The past decade has witnessed students with disabilities attending university in everincreasing numbers. In particular, many countries, including Australia, now report that students with so-called 'invisible disabilities' comprise the vast majority of those seeking support from Student Disability Services at university. Despite this increase, relatively few researchers have investigated the processes involved in the university education of students with disabilities, particularly during their crucial first year, when the highest rate of student attrition occurs across the board. The substantial body of research which has investigated the 'first year experience' for university students in Australia and the United States of America has ignored the issues unique to students with disabilities during this critical period. At the same time, some researchers, predominantly in the United States of America and the United Kingdom, have studied the tertiary education of students with disabilities. However, the subject has received less attention in Australia. Also, certain categories of university students with disabilities have been overlooked. In particular, university students diagnosed with Attention Deficit/Hyperactivity Disorder (AD/HD) appear to be one of the groups that have attracted little attention worldwide, despite the vast body of research that exists on children and, increasingly, on adults with the diagnosis. These students constituted the focus of the study reported in this thesis. The aim of this study was to develop substantive theory about how university students who are diagnosed with Attention-Deficit/Hyperactivity Disorder (AD/HD) deal with their first year. The study is conceptualised within the social theory of symbolic interactionism. A central research question and a series of related guiding questions were used as the starting point for data collection. Data collection was conducted largely through in-depth, individual, face-to-face semistructured interviews, and participant observation consistent with the interpretivist qualitative research tradition. In addition, informal interviews, telephone interviews and documents provided supplementary data for the study. Data analysis, which occurred concurrently with data collection, employed the open coding method consistent with the grounded theory model and the development and testing of propositions. The central proposition of the substantive theory generated from this study is that students diagnosed with AD/HD experience a sense of developing empowerment as they progress through three stages in their first year at university. The first stage in the theory of developing empowerment is entitled the development of empowerment through realising a dream. The second stage is entitled the development of empowerment through becoming proactive. The final stage is entitled the development of empowerment through the feeling of belonging. The theory of developing empowerment provides a new perspective on how university students with a diagnosis of AD/HD deal with their first year of study. A number of implications for further theory development, policy and practice are drawn from it. There are also several recommendations for further research.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

In this qualitative research study the focus is on the use of sensory integration strategies with children who have Attention Deficit/Hyperactivity Disorder. Three respondents specialising in sensory integration in the Durbanville area were involved. Individual semi-structured interviews were conducted with each of the respondents in order to gain knowledge on the use of sensory integration strategies with children who have Attention Deficit/Hyperactivity Disorder by a professional other than an occupational therapist. After permission had been obtained, the interviews were captured on video tape and transcribed for use in the empirical study. Seven themes were identified from the interviews and a literature control was done with each of the themes. The researcher did not attempt to generalise the results of the research, but tried to reflect on the information that the respondents provided. The researcher summarised the findings of the empirical study and made recommendations. / Social Work / M. Diac (Play Therapy)

The aim of my dissertation is to map parents´ life who have children with the ADHD syndrome. This presented dissertation consists of the theoretical and practical part. In the theoretical part I am dealing with ADHD syndrome, his definition, characteristics, causes of origin, diagnostics, then I mention difficulties which are connected to ADHD syndrome and his presence in population. Then in chapter Child with ADHD I focus on particularities of its evolution, then I describe the sense and role of the child´s family. The important part is the upbringing ADHD children and, also suitable attitudes for them. I am also dealing with parents who have ADHD child and their potential difficulties, which they can be faced. The last chapter is ADHD Child in the school, where I describe the sense of the teacher for ADHD child and how relations the family and the school have, possibilities how to help, support for parents and their ADHD children. The qualitative method which means interview was chosen for this research. The content of the practical part is to analyse and make dialogues with the parents of ADHD children with the aim to answer on given research questions and to fulfil the aim of my dissertation. Interviews was realised with four respondents. With one of them there was also respondent´s husband. The respondents´ children´s age was from 6 to 12 years, 3 boys and 1 girl. Interviews were rewritten word to word by direct transcription towards written form and subsequently were elaborated by open coding with the subsequent setting cards. Respondents described similar characteristics their children with ADHD as hyperactivity, inattentiveness, impulsiveness and madness. Also they agreed that child´s ADHD negatively influenced the relationship with their partners.

Introdução: O metilfenidato de liberação imediata (MFD-LI) é um psicofármaco receitado mundialmente para o tratamento do Transtorno de Déficit de Atenção/hiperatividade (TDAH). Embora eficaz, o MFD-LI está associado a problemas de adesão ao tratamento, uma vez que os pacientes necessitam ingerir os comprimidos várias vezes ao dia. O Spheroidal Oral Drug Absorption System (SODAS™) é uma formulação de metilfenidato de liberação prolongada (MFD-LP) que mimetiza a administração de MFD-LI duas vezes ao dia, e que apresenta menor flutuação nos níveis séricos. Nesta formulação, cinqüenta por cento dos grânulos com revestimento para liberação entérica são liberados aproximadamente 4 horas após a administração, proporcionando um perfil de ação semelhante a duas tomadas ao dia do MFD-LI. O MFD SODAS™ libera de imediato 50% do medicamento, proporcionando um rápido início de ação quando comparado ao sistema de liberação OROS®. Poucos estudos avaliaram a troca do MFD-LI para o MFD-LP, sendo que desses, apenas crianças e adolescentes foram avaliados, e nenhum verificou os preditores de insatisfação da troca do MFD-LI para o MFD-LP. Objetivos: Este estudo tem como objetivo avaliar os sintomas de TDAH, ou preditores de insatisfação e/ou desistência do tratamento naqueles pacientes clinicamente estáveis que fizeram a troca do MDF-LI para o MFD SODAS™. Método: Os critérios de inclusão foram: diagnóstico de TDAH de acordo com os critérios do DSM-IV, e estabilidade de sintomas com o uso do MFD-LI. Os critérios de exclusão foram: condição clínica coexistente que pudesse impedir a prescrição de MFD SODAS™; diagnóstico de abuso ou dependência de álcool e/ou drogas de abuso; diagnóstico prévio de retardo mental moderado; tratamento psicoterápico concomitante. Este é um ensaio clínico aberto realizado em oito semanas. Os pacientes foram designados a receber doses de MFD SODAS™ de acordo com a dose de MFD-LI previamente estabelecida. A eficácia foi avaliada através das escalas SNAP-IV e CGI-S, e eventos adversos através da Barkley's Side Effect Rating Scale (SERS). Foi solicitado aos participantes que classificassem sua satisfação com o tratamento através de uma escala Likert de 5 pontos. Também foram avaliados os seguintes potenciais preditores de resposta: sexo, idade, etnia, nível socioeconômico, comorbidades, subtipos de TDAH, resultados das escalas SNAP-IV e SERS no baseline, tempo de tratamento, tratamento farmacológico concomitante, dose de MFD-LI prévia ao início do estudo e a existência de pausa do tratamento nos finais de semana. Resultados: A partir de uma amostra total de 207 crianças, adolescentes e adultos (provenientes do ambulatório adulto e infantil de transtorno de déficit de atenção/hiperatividade do Hospital de Clínicas de Porto Alegre) foi possível contatar 133 pacientes, os quais sessenta e dois pacientes foram elegíveis a participar do estudo, e 47 completaram as oito semanas de tratamento. Não se encontrou diferença significativa no escore total do SNAP-IV durante o protocolo - baseline, semana 4 e 8 [F(1, 51,26) =0,012; p=0,913]. Ao todo, 46 (74,2%) dos pacientes relataram estar satisfeitos com o novo tratamento, 16 (25,8%) estavam insatisfeitos ou saíram do protocolo. Nas análises univariadas, foi detectada uma tendência para a associação entre etnia e insatisfação (p=0.05). Não se encontrou uma diferença significativa nos escores da SERS durante o ensaio clínico [F(1, 111,49) =0,748; p=0,389]. Em onze eventos adversos ocorreram ao menos 5% em alguma das avaliações (baseline, 4ª ou 8ª semana). Um adulto, que apresentava uma doença cardiovascular previamente ao estudo, apresentou um acidente vascular cerebral hemorrágico (AVCH) após a quarta semana de tratamento, evoluindo ao óbito após três semanas. Conclusão: Poucos estudos abordaram os sintomas de TDAH após a troca do MFD-LI para qualquer formulação de MFD-LP, e nenhum estudo prévio foi conduzido em populações de países em desenvolvimento ou em amostras com adultos. A taxa de satisfação encontrada (74,2%) na troca do MFD-LI para MFD SODAS™ possivelmente reflete a conveniência da dose única diária deste MFD-LP, como já especulado em estudos prévios. Não foram identificados fatores preditores de insatisfação. O número médio de efeitos colaterais pode ser considerado alto, mas isso pode ser o resultado do uso de uma escala de avaliação adequada, diferentemente do relato espontâneo do evento adverso. Não foi possível encontrar uma relação direta entre os efeitos do MFD SODAS™ e a morte por AVCH ocorrida em um dos sujeitos da amostra. Entretanto, o evento cardiovascular ocorrido sugere extrema cautela ao medicar pacientes com doenças cardiovasculares, conforme proposto pelo FDA. Os achados desse estudo sugerem que o MFD SODAS™ possui eficácia e perfil de eventos adversos similares ao MFD-LI. / Introduction: Immediate-release methylphenidate (MPH-IR) is a pharmacological treatment prescribed worldwide for patients with attention-deficit/hyperactivity disorder (ADHD). The MPH-IR, although highly efficacious, need to be used more than once a day, and consequently might be associated with poor adherence. The Spheroidal Oral Drug Absorption System (SODAS™) is one type of MPH-ER (Extended-release methylphenidate) that mimics the twice-daily administration of MPH-immediate release, but presents less peak and trough fluctuations. This formulation allows the immediate release of 50% of the drug, providing a rapid onset if compared with OROS® formulation. Few studies have evaluated specifically the switching from MPH-IR to MPH-ER. All previous studies accessed only children and adolescents; none evaluated switching to MPH SODAS™ and no predictors of treatment dissatisfaction were mentioned. Objectives: The present study aims to assess ADHD symptoms for 08 weeks after switching from MPH-IR to MPH SODAS™ in clinically stable patients, and to identify predictors of dissatisfaction with MPH SODAS™, and/ or withdrawal from the protocol. Method: The inclusion criteria were: ADHD diagnosis according to the DSM-IV criteria and clinical stability with MPH-IR. The exclusion criteria were: a clinically coexisting medical condition interfering with the administration of MPH SODAS™; previous diagnosis of alcohol and/or drug abuse or dependence; previous diagnosis of moderate mental retardation; concomitant psychotherapy. This is an 8-week open clinical trial. Patients were assigned to doses of MPH SODAS™ according to their pre-study dose of MPH-IR. Assessment of efficacy and side effects was performed by means of the SNAP-IV, CGI-S, Barkley's Side Effect Rating Scale (SERS). Subjects were also asked to report their satisfaction with the treatment in a 5-point Likert scale. We also evaluated the following potential predictors of treatment response: sex, age, ethnicity, socioeconomic status, comorbidities, baseline scores on the SNAP-IV, and SERS, length of treatment, concomitant treatment, previous prescribed dose of MPH-IR, and pause of treatment on weekends. Results: From a total sample of 207 children, adolescents and adults (enrolled from the ADHD outpatient clinic at both Adult and Child and Adolescent Psychiatric Division of Hospital de Clínicas de Porto Alegre) we were able to re-contact 133 patients, where sixty-two patients were eligible to the clinical trial, and 47 completed the 08 weeks of treatment. There was no significant change in the total score of the SNAP-IV during the protocol – baseline, week 4 and 8 [F(1, 51.26)=0.012; p=0.913]. Overall, 46 (74.2%) patients had reported to be satisfied with the new treatment, and 16 (25.8%) were dissatisfied or withdrew from the protocol. In univariate analyses, only ethnicity (p=0.05) were associated with dissatisfaction. No significant change in the SERS score was found during the protocol [F(1, 111.49)=0.748; p=0.389]. Eleven adverse events occurring in at least 5% of the group in any assessment (baseline, 04 or 08 weeks) were observed according to SERS. One adult, with previous cardiovascular disease, presented a hemorrhagic cerebral vascular accident (CVA) after the forth week assessment, resulting in her obit. Conclusion: There is a scarcity of research assessing the switch from MPH-IR to different forms of MPH-ER, and none across the life cycle or in populations from developing countries. The 74.2% of satisfaction with the new treatment may reflect the convenience of the once-a-day dosing of the MPH SODAS™. No predictor of dissatisfaction/withdrawal from the trial was found. The number of adverse events reported during the protocol could be considered high, but this can be the result of the use of an appropriate assessment scale, rather than monitoring only by spontaneous report. It was not possible to find a direc relationship between the MPH SODAS™ and death from a CVA occurred in one of the subjects. However, the cardiovascular event found during the trial, suggest extreme caution when medicating patients with cardiovascular diseases as recently proposed by the FDA. Findings from this study suggest that MPH SODAS™ has similar efficacy and adverse event profile than MPH-IR.

Introdução: O metilfenidato de liberação imediata (MFD-LI) é um psicofármaco receitado mundialmente para o tratamento do Transtorno de Déficit de Atenção/hiperatividade (TDAH). Embora eficaz, o MFD-LI está associado a problemas de adesão ao tratamento, uma vez que os pacientes necessitam ingerir os comprimidos várias vezes ao dia. O Spheroidal Oral Drug Absorption System (SODAS™) é uma formulação de metilfenidato de liberação prolongada (MFD-LP) que mimetiza a administração de MFD-LI duas vezes ao dia, e que apresenta menor flutuação nos níveis séricos. Nesta formulação, cinqüenta por cento dos grânulos com revestimento para liberação entérica são liberados aproximadamente 4 horas após a administração, proporcionando um perfil de ação semelhante a duas tomadas ao dia do MFD-LI. O MFD SODAS™ libera de imediato 50% do medicamento, proporcionando um rápido início de ação quando comparado ao sistema de liberação OROS®. Poucos estudos avaliaram a troca do MFD-LI para o MFD-LP, sendo que desses, apenas crianças e adolescentes foram avaliados, e nenhum verificou os preditores de insatisfação da troca do MFD-LI para o MFD-LP. Objetivos: Este estudo tem como objetivo avaliar os sintomas de TDAH, ou preditores de insatisfação e/ou desistência do tratamento naqueles pacientes clinicamente estáveis que fizeram a troca do MDF-LI para o MFD SODAS™. Método: Os critérios de inclusão foram: diagnóstico de TDAH de acordo com os critérios do DSM-IV, e estabilidade de sintomas com o uso do MFD-LI. Os critérios de exclusão foram: condição clínica coexistente que pudesse impedir a prescrição de MFD SODAS™; diagnóstico de abuso ou dependência de álcool e/ou drogas de abuso; diagnóstico prévio de retardo mental moderado; tratamento psicoterápico concomitante. Este é um ensaio clínico aberto realizado em oito semanas. Os pacientes foram designados a receber doses de MFD SODAS™ de acordo com a dose de MFD-LI previamente estabelecida. A eficácia foi avaliada através das escalas SNAP-IV e CGI-S, e eventos adversos através da Barkley's Side Effect Rating Scale (SERS). Foi solicitado aos participantes que classificassem sua satisfação com o tratamento através de uma escala Likert de 5 pontos. Também foram avaliados os seguintes potenciais preditores de resposta: sexo, idade, etnia, nível socioeconômico, comorbidades, subtipos de TDAH, resultados das escalas SNAP-IV e SERS no baseline, tempo de tratamento, tratamento farmacológico concomitante, dose de MFD-LI prévia ao início do estudo e a existência de pausa do tratamento nos finais de semana. Resultados: A partir de uma amostra total de 207 crianças, adolescentes e adultos (provenientes do ambulatório adulto e infantil de transtorno de déficit de atenção/hiperatividade do Hospital de Clínicas de Porto Alegre) foi possível contatar 133 pacientes, os quais sessenta e dois pacientes foram elegíveis a participar do estudo, e 47 completaram as oito semanas de tratamento. Não se encontrou diferença significativa no escore total do SNAP-IV durante o protocolo - baseline, semana 4 e 8 [F(1, 51,26) =0,012; p=0,913]. Ao todo, 46 (74,2%) dos pacientes relataram estar satisfeitos com o novo tratamento, 16 (25,8%) estavam insatisfeitos ou saíram do protocolo. Nas análises univariadas, foi detectada uma tendência para a associação entre etnia e insatisfação (p=0.05). Não se encontrou uma diferença significativa nos escores da SERS durante o ensaio clínico [F(1, 111,49) =0,748; p=0,389]. Em onze eventos adversos ocorreram ao menos 5% em alguma das avaliações (baseline, 4ª ou 8ª semana). Um adulto, que apresentava uma doença cardiovascular previamente ao estudo, apresentou um acidente vascular cerebral hemorrágico (AVCH) após a quarta semana de tratamento, evoluindo ao óbito após três semanas. Conclusão: Poucos estudos abordaram os sintomas de TDAH após a troca do MFD-LI para qualquer formulação de MFD-LP, e nenhum estudo prévio foi conduzido em populações de países em desenvolvimento ou em amostras com adultos. A taxa de satisfação encontrada (74,2%) na troca do MFD-LI para MFD SODAS™ possivelmente reflete a conveniência da dose única diária deste MFD-LP, como já especulado em estudos prévios. Não foram identificados fatores preditores de insatisfação. O número médio de efeitos colaterais pode ser considerado alto, mas isso pode ser o resultado do uso de uma escala de avaliação adequada, diferentemente do relato espontâneo do evento adverso. Não foi possível encontrar uma relação direta entre os efeitos do MFD SODAS™ e a morte por AVCH ocorrida em um dos sujeitos da amostra. Entretanto, o evento cardiovascular ocorrido sugere extrema cautela ao medicar pacientes com doenças cardiovasculares, conforme proposto pelo FDA. Os achados desse estudo sugerem que o MFD SODAS™ possui eficácia e perfil de eventos adversos similares ao MFD-LI. / Introduction: Immediate-release methylphenidate (MPH-IR) is a pharmacological treatment prescribed worldwide for patients with attention-deficit/hyperactivity disorder (ADHD). The MPH-IR, although highly efficacious, need to be used more than once a day, and consequently might be associated with poor adherence. The Spheroidal Oral Drug Absorption System (SODAS™) is one type of MPH-ER (Extended-release methylphenidate) that mimics the twice-daily administration of MPH-immediate release, but presents less peak and trough fluctuations. This formulation allows the immediate release of 50% of the drug, providing a rapid onset if compared with OROS® formulation. Few studies have evaluated specifically the switching from MPH-IR to MPH-ER. All previous studies accessed only children and adolescents; none evaluated switching to MPH SODAS™ and no predictors of treatment dissatisfaction were mentioned. Objectives: The present study aims to assess ADHD symptoms for 08 weeks after switching from MPH-IR to MPH SODAS™ in clinically stable patients, and to identify predictors of dissatisfaction with MPH SODAS™, and/ or withdrawal from the protocol. Method: The inclusion criteria were: ADHD diagnosis according to the DSM-IV criteria and clinical stability with MPH-IR. The exclusion criteria were: a clinically coexisting medical condition interfering with the administration of MPH SODAS™; previous diagnosis of alcohol and/or drug abuse or dependence; previous diagnosis of moderate mental retardation; concomitant psychotherapy. This is an 8-week open clinical trial. Patients were assigned to doses of MPH SODAS™ according to their pre-study dose of MPH-IR. Assessment of efficacy and side effects was performed by means of the SNAP-IV, CGI-S, Barkley's Side Effect Rating Scale (SERS). Subjects were also asked to report their satisfaction with the treatment in a 5-point Likert scale. We also evaluated the following potential predictors of treatment response: sex, age, ethnicity, socioeconomic status, comorbidities, baseline scores on the SNAP-IV, and SERS, length of treatment, concomitant treatment, previous prescribed dose of MPH-IR, and pause of treatment on weekends. Results: From a total sample of 207 children, adolescents and adults (enrolled from the ADHD outpatient clinic at both Adult and Child and Adolescent Psychiatric Division of Hospital de Clínicas de Porto Alegre) we were able to re-contact 133 patients, where sixty-two patients were eligible to the clinical trial, and 47 completed the 08 weeks of treatment. There was no significant change in the total score of the SNAP-IV during the protocol – baseline, week 4 and 8 [F(1, 51.26)=0.012; p=0.913]. Overall, 46 (74.2%) patients had reported to be satisfied with the new treatment, and 16 (25.8%) were dissatisfied or withdrew from the protocol. In univariate analyses, only ethnicity (p=0.05) were associated with dissatisfaction. No significant change in the SERS score was found during the protocol [F(1, 111.49)=0.748; p=0.389]. Eleven adverse events occurring in at least 5% of the group in any assessment (baseline, 04 or 08 weeks) were observed according to SERS. One adult, with previous cardiovascular disease, presented a hemorrhagic cerebral vascular accident (CVA) after the forth week assessment, resulting in her obit. Conclusion: There is a scarcity of research assessing the switch from MPH-IR to different forms of MPH-ER, and none across the life cycle or in populations from developing countries. The 74.2% of satisfaction with the new treatment may reflect the convenience of the once-a-day dosing of the MPH SODAS™. No predictor of dissatisfaction/withdrawal from the trial was found. The number of adverse events reported during the protocol could be considered high, but this can be the result of the use of an appropriate assessment scale, rather than monitoring only by spontaneous report. It was not possible to find a direc relationship between the MPH SODAS™ and death from a CVA occurred in one of the subjects. However, the cardiovascular event found during the trial, suggest extreme caution when medicating patients with cardiovascular diseases as recently proposed by the FDA. Findings from this study suggest that MPH SODAS™ has similar efficacy and adverse event profile than MPH-IR.

Introdução: O metilfenidato de liberação imediata (MFD-LI) é um psicofármaco receitado mundialmente para o tratamento do Transtorno de Déficit de Atenção/hiperatividade (TDAH). Embora eficaz, o MFD-LI está associado a problemas de adesão ao tratamento, uma vez que os pacientes necessitam ingerir os comprimidos várias vezes ao dia. O Spheroidal Oral Drug Absorption System (SODAS™) é uma formulação de metilfenidato de liberação prolongada (MFD-LP) que mimetiza a administração de MFD-LI duas vezes ao dia, e que apresenta menor flutuação nos níveis séricos. Nesta formulação, cinqüenta por cento dos grânulos com revestimento para liberação entérica são liberados aproximadamente 4 horas após a administração, proporcionando um perfil de ação semelhante a duas tomadas ao dia do MFD-LI. O MFD SODAS™ libera de imediato 50% do medicamento, proporcionando um rápido início de ação quando comparado ao sistema de liberação OROS®. Poucos estudos avaliaram a troca do MFD-LI para o MFD-LP, sendo que desses, apenas crianças e adolescentes foram avaliados, e nenhum verificou os preditores de insatisfação da troca do MFD-LI para o MFD-LP. Objetivos: Este estudo tem como objetivo avaliar os sintomas de TDAH, ou preditores de insatisfação e/ou desistência do tratamento naqueles pacientes clinicamente estáveis que fizeram a troca do MDF-LI para o MFD SODAS™. Método: Os critérios de inclusão foram: diagnóstico de TDAH de acordo com os critérios do DSM-IV, e estabilidade de sintomas com o uso do MFD-LI. Os critérios de exclusão foram: condição clínica coexistente que pudesse impedir a prescrição de MFD SODAS™; diagnóstico de abuso ou dependência de álcool e/ou drogas de abuso; diagnóstico prévio de retardo mental moderado; tratamento psicoterápico concomitante. Este é um ensaio clínico aberto realizado em oito semanas. Os pacientes foram designados a receber doses de MFD SODAS™ de acordo com a dose de MFD-LI previamente estabelecida. A eficácia foi avaliada através das escalas SNAP-IV e CGI-S, e eventos adversos através da Barkley's Side Effect Rating Scale (SERS). Foi solicitado aos participantes que classificassem sua satisfação com o tratamento através de uma escala Likert de 5 pontos. Também foram avaliados os seguintes potenciais preditores de resposta: sexo, idade, etnia, nível socioeconômico, comorbidades, subtipos de TDAH, resultados das escalas SNAP-IV e SERS no baseline, tempo de tratamento, tratamento farmacológico concomitante, dose de MFD-LI prévia ao início do estudo e a existência de pausa do tratamento nos finais de semana. Resultados: A partir de uma amostra total de 207 crianças, adolescentes e adultos (provenientes do ambulatório adulto e infantil de transtorno de déficit de atenção/hiperatividade do Hospital de Clínicas de Porto Alegre) foi possível contatar 133 pacientes, os quais sessenta e dois pacientes foram elegíveis a participar do estudo, e 47 completaram as oito semanas de tratamento. Não se encontrou diferença significativa no escore total do SNAP-IV durante o protocolo - baseline, semana 4 e 8 [F(1, 51,26) =0,012; p=0,913]. Ao todo, 46 (74,2%) dos pacientes relataram estar satisfeitos com o novo tratamento, 16 (25,8%) estavam insatisfeitos ou saíram do protocolo. Nas análises univariadas, foi detectada uma tendência para a associação entre etnia e insatisfação (p=0.05). Não se encontrou uma diferença significativa nos escores da SERS durante o ensaio clínico [F(1, 111,49) =0,748; p=0,389]. Em onze eventos adversos ocorreram ao menos 5% em alguma das avaliações (baseline, 4ª ou 8ª semana). Um adulto, que apresentava uma doença cardiovascular previamente ao estudo, apresentou um acidente vascular cerebral hemorrágico (AVCH) após a quarta semana de tratamento, evoluindo ao óbito após três semanas. Conclusão: Poucos estudos abordaram os sintomas de TDAH após a troca do MFD-LI para qualquer formulação de MFD-LP, e nenhum estudo prévio foi conduzido em populações de países em desenvolvimento ou em amostras com adultos. A taxa de satisfação encontrada (74,2%) na troca do MFD-LI para MFD SODAS™ possivelmente reflete a conveniência da dose única diária deste MFD-LP, como já especulado em estudos prévios. Não foram identificados fatores preditores de insatisfação. O número médio de efeitos colaterais pode ser considerado alto, mas isso pode ser o resultado do uso de uma escala de avaliação adequada, diferentemente do relato espontâneo do evento adverso. Não foi possível encontrar uma relação direta entre os efeitos do MFD SODAS™ e a morte por AVCH ocorrida em um dos sujeitos da amostra. Entretanto, o evento cardiovascular ocorrido sugere extrema cautela ao medicar pacientes com doenças cardiovasculares, conforme proposto pelo FDA. Os achados desse estudo sugerem que o MFD SODAS™ possui eficácia e perfil de eventos adversos similares ao MFD-LI. / Introduction: Immediate-release methylphenidate (MPH-IR) is a pharmacological treatment prescribed worldwide for patients with attention-deficit/hyperactivity disorder (ADHD). The MPH-IR, although highly efficacious, need to be used more than once a day, and consequently might be associated with poor adherence. The Spheroidal Oral Drug Absorption System (SODAS™) is one type of MPH-ER (Extended-release methylphenidate) that mimics the twice-daily administration of MPH-immediate release, but presents less peak and trough fluctuations. This formulation allows the immediate release of 50% of the drug, providing a rapid onset if compared with OROS® formulation. Few studies have evaluated specifically the switching from MPH-IR to MPH-ER. All previous studies accessed only children and adolescents; none evaluated switching to MPH SODAS™ and no predictors of treatment dissatisfaction were mentioned. Objectives: The present study aims to assess ADHD symptoms for 08 weeks after switching from MPH-IR to MPH SODAS™ in clinically stable patients, and to identify predictors of dissatisfaction with MPH SODAS™, and/ or withdrawal from the protocol. Method: The inclusion criteria were: ADHD diagnosis according to the DSM-IV criteria and clinical stability with MPH-IR. The exclusion criteria were: a clinically coexisting medical condition interfering with the administration of MPH SODAS™; previous diagnosis of alcohol and/or drug abuse or dependence; previous diagnosis of moderate mental retardation; concomitant psychotherapy. This is an 8-week open clinical trial. Patients were assigned to doses of MPH SODAS™ according to their pre-study dose of MPH-IR. Assessment of efficacy and side effects was performed by means of the SNAP-IV, CGI-S, Barkley's Side Effect Rating Scale (SERS). Subjects were also asked to report their satisfaction with the treatment in a 5-point Likert scale. We also evaluated the following potential predictors of treatment response: sex, age, ethnicity, socioeconomic status, comorbidities, baseline scores on the SNAP-IV, and SERS, length of treatment, concomitant treatment, previous prescribed dose of MPH-IR, and pause of treatment on weekends. Results: From a total sample of 207 children, adolescents and adults (enrolled from the ADHD outpatient clinic at both Adult and Child and Adolescent Psychiatric Division of Hospital de Clínicas de Porto Alegre) we were able to re-contact 133 patients, where sixty-two patients were eligible to the clinical trial, and 47 completed the 08 weeks of treatment. There was no significant change in the total score of the SNAP-IV during the protocol – baseline, week 4 and 8 [F(1, 51.26)=0.012; p=0.913]. Overall, 46 (74.2%) patients had reported to be satisfied with the new treatment, and 16 (25.8%) were dissatisfied or withdrew from the protocol. In univariate analyses, only ethnicity (p=0.05) were associated with dissatisfaction. No significant change in the SERS score was found during the protocol [F(1, 111.49)=0.748; p=0.389]. Eleven adverse events occurring in at least 5% of the group in any assessment (baseline, 04 or 08 weeks) were observed according to SERS. One adult, with previous cardiovascular disease, presented a hemorrhagic cerebral vascular accident (CVA) after the forth week assessment, resulting in her obit. Conclusion: There is a scarcity of research assessing the switch from MPH-IR to different forms of MPH-ER, and none across the life cycle or in populations from developing countries. The 74.2% of satisfaction with the new treatment may reflect the convenience of the once-a-day dosing of the MPH SODAS™. No predictor of dissatisfaction/withdrawal from the trial was found. The number of adverse events reported during the protocol could be considered high, but this can be the result of the use of an appropriate assessment scale, rather than monitoring only by spontaneous report. It was not possible to find a direc relationship between the MPH SODAS™ and death from a CVA occurred in one of the subjects. However, the cardiovascular event found during the trial, suggest extreme caution when medicating patients with cardiovascular diseases as recently proposed by the FDA. Findings from this study suggest that MPH SODAS™ has similar efficacy and adverse event profile than MPH-IR.

Syftet med denna kvalitativa studie var att undersöka upplevelser av gruppbaserat föräldrastöd hos mammor med Adhd som deltagit i en universell föräldragrupp på barnhälsovårdscentral (BVC) samt i en anpassad självhjälpsgrupp (Mammagruppen). Mammagruppen bestod av fem mammor med diagnosen Adhd, en hade även Asperger syndrom. Med ett bortfall deltog fyra av dem i studien. Tre av informanterna deltog även i föräldragrupp på BVC. Deras barn var 0-2 år gamla utan uttalade problem. Datainsamling skedde genom semistrukturerade intervjuer och en induktiv tematisk analys resulterade i två huvudteman; Samhörighet och Stöd. Resultatet visar att informanternas upplevelser av Mammagruppen blev övervägande positiva och upplevelser av föräldragruppen på BVC blev övervägande negativa. Några grundläggande faktorer som bidrog till detta var huruvida de har upplevt samhörighet i grupperna samt om de har fått utrymme till att samtala om sina egna behov och känslor. Detta bidrar med unik kunskap och belyser det upplevda behovet av ett anpassat stöd. Det behövs vidare forskning innan vi kan säga att det finns skillnader. / The aim of this qualitative study was to examine experiences of group based parental support among mothers with Adhd - who had participated in an universal parent group at the swedish child healthcare centre (CHC), and in a tailored selfhelpgroup (the Momgroup). The participants in the Momgroup was five mothers with Adhd, one also had Asperger syndrome. With a loss of one, four of them participated in this study. Three of the informants had also participated, in a parent group at CHC. Their children were 0-2 years old, without any explicit problems. The data were collected through semi-structured interviews and an inductive thematic analysis resulted in two main themes: Togetherness and Support. The result shows that the informants’ experiences of the Momgroup were mainly positive and the experiences of the parent goup at CHC were mainly negative. A few basic factors that contributed to this, were whether they have experienced togetherness in the groups, and if they were given the opportunity to talk about their own needs and feelings. This contributes with unique knowledge and illustrates the perceived need for tailored support. Further research is needed before we can say that there are any differences.

Attention deficit hyperactivity disorder (ADHD) är den mest förekommande beteendestörningen hos barn. Forskning visar att minst 5% av barn och ungdomar är drabbade världen över, men det finns troligtvis ett stort mörkertal hos såväl vuxna som barn. ADHD har blivit ifrågasatt för sin autenticitet och har varit föremål för diskussion de senaste årtiondena. De drabbade möts ofta av förutfattade meningar vilket skapar stigmatisering. Denna litteraturstudies syfte var att belysa individers egna upplevelser av att leva med ADHD. Resultatet visade att individer upplevde ett utanförskap i samhället oavsett ålder, genus och ursprung. Upplevelserna behandlade känslor av att vara i otakt med sin omgivning, att inte passa in i samhällets normer samt att bli stämplad som stökig och lat. Även upplevelser av att vara speciell med unika gåvor framkom i resultatet. Slutsatsen är att individer med ADHD lever i en verklighet med en alldeles särskild livsvärld. Att vilja förstå och kunna sätta sig in i denna livsvärld är av betydelse för alla i den drabbades närhet. Då vården i framtiden kommer att möta fler patienter med ADHD behövs mer kunskap inom området för att kunna främja hälsa hos dessa individer. / Attention deficit hyperactivity disorder (ADHD) is the most common behavioral disorder among children. Research has proved that at least 5% of children and adolescents are affected in a worldwide perspective. A large number of people are probably unrecorded with the diagnosis. The authenticity of ADHD as a real diagnosis has been questioned during the last decades, and ADHD and its symptoms is still a matter for discussions. People living with ADHD are facing preconceptions which can cause stigmatization. The purpose of this literature study was to illustrate lived experiences of ADHD. The result of the study showed feelings of alienation in the community regardless of age, gender and origin. Their experiences were about feelings of being out of time with their surroundings, to not fit in the norms of society as well as being labelled as disorderly and lazy. Despite this, feelings of being special and gifted were also reported. The conclusion is that people living with ADHD holds a unique lifeworld, which is important to understand. The future holds a surge in demand for caring of patients with ADHD. To support health and wellbeing this require more knowledge within the area of behavioral impairments.

Please read the abstract in the section 00front of this document / Thesis (DPhil (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / DPhil / Unrestricted