Fatores associados ao controle de sintomas nucleares em pacientes pediátricos com transtorno de déficit de atenção e hiperatividade, em um centro especializado em Medellín entre 2018 e 2019

Conteúdo do artigo principal

Daniel Alejandro Restrepo Arbeláez
Santiago Sepúlveda López
María Alejandra Parra Cardona
Daniela Sánchez Acosta
Cristóbal Restrepo Conde

Resumo

Objetivo: o transtorno de déficit de atenção e hiperatividade (TDAH ) tem sido descrito como o transtorno do neurodesenvolvimento mais comum na infância. Esta condição está associada a uma deterioração significativa na qualidade de vida, múltiplas comorbidades e, a longo prazo, menores rendimentos acadêmicos e profissionais. A pesar de ter sido demonstrado que os pacientes de ascendência latina apresentam um possível subdiagnóstico, e que na Colômbia foram estimadas prevalências mais altas do que as descritas no planeta e que os efeitos da pandemia de Covid-19 foram capazes de exacerbar esse problema, o volume de estudos com estimativas reprodutíveis sobre as características, tratamentos recebidos e controle de sintomas desses pacientes ainda precisam ser ampliados. Este estudo busca estabelecer os fatores sociodemográficos, clínicos e de tratamento associados ao controle dos sintomas centrais desse transtorno, que consistem em padrões persistentes e generalizados de desatenção, impulsividade e hiperatividade.


Metodologia: estudo descritivo com intenção analítica em uma coorte retrospectiva de pacientes pediátricos com transtorno de déficit de atenção e hiperatividade acompanhados por seis meses em um centro especializado em Medellín, Colômbia, entre 2018 e 2019.


Resultados: identificou-se uma incidência de controle dos sintomas de 46,7%, significativamente associada à adesão ao tratamento e ao histórico familiar de TDAH .


Conclusões: Pode-se afirmar que, em pacientes pediátricos com TDAH , esses fatores podem aumentar a probabilidade de controle dos sintomas nucleares.

Palavras-chave:
transtorno de déficit de atenção e hiperatividade, distúrbios do neurodesenvolvimento, características da população, adesão ao tratamento, tratamento multimodal

Detalhes do artigo

Biografia do Autor

Daniel Alejandro Restrepo Arbeláez, Universidad CES

Universidade CES, Medellín, Colômbia.

Santiago Sepúlveda López, Centro de Atendimento Neuropediátrico Integral

Centro de Atenção Neuropediátrica Integral, Medellín, Colômbia.

María Alejandra Parra Cardona, Centro de Atenção Neuropediátrica Integral

Centro de Atenção Neuropediátrica Integral, Medellín, Colômbia.

Daniela Sánchez Acosta, Universidad CES

Universidade CES, Medellín, Colômbia.

Cristóbal Restrepo Conde, Universidad Pontificia Bolivariana

Universidade Pontifícia Bolivariana, Medellín, Colômbia.

Referências

Swaiman KF, Ashwal S, Ferriero DM, Schor NF, Finkel RS, Gropman AL, et al. Swaiman’s Pediatric Neurology E-Book: Principles and Practice. Elsevier Health Sciences; 2017.

Spetie L, Arnold E, Martin A, Bloch M, Volkmar F. Lewis’s child and adolescent psychiatry: a comprehensive textbook. 2018.

Taylor E, Sonuga-Barke E. Disorders of Attention and Activity. En: Rutter’s Child and Adolescent Psychiatry. John Wiley & Sons, Ltd; 2008 [citado 7 de mayo de 2022]. 519-42.

Hechtman L, Swanson JM, Sibley MH, Stehli A, Owens EB, Mitchell JT, et al. Functional adult outcomes 16 years after childhood diagnosis of attention-deficit/hyperactivity disorder: MTA results. J Am Acad Child Adolesc Psychiatry. 2016;55(11):945-52.

Subcommittee on Attention-Deficit/Hyperactivity Disorder. tdah: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007-22.

Molina BSG, Hinshaw SP, Swanson JM, Arnold LE, Vitiello B, Jensen PS, et al. The MTA at 8 Years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry. 2009;48(5):484-500.

Molina BS, Hinshaw SP, Eugene L, Swanson JM, Pelham WE, Hechtman L, et al. Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. J Am Acad Child Adolesc Psychiatry. 2013;52(3):250-63.

Dvorsky MR, Langberg JM. A review of factors that promote resilience in youth with ADHD and ADHD symptoms. Clin Child Fam Psychol Rev. 2016;19(4):368-91.

Belcher JR. Attention deficit hyperactivity disorder in offenders and the need for early intervention. Int J Offender Ther Comp Criminol. 2014;58(1):27-40.

Haynes V, López-Romero P, Anand E. Attention-deficit/hyperactivity disorder under treatment outcomes research (AUTOR): a European observational study in pediatric subjects. ADHD Atten Deficit Hyperact Disord. 2015;7(4):295-311.

Catala-López F, Hutton B, Núñez-Beltrán A, Page MJ, Ridao M, Saint-Gerons DM, et al. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. Plos One. 2017;12(7):e0180355.

Cornejo J, Osío O, Sánchez Y, Carrizosa J, Sánchez G, Grisales H, et al. Prevalencia del trastorno por déficit de atención-hiperactividad en niños y adolescentes colombianos. Rev Neurol. 2005;40(12):716-22.

O’Connor C, McNicholas F. What differentiates children with ADHD symptoms who do and do not receive a formal diagnosis? Results from a prospective longitudinal cohort study. Child Psychiatry Hum Dev. 2019;1-13.

Osooli M, Ohlsson H, Sundquist J, Sundquist K. Attention deficit hyperactivity disorder in firstand second-generation immigrant children and adolescents: A nationwide cohort study in Sweden. J Psychosom Res. 2021;141:110330.

Palacio JD. Algoritmo latinoamericano de tratamiento multimodal del trastorno por déficit de atención e hiperactividad (tdah) a través de la vida. Revista Colombiana de Psiquiatría. 2009;38(1):31.

Zuluaga AMD. Research experience in psychiatric genetics in Colombia: Ongoing studies. Eur Neuropsychopharmacol. 2019;29:S719.

Arcos-Burgos M, Castellanos F, Konecki D, Lopera F, Pineda D, Palacio J, et al. Pedigree disequilibrium test (PDT) replicates association and linkage between DRD4 and ADHD in multigenerational and extended pedigrees from a genetic isolate. Mol Psychiatry. 2004;9(3):252.

Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: An updated systematic review and meta-regression analysis. Int J Epidemiol. 2014;43(2):434-42.

Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics. 2015;135(4):e994-1001.

Palacio-Ortiz JD, Peña-Quintero CE, Gómez-Valero MA, Bustamante-Gómez PA, Arroyave- Sierra PH, Vargas-Upeguí CD, et al. Trastornos psiquiátricos a través de la vida: un estudio de comparación de hijos de padres con trastorno afectivo bipolar tipo I frente a hijos de padres controles de la comunidad. Rev Colomb Psiquiatr. 2017;46(3):129-39.

Van Meerbeke AV, Gutiérrez CT, Reyes RG, Pinilla MI. Prevalencia de trastorno por déficit de atención con hiperactividad en estudiantes de escuelas de Bogotá, Colombia. Acta Neurol Colomb. 2008;24(1):6-12.

Orozco R, Vigo D, Benjet C, Borges G, Aguilar-Gaxiola S, Andrade LH, et al. Barriers to treatment for mental disorders in six countries of the Americas: A regional report from the World Mental Health Surveys. J Affect Disord. 2022;303:273-85.

Bará-Jiménez S, Vicuña P, Pineda D, Henao G. Perfiles neuropsicológicos y conductuales de niños con trastorno por déficit de atención/hiperactividad de Cali, Colombia. Rev Neurol. 2003;37(7):608-15.

Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144(4).

Atkinson M, Hollis C. NICE Guideline: Attention deficit hyperactivity disorder. Arch Dis Child - Educ Amp Pract Ed. 2010;95(1):24.

Weiss M, Childress A, Nordbrock E, Adjei AL, Kupper RJ, Mattingly G. Characteristics of ADHD symptom response/remission in a clinical trial of methylphenidate extended release. J Clin Med. 2019;8(4):461.

Roskell N, Setyawan J, Zimovetz E, Hodgkins P. Systematic evidence synthesis of treatments for ADHD in children and adolescents: indirect treatment comparisons of lisdexamfetamine with methylphenidate and atomoxetine. Curr Med Res Opin. 2014;30(8):1673-85.

Tamayo JM, Pumariega A, Rothe EM, Kelsey D, Allen AJ, Velez-Borras J, et al. Latino versus caucasian response to atomoxetine in attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2008;18(1):44-53.

Apiquián R, Córdoba R, Louza M, Fresán A. Electronic schizophrenia treatment adherence. Salud Ment. 2013;36(1):19-26.

Xochilcal-Morales M, Castro EM, Guajardo-Rosas J, Obregon T, Acevedo J, Chucan J, et al. A prospective, open-label, multicentre study of pregabalin in the treatment of neuropathic pain in Latin America. Int J Clin Pract. 2010;64(9):1301-9.

Lee YS, Lee JI, Takita Y, Takahashi M, Lee S. Efficacy and safety of atomoxetine hydrochloride in Korean adults with attention-deficit hyperactivity disorder. Asia-Pac Psychiatry. 2014;6:386-96.

Grau M. Análisis del contexto familiar en niños con tdah. Universitat de València; 2007.

Klassen AF, Miller A, Fine S. Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics. 2004;114(5):e541-7.

Chu K, Li S, Chen Y, Wang M. Family dynamics in families with children with attention déficit hyperactivity disorder. Shanghai Arch Psychiatry. 2012;24(5):279.

Pires T de O, Silva CMFP da, Assis SG de. Family environment and attention-deficit hyperactivity disorder. Rev Saúde Pública. 2012;46(4):624-33.

Moen ØL, Hedelin B, Hall-Lord ML. Family functioning, psychological distress, and well-being in parents with a child having ADHD. SAGE Open. 2016;6(1):2158244015626767.

Observatorio de Políticas de las Familias. [Internet] Tipologías de familias en Colombia: evolución 1993-2014. Disponible en: https://www2.congreso.gob.pe.

Tistarelli N, Fagnani C, Troianiello M, Stazi MA, Adriani W. The nature and nurture of ADHD and its comorbidities: A narrative review on twin studies. Neurosci Biobehav Rev. 2020;109:63-77.

Preuss U, Ralston SJ, Baldursson G, Falissard B, Lorenzo MJ, Pereira RR, et al. Study design, baseline patient characteristics and intervention in a cross-cultural framework: results from the ADORE study. Eur Child Adolesc Psychiatry. 2006;15(1):i4-14.

Pineda D, Puerta I, Merchan V, Arango C, Galvis A, Velasquez B, et al. Perinatal factors associated with attention deficit/hyperactivity diagnosis in Colombian Paisa children. Rev Neurol. 2003;36(7):609-13.

Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry. 2007;190(5):402-9.

Tarver J, Daley D, Sayal K. Attention-deficit hyperactivity disorder (ADHD): An updated review of the essential facts. Child Care Health Dev. 2014;40(6):762-74.

Wilens TE, Biederman J, Brown S, Tanguay S, Monuteaux MC, Blake C, et al. Psychiatric comorbidity and functioning in clinically referred preschool children and school-age youths with ADHD. J Am Acad Child Adolesc Psychiatry. 2002;41(3):262-8.

Artigas-Pallarés J. Comorbilidad en el trastorno por déficit de atención/hiperactividad. Rev Neurol. 2003;36(Supl 1):S68-78.

Rodríguez L, López J, Garrido M, Sacristán A, Martínez M, Ruiz F. Estudio psicométrico-clínico de prevalencia y comorbilidad del trastorno por déficit de atención con hiperactividad en Castilla y León (España). Pediatría Aten Primaria. 2009;11(42):251-70.

Polanczyk G, Rohde LA, Szobot C, Schmitz M, Montiel-Nava C, Bauermeister JJ. ADHD treatment in Latin America and the Caribbean. J Am Acad Child Adolesc Psychiatry. 2008;47(6):721-2.