American Academy of Child & Adolescent Psychiatry

ADHD and Emotional Memory

Posted on Actualizado enn

Emotional memory can be defined as the memory of the emotions related to an specific event of our life. In case of negative events, this memory allows us to accommodate our conduct in order to avoid negative consequences in similar situations, which implies a capacity to analyze the situation and remember and be aware of our feelings related to it. It is well known that children with ADHD have alterations in the structure and function of the prefrontal cortex (which regulates our ability to plan and analyze our behavior), and also in brain structures linked with emotional processes such as the amygdala and the hippocampus (Plessen et al., 2006), which underlies their difficulties to cope with their emotions and behavior.

On the other hand, there is a growing literature studying the linkage between emotional memory lack in ADHD children and alterations in brain activity during sleep. For sleep disorder in children (Meltzer et al., 2010), the prevalence is 3.7%. The most-common diagnoses are enuresis and sleep-disordered breathing. ADHD is a predictor of sleep disorders.

Sleep disturbances are ADHD and Memorycommon in ADHD children (Cortese, Faraone, Konofal, & Lecendreux, 2009) and during sleep, new memory representations are reactivate during slow wave sleep SWS (sleep phase when our brain have the lowest activity rates) promoting memory consolidation. Studies show that ADHD children have abnormal SWS activity compared with healthy controls (Ringli et al., 2013), reflecting a neuromaturational delay of this brain wave rhythm in nonREM sleep. This imbalanced activity of slow waves is also associated with difficulties in consolidation of declarative memory (Prehn-Kristensen et al., 2011) which may explain difficulties to memorize facts and consequent learning problems related with ADHD.

In a recent study, the same author find that ADHD children have less activity in brain regions related to the consolidation of emotional memory (cited above), and suggest that these deficits are implicated in emotional symptoms reported by ADHD children during daytime (Prehn-Kristensen et al., 2013). ADHD children seem to have difficulties to select properly between emotional and non-emotional stimuli during sleep, which causes a diminished capacity to consolidate emotions related to events, which in turn, should have a direct impact on emotional relationships established with their peers.

Although more research is needed to strengthen the association between emotional memory and sleep, it is an important perspective because highlights the role of brain activity during sleep-time and allows us to better understand ADHD children not only in relation to their behavior, but also in relation to their emotions.

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References

Cortese, S., Faraone, S. V., Konofal, E., & Lecendreux, M. (2009). Sleep in Children With Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Subjective and Objective Studies. Journal of the American Academy of Child & Adolescent Psychiatry, 48(9), 894-908. doi:10.1097/CHI.0b013e3181ac09c9

Plessen, K. J., Bansal, R., Zhu, H., Whiteman, R., Amat, J., Quackenbush, G. A., … Peterson, B. S. (2006). Hippocampus and Amygdala Morphology in Attention-Deficit/Hyperactivity Disorder. Archives of general psychiatry, 63(7), 795-807. doi:10.1001/archpsyc.63.7.795

Prehn-Kristensen, A., Göder, R., Fischer, J., Wilhelm, I., Seeck-Hirschner, M., Aldenhoff, J., & Baving, L. (2011). Reduced sleep-associated consolidation of declarative memory in attention-deficit/hyperactivity disorder. Sleep Medicine, 12(7), 672-679. doi:10.1016/j.sleep.2010.10.010

Prehn-Kristensen, A., Munz, M., Molzow, I., Wilhelm, I., Wiesner, C. D., & Baving, L. (2013). Sleep Promotes Consolidation of Emotional Memory in Healthy Children but Not in Children with Attention-Deficit Hyperactivity Disorder. PLoS ONE, 8(5). doi:10.1371/journal.pone.0065098

Ringli, M., Souissi, S., Kurth, S., Brandeis, D., Jenni, O. G., & Huber, R. (2013). Topography of sleep slow wave activity in children with attention-deficit/hyperactivity disorder. Cortex, 49(1), 340-347. doi:10.1016/j.cortex.2012.07.007

Meltzer, L. J., Johnson, C., Crosette, J., Ramos, M., & Mindell, J. A. (2010). Prevalence of diagnosed sleep disorders in pediatric primary care practices.Pediatrics125(6), e1410-e1418.

Eficacia de la Telepsicología

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La Telepsicología puede definirse como el uso de la tecnología web para proporcionar evaluación y tratamiento a distancia en salud mental. Su fiabilidad en niños y adolescentes se ha hecho entre otros, con la entrevista diagnóstica Schedule for the Assessment of Depression and Schizophrenia (K-SADS), y nuevos estudios apoyan la evidencia que la telepsicología tiene su propia eficacia (Richardson, Frueh, Grubaugh, Egede y Elhai, 2009). Por otra parte, se ha hecho en los últimos años un esfuerzo con el fin de sistematizar y regular este campo cada vez más importante, y ya se cuenta con un reglamento para una buena práctica (Myers et al, 2008; American Telemdicine Association, ATA , 2013).

En cuanto a las ventajas sobre la terapia cara a cara, Pakyurek, Yellowlees y Hilty (2010) destacan que la telepsicología puede ser mejor que el servicio en persona por varias razones: 1. Novedad: la interacción paciente-psicólogo se percibe como más emocionante y menos amenazante, 2. Dirección: el paciente (como en el caso del Autismo o el TDAH) parece estar dirigido por la tecnología y las consecuencias directas de su comportamiento (lanzar una goma) no recaen directamente en el terapeuta, 3. Distancia: algunos pacientes se sienten más cómodos y hablan más libremente con una distancia entre ellos y el terapeuta; 4. Autenticidad de la interacción de la familia: el psicólogo puede observar la interacción entre padres e hijos en un entorno más natural, lo cual es menos probable de ser observado cara a cara. La telepsicología puede ser especialmente útil para algunos pacientes, por ejemplo aquellos localizados en zonas rurales, que pueden tener acceso a servicios de salud y a buenos recursos educativos en línea, pero también para algunos trastornos como el TDAH ( Palmer et al., 2010).

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Referencias

Myers, K., Cain, S., Work Group on Quality Issues, & American Academy of Child and Adolescent Psychiatry Staff. (2008). Practice parameter for telepsychiatry with children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 47(12), 1468-1483. doi:10.1097/CHI.0b013e31818b4e13

Pakyurek, M., Yellowlees, P., & Hilty, D. (2010). The Child and Adolescent Telepsychiatry Consultation: Can It Be a More Effective Clinical Process for Certain Patients Than Conventional Practice? Telemedicine and e-Health, 16(3), 289-292. doi:10.1089/tmj.2009.0130

Palmer, N. B., Myers, K. M., Vander Stoep, A., McCarty, C. A., Geyer, J. R., & DeSalvo, A. (2010). Attention-Deficit/Hyperactivity Disorder and Telemental Health. Current psychiatry reports, 12(5), 409-417. doi:10.1007/s11920-010-0132-8

Richardson, L. K., Frueh, B. C., Grubaugh, A. L., Egede, L., & Elhai, J. D. (2009). Current Directions in Videoconferencing Tele-Mental Health Research. Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association, 16(3), 323-338. doi:10.1111/j.1468-2850.2009.01170.x