Habilidades sociais e problemas de comportamento de crianças com altas habilidades/superdotação / Social skills and behavioral problems of high-ability/gifted children / Habilidades sociales y problemas conductuales de niños con altas habilidades/superdotados

Resumo O estudo das habilidades sociais contribui para a compreensão das relações interpessoais, embora ainda haja poucos estudos que relacionem esse tema a crianças com altas habilidades/superdotação (AH/SD). Portanto, os objetivos deste estudo foram: a) descrever e comparar as habilidades sociais de crianças com AH/SD sob o ponto de vista da criança e de seus respectivos pais/responsáveis e professoras; b) descrever e comparar as habilidades sociais e os problemas de comportamento de crianças com AH/SD sob o ponto de vista de seus pais/responsáveis e professoras, considerando o sexo e comparando a importância das habilidades sociais para os dois grupos; e c) descrever a competência acadêmica das crianças segundo as professoras. Participaram dez pais/responsáveis, oito professoras e dez crianças estudantes do ensino fundamental identificados com AH/SD. Os participantes responderam ao questionário Sistema de Avaliação de Habilidades Sociais (SSRS) versão para pais, professores e alunos, e ao Questionário de Respostas Socialmente Habilidosas (QRSH), versão para pais e professores. Os resultados apontaram que as crianças apresentaram habilidades sociais acima da média para seus pais e professores, e abaixo da média no autorrelato das crianças. Entretanto, há indicativos de necessidade de atenção preventiva e de intervenção nos fatores que apresentaram déficits sociais de acordo com o relato dos três grupos de participantes em: autocontrole/civilidade; cooperação/empatia; assertividade/desenvoltura social; problemas de comportamento externalizantes e internalizantes; e hiperatividade. Tais dados possibilitam que sejam programadas intervenções preventivas, conforme indicação dos pais/responsáveis e professoras, condizentes com a necessidade apontada pelas próprias crianças para a promoção de habilidades sociais. (AU)

Abstract Studying social skills helps understanding interpersonal relations, but studies relating both issues in high-ability/gifted (HA/G) children are still scarce. Thus, this study aimed to describe (a) the social skills of HA/G children from the viewpoints of the children themselves, their parents/guardians, and teachers; (b) the social skills and behavioral problems of HA/G children from the viewpoints of their parents/guardians and teachers, considering gender and the importance attributed by each group to social skills; and (c) children academic competence according to their teachers. The study comprised ten parents/guardians, eight teachers, and ten elementary school students identified as presenting with high abilities/giftedness. Data were collected by means of the Social Skills Rating System (SSRS), applied to parents, teachers, and students; and the Socially Skillful Responses Questionnaire (SSRQ), applied to parents and teachers. For parents and teachers, children's social skills were considered above average, whereas for themselves they were considered below average. However, the three groups indicated social deficits in some factors that require preventive attention and interventions, namely: self-control/civility; cooperation/empathy; social assertiveness/resourcefulness; external and internalizing behavior problems; and hyperactivity. These findings enable the development of preventive interventions aimed at promoting social skills among HA/G children based on the reports of parents/guardians, teachers and children themselves. (AU)

Resumen Los estudios de las habilidades sociales contribuyen a la comprensión de las relaciones interpersonales, pero todavía son pocos los que relacionan este tema al de niños con altas habilidades/superdotados (AH/SD). Teniendo en cuenta esto, los objetivos de este estudio fueron: a) describir y comparar las habilidades sociales de niños con AH/SD desde el punto de vista del niño y de sus respectivos padres/responsables y profesoras; b) describir y comparar las habilidades sociales y los problemas conductuales de niños con AH/SD desde el punto de vista de sus padres/responsables y profesoras, considerando el sexo y la importancia de las habilidades sociales para ambos grupos; y c) describir la competencia académica de los niños según las profesoras. Participaron 10 padres/responsables, siendo ocho profesoras y diez alumnos de educación primaria de una escuela pública identificados con AH/SD. Los participantes respondieron al cuestionario Sistema de Evaluación de las Habilidades Sociales (SSRS), versión para padres, profesores y alumnos, y al Cuestionario de Respuestas Socialmente Habilidosas (CRSH), versión para profesores. Los resultados indicaron que los niños presentaban habilidades sociales mayor del promedio para sus padres y maestros y por debajo del promedio en el autoinforme de los niños. Sin embargo, se observó la necesidad de atención preventiva e intervención en los factores que presentaron déficits sociales de acuerdo con el relato de los tres grupos de participantes en: autocontrol/cortesía; cooperación/empatía; asertividad social/ingenio; problemas de conducta externos e internalizantes e hiperactividad. Estos datos permiten programar intervenciones preventivas, conforme indicación de los padres/responsables y profesoras y la necesidad de los propios niños, para la promoción de habilidades sociales. (AU)

Contribuição de múltiplos informantes para avaliação comportamental de adolescentes com queixas de desatenção e hiperatividade / Multiple informants' contribution on behavioral assessment of youths with inattention and hyperactivity symptoms / Contribución de múltiples informantes para evaluación conductal de adolescentes con quejas de falta de atención e hiperactividad

O objetivo do estudo foi avaliar a concordância entre múltiplos informantes sobre problemas de comportamento externalizantes e internalizantes de adolescentes entre 11 e 16 anos encaminhados para avaliação diagnóstica com queixas de desatenção e/ou hiperatividade. A amostra foi composta por 24 pais, 24 professores e 24 adolescentes que responderam aos questionários CBCL/6-18, TRF/6-18 e YSR/11-18, respectivamente, completando um total de 72 participantes. Em média, os pais reportaram mais problemas que os demais, o que levou a um maior número de casos na faixa clínica dos instrumentos. Os índices de concordância quanto à classificação dos problemas na faixa normal ou clínica dos instrumentos variaram de k=0,333 a k=0,120 e as correlações Q entre os pares de instrumentos variaram de 0,715 a 0,804, semelhantes às encontradas em trabalhos com amostras populacionais. As implicações para o diagnóstico clínico são discutidas tendo como base a importância da avaliação feita por múltiplos informantes para conhecer os comportamentos dos adolescentes com queixas de saúde mental em diferentes contextos e assim elaborar diagnósticos mais precisos e planejar intervenções mais adequadas.

The objective of this study was to verify the agreement rates among multiple informants regarding internalizing and externalizing behavioral problems in adolescents between 11 and 16 years old referred for diagnostic assessment with complaints of inattention and/or hyperactivity. The sample was composed by 24 parents, 24 teachers and 24 youths that filled the forms CBCL/6-18, TRF/6-18 and YSR/11/18, respectively, completing a total of 72 participants. On average, parents reported more problems than other informants for all problem-scales, which led to a greater number of cases identified in the clinical range of the form. Agreement indexes for classification of problems in normal vs. clinical range ranged from k=0.333 to k=0.120. Q Correlations for items ratings by pair of forms ranged from 0.715 to 0.804, similar to those found in other population sample studies. The implications for clinical diagnosis are discussed based on the important of multiple informants' assessment to understand adolescents' behaviors with mental health complaints in different contexts, to elaborate more accurate diagnoses and to plan appropriate interventions.

El objetivo de este estudio fue verificar los índices de concordancia entre múltiples informantes sobre problemas de conducta externalizantes e internalizantes de adolescentes entre 11 y 16 años llevados por los padres para evaluación diagnóstica por quejas de falta de atención y/o hiperactividad. La muestra del estudio fue compuesta por 24 padres, 24 profesores y 24 jóvenes (completando un total de 72 participantes) que llenaron los formularios CBCL/6-18, TRF/6-18 y YSR/11-18. En la media los padres reportaron más problemas que los otros informantes, lo que llevó a un mayor número de casos identificados en el rango clínico de los instrumentos. Los índices de concordancia de la clasificación de los problemas en el rango normal o clínico de los instrumentos variaron de k=0,333 a k=0,120 y las correlaciones Q entre los pares de instrumentos variaron de 0,715 a 0,804, datos que fueron semejantes a los encontrados en trabajos con muestras poblacionales. Las implicaciones para el diagnóstico clínico son discutidas teniendo como base la importancia de la evaluación hecha por informantes múltiples para conocer las conductas de los adolescentes con quejas de salud mental en diferentes contextos y así elaborar diagnósticos más precisos y planificar intervenciones más adecuadas.

Identificación por padres y maestros de síntomas del trastorno por déficit de atención con hiperactividad / Identification by parents and teachers of symptoms of attention deficit hyperactivity disorder / Identificação por pais e professores de sintomas do transtorno por déficit de atenção com hiperatividade

Con el fin de contribuir a la investigación epidemiológica del Trastorno por Déficit de Atención con Hiperactividad-TDAH se analizaron las semejanzas y diferencias en los cuestionarios contestados por padres y maestros para la identificación de síntomas del TDAH en niños que acuden a consulta psicológica al Hospital Civil Fray Antonio Alcalde en Guadalajara, México. Padres y maestros de 168 niños (46 niñas, 122 niños, edad promedio de 8.2 años) contestaron respectivamente un cuestionario de 18 preguntas, estructurado a partir de los criterios diagnósticos para el TDAH propuestos en el DSM-IV. Como resultados, el análisis estadístico arrojó una concordancia moderada entre padres y maestros, observando diferencias significativas (p < 0.05) en 6 de los 18 reactivos. Los criterios concordantes se refieren, en su mayoría, a síntomas de desatención, mientras que las diferencias observadas tienen que ver con conductas asociadas a hiperactividad e impulsividad, con puntuaciones más altas otorgadas por parte de los padres. También se observó que al analizar en forma separada a niños y niñas no se encuentran diferencias significativas en la mayoría de las puntuaciones otorgadas a las niñas, mientras que las discrepancias son observadas principalmente en los puntajes otorgados a los niños, tanto de los primeros como de los últimos grados escolares, con mayores puntuaciones asignadas por los padres de familia. Se concluye que, efectivamente, tanto padres como maestros dan diferente significación a la conducta de los menores, dependiendo de su edad y su género, principalmente por su capacidad de control atencional y de su actividad motora, tanto en casa, como en la escuela.

In order to contribute to the epidemiological research on Attention Deficit Disorder with Hyperactivity -ADHD- similarities and differences in the questionnaires completed by parents and teachers were analyzed to identify ADHD symptoms in children attending psychological counseling at the Civil Hospital Fray Antonio Alcalde in Guadalajara, Mexico. Parents and teachers of 168 children (46 girls, 122 boys, mean age 8.2 years) completed, respectively, an 18 items questionnaire, structured from the diagnostic criteria for ADHD in DSM-IV. As a result, the statistical analysis showed moderate agreement between parents and teachers, noting significant differences (p <0.05) in 6 out of the 18 questions. Consistent agreements relate mostly to symptoms of inattention, while observed differences are related to behaviors associated with hyperactivity and impulsivity, where parents gave higher scores. It was also noted that when analyzing separately the results for boys and girls, no significant differences were found in most of the scores given to girls, while discrepancies are mainly observed in the scores given to boys, both of the first and last school grades, with higher scores assigned by parents. It is concluded that parents and teachers give different meaning to the behavior of children, depending on their age and gender, primarily for their attentional control ability and motor activity, both at home and at school.

Com o objetivo de contribuir à pesquisa epidemiológica do Transtorno por Déficit de Atenção com Hiperatividade-TDAH analisaram-se as semelhanças e diferenças nos questionários respondidos por pais e professores para a identificação de sintomas do TDAH em crianças que fazem consulta psicológica no Hospital Civil Frei Antonio Alcalde em Guadalajara, México. Pais e professores de 168 crianças (46 meninas, 122 meninos, idade média de 8.2 anos) responderam respectivamente a um questionário de 18 perguntas, estruturado a partir dos critérios diagnósticos para o TDAH propostos no DSM-IV. Como resultados, a análise estatística mostrou uma concordância moderada entre pais e professores, observando diferença significativas (p<0.05) em 6 dos 18 reativos. Os critérios concordantes se referem, na sua maioria, a sintomas de desatenção, enquanto que as diferenças observadas estão relacionadas com condutas associadas à hiperatividade e impulsividade, com pontuações mais altas dadas pelos pais. Observou-se também que ao analisar em forma separada a meninos e meninas não se encontram diferenças significativas na maioria das pontuações dadas às meninas, enquanto que as discrepâncias são observadas principalmente nas pontuações dadas aos meninos, tanto dos primeiros como de os últimos anos escolares, com maiores pontuações atribuídas pelos pais de família. Conclui-se que, efetivamente, tanto pais como professores dão um significado diferente à conduta dos menores, dependendo de sua idade e seu gênero, principalmente por sua capacidade de controle de atenção e de sua atividade motora, tanto em casa, como na escola.

Problemas de comportamento segundo vítimas de bullying e seus professores / Behavior problems according to victim of bullying and their teachers / Problemas de conducta según victim de bullying y sus maestros profesores

O estudo teve como objetivo comparar os escores de problemas de comportamento relatados por adolescentes, vítimas de bullying, aos escores reportados por seus professores, e discutir acerca das convergências e divergências, e de suas implicações. Para identificar alvos de bullying se utilizou a Escala de Violência Escolar e a versão traduzida do PeerAssessment. Na avaliação de problemas de comportamento foram utilizados o Youth Self Report e o Teacher Report Form. Participaram 50 adolescentescom média de 11,3 anos (DP=0,7), matriculados em duas turmas de EnsinoFundamental II (6º e 7º anos) de uma escola pública paulista. Destes, sete(14%) foram identificados como alvos de bullying, sendo quatro do gêneromasculino. Problemas de comportamento internalizantes, externalizantes e totais estiveram em nível clínico na maioria das vítimas, segundo o relato dos próprios alunos e de seus professores, que relataram menos problemas de comportamento internalizantes e mais problemas de comportamento externalizantes em comparação ao referido pelos alunos alvos de bullying. Houve diferenças estatisticamente significativas em externalizantes (Z=- 2,31; p=0,01). Os resultados encontrados fornecem informações sobre os padrões de interação presentes no grupo avaliado, ratificando a importância de estudos voltados ao tema e de intervenções que visem reduzir e prevenir a ocorrência de bullying...

The goal of this study was to compare the scores of behavior problemsreported by bullied teenagers and their teachers, and to discuss similarities and differences among them and their implications. The School ViolenceScale and the translated version of the Peer Assessment were used to identify teenagers who were targets of bullying. To assess the behavior problems, we used the Youth Self Report and the Teacher Report Form. Fifty teenagers participated in the study, with mean age of 11.3 years (SD = 0.7). They were enrolled in two classes of Elementary Education II (6º and 7º grades) of a public school in Sao Paulo. Seven of them (14%) were identified as targets of bullying, from which four were males. Internalizing, externalizing and total behavior problems reached clinical level in most of the victims, according to themselves and their teachers, who alsoreported fewer internalizing behavior problems and more externalizingbehavior problems when compared to bullied students’ reports. There were statistically significant differences for externalizing problems reports (Z = -2.31, p = 0.01). The results provide information about patterns of interaction present in the evaluated group, confirming the importance ofstudies regarding this topic, as well as the studies about interventions thatcan reduce and prevent the occurrence of bullying...

El estudio tuvo como objetivo comparar puntuaciones de problemas de comportamiento reportados por adolescentes víctimas de bullying apuntajes reportados por sus maestros, y discutir acerca de las similitudes y diferencias, y sus implicaciones. Para identificar las víctimas de intimidación se utilizó la Escala de Violencia Escolar y la versión traducida de la Evaluación por Pares. En la evaluación de problemas de conducta se utilizaron el Youth Self Report y el Teacher Report Form. Participaron 50 adolescentes, media de 11,3 años (DE = 0,7), matriculados en dos clases de Educación Primaria II (6º y 7º años) de una escuela pública deSao Paulo. Siete (14%) fueron identificados como víctimas de bullying,entre ellos cuatro varones. Internalización, externalización y problemas de comportamiento total atingieron nivel clínico en la mayoría de las víctimas, según informes de los propios y de sus maestros, que reportaron menos problemas de internalización y más problemas de externalización en comparación a los informes de las víctimas de bullying. Hubo diferencias estadísticamente significativas en la externalización (Z = -2.31, p = 0,01). Los resultados proporcionan información acerca de patrones de interacción presentes en el grupo evaluado, lo que confirma la importancia de estudios realizados hasta el tema y las intervenciones que reducen y previenen la aparición de bullying...

Potencial terapêutico e uso de plantas medicinais em uma área de Caatinga no estado do Ceará, nordeste do Brasil / Therapeutic potential and use of medicinal plants in an area of the Caatinga in the state of Ceará, northeastern Brazil

O presente trabalho visou o levantamento etnobotânico das plantas medicinais, verificando a versatilidade das espécies utilizadas e o consenso de uso e/ou conhecimento entre os informantes, do Distrito de Aratama, no Município de Assaré, Ceará. As informações etnobotânicas foram obtidas através de entrevistas estruturadas e semi-estruturadas com os moradores locais. Foram citadas 116 espécies com fins medicinais pertencentes a 103 gêneros e 58 famílias com destaque para Fabaceae (10ssp.), Asteraceae (7spp.) e Lamiaceae (6spp.). Entre as espécies levantadas, Mentha spicata L., Rosmarinus officinalis L., Allium sativum L., Bauhinia cheilantha (Bong.), Ximenea americana L., se destacaram como as mais versáteis dentro da comunidade. As indicações terapêuticas citadas foram agrupadas em 16 categorias de sistemas corporais, dos quais as Desordens mentais e comportamentais, as Afecções ou dores não definidas, os Transtornos do sistema respiratório, as Doenças de pele e do tecido celular subcutâneo, e os Transtornos do sistema sensorial (ouvidos), mostram maior concordância entre os informantes na utilização de espécies para tratar um sistema corporal especifico. Os resultados mostraram elevada riqueza da flora medicinal presente na caatinga. Neste sentido, torna-se necessária a intensificação de estudos que avaliem e consolidem as propriedades químicas e farmacológicas destas espécies.

This study is about an ethnobotanical survey of medicinal plants, checking the versatility of the species used and the consensus of use and/or knowledge among informants from the Aratama District, in the municipality of Assaré, state of Ceará, Brazil. The ethnobotanical information was obtained through structured interviews and semi-structured interviews with local residents. Approximately, 116 species were mentioned for medicinal purposes, belonging to 103 genera and 58 families, especially Fabaceae (10ssp.), Asteraceae (7spp.) and Lamiaceae (6spp.). Among the surveyed species, Mentha spicata L., Rosmarinus officinalis L., Allium sativum L. and Bauhinia cheilantha (Bong.) Ximenea americana L. stood out as the most versatile in the community. The therapeutic indications mentioned were grouped into 16 categories of body systems; the mental and behavioral disorders, disorders or pain not defined, disorder of the respiratory system, skin diseases and subcutaneous tissue disorder, and disorder of the sensory system (ears) showed greater agreement among informants in the use of species to treat a specific body system. The results showed a high species richness of the medicinal flora present in the Brazilian Caatinga. Thus, it is necessary to intensify and consolidate studies assessing the chemical and pharmacological properties of these species.

Problemas emocionales y conductuales en niños: predictores desde la percepción de los padres y de los hijos / Emotional and Behavioral Problems in Children: Predictors from the Perception of Parents and Children

Los objetivos del presente estudio fueron: determinar si existen diferencias entre padres e hijos en prácticas parentales y problemas emocionales y conductuales de los hijos; analizar el grado de acuerdo entre la percepción de los hijos acerca de las prácticas parentales y sus problemas emocionales y conductuales y las prácticas parentales y problemas de los hijos expresados por el padre y la madre y comparar el nivel de predicción de las prácticas parentales en los problemas emocionales y conductuales de los hijos desde la perspectiva de la madre, el padre y el hijo(a). Participaron 552 niños (52.5% niños y 47.5% niñas), con una edad promedio de 10.8 años; también participaron 395 mamás y 349 papás de los niños. Se utilizó la escala de Prácticas Parentales de Andrade y Betancourt (2010) y la escala de Problemas Emocionales y Conductuales de Andrade y Betancourt (2009). En cuanto el nivel de predicción de las prácticas parentales en los problemas emocionales y conductuales de los hijos, los resultados mostraron mayores porcentajes de varianza explicados cuando los niños y niñas son los informantes que cuando lo son la madre o el padre.

The objectives of this study were to determine whether differences exist between parents and children in parenting practices, and behavioral and emotional problems of children, to analyze the degree of agreement between the perceptions of children about parenting practices and their emotional and behavioral problems, and parenting practices and problems of the children expressed by the father and mother, and comparing the prediction of parenting practices in emotional and behavioral problems of children from the perspective of the mother, father and children. 552 children participated (52.5% boys and 47.5% girls), with an average age of 10.8 years, students from public schools; 395 mothers and 349 fathers of children were also involved. To measure parenting practices Andrade and Betancourt scale (2010) was used, which consists of five dimensions for mother (Communication, Autonomy, Imposition, Behavioral control and Psychological control) and four for father. (Communication/Behavioral Control, Autonomy, Imposition and psychological control). Andrade and Betancourt scale (2009) was used for measuring emotional and behavioral problems; it assesses eight dimensions (rule breaking, somatic problems, depression, attention problems, harassment, friend's problems, aggressive behavior and thought problems). The results showed that significant differences exist between parents and children in the reporting of emotional problems but not for behavioral problems, we also found no significant differences between the assessments made for mothers and fathers in both types of problems. Regarding parenting practices, only significant differences were found between the perceptions of children, and what was expressed by mothers, in the comparison between parents and children no significant differences were found. As for predicting the level of parenting practices in emotional and behavioral problems of children, from the perspective of different informants, the results showed that the percentages of explained variance of emotional and behavioral problems of children when they are informants are higher than, when the mother and father are the informants.

Construcción y validación de un cuestionario para identificación de Factores Asociados al Desempeño Escolar (FADE) / Construction and validation of a questionnaire for identification of factors associated with school performance / Construção e validação de um questionário para identificação de fatores associados ao desempenho escolar (FADE)

Se construyó una prueba psicológica para medir los Factores Asociados al Desempeño Escolar (FADE), siguiendo lineamientos de la Teoría Clásica de los Test y aspectos de medición y evaluación desde una estrategia multi-informante aplicada a los contextos escolares. La finalidad de la prueba es la identificación de debilidades y fortalezas asociadas al desempeño escolar en niños de primer grado de primaria del municipio de Pasto. La muestra utilizada fue de 277 participantes pertenecientes a instituciones públicas de carácter urbano y rural. La confiabilidad calculada a través del coeficiente KR20 fue de .92 para la prueba total. Se obtuvieron evidencias favorables para validez de contenido, criterio y constructo. Se establecieron normas de estandarización para la aplicación y calificación de la prueba. La evidencia encontrada da cuenta de que la prueba resulta útil para su aplicación práctica como herramienta en la evaluación clínica y su uso en investigación.

A psychological test was constructed to measure School Performance Associated Factors (FADE, by its Spanish acronym), following the guidelines of the Classical Theory of Tests and aspects of measuring and assessment from a multiple informant strategy applied to school settings. The purpose of the test is to identify weaknesses and strengths associated with school performance in first grade primary school children from the municipality of Pasto. The sample consisted of 277 participants from public institutions of urban and rural character. The reliability calculated by KR20 coefficient was 0.92 for the total test. Favorable evidence was obtained for content, criteria and construct validity. Standardized rules were established for the test administration and scoring. The evidence found shows that the test is useful for its practical application as a tool for clinical assessment and research.

Construiu-se um teste psicológico para medir os Fatores Associados ao Desempenho Escolar (FADE), seguindo as diretrizes da Teoría Clássica dos Testes e aspectos de medição e avaliação desde uma estratégia multi-informante aplicada aos contextos escolares. A finalidade do teste é a identificação de pontos fortes e pontos fracos associados ao desempenho escolar em crianças do primeiro ano do primário do município de Pasto. A mostra utilizada foi de 277 participantes pertencentes a instituições públicas de caráter urbano e rural. A confiabilidade calculada através do coeficiente KR20 foi de ,92 para a prova total. Obtiveram-se evidências favoráveis para validade de conteúdo, critério e constructo. Estabeleceram-se normas de padronização para a aplicação e qualificação da prova. A evidência encontrada mostra que a prova é útil para sua aplicação prática como ferramenta na avaliação clínica e seu uso em pesquisa.

Padrões de concordância entre múltiplos informantes na avaliação dos problemas comportamentais de adolescentes: implicações clínicas / Agreement patterns between multiple informants in adolescents' behavioral assessment: clinical implications

Uma avaliação abrangente inclui informações advindas de múltiplos informantes, inclusive do próprio adolescente, que oferece uma perspectiva única sobre o caso. Buscando verificar padrões de concordância entre pais e adolescentes na avaliação dos problemas dos últimos e discutir as implicações clínicas das divergências, as autoavaliações de 66 adolescentes encaminhados para atendimento psicológico, expressas na resposta ao YSR, foram comparadas às avaliações feitas pelos respectivos pais sobre os comportamentos dos filhos, expressas nas respostas ao CBCL. O relato dos pais apontou mais problemas emocionais/comportamentais em termos de escores e na quantidade de casos que atingiram a faixa clínica dos instrumentos. Discutem-se razões para a concordância entre informantes ser maior na Escala de Externalização e implicações que discrepâncias trazem para o clínico. Conclui-se que a avaliação feita por múltiplos informantes é importante, independentemente das divergências, pois conhecer os comportamentos em diferentes contextos é fundamental para elaborar diagnósticos completos e intervenções adequadas. (AU)

A comprehensive assessment includes information obtained with multiple informants, including the adolescent himself, who offers a unique perspective of the case. In order to verify agreement patterns between parents and youths on the assessment of behavioral problems, and to discuss the clinical implications of the differences, the self-report of 66 adolescents referred for psychological treatment, on the YSR, was compared with the parents' report of their children's behavior, on the CBCL. Parents reported more behavioral problems in terms of scores and in number of clinical cases identified by the instruments. The possible reasons for the higher agreement found between informants on the Externalizing Problems scale is discussed, as well as the clinical implications of the differences. It is concluded that the use of multiple informants on the assessment process is important, regardless of the divergences, because knowing behaviors in different contexts is crucial to elaborate complete diagnostics and adequate interventions. (AU)

Some considerations about the use and applicability of preference-based health-related quality of life measures to survivors of cancer in childhood and adolescence in developing countries / Algumas considerações acerca do uso e aplicação de medidas de qualidade de vida associada à saúde, com ênfase em estudos sobre sobreviventes de câncer na infância e adolescência em países em desenvolvimento / Algunas consideraciones sobre el uso y la aplicación de medidas de calidad de vida asociada a la salud, con énfasis en estudios sobre sobrevivientes de cáncer en la infancia y adolescencia en países en desarrollo

Measures of health-related quality of life (HRQoL) have become widely available in developed countries such as the United States, Canada and the United Kingdom. Such measures, instruments or questionnaires need to undergo translation processes, validation and cultural adaptation in order to be used in other countries and in other languages. The utilization of measures developed in settings other than the originating ones poses several challenges, including the appropriateness of the translation and of the cross-cultural adaptation and adequate validation process. Preference-based or preference-weighted utilities for health states have an important role in measurement and in economic evaluation regarding a wide range of conditions, such as childhood cancer and survivorship. Some attempts have been made to create and apply preference-based HRQoL indexes to young populations, such as children, adolescents and young adults. Use of proxy respondents is an issue for studying HRQoL in these groups, especially children. This review aims at providing a critical evaluation of the use of preference-based HRQoL measures in developing countries, focusing on the Health Utilities Index, Mark 2 and Mark 3, commonly called HUI2 and HUI3, and their application to survivors of childhood cancer in Latin America. The process researchers undertake, especially in regards to the use of already translated instruments is discussed. The appropriateness of the instruments is also assessed and focus is on the attributes of the instrument and the population, the cultural aspects and the use of proxy respondents. Finally, the adequateness of other commonly used preference-based instruments for childhood cancer is discussed. This critical assessment could benefit future work in the area of health-related quality of life, especially guiding those interested in the trans-cultural use of existing generic preference-based HRQoL instruments.

Instrumentos para medir a qualidade de vida associada à saúde vêm se tornando cada vez mais usados em países desenvolvidos, como Estados Unidos, Canadá e Reino Unido. Essas medidas devem passar por processos de tradução, validação e adaptação cultural antes de serem usadas em países e/ou línguas, que não os de origem. A utilização de instrumentos desenvolvidos em outros contextos culturais apresenta vários desafios, tais como a propriedade da tradução, adequação da adaptação cultural, bem como satisfatório processo de validação. Preferências por estados de saúde baseadas na teoria da utilidade têm papel importante na avaliação econômica, principalmente em análises de custo-efetividade e custo-utilidade de intervenções relacionadas a diversas doenças e condições de saúde, como câncer infantil e sobrevivência. Alguns trabalhos desenvolvidos recentemente visam criar e aplicar medidas de qualidade de vida obtidas por meio da mensuração de preferências por estados de saúde, em grupos jovens, tais como crianças e adolescentes. A necessidade de utilização de respondentes substitutos é uma questão que permeia o uso dessas medidas nestes grupos, especialmente em crianças. Esta revisão apresenta uma avaliação crítica do uso de medidas de qualidade de vida associadas à saúde, obtidas por meio de preferências por estados de saúde, em países em desenvolvimento, com enfoque nas medidas denominadas Health Utilities Index, Mark 2 e Mark 3, comumente conhecidas como HUI2 e HUI3, e sua aplicação para sobreviventes de câncer na infância, na América Latina. Realiza-se uma discussão crítica do processo utilizado pelos pesquisadores quando empregam instrumentos já anteriormente traduzidos. A propriedade de outros instrumentos também é abordada, com ênfase nos atributos ou domínios abrangidos por cada medida analisada, para o câncer infantil. Espera-se que esta revisão beneficie futuros trabalhos na área de qualidade de vida associada à saúde, especialmente ...

En los países en desarrollo, como Estados Unidos, Canadá y Reino Unido, es cada vez mayor el empleo de instrumentos para medir la calidad de vida asociada a la salud. Estas medidas deben pasar por procesos de traducción, validación y adaptación cultural antes de ser utilizadas en países y/o idiomas diferentes a los de su origen. La utilización de instrumentos desarrollados en otros contextos culturales presenta varios desafíos, tales como la propiedad de la traducción, la adecuación de la adaptación cultural, así como un proceso de validación satisfactorio. Las preferencias por estados de salud basadas en la teoría de la utilidad tienen un rol importante en la evaluación económica, principalmente en el análisis de costo-eficacia y costo-utilidad de intervenciones relacionadas con diversas enfermedades y condiciones de salud, como el cáncer en la infancia y la supervivencia. Algunos trabajos desarrollados recientemente tienen como objetivo crear y aplicar medidas de calidad de vida obtenidas a través de la medición de preferencias por estados de salud, en grupos jóvenes, tales como niños y adolescentes. La necesidad de utilización de informantes sustitutos es un tema que traspasa el uso de estas medidas en estos grupos, especialmente en niños. Esta revisión presenta una evaluación crítica del uso de medidas de calidad de vida asociadas a la salud, obtenidas a través de las preferencias por estados de salud en países en desarrollo, con foco en las medidas denominadas Health Utilities Index, Mark 2 y Mark 3, comúnmente conocidas como HU12 y HU13, y su aplicación para sobrevivientes de cáncer en la infancia en América Latina. Se realiza una discusión crítica del proceso utilizado por los investigadores cuando emplean instrumentos anteriormente traducidos. También se plantea la propiedad de otros instrumentos, con énfasis en los atributos o dominios comprendidos por cada medida analizada para el cáncer en la infancia. Se espera que esta revisión ...

Combined instruments for the screening of dementia in older people with low Education / Instrumentos combinados para o rastreio de demência em idosos com baixo nível educacional

OBJECTIVE: To determine which combination of cognitive tests and informant reports can improve the diagnostic accuracy of dementia screening in low educated older people. METHOD: Patients with mild to moderate dementia (n=34) according to ICD-10 and DSM-III-R criteria and 59 older controls were assessed with the Mini-Mental State Examination (MMSE) and the Fuld Object Memory Evaluation (FOME). Informants were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Bayer-Activities of Daily Living Scale. RESULTS: The 4 instruments combined with the mixed rule correctly classified 100 percent and the logistic regression (weighted sum) classified 95.7 percent of subjects. The weighted sum had a significantly larger ROC area compared to MMSE (p=0.008) and FOME (p=0.023). The specificity of the tested combinations was superior to the MMSE alone (p=0.002). CONCLUSIONS: Cognitive tests combined with informant reports can improve the screening of mild to moderate dementia in low educated older people.

OBJETIVO: Determinar qual combinação de testes cognitivos e avaliações do informante pode melhorar o rastreio de demência em idosos com baixo nível educacional. MÉTODO: Pacientes com demência leve a moderada (n=34) de acordo com critérios da CID-10 e DSM-III-R, e 59 controles idosos foram avaliados com o Mini-Exame do Estado Mental (MEEM) e com o "Fuld Object Memory Evaluation" (FOME). Informantes foram avaliados com o "Informant Questionnaire on Cognitive Decline in the Elderly" e a escala Bayer-Atividades da Vida Diária. RESULTADOS: Os quatro instrumentos combinados com a regra mista classificaram 100 por cento e a regressão logística (soma ponderada) classificou 95,7 por cento dos sujeitos. A soma ponderada teve uma área da curva ROC significativamente maior comparada ao MEEM (p=0,008) e FOME (p=0,023). A especificidade das combinações testadas foi superior ao MEEM isolado (p=0,002). CONCLUSÕES: Testes cognitivos combinados com relatos dos informantes podem melhorar o rastreio de demência leve a moderada em idosos com baixo nível educacional.

Evaluación de la conducta adolescente con las Escalas de Achenbach: ¿existe concordancia entre diferentes informantes?

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Summary: Introduction Behavioural problems in adolescents are thought to be relevant as strong predictors for the detection of other psychological disorders. For this reason and due to the importance they present by themselves, carrying out an adequate assessment of them is fundamental. Mental health professionals have diverse opinions about the value and importance of the different informants. The majority choose of their sources according to the disorder and necessities of each evaluator. On the other hand, the need to obtain data about adolescents' functioning from multiple resources has been emphasised and numerous reasons have been exposed. Concretely, the fact of carrying out the most objective and complete evaluations as possible has been considered essential in those studies aimed at evaluating behavioural alteration in adolescents. For this reason, Achenbach developed three versions of his scale: one for the parents, another for the teachers and a third one for the adolescents themselves. Numerous investigations have studied the concordance between groups of informants about different behavioural alterations in adolescents, but none have carried out a complete analysis of all informants in all subscales (not only the total ones). For this reason, the current study has been developed with the aim of contributing to obtain an enriching vision for the professional in the field. Objectives. a) To systematically explore agreement patterns between adolescents, teachers and parents who inform of behavioural problems in adolescents in the general population and b) in those cases in which no agreement is found, to analyse the level of disagreement between each pair of informants for each subscale. Methodology. Cross-sectional and descriptive study Participants. The study was formed by 160 triads of parents, teachers and 13-16 year old adolescents selected from several schools in Barcelona. Instruments. The three forms of the Achenbach scale to measure behavioural alterations were applied. The scale was translated into Spanish by the Unit of Epidemiology and Diagnostic in Psychopathology of the Development of the Universidad Autónoma de Barcelona: Youth Self-Report, self-evaluated, Child Behaviour Checklist/4-18 and Teacher's Report Form, both heteroevaluated and completed by parents and teachers, respectively. These three forms contain a 89-item set that evaluates the same behaviour, where eight items are organised in scales of syndromes derived empirically and which are invariant throughout informants. The eight subscales are: withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behaviour and aggressive behaviour. Some of them are grouped in second order factors: the first three in internalising, the last two in externalising, and the rest of them provide a total problems punctuation. Statistical procedure. Agreement values were analysed for each pair of informants and each subscale through the Intraclass Correlation Coefficient (ICC). A value below 0.40 indicates low concordance. In these cases, the statistical analysis proceeds with the discordance analysis by pairs of informants and for each subscale through the Bland Altman Method. Results. A low concordance (below 0.40) between informants was found especially in internalizing scales (0.230). A slightly higher value was found in attention (0.334), aggressive behaviour (0.371), externalizing (0.357), and total subscales (0.327). Secondly, it was observed that, when informing about somatic complains, thought and attention problems, internalising items and the total scale, parents reported more alterations, followed by adolescents and teachers. Also, parents indicated more withdrawal problems in adolescents, although in this case they were followed by teachers and adolescents themselves. Finally, in the evaluation of the anxiety/depression scales, social problems, delinquent behaviour, aggressiveness and externalising conducts, adolescents informed of more alterations followed by their parents, and then by the teachers. Regarding the agreement/disagreement variability throughout the scales scores, the discordance between different informants was higher when the punctuation was further away from normality, generally when the scales were scored higher. Discussion. The normative criteria of comparison and the reference frames for each group of informants are different. For instance, the fact that teachers report less behavioural alterations could be explained because of their familiarity in dealing with adolescents and a higher tolerance towards some behaviors. In general terms, this result fits in with most conclusions from investigations carried out in this field. On the other hand, the fact that parents inform of more internalising problems could be attributed to adolescent behaviour which would in turn alter the family context. Another explanation might be that parents are on the whole more implicated and more sensitive in detecting certain conducts or behavioural alterations in their offspring. In any case, it is disputable whether the lack of concordance between the different informants does really exist or, on the contrary, adolescent behaviour changes depending on the context. Finally, a result contradicting those found in the studies reviewed is that adolescents are the ones who report more externalising problems. Other authors have found that adolescents inform more about internalising problems, something which should be expected taking into account that they are the ones who know themselves better. This could be possibly explained by the presence of more social desirability/undesirability among the adolescents of our sample in front of their pair group when answering to the evaluation scales; this may be due to the group context in which the case was applied. The main limitation of the present study that it was carried out with a general population sample, although from another point of view this may be considered as a gain of the study. We recommend carrying out explicative studies about discordance, which could clarify the predictive validity of each informant group and make variations in the type of sample under study. Conclusions. Data from different sources contribute with specific information of relative validity. This is why a multidimensional, multisituational and mulitiinformant approach is fundamental. This is necessary not only to evaluate behavioural alterations in adolescents within a research context, but also when taking diagnostic decisions in a clinical context, because, depending on the chosen informant, the diagnostic criteria for one disorder or another might change. Also, our results imply that there may be an underdetection of behavioural problems in adolescents by the adults, which would result in a lower psychological demand than the necessary.

¿Explica la esquizotipia la discordancia entre informantes de alteraciones conductuales adolescentes?

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Summary: Introduction. Behavioural alterations are a quite potent predictor for schizophrenia. Very often, apparently healthy adolescents (who will later develop schizophrenia) present altered conducts similar to those manifested by schizophrenic subjects and as predictors for the disorder. There are studies that describe the relationship between these behavioural alterations and the features found in schizotypical personality disorder or schizophrenic symptoms. In this way, it has been established that those subjects who obtain high scores in schizotypy present more behavioural alterations. Concretely, the different behavioural alterations have been differentially related to the positive and negative subtypes of the schizotypical personality, suggesting continuity between the nature of premorbid conducts and the adult symptoms patterns in which the illness develops. On the other hand, comparing adolescents that will later develop schizophrenia with those who will not, it has been found that the best schizophrenia predictor is a poor behavioural adjustment. Moreover, if the teachers' reports are examined, there can be certain aspects such as the early behavioural patterns which will identify children who, for instance, will develop schizophrenia thirty years later, or even differential patterns according to the gender of the subjects. Therefore, if we want to carry out a schizophrenia prediction according to these behavioural criteria, knowing which informants are more useful and how their opinions match among them is of a great interest. Until this moment, the majority of studies have pointed out at the ability of teachers to identify conducts that can be used to select people at risk for schizophrenia. However, having into account that numerous studies conclude that there is a lack of agreement between these and other different informants for behavioural alterations in adolescents, the importance of studying the variables that can be influencing this matter must be raised. Following with the line of our research group a question is raised. We wonder if the presence of schizotypical personality traits makes the adolescents behaviour more ambiguous, with the consequent difficulty to define it in a coincident way from different evaluators and from themselves. Objectives. To analyse the influence of the schizotypical personality (assessed with the Oxford-Liverpool Inventory of Feelings and Experiences), the demographic variable gender and the interaction between them, in the discordance of different informants (parents, teachers and adolescents) when they inform about behavioural problems in adolescents (assessed with the Achenbach's scales). Methodology. This is an analytic transversal study that can be framed into a longitudinal study of 2 cohorts from the general population, which started on 2000 and has been then followed-up ("Psychoeducation program and early detection of schizophrenic disorders of adolescent onset"). Participants. 160 triads of parents, teachers and adolescents from 13 to 16 years old selected from 7 schools of Barcelona took part in the study. Instruments. The three forms of the Achenbach scale for the measure of behavioural alterations were applied: Youth Self- Report, Child Behaviour Checklist/4-18 and Teacher's Report Form. These forms contain 8 scales which are invariant throughout informants: Withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behaviour and aggressive behaviour. Some of them are grouped in second order factors: Internalizing, externalizing and total. To evaluate the psychometrical schizotypical personality of adolescents we used the Oxford-Liverpool Inventory for Feelings and Experiences. It consists of an autoadministered inventory with 159 items that includes four schizotypical scales. The Unusual Experiences scale reflects the positive dimension of schizotypy and includes items of unusual perception aberrations and magical thinking. The Introvert Anhedonia Scale reflects the negative dimension of schizotypy and consists of items assessing restricted affect, social isolation and anhedonia. The Cognitive Disorganization Scale refers to disorganized aspects of the psychosis and it is composed of items assessing difficulties in concentration and decision-making. Finally, the Impulsive Nonconformity Scale reflects the characteristics of impulsive-type personality, social anxiety and maladjusted behaviours. Statistical proceed. Multiple regression analyses were carried out in order to revise the influence of the schizotypical personality, the demographic variable gender and the interaction between them as possible explicative variables, in the discordance between different informants about behavioural problems of adolescents. The dependent variable was a measure of the level of discordance between the three groups of informants. Results. A major discordance between informants of behavioural problems was found as schizotypy was higher. Concretely, a larger number of unusual experiences in adolescents increase the discordance for thought and internalizing problems. Discordance is also higher in aggressiveness and anxiety/depression as cognitive disorganization increases. Also, the higher the introverted anhedonia, the higher the discordance is for social problems, anxiety/depression, attention, externalizing problems, and for the total. To finish, a high score in non-conformity impulsivity increases the discordance for attention, delinquency and aggressive problems. About the influence of gender, discordance between informants for anxiety/depression is higher for females than for males. However, this varies when the interaction effects found are considered. In this way, a differential effect for the increase of non-conformity impulsivity and introvert anhedonia can be observed in males and females. Therefore, discordance between informants is higher when evaluating anxiety/ depression in males when non-conformity impulsivity is high. Just the opposite happens for girls. In addition, the discordance for the internalizing subscale increases just as the introverted anhedonia raises for females, but it decreases when evaluating males. Discussion. It seems clear that no source of data can be substituted for any other when evaluating behavioural problems in adolescents and much less when attention is centred in those adolescents who score high in schizotypy. Specifically, when evaluating the behaviour of those subjects who score high in the positive dimension of schizotypy, the agreement between informants decreases for thought and internalizing problems; and, when the behaviour of those who are defined for a more negative schizotypy is evaluated, the agreement decreases for social problems, anxiety/ depression, externalizing and total. Having all this into account and adding information that other authors have found related to each schizotypy subtype (which, besides, are the ones which more concordance show), some conclusions could be raised. It can be assumed as evident that schizotypical personality (and each trait type) and the subjacent conduct in these subjects can generate a difficulty in perceiving certain conducts which are not predominant in the subject, with the consequent discordance between informants. For future studies, it would be very interesting to carry out studies examined which group of informants augurs the behavioural predisposition for schizophrenia and its dimensions in the most accurately way possible. Conclusions. A most exact and objective method to assess behavioural problems as well-demonstrated predictor to schizophrenia, is necessary in order to select vulnerable teenagers to the illness and to develop programs of early intervention.

Plantas utilizadas en trastornos ginecológicos, parto y control de natalidad en mujeres de la parte baja del rio Ucayali-Amazonas peruana / Plants used in gynecological disorders, birth and birth control in women from the lower part of the Ucayali-Amazonas river in Peru

En las comunidades ribereñas a lo largo del Bajo Ucayali, siete varones y seis mujeres informantes fueron interrogados en forma independiente durante dos días, sobre sus conocimientos en relación a plantas medicinales con el objetivo de identificar las plantas de uso principal en afecciones femeninas y comparar este conocimiento entre varones y mujeres. Las entrevistas fueron estructuradas y dirigidas aplicando cuestionarios estandarizados. Se presentan plantas utilizadas para solucionar problemas femeninos como trastornos menstruales, control de natalidad, trabajo de parto y algunas afecciones ginecológicas. Las principales conclusiones son: 1) Aproximadamente 70 diferentes plantas se reportaron como útiles para esos propósitos; la mayor parte solamente se menciona una vez para el mismo propósito y algunas se reportaron repetidamente. 2) Aproximadamente 60% de los usos reportados a afecciones femeninas se refiere a plantas encontradas en huertos, chacras y purmas y 40% a especies del bosque. Esto corresponde a los que informaron sobre todo tipo de plantas para medicina, pero si miramos solamente a las plantas para control de fertilidad y natalidad más del 75% provienen de los alrededores de los caseríos. 3) El conocimiento de hombres y mujeres es relativamente uniforme, probablemente a causa de tratamientos combinando el uso de hierbas cultivadas (más conocidas por mujeres) y árboles del bosque (más conocidos por hombres). De las hierbas cultivadas se usaron mayormente las hojas y de los árboles del bosque corteza, látex y res ma.