Dídia Fortes

Dificuldades no diagnóstico de TDAH em crianças

Attention deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder among school age children. Once understood as a common and mild disorder restricted to childhood, ADHD is now recognized as an important condition because of its poor outcome and strong association with comorbidities. Pervasive disorders and cognitive deficits, as well as learning disorders, are complex conditions and their co-ocurrence with ADHD is commonly associated with marked impairments and disabilities. These patients need more attention and personalized treatment strategies. The aim of this article is to establish a discussion about these differential diagnoses, which are a challenge in clinical practice. Palavras-chaves TDAH, comorbidade, diagnostico.Attention deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder among school age children. Once understood as a common and mild disorder restricted to childhood, ADHD is now recognized as an important condition because of its poor outcome and strong association with comorbidities. Pervasive disorders and cognitive deficits, as well as learning disorders, are complex conditions and their co-ocurrence with ADHD is commonly associated with marked impairments and disabilities. These patients need more attention and personalized treatment strategies. The aim of this article is to establish a discussion about these differential diagnoses, which are a challenge in clinical practice.

Is ADHD a risk factor independent of conduct disorder for illicit substance use? A meta-analysis and metaregression investigation.

Objective: To investigate meta-analytically if the association between ADHD and illicit substance use (ISU) is maintained when controlling for conduct disorder/oppositional-defiant disorder (CD/ODD). Method: A systematic literature review was conducted through Medline from 1980 to 2008. Data extracted and selections made by one author were reviewed by another. Results: Fifteen articles presented odds ratios (ORs) for the development of ISU in individuals with ADHD controlling for CD/ODD. In total, the study covered results for more than 1,000 individuals. The combined OR for studies that included in their analysis exclusively ISU was 1.35 (0.90-2.03), p = .15, heterogeneity = 55%. Lack of control for socioeconomic status was related with a weaker association between ADHD and ISU. Conclusion: The existing data do not indicate that ADHD increases the risk of ISU beyond the effects of CD/ODD. However, the combination of all existing data is limited in power to detect a small increase in chance.

Multilevel analysis of ADHD, anxiety and depression symptoms aggregation in families

A strong genetic role in the etiology of attention-deficit hyperactivity disorder (ADHD) has been demonstrated by several studies using different methodologies. Shortcomings of genetic studies often include the lack of golden standard practices for diagnosis for ADHD, the use of categorical instead of a dimensional approach, and the disregard for assortative mating phenomenon in parents. The current study aimed to overcome these shortcomings and analyze data through a novel statistical approach, using multilevel analyses with Bayesian procedures and a specific mathematical model, which takes into account data with an elevated number of zero responses (expected in samples with few or no ADHD symptoms). Correlations of parental clinical variables (ADHD, anxiety and depression) to offspring psychopathology may vary according to gender and type of symptoms. We aimed to investigate how those variables interact within each other. One hundred families, comprising a proband child or adolescent with ADHD or a typically developing child or adolescent were included and all family members (both biological parents, the proband child or adolescent and their sibling) were examined through semi-structured interviews using DSM-IV criteria. Results indicated that: (a) maternal clinical variables (ADHD, anxiety and depression) were more correlated with offspring variables than paternal ones; (b) maternal inattention (but not hyperactivity) was correlated with both inattention and hyperactivity in the offspring; (c) maternal anxiety was correlated with offspring inattention; on the other hand, maternal inattention was correlated with anxiety in the offspring. Although a family study design limits the possibility of revealing causality and cannot disentangle genetic and environmental factors, our findings suggest that ADHD, anxiety and depression are variables that correlate in families and should be addressed together. Maternal variables significantly correlated with offspring variables, but the paternal variables did not.

Concordância entre relato de pais e professores para sintomas de TDAH: resultados de uma amostra clínica brasileira

CONTEXTO: O diagnostico de TDAH em criancas e adolescentes, segundo os criterios do DSM-IV, requer que os sintomas estejam presentes em, ao menos, dois ambientes distintos (principalmente escola e casa). Apesar da importância do relato de pais e professores, esse tema tem sido pouco investigado no Brasil. OBJETIVO: Investigar a concordância entre os relatos de pais e professores de uma amostra clinica de criancas e adolescentes com diagnostico de TDAH. METODOS: A amostra era composta por 44 criancas e adolescentes com idades variando entre 6 e 16 anos (40 meninos e 4 meninas), com diagnostico clinico de TDAH. Foram comparadas as respostas de pais e professores no questionario SNAP-IV, visando a calcular taxas de concordância entre diferentes fontes de informacao para sintomas de TDAH. RESULTADOS: Concordância para o diagnostico de TDAH ocorreu em aproximadamente metade dos casos; pais relataram mais sintomas de TDAH que professores. CONCLUSAO: Os achados aqui apresentados podem mostrar que informacoes acerca da sintomatologia de TDAH nao sao bem divulgadas para professores brasileiros, indicando a necessidade de se investir em sessoes educacionais sobre o transtorno, tendo em vista a importância do relato de profissionais de educacao para o diagnostico de TDAH.CONTEXTO: O diagnostico de TDAH em criancas e adolescentes, segundo os criterios do DSM-IV, requer que os sintomas estejam presentes em, ao menos, dois ambientes distintos (principalmente escola e casa). Apesar da importância do relato de pais e professores, esse tema tem sido pouco investigado no Brasil. OBJETIVO: Investigar a concordância entre os relatos de pais e professores de uma amostra clinica de criancas e adolescentes com diagnostico de TDAH. METODOS: A amostra era composta por 44 criancas e adolescentes com idades variando entre 6 e 16 anos (40 meninos e 4 meninas), com diagnostico clinico de TDAH. Foram comparadas as respostas de pais e professores no questionario SNAP-IV, visando a calcular taxas de concordância entre diferentes fontes de informacao para sintomas de TDAH. RESULTADOS: Concordância para o diagnostico de TDAH ocorreu em aproximadamente metade dos casos; pais relataram mais sintomas de TDAH que professores. CONCLUSAO: Os achados aqui apresentados podem mostrar que informacoes acerca da sintomatologia de TDAH nao sao bem divulgadas para professores brasileiros, indicando a necessidade de se investir em sessoes educacionais sobre o transtorno, tendo em vista a importância do relato de profissionais de educacao para o diagnostico de TDAH.

ADHD: the impact when not diagnosed

ADHD is a highly prevalent disorder in childhood with social, academic and familial difficulties when not diagnosed and treated correctly. The aim of this case report is to demonstrate the impairment of ADHD among generations of the same family.O TDAH e uma doenca de alta prevalencia na infância, ocasionando dificuldades sociais, academicas e familiares quando nao diagnosticado e tratado adequadamente. O objetivo desse estudo de caso e demonstrar o grave prejuizo causado pelo TDAH em tres geracoes de uma mesma familia.

Transcultural adaptation to Portuguese of the Mind Excessively Wandering Scale (MEWS) for evaluation of thought activity

INTRODUCTION The concept of mind wandering refers to periods during which attention and content of thoughts depart from the original idea or activity being performed. The phenomenon occurs commonly in the general population and the Mind Wandering Excessively Scale (MEWS) evaluates its frequency, intensity and related negative outcomes. OBJECTIVE To describe the cross-cultural adaptation of the MEWS. METHODS Cross-cultural adaptation of the original scale followed five consecutive steps: translation, backtranslation, appreciation of semantic equivalence and administration to a convenience sample to 20 adults with attention deficit hyperactivity disorder (ADHD) and 20 normal controls. RESULTS Results indicated a satisfactory equivalence between the original and translated versions. A synthesis version for Brazilian Portuguese is presented. CONCLUSIONS MEWS provides information on thought activity, which is particularly important in ADHD cases. The Brazilian Portuguese version would be welcome to address specific treatment responses and obtain new outcome measures.

Quantitative measurement of impairment in ADHD: perspectives for research and clinical practice

Background Functional impairment is needed to make an attention deficit hyperactivity disorder (ADHD) diagnosis, but there is a paucity of instruments addressing this issue. Objective Perform psychometric analysis of a functional impairment scale (FIE). Methods A sample of 320 individuals, including ADHD probands, their siblings and parents, filled the FIE. We analyzed psychometric properties for the entire sample and age groups. Factor structure was determined by a principal component factor analysis, using oblique rotation with Kaiser normalization and Eigenvalues higher than 1. Cronbach’s alpha and Spearman-Brown were calculated. Results Family analysis revealed four components: a) “family life”, b) “self-perception”, c) “performance” and d) “social life”. Adults’ analysis revealed two components: a) “family life, social life and self-perception” and b) “performance”. Children showed the domains: a) “performance and social life”, b) “self-perception” and c) “family life” components. Cronbach’s alpha were above 0.9 in all components. Discussion Results revealed up to four domains depending on the group considered. Different life demands might explain the variability of domains on the groups.