Made available in DSpace on 2016-04-28T20:38:05Z (GMT). No. of bitstreams: 1 Ana Leticia Guedes Pereira.pdf: 957994 bytes, checksum: 308771ecb4b54b80cc03044e1c734607 (MD5) Previous issue date: 2012-04-23 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / In recent years, complaints about Attention Deficit Disorder and Hyperactivity became frequent services to destinations child and adolescent population. This disorder is also presented by adults and impairs the academic, professional and staff who present it. Although they have many strengths, people with ADHD can be put in place a number of problems in the environments they frequent. And it is noteworthy that there are studies that demonstrate the existence of comorbidities related to the disorder in question. Based on the facts presented above, research on the subject are essential to enhance understanding about it. This research aimed to verify the existence of similarities and differences in the design of the parents in relation to ADHD, specifically to verify the existence of factors related to the dynamics between parents and children that could be contributing to the maintenance of the difficulties experienced and the existence of alternative used by the family to minimize these difficulties. To this end, this research adopted a qualitative design and is based on the systemic approach, participants were two sets of parents with children who have complaints of ADHD. To collect data we used a semi-structured interview, dealing with the issue. The results showed that parents differ little about ADHD. And that among the alternative coping adopted the recurrence of professionals working on the subject and finding information, using instruments such as the Internet, strategies are chosen by parents. Through analysis of the collected material was observed that at times during the trajectory family responsibility dimension of each of the difficulties faced, remained forgotten and because some member of this family was placed in a position crystallized within the family. On the other hand the existence of family myths and communication difficulties disrupted the relationship between parents and children / Nos últimos anos, queixas sobre Transtorno do Déficit de Atenção e Hiperatividade se tornaram frequentes nos serviços destinados à população infantil e adolescente. Vale ressaltar que este transtorno é apresentado ainda por adultos e prejudica a vida acadêmica, profissional e pessoal de quem o apresenta. Apesar de possuírem muitas potencialidades, pessoas com TDAH podem ser colocadas no lugar de problemáticas nos diversos ambientes que frequentam. Por outro lado há ainda estudos que demonstram a existência de comorbidades relacionadas ao transtorno em questão. Com base nos fatos expostos, pesquisas sobre o tema são essenciais para ampliar a compreensão acerca deste. Esta pesquisa teve por objetivo verificar a existência de semelhanças e diferenças na concepção dos pais em relação ao TDAH, mais especificamente de verificar a existência de fatores relacionados à dinâmica entre pais e filhos que pudessem estar colaborando para a manutenção das dificuldades vivenciadas e a existência de alternativas utilizadas pela família para minimizar estas dificuldades. Para tanto, esta pesquisa adotou um delineamento qualitativo e fundamenta-se na abordagem sistêmica. Foram participantes dois casais de pais com filhas que têm queixa de TDAH. Para a coleta de dados, foi utilizado um roteiro semiestruturado de entrevista, versando sobre o tema. Os resultados evidenciaram que os pais divergem pouco acerca do TDAH. E que dentre as alternativas de enfrentamento adotadas a recorrência a profissionais atuantes sobre o tema e a busca de informações, por meio de instrumentos como a internet, foram estratégias escolhidas pelos mesmos. Por meio da análise do material coletado, foi possível observar que, em alguns momentos durante a trajetória familiar, a dimensão da responsabilidade de cada um sobre as dificuldades enfrentadas permaneceu esquecida e que, em decorrência disso, algum membro familiar foi colocado em uma posição cristalizada dentro da família em tais momentos. Por outro lado, a existência de mitos familiares e dificuldades de comunicação tumultuaram as relações entre pais e filhos

Submitted by Andreza Leão (andrezaflh@gmail.com) on 2018-06-21T17:35:07Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_TDAHBrasilEspanha.pdf: 3304276 bytes, checksum: ce9bf46771071c64d075c0d52a730602 (MD5) / Approved for entry into archive by Celia Santana (celiasantana@ufpa.br) on 2018-12-12T17:49:28Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_TDAHBrasilEspanha.pdf: 3304276 bytes, checksum: ce9bf46771071c64d075c0d52a730602 (MD5) / Made available in DSpace on 2018-12-12T17:49:28Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_TDAHBrasilEspanha.pdf: 3304276 bytes, checksum: ce9bf46771071c64d075c0d52a730602 (MD5) Previous issue date: 2016-11-30 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A presente tese de doutorado objetivou comparar o TDAH no Brasil e na Espanha sob a perspectiva de mães e professores. Essa obra está dividida em 3 estudos: a) O estudo 1, consistiu em uma revisão de literatura dos estudos de prevalência de TDAH nos cinco continentes, enfocando-se as estimativas de prevalência; o processo de amostragem; o tipo de estudo; os critérios diagnósticos; e, as principais variáveis exploradas pelos estudos; b) O estudo 2 comparou a percepção de mães em relação aos problemas de comportamentos listados no CBCL (Child Behavior Checklist) em duas amostras clínicas independentes compostas por pais de crianças brasileiras e espanholas com o diagnóstico de TDAH. O estudo foi do tipo exploratório-descritivo, documental, retrospectivo, transversal, de caráter quantitativo dos prontuários atendidos entre 2010 a abril de 2015 no Hospital Universitário Virgen de la Arrixaca- Murcia/Espanha, e no Hospital Universitário Bettina Ferro de Souza – Belém/Brasil; c) O estudo 3, comparou a perspectiva dos professores no que tange aos problemas de comportamento nos alunos com o diagnóstico de TDAH. Trata-se de uma investigação documental do tipo exploratória-descritiva, retrospectiva e transversal, em que se recorreu a análise de prontuários de crianças e adolescentes, em especial ao TRF (Teacher Report Form) entre os anos de 2013 e 2014 diagnosticados com TDAH em duas unidades clínicas de psicologia situadas no Brasil e Espanha. A principal contribuição desta obra foi encontrar sintomas semelhantes nas duas amostras. A comparação das duas culturas distintas a partir da perspectiva de dois informantes que representam ambientes diferentes, no caso, as mães que avaliaram o comportamento no ambiente familiar, e os professores que interpretaram os sintomas no ambiente escolar, enriqueceram tais achados. / This PhD thesis aimed to investigate ADHD in Brazil and Spain from the perspective of parents and teachers. This work is divided into three studies: a) Study 1 consisted of a literature review of studies on the prevalence of ADHD in five continents, focusing on the estimates of prevalence; the sampling process; the type of study; diagnostic criteria; and the main variables explored by studies; b) Study 2 compared the perception of mothers in relation to behavior problems listed in the CBCL (Child Behavior Checklist) in two independent clinical samples composed of Brazilian and Spanish children with ADHD diagnosis. The study was exploratory-descriptive, documental, retrospective, cross-sectional, quantitative nature of the medical records treated between 2010 to April 2015 at the University Hospital Virgen de la Arrixaca- Murcia / Spain, and the University Hospital Bettina Ferro de Souza - Belém / Brazil; c) Study 3, compared the teacher’s perspective in relation to behaviour problems in students diagnosed with ADHD. This is a documentary investigation of exploratory-descriptive, retrospective and cross-sectional, in which resorted to analysis of children and adolescents records, especially the TRF (Teacher Report Form) between the years 2013 and 2014 diagnosed with ADHD two clinical psychology units located in Brazil and Spain. The main contribution of this work was to find similar symptoms in two independent samples composed of children and adolescents ADHD diagnosis. The comparison of the two different cultures from the perspective of two informants representing different environments, in this case, mothers who evaluated the behavior in the family environment, and teachers who interpreted the symptoms in the school environment, enriched these findings.

Made available in DSpace on 2011-03-23T21:19:14Z (GMT). No. of bitstreams: 0 / Item created via OAI harvest from source: http://www.bdtd.ufpa.br/tde_oai/oai2.php on 2011-03-23T21:19:14Z (GMT). Item's OAI Record identifier: oai:bdtd.ufpa.br:68 / Attention Deficit/Hyperactivity Disorder (ADHD) is a phenomenon studied in many countries. It is characterized by symptoms like inattentiveness, hyperactivity, and impulsivity. It happens in infancy but can persist until adult age. This behavioral disorder causes prejudice in the academical, social, and occupational areas. It reduces self-esteem, can lead to delinquency, to the use of drugs and alcohol. It generates stressful familial relationship and it has a high social and financial impact on the family. Its diagnosis is made by using clinical criteria of DSM IV and its treatment combines pharmacotherapy and psychotherapy. Considering that ADHD is a behavioral disorder related to the development of self-control and also considering that previous studies suggest self-control can be acquired in training conditions, it becomes relevant to make applied research using behavior analytic principles to minimize prejudice and to contribute for a better quality of life of people affected by ADHD. The objective of this study was to verify the efficacy of the use of differential reinforcement of other behaviors (DRO) and of reinforcement delay on the installation and/or increase of self-control behaviors in 9-year-old boy with diagnostic of ADHD and on medication. The participant was submitted to the procedure of self-control training. He performed tasks during which, if his behavior was as previously programmed, he received tokens. At final of every session he traded tokens in for toys. He could choose accumulate more tokens to trade them in later for more valuable toys. The procedure was divided in 7 stages: (1) Interview with a neuropediatric; (2) Analysis of psychological report and convocation; (3) Initial interview with responsibles for child; (4) Visit to the school and interview with teachers; (5) Sessions of direct observation (baseline, habituation to instructions, installation, maintenance, fading and stability evaluation); (6) Follow-up; and (7) Last session. Eighteen sessions of direct observation have been proceeded. These sessions were recorded and their transcriptions were sorted according to categorical system of relevant behaviors to analysis. Results were analyzed through the comparison between interviews, results of standard instruments and classificatory categories extracted from directly observed behaviors. Self-control behaviors were increased and generalization these repertories to others contexts was observed, during sessions and at the childs house, according to description of parents and teacher, and direct observation record of therapist-researcher. It was observed that using DRO schedule with limited hold can help to increase self-control behavior and produce positive generalization of this behavior to new environments in a child with ADHD. / Transtorno do Déficit de Atenção e Hiperatividade (TDAH) é um fenômeno estudado em diversos países, composto de sintomas de desatenção, imperatividade e impulsividade, ocorre na infância podendo persistir até a idade adulta. Este transtorno causa prejuízos nas áreas acadêmicas, sociais e ocupacionais, reduz a auto-estima, pode evoluir para delinqüência, uso de drogas e álcool, gera estresse nas famílias, tem alto custo financeiro e impacto social. O diagnóstico é feito com base em critérios clínicos adotados pelo DSM IV e o tratamento indicado combina farmacoterapia e psicoterapia. Considerando-se que TDAH é um transtorno de desenvolvimento de autocontrole e que estudos sugerem que autocontrole pode ser adquirido em condições de treino, torna-se relevante a realização de pesquisas aplicadas utilizando princípios da análise do comportamento, para minimizar prejuízos e contribuir para melhoria de qualidade de vida de portadores de TDAH. Este estudo objetivou verificar a eficácia do uso de esquemas de reforçamento diferencial de outro comportamento (DRO) e de atraso de reforço na instalação e/ ou aumento de comportamentos de autocontrole em um menino de 9 anos diagnosticado com TDAH, que faz uso de medicamento. O participante foi exposto ao procedimento de treino de autocontrole, realizou tarefas, durante as quais, caso se comportasse como combinado, recebia reforço. Ao final de cada sessão, trocava os reforços por brinquedos e poderia escolher reservá-los para obter reforços de maior valor. O procedimento foi dividido em sete etapas: (1) entrevista com a neuropediatra; (2) análise do prontuário e convocação; (3) entrevista inicial com responsáveis; (4) visita à escola e entrevista com professores; (5) sessões de observação direta (linha de base, habituação às regras, instalação, manutenção, fading e avaliação da estabilidade); (6) followp-up; e (7) encerramento. Realizaram-se 18 sessões de observação direta, gravadas em vídeo e transcritas para a elaboração de um sistema de categorias de comportamentos para análise. Os resultados foram analisados por meio da comparação entre relatos de entrevistas, resultados de instrumentos padronizados e categorias de comportamentos observados. Identificou-se que os comportamentos de autocontrole do participante se ampliaram e generalizaram para outros contextos, durante as sessões e em domicílio, conforme os relatos dos pais e da professora da escola atual, e registro de observação direta da terapeuta-pesquisadora. Verificou-se que a utilização de esquema de reforçamento DRO com disponibilidade limitada pode favorecer o aumento de comportamentos de autocontrole e generalizações em crianças com TDAH.

Esta revisão de literatura apresenta uma análise dos trabalhos sobre Transtorno de Déficit de Atenção e Hiperatividade, TDAH, quanto às psicoterapias e aos tratamentos psicológicos ofertados a crianças e adolescentes, recuperados nas principais bases de dados da área. Transtorno de grande prevalência na população escolar, com sérios prejuízos pessoais e sociais, pois comportamentos de hiperatividade, desatenção e impulsividade, em graus atípicos, comprometem as funções executivas como concentração, planejamento de ações e controle sobre impulsos, o TDAH é conceito que gera controvérsias na comunidade científica. De um lado têm-se as perspectivas da terapia comportamental e cognitivo-comportamental, com o objetivo de reeducação comportamental, apoiada pela psiquiatria e psicofarmacologia. De outro, as linhas compreensivas e a psicanálise buscam não só comportamentos observáveis, mas a singularidade de cada envolvido, ou seja, a contribuição da família e/ou da cultura nesses quadros. A fim de mapear as publicações nessa área, foram analisadas as produções dos últimos dez anos (20002010) locadas nas bases de dados MEDLINE, PsycINFO, SciELO, LILACS e PSICODOC, por meio do termo TDAH, cruzado com tratamento psicológico e psicoterapia, respeitando-se o idioma da base de dados. Os resultados encontrados revelaram a supremacia de publicações sob a ótica comportamental ou cognitivo-comportamental, principalmente em seu modelo combinado, associado à medicação, tratamento validado através de evidências. As outras abordagens psicológicas, quando publicadas, não são absorvidas pelo modelo psiquiátrico, o que contribui para a sua invisibilidade queixas do transtorno são levadas primeiramente a pediatras, neurologistas e profissionais de orientação comportamental. Os bancos de dados, assim, revelaram ser amplamente usados por pesquisadores positivistas, o que pode vir a sugerir que seus tratamentos sejam os únicos disponíveis, o que não é fato. Existem métodos investigativos, como o estudo de caso que, embora pouco disseminados, apresentaram resultados favoráveis em seus tratamentos singulares / This literature review presents an analysis of the works about Attention-Deficit Hyperactivity Disorder, ADHD and psychotherapy and psychological treatments offered to children and adolescents recovered in the main database area. Disorder of high prevalence in school population, with serious personal and social impairments, since the hyperactivity, inattention e impulsivity behaviors, in atypical degrees, compromises executive functions such as concentration, action planning and impulses control, Attention Deficit Hyperactivity Disorder (ADHD) has been a controversy target among the scientific community. On one hand we have the behavioral therapy and cognitive-behavioral therapy, seeking for the behavioral rehabilitation, supported by psychiatry and psychopharmacology. On the other hand, comprehensive psychological approaches and the psychoanalysis does not aim to reduce these children to observable behaviors and, actually, to understand their symptoms as an expression of their singularity, explaining hyperactive and/or inattentive behavior in contemporary context. In order to map the publications in this area, it was analyzed the productions in the last decade (2000-2010) leased in the databases MEDLINE, PsycINFO, SciELO, LILACS and PSICODOC, through the term ADHD crossed with psychological treatment and psychotherapy, respecting the language of the database. The results showed the superiority of publications from the perspective of behavioral or cognitive-behavioral therapy, mainly in a combined model with medication, treatment validated by evidences. The others psychological approaches, when published, are not absorbed by the psychiatric model, which generates its invisibility complaints of disorder are taken primarily to pediatricians, neurologists and professional behavioral treatments. The databases thus shown to be widely used by researchers at positivism, which might suggest that their treatments are the only ones available, which is not fact. There are investigative methods, as the case study, although a little spread, showed favorable results in their singular treatments

Submitted by Cleide Dantas (cleidedantas@ufpa.br) on 2014-05-06T16:35:39Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_AnaliseEfeitoTreino.pdf: 2005591 bytes, checksum: 161ef5f76324baf4e690de318f71049f (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2014-06-18T13:04:58Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_AnaliseEfeitoTreino.pdf: 2005591 bytes, checksum: 161ef5f76324baf4e690de318f71049f (MD5) / Made available in DSpace on 2014-06-18T13:04:59Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_AnaliseEfeitoTreino.pdf: 2005591 bytes, checksum: 161ef5f76324baf4e690de318f71049f (MD5) Previous issue date: 2008 / Esse estudo foi realizado com o objetivo de contribuir com a avaliação dos efeitos de uma intervenção comportamental direcionada a pais/responsáveis de crianças com Transtorno do Déficit de Atenção e Hiperatividade-TDAH, investigando os efeitos desse modelo de treino parental em duas condições, setting terapêutico (Condição 1) e ambiente domiciliar (Condição 2), sobre a ocorrência de comportamentos de hiperatividade versus autocontrole. Os participantes foram pais de quatro crianças, na faixa etária entre cinco e nove anos. Utilizaram-se como instrumentos: Termo de Consentimento Livre e Esclarecido-TCLE, Inventário de Estilos Parentais-IEP, Lista de Verificação Comportamental para Crianças e Adolescentes-CBCL/TRF, Escala do TDAH versão para professor, Roteiro de Entrevista Inicial, Roteiro de Entrevista de Avaliação, Roteiro de Entrevista Final, Critério de Classificação Econômica Brasil-CCEB. O procedimento de pesquisa consistiu em: (a) contato com neuropediatra; (b) triagem e convite aos participantes; (c) distribuição de dois participantes para cada condição de intervenção; (d) avaliação inicial, incluindo entrevista com os responsáveis, aplicações do TCLE, IEP e CBCL; (e) visita à escola e aplicações do TCLE, da Escala do TDAH e do TRF, versões para professor; (f) realização de cinco sessões de intervenção, gravadas em áudio e vídeo, duas de linha de base, uma de habituação às regras e duas de manutenção das regras e instalação de comportamento de auto-observação, que envolveram situações de interação em jogos de regras, com participação da terapeuta-pesquisadora, da mãe e da criança; (g) realização de entrevista de avaliação da primeira fase; (h) reversão de contextos para os participantes e (i) avaliação final, realizada por meio de entrevista com os responsáveis e re-aplicação dos instrumentais padronizados com pais e professores, utilizados anteriormente, mais o CCEB. Os dados obtidos por meio dos instrumentos padronizados receberam o tratamento indicado nos manuais. Dois sistemas de categorias de análise do comportamento foram utilizados, um para descrever os comportamentos das mães e outro para comportamentos observados nas crianças. Os principais resultados sugerem que as crianças em ambiente de consultório tiveram maior ocorrência de emissão de comportamentos de autocontrole do que as em ambiente de domicílio, as quais, por sua vez, tiveram prevalência de comportamentos de hiperatividade/impulsividade. Do mesmo modo, as mães em ambiente de consultório obtiveram maiores escores em práticas educativas positivas e menos em negativas, comparadas às mães do grupo de domicílio. Houve aumento de práticas educativas positivas para a maioria das mães. Discute-se o contexto de consultório enquanto um ambiente eficaz de intervenção, embora se reconheça que as dificuldades de controle de comportamentos inadequados são maiores para os pais em ambiente domiciliar, por isso, intervenções em ambiente natural devem ser consideradas no processo terapêutico. Por outro lado, o treino parental demonstrou ser efetivo na aquisição, fortalecimento e manutenção de práticas educativas positivas em todas as mães, o que pode influenciar beneficamente os comportamentos das crianças com TDAH. / This study aims to contribute with the evaluation of the effects of behavioral intervention addressed to parents/guardians of children with Attention Deficit Hyperactivity Disorder – ADHD, investigating the effects of this model on parental training under two conditions, therapeutic setting (Condition 1) and home environment (Condition 2), on the occurrence of hyperactivity behavior versus self-control. The participants were the parents of four children, between five and nine years of age. The following instruments were used: Free Informed Term of Consent - FITC, Parental Style Inventory – PSI, Child Behavior Checklist – Teachers Report Form CBCL/ TRF, teacher’s version of the ADHD rating scale, Initial Interview Guideline, Interview and Evaluation Guideline, Final Evaluation Guideline, Brazilian Economic Rating Criteria-BERC. The research process consisted in: (a) contacting a pediatric neurologist; (b) participants’ triage and invitation; (c) distribution of two participants for each condition of intervention; (d) initial evaluation, including interview with the guardians, application of FTIC, PSI and CBCL; (e) visit to school and application of FTIC, ADHD rating scale and teacher’s versions of TRF; (f) five intervention sessions, taped in audio and video, two baselines, one habituation to rules and two maintenance in behavior and installation of self-observation behavior, which involved situations of interaction in games with rules, with participation of therapist- researcher, the child’s mother, (g) an evaluation interview on the first phase; (h) reversion of context for the participants and (i) final evaluation, done through interviews with the guardians and a repetition of the previously used standard instruments with the parents and teachers, plus the BERC. The data obtained through such standardized instruments received treatment indicated in the manuals. Two systems of categories for behavior analysis were used, one to describe the mothers’ behavior and the other, the children’s behavior. The main results suggest that children in the consulting room environment had a greater occurrence of behavior emission of self-control than in the home environment, which, on the other hand, had prevalence of hyperactivity-impulsivity behavior. Likewise, mothers in the consulting room environment scored better than those in the home environment group. There was an increase in educative practices for most mothers. One discusses the consulting room context as an effective intervention environment, although it is recognized that the difficulties of control of inadequate behavior are greater for parents in the home environment, as a result, intervention in a natural environment must be considered during the therapeutic process. On the other hand, parental training has demonstrated to be effective in the acquisition, enhancement and maintenance of positive educative practices for all mothers, which may influence beneficially the behavior of children with ADHD.

Cette thèse poursuit un double objectif. D’une part, mesurer et situer le niveau de la condition physique, de la performance motrice et de la participation aux activités physiques chez des enfants ayant un TDAH. D’autre part, apprécier l’impact d’un programme structuré en activité physique sur la condition physique, la performance motrice, certains comportements cibles ainsi que sur les fonctions cognitives propres à ces enfants. Pour vérifier l’atteinte de ces objectifs, trois études expérimentales ont été complétées et ont fait l’objet d’articles soumis pour publications. Dans le premier article, on évalue la condition physique et la performance motrice chez des enfants ayant un TDAH prenant ou non de la médication. Les résultats obtenus démontrent que la condition physique, comprenant ici des variables reliées à la composition corporelle, l’endurance musculaire et la flexibilité de ces enfants, ne diffèrent pas de celle des membres d’un groupe témoin. Seul l’indice de masse corporelle est significativement moins élevé chez les enfants ayant un TDAH prenant de la médication. Aucune différence n’est observée entre les groupes en ce qui a trait à la capacité aérobie telle que mesurée lors d’une épreuve de tapis roulant. Par contre, lorsqu’évaluée à partir d’un test navette, la performance aérobie de tous les participants est significativement moins élevée, d’où l’importance du choix de l’instrument de mesure. Finalement, les enfants ayant un TDAH ont significativement plus de problèmes de motricité globale que les enfants du groupe témoin. Ces difficultés sont particulièrement importantes pour la locomotion. Dans le cadre d’un programme d’activités physiques structurées et supervisées, le deuxième article porte, d’une part, sur l’évaluation de l’intensité de la participation aux exercices proposés chez des enfants ayant un TDAH. D’autre part, l’impact potentiel de facteurs comme les problèmes de poids et la présence de difficultés motrices sont également pris en considération. Les résultats obtenus suggèrent que ces enfants atteignent une intensité et une durée d’exercice qui ne diffèrent pas de celles des enfants du groupe témoin. Quant aux enfants qui ont un problème de poids ou des difficultés motrices, l’intensité et la durée de leur participation ne diffèrent pas de celles des participants témoins. Sur la base des données obtenues, les enfants ayant un TDAH peuvent parvenir à un degré de participation aux exercices qui permet de bénéficier des bienfaits de la pratique d’activités physiques. Le troisième article traite de l’impact potentiel d’un programme d’activités physiques sur la condition physique, la performance motrice, certains comportements ainsi que sur les fonctions cognitives des enfants ayant un TDAH. Sur la base des résultats obtenus, il est possible de faire valoir que la participation à un tel programme permet d’améliorer les capacités musculaires, les habiletés motrices, certains comportements observés par les parents et les enseignants ainsi que la capacité d’attention. Cela pourrait produire un impact significatif dans l’adaptation fonctionnelle de ces jeunes. Ces résultats soulignent le besoin de continuer la recherche dans les domaines de l’activité physique et du TDAH. La discussion générale présente les liens existants entre les manuscrits en fonction du modèle de l’engagement dans les activités physiques. Le déficit de la motricité globale ainsi que l’impact clinique potentiel de l’activité physique dans le traitement du TDAH sont les deux axes de recherche qui semblent le plus propices à des travaux futurs. / The first purpose of this thesis is to describe fitness and gross motor performance of children with ADHD taking medication or not, in addition with the description of their participation in structured physical activity sessions. The second objective is to evaluate the impact of a physical activity program on fitness, gross motor performance, behaviour and cognition of those children. Three manuscripts are presented. The purpose of the first study is to assess fitness and gross motor performance of children with ADHD, including users and non-users of methylphenidate medication. Fitness level of children with ADHD using medication or not, including body composition, flexibility and muscular endurance, is similar to that of a control group. The only difference is observed for body mass index, which was lower in children with ADHD using medication. Aerobic capacity is also similar when measured by a treadmill test. However, a lower performance is observed when aerobic capacity was estimated using a field shuttle test, suggesting that the methodology used is important. Finally, both groups of children with ADHD present significantly lower scores for locomotion skills. The objectives of the second manuscript are to assess the participation of children with ADHD in structured physical activity sessions and to explore the impact of variables such as weight and motor problems on this participation level. Results suggest that children with ADHD can have an intensity and duration of participation similar to children without the disorder, with a simple behavioural management system for negative behaviours. Furthermore, the intensity of participation is not different for children with ADHD having weight problems or motor skills difficulties. This highlights the fact that children with ADHD can attain effective physical activity participation when they are included in a structured supervised program. Finally, the objective of the third study is to assess the effects of a moderate- to high-intensity physical activity program on fitness, gross motor skills, cognitive functions and ADHD-related behaviour in children with ADHD. Results show that participation in a physical activity program improves muscular capacities, motor skills, behaviour reports by parents and teachers and attention capacity. The results suggest that a structured physical activity program may have clinical relevance in the functional adaptation of children with ADHD. This highlights the need for further research in the area of physical activity with this population. The general discussion presents the links between the three studies using the physical activity engagement model. Gross motor skills difficulties and the clinical impact of physical activity programs in ADHD treatment are proposed as promising research avenues.

Le trouble du déficit de l’attention/hyperactivité (TDA/H) est un des troubles comportementaux le plus commun chez les enfants. TDAH a une étiologie complexe et des traitements efficaces. Le médicament le plus prescrit est le méthylphénidate, un psychostimulant qui bloque le transporteur de la dopamine et augmente la disponibilité de la dopamine dans la fente synaptique. Des études précliniques et cliniques suggèrent que le cortisol peut potentialiser les effets de la dopamine. Un dysfonctionnement du système hypothalamo-hypophyso-surrénalien (HHS) est associé avec plusieurs maladies psychiatriques comme la dépression, le trouble bipolaire, et l’anxiété. Nous avons fait l’hypothèse que le cortisol influence l’efficacité du traitement des symptômes du TDAH par le méthylphénidate. L’objectif de cette étude est de mesurer les niveaux de cortisol le matin au réveil et en réponse à une prise de sang dans un échantillon d’enfants diagnostiqué avec TDAH âgé de 8 ans. Le groupe était randomisé dans un protocole en chassé croisé et en double aveugle avec trois doses de méthylphénidate et un placebo pour une période de quatre semaines. Les enseignants et les parents ont répondu aux questionnaires SWAN et à une échelle d’évaluation des effets secondaires. Les résultats ont démontrés qu’un niveau de cortisol élevé au réveil prédit les sujets qui ne répondent pas au traitement du TDAH, si on se fie aux rapports des parents. En plus, la réactivité au stress élevé suggère un bénéfice additionnel d’une dose élevée de méthylphénidate selon les enseignants. Aussi, les parents rapportent une association entre la présence de troubles anxieux co-morbide avec le TDAH et une meilleure réponse à une dose élevée. Cette étude suggère qu’une forte réactivité de l’axe HHS améliore la réponse clinique à des doses élevées, mais qu’une élévation chronique du niveau de cortisol pourrait être un marqueur pour les non répondeurs. Les résultats de cette étude doivent être considérés comme préliminaires et nécessitent des tests plus approfondis des interactions possibles entre les médicaments utilisés pour traiter le TDAH et l’axe HHS. / ADHD is the most common behavioural disorder in children with complex aetiology and efficacious treatments. The most prescribed medication for ADHD is methylphenidate, a psychostimulant that blocks the dopamine transporter and increases dopamine availability in the synaptic cleft. Preclinical and clinical studies show that cortisol may enhance dopamine effects. Dysregulation of the hypothalamic-pituitaryadrenal axis is also associated with many psychiatric disorders such as depression, bipolar disease, and anxiety. We hypothesized that cortisol has an influence on the efficacy of the treatment of ADHD symptoms with methylphenidate. The objective of this study was to measure the salivary level of cortisol in a sample of 8-year-old children with ADHD upon waking and in response to a venipuncture. The children were then randomized to three doses of methylphenidate and a placebo in a double-blind cross-over design. Teachers and parents rated the behaviour of the children using the SWAN and a side effect rating scale. The results showed that high morning cortisol is a good predictor of a nonresponder under active medication, as reported by parents. Also, the high stress reactivity group, but not the low stress reactivity group, demonstrated a greater benefit going to a higher dose of methylphenidate, according to teachers. In addition, parents demonstrated an association between anxiety comorbid disorders and a better response to a high dose of methylphenidate. This study suggests that a strong reactivity of the HPA axis improves the clinical response at high dose, but that chronically elevated cortisol might be a marker for non responders. The results of this study should be seen as preliminary and require further testing of the possible interactions between ADHD medication and HPA activity.

No description available.

Le trouble déficit de l’attention avec ou sans hyperactivité (TDAH) est une maladie neurodéveloppementale de l’enfant et de l’adulte caractérisée par un déficit attentionnel, une impulsivité et une hyperactivité. La physiopathologie de cette maladie demeure non élucidée, néanmoins des stratégies thérapeutiques médicamenteuses s’avèrent efficaces. En France, le médicament utilisé dans le traitement du TDAH est le méthylphénydate (MPH) qui est un psychostimulant, et deux autres molécules paraissent prometteuses : le dymésilate de lisdexamfétamine (LDX - psychostimulant) et la guanfacine (GFC - non psychostimulant). Les cibles moléculaires de ces médicaments sont bien connues mais l’impact de ces traitement en aigu et chronique sur le fonctionnement cérébral est pour l’instant peu documenté. L’objectif de cette thèse a été d’étudier (i) la physiopathologie du TDAH et (ii) les effets de ces traitements du TDAH en aigu et en chronique sur un versant préclinique et à l’aide de l’imagerie microTEP couplée au 2-deoxy-2-(18F)fluoro-d-glucose (18FDG). Dans la première étude, des modèles animaux du TDAH ont été utilisés : des rats SHR/NCrl présentanttroubles de l’attention, hyperactivité et impulsivité et des rats WKY/NCrl présentant uniquement des troubles de l’attention. Une imagerie microTEP au 18FDG sur animal éveillé a été réalisée sur ces animaux adultes afin d’obtenir leurs profils d’activité cérébrale. Notre hypothèse était que les rats SHR/NCrl et WKY/NCrl présenteraient des modifications de capture de 18FDG similaires qui seraient impliquées dans le trouble attentionnel commun aux deux souches, alors que les rats SHR/NCrl présenteraient aussi des modifications non retrouvés chez les WKY/NCrl qui joueraient un rôle dans la genèse de l’hyperactivité-impulsivité. Cettehypothèse a été confirmée par nos résultats montrant des dysfonctions fronto-striatales limbiques et du réseau du mode par défaut chez les rats SHR/NCrl et WKY/NCrl, ainsi que des dysfonctions fronto-striatales associatives spécifiques aux rats SHR/NCrl.Dans la seconde étude, un traitement journalier au MPH, au LDX ou à la GFC a été mis en place chez des rats témoins de l’adolescence à l’âge adulte (mimant un traitement de l’enfance à la fin de l’adolescence chez l’homme). Les effets de ces traitements sur l’activité cérébrale ont été évalués après la première et la dernière injection par imagerie microTEP au 18FDG sur animal éveillé. Nos résultats montrent que chaque médicament a un effet important sur les régions limbiques, et que le LDX présente une action supplémentaire sur des régions associatives et sur les régions du réseau du mode par défaut. A notre connaissance, ce sont les premières données de neuroimagerie en préclinique qui mettent en avant l’implication des régions limbiques liées à la motivation et du réseau du mode par défaut dans la physiopathologie du TDAH. Nos résultats renforcent l’hypothèse selon laquelle les médicaments du TDAH agiraient sur les troubles primaires du TDAH et non en compensant un déficit d’attention par une augmentation de la motivation. Ces résultats suggèrent aussi que (i) la GFC est un non psychostimulant qui présente deseffets similaires au médicament de référence le MPH, et que (ii) le LDX montre un profil d’action intéressant car touchant à la fois les régions limbiques, associatives et le réseau du mode par défaut que nous trouvons toutes perturbées chez les rats SHR/NCrl. / Attention Deficit Hyperactivity Disorders (ADHD) is a neurodevelopment disorder affecting childs and adults presenting attention deficits, hyperactivity and impulsivity. Despite numerous neuroimaging studies on ADHD patients, the specific dysfunctions underlying the symptoms of ADHD remain unknown. To date, ADHD patients can be treated using psychostimulant drugs such as methylphenidate (MPH) and other promising compounds are currently in development (dymesilate-lisdexamfétamine (LDX) and guanfacine (GFC), that are psychostimulant and non psychostimulant medications, respectively). Even if the molecular targets of these medications are well defined, how these compounds will impact the brain activity to reverse ADHD symptoms is less known. The objectives of this work were to study (i) the pathophysiology of ADHD and (i) the effects of an acute or repeated administration of MPH, LDX or GFC using animal models and microPET imaging with 2-deoxy-2-(18F)fluoro-d-glucose (18FDG). First, we used an animal model of ADHD, namely the SHR/NCrl and WKY/NCrl rats that both exhibit attention deficits, with impulsivity-hyperactivity only displayed by SHR/NCrl rats. MicroPET imaging using 18FDG on awake rats was performed to obtain brain metabolic profiles of these animals. Our hypothesis was that SHR/NCrl and WKY/NCrl would shared brain dysfunctions in several regions of interest involved in the attention deficits, while SHR/NCrl rats would also displayed specific abnormalities related to hyperactivity-impulsivity. Our results confirmed these hypothesis as both SHR/NCrl and WKY/NCrl showed metabolic alterations in fronto-striatal limbic regions and in areas of the default mode network. In addition, SHR/NCrl specifically exhibited functional modifications in fronto-striatal associative areas.Second, daily injections with MPH, LDX or GFC were performed on control rats from adolescence to adulthood (corresponding to a treatment from childhood to the end of adolescence in humans). The effects of such treatments were evaluated after the first and the last injections on freely moving rats using microPET imaging with 18FDG. Our results showed that each medication affects the activity of limbic brain regions. In addition, LDX has an interesting profile showing effects also on associative fronto-striatal areas and on thedefault mode network. To our knowledge, these are the first preclinical neuroimaging results highlighting the crucial role of limbic brain regions related to motivation and the default mode network in the pathophysiology of attention deficits in ADHD. These data also reinforce the hypothesis that ADHD medications act on the brain areas primarily involved in the pathophysiology of ADHD. Interestingly, we showed that GFC and MPH shared the same effects on the limbic brain regions suggesting that this non psychostimulant medication is of a great interest for the treatment of ADHD. While MPH and GFC act primarily on limbic circuits, LDX also altered the activity of the default mode network and associative fronto-striatal areas. This support the hypothesis that LDX could be an interesting education for treating ADHD acting on all the systems identified as dysfunctional in the animal models of ADHD.

No description available.