Trastorno por Déficit de Atención con Hiperactividad: Autorregulación Emocional y Funciones Ejecutivas

Para ello, se llevará a cabo en la Parte Primera del estudio (capítulos 1º, 2º, 3º, 4º y 5º), una revisión del concepto, las características y los modelos explicativos más extendidos en torno al origen y desarrollo del trastorno, particularmente en relación con sus dificultades emocionales y sociales. En la Segunda Parte (capítulos 6º, 7º y 8º), se exponen los resultados de la investigación llevada a cabo con una amplia muestra de personas con TDAH y sus familias, con el objeto de comprobar y analizar los beneficios de una intervención específica Emocional, Social y Cognitiva; diseñada para potenciar procesos emocionales de identificación, expresión y regulación emocional, y consecuentemente: reducir problemas emocionales, mejorar sus habilidades socio-comunicativas y pragmáticas, potenciar sus habilidades mentalistas, sociales y de resolución de conflictos. Además, se analiza la relación que otras variables pueden tener sobre dichas competencias: como la edad de los participantes y el tipo de tratamiento recibido; así como se comparan dichos resultados con los de un grupo control. Para poder llevar a cabo este tratamiento psicoeducativo, se ha elaborado y aplicado un Programa de Intervención Emocional, Social y Cognitivo, destinado a niños con TDAH de edades comprendidas entre los 7 y los 14 años, y a sus padres.El Trastorno por Déficit de Atención con Hiperactividad (TDAH, en lo sucesivo), constituye uno de los trastornos del desarrollo neuropsicológico que en la actualidad afecta a más niños y adolescentes, se estima una prevalencia de en torno al 5%, según el DSM-V (American Psychiatric Association, 2013); y en el que coexisten diversos síntomas que van a ocasionar a la persona que lo padece serias dificultades para poder adaptarse de forma óptima a los contextos en los cuales se ve inmersos. Dicho trastorno se caracteriza por un patrón persistente de hiperactividad/impulsividad y/o inatención superior a lo esperado de acuerdo con el nivel de desarrollo del individuo, apareciendo antes de los doce años y alterando el funcionamiento normalizado del sujeto a nivel académico, familiar y social (Barkley, 2006; Lavigne y Romero, 2010; Miranda, 2000, 2004; Pérez, 2009; Servera, 2005). El problema del que se parte para llevar a cabo nuestro estudio gira en torno a la escasa cantidad de investigaciones que existen con el objetivo de analizar los déficit que van más allá de estos tres síntomas categoriales y que se producen a nivel social y emocional en los sujetos con Trastorno por Déficit de Atención con Hiperactividad; especialmente en comparación con el robusto cuerpo de estudios que se han llevado a cabo para profundizar en el origen y desarrollo de las alteraciones de corte cognitivo y conductual, así como en las diferentes opciones que se ocupan de su diagnóstico y tratamiento. Por tanto, la tesis que a continuación se presenta, surge con dos objetivos fundamentales: en primer lugar, con el de proporcionar un modelo de comprensión y explicación del TDAH que, además de abordar los déficit de origen cognitivo y conductual, atienda al papel que las emociones desempeñan en el comportamiento de las personas que padecen el trastorno, cómo influyen en su desarrollo y dominio social, así como qué relación establecen con el resto de procesos neuropsicológicos implicados

Consequences of Confinement Due to COVID-19 in Spain on Anxiety, Sleep and Executive Functioning of Children and Adolescents with ADHD

The outbreak and the quick expansion of SARS-CoV-2, from December 2019 to today, has forced countries around the world to resolve virus containment measures in order to slow down the contagion curve. Between these measures, the situation of lockdown, and the isolation or limitation of social contact between the citizens, there has been an unknown psychological impact. Certain groups (the elderly, children and teenagers, and the clinical population, for instance) arouse serious fears among professionals due to their greater vulnerability and ignorance regarding the short- and long-term consequences. The main purposes of this work are first of all to evaluate the consequences of the lockdown in children and teenagers diagnosed with attention deficit hyperactivity disorder (ADHD), sleep-related problems, and problems with executive functions. Secondly, we aim to compare the effects produced with respect to the previously mentioned variables with normotypic subjects; that is to say, between a group that was subject to lockdown and another group that was not confined. The findings show that the clinic confined group had high levels of state anxiety and problems with sleep and executive functions; differences could also be seen between the two groups, with the confined ADHD group being more negatively affected in all measured variables

Consequences of COVID-19 Confinement on Anxiety, Sleep and Executive Functions of Children and Adolescents in Spain

Children and adolescents are not indifferent to the dramatic impact of the COVID-19 pandemic, and the need to be forced to live in confinement. The change in life to which they have been abruptly subjected forces us to understand the state of their mental health in order to adequately address both their present and future needs. The present study was carried out with the intention of studying the consequences of confinement on anxiety, sleep routines and executive functioning of 1,028 children and adolescents, aged from 6 to 18 years, residing in Spain to; assess if there are differences regarding these consequences in terms of sex and age; how anxiety affects executive functioning in males and females; and to examine the possible correlations between the measured variables. For this purpose, an online questionnaire containing five sections was designed: the first section gathers information on sociodemographic and health data, while the following sections gather information from different standardized scales which measure anxiety, sleep and executive functions, whose items were adapted in order to be completed by parents, and/or legal guardians. The statistical analyzes carried out highlights significant differences in executive functioning between males and females. In turn, in regards to age, greater difficulties were detected in anxiety in the 9 to 12 age group and greater sleep disturbances between 13 and 18 year olds. On the other hand, significant differences were found in intra-sexual executive functioning depending on whether they presented greater or lesser anxiety, with executive functioning being more tendentiously maladjusted in males than in females, revealing a significantly relevant effect size (p = 0.001; ω2 = 0.27 BRIEF-2; ω2 = 0.19 BDEFS-CA; 95%). Positive correlations are obtained between state anxiety and sleep and executive functioning alterations. Finally, through Path Analysis, it is verified that state anxiety is the variable with the greatest weight within the model that would explain the alteration in the executive functioning of the present sample

Implications of the Online Teaching Model Derived from the COVID-19 Lockdown Situation for Anxiety and Executive Functioning in Spanish Children and Adolescents

Given the seriousness of the existing situation regarding the mental health of children and adolescents relating to the confinement period imposed due to COVID-19, we conducted this study to describe the effects of the confinement on state anxiety and executive functioning dimensions in a period of online educational modality. A sample of 953 children and adolescents was assessed. A sociodemographic questionnaire, the State Anxiety Inventory for Children (STAIC), and the Behavioral Evaluation of Executive Function (BRIEF-2) scale were applied. The analysis of the results indicates that 68.8% of children and adolescents presented medium–high levels of anxiety. Regarding sex, females showed higher levels of anxiety and worse levels of executive functioning. Although the group aged 11 to 18 years showed methodologically higher state anxiety (p = 0.041) than the group aged 6 to 10 years, the difference was not clinically relevant (δ = −0.113). The state anxiety variable was also correlated positively and significantly to the three executive functioning dimensions explored. In conclusion, it seems evident that COVID-19 lockdowns could have psychological and emotional effects on children and adolescents

Proposal for an Integrative Cognitive-Emotional Conception of ADHD

first_pagesettingsOrder Article Reprints Open AccessReview Proposal for an Integrative Cognitive-Emotional Conception of ADHD by Rocío Lavigne-Cerván 1ORCID,Marta Sánchez-Muñoz de León 1,Rocío Juárez-Ruiz de Mier 1,*ORCID,Marta Romero-González 1ORCID,Sara Gamboa-Ternero 2,Gemma Rodríguez-Infante 1 andJuan F. Romero-Pérez 1 1 Department of Developmental and Educational Psychology, University of Malaga, 29071 Malaga, Spain 2 Department of Developmental and Educational Psychology, University of Alicante, 03690 Alicante, Spain * Author to whom correspondence should be addressed. Int. J. Environ. Res. Public Health 2022, 19(22), 15421; https://doi.org/10.3390/ijerph192215421 Received: 23 September 2022 / Revised: 16 November 2022 / Accepted: 19 November 2022 / Published: 21 November 2022 (This article belongs to the Special Issue Emotion Regulation in Children and Adolescents) Download Browse Figure Review Reports Versions Notes Abstract Although numerous efforts have been made to deepen our understanding of the etiology of Attention Deficit Hyperactivity Disorder (ADHD), no explanation of its origins, nor of its consequences, has yet found a consensus within the scientific community. This study performs a theoretical review of various research studies and provides a reflection on the role of emotions in the origin of the disorder, at the neuroanatomical and functional level. To this end, theoretical models (single and multiple origin) and applied studies are reviewed in order to broaden the perspective on the relevance of the executive system in ADHD; it is suggested that this construct is not only composed and activated by cognitive processes and functions, but also includes elements of an emotional and motivational nature. Consequently, it is shown that ADHD is involved in social development and in a person’s ability to adapt to the environment.Partial funding for open access charge: Universidad de Málag

Análisis de patrones cognitivos, teoría de la mente, pragmática y problemas emocionales en una muestra de sujetos diagnosticados de TDAH

A lo largo del presente simposio se pretende aportar los datos que arrojan varias investigaciones llevadas a cabo con niños y adolescentes diagnosticados de TDAH. Para ello, en primer lugar se presentan los resultados de un estudio que busca explorar si la presencia más o menos severa de síntomas clínicos de TDAH, se asocia a un perfil cognitivo específico, medido este a través de la escala Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV) en una muestra de 239 sujetos entre 6 y 16 años de edad. En segundo lugar, se pretende en analizar y comparar las percepciones de problemas emocionales entre 64 padres y/o madres y 64 niños con TDAH entre 8 y 14 años de edad a través del Sistema de Evaluación de Niños y Adolescentes (SENA). En tercer lugar, se exponen los resultados sobre el rendimiento de 64 niños con TDAH de 8-14 años de edad, en tareas de Teoría de la Mente medidas con la batería NEPSY-II, antes y después de la aplicación de un Programa Específico de Intervención Socio-emocional. Y por último, se analizan los déficit pragmáticos, a través de la información recogida mediante el cuestionario CCC-2, de acuerdo con las opiniones aportada por 64 padres y/o madres de niños y adolescentes de 8-14 años diagnosticados con TDAH.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study

Background: Healthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area. Methods: A prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006–2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression. Results: 341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found. Conclusion: HCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment : A qualitative pilot study

Background: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. Methods: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. Results: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. Conclusions: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. Trial registration: ClinicalTrials.gov, NCT02757781. Registered on 25 April 2016

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment: A qualitative pilot study

Background: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. Methods: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. Results: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. Conclusions: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. Trial registration: ClinicalTrials.gov, NCT02757781. Registered on 25 April 2016.This study was financed by Instituto de Salud Carlos III and Cofinanced by Fondo Europeo de Desarrollo Regional (FEDER). Ministerio de Economía y Competitividad. Gobierno de España. (PI15/00164, PI15/00586, PI15/00566

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe