Attention deficit disorder with hyperactivity (ADHD): Concepts, diagnosis, types of ADHD / Transtorno de déficit de atenção com hiperatividade (TDAH): Conceitos, diagnóstico, tipos de TDAH

Our work describes about ADHD, a neurobiological disorder that results from brain chemistry, showing three behavioral indicators: inattention, hyperactivity and impulsivity. This study aims to conceptualize ADHD, show how to find the disorder, starting from the diagnosis, the types of ADHD, the possible treatments applied, the attention of the family, relatives and friends, the school, the community where the student lives. ADHD and looks from government agencies.

The Stop Signal Task for Measuring Behavioral Inhibition in Mice With Increased Sensitivity and High-Throughput Operation

Ceasing an ongoing motor response requires action cancelation. This is impaired in many pathologies such as attention deficit disorder and schizophrenia. Action cancelation is measured by the stop signal task that estimates how quickly a motor response can be stopped when it is already being executed. Apart from human studies, the stop signal task has been used to investigate neurobiological mechanisms of action cancelation overwhelmingly in rats and only rarely in mice, despite the need for a genetic model approach. Contributing factors to the limited number of mice studies may be the long and laborious training that is necessary and the requirement for a very loud (100 dB) stop signal. We overcame these limitations by employing a fully automated home-cage-based setup. We connected a home-cage to the operant box via a gating mechanism, that allowed individual ID chipped mice to start sessions voluntarily. Furthermore, we added a negative reinforcement consisting of a mild air puff with escape option to the protocol. This specifically improved baseline inhibition to 94% (from 84% with the conventional approach). To measure baseline inhibition the stop is signaled immediately with trial onset thus measuring action restraint rather than action cancelation ability. A high baseline allowed us to measure action cancelation ability with higher sensitivity. Furthermore, our setup allowed us to reduce the intensity of the acoustic stop signal from 100 to 70 dB. We constructed inhibition curves from stop trials with daily adjusted delays to estimate stop signal reaction times (SSRTs). SSRTs (median 88 ms) were lower than reported previously, which we attribute to the observed high baseline inhibition. Our automated training protocol reduced training time by 17% while also promoting minimal experimenter involvement. This sensitive and labor efficient stop signal task procedure should therefore facilitate the investigation of action cancelation pathologies in genetic mouse models.

Comparison of caregivers’ characteristics, stigma, and disease burden of children with autism spectrum disorder and attention-deficit disorder in Egypt

Background Studies show that autism spectrum disorder and attention-deficit hyperactivity disorder place a significant stigma and burden on caregivers, economically as well as socially, psychologically, and emotionally. The current study aims to assess caregivers of those children with reference to stigma and disease burden, evaluation of different psychiatric symptoms, and quality of life. Also, it aims to compare the extent of such disruption related to the type of the disorder (ASD versus ADHD). A cross-sectional, analytical study was designed including 72 caregivers {38 caregivers of autism versus 34 caregivers of ADHD}; all of them were assessed for (1) stigma; (2) disease burden; (3) depression, anxiety, and sensitivity; and (4) quality of life. Results The current results show that caregivers of ASD and ADHD have a higher score of stigmas, burden, depression, anxiety, and a poorer QoL than normal; all these variables are worse in ASD caregivers than ADHD caregivers. Conclusion This study supports the notion that both ADHD and ASD pose a great challenge for their caregivers which is higher in ASD than ADHD caregivers.

The Association between Serum Bilirubin and Kernicterus Spectrum Disorder: A Systematic Review and Meta-Analysis

<b><i>Background:</i></b> Total serum bilirubin (TSB) is used in managing neonates with jaundice, but clear evidence on its association with major outcomes is lacking. <b><i>Objectives:</i></b> We evaluated the association between TSB and kernicterus spectrum disorder (KSD). <b><i>Methods:</i></b> We searched PubMed, EMBASE, and CENTRAL till July 2021. Two authors independently selected relevant cohort studies, extracted data (CHARMS checklist), assessed risk of bias (RoB) (QUIPS tool), and rated certainty-of-evidence (Grades of Recommendation, Assessment, Development, and Evaluation). We pooled adjusted odds ratio (aOR) (random-effect) via generic inverse variance methods. <b><i>Results:</i></b> From 2,826 records retrieved, we included 37 studies (<i>n</i> = 648,979). Fifteen studies had low, 16 moderate, and 6 high RoB, with majority having concerns on confounder adjustment and statistical analysis. Twenty-two studies contributed meta-analysis data, and 15 were summarized narratively. TSB appears associated with KSD in infants with certain risk factors (aOR 1.10, 95% CI: 1.07–1.13; 5 studies [<i>n</i> = 4,484]). However, TSB (aOR 1.10, 95% CI: 0.98–1.23; 1 study [<i>n</i> = 34,533]) or hyperbilirubinemia (aOR 1.00, 95% CI: 0.51–1.95; 2 studies [<i>n</i> = 56,578]) have no clear association with kernicterus or neurological diagnosis in overall neonatal population (moderate-certainty-evidence). One study shows that infants with hyperbilirubinemia appear likelier to develop attention-deficit disorder (aOR 1.90, 95% CI: 1.10–3.28) and autistic spectrum disorder (aOR 1.60, 95% CI: 1.03–2.49, <i>n</i> = 56,019) (low-certainty-evidence). Certain clinical factors appear associated with KSD, although very few studies contributed to the analyses. <b><i>Conclusions:</i></b> Despite the importance of this question, there is insufficient high-quality evidence on the independent prognostic value of TSB for adverse neurodevelopmental outcomes in most neonatal populations. Future studies should incorporate all known risk factors alongside TSB in a multivariable analysis to improve certainty-of-evidence.

543 - Cultural Considerations for Older LGBTQ Adults During the COVID-19 Pandemic: Case and Review

IntroductionThroughout the COVID-19 pandemic, older adults have been disproportionately impacted by both illness and fatalities. Of the nearly 39 million adults over age 65 in the United States, approximately 2.4 million older adults identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). LGBTQ older adults face unique challenges due to their intersecting identities and histories, including the effects of heterosexism, ageism, and being more likely to live alone, be single, and not have children. As we implement social distancing as a primary COVID-19 prevention method, older adults have faced increased isolation.MethodsWe presented a case of a lesbian older adult patient who has experienced increased depression during the COVID-19 pandemic. A table will be added featuring culturally competent recommendations for LGBTQ older adults from a literature review.ResultsA 77-year-old female with history of major depression, attention deficit disorder, hypertension, xerostomia, and polymyalgia rheumatica. The patient has been on multiple trials of medications for depression as well as ECT treatments. She was initially engaged to a man and after some years fell in love with a woman. The patient is currently single and has no children. She typically has a strong support system with her lifelong friend and attends church. She transitioned from independent living to an adult living facility, with the hope of increased social activity and connectedness. However, due to COVID-19, she experienced her move as extremely difficult, and was disappointed that all social activities were canceled. For a period of several months, she was unable to visit her chosen family, was limited to attending church via Zoom, and was restricted from multiple areas of the complex. As a result, she reported increased depression, anxiety, and difficulty sleeping with passive suicidal ideation due to isolation and no direct family support.ConclusionOlder LGBTQ populations are at disproportionately higher risk for mental health conditions and with the current social distancing measures in place, social isolation and loneliness has been exacerbated.Connection with accepting family and community are well documented in the literature as key protective factors and sources of resiliency in LGBTQ populations. Culturally competent care is integral to psychiatric treatment of older LGBTQ adults.Note:This abstract was presented at the American Association of Geriatric Psychiatry 2021 Annual Meeting.

Prevalence of neurological problems in a community-based sample of paediatric coeliac disease: a cross-sectional study

BackgroundThe prevalence of and risk factors for neurological problems in childhood coeliac disease (CD) are unclear.MethodsWe performed a cross-sectional, community-based audit of CD in children diagnosed from January 2010 to December 2016 in Lothian.Results79 (28%) of 284 children with CD (201, 70.8% female) (mean age 8.3 years, range of 1–16) had neurological problems. Fifteen (5%) had headaches/migraine, 3 (1%) seizures, 32 (11%) ASD (autistic spectrum disorder), 5 (2%) ADD (attention deficit disorder) and 4 (1%) had ADHD (attention deficit hyperactivity disorder). Fifteen (5%) had anxiety (n=10, 3.5%) or low mood (n=5, 2%). Neurological problems were more common with later age at CD diagnosis (OR 1.07, 95% CI 1.01 to 1.14) and male gender (OR 1.69, 95% CI 0.96 to 2.95).ConclusionPrevalence of neurological problems in children with CD in Lothian is lower than published adult CD studies and similar or lower to the reported prevalence in the general childhood population.