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Adult ADHD: Genetic factors, evaluation and pharmacological treatment

Adult ADHD: Genetic factors, assessment and drug treatment. [PhD THESIS] College: UAB. Department / Institute: Department of Psychiatry and Legal Medicine. Direction of thesis: Homes Brugué, Miguel; Cormand Rifà, Bru. Defense Date: 07/03/2009

. Summary:

This thesis focuses on the study of attention deficit disorder (ADHD) in adults. We present a total of four papers published in journals with impact factor. The first two genetic factors, the third on the validation of the questionnaire in English ASRS 1.1 of the WHO screening of ADHD in adults and útlimo on pharmacological treatment of ADHD in this population.

The main conclusions are:

1. The results of association studies of case-control population made a total of 19 genes related to the serotonin neurotransmitter system provide evidence for the contribution of genes DDC (aromatic amino acid decarboxylase) and 5HT2A (receiver Serotonin 2A) with ADHD in both adults and children. Furthermore, the effect is specific 5HT2A gene combined clinical subtype. It has also identified association between the gene MAOB (monoamine oxidase B) and ADHD only in adults, suggesting a role in the persistence of the disorder throughout life. 2. Association studies of case-control studies of 10 genes encoding neurotrophins or their receptors allow us to relate the gene CNTFR (ciliary neurotrophic factor receptor) with ADHD in both adults and children. In addition, the results provide evidence for a specific association between childhood ADHD and genes NTF3 (neurotrophin 3) and NTRK2 (neurotrophic tyrosine kinase receptor type 2), suggesting its potential influence changes in ADHD symptoms throughout life.

3. The questionnaire ASRS v1.1 approved by WHO for use in English presents a psychometric properties, justifying its utility as a tool to detect cases of adult ADHD patients in the outpatient clinical setting. The guest ASRS v1.1 optimizes performance to be scored in a range between 0 and 24 and considering a total cutoff of 12 units. (See blog entry explaining how to do http://tdahenadultos.blogspot.com/2011/04/un-test-para-ver-si-podriamos-tener-un.html )

4. Methylphenidate on both LI and OROS formulations is an effective and safe treatment. LI metilenidato change OROS methylphenidate is safe and effective in adults with ADHD. OROS Methylphenidate treatment was associated with improved compliance and effectiveness. Most patients prefer to OROS methylphenidate treatment. For more information see theses Network: http://www.tdr.cesca.es/

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ADHD

A new study suggests that secondhand smoke increases the risk of disorders mental and behavioral in children, including ADHD.

Summary

Exposure to secondhand smoke is associated with cardiac and respiratory problems in children. In addition, research suggests, breathing secondhand smoke increase the risk of developing mental and behavioral disorders in children, including attention deficit disorder with hyperactivity (ADHD).

team Frank Bandiera, Miller School of Medicine, University of Miami, studied the relationship between secondhand smoke and mental health in a representative sample of the country with nearly 3,000 children between 8 and 15.
study midió el nivel de nicotina en sangre para detectar qué niños habían estado expuestos al humo de segunda mano. A aquellos con los niveles más altos se los consideró fumadores y se los excluyó. Además, el equipo entrevistó a todos los participantes para identificar síntomas mentales o conductuales.

Tras considerar factores como la edad y la etnia, los varones expuestos al humo de segunda mano eran más propensos a tener síntomas de TDAH, depresión, ansiedad y trastornos de conducta que los que no estaban expuestos al humo de cigarrillo. Las niñas expuestas al humo de segunda mano tenían sólo más síntomas de TDAH y de ansiedad que el resto.

Aun así, la cantidad children with most of these diseases diagnosed remained low. While 201 children (7 percent) had sufficient symptoms to be diagnosed as ADHD, only 15 were diagnosed with depression and anxiety disorder to nine participants.

The authors acknowledge that it is difficult to separate the effects of second-hand smoke damage they could cause mothers to smoke during pregnancy. Further studies are needed to determine how exposure to secondhand smoke can affect children's brains.

The authors conclude that it needs to extend the ban on smoking in public places where children and avoid childhood exposure to secondhand smoke at home.

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SNUFF AND A TEST TO SEE IF WE COULD HAVE A DO YOU

's make a sincere exercise of self-analysis? Many of us do not express any of these symptoms:

how I started my previous blog post, with intent to provoke the reader, the possibility

assess if you think it could have undiagnosed adult ADHD.

The statistics visiting the blog, on the first day has had 160 visits, it is clear that readers, if you have been interested in the subject, but not if more than clarify concepts to this blog entry, I could create more questions that clarification is why we repeat and expand

the topic to answer the question 'I might have ADHD?

saw in the previous entry these questions are of the questionnaire (ASRS-V1.1de Composite International Diagnostic Interview WHO © World Health Organization this questionnaire self report is used for screening of adult ADHD I put below:

1. Sometimes I have trouble finishing the projects 2. Sometimes I have trouble sorting office, office 3. Sometimes I have problems remembering appointments (agendas) 4. Often avoids tasks that require thinking a lot 5. Often continually move the hands and feet 6. I often feel compelled to do things: I'm too active

The World Health Organization has performed this test (Kessler et al 2005) and have proposed this test for a escrenig or study to the population to make a diagnosis of suspicion, or rather to assess whether the respondent has criteria for thinking that may have adult ADHD. In 2005 this test was used for a stadium in the e2005 by WHO in a global study, using a long version of the test with 18 questions, which meet the criteria for ADHD symptoms. Therefore I propose that what you do, this test CAARS V 11 6-question short version right now, for this need paper and pencil. As you can see there are six easy questions, asking us about our performance in the last six months.

The responses are marked with a cross in the boxes that you can see, choosing the following options for each question

• NEVER
• RARE TIME
• SOMETIMES
• OFTEN
• VERY OFTEN

Well sit a while and answer the test, the final say as you can evaluate it.

RISK FACTORS THAT MAKE YOU MAY HAVE AN ADHD

ADHD is inherited in an 52%

Research suggest that symptoms of ADHD can persist into adulthood, genetic studies demonstrate a poligentetico locus for ADHD, a study of twins and is amply confirmed the heritability of parents have children, according to Biderman studies the probability of having a child with where the father is ADHD ADHD is 52%,

having a child with ADHD

The probability that a parent with a child with ADHD is 25%. This means that two families with a child with ADHD one of the four parents have ADHD

After the test we continue to work ...., First pair to a diagnosis of ADHD, both in children and in adults, must be by a physician who specializes in the topic, which together with the psychologist's assessment you can tell whether or not you have ADHD and that pattern to continue. In the adult ADHD, their clinical inattention, impulsivity and hyperactivity are present in other psychiatric disorders, or are asking the patient compasándoos desarpecibido pass, which is why I insist that this test can tell if we have criteria to have ADHD, but with this single test can not be diagnosed with ADHD .

Correcting Test

psychometric properties of this test are a sensitivity of 68.7 % and a specificity of 99.5%

As you can see the test has to answer several options which we will give These rating points

• 0 for the option NEVER
• 1 for the option RARELY
• 2 for option SOMETIMES
• option 3 for OFTEN
• of 4 for VERY OFTEN

Now add up the values \u200b\u200bof their responses, for example if the first question you checked with a X "often" have to give a value of 3 points.

As you can see from the above test, the result would be 11 points. Each question as you can see can be assessed from 0 to 4 points for this minimum and maximum values \u200b\u200bof the test range from 0 to 24, taking a cut of 14 points, or if you have a value of 14 points or more, may have ADHD, if you have some high points near 14 and has four answers in the area marked in blue (see test without answering) would be in the same situation. Once again I remind you that measurement is a test to see how likely we are to have ADHD, to reach a diagnosis is to consult with your doctor. Because for the diagnosis of ADHD in adult we evaluate other criteria, such as from the time you have symptoms, it affects two or three different situations, if these clinical signs are normal or may be because of another disorder etc.

I IMPORTANT TEST RATE THIS BE THE POSSIBILITY OF ADHD TO CONFIRM THE DIAGNOSIS HAS TO BE SEEN YOUR DOCTOR

Information general adult ADHD

Currently ADHD psychiatric disorder is considered the most common undiagnosed in adults. Often, adults with ADHD are diagnosed when they're diagnosed their children and ask them if there have been some cases in the family. Then the father or mother of the boy or girl in question is a review of his personal history and identify himself with what now is happening to your child. Even begins to realize he has become accustomed to live with symptoms that make it very difficult day. Until relatively recently, it was thought that children and adolescents suffering from ADHD were improving with age and that on reaching adulthood, the symptoms decrease in intensity to disappear. However, in recent years have come to accept that many adults continue to have symptoms of ADHD, and therefore, are susceptible to interventions that allow them to live better and reduce these symptoms as bothersome. Current research estimates that around 65% of children diagnosed with ADHD may continue into adulthood presenting symptoms such as inattention, impulsivity and hyperactivity that are characteristic of the disorder and are present before 6 years of age in approximately 2-4% of adults. While in childhood, is presented in a ratio of 3 children per child, adults, the relationship is 2 men for every woman with ADHD, or even less.

now know that ADHD has a genetic component that makes it more frequent among children of parents who suffered, so it's easier than adults to be present among the parents of children diagnosed.

If you suspect that you have or may have suffered from ADHD, before going to a specialist should be worded questions such as:

"Do I have obvious difficulty sustaining attention ?

Am I continually moving around?

Do I feel that this since I was a child?

Do I have trouble controlling my temper?

Am often in a bad mood?

Am happens at work ... at home ... on the street, in almost all sites?

My family and friends tell me I have a problem like this? "

If most of these answers are yes, then you should see a specialist, as the diagnosis is not easy. Once you have determined that there are several steps you can take to improve the situation.

Current diagnostic criteria for ADHD in adults are very similar to those of children according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and can be defined as:

Difficulty paying attention to small details or committing careless mistakes at work.

constant movement of hands or feet, or concerns in the chair when it's supposed to sit.

difficulty maintaining sustained attention in tasks or even during their activities leisure.

inability to be quiet in social situations in which it was expected.

feeling that does not listen even when spoken to directly.

Feeling restless and internal unrest.

Difficulty following instructions and complete the work properly. Difficulty

to enjoy quiet activities in their leisure time.

Difficulty organizing their daily life activities (planning and time management).

Feeling constantly moving "As with a motor inside."

avoidance jobs that require sustained mental effort and chronic postponement of tasks ("I'll try later").

Excessive talkativeness. Ease

to lose things.

impulsive responses, even before they finish asking. Excessive

ease of distraction.

Difficulty waiting their turn.

Forgetfulness of daily duties.

constant interruptions and intrusions in conversations and activities of others.

Not all people with ADHD have all the symptoms or the same level of gravity. Each person will have their own symptom profile that will result in a more or less decline in their quality of life, and these factors should be considered when deciding the best treatment for each. Many can lead a happy and productive life.

A general psychiatrist with some experience with the disorder is the ideal expert to conduct a thorough clinical evaluation, which is the definitive method of diagnosis. A psychologist with experience in this field and even a family doctor can guide the problem quite accurately, but ultimately it would be appropriate for a final evaluation by a psychiatrist to confirm the diagnosis. No additional final examinations (or MRI or EEG or blood tests ...), to ensure the diagnosis, because the criteria are purely clinical, as we have seen.

The clinical evaluation includes a comprehensive collection of data from clinical history, with special emphasis on early developmental history of their school curriculum, their careers and their experiences in social relationships, and this usually requires interviews of not less than two hours in a single session or divided into two or three sessions. Ideally, also consults with the person concerned a family member who can provide additional information (either parent or a sibling who can complement the history of early development and corroborate the current perceptions assessed). It is important to take information about how it operates in different environments (which can be oriented in some of the statements included in the traditional diagnostic scales used by specialists.)

As already mentioned in other sections, both the diagnosis and treatment plan should be individualized, taking into account the particular characteristics of each individual, family composition, type of work done and the means at its disposal.

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ADHD ADHD?

's make a "sincere exercise of self-analysis ? Many of us do not express any of these symptoms:

1. Sometimes I have trouble finishing the projects 2. Sometimes I have trouble sorting office, office 3. Sometimes I have problems remembering appointments (agendas) 4. Often avoids tasks that require thinking a lot 5. Often continually move the hands and feet 6. I often feel compelled to do things: I'm too active

These questions are of the questionnaire (ASRS-V1.1de Composite International Diagnostic Interview WHO © World Health Organization This self-report questionnaire used to screen for adult ADHD

Could you have ADHD? Research suggests that symptoms of ADHD can persist into adulthood, genetic studies show poligentetico locus for ADHD, twin study and is amply confirmed the heritability of parents have children, according to studies Bderman the probability of having a child with ADHD when the father is ADHD is 52% and the probability that a parent with a child with ADHD is 25%.

Having ADHD increases the risk of having a significant impact on the child and therefore in the adult, about personal relationships, career and even personal safety of patients with this disorder. Because many times this disorder is not well understood, many people who suffer from undiagnosed or not treated properly and as a result, never reach their full potential. Part of the problem is not that it can be difficult to diagnose ADHD in adults, but perhaps lies in that differential diagnosis is made, or not valued in the adult this possible diagnosis, we are currently talking about many patients, especially them, attending a primary care or psychiatry, a clinical picture of anxiety and depression, and do not improve with usual treatment, the cause is because it is a box anxiety-depression and comorbid box adult ADHD, undiagnosed and therefore untreated. In this situation we have to see if there is a history in childhood and especially if the patient has adult family next or descendants with ADHD. reflection ADHD is a condition of life, not a disease, defined by three clinical dimensions, inattention, hyperactivity and impulsivity and two vital consequences in children, a social area or academic relationship and that in a affect the future employment of the adult area ... If an adult with ADHD is not a patient and not feel sick ... if she really lives in a particular way, and the 'modus vivendi' (genetically determined) may not impact on their adaptation the environment ... it is clear that if, so early diagnosis and proper treatment and the child will avoid coomorbidades in adults prevent school fracacasos labor instability in the adult. so if you have a family history of ADHD or a child with this disorder, do not hesitate to ask for a diagnosis or differential diagnosis if you have anxiety disorder, dysthymic disorder or depression, drug problems and so on. Because we are at a good time to diagnose and treat ADHD.

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Throwing bread to the ducks

Looking bread to the ducks

XLSemanal - 28/3/2011

Arturo Perez Reverte.

I wonder what they're waiting in Spain, with fans who are to run in front of the locomotive, and whoever does not want to run, force by decree. More than a political amateur psychology laboratory and spoken and written language controlled by law should gotearle Fang: more smoke that beating around the bush. More likely that the rock python prone to drift when you shake a cloak from barrier, do not think he ought to think, which is falling and will fall. Good times throwing bread to the ducks.

a couple of months ago, an editorial published gringa politically correct issues of Huckleberry Finn and Tom Sawyer by Mark Twain in which, in addition to tweak crudities of the speech of the time, the deletes the word nigger, which means black. The students were offended, argued the responsible: a teacher in Alabama who, instead of explaining to their students scandalizing Twain's characters use language appropriate to their age and character, "Joseph Conrad novel titled The nigger of the Narcissus- prefers to distort the original text, infiltrating anachronisms that fit in today's prudish ways. Converting natural acid, typical of those times, cloying plum jam for fools and plum.

matches the thing with the French Culture Ministry, mistaking the word mark to celebrate, exclude Louis-Ferdinand Céline of commemoration of this year, when the death marks fifty the writer. That was terrible person, anti-Semite and collaborator with the Gestapo-like, on the other hand, thousands of his compatriots, "and author of a filthy anti-Semitic pamphlet titled Bagatelle pour un massacre, but also one of the great novelists of the twentieth century, the most important in France, with Proust, whose Journey to the End of the night transforms narrative with immense talent, a very muddy squalor in stunning literary beauty. It shows, among other things, that a writer can be twisted special miserable, and that an artist is not required to be socially correct, but can, and should, go into the dark views. In the black hole of the human condition and its many atrocities.

So, all English, heard the patch. Assuming-perhaps a very big "those who are monitoring law to blow our physical and moral knows who is Twain or Celine, imagine the possibilities this offers to touch us a little more balls ... What are trifles such as banning snuff or to criminalize the correct use of English, compared to rewriting, forced by decree, three thousand years of literature, history and philosophy ethically dubious? ... What to expect in English schools as revision or ban does not fit into the forest in Bambi? ... What about those translations of Moby Dick fascists where they kill whales despite international conventions now ...? And with Phileas Fogg, treating his servant Passepartout as if from Jules Verne would not have been here class struggle? ... Are we going to let him go scot-the Marquis de Sade with underage deflowered and sodomized before the existence of the newscast? ... And what about English history and literature? ... How much longer in the bookstores disgusting life of a murderer of men and animals called Pascual Duarte? ... How is it possible that the genocide of Indians Bernal Díaz del Castillo study it in schools? ... And now that everyone is equal before the law and order, why can not be a gentleman as Sancho Panza, Don Quixote, or, better yet, the commoner and Sancho? ... What we hope to convert lo de Fernán González y la batalla de Covarrubias en el tributo de las Cien doncellas y doncellos?... ¿Cómo un machista homófobo y antisemita como Quevedo, que se choteaba de los jorobados y escribió una grosería llamada Gracias y desgracias del ojo del culo, no ha sido apeado todavía de los libros escolares?... En cuanto a la infame frase Viva España, que como todo el mundo sabe fue inventada por Franco en 1936, ¿por qué no se elimina en boca de numerosos personajes de los Episodios nacionales de Galdós, donde afrenta a las múltiples y diversas naciones que, ellas sí, nos conforman y enriquecen?... ¿Y cómo no se ha expurgado todavía El cantar del Cid de las 118 veces que utiliza la palabra Moor, replacing it with English-North African Islam, and seeking the way, not to spoil the verse, rhyme right?

Fortunately not read, or think they do in the future. Relax. The danger is minimal. Thankfully, those pretentious illiterate Gazette owners have not opened a book in his fucking life

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oppositional defiant disorder and ADHD ADHD

oppositional defiant disorder (ODD ) is defined by a recurrent pattern of negative, defiant, disobedient and hostile targets figures authority While TOD has important clinical relevance, relatively few of our knowledge, possibly due to the false belief of considering this disorder as a variant or a manifestation of conduct disorder (CD).

TC t rastorno of conduct is a more serious disorder characterized by repetitive and persistent pattern of conduct that involves a violation of basic rights of others, social norms or laws.

for diagnosis requires the identification of conduct located at least

in three of the following groups:

1) aggression to people or animals;

2) aggressive behaviors that involve destruction of property;

3) fraud or theft;

4) serious violation of the rules. It is necessary that such conduct involving a social misfit, academic or occupational

In the general population, the prevalence of ODD is estimated approximately 2-16 %. About 75% of cases of attention deficit disorder and hyperactivity disorder (ADHD) are associated with other disorders. The most frequent comorbid ODD. This disorder increases the risk of having a TC during adolescence and antisocial personality in adulthood. The concurrence of the TC or DOT has been estimated between 15 and 60% for children with ADHD. Studies indicate that 40-60% of children / adolescents with ADHD have at some point in their lives a TOD. By contrast, if one looks at the problem from the opposite side, it appears that between 69 [6] and 80% of tweens with CT or TOD The criteria for ADHD. However, during adolescence forms 'pure' TC without ADHD are more prevalent.

Behavior problems are, in addition to learning difficulties, the most negative impact of ADHD. is therefore difficult to determine whether the behavior problems represent a comorbid or whether they are one of the main manifestations of ADHD. However, if the spotlight is fixed in the most severe behavioral problems, it is clear that these are distinct disorders, but may be related and mutually reinforcing. This does not contradict the existence of a large symptomatic overlap between the disorders. Regardless of the identification of TOD, most of children with ADHD have behavior problems with peers (classmates, friends ...) or with authority figures (parents, teachers, monitors ...).

Many of these problems stem from the difficulty that children with ADHD management or control of their emotions and activity. When compared the family environment of children with ADHD to children with ADHD more DOT or TC, has shown that in the pure forms of ADHD there is a much lesser degree psychopathology and family stress. Marital separations and family adversity were generally four times more often in cases of association ADHD with ODD or CT. Children with ADHD at 5 years living in family environments with high levels of adversity were five times more likely to become criminals.

An interesting follow-up study of 89 showed that hyperactive children into adulthood 39% of the sample had been any arrests, a figure significantly higher than the control group, which had been arrested only 20%. However, c hen analyzed the characteristics of patients with ADHD who had been arrested, only showed differences from the control group in the association of comorbidity with antisocial personality

Children with ODD are often identified from 2-3 years because of their disruptive behavior. Family disruption caused can be very important and creates serious problems in family life.

The diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) for the TOD are:

A. A pattern of negativistic, hostile and defiant behavior lasting at least six months and which are present four or more of the following behaviors:

1. Gets angry and breaks into tantrums

2. Argues with adults

3. Adults actively defies or refuses to comply with its demands

4. Deliberately annoying others

5. He accuses others of their mistakes or misbehavior

6. Is susceptible or easily annoyed by others

7. Angry and resentful

8. Spiteful or vindictive

B. Clinically significant impairment in social, academic or occupational

C. The behaviors do not occur exclusively during the course of a psychotic disorder or a mood disorder

D. Not met disorder criteria and, if the subject is 18 years or more, nor those of antisocial personality disorder to understand the specific cognitive deficits that underlie ADHD place particular emphasis on executive functions

We have seen that executive functions are also involved in the development of disruptive behavior These include the 'working memory' , self-regulation, cognitive flexibility or ability to change and ability to solve problems through planning and organization. Working memory, occupying a nuclear role in executive functions, possibly because all are linked to this ability, is defined as the individual's ability to keep in mind events or information and operate with it s These deficits in executive functions affect the child's ability to respond adaptively to the environment or the adult guidelines.

The child with difficulties in working memory have difficulty discerning the consequences of a behavior based on past experience. For the same reason, can not anticipate the potential consequences of their actions. These cognitive difficulties the child can contribute to the emergence of a variety of behaviors that are considered oppositional.

BEHAVIORAL INTERVENTION

The first step before the onset of any behavioral intervention is tell whether a child's behavior is part of a normal variant or pathologic should consider taking into account the parameters of persistence, frequency and intensity. Not all children who misbehave are children with ODD .

Most disruptive behaviors occur regularly in children without psychopathology identifiable. In reality, wrongdoing as part of normal childhood behavior. In these cases the approach is simply an educational intervention was determined by the education of families. Of course, certain educational models may be more coherent and effective than others. But in any case, the ability to guide the child toward positive behavior, respectful and responsible is largely determined by the presence or absence of TOD.

conventional educational measures often fail in the DOT with executive dysfunction. The popular approach assumes that children who misbehave are consistent with the following assumptions: they are stubborn, manipulative, coercive, rude, controlling, challenging and seeking attention. Therefore, under this approach, the intervention should seek to show who is boss and what is the correct behavior, so that in this way the child to obey. Obviously, this model does not usually give too optimistic results, since the problem is not a child's ignorance about who the boss or what is good and bad behavior. Behavioral approach: Defiant Children

behavioral conceptualization of the idea that the misconduct is the result of poor parenting (inconsistent, non-contingent). For this reason, the child has learned that oppositional behavior is effective to manipulate the adults in order to capitulate to their wishes.

intervention programs from a behavioral perspective covering all contexts: family, school and the child itself. Most models behavioral intervention based on an analysis of behavior by so-called ABC approach (previous history, behavior, Consequences).

One of the most commonly used from the eighties is the behavioral-based program Defiant Children, adapted by Barkley and translated into Castilian in 1999. This has been one of the most common behavioral treatments used in the treatment of ODD. It provides for the involvement of parents through very structured guidelines systematized. An adaptation, is behavioral intervention program Orjales

Barkley program consists of eight steps which are to improve child's behavior, social relations and the general adaptation at home. This involves the application of certain principles. It tries to get the child to acquire a range of positive behaviors that help them succeed in school and in their social relations. The strategies used are designed to reduce the stubbornness, the behavior oppositional behaviors and increase collaboration. This program is based on the assumption that positive behaviors tend to increase if the child receives a reward or recognition for them, while the negative behaviors tend to die if they are ignored or receive negative consequences. Barkley introduces as a key collaborative effort of parents. The general concepts that underpin the program is summarized as follows:

• Consequences should be immediate


• not wait to repeat misconduct to respond


• Meet the positive behaviors to give immediate reinforcement The more immediate is the consequence of a behavior will more effectively control intervention helps


• The Consequences should be specific


• Both the prize and the punishment should be directed to a specific behavior, never to general aspects


• Punishment should be commensurate with the transgression not so much of impatience or frustration that parents have generated


• Consequences should be consistent Regardless of the setting, the consequence should be the same


• If a behavior is considered intolerable one day must also receive the same consideration other day


• Both father and mother must give the same answer


• Establish an incentive program before using punishment


• action plan prior to possible misconduct


• Anticipate, analyze and, if possible, prevent


• Recognize and accept that the interactions within the family are reciprocal. The parents' behavior is strongly influenced by the child's behavior and vice versa. Attributing blame is unproductive

The methods used to modify behavior are:

- Define a list of behaviors (the priority is compliance).

- A menu of rewards and punishments (ignore inappropriate behavior, time out).

- A token system.

The program requires eight steps to follow weekly intervals preferably are

• Learn to give your child positive attention


• Use the power of their attention to obey get


• effectively orders


• Teach your child not to interrupt activities


• home Set a reward system tabbed


• Learn to punish bad behavior constructively


• Expand the use of time out


• Learn to control your child in public places

is also important to monitor the effectiveness of parental interventions. For this purpose you can use a chart like the one shown in Fig. Cognitive approach: Collaborative Problem Solving (CPS) The CPS model has been developed by Greene

Most of the disruptive behaviors can be conceptualized as inflexible and / or explosive. Inflexible-explosive child has characteristics that are

• Difficulty controlling emotions


• Very low threshold for frustration


• Very low tolerance to frustration


• Low capacity for flexibility and adaptability


• tendency to think in a very radical black or white only


• Persistence of inflexibility and poor response to frustration


• despite a high level of motivation


• Episodes explosives for trivial reasons


• While other children may be more irritable when tired or hungry, inflexible-explosive children can be completely blocked in these circumstances

The PSC based on the idea that the child's behavior is due to a delay in the development of specific cognitive abilities (executive skills, skills in language processing, ability to regulate emotions, cognitive flexibility and social skills) or hard to implement these skills when necessary. Therefore, the behavioral problem must be viewed as a learning disorder focused on cognitive dysfunction. It is, therefore, closely linked to the internal language, emotional control, motivation and, ultimately, learning behavior.

Therefore, this approach focuses more on cognition in behavior, it is say, the approach to conduct disorder based on the premise that the child can do things correctly if you have the necessary skills. This model modifies the classical view according to which the child can do things the right way if he wants.

The fact the emphasis in these pathways allows the adult to understand that the explosive behavior is not intentional, goal-directed, manipulative or intended to get attention. Therefore, to identify the cognitive skills that need training.

is also based on the interrelationship between the child and adult. It is emphasized that the regulation of emotions, frustration tolerance and problem solving by the child does not develop independently, but depend, in large part on the way and the models used by adults to teach children. This model believes that the outcome of the behavior depends on the degree of compatibility between the characteristics of child and adult.

From this perspective, be considered oppositional behavior influenced by a conflict between parents and children, within which the characteristics of the interaction of one party (eg the child) are valued negatively by the second component interaction (the father), which contributes to maladaptive behaviors.

The compatibility between the characteristics of each component of the relationship has important implications in order to reduce oppositional behaviors. Therefore, the first objective is to resolve those points observed inconsistencies between the two parties. Given that a basic skills required to regulate the conduct, it is understandable that behavioral problems are observed in situations as diverse as:

• attention deficit disorder and hyperactivity


• nonverbal learning disorder


• language disorders


• autistic spectrum disorders



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in all of which can be affected the cognitive functions involved in behavior.

An example to understand how some of the dysfunctions displayed modulates the behavior is reflected in the example of Charlie, age 8 (ADHD and ODD):

- Father: Turn off the TV and come eat.

- Charlie: No, not yet completed the drawings.

- P: Turn off the TV and come eat. Next!

- C: I can not.

- Q: What does it mean I can not? The food is getting cold, come quickly!

- C: Hush, do not listen.

- Q: I've said this a million times ... Why not do what I say?, Why are you so angry?

- C: I do not know ...!!!

Regardless of what might happen from now on, we can stop Carlitos to understand what would explain if I had some basic problems which prevent it from, 'Look, Dad and Mom, I have this little problem.

constantly are asking me to go from A to B and I'm not very good at this. When you ask these changes, I start to feel frustrated. And when I start frustrated, I have trouble thinking clearly and I'm still so frustrated. Then you become crazy. I start doing and saying things that I would not do or say. Ye enfadáis and chastise me, and that makes me explode. Then, when everything is over, I begin to think clearly and I ask forgiveness. I know that you do not like, but it's fun for me either. "

When you see the frustration in a given situation and this can lead to explosive behavior, start a therapeutic approach. Once you know when the child is explosive, you have to find a cognitive explanation of what the functions do not have. explosive behavior occurs when the cognitive demands exceed the child's ability to respond adaptively . If you know what triggers this reaction, helps adults understand the child when an explosive acts, not intentional or manipulative. Thus, while cognitive skills are recognized, they have to train

addition to understanding the underlying deficit in disruptive behavior, the implementation of CPS requires placing each of the behaviors of the three categories listed below:

Behavior
basket

A

• risk of hurting

Assault
• another


• Risk of breaking or damaging


• Attacking people's property (Examples: Paste , steal)

Behavior basket B

• behaviors without risk to himself or others, but they generate major problems in family dynamics (Examples: refusing to go with the family or an important event, excessive demands )

Behavior

basket C

• misconduct that do not generate risks for themselves and do not generate important problems in family dynamics (Examples: walking barefoot, swearing, not wanting to eat lentils, no follow the standard of 'civility', finger foods, leaving the table)

educational purposes bearing the title of 'basket' for each of the three categories.

The performance of the parents must be determined by the rating to be established for each improper conduct. If the conduct is for the drum A, the priority is to curb the behavior, otherwise it could lead to unacceptable consequences. Therefore, in this situation is not discussed, not argued, no yelling, just repressed adult behavior and imposes its authority. It is certainly possible that the child does not improve their basic skills, but has avoided damage.

behaviors basket

C are the most frequent and, therefore, the most common cause of domestic disputes. The popular belief is that if parents do not intervene, they lose their authority and the child each time is worse educated, spoiled and rebellious. Certainly parents will lose their authority if they try to suppress the behavior and fail. Conversely, if parents get curb the behavior, they may trigger an extremely stressful for families and children, without necessarily have improved the cognitive skills underlying the problem. It's hardly bearable in a family setting a daily struggle to get the child to permanently control situations that are very difficult because of their low ability to regulate behavior (flexibility, impulsivity, low frustration tolerance, etc.).. Appropriate in situations C is' so far no action. " Not prohibit, without thereby accepting that such behavior is appropriate. Thus, the authority or parental influence is not affected, since there is no violation of the rules.

basket B behaviors are most important to influence the improvement of basic skills. From these situations it is intended that the child is able to modulate their behavior based on reflection, flexibility and restraint. But This will require certain steps to achieve these objectives.

The initial steps are to show empathy, define the problem and invite the child to find a solution acceptable to him and the adult, in which both must compromise. Empathy makes it easier for children and adults remain calm. The definition of the problem ensures that the concerns of the child is on the table (if you do not know what the concern, we find out). Sometimes it is necessary as an additional reassurance to stay calm. It allows the child to detect that we are doing something 'with it' rather than 'a him. " Let's see how we can solve this problem. It must give the child the first opportunity to generate solutions. Solutions are not really bad, just not realistic solutions mutually satisfactory or not. Therefore, it must reach an ingenious solution, ie any solution in which parents and child agree, besides being a realistic and mutually satisfactory alternative. In reality, what matters is not who 'wins', but the process itself. Resume

whole process. Structure of the Collaborative Problem Solving.

Basic principle :

behavior is a cognitive function. Behavior problems are due to delayed development of the necessary functions to be flexible and tolerate frustration

All behavior can

Basket A: adult imposition

Basket B: for jointly solve the problem states:

• Empathy


• Define the problem


• Invitation

basket C: ignore certain behaviors

The CPS aims to:

- Understand the executive or emotional deficits that underlie each of the oppositional behavior. The adult, guided by the therapist should be aware of the cognitive mechanisms that cause the child to react in a certain way.

- to help adults identify and use three basic strategies to improve the skills required by the child to "learn" the correct behavior.

- Helping adults to recognize the impact of each of the three strategies in their interactions with the child.

- Help the child and adult to become experts in the CPS as a way to resolve disagreements and reduce potential conflict situations, so as to improve the compatibility between them.

This approach is a multifaceted psychosocial model of treatment which aims to teach the cognitive deficit with these children, which is part of the idea that many TOD have their origin in a

executive dysfunction. The main objective of this program is to assist adults to work effectively with the child to solve those problems or situations that trigger the explosive behavior and to provide a space which, through empathy, negotiation and language, is conducive to joint resolution of the situation problematic.

Finally, we must take into account, as stated by Greene [19], that 'the major premise of this approach is to consider that the child chooses to be explosive or go against the rules

-in the same way a child does not choose to have difficulties in literacy, but has a delay on these skills that are crucial to be flexible and tolerating frustration. "

DRUG INTERVENTION

Drugs can be helpful, since functionalism that affect nervous system related to disruptive behavior. The drugs most commonly used are:

- selective inhibitors serotonin reuptake (sertraline, fluoxetine, paroxetine). Indicated when there is an important component of anxiety or obsessive behavior.

- Stimulants, selective inhibitors of dopamine reuptake (methylphenidate). Indicated when comorbidity with ADHD and behavioral problems related to impulsivity, self-control or difficulty processing information from the environment. You must use methylphenidate sustained action to obviate the rebound effect by itself can worsen the behavior in the family. Must also do weekend breaks or holidays therapeutic.

- reuptake inhibitors of noradrenaline (atomoxetine). also indicated for ADHD, is indicated when there is an anxiety component.

- atypical antipsychotics (risperidone, aripiprazole) . Only the first is authorized for use in children and is an indication in sheet behavior problems in children with autism spectrum disorder. Can be used in cases of aggressive behavior of a serious nature. Moreover, risperidone is an excellent drug for the control of tics.

The optimal approach will be that a reasonable and sensible to contribute, either alone or together, behavioral techniques and the prescription of the drug or drugs suitable.

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Wild Silk. Eloy Tizon. ISLAND

"... put the bag upside down and is a treasure chest laughing off a shower of brilliant clips and coins and beads, I felt the closeness of an explosion orgiastic.

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IGNORED

IGNORED ISLAND


I like that ignored
island cradled by trees
Late
-
juicy in the center of a sea

I do not understand, surrounded

NOTHING

only one.

There are birds on my island and gleaming

angels painted by artists,

There are beasts that look at me sweetly,

and poisonous flowers.

poets

There are streams and inner voices from

dormant volcanoes.


There may be some treasure


Deep inside my womb.
Who

know if I have my mountain
diamond,

or just a small piece of coal!

forest trees

my island is you, my verses. How well


sometimes you sound like if the great musician


wind when your turn comes from the sea that surrounds me



to this island that I am, if someone comes,

That is something I desire to
verses
-springs and waterfalls turned

peace is what I have.

a name I climb

soul and does not want to cry my secrets;

And I'm happy land, "I have art If

happy and poor at the same time.



It is my pleasure to be ignored, ignored Island

eternal ocean.

In the center of the world without a book,

know everything, because it came a missionary

And left me for life
Cruz
-for death left a mystery.



(De Isla Ignored. Torremozas Editions, 1999)

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The Elegance of the Hedgehog. Muriel Barbery

recognize that this curious book, which belongs to the 2010 reading, and I find myself rereading some of your pages , I never would come to its interior, except that it was an unexpected gift: a friend, whom we had previously given him, after reading it, was thrilled and bought several copies and gave them to us on his birthday.

Apparently, from time to time adults take the time to sit and contemplate the disaster of their lives. So grieve without understanding and, as flies that crash again and again against the same crystal, are concerned, suffer, eat, grieve and wonder about the gear that has led them where they do not want to go .

The Elegance of the Hedgehog is not a masterpiece nor a masterpiece, but it draws the reader into its pages can breathe peace, tranquility, there are jazz and jasmine tea with camellias and Russian writers.

This morning, while listening to the radio station France Inter, I have been surprised to discover that I am not one who thought he was.

How much better would be if we shared each other our insecurity, if all together we shall go in ourselves to say that the green beans and vitamin C, Although the animal feed are not lifesaving or sustain the soul.

Where is beauty? What great things, like others, are doomed to die, or in the small, unpretentious, crimping know the instant a gem of infinity?

The tea ritual, the precise repetition of the same gestures and the same taste, the sensations access to simple, authentic and refined, the license granted to everyone, without much effort, to become an aristocrat taste, because tea is the drink of the rich as it is for the poor, the tea ritual, then, has the extraordinary virtue of introducing into the absurdity of our lives a serene harmony gap. Yes, the universe conspires to emptiness, lost souls mourn the beauty around us insignificance. Then, take a cup of tea. There is silence, out hear the wind blowing, rustling the leaves fall and fly away, the cat, bathed in warm light. And each sip, the time is sublime.

But every morning, although there was an evening session and Solola have slept two hours, gets up at six and read su periódico tomándose un café bien cargado.

(...) mamá se pidió un té de jazmín y me dio a probar. Lo encontré tan rico, tan yo misma, que esta mañana he declarado que es lo que quería tomar siempre de desayuno a partir de ahora.

La camelia sobre el musgo del templo, el violeta de los montes de Kyoto, una taza de porcelana azul, esta eclosión de la belleza en el corazón mismo de las pasiones efímeras, ¿no es acaso a lo que todos aspiramos? ¿Y lo que nosotros, civilizaciones occidentales, no sabemos alcanzar?. La contemplación de la eternidad en el movimiento mismo de la vida.

I am very camellia on moss

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Tiff cats. Madrid 1936. Eduardo Mendoza

An Englishman named Anthony Whitelands arrives aboard a train to Madrid turbulent spring of 1936. Must authenticate an unknown box owned by a friend of Jose Antonio Primo de Rivera, whose economic value can be decisive for the crucial political change in Spain's history. Turbulent love affairs with women from different social classes distract the art critic before he had time to gauge how they are multiplying their persecutors, police, diplomats, politicians and spies in an atmosphere of conspiracy and riot.

The exceptional narrative skills of Eduardo Mendoza combine perfectly the seriousness of the events narrated in the presence, very subtle, of his famous sense of humor, because every tragedy is also part of the human comedy.

All of the above is as shown on the cover of the first edition of Tiff Gatos. Madrid 1936 by Eduardo Mendoza.

Mendoza, who read from the 15 years after giving me my cousin MD The Labyrinth of olives, a book that I liked and paid much . In this first book was followed by The mystery of the haunted vault, this time the book was required reading for my sister and followed, also my sister's required reading in high school, no Gurb news.

RBA in a library when edited cheaply and better than the current format, I did with the city of wonder. Upon leaving the opposition, one day I got lost and the savings he had invested it in a library that no longer exists, a light comedy and the truth about the case Savolta.

The last, The Mystery of the ladies room, Maurice or the last elections, three lives of saints, the amazing journey of Pomponio Flato ...

Forgot

a book? Maybe.

This does not mean that everyone that my cousin writer I read give me like a religion, Isabel Allende did not like.

Whitelands

Anthony, 34, reaches Spain in March 1936 to appraise the artwork of Don Alvaro del Valle and Salomero, Duke of Igualada.

Anthony zascandilea in Madrid, sometimes lost, others fled, most of the time clueless as soon as hurd known behind his back.

The art collection is not of great value pricing and causes disappointment in Anthony, who, skilled in the English Golden Age, is to nineteenth century paintings. However, the lovely Paquita, he has kept a surprise.

In the basement of the family mansion Valley lies a Velazquez that he has never seen the light and it never will. Here I would say as in the previous post, I refer to unravel the mystery out of reading the book, but the mystery was already solved by El Pais, in an article entitled A painting of Goya by José Carlos Mainer.

Goya Pictures do not appear either in the book. I do not know the title, it will be for the shootings.

Made in

missing from the book's non-participation of artists of the time and who attended the Madrid of 1933. Lorca maybe not, because from 1933 to 1934 was in New York. This poet is mentioned only when, after visiting a tavern where rocks come bullfighting, Anthony remembers seeing Ignacio Sánchez Mejías in one of his previous visits to the city and after having read the famous poem by Lorca, translated into English lose passion and interest.

not proliferate over the politicians of that era. José Antonio Primo de Rivera, Marquis of Stella, a friend of the family del Valle y enamorado de la hija mayor, Paquita; cuyos amores no llegaron a término porque Don Alvaro, imaginando el futuro del apuesto joven y de la propia España, se opuso. 

Queipo de Llano y Francisco Franco, quienes acuden al palacete de Don Álvaro, y cuyas identidades tratan de ser ocultadas. 

Azaña. 

Niceto Alcalá-Zamora. 

Como ya afirmó tras ganar el Planeta Eduardo Mendoza, Riña de gatos no es una novela histórica. Y todo ello a pesar de los fantásticos art and political dialogues that take place throughout the novel.

The book opens and closes with the painting The Death of Actaeon, a metaphor for what the children in Spain will themselves: eat them alive.

On the train that Anthony brings to Spain, as a prelude to the riots and quarrels in the streets, witness the following conversation between a Republican and a priest, rather curious:

"Republican said the priest with his thumb and said

- Here, without going any further, you have an example of what he was saying. Until four days ago, they did and deshacíann at will. Now living on borrowed time and that we're running out of hand the boinazo. Or not, father?

The priest clasped her hands in her lap and stared fixedly at the passenger.

- laughs best who laughs last, undaunted answered. ;

English left them locked in a duel of words and paraphrase. Slow and monotonous, the train continued its way through a desolate plain, leaving a thick column of smoke into the air and crystal meseteño winter. Before going back to sleep he heard the Republican argument:

- Look, father, people do not burn churches and monasteries without rhyme or reason. They have never burned a tavern, a hospital or a bullring. If the whole of Spain the people choose to burn churches with the cost of lighting, there must be. "