Alterações Fonoaudiológicas no Transtorno de Déficit de Atenção e Hiperatividade: revisão sistemática de literatura

A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder

BACKGROUND

There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD.

METHODS

We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria.

RESULTS

The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed.

CONCLUSIONS

Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.

Speech motor control and orofacial point pressure sensation in adults with ADHD

Attention-Deficit Hyperactivity Disorder (ADHD) is a predominant neurobehavioral disorder of childhood with motor and sensory symptoms often persisting into adulthood. Motor control theories highlight the importance of the bidirectional relationship between sensation and movement for maintaining skilled behaviors like speech. The impact of ADHD on speech in adults has not been well established. The purpose of this study is to assess group differences in quantitative speech and oral somatosensory measures in adults with and without ADHD and to describe the relationship between ADHD symptomology and speech production. A total of 50 adults (18-26 years) were recruited and divided in two groups based on diagnosis: those with (n = 28) and those without (n = 22) ADHD. All participants provided a speech sample to measure articulatory accuracy and speech rate and completed quantitative point-pressure testing using tactile detection and discrimination on bilateral sites on the lower lip and lateral edge of the tongue tip. Independent t-tests corrected for multiple comparisons identified significant group differences using FDR corrected q values in speech production for correct syllables per second and overall speech rate (q<.05). Additionally, there were significant group differences (q<.05) for detection and discrimination threshold estimates at one testing location. Bivariate correlations identified a relationship between several speech measures and self-reported ADHD symptoms such that as symptom severity increased, speech accuracy for correct syllables per second decreased. Young adults with ADHD have subtle differences in speech production compared to non-ADHD control participants. Speech scientists might consider screening for ADHD when collecting normative data samples.

Estrutura e coerência da narrativa oral de crianças com transtorno de déficit de atenção e hiperatividade

RESUMO Objetivo O objetivo do estudo foi caracterizar e comparar o uso de elementos típicos da gramática de história e o nível de coerência global na narrativa oral de crianças com Transtorno de Déficit de Atenção e Hiperatividade à narrativa de crianças sem o transtorno e com desenvolvimento típico. Método Participaram 40 crianças com idade entre 5 e 10 anos, de ambos os sexos, que frequentavam o ensino fundamental, sendo 20 com diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade (Grupo TDAH) e 20 com desenvolvimento típico (Grupo TD). Os participantes de cada grupo eram semelhantes quanto ao sexo, idade cronológica, escolaridade e nível socioeconômico. O livro “Frog Where Are You?” foi utilizado para eliciar a narrativa oral de história, que foi analisada quanto à presença dos principais elementos típicos do esquema de história (personagem, tema/tópico, evento/trama e desfecho) e posteriormente classificada dentre quatro diferentes níveis crescentes de organização, correspondendo ao nível de coerência global da história. Resultados O grupo TDAH apresentou menor pontuação nos elementos estruturais “tema/tópico” e “desfecho” e narrativa com grau de coerência inferior quando comparado ao grupo TD. Conclusão As crianças com TDAH deste estudo apresentaram dificuldades no uso de elementos típicos da gramática de história, principalmente relacionados com a manutenção do tema central e desfecho da história. Tais elementos são considerados fundamentais para a construção do sentido da narrativa, o que justifica os níveis inferiores de coerência encontrados na narrativa oral do grupo TDAH.