeros atualmente publicados. Embora a neurociencia tenha alcancado grandes avancos no conhecimento dessas patologias, ainda e necessario um melhor entendimento sobre como os fatores geneticos e ambientais interagem e influenciam a origem, gravidade e resposta ao tratamento. CONCLUSOES: Os transtornos do humor sao patologias de alta prevalencia na infância e adolescencia, com grande impacto na vida dos portadores no longo prazo. Constatamos a necessidade de aprimorar os criterios diagnosticos, adequando-os a populacao infantil, com objetivo de facilitar ao clinico, particularmente ao pediatra, diagnostico e intervencao precoce. Avancos na area de epigenetica podem colaborar para o desenvolvimento de outras abordagens preventivas, diagnosticas e terapeuticas.

Attention–memory training yields behavioral and academic improvements in children diagnosed with attention-deficit hyperactivity disorder comorbid with a learning disorder

Background Recent studies have suggested that children with attention-deficit hyperactivity disorder (ADHD) may benefit from computerized cognitive training. Therapy implementation is especially complicated when ADHD is associated with learning disorders (LDs). This study tested the efficacy of a computer-based cognitive training program, namely, computerized cognitive training (CCT), in children with ADHD comorbid with an LD (ADHD-LD), with or without psychostimulant medication. Materials and methods After diagnostic evaluations, 27 children with ADHD-LD (8 unmedicated and 19 medicated) participated in CCT, which is intended to improve attention, memory, reasoning, visual processing, and executive functioning. The participants completed 24 1-hour sessions over 3 months. Neuropsychometric and standardized academic test results before and after training were compared to assess treatment efficacy. Shapiro–Wilk normality tests were applied, and subsequent Wilcoxon tests were used to identify significant differences in pre-versus post-training performance. Results After CAT, children diagnosed with ADHD-LD showed 1) improvements in trained skills, measured directly within the software and indirectly by external psychometric tests; 2) improvements in attention, memory, and some executive functioning; 3) improvements in academic performance, particularly in mathematics; and 4) reductions in maladaptive behavioral features. Conclusion The present findings suggest that cognitive training programs should be explored further as potential adjunctive therapies to improve outcomes in children with ADHD-LD.

Eating habits and psychopathology: translation, adaptation, reliability of the Nutrition Behavior Inventory to Portuguese and relation to psychopathology

Objective: The Nutrition-Behavior Inventory (NBI) is a self-administered instrument that allows eating habits to be correlated with psychopathological symptoms. The objective was to translate and adapt the NBI to Portuguese, and test the Portuguese NBI’s reliability. The second aim was to verify its sensitivity for identification of risk factors in terms of behavior/eating habits in children and adolescents. Methods: The NBI was translated, adapted, and back-translated. The Portuguese version of the NBI was then applied (N = 96; 9-12 years). In order to verify the internal consistency, Cronbach’s alpha was used. The psychopathological indicators of the participants were accessed using the Child Behavior Checklist (CBCL). The mean CBCL scores were analyzed in relation to the NBI data (cutoff point: ≥ 30 with indicators, and 30) on the following: anxiety and depression (p = 0.041), social difficulties (p = 0.028), attention problems (p = 0.001), aggressive behavior (p = 0.015); ADHD (p < 0.001), and conduct problems (p = 0.032). Conclusion: The present results indicate that the NBI is a reliable instrument. The NBI can be useful for evaluating psychopathological symptoms related to the eating habits and behaviors of children and adolescents.

Receiver operating characteristic curve analysis of the Child Behavior Checklist and Teacher’s Report Form for assessing autism spectrum disorder in preschool-aged children

Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social, behavioral, and communication impairments with an estimated prevalence of 1 in 68 school-aged children. There is a need for objective and easily applicable instruments for early identification of autistic children to enable initiation of early interventions during a very sensitive period of brain development and, consequently, optimize prognosis. Here, we tested the utility of the Child Behavior Checklist (CBCL) and the Caregiver-Teacher’s Report Form (C-TRF) scales for assessing ASD in Brazil, where ASD screening research is emergent. Subjects and methods A total of 70 children (2–5 years old, both sexes) were enrolled, including an ASD group (n=39) and a non-ASD control group (n=31). The preschool versions of the CBCL and C-TRF were applied. The CBCL and C-TRF results were compared between the ASD and non-ASD control groups with Mann–Whitney U tests and receiver operating characteristic analyses. Results The CBCL and C-TRF were found to have moderate accuracy for the dimensions withdrawn and autism spectrum problems, and to correlate with each other. Conclusion The CBCL and C-TRF may aid in early ASD detection.

Receiver Operating Characteristic Curve Analysis of Screening Tools for Bipolar Disorder Comorbid With ADHD in Schoolchildren

Objective: We compared Child Behavior Checklist (CBCL)-AAA (Attention Problems, Aggressive Behavior, and Anxious/Depressed) and Parent–Young Mania Rating Scale (P-YMRS) profiles in Brazilian children with ADHD, pediatric-onset bipolar disorder (PBD), and PBD + ADHD. Method: Following analyses of variance or Kruskal–Wallis tests with multiple-comparison Least Significant Difference (LSD) or Dunn’s Tests, thresholds were determined by Mann–Whitney U Tests and receiver operating characteristic (ROC) plots. Results: Relative to ADHD, PBD and PBD + ADHD groups scored higher on the Anxious/Depressed, Thought Problems, Rule-Breaking, and Aggressive Behavior subscales and Conduct/Delinquency Diagnostic Scale of the CBCL; all three had similar attention problems. The PBD and PBD + ADHD groups scored higher than the ADHD and healthy control (HC) groups on all CBCL problem scales. The AAA-profile ROC had good diagnostic prediction of PBD + ADHD. PBD and PBD-ADHD were associated with (similarly) elevated P-YMRS scores. Conclusion: The CBCL-PBD and P-YMRS can be used to screen for manic behavior and assist in differential diagnosis.