The International ADHD in Substance Use Disorders Prevalence (IASP) study: background, methods and study population

Attention deficit/hyperactivity disorder (ADHD) is an increasingly recognized comorbid condition in subjects with substance use disorders (SUDs). This paper describes the methods and study population of the International ADHD in Substance Use Disorders Prevalence (IASP) study. Objectives of the IASP are to determine the prevalence of ADHD in adult treatment seeking patients with SUD in different countries and SUD populations, determine the reliability and validity of the Adult ADHD Self-report Scale V 1.1 (ASRS) as ADHD screening instrument in SUD populations, investigate the comorbidity profile of SUD patients with and without ADHD, compare risk factors and protective factors in SUD patients with and without a comorbid diagnosis of ADHD, and increase our knowledge about the relationship between ADHD and the onset and course of SUD. In this cross-sectional, multi-centre two stage study, subjects were screened for ADHD with the ASRS, diagnosed with the Conner's Adult ADHD Diagnostic Interview for DSM-IV (CAADID), and evaluated for SUD, major depression, bipolar disorder, anti social personality disorder and borderline personality disorder. Three thousand five hundred and fifty-eight subjects from 10 countries were included. Of these 40.9% screened positive for ADHD. This is the largest international study on this population evaluating ADHD and comorbid disorders.

Empirische Evidenz der INT

Die INT wurde in einer randomisierten, internationalen Multicenterstudie in der Schweiz, Deutschland und Österreich evaluiert und vom Schweizerischen Nationalfonds unterstützt (Projektnummer 3200 B0‑108133). Insgesamt nahmen 169 Personen an der Studie teil. Personen wurden in die Studie eingeschlossen, wenn sie die Diagnosekriterien für eine schizophrene oder schizoaffektive Erkrankung gemäß ICD‑10 oder DSM-IV‑R erfüllten, in ambulanter oder teilstationärer Behandlung waren, ein Alter zwischen 18 und 50 Jahren sowie eine Krankheitsdauer von mehr als zwei Jahren aufwiesen und einen Intelligenzquotienten über 80 erreichten (Reduzierter Wechsler Intelligenztest, WIP). Ausschlusskriterien waren eine akute psychotische Episode, eine primäre Substanzabhängigkeit sowie eine hirnorganische Erkrankung.

Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features.

Bipolar mixed states combine depressive and manic features, presenting diagnostic and treatment challenges and reflecting a severe form of the illness. DSM-IV criteria for a mixed state require combined depressive and manic syndromes, but a range of mixed states has been described clinically. A unified definition of mixed states would be valuable in understanding their diagnosis, mechanism and treatment implications. We investigated the manner in which depressive and manic features combine to produce a continuum of mixed states. In 88 subjects with bipolar disorder (DSM-IV), we evaluated symptoms and clinical characteristics, and compared depression-based, mania-based, and other published definitions of mixed states. We developed an index of the extent to which symptoms were mixed (Mixed State Index, MSI) and characterized its relationship to clinical state. Predominately manic and depressive mixed states using criteria from recent literature, as well as Kraepelinian mixed states, had similar symptoms and MSI scores. Anxiety correlated significantly with depression scores in manic subjects and with mania scores in depressed subjects. Discriminant function analysis associated mixed states with symptoms of hyperactivity and negative cognitions, but not subjective depressive or elevated mood. High MSI scores were associated with severe course of illness. For depressive or manic episodes, characteristics of mixed states emerged with two symptoms of the opposite polarity. This was a cross-sectional study. Mixed states appear to be a continuum. An index of the degree to which depressive and manic symptoms combine appears useful in identifying and characterizing mixed states. We propose a depressive or manic episode with three or more symptoms of the opposite polarity as a parsimonious definition of a mixed state.

Adolescence and parental history of alcoholism: insights from the sleep EEG

BACKGROUND Disrupted sleep is a common complaint of individuals with alcohol use disorder and in abstinent alcoholics. Furthermore, among recovering alcoholics, poor sleep predicts relapse to drinking. Whether disrupted sleep in these populations results from prolonged alcohol use or precedes the onset of drinking is not known. The aim of this study was to examine the sleep electroencephalogram (EEG) in alcohol-naïve, parental history positive (PH+), and negative (PH-) boys and girls. METHODS All-night sleep EEG recordings in 2 longitudinal cohorts (child and teen) followed at 1.5 to 3 year intervals were analyzed. The child and teen participants were 9/10 and 15/16 years old at the initial assessment, respectively. Parental history status was classified by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria applied to structured interviews (DIS-IV) resulting in 14 PH- and 10 PH+ children and 14 PH- and 10 PH+ teens. Sleep data were visually scored in 30-second epochs using standard criteria. Power spectra were calculated for EEG derivations C3/A2, C4/A1, O2/A1, O1/A2 for nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. RESULTS We found no difference between PH+ and PH- individuals in either cohort for any visually scored sleep stage variable. Spectral power declined in both cohorts across assessments for NREM and REM sleep in all derivations and across frequencies independent of parental history status. With regard to parental history, NREM sleep EEG power was lower for the delta band in PH+ teens at both assessments for the central derivations. Furthermore, power in the sigma band for the right occipital derivation in both NREM and REM sleep was lower in PH+ children only at the initial assessment. CONCLUSIONS We found no gross signs of sleep disruption as a function of parental history. Modest differences in spectral EEG power between PH+ and PH- children and teens indicate that a marker of parental alcohol history may be detectable in teens at risk for problem drinking.

Bindung und Bindungsstörung. Diagnostische Berührungspunkte zweier distinkter Konzepte

In der vorliegenden Arbeit wurde der Frage nach einer möglichen Verknüpfung der Bindungstheorie und der diagnostischen Kriterien einer Bindungsstörung nachgegangen. Dabei wurde untersucht, ob sich ein distinkter Einfluss der Bindungsqualität auf die Entstehung und Aufrechterhaltung der Subtypen der Bindungsstörung aufzeigen lässt und inwiefern der Bindungstheorie in der Erklärung der Bindungsstörung Grenzen gesetzt sind. Die Bindungsstörung ( reactive attachment disorder nach DSM-IV) betrifft eine relativ neue Diagnose mit bisher nur vage formulierten Kriterien. In vielen empirischen Arbeiten wird implizit davon ausgegangen, dass sich die Ätiologie der Bindungsstörung hauptsächlich aus der Bindungstheorie ableiten lässt. Letztendlich bleibt jedoch unklar, wo die Berührungspunkte der beiden Konzepte bestehen, wo sie sich ergänzen und wo sie klar abgegrenzt werden müssen.

Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study

OBJECTIVE The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study. METHOD All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization. RESULTS Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002). CONCLUSIONS ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01888627.

The association of childhood trauma and personality disorder with adult chronic depression. A cross-sectional study in depressed outpatients

Objective: Chronic depression has often been associated with childhood trauma. There may, however, be an interaction between personality pathology, childhood trauma, and chronic depression. This interaction has not yet been studied. Method: This retrospective analysis is based on 279 patients contacted for a randomized trial in an outpatient psychotherapy center over a period of 18 months from 2010 to 2012. Current diagnoses of a personality disorder and presence of chronic depression were systematically assessed using the Structured Clinical Interview for DSM-IV. Retrospective reports of childhood trauma were collected using the short form of the Childhood Trauma Questionnaire (CTQ-SF). DSM-IV–defined chronic depression was the primary outcome. The association between chronic depression, childhood trauma, and personality disorders was analyzed using correlations. Variables that had at least a small effect on correlation analysis were entered into a series of logistic regression analyses to determine the predictors of chronic depression and the moderating effect of childhood trauma. Results: The presence of avoidant personality disorder, but no CTQ-SF scale, was associated with the chronicity of depression (odds ratio [OR] = 2.20, P = .015). The emotional abuse subscale of the CTQ-SF did, however, correlate with avoidant personality disorder (OR = 1.15, P = .000). The level of emotional abuse had a moderating effect on the effect of avoidant personality disorder on the presence of chronic depression (OR = 1.08, P = .004). Patients who did not suffer from avoidant personality disorder had a decreased rate of chronic depression if they retrospectively reported more severe levels of emotional abuse (18.9% vs 39.7%, respectively). Conclusions: The presence of avoidant personality pathology may interact with the effect of childhood trauma in the development of chronic depression. This has to be confirmed in a prospective study.

Early developmental, temperamental and educational problems in ‘substance use disorder’ patients with and without ADHD. Does ADHD make a difference?

Introduction: The prevalence of ADHD among patients with substance use disorder (SUD) is substantial. This study addressed the following research questions: Are early developmental, temperamental and educational problems overrepresented among SUD patients with ADHD compared to SUD patients without ADHD? Do this comorbid group receive early help for their ADHD, and are there signs of self-medicating with illicit central stimulants? Method: An international, multi-centre cross-sectional study was carried out involving seven European countries, with 1205 patients in treatment for SUD. The mean age was 40 years and 27% of the sample was female. All par- ticipants were interviewed with the Mini International Neuropsychiatric Interview Plus and the Conners' Adult ADHD Diagnostic Interview for DSM-IV. Results: SUD patients with ADHD (n = 196; 16.3% of the total sample) had a significantly slower infant develop- ment than SUD patients without ADHD (n = 1,009; 83.4%), had greater problems controlling their temperament, and had lower educational attainment. Only 24 (12%) of the current ADHD positive patients had been diagnosed and treated during childhood and/or adolescence. Finally, SUD patients with ADHD were more likely to have central stimulants or cannabis as their primary substance of abuse, whereas alcohol use was more likely to be the primary substance of abuse in SUD patients without ADHD. Conclusion: The results emphasize the importance of early identification of ADHD and targeted interventions in the health and school system, as well as in the addiction field.

Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS-kid studies

Early detection of psychosis is an important topic in psychiatry. Yet, there is limited information on the prevalence and clinical significance of high-risk symptoms in children and adolescents as compared to adults. We examined ultra-high-risk (UHR) symptoms and criteria in a sample of individuals aged 8-40 years from the general population of Canton Bern, Switzerland, enrolled from June 2011 to May 2014. The current presence of attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BLIPS) and the fulfillment of onset/worsening and frequency requirements for these symptoms in UHR criteria were assessed using the Structured Interview for Psychosis Risk Syndromes. Additionally, perceptive and non-perceptive APS were differentiated. Psychosocial functioning and current non-psychotic DSM-IV axis I disorders were also surveyed. Well-trained psychologists performed assessments. Altogether, 9.9% of subjects reported APS and none BLIPS, and 1.3% met all the UHR requirements for APS. APS were related to more current axis I disorders and impaired psychosocial functioning, indicating some clinical significance. A strong age effect was detected around age 16: compared to older individuals, 8-15-year olds reported more perceptive APS, that is, unusual perceptual experiences and attenuated hallucinations. Perceptive APS were generally less related to functional impairment, regardless of age. Conversely, non-perceptive APS were related to low functioning, although this relationship was weaker in those below age 16. Future studies should address the differential effects of perceptive and non-perceptive APS, and their interaction with age, also in terms of conversion to psychosis.

Depression predicts persistence of paranoia in clinical high-risk patients to psychosis: results of the EPOS project.

BACKGROUND The link between depression and paranoia has long been discussed in psychiatric literature. Because the causality of this association is difficult to study in patients with full-blown psychosis, we aimed to investigate how clinical depression relates to the presence and occurrence of paranoid symptoms in clinical high-risk (CHR) patients. METHODS In all, 245 young help-seeking CHR patients were assessed for suspiciousness and paranoid symptoms with the structured interview for prodromal syndromes at baseline, 9- and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood adversities by the Trauma and Distress Scale, trait-like suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressiveness by the Positive and Negative Syndrome Scale. RESULTS At baseline, 54.3 % of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 and 24.4 %. Depressive, obsessive-compulsive and somatoform disorders, emotional and sexual abuse, and anxiety and suspiciousness associated with paranoid symptoms. In multivariate modelling, depressive and obsessive-compulsive disorders, sexual abuse, and anxiety predicted persistence of paranoid symptoms. CONCLUSION Depressive disorder was one of the major clinical factors predicting persistence of paranoid symptoms in CHR patients. In addition, obsessive-compulsive disorder, childhood sexual abuse, and anxiety associated with paranoia. Effective pharmacological and psychotherapeutic treatment of these disorders and anxiety may reduce paranoid symptoms in CHR patients.

Der WHO Wellbeing Index (WHO-5) als Depressivitätsmaß

Der WHO-5 erfasst mit fünf Items psychisches Wohlbefinden, er dient auch als Screeninginstrument zur Erfassung depressiver Symptomatik. Wenige Studien untersuchten diesen Validitätsaspekt jedoch im klinischen Kontext. Ziel der vorliegenden Studie war es, die Messinvarianz des WHO-5 zwischen depressiven und nicht-depressiven Stichproben sowie Art und Spezifität des Zusammenhangs mit Skalen zur Erfassung der Depressionsschwere zu überprüfen. Insgesamt 414 Personen füllten den WHO-5 und das BDI-II aus. Aktuell erfüllten 207 Personen die DSM-IV-Kriterien einer Major Depression (SKID-I). Eine Teilstichprobe erhielt zusätzlich das Beck-Anxiety-Inventory (BAI) und wurde auf der Hamilton-Depression-Rating-Scale (HAM-D) und der Hamilton- Anxiety-Rating-Scale (HAM-A) durch trainierte Rater eingeschätzt. Der WHO-5 wies hohe Messinvarianz bezüglich des Vorliegens/Nichtvorliegens einer Major Depression auf. Er zeigte hohe negative Zusammenhänge mit selbst- und fremdeingeschätzter Depressivität (BDI-II, HAM-D), insbesondere bei milderer und moderater Symptomschwere und auch nach Kontrolle gleichzeitig bestehender Angstsymptomatik. Diese Ergebnisse unterstützen die Verwendung des WHO-5 als Depressionsmaß, zumindest im Bereich milder und mittlerer Depressionsschwere.

Manifestation of depression symptoms among Mexican American adolescents

Background. Previous findings reported more depression among Mexican American adolescents than among adolescents from other groups. There has been minimal research published on distribution of depression symptoms among Mexican American adolescents and practically no data has been published from community samples. ^ Objective. To examine the phenomenology of DSM-IV major depression symptoms across groups defined by ethnic status, by gender and language use focusing on the Mexican American group. ^ Methods. Secondary data from 2624 adolescents (ages 10-17) among three ethnic subgroups, Mexican (26.7%), African (45%) and Anglo Americans (28.3%), was analyzed. Data come from the Teen Life Changes (TLC) Survey conducted in 1994 by Roberts et al. (1997). A self-report questionnaire, which includes the DSD scale to measure depression, was used. ^ Results. Analysis of data showed significant differences among youth in the phenomenology of depression symptoms by ethnicity, by gender and by language use at home. ^ Conclusion. This study adds knowledge to the psychopathology and mental health literature from the identification of depression symptoms profile as well as permits the design of more appropriate policy for prevention and intervention programs among culturally diverse youth. ^

Nonpurging binge eaters versus nonbinge eaters and treatment retention for adult obesity

Dropout from obesity treatment has been a major factor associated with weight control failure, with few reliable predictors of dropouts or completers. Previous studies have tended to treat obese people as a homogeneous group with standard behavior modification-based interventions. Current research indicates there may be subgroups within the obese population, binge eaters and nonbinge eaters, who have different dropout rates. Current studies also recommend focusing on the subset of this subgroup that does not engage in purging (vomiting, laxative abuse, or excessive exercise) to compensate for binge eating. This research uses a secondary dataset (N = 156) from a prospective study in which participants were randomized to a Food Dependency (FD) and a Behavioral Self-Management (BSM) group for weight reduction. Criteria for subjects in the original study included (1) scoring higher on the existing Binge Eating Scale (BES) in order to ensure enrollment of more binge eaters and (2) no compensatory purging behavior for binge eating. Subjects were then reclassified in this study as binge eaters or nonbinge eaters using the more stringent proposed 1994 DSM-IV criteria for Binge Eating Disorder (BED). Subjects were followed for dropout. Variables studied were binge status, age at obesity onset, age at study baseline, class instructor, number of previous weight loss attempts, race, marital status, body mass index (BMI kg/m$\sp2$), type of intervention, work status, educational level, and social support. Stepwise backward regression Cox survival analysis indicated binge status had a consistent, statistically significant protective effect on dropout in which binge eaters were half as likely to dropout versus nonbinge eaters (p = 0.04). Cox proportional hazards analysis indicated no statistical difference in dropout by type of intervention (FD, p = 0.13; BSM, p = 0.80) when controlling for binge status. All other variables did not reach significance, which is consistent with the literature. Implications of these findings suggest that (1) the proposed 1994 DSM-IV criteria for BED is a more useful classification that the existing DSM-III-R criteria, and (2) the identification of subgroups among obese subjects is an important step in dropout and weight loss intervention research. Future research can confirm this finding. ^

Trastorno obsesivo compulsivo/Neurosis obsesiva : Consecuencias clínicas

Este trabajo ha surgido como resultado de una clase de un Seminario dictado en el marco de la cátedra de Psicoterapia I de la Facultad de Psicología de la U.N.L.P. El mismo se tituló 'Los padecimientos actuales y sus abordajes terapéuticos', y tuvo como objetivo explicitar algunos modos de nominar y tratar a las formas en que se presentan actualmente el malestar humano en nuestra época. En lo que hace a nuestra presentación, nos referiremos específicamente al TOC y a la Neurosis Obsesiva. Nos interesa mostrar que no se trata del mismo fenómeno, como suele pensarse. El diagnóstico de TOC no autoriza a pensar que se trataría de una neurosis obsesiva tal como se plantea desde el psicoanálisis. Tampoco el diagnóstico de neurosis obsesiva supone uno de TOC. De ambas categorías se desprenden operaciones psicoterapéuticas diferentes, en la medida en que suponen distintas concepciones del sujeto a tratar, así como también posiciones diferentes en relación al diagnóstico psicopatológico (semiológico y estructural). El diagnóstico de neurosis obsesiva reviste una particularidad: la de ser realizado bajo transferencia en el marco de la oferta del dispositivo analítico, donde se pone en juego la realidad sexual del inconciente para cada sujeto, en relación a la cual tomarán lugar las intervenciones y la lógica del tratamiento. Ello a diferencia del diagnóstico de TOC, que dependería de la verificación o no de determinados signos (obsesiones, compulsiones, dudas, consideradas inútiles) a los cuales le subyacen creencias o cogniciones disfuncionales típicas a cuestionar o sustituir en el marco de la cura, valiéndose de determinados procedimientos técnicos. De aquí se desprende que otra diferencia estaría en relación a la concepción de la causa (etiología sexual y mecanismo psíquico, desde el psicoanálisis; las cogniciones desde las TCC) y las intervenciones que de ella se desprenden. La neurosis obsesiva es establecida como estructura clínica con una etiología y mecanismos particulares formalizados por Freud: la represión frente a lo sexual, mediante anulación y aislamiento. El corte en acto bajo transferencia es una maniobra propiamente analítica. La misma es vez a vez, no supone ninguna técnica o receta programada de antemano. Por su parte, el TOC es una categoría semiológica descriptiva del DSM IV (Manual Diagnóstico y Estadístico de Trastornos Mentales) usada tanto por psiquiatras y terapeutas cognitivo comportamentales. Estos últimos le adjudican al mencionado trastorno una serie de pensamientos y creencias que se reiterarían en la mayoría de los TOC. Las 'creencias disfuncionales', o 'errores cognitivos', serían la causa del padecimiento. Su cuestionamiento, problematización, cambio, eliminación o sustitución por otras con mayor funcionalidad, mediante diversas técnicas e instrumentos preestablecidos de antemano (principalmente el cuestionamiento socrático y el empiricismo colaborativo entendido, entre otras cosas, como un tipo de alianza terapéutica y común acuerdo), traería aparejados cambios en las emociones y en las conductas. Allí radicaría su eficacia. A tales fines, se maneja en esta práctica psicoterapéutica una concepción de la realidad diferente a la establecida desde la praxis psicoanalítica. Para las terapias cognitivo comportamentales, se trataría de una realidad no afectada por lo que la creencia que el cliente le adjudica, una realidad compartida, señalada por el terapeuta para brindar evidencia objetiva que contradiga dichas creencias. Desde el psicoanálisis, se considera la realidad fantasmática (psíquica y sexual) del sujeto como algo fundamental a dar lugar en el tratamiento

La función atencional en la generación Millenium : Interrogando al diagnóstico de ADD y ADHD

El Déficit de Atención con o sin hiperactividad (ADD ADHD por su sigla en inglés) es un cuadro que aparece descrito bajo esa denominación por primera vez en 1980 en el DSM III, teniendo luego diversas descripciones en las siguientes ediciones del Manual (DSM III-R 1987, DSM IV 1992). El DSM, a diferencia del CIE 10, se ocupa de describir un repertorio de síntomas sin que esto suponga un abordaje conceptual del cuadro. Es un cuadro que aparece descrito bajo esa denominación por primera vez en 1980 en el DSM III, teniendo luego diversas descripciones en las siguientes ediciones del Manual (DSM III-R 1987, DSM IV 1992). El DSM, a diferencia del CIE 10, se ocupa de describir un repertorio de síntomas sin que esto suponga un abordaje conceptual del cuadro. Es un cuadro que aparece descrito bajo esa denominación por primera vez en 1980 en el DSM III, teniendo luego diversas descripciones en las siguientes ediciones del Manual (DSM III-R 1987, DSM IV 1992). El DSM, a diferencia del CIE 10, se ocupa de describir un repertorio de síntomas sin que esto suponga un abordaje conceptual del cuadro. Metodología: Se realiza un muestreo no probabilístico de niños que cursan 1o año escolar, y que concurren a escuelas pertenecientes a una de las tres categorías establecidas por la ANEP1. Este criterio contempla la incidencia de la variable contexto sociocultural en el problema a estudiar. Se estudian una serie de indicadores vinculados a la función atencional, fundamentalmente la atención selectiva, a través de una estrategia cuanti-cualitativa. Objetivo general: Investigar la función atencional desde el punto de vista cognitivo y afectivo, para contribuir al diagnóstico y tratamiento de las dificultades en la atención. Objetivos específicos: 1) Determinar las características afectivas que presentan los niños con dificultades en la atención 2) Caracterizar la modalidad atencional de los niños con dificultades en la atención 3) Analizar si existen diferencias significativas en el modo de atender (desde el punto de vista cognitivo y afectivo) entre los niños que presentan desatención y los que no la presentan. Los resultados que presentamos corresponden a los datos de la primera escuela: urbana de contexto medio. Conclusiones: Al organizar las conclusiones en función de los objetivos que nos proponemos en la investigación decimos 1) Los niños que presentaron dificultades en la atención (manifiestas o no en el aula) no muestran en sus producciones características afectivas que nos permitan considerarlo un grupo diferenciado. 2) La modalidad atencional (al considerar resultados del Denckla y los subtests estudiados del WISC III) no tiene un patrón común entre los niños que podríamos llamar desatentos (por su comportamiento en clase o por su bajo rendimiento en las pruebas) ya que no siempre tienen bajo rendimiento en ambas pruebas. 3) No existen diferencias significativas en los modos de atender entre los niños que presentaron problemas de atención y los que no lo presentaron. Por todo lo anterior podemos concluir que en la muestra estudiada: Los niños que presentan dificultades en la atención son una población muy heterogénea en los diferentes aspectos estudiados. Podemos pensar que no existe una entidad específica, más bien la desatención parece presentarse como un síntoma. Por otra parte resulta significativo desde el punto de vista de los aspectos afectivos puestos en juego en la función, esto es, una función que se desarrolla en la interacción con otros, la alta frecuencia de dibujos en los que el único personaje es el niño