Relationship between aggressive behavior, depressed mood, and other disruptive behavior in Puerto Rican children diagnosed with attention deficit and disruptive behaviors disorders.

Scientific Research Institute, Carlos Albizu University, San Juan, Puerto Rico.
Puerto Rico health sciences journal (Impact Factor: 0.67). 04/2007; 26(1):43-9.
Source: PubMed


The present study was directed at examining the relationship between aggressive behavior, depressed mood, other disruptive behaviors in children diagnosed with ADHD or ODD disorders in Puerto Rico.
One hundred seventy six (176) students (127 males and 49 females) from 12 public elementary schools in the San Juan Area of Puerto Rico participated in the study. The participants were divided into a group of ADHD children who exhibited aggressive behavior, a group of ADHD children that did not show aggressive behavior, and a normal group. Several self-report measures were administered to the children and teachers.
Our results indicate that the best predictor of aggressive behavior was the hyperactivity and impulsiveness for both ADHD males and females. In addition, depressed mood in both males and females was also a significant predictor of aggressive behavior in Puerto Rican ADHD children. However, in females the social problems variable was also found to be a significant grouping variable.
The first conclusion of these results is that inattentiveness does not appear to be a relevant factor in ADHD Puerto Rican children who exhibit aggressive behavior. Second, we need to be cognizant to the fact that Puerto Rican ADHD children do exhibit high co-morbidity for aggressive behavior, depressed mood, and social problems. Thus, our diagnostic and treatment approaches with ADHD Puerto Rican children need to include an assessment of the social environment of the child and its effect on his emotional state, in particular his or her mood.

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On the other hand, functional magnetic resonance imaging (fMRI) constitutes a technique to obtain brain images which can be interpreted as regions and networks of neural activity elicited during the performance of a cognitive process. Based on the information that the ADD patients are susceptible to cognitive interferences, some researches have applied the classical and the counting versions of the Stroop task paradigms in fMRI. In comparison with control subjects, adult patients show alack of neural activation in the anterior cingulated cortex. Nevertheless, results in children are more controversial and attribute neurobiological and social factors in the ADD etiology. The anterior cingulated cortex and prefrontal region of the human brain conform the execution system of attention and their function is essential for emotional processes. The neurocognitive relation between attention and emotion involves the influence of the affective system in the alert and execution systems of attention through reciprocal connections between limbic and frontal regions, which permit a mnemonic and affective valuation of the attended environment. Understanding the relations between attention and emotion is essential in basic and clinical approaches, due to the co-morbidity of ADD with some emotional disorders, such as the oppositional defiant disorder, anxiety and impulsive aggression, the last one elicited by uncontrolled experiences of anger. In this sense, some studies describe that the metabolic brain activity correlated with the experience of anger is manifested in the frontal, anterior cingulated and insular cortices and the temporal pole. Clinical situations require individualized decisions on the immediate and emergent treatment of one case. Furthermore, when the clinical case refers to a behavioral disorder probably related with neurobiological dysfunctions, a comparison of test with control subjects is necessary. In this sense, the present work constitutes an fMRI study designed to evaluate neurological functional alterations in a child patient diagnosed with ADHD, with persistent severe impulsive aggression behaviors that required a swift evaluation to enhance the diagnosis and treatment proposed by other clinical techniques. Besides the patient, three infant participants were evaluated. One of them was diagnosed with ADD but did not manifest aggressive or impulsive behaviors and was not under any pharmacological treatment. The other two healthy children had no neurological and psychiatric disorders history. All the participants presented similar intellectual coefficient and performed the same cognitive and emotional tests. In the case of the patient, test were applied in two conditions: under the proposed pharmacological treatment and without medication. The attention test consisted in a version of the counting Stroop task in Spanish language, presented in a block design through the EPrime software. Subjects practiced the task in a personal computer before the functional image acquisition and were trained to answer by using a bottom response system that will be used in the scanner. For the emotional-anger paradigm, children were interviewed about scenes and situations of their personal experience which elicited anger and calm. Situations were ordered and planned in a block design to be executed in the magnetic resonance instrument. During the functional images acquisition children listened to the situations conducted by imaginery techniques. Functional images were acquired in a 1.5 T G.E. instrument in the Magnetic Resonance Unit of the Hospital Ángeles Metropolitano in Mexico City. Data were analyzed by using the SPM 5 software applying a contrast using FWE with p < 0.05. Brain coordinates obtained in SPM 5 were converted to the Talairach Deamond system in order to obtain the Brodmann areas related to those coordinates. During the performance of the counting Stroop task, the patient with ADHD under medication manifested activation in frontal areas, but not during the medication suspension trial. Frontal activity identified in this patient in the treatment trial was similar to that identified in the unaggressive ADD patient. In both cases, ADHD without medication and ADD, a lack of activity was identified in the anterior cingulate cortex (ACC). Nevertheless, activation in ACC, in parietal and temporal regions was present in the aggressive patient under treatment but not in the suspension condition. 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It is necessary a consensual and standard integration of neuropsychological tests which identify different cognitive qualities of ADD. 2. The selection of children samples to study the neurobiology of ADD must include several variables associated with its etiology, such as parental relations, social and scholar environments. 3. Experimental paradigms could be designed to be performed using different neuroimaging techniques, such as fMRI or event-related potential. Thus, the results of the same test can be used to complement different approaches. 4. Results obtained by fMRI must not be understood in a phrenologycal and deterministic approach, but as brain region activations indicating dynamic neural networks.
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