Asociación Española de Psiquiatría del Niño y el Adolescente - AEPNyA

TDAH: Actualización 16.12.2007

ACTUALIZACION SEMANAL (16 diciembre) DE TODO LO PUBLICADO SOBRE ADHD -TDHA

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Sent on Sunday, 2007 Dec 16


tems 1 - 14 of 14

1: J Atten Disord. 2007 Dec 13; [Epub ahead of print]      
  
 Comparison of a Norm-Based Versus Criterion-Based Approach to Measuring ADHD Symptomatology in College Students.
    McKee TE.
    Hamilton College.

    Objective: The prevalence of ADHD symptomatology in college students is unclear because rates can vary depending on the methodology that is employed. Gender differences in college prevalence have also remained unexplored. Method: Self-reported ADHD symptomatology was assessed in 1,096 college students using the College ADHD Response Evaluation, a measure that has been normed on college students and that also contains the 18 criteria currently used for diagnosis. Results: Almost 20% met the threshold for a modified diagnosis if the 97th percentile was used, whereas 7.48% reported the number of symptoms required for current diagnostic criteria. Few women reported extreme levels of impulsivity, whereas both men and women reported excessive inattention. However, men exceeded women in number and severity of inattentive symptoms. Conclusion: These findings suggest that rates of ADHD symptomatology are higher when college students are compared to their peers, which has implications for using current diagnostic criteria with this population. (J. of Att Dis. XXXX, XX(X), XXX-XXX).

    PMID: 18079307  

Blog. No sabemos qué decir. Resulta difícil entender unas conclusiones que no tienen que ver con resultados.

2: J Int Neuropsychol Soc. 2008 Jan;14(1):119-29.
     
    Differences in executive functioning in children with heavy prenatal alcohol exposure or attention-deficit/hyperactivity disorder.
    Vaurio L, Riley EP, Mattson SN.
    Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California.

    Children with either fetal alcohol spectrum disorder (FASD) or attention-deficit/hyperactivity disorder (ADHD) display deficits in attention and executive function (EF) and differential diagnosis of these two clinical groups may be difficult, especially when information about prenatal alcohol exposure is unavailable. The current study compared EF performance of three groups: children with heavy prenatal alcohol exposure (ALC); nonexposed children with attention-deficit/hyperactivity disorder (ADHD); and typically developing controls (CON). Both clinical groups met diagnostic criteria for ADHD. The EF tasks used were the Wisconsin Card Sorting Test (WCST), the Controlled Oral Word Association Test (COWAT), and the Trail Making Test (TMT). Results indicated different patterns of deficit; both clinical groups displayed deficits on the WCST and a relative weakness on letter versus category fluency. Only the ALC group displayed overall deficits on letter fluency and a relative weakness on TMT-B versus TMT-A. In addition, WCST performance was significantly lower than expected based on IQ in the ADHD group and significantly higher than expected in the ALC group. These results, which indicate that, although EF deficits occurred in both clinical groups, the degree and pattern of deficit differed between the ALC and ADHD groups, may improve differential diagnosis. (JINS, 2008, 14, 119-129.).

    PMID: 18078538 

Blog. Otro artículo con problemas de redacción. No somos los únicos. El problema del espacio lleva a que lo único que se lee sea un galimatías.  De nuevo unas conclusiones excesivamente optimista que por otro lado nos intentan clarificar la maraña de datos y acrónimos.

3: CNS Drug Rev. 2007 Winter;13(4):465-74.      

    Guanfacine and guanfacine extended release: treatment for ADHD and related disorders.
    Posey DJ, McDougle CJ.
    Christian Sarkine Autism Treatment Center, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.

    Guanfacine, an alpha(2A) adrenoceptor agonist, is U.S. Food and Drug Administration (FDA)-approved for the treatment of hypertension in adolescents and adults. It also has been used "off-label" for several years in children as a possible treatment for attention-deficit/hyperactivity disorder (ADHD) and pervasive developmental disorders (PDDs). Small placebo-controlled trials support the use of guanfacine for the treatment of ADHD. There is more limited research on the use of guanfacine in treating hyperactivity occurring in children diagnosed with PDD. Recently, guanfacine extended release (GXR), a once-daily formulation has been manufactured and studied in phase III clinical trials. Based on preliminary scientific presentations, it also appears to be efficacious in improving ADHD in children. The most common adverse effects associated with guanfacine and GXR treatment is sedation. Adverse cardiovascular effects are uncommon, although modest reductions in blood pressure and heart rate are common. If GXR is FDA-approved, it would be the first alpha(2A) adrenoceptor agonist marketed for ADHD.
PMID: 18078429 

Blog. Esto si que puede acabar en indicación, teniendo en cuenta efectos adversos inversos a los de los estimulantes (sedación, disminución de tensión y frecuencia cardíaca). Aun así cuesta pensar en combinaciones o potenciaciones en el momento actual. Si se logra indicación los primeros usos serán en TDAH moderado comórbido a ansiedad. Por otro lado si un fármaco cuesta actualmente 8000 millones de dólares y dolores de desarrollar no nos ha de extrañar que vayamos a vivir una temporada “retro” miradas atrás para reutilizar ya desarrollados.


4: Proc Natl Acad Sci U S A. 2007 Dec 11;104(50):19663-4. Epub 2007 Dec 6.      

    Neuro-anatomic evidence for the maturational delay hypothesis of ADHD.
    Rubia K.

    Department of Child Psychiatry/Medical Research Council Social, Genetic, and Developmental Psychiatry Research Center (SGDP), Institute of Psychiatry, 16 De Crespigny Park, SG DP PO46, London SE5 8AF, United Kingdom. k.rubia@i op.kcl.ac.uk

    Publication Types:
        * Comment
    PMID: 18077397 

PMID: 18078429 

Blog. Cualquier cosa en proceedings suele ser de nuestra gusto ya que nos toca la fibra evolucionista. Precisamente el usar la fórmula del comentario permite decir alguna cosa arriesgada y todo sea dicho muy interesante, al estilo de Medical Hipótesis

5: Acta Paediatr. 2007 Dec 11; [Epub ahead of print]      
    The ADHD Tetragrammaton taken in vain in neurogenetic disorders?
    Pelc K, Dan B.
 Department of Neurology, Hopital Universitaire des Enfants Reine Fabiola, Universite Libre de Bruxelles (ULB), Brussels, Belgium.

    PMID: 18076713  
Blog. Qué pais Bélgica!! Vaya título!!

6: Bipolar Disord. 2007 Dec;9(8):895-900.      

    Prevalence of the Child Behavior Checklist-pediatric bipolar disorder phenotype in a German general population sample.

    Holtmann M, Bolte S, Goth K, Dopfner M, Pluck J, Huss M, Fegert JM, Lehmkuhl G, Schmeck K, Poustka F.
    Department of Child and Adolescent Psychiatry and Psychotherapy, JW Goethe-University, Frankfurt/Main, Germany.

    Background: In children with pediatric bipolar disorder (PBD), a consistent pattern of elevations in inattention/hyperactivity, depression/anxiety, and aggression has been identified on the Child Behavior Checklist (CBCL-PBD profile). In Germany, no epidemiological study has included PBD to date. Objectives: To estimate the six-month prevalence of the CBCL-PBD profile in Germany in a large normative general population sample, and to examine subjects with CBCL-PBD profile with regard to symptoms assumed to coexist with PBD (e.g., suicidality, decreased need for sleep, and hypersexuality). Methods: We studied a nationwide representative general population sample of 2,856 children and adolescents aged 4-18 years. Results: A total of 21 subjects [0.7% of the sample; 95% confidence interval (CI) = 0.5-1.1] met the criteria for the CBCL-PBD phenotype. CBCL-PBD subjects were more pervasively disturbed than clinical controls (n = 118; 4.1% of total sample; 95% CI = 3.4-4.9), demonstrated in significantly more social problems and delinquent behavior, and showed significantly higher rates of suicidality, decreased need for sleep and hypersexual behavior. Conclusions: The prevalence of CBCL-PBD subjects in the general German population compares to rates of PBD in US and Dutch epidemiological samples. Regardless of whether these subjects are affected by 'real' PBD or 'severe, pervasive ADHD' with pronounced emotional dysregulation, they constitute a group of seriously disturbed children and adolescents. The high rate of suicidality among CBCL-PBD subjects emphasizes the need for the identification and adequate treatment of children meeting this profile.

    PMID: 18076540 

Blog. Sea el CBCL-PBD y el CBCL-PBD se hizo y vio el neuropsicólogo que era bueno. Desaparezca por tanto la discusión (y la valoración clínica) de si un determinado grupo de pacientes son bipolares reales o TDAH severos con desregulación emocional. Para qué vamos a  discutir, o hacer valoraciones o diagnósticos categoriales si tenemos un test que nos identifica a un grupo que quizás no son ni lo uno ni lo otro pero que a lo mejor son algo de lo uno o lo otro. Optemos por el enfoque pragmatico del test que faltan profesionales para valorar en la medicina y sobran en otras áreas.
De repente, sería muy apropiado decir mejor “out of the blue”, vemos que la prevalencia del CBCL-PBD se compara con las de los bipolares como sugiriendo que son lo mismo. En la siguiente frase se corrige esta sugerencia y se dice que quizás si o quizás no pero que en cualquier caso este grupo CBCL es un grupo a tener en cuenta.

7: Behav Genet. 2007 Dec 12; [Epub ahead of print]      

    Genetic and Environmental Influences on the Relation Between Attention Problems and Attention Deficit Hyperactivity Disorder.
    Derks EM, Hudziak JJ, Dolan CV, van Beijsterveldt TC, Verhulst FC, Boomsma DI.

    Department of Biological Psychology, Vrije Universiteit, Van der Boechorststraat 1, Amsterdam, 1081 BT, The Netherlands, Esta dirección de correo electrónico está protegida contra spambots. Usted necesita tener Javascript activado para poder verla. .

    Objective The assessment of symptoms of ADHD in children is usually based on a clinical interview or a behavior checklist. The aim of the present study is to investigate the extent to which these instruments measure an underlying construct and to estimate the genetic and environmental influences on individual differences in ADHD. Methods Maternal ratings were collected on 10,916 twins from 5,458 families. Child Behavior Checklist (CBCL) ratings were available for 10,018, 6,565, and 5,780 twins at the ages 7, 10, and 12, respectively. The Conners Rating Scale (4,887 twins) and the DSM interview (1,006 twins) were completed at age 12. The magnitude of genetic and environmental influences on the variance of the three measures of ADHD and the covariance among the three measures of ADHD was obtained. Results Phenotypic correlations range between .45 and .77. Variances and covariances of the measurements were explained mainly by genetic influences. The model that provided the best account of the data included an independent pathway for additive and dominant genetic effects. The genetic correlations among the measures collected at age 12 varied between .63 and 1.00. Conclusions The genetic overlap between questionnaire ratings and the DSM-IV diagnosis of ADHD is high. Clinical and research implications of these findings are presented.

    PMID: 18074222  
Blog. Se empieza mal al decir que para diagnosticar se usa la entrevisa o un checklist, salvo que se quiera decir que hay quien lo hace. Da la impresión de que en este y otros artículos de este mes haya problemas con el inglés, pero cualquier que haya estado en Holanda sabe que esto no puede ser, ya que hasta las películas en los cines las ven sin doblar, así que echaremos la culpa al espacio de los abstracts, que insistimos, siendo lo único que se lee habitualmente debiera por interés propio de las revistas tener más espacio.
 En el artículo se proponen dos objetivos que no acaban de casar, ver si los instrumentos que todos usamos valoran algo similar (les adelantamos la respuesta: si) y segundo, sólo con estos instumentos (según metodología) consiguen determinar que la mayoría de efectos en la varianza son genético, eso ya tiene mérito.

8: Behav Genet. 2007 Dec 11


    Speed, Variability, and Timing of Motor Output in ADHD: Which Measures are Useful for Endophenotypic Research?

    Rommelse NN, Altink ME, Oosterlaan J, Beem L, Buschgens CJ, Buitelaar J, Sergeant JA.
    Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorststraat 1, Amsterdam, 1081 BT, The Netherlands, Esta dirección de correo electrónico está protegida contra spambots. Usted necesita tener Javascript activado para poder verla. .

    Attention-Deficit/Hyperactivity Disorder (ADHD) shares a genetic basis with motor coordination problems and probably motor timing problems. In line with this, comparable problems in motor timing should be observed in first degree relatives and might, therefore, form a suitable endophenotypic candidate. This hypothesis was investigated in 238 ADHD-families (545 children) and 147 control-families (271 children). A motor timing task was administered, in which children had to produce a 1,000 ms interval. In addition to this task, two basic motor tasks were administered to examine speed and variability of motor output, when no timing component was required. Results indicated that variability in motor timing is a useful endophenotypic candidate: It was clearly associated with ADHD, it was also present in non-affected siblings, and it correlated within families. Accuracy (under- versus over-production) in motor timing appeared less useful: Even though accuracy was associated with ADHD (probands and affected siblings had a tendency to under-produce the 1,000 ms interval compared to controls), non-affected siblings did not differ from controls and sibling correlations were only marginally significant. Slow and variable motor output without timing component also appears present in ADHD, but not in non-affected siblings, suggesting these deficits not to be related to a familial vulnerability for ADHD. Deficits in motor timing could not be explained by deficits already present in basic motor output without a timing component. This suggests abnormalities in motor timing were predominantly related to deficient motor timing processes and not to general deficient motor functioning. The finding that deficits in motor timing run in ADHD-families suggests this to be a fruitful domain for further exploration in relation to the genetic underpinnings of ADHD.

    PMID: 18071893  
Blog. Primera afirmación: el TDAH está asociado a tr de la coordinación motora, hasta ahí bien, incluso excelente, ya que es lo más habitual y más pasado por alto; pero añaden que el vínculo es genético, esto no está probado con seguridad de Medicina Basada en la Evidencia. De ahí se realiza un salto muy, pero que muy libre a que hay una relación con la secuenciación (timing) motora. No hace falta dar estos saltos para justificar poner a prueba una hipótesis, en este caso que el fallo en la secuenciación temporal es un endofenotipo del TDAH; efectivamente, este fallo aparece en familiares no afectos y “corre” en familias. La adecuación a la tarea, lentitud o variabilidad en la respuesta no están asociadas por lo que el déficit del timing motor es algo específico. En todo caso merece la pena pedir el artículo completo, parece tocar y con buena muestra un tema importante.

9: Eur Child Adolesc Psychiatry. 2007 Dec 10;

    Heterogeneity in the pharmacodynamics of two long-acting methylphenidate formulations for children with attention deficit/hyperactivity disorder : A growth mixture modelling analysis.

    Sonuga-Barke EJ, Van Lier P, Swanson JM, Coghill D, Wigal S, Vandenberghe M, Hatch S.
    University of Southampton, Southampton, UK.

    OBJECTIVES: To use growth mixture modelling (GMM) to identify subgroups of children with attention deficit hyperactive disorder (ADHD) who have different pharmacodynamic profiles in response to extended release methylphenidate as assessed in a laboratory classroom setting. METHODS: GMM analysis was performed on data from the COMACS study (Comparison of Methylphenidates in the Analog Classroom Setting): a large (n = 184) placebo-controlled cross-over study comparing three treatment conditions in the Laboratory School Protocol (with a 1.5-h cycle of attention and deportment assessments). Two orally administered, once-daily methylphenidate (MPH) bioequivalent formulations [Metadate CD(trade mark)/Equasym(trade mark) XL (MCD-EQXL) and Concerta XL (CON)] were compared with placebo (PLA). RESULTS: Three classes of children with distinct severity profiles in the PLA condition were identified. For both MCD-EQXL and CON, the more severe their PLA symptoms the better, the children's response. However, the formulations produced different growth curves by class, with CON having essentially a flat profile for all three classes (i.e. no effect of PLA severity) and MCD-EQXL showing a marked decline in symptoms immediately post-dosing in the two most severe classes compared with the least severe. Comparison of daily doses matched for immediate-release (IR) components accounted for this difference. CONCLUSION: The results suggest considerable heterogeneity in the pharmacodynamics of MPH response by children with ADHD. When treatment response for near-equal, bioequivalent daily doses the two formulations was compared, marked differences were seen for children in the most severe classes with a strong curvilinear trajectory for MCD-EQXL related to the greater IR component.

    PMID: 18071840  

Blog. No todos los larga acción son iguales al menos farmacodinámicamente. ¿había dudas?  Obviamente a los casos leves todo les va bien y las diferencias para esta como cualquier otra variable se ven mejor en casos severos.

10: Behav Brain Funct. 2007 Dec 10;3(1)
 
    Tetrahydroisoquinoline derivatives: a new perspective on monoaminergic dysfunction in children with ADHD?
    Roessner V, Walitza S, Riederer F, Hunnerkopf R, Rothenberger A, Gerlach M, Moser A.

    ABSTRACT: BACKGROUND: The dopamine-derived tetrahydroisoquinolines (TIQ) synthesized endogeneously from aldehydes and catecholamines have shown to modulate neurotransmission, central metabolism and motor activity. Converging evidence has implicated abnormalities of the dopamine metabolism to the pathophysiology of Attention-Deficit/Hyperactivity Disorder (ADHD). Therefore, four TIQ derivatives involved in central dopamine metabolism (salsolinol, N-methyl-salsolinol, norsalsolinol, N-methyl-norsalsolinol) have been analyzed for the first time in children and adolescents with ADHD and healthy controls. METHODS: 42 children and adolescents with ADHD and 24 controls from three sites participated in this pilot study. Free and bound amounts of salsolinol, N-methyl-salsolinol, norsalsolinol, N-methyl-norsalsolinol have been analyzed in urine. RESULTS: In the ADHD group, free and total amounts of the four TIQ derivatives in urine were significantly higher compared to urine levels of healthy controls. For N-methyl-salsolinolfree, most of the ADHD patients were identified correctly with a sensitivity of 92.5 % (specificity 94.4%). CONCLUSIONS: Urine levels of salsolinol, N-methyl-salsolinol, norsalsolinol and N-methyl-norsalsolinol are elevated in children and adolescents with ADHD and point to a new perspective on catecholaminergic dysfunction in ADHD. However, replication and extension of this pilot study would progress this innovative and promising field.

    PMID: 18070346  

BLOG. Otro artículo para pedir. SIN FALTA. Da gusto, que claridad y qué humildad, lo digo sin ironías. Y podrían presumir, ya que el N-methyl-salsolinol, tiene una sensibilidad del 92,5% y una especificidad del 94,4% en la determinación de pacientes TDAH. Además se publica en una revista serias donde las haya, que de vez en cuando se atreve a hacer un peer review abierto. Memorable el de Linda Mealey, nuestra guía en el mundillo social evolucionista.

11: Behav Brain Funct. 2007 Dec 10;3(1):62

    Distinguishing low frequency oscillations within the 1/f spectral behaviour of electromagnetic brain signals.
    Demanuele C, James CJ, Sonuga-Barke EJ.

    ABSTRACT: BACKGROUND: It has been acknowledged that the frequency spectrum of measured electromagnetic (EM) brain signals shows a decrease in power with increasing frequency. This spectral behaviour may lead to difficulty in distinguishing event-related peaks from ongoing brain activity in the electro- and magnetoencephalographic (EEG and MEG) signal spectra. This can become an issue especially in the analysis of low frequency oscillations (LFOs) - below 0.5 Hz - which are currently being observed in signal recordings linked with specific pathologies such as epileptic seizures or attention deficit hyperactivity disorder (ADHD), in sleep studies, etc. METHODS: In this work we propose a simple method that can be used to compensate for this 1/f trend hence achieving spectral whitening. This method involves filtering the raw measured EM signal through a differentiator prior to further data analysis. RESULTS: Applying the proposed method to various exemplary datasets including very low frequency EEG recordings, epileptic seizure recordings, MEG data and evoked response data showed that this compensating procedure provides a flat spectral base onto which event related peaks can be clearly observed. CONCLUSIONS: Findings suggest that the proposed filter is a useful tool for the analysis of physiological data especially in revealing very low frequency peaks which may otherwise be obscured by the 1/f spectral activity inherent in EEG/MEG recordings.

    PMID: 18070337  

Blog. Se describe un filtro de señales EEG/MEG.

12: MMW Fortschr Med. 2007 Nov 22;149(47):32-5.    

    [Children with attention deficit hyperactivity disorder in school]
[Article in German]
    Von Trott GE, Schlander M.
    Institute for Innovation and Valuation in Health Care, Aschaffenburg. Esta dirección de correo electrónico está protegida contra spambots. Usted necesita tener Javascript activado para poder verla.

    To keep secondary disorders to a minimum, the early diagnosis and treatment of ADHD and its possible comorbidities is important. Aside from the care of a specialist, several additional measures permit the integration of these children into a structured everyday school routine and thus also permit age-appropriate development.
    PMID: 18069139 

Blog Técnicas de integración.

13: Clin Psychol Rev. 2007 Nov 6

    Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: A meta-analysis.
    Van der Oord S, Prins PJ, Oosterlaan J, Emmelkamp PM.
    Department of Clinical Psychology, University of Amsterdam, Roeterstraat 15, 1018 WB Amsterdam, The Netherlands.

    INTRODUCTION: This meta-analysis compares effect-sizes of methylphenidate and psychosocial treatments and their combination on ADHD, concurrent oppositional, conduct symptoms, social behaviors and academic functioning. METHOD: Several databases (PubMed, PsycInfo, ISI Web of Science) were searched for articles published between 1985 and September 2006. Inclusion criteria were: a diagnosis of ADHD; age from 6-12 years; a randomized controlled treatment design; efficacy established with parent and teacher rating scales; psychosocial treatments used were described as behavioral or cognitive-behavioral; the methylphenidate treatment was short-acting; and finally, treatment was conducted in a clinical setting. RESULTS: ADHD outcomes showed large mean weighted effect-sizes for both methylphenidate and combined treatments, psychosocial treatments had a moderate mean weighted effect-size; a similar pattern emerged for oppositional and conducted behavior symptoms. Social behavior outcomes showed comparable moderate mean weighted effect-sizes for all treatments, while on academic functioning, all treatments had low mean weighted effect-sizes. There was no correlation between duration of psychosocial treatment and effect-size. CONCLUSIONS: Both methylphenidate and psychosocial treatments are effective in reducing ADHD symptoms. However, psychosocial treatment yields smaller effects than both other treatment conditions. Psychosocial treatment has no additional value to methylphenidate for the reduction of ADHD and teacher rated ODD symptoms. However, for social behavior and parent rated ODD the three treatments were equally effective. For improvement of academic functioning no treatment was effective.

    PMID: 18068284  

Blog. La última conclusión es algo desconcertante, ¿nada mejora el rendimiento académico?, en mi consulta y 20 más que conozco sí mejoran con tratamiento farmacológico y con el combinado. Leyendo esto, todo lo anterior que iba en la líneas del MTA se tambalea . Recordemos que es un metanálisis con criterios de inclusión estrictos, por ejemplo sólo incluye fármacos de corta acción.

14: Epilepsy Behav. 2007 Dec 5; [Epub ahead of print]    

    Attention-deficit/hyperactivity disorder in pediatric patients with epilepsy: Review of pharmacological treatment.
    Torres AR, Whitney J, Gonzalez-Heydrich J.
    Department of Neurology, Children's Hospital, Harvard Medical School, Boston, MA, USA.

    Attention-deficit/hyperactivity disorder (ADHD) in children with epilepsy is a common source of impairment. Based on review of Medline indexed articles, meeting abstracts, and data requested from drug manufacturers, a summary of evidence that might guide treatment and research is presented. Methylphenidate (MPH) has shown high response rates and no increase in seizures in small trials. However, low baseline seizure rates, small numbers of subjects, and short observation periods limit the power of these studies to detect increases in seizure risk. Although longer-term effects of MPH and its effects in children with frequent seizures need to be studied, the evidence available at this time best supports use of MPH for the treatment of ADHD not amenable to changes in antiepileptic drugs or improvements in seizure control. This treatment should be part of a biopsychosocial approach. Other agents show promise. Preclinical, retrospective and open-label studies on amphetamines and atomoxetine support undertaking randomized controlled studies of these agents in patients with ADHD plus epilepsy. In contrast, additional data on guanfacine and modafinil should be gathered before undertaking randomized controlled studies with these agents.

    PMID: 18065271  
Blog. Recuerdan que los tratamientos TDAH no incrementan riesgo convulsivo.

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