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22 IACAPAP 2012 – 20th World congress / Neuropsychia

ptimal outcome in ASD

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ow does the presentation of autism spectrum changecross the lifespan?.M. Munir

Developmental Medicine and Psychiatry, Children’s Hospital Boston,arvard Medical School, Boston, USA

his presentation will introduce the over arching perspective on “optimal out-omes” (OO) of ASD. Potentially one in 10 children with ASD achieve optimalutcomes. Epidemiological studies show that ∼7% of children with ASD leavehe spectrum. Clinical studies show that optimal subgroup share characteristicsith high functioning subjects in head-growth pattern and IQ. There is also evi-ence across national contexts (US and Turkey) that early intensive behavioralnterventions are over-represented in the optimal subgroup. A sobering observa-ion is that many children in optimal subgroup experience comorbid symptomsf inattention/anxiety/depression. Data from Africa in general, and in sub Saha-an Africa in particular, suggest that age at first presentation of ASD revealxcess of non-verbal children with late diagnosis/interventions well above 8ears of age, and a backdrop of meager ASD knowledge/awareness, problemsith help seeking/stigma, lack of healthcare facilities, and trained personnel. An

mportant goal for the DSM-5 classification is the introduction of developmen-ally sensitive criteria adapted to the children’s symptom severity and “requiredubstantial supports”. Symptoms of ASD may be present early but not becomevident until the threshold of “social demands exceed limited capacities”. Thisew framework is highlighted in the context of findings from US, Turkey, andigeria.

ttp://dx.doi.org/10.1016/j.neurenf.2012.05.051

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ptimal outcome in ASD with early intensive behavioralntervention: A prospective follow up study in Istanbul,urkey.M. Mukaddes

Child Psychiatry, Istanbul University, School of Medicine, Istanbul, Turkey

lthough follow up studies on individuals who met diagnostic criteria for ASDhow that the outcome is not favorable in general, with scattered evidence sug-esting a loss of diagnosis in 3–25% of individuals with ASD. Among publishedtudies on treatment effects of different approaches, the most robust treatmentffects have been observed when ABA treatments were implemented at a veryoung age and very intensively. We studied:characteristics of subjects with former diagnosis of ASD who recovered from

he disorder;the quality of intervention programs that they received.articipants were 38 children, with diagnosis of ASD according to DSM-IVriteria and with total CARS score > 30 at referral, who lost the diagnosis of ASDuring regular follow up (1–9 years). Patients were in an eclectic educationalrogram (home-based ABA program, social skills training, and speech therapy).n addition to the clinical examination, the outcomes were assessed using CARS,BC, and IQ testing. The final CARS scores were 15–21. All the subjects had

Q scores > 89. Early identification and intervention programs could potentiallyelp a subgroup of children with diagnosis of ASD who no longer endorseiagnostic criteria for ASD.

ttp://dx.doi.org/10.1016/j.neurenf.2012.05.052

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xcess of non-verbal cases of ASD presenting to orthodoxlinical practice in Africa: A trend possibly resulting from

ate diagnosis and intervention

.O. BakareChild Psychiatry, Federal Neuropsychiatric Hospital, Enugu State, Nigeria

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e l’enfance et de l’adolescence 60S (2012) S12–S63

his review explored the age at first presentation of African children with ASDso orthodox clinical practice and their expressive language ability at presentation.iterature search of case series and case reports of ASDs coming from Africaas done. Six literatures included the content related to age of the child at firstresentation to orthodox clinical practice and symptoms presentation related toxpressive language ability and thus fulfilled the inclusion criteria. Postulationsere made to explain the observations emanating from the review. Excess ofon-verbal cases over verbal cases of ASDs were presenting to orthodox clinicalractice and there is a common denominator of late presentation/diagnosis andn turn interventions with most cases presenting for the first time well above eightears of age. Postulations made to explain these observations included; low levelf knowledge and awareness about ASDs in Africa; problems with help seekingehaviour and lack of mental healthcare facilities and trained personnel. Thereay be a shift in the trend of excess non-verbal cases of ASDs over the verbal

ases presenting to orthodox clinical practice with enhancement of processesirected at ensuring early diagnosis and interventions, especially interventionsimed at improving speech and language development well early.

ttp://dx.doi.org/10.1016/j.neurenf.2012.05.053

tilité des prises en charge au long court en psychiatrie de’adolescent

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norexie mentale : hospitalisation de longue durée etevenir à long terme. Godart

Inserm U669, service de psychiatrie de l’adolescent et du jeune adulte de’Institut mutualiste Montsouris, universités Paris Descartes et Paris-Sud,aris, France

e analyzed structured clinical charts of 200 consecutive hospitalizations for ANf 12–22 year-old patients. Patients were hospitalized in our specialized eatingisorder unit in Paris offering multidisciplinary treatment. The focal point ofreatment is the therapeutic contract, established at admission. The duration ofospitalization depends on the patient, who is discharged when the final targeteight has been reached. Mean LOS was 135 days. We then investigated whetherOS was associated with 10 years outcome. The result will be presented andiscussed here.

ttp://dx.doi.org/10.1016/j.neurenf.2012.05.054

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ntérêt et limites des hospitalisations soins-études à’adolescence. Bié ∗, E. Berthaut

Fondation Santé des Étudiants de France, centre médical et pédagogique,eufmoutiers-en-Brie, FranceCorresponding author.

sychiatric care facilities provided by the “Fondation santé des étudiants derance” are one of the few resources for long lasting in-patient treatment fordolescents in France.dolescents referred to our units suffer from severe and long-lasting disorders

nd usually already had a long psychiatric history with several care attempts.hose previous attempts, either ambulatory or in hospital, having proved to be

nadequate, we offer them long-lasting care aiming at mental restoration andehabilitation rather than acute symptoms relief. Hospitalization is thought as aupport to the adolescence undergoing developmental process, through family

art in the care. One of the issues we mean to address is the risk of chronicization

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IACAPAP 2012 – 20th World congress / Neuropsychia

inked to such long hospitalization and how the care organization can preventhis.

ttp://dx.doi.org/10.1016/j.neurenf.2012.05.055

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pécificités du rapport risques/bénéfices dans lesospitalisations au long cours pour adolescents. Mammar

Fondation Santé des Étudiants de France, clinique médicale et pédagogiqueupré, Sceaux, France

es hospitalisations au long cours en psychiatrie de l’adolescent sont des dis-ositifs lourds, complexes et ambitieux, mis en oeuvre avec la perspective deusciter des changements positifs pour les jeunes patients qui en bénéficient.éanmoins, elles ne sont pas sans comporter d’importants risques. À l’heureù l’établissement du rapport risques/bénéfices est présenté comme une exi-ence incontournable, nous voudrions montrer, à partir de notre expérience enoins/études, comment le cadre de soins se doit de prendre en compte cetteialectique risques/bénéfices. Les risques nous semblant liés aux interactionsntre psychopathologie individuelle et fonctionnement institutionnel, nous tra-aillons activement à l’établissement d’un cadre de soins qui les réduise. Pourela, nous nous situons dans une démarche institutionnelle qui prend en comptee facon dynamique la problématique individuelle du patient, ce qui supposene approche qualitative et subtile et non quantitative ou protocolisée. Nousllustrerons notre propos par des exemples.

ttp://dx.doi.org/10.1016/j.neurenf.2012.05.056

DHD: special issues in hispanic population

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evelopmental aspects of ADHD. Quintero

Psychiatry, Hospital Universitario Inafanta Leonor, Madrid, Spain

ttention deficit hyperactivity disorder (ADHD) is a very common childhoodisorders, affecting up to 7–8% of children, and at least one-third to one-halfill continue through adulthood. Moreover it is important the high comorbidityot only in children, but in adolescents and adults. Therefore, ADHD becomesspecially important when we focus on The Developmental aspects; ADHD cane observed as a risk factor for the development of another psychopathologynd that add more complexity to the diagnosis along the life cycle, and confersn evolutionary risk. Not many studies has been done on Hispanic Populationsbout the evolutionary aspects of ADHD, this is one of the firsts.aterials, method and results.– Correlational study with a Spanish sample of

78 patients diagnosed with ADHD in the childhood between1988 and 2000ho had initiated treatment after been diagnosed. 88 patients had been evaluatedears after (2006) with ages between 18 and 33 years old. Eighty-five percentf the patients in this study had had combined treatment.iscussion and conclusions.– The data found in this study show lower comor-idity than other published studies (36.4%), the anxiety disorders (11%) andepression (21%), were the most prevalent disorders. We found lower persis-ence of the diagnosis of ADHD in the adulthood too (15%). Sixty-two percentf the patients use alcohol, and 14% other drugs, the cannabis was the principalrug consumed. Rest of data will be presented and discussed in the congress.his research shows data of the outcome of ADHD Spanish patients when they

each the adulthood, as this is a treated population, the results may lead to aossible protector role of the early intervention in ADHD.

ttp://dx.doi.org/10.1016/j.neurenf.2012.05.057

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DHD: Pharmacological treatment adherence. abadi

Salud Mental Pediatrica, Hospital Italiano de Buenos Aires, Caba, Argentina

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e l’enfance et de l’adolescence 60S (2012) S12–S63 S23

DHD is a chronic pathology that involves the entire life of an individual,ll long-term pathologies, poor outcome is often influenced by drug treatmentiscontinuation. Little research is available on pharmacological adherence inDHD; there is evidence that long-term treatment is effective.here are few studies that evaluate ADHD treatment satisfaction, but most of

hem are short-term studies, except MTA.TA was an excellent long-term study, which was done on a continuous eva-

uation setting, (it is not a naturalistic study).he aim of our research was to estimate how many patients were undergoingharmacological treatment over a school year. Also to investigate whetherearning difficulties and behavioral difficulties changed the pharmacologicalreatment compliance of patients with ADHD. Another goal of the study was tossess whether there were differences in pharmacological treatment adherence,etween methylphenidate and atomoxetine, both usually used to treat ADHDhildren.

ttp://dx.doi.org/10.1016/j.neurenf.2012.05.058

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rritability in attention deficit disorder. Subtype oromorbidity?. Viola

Child and Adolescent Psychiatry, faculty of medicine, University of Uruguay,ontevideo, Uruguay

rritability is an important symptom in childhood psychopathology that has recei-ed an increase research attention in the last decade. There is not an operationalefinition of irritability that represents one and the same phenotype, which coulde used by different researchers. In this research, the variable used is non-violentggression (Althoff, 2010).bjective.– Analyze the presence of irritability or non-violent aggression in a

linical sample referred with and without ADD.esign.– Retrospective review of medical records.ample.– Five hundred patients from 6 to 16-years-old with CBCL-Parent 6–18.esults.– The variable non-violent aggression (1) or irritability (� 0.855), isresent in severe childhood psychopathology (50%) and can also distinguishwo sub-groups of patients with attention deficit disorder. There are significantifferences between those sub-groups in mean of Total Problems (á◦STP 57.7E 16.3 and á◦STP 93.1 DE 26.7), in the pattern of comorbidity, and presencef suicidal ideation.onclusions.– The CBCL variable of non-violent aggression allows distingui-

hing a clinical sub-group of ADD with severe psychopathology and if present,equires combination drug treatments.

ttp://dx.doi.org/10.1016/j.neurenf.2012.05.059

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haracteristic of symptoms of attention deficit disorderith hyperactivity (ADHD): Severity, frequency, areas ofysfunction and symptoms associated thresholds. Clinicalopulation study of Latin-American child and adolescent.R. De la Pena Olvera

Fomento A La Investigacion, Instituto Nacional de Psiquiatria RFM, Mexico,exico

bjective.– To establish characteristics Attention Deficit Hyperactivity DisorderADHD) symptoms, severity, frequency, associated areas of dysfunction andymptoms thresholds. Clinical population study of Latin-American children anddolescent.ethods.– Children and adolescents with ADHD from Mexico, Colombia,enezuela, Argentina were included, a Spanish DSM.IV ADHD check list

ADHD-CL) was used to establish the best clinical estimation. To reach thre-hold, a symptom need to be 3 in a 1–5 level evaluation for severity and frequencyith at least two areas of dysfunction.

esults.– Two hundred and thirty five subjects, mean age 10.3 years,77.8%ales. ODD presented in 36.5%. All symptoms reported a moderate to

igh severity/frequency correlation. Inattention symptoms reported more