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Resumo Objetivo Investigar validade e fidedignidade de uma escala de rastreio para dislexia do desenvolvimento (DD) no ensino fundamental preenchida por professores. Método Avaliação empírica - 12 professores responderam a Escala de Leitura e Escrita (ELE) sobre 95 alunos de 3º ano do ensino fundamental, em dois momentos; os escolares realizaram testes de leitura e escrita (variáveis externas) para investigar a correlação entre a escala e o desempenho dos mesmos. Realizaram-se (1) análise fatorial, (2) avaliação da consistência interna, (3) investigação da relação entre um item da escala e o construto medido por teoria da resposta ao item (TRI) (4) correlação da escala com variáveis externas (Validade Convergente-VC); e (5) investigação da estabilidade temporal da avaliação. Resultados (1) a escala avalia um único fator; (2) o coeficiente alpha apontou que os itens são bons indicadores do construto; (3) a análise por TRI mostra que todos os itens foram monotônicos, indicando que um único construto determina a variabilidade (4) a correlação de Spearman foi moderada (11/17 itens), apontando a existência de VC; (5) o valor da correlação do coeficiente de estabilidade temporal indica que o resultado da ELE não varia de maneira significativa no tempo; (6) nove crianças obtiveram pontuações que sugerem encaminhamento para uma avaliação diagnóstica devido ao grau de dificuldade apresentado. Conclusão O estudo mostra evidências empíricas de validade e fidedignidade da ELE para rastreio de risco de DD. A porcentagem de crianças com suspeita de DD (aproximadamente 9%) corrobora a literatura internacional sobre prevalência de dislexia. Abstract Purpose To investigate the empirical validity and reliability of a screener for risk of developmental dyslexia (DD) by elementary school teachers. Methods The scale was tested with 12 teachers who answered questions about their students (95 students total, all in the third year of elementary school); the students, in turn, performed reading and writing tasks which were used to investigate the association between screening scores and performance. The following analyses were carried out: (1) factor analysis; (2) internal consistency; (3) relationship between each scale item and the construct of interest, as measured by item response theory (IRT); (4) correlation of each scale item with external variables (reading and writing tests); and (5) the temporal stability of teachers’ evaluations. Results The analyses showed: (1) one factor was extracted; (2) strong internal consistency – the items in the scale are good indicators for screening of this construct; (3) items were monotonic (IRT), i.e., item variability is associated with one construct; (4) moderate Spearman correlation (11/17 items); (5) temporal stability – the result of screening did not vary over time. Conclusion This study shows evidence of validity and reliability of the proposed scale in its intended use of screening for developmental dyslexia. The percentage of children at risk for developmental dyslexia, according to the scale, was approximately 9%, which is in agreement with the international literature on the prevalence of dyslexia.

Introduction Children with anxiety disorders have been suggested to possess deficits in verbal fluency, shifting and attention, with inconsistent results regarding working memory and its subcomponents. This study extends previous findings by analyzing the performance of children with anxiety disorders in a wide range of neuropsychological functions. Methods We evaluated 54 children with a primary diagnosis of an anxiety disorder according to diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) using subtests of a neuropsychological battery. The severity of anxiety disorders was assessed using the Pediatric Anxiety Rating Scale (PARS). We calculated the frequency of neuropsychological impairments (-1.5 standard deviation of the normative sample). Comparisons between groups were performed based on the severity of anxiety symptoms, as well as in the presence of one vs. more diagnoses of anxiety disorder. Results We found higher impairment in visuospatial working memory (23.1%), semantic memory (27.8%), oral language (35.4%) and word writing (44.4%) in anxious children. Moreover, children with higher anxiety severity presented lower performance in visuospatial working memory, inferential processing, word reading, writing comprehension, copied writing, and semantic verbal fluency (d = 0.49 to 0.96 [Cohen’s d]). The higher the number of anxiety diagnoses, the lower the performance in episodic memory and oral and written language (d = 0.56 to 0.77). Conclusion Our data suggested the presence of memory (visuospatial working memory and semantic memory) and language deficits (oral and writing) in some children with an anxiety disorder. Severity and number of anxiety diagnoses were associated with lower performance in memory and language domains in childhood.

Introduction Early life adversity, including the perception of poor quality of maternal care, is associated with long-term metabolic and psychosocial consequences. The negative quality of mother/child relationship is associated with emotional overeating in young children, which is defined by eating in response to emotional arousal states such as fear, anger or anxiety. However, it is not known if this association persists through adolescence. Therefore, we aimed at verifying if maternal care during infancy can influence emotional eating in young adults. Methods Seventy-five adolescents, residents of Porto Alegre, who participated in the PROTAIA Program (anxiety disorder in childhood and adolescence program), answered the Parental Bonding Instrument (PBI – assessment of perceived maternal care), and the Dutch Eating Behavior Questionnaire (DEBQ). Regression analysis models were built to predict Emotional Eating, a domain of the DEBQ, using maternal care, gender, and anxiety as independent variables. Results The model was statistically significant when adjusted for potential confounders (r2 = 0.272; p Conclusion The results demonstrated a negative association between the quality of maternal care and emotional eating in young adults, suggesting that the early environment could be involved on the development of eating disorders or on the differential eating behavior in adolescents with emotional disorders.

To investigate the empirical validity and reliability of a screener for risk of developmental dyslexia (DD) by elementary school teachers.The scale was tested with 12 teachers who answered questions about their students (95 students total, all in the third year of elementary school); the students, in turn, performed reading and writing tasks which were used to investigate the association between screening scores and performance. The following analyses were carried out: (1) factor analysis; (2) internal consistency; (3) relationship between each scale item and the construct of interest, as measured by item response theory (IRT); (4) correlation of each scale item with external variables (reading and writing tests); and (5) the temporal stability of teachers' evaluations.The analyses showed: (1) one factor was extracted; (2) strong internal consistency - the items in the scale are good indicators for screening of this construct; (3) items were monotonic (IRT), i.e., item variability is associated with one construct; (4) moderate Spearman correlation (11/17 items); (5) temporal stability - the result of screening did not vary over time.This study shows evidence of validity and reliability of the proposed scale in its intended use of screening for developmental dyslexia. The percentage of children at risk for developmental dyslexia, according to the scale, was approximately 9%, which is in agreement with the international literature on the prevalence of dyslexia.Investigar validade e fidedignidade de uma escala de rastreio para dislexia do desenvolvimento (DD) no ensino fundamental preenchida por professores.Avaliação empírica - 12 professores responderam a Escala de Leitura e Escrita (ELE) sobre 95 alunos de 3º ano do ensino fundamental, em dois momentos; os escolares realizaram testes de leitura e escrita (variáveis externas) para investigar a correlação entre a escala e o desempenho dos mesmos. Realizaram-se (1) análise fatorial, (2) avaliação da consistência interna, (3) investigação da relação entre um item da escala e o construto medido por teoria da resposta ao item (TRI) (4) correlação da escala com variáveis externas (Validade Convergente-VC); e (5) investigação da estabilidade temporal da avaliação.(1) a escala avalia um único fator; (2) o coeficiente alpha apontou que os itens são bons indicadores do construto; (3) a análise por TRI mostra que todos os itens foram monotônicos, indicando que um único construto determina a variabilidade (4) a correlação de Spearman foi moderada (11/17 itens), apontando a existência de VC; (5) o valor da correlação do coeficiente de estabilidade temporal indica que o resultado da ELE não varia de maneira significativa no tempo; (6) nove crianças obtiveram pontuações que sugerem encaminhamento para uma avaliação diagnóstica devido ao grau de dificuldade apresentado.O estudo mostra evidências empíricas de validade e fidedignidade da ELE para rastreio de risco de DD. A porcentagem de crianças com suspeita de DD (aproximadamente 9%) corrobora a literatura internacional sobre prevalência de dislexia.

Introduction The goal of the present study was to investigate the association of anxiety disorder and brain activation while reading stories whose outcomes show protagonists experiencing emotions. Methods We carried out an fMRI study of 28 adolescents and young adults (14–22 years; 14 Anxiety Disorder Participants and 14 Controls) who read short narratives with angry, happy, sad, or neutral. outcomes We used mixed analyses of variance to test the effects of Group (anxiety/comparison), Emotion (angry/happy/sad, neutral) and Group by Emotion interaction. Results A significant Group by Emotion interaction was identified in a thalamic-region cluster of brain activation. Participants with anxiety disorders showed significantly less thalamic activation relative to controls. The interaction was identified by contrasting emotional vs. neutral passages. There was also a main effect of emotional passages versus neutral passages in a network of anterior and posterior areas of the brain, which included mid and superior temporal, left inferior frontal, left inferior parietal and dorsomedial prefrontal areas, some of which are among brain regions identified in studies of understanding the mind of a protagonist. Finally, we did not find a main effect of Group. The results suggest that anxiety in adolescents and young adults is associated with modulating activation of thalamic regions when processing emotions of fictional characters. The thalamic cluster identified in the present study corroborates previous studies that have addressed brain activation associated with anxiety.

While classically linked to memory, the hippocampus is also a feeding behavior modulator due to its multiple interconnected pathways with other brain regions and expression of receptors for metabolic hormones. Here we tested whether variations in insulin sensitivity would be correlated with differential brain activation following exposure to palatable food cues, as well as with variations in implicit food memory in a cohort of healthy adolescents, some of whom were born small for gestational age (SGA). Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was positively correlated with activation in the cuneus, and negatively correlated with activation in the middle frontal lobe, superior frontal gyrus and precuneus when presented with palatable food images versus non-food images in healthy adolescents. Additionally, HOMA-IR and insulinemia were higher in participants with impaired food memory. SGA individuals had higher snack caloric density and greater chance for impaired food memory. There was also an interaction between the HOMA-IR and birth weight ratio influencing external eating behavior. We suggest that diminished insulin sensitivity correlates with activation in visual attention areas and inactivation in inhibitory control areas in healthy adolescents. Insulin resistance also associated with less consistency in implicit memory for a consumed meal, which may suggest lower ability to establish a dietary pattern, and can contribute to obesity. Differences in feeding behavior in SGA individuals were associated with insulin sensitivity and hippocampal alterations, suggesting that cognition and hormonal regulation are important components involved in their food intake modifications throughout life.

Background The A3669G single nucleotide polymorphism (SNP) of the glucocorticoid receptor (GR) gene NR3C1 is associated with altered tissue sensitivity to glucocorticoids (GCs). GCs modulate the food reward circuitry and are implicated in increased intake of palatable foods, which can lead to the metabolic syndrome and obesity. We hypothesized that presence of the G variant of the A3669G SNP would affect preferences for palatable foods and alter metabolic, behavioural, and neural outcomes. Methods One hundred thirty-one adolescents were genotyped for the A3669G polymorphism, underwent anthropometric assessment and nutritional evaluations, and completed behavioural measures. A subsample of 74 subjects was followed for 5 years and performed a brain functional magnetic resonance imaging (fMRI) paradigm to verify brain activity in response to food cues. Results Sugar and total energy consumption were lower in A3669G G allele variant carriers. On follow-up, this group also had reduced serum insulin concentrations, increased insulin sensitivity, and lower anxiety scores. Because of our unbalanced sample sizes (31/37 participants non-G allele carriers/total), our imaging data analysis failed to find whole brain-corrected significant results in between-group t-tests. Conclusion These results highlight that a genetic variation in the GR gene is associated, at the cellular level, with significant reduction in GC sensitivity, which, at cognitive and behavioural levels, translates to altered food intake and emotional stress response. This genetic variant might play a major role in decreasing risk for metabolic and psychiatric diseases.

Background: The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. Methods: A total of 310 treatment-naive children (7–11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). Results: There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI] −0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2–9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08–8.57), and CT + ACT (30% response; 0.8 points, 95% CI −3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. Conclusions: We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.

The goal of the present study was to investigate intrinsic and reading-related brain function associated with dyslexia and typical readers in monolingual Brazilian children. Two fMRI studies were carried out: a resting-state and a word-reading study. The results show (a) underconnectivity between the occipitotemporal region (visual word form area) and the brain's default-mode network in dyslexic readers and (b) more activation of the anterior cingulate cortex for typical readers relative to dyslexic readers. The findings provide evidence for brain connectivity and function differences in an underrepresented population in fMRI studies of dyslexia; the results suggest atypical intrinsic function, and differences in directed attention processes in dyslexia.

Anxiety disorders (AD) are the most prevalent group of psychiatric disorders in adolescents and young adults. Nevertheless, the pathophysiology of anxiety disorders is still poorly understood. This study investigated differences in the functional connectivity of intrinsic amygdala-based networks of participants with and without AD. Resting state fMRI data were obtained from 18 participants with an AD and 19 healthy comparison individuals. Psychiatric diagnosis was assessed using standardized structured interviews. The comparison between groups was carried out using functional connectivity maps from six seed regions defined using probabilistic maps bilaterally within the amygdala (basolateral, superficial and centromedial amygdala). We found significant between-group differences in five clusters, which showed aberrant functional connectivity with the left basolateral amygdala: right precentral gyrus, right cingulate gyrus, bilateral precuneus, and right superior frontal gyrus in subjects with AD as compared with the comparison subjects. For the comparison subjects, the correlations between the amygdala and the five clusters were either non-significant, or negative. The present study suggests there is an intrinsic disruption in the communication between left basolateral amygdala and a network of brain regions involved with emotion regulation, and with the default mode network in adolescents and young adults with anxiety disorders.

The goal of the present study was to investigate whether intrauterine growth restriction (IUGR) affects brain responses to palatable foods and whether docosahexaenoic acid (DHA, an omega-3 fatty acid that is a primary structural component of the human brain) serum levels moderate the association between IUGR and brain and behavioral responses to palatable foods. Brain responses to palatable foods were investigated using a functional magnetic resonance imaging task in which participants were shown palatable foods, neutral foods and non-food items. Serum DHA was quantified in blood samples, and birth weight ratio (BWR) was used as a proxy for IUGR. The Dutch Eating Behavior Questionnaire (DEBQ) was used to evaluate eating behaviors. In the contrast palatable food > neutral items, we found an activation in the right superior frontal gyrus with BWR as the most important predictor; the lower the BWR (indicative of IUGR), the greater the activation of this region involved in impulse control/decision making facing the viewing of palatable food pictures versus neutral items. At the behavioral level, a general linear model predicting external eating using the DEBQ showed a significant interaction between DHA and IUGR status; in IUGR individuals, the higher the serum DHA, the lower is external eating. In conclusion, we suggest that IUGR moderates brain responses when facing stimuli related to palatable foods, activating an area related to impulse control. Moreover, higher intake of n-3 PUFAs can protect IUGR individuals from developing inappropriate eating behaviors, the putative mechanism of protection would involve decreasing intake in response to external food cues in adolescents/young adults.

Studies in rodents have shown that early life trauma leads to anxiety, increased stress responses to threatening situations, and modifies food intake in a new environment. However, these associations are still to be tested in humans. This study aimed to verify complex interactions among anxiety diagnosis, maternal care, and baseline cortisol on food intake in a new environment in humans. A community sample of 32 adolescents and young adults was evaluated for: psychiatric diagnosis using standardized interviews, maternal care using the Parental Bonding Inventory (PBI), caloric consumption in a new environment (meal choice at a snack bar), and salivary cortisol. They also performed a brain fMRI task including the visualization of palatable foods vs. neutral items. The study found a three-way interaction between anxiety diagnosis, maternal care, and baseline cortisol levels on the total calories consumed (snacks) in a new environment. This interaction means that for those with high maternal care, there were no significant associations between cortisol levels and food intake in a new environment. However, for those with low maternal care and who have an anxiety disorder (affected), cortisol was associated with higher food intake; whereas for those with low maternal care and who did not have an anxiety disorder (resilient), cortisol was negatively associated with lower food intake. In addition, higher anxiety symptoms were associated with decreased activation in the superior and middle frontal gyrus when visualizing palatable vs. neutral items in those reporting high maternal care. These results in humans mimic experimental research findings and demonstrate that a combination of anxiety diagnosis and maternal care moderate the relationship between the HPA axis functioning, anxiety, and feeding behavior in adolescents and young adults.

Anxiety disorders typically begin in childhood and adolescence and predict risk for many problems throughout life. Although some neuropsychological correlates have been described, more research is needed, particularly in adolescents. This study compares neurocognitive characteristics of anxious adolescents with and without comorbidity to externalizing disorders to those of typically developing comparison (TDC) adolescents and adolescents with externalizing disorders alone.The study included 57 adolescents 12-18 years of age (TDC, n=23; anxiety, n=16; externalizing, n=11; comorbid, n=7). We used a neuropsychological battery to assess eight domains: Orientation, attention, visual perception, memory, arithmetic, language, praxis, and executive function.Multivariate analysis of variance revealed a main effect of group in the neurocognitive domains evaluated (F8,48=2.32, p=0.034, ηp(2)=0.279). Post-hoc analysis revealed that executive functions score differed among groups, specifically in the task of verbal fluency (F[df=3]=5.01, p=0.004, ηp(2)=0.221), with both the anxious groups (anxiety and comorbid) presenting a lower score than the TDC and externalizing groups. This effect was independent of age, intelligence, and levels of education.Verbal fluency is specifically impaired in adolescents with anxiety disorders. This extends results from neuroimaging research implicating prefrontal areas in pediatric anxiety disorder neurobiology, and has potential implications to new therapeutics.

OBJECTIVE: This study aims to describe the design, methods and sample characteristics of the Multidimensional Evaluation and Treatment of Anxiety in Children and Adolescents - the PROTAIA Project. METHOD: Students between 10 and 17 years old from all six schools belonging to the catchment area of the Primary Care Unit of Hospital de Clínicas de Porto Alegre were included in the project. It comprises five phases: (1) a community screening phase; (2) a psychiatric diagnostic phase; (3) a multidimensional assessment phase evaluating environmental, neuropsychological, nutritional, and biological factors; (4) a treatment phase, and (5) a translational phase. RESULTS: A total of 2,457 subjects from the community were screened for anxiety disorders. From those who attended the diagnostic interview, we identified 138 individuals with at least one anxiety disorder (apart from specific phobia) and 102 individuals without any anxiety disorder. Among the anxiety cases, generalized anxiety disorder (n = 95; 68.8%), social anxiety disorder (n = 57; 41.3%) and separation anxiety disorder (n = 49; 35.5%) were the most frequent disorders. CONCLUSION: The PROTAIA Project is a promising research project that can contribute to the knowledge of the relationship between anxiety disorders and anxiety-related phenotypes with several genetic and environmental risk factors. OBJETIVO: o objetivo deste estudo é descrever o desenho, os métodos e as características amostrais da Avaliação Multidimensional e Tratamento da Ansiedade em Crianças e Adolescentes - Projeto PROTAIA. MÉTODO: Escolares entre 10 e 17 anos de todas as escolas pertencentes à área de abrangência da unidade de atenção primária do Hospital de Clínicas de Porto Alegre foram incluídos no projeto. O projeto compreende cinco fases: 1) triagem comunitária; 2) diagnóstico psiquiátrico; 3) avaliação multidimensional, incluindo fatores ambientais, neuropsicológicos, nutricionais e marcadores biológicos; 4) tratamento; e 5) fase translacional. RESULTADOS: Um total de 2.457 sujeitos foram triados para transtornos de ansiedade na comunidade. Dos indivíduos que compareceram à avaliação diagnóstica, 138 foram detectados com ao menos um transtorno de ansiedade (excluindo fobia específica) e 102 indivíduos sem nenhum transtorno de ansiedade. Dentre os casos de ansiedade, o transtorno de ansiedade generalizada (n = 95; 68,8%), transtorno de ansiedade social (n = 57; 41,3%) e o transtorno de ansiedade de separação (n = 49; 35,5%) foram os mais frequentes. CONCLUSÃO: O projeto PROTAIA é um projeto de pesquisa promissor que pode contribuir para o entendimento da relação entre transtornos de ansiedade e fenótipos relacionados à ansiedade com vários fatores de risco, tanto genéticos quanto ambientais.

Objective The aim of the present study was to test the ability of adolescents with a current anxiety diagnosis to recognize facial affective expressions, compared to those without an anxiety disorder. Methods Forty cases and 27 controls were selected from a larger cross sectional community sample of adolescents, aged from 10 to 17 years old. Adolescent’s facial recognition of six human emotions (sadness, anger, disgust, happy, surprise and fear) and neutral faces was assessed through a facial labeling test using Ekman’s Pictures of Facial Affect (POFA). Results Adolescents with anxiety disorders had a higher mean number of errors in angry faces as compared to controls: 3.1 (SD = 1.13) vs. 2.5 (SD = 2.5), OR = 1.72 (CI95% 1.02 to 2.89; p = 0.040). However, they named neutral faces more accurately than adolescents without anxiety diagnosis: 15% of cases vs. 37.1% of controls presented at least one error in neutral faces, OR = 3.46 (CI95% 1.02 to 11.7; p = 0.047). No differences were found considering other human emotions or on the distribution of errors in each emotional face between the groups. Conclusion Our findings support an anxiety-mediated influence on the recognition of facial expressions in adolescence. These difficulty in recognizing angry faces and more accuracy in naming neutral faces may lead to misinterpretation of social clues and can explain some aspects of the impairment in social interactions in adolescents with anxiety disorders.