Flávia Wagner

Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD

OBJECTIVE To assess differences in executive functioning between children and adolescents with attention-deficit/hyperactivity disorder (ADHD) comorbid or not with bipolar disorder (BD), and to study the neuropsychological profile of subjects with the comorbidity in a clinical sample from a developing country. METHOD Case-control study comparing 23 participants with BD + ADHD and 85 ADHD-only subjects aged 6 to 17 years old. Both groups were drug-free. Executive function domains were assessed with the Stroop Test, the Wisconsin Card Sorting Test, and the Continuous Performance Test II. RESULTS The group with juvenile BD + ADHD showed a significantly worse performance on the Stroop task, including time in color (p = 0.002), time in color-word (p < 0.001), interference, number or errors in color and color-word (p = 0.001), and number of errors in word cards (p = 0.028). No between-group differences were found in other tests. CONCLUSIONS Our findings suggest that ADHD-only and ADHD + BD do not show differences in inhibitory control and set-shifting domains. However, children and adolescents with BD and comorbid ADHD show greater impairment in processing speed and interference control. This suggests a potentially higher impairment in the dorsolateral prefrontal cortex and may be a potential neuropsychological signature of juvenile BD comorbid with ADHD.

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I

Concepções de policiais sobre crianças em situação de rua: um estudo sobre preconceito

). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I

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

38, the incremental cost-effectiveness ratio (ICER) of treatment was I

Neuropsicologia do Transtorno de Déficit de Atenção/Hiperatividade: Modelos Neuropsicológicos e Resultados de Estudos Empíricos

9,103/QALY for children and I

Attention-deficit/hyperactivity disorder dimensionality: the reliable ‘g’ and the elusive ‘s’ dimensions

11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I

Estratégias de avaliação rápida da inteligência através das Escalas Wechsler

11,530) as willingness-to-pay, a cost of no-treatment lower than I

A systematic review of validity procedures used in neuropsychological batteries

45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

Qual é a participação de fatores socioeconômicos na inteligência de crianças

O objetivo deste estudo foi investigar a concepcao que policiais militares tem das criancas em situacao de rua. Pela tecnica da insercao ecologica, doze policiais homens foram selecionados ao acaso e entrevistados nas ruas perante um roteiro pre-estabelecido. Foi realizada uma analise qualitativa do conteudo das entrevistas e de diarios de campo dos pesquisadores. Os criterios utilizados pelos policiais para definir a crianca em situacao de rua foram a aparencia, as atividades desenvolvidas na rua, o comportamento, a frequencia com que as criancas estao na rua, o local de permanencia e a relacao da crianca com a familia. Para todos os criterios houve uma tendencia a valoracao negativa, no entanto, percebeu-se uma relativizacao do conceito criado. O estudo destacou a importância da qualificacao profissional no enfrentamento deste problema social, sobretudo num carater educativo que revele melhor a dinâmica de vida das criancas em situacao de rua.

Face and content validity of smoking-related and matched control pictures

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.