ABSTRACT
Ateneo centrado en la intervención psicopedagógica en niños y niñas con conductas externalizantes, En una pirmera parte, se desarrollan algunos conceptos que forman parte del marco teórico del equipo, y más adelante, los referidos a la Terapia Cognitivo Conductual. Se define la conducta y sus funciones, diferenciando conductas internalizantes y externalizantes. Luego se ejemplifican las estrategias de la Terapia Cognitivo Conductual utilizadas en cada uno de los tres subsistemas (familia, escuela y niño/a) a partir de diferentes casos clínicos. Por último, se reflexiona invitando a seguir repensando las intervenciones y prácticas clínicas con pacientes con estas características.
Subject(s)
Humans , Male , Female , Child , Cognitive Behavioral Therapy/instrumentation , Cognitive Behavioral Therapy/trends , Child Behavior/classification , Child Behavior/psychology , Child Behavior Disorders/diagnosis , Child Behavior Disorders/therapyABSTRACT
Ateneo centrado en el abordaje en niños pequeños en la práctica de la Unidad de Salud Mental del Hospital de Niños Ricardo Gutiérrez, de la Ciudad de Buenos Aires. En una primera parte del texto, se describen algunos conceptos centrales en relación a la clínica con niños pequeños, y a la complejidad de la primera infancia. En un segundo momento, se profundiza en aspectos que se consideran fundamentales al realizar una evaluación. Por último, se abordan los modos de intervenir propios del Equipo de Psicopedagogía de esta Unidad.
Subject(s)
Humans , Male , Female , Child, Preschool , Child Behavior/psychology , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Child Development , Mental Health Services/organization & administration , Mental Health Services/trendsABSTRACT
INTRODUCCIÓN: El perfil de desregulación (PD) es una entidad clínica de interés en el área infantojuvenil, puesto que se asocia a psicopatología futura. El PD se define a partir del instrumento Child Beha vior Checklist (CBCL), combinando síntomas internalizantes (ansiedad/depresión) y externalizantes (agresividad, problemas de atención). OBJETIVO: Estudiar la frecuencia del perfil de PD por CBCL en una muestra de preescolares chilenos. PACIENTES Y MÉTODO: Se aplicó una encuesta sociodemográfica y Cuestionario CBCL 1% - 5 a cuidadores de niños entre 30 y 48 meses de edad, en una muestra representativa nacional de usuarios de red pública. Se estimó la frecuencia utilizando el método de Kim y colaboradores y se realizó un modelo explicativo mediante regresión logística binaria del PD utilizando variables del cuidador, del niño y del contexto. RESULTADOS: La muestra fue de 1429 pre escolares y sus cuidadores. La frecuencia de PD fue de 11,6% (IC 95% 9,9-13,5%). Las variables que permiten predecir el PD en un 88,6% fueron: Síntomas depresivos actuales en el cuidador principal (OR: 2,24; IC95%: 1,37-3,67); Número de eventos vitales estresantes vividos por el cuidador principal (p = 0,005); Número de elementos disponibles para estimulación en el hogar (p = 0,001); Número de enfermedades crónicas del niño (p = 0,006). CONCLUSIONES: PD tiene una frecuencia alta en preesco lares, lo que implica una carga en salud mental relevante, apuntando a la necesidad de intervenciones en esta área, además de seguimiento longitudinal de esta subpoblación.
INTRODUCTION: The dysregulation profile (DP) is a relevant clinical entity in the children and ado lescent area since its association with future psychopathology. DP is defined by the Child Behavior Checklist (CBCL), combining internalizing symptoms (anxiety/depression) and externalizing ones (aggressiveness, attention problems). OBJECTIVES: To study the frequency of CBCL-DP in a sample of Chilean preschoolers. PATIENTS AND METHOD: A sociodemographic survey and CBCL 1.5-5 was applied to caregivers of children aged 30 to 48 months in a national representative sample of public health system users. Frequency was estimated using the Kim et al. method and an explanatory model was made using binary logistic regression of DP using the child, caregiver, and contextual variables. RESULTS: The sample size was n = 1,429 preschool children and their caregivers. The frequency of DP was 11.6% (95% CI 9.9-13.5%). The variables that allow to classify DP in 88.6% of cases were: current depressive symptoms in the main caregiver (OR: 2.24; 95% CI 1.37-3.67); number of stressful events experienced by the main caregiver (p = 0.005); number of available elements for child development stimulation in the home (p = 0.001); number of chronic diseases of the child (p = 0.006). CONCLUSIONS: DP has a high frequency in preschoolers, which implies a relevant mental health burden. This finding points to the need for interventions in this area and also longitudinal monitoring of this subgroup.
Subject(s)
Humans , Male , Female , Child, Preschool , Psychiatric Status Rating Scales , Child Behavior Disorders/diagnosis , Logistic Models , Child Behavior Disorders/psychology , Child Behavior Disorders/epidemiology , Chile/epidemiology , Caregivers/psychology , Cost of Illness , Models, PsychologicalABSTRACT
Objective: To identify child behaviors and types of impairment that increase the likelihood of maternal recognition of emotional/behavioral problems (EBP) in children and adolescents. Methods: Maternal-reported data were obtained from two subsamples of 11-to-16-year-olds derived from cross-sectional studies conducted in two Brazilian municipalities: Itaboraí, state of Rio de Janeiro (n=480), and Embu, state of São Paulo (n=217). The Itaboraí study involved a representative sample of 6-to-16-year-olds (n=1,248; response rate = 86.0%) selected from the Family Health Program registry, which covered 85.5% of the municipal population. The Embu study was based on a probabilistic sample of clusters of eligible households (women aged 15-49 years, child < 18 years), with one mother-child pair selected randomly per household (n=813; response rate = 82.4%). The outcome variable was mother's opinion of whether her child had EBP. Potential correlates included types of child behaviors (hyperactivity/conduct/emotional problems as isolated or combined conditions) and impairment, assessed using the Strengths and Difficulties Questionnaire (SDQ); child's age and gender; maternal education and anxiety/depression (assessed using the Self-Reporting Questionnaire [SRQ]). Results: Multivariate regression models identified the following correlates of maternal perception of child EBP: comorbidity (co-occurring hyperactivity/conduct/emotional problems), emotional problems alone, and interference of problems with classroom learning and friendships. Conclusion: Comorbidity of different problem types, emotional problems alone, and interference with classroom learning and friendships increase the likelihood of maternal recognition of EBP in children.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Young Adult , Mental Disorders/diagnosis , Mother-Child Relations , Brazil/epidemiology , Comorbidity , Child Behavior Disorders/classification , Child Behavior Disorders/diagnosis , Child Behavior Disorders/epidemiology , Mental Health , Cross-Sectional Studies , Surveys and Questionnaires , Mental Disorders/classification , Mental Disorders/epidemiologyABSTRACT
Serotonin 2C receptors (5HT2C) are involved in serotonin-driven dynamic equilibrium adjustments responsible for homeostatic stability in brain structures that modulate behavior and emotions. Single nucleotide polymorphisms (SNPs) from the serotonin 2C receptor gene (HTR2C) have been associated with several neurological and mental disorders, including abnormalities in cognitive and emotional processes. The aim of this study was to evaluate the association between the rs6318 SNP of the HTR2C gene and behavioral characteristics exhibited by children and adolescents based on the Child Behavior Checklist (CBCL/6-18) inventory. Eighty-five psychiatric outpatients between 8 and 18 years of age underwent genotyping of the rs6318 SNP. The CBCL/6-18 scale was administered to their caregivers. The chi-squared test was used to assess differences in the frequency of C and G alleles of the rs6318 SNP relative to the grouped CBCL/6-18 scores; significance level was 5%. The presence of the G allele of rs6318 was found to be associated with characteristics of aggressive behavior and social problems, and aggressive behavior was found to be associated with heterozygosis in females. These findings contribute to the identification of mental and behavioral phenotypes associated with gene expression.
Subject(s)
Humans , Male , Female , Child , Adolescent , Child Behavior Disorders/genetics , Receptor, Serotonin, 5-HT2C/genetics , Mental Disorders/genetics , Psychiatric Status Rating Scales , Chi-Square Distribution , Child Behavior Disorders/diagnosis , Cross-Sectional Studies , Surveys and Questionnaires , Polymorphism, Single Nucleotide/genetics , Alleles , Checklist , Gene-Environment Interaction , Gene Frequency/genetics , Genotype , Mental Disorders/diagnosisABSTRACT
El Inventario de Conductas Infantiles 1.5-5 años (CBCL/1.5-5 por su acrónimo en inglés) y el informe del cuidador/educador (C-TRF por su acrónimo en inglés), son de los instrumentos más ampliamente reconocidos internacionalmente para evaluar conductas desadaptativas que pueden afectan el desarrollo presente y futuro de niños y niñas preescolares. Se evaluó el comportamiento psicométrico de ambos instrumentos en una muestra diversa socioeconómicamente de 550 preescolares chilenos. En general, ambos mostraron un comportamiento psicométrico análogo al obtenido con estudios en otras sociedades. Los análisis factoriales confirmatorios mostraron un ajuste adecuado del modelo bifactorial original. Sin embargo, en el CBCL/1.5-5 los puntajes obtenidos son más altos que en la mayoría de los países y, comparativamente, en ambos instrumentos, se observó un mayor efecto de género. Se analizan los hallazgos obtenidos, y se dan sugerencias normativas y conceptuales para el empleo de ambos instrumentos en niños y niñas preescolares en nuestro país.
The child Behavior checklist/1.5-5 and the caregiver/teacher report Form are one of the most widely internationally recognized instruments to evaluate desadaptative behaviors which may affect the current and future development of preschool children. The psychometric behavior of both instruments was evaluated in a socioeconomically diverse sample of 550 chilean preschool children. In general, it was observed an analog behavior of both compared to the one obtained with studies in other societies. The confirmatory factor analysis showed a suitable adjustment of the original bifactor model. However, in the CBCL, the scores obtained are higher than in most of the countries and, comparatively, in both instruments, a greater effect of gender was observed. The findings obtained are analyzed and, normative and conceptual suggestions are given for the use of both instruments in preschool children in our country.
Subject(s)
Humans , Male , Female , Child, Preschool , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Personality Inventory , Checklist , Child Behavior/psychology , Chile , Factor Analysis, Statistical , Internal-External Control , PsychometricsABSTRACT
Objetivo: Investigar la consistencia interna y la validez de la versión mexicana de la lista de síntomas de niños de 1,5 a 5 años de edad del Child Behavior Checklist (CBCL/1.5-5) que mide la psicopatología más común en niños preescolares en el contexto clínico y epidemiológico. Pacientes y método: Diseño transversal, comparativo, en una muestra de 438 padres de 2 grupos: clínico-psiquiátrico (n = 62) y comunitario (n = 376). Se aplicó el instrumento CBCL/1,5-5 adaptado al lenguaje español coloquial mexicano. Para el análisis estadístico se utilizó el coeficiente alfa de Cronbach, prueba de Feldt y correlación de Pearson. Resultados: La consistencia interna para las subescalas fue elevada para problemas totales α = 0,95, internalizados α = 0,89, externalizados α = 0,91. El test-retest mediante el coeficiente de correlación intraclase fue mayor a 0,95 para las subescalas de problemas internalizados, externalizados y totales. La curva de Receiver Operating Characteristic, para el criterio de los grupos referido-clínicamente frente a no-referido para la escala total de problemas ≥ 24 resultó en un área bajo la curva 0,77, especificidad 0,73 y sensibilidad 0,70. Conclusiones: El CBCL/1,5-5/versión mexicana es un instrumento válido y confiable.
Objective: To investigate the validity and internal consistency of the Mexican version of the CBCL/1.5-5 that assesses the most common psychopathology in pre-school children in clinical and epidemiological settings. Patients and method: A total of 438 parents from two groups, clinical-psychiatric (N= 62) and community (N= 376) completed the CBCL/1.5-5/Mexican version. Results: The internal consistency was high for total problems α=0.95, and internalized α=0.89 and externalized α=0.91 subscales. The test re-test (one week) using the intraclass correlation coefficient (ICC) was ≥ 0.95 for the internalized, externalized, and total problems subscales. The ROC curve for the criterion status of clinically-referred vs. non-referred using the total problems scale ≥ 24 resulted in an AUC (area under curve) of 0.77, a specificity 0.73, and a sensitivity of 0.70. Conclusions: The CBCL/1.5-5/Mexican version is a reliable and valid tool.
Subject(s)
Humans , Male , Female , Child, Preschool , Child Behavior , Child Behavior Disorders/diagnosis , Checklist , Psychiatric Status Rating Scales , Reproducibility of Results , Sensitivity and Specificity , MexicoABSTRACT
Abstract Objective: To review the epidemiology and update the scientific knowledge on the problems of development and behavior in childhood, and the recommendations for the role of the pediatrician in identifying and managing delays and disturbances in child development and mental health. Sources: A search for relevant literature was performed in the PubMed and Scopus databases and publications of the National Scientific Council on the Developing Child. Summary of the findings: With the decline in the incidence of communicable diseases in children, problems with development, behavior, and emotional regulation are increasingly becoming a part of the work of pediatricians, yet many are not trained and feel uncomfortable about this extension of their role. The available screening tools for child development and behavior are reviewed, and a ‘school readiness’ checklist is presented, together with recommendations on how the pediatrician can incorporate developmental surveillance into routine practice, aware of the need for children to acquire social, emotional, and cognitive skills so that they can develop their full potential. Conclusions: The pediatrician's role in the future will include both physical and mental health, recognizing that social development, resilience, and emotional maturity are as important as physical growth and neuromotor skills in a child's life course.
Resumo Objetivo: Revisar a epidemiologia e atualizar os conhecimentos científicos sobre os problemas do desenvolvimento e do comportamento na infância e das recomendações do papel do pediatra na identificação e conduta frente aos transtornos da saúde mental infantil. Fontes de dados: Pesquisamos a literatura relevante nas bases de dados PubMed e Scopus e em publicações do National Scientific Council on the Developing Child. Síntese dos dados: Com o declínio na incidência de doenças transmissíveis em crianças, problemas do desenvolvimento, comportamento e regulação emocional fazem cada vez mais parte do trabalho do pediatra, mas muitos ainda não estão treinados e se sentem desconfortáveis com essa extensão do seu papel. Os instrumentos de triagem do desenvolvimento e comportamento foram revisados e uma lista de verificação da “prontidão escolar” foi apresentada, juntamente com orientações sobre como o pediatra pode incorporar a vigilância da saúde mental em sua de rotina de atendimento, consciente da necessidade da aquisição das habilidades sociais, emocionais e cognitivas para que a criança possa desenvolver toda sua potencialidade. Conclusões: O papel do pediatra no futuro irá abranger tanto a saúde física quanto a mental e reconhecer que o desenvolvimento social, a resiliência e o amadurecimento emocional são tão importantes quanto o crescimento físico e as habilidades neuromotoras no curso da vida de uma criança.
Subject(s)
Humans , Child , Physician's Role , Child Behavior Disorders/diagnosis , Developmental Disabilities/diagnosis , Motor Disorders/diagnosis , Mental Disorders/diagnosis , Brazil , Child Behavior Disorders/physiopathology , Child Development/physiology , Developmental Disabilities/physiopathology , Mass Screening/methods , Mental Health , Motor Disorders/physiopathology , Mental Disorders/physiopathology , Motor Skills/physiologyABSTRACT
RESUMO Objetivo investigar os aspectos temporais auditivos de crianças de 7 a 12 anos de idade com mau desempenho escolar e a associação com aspectos comportamentais, percepção de saúde, perfil escolar e de saúde e fatores sociodemográficos. Métodos trata-se de estudo observacional analítico transversal com 89 crianças de 7 a 12 anos de idade, com mau desempenho escolar das escolas públicas municipais de uma cidade do interior de Minas Gerais, participantes dos Atendimentos Educacionais Especializados. A primeira etapa da pesquisa foi realizada com os pais para coleta de informações sobre questões sociodemográficas, perfil de saúde e vida escolar. Além disso, os pais preencheram o Strengths and Difficulties Questionnaire (SDQ). A segunda etapa foi realizada com as crianças para investigação da autopercepção de saúde e da avaliação auditiva que constou da meatoscopia, Emissões Otoacústicas Transientes e testes que avaliam os aspectos temporais auditivos de ordenação temporal simples e resolução temporal. Foram consideradas como variáveis respostas os testes que avaliam os aspectos temporais auditivos e as variáveis explicativas foram agrupadas para realização da análise de regressão logística uni e multivariável, considerando o nível de significância de 5%. Resultados foi encontrada associação com significância estatística entre aspectos temporais auditivos e as variáveis idade, gênero, presença de reprovação e autopercepção de saúde. Conclusão as crianças com mau desempenho escolar apresentaram alterações dos aspectos temporais auditivos. As habilidades temporais avaliadas sugerem associação a diferentes fatores como: processo maturacional, autopercepção de saúde e histórico escolar.
ABSTRACT Purpose To investigate the auditory temporal aspects in children with poor school performance aged 7-12 years and their association with behavioral aspects, health perception, school and health profiles, and sociodemographic factors. Methods This is an observational, analytical, transversal study including 89 children with poor school performance aged 7-12 years enrolled in the municipal public schools of a municipality in Minas Gerais state, participants of Specialized Educational Assistance. The first stage of the study was conducted with the subjects’ parents aiming to collect information on sociodemographic aspects, health profile, and educational records. In addition, the parents responded to the Strengths and Difficulties Questionnaire (SDQ). The second stage was conducted with the children in order to investigate their health self-perception and analyze the auditory assessment, which consisted of meatoscopy, Transient Otoacoustic Emissions, and tests that evaluated the aspects of simple auditory temporal ordering and auditory temporal resolution. Tests assessing the temporal aspects of auditory temporal processing were considered as response variables, and the explanatory variables were grouped for univariate and multivariate logistic regression analyses. The level of significance was set at 5%. Results Significant statistical correlation was found between the auditory temporal aspects and the variables age, gender, presence of repetition, and health self-perception. Conclusion Children with poor school performance presented changes in the auditory temporal aspects. The temporal abilities assessed suggest association with different factors such as maturational process, health self-perception, and school records.
Subject(s)
Humans , Male , Female , Child , Auditory Perception/physiology , Auditory Perceptual Disorders/diagnosis , Underachievement , Self Concept , Auditory Perceptual Disorders/psychology , Socioeconomic Factors , Time Factors , Child Behavior Disorders/diagnosis , Cross-Sectional Studies , Surveys and Questionnaires , Hearing TestsABSTRACT
PURPOSE: The purpose of this study was to test the reliability and validity of the Behavior Assessment for Children (BAC) in a community of school-aged children in Taiwan. METHOD: A school-based sample comprising third grade and fourth grade students was recruited from Taichung City in Taiwan. The parents (n = 248) and teachers (n = 15) of these students completed structured questionnaires, including the Child Behavior Checklist (CBCL) and the proposed BAC. Content validity, concurrent validity, construct validity, internal consistency, and inter-rater reliability of the BAC were assessed. RESULTS: The BAC comprised three subscales (attention, emotion, and self-control) that included 17 items. The content validity index (CVI) score was 0.98. The result of the confirmatory factor analysis (goodness of fit = .90, root mean square of residual = .03, root mean square error of approximation = .06, and comparative fit index = .94) supported the construct validity of the three BAC subscales. The concurrent validity of the BAC subscales significantly correlated with the compatible CBCL subscales (r = .59-.78, p < .001). Cronbach α of the subscales of the BAC ranged from .78 to .92. The intraclass correlation coefficient between the parents and teachers ranged from .31 to .44, and the joint probability of agreement ranged from 31.4% to 92.2%. CONCLUSIONS: The BAC is a valid and reliable instrument for evaluating behavioral problems in schoolaged children.
Subject(s)
Child , Female , Humans , Male , Attention , Child Behavior Disorders/diagnosis , Diagnostic Techniques and Procedures , Emotions , Psychometrics , Reproducibility of Results , Self-Control , TaiwanABSTRACT
Psychosocial problems increase the risk for mental health problems and increase the need for health care services in children and adolescents. Primary care practice is a valuable avenue for identifying the need for more specialized mental health care. We hypothesized that Korean version of the pediatric symptom checklist (PSC) would be a useful tool for early detection of psychosocial problems in children and adolescents in Korea and we aimed to suggest cut-off scores for detecting meaningful psychosocial problems. A total of 397 children with their parents and 97 child patients with their parents were asked to complete the PSC Korean version and the child behavior checklist (CBCL). The internal reliability and test-retest reliability of the PSC as well as the cut-off score of the PSC was determined via receiver operating characteristic analysis of the CBCL score, clinical group scores and non-clinical group scores. The internal consistency of the PSC-Korean version was excellent (Cronbach's alpha = 0.95). The test-retest reliability was r = 0.73 (P or = 60) and presence of clinical diagnosis, the recommended cut-off score of the PSC was 14. Using 494 Korean children aged 7-12 yr, the current study assessed the reliability and validity of a Korean version of the PSC and suggested a cut-off for recommending further clinical assessment. The present results suggest that the Korean version of the PSC has good internal consistency and validity using the standard of CBCL scores.
Subject(s)
Child , Female , Humans , Male , Checklist/methods , Child Behavior Disorders/diagnosis , Mass Screening/standards , Pediatrics/standards , Population , Psychometrics/methods , Reproducibility of Results , Republic of Korea , Sensitivity and Specificity , Surveys and Questionnaires/standards , Symptom Assessment/methods , Translating , United StatesABSTRACT
Epilepsy compromises the development of cognitive and social skills and represents a risk of psychiatric comorbidity. Objective: To compare psychopathological symptoms in children with epilepsy and in a healthy group, and to correlate the results with neuropsychological and clinical variables. Method: Forty five children with idiopathic epilepsy and sixty five healthy controls underwent neuropsychological evaluation and their caregivers replied to a psychopathology questionnaire (Child Behavior Checklist – CBCL). Results: There were significant differences in CBCL, with poorer results showed mainly by patients with epilepsy. There was no significant association between any psychopathological symptom and disease duration or amount of antiepileptic drugs used. There was positive correlation between intelligence quocient and CBCL on items such as sluggish cognitive tempo, aggressive behavior, attention problems and activities and a negative relation between academic achievement, conduct and rule-breaking behavior. Conclusion: Children with epilepsy had the worse results in the psychopathology evaluation. Certain psychopathological variables are related to the cognitive profile, with no relation to clinical variables. .
A epilepsia compromete o desenvolvimento de habilidades cognitivas e sociais e representa um risco para comorbidade psiquiátrica. Objetivo: Comparar sintomas psicopatológicos em crianças com epilepsia e um grupo saudável, e correlacionar os resultados com variáveis neuropsicológicas e clínicas. Método: Quarenta e cinco crianças com epilepsia idiopática e sessenta e cinco controles saudáveis foram submetidos à avaliação neuropsicológica e seus cuidadores responderam a um questionário de psicopatologia (Child Behavior Checklist – CBCL). Resultados: Houve diferenças significativas no CBCL, com piores resultados principalmente para pacientes com epilepsia. Não houve associação significativa entre os resultados e duração da doença ou número de drogas antiepilépticas. Houve relação positiva entre quociente de inteligência e CBCL em itens como tempo cognitivo lento, comportamento agressivo, problemas de atenção e atividades e uma relação negativa entre o desempenho acadêmico e conduta e comportamento de quebras de regra. Conclusão: Crianças com epilepsia apresentaram piores resultados em psicopatologia, com certas variáveis psicopatológicas relacionadas ao perfil cognitivo, mas sem relação com variáveis clínicas. .
Subject(s)
Adolescent , Child , Female , Humans , Male , Child Behavior Disorders/psychology , Epilepsy/psychology , Mental Health , Case-Control Studies , Child Behavior Disorders/diagnosis , Child Behavior Disorders/etiology , Neuropsychological Tests , Psychiatric Status Rating Scales , Surveys and QuestionnairesABSTRACT
O artigo propõe uma reflexão clínica sobre o diagnóstico estrutural de psicose e as dificuldades em se considerar tal diagnóstico na ausência de delírios e alucinações. A constatação foi embasada na noção de estruturas psíquicas, baseadas na teoria psicanalítica de Lacan. Discutem-se, com passagens do atendimento clínico, a consequência desorganizadora de uma intervenção que consistiu em uma hipótese diagnóstica de neurose e os efeitos da mudança no manejo, produzidos ao se reformular a hipótese diagnóstica, encaminhando o caso para o final de análise.
The article proposes a clinical reflection on the psychosis structural diagnosis and also on the difficulties of considering this diagnosis for lack of delirium and hallucinations. The finding was based on the notion of such as psychic structures, based on Lacan's psychoanalytic theory. It is discussed, with clinical service events, the disorganizer consequence of an intervention that consisted of a diagnosis hypothesis of neurosis and the effects of change in management, produced by reformulating the diagnosis hypothesis, referring the case to the end of analysis.
El articulo propone una reflexión clínica sobre el diagnostico estructural de psicosis y las dificultades en considerar tal diagnóstico, en la ausencia de delirios y alucinaciones. Esa observación fue basada en la noción estructuras psíquicas, basadas en la teoría psicoanalítica de Lacan, se discute, con ejemplos del atendimiento clínico, la consecuencia desorganizadora de una intervención que se constituyó en una hipótesis diagnostica de neurosis y los efectos de los cambios en el manejo, producidos al reformularse la hipótesis diagnostica, encaminando el caso para el final del análisis.
Subject(s)
Child , Psychotic Disorders , Child Behavior Disorders/diagnosis , Child Behavior Disorders/therapy , Clinical Diagnosis , PsychoanalysisABSTRACT
The puzzle model is a brief intervention, an interdisciplinary diagnostic and therapeutic tool focused on the family. Its aim is to determine the impact of family dynamics on eliciting and developing the patient´s symptom. The adult and the child joint participation, by means of discourse in the case of the adult, and cognitive and projective games, in the case of the child, enable, through mutual interaction, the disclosure of the family structure and dynamics. The therapist, based on the elements arising from the interaction of both parties during the interview, reframes or sets up the new perspective of the described problem. The objective of this article is to describe the technique used. Two clinical cases and some results of this model are presented as an example.
El modelo del rompecabezas es una intervención breve, interdisciplinaria, diagnóstico-terapéutica, que toma como foco a la familia. Su finalidad es determinar el grado de participación de la dinámica familiar en la generación y desarrollo del síntoma presentado por el paciente. Participan de manera conjunta el adulto mediante el discurso y el niño mediante juegos cognitivos y proyectivos que permiten, a través de la interacción mutua, descubrir la estructura y la dinámica familiar. El terapeuta, a partir de los elementos aportados en la interacción de las partes durante la entrevista, arma y realiza el reencuadre o nueva mirada del problema presentado. El objetivo de este trabajo es describir la técnica empleada. Se ejemplifica con dos casos clínicos y se muestran algunos resultados del modelo de atención.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Child Behavior Disorders , Family Therapy/methods , Psychophysiologic Disorders , Child Behavior Disorders/diagnosis , Child Behavior Disorders/therapy , Interviews as Topic , Models, Theoretical , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/therapyABSTRACT
A partir de sua experiência clínica em diversos campos de atuação, a autora visa a refletir sobre apsiquiatrização do discurso e a medicalização na infância. Indaga de que modo o saber médico-psiquiátrico foi respondendo às demandas sociais a ele endereçadas, cuja resposta, atualmente, se reduziu ao diagnóstico do desvio comporta-mental e sua tentativa de normatização, via medicação. Para tanto, retoma a história da psiquiatria infantil e da clínica médica com crianças, discutindo de que modo o discurso médico-psiquiátrico, através de seusdispositivos disciplinares, vem sendo convocado a responder sobre o mal-estar que a infância introduz no projeto social na atualidade.
Based on her clinical experience in several fields, the author proposes to reflect about psychiatrization of discourse and children medicalization. She questions how the psychiatric knowledge has been responding to social demands; the current response is merely a diagnosis of behavioral deviations and an attempt of standardization by medication. This article presents children psychiatry and medical clinic with children history, discussing how the psychiatric medical discourse, through its disciplinary mechanisms, has been summoned to respond to the malaise that childhood introduces in the social project today.
A partir de la experiencia clínica en diversos campos de actuación, la autora reflexiona sobre la psiquiatrización del discurso y la medicalización de la infancia. Indaga de qué forma el saber psiquiátrico fue respondiendo a las demandas sociales que se le dirigieron, cuya respuesta, actualmente, se limitó al diagnóstico de la desviación del comportamiento y el intento de normalización, por medio de la medicación. Para esto, retoma la historia de la psiquiatría infantil y de la clínica médica con niños y niñas, discutiendo de qué manera el discurso médico-psiquiátrico, a través de sus dispositivos disciplinarios, ha sido convocado a responder sobre el malestar que la infancia introduce en el proyecto social en la actualidad.
Subject(s)
Child , Child Psychiatry , Child Behavior Disorders/diagnosis , ChildABSTRACT
The Achenbach System of Empirically Based Assessment (ASEBA) for school-age children includes three instruments for assessing emotional and/or behavioral problems: Child Behavior Checklist (CBCL), completed by parents, Youth Self-Report (YSR), completed by adolescents and Teacher's Report Form (TRF), completed by teachers. This review article gives detailed information on the development of these forms in the United States and Brazil, describing the main changes to the items, scales and score cut-off points in original versions between 1991 and 2001, as well as the process involved in the translation, back-translation and cultural adaptation of the original questionnaires to develop the current official Brazilian versions of the CBCL, YSR and TRF. The utility of these tools for research and clinical practice is highlighted, mentioning epidemiological studies and evaluation of interventions conducted in Brazil. Researchers' and clinicians' doubts regarding the correct use of the current official Brazilian versions are answered, giving examples of frequently asked questions relevant to the Brazilian context.
O Sistema de Avaliação de Base Empírica de Achenbach para crianças/adolescentes em idade escolar inclui três instrumentos para avaliar problemas emocionais e/ou comportamentais: Child Behavior Checklist (CBCL) [pais], Youth Self-Report (YSR) [adolescentes] e Teacher's Report Form (TRF) [professores]. Este artigo de revisão fornece informações detalhadas sobre o desenvolvimento desses instrumentos nos Estados Unidos e no Brasil, descrevendo as principais alterações em itens, escalas e pontos de corte na pontuação, ocorridas nas versões originais de 1991 a 2001, e o processo de tradução, retrotradução e adaptação cultural dos questionários originais para desenvolver as atuais versões brasileiras oficiais do CBCL, YSR e TRF. A utilidade desses instrumentos em pesquisa e na prática clínica é salientada, mencionando estudos epidemiológicos e de avaliação de intervenções conduzidos no Brasil. Pesquisadores e clínicos são instruídos a respeito do uso correto das atuais versões brasileiras oficiais, dando exemplos de perguntas frequentes, relevantes para o contexto brasileiro.
El sistema de evaluación de base empírica de Achenbach para niños/adolescentes en edad escolar incluye tres instrumentos para evaluar problemas emocionales y/o de comportamiento: Child Behavior Checklist (CBCL) [padres], Youth Self-Report (YSR) [adolescentes] y Teacher's Report Form (TRF) [profesores]. Este artículo de revisión proporciona información detallada sobre el desarrollo de estos instrumentos en los Estados Unidos y en Brasil, describiendo las principales alteraciones en ítems, escalas y puntos de corte en la puntuación, que se realizaron en las versiones originales de 1991 a 2001, y el proceso de traducción, retrotraducción y adaptación cultural de los cuestionarios originales, con el fin de desarrollar las actuales versiones brasileñas oficiales del CBCL, YSR y TRF. La utilidad de estos instrumentos en investigación y en la práctica clínica se resalta mencionando estudios epidemiológicos y de evaluación de intervenciones, llevados a cabo en Brasil. Investigadores y personal clínico son instruidos en lo que se refiere al uso correcto de las actuales versiones brasileñas oficiales, dando ejemplos de preguntas frecuentes y relevantes para el contexto brasileño.
Subject(s)
Adolescent , Child , Female , Humans , Male , Checklist , Child Behavior Disorders/diagnosis , Child Behavior/psychology , Surveys and Questionnaires , Brazil , Cross-Cultural Comparison , Child Behavior Disorders/psychology , Language , TranslatingABSTRACT
Introducción: En el Trastorno por Déficit Atencional e Hiperactividad (TDAH) se han observado diferencias en los reportes de cuestionarios entre padres y profesores. Objetivos: Observar la concordancia entre padres y profesores en el test de Conners abreviado (TCA) en el TDAH. Métodos: Se evaluó con TCA para profesores y para padres a niños atendidos por becados de primer año, con diagnóstico clínico de TDAH. Resultados: De 57 pacientes, 21por ciento mujeres y 78,9 por ciento hombres, el promedio de los TCA de profesores fue de 16,85 puntos y el de padres de 16,98, existiendo mayor diferencia al separarlos por género. El coeficiente de correlación fue de 0,41. Las únicas variables significativamente asociadas al puntaje fueron edad y comorbilidad con Trastorno Oposicionista Desafiante (TOD). Conclusión: No existe correlación entre Conners de padres y profesores, lo que recalca la importancia de objetivar los síntomas en más de un ambiente, para llegar a un diagnóstico certero.
Introduction: There has been observed in the Attention Deficit and Hyperactivity Disorder (ADHD) differences in the reports between parental and teachers questionnaires. Objectives: Observe concordance between parents and teachers in the abbreviated Conners Test (TCA) in ADHD. Methods: Children with clinical diagnosis of ADHD were evaluated by first year residents with parental and teachers TCA. Results: From a total of 57 patients, 21percent were women and 78, 9 percent men, the average of the TCA from teachers was 16, 85 points and from parents 16, 98, there was more difference if separated by sex. The correlation coefficient was 0, 41. And the only significant association between variables was TCA scores with childs age and comorbidity with Oppositional Defiant Disorder. Conclusions: There is no correlation between parental and teachers TCA scores, which enhances the importance of objetivation of symptoms in more than one setting to get an accurate diagnosis.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Child , Personality Assessment , Attention Deficit Disorder with Hyperactivity/diagnosis , Cross-Sectional Studies , Faculty , Parents , Psychiatric Status Rating Scales , Child Behavior Disorders/diagnosisABSTRACT
Antiretroviral therapy has marked a change in the course of HIV infection, posing new challenges to improve quality of life in pediatric patients. Objective: The goal of this paper was to identify psychosocial aspects of HIV-infected children and adolescents, and to evaluate their neuropsychological development and psychiatric co-morbidity. Patients and Methods: A descriptive study was conducted, evaluating the neurocognitive performance of patients attending at the Pediatric Department of Instituto de Medicina Tropical Pedro Kourí of La Habana, Cuba, between February and July of 2008. For that purpose, interviews to the patients and their relatives were done with the application of appropriate tests for each age. Results: Twenty-three patients ages 3-17 years (57 percent female) were studied. Sixteen (69.5 percent) were infected through vertical transmission, and 7 (30.5 percent) through other routes. School children infected through vertical transmission showed the most symptoms. Hyperactivity, anxiety, and learning disorders were the most frequently observed symptoms as well as hyperkinetic disorders, temporary tic disorders and mental retardation. Conclusion: This study shows the neuropsychological characterization of HIV-positive children and adolescents, considering the route of acquisition of the infection and the stage of the disease. It also describes psychiatric comorbidity of HIV-infected children.
El tratamiento anti-retroviral marcó un cambio en la evolución de la infección por VIH, planteándose nuevos retos que mejoren la calidad de vida en las edades pediátricas. Objetivos: Identificar aspectos psicosociales en niño y adolescente que adquirieron la infección por VIH, evaluar el desarrollo neuropsicológico y describir la co-morbilidad psiquiátrica presente en el grupo estudiado. Pacientes y Métodos: Se realizó un estudio descriptivo, donde se evaluó el desempeño neurocognitivo de pacientes atendidos en la clínica pediátrica del Instituto de Medicina Tropical Pedro Kourí de La Habana, Cuba, entre los meses de febrero y julio de 2008, para lo cual se realizaron entrevistas a familiares, examen directo del participante y la aplicación de instrumentos específicos para cada edad. Resultados: Se evaluaron 23 niños y adolescentes entre los 3 y 17 años, predominó el sexo femenino con 13 (56,5 por ciento) y las edades entre los 6-11 años con 10 (43,5 por ciento) niños, más del 50 por ciento de los cuales se encontraban en los primeros años de escolarización, 16 (69,5 por ciento) infectados por trasmisión vertical y 7 (30,5 por ciento) por otras vías. Los escolares infectados por vía vertical fueron los que mayor sintomatología aportaron, la hiperactividad (57,1 por ciento), la ansiedad (42,8 por ciento) y las dificultades en el aprendizaje (14,2 por ciento), fueron los síntomas más frecuentes. El diagnóstico de trastorno hipercinético (13,0 por ciento) fue el más importante en la etapa escolar, mientras que el trastorno de adaptación depresivo lo fue en la adolescencia (8,6 por ciento). Conclusión: El estudio permitió la caracterización neuropsicológica de los niños y adolescentes estudiados, teniendo en cuenta las vías de adquisición de la infección, el momento evolutivo de la enfermedad y describir la co-morbilidad psiquiátrica asociada.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Child Behavior Disorders/psychology , HIV Infections/psychology , Mental Disorders/psychology , Comorbidity , Child Behavior Disorders/diagnosis , Child Behavior Disorders/epidemiology , Cuba/epidemiology , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Neuropsychological Tests , Quality of LifeABSTRACT
Background: Iron deficiency causes abnormal dopaminergic neurotransmission and may contribute to behavioral disorders. Objective: Iron Profile Estimation in Children (5-14 yrs) of Behavioral Disorders. Design : Cross-sectional study. Setting: Child Guidance Clinic of University College of Medical Sciences and Guru Tegh Bahadur Hospital. The sample consisted of Forty children in the age group of 5 to 14 years suffering from behavioral disorders. Haemoglobin , Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, Serum Iron ,Total Iron Binding Capacity, Peripheral smear, Percentage transferrin saturation , serum ferritin estimations were done. The behavioral symptoms were scored on Achenback Child Behavior Checklist. Results: Iron deficiency anemia was present in 75% of the children with behavioral symptoms. Serum ferritin was abnormal (<20micrograms/litre) in 67.8% of the children. There was statistically significant association between pica and iron deficiency anemia(p<0.001).Serum ferrittin levels correlated negatively with behavioral symptoms (r=-.067), though not significant.
Subject(s)
Adolescent , Anemia/complications , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/psychology , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/blood , Child Behavior Disorders/psychology , Humans , Iron/analysis , Iron/blood , Iron/deficiency , Surveys and QuestionnairesABSTRACT
Primary Care physicians play an important role in detecting psychomotor development problems. There are a number of useful tools available for this purpose. This paper provides a review of the literature of some methods utilized in Latin America, with special emphasis on screening tools. A follow up protocol for patients with developmental delay is suggested in order to simplify the diagnostic process. Finally, a few hurdles in implementation of developmental control are pointed out.
El médico que trabaja en atención primaria cumple un papel fundamental en la detección de los problemas del desarrollo psicomotor. Actualmente se dispone de una gran cantidad de herramientas útiles para la pesquisa de este tipo de trastornos. En este artículo se presenta una revisión actualizada de algunos de los métodos de evaluación del desarrollo psicomotor más frecuentemente utilizados en América Latina, con especial énfasis en las técnicas de screening. También se presenta un esquema de seguimiento de los pacientes con retraso psicomotor a fin de simplificar el proceso diagnóstico y, por último se plantean algunas dificultades para implementar la vigilancia del desarrollo.