Giuseppe Pastura

Desempenho escolar e transtorno do déficit de atenção e hiperatividade

OBJETIVO: esta revisao visa fornecer aos pediatras, neurologistas infantis e psiquiatras infantis nocoes atualizadas sobre a relacao entre desempenho escolar e transtorno do deficit de atencao e hiperatividade (TDAH). FONTE DE DADOS: revisao abrangente nao-sistematica da literatura medica sobre a relacao entre desempenho escolar e TDAH. SINTESE DE DADOS: os dados da literatura demonstram que o TDAH, principalmente o tipo desatento esta relacionado a mau desempenho escolar. CONCLUSOES: criancas com TDAH estao sob risco de mau-desempenho escolar e devem receber cuidados especiais.

Prevalência do transtorno do déficit de atenção e hiperatividade e suas comorbidades em uma amostra de escolares

ABSTRACT - Attention deficit hyperactivity disorder (ADHD) is a frequent condition in school-age children and commonly presents in comorbidity with other psychiatric diseases. In Brazil, there are few studies con-cerning non-clinical samples. Purpose: The present study aims to calculate the prevalence of this disorder and its comorbidities in a sample of school-age children. Method: Cross-sectional analytic study was con-ducted on a non-clinical sample of children and adolescents registered in 2003 in the elementary school of the Federal University of Rio de Janeiro. A screening questionnaire was used and parents of those possible affected children were invited for a clinical structured interview. Results: The prevalence of ADHD was 8.6%. Comorbidities were present in 58% of the cases and oppositional-defiant disorder was the most com-mon, found in 38.5%. Conclusions: The prevalence of the ADHD and its comorbidities in this sample is sim-ilar to that observed in the literature. KEY WORDS: attention deficit disorder with hyperactivity, child; adolescent, comorbidity, prevalence.A prevalencia do transtorno do de fi cit de atencao e hiperatividade (TDAH) varia entre 3 e 5% das crian-cas em idade escolar

Efeitos colaterais do metilfenidato

OBJECTIVE: To review main short-term and long-term side effects of methylphenidate in the treatment of Attention-Deficit Disorder in children. SOURCE OF DATA: a 12-year review in Medline and Lilacs. RESULTS: Among those side effects showed in the short-term, anorexia, insomnia, headache and abdominal pain are the most common ones, being the majority self-limited, dose-dependent and of medium intensity. Long-term side effects consist of mild blood pressure and heart rate increase and possible light growth suppression effect. Abuse and dependency are very rare. CONCLUSIONS: Methylphenidate side effects profile is safe and does not seem to justify its restricted use in Brazil, considering its solid benefits widely demonstrated in literature.

The effect of methylphenidate on oppositional defiant disorder comorbid with attention deficit/hyperactivity disorder

OBJECTIVE To assess the effect of methylphenidate on the diagnosis of oppositional-defiant disorder (ODD) comorbid with attention-deficit hyperactivity disorder (ADHD). METHOD We conducted an open-label study in which 10 children and adolescents with a dual diagnosis of ODD and ADHD were assessed for their ODD symptoms and treated with methylphenidate. At least one month after ADHD symptoms were under control, ODD symptoms were reevaluated with the Parent form of the Children Interview for Psychiatric Syndromes (P-ChIPS). RESULTS Nine of the 10 patients no longer fulfilled diagnostic criteria for ODD after they were treated with methylphenidate for ADHD. CONCLUSION Methylphenidate seems to be an effective treatment for ODD, as well as for ADHD itself. The implications for the treatment of patients with ODD not comorbid with ADHD needs further investigation.

Academic Performance in ADHD When Controlled for Comorbid Learning Disorders, Family Income, and Parental Education in Brazil

Objective: Scholastic achievement in a nonclinical sample of ADHD children and adolescents was evaluated taking into consideration variables such as comorbid learning disorders, family income, and parental education which may also be associated with poor academic performance. Method: After screening for ADHD in 396 students, the authors compared academic performance of 26 ADHD individuals and 31 controls paired for gender, age, and intelligence level considering both mathematics and Portuguese language scores. Learning disorders were investigated and the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV ) criteria were met using structured interviews. Results: The prevalence of academic underachievement was 2.98 times higher in students with ADHD, the most frequent subtype being predominantly inattentive. Parental educational level, family income, and comorbid learning disorders could not explain the discrepancies between ADHD students and controls. Conclusions: ADHD seems to be associated with poor academic performance even in the absence of comorbid learning disorders, lower family income, and parental educational level. (J. of Att. Dis. 2009; 12(5) 469-473)

Advanced techniques in magnetic resonance imaging of the brain in children with ADHD

Attention deficit hyperactivity disorder (ADHD) affects about 5% of school-aged child. Previous published works using different techniques of magnetic resonance imaging (MRI) have demonstrated that there may be some differences between the brain of people with and without this condition. This review aims at providing neurologists, pediatricians and psychiatrists an update on the differences between the brain of children with and without ADHD using advanced techniques of magnetic resonance imaging such as diffusion tensor imaging, brain volumetry and cortical thickness, spectroscopy and functional MRI. Data was obtained by a comprehensive, non-systematic review of medical literature. The regions with a greater number of abnormalities are splenium of the corpus callosum, cingulate gyrus, caudate nucleus, cerebellum, striatum, frontal and temporal cortices. The brain regions where abnormalities are observed in studies of diffusion tensor, volumetry, spectroscopy and cortical thickness are the same involved in neurobiological theories of ADHD coming from studies with functional magnetic resonance imaging.

Exploratory analysis of diffusion tensor imaging in children with attention deficit hyperactivity disorder: evidence of abnormal white matter structure

Abnormalities in the white matter microstructure of the attentional system have been implicated in the aetiology of attention deficit hyperactivity disorder (ADHD). Diffusion tensor imaging (DTI) is a promising magnetic resonance imaging (MRI) technology that has increasingly been used in studies of white matter microstructure in the brain. The main objective of this work was to perform an exploratory analysis of white matter tracts in a sample of children with ADHD versus typically developing children (TDC). For this purpose, 13 drug-naive children with ADHD of both genders underwent MRI using DTI acquisition methodology and tract-based spatial statistics. The results were compared to those of a sample of 14 age- and gender-matched TDC. Lower fractional anisotropy was observed in the splenium of the corpus callosum, right superior longitudinal fasciculus, bilateral retrolenticular part of the internal capsule, bilateral inferior fronto-occipital fasciculus, left external capsule and posterior thalamic radiation (including right optic radiation). We conclude that white matter tracts in attentional and motor control systems exhibited signs of abnormal microstructure in this sample of drug-naive children with ADHD.

Processamento da linguagem no Transtorno do Déficit de Atenção e Hiperatividade (TDAH)

Attention-Deficits/Hyperactivity Disorder (ADHD) is the most frequent psychiatric diagnosis in children with learning disorders. Individuals with ADHD usually present working memory difficulties. We raise the hypothesis that people with ADHD wouldn’t have the same performance in reading tasks, compared to a control group. Five psycholinguistic experiments using on-line methodology were applied. The aim was to distinguish between the processing of reading and metalinguistic processing, in order to identify the nature of the linguistic impairments in ADHD volunteers. Both groups obtained similar accuracy rates, but latencies were significantly higher for the ADHD group than for the controls, demonstrating that ADHD subjects are able to achieve the same results, but that they need more time than the control group. This result suggests that there is a language processing problem intrinsic to ADHD individuals.

Transcranial sonography in psychiatry as a potential tool in diagnosis and research

Abstract Objectives: During the last two decades transcranial sonography (TCS) of the brain parenchyma evolved from a pure research tool to a clinical relevant neuroimaging method especially in Parkinson’s disease and related movement disorders. The aim of this systematic review is to update and summarise the published TCS findings in psychiatric disorders and critically address the question whether TCS may be a valuable tool for the diagnosis or differential diagnosis of psychiatric disorders similarly to the field of movement disorders. Methods: This paper provides detailed information about the perspectives and limitations of TCS, including guidelines for the scanning procedures, assessment of midbrain structures and discusses the potential causes of the ultrasound abnormalities in psychiatric disorders. Results: Changes in the echogenicity of subcortical brain structures were detected in different disorders, such as obsessive-compulsive disorder, autism spectrum disorder, schizophrenia, panic disorder, attention-deficit/hyperactivity (ADHD), bipolar disorder and depressive disorder. Although the physical properties of brain tissue underlying the echogenic features in TCS are largely unknown, no alternative technique provides the same insight into the specific central nervous structural characteristics. Conclusions: Urgent research questions to further clarify the underlying pathophysiological and structural alterations are further outlined to bring this promising technique to the clinic.

Working memory and left medial temporal cortical thickness

Objective To perform a pilot study to investigate the association between working memory and cortical thickness in a sample of attention deficit/hyperactivity disorder (ADHD) children. Methods Seventeen children aged 7-10 years diagnosed with ADHD and 16 healthy children underwent a magnetic resonance scan for cortical thickness measurements. Data was correlated with working memory performance using the Backwards Digit Span subtest of the Wechsler Intelligence Scale for Children. Results Working memory impairment, evidenced by lower scores on the Backwards Digit Span, was observed in patients with ADHD compared to healthy controls. There was a direct correlation between working memory and cortical thickness of the left medial temporal lobe (Spearmans correlation coefficient: 0.499; p < 0.005). Conclusions Our data suggests, for the first time, a correlation between working memory, evaluated by the Backwards Digit Span, and left medial temporal cortical thickness.