Cuidado com o "enhancement" cerebral!

Dr. Marcelo Masruha, a neurologist specializing in pediatric neurology, holds a master's and doctorate from UNIFESP. Dr. Edson Bor-Seng-Shu, a tenured professor of Neurology at HCFMUSP. Dr. Marcelo de Lima Oliveira, a doctorate from HCFMUSP. The acronym "ADHD" stands for attention deficit/hyperactivity disorder. There are three types of attention deficit disorder: 1) predominantly inattentive, where attention deficit is predominant; 2) predominantly hyperactivity; and 3) mixed presentation with hyperactivity and attention deficit. ADHD is a neurodevelopmental disorder characterized by chronic conditions involving genetic and environmental factors that lead to an abnormal brain development process in utero and during the first years of life, leading to cognitive and emotional repercussions with a negative impact on the individual's life. There are some disorders in this group, such as autism, dyslexia, dyscauculia, tic disorder, and ADHD, which is the most prevalent in the population (5 to 7% of the population). The causes can be genetic or environmental. The main environmental factor is screens (cell phones). Unfortunately, streaming services increase screen consumption, and cell phones amplify this consumption because children can watch programming from anywhere. Studies show changes in white matter, myelin, and tracts in children with excessive screen consumption. These children may experience language impairment, semantic poverty, reduced IQ, and attention difficulties. This reduced attention span has led to a significant increase in the consumption of short videos on social media. Furthermore, children may miss out on the opportunity to practice movements important for developing proprioception and motor coordination due to lack of physical activity. The average screen time in the US is 8 hours. The recommendation is to avoid screen time until the age of two, with a maximum of 1 hour per day for preschoolers, 2 hours per day for school-aged children, and 3 hours per day for adolescents. Society needs to reconsider the amount of time spent daily on cell phone screens. An overly permissive upbringing and sleep deprivation can also be environmental causes of HDD. HDD has a genetic basis, with a 76% heritability rate. Alcohol use, smoking during pregnancy, and prematurity at birth increase the risk of HDD. Environmental risk factors can trigger the disease in individuals predisposed to the condition. Untreated HDD can pose risks in various environments. These include academic failure, underemployment, divorce, early pregnancy, frustration, and low self-esteem, among other events. A child with mild HDD at the onset of the disease may even keep up with other children with reasonable academic performance even if unmedicated. However, as the level of difficulty increases, there will be serious difficulties in maintaining adequate academic performance. Children with more severe ADHD will certainly have significantly compromised academic performance. Therefore, early diagnosis is crucial to prevent poor academic performance. It is important to emphasize that one-third of autistic children have ADHD. Teachers play a crucial role in identifying children with suspected ADHD behaviors and referring them to specialists. Behavioral and academic performance analysis can reveal atypical academic performance. Teachers are the primary screeners for ADHD patients. Therefore, ongoing training and education for these professionals is crucial to identify the disorder. The diagnosis is clinical and can be made during a consultation with a specialist and with psychological testing, if necessary. This diagnosis is based on anamnesis data (patient history) based on the DSN5 criteria. It is important to observe characteristics of autism. There are nine attention-deficit/hyperactivity/impulsivity criteria, and depending on whether these criteria are met, patients are classified into one of three forms of ADHD. Furthermore, anxiety, depression, schizophrenia, mild intellectual disability, bipolar disorder in children, early hypersexualization, a family diagnosis of bipolar disorder, screen time with sleep deprivation, and hypothyroidism should be ruled out. Even if diagnostic criteria exist, there must be a detrimental impact on the individual's life for diagnosis and treatment. There are no biological markers for this disease, such as findings on CT scans, MRIs, or other exams. The main specialists for diagnosing ADHD are neurologists, child neurologists, psychiatrists, and child psychiatrists. Furthermore, a multidisciplinary team is important, such as psychologists for cognitive behavioral therapy. Medication is essential for treating patients with ADHD; medication fully improves the symptoms of this disorder. ADHD is the only developmental disorder that improves completely with medication. The best medications for treatment are stimulants (Ritalin and Venvance). #attentiondeficithyperactivitydisorder