Aprendizagem auditivo-verbal e aspectos afetivo-emocionais encobertos pelo diagnóstico de transtorno de déficit de atenção/hiperatividade (TDAH) : estudo de caso clínico

Abstract

The diagnosis of Attentional-Deficit/Hyperactivity Disorder (ADHD) is still a challenge because there are no biological markers or tests that prove the presence of the disorder, and some symptoms are compatible with other disorders, such as Specific Learning Disorder, Oppositional Defiant Disorder, Autism Spectrum Disorder, among others. Thus, there is a risk of not only inaccurate diagnoses of ADHD, but also unnecessary prescriptions of psychotropic drugs. A disorder that can be masked by a diagnosis of ADHD from another health area is the Auditory Processing Central Disorder (APCD), which is characterized by difficulty in interpreting verbal stimuli, received by hearing, especially in sequence, and can be confused with attentional deficit and behavioral characteristics equally impaired in ADHD. Moreover, there may be emotional implications in both disorders. The aim of the present research was to analyze the diagnostic hypothesis of ADHD of an eight-year-old child and the clinical diagnosis of ADHD of a twelve-year-old adolescent, and to investigate the possible relationship between ADHD and auditory-verbal learning deficits. To this end, we analyzed the cognitive functions, verbal auditory learning, and emotional aspects assessment of this sample. The data collected came from anamnesis interviews, the Wechsler Intelligence Scale for Children, the School Performance Test II, Rey's Complex Figure, Rey's Verbal Auditory Learning Test, the D2-R Concentrated Attention Test, the Psychological Battery for Attention Assessment, the Five Digits Test, the Wisconsin Card Sorting Test, the Attention Deficit/Hyperactivity Disorder Scale: Teacher Version and SNAP-IV (for parent and teacher). In both cases no deficits were identified in attentional functions. In the child, deficits in mental processing speed, academiclanguage skills, verbal-episodic short-term memory, mental flexibility, organization, and impulse control emerged, suggesting a diagnosis of predominantly mild hyperactive-impulsive ADHD. In the adolescent, deficits were found in mental control for verbal auditory stimuli, very short-term auditory memory, verbal abstract reasoning, verbal conceptualization, listening comprehension, verbal auditory learning, retroactive interference, academic-language skills, difficulty in changing behavior in the absence of external feedback and there were problematic acting-out behaviors. At the end of the assessment, the mother of the adolescent who had been previously diagnosed with ADHD provided a CAP assessment report that showed alterations. Thus, we concluded that it is possible to confuse ADHD with CAP, confirming the hypothesis of this study. It was also concluded that auditory-verbal learning deficits do not necessarily indicate the presence of ADHD, and the diagnosis of ADHD may be mistaken because of the presence of APD and affective-emotional aspects. However, ADHD and APCD can occur concomitantly. Due to the limitations of this study and the fact that the questions are not exhaustive, it is important that more research be done on the proposed theme. Even so, based on the findings, interventions and referrals are possible because of psychological and neuropsychological assessment. Based on the results of this research, it is still possible to propose evaluative and interventional actions for the age group studied, in addition to the development of guidelines for schools and institutions, and psychoeducation for parents or guardians.