Tdah

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, and beingeasily 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 of life in 4sections (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 a continuum throughoutthe 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. Attention deficit hyperactivitydisorder. 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 de atención con hiperactividad) semanifiesta 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. Ese impacto académico se ha calculado queafecta 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 diagnósticas y los aspectos clínicos del...