Ênio Roberto de Andrade

ABR and auditory P300 findings inchildren with ADHD

Auditory processing disorders (APD), also referred as central auditory processing disorders (CAPD) and attention deficit hyperactivity disorders (ADHD) have become popular diagnostic entities for school age children. It has been demonstrated a high incidence of comorbid ADHD with communication disorders and auditory processing disorder. The aim of this study was to investigate ABR and P300 auditory evoked potentials in children with ADHD, in a double-blind study. Twenty-one children, ages between 7 and 10 years, with a primary diagnosis of ADHD, participated in this experiment. Results showed that all children had normal ABR with normal latency for wave V. Results also showed that among 42 ears combined 52.38% did not have P300. For the medicated subjects we observed that among 28 ears, 42.85% did not have P300 and for the non-medicated 71.43% (N = 14 ears) did not have P300. Our results suggest that the medicated subjects had more presence of P300 (57.15%) than the non-medicated group (28.57%), though the absence of these potentials were high among the group--52.38%.

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.

Diagnóstico e tratamento de transtorno bipolar e TDAH na infância: desafios na prática clínica

Bipolar mood disorder (BD) and attention deficit hyperactivity disorder (ADHD) are serious maladies with chronic course, with strong social, familial and educational impact. Since both of them may present similar symptomatology and may also occur as comorbidity, the differential diagnosis can be considered difficult. However the medication used for the treatment of ADHD can aggravate BD in children who are not treated. Rates raging from 49% to 87% ADHD are described in children and adolescents with BD. Children who present both disorders have a more serious course and present higher rates of psychotic symptoms, depression, learning problems, hospitalization, anxiety and disruptive behavior. Children with BD and ADHD should start treatment with mood stabilizers, whereas the impact of the maniac symptoms is greater than the symptoms of ADHD. If the symptoms of inattention, impulsivity and hyperactivity remain, even after mood stabilization, treatment for ADHD with psychostimulants is warranted.

Methylphenidate use in children with attention deficit hyperactivity disorder

A Brazilian Health Technology Assessment Bulletin (BRATS) article regarding scientific evidence of the efficacy and safety of methylphenidate for treating attention deficit hyperactivity disorder (ADHD) has caused much controversy about its methods. Considering the relevance of BRATS for public health in Brazil, we critically reviewed this article by remaking the BRATS search and discussing its methods and results. Two questions were answered: did BRATS include all references available in the literature? Do the conclusions reflect the reviewed articles? The results indicate that BRATS did not include all the references from the literature on this subject and also that the proposed conclusions are different from the results of the articles chosen by the BRATS authors themselves. The articles selected by the BRATS authors showed that using methylphenidate is safe and effective. However, the BRATS final conclusion does not reflect the aforementioned and should not be used to support decisions on the use of methylphenidate.