Evolución de los síntomas del TDAH y problemas asociados: efectos del tratamiento farmacológico

Introducción. El objetivo de esta investigación fue analizar los efectos del tratamiento con psicoestimulantes sobre la severidad de los síntomas de TDAH y problemas asociados. Método. 65 niños con TDAH fueron clasificados de acuerdo con su historial de medicación en tres grupos: Grupo-1: TDAH-MP (medicación prolongada; N=23), con medicación al menos durante tres años; Grupo-2: TDAH-MB (medicación breve; N=20), con medicación menos de tres años y Grupo-3: TDAH-SM (sin medicación; N=22). En la fase-1 y en la fase-2 de seguimiento los padres cumplimentaron la escala de Conners. Resultados. Las manifestaciones de inatención, hiperactividad e impulsividad y los problemas de conducta en general disminuyeron en el seguimiento en comparación con la primera fase. La ansiedad fue la única variable que mostró un aumento significativo en el tiempo. Respecto a la medicación, en las variables relacionadas con síntomas del TDAH se observó la misma tendencia, mostrando el grupo TDAH-MP puntuaciones significativamente superiores al grupo TDAH-SM. No aparecieron efectos de interacción de Tiempo X Medicación. Conclusiones. Los resultados evidencian la necesidad de análisis más complejos para valorar la respuesta a largo plazo de los fármacos en el tratamiento del TDAH.Introduction. The aim of this research was to analyze the effects of psychostimulant treatment on the severity of ADHD symptoms and associated problems. Method. 65 children with ADHD were classified into three groups according to their medication history: Group-1: ADHD-MP (long-term medication, N=23), under medication for at least three years; Group-2: ADHD-MB (short medication, N=20), under medication for less than three years and Group-3: ADHD-SM (without medication, N=22). In time 1 and time 2 (follow-up) parents filled out the Conners rating scale. Results. Generally, inattention, hyperactivity and impulsivity symptoms and behavioral problems decreased in the follow-up. Anxiety was the only variable that showed a significant increase over time. Moreover, the ADHD-MP group showed significantly higher scores than ADHD-SM group on variables related to ADHD symptoms. There were no interaction effects of Time x Medication. Conclusions. The results suggest the need for more complex analysis to assess the long-term response to medication in the treatment of ADHD

The Impact of Inattention, Hyperactivity/Impulsivity Symptoms, and Executive Functions on Learning Behaviors of Children with ADHD

Children diagnosed with attention deficit/hyperactivity disorder (ADHD) are at risk of experiencing lower academic achievement compared to their peers without ADHD. However, we have a limited understanding of the mechanisms underlying this association. Both the symptoms of the disorder and the executive functions can negatively influence learning behaviors, including motivation, attitude toward learning, or persistence, key aspects of the learning process. The first objective of this study was to compare different components of learning behaviors in children diagnosed with ADHD and typically developing (TD) children. The second objective was to analyze the relationships among learning behaviors, executive functioning, and symptoms of hyperactivity/impulsivity in both groups. Participants were 35 children diagnosed with ADHD and 37 with TD (7–11 years old), matched on age and IQ. The teachers filled out the Behavior Rating Inventory of Executive Function (BRIEF) and the Learning Behaviors Scale, which evaluates Competence/motivation, Attitude toward learning, Attention/persistence, and Strategy/flexibility. In addition, parents and teachers filled out the DSM-5 diagnostic criteria for ADHD. ANOVAs showed significant differences between children with ADHD and TD children on all the learning behaviors. Moreover, in both the ADHD and TD groups, the behavioral regulation index of the BRIEF predicted the search for strategies, and the metacognition index was a good predictor of motivation. However, attitude toward learning was predicted by metacognition only in the group with ADHD. Therefore, the executive functions had greater power than the typical symptoms of inattention and hyperactivity/impulsivity in predicting learning behaviors of children with ADHD. The findings are in line with other studies that support the influence of the executive functions on performance, highlighting the importance of including their development as a top priority from early ages in the school setting in order to strengthen learning behaviors.This work is supported by the Spanish State Research Agency (Agencia Española de Investigación, AEI) and the European Regional Development Fund (Fondo Europeo de Desarrollo Regional, FEDER) through the Project PSI2016-78109 (AEI/FEDER, UE) and by the University of Valencia (UV-INVPREDOC15- 265889)

Children with autism spectrum disorder and comorbid attention deficit hyperactivity disorder. Relationships between symptoms and executive function, social cognition, and behavioral problems

Numerous studies have mentioned the importance of discovering the mechanisms underlying the association between autism spectrum disorder (ASD) and comorbid attention deficit hyperactivity disorder (ADHD), with executive function (EF) deficits and theory of mind (ToM) being the most widely investigated cognitive processes. The present study proposed, first, to analyze the executive profile and social cognition processes in children with ASD, ASD+ADHD, ADHD, and typical development (TD). A second objective was to explore the relationship between ASD and ADHD symptoms and EF, ToM, and behavioral problems in children with ASD+ADHD. Participants were 124 children between 7 and 11 years old, distributed in four groups: 37 TD, 35 ADHD, 30 ASD, and 22 ASD+ADHD, matched on age and IQ. The teachers evaluated the EF with the BRIEF, and the parents assessed the application of ToM skills and the behavioral problems. In addition, a subscale of the NEPSY-II battery was administered to measure performance on emotion recognition. The results showed a similar profile of executive deficits in the ASD+ADHD and ADHD groups, whereas the difficulties in ToM skills in the group with ASD+ADHD were similar to those of the group with ASD. Finally, in children with ASD+ADHD, inattention symptoms were significantly associated with metacognitive deficits and ToM difficulties, and ASD symptoms were associated with behavioral problems. These findings support the need to take inattention symptoms into account and provide training in communication strategies when designing treatments for children with ASD

Social Cognition in Children with High-Functioning Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. Associations with Executive Functions

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders characterized by social impairments. The first objective of this study was to analyze social cognition deficits of children with ADHD, high-functioning ASD (HFASD), and typical development (TD) in their performance on explicit and applied measures of theory of mind (ToM). The second objective was to investigate the relationships between executive functions and social cognition in HFASD and ADHD. One hundred and twenty-six 7- to 11-year old children, 52 with HFASD, 35 with ADHD, and 39 with TD, performed the NEPSY-II social perception subtests. Parents estimated their children’s ToM skills using the Theory of Mind Inventory (ToMI). Teacher-reported data from the Behavior Rating Inventory of Executive Function (BRIEF) were also obtained. The HFASD and ADHD groups showed worse performance on the verbal ToM task than the TD group, and only the performance of the HFASD group was significantly lower than the TD group on the contextual ToM task. Parents also estimated that the HFASD group had more difficulties on the applied ToM than the ADHD and TD groups. Furthermore, there is a different executive function-theory of mind link in the HFASD and ADHD groups: behavioral regulation processes such as inhibition and emotional control are more associated with social cognition in children with ADHD, whereas metacognitive processes such as initiation and planning have a strong association with social cognition in children with HFASD. These findings have implications for understanding social perception deficits in neurodevelopmental disorders, highlighting the need for early intervention

Analysis of personal and family factors in the persistence of attention deficit hyperactivity disorder: results of a prospective follow-up study in childhood

Objectives To study the course of ADHD during childhood and analyze possible personal and family predictor variables of the results. Method Sixty-one children with ADHD who were between 6 and 12 years old at the baseline assessment were evaluated 30 months later (mean age at baseline: 8.70 ± 1.97; mean age at follow-up: 10.98 ± 2.19). Status of ADHD in follow-up was identified as persistent (met DSM-IV-TR criteria according to parents’ and teachers’ ratings), contextually persistent (met ADHD criteria according to one informant, and there was functional impairment) and remitted ADHD (with subthreshold clinical symptomatology). Associated psychological disorders of the three groups were analyzed in the follow-up with the Conners' Rating Scales. The groups were compared on ADHD characteristics (symptoms of ADHD and impairment), child psychopathology, executive functioning (EF; inhibition, working memory) and parenting characteristics (parental stress and discipline styles) at baseline. Results At the follow-up, 55.7% of the children continued to meet the DSM-IV-TR criteria for ADHD, 29.5% showed contextual persistence, and 14.8% presented remission of the disorder. The persistent and contextually persistent ADHD groups showed more associated psychological disorders. Inattention, oppositional problems, cognitive problems and impairment at baseline distinguished the remitted ADHD children from the persistent and contextually persistent ADHD children. Moreover, the persistent groups had significantly more emotional liability and higher parental stress than the group in remission, while no differences in EF where found among the groups. Conclusions ADHD children continue to present symptoms, as well as comorbid psychological problems, during adolescence and early adulthood. These findings confirm that persistence of ADHD is associated with child psychopathology, parental stress and impairment in childhood.MICINN (Ministerio de Educacion y Ciencia, Spain) EDU2009-0767

Communicative skills in Spanish children with Autism Spectrum Disorder and children with Attention Deficit Hyperactivity Disorder. Analysis through parents’ perceptions and narrative production

Background Communicative skills are one of the main deficits experienced by children with Autism Spectrum Disorder (ASD). The differential diagnosis is a complex issue that clinicians often face. For this reason, this study has two objectives: 1) to analyze the similarities and differences that children with Attention Deficit Hyperactivity Disorder (ADHD) and children with ASD present in their linguistic and communicative skills, through parentś perceptions and narrative production; 2) to identify the relative importance of the skills analyzed in discriminating children with ASD versus children with ADHD, as well as the classification power of each of the two measurement methods used. Method Participants were 37 children with typical development (TD), 52 with ASD, and 35 with ADHD. Their communicative competence was assessed through The Children's Communication Checklist Second Edition (CCC-2) (Bishop, 2003) and a narrative task. Results The results of the family ratings indicated that the difficulties were not as severe in ADHD as in ASD, where the deficit was much more pronounced in the interpretation of the context, non-verbal communication, and stereotyped language. On the narrative task, both groups displayed difficulties on expressing relevant information and inferential comprehension, and they differed on erroneous interpretations, with the children with ASD presenting worse performance. These variables showed a greater capacity to classify participants in the diagnostic categories studied. Conclusions These findings have direct clinical implications for optimizing the assessment process, making it possible to identify which specific language aspects can best differentiate between groups

Perfiles en comprensión lectora y en composición escrita de niños con autismo de alto funcionamiento

La investigación sobre el perfil académico de los estudiantes con Trastorno del Espectro Autista (TEA) refiere un desempeño variable, generalmente inferior a lo esperado para la capacidad cognitiva. En el marco escolar, la lectura y la escritura constituyen aprendizajes instrumentales cruciales que vertebran el éxito en distintas áreas curriculares y tienen implicaciones importantes a lo largo de la vida, no solo académica, sino también social y ocupacional. En este artículo se realiza una breve revisión de las principales dificultades que presentan los estudiantes con TEA en la lectura y la escritura. Con respecto a la lectura, los estudios coinciden en señalar un buen dominio de los procesos de decodificación, pero un rendimiento inferior a la edad y al nivel intelectual en la comprensión lectora, especialmente en la comprensión inferencial. También se han identificado déficits en los diversos componentes de la escritura, particularmente en el grafismo y la coherencia textual. Este perfil ha llevado a tratar de dilucidar diversos factores explicativos, entre ellos, factores lingüísticos o aspectos relacionados con las propias teorías psicológicas del autismo, que pueden orientar propuestas de intervenció

Profiles of families with risk factors and behavioral problems in children with attention deficit hyperactivity disorder

INTRODUCCIÓN: La literatura evidencia que las familias de niños con déficit de atención e hiperactividad (TDAH) experimentan factores de riesgo relacionados con niveles elevados de estrés, menor apoyo social, o menor capacidad de afrontamiento. Estos factores familiares contextuales pueden verse agravados por la presencia de problemas comportamentales y sociales en niños con TDAH. OBJETIVOS: El presente estudio se planteó los siguientes objetivos: 1) Identificar perfiles de familias de niños con TDAH en edad escolar de acuerdo con indicadores contextuales y variables socioemocionales como el nivel de estrés, las estrategias de afrontamiento y el apoyo social. 2) Evaluar las diferencias entre los grupos establecidos en diferentes dominios de dificultades comportamentales y emocionales. MÉTODO: Participaron en este estudio 35 niños, entre 7 y 11 años, que habían recibido un diagnóstico clínico de TDAH. Se determinó un índice de riesgo familiar a partir de la información que aportaron las familias sobre el nivel educativo de los padres, la situación laboral, la existencia de psicopatología parental y la tipología familiar. Además, se evaluó el nivel de estrés parental, el apoyo social, las habilidades de afrontamiento y los problemas comportamentales y emocionales del niño. RESULTADOS: Los análisis clúster jerárquicos realizados determinaron la existencia de dos grupos de familias; una con “riesgo severo” y otra con “riesgo moderado-bajo”. El perfil severo se asoció con mayores problemas sociales en los niños. Concretamente se apreció mayor hiperactividad y más problemas con los iguales. CONCLUSIONES: Los factores contextuales y socioemocionales de las familias deberían tenerse en cuenta en el abordaje de los problemas comportamentales que presentan los niños con TDAH.INTRODUCTION: Literature shows that families of children with attention deficit hyperactivity disorder (ADHD) experience risk factors related to high levels of stress, less social support, or less coping skills. These contextual family factors can be aggravated by the presence of behavioral and social problems in children with ADHD. AIMS: The present study set out the following objectives: 1) To identify profiles of families of children with ADHD at school age according to contextual indicators and socio-emotional variables such as stress level, coping strategies and social support. 2) To evaluate the differences between groups established in different domains of behavioral and emotional difficulties. METHOD: Thirty-five children, between 7 and 11 years old, who had received a clinical diagnosis of ADHD participated in this study. A family risk index was determined from the information provided by the families on the educational level, professional situation, parental psychopathology and parental status. In addition, the level of parental stress, social support, coping skills and behavioral and emotional problems of the child were evaluated. RESULTS: Hierarchical cluster analyses carried out determined the existence of two groups of families; one with “severe risk” and another one with “moderate-low risk”. The severe profile was associated with greater social problems in children. Specifically, more hyperactivity and problems with peers. CONCLUSIONS: Contextual and socio-emotional factors of families should be taken into account in the approach of behavioral problems that children with ADHD present.peerReviewe

Theory of Mind Profiles in Children With Autism Spectrum Disorder: Adaptive/Social Skills and Pragmatic Competence

Theory of Mind (ToM) is one of the most relevant concepts in the field of social cognition, particularly in the case of Autism Spectrum Disorders (ASD). Literature showing that individuals with ASD display deficits in ToM is extensive and robust. However, some related issues deserve more research: the heterogeneous profile of ToM abilities in children with ASD and the association between different levels of ToM development and social, pragmatic, and adaptive behaviors in everyday life. The first objective of this study was to identify profiles of children with ASD without intellectual disability (ID), based on explicit and applied ToM knowledge, and compare these profiles with a group of children with typical development (TD). A second objective was to determine differences in symptom severity, adaptive/social behavior, and pragmatic abilities between the profiles identified. Fifty-two children with a clinical diagnosis of ASD without ID and 37 children with TD performed neuropsychological ToM tasks and two vocabulary and memory tests. In addition, all of their mothers completed different questionnaires about applied ToM abilities, severity of ASD symptoms, adaptive/social skills, and pragmatic competence. Two subgroups were identified in the cluster analysis carried out with explicit and applied ToM indicators. The “Lower ToM abilities” profile obtained significantly lower scores than the “Higher ToM abilities” profile on all the ToM measures. Furthermore, the analysis of covariance, controlling for vocabulary and working memory (ANCOVAs), showed statistically significant differences in applied ToM abilities between the two groups of children with ASD without ID and the group with TD. However, only the group with “Higher ToM abilities” achieved similar performance to the TD group on the verbal task of explicit ToM knowledge. Finally, the “Lower ToM abilities” cluster obtained significantly higher scores on autism symptoms (social and communication domains) and lower scores on adaptive behavior and pragmatic skills than the cluster with “Higher ToM abilities.” Taken together, these findings have implications for understanding the heterogeneity in ToM skills in children with ASD without ID, and their differential impact on social, communicative, and adaptive behaviors

Inhibition, emotional self-control, working memory and monitoring. Do they predict the typical manifestations of adults with ADHD?

INTRODUCCIÓN: Los déficits en inhibición, control emocional, memoria de trabajo y supervisión se han evidenciado en numerosas investigaciones focalizadas en el trastorno por déficit de atención con hiperactividad (TDAH), pero la información sobre su posible influencia diferencial en las manifestaciones características del trastorno es escasa. OBJETIVOS: El presente estudio se propuso analizar las relaciones de las funciones ejecutivas de regulación (inhibición y control emocional) y metacognitivas (memoria de trabajo y supervisión) con manifestaciones del TDAH y determinar el poder de predicción de esas cuatro funciones ejecutivas en dichas manifestaciones. MÉTODO: Sesenta y un jóvenes adultos entre18 y 24 años con un diagnóstico clínico de subtipo combinado de TDAH en la infancia completaron la Escala Conners de síntomas de TDAH y el Inventario de Funcionamiento Ejecutivo (BRIEF). RESULTADOS: Se encontraron relaciones estadísticamente significativas entre inhibición, regulación emocional, memoria de trabajo y supervisión y las subescalas del Conners. Además, los déficits en las funciones ejecutivas fueron diferencialmente sensibles en la predicción de problemas significativos del TDAH. La memoria de trabajo y la supervisión fueron predictores de los problemas de atención, la inhibición predijo los problemas de autoconcepto y la hiperactividad/ inquietud mientras que el autocontrol emocional fue el mejor predictor de la impulsividad. CONCLUSIONES: La medida de funciones ejecutivas de regulación y metacognitivas pueden ayudar tanto en el diagnóstico como en las evaluaciones de seguimiento del tratamiento de adultos con TDAH.INTRODUCTION: Deficits in inhibition, emotional control, working memory and monitoring have been evidenced in numerous investigations focused on attention déficit hyperactivity disorder (ADHD), but information about its posible differential influence on the characteristic manifestations of the disorder is not very well known. OBJECTIVES: The purpose of this study was to analyze the relationships and the predictive power of the regulation functions (inhibition and emotional control) and metacognitive functions (working memory and supervisión) in the manifestations of ADHD. METHOD: Sixty-one Young adults between the ages of 18 and 24 with a combined clinical diagnosis of ADHD subtype in childhood completed the Conners Scale of ADHD Symptoms and the Executive Performance Inventory (BRIEF). RESULTS: Statistically significant relationships were found between inhibition, emotional regulation, working memory and monitoring and the Conners subscales. In addittion, deficits in executive functions were diferentially sensitive in predicting significant ADHD problems. Working memory and supervisión were predictors of attention problems, inhibition prediced self-concept problems and hyperactivity/restlessness while emotional self-control was the best predictor of impulsivity. CONCLUSIONS: The assessment of behavioral regulation functions and metacognitive executive functions may assist both in the diagnosis and the follow-up evaluations of treatment of adults with ADHD.peerReviewe