Isabella Souza

Attention-deficit/hyperactivity disorder and comorbidity in Brazil: Comparisons between two referred samples

Abstract.Objective:The aim of this study was to compare the pattern of comorbidity in referred samples of Attention-Deficit/Hyperactivity Disorder (ADHD) patients from two different geographic areas in Brazil.Methods:The diagnoses of ADHD and comorbid conditions, according to DSM-IV criteria, were achieved in both clinics through semi-structured interview methodology, complemented by clinical interviews with the children or adolescents and their parents.Results:We assessed 343 ADHD children and adolescents in Porto Alegre (capital of the southernmost state of the country) and 78 ADHD youths in Rio de Janeiro (capital of a southestern state). Although a significant difference in the prevalence of ADHD without comorbidity was detected between the two groups (p = 0.02), no significant difference was detected in the profile of comorbidities between them. Main ADHD comorbidities in both samples were: a) Oppositional Defiant Disorder (Porto Alegre = 39.1%; Rio de Janeiro = 51.3 %); b) Anxiety Disorders (Porto Alegre = 24.2%; Rio de Janeiro = 30.8 %); c) Conduct Disorder (Porto Alegre = 13.7%; Rio de Janeiro = 17.9 %); and d) Major Depression and/or Dysthymia (Porto Alegre = 11.4%; Rio de Janeiro = 10.3 %).Conclusions:Our results from clinical samples in a developing country with a diverse culture suggest the crosscultural validity of the ADHD comorbidity profile.

Comorbidade em crianças e adolescentes com transtorno do déficit de atenção: resultados preliminares

Thirty-four children and adolescents with ages from 6 to 16 years having a diagnosis of attention-deficit hyperactivity disorder (ADHD)according to DSM-IV criteria were examined. Psychiatric comorbidity was evaluated through a standard questionnaire given to parents. There was a significant comorbidity (85,7%) in the sample, oppositional-defiant disorder (20,6%) and conduct disorder (39,2%) being the most common comorbid diagnosis. At least two diagnosis other than ADHD could be found in 57% of the sample. Major depression was seen in four cases and anxiety states (generalized anxiety disorder, separation anxiety and phobias) were seen in 34.3% of the sample. Comorbidity modifies prognosis in a significant way and may suggest specific therapeutic interventions according to each case. Frequent comorbidity may suggest the need for diagnostic interviews that covers other psychiatric disorders.

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.

Anxiety disorders in an attention-deficit/hyperactivity disorder clinical sample

OBJECTIVE To evaluate the prevalence of anxiety disorders in a clinical referred sample of children and adolescents with attention deficit/hyperactivity disorder (ADHD). METHOD 78 children and adolescents with ADHD according to DSM-IV criteria were investigated with a semi-structured interview (P-CHIPS), complemented by clinical interviews with the children or adolescents and their parents. Their IQ was calculated with neuropsychological testing. RESULTS A high prevalence of anxiety disorders (23.05%) was found in the sample. Generalized anxiety disorder was the most prevalent disorder (12,8%), followed by social phobia (3,84%) and separation anxiety disorder (3,8%). Two children showed more than one anxiety disorder. CONCLUSION Children and adolescents with ADHD seem to be more prone to have comorbid anxiety disorders, at least in clinical samples referred to specialized units.

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.

Transtorno desafiador de oposição: uma revisão de correlatos neurobiológicos e ambientais, comorbidades, tratamento e prognóstico.

Oppositional defiant disorder (ODD) is an independent diagnostic entity but it is frequently studied in conjunction with Attention-Deficit Hyperactivity Disorder (ADHD) or Conduct Disorder (CD). The purpose of this paper is to review the extant evidence, through the PubMed database, on the neurobiological correlates of oppositional defiant disorder and also describe the familiar and school functioning, comorbidities, prognosis and therapeutic options for oppositional defiant disorder. Evidence of hormonal, genetic and neurofunctional findings in oppositional defiant disorder, correlation with the family, school relations and performance, and the association with mood and anxiety and disruptive disorders are described. The risk of an evolution to conduct disorder and of persistence of the oppositional defiant disordersymptoms is depicted. A review of the effect of Cognitive-Behavioral Therapy and medication is presented. Analysis of the available evidence shows that the impact of oppositional defiant disordershould not be ignored and it should be properly addressed. The effect of treatment for oppositional defiant disorderon the long-term outcome of patients still needs to be addressed.Oppositional defiant disorder (ODD) is an independent diagnostic entity but it is frequently studied in conjunction with Attention-Deficit Hyperactivity Disorder (ADHD) or Conduct Disorder (CD). The purpose of this paper is to review the extant evidence, through the PubMed database, on the neurobiological correlates of oppositional defiant disorder and also describe the familiar and school functioning, comorbidities, prognosis and therapeutic options for oppositional defiant disorder. Evidence of hormonal, genetic and neuro-functional findings in oppositional defiant disorder, correlation with the family, school relations and performance, and the association with mood and anxiety and disruptive disorders are described. The risk of an evolution to conduct disorder and of persistence of the oppositional defiant disorder symptoms is depicted. A review of the effect of Cognitive-Behavioral Therapy and medication is presented. Analysis of the available evidence shows that the impact of oppositional defiant disorder should not be ignored and it should be properly addressed. The effect of treatment for oppositional defiant disorder on the long-term outcome of patients still needs to be addressed.

A Brazilian version of the "Children's Interview for Psychiatric Syndromes" (ChIPS)

OBJETIVE: The advance of research in child and adolescent psychiatry in Brazil heavily depends on the existence of instruments for the investigation of psychiatric syndromes adapted to Brazilian Portuguese. METHODS: This article describes a careful process of translation of the Childrens Interview for Psychiatric Syndromes for the purpose of use in research in Brazil. The Childrens Interview for Psychiatric Syndromes has a version for parents (P-ChIPs) and a version for children (ChIPS). In this article, the sections of P-ChIPS referring to attention-deficit hyperactivity disorder, oppositional-defiant disorder, conduct disorder, mania/hypomania, anorexia nervosa, bulimia nervosa and psychotic disorders were translated to Brazilian Portuguese. The sections of the ChIPS referring to substance use disorders, social anxiety disorder, specific phobias, obsessive-compulsive disorder, generalized anxiety disoder, separation anxiety disorder, post-traumatic disorders and depression/dysthimia were also adapted. Each section was translated by two independent translators and later discussed in a committee composed of experts in the field of Psychiatry and a professional of the field of linguistics. RESULT: A final version containing an interview for the main psychiatric syndromes was defined. CONCLUSION: The translated P-ChIPS is a helpful instrument in children and adolescent clinical evaluation.