O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) é caracterizado por sintomas de desatenção, hiperatividade e impulsividade. Surge na infância e pode persistir ao longo da vida, podendo ocasionar dificuldades pessoal, acadêmica, familiar, social e profissional. Este trabalho objetivou compreender os sentidos e os significados para os pais ou responsáveis por adolescentes com TDAH acerca do transtorno e as respectivas relações que esses adolescentes estabelecem no convívio familiar ou fora deste. Para tanto foi realizado um estudo qualitativo com uso da história oral temática. Participaram do estudo 9 pais dos adolescentes com TDAH atendidos no Ambulatório de Psiquiatria Juvenil de um hospital público universitário do interior do Estado de São Paulo. A entrevista temática foi realizada no domicílio dos participantes. A análise das narrativas permitiu construir quatro unidades temáticas: \"Sentidos e significados acerca do TDAH\"; \" Compreensão dos pais sobre o diagnóstico e tratamento do TDAH\"; \"Conflitos no convívio familiar\"; \"Conflitos no contexto da escola e da comunidade\". Os pais percebem que tanto eles como os profissionais das escolas apresentam dificuldades ao lidar com o adolescente portador do TDAH. Reconhecem que desde a infância seus filhos manifestam comportamentos diferentes de outras crianças. Referiram falta de conhecimento, informação e orientações sobre o universo desse transtorno. Diante dessas dificuldades os pais adotaram práticas educativas negativas. Apresentaram preocupações com a discriminação sofrida pelos adolescentes. As relações sociais e familiares estabelecidas com os adolescentes portadores do TDAH podem ser caracterizadas por constantes conflitos. Os atos de violência identificados foram de natureza física e psicológica. A comunicação entre áreas, setores, profissionais e família demonstra-se prejudicada, problemática que se reflete nas relações sociais estabelecidas com os adolescentes com TDAH. É necessário oferecer suporte e orientações aos pais com a participação conjunta de profissionais da saúde e da educação. As abordagens devem ser constantemente avaliadas no sentido de aperfeiçoá-las e adequá-las, acompanhando as diferentes fases do desenvolvimento dos jovens / Disorder Attention Deficit / Hyperactivity Disorder (ADHD) is characterized by the symptoms of inattention, hyperactivity and impulsivity. It appears in childhood and can persist throughout life leading to personal, academic, family, social and professional difficulties. This study aimed to understand the senses and meanings relating to parents of adolescents with ADHD about the disorder and the relationships these adolescents establish in and out family life. A qualitative study was conducted with the use of thematic oral history. The study included nine parents of adolescents with ADHD in the Outpatient Psychiatric Trainee of a public hospital in the state of São Paulo. The thematic interview was conducted at the participants\' residences. The analysis of the narratives allowed building four thematic units: \"Senses and meanings about ADHD\"; \"Parents ´understanding about the diagnosis and treatment of ADHD\"; \"Conflicts in family environment \"; \"Conflicts in the context of school and community.\" Parents realize that both they and school professionals have difficulties in dealing with adolescents with ADHD. They acknowledged that since their childhood, children manifest different behaviors compared to others. They mentioned lack of knowledge, information and guidance relating the universe of this disorder. Considering these difficulties parents have adopted negative educational practices. They showed concerns about the discrimination faced by the adolescents. Social and family relations established with adolescents with ADHD can be characterized by constant conflict. The acts of violence identified were of physical and psychological nature. The communication between areas, sectors, professionals and family is impaired, which is reflected in problematic social relationships with adolescents with ADHD. It is vital to offer support and guidance to parents with joint participation of health and education professionals. The approaches must be constantly evaluated in order to achieve improvement and adaptation, with close attention to the different stages of the youngsters\' development

O Transtorno do Déficit de Atenção/Hiperatividade (TDAH) é o transtorno psiquiátrico mais comum em crianças e adolescentes, com prevalência de 6%. O TDAH classifica-se nos subtipos desatento (TDAHD), hiperativo (TDAHH) ou combinado (TDAHC). Suas manifestações incluem problemas de cognição, comportamentais, afetivos e sociais. Distúrbios de memória e atenção são problemas cognitivos freqüentes. A memória de curta e longa duração foi avaliada em 44 sujeitos portadores do TDAH por subtipos, (TDAHD, n=17; TDAHH, n=11 ;TDHAC, n=16; idade: 12,8 anos; escolaridade: 6,1 a) e 43 indivíduos não portadores que constituíram o grupo controle (idade: 12,11 anos; escolaridade: 6,4 a). Os escores foram a média de evocações corretas em um experimento desenvolvido para este estudo. 64 figuras distribuídas em 4 apresentações com 16 figuras cada constituíram a avaliação de memória (MEMO). As apresentações para recordação imediata e tardia: memória categorizável agrupada, memória não-categorizável seriada, memória não-categorizável agrupada. Inteligência e atenção também foram analisadas. Os resultados mostraram os grupo TDAHH e TDAHC tiveram um pior desempenho na memória de longa duração categorizável e não categorizável na apresentação seriada; os três grupos com TDAH tiveram desempenho inferior ao grupo controle com figuras categorizáveis e não-categorizáveis agrupadas, com maior efeito para TDAHD e TDAHC. Os resultados indicam prejuízo de memória de longa e curta duração no TDAH independente da contribuição de estratégias de memória. / Attention Deficit Hyperactivity Disorder (ADHD) is the most common psychiatric disorder among children and teenagers, with a prevalence of 6%. ADHD disorder has three subtypes: inattentive (ADHDI), hyperactive (ADHDH) and combined (ADHDC). The symptoms include cognitive, behavioral, affective, and social disturbances. Memory and attention deficits are the cognitive problems that frequently attend this disorder. Long and short-term memory were assessed in 44 children and teenagers with ADHD (ADHDD, n=17; ADADH, n=11 ;ADHDC, n=16; age: 12,8 y; 6,1 years of education) and 44 healthy participants (Control group, age: 12,11; 6,4 years of education). An experiment was developed to investigate memory (MEMO). The experiment consisted of 64 figures in 4 different presentations. Each presentation had 16 figures designed to measure immediate and delayed recall in four conditions: serial categorizable memory, grouped categorizable memory, serial non-categorizable memory, and grouped non-categorizable memory. Intelligence and attention were also assessed. The recall of ADHDD and ADHDC groups was worse in the categorizable and non-categorizable serial conditions; the performance of all three ADHD groups was worse than that of the control group with respect to the two grouped conditions, but ADHDD and ADHDC were the worst. These results suggest memory deficit for long and short-term memory on ADHD independent of memory strategies contribution.

Orientador: Sylvia Maria Ciasca / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-28T02:20:44Z (GMT). No. of bitstreams: 1 Ferreira_TaisdeLima_D.pdf: 3092398 bytes, checksum: 39acfb8174f073f0cefbf025b1eeb6f3 (MD5) Previous issue date: 2015 / Resumo: O objetivo geral deste estudo foi verificar o processamento fonológico, leitura e escrita em crianças com dislexia do desenvolvimento e em crianças com transtorno do déficit de atenção e hiperatividade. O objetivo específico foi comparar o desempenho de processamento fonológico, leitura, escrita entre a dislexia do desenvolvimento e o transtorno do déficit de atenção e hiperatividade e levantar quais os aspectos diferenciam os sujeitos entre si. Participaram 51 crianças, de ambos os gêneros, com idades entre 8 e 14 anos, divididas em três grupos: GDD ¿ 17 crianças com o diagnóstico de Dislexia do Desenvolvimento; GTH ¿ 17 crianças com o diagnóstico de Transtorno do Déficit de Atenção e Hiperatividade; GC ¿ 17 crianças sem dificuldades de aprendizagem ou atencionais. As crianças de GDD e GTH foram avaliadas no Ambulatório de Neuro-Dificuldades de Aprendizagem do Hospital de Clínicas/UNICAMP e as crianças do GC foram avaliadas em duas escolas públicas na cidade de São Carlos (SP). Foram realizadas avaliações individuais utilizando os instrumentos: Instrumento de Avaliação Sequencial (CONFIAS), Prova de Nomeação Automática Rápida (RAN), Protocolo de Avaliação de Memória de Trabalho (PMT), Prova de Nível de Leitura, Prova de Velocidade de Leitura Oral, Prova de Leitura e Escrita sob Ditado de Palavras Reais e Inventadas. Os dados foram analisados estatisticamente por meio do Programa SPSS. Os resultados deste estudo indicaram que as crianças com Dislexia do Desenvolvimento apresentaram piores médias de desempenho em consciência fonológica e nomeação automática rápida e as crianças com transtorno do déficit de atenção e hiperatividade apresentaram pior desempenho em memória de trabalho. Em relação à leitura e escrita, as crianças com Dislexia do Desenvolvimento apresentaram piores médias de desempenho em nível de leitura, velocidade de leitura oral, compreensão leitora, leitura e escrita de palavras reais de alta e baixa frequência e pseudopalavras quando comparadas às crianças com Transtorno do Déficit de Atenção e Hiperatividade. As diferenças estatísticas entre GDD e GTH indicaram que no processamento fonológico os grupos se diferenciam em exclusão e transposição fonêmica. Na leitura, GDD e GTH se diferenciam em leitura de palavras reais e irregulares de alta e baixa frequência, leitura de palavras regulares de alta frequência e em leitura de palavras inventadas. Na escrita, GDD e GTH se diferenciam em escrita de palavras reais de alta frequência e em palavras inventadas. Conclui-se que as crianças com dislexia do desenvolvimento e as crianças com transtorno do déficit de atenção tem semelhanças e diferenças no desempenho em processamento fonológico, leitura e escrita e neste estudo elas puderam ser diferenciadas pelo desempenho em exclusão e transposição fonêmica e em leitura, leitura e escrita de palavras reais e inventadas de alta e baixa frequência. Ressalta-se a importância da avaliação multidisciplinar e do olhar clínico aguçado para a realização da análise dos dados e do diagnóstico diferencia / Abstract: The purpose of this study was to evaluate phonological processing, reading, and writing in children with developmental dyslexia (DD) and attention-deficit hyperactivity disorder (ADHD). Its objective was to compare these activities across the study groups and indicate relevant distinctions. Participants were 51 children, of both genders, ages 8 to 14. Subjects were categorized by three groups: 17 children diagnosed with developmental dyslexia, 17 children diagnosed with ADHD, and a control group (CG) comprising 17 children without learning disabilities or attentional deficits. The DD and ADHD groups were evaluated at the Neurological Learning Disabilities Clinic of the Hospital de Clínicas, Universidade Estadual de Campinas, and the CG subjects were evaluated in two public schools in São Carlos, SP. Individual evaluations were performed using the following instruments: sequential evaluation instrument (CONFIAS), rapid automatized naming test, working memory assessment protocol, reading level test, oral reading speed test, and test of reading and writing dictated words and non-words. Data were statistically analyzed using SPSS. Study results indicate that children with developmental dyslexia and those with attention-deficit disorder present different profile changes in phonological processing, reading, and writing. Children with developmental dyslexia had worse performance averages in phonological awareness and rapid automatized naming, and children with ADHD exhibited worse performance averages in working memory. In regard to reading and writing, children with developmental dyslexia had worse performance averages in reading level, oral reading speed, reading comprehension, and reading and writing high- and low-frequency words and non-words compared to children with ADHD. The statistical deviations between the DD and ADHD groups indicate that they differ in phonological processing concerning phonemic exclusion and transposition. In reading, the DD and ADHD subjects differ in reading irregular words of high and low frequency, regular words of high frequency, and non-words. In writing, they differ in writing high-frequency words and non-words. Children with DD and ADHD present both similarities and differences in phonological processing, reading, and writing. The study¿s findings of distinctions in exclusion and phonemic transposition, as well as reading and writing words and non-words of high and low frequency, underscore the importance of multidisciplinary assessment and a keen clinical eye in conducting data analysis and differential diagnosis / Doutorado / Ciencias Biomedicas / Doutora em Ciências Médicas

Attention deficit hyperactivity disorder (ADHD) is a commonly diagnosed disorder in children. Methylphenidate (MPH) or Ritalin, is a psychostimulant widely prescribed to treat ADHD from childhood to adulthood. Although patients take MPH for years, studies investigating long-term MPH use are lacking. Additionally, abuse of MPH is a growing problem in young adults. MPH blocks dopamine and norepinephrine transporters, which extends these neurotransmitters’ actions by preventing their reuptake from the cleft. Previous research has shown that long-term exposure to MPH causes dopamine-releasing neurons in the nigrostriatal pathway to become more susceptible to the Parkinsonian toxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Here, the mechanism by which MPH sensitizes neurons to MPTP in a female model was investigated. The hypothesis was that oxidation of excess dopamine to a quinone causes neurons within this pathway to become more susceptible to MPTP. This dopamine quinone may be conjugated by the antioxidant glutathione (GSH); however, with an excess of dopamine and therefore quinones, GSH levels will become depleted. Without protection from GSH, quinones may lead to production of highly reactive free radicals, precipitating cell death. Estrogen is thought to be neuroprotective to MPTP, so it was further hypothesized that anestrus (low estrogen) females will show more dopamine cell loss, more quinone production, and more GSH depletion than proestrus (high estrogen) females. To test this hypothesis, MPTP-resistant adolescent female Swiss-Webster mice were divided into 3 treatment groups: saline (control), 1 mg/kg MPH (therapeutic dose), or 10 mg/kg (abusive dose). Within each group, mice were divided into proestrus and anestrus subgroups. All mice were injected twice daily with MPH or saline. After 12 weeks of injections followed by a 7 day washout period, half of each grouping received MPTP injections (4 x 20 mg/kg every 2 hours), while the other half received 4 injections of sterile saline. Mice were sacrificed either 3 or 7 days post-MPTP or saline injection. The substantia nigra and striatum of the nigrostriatal pathway that are affected by Parkinson’s disease were collected. Proestrus females in the saline group showed a significant (pmore dopamine quinone production (*p

Research suggests that the causal attributions utilized by children with attentiondeficit/ hyperactivity disorder (ADHD) differ from those of nonclinical children. Additionally, research indicates differences among the mothers of children with and without ADHD regarding parenting behaviors and attributions for child behavior. In this study, children' s attributions , maternal attributions , and maternal discipline styles were examined in ADHD and non-ADHD populations Participants included 26 children diagnosed with ADHD and their mothers as well as a nonclinical sample of 24 children who had never been diagnosed with ADHD and their mothers. The results support the hypotheses that child and maternal attributions would differ between these two groups. The hypothesis that discipline styles would differ between the two groups was not supported Results suggest that while maternal discipline styles are correlated with children's attributions, the nature of this association differs within AD.HD versus nonADHD populations.

Bakgrund: Att ha ADHD påverkar många aspekter i livet. Barn kan ha svårigheter med att bibehålla uppmärksamhet, impulskontroll och känsloreglering. Sjuksköterskor möter barn med ADHD inom all hälso- och sjukvård. Sjuksköterskors roll sträcker sig från bedömning till att ge individanpassat stöd, därför är det viktigt att förstå helheten om det barn som är i behov av hjälp vilket kan erhållas genom mötet med barnet och dennes föräldrar. Kunskap om hur föräldrar upplever sjukvården gällande sitt barn kan hjälpa sjuksköterskor att bidra till bättre hälsa för barn och föräldrar. Syfte: Att sammanställa och beskriva föräldrars upplevelse av sjukvården gällande sitt barn med ADHD. Metod: Litteraturstudie med deskriptiv design och tematisk analys inkluderande tio vetenskapliga kvalitativa artiklar. Huvudresultat: Resultatet visade att föräldrar hade olika upplevelser av sjukvården gällande sitt barn med ADHD. Sjuksköterskors bemötande gällande kommunikation och information påverkade upplevelsen hos föräldrar. När föräldrarna upplevde brister kunde det leda till svårigheter i deras barns fortsatta behandling men om de fick individanpassad omvårdnad ledde det till en trygghet, lättnad och ett mer fungerande vardagsliv. Slutsats: Hur vårdpersonal bemöter och ger information gällande vårdprocessen och behandling påverkar föräldrars upplevelse av situationen. En del föräldrar upplevde stress, ångest och skam och beskrev det som en kamp att hitta rätt väg till individanpassad hjälp. Detta kan däremot förbättras genom tydlig kommunikation och fasta vårdkontakter som ser helheten gällande problematiken. Bättre kunskap inom ämnet är avgörande för att kunna ge personcentrerad och förbättrad omvårdnad vilket denna litteraturstudie bidrar med. / Background: ADHD affects a person in many aspects of life. Children can have difficulties with maintaining attention, problems with controlling their impulses and emotions at home, at school and during playtime. Nurses meet children with ADHD in all aspects of healthcare. Nurses’ role regarding children with ADHD extends from assessment to providing individually customized support. How parents experience healthcare received by their child can help nurses contribute to better health for children, which in the long run leads to better health for parents as well. Aim: the purpose of this study was to describe parent’s experiences of healthcare regarding their child with ADHD. Method: A literature review with descriptive design and thematic analysis based on ten qualitative scientific articles. Main results: The results showed that parents had different experiences of healthcare regarding their child with ADHD. The main finding was how healthcare staff communicate and gave information affected parents experience, which also affected the health of child and parent. When parents experienced lack from healthcare staff, it could lead to difficulties in their child's continued treatment, but if they received individualized care, it led to a feeling of comfort, security and a more functioning everyday life. Conclusion: How healthcare staff communicate and provide information regarding the process and treatment affects parents' experience of healthcare. Some parents experienced stress, anxiety and guilt because of the way the healthcare staff treat them and described it as a struggle to get individualized help. However, this can be improved through communication and receiving continuous care with healthcare staff who know the full extent of the history. Better knowledge for nurses in this subject is crucial and the results of this literature review can contribute to an improved person-centered care.

Bakgrund: Fysioterapeutiska interventioner som exempelvis fysisk aktivitet har positiv effekt på flertalet symptom hos personer med ADHD. Dessa personer har även påvisad nedsatt motorisk kontroll och motorisk färdighet jämfört med neurotypiska personer. Trots påvisade positiva effekter nyttjas inte fysioterapeuters kompetens vid rehabilitering av ADHD. Syfte: Syftet var att kartlägga det aktuella kunskapsläget angående fysisk träning som fysioterapeutisk intervention för ökad motorisk färdighet och ökad motorisk kontroll hos personer med ADHD. Metod: En artikelsökning utfördes i databaserna Pubmed, PEDro, Cinahl, Web of Science och Scopus. Sökningen resulterade i elva relevanta artiklar varav fyra av dessa inkluderades. Referenslistor på inkluderade artiklar och review-studier granskades, vilket resulterade i ytterligare två inkluderade artiklar. Alla artiklar kvalitetsgranskades och sammanställdes i en resultattabell. Resultat: Fem artiklar, varav fyra av dessa med högt bevisvärde, visar att fysisk träning har signifikant effekt på motorisk färdighet. En artikel med högt bevisvärde indikerar att fysisk träning har signifikant effekt på motorisk kontroll. Effekten verkar inte bero på vilken typ av träning som utfördes, däremot visar en studie att högintensiv träning verkar ha bättre effekt på motorisk färdighet än lågintensiv. Konklusion: Fysisk träning verkar ha effekt på motorisk färdighet och motorisk kontroll hos personer med ADHD oavsett typ av träningsform. Högintensiv träning verkar ge bättre effekt på motorisk färdighet än lågintensiv. Brist på forskning inom området leder till svårigheter att dra tydliga slutsatser utifrån dessa resultat, därav behöver fler studier utföras.

The current study examines racial differences in the management of Attention Deficit Hyperactivity Disorder (ADHD) among Black adolescents. This study also examines Black adults' reflection upon adolescent symptoms of ADHD. Drawing on literature from racial/ethnic disparities in diagnosis and treatment of ADHD, health care service utilization, health behaviors, structural racism and medicalization, this study examines the health behavior and health care utilization practices of Black people, analyzing the avenues through which racism structures the management of symptoms. This study also explores the ways in which management of adolescent symptoms of ADHD shape Black adults' self-management of symptoms in adulthood. To investigate such ideas data from the National Comorbidity Survey- Adolescent Supplement (NCS-A) and the Parent Self-Administered Questionnaire (PSA-Q) were analyzed to offer a descriptive picture of differences in management and treatment of adolescent ADHD symptoms. Ten interviews were conducted with Black adults to offer depth to reported interpersonal causes of racial differences in management and treatment and assist in placing such causes within a framework of structural racism. Interview questions focused on participant's articulation of the socio-political landscape in which adolescent symptoms of ADHD were experienced. Additional questions targeted processes around parent's management of symptoms, the school systems management of symptoms, participant's relationships to medical care providers and avenues to treatment. Quantitative findings suggest there are racial differences present in the management of adolescent ADHD and qualitative findings offer that these differences are reflective of a structural system of power and privilege that shapes Black people's engagement with and access to care for symptoms of ADHD. This research contributes to existent knowledge about reported racial differences in management of symptoms of ADHD, and has implications for the ways in which literature approaches racial disparities in diagnosis and treatment of ADHD among Black adolescents. / Doctor of Philosophy / The current study examines racial differences in the management of Attention Deficit Hyperactivity Disorder (ADHD) among Black adolescents. This study also examines Black adults’ reflection upon adolescent symptoms of ADHD. Drawing on literature from racial and ethnic disparities in diagnosis and treatment of ADHD, health care service utilization, health behaviors, structural racism and medicalization, this study examines the health behavior and health care utilization practices of Black people. This study also explores the relationship between adolescent and adult management of ADHD symptoms. To investigate differences by race data from the National Comorbidity Survey- Adolescent Supplement (NCS-A) and the Parent Self-Administered Questionnaire (PSA-Q) were analyzed. In addition, interviews were conducted with Black adults to offer depth and give context to the ways in which race and racism shaped quantitative findings. Interview questions focused on participant’s adolescent management of symptoms by familial networks and school systems, as well as participant’s adult relationships to medical care providers and symptom management. Quantitative findings suggest racial differences are present in the management of adolescent ADHD and qualitative findings offer that these differences are reflective of the ways in which racism shapes Black people’s engagement with and access to care for symptoms of ADHD. This research contributes to existent knowledge about reported racial differences in management of symptoms of ADHD, and has implications for the ways in which literature approaches racial disparities in diagnosis and treatment of ADHD among Black adolescents.

Psychology / M.A. (Psychology)

Transition into adulthood has been regarded as a priority in health. However, there is scarcity of literature on the transition of adolescents with intellectual disability. The purpose of this study was to develop a strategy for transition of adolescents with intellectual disabilities into adulthood based on the Transition Theory proposed by Meleis, Sawyer, Im, Hilfinger and Schumacher (2000). The research objectives of this study were in three phases: Phase I: Desk review  To explore the known factors about the transition process of adolescents with IDs into adulthood.  To identify gaps in literature on the transition of adolescents with intellectual disabilities’ transition into adulthood. Phase II: Mixed method  To explore and describe the experiences of caregivers and health care professionals on the transition of adolescents with IDs into adulthood.  To investigate challenges that hamper the transition process of adolescents with IDs into adulthood. Phase III: Development of strategy  To develop a strategy for transition of adolescents with IDs into adulthood informed by findings from phases I and II. A sequential exploratory mixed method approach was used. A purposive, snowballing and simple random sampling were used to select participants for this study. The study was conducted in Special schools, Non-Governmental Organisations and Care and Rehabilitation Centres based in Gauteng province of South Africa. Triangulation of data sources and data collection methods was used to sample one hundred and forty nine (149) participants aged 21-60+ years who experienced caring for individuals with intellectual disabilities. Interpretative analysis proposed by Terrablanche. Durrheim and Kelly (2006) was used for qualitative data limited to a sample of n=29 participants. Quantitative data was analysed by use of IBM Statistical Package of Social Sciences (SPSS: 24) with a blend of descriptive and inferential statistics limited to a sample of n=120. Five themes from both qualitative and quantitative results emerged that is, transition possibility; the role of different stakeholders; the provision and development of working skills; caregivers’ knowledge and understanding of guidelines and alterations to adapt to change. The development of the transition strategy bridged a significant gap that informs nurses, teachers, parents, policy-makers and other stakeholders in supporting transition of adolescents with intellectual disabilities into adulthood. / Health Studies / D. Litt. et Phil. (Health Studies)