Thesis (MEdPsych (Educational Psychology)--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Attention Deficit/Hyperactivity Disorder (AD/HD) is one of the most well-known behaviour disorders in South Africa. Limited studies regarding adolescents’ experience of their own AD/HD are available despite the extensive research on AD/HD. The purpose of this exploratory and descriptive qualitative study was to understand 7 adolescents' experience of their own AD/HD in a special school in order to identify supportive strategies. This study was approached from an interpretive and/or constructivist research paradigm. A collective case study research design was used. Data was collected by means of observation, personal documents as well as semi-structured interviews. The data was transcribed and analised according to the constant comparative method. According to the results it seems as if the adolescents’ experiences of their own AD/HD are unique. However, these unique experiences are influenced by their barriers to learning, the process of diagnosis, development, AD/HD medication and social context. The adolescents seek that others empower them to regulate their own AD/HD by: (1) trying to understand how it feels to live with AD/HD; (2) providing information regarding AD/HD; and (3) focusing on their talents and strengths. The practical implications of the results are individualized intervention, changing roles of educators and support professionals, whole school development, changing attitudes, as well as professional development. Further qualitative research is recommended to investigate adolescents’ experiences of their own ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is a complicated psychiatric disorder that is typically first diagnosed in childhood and associated with negative outcomes in adulthood such as poor academic performance and difficulties with social relationships. ADHD can be difficult to accurately diagnose in adulthood, given the absence of clear, agreed upon ADHD symptomology in adults. In the current study, two raters used psychometrically sound instruments and diagnostically valid assessment techniques on an archival dataset to create three distinct groups: ADHD [2/3 with other mental health diagnosis (OMH)], OMH only, and no diagnosis. Findings support the value of comprehensive assessment, combined with a thorough evaluation of the material by a trained clinician, for the accurate diagnosis of ADHD for research purposes. Comparisons were made across groups to infer that college students with ADHD have lower grade point averages and academic self-concept than students without mental health diagnoses. Yet, contrary to much of the current literature, college students with ADHD seem to create as strong, deep, supportive and harmonious relationships with loved ones and close friends as their non-diagnosed peers. Clinicians working with college students with ADHD may use the results of the current study to better inform conceptualization, better recognize the innate resilience college students with ADHD likely have, and inform treatment interventions.

O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é um dos transtornos de maior prevalência na infância e adolescência. Pesquisas recentes demonstram que, ao menos do ponto de vista cognitivo, existem diferenças importantes no desenvolvimento de crianças com TDAH quando comparadas com crianças sem qualquer diagnóstico psiquiátrico. O presente trabalho pretende contribuir para o campo de pesquisa sobre o TDAH, buscando uma compreensão mais dinâmica deste transtorno, ultrapassando o nível descritivo dos sintomas, incorporando aspectos da Psicologia do Desenvolvimento. Acreditamos que a teoria de Piaget acerca do desenvolvimento psicológico, do processo de transição do estágio pré-operatório para o estágio operatório concreto de desenvolvimento, é um subsídio teórico importante para a compreensão deste transtorno, em especial a construção operatória da noção de tempo. A hipótese geral foi a de que crianças com TDAH apresentariam déficits no desenvolvimento de noções operatórias, como a conservação, reversibilidade e apreensão temporal. Foram entrevistadas 62 crianças, com idades entre 6 a 12 anos, subdividas em dois grupos: uma amostra clínica de crianças diagnosticadas com TDAH (n=32), e uma amostra de crianças sem diagnóstico (grupo controle, n=30). A amostra clínica foi também dividida entre crianças que faziam uso de metilfenidato, e crianças não medicadas, com o intuito de observar se a medicação exerceria alguma influência no desempenho das crianças em provas piagetianas. Para a composição dos grupos, foi utilizada a K-SADS-PL, elaborada segundo os critérios do DSM-IV. Com o objetivo de avaliar os níveis de desatenção e hiperatividade, os pais e/ou responsáveis responderam a dois questionários: a versão abreviada do questionário de Conners, e o Inventário dos Comportamentos de Crianças e Adolescentes entre 6 e 18 anos (CBCL). Tendo como referência a entrevista clínica de Piaget, foram aplicadas as seguintes provas piagetianas: Conservação das quantidades discretas; Mudança de critério dicotomia; as provas de Sucessão dos Acontecimentos Percebidos e da Simultaneidade, e O tempo da ação própria e a duração interior. Os resultados demonstram haver diferença estatisticamente significativa entre o desempenho das crianças dos diferentes grupos, para as provas piagetianas como um todo (p < 0,001), e, quando analisadas separadamente, para as provas de Conservação de Quantidades Discretas (p = 0,003), Simultaneidade (p = 0,004), e O tempo da ação própria e a duração interior (p < 0,001). Crianças com TDAH apresentaram uma tendência a terem suas respostas classificadas em níveis inferiores ao esperado, quando comparadas ao grupo controle. Em relação ao uso do metilfenidato na amostra clínica, não foi observada diferença significativa entre os grupos. Apesar importante no tratamento, o metilfenidato não demonstrou ser suficiente para potencializar o desenvolvimento cognitivo de crianças com TDAH, superando os déficits observados. Esses achados corroboram a hipótese de déficit na aquisição das noções operatórias em crianças com TDAH. Assim, são necessárias novas reflexões a respeito do TDAH, considerando alternativas de intervenções que considerem os déficits observados, ultrapassando o tratamento medicamentoso. / Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent disorders in childhood and adolescence. Recent research shows that, at least from a cognitive level, there are important differences in the development of children with ADHD when compared with children without any psychiatric diagnosis. This work aims to contribute to the field of research on ADHD, seeking a more dynamic understanding of this disorder, surpassing the descriptive level of symptoms, incorporating aspects of Developmental Psychology. We believe that Piaget´s theory about the psychological development, the process of transition from pre-operative stage to concrete operative stage of development, is important for the theoretical understanding of this disorder, especially the construction of the operative notion of time. The general hypothesis was that children with ADHD present deficits in the development of operational concepts, such as conservation, reversibility and temporal seizure. Sixty two children, aged 6 to 12 years, were interviewed, and subdivided into two groups: a clinical sample of children diagnosed with ADHD (n = 32) and a sample composed by children without diagnosis (control group, n = 30). The clinical sample was divided between children who made use of methylphenidate, and children non-medicated, in order to see if the medication did some influence on the children´s performance in piagetian tasks. For the composition of groups, the K-SADS-PL was utilized, prepared according to the DSM-IV criteria. To assess the levels of inattention and hyperactivity, the parents and / or guardians answered two questionnaires: Conners´ Abbreviated Parents Rating Scale, and the Child Behavior Checklist (CBCL). According to the Piaget´s clinical interview, the following tasks were applied: Conservation of discrete quantities; Change of criteria - dichotomy; the tasks Succession of Events Perceived; Simultaneity, and The time of the action and the internal duration. Results show statistically significant differences between the performance of children from different groups, for piagetians tasks as a whole (p <0001) and, when analyzed separately, for the tasks Conservation of Discrete Quantities (p = 0003), Simultaneity, (p = 0004), and The time of the action and the internal duration. (p <0001). Children with ADHD showed a tendency to take their responses classified at levels lower than expected when compared to the control group. Regarding the use of methylphenidate in the clinical sample, there was no significant difference between groups. Although necessary of treatment, methylphenidate has not be sufficient to enhance the cognitive development of children with ADHD, overcoming the deficits observed. These findings support the hypothesis of deficits in the acquisition of concepts operative in children with ADHD. This calls for new thinking about the ADHD, considering alternatives for interventions that consider the deficits observed, surpassing the drug treatment.

Made available in DSpace on 2016-04-28T20:38:05Z (GMT). No. of bitstreams: 1 Helena Maria Daquanno Martins Testi.pdf: 2024967 bytes, checksum: 4a9ae508bfb6deb8424fb9530dba9133 (MD5) Previous issue date: 2012-05-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present study investigates from the point of view of Psychoanalysis a case of attention deficit disorder/hyperactivity disorder (ADHD). Articulate this point of view the research developed by doctors and scientists, like Barkley, Camargos Jr. and Hounie, Cypel, Rohde, Topoczewski, Ajuriaguerra, among others, to investigate the context of diagnosis and onset of that name, and its evolution in the field of Medicine. Guide this work theoretically studies of Freud and Piera Aulagnier, which postulate the psychic constitution of the subject based on conflicts of early childhood. The basic concepts for the analysis of the case were the transfer, identificatory conflicts and maniac defense. The notion of melancholy potentiality, developed by Violante, was also important for this study. The case investigated is that of a six year old child diagnosed as ADHD, the inattentive subtype. Manoel, as it is called the child in this study, was referred by the school because he had difficulty reading and writing, and can not focus and disrupt colleagues in the classroom. Was in attendance at weekly meetings during the year and a half, most of which, alone. Were also individually interviewed the mother (on three separate occasions) and father (in one). The researcher's notes during the meetings served as the basis for the constitution of the case and further analysis. The research questions that guided the research were: a) From the discussion of a clinical case, which conflicts are the basis of somatic manifestation? b) What defenses are mobilized or not for these conflicts? c) What are the implications of changes in family structure and how this affects relations with each parent? The analysis indicated that the identificatory conflicts were those at the base of the somatic manifestations, taken as hyperactivity. The maniac defenses were deployed against a potentiality of melancholy. Furthermore, Manoel was subjected to an environment psychic disturbing / O presente estudo consiste em investigar, sob o ponto de vista da Psicanálise, um caso de transtorno do déficit de atenção/hiperatividade (TDAH). Articulam-se a esse ponto de vista as pesquisas desenvolvidas por médicos e cientistas, como Barkley, Camargos Jr. e Hounie, Cypel, Rohde, Topoczewski, Ajuriaguerra, dentre outros, no sentido de investigar o contexto de aparecimento desse diagnóstico e dessa denominação, bem como a sua evolução na área da Medicina. Norteiam teoricamente este trabalho os estudos de Freud e Piera Aulagnier, dos quais se postula a constituição psíquica do sujeito pautada nos conflitos da primeira infância. Os conceitos basilares para a análise do caso foram os de transferência, conflitos identificatórios e defesa maníaca. A noção de potencialidade melancólica, desenvolvida por Violante, também foi importante para este estudo. O caso clínico investigado é o de uma criança de seis anos, diagnosticada como TDAH, do subtipo desatento. Manoel, como é chamada essa criança neste trabalho, foi encaminhada à análise pela escola, pois tinha dificuldades para ler e escrever, além de não conseguir se concentrar e atrapalhar os colegas em sala de aula. Esteve em atendimento em encontros semanais durante o período de um ano e meio, na maioria dos quais, sozinho. Foram entrevistados individualmente também a mãe (em três ocasiões distintas) e o pai (em uma única). As anotações da pesquisadora durante os encontros serviram de base para a constituição do caso e posterior análise. As perguntas de pesquisa que orientaram a investigação foram: a) A partir da discussão de um caso clínico, que conflitos estão na base dessa manifestação somática?; b) Que defesas são mobilizadas ou não por esses conflitos?; c) Quais são as implicações das mudanças na organização familiar e como isso repercute nas relações vinculares com cada um dos pais? A análise indicou que os conflitos identificatórios eram os que estavam na base da manifestação somática, tida como hiperatividade. As defesas maníacas foram mobilizadas contra uma possível potencialidade melancólica. Além disso, Manoel era uma criança submetida a um meio ambiente psíquico perturbador

Entender o funcionamento cerebral da aquisição e desenvolvimento da leitura e da escrita e consequentemente seus desarranjos, tem sido objeto de investigação de diversos pesquisadores de todo o mundo. Por ser uma atividade cognitiva complexa, a atividade de leitura e escrita requer o recrutamento de diversas regiões cerebrais, promovendo a integração de múltiplas habilidades linguístico-cognitivas dentre as quais, as do processamento fonológico. Consciência fonológica, memória operacional fonológica e acesso lexical são habilidades que integram o processamento fonológico sendo responsáveis pela forma como as informações são processadas, armazenadas e utilizadas. Uma falha no processo de aprendizagem da leitura, resultante de um déficit no componente fonológico da linguagem, em que se observa dificuldades tanto com a fluência correta na leitura quanto com a habilidade de decodificação e ortografia é chamada de Dislexia do Desenvolvimento (DD). O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é o transtorno neuropsiquiátrico que tem como característica sintomas como a desatenção, hiperatividade e impulsividade. Tanto a DD quanto o TDAH são bastante frequentes na infância, estando ambos entre as causas mais comuns de fracasso escolar. Assim sendo, a presente pesquisa teve como objetivo caracterizar as semelhanças e diferenças de crianças com DD e com DD+TDAH em relação a um grupo de crianças sem queixas de aprendizagem escolar, com a premissa de que os escolares com a comorbidade teriam um maior prejuízo nas habilidades avaliadas devido à sobreposição de déficits. Participaram da pesquisa 70 crianças, estudantes do terceiro ao quinto distribuídas em três grupos: 32 escolares sem queixa de dificuldade de aprendizagem, média de idade de 9.5 anos; 22 escolares com DD, média de idade de 10 anos; e 16 escolares com TDAH+DD, média de idade de 9.9. As habilidades do processamento fonológico, leitura e ortografia das crianças foram avaliadas por meio de testes padronizados. Os dados indicaram que os escolares com DD e com DD+TDAH apresentaram um pior desempenho em todas as habilidades avaliadas quando comparados ao grupo sem queixa de aprendizagem. Não houve diferença estatística entre o desempenho dos escolares com DD e com DD+TDAH, nas habilidades do processamento fonológico, nos processos de leitura e no número de acertos na ortografia, embora o desempenho do grupo com DD+TDAH tenha sido pior. Os escolares com DD e DD+TDAH diferiram apenas quanto ao tipo de erro ortográfico produzido por cada grupo. Todas as habilidades estudadas se correlacionaram, variando a força dessa correlação, indicando a relação de reciprocidade entre o processamento fonológico e a leitura e escrita. Os dados da presente pesquisa contribuem para o delineamento de melhores programas de intervenção para a população estudada / The understanding of cerebral functioning regarding acquisition and development of reading and writing and consequently its disorders, have been investigated by several researchers worldwide. Due to its complexity, reading requires various brain areas and promotes integration of multiple linguistic-cognitive skills such as those from phonological processing. Phonological awareness, phonological short-term memory and lexical access are skills which compose phonological processing and also are responsible for how the information are processed, recovered and used. A failure in reading learning process due to a deficit in the phonological processing in which are observed struggle both in decoding and reading fluency is known as developmental dyslexia (DD). Attentional deficit and hyperactivity disorder (ADHD) is a neuropsychiatric disorder whose main trait are inattention, hyperactivity and impulsivity. Both DD and ADH are commonly seen in childhood and are often related to school failure. Thus, this research aimed to characterize similarity and differences of children with DD and DD+ADHD comparing them to a group of children without complaints of the learning process; we hypothesized that children with comorbid would present greater impairment in the skills investigated due to the overlapping deficits. Seventy students, from the third to fifth grade, participated in this study divided as follows: 32 children without complaints of learning difficulties mean age 9,5 years; 22 students with DD and mean age 10 years; 16 scholars with DD+ ADHD mean age 9,9. Skills of phonological processing, reading and spelling were assessed through standardized tests. Data indicated that children with DD and DD+ADH presented lower performance in all assessed skills when compared with typically developed children. There was no statistical difference between the performance of children with DD and DD+ADHD in the phonological processing, reading processes and score reached in spelling, although DD+ADHD group presented the lowest performance. Differences were observed between DD and DD+ADHD only in the type of misspelling. All assessed skills presented correlation with variation in its strength, indicating reciprocity between phonological processing, reading and writing. Data from this research contribute to develop better programs for intervention in the studied population

Background. Numerous clinical trials demonstrate the efficacy of medication and behavioral treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) in children, but provision of behavioral treatment for ADHD is limited in community clinics and only the pharmacological treatment is the standard care for children with ADHD. The current study evaluated the treatment effectiveness of combining psychosocial treatment to methylphenidate and to compare this combined treatment with medication alone in treating ADHD in children of a community mental health center in Hong Kong. Psychosocial treatment consisted of parent training and child intervention. The treatment group for children was a 24-week problem solving, anger coping, and social skills training program. Parent training consisted of 18 weekly sessions, highlighting parenting as an integration of elements of cognition, emotion, and behavior, as well as introducing effective parenting techniques based on social learning principles. Method. A group of 146 consecutive child patients with ADHD symptoms attending Yaumatei Child Psychiatric Center were invited for screening their eligibility of participating in this study. A randomized group comparison design was used with two treatment conditions (medication-only; combined medication and psychosocial treatment) and four assessment time points. Ninety eligible child-parent dyads were randomly allocated to the combined treatment condition or medication-only condition. Treatment outcomes were assessed in multiple domains at pre-intervention and post-intervention, and at 6-month and 12-month follow-ups. Data was analyzed through intent-to-treat mixed-effects regression model. / Conclusions. The combined treatment condition not only yielded significantly greater benefits than the medication-only condition on primary ADHD symptoms, but also other advantages in terms of conduct problem and adaptive functioning outcomes. / Results. Regarding ADHD symptoms, children in combined treatment condition showed significantly greater improvement than those given medication alone at post-treatment assessment. Combined treatment also proved better than medication alone in several other domains, such as oppositional behavior, a child's performance on computerized test, parenting behavior, and parental accurate knowledge of ADHD. Parental treatment-related attributions were also found to be changing over the course of treatment. Follow-up assessments revealed that children in the combined treatment condition maintained greater reduction in oppositional behavior one year after the completion of psychosocial treatment. / So Yuk-chi. / "May 2005." / Adviser: Patrick W. L. Leung. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 4119. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 222-247). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Entender o funcionamento cerebral da aquisição e desenvolvimento da leitura e da escrita e consequentemente seus desarranjos, tem sido objeto de investigação de diversos pesquisadores de todo o mundo. Por ser uma atividade cognitiva complexa, a atividade de leitura e escrita requer o recrutamento de diversas regiões cerebrais, promovendo a integração de múltiplas habilidades linguístico-cognitivas dentre as quais, as do processamento fonológico. Consciência fonológica, memória operacional fonológica e acesso lexical são habilidades que integram o processamento fonológico sendo responsáveis pela forma como as informações são processadas, armazenadas e utilizadas. Uma falha no processo de aprendizagem da leitura, resultante de um déficit no componente fonológico da linguagem, em que se observa dificuldades tanto com a fluência correta na leitura quanto com a habilidade de decodificação e ortografia é chamada de Dislexia do Desenvolvimento (DD). O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é o transtorno neuropsiquiátrico que tem como característica sintomas como a desatenção, hiperatividade e impulsividade. Tanto a DD quanto o TDAH são bastante frequentes na infância, estando ambos entre as causas mais comuns de fracasso escolar. Assim sendo, a presente pesquisa teve como objetivo caracterizar as semelhanças e diferenças de crianças com DD e com DD+TDAH em relação a um grupo de crianças sem queixas de aprendizagem escolar, com a premissa de que os escolares com a comorbidade teriam um maior prejuízo nas habilidades avaliadas devido à sobreposição de déficits. Participaram da pesquisa 70 crianças, estudantes do terceiro ao quinto distribuídas em três grupos: 32 escolares sem queixa de dificuldade de aprendizagem, média de idade de 9.5 anos; 22 escolares com DD, média de idade de 10 anos; e 16 escolares com TDAH+DD, média de idade de 9.9. As habilidades do processamento fonológico, leitura e ortografia das crianças foram avaliadas por meio de testes padronizados. Os dados indicaram que os escolares com DD e com DD+TDAH apresentaram um pior desempenho em todas as habilidades avaliadas quando comparados ao grupo sem queixa de aprendizagem. Não houve diferença estatística entre o desempenho dos escolares com DD e com DD+TDAH, nas habilidades do processamento fonológico, nos processos de leitura e no número de acertos na ortografia, embora o desempenho do grupo com DD+TDAH tenha sido pior. Os escolares com DD e DD+TDAH diferiram apenas quanto ao tipo de erro ortográfico produzido por cada grupo. Todas as habilidades estudadas se correlacionaram, variando a força dessa correlação, indicando a relação de reciprocidade entre o processamento fonológico e a leitura e escrita. Os dados da presente pesquisa contribuem para o delineamento de melhores programas de intervenção para a população estudada / The understanding of cerebral functioning regarding acquisition and development of reading and writing and consequently its disorders, have been investigated by several researchers worldwide. Due to its complexity, reading requires various brain areas and promotes integration of multiple linguistic-cognitive skills such as those from phonological processing. Phonological awareness, phonological short-term memory and lexical access are skills which compose phonological processing and also are responsible for how the information are processed, recovered and used. A failure in reading learning process due to a deficit in the phonological processing in which are observed struggle both in decoding and reading fluency is known as developmental dyslexia (DD). Attentional deficit and hyperactivity disorder (ADHD) is a neuropsychiatric disorder whose main trait are inattention, hyperactivity and impulsivity. Both DD and ADH are commonly seen in childhood and are often related to school failure. Thus, this research aimed to characterize similarity and differences of children with DD and DD+ADHD comparing them to a group of children without complaints of the learning process; we hypothesized that children with comorbid would present greater impairment in the skills investigated due to the overlapping deficits. Seventy students, from the third to fifth grade, participated in this study divided as follows: 32 children without complaints of learning difficulties mean age 9,5 years; 22 students with DD and mean age 10 years; 16 scholars with DD+ ADHD mean age 9,9. Skills of phonological processing, reading and spelling were assessed through standardized tests. Data indicated that children with DD and DD+ADH presented lower performance in all assessed skills when compared with typically developed children. There was no statistical difference between the performance of children with DD and DD+ADHD in the phonological processing, reading processes and score reached in spelling, although DD+ADHD group presented the lowest performance. Differences were observed between DD and DD+ADHD only in the type of misspelling. All assessed skills presented correlation with variation in its strength, indicating reciprocity between phonological processing, reading and writing. Data from this research contribute to develop better programs for intervention in the studied population

O transtorno de déficit de atenção/ hiperatividade (TDAH) é o distúrbio neurocomportamental mais comum na população pediátrica e, a habilidade psicomotora dessas crianças pode ser significativamente mais baixa do que se espera em cerca de 30% a 50% dos casos. O objetivo desse estudo foi traçar o perfil psicomotor de crianças com TDAH do tipo combinado. O grupo caso foi formado por 34 pacientes acompanhados nos ambulatórios de Neurologia Infantil do Instituto Central e de Distúrbios do Aprendizado do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, que apresentavam idade entre sete e 11 anos, sexo masculino, diagnóstico de TDAH tipo combinado, sem comorbidades (exceto o transtorno desafiador opositivo) e sem terem iniciado tratamento. O grupo controle foi composto de 32 escolares da rede pública do município de São Paulo e seguiu os mesmos critérios de inclusão em relação à idade e sexo. A avaliação foi feita por meio da Escala de Desenvolvimento Motor, descrita por Rosa Neto, na qual foram utilizados todos os testes propostos: motricidade fina, motricidade global, equilíbrio, esquema corporal, organização espacial e temporal. Todos os testes foram aplicados em uma única sessão, com tempo médio de 40 minutos. Para a análise estatística foi utilizado o pacote estatístico Stata versão 11.0 (Stata Corporation, College Station, TX, E.U.A.) e empregados os testes Shapiro-Wilks, teste t de Student, teste U de Mann-Whitnney. Os resultados demonstraram que os quocientes motores de todas as áreas estudadas foram mais baixos no grupo caso que no grupo controle, apesar de em sua maioria representarem valores normais segundo a escala (53% apresentaram desenvolvimento normal médio, 29% normal baixo, 9% muito inferior, 6% normal alto e 3% inferior). A maioria das crianças com TDAH (88,3%) atingiu idades negativas (média -12,8 meses), através da diferença da idade motora geral e a idade cronológica. Nos indivíduos saudáveis, a idade negativa média foi igual a -3,9 meses e ocorreu em 53,1% da amostra. Houve diferenças estatisticamente significantes entre os grupos quanto à idade motora geral (p=0,004), quociente motor geral (p<0,001), equilíbrio (p=0,008), organização espacial (p<0,001), motricidade fina (p=0,009) e global (p=0,008). Assim, foi possível verificar dificuldades no desempenho psicomotor de crianças com TDAH do tipo combinado. O conhecimento sobre o perfil psicomotor dessas crianças pode auxiliar na definição das propostas terapêuticas, a fim de minimizar os prejuízos em sua qualidade de vida. / The attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children and the psychomotor skill of these children may be significantly lower than expected by about 30% to 50% of cases. The aim of this study was to determine the psychomotor profile of children with ADHD combined type. The case group consisted of 34 patients followed in outpatient clinics of the Child Neurology of Central Institute and Learning Disorders of Children\'s Institute of Clinics Hospital of the Faculty of Medicine of University of São Paulo, who were aged between seven and 11 years, sex male, diagnosis for ADHD combined type, without comorbidity (except oppositional defiant disorder) and had not begun treatment. The control group was composed of 32 scholars from public schools in São Paulo and followed the same inclusion criteria regarding age and sex. The evaluation was made through the Motor Development Scale, described by Rosa Neto, which were used in all tests available: fine motricity, gross motricity, balance, body scheme, spatial and temporal organization. All tests were applied in one session, wtith medium time of 40 minutes. For the statistical analysis used Stata software version 11.0 (Stata Corporation, College Station, TX, USA) and used the Shapiro-Wilks tests, Student t test, Mann-U Whitnney test. The results showed that the ratios engines all areas studied were lower in case group than the control group, although in most cases represent normal values according to scale (53% were classified as normal medium motor development, 29% normal low, 9% very low, 6% normal high and 3% lower). Most children with ADHD (88.3%) achieved negative ages (average -12.8 months) by age difference genreal motor age and chronological age. In healthy subjects, the average of negative age was equal to -3.9 months and occurred in 53.1% of the sample. Statistically significant differences between groups in general motor age (p = 0.004), general motor quotient (p <0.001), balance (p = 0.008), spatial organization (p <0.001), fine motricity (p = 0.009) and gross motricity (p = 0.008). Thus, it was possible observed problems in psychomotor performance of children with ADHD combined type. Knowledge about the psychomotor profile of these children may assist in determining treatment proposals in order to minimize losses in their quality of life.

Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder with onset at preschool age Approximately 5-10% of school-aged children worldwide have ADHD. Psychostimulants are the most common treatments for ADHD, although the precise etiology and pathological mechanisms underlying ADHD are poorly understood. Animal models could help to elucidate and further the understanding of this disorder. Among the major rodent models of ADHD of the genetic and neurotoxin-exposed animal models, the spontaneously hypertensive rats (SHR) are more extensively studied. Nevertheless, the mechanism of ADHD is complex and the evidence of SHR model for ADHD has been conflicting. Objective. In this work, we combined behavioral, neurochemical, neuroimaging, pharmacological and molecular studies to examine SHR as an animal model of ADHD. At the same time, the results of our studies could help us to explore the potential mechanism of ADHD. Material and methods. We compared the locomotor activity, attention, inhibition, learning and memory of juvenile male SHR with those of age- and gender-matched genetic control Wistar-Kyoto rats (WKY) by using the open field test, Morris water maze and prepulse inhibition test. We employed magnetic resonance imaging (MRI) to measure potential morphological differences between different brain areas of SHR and WKY, and the functional MRI (fMRI) for functional differences in these brain areas. We also measured dopamine concentration and dopamine related genes expression in the different dopamine pathways by using enzyme-linked immunosorbent assay (ELISA) to measure the dopamine concentration and by using real time PCR to assay genes expression. We examined SHR responses to D-amphetamine (D-AMP), which is psychostimulant. These included locomotor activity and inhibition ability during D-AMP treatment, expression of dopamine related genes after D-AMP treatment measured by real time PCR and c-fos protein after repeated treatment of D-AMP by the Western Blotting. Results . Hyperactivity, impulsivity and attention deficit were observed in SHR. Decreased brain volume in caudate-putamen and vermis cerebelli in SHR were demarcated using MRI. Functional MRI (fMRI) and altered c-fos expression indicated plasticity changes of the prefrontal cortex (PFC) in SHR. Dopamine content was found to decrease in mesocortical and mesolimbic dopamine pathways, but increased in the striatum. Dopamine D4 receptors gene and protein expression were decreased in the PFC in SHR. We also found that the expression of the synaptosomal-associated protein 25 (SNAP-25) gene was initially lower in the PFC but higher in the striatum in SHR. However, this disparity of SNAP-25 in the PFC vanished after repeated treatment of D-AMP between SHR and WKY. Conclusions. In the present study, we demonstrated that SHR could be established as an ADHD model by completing complex assessments of face validity, construct validity and prediction validity. We suggested that the "synaptogenesis hypotheses" might contribute to the abnormal release of dopamine and dysfunction of PFC and the striatum in SEER. In conclusion, our results have provided further new information relevant to the understanding of ADHD in human via the analysis of the SHR model. / Li, Qi. / Adviser: David Yen. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 1375. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 108-125). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / School code: 1307.

O transtorno de déficit de atenção/ hiperatividade (TDAH) é o distúrbio neurocomportamental mais comum na população pediátrica e, a habilidade psicomotora dessas crianças pode ser significativamente mais baixa do que se espera em cerca de 30% a 50% dos casos. O objetivo desse estudo foi traçar o perfil psicomotor de crianças com TDAH do tipo combinado. O grupo caso foi formado por 34 pacientes acompanhados nos ambulatórios de Neurologia Infantil do Instituto Central e de Distúrbios do Aprendizado do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, que apresentavam idade entre sete e 11 anos, sexo masculino, diagnóstico de TDAH tipo combinado, sem comorbidades (exceto o transtorno desafiador opositivo) e sem terem iniciado tratamento. O grupo controle foi composto de 32 escolares da rede pública do município de São Paulo e seguiu os mesmos critérios de inclusão em relação à idade e sexo. A avaliação foi feita por meio da Escala de Desenvolvimento Motor, descrita por Rosa Neto, na qual foram utilizados todos os testes propostos: motricidade fina, motricidade global, equilíbrio, esquema corporal, organização espacial e temporal. Todos os testes foram aplicados em uma única sessão, com tempo médio de 40 minutos. Para a análise estatística foi utilizado o pacote estatístico Stata versão 11.0 (Stata Corporation, College Station, TX, E.U.A.) e empregados os testes Shapiro-Wilks, teste t de Student, teste U de Mann-Whitnney. Os resultados demonstraram que os quocientes motores de todas as áreas estudadas foram mais baixos no grupo caso que no grupo controle, apesar de em sua maioria representarem valores normais segundo a escala (53% apresentaram desenvolvimento normal médio, 29% normal baixo, 9% muito inferior, 6% normal alto e 3% inferior). A maioria das crianças com TDAH (88,3%) atingiu idades negativas (média -12,8 meses), através da diferença da idade motora geral e a idade cronológica. Nos indivíduos saudáveis, a idade negativa média foi igual a -3,9 meses e ocorreu em 53,1% da amostra. Houve diferenças estatisticamente significantes entre os grupos quanto à idade motora geral (p=0,004), quociente motor geral (p<0,001), equilíbrio (p=0,008), organização espacial (p<0,001), motricidade fina (p=0,009) e global (p=0,008). Assim, foi possível verificar dificuldades no desempenho psicomotor de crianças com TDAH do tipo combinado. O conhecimento sobre o perfil psicomotor dessas crianças pode auxiliar na definição das propostas terapêuticas, a fim de minimizar os prejuízos em sua qualidade de vida. / The attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children and the psychomotor skill of these children may be significantly lower than expected by about 30% to 50% of cases. The aim of this study was to determine the psychomotor profile of children with ADHD combined type. The case group consisted of 34 patients followed in outpatient clinics of the Child Neurology of Central Institute and Learning Disorders of Children\'s Institute of Clinics Hospital of the Faculty of Medicine of University of São Paulo, who were aged between seven and 11 years, sex male, diagnosis for ADHD combined type, without comorbidity (except oppositional defiant disorder) and had not begun treatment. The control group was composed of 32 scholars from public schools in São Paulo and followed the same inclusion criteria regarding age and sex. The evaluation was made through the Motor Development Scale, described by Rosa Neto, which were used in all tests available: fine motricity, gross motricity, balance, body scheme, spatial and temporal organization. All tests were applied in one session, wtith medium time of 40 minutes. For the statistical analysis used Stata software version 11.0 (Stata Corporation, College Station, TX, USA) and used the Shapiro-Wilks tests, Student t test, Mann-U Whitnney test. The results showed that the ratios engines all areas studied were lower in case group than the control group, although in most cases represent normal values according to scale (53% were classified as normal medium motor development, 29% normal low, 9% very low, 6% normal high and 3% lower). Most children with ADHD (88.3%) achieved negative ages (average -12.8 months) by age difference genreal motor age and chronological age. In healthy subjects, the average of negative age was equal to -3.9 months and occurred in 53.1% of the sample. Statistically significant differences between groups in general motor age (p = 0.004), general motor quotient (p <0.001), balance (p = 0.008), spatial organization (p <0.001), fine motricity (p = 0.009) and gross motricity (p = 0.008). Thus, it was possible observed problems in psychomotor performance of children with ADHD combined type. Knowledge about the psychomotor profile of these children may assist in determining treatment proposals in order to minimize losses in their quality of life.