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Au Canada, 13 % de la population consomme des drogues illicites et il est estimé qu’un jeune sur trois consomme régulièrement du cannabis. Cela génère un fardeau social, coûtant 46 milliards de dollars et entraînant l’hospitalisation de 275 000 personnes. La compréhension des facteurs de risque et des processus menant au développement d’une consommation problématique du cannabis et des autres substances chez les jeunes s’avère ainsi critique. Bien que plusieurs facteurs individuels et environnementaux soient impliqués dans le développement d’une consommation problématique du cannabis et des autres substances, l’adversité à l’enfance et le tempérament impulsif sont identifiés comme deux facteurs de risque importants pour le développement d’une consommation problématique. Cependant, aucune étude n’existe dans la prédiction spécifique des problèmes de consommation du cannabis. L’objectif principal de cette étude a été d’examiner le rôle de l’adversité et de l’impulsivité à l’enfance dans la prédiction d’une consommation problématique du cannabis et des autres substances à l’âge de 24 ans chez des Québécois suivis depuis de leur naissance, et ce dans le cadre d’une étude de cohorte longitudinale. Une relation a été trouvée entre l’adversité à l’enfance et la consommation problématique des substances autres que le cannabis. On retrouve également l’impact de l’impulsivité en tant que facteur de risque pour la consommation problématique des substances autres que le cannabis. Dû à l’absence de résultat significatif quant à la consommation problématique du cannabis, davantage d’études sont nécessaires afin d’explorer son lien avec l’adversité à l’enfance et l’impulsivité. / In Canada, 13% of the population uses illicit drugs and it is estimated that one individual out of three regularly between the ages of 16 to 25 consume cannabis on a regular basis. This creates a social burden, costing $46 billion and leading to the hospitalization of 275,000 individuals. Understanding the risk factors and processes leading to the development of cannabis and other substance use problems in young adult is therefore critical. While it is evident that several individual and environmental factors are involved in the development of cannabis and other substance use problems, childhood adversity and impulsivity have been identified as two important risk factors for the development of problematic cannabis and other substance use. However, there are no studies that examines the specific prediction of cannabis use problems. Thus, the main objective of this study was to examine the role of childhood adversity and impulsivity in the prediction of cannabis use problems in Quebec young adults at age 24, followed since birth in a longitudinal cohort study. A relationship was found between childhood adversity and problematic use of substances other than cannabis at age 24. We also found the impact of impulsivity as a risk factor for problematic consumption of substances other than cannabis. Due to the lack of significant results regarding problematic cannabis use, more studies are needed to explore the link between problematic cannabis use, childhood adversity and impulsivity.

Thesis (MEd (Educational Psychology)--University of Stellenbosch, 2006. / Many adults living in previously disadvantaged communities were confronted with daily racism, oppression and the abuse of human rights during the apartheid government's ruling of South Africa. Since the demise of apartheid, however, many of these same adults have continued to be challenged by adversities, such as crime, violence, unemployment, poverty, gangsterism and drug and alcohol abuse on a daily basis. Despite these adversities many adults nevertheless manage to cope and thrive. Yet, little research regarding the nature of adult resilience within high-risk communities, especially within the South African context, exists. The aim of this study was to gain insight into, and understanding of, adults' experiences of resilience within a high-risk South African community. In order to address the aims of the study, a basic interpretive qualitative study was undertaken. A high-risk community on the Cape Flats, Western Cape, was selected as the site for data collection, as it was known that adults in the community were exposed to high incidences of crime, violence, poverty, unemployment and gangsterism. The selected participants were viewed, both by themselves and by other community members, as resilient as they had managed to overcome years of racism, oppression and the abuse of human rights at the hands of the apartheid South African government. Additionally, participants had had to fight the harrowing effects of negative influences on a daily basis. The findings of this study indicated that, despite being confronted with ongoing extreme situations of adversity, the participants managed to cope and remain optimistic. Resilient attributes, such as intrapersonal, interpersonal and community resources, were found to contribute to adults' experiences of resilience. Intrapersonal resources, such as the maintenance of a positive attitude, the ability to set goals and the willingness to make sacrifices in order to achieve personally set goals, emerged. Other intrapersonal factors which were attributed to the adults' experiences of resilience related to the awareness of, and dedication to, future planning and the importance of maintaining a healthy body and mind. Interpersonal factors which came to the fore related to recognition of the importance of family relationships, involvement in activities which served to uplift and empower others, and acknowledgement of the need to mix with a diverse group of people in order to gain exposure to new ideas and experiences. Community resources were recognised as playing an additional role in supporting adults in their quest for success, with resources, such as religious organisations, schools and clinics, being identified by the participants concerned. Despite exposure to adversity, resilient adults in high-risk communities were found to make use of three sources of resources and to continue to remain hopeful and positive about their future. This study demonstrates, then, that resilience in a high-risk community is related to the use of intrapersonal, interpersonal and community resources.

Résumé : Les enfants de maternelle dont la préparation scolaire est limitée risquent de présenter des difficultés comportementales nuisibles à leur adaptation ultérieure. L’implication des parents à l’école, plus précisément la collaboration famille-école (CFE), peut représenter un facteur de protection favorisant l’adaptation de l’enfant tout au long de son parcours scolaire. Les écrits scientifiques suggèrent que la CFE jouerait un rôle important dans l’explication des difficultés de comportement, surtout auprès des enfants provenant de familles défavorisées. Cette étude porte sur le rôle de la CFE dans l’explication des difficultés de comportement intériorisé et extériorisé des enfants de maternelle qui présentaient des lacunes sur le plan de leur préparation scolaire. Les analyses de régression linéaire montrent que pour l’ensemble des familles de l’échantillon (n=47), plus il y a de communication entre le parent et l’enseignant, plus il y a présence de comportements extériorisés et intériorisés. Par contre, la CFE modère la relation entre un indice d’adversité constitué du cumul de cinq facteurs de risque sociodémographiques et les difficultés de comportement intériorisé. Ainsi, chez les familles défavorisées, une communication plus fréquente est associée à moins de comportements de type intériorisé. / Abstract : Children with limited school readiness are at risk for behavioral problems, which impact their school adjustment. Parents’ involvement in school, such as family-school partnership (FSP), may be a protective factor improving child's adaptation throughout their school career. Literature shows the important role of the FSP in reducing behavioral difficulties, especially for children from disadvantaged families. This study aims to explain child externalizing and internalizing behavior problems in kindergarten through FSP in children showing a limited school readiness. Linear regressions show that a frequent communication between the parent and the teacher is associate with a greater presence of externalizing and internalizing behaviors for the whole sample (n=47). However, FSP moderates the relationship between the demographics vulnerabilities and internalized child behavior problem in kindergarten. Indeed, for disadvantaged families, when there is a more frequent communication, children have less internalized behaviors.

Les enfants présentant un niveau élevé d’agressivité physique sont davantage à risque de commettre des actes criminels à l’âge adulte. Ces enfants sont également plus à risque de consommer des substances psychoactives au cours de leur adolescence. Les études portant sur le lien entre la consommation de substances psychoactives et la criminalité arrivent à des conclusions différentes, dépendamment des substances à l’étude et des comportements criminels ciblés. Un lien positif a été démontré entre la consommation chronique d’alcool et la perpétration d’actes criminels contre la personne et contre la propriété, tandis que la consommation de cannabis a été associée positivement aux actes criminels contre la propriété et négativement aux crimes contre la personne. La présente étude visait à tester l’hypothèse que l’agressivité physique manifestée à l’enfance est associée à une augmentation du nombre de charges criminelles durant l’âge adulte et que cette association est spécifique au type de criminalité et modérée différemment par la consommation d’alcool et de cannabis durant l’adolescence. À cette fin, 887 participants de sexe masculin provenant de milieu défavorisé ont été suivis de 6 à 25 ans. Les analyses de régressions logistiques multinomiales indiquent que les individus cheminant sur une trajectoire modérée ou élevée d’agressivité physique durant l’enfance sont plus à risque de commettre des actes criminels. Cette association reste significative après avoir contrôlé pour l’adversité familiale et de la consommation de substances psychoactives. Les hypothèses des effets modérateurs de la consommation d’alcool et de cannabis sont infirmées. Toutefois, des effets principaux de la consommation d’alcool sur les crimes contre la personne et de la consommation de cannabis sur les crimes contre la propriété sont observés. Les implications de ces résultats sont discutées. / Individuals exhibiting high levels of physical aggression during childhood are more at risk of criminal behaviors during adulthood regardless of the presence of several risk factors. Aggressive children are also more at risk of using psychoactive substances during adolescence. Studies of the relationship between substance use and crime have provided different conclusions, depending on the substance under consideration and depending on the category of crime. Alcohol consumption has been positively associated with crimes, both against people and against property. Cannabis consumption has been associated positively with crime against property and negatively with crime against people. This present study aimed at investigating the hypothesis that physical aggression manifested in childhood is associated with an increase in criminal charges during adulthood and that association is specific to the type of crime and moderated differentially by alcohol and cannabis use. To this end, 887 male participants from lower socioeconomic status were followed from age 6 to age 25. Multinomial logistic regressions indicate that individuals belonging to a moderate or a high trajectory of physical aggression during childhood are more likely to commit crimes later in adulthood. This association remains significant after control of family adversity and drug use. Alcohol and cannabis use during adolescence has no effect on this association. However, main effects of alcohol use on crimes against person and cannabis use on crimes against property are observed. The implications of these findings are discussed.

Plusieurs facteurs de risque de développement de troubles intériorisés, tels que les troubles d’anxiété et de l’humeur, ont été identifiés dans la littérature. Les deux plus importants facteurs de risques regroupent l’adversité vécue durant l’enfance (par exemple la maltraitance) et le risque parental (c’est-à-dire la présence d’un trouble intériorisé chez l’un ou les deux parents). Ces facteurs de risque ont été liés à des changements neuroanatomiques similaires à ceux observés en lien avec les troubles intériorisés. Ainsi, en présence de ces facteurs de risque, des anomalies anatomiques pourraient laisser présager l’apparition prochaine d’une symptomatologie de troubles intériorisés chez des individus encore asymptomatiques. Chez les quelques populations de jeunes investiguées, les participants présentaient des comorbidités et/ou étaient sous médication, ce qui rend difficile l’interprétation des atteintes cérébrales observées. Ce travail de thèse s’est intéressé aux liens entre ces deux facteurs de risque et les substrats neuroanatomiques associés à chacun d’eux, chez des adolescents asymptomatiques et n’étant sous aucune médication. Une première étude a examiné le lien entre le niveau de pratiques parentales coercitives et le niveau de symptômes d’anxiété, mesurés de manière longitudinale depuis la naissance, et les différences neuroanatomiques observées à l’adolescence (voir Chapitre 2). Une deuxième étude a examiné le lien entre le risque parental de développer des troubles d’anxiété et les différences neuroanatomiques observées à l’adolescence (voir Chapitre 3). Une troisième étude s’est intéressée au lien entre le risque parental de développer un trouble de dépression ou un trouble bipolaire et les différences neuroanatomiques observées à l’adolescence (voir Chapitre 4). Les résultats démontrent des différences de volume et/ou d’épaisseur corticale dans plusieurs structures clés impliquées dans le traitement et la régulation des émotions. C’est le cas du cortex préfrontal, de l’amygdale, de l’hippocampe et du striatum. Ces résultats suggèrent que certaines des différences neuroanatomiques observées dans les troubles intériorisés peuvent être présentes avant que le trouble ne se manifeste, et représenter des marqueurs neuronaux du risque de développer le trouble. Les implications théoriques et les limites de ces trois études sont finalement discutées dans le Chapitre 5. / Several risk factors for the development of internalized disorders such as anxiety, depression, and bipolar disorders have been identified in the literature. The two most important risk factors include adversity during childhood (i.e. abuse, neglect and harsh parenting) and parental risk (i.e. the presence of an internalized disorder in one or both parents). These risk factors have been linked to anatomical changes in several brain structures, which are similar to those observed in internalized disorders. Thus, in the presence of these risk factors, anatomical abnormalities may predict the appearance of internalized disorders in asymptomatic individuals. In the few studies that have investigated the influence of these risk factors in a youth population, participants often had comorbidities and/or were medicated, which makes the observed anatomical changes difficult to interpret. This work has focused on these two risk factors (i.e. adversity during childhood, in the form of harsh parenting, and the parental risk) and their link with the anatomical cerebral substrates, in asymptomatic and un-medicated adolescents. A first study examined the link between harsh parenting, levels of anxiety symptoms, as measured longitudinally from birth, and neuroanatomical differences in adolescents (see Chapter 2). A second study examined the link between parental risk of developing anxiety disorders, and neuroanatomical differences in adolescents (see Chapter 3). A third study looked at the link between parental risk for developing depressive disorder or bipolar disorder, and neuroanatomical differences in adolescents (see Chapter 4). Results show differences in volume and/or cortical thickness of several key cerebral structures involved in emotional processing and regulation. This is the case of the prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex, the amygdala, hippocampus and striatum. These results suggest that some neuroanatomical differences in internalized disorders may be present before the disorder emerges, and represent neuronal markers denoting the risk of developing the disorder. The theoretical implications and limitations of these three studies are discussed in Chapter 5.

本研究旨在探討當前國小學童人際智能、內省智能、創造力與逆境經驗之關係，以問卷調查的方式，針對台灣地區國小學童進行調查研究。正式施測共得642份有效樣本，以北、中、南、東四大行政區域，取樣國小中、高年級學生，研究工具採用人際智能量表、內省智能量表、創造力自我效能量表、創新行為量表及逆境經驗量表。研究運用描述統計分析、t考驗、單因子變異數分析、皮爾遜積差相關分析、多元迴歸分析考驗研究假設。主要研究結果如下： 一、現今國小學童之人際、內省智能自我效能感良好，對相關領域上的活動有興趣；認為自己還算具有創新行為及良好創造力自我效能感；面對逆境時普遍會有負面感受，且能以較積極的方式及態度因應逆境，並多能建構正向的逆境意義。 二、較低年級的國小學童，其對人際智能領域之相關活動較感興趣，人際智能也較高，且認為自己較常表現出創新行為，也較有創造力自我效能感，面對逆境時較不會有負面感受、較能正向因應逆境，但對於逆境意義的建構、內省智能發展並不因年級有所差異。 三、國小學童人際智能越高，越能積極因應逆境，也越能建構較良好之逆境意義。 四、國小學童內省智能越高，越能積極因應逆境，也越能建構較良好之逆境意義。 五、國小學童創新行為越多、創造力自我效能越高，越能積極因應逆境，也越能建構較良好之逆境意義。 六、人際智能、內省智能、創新行為及創造力可顯著預測逆境之負面感受、逆境因應方式及逆境意義建構的正向程度。 七、逆境經驗可顯著預測人際智能、內省智能、創新行為及創造力，且其中的逆境意義建構是最主要的預測變項。 最後，根據研究結果對教育與未來研究兩方面提出建議。 關鍵字：人際智能、內省智能、創造力、逆境經驗 / The main purpose of this study was to explore the relationships among interpersonal intelligence, intrapersonal intelligence, creativity and adversity experience of elementary school students. A total of 642 children in the forth to sixth grade of elementary school students (314 male, 324 female) in Taiwan was sampled in this study. This study involved a survey that comprised of four sets of questionnaires: the Inventory of Interpersonal Intelligence, the Inventory of Intrapersonal Intelligence, the Inventory of Creative Behavior, and the Inventory of Creative Self-efficacy. The quantitative of data was analyzed by descriptive statistics, Pearson’s correlation, t-test, ANOVA, and regression analysis. The main findings of this study were as follows. (a)Elementary school students are rated above middle on their self-efficacy of interpersonal intelligence and intrapersonal intelligence, and also interested in relevance activities. In face of adversity, they tend to have negative emotions, but at the same time they know how to actively cope, adjust and reframe. They can also construct meaning from the adversity; (b) Elementary school students who has the higher interpersonal intelligence, intrapersonal intelligence, creative self-efficacy, and behaved more creative, would be more active to face adversity, but also can construct more positive life meaning from the adversity; (c) interpersonal intelligence, intrapersonal intelligence, creative self-efficacy and creative behavior significantly predicted negative emotions, coping methods, and meaning construction of adversity, and vice versa. According to the results of the study, some suggestions were made for educators and further studies. Key words: interpersonal intelligence, intrapersonal intelligence, creativity, adversity experience.

Les enfants présentant un niveau élevé d’agressivité physique sont davantage à risque de commettre des actes criminels à l’âge adulte. Ces enfants sont également plus à risque de consommer des substances psychoactives au cours de leur adolescence. Les études portant sur le lien entre la consommation de substances psychoactives et la criminalité arrivent à des conclusions différentes, dépendamment des substances à l’étude et des comportements criminels ciblés. Un lien positif a été démontré entre la consommation chronique d’alcool et la perpétration d’actes criminels contre la personne et contre la propriété, tandis que la consommation de cannabis a été associée positivement aux actes criminels contre la propriété et négativement aux crimes contre la personne. La présente étude visait à tester l’hypothèse que l’agressivité physique manifestée à l’enfance est associée à une augmentation du nombre de charges criminelles durant l’âge adulte et que cette association est spécifique au type de criminalité et modérée différemment par la consommation d’alcool et de cannabis durant l’adolescence. À cette fin, 887 participants de sexe masculin provenant de milieu défavorisé ont été suivis de 6 à 25 ans. Les analyses de régressions logistiques multinomiales indiquent que les individus cheminant sur une trajectoire modérée ou élevée d’agressivité physique durant l’enfance sont plus à risque de commettre des actes criminels. Cette association reste significative après avoir contrôlé pour l’adversité familiale et de la consommation de substances psychoactives. Les hypothèses des effets modérateurs de la consommation d’alcool et de cannabis sont infirmées. Toutefois, des effets principaux de la consommation d’alcool sur les crimes contre la personne et de la consommation de cannabis sur les crimes contre la propriété sont observés. Les implications de ces résultats sont discutées. / Individuals exhibiting high levels of physical aggression during childhood are more at risk of criminal behaviors during adulthood regardless of the presence of several risk factors. Aggressive children are also more at risk of using psychoactive substances during adolescence. Studies of the relationship between substance use and crime have provided different conclusions, depending on the substance under consideration and depending on the category of crime. Alcohol consumption has been positively associated with crimes, both against people and against property. Cannabis consumption has been associated positively with crime against property and negatively with crime against people. This present study aimed at investigating the hypothesis that physical aggression manifested in childhood is associated with an increase in criminal charges during adulthood and that association is specific to the type of crime and moderated differentially by alcohol and cannabis use. To this end, 887 male participants from lower socioeconomic status were followed from age 6 to age 25. Multinomial logistic regressions indicate that individuals belonging to a moderate or a high trajectory of physical aggression during childhood are more likely to commit crimes later in adulthood. This association remains significant after control of family adversity and drug use. Alcohol and cannabis use during adolescence has no effect on this association. However, main effects of alcohol use on crimes against person and cannabis use on crimes against property are observed. The implications of these findings are discussed.

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No. of bitstreams: 1 felipe_mamp_me_sjrp.pdf: 1349367 bytes, checksum: 5134bbfaa32606a8fd9a753773e5fd66 (MD5) Previous issue date: 2018-05-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Este estudo investiga as orações concessivas do espanhol falado introduzidas por aunque, juntor que, de acordo com os compêndios gramaticais, pode assinalar uma relação concessiva ou adversativa em língua espanhola. Sob a perspectiva da teoria da Gramática Discursivo-Funcional (GDF) (HENGEVELD; MACKENZIE, 2008), pretendemos averiguar como o fenômeno da sobreposição semântica entre concessão e adversidade é concebido e, de maneira específica, investigar as particularidades da relação concessiva que ocorre nos níveis e camadas do modelo da Gramática Discursivo-Funcional, especialmente no Nível Interpessoal. Diversos autores na literatura do espanhol afirmam que “as relações de concessão e de adversidade fazem referência a domínios nocionais muito próximos” apoiados no argumento de que ambas apresentam elementos de informação contrastantes entre si (FLAMENCO GARCÍA, 2000, p.3809). Em espanhol, algumas estruturas, quando introduzidas por aunque, podem comportar diferentes leituras, o que se comprova substituindo a conjunção aunque por pero, como se observa em: Parece tonto, aunque a veces sorprende e Parece tonto, pero a veces sorprende (CASCÓN MARTÍN, 2000, p.169). O presente trabalho parte do pressuposto de que todo uso de aunque é, na realidade, concessivo, e o que permite uma leitura adversativa é, na verdade, uma questão de ordem pragmática. Os dados mostram que as orações consideradas pela literatura como adversativas são as que se constituem entre Atos Discursivos e entre Movimentos, ambas do Nível Interpessoal. Nesse caso, tendem a ser não pressupostas, pois essas construções carregam a informação mais saliente do ponto de vista informativo ou simplesmente configuram casos nos quais o falante deseja mencionar/relembrar alguma informação, não importando se o ouvinte a conhece ou não; além disso, são construções que tendem à factualidade, alternam a forma verbal entre indicativo e subjuntivo (embora apenas os casos com verbo no indicativo aceitem substituição por pero) e tendem a aparecer em posição posposta ou independente. No que diz respeito à análise dos dados, o universo de investigação adotado consiste em amostras extraídas do Projeto PRESEEA. / This study investigates the concessive clauses from the spoken Spanish introduced by aunque, enconnective that, according to the gramatical compedia, can indicate a concessive or adversative relation in the Spanish language. From the perspective of the Functional Discourse Grammar (FDG) (HENGEVELD; MACKENZIE, 2008), we intend to inquire how the phenomenon of the semantic overlap between concession and adversity is conceived and, in a specific way, to investigate the particularities of the concessive relation that occurs in the levels and layers of the Discursive-Functional Grammar model, especially in the Interpersonal Level. Many authors in the Spanish literature claim that “the relations of concession and adversity make reference to very close notional domains” supported by the argument that both present contrasting elements of information (FLAMENCO GARCÍA, 2000, p.3809). In Spanish, some structures, when introduced by aunque, may have different readings, which is proven by substituting the conjunction aunque for pero, as seen in: Parece tonto, aunque a veces sorprende and Parece tonto, pero a veces sorprende (CASCÓN MARTÍN, 2000, p.169). The present work is based on the assumption that every use of aunque is, in reality, concessive, and what allows the adversative reading is, actually, a pragmantic matter. The data show that the clauses considered by literature as adversative are the ones that constitute between Discursive Acts and between Move, both in the Interpersonal Level. In this case, they tend to be non-pressuposed because these constructions carry more salient information from the informative point of view or simply configure cases in which the speaker wishes to emphasize some information, not being important if the listener knows it or not; in addition, they are contructions that tend to factuality, they alternate the verbal form between indicative and subjunctive (although only cases with the verb in the indicative accept the substitution for pero) and tend to appear in a postero or independent position. As for the data analysis, the universe of research adopted consists of samples extracted from the PRESEEA Project. / Este estudio investiga las oraciones concesivas del español hablado introducidas por aunque, conjunción que, según la perspectiva tradicional, puede indicar una relación concesiva o adversativa en lengua española. Desde el punto de vista de la Gramática Discursivo-Funcional (GDF) (HENGEVELD; MACKENZIE, 2008), pretendimos investigar cómo el fenómeno de la superposición semántica entre concesión y adversidad se concibe y, de modo específico, investigar las particularidades de la relación concesiva que ocurre en los niveles y camadas de la Gramática Discursivo-Funcional, especialmente en el Nivel Interpersonal. Diversos autores en la literatura del español dicen que “las construcciones concesivas y adversativas hacen referencia a dominios nocionales muy próximos”, apoyadas en el argumento de que las dos presentan elementos de información que contrastan entre ellos (FLAMENCO GARCÍA, 2000, p.3809). En español, algunas estructuras, cuando van introducidas por aunque, pueden permitir distintas lecturas, lo que se comprueba por la sustitución de aunque por pero, como en Parece tonto, aunque a veces sorprende e Parece tonto, pero a veces sorprende (CASCÓN MARTÍN, 2000, p.169). El presente estudio parte de la idea de que todo uso de aunque es, en realidad, concesivo, y lo que permite una lectura adversativa es una cuestión de orden pragmática. Los datos nos enseñan que las oraciones consideradas por la literatura como adversativas son las que se constituyen entre Actos Discursivos y entre Movimientos, en el Nivel Interpersonal. En estos casos, tienden a ser no presupuestas, pues llevan la información más saliente desde el punto de vista informativo o simplemente son casos en los cuales el hablante desea reforzar alguna información, sin importarse con el hecho de que su oyente la conozca o no; además, son construcciones que tienden a la factualidad, alternan la forma verbal entre indicativo y subjuntivo (aunque apenas los casos con verbo en indicativo aceptan sustitución por pero) y tienden a aparecer en posición pospuesta o independiente. En lo que se refiere al análisis de datos, el universo de investigación adoptado se constituye por amuestras del Proyecto PRESEEA. / CAPES: 3300415-3

Introdução O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) está associado a um significativo impacto negativo em diferentes esferas da vida dos pacientes e de seus familiares. O tratamento medicamentoso com metilfenidato (MFD), embora reduza os prejuízos associados ao transtorno, não é universalmente eficaz. Existem poucos estudos sobre fatores preditores de resposta ao MFD e a maior parte das informações origina-se de uma única amostra. Objetivos O presente estudo tem por objetivo avaliar fatores preditores de resposta ao tratamento com MFD em crianças e adolescentes com TDAH. Especificamente, foram estudados fatores clínicos, demográficos, funcionamento familiar, psicopatologia parental e fatores ambientais adversos. Métodos Este é um estudo longitudinal com um design de quase-experimento. Crianças e adolescentes com TDAH e indicação primária de MFD foram tratadas e acompanhadas por 6 meses por psiquiatras da infância e adolescência. Foi utilizado MFD em doses otimizadas até o máximo de efeito ou o surgimento de efeitos colaterais limitantes. A eficácia foi avaliada pelas escalas SNAP-IV e CGI-G, preenchidas pelos pais e pelo médico, respectivamente. Os fatores preditores avaliados pertencem a três dimensões: clínica e demográfica, características familiares (psicopatologia parental e funcionamento familiar) e fatores de adversidade psicossocial. O funcionamento familiar foi avaliado através da escala FES; a avaliação de psicopatologia parental foi realizada através da entrevista diagnóstica SCID-IV, da escala ASRS e de avaliação de sintomas de psicopatia. Os fatores de adversidade psicossocial foram derivados dos Indicadores de Adversidade de Rutter. A análise estatística foi realizada através dos testes do 2 ou teste exato de Fisher (para variáveis categóricas) e teste t de Student (para variáveis contínuas). Foram desenvolvidos modelos multivariados para avaliação dos fatores preditores de resposta através de modelos de efeitos mistos. Resultados Foram incluídos 125 pacientes nas análises. Nas análises univariadas, menor idade (p=0,01), subtipo combinado de TDAH (TDAH-C) (p<0,001), comorbidade com Transtorno de Conduta (TC) (p=0,03) e Transtorno de Oposição e Desafio (TOD) (p<0,001) foram associados a pior desfecho. No funcionamento familiar, as dimensões de organização (p=<0,001) e coesão (p=0,01) foram preditores de melhor resposta. A dimensão de conflito (p=<0,001) esteve associada à pior resposta. Em relação à psicopatologia materna, a presença de sintomas antisociais (p=0,002), o número de diagnósticos psiquiátricos de Eixo I (p=0,03) e a gravidade de sintomas de TDAH (p=<0,001) também foram preditores de pior resposta. A psicopatologia paterna não esteve associada à resposta ao tratamento. Em termos de adversidade psicossocial, apenas gestação indesejada (p=0,002) esteve associada à pior desfecho. Nas análises multivariadas, TDAH-C, comorbidade com TOD e maior gravidade de sintomas basais (CGAS) foram preditores de pior resposta. Da mesma forma, conflito familiar e sintomas maternos de TDAH predisseram um pior resultado. O efeito de gestação indesejada manteve-se estatisticamente significativo no modelo multivariado. Em um modelo que abrangeu todas as dimensões estudadas, os seguintes fatores foram preditores de pior resposta ao tratamento: TDAH-C, comorbidade com TOD, sintomas maternos de TDAH e gestação indesejada. CONCLUSÃO Este é o primeiro estudo realizado em população de país em desenvolvimento a avaliar o impacto de diferentes fatores adversos psicossociais na resposta a metilfenidato em crianças e adolescentes com TDAH. Demonstramos que o subtipo combinado de TDAH, a comorbidade com TOD, sintomas maternos de TDAH e gestação indesejada foram preditores de pior resposta ao MFD. Tais achados ressaltam a importância de ter-se uma visão ampla no atendimento destas crianças, levando em consideração o ambiente no qual elas estão inseridas e possíveis fatores preditores de piores desfechos. Além disso, os nossos resultados enfatizam a importância de se avaliar os pais no atendimento de crianças e adolescentes, especialmente investigando sintomas maternos de TDAH. Pesquisas futuras devem expandir o conhecimento acerca de interações entre fatores genéticos e ambientais, possibilitando que sejam desenvolvidas abordagens mais eficazes e que contribuam para a redução do impacto negativo deste transtorno. / Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with a negative impact in different aspects of patients and their relatives’ lives. Although pharmacological treatment with methylphenidate (MPH) may reduce the impairment associated with the disorder, it is not universally effective. There are few studies of the predictive factors of MPH treatment response and most of available data come from a single sample. Objectives The aim of our study was to evaluate the impact of demographic, clinical, familial (parental psychopathology and family functioning), and psychosocial adversity factors on the response to methylphenidate in a naturalistic sample of children and adolescents with ADHD. Methods This is a longitudinal study with a quasi-experiment design. Children and adolescents with ADHD and a primary indication for MPH treatment were treated and followed for 6 months by child and adolescent psychiatrists. Medication doses were augmented until no further clinical improvement was detected or there were limiting side effects. Treatment response was evaluated according to SNAP-IV and CGI-S scales, completed by parents and researchers, respectively. Predictive factors were divided into three dimensions: clinical and demographic, family characteristics (parental psychopathology and family functioning) and psychosocial adversity. Family functioning was evaluated by the FES scale; parental evaluation consisted of a diagnostic interview (SCID-IV), self-reported ASRS scale and psychopathic symptoms investigation. Psychosocial adversity factors were derived from Rutter’s indicators of adversity. Statistical analysis were performed using 2 test or Fisher’s Exact Test (categorical variables), and Student t test (continuous variables with normal distribution). Multivariable models were constructed with a Mixed-Effects Model (MEM) approach for analysis of predictive factors of treatment response. Results One hundred and twenty-five patients were included. In the univariate analysis, younger age (p=.01), the presence of ADHD combined subtype (p<.001), CD (p=.03) and ODD (p<.001) were associated with a worse response to treatment. Higher scores on the organization (p=<.001) and cohesion (p=.01) dimensions of FES were associated with better response to treatment, while more conflicted families had a worse response (p=<.001). In terms of maternal psychopathology, antisocial symptoms (p=.002) and number of Axis I diagnosis (p=.03) were associated with a worse response to methylphenidate. Also, maternal ADHD symptoms predicted a worse response to treatment (p=<.001). Paternal psychopathology did not predict treatment response. In terms of psychosocial adversity, only undesirable pregnancy (p=.002) predicted a worse response to treatment. In the multivariate analysis, ADHD combined subtype, ODD comorbidity and lower baseline CGAS scores were significant predictors of a reduced response to treatment. Family conflict and maternal ADHD symptoms were also significant predictors of poor response. Undesirable pregnancy also remained significant in the multivariate analysis. A final multivariate mixed-effect model was created including significant predictors of response in each individual multivariate model. Results indicated that ADHD combined subtype, ODD diagnosis, maternal ADHD symptoms, and undesirable pregnancy were significant predictors of a reduced response to methylphenidate during 6 months of treatment. Conclusion This is the first study in a developing country to evaluate the impact of different adversity factors on ADHD treatment response in children and adolescents. We were able to demonstrate that ADHD combined subtype, ODD comorbidity, ADHD maternal symptoms and undesirable pregnancy were predictors of a worse response to MPH. These findings highlight the need to have a global perspective on children’s environment and be aware of the presence of negative predictors of treatment response. In addiction, our results stress the role of parental evaluation, especially maternal ADHD symptoms. Future research should expand our knowledge on how genetic factors interact with environmental factors, which might pave the road to the development of alternative clinical strategies that might reduce the burden associated with ADHD.