Language: Spanish
References: 31
Page: 55-62
PDF size: 133.56 Kb.

ABSTRACT

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric disorders. The current prevalence of the disorder in pediatric population has been estimated around 5.29% worldwide. ADHD is a lifelong illness with different manifestations during childhood, adolescence, and adulthood. Untreated ADHD generates a great dysfunction in several domains, including school and work performance, family, and peer relationships. Because of the high prevalence and dysfunction linked to the disorder, there is a need to use severity checklists and screening instruments. Some of the dimensional scales used to evaluate ADHD are: The Child Behavior Checklist and the Brief Psychiatry Rating Scale for Children and Adolescents, both translated and validated in Spanish. The severity scales most commonly used are the Conners Scales and some others like the Teachers Rating Scale from the Hospital Psiquiatrico Infantil in Mexico and several checklists derived from the 18 symptoms of the DSM, including the Argentine SNAP-IV version. Some screening instruments had been used in epidemiological searching of ADHD symptoms.
Objectives: To design an screening instrument for ADHD suitable for the evaluation of Latin American school age children and adolescents, and describe the sociodemographic and clinical characteristics of the sample used for its evaluation.
Methods: The construction of the instrument was carried out by an expert panel, integrated with psychiatrists, child and adolescent psychiatrists, child-neurologists, and neuropsychologists. During the first Latin American Consensus for ADHD held in Mexico, City in June 17-18 of 2007. All of them were certified by the respective boards in each country. The items from the instrument were developed taking in to account the criteria used for ADHD in the Diagnostic and Statistical Manual for Mental Disorders, IV edition (DSM-IV) of the American Psychiatric Association and to be responded by the father or the mother in a Likert-type scale. The main criteria for the detection of inattention, hyperactivity, and impulsivity were included, as well as a poor psychomotor coordination ítem. The instrument was translated into Portuguese. A pilot study was run at three countries with 10 subjects in each one. The sample was integrated with epidemiological and clinical evaluated subjects; the clinical sample was also diagnosed for other major psychopathologies according to the DSM-IV.
Results: The final instrument was composed by 28 items: 15 for inattention, seven for hyperactivity and four for impulsivity. The severity of each ítem could be evaluated from 0 to 3 and the total maximum score was 84 points. We received 985 completed questionnaires from nine countries from North, Central and South America. The sample was integrated with 403 (40.9%) and 582 (59.1%) of epidemiological and clinical sources, respectively; 644 (65%) were male and the mean age of those evaluated was 9.72 (± 3.06) years. Most questionnaires (79%) were responded by the mothers. In the clinical sample, 487 subjects were diagnosed with ADHD and 53.99% with a combined subtype. Males obtained significantly higher total scores than females (40.25 ± 19.21 vs. 31.03 ± 18.63; p‹0.05). Children obtained significantly higher scores than adolescents in hyperactivity subscales (9.38 ± 5.93 vs. 7.57 ± 5.33; p‹0.05). Clinical population obtained significantly higher total scores than epidemiological population (43.92 ± 17.54 vs. 27.15 ± 17.88; p‹0.05).
Discussion: This is the first Latin American ADHD screening instrument designed to be used in different countries of the region and based on DSM-IV criteria. Questionnaires from Mexico, Argentina and Colombia integrated together around 80% of the sample. The instrument can distinguish between clinical and epidemiological population, females and males, and the severity of hyperactivity symptoms between children and adolescents. It may be a useful sensitive instrument to Latin American cultural expressions.

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