hiperactividad en el prescolar

TRASTORNO POR DÉFICIT DE ATENCIÓN E HIPERACTIVIDAD (TDAH)

Hiperactividad en el niño preescolar: descripción clínica
J. Vaquerizo-Madrid a,b
HYPERACTIVITY IN PRESCHOOLERS: A CLINICAL DESCRIPTION
Summary. Introduction. Hyperactivity is a behavioural development disorder characterised by disruptive motor activity that
prevents the individual from establishing adequate social ties and normalcommunication, which are an essential part of a
child's overall development. It is an unspecific symptom of several neurocognitive disorders, the most frequent of which is
attention deficit hyperactivity disorder (ADHD). Patients and methods. We present the results of two investigations. In the first,
a case-control study, we conducted a comparative analysis of how the parents of 50 childrendiagnosed with ADHD remember
the behaviour of their children during the first 12 months of their lives. The symptoms were separated into 3 clinical profiles
(daytime irritability, eating disorders and sleep dysfunctions). Up to 33% of the families reported a history of at least one of
these aspects. 41% of the children were described as being excessively restless, crying a lot or irritability, andbeing easily
startled and very sensitive to noises, and 42.7% had difficulty in getting to sleep or displayed intermittent periods of sleep and
woke up crying. For the second research project, which was to complement the previous one, we designed a survey which was
answered by the parents of 78 patients diagnosed with ADHD. The questionnaire collected information about the first 5 years
oflife in 4 sections (28 items): behaviour up to the age of one year, psychomotor development, development of play, and the
parents' general perception of their child (distracted-inattentive, impulsive, destructive, immature, negativist, oppositional,
other). The Rasch mathematical model was used to obtain the clinical profile of the case mix. Conclusions. The clinical
symptoms appear on acontinuum throughout the early years of the child's life. The results of our experience allow us to
develop a method of clinical examination focused on the evaluation of the individual's development, play, and communication
and socialisation skills which can be used to approach the differential diagnosis of the hyperactive preschooler. [REV
NEUROL 2005; 40 (Supl 1): S25-32]
Key words. Attentiondeficit hyperactivity disorder. Hyperactivity. Preschool age. Rasch model.

INTRODUCCIÓN
Al analizar clínicamente la conducta del lactante y el preescolar
nos asalta una pregunta fundamental: ¿cómo entender la conducta del niño pequeño para poder definir posteriormente el
concepto de hiperactividad? Y, ¿cómo comprender y acotar los
límites entre la normalidad y los comportamientos patológicos?.Darwin [1] planteó que ‘ciertas emociones innatas del lactante se manifiestan a través de sus propias expresiones faciales
y actividades musculares posturales’. Ese planteamiento resulta
esencial para comprender cómo los pequeños expresan sus
emociones y sentimientos antes de comenzar a hablar: a través
de señales corporales, sonidos y expresiones faciales.
El TDAH (trastorno por déficit deatención con hiperactividad) se manifiesta de forma distinta en cada etapa de la vida, en
parte por el particular desarrollo del lóbulo frontal. Antes de los
7 años los niños con TDAH suelen ser especialmente hiperactivos e impulsivos. Después de esa edad la conducta se modula y
comienzan a reflejarse la consecuencias del déficit de atención,
el trastorno del aprendizaje y otros síntomas. Eseimpacto académico se ha calculado que afecta al 70% de los escolares
TDAH de 9 a 10 años de Suecia y a menos del 7% de los niños
sanos. Incluso el 15% del primer grupo necesitará educación
especial individualizada [2]. Sabemos que la mitad de los escolares hiperactivos experimentará además dificultades interpersonales en el ámbito socioescolar.
En este trabajo se plantean las dificultades...