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Vieira Neto E, Maia Filho HDS, Monteiro CB, Carvalho LDM, da Cruz TS, de Barros BV, Ribeiro MG. Behavioral and Emotional Problems in Early-Treated Brazilian Children and Adolescents with Phenylketonuria. Med Sci Monit 2018; 24:7759-7769. [PMID: 30375370 PMCID: PMC6354646 DOI: 10.12659/msm.909146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Phenylketonuria (PKU) is an inborn error of metabolism caused by mutations in the phenylalanine hydroxylase (PAH) gene. When untreated, PKU leads to a significant intellectual deficiency. Although early initiation of dietary therapy allows normal cognitive development, low adherence to treatment may result in neuropsychological deficits, including attention problems. This study was performed to evaluate emotional and behavioral problems in early-treated children and adolescents with PKU using the Child Behavior Checklist – CBCL/6–18 answered by parents. Material/Methods The study included 36 PKU patients. The mean scores of internalizing, externalizing, and total problems, syndrome scales, and DSM-IV-oriented scales of patients were compared with those of controls. An analysis to evaluate the importance of adherence to treatment and presence of intellectual disability was also performed. Results There were no significant differences between patients and controls for almost all CBCL/6–18 scales, with the exception of the Attention Problem Scale – CBCL-APS. The mean (±SD) of the CBCL-APS scores of patients (7.86±5.33) was considerably higher than the mean of the controls (6.07±4.37; p=0.016), but not different from the mean of a matched control subsample (6.69±4.46; p=0.316). The difference between the mean of the scores of DSM-IV/ADHD scale of patients (6.72±4.07) and controls (5.73±3.56; p=0.102) was not significant. Non-adherence to treatment and intellectual disability had a negative impact on both CBCL-APS and DSM-IV/ADHD scale scores. Conclusions Our findings indicate a significant prevalence of parents’ complaints of attention problems and hyperactivity in non-adherent to treatment and intellectually low performing patients with PKU.
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Affiliation(s)
- Eduardo Vieira Neto
- Institute of Childcare and Pediatrics "Martagão Gesteira", Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Healthcare Monitoring Department, Brazilian National Agency of Private Health Insurance and Plans, Rio de Janeiro, RJ, Brazil
| | - Heber de Souza Maia Filho
- Department of Maternal and Child Health, College of Medicine, "Fluminense" Federal University, Niteroi, RJ, Brazil
| | - Claudia Braga Monteiro
- Center of Adolescent Health Studies (NESA), Rio de Janeiro State University, Rio de Janeiro, RJ,, Brazil
| | - Lilian de Mattos Carvalho
- Newborn Screening Unit, State Institute of Diabetes and Endocrinology "Luiz Capriglione", Rio de Janeiro, RJ, Brazil
| | - Thuane Silva da Cruz
- Institute of Childcare and Pediatrics "Martagão Gesteira", Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Belisia Vasconcelos de Barros
- Institute of Childcare and Pediatrics "Martagão Gesteira", Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcia Gonçalves Ribeiro
- Institute of Childcare and Pediatrics "Martagão Gesteira", Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Downes M, Bathelt J, De Haan M. Event-related potential measures of executive functioning from preschool to adolescence. Dev Med Child Neurol 2017; 59:581-590. [PMID: 28164277 DOI: 10.1111/dmcn.13395] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/20/2022]
Abstract
Executive functions are a collection of cognitive abilities necessary for behavioural control and regulation, and are important for school success. Executive deficits are common across acquired and developmental disorders in childhood and beyond. This review aims to summarize how studies using event-related potential (ERP) can provide insight into mechanisms underpinning how executive functions develop in children from preschool to adolescence. We specifically focus on ERP components that are considered to be well-established markers of executive functioning, including the ability to resist distraction (inhibition, N200), hold scenes in mind (visuospatial working memory, contralateral delay activity), attend to specific stimuli (information processing, P300), follow rules (response monitoring, error-related negativity [ERN], and error-related positivity [Pe]), and adjust to feedback (outcome monitoring, feedback-related negativity). All of these components show developmental changes from preschool to adolescence, in line with behavioural and neuroimaging findings. These ERP markers also show altered developmental trajectories in the context of atypical executive functions. As an example, deficits in executive function are prominently implicated in attention-deficit-hyperactivity disorder. Therefore, this review highlights ERP studies that have investigated the above ERP components in this population. Overall, ERPs provide a useful marker for the development and dysfunction of executive skills, and provide insight into their neurophysiological basis.
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Affiliation(s)
- Michelle Downes
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Joe Bathelt
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Michelle De Haan
- Developmental Neurosciences Programme, University College London, London, UK
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Bruckmann M, Santos Filha VAVD, Biaggio EPV, Garcia MV. Aplicabilidade do mismatch negativity em crianças e adolescentes: uma revisão descritiva. REVISTA CEFAC 2016. [DOI: 10.1590/1982-0216201618423415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O Mismatch Negativity (MMN) é um potencial cortical que ocorre em resposta a uma mudança de um estímulo acústico em meio a uma sequência de repetidos estímulos, o que reflete a capacidade do cérebro em discriminar o som de modo passivo, ou seja, sem a necessidade de atenção do indivíduo ao estímulo sonoro. Diante disso, o objetivo deste estudo foi realizar uma revisão descritiva sobre o MMN, a fim de identificar a sua aplicabilidade em crianças e adolescentes nos últimos cinco anos. Para isso, realizou-se uma busca nas bases de dados Lilacs, SciELO, Medline e Pubmed utilizando os seguintes descritores: córtex auditivo, eletrofisiologia, potenciais evocados auditivos e as palavras Mismacth e Negativity. Nesta revisão, foram encontrados 14 estudos que avaliaram crianças e/ou adolescentes com dificuldade de articulação na fala, distúrbio específico de linguagem, transtorno do processamento auditivo, Transtorno do Déficit de Atenção e Hiperatividade (TDAH), dislexia, autismo, risco para esquizofrenia, psicose, amusia, fenilcetonúria e atenção seletiva. Foi possível, assim, realizar a revisão descritiva sobre a aplicação do MMN em crianças e adolescentes, concluindo-se que, nos últimos cinco anos, houve uma produção considerável de artigos sobre o tema, embora no Brasil a presença de estudos a esse respeito ainda seja escassa. Nesse sentido, apesar de existir uma variedade de aplicações para o MMN, no que diz respeito à população brasileira, necessita-se ainda de evidências científicas que assegurem o efeito deste potencial nas diferentes faixas etárias. Verificou-se, também, que a busca por estudos sobre MMN nas bases de dados citadas pode ser realizada apenas utilizando as palavras Mismacth e Negativity.
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Wyrwich KW, Shaffer S, Gries K, Auguste P, Mooney KH, Prasad S, Bilder DA. Content Validity of the ADHD Rating Scale (ADHD RS-IV) and Adult ADHD Self-Report Scale (ASRS) in Phenylketonuria. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816639316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Deborah A. Bilder
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
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Wyrwich KW, Auguste P, Yu R, Zhang C, Dewees B, Winslow B, Yu S, Merilainen M, Prasad S. Evaluation of Neuropsychiatric Function in Phenylketonuria: Psychometric Properties of the ADHD Rating Scale-IV and Adult ADHD Self-Report Scale Inattention Subscale in Phenylketonuria. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:404-412. [PMID: 26091594 DOI: 10.1016/j.jval.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/18/2014] [Accepted: 01/26/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Previous qualitative research among adults and parents of children with phenylketonuria (PKU) has identified inattention as an important psychiatric aspect of this condition. The parent-reported ADHD Rating Scale-IV (ADHD RS-IV) and the Adult ADHD Self-Report Scale (ASRS) have been validated for measuring inattention symptoms in persons with attention-deficit/hyperactivity disorder (ADHD); however, their psychometric attributes for measuring PKU-related inattention have not been established. OBJECTIVE The primary objective of this investigation was to demonstrate the reliability, validity, and responsiveness of the ADHD RS-IV and ASRS inattention symptoms subscales in a randomized controlled trial of patients with PKU aged 8 years or older. METHODS A post hoc analysis investigated the psychometric properties (Rasch model fit, reliability, construct validity, and responsiveness) of the ADHD RS-IV and ASRS inattention subscales using data from a phase 3b, double-blind, placebo-controlled clinical trial in those with PKU aged 8 years or older. RESULTS The Rasch results revealed good model fit, and reliability analyses revealed strong internal consistency reliability (α ≥ 0.87) and reproducibility (intraclass correlation coefficient ≥ 0.87) for both measures. Both inattention measures demonstrated the ability to discriminate between known groups (P < 0.001) created by the Clinical Global Impression-Severity scale. Correlations between the ADHD RS-IV and the ASRS with the Clinical Global Impression-Severity scale and the age-appropriate Behavior Rating Inventory of Executive Function Working Memory subscale were consistently moderate to strong (r ≥ 0.56). Similarly, results of the change score correlations were of moderate magnitude (r ≥ 0.43) for both measures when compared with changes over time in Behavior Rating Inventory of Executive Function Working Memory subscales. CONCLUSIONS These findings of reliability, validity, and responsiveness of both the ADHD RS-IV and the ASRS inattention scales, in addition to content validation results, support their use for the assessment of inattention symptoms among persons with PKU aged 8 years or older in both clinical and research settings.
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Affiliation(s)
| | | | - Ren Yu
- Evidera, Bethesda, MD, USA
| | | | | | | | - Shui Yu
- BioMarin Pharmaceutical, Inc., Novato, CA, USA
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Leuzzi V, Mannarelli D, Manti F, Pauletti C, Locuratolo N, Carducci C, Carducci C, Vanacore N, Fattapposta F. Age-related psychophysiological vulnerability to phenylalanine in phenylketonuria. Front Pediatr 2014; 2:57. [PMID: 25003100 PMCID: PMC4066367 DOI: 10.3389/fped.2014.00057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/23/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Phenylketonuria (PKU) is caused by the inherited defect of the phenylalanine hydroxylase enzyme, which converts phenylalanine (Phe) into tyrosine (Tyr). Neonatal screening programs and early treatment have radically changed the natural history of PKU. Nevertheless, an increased risk of neurocognitive and psychiatric problems in adulthood remains a challenging aspect of the disease. In order to assess the vulnerability of complex skills to Phe, we explored: (a) the effect of a rapid increase in blood Phe levels on event-related potentials (ERP) in PKU subjects during their second decade of life; (b) the association (if existing) between psychophysiological and neurocognitive features. METHODS Seventeen early-treated PKU subjects, aged 10-20, underwent ERP [mismatch negativity, auditory P300, contingent negative variation (CNV), and Intensity Dependence of Auditory Evoked Potentials] recording before and 2 h after an oral loading of Phe. Neurocognitive functioning, historical and concurrent biochemical values of blood Phe, Tyr, and Phe/Tyr ratio, were all included in the statistical analysis. RESULTS Event-related potential components were normally detected in all the subjects. In subjects younger than 13 CNV amplitude, W2-CNV area, P3b latency, and reaction times in motor responses were negatively influenced by Phe-loading. Independently from the psychophysiological vulnerability, some neurocognitive skills were more impaired in younger patients. No correlation was found between biochemical alterations and neurocognitive and psychophysiological findings. CONCLUSION The vulnerability of the emerging neurocognitive functions to Phe suggests a strict metabolic control in adolescents affected by PKU and a neurodevelopmental approach in the study of neurocognitive outcome in PKU.
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Affiliation(s)
- Vincenzo Leuzzi
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza Università di Roma , Rome , Italy
| | - Daniela Mannarelli
- Department of Neurology and Psychiatry, Sapienza Università di Roma , Rome , Italy
| | - Filippo Manti
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza Università di Roma , Rome , Italy
| | - Caterina Pauletti
- Department of Neurology and Psychiatry, Sapienza Università di Roma , Rome , Italy
| | - Nicoletta Locuratolo
- Department of Neurology and Psychiatry, Sapienza Università di Roma , Rome , Italy
| | - Carla Carducci
- Department of Experimental Medicine, Sapienza Università di Roma , Rome , Italy
| | - Claudia Carducci
- Department of Molecular Medicine, Sapienza Università di Roma , Rome , Italy
| | - Nicola Vanacore
- Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Istituto Superiore di Sanità , Rome , Italy
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