4 ADHD Workshop Dalle evidenze alla pratica clinica - Iss

 
4 ADHD Workshop Dalle evidenze alla pratica clinica - Iss
Università degli Studi di Cagliari              Azienda Ospedaliero-Universitaria di Cagliari
    Dipartimento di Scienze Biomediche                        Clinica di NeuroPsichiatria
Sezione Neuroscienze e Farmacologia Clinica                             Infantile

                             4° ADHD Workshop
                                       Dalle evidenze
                                     alla pratica clinica

                                   CAGLIARI 8/10 MARZO 2012
                                       SALA CONGRESSI
                              CENTRO COMUNALE D'ARTE E CULTURA
                                         “IL GHETTO”
                                     VIA SANTA CROCE, 18
                                           CAGLIARI
ABSTRACT
4°ADHD Workshop
                                                                                                            Dalle evidenze alla pratica clinica
                                                                                                            Cagliari, 8-10 Marzo 2012

Friday 9th of March

1. Self-esteem evaluation in children and adolescents suffering from ADHD....................... 7
   Reale Laura, Guarnera Manuela, Mannino Valeria, Armando Marco, Fatta Laura, Postorino
   Valentina, De Peppo Lavinia, Vicari Stefano, Mazzone Luigi ..........................................................

2. Design and development of psycho educational interventions with parents and teachers
to cope with the adhd disorder: analysis of the effectiveness of the paths through a
quantitative and qualitative analysis of the interventions. ................................................. 9
   Mannino Valeria, Costantino Antonella, Bissoli Claudio, Cropanese Isabella .................................
   Pagnotta Giulia, Querci Michela, Santi Chiara ................................................................................

3. Sharing project of diagnostic and therapeutic pathways for ADHD in Lombardy............ 10
   Tiberti Alessandra, Effedri Paola, Filippini Elena; Daffi Gianluca. ...................................................

4. Assessment of BMI in an Italian ADHD community care. ............................................. 11
   Germinario Elena, Chiarotti Flavia, Arcieri Romano, Panei Pietro .................................

5. Infection with cytomegalovirus and other herpes viruses as possible factors in the
development of attention deficit and hyperactivity disorder:preliminary results. ............... 12
   Riccio M.P., Borgia G., Cascella R., Gentile I., Maiorano A., Marino M., Pascotto A., Scarica S.,
   Zappulo E., Bravaccio C. ................................................................................................................

6. ADHD and Epilepsy in children with Tourette Syndrome: a triple comorbidity? ............. 13
   Rizzo Renata, Gulisano Mariangela, Calì Paola Valeria, Curatolo Paolo ........................................

7. BMI andpsychopathological disorders in comorbiditieswith ADHD:correlation studyin a
populationof patients of campania region ..................................................................... 14
   Sarnataro E., Bernardo P., Granata R., Grimaldi A., Maresca R., Pascotto A., Russo L., Tiano
   C., Bravaccio C. .............................................................................................................................

8. Self-esteem and parental stress in children with ADHD ............................................... 15
   Lamberti Marco, Boncoddo Maria, Siracusano Rosamaria, Germanò Eva, Ciuffo Massimo,
   Cucinotta Francesca, Cedro Clemente, Gagliano Antonella. ..........................................................

9. ADHD patients: observational multicenter study in three Italian dedicated ADHD centers.
Preliminary data ......................................................................................................... 17
   Sposato M.; Trinari E.; Cannarozzo M; Pincherle M.; Fini F.; Filippini V.; Mazzotta G.. ..................

10. Multimodal intervention in ADHD: the experience of Scientific Institute E.Medea of
Ostuni-Brindisi in the Apulia Region (Italy).................................................................... 18
  Fanizza Isabella, Massagli Angelo ..................................................................................................

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4°ADHD Workshop
                                                                                              Dalle evidenze alla pratica clinica
                                                                                              Cagliari, 8-10 Marzo 2012

11. Research protocol in the diagnostic investigation on ADHD ...................................... 19
  Ragazzo F., Benso F., Fiorella R., Stella S., Morando M., Castellani S., Gazzellini S. ...................

12. Clinical suggestions about parent training comparing two groups of children with ADHD,
ODD and LD. .............................................................................................................. 20
  Galimberti G., Actis Perinetti B., Aggio F., Saccani M. ....................................................................

13. ADHD and AUTISM: a study in the ASL of Novara ..................................................... 21
  Guccione Fulvio, Antonini Alessia, Vallana Marianna, Duella Sara, Tettamanti Elena ....................

14. Cognitive impairment in ADHD with language disorder in preschoolers:confront with
ADHD without language disorder and SLI. .................................................................... 22
  Melegari Maria Grazia1, Manzi B., Costa A., Canzano L., Uberti Paola ..........................................

15. ADHD subtypes and comorbidity in Italy .................................................................. 23
  Valenti Vera, Di Trani Michela, Galantini Chiara, Merati Silvia, Donfrancesco Renato ...................

16. Major Depression and Dysthymia in children with ADHD. .......................................... 24
  Leo G., Leone D., Di Trani M, Martines F., Sferrazza A,Torrioli MG , Donfrancesco R. ..................

17. An ADHD complex case report................................................................................ 25
  Pagana Lucia; Bassi Bianca; Mariani Alessandro; Magnano Lara ..................................................

18. Systemic multimodal approach to ADHD children and their families ........................... 26
  Cremaschi Silvana, Zappulla Giuseppe, Bortolossi Barbara, Sartor Graziella, Martignon Fabrizia.

19. Response Time Intra-subject Variability: commonalities between children with children
with Attention Deficit/Hyperactivity Disorder (ADHD) and children with Autism Spectrum
Disorders (ASD). ........................................................................................................ 27
  Adamo N., Adelsberg S., Petkova E., Castellanos F. X.and Di Martino A.1 ....................................

20. ADHD and Autism Spectrum Disorder symptoms overlapping: social functioning
impairment ................................................................................................................ 28
  Anchisi L., Carucci S1, Ambu G., Lecca L., Zuddas A. ....................................................................

21. Face emotion recognition: a preliminary analysis in Attention-Deficit Hyperactive
Disorder (ADHD) and Autism Spectrum Disorder (ASD) .................................................. 29
  Peddis Cristina, Reale Laura, Petza Silvia, Liori Arianna, Carucci Sara, Zuddas Alessandro.........

                                                              2
4°ADHD Workshop
                                                                                                               Dalle evidenze alla pratica clinica
                                                                                                               Cagliari, 8-10 Marzo 2012

Saturday10th of March

1. Moderation by the Tryptophan Hydroxylase 2 (TPH2) gene on the continuity/discontinuity
of emotional Dysregulation symptoms throughout adolescence and the role of family
structure.................................................................................................................... 31
   Nobile Maria M.D., ColomboPaola Ph.D., BellinaMonica D.Psych, Greco Andrea D.Psych.,
   Monzani Dario D.Psych., Bianchi ValentinaD.Psych., Carletto Ombretta M.D. and Molteni
   Massimo M.D. .................................................................................................................................

2. ADHD, intellectual disability and other comorbidities: analysis of findings at the CGH-
array in a small sample of subjects .............................................................................. 33
   Di Vita G., Galesi O., Fichera M., Castiglia L., Torrisi A.M., Amata M.T., Costanzo A., Di Guardo
   G., Musumeci S.A. .........................................................................................................................

3. Neuropsychological and neurobiological model of aggression in children with
externalizing disorders ............................................................................................... 35
   Mazzone Luigi, De Peppo Lavinia, Vicari Stefano, Williams Riccardo, Postorino Valentina, Milone
   Annarita, Lenzi Francesca, Pisano Simone, Manfredi Azzurra, Muratori Pietro, Masi Gabriele ......

4. Executive functions in Attention-Deficit/Hyperactivity Disorder ................................... 37
   Menghini Deny, Varvara Pamela, Napolitano Carmen, Calcagni Marta , Armando Marcoand
   Vicari Stefano ..................................................................................................................................

5. Influence of General Anxiety Disorder, state anxiety and depressive symptoms on
executive function in children with ADHD ..................................................................... 39
   Armando M., Napolitano C., Calcagni M., Casini M.P., Menghini D., Vicari S.................................

6. Evidences of SNAP25 single nucleotide polymorphisms associated with hyperactivity and
ASD disorders: future prospects related to ADHD. ......................................................... 41
   Cosi A., Aggio F.A., Nossa M. , Paccione F., Magnaghi E, Tuci A., Galimberti G., Saccani M.,
   Lenti C. and Guerini F.R. ................................................................................................................

7. Stress levels in parents of children with and without ADHD during the back-to-school
period: results of a non-clinical opinion survey ............................................................. 43
   Gagliano A., Hernandez Otero I., Doddamani L., Haertling F., Dutray B., Ramnath G. ..................

8. Overlapping between oscillation frequencies of RTs and Beta/Theta EEG Frontal Ratio in
Pediatric Patients suffering from Sustained Attention Deficit after Acquired Brain Injury ... 45
   Gazzellini Simone, Benso Francesco, Bauleo Graziella, Bisozzi Eleonora, Napolitano Antonio,
   Clavarezza Valentina, Lispi Maria Luisaand Castelli Enrico1 ..........................................................

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4°ADHD Workshop
                                                                                                      Dalle evidenze alla pratica clinica
                                                                                                      Cagliari, 8-10 Marzo 2012

9. Iron and ADHD: time to move beyond serum ferritin levels .......................................... 47
   Margotta Milena M.D. Parisi Pasquale, M.D., Ph.D., Liguori Simona, Vanacore Nicola,
   M.D.,Martines Francesca, Psy.D., Sargentini Vittorio, M.D., Cortese Samuele, M.D., Ph.D.
   Donfrancesco Renato, M.D. ............................................................................................................

10. Major Depression and Dysthymia in children with ADHD ........................................... 49
  Leo G, Leone D., Di Trani M, Martines F, Sferrazza A, Torrioli MG, Donfrancesco R. ....................

11. Defining Deficient Emotional Self-Regulation (DESR) in an Italian Sample of Youth with
ADHD Using a profile of the empirically derived Child Behavior Checklist ........................ 51
  Marano, A., Innocenzi, M*, Donfrancesco, R. , Biederman, J. .........................................................

12. Comorbidity and psychosocial impairment in Deficient Emotional Self-Regulation
(DESR) and Attention/deficit hyperactivity disorder........................................................ 52
  Innocenzi Margherita, Marano Assunta , Donfrancesco Renato ....................................................

13. Attention-deficit/hyperactivity disorder and alexithymia: a pilot study ........................ 54
  Di Trani Michela, Donfrancesco Renato, Gregori Paola, Auguanno Giovanna, Melegari Maria
  Grazia, Zaninotto Sabrina, Luby Joan .............................................................................................

14. A possible role of anti-Purkinje cell Abs as a biological marker in Attention
Deficit/Hyperactivity Disorder: a pilot study .................................................................. 55
  Nativio Paola, Passarelli Francesca, Pascale Esterina,Villa Maria Pia and Donfrancesco Renato .

15. Temperament, Awareness and Acceptance and: new perspectives in Parent Training for
ADHD ........................................................................................................................ 57
  Andriola E., Di Trani M. Donfrancesco Rb .......................................................................................

16. Temperament Feauteres as vulnerability factor ofAttention Deficit Hyperactivity Disorder
(ADHD) ...................................................................................................................... 59
  Andriola E., Di Trani M., Porfirio M.C., Donfrancesco Rb ................................................................

17. Cognitive profile and scholastic learning difficulties in a sample of children with
Attention Deficit and Hyperactivity Disorder: clinical and treatment relapses.................... 60
  Tacchi Annalisa , Grazi Amanda , Pfanner Chiara , Millepiedi Stefania , Manfredi Azzurra , Ricci
  Federica , Di Emidio Fabiola , Lenzi Francesca , Masi Gabriele ....................................................

18. Preliminary data from a consecutive sample of ADHD children and adolescents enrolled
in Tuscany for pharmacological treatment. ................................................................... 62
   Pfanner Chiara, Manfredi Azzurra, Lenzi Francesca, Di Emidio Fabiola, Tacchi Annalisa, Ricci
   Federica, Berloffa Stefano, Millepiedi Stefania, Grazi Amanda, Masi Gabriele ...............................

                                                                   4
4°ADHD Workshop
                                                                                           Dalle evidenze alla pratica clinica
                                                                                           Cagliari, 8-10 Marzo 2012

19. Efficacy and safety of methylphenidate and atomoxetine in ADHD: preliminary data from
a sample sample enrolled during 2011 in IRCCS Stella Maris .......................................... 63
   Pfanner Chiara, Manfredi Azzurra, Lenzi Francesca, Di Emidio Fabiola, Tacchi Annalisa, Ricci
   Federica, Berloffa Stefano, Millepiedi Stefania, Grazi Amanda, Masi Gabriele ...............................

20. Epidemiology of severe ADHD in an Italian sample of school aged children ................ 64
  Miano Silvia, Leone Daniela Donfrancesco Renato ........................................................................

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4°ADHD Workshop
    Dalle evidenze alla pratica clinica
    Cagliari, 8-10 Marzo 2012

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4°ADHD Workshop
                                                                               Dalle evidenze alla pratica clinica
                                                                               Cagliari, 8-10 Marzo 2012

    Self-esteem evaluation in children and adolescents suffering from ADHD

Reale Laura1, Guarnera Manuela1, Mannino Valeria 1, Armando Marco2, Fatta Laura2, Postorino Valentina2,
                         De Peppo Lavinia2, Vicari Stefano2, Mazzone Luigi1,2

     1 DivisionofChild Neurologyand Psychiatry,Department ofPediatrics, UniversityofCatania, Catania,
 2 Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children's Hospital Bambino Gesù

Background: Teachers, general practitioners and parents often consider low self-esteem as an
unspecific reason for psychiatric referral. Given how widely the “self-esteem” term is used in mental
health field, it is surprising that self-esteem in children and adolescents is not more frequently
quantified. This study has two objectives: 1) to analyse the characteristics of self-esteem in a
sample of children and adolescents suffering from attention deficit/hyperactivity disorder (ADHD);
and 2) to explore the relationships between self-esteem and age, ADHD symptoms severity and
treatment strategies.

Patients and Methods:Patients sample, referred to the clinic of Child and Adolescent
Neuropsychiatry of the Paediatric Department at the University of Catania and to the Child
Neuropsychiatry Unit at Children's Hospital Bambino Gesù of Rome, included 85 children and
adolescents (80males,5females;age range=8-15;mean age±SD=10.03±2.0) suffering from ADHD.
44 (40males,4 females;age range=8-15;mean age±SD=9.97±2.8) were drug-free and 41
(40males,1 females;age range=8-15;mean age±SD=10.70±2.0) receiving medication for at least 6
months; among the latter, 23 (23males,0females;age range=8-15;mean age±SD=10.03±2.3) were
Atomoxetine-treated and 18 (17males, 1females; age range=8-15;mean age±SD=9.85±2.2)
received Methylphenidate. 26 subjects (26males,0females;age range=8-14;mean
age±SD=11.29±1.4) were included in the NC group. To explore the characteristics of self-concept
and self-esteem the TMA (Self-esteem Multidimensional Test) was administered to both subjects
suffering from ADHD and healthy controls. The test provides scores in 6 self-esteem dimensions
and a global self-esteem related score (Personal,Skills,Emotional,School,Family,Body,Total). The
average values of self-esteem of the normative sample are between 86 and 115.

Results:Compared with NC, ADHD group had significantly lower scores on all self-esteem domains
(Personal,Skills,Emotional,School,Family,Body,Total). Among ADHD drug-treated, Methylphenidate
group showed significant higher self-esteem scores as compared to Atomoxetine group, except for
the family domain.Age was not found to correlate significantly with TMA scores in all groups
(ADHD:r=.04,P=.69;Ctrl:r=-.04,P=.82). Moreover, in ADHD group no significant correlation between
all self-esteem domains and symptoms severity, assessed by SNAP-IV, was detected (r=-
.27,P=.07). Most of the ADHD patients had scores within the pathological range (TMATotal≤85);
both ADHD Drug-free (47%) and Drug-treated (44%) groups showed significant higher rate of
subjects in the pathological range as compared to NC group (8%)(P
4°ADHD Workshop
                                                                        Dalle evidenze alla pratica clinica
                                                                        Cagliari, 8-10 Marzo 2012

Conclusion: A lower self-esteem profile is more common in subjects suffering from ADHD than in
healthy controls, with no differences between drug-free and -treated subjects. Although from our
data a lower self-esteem seems to be a peculiar trait of ADHD regardless of the treatment type,
symptoms severity or age, the Methylphenidate group showed a lower percentage of subjects in the
pathological range as compared to the other ADHD groups

                                               8
4°ADHD Workshop
                                                                               Dalle evidenze alla pratica clinica
                                                                               Cagliari, 8-10 Marzo 2012

Design and development of psycho educational interventions with parents and
 teachers to cope with the adhd disorder: analysis of the effectiveness of the
   paths through a quantitative and qualitative analysis of the interventions.

                Mannino Valeria, Costantino Antonella, Bissoli Claudio, Cropanese Isabella
                              Pagnotta Giulia, Querci Michela, Santi Chiara

   Unità Operativa di NeuroPsichiatria dell’Infanzia e dell’Adolescenza, Fondazione IRCCS Ca’ Granda,
                                 Ospedale Maggiore Policlinico Milano.

In literature there are many studies indicating psycho educational interventions (Parent and
Teacher Training) as being empirically valid and meaningful to deal with the ADHD disorder
(Pelham and GA Fabiano, 2008.; Antshel KM, Barkley R 2008; Laforett DR et al. 2008; Pouretemad
HR et al. 2009; Hautmann et al. 2009; Huang et al. 2009; Fabiano GA et al. 2009). Parents’ group
training have been extensively studied: many data documenting the benefits in several domains
such as the parent - child relation and parental stress. The training sessions with teachers are less
studied in literature, and have less quantifiable data, but have sufficient empirical evidence to justify
their application in the prevention and treatment of ADHD. Furthermore, as shown in the literature,
the effectiveness of interventions is strongly influenced by the possibility of acting on the different
contexts of the child's life. This makes it also possible to build a network of functional relationships
between the service, the family and the school to address the problem globally ADHD.
Thus giving effectiveness of these psycho educational interventions and pursuing a working
methodology for a multimodal therapy, we have developed interventions with the faculties of
teachers for the schools in our area based upon Behavioral-Cognitive Parent Training.
The Parent and Teacher Training assume a direct role in the treatment of ADHD: the parent and
teacher information acquire knowledge about ADHD, learn techniques to manage challenging
behaviors of children. They become an integral part of the therapeutic actively participating, sharing
and experimenting new solutions aiming to solve the problem. The group, with its peculiarity and
differences in the role playing, then becomes a container producing changes throughout the
decentralization of the problem from the child along with the activation of functional strategies linked
to the relationship and solution to the task.
Through the use of both qualitative and quantitative tools in this study we have analyzed the impact
of our interventions upon the stress levels of care-givers (parents and teachers) and their sense of
competence in dealing with problem-situations.In addition, by introducing a self-administered
questionnaire we have detected what is most indicative from the group’s perception in relation to
their drive to the change. The gathered feed backs were used to improve our interventions.
Taking into account the different size of the available the data for the evolution of Parent Training
(32 pairs of parents from 2009 to present) and evolution of the Teacher Training (18 teachers, two
pilot projects in the 2011), the first qualitative and quantitative data results available will be
presented and shared for discussion.
The analysis of the study allows us to highlight some elements to develop effective interventions:
the integrated intervention plays a decisive role to address the critical size of the problem of ADHD.
To implement a methodology of network with and between medical - social services, school, and
family, we think is the direction we need to follow to manage more efficiently the problem of ADHD.
This also will also produce a better management of Neuro-Psychiatric unit in relation to the costs
vs. benefit issue.

                                                    9
4°ADHD Workshop
                                                                                   Dalle evidenze alla pratica clinica
                                                                                   Cagliari, 8-10 Marzo 2012

Sharing project of diagnostic and therapeutic pathways for ADHD in Lombardy
 Testing of shared protocols for the formation of local Pediatricians upon the disorder and
             for the training of NPIs on the supply of parent training services.

                     Tiberti Alessandra, Effedri Paola, Filippini Elena; Daffi Gianluca.

                 Pediatric Neuropsychiatry, Pediatric Hospital, “Spedali Civili” of Brescia.

Objectives: This paper aims at presenting the protocols for the training of pediatriciansandNPIs
of Lombard territory with respect to the paths of parent training for parents of ADHD children, to the
diagnostic path and to the epidemiology and multimodal interventions. These protocols have been
developed within the SHARING PROJECT OF DIAGNOSTIC AND THERAPEUTIC PATHWAYS
FOR ADHD IN LOMBARDY from centersparticipating in theresearch alreadypresented in
2011. In particular, we highlight the use and dissemination in the Lombardy region of operating
protocols that can ensure consistency in the psycho-educational interventions and meet the training
needs expressed by the operators involved in the NPIs; these protocols are proposed as a model
transferable to other contexts of intervention in the treatment of neuropsychiatric disorders.

Patients & Methods: At this stage of the project, to date, the subjects involved in the training were
Pediatricians belonging to the territories of the 18 NPI involved (in particular Brescia, Cremona,
Lodi, Valle Camonica , Legnano, Pavia, Rho, Bosisio Parini, Lecco, Sondrio, Como, Mantova,
Varese) and NPI operators involved in the project.The training sessions were organized for
pediatricians from each center in the form of four-hour seminars run by the operators of the NPI
reference. During these seminars, repeated according to standards agreed at the centers, we tried
to implement the following skills: Knowing and recognizing the characteristic clinical picture of
ADHD; Knowing the main differential diagnoses and co-morbidity factors; Knowing the
epidemiological spread of the disease; Knowing the correct way of sending and accessing to
regional centers; Knowing the major forms of multimodal treatment.
The training courses for operators have been realized through three editions of the same path that
consists of two sessions of eight hours each, followed by a follow-up time of 4 hours. The first day,
managed by the operators of the participating centers, had as its purpose the sharing of current
practices for the design and delivery of services of parent training; the second day, managed by Dr
Sara Pezzica (AIDA Tuscany) and by Dr. Tiziana De Meo (Pediatric Neuropsychiatry in San Donà
di Piave - ASSL No. 10 "Veneto Orientale”), had as its purpose the sharing of tools and strategies
for the activation of pathways of parent training, following shared protocols; the third day, managed
by Dr. Paola Effedri and Dr. Gianluca Daff (“Spedali Civili” of Brescia, Lead Center for Project), had
as its aim the reflection on the possibility of developing a protocol shared system. Locations of the
issues were the centers of Brescia, Milan Fatebenefratelli and Garbagnate Milanese.

Results: The meetings were attended by about 350 Pediatricians of the territories and about 180
members of the Operators of the NPIs involved in the project.

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4°ADHD Workshop
                                                                                Dalle evidenze alla pratica clinica
                                                                                Cagliari, 8-10 Marzo 2012

                 Assessment of BMI in an Italian ADHD community care.

               Germinario Elena 1 , Chiarotti Flavia 2 , Arcieri Romano 1 , Panei Pietro 1 .

      1Dept.   of Therapeutic Research and Medicines Evaluation, and 2Department of Cell Biology and
                             Neuroscience, Istituto Superiore di Sanità, Rome, Italy

Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most commonly
diagnosed disorders in children and adolescents, with an estimated worldwide prevalence of over
5%,but in Italy the observed rate is 1-2% in several settings. One co-morbidity related to ADHD, as
hypothesized by some research groups, is an increased body weight, or a higher prevalence of
overweight; however, these findings have not confirmed by a recent study.

Aims: To assess an association between overweight and attention-deficit/hyperactivity disorder
(ADHD) in children who have been enrolled in the Italian ADHD National Registry.

Patients and Methods:.The assessment of BMI (medium value +SD) was performed at baseline,
stratifying by gender and age classes (11- 15 years). Data on height and
weight was collected. Chart of Cacciari was used to analyze data (Cacciari E et al, Endocrinol
Invest 2006; 29; 581-593)

Results:At the end of January 2012, 2.083 children with ADHD were recruited in the Italian ADHD
National Registry. Data about 1.637 (78.6%) children and adolescents were available to perform
BMI. 1.451 (88.6%) were males and 186 (11.4%) were females. For males, BMI was equal to
20.38+3.68, for females BMI was 20.31+4.01. Stratifying BMI by gender and percentile classes
(3-50-97th) no statistically significant difference was observed (p=0.94).
However, when stratifying for overweight, a higher percentage in male group than in female group
was observed, 23.3% vs 17.7%, respectively (p=0.09). Analyzing BMI by age classes, a statistically
significant difference was detected (p
4°ADHD Workshop
                                                                                    Dalle evidenze alla pratica clinica
                                                                                    Cagliari, 8-10 Marzo 2012

Infection with cytomegalovirus and other herpes viruses as possible factors in
        the development of attention deficit and hyperactivity disorder:
                             preliminary results.

  Riccio M.P.,** Borgia G., Cascella R., ** Gentile I., Maiorano A., Marino M., Pascotto A., ** Scarica S., **
                                          Zappulo E., * Bravaccio C.

Cattedra di Neuropsichiatria Infantile- Dipartimento di Psichiatria, Neuropsichiatria Infantile, Audiofoniatria,
Dermatovenereologia- Seconda Università degli Studi di Napoli, *Dipartimento di Pediatria &**Dipartimento
                                 di Malattie Infettive “Federico II” di Napoli

Introduction: Infection with cytomegalovirus (CMV) is the most common congenital infection with a
prevalence between 0.5% and 2% of all newborns. Transmission is by the mother or because she
contracted a primary infection during pregnancy or because a previous infection is reactivated
during pregnancy. In most cases (85-90%) the infection is asymptomatic at birth, although it is
possible that there are followings. Clinical studies have reported cases of symptomatic congenital
CMV infection associated with autism. Some authors describe the presence of behavioral
disturbances in 10% of cases of congenital CMV infection. They also reported an association
between congenital CMV infection and hyperactive behavior.

Aims: To study systematically the role that CMV infection (congenital, or acquired thereafter) or
infection by other herpes viruses (HSV-1 and 2, HHV6, Epstein Barr virus, Varicella, Measles,
Rubella, Mumps, Polyomavirus and JKC) can have in children with neuropsychiatric problems,
verifying the possible correlation between the presence of anti-CMV IgG and the development of
attention deficit hyperactivity disorder and draw a possible advantage in clinical practice (screening
at birth, prophylaxis with immunoglobulin, early antiretroviral therapy).

Patients and methods: A prospective case-control study of patients aged less than 12 years
diagnosed with attention deficit and hyperactivity disorder. The control group is made up of a cohort
of age-matched subjects. There are currently enrolled 19 subjects with ADHD and 29 healthy
controls. Enrollment is ongoing. We proceeded to the determination of CMV-DNA on a sterile urine
sample taken in the morning, the determination of anti-CMV antibody titer (IgG and IgM) in serum
following a peripheral blood sample withdrawal.

Results and Conclusions: The preliminary study has not yet shown a statistically significant
correlation between herpes viruses and ADHD.

                                                      12
4°ADHD Workshop
                                                                                 Dalle evidenze alla pratica clinica
                                                                                 Cagliari, 8-10 Marzo 2012

 ADHD and Epilepsy in children with Tourette Syndrome: a triple comorbidity?

                *Rizzo Renata, *Gulisano Mariangela, *Calì Paola Valeria, **Curatolo Paolo

*Section of Child Neuropsychiatry, Maternal Infantile and Radiological Sciences, Catania University, Catania,
     ** Section of Child Neuropsychiatry, Department of Neurosciences, University Tor Vergata, Rome

Aims: The comorbidity TS and epilepsy is rarely reported. We report a long term follow-up of 8
young patients presented a triple comorbidity : TS, ADHD and epilepsy.

Patients and Methods: Our series includes 8 patients (7 males and 1 females) with a median age
of 14.75 years (range 10-17) with definite diagnosis of TS according to DSM-IV-TR criteria,
assessed at the Neuropediatric Unit of Catania University, Italy and followed up for a period of ten
years. For the definition of epilepsy we considered the presence of at least two afebrile seizures; for
the ADHD definition we considered excessive inattention, hyperactivity and impulsivity either alone
or in combination. All the patients underwent a complete physical, neurological and
neuropsychological examinations, routine laboratory examinations and MRI. All the patients had a
routine awake EEG.

Results: Neurological examination showed incoordination in 3 patients; 2 of them presented also
clumsiness. All the patients showed soft neurological signs
Tics: There were a positive family history either for tic or for TS in 4 patients. All the patients had a
typical onset of TS; they presented first motor tics at the age of 6.37 years (age range 6-10 years);
after a few years at the age of 9.78 years (age range 8-13 years) they started to present also vocal
tics. One of them presented OCD and two of them presented behavioral disorder.
Neuropsychological findings showed a normal IQs in 6 out 8 patients. Two patients showed mental
retardation. TS was pharmacologically treated in five patients who presented severe impairment in
their daily life with improvement of the symptoms. All of them are still take pharmacological
treatment. 3 patients had mild tics and they didn’t take any medications.
Seizures:There were a positive family history for epilepsy in 4 patients. All the patients presented
idiopathic benign seizures. The seizure onset was after 4 years (age range 5-9) and in all the
patients except in 2 seizures came before tics. MRIs were normal in all the sample. All of them had
a good response to the therapy and obtained the complete resolution of the seizures. At the last
follow up, after at least 7 years, 7 patients were seizure free; only one patient had occasionally
seizures and he still take valproic acid.
ADHD: 6 patients presented “combined ADHD” type, 2 showed predominantly hyperactive “ADHD-
H” type. All the patients presented mild ADHD and for this reason they didn’t take any medications;
all of them were treated with psychological therapy including psychoeducational input, cognitive
behavioural therapy, either in individual or in group format. Parent and teachers received a specific
training to learn how to manage with ADHD children. They obtained an improvement of the
symptoms.

Conclusion: The relationship between TS , ADHD and epilepsy is not fully understood. Our study
hypothesize that it could be a relationship in the aetiology of TS, ADHD and epilepsy. The
increased excitatory activity, DOPA and GABA mediated, could be the common aetiology than
cause all the clinical symptoms.

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        BMI andpsychopathological disorders in comorbiditieswith ADHD:
         correlation studying a populationof patients of campania region

   Sarnataro E., Bernardo P., **Granata R., ***Grimaldi A., Maresca R., Pascotto A., Russo L., Tiano C.,
                                               *Bravaccio C.

 Cattedra di Neuropsichiatria Infantile- Dipartimento di Psichiatria, Neuropsichiatria Infantile, Audiofoniatria,
 Dermatovenereologia- Seconda Università degli Studi di Napoli, *Dipartimento di Pediatria “FedericoII” di
              Napoli, ** Ospedale Moscati di Aversa (Ce), ***Ospedale “Santobono” di Napoli

Introduction: Attention deficit hyperactivity disorder is associated with several psychopathological
disorders such as conduct disorder, oppositional defiant disorder, mood disorder, specific learning
disabilities and mental retardation. In addition to these psychiatric comorbidities, recent studies in
the literature suggest the presence of an association between the presence of ADHD and obesity;
in fact, the prevalence of overweight and obesity was significantly higher in patients with ADHD
compared to populations equivalent for sex and age, not affected by the disease.

Objectives: Toassess the correlation betweenBMI andpsychopathological disorders in
comorbiditieswith ADHD.

Patients and methods: The subjects, with a first diagnosis of ADHD, visited at the regional
reference centers in the Campania region, in the year 2010, and later in the year 2011, were valued
not yet in drug treatment. We proceeded to the diagnostic evaluation for each patient as guidelines,
with identification of comorbidities associated, and to the calculation of BMI (in kg/m2 body surface
area) with the identification of four different sub-groups: underweight (BMI
4°ADHD Workshop
                                                                                 Dalle evidenze alla pratica clinica
                                                                                 Cagliari, 8-10 Marzo 2012

                 Self-esteem and parental stress in children with ADHD

         Lamberti Marco, Boncoddo Maria, Siracusano Rosamaria, Germanò Eva, Ciuffo Massimo,

                        Cucinotta Francesca, Cedro Clemente, Gagliano Antonella.

                  Division of Child Neurology and Psychiatry, University of Messina, Italy

Aim:Attention-deficit/hyperactivitydisorder (ADHD) is a common child and adolescent disorder that
is frequently associated with negative outcomes, such as emotional and behavioural problems and
low self-esteem. Conversely, low self-esteem has been associated with feelings of inadequacy and
frustration which in turn can result in the worsening of the behavioural symptoms. The behavioral
problems could lead to poor peer relations, aggression, and learning problems which are
associated with academic failure and, consequently, with a further risk for low self-esteem. This
vicious circle can even have the effect of increasing the likelihood to develop psychiatric
disorders.The current study examine the relation between ADHD and self-esteem, and observe
how self-esteem impacts the relation between parental stress and ADHD symptoms. We
hypothesized that children with ADHD experience lower self-esteem than children with other
chronic and severe conditions, like epilepsy. Furthermore, we also wished to investigate the
association between ADHD symptoms, parental stress and self-esteem.

Patients & Methods: Data were collected from 20 children aged between 9 and 12 years,
diagnosed as having ADHD (according with DSM-IV criteria) and their parents. The ADHD-RS and
Conner's Scales (CPRS) were used to assess ADHD symptom severity, and the Multidimensional
Self-esteem Test (MSET) was used to measure self-concept. MSET is a self-report instrument,
which consist of 150 items, divided in six subscale, exploring Social Relations, Problems Solving,
Emotions, Academic Success, Family Relations and Bodily Experience. The Parent Stress
Inventory (PSI) was used as measure of the parents stress level. A group of 20 patients with
epilepsy was recruited and assessed by means the same instruments. Both these groups were
compared with a control group of 20 children, free from epilepsy, neurological disorders, academic
and behavioural problems, homogeneous as regards gender, age, level of education and social-
economic background.

Results: Among ADHD children, the symptoms severity and the presence of comorbid conditions
(i.e. anxiety, academic difficulties, etc,) predicted lower self-esteem. Besides, there were significant
differences between ADHD and Epileptic patients on self-concept scores. In particular, ADHD
patients had lower scores in some MSET sub-scales (i.e. Social Relations and Academic Success).
Results further revealed that the parental stress levels was related with the self-esteem scores in
ADHD children.

Conclusions: The findings indicate that there is a need to assess self-esteem in children and
adolescents with ADHD, especially those with comorbid conditions such as anxiety and academic
difficulties. Even if it is well known that parents of children with attention-deficit/hyperactivitydisorder
experience elevated levels of caregiver stress, it could be helpful investigate the relation between
parental distress and self-esteem. Our results can have implications for treatments that target

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ADHD children with low self-esteem and their parents, as these patients are at risk for many
negative outcomes. A comprehensive treatment plan for children with ADHD and low self-esteem
should also contain programs designed to help all parents identify and manage their own parenting
stressors.

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                                                                                    Cagliari, 8-10 Marzo 2012

    ADHD patients: observational multicenter study in three Italian dedicated
                       ADHD centers. Preliminary data

       Sposato M. °; Trinari E. °; Cannarozzo M.°; Pincherle M.*; Fini F.*; Filippini V.*; Mazzotta G. §.

    (°Regione Umbria; *Regione Marche; §Director of Childhood and Adolescent Neuropsychiatry Unit,
                                       University of Perugia)

Introduction: ADHD is a strongly compromising syndrome with a significant impact on the quality
of life of both children and their families; moreover, it is a condition with an important social impact
in terms of monetary costs which both the community and the child’s family are burdened with.
Costs are higher for those subjects with a higher number of comorbidities 1.The Italian Register for
ADHD was born in 2007;it is coordinated by the Drug Department of the Italian National Institute of
Health, in collaboration with the Italian Drug Agency (AIFA), and has the following aims: control
over diagnostic accuracy and appropriateness of drug prescription, drug vigilance, patient follow-up
and collection of epidemiological data.In concomitance with the institution of the register, AIFA has
authorized the establishment of regional dedicated centers, with the scope of finalizing the register’s
objectives and coordinate multimodal treatment measures.

Objectives: the aim of the present work is to describe the epidemiological data regarding children
and adolescents who were referred to three dedicated ADHD centers belonging to the Umbria-
Marche chapter of the Italian Society of Childhood and Adolescent Neuropsychiatry (SINPIA).We
conducted an observational multicenter study among a homogeneous population of subjects
referred to the center in Terni for the Umbria region and Macerata and Ascoli Piceno for the Marche
region, with the objective of highlighting the insurgence of adverse events related to the
administration of Atomoxetine (ATX) or Metilphenidate (MTH), estimate the frequency of
suspension of treatment and the related motivations, estimate the presence of comorbidity and
evaluate the efficacy of the pharmacological treatment.

Materials & methods: 92 patients were observed (81 males and 11 females; age between 7 and
18 years) enrolled in the register during the period between June 2007 and December 2011.
Among these patients, 72% were in intermittent treatment with MTH, 26% with ATX and 2%
switched from ATX to MTH. The patients were classified on the basis of subtype and comorbidity.
Treatment duration varied between 1 and 48 months. 33% of the patients eventually dropped out
from the register; none of the drop-outs were due to insurgence of adverse events. Clinical
progression was evaluated through the Children Global Assessment Scale (C-GAS)2.
Results: preliminary data show no treatment suspension due to insurgence of adverse events,
good therapy compliance (61 patients out of 92 continued pharmacological treatment) and a
positive clinical progression.

References:1)Mazzotta et al. : The economic impact of attention deficit hyperactivity disorder in a
study group of children in Umbria; Gior Neuropsich Età Evol 2008;28:45-56.
2) Shaffer et al: A children global assessment scale (C-GAS), Arch Gen Psychiatry,1984; 40:1228-
1231

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Multimodal intervention in ADHD: the experience of Scientific Institute E.Medea
                 of Ostuni-Brindisi in the Apulia Region (Italy)

                                    Fanizza Isabella, Massagli Angelo

  Department of Neurorehabilitation 2 – Child Psychiatry, Scientific Institute I.R.C.C.S. “Eugenio Medea”
                               Regional Branch of Ostuni – Brindisi, Italy

Background: We know that multimodal approach is the more appropriate intervention in ADHD as
evidenced, among others, by the famous MTA Study (Multimodal Treatment of Children with ADHD.
Arch Psychiatry in January, 1999, 56: 1073 -86). The ADHD Reference Centers (created in Italy by
the Health Ministry in 2007 to control drug therapy), can or deal directly patients or supervise and
treat cases of territorial child psychiatry when they need drug therapy. AIMS: check, through
evaluation of our ADHD Reference Center, the actual implementation of multimodal treatment in
children with this disorder in our area. Evaluate effectiveness of the two drugs used in Italy for
ADHD (Methylphenidate or Atomoxetine).

Patients& Methods: We made an observational study of 166 patients that came to our Center
since 2007 (year of the beginning of the National Register and of the authorization for marketing of
the specific drugs for ADHD from Italian Health Ministry) to 2010. They came from Apulia Region,
affected by Attention Deficit Hyperactivity Disorder (ADHD), diagnosed by child psychiatrists
according to the DSM IV-TR criteria.

Results: In our sample, only 35 patients (21%) underwent multimodal intervention including a
pharmacological approach, specific for the disease, and psychoeducational treatment. Furthermore,
only 5 patients had parent training cycle, while the others had only family counseling. Among these
35 patients, 24 were treated with Atomoxetine, 9 with Methylphenidate only, 2 were first treated with
Atomoxetine and then with Methylphenidate due to the ineffectiveness of the first treatment. Among
patients treated with Atomoxetine, 16 (61%) showed no clinical improvement, 8 (30%) showed a
slight improvement (reduction of 1 point in CGI score) and in 2 patients (7.6%) occurred a
worsening of the clinical picture with emphasis on hyperactivity. Among patients treated with
methylphenidate, 7 (63%) showed significant clinical improvement (reduction of 2 points in CGI
score), while 4 (36%) showed a slight improvement (reduction of 1 point in CGI score).

Conclusion: Although has been proven by scientific literature and confirmed by the SINPIA
guidelines importance of carrying out multimodal treatment in ADHD, involving the specific
pharmacological treatment, psycho-educational work and parent training, data we analyzed show
that at the present time, in our area, such treatment, actually, is applied only in a minority of cases.
Therefore, compared with a high number of children receiving this diagnosis, only a few are able to
implement the multimodal treatment strategy. We think that the main reason for this is that the
locally available resources are few. To overcome this drawback you need to increase update
especially for parent training, allowing to territorial child psychiatrists handle also the
pharmacotherapy. Finally, about the drug treatment, Methylphenidate is confirmed as the drug of
first choice in terms of efficacy and tolerability compared with Atomoxetine.

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4°ADHD Workshop
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             Research protocol in the diagnostic investigation on ADHD

       Ragazzo F.*, Benso F.**, Fiorella R.*, Stella S.*, Morando M.**, Castellani S.**, Gazzellini S.°

    * Centro di Riferimento ADHD Savigliano, ** Università di Genova, ° Ospedale Bambin Gesù Roma

The regional point of reference for ADHD, constituted inside ASL1 of Savigliano (CN) in 2007, has
made 166 ADHD diagnosis; including 58 treated with drugs (Atomoxetine or Methilphenidate).
In order to ameliorate the clinical definition of the ADHD diagnosis and to orienting both
pharmacological and rehabilitative treatment, our teamwork (child neuropsychiatrist, psychologists
and professional educators) has settled down a new pathway of clinical evaluation.
This pathway foresees three steps:
      1) clinical and neuropsychiatric assessment
      2) psychological tests administration (specific for ADHD and its co-morbidities);
      3) neuropsychological tasks, focused particularly on the attentional networks and executive
          functions.
To research aims, tasks supplied from Benso, Morando and Castellani (University of Genoa) are
administered. Referring these tasks, we’re working in order to calibrate them basing on the most
recently studies. First, we’re focusing on the evaluation of the efficiency of attentive neural networks
(i.e. alert, orienting, and executive control) using computerized tasks; our tasks measure just one
attentive aspect at time in order to avoid possible interactions and to find more pure parameters
referring different attentive aspects activated by the tasks. Second, we’re evaluating the “white
noise” of the “default mode networks” and the intra-individual variability by studying RTs ex-
Gaussian distribution (standardizing and analyzing mu, sigma and tau parameters). By this way, we
have first standardized ex-Gaussian values from subjects attending IInd, IIIrd, IVth and Vth classes
of primary school, and then the same tasks were administered to ADHD subjects before and after
drug treatment. Third, using the same RTs, we’re studying the temporal series in order to find
eventual periodical attention disorder. Finally, we’re investigating correlation between
questionnaires attentional network and general measures on executive functions (paper and pencil
tests).
The final goal is to set a battery tests able to recognize relevant indexes that could be placed at the
base of a more objective ADHD diagnosis.

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                                                                                 Cagliari, 8-10 Marzo 2012

 Clinical suggestions about parent training comparing two groups of children
                          with ADHD, ODD and LD.

                        Galimberti G.*, Actis Perinetti B.*, Aggio F.*, Saccani M.*

         *Department of Child and Adolescent Psychiatry, San Paolo Hospital, University of Milan.

Aims: Parent Training (CBPT) has a long, successful history as a treatment for children with ADHD
(Pelham et al.,1998) and ODD (Brestan & Eyberg, 1998). According to a previous study (Aggio et
al., 2008) mothers of ADHD-ODD children show higher maternal depression, parenting stress, lax
parenting and significant correlations between overreactive parenting and depression, external
LCB, sense of competence and parental stress in the ADHD+ODD group. Therefore we
hypothesize that ADHD families may benefit from an expanded version of parent training that
includes sessions directly targeting parental affective and cognitive factors. The present study
compares two groups and suggests. clinical issues about tailored intervention.

Patients: 2 groups of parents. The first group was composed by 8 couples of 10-11-years-old
children with ADHD and ODD (n=3) and ADHD C (n=5); the second group was composed by 4
couples of from 7 to 9 years old children with ADHD and LD (n=3) and ADHD and ODD (n=1).

Methods: We used a typical sequence of 10 sessions for PT (Vio, Marzocchi & Offredi, 2009) in
addition with emotional self-regulation, attunement and anger management. We administered to the
first group questionnaires pertaining to: child behaviour and parental cognitions about their
behaviour. We administered to second group as pre and post test Conners’ Parent Rating Scale,
PSI-SF, BDI and BAI in order to evaluate PT efficacy. Moreover parents were asked to complete
ADHD Adult Symptoms Questionnaire.

Results: Preliminary results show improvements in parental reports of sense of competence and
parental cognitions about themselves and their children.

Conclusion: Child age, ADHD comorbidity and families expectations and characteristics are
essential issues to create tailored interventions and PT with specific sessions about affective and
cognitive factors are likely to be more responsive to ADHD families and needs.

                                                    20
4°ADHD Workshop
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                                                                                       Cagliari, 8-10 Marzo 2012

                      ADHD and AUTISM: a study in the ASL of Novara

             Guccione Fulvio, Antonini Alessia, Vallana Marianna, Duella Sara, Tettamanti Elena

                     Centro di Riferimento ADHD ASL Novara Ospedale di Borgomanero

Objective: Aim of the present study is to estimate the presence of ADHD symptom in patients with
diagnosis of autism. Both DSM IV and ICD 10 exclude the possibility to make a diagnosis of ADHD
when exist a diagnosis of autism. A large number of study (Pondè e al. 2010; Holtman M. e. al.
2007 Sverd, J. 2003) in literature reveal that could exist a possible comorbidty between autism and
symptoms of ADHD. I particular Pondè and colleagues (2010) show that the 78% of subjects wit a
diagnosis of autism met the DSM IV criteria for ADHD. Leyfer O.T. and colleagues (2006) show
that 55% of autistic patients present typical symptom of ADHD and that 38% met the DSM IV
criteria for ADHD. Aim of the present study is to explore the presence of ADHD symptom in
patients with diagnosis of autism.

Method:Seventeen individuals from 6 to 14 years old with a diagnosis of autism according to the
ICD-10 (ICD10 F84 -F984.9), their parents and their teachers took part in the research. Actually, all
participants were patients of the Novara district health authority.The symptomatology of the ADHD
patients at the time of testing was investigated with specific test battery. In particular the battery
used was: Sustained Attention Leiter-R, Rey-Osterrieth Complex Figure Test, Arithmetic and Digit
span subtest from WISC III. Parents and teacher were asked to assess episodes of
psychopathology in children and adolescents by two structurated scale: Conners’ Parent Ratig
Scale, Conners’ Teacher Ratig Scale, Child Behavior CheckList T. Achenbach (CBCL).

Conclusion: In accord with Pondè e al. (2010), the preliminary data of our sample, show that a
significant number of patient with a diagnosis of autism show typical symptom of ADHD.
Another hypothesis supported in literature is that different neuropsychiatric disorder seem to have a
common genetic etiology. We think that an important step is to understand the real nature of
clinical relation between autism and ADHD. A correct interpretation can be a useful starting point for
planning rehabilitative treatments.

References
Holtmann M, Bolte S, Poustka F. Attention deficit hyperactivity disorder symptoms in pervasive developmental
disorders: association with autistic behavior domains and coexisting psychopathology. Psychopathology 2007;40:172-
177.

Leyfer OT, Folstein SE, Bacalman S, et al. Comorbid psychiatric disorders in children with autism: interview
development and rates of disorders. J Autism Dev Disord 2006;36:849-861.

Lichtenstein P., Carlström E., Råstam, M., Gillberg, C., Anckarsäter H. (2010).The Genetics of Autism Spectrum
Disorders and Related Neuropsychiatric Disorders in Childhood.Am J Psychiatry 2010;167:1357-1363.

Pondè, M.P., Novaes, C.M., Losapio, M.F. (2010) Frequency of symptoms of attention deficit and hyperactivity disorder
in autistic children. Arq. Neuro-Psiquiatr. [online]. 2010, vol.68, n.1, pp. 103-106.

Sverd J.Psychiatric disorders in individuals with pervasive developmental disorder. J Psychiatr Practice 2003;9:111-
127.

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4°ADHD Workshop
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                                                                                Cagliari, 8-10 Marzo 2012

     Cognitive impairment in ADHD with language disorder in preschoolers:
            confront with ADHD without language disorder and SLI.

                Melegari Maria Grazia 1, Manzi B.2, Costa A.3, Canzano L. 4, Uberti Paola 5

             1ASL   Roma A; 2 Consorzio Rirei 3 CRC Balbuzie; 4Onlus Tandem; 5ASL Roma C

Aims: The study of comorbidity has always been proposed as a field of great interest to investigate
the association between ADHD with other disorders. The comorbidity between ADHD and
language disorders (SLI) has been documented since the 80s (Beitchman et al., 1989) specifically
in scholar age.– Till now, few studies up to date (less than 10) have been conducted with preschool
children in respect to the relationship between SLI, ADHD and theimpairment of cognitive
processes that can explain the interrelation between disorders in comorbidity. The present work
wants to investigate different or common cognitive functioning patterns between sub groups ADHD
without (ADHD) or with language disorder ( ADHDL) and between ADHDL and SLI in preschoolers.

Method: 33 ADHD preschoolers with and without comorbidity with SLI (29 males; 4 females; mean
age months 65,87); 32 SLI preschoolers with expressive language disorder (29 males; 4 females,
mean age months 66,56). 35 preschoolers (10 males; 13 female, mean age months 65,18) without
psychiatric disorders, as control group, participated to study. Clinical samples were selected
according to symptoms criteria required DSM-IV for diagnosis and comorbidity using adapted age
psychiatric (PAPA) and language assessment. Exclusion and inclusion criteria were considered.
Neuropsychological assessment: EFs and verbal-non verbal processing tasks were administrated
to study different and common impairment in clinic groups. Statistical analyses: 1° step: three
discriminative function analyses (ADHDL vs. ADHD, vs. SLI and vs. control group) in order to detect
differences between groups. 2° step: three Univariate Analyses of Variance ( ADHL, SLI, ADHD vs.
control) were also computed in order to identify common features in the groups.

Results: The percentage of explained variance among groups: 80.6% in the ADHDL-Control, 53%
for ADHDL-ADHD and 53% for ADHD-SLI comparisons. The percentage of variance explained by
discriminating functions in all comparisons was significant (p < .01), except for ADHDL-ADHD that
showed a trend toward statistical significance (p =.10). All variables discriminated ADHDL from
other groups. The stronger discriminating variables between ADHDL and Control: phonological
processing,Working Memory and categorical fluency. All variables - except Shifting and Stroop test
- had a coefficient > .30. 2nd step: a significant difference (p
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