Le Trouble Déficit de l’Attention Hyperactivité (TDAH) est un trouble du neurodéveloppement associant des symptômes d’inattention, d’hyperactivité et/ou d’impulsivité. Fréquemment, le tableau clinique est marqué par une labilité émotionnelle pouvant se manifester sous différentes formes jusqu’à parfois s’agencer en un véritable syndrome : le Trouble Disruptif avec Dysrégulation Emotionnelle, récemment inclus dans le DSM-5. La labilité émotionnelle est-elle un symptôme du TDAH ou de troubles comorbides ? Est-elle caractéristique d’un tableau clinique du TDAH ? Ce travail de thèse propose d’étudier le profil psychopathologique associé à la labilité émotionnelle sous différentes approches, catégorielle et dimensionnelle, et à deux périodes clés du développement de l’enfant atteint de TDAH, l’âge préscolaire et l’âge scolaire. Quatre études composent ce travail de thèse : les trois premières en milieu clinique et la dernière en population générale. Les résultats ont indiqué que la labilité émotionnelle d’un point de vue dimensionnel mais également catégoriel au travers du diagnostic de Trouble Disruptif avec Dysrégulation Emotionnelle, était associée à des symptômes plus sévères et un retentissement fonctionnel plus important à l’âge préscolaire et scolaire. L’approche dimensionnelle s’est montrée plus pertinente pour identifier les enfants avec labilité émotionnelle ayant des besoins spéciaux de prises en charge au-delà de celle du TDAH. De plus, la labilité émotionnelle et l’irritabilité ont semblé être associées à des tableaux cliniques différents. Ces résultats suggèrent l’intérêt de l’évaluation de la labilité émotionnelle et des manifestations associées dans le diagnostic du TDAH chez l’enfant. Une approche clinique fine, à la fois quantitative et qualitative, semble prometteuse dans la prévention des formes prodromiques de TDAH et dans le pronostic de ce trouble afin de proposer des interventions adaptées afin d’infléchir de potentielles trajectoires développementales à risques. / Attention Deficit Hyperactivity disorder is a neurodevelopmental disorder characterized by inattentive, hyperactive and/or impulsive symptoms. Emotional lability is frequently associated with the disorder. It can cover several manifestations. These manifestations are sometimes that serious that there are parts of a disorder: the Disruptive Mood Dysregulation Disorder recently added to the DSM-5. Is emotional lability a core symptom of ADHD or one of a comorbid disorder? Is it featured with different symptoms and functional impairment in children with ADHD? This PhD work tried to provide elements to respond to these questions assessing the psychopathological profile associated with emotional lability as a categorical and dimensional feature at two crucial developmental periods: the preschool and the school aged. Four studies are part of this PhD work: three in clinical population and one in general population. Results emphasized that emotional lability is associated with more severe symptoms and functional impairment in both preschool a school aged children. Results were similar when emotional lability was assessed as a dimensional feature and as a categorical feature. Nevertheless, the dimensional approach of emotional lability seemed relevant identifying children with ADHD and emotional lability that were at special need for interventions, beyond the ADHD one. Moreover, emotional lability and irritability seemed associated with different clinical outcomes. These results suggested the value of the emotional lability assessment and of its others manifestations in the ADHD diagnosis in children. A qualitative and quantitative approach seems promising in preventing prodromal ADHD and in its prognostic. This might serve targeting adapted interventions in order to inflect potential harmful developmental trajectories.

This dissertation named Family and child with hyperactivity syndrome and attention deficit (hereinafter child with ADHD - Attention Deficit Hyperactivity Disorders) is concerning with problems of families which are bringing up, caring and a looking after a child with ADHD. The aim of the dissertation is mapping of life of a family with child suffering from ADHD. Furthermore to describe how such a family perceives behavior of other people from the surrounding towards such a family. Also how a child with ADHD syndrome intervene in a life of its siblings and social functioning of its own family. Within the dissertation there is determined one important question "What is like a life of a family with a child suffering from ADHD syndrome". Theoretical part of the dissertation describes ADHD syndrome. How is it possible to influence ADHD and what are latest medical treatments of children and adults. Within the theoretical part attention is also given to the educational possibilities for children with ADHD, family relationships and potentially socially dangerous effects of children and adults influenced by ADHD syndrome. For the empiric part of the dissertation was chosen method of qualitative research via technique of semi-structured interview containing 26 questions led with 7 mothers of children suffering from ADHD syndrome. Questions are directed at social functioning of each family and their family life. The findings are showing that family life where there is a child with ADHD is directly and strongly influenced. Children with ADHD syndrome need more care than other children in the family and this causes unease and uneven relations between siblings. Children with syndrome do not achieve results matching their intelligence, they lag behind their potential. It was proved that older children show socially dangerous effects such as tobacco or drug addiction. Also the whole family is often seen in by the public in a negative light. This dissertation can be beneficial to parents of children with ADHD syndrome who can compare their feelings with feelings and experience of other parents who have a child affected with such disorder.

Introdução O transtorno de déficit de atenção/hiperatividade (TDAH) afeta entre 3 e 10% das crianças em idade escolar, ocasionando prejuízos no funcionamento individual, acadêmico e social na infância e adolescência. Apesar disso, sua etiologia ainda não é totalmente conhecida. A alta herdabilidade do TDAH leva a crer que fatores genéticos exerçam papel fundamental na predisposição para o transtorno. Entretanto, a ocorrência da patologia vai depender ainda da interação de genes com fatores de risco ambientais. Restam muitas questões a serem esclarecidas, uma delas é se há relação entre os fatores de risco ambientais e a expressão fenotípica, resultando nos diferentes subtipos do TDAH. Objetivo O objetivo do presente estudo é investigar a associação entre complicações perinatais (complicações ocorridas nos períodos pré, peri e pós-natal imediato - CPPs) e TDAH do subtipo desatento (TDAH-D). Método Participaram desse estudo, crianças e adolescentes entre 6 e 17 anos, provenientes de doze escolas estaduais e de um ambulatório especializado em TDAH de Porto Alegre. Após a realização de extensa avaliação diagnóstica, foram incluídas 124 crianças e adolescentes com o diagnóstico de TDAH-D e 124 controles sem o transtorno, pareados por idade e sexo. Informações sobre complicações ocorridas durante os períodos pré, peri e pós-natal imediato, assim como sobre potencias confundidores, foram coletadas diretamente com as mães biológicas dos sujeitos. Resultados A análise de regressão logística condicional mostrou que, para as crianças e adolescentes cujas mães apresentaram maior número de complicações perinatais, o risco de TDAH-D foi significativamente mais elevado (p = 0.005; OR= 1.25; IC95%: 1.1 – 1.5). Conclusões Em um estudo de caso-controle, foi possível expandir para o TDAH predominantemente desatento os achados prévios que sugeriam a associação entre fatores perinatais e TDAH sem um subtipo específico. / Introduction Attention-deficit/hyperactivity disorder (ADHD) affects between 3% and 10% of school aged children, leading to impaired individual, academic and social functioning in childhood and adolescence. Despite of that, the etiology of ADHD remains unclear. The high heritability points to a large genetic contribution to the etiology of ADHD. However, the development of the disorder will also depend of an interaction between genetic and environmental risk factors. Many questions remain to be answered, such as the association between the ADHD phenotypic heterogeneity and the environmental risk factors, leading to different subtypes of the disorder. Objective The objective of the present study is to investigate the association between pre-, peri-, and early postnatal complications (PDPC) and ADHD predominantly inattentive type (ADHD-I). Method: Children and adolescents between 6 and 17 years old from 12 public schools, and from an ADHD outpatient program both in Porto Alegre were assessed. After an extensive diagnostic evaluation, 124 ADHD-I cases and 124 non-ADHD controls, matched by sex and age, were included in the study. Informations about prenatal, delivery and early postnatal complications, as well as potential confounders were obtained by direct interview with biological mothers. Results: Conditional logistic regression analysis showed that children and adolescents whose mothers presented more PDPC had a significant higher risk for ADHD-I (p = 0.005; OR= 1.25; CI95%: 1.1 – 1.5). Conclusions: In a case-control study, we expanded to ADHD-I previous findings suggesting the association between perinatal factors and broadly defined ADHD.

Made available in DSpace on 2016-06-02T19:46:30Z (GMT). No. of bitstreams: 1 6354.pdf: 1294561 bytes, checksum: 3be7fe07f80854809bf2a4239bbf19d9 (MD5) Previous issue date: 2014-02-20 / Financiadora de Estudos e Projetos / Children born premature and extreme birth weight are more likely to have cognitive, neuropathological and behavioral changes such as attention deficit hyperactivity disorder (ADHD). Early identification of ADHD is important because it is known that the effects caused by this disorder in school and personal lives may pass into adulthood, and the social and educational impact can cause those students requiring specialized educational assistance. In this sense, the present study aimed at identifying early signs suggestive of Attention Deficit Hyperactivity Disorder (ADHD) in children at 3 years of age with a history of extreme preterm birth and low birth weight. The sample comprised 29 children with a history of extreme prematurity and low birth weight with 3 years old now, enrolled in municipal schools. Participants were first characterized with the CCEB (Economic Classification Criterion Brazil) to homogenize the sample. After, were evaluated with the SDQ questionnaire version Pa 3/4 years (for the parents) and version Pr 3/4 years (for teachers). We also used the Denver II screening test in order to evaluate the overall development of these children and relate to behavioral findings. From the statistical correlation - Pearson Correlation - the data we found that there was a significant correlation between the variables IG with hyperactivity subscale, indicated by SDQ Pa (R= -,465*), correlation between IG and birth weight with the hyperactivity subscale, indicated by SDQ Pr ( R= -,528**; R= -,429*, respectivamente). All these correlations were significantly negative which confirms findings in the literature, that is, the lower gestational age and birth weight, the greater are the chances of having behavioral problems suggestive of ADHD. It was also verified that parents and teachers rated similarly children's development. It is concluded that children with a history of preterm birth and low birth weight have signs suggestive of ADHD at 3 years of age, and that the performance of screening for early detection of these signals facilitates therapeutic intervention and can thereby reduce the performance impact academic school with a history of extreme preterm birth and low birth weight. / Crianças nascidas prematuras extremas e com baixo peso, igual ou inferior a 2500g, estão mais propensas a apresentarem alterações cognitivas e neuropatológicas, bem como alterações comportamentais, tais como o Transtorno de Déficit de Atenção e Hiperatividade (TDAH). A identificação precoce do TDAH é importante, pois sabe-se que as repercussões causadas por este transtorno na vida escolar e pessoal podem repercutir até a vida adulta, e o impacto social e educacional pode fazer com que esses alunos necessitem de assistência educacional especializada. Neste sentido, o presente estudo teve por objetivo geral identificar sinais precoces sugestivos do Transtorno de Déficit de Atenção e Hiperatividade (TDAH), em crianças aos 3 anos de idade com histórico de nascimento prematuro extremo e baixo peso ao nascer. A amostra foi composta por 29 crianças com histórico de prematuridade extrema e baixo peso ao nascer com 3 anos de idade atual, matriculadas na rede municipal de ensino. Os participantes foram caracterizados primeiramente com o CCEB (Critério de Classificação Econômica Brasil), a fim de homogeneizar a amostra. Após foram avaliado com o questionário SDQ versão Pa3/4anos (destinado a pais) e versão Pr3/4 anos (destinado a professores). Foi utilizado também, o teste de triagem Denver II, no intuito de avaliar o desenvolvimento global destas crianças e relacionar com os achados comportamentais. A partir da análise estatística correlacional Correlação de Pearson - dos dados foi possível verificar que houve uma correlação significativa entre as variáveis IG com a subescala hiperatividade, indicados pelo SDQ Pa (R= -,465*), correlação entre IG e peso ao nascer com a subescala hiperatividade, indicados pelo SDQ Pr ( R= -,528**; R= - ,429*, respectivamente). Todas essas correlações se apresentaram significativamente negativa o que corrobora com os achados da literatura, isto é, quanto menor a IG e peso ao nascer, maiores são as chances de apresentarem problemas comportamentais sugestivos de TDAH. Foi possível verificar também, que pais e professores avaliaram de forma semelhante o desenvolvimento das crianças. Conclui-se assim, que crianças com histórico de nascimento prematuro e baixo peso apresentam sinais sugestivos de TDAH aos 3 anos de idade, e que a realização de triagem para detectar precocemente estes sinais facilita a intervenção terapêutica e pode com isso reduzir o impacto no desempenho acadêmico de escolares com histórico de nascimento prematuro extremo e baixo peso.

Hyperactivity and attention deficit disorder belong to very complicated disorders which should be considered in a global view. At present no general or miracle medicine can be used. However, specific learning disabilities and ADHD are focused on very intensively at basic schools in the Czech Republic. Children´s aggressiveness, hyperactivity and difficulties in raising are discussed very often. No programme or method can substitute a nice family life, loving parental care and good relations in the family. However, many cases of destroying a contended family life caused by child´s disorders or disharmony are reported. Even the best family is not expected to be able to bring up a hyperactive child by itself. The dissertation is focused on children who suffer from functional disorder called ADHD syndrom. First part of the work is divided into chapters which detail ADHD terminology, its historical development, symptoms, probable causes, diagnostics and ways of dealing with it in general. Further chapters analyse specific learning disabilities which are closely related to ADHD. The goal of the work consists in emphasising importance of self-help societies and civic associations at local and national dimensions. Next part concerns with the study on current situation of the care and service provided for ADHD children and their families in the region of Česká Lípa.Children´s parents were asked to fill in the questionnaire in order to find out their opinions and needs, and if they are satisfied with services provided for their children. They were also informed about the self-help societies and civic associations and ways of establishing local ones. The work should draw attention to the disorders mentioned above and most of all emphasise the importance of civil sector which plays a significant role in dealing with these problems. The author would also like to refer to the necessity of improving lives of these childrens and their close relatives.

Introdução O transtorno de déficit de atenção/hiperatividade (TDAH) afeta entre 3 e 10% das crianças em idade escolar, ocasionando prejuízos no funcionamento individual, acadêmico e social na infância e adolescência. Apesar disso, sua etiologia ainda não é totalmente conhecida. A alta herdabilidade do TDAH leva a crer que fatores genéticos exerçam papel fundamental na predisposição para o transtorno. Entretanto, a ocorrência da patologia vai depender ainda da interação de genes com fatores de risco ambientais. Restam muitas questões a serem esclarecidas, uma delas é se há relação entre os fatores de risco ambientais e a expressão fenotípica, resultando nos diferentes subtipos do TDAH. Objetivo O objetivo do presente estudo é investigar a associação entre complicações perinatais (complicações ocorridas nos períodos pré, peri e pós-natal imediato - CPPs) e TDAH do subtipo desatento (TDAH-D). Método Participaram desse estudo, crianças e adolescentes entre 6 e 17 anos, provenientes de doze escolas estaduais e de um ambulatório especializado em TDAH de Porto Alegre. Após a realização de extensa avaliação diagnóstica, foram incluídas 124 crianças e adolescentes com o diagnóstico de TDAH-D e 124 controles sem o transtorno, pareados por idade e sexo. Informações sobre complicações ocorridas durante os períodos pré, peri e pós-natal imediato, assim como sobre potencias confundidores, foram coletadas diretamente com as mães biológicas dos sujeitos. Resultados A análise de regressão logística condicional mostrou que, para as crianças e adolescentes cujas mães apresentaram maior número de complicações perinatais, o risco de TDAH-D foi significativamente mais elevado (p = 0.005; OR= 1.25; IC95%: 1.1 – 1.5). Conclusões Em um estudo de caso-controle, foi possível expandir para o TDAH predominantemente desatento os achados prévios que sugeriam a associação entre fatores perinatais e TDAH sem um subtipo específico. / Introduction Attention-deficit/hyperactivity disorder (ADHD) affects between 3% and 10% of school aged children, leading to impaired individual, academic and social functioning in childhood and adolescence. Despite of that, the etiology of ADHD remains unclear. The high heritability points to a large genetic contribution to the etiology of ADHD. However, the development of the disorder will also depend of an interaction between genetic and environmental risk factors. Many questions remain to be answered, such as the association between the ADHD phenotypic heterogeneity and the environmental risk factors, leading to different subtypes of the disorder. Objective The objective of the present study is to investigate the association between pre-, peri-, and early postnatal complications (PDPC) and ADHD predominantly inattentive type (ADHD-I). Method: Children and adolescents between 6 and 17 years old from 12 public schools, and from an ADHD outpatient program both in Porto Alegre were assessed. After an extensive diagnostic evaluation, 124 ADHD-I cases and 124 non-ADHD controls, matched by sex and age, were included in the study. Informations about prenatal, delivery and early postnatal complications, as well as potential confounders were obtained by direct interview with biological mothers. Results: Conditional logistic regression analysis showed that children and adolescents whose mothers presented more PDPC had a significant higher risk for ADHD-I (p = 0.005; OR= 1.25; CI95%: 1.1 – 1.5). Conclusions: In a case-control study, we expanded to ADHD-I previous findings suggesting the association between perinatal factors and broadly defined ADHD.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-01-30T10:43:20Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Claudia Santos Goncalves Barreto Bezerra.pdf: 2059173 bytes, checksum: 45f41522691fac0d28d22bbc3d3ec16b (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-30T12:49:14Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Claudia Santos Goncalves Barreto Bezerra.pdf: 2059173 bytes, checksum: 45f41522691fac0d28d22bbc3d3ec16b (MD5) / Made available in DSpace on 2015-01-30T12:49:14Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Claudia Santos Goncalves Barreto Bezerra.pdf: 2059173 bytes, checksum: 45f41522691fac0d28d22bbc3d3ec16b (MD5) Previous issue date: 2014-04-28 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The attention deficit/hyperactivity disorder is a neurodevelopmental disorder provided in the International C lassification of Diseases (ICD) characterizing a continuing pattern of attention deficit and/or hyperactivity/impulsivity with more intense and higher rates than what presented by individuals at the same development level. This dissertation was organized u sing the models of scientific articles analyzing the results from school performance by students of the Colégio de Aplicação (a school maintained by a university) of the Federal University of Goiás, 7 to 14 age group with and without ADHD diagnosis. Initia lly, the prospective observational study to assess comparative effectiveness involved 355 students and investigated the results from school performance by 60 of them before and during Methylphenidate - based treatment (MPH) and psychotherapy compared with th e control group. The students had their school performance and treatment adherence monitored for the first eight months. The literature review on the theme is presented in the first article submitted to the journal “Revista Ciência & Saúde Coletiva” (Journ al of Science and Collective Health), entitled “ Methylphenidate - based treatment and school performance by students with attention deficit/hyperactivity disorder : integrative literature review”. The review included scientific articles published from 2006 to 2013. Six hundred and sixteen out of the 629 articles found did not meet the criteria for inclusion and 13 were part of the sample. Most of the studies emphasized that the group of children with ADHD undergoing methylphenidate - based treatment improved the ir performance compared with the group of children with ADHD with no records for the treatment and stimulant - based therapies are more beneficial in the long term. The second article, entitled “Re/Assessment on the diagnosis of attention deficit/hyperactivi ty disorder in students ” presents the results from the clinical reassessment of 29 children previously diagnosed with ADHD or suspected ADHD. The reassessment confirmed the diagnosis of 74% of the children previously diagnosed and 70% of suspected ADHD. Th e third article, entitled “The use of methylphenidate for students with attention deficit/hyperactivity disorder and poor school performance” presents the major results of this study and proves that the use of methylphenidate - based treatment for students A DHD was associated with improved school records for basic mandatory disciplines . The medication had positive influence on school performance however even undergoing drug - based treatment the students were not able to achieve the levels of performance by stu dents without ADHD with typical school performance. / xii RESUMO O Transtorno de Déficit de Atenção/Hiperatividade é um transtorno do neurodesenvolvimento previsto no Código Internacional de Doenças e caracterizado por um quadro persistente de déficit de atenção e/ou de hiperatividade/impulsividade mais acentuado e grave do que o observado em outros indivíduos com o mesmo nível de desenvolvimento. A presente tese foi construída no modelo de artigos científicos que an alisou os resultados do desempenho acadêmico de escolares do Colégio de Aplicação da Universidade Federal de Goiás, de 7 a 14 anos com e sem diagnóstico de TDA/H. O estudo de caráter prospectivo, observacional e comparativo teve a participação inicial de 3 55 estudantes e investigou os resultados de desempenho escolar de 60 deles, antes e durante o tratamento com metilfenidato (MPH) e psicoterapia em comparação com um grupo controle. Os estudantes foram acompanhados em seu desempenho escolar e em adesão supe rvisionada ao tratamento durante o período de oito meses. A revisão de literatura do tema investigado é apresentada no primeiro artigo, submetido à “Revista Ciência & Saúde Coletiva”, intitulado “Tratamento com Metilfenidato e o desempenho de escolares com Transtorno de Déficit de Atenção/Hiperatividade: revisão integrativa da literatura”. A revisão incluiu artigos científicos publicados no período 2006 a 2013. Dos 629 artigos encontrados, 616 não atenderam aos critérios de inclusão e 13 fizeram parte da am ostra. A maioria dos estudos evidenciou que o grupo de crianças com TDA/H, em tratamento com MPH, mostrou melhor desempenho escolar em relação ao grupo com TDA/H sem histórico de tratamento. E que os tratamentos com estimulantes trazem mais benefícios quan do adotados em longo prazo. O segundo artigo intitulado “Re/Avaliação diagnóstica de Transtorno de Déficit de Atenção/Hiperatividade em escolares” apresenta os resultados da reavaliação clínica de 29 crianças, anteriormente, diagnosticadas com TDA/H ou cas os suspeitos. A re/avaliação confirmou o diagnóstico de 74% das crianças portadoras de diagnóstico e 70% dos casos suspeitos. Já o terceiro artigo intitulado: “A utilização do Metilfenidato por escolares com Transtorno de Déficit de Atenção/Hiperatividade e baixo desempenho escolar” apresenta os resultados principais desse estudo e constatou que o tratamento com Metilfenidato pelos escolares com TDA/H foi associado ao aumento das médias nos resultados da avaliação escolar das disciplinas elementares. A medi cação influenciou positivamente no desempenho dos estudantes, entretanto, mesmo em tratamento medicamentoso esses estudantes não atingiram o nível de desempenho dos escolares sem TDA/H com desempenho escolar típico.

O desenvolvimento de novas tecnologias vem contribuindo para um conhecimento mais aprofundado da fisiopatologia dos transtornos psiquiátricos, mas os resultados ainda são controversos e não parecem ser específicos para cada diagnóstico. As altas taxas de comorbidade também questionam as características principais de um diagnóstico específico. Em 2009, o Instituto Nacional de Saúde Mental dos EUA iniciou um projeto chamado Research Domain Criteria (RDoC) com o objetivo de desenvolver novas classificações para a pesquisa baseadas em dimensões de comportamentos observáveis associadas a medidas neurobiológicas. Para o estudo da fisiopatologia da comorbidade entre duas doenças mentais, esta proposta sugere que se execute o estudo de sintomas compartilhados e não partir de dois grupos diagnósticos distintos. Na psiquiatria infantil, as altas taxas de comorbidade entre o transtorno do humor bipolar (THB) e o transtorno de déficit de atenção e hiperatividade (TDAH) são um tema controverso. O prejuízo na atenção é um forte candidato para um estudo com a metodologia proposta pelo RDoC visto que os poucos estudos que avaliaram concomitantemente a atenção em jovens com THB e TDAH apresentaram resultados contraditórios. Um dos testes mais utilizados para o estudo da atenção em THB e TDAH é o Continuous Performance Test (CPT). Nossos objetivos foram: 1.Verificar qual é o melhor agrupamento dos sujeitos através dos resultados do Conner\'s Continuous Performance Test (CPT II) independentemente do grupo de origem (THB, TDAH, THB+TDAH, controles); 2. Construir um classificador baseado nos resultados do CPT II; 3com THB+TDAH e 18 controles com idades entre 12 e 17 anos. A melhor divisão dos sujeitos, baseada nos resultados do CPT II, foi em dois novos subgrupos. Grupo A com 35 sujeitos composto de: 30% THB, 52,2% TDAH, 51,5% THB+TDAH, e 16,7% controles. Grupo B com 49 sujeitos: 70% THB, 47,8% TDAH, 48,5% THB+TDAH, e 83,3% controles. O grupo A comparado com o B apresentou um prejuízo funcional maior evidenciado por médias significativamente mais altas no CPT II, com uma diferença significativa em oito das 12 variáveis do CPT II: omissão (p=0,0003), comissão (p=0,00000002), erro padrão (EP) do tempo de reação (TR) (p=1,7x10-20), variabilidade do EP (p=4,3x10-22), detectabilidade (p=0,000008), perseveração (p=0,0000001), TR por intervalo interestímulo (IIE) (p=4,7x10-10) e TR(EP)IIE (p= 1,5x10 -13). Foi possível construir um classificador baseado nas doze variáveis do CPT II, sendo sua acurácia de 98,8% em relação a nossa amostra e 95,2% em relação à validação cruzada confirmando a consistência desses novos grupos. As principais variáveis do CPT II usadas na função discriminante desses novos agrupamentos foram: variabilidade do erro padrão, erro padrão de TR e erro padrão de TR por intervalo interestímulo. Não houve diferença estatística em nenhuma das variáveis do CPT II quando realizamos a comparação tradicional entre THB, TDAH, THB+TDAH, e controles; e a acurácia do classificador para esses grupos foi mais baixa, de 40,5% na nossa amostra e 23,8% na validação cruzada. Discussão: Esses resultados evidenciam a heterogeneidade encontrada nas respostas do CPT II pelos grupos THB, TDAH, THB+TDAH, e controles. As três medidas que mais influenciaram a diferenciação entre os novos agrupamentos A e B foram as que medem a variação no tempo de resposta, que é um dos prejuízos mais replicados no TDAH e também está associada com THB. Essa variabilidade de resposta aumentada é sugerida como um marcador endofenotípico inespecífico de psicopatologia. Conclusão: Nossos achados refletem a heterogeneidade encontrada em pacientes classificados através de categorias diagnósticas vigentes e sugerem que a abordagem da metodologia do RDoC pode ser de grande valia para a melhor compreensão dos transtornos psiquiátricos que acometem crianças e adolescentes. Essa metodologia pode identificar subgrupos com diferenças relevantes do ponto de visto neurobiológico contribuindo para a melhor compreensão da fisiopatologia dos transtornos e promovendo caminhos nos quais a pesquisa pode trazer benefícios para decisões clínicas / The better understanding of psychiatric disorders\' pathophysiology is undeniable. Yet, the results are still replete of controversy and are not diagnostic specific. Categorical approach analysis implicitly involves the notion of a unitary entity, not taking into account the acknowledged heterogeneity present in clinical diagnoses. High comorbidity rates also raises questions about the core features of a specific diagnosis. For this purpose, the National Institute of Mental Health has initiated the Research Domain Criteria (RDoC) project. Instead of using disorders categories as the basis for grouping individuals, RDoC suggests to find relevant dimensions that can cut across traditional disorders. The starting point suggested to study comorbid disorders should be shared symptoms and behaviors, instead of two distinct diagnostic groups. One of the strongest controversies in child psychiatry is the high comorbidity rate between bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD). Distractibility, one of the most common symptoms in BD and ADHD could be a good candidate for an RDoC unit of analysis. Our aim was first to study the patterns of attention based on the Conners\' Continuous Performance Test (CPTII) results in youth with BD, ADHD, BD+ADHD and controls; followed by developing a classifier to compare the classification accuracy of this new formed groups and the original diagnostic ones. Results: 18 healthy controls, 23 patients with ADHD, 33 BD+ADHD and 10 BD were assessed. Using cluster analysis, the entire sample was best clustered in two new groups, A and B, based on the twelve CPT II variables performance, independently of the original diagnoses. 35 subjects in group A: 30% BD, 52.2% ADHD, 51.5% BD+ADHD and 16.7% controls. 49 individuals in group B: 70% BD, 47.8% ADHD, 48.5% BD+ADHD and 83.3% controls. Group A presented a greater impairment exhibited by higher means in all CPTII variables, SNAP-IV means, and lower CGAS means. When we compared the CPT II variables performance between the new clustered groups A and B we found eight out of the twelve CPT II measures that were statistically significant: omission (p=0.0003), commission (p=0.00000002), standard error (SE) of hit reaction time (RT) (p=1.7x10-20), variability of SE (p=4.3x10 -22), detectability (p=0.000008), perseveration (p=0.0000001), hit RT by interstimulus interval (ISI) (p=4.7x10 - 10) and hit RT SE ISI. We found high cross-validated classification accuracy for A and B groups: 95.2%. The stronger CPT II variables in the discriminative pattern were: variability of standard error ranking first, followed by hit RT SE, hit RT SE ISI. There were no statistically significant differences in any of the CPT II measures when comparing the four original groups (BD, ADHD, BD+ADHD, controls). The cross-validated classification accuracy based on the CPT II measures performance in order to classify subjects in the original four groups was much lower (23.8%). Discussion: These results highlight the heterogeneity of CPT II responses among each of the four original groups: BD, ADHD, BD+ADHD and controls. The three variables that most influenced the new clustered groups were the ones that measure and adolescents may share this attentional trait marker. Conclusion: In summary, our findings highlighted the heterogeneity of patients clustered by categorical diagnostic classification. In addition, our classificatory exercise supports the concept behind new approaches like the RDoC framework for child and adolescent psychiatry. It can define meaningful clinical subgroups for the purpose of pathophysiological studies and treatment selection, and provide a pathway by which research findings can be translated into changes in clinical decision making

Le Trouble Déficit de l'Attention/Hyperactivité (TDA/H) et le Trouble des Conduites (TC) sont associés à des Conduites à Risque (CAR) comme les consommations de substances psycho-actives, les comportements suicidaires et les comportements sexuels à risque. Cependant, la question des rôles respectifs du TDA/H et du TC dans l'émergence des CAR reste controversée : le TDA/H est-il un facteur de risque indépendant de la survenue ultérieure de CAR? Le TC est-il un facteur de confusion ou un modificateur de l'effet de la relation entre TDA/H et CAR? L'objectif de cette thèse était d'examiner le lien entre les symptômes de l'hyperactivité-inattention dans l'enfance et l'adolescence et la survenue de CAR à l'adolescence et au jeune âge adulte, en prenant en compte différents facteurs de risque potentiels dont les symptômes du trouble des conduites. Nous avons mené cinq analyses à partir des données de la cohorte GAZEL enfants issue de la population générale française. Les résultats suggèrent des effets différents des symptômes de l'hyperactivité-inattention selon le type de conduite à risque considéré et selon le genre. Ils montrent chez les garçons un effet des symptômes de l'hyperactivité-inattention sur la survenue de CAR plus sévères comme la consommation régulière de cannabis, l'expérimentation de drogues illégales et la survenue de comportements suicidaires. Chez les filles, on retrouve un effet des symptômes de l'hyperactivité-inattention sur la consommation ultérieure régulière de tabac. L'initiation de CAR pourrait être aggravée par la présence de hauts niveaux de symptômes de l'hyperactivité-inattention chez les jeunes présentant simultanément des hauts niveaux de symptômes du trouble des conduites. Ce travail renforce la connaissance de l'existence d'une association entre troubles du comportement perturbateur dans l'enfance et survenue ultérieure de conduites à risque. Il souligne la nécessité de reconnaitre l'existence de ces troubles, pour les identifier et mieux les prendre en charge afin d'en prévenir les possibles conséquences à long terme. / Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) are associated with Youth Risk Behaviors (YRB) such as substance-related problems, suicidal behaviors and sex risk behaviors. However, a main issue is the respective role of ADHD and CD regarding YRB : is ADHD an independent risk factor for YRB? Is CD a confounding factor or a moderator of the relationship between ADHD and YRB? The aim of this thesis was to assess the link between childhood hyperactivity-inattention symptoms and subsequent YRB, controlling for other risk factors among which conduct disorder symptoms. We have conducted five analyses from a French community-based sample belonging to the youth GAZEL cohort. Results suggest different effects of hyperactivity-inattention symptoms on YRB according to the the type of YRB and gender. In males, they show an effect of hyperactivity-inattention symptoms on more severe YRB such as regular cannabis use, illicit drug experimentation and suicidal behaviors. In females, they show an effect of hyperactivity-inattention symptoms on regular tobacco use. The risk of YRB initiation was increased in youths with high levels of conduct disorder symptoms, particularly in combination with simultaneously high levels of hyperactivity-inattention symptoms. This thesis enhances the knowledge of a link between disruptive behaviors in childhood and subsequent risk behaviors. It underscores the importance of a better acknowledgement of these disorders, in order to better identify and treat them to prevent negative long-term outcomes.

I examined the effectiveness of child-centered play therapy (CCPT) and person-centered teacher consultation (PCTC) for elementary school children identified with clinical or borderline levels of ADHD behaviors on the Teacher Report Form and the Conners' Teacher Rating Scale Revised - Short Form. Additionally, I examined the impact of CCPT and PCTC on the levels of parenting and teaching stress. Due to the current trend to determine interventions that are evidence-based through between-group or single case designs, for this study, I utilized a single case design experiment for which the behaviors of five children were examined. Trained observers utilized the Direct Observation Form in observations of all five students three times per week. Additionally, parents and teachers completed behavioral rating scales and stress inventories at pre-, mid-, and post-intervention. To prevent biased observational ratings, observers were blind to the assignment of the five children. Three students participated in 24 sessions of twice-weekly 30-minute sessions of CCPT, and these students' teachers participated in six sessions of once-weekly 10-minute PCTC. Two students participated in twice-weekly 30-minute sessions of reading mentoring, after which they participated in 14 sessions of CCPT. Visual analysis of the data indicated mixed results. Three students demonstrated substantial improvement in the observed ADHD behaviors within the classroom. Results of the parent and teacher assessment data were inconsistent, but did indicate behavior change for some children and a reduction in teaching stress for one teacher. Parenting stress appeared unaffected. Implications for future research regarding the use of single case design, the measurement of student behavior change, and issues of comorbidity are indicated.