Mechanisms underpinning inattention and hyperactivity: neurocognitive support for ADHD dimensionality.

BackgroundTaxometric and behavioral genetic studies suggest that attention deficit hyperactivity disorder (ADHD) is best modeled as a dimension rather than a category. We extended these analyses by testing for the existence of putative ADHD-related deficits in basic information processing (BIP) and inhibitory-based executive function (IB-EF) in individuals in the subclinical and full clinical ranges. Consistent with the dimensional model, we predicted that ADHD-related deficits would be expressed across the full spectrum, with the degree of deficit linearly related to the severity of the clinical presentation.MethodA total of 1547 children (aged 6-12 years) participated in the study. The Development and Well-Being Assessment (DAWBA) was used to classify children into groups according to levels of inattention and hyperactivity independently: (1) asymptomatic, (2) subthreshold minimal, (3) subthreshold moderate and (4) clinical ADHD. Neurocognitive performance was evaluated using a two-choice reaction time task (2C-RT) and a conflict control task (CCT). BIP and IB-EF measures were derived using a diffusion model (DM) for decomposition of reaction time (RT) and error data.ResultsDeficient BIP was found in subjects with minimal, moderate and full ADHD defined in terms of inattention (in both tasks) and hyperactivity/impulsivity dimensions (in the 2C-RT). The size of the deficit increased in a linear manner across increasingly severe presentations of ADHD. IB-EF was unrelated to ADHD.ConclusionsDeficits in BIP operate at subclinical and clinical levels of ADHD. The linear nature of this relationship provides support for a dimensional model of ADHD in which diagnostic thresholds are defined in terms of clinical and societal burden rather than representing discrete pathophysiological states

Mechanisms underpinning inattention and hyperactivity: Neurocognitive support for ADHD dimensionality

Background. Taxometric and behavioral genetic studies suggest that attention deficit hyperactivity disorder (ADHD) is best modeled as a dimension rather than a category. We extended these analyses by testing for the existence of putative ADHD-related deficits in basic information processing (BIP) and inhibitory-based executive function (IB-EF) in individuals in the subclinical and full clinical ranges. Consistent with the dimensional model, we predicted that ADHD-related deficits would be expressed across the full spectrum, with the degree of deficit linearly related to the severity of the clinical presentation. Method. A total of 1547 children (aged 6-12 years) participated in the study. The Development and Well-Being Assessment (DAWBA) was used to classify children into groups according to levels of inattention and hyperactivity independently: (1) asymptomatic, (2) subthreshold minimal, (3) subthreshold moderate and (4) clinical ADHD. Neurocognitive performance was evaluated using a two-choice reaction time task (2C-RT) and a conflict control task (CCT). BIP and IB-EF measures were derived using a diffusion model (DM) for decomposition of reaction time (RT) and error data. Results. Deficient BIP was found in subjects with minimal, moderate and full ADHD defined in terms of inattention (in both tasks) and hyperactivity/impulsivity dimensions (in the 2C-RT). The size of the deficit increased in a linear manner across increasingly severe presentations of ADHD. IB-EF was unrelated to ADHD. Conclusions. Deficits in BIP operate at subclinical and clinical levels of ADHD. The linear nature of this relationship provides support for a dimensional model of ADHD in which diagnostic thresholds are defined in terms of clinical and societal burden rather than representing discrete pathophysiological states

Estudo retrospectivo da associação entre transtorno de pânico em adultos e transtorno de ansiedade na infância Retrospective study of the association between adulthood panic disorder and childhood anxiety disorders

OBJETIVO: A etiologia do transtorno do pânico (TP) é provavelmente multifatorial, incluindo fatores genéticos, biológicos, cognitivo-comportamentais e psicossociais que contribuem para o aparecimento de sintomas de ansiedade, muitas vezes durante a infância. O objetivo deste estudo foi avaliar a relação entre história de transtornos de ansiedade na infância e transtorno do pânico na vida adulta. MÉTODOS: Foram avaliados retrospectivamente 84 pacientes adultos com transtorno do pânico quanto à presença de história de transtornos de ansiedade na infância, por meio de uma entrevista estruturada (K-SADS-E e DICA-P). A presença de comorbidades com outros transtornos de ansiedade e de humor foi avaliada por uma revisão de registros médicos. RESULTADOS: Observou-se que 59,5% dos pacientes adultos com TP apresentavam história de ansiedade na infância. Encontrou-se uma associação significativa entre a presença de história de transtorno de ansiedade generalizada na infância e a presença de comorbidades com o TP na vida adulta, como agorafobia (p=0,05) e depressão (p=0,03). CONCLUSÕES: Este estudo sugere que a história de transtorno de ansiedade na infância pode ser considerada um preditor de maior gravidade para o transtorno do pânico na vida adulta.<br>OBJECTIVE: The etiology of panic disorder is probably multifactorial, involving genetic, biological, cognitive-behavioral and psychosocial factors that may contribute to the onset of anxiety symptoms in childhood. The aim of this study is to analyze the relationship between past history of anxiety disorder in childhood and panic disorder in adult life. METHODS: Using a structured interview (K-SADS-E and DICA-P), 84 panic disorder adult patients were interviewed and childhood anxiety disorder was retrospectively investigated. A review of medical registers was performed to assess comorbidities with other anxiety and mood disorders. RESULTS: Of the patients studied, 59,5% had past history of childhood anxiety disorders. There was a significant association between generalized anxiety disorder history during childhood and panic disorder in adult life and its comorbidities such as agoraphobia (p=0,05) and depression (p=0,03). CONCLUSION: This study suggests that childhood anxiety disorder may be a predictor of the severity of panic disorder in adult life

Relationship between adult social phobia and childhood anxiety Relação entre fobia social na vida adulta e ansiedade na infância

OBJECTIVE: The aim of this study was to evaluate the prevalence of traumas and the presence of childhood anxiety disorders in adult patients with social phobia and investigate their influence on the presentation of the disorder. METHODS: Twenty-four adult patients with social phobia were asked about the presence of trauma before the age of 16. The K-SADS-E and the DICA-P interviews were used to assess these patients regarding childhood anxiety disorders. RESULTS: Twelve (50%) patients reported a history of trauma before the age of 16. The presence of trauma did not influence the presentation of the disorder. Seventy-five percent of patients had a history of anxiety disorders in childhood. Patients with a history of at least 2 childhood anxiety disorders had an increased lifetime prevalence of major depression (10 vs. 3; p=.04) and family history of psychiatric disorders (13 vs. 6; p=.02). CONCLUSION: Anxiety disorder in childhood is associated with family history of psychiatric disorders. The presence of more than one diagnosis of anxiety disorder in childhood can be considered a risk factor for the development of depression in adult patients with social phobia.<br>OBJETIVO: A meta desse estudo foi avaliar a prevalência de traumas e a presença de transtornos de ansiedade na infância em pacientes adultos com fobia social e investigar sua influência na apresentação do transtorno. MÉTODOS: Vinte e quatro pacientes adultos com fobia social foram questionados sobre a presença de trauma antes dos 16 anos. A presença de transtornos de ansiedade na infância foi avaliada por meio do K-SADS-E e DICA-P. RESULTADOS: Doze (50%) pacientes relataram história de trauma antes dos 16 anos. A presença de trauma não influenciou a apresentação do transtorno de ansiedade social. Três quartos dos pacientes apresentavam história de transtorno de ansiedade na infância. Pacientes com história de dois ou mais transtornos de ansiedade na infância tinham uma prevalência aumentada de depressão maior na vida (10 vs. 3; p=0.04) e de história familiar de doença psiquiátrica (13 vs. 6; p=0.02). CONCLUSÃO: Transtorno de ansiedade na infância está associado com história familiar de doenças psiquiátricas. A presença de mais de um diagnóstico de transtorno de ansiedade na infância pode ser considerada um fator de risco para o desenvolvimento de depressão em pacientes adultos com fobia social

Behaviorial inhibition and history of childhood anxiety disorders in Brazilian adult patients with panic disorder and social anxiety disorder Comportamento inibido e história de transtornos de ansiedade na infância em pacientes brasileiros adultos com transtorno do pânico e transtorno de ansiedade social

PURPOSE: To evaluate the presence of behavioral inhibition and anxiety disorders during childhood in Brazilian adult patients with panic disorder and social anxiety disorder compared to a control group. METHODS: Fifty patients with panic disorder, 50 patients with social anxiety disorder, and 50 control subjects were included in the study. To assess the history of childhood anxiety, the Schedule for Affective Disorders and Schizophrenia for School Age Children, Epidemiologic Version (K-SADS-E), and the Diagnostic Interview for Children and Adolescents-Parent Version (DICA-P) were used. The presence of behavioral inhibition in childhood was assessed by the self-reported scale of Behavioral Inhibition Retrospective Version (RSRI-30). RESULTS: Patients showed significantly higher prevalence of anxiety disorders and behavioral inhibition in childhood compared to the control group. Patients with social anxiety disorder also showed significantly higher rates of avoidance disorder (46% vs. 18%, p = 0.005), social anxiety disorder (60% vs. 26%, p = 0.001), presence of at least one anxiety disorder (82% vs. 56%, p = 0.009) and global behavioral inhibition (2.89 ± 0.61 vs. 2.46 ± 0.61, p < 0.05) and school/social behavioral inhibition (3.56 ± 0.91 vs. 2.67 ± 0.82, p < 0.05) in childhood compared to patients with panic disorder. CONCLUSION: Our data are in accordance to the literature and corroborates the theory of an anxiety diathesis, suggesting that a history of anxiety disorders in childhood is associated with an anxiety disorder diagnosis, mainly social anxiety disorder, in adulthood.<br>OBJETIVOS: Avaliar a presença de história de comportamento inibido e de transtornos de ansiedade na infância em pacientes brasileiros adultos com transtorno do pânico e com transtorno de ansiedade social, comparando-os com um grupo controle. MÉTODOS: Cinqüenta pacientes com transtorno do pânico, 50 com transtorno de ansiedade social e 50 controles participaram do estudo. Para avaliar a presença de história de ansiedade na infância foi utilizada a Escala para Avaliação de Transtornos Afetivos e Esquizofrenia para Crianças em Idade Escolar - Versão Epidemiológica (K-SADS-E) e o Diagnostic Interview for Children and Adolescents-Parent Version (DICA-P). A presença de comportamento inibido na infância foi avaliada através da Escala Auto-Aplicativa de Comportamento Inibido - Versão Retrospectiva (RSRI-30). RESULTADOS: Os pacientes apresentavam uma prevalência significativamente maior de história de transtornos de ansiedade e de comportamento inibido em relação ao grupo controle. Pacientes com transtorno de ansiedade social apresentavam, também, taxas significativamente maiores de transtorno de evitação (46% x 18%, p = 0,005), transtorno de ansiedade social (60% x 26%, p = 0,001), presença de pelo menos um transtorno de ansiedade na infância (82% X 56%, p = 0,009), comportamento inibido global (2,89 ± 0,61 vs. 2,46 ± 0,61, p < 0,05) e comportamento inibido escola/social (3,56 ± 0,91 vs. 2,67 ± 0,82, p < 0.05) na infância em comparação com pacientes com transtorno do pânico. CONCLUSÃO: Nossos dados são similares aos encontrados na literatura e corroboram a teoria da diátese de ansiedade, sugerindo que a história de transtornos de ansiedade na infância é associada com transtornos de ansiedade, principalmente transtorno de ansiedade social, na vida adulta