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.

Attention Deficit Hyperactivity Disorder (ADHD), an intellectual impairment, generally characterised by inattentiveness and impulsivity has become prevalent in South African schools. ADHD learners require support from within the classroom to accommodate their academic and behavioural needs. A quantitative research was undertaken to determine the impact of an educator's knowledge of ADHD on teaching support strategies. An educator's ADHD knowledge is based on their understanding of the diagnosis, causes, symptoms and management of ADHD as well as the effect that ADHD has on a learner's classroom skills. Data was obtained from responses to questionnaires from randomly selected respondents within randomly selected government secondary schools in the Umlazi District of Kwa-Zulu Natal. The data was descriptively analysed to conclude that the level of ADHD knowledge possessed by educators impact on the appropriateness of their teaching strategies. There is a need to impart knowledge regarding learning barriers to educators, to ensure the efficacy of teaching strategies. / Inclusive Education / M. Ed. (Inclusive Education)

TITLE Physical activity and its impact on pupils with specific learning disabilities and behavior disabilities in normal education at primary school AUTHOR Lucie Muráriková SUPERVISOR PhDr. Martin Dlouhý, Ph.D. ABSTRACT This work is focusing on the specific learning and behavioral disabilities. The aim is to create several activity plans and exercise plans which could be used to determine the effect of physical activity on the work of students with learning disabilities and ADHD/ADD. My idea is that the physical activity should not only positively affect the overall quality of teaching, but should also serve very well in the reeducation of specific learning disabilities in children with ADHD and ADD. Pupils with specific learning disabilities should, after a certain period of this experiment, be showing significant changes in their results and knowledge. Pupils with the ADHD and ADD should be showing better results and knowledge due to the improving attention and at the same time the physical activity should influence their length of concentration, disturbance during lessons, or tendencies to aggression. I consulted a child psychologist and a special pedagogue during the creation of the plans and activities for reeducation. And during the observations of two groups - experimental and control - I collected...

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This thesis aims to to see if its possible to meet some of the complex needs of people with ADHD, in the form of aiding them with remembering to complete tasks and chores. Current studies have mainly focused on either assessing or treating ADHD rather than looking at aiding people already diagnosed. In order to evaluate if the needs can be met the participants of the paper are first interviewed to determine some of the needs. A mobile application was then developed based on the data collected from the interviews and later evaluated by the participants in a second round of interviews. The result of this paper showed that these complex needs can be met, in this paper the needs managed to be met with the use of mobile notifications that server as reminders and also by letting the participants prioritize the importance of the task. However the application did not fully suit all participants and had some shortcomings which could lead to further research that looks at trying to meet more of these needs, either by continued development of the application or by mapping out what the needs are.

Attention deficit hyperactivity disorder (ADHD) is usually associated with deficits in Organization, Time Management, and Planning skills (OTMP; Pfiffner et al., 2013). Without adequate intervention, students with ADHD are more at risk of significant academic difficulties during the transition to secondary school mainly because of the increased organizational demands and expectations of greater autonomy characterizing this learning environment (Litner, 2003). The objective of this thesis was to better understand the factors associated with the effectiveness of the TRANSITION Project (Normandeau et al., 2011), a multimodal intervention aiming to support parents and ADHD children as they transition from primary school (Grade 6) to secondary school (Secondary 1). It includes a) a group intervention component for youths, targeting the improvement of OTMP and study skills, b) a group intervention component for parents, targeting the adoption of effective educational strategies to support their child in their learning activities, and c) a mentoring component in participants’ homes, for individualized support for youths and parents in acquiring the targeted skills. To participate in the study, children had to present a diagnosis of ADHD confirmed during a diagnostic interview based on DSM-IV criteria and certified by a physician. Families were randomly assigned to an intervention group or a group receiving usual community services. Improvement in OTMP skills at the end of secondary 1 was measured using a two-dimensional questionnaire (Time Management and Planning skills; Memorization and Material Management). The first article verified whether some individual (sex, comorbidity, intensity of ADHD symptoms) or familial characteristics (parental depression, parental stress, stressful life events) modulated the effectiveness of the TRANSITION Project in improving children's OTMP skills. Moderation analysis showed that OTMP skills improvement is influenced by few individual and family characteristics. The benefits of the TRANSITION Project in terms of Memorization and Material Management skills improvement are particularly favored in children presenting more ADHD residual symptoms following pharmacological treatment. Parental depressive symptoms reduce the added value of the intervention in terms of improving Time Management and Planning skills. The second article aimed to verify whether the OTMP skills improvement at the end of secondary 1 occurred through an effect of the TRANSITION Project on parental practices. Multivariate regression analysis and test of indirect effects (using PROCESS software) showed that parents' participation in the TRANSITION Project was associated with greater consistency in the use of effective parenting practices, which contributed to the improvement of the child’s OTMP skills. Globally, the studies presented in the thesis support the effectiveness of the TRANSITION Project and the relevance of an intervention tailored to the needs of youths with ADHD and their family during the transition from primary to secondary school. / Le trouble déficit de l'attention avec ou sans hyperactivité (TDAH) est généralement associé à des difficultés d’organisation du temps et de l’espace, et de planification de l’étude (OTEPE) (Pfiffner et al., 2013) persistant même avec l’utilisation d’un traitement pharmacologique. Sans intervention adéquate, les jeunes ayant un TDAH sont à risque de difficultés scolaires importantes, et ce particulièrement lors de la transition primaire-secondaire où ils seront confrontés à une augmentation des exigences organisationnelles et des attentes d’autonomie (Litner, 2003). L’objectif de cette thèse était de mieux cerner les facteurs associés à l’efficacité du Projet TRANSITION (Normandeau et al., 2011), un programme d'intervention multimodal visant à soutenir les jeunes ayant un TDAH et leur famille lors de la transition primaire-secondaire par l’amélioration des habiletés d’OTEPE du jeune, et l’acquisition de stratégies éducatives parentales adaptées afin de soutenir la mise en pratique des stratégies d’OTEPE du jeune. L’intervention se déroule de la fin de la 6e année primaire à la fin du secondaire 1, et comporte deux volets de groupe (jeunes; parents) et un volet de mentorat à domicile. Afin de participer à l’étude, les jeunes devaient présenter un diagnostic de TDAH (attesté par un médecin) et être sous traitement pharmacologique (dosage optimal). Les familles ont été assignées aléatoirement entre un groupe recevant l’intervention et un groupe recevant les services usuels de la communauté. L’amélioration des habiletés d’OTEPE à la fin du secondaire 1 était mesurée à l’aide d’un questionnaire à deux dimensions (mémorisation et organisation du matériel; gestion du temps et de planification). Le premier article de la thèse visait à vérifier si certaines caractéristiques présentes chez les participants avant le début de l’intervention (sexe de l’enfant, problèmes co-occurrents, intensité des symptômes de TDAH, dépression parentale, stress parental, événements de vie stressants) modulaient l’efficacité du Projet TRANSITION sur l’amélioration des habiletés d’OTEPE des jeunes. Les analyses de modération ont mis en évidence que l’amélioration des habiletés d’OTEPE chez les jeunes est influencée par peu des caractéristiques individuelles et familiales étudiées. Les bénéfices du Projet TRANSITION pour l’amélioration des habiletés de mémorisation et organisation du matériel sont particulièrement marqués chez les jeunes présentant davantage de symptômes résiduels de TDAH suite au traitement pharmacologique. À l’inverse, la présence de symptômes dépressifs chez le parent réduit la valeur ajoutée de l’intervention au niveau de l’amélioration des habiletés de gestion du temps et de planification. Le second article vérifiait si l’amélioration des habiletés d’OTEPE à la fin du secondaire 1 se produisait notamment par le biais d’un effet du Projet TRANSITION sur les pratiques parentales. Les analyses de régressions linéaires et tests d’effet indirect par échantillonnage multiples (logiciel PROCESS) ont mis en évidence que la participation des parents au Projet TRANSITION était associée à une meilleure constance dans l’utilisation des pratiques parentales efficaces, et que celle-ci contribuait à l’amélioration des habiletés d’OTEPE des jeunes. Globalement les résultats de ce travail doctoral appuient l’efficacité du Projet TRANSITION et soutiennent la pertinence d’offrir une intervention adaptée aux besoins des jeunes ayant un TDAH et de leur famille lors du passage primaire-secondaire.