Maria Antonia Serra-Pinheiro

Apresentação de uma versão em português para uso no Brasil do instrumento MTA-SNAP-IV de avaliação de sintomas de transtorno do déficit de atenção/hiperatividade e sintomas de transtorno desafiador e de oposição

The SNAP-IV questionnaire was developed to evaluate symptoms of attention-deficit/hyperactivity disorder in children and adolescents. It can be fulfilled by parents or teachers and consists of the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for attention-deficit/hyperactivity disorder (criterion A) and oppositional-defiant disorder. OBJECTIVES: To develop a version of the SNAP-IV used in the Multimodal Treatment Assessment Study to be applied in Brazil. METHODS: Translation, back-translation, evaluation of semantic equivalence, debriefing and definition of a final version was the methodology used to reach an adequate version. RESULTS: After translation and back-translation, 20 items were considered similar, six items were considered approximate in meaning, and five items were considered different from the original instrument in English. The final version was chosen considering many aspects, including similarity to the original version, ease of understanding and level of equivalence of the terms in different regions of the country. CONCLUSION: The Portuguese version of the SNAP-IV will allow the screening of attention-deficit/hyperactivity disorder and oppositional-defiant disorder in a similar manner to the original version.

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.

Inattention, Hyperactivity, and Oppositional-Defiant Symptoms in Brazilian Adolescents: Gender Prevalence and Agreement between Teachers and Parents in a Non-English Speaking Population.

Objective: To assess hyperactivity (H/I), inattention (IN), and oppositional—defiant (OP) symptoms in a nonclinical Brazilian sample of adolescents, and to investigate the association between scoring profiles of teachers and parents, symptom levels, and gender. Method: Symptoms were assessed through the Swanson, Nolan, and Pelhman (SNAP-IV) Questionnaires distributed for teachers and parents to fill out. Score means and prevalence rates based on Criterion A of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) for ADHD or oppositional—defiant disorder were estimated. Agreement rates between teachers and parents were calculated for each group of symptoms. Mean scores were compared by gender. Results: Between 7% and 33% of students were rated as having high scores of symptoms. Boys and girls had the same level of symptoms, when scored by parents. Teachers rated boys as having more H/I and OP symptoms. Parents gave scores significantly higher for H/I and OP symptoms, and teachers rated more students as inattentive. Conclusions: H/I, IN, and OP symptoms were highly prevalent in this nonclinical sample. Few differences between boys and girls were observed in symptom levels. Teachers and parents have different scoring profiles for the different SNAP subscales and are probably influenced by cultural aspects. (J. of Att. Dis. 2008; 12(2) 135-140)

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

OBJECTIVEnTo assess the effect of methylphenidate on the diagnosis of oppositional-defiant disorder (ODD) comorbid with attention-deficit hyperactivity disorder (ADHD).nnnMETHODnWe 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).nnnRESULTSnNine of the 10 patients no longer fulfilled diagnostic criteria for ODD after they were treated with methylphenidate for ADHD.nnnCONCLUSIONnMethylphenidate 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.

Resiliência e transtorno do déficit de atenção/hiperatividade

The aim of this article is to perform an update regarding the definition of resilience, risk factors and protective factors, and to correlate them with the impact of Attention Deficit/Hyperactivity Disorder (ADHD). Resilience is the capacity to resist and overcome adversity. Family is associated with the concept of resilience not only because of its capacity to interfere with the resilience of its members, but also because of its ability to respond as a functional unit when challenged with adversity. Relationships with affectively meaningful figures during childhood, the number of adverse events to which the individual is submitted and his subjective understanding of the stressor modify the ability to be resilient. ADHD has a smaller negative impact in children without conduct problems, social relationship problems, somatic symptoms or coordination problems.

Conflitos conjugais e familiares e presença de transtorno de déficit de atenção e hiperatividade (TDAH) na prole: revisão sistemática

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobiological disorders among children and might either influence or be influenced by problems in marital functioning of the parents of affected children. Studies aimed at investigating marital functioning in parents of these children have found controversial results. OBJETIVE: To perform a systematic review about the marital aspects of families with ADHD children and, to correlate those aspects with other variables, like the presence of comorbidities, socioeconomical aspects and parentsx92 mental health. METHODS: A systematic review of the literature was conducted in Pubmed between 1996 and 2006, using the following keywords: ADD, ADHD, Attention-Deficit Hyperactivity Disorder, Attention-Deficit, marital conflict, and family. RESULTS: Sixteen of the 628 initial articles and 55 additional papers included in a following phase, based on bibliographical references, were evaluated. Impairment in marital relationships has been documented in most studies, specially when ADHD is comorbid with Oppositional-Defiant Disorder (ODD) or Conduct Disorder (CD). However, studies indicating normal marital functioning also exist. CONCLUSIONS: Study results concerning ADHD and marital dysfunction have conflicting results. Futures longitudinal studies will be necessary to clarify the impact of ADHD in marital conflict of parents of children with ADHD, and also to determine the influence of the marital conflicts in the clinical expression of the disorder.

Inattention, hyperactivity, oppositional-defiant symptoms and school failure

BACKGROUNDnAttention-deficit hyperactivity disorder (ADHD) is associated with school failure. Inattention has been mainly implicated for this association. Oppositional-defiant disorders (ODD) impact on academic performance remains controversial, because of the high comorbidity between ODD and ADHD.nnnOBJECTIVEnTo understand the role of inattention (IN), hyperactivity (H/I) and ODD in school failure.nnnMETHODnParents and teachers filled out SNAP-IV questionnaires for 241 / 6th grade students. The associations of the scores of oppositional-defiant (OP), H/I and IN symptoms with school year failure were calculated.nnnRESULTSnIN was strongly correlated with school failure. H/I and OP were not associated with school failure, when controlled for IN.nnnCONCLUSIONnOP and H/I symptoms do not play an important role in school failure, when controlled for IN symptoms. Our study supports the cross-cultural role of IN as a major predictor of school failure.Transtorno do deficit de atencao e hiperatividade (TDAH) esta fortemente correlacionado a fracasso escolar. Desatencao (DA) parece ser primordialmente responsavel por essa associacao. A influencia de transtorno desafiador de oposicao (TDO) sobre o desempenho academico continua a ser controversa, principalmente devido a alta comorbidade entre TDO e TDAH. OBJETIVO: Entender melhor o papel da DA, hiperatividade/impulsividade (H/I) e sintomas opositivo-desafiadores (OP) no fracasso escolar. METODO: Duzentos e quarenta e um estudantes da 6a serie foram avaliados com os questionarios de Swanson, Nolan e Pelham (SNAP-IV), preenchidos pelos pais e professores. As associacoes entre as sub-escalas de OP, H/I e DA, com o numero de notas I (insuficiente) e com reprovacao escolar foram calculadas. RESULTADOS: Sintomas OP nao foram correlacionados com o numero de notas I, apos o controle para a sua associacao com H/I e DA. DA se associou com fracasso escolar. H/I nao se correlacionou com fracasso escolar, uma vez controlada a sua associacao com DA. CONCLUSAO: OP e H/I nao exercem papel importante no fracasso escolar, uma vez controladas as suas associacoes com DA. Esse estudo ressalta, em amostra brasileira, o papel transcultural da DA como ameaca ao bom desempenho escolar. A associacao entre transtornos do aprendizado e sintomas de DA precisa ser mais extensamente investigada.

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.

The effectiveness of parent management training in a Brazilian sample of patients with oppositional-defiant disorder

BACKGROUND: Oppositional-defiant disorder (ODD) is considered a hard to treat condition. The aim of this study was to assess the effect of parent management training (PMT) on the symptoms of ODD and conduct disorder (CD) in Brazilian children with ODD. METHODS: We conducted a clinical evaluation in which data was analyzed from parents of five patients with ODD who participated in a PMT group. The ODD and CD symptoms were assessed before and at least a month after they started participating in the group. The outcome measures were rating scales based on the DSM-IV criteria for ODD and CD. RESULTS: Most patients continued to fulfill criteria for ODD, but the severity of their ODD symptoms was reduced 48,75%. The difference between the means on the severity scale of ODD symptoms was statistically significant (p= 0,031) The fulfillment of criteria for CD was largely diminished. CONCLUSIONS: PMT was effective for the reduction of ODD and CD symptoms in patients with ODD. PMT may represent a valuable therapeutic option for patients with ODD in different cultures.INTRODUCAO: O transtorno desafiador de oposicao (TDO) e considerado uma condicao de dificil tratamento. O objetivo deste estudo foi avaliar a eficacia de um programa em grupo de treinamento de pais (TP) na reducao dos sintomas de TDO e transtorno de conduta (TC) em criancas brasileiras com TDO. METODO: conduziu-se um estudo naturalistico em que se analisou dados dos pais de cinco pacientes com TDO que participaram de um grupo de TP. Os sintomas de TDO e TC foram avaliados antes e pelo menos um mes depois de iniciarem a participacao no grupo. As medidas utilizadas foram escalas baseadas nos criterios da DSM-IV para TDO e TC. RESULTADOS: A maioria dos pacientes continuou preenchendo criterios para TDO, mas a gravidade dos seus sintomas de TDO diminuiu 48,75%. A diferenca entre as medias na escala de gravidade de sintomas desafiadores-opositivo foi estatisticamente significativa (p = 0,031). O numero de criterios de TC preenchido pelos pacientes tambem foi largamente reduzido. CONCLUSAO: TP mostrou-se eficaz na melhoria de sintomas de TDO e TC em pacientes com TDO. TP pode ser uma opcao terapeutica util para o tratamento de TDO.