Emotional and behavioral problems: a school-based study in southern Brazil / Problemas emocionais e comportamentais: um estudo de base escolar no sul do Brasil

Abstract Introduction Mental health assessment in childhood needs to be carried out within a broader context that includes different factors. Objective To assess the prevalence of emotional and behavioral problems in schoolchildren and associated factors. Method A cross-sectional study was conducted with a school-based sample at 20 schools selected by systematic random sampling. Participants consisted of children aged 7-8 year old and their parents or primary caregivers. The Strengths and Difficulties Questionnaire (SDQ) was used to screen for the presence of emotional and behavioral problems in children. Results A total of 596 dyads were evaluated. The prevalence of emotional and behavioral problems was 30.0% among boys and 28.2% among girls. Hyperactivity/inattention were more prevalent among boys (p=0.015). Belonging to economically disadvantaged strata increased the likelihood of emotional and behavioral problems among schoolchildren by 71% (p=0.001), while having parents or caregivers with mental disorder increased by 2.2 times that probability (p<0.001). Conclusion: Our findings showed a high prevalence of emotional and behavioral problems among schoolchildren, as well as the influence of economic conditions and of the mental health of parents and caregivers on child mental health.

Resumo Introdução A avaliação da saúde mental na infância necessita ser realizada dentro de um contexto amplo que considere os diferentes fatores envolvidos. Objetivo Verificar a prevalência de problemas emocionais e comportamentais em escolares, bem como fatores associados. Método Estudo transversal, com amostra de base escolar em que foram selecionadas 20 escolas por amostragem aleatória sistemática. Participaram crianças com 7-8 anos e seus pais ou principais cuidadores. A presença de problemas emocionais e comportamentais nas crianças foi rastreada pelo Strengths and Difficulties Questionnaire (SDQ). Resultados Foram avaliadas 596 díades. A prevalência de problemas emocionais e comportamentais foi de 30,0% entre os meninos e 28,2% entre as meninas. Sintomas de hiperatividade/desatenção foram mais prevalentes entre meninos (p=0,015). Pertencer a camadas menos favorecidas economicamente aumentou em 71% a probabilidade de problemas emocionais e comportamentais entre os escolares (p=0,001), enquanto ter pais ou cuidadores com transtorno mental aumentou 2,2 vezes tal probabilidade (p<0,001). Conclusões: Nossos achados demonstram a elevada prevalência de problemas emocionais e comportamentais entre escolares, bem como a influência das condições econômicas e da saúde mental de pais e cuidadores sobre a saúde mental infantil.

Perfil de desregulación definido mediante el instrumento Child Behavior Checklist en preescolares / Dysregulation profile defined by Child Behavior Checklist in a sample of preschool children

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.

Childhood emotional and behavior problems and their associations with cesarean delivery

Objective: To determine the prevalence of childhood emotional and behavioral problems and examine their associations with cesarean delivery. Methods: Our sample consisted of 8,900 preschoolers from 35 kindergartens in four cities in East China. Parents completed the Strengths and Difficulties Questionnaire (SDQ) and provided other information. Children's emotional and behavioral problems were assessed using five subscales of the SDQ. Mode of delivery was classified as vaginal or cesarean section (CS); in sub-analyses, we divided CS into elective or emergency delivery. Logistic regression was used to examine associations. Results: A total of 1,209 (13.6%) children had a total SDQ score within abnormal range; 25.5% had peer problems within abnormal range, 9.0% had abnormal emotional symptoms, 13.9% had abnormal conduct problems, 18.9% had abnormal hyperactivity problems, and 16.2% were rated abnormal in pro-social behavior. Overall, 67.3% of the children who participated were delivered by CS. In fully adjusted analysis, CS was significantly associated with abnormal total SDQ score (OR = 1.27; 95%CI 1.10-1.46; p < 0.05) and pro-social behavior (OR = 1.27; 95%CI 1.12-1.45; p < 0.0001). No significant association was found between CS and risk of having conduct problems (OR 1.13; 95%CI 0.98-1.29), peer problems (OR 1.11; 95%CI 0.99-1.24), hyperactivity (OR 1.02; 95%CI 0.91-1.15), or emotional problems (OR 1.06; 95%CI 0.90-1.24). Conclusion: In this sample, CS was associated with risk of behavioral problems, but not with emotional problems. Further research is needed to better understand these associations.

Maternal recognition of child mental health problems in two Brazilian cities

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.

Population profiles associated with severe functioning difficulties and disability among two to four years old children in Mexico / Perfiles poblacionales asociados a dificultades severas de funcionamiento y discapacidad en niños de dos a cuatro años de edad en México

Abstract: Objective: To describe the prevalence and factors associated with severe child functioning difficulties and disability (CFD) among two to four year old children in Mexico, and estimates the probability of presenting CFD based on specific population profiles. Materials and methods: The sample consists of 5 104 children who participated in the National Survey of Children and Women 2015 (ENIM). We used post-estimation exploration by computing predicted values of CFD to interpret the logistic models for discrete combinations of the independent variables. Results: CFD prevalence is 2%, which means at least 130 000 two to four year-old children are at risk of experiencing severely limited participation in an unaccommodating environment. The probability of presenting CFD is dramatically higher in specific sub-groups of the population, in particular, male children of women with low education, who live in the poorest households. Conclusions: A significant proportion of Mexican children face important challenges due to functioning difficulties and disability. Public policies must be developed to accommodate the needs of these children and provide a proper environment for their development.

Resumen: Objetivo: Describir la prevalencia y los factores asociados con las dificultades severas de funcionamiento y discapacidad (CFD, por sus siglas en inglés) en niños de dos a cuatro años de edad en México y estimar la probabilidad de presentar CFD basada en perfiles poblacionales específicos. Material y métodos: La muestra fue conformada por 5 104 niños participantes de la Encuesta Nacional de los Niños, Niñas y Mujeres (ENIM) 2015. Se realizó una post-estimación calculando los valores predichos de CFD para interpretar los modelos logísticos a partir de combinaciones discretas de las variables independientes. Resultados: La prevalencia de CFD es de 2%, lo que significa que al menos 130 000 niños de 2 a 4 años de edad están en riesgo de experimentar una participación severamente limitada en un ambiente no adaptado a sus necesidades. La probabilidad de presentar CFD aumenta dramáticamente en subgrupos específicos de la población, en particular los hijos varones de mujeres con baja educación, que viven en los hogares más pobres. Conclusión: Una proporción importante de la población infantil mexicana enfrenta retos importantes derivados de las dificultades de funcionamiento y la discapacidad. Es necesario desarrollar políticas públicas que respondan a las necesidades específicas de este grupo poblacional, proporcionando un entorno apropiado para su desarrollo.

Population profiles associated with severe functional difficulties and disability among 5-17 years-old children in México / Perfiles poblacionales asociados con dificultades funcionales y discapacidad severa en niños de 5-17 años en México

Abstract: Objectives: To report the prevalence of severe functional difficulties and disability (SFD) in a nationally representative sample of children ages 5 to 17 in Mexico, to identify factors associated with SFD, and population profiles predictive of SFD. Materials and methods: Using data from the National Survey on Children and Women we estimated prevalence and 95% confidence intervals of SFD and risk factors. We fitted bivariate and multivariate logistic regression models. We then examined which combinations of the sociodemographic factors best predicted SFD. Results: The prevalence of SFD was 11.2%. The most prevalent SFD were on the socioemotional dimension (8.3%). The associated risk factors in the three dimensions were: living in a poor household, being a boy, having a mother with basic education or less, and non-indigenous background or living in an urban area. Conclusions: Identifying groups of the population at higher risk for SFD provides useful information for targeted intervention implementation.

Resumen: Objetivos: Reportar la prevalencia de dificultades funcionales y discapacidad severa (SFD) en una muestra nacional representativa de niños de 5 a 17 años en México; identificar los factores asociados con SFD; documentar los perfiles poblacionales que predicen SFD. Material y métodos: Se utilizaron los datos de la Encuesta Nacional de Niñas, Niños y Mujeres en México; se estimaron prevalencias e intervalos de confianza al 95%. Se ajustaron modelos bivariados y multivariados. Se examinaron las combinaciones de factores sociodemográficos que mejor predecían la SFD. Resultados: La prevalencia de SFD fue de 11.2%. Las SFD más prevalentes fueron en la dimensión socioemocional (8.3%). Los factores de riesgo asociados en las tres dimensiones fueron pobreza, ser hombre, tener una madre con educación primaria o menor, no ser indígena o vivir en zonas urbanas. Conclusiones: Identificar a los grupos con mayor riesgo de SFD dentro de la población proporciona información útil para el desarrollo de intervenciones.

Child labor and severe functioning difficulties and disability in Mexican children and adolescents 5-17 years of age / Trabajo infantil y dificultades severas de funcionamiento y discapacidad en niños y adolescentes mexicanos de 5-17 años

Abstract: Objective: To describe the characteristics of Mexican children and adolescents 5-17 years with severe functioning difficulties and disability and explore their participation in child labor. Materials and methods: Using data from the National Survey of Boys, Girls and Women in Mexico 2015 we estimated prevalence of functioning difficulties and disability and used logistic regression to explore the association between this condition and child labor. Results: While 11.2% of Mexicans 5-17 years-old has severe functioning difficulties or disability, 13.4% work. The functioning difficulty and disability domains with the highest prevalence are experiencing anxiety (5.4%) and depression (1.5%) daily. Children and adolescents with severe functioning difficulties and disability are 70% more likely to do child labor [OR=1.7, 95%CI:1.2,2.4]. Educational lag doubles the likelihood of doing child labor [OR=2.2, 95%CI:1.5,3.3]. Conclusions: Guaranteeing educational opportunities and respect for the rights of children with severe functioning difficulties and disability is essential to achieve development of their full potential.

Resumen: Objetivo: Describir la población mexicana de 5-17 años con problemas severos de funcionamiento y discapacidad y explorar su realización de trabajo infantil. Material y métodos: Basado en la Encuesta Nacional de Niños, Niñas y Mujeres 2015, se estimaron prevalencias de problemas de funcionamiento y discapacidad y se exploró la relación con el trabajo infantil en un modelo de regresión logística. Resultados: El 11.2% de los mexicanos de 5-17 años tiene dificultades severas de funcionamiento o discapacidad y 13.4% realiza trabajo infantil. Los ámbitos con la mayor prevalencia fueron ansiedad (5.4%) y depresión (1.5%) experimentadas diariamente. Niños y adolescentes con problemas severos de funcionamiento o discapacidad tienen 70% más posibilidades de realizar trabajo infantil [RM=1.7, IC95%:1.2,2.4]. El rezago educativo duplica las posibilidades de realizar trabajo infantil [RM=2.2, IC95%:1.5,3.3]. Conclusiones: Es imprescindible garantizar oportunidades educativas y respeto a los derechos de la población infantil con problemas de funcionamiento y discapacidad para lograr su desarrollo integral.

Prevalence of behavior problems and associated factors in preschool children from the city of Salvador, state of Bahia, Brazil

Objective: To identify the prevalence of internalizing and externalizing behavior problems among preschoolers from the city of Salvador, state of Bahia, Brazil, and their associations with maternal mental health and family characteristics. Methods: This was a cross-sectional study of 349 children aged 49 to 72 months, randomly selected from 20,000 households representing the range of socioeconomic and environmental conditions in Salvador. In 1999, we assessed sociodemographic variables and family environment characteristics. In 2001, we used the Child Behavior Checklist to measure and describe the frequencies of behavior problems. We conducted bivariate and multivariate analysis to estimate associations between family and maternal factors and prevalence of behavior problems. Results: The overall prevalence of behavior problems was 23.5%. The prevalence of internalizing problems was 9.7%, and that of externalizing problems, 25.2%. Behavior problems were associated with several maternal mental health variables, namely: presence of at least one psychiatric diagnosis (odds radio [OR] 3.01, 95%CI 1.75-5.18), anxiety disorder (OR 2.06, 95%CI 1.20-3.46), affective disorder (OR 2.10, 95%CI 1.21-3.65), and mental health disorders due to use of psychoactive substances (OR 2.31, 95%CI 1.18-4.55). Conclusion: The observed prevalence of child behavior problems fell within the range reported in previous studies. Maternal mental health is an important risk factor for behavior problems in preschool-aged children.

Juvenile Huntington disease in Argentina / Doença de Huntington juvenil na Argentina

ABSTRACT We analyzed demographic, clinical and genetic characteristics of juvenile Huntington disease (JHD) and it frequency in an Argentinean cohort. Age at onset was defined as the age at which behavioral, cognitive, psychiatric or motor abnormalities suggestive of JHD were first reported. Clinical and genetic data were similar to other international series, however, in this context we identified the highest JHD frequency reported so far (19.72%; 14/71). Age at onset of JHD is challenging and still under discussion. Our findings reinforce the hypothesis that clinical manifestations, other than the typical movement disorder, may anticipate age at onset of even many years. Analyses of JHD cohorts are required to explore it frequency in populations with different backgrounds to avoid an underestimation of this rare phenotype. Moreover, data from selected populations may open new pathways in therapeutic approaches and may explain new potential correlations between HD presentations and environmental or biological factors.

RESUMO Foram analisadas as características demográficas, clínicas e genéticas de doença de Huntington juvenil (JHD) e na freqüência em uma coorte argentino. A idade de início foi definida como a idade em que distúrbios comportamentais, cognitivos, psiquiátricos ou anormalidades motoras sugestivas de JHD foram relatada pela primeira vez. Os dados clínicos e genéticos foram semelhantes aos de outras séries internacionais, no entanto, neste contexto identificamos a maior freqüência de JHD relatados até agora (19,72%; 14/71). A idade de início de JHD é um desafio ainda em discussão. Nossos resultados reforçam a hipótese de que as manifestações clínicas, além do transtorno de movimento típico, pode antecipar a idade de início em muitos anos. As análises de coortes de JHD são obrigados a explorar frequências em populações com diferentes formações, para evitar uma subestimação deste fenótipo raro. Além disso, os dados de populações selecionadas podem abrir novos caminhos em abordagens terapêuticas e pode explicar novas correlações potenciais entre apresentações de HD e fatores ambientais ou biológicas.

Achados comportamentais e cognitivos em crianças de 5 a 11 anos nascidas com baixo peso / Behavioral and cognitive fi ndings in 5-11-year-old children born underweight

Introdução: O número de nascimentos prematuros cresceu nos últimos anos, aumentando a morbimortalidade infantil. Sabe-se que estes estão mais sujeitos a problemas futuros, devido à pouca maturidade de órgãos e ao baixo peso ao nascer. Contudo, a interação do indivíduo com o ambiente familiar e social também influencia no desenvolvimento e comportamento. O estudo avaliou crianças entre cinco e 11 anos de idade em acompanhamento no ambulatório de Pediatria da Faculdade de Medicina da Universidade Federal de Pelotas nascidas prematuras ou com baixo peso ao nascer e avaliou o perfil cognitivo e comportamental. Método: Participaram do estudo 47 crianças, sendo 11 prematuras e 36 nascidas a termo. Os instrumentos de avaliação utilizados foram: uma escala de Avaliação de Sintomas de Transtorno de Déficit de Atenção e Hiperatividade, o MTA SNAP-IV e o Questionário de Habilidades e Dificuldades (SDQ). Para avaliação econômica, utilizou-se o Critério de Classificação Econômica Brasil ­ ABEP. Utilizou-se ainda o teste das matrizes progressivas de Raven para estimar o quociente intelectual e um questionário com dados do histórico da criança, gestação e antecedentes dos pais. Resultados: Foi observada diferença estatisticamente significativa entre crianças a termo e prematuras, no sintoma impulsividade e e nos sintomas de transtorno de conduta, além de uma maior pontuação nos sintomas psiquiátricos em geral. Conclusão: Os achados sugerem que crianças prematuras apresentam maior prevalência de problemas de comportamento do que as nascidas a termo (AU)

Introduction: The number of preterm births has grown in recent years, increasing infant morbidity and mortality rates. It is known that preterm infants are more prone to future problems due to low maturity of organs and low birth weight. However, the interaction of the individual with the family and social environment also influences the development and behavior. This study assessed the cognitive and behavioral characteristics of children with low weight between 5 and 11 years as pediatric outpatients cared for in the School of Medicine, Federal University of Pelotas. Method: The study included 47 children, 11 preterm and 36 term born. The assessment instruments used were the MTA SNAP-IV ­ Assessment Scale of Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and the Skills and Difficulties Questionnaire (SDQ). For socioeconomic evaluation, we followed the Economic Classification Criterion Brazil ­ ABEP. We also used Raven's Progressive Matrices and a questionnaire with the child's historical data, gestation, and parental background. Results: A statistical difference between preterm and full-term children was observed in the symptom impulsivity and conduct disorders as well as a higher score in psychiatric symptoms in general. Conclusion: The findings suggest that preterm infants have a higher prevalence of behavior problems than those born at term (AU)

Ambiente familiar e transtorno de déficit de atenção e hiperatividade / Family environment and attention-deficit hyperactivity disorder

OBJETIVO: Analisar fatores associados a transtorno de déficit de atenção e hiperatividade em crianças. MÉTODOS: Estudo longitudinal sobre problemas de comportamento em crianças escolares de São Gonçalo, RJ, em 2005. Foram analisados 479 escolares da rede pública selecionados por amostragem por conglomerados em três estágios. Foi utilizada a escala Child Behavior Checklist para medição do desfecho. Foi aplicado um questionário para pais/responsáveis acerca dos fatores de exposição analisados: perfil da criança e da família, variáveis de relacionamento familiar, violências físicas e psicológicas. O modelo regressão log-binomial com enfoque hierarquizado foi empregado para a análise. RESULTADOS: Quociente de inteligência mais alto associou-se inversamente à frequência do transtorno (RP = 0,980 [IC95% 0,963;0,998]). A prevalência de transtorno nas crianças foi maior quando havia disfunção familiar do que entre famílias com melhor forma de se relacionar (RP = 2,538 [IC95% 1,572;4,099]). Crianças que sofriam agressão verbal pela mãe apresentaram prevalência 3,7 vezes maior do que aquelas não expostas a essa situação no último ano (RP = 4,7 [IC95% 1,254;17,636]). CONCLUSÕES: Relações familiares negativas estão associadas aos sintomas de transtorno de déficit de atenção e hiperatividade. Sua associação com quociente de inteligência reitera a importância da base genética e ambiental na origem do transtorno.

OBJECTIVE: To analyze factors associated with attention-deficit and hyperactivity disorder in children. METHODS: This is a longitudinal study about behavior problems in schoolchildren that was carried out in the city of São Gonçalo (Southeastern Brazil) in 2005. A total of 479 students from public schools was analyzed, selected through three-stage cluster sampling. The Child Behavior Checklist was used to measure the outcome. A questionnaire was administered to parents/guardians concerning the exposure factors, which were: child's and family's profile, family relationship variables, physical and psychological violence. The log-binomial regression model with a hierarchical approach was employed in the analysis. RESULTS: Higher intelligence quotient was inversely associated with the frequency of the disorder (PR=0.980 [95%CI 0.963;0.998]). The prevalence of the disorder in the children was higher when there was family dysfunction than among families with a better way of relating (PR=2.538 [95%CI 1.572; 4.099]). Children who suffered verbal abuse from the mother had a prevalence 3.7 times higher than the ones not exposed to this situation in the last year (PR=4.7 [95%CI 1.254;17.636]). CONCLUSIONS: Negative family relationships are associated with symptoms of Attention-Deficit and Hyperactivity Disorder. Its association with the intelligence quotient reiterates the importance of the genetic and environmental basis at the origin of the disorder.

Evaluación neuropsicológica, factores psicosociales y co-morbilidad psiquiátrica en pacientes pediátricos infectados con el VIH / Neuropsychological evaluation, psychosocial factors, and psychiatric comorbidity of children with HIV infection

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.

El acoso escolar (bullying) y su asociación con trastornos psiquiátricos en una muestra de escolares en México / Bullying and its association with psychiatric disorders in a Mexican students sample

OBJETIVO: Estudiar la relación entre el tipo de psicopatología y el acoso escolar en una muestra de niños de las escuelas públicas de la Ciudad de México. MATERIAL Y MÉTODOS: Un total de 1 092 escolares identificó por medio del Test Bull-S a un grupo de agresores,víctimas,víctima-agresores y neutros. Los padres contestaron la Lista de Síntomas del Niño (Child Behavior Checklist, CBCL) para determinar el rango clínico de psicopatología. RESULTADOS: El grupo de agresores tuvo asociación con las escalas de ansiedad, síntomas somáticos, oposicionismo y de conducta. El grupo de víctima-agresores presentó asociación con los problemas de atención,oposicionismo y de conducta.En el grupo de víctimas las asociaciones encontradas fueron con los problemas de ansiedad.Estas diferencias fueron significativas frente al grupo control (neutros). CONCLUSIÓN: El acoso escolar se asocia con psicopatología que requiere de atención psiquiátrica oportuna.

OBJECTIVE: To study the relationship between bullying behavior and psychopathology. MATERIALS AND METHODS: A total of 1 092 students identified their peers' bullying status based on the Bull-S questionnaire. Parents completed the Child Behavior Checklist (CBCL) to determine psychopathology levels. RESULTS: The bullying group had associations with anxiety, somatic symptoms, oppositionalism and behavior problems; the bully-victims group had associations with attention, oppositionalism and behavior problems; victims had higher anxiety scores.These differences were significant compared with the control group. CONCLUSIONS: Bullying is associated with psychopathology, which requires timely psychiatric attention.

Validez de un instrumento multidimensional para medir factores de riesgo asociados a trastornos de la conducta alimentaria en púberes mexicanos / Validity of a multidimensional questionnaire to measure risk factors associated to eating disorders in Mexican pubescents

Objective: To obtain the validity and internal consistency of a questionnaire for the screening of risk factors associated to eating disorders in Mexican pubescent males and females. Subjects and methods: The questionnaire was applied to a non-probabilistic sample of 504 males and 511 female students in México City from 11 to 15 years of age with a median of 12,13. Statistical methods included internal consistency analysis (Cronbach's alpha) and principal components factor analysis with oblimin rotation. Results: Both instruments obtained five-factors structure, showed a good total Cronbach's alpha score: males 0,75 (55,6 percent), and females 0,83 (57,6 percent) of the total explained variance. Males displayed a normal eating behavior factor, while for females a restrictive dieting factor was obtained. Conclusions: This questionnaire is a valid measure in pubescent boys and girls for assessing risk factors associated with eating disorders, in particular socio-cultural factors, eating behaviors and pubertal development.

Objetivo: obtener la validez y consistencia interna de un cuestionario para púberes mexicanos, hombres y mujeres, que evalúe factores de riesgo asociados a trastornos de la conducta alimentaria. Sujetos y método: El cuestionario se aplicó a una muestra no probabilística, de púberes estudiantes de la ciudad de México (504 hombres y 511 mujeres), con edades de 11 a 15 años de edad, con una media de 12,13. Se realizó un análisis de consistencia interna (alfa de Cronbach) y un análisis factorial de componentes principales con rotación oblimin por el método de máxima verosimilitud. Resultados: Ambos instrumentos arrojaron 5 factores, con una buena consistencia interna, alcanzando un valor total de alpha de Cronbach de 0,75 para hombres (55,6 por ciento de varianza explicada) y 0,83 para mujeres (57,6 por ciento de varianza explicada). Conclusión: El instrumento resultó válido en hombres y mujeres, para medir factores de riesgo asociados a trastornos alimentarios, principalmente socioculturales, conductas alimentarias y desarrollo puberal.

Psychological status of children with type 1 diabetes in Kuwait

Childhood diabetes puts an enormous burden on both the child and his family and may put them at increased risk for psychological problems. The purpose of the study was to assess the psychological reactions to type 1 diabetes in children and the effect of glycemic control on them. A specially designed questionnaire was used to collect demographic data. The children behavioral check list and the Arabic childhood depression inventory were used to assess depression, anxiety and other behavioral disorders. Social workers and research assistants interviewed the patients in the outpatients of the 5 hospitals. Controls were interviewed at school. A total of 215 diabetic and 221 age and sex matched healthy subjects were enrolled in the study. Measure depression, and other behavioral disorders in diabetic patients. Mild depression was reported in 63% of the diabetic subjects, 3-fold higher than in the control group [p < 0.05]. Medium and high anxiety scores were significantly more frequent in diabetic children [p <0.001, and p < 0.01 respectively] Attention, concentration problems, hyperactivity and aggressive behavior were significantly more frequent in the diabetic children compared to matched controls. There was a significant association between poor glycemic control and depression; p < 0.001. hyperactivity [p = 0.001], poor attention [p - 0.007], and aggression [p = 0.03]. Children with diabetes are at increased risk of depression and behavioral problems. Regular psychological assessment along with medical treatment must be addressed to optimize control

Prevalence of seizure in PKU: an analytic historical study

Phenylketonuria [PKU] is an autosomal recessive metabolic genetic disorder characterized by a deficiency in the hepatic enzyme phenylalanine hydroxylase [PAH] which can cause problems with brain development, leading to progressive mental retardation, brain damage, and seizures. In this study we evaluated the frequency of seizure, EEC abnormality and behavioral disorders. In this case study, 94 PKU children aged between 1 month and 23 years who were referred to Mofid children Hospital between 2009 and 2010 were enrolled. Patients were age and sex matched. Statistical tests were used for comparing patients' data. The mean age of patients was 8.4 years. Parents were relatives in 80.9% of the cases [76 patients]. Of all, 43% [45 patients] had seizure but EEC was abnormal only in 81% of them [35 patients out of 43 patients]. Totally, EEC was abnormal in 67% of the cases [63 patients] of whom 44.4% [28 patients of 63 patients] did not have seizure. Therefore, there was a significant relationship between seizure and EEC abnormality The phenylalanine level ranged from 8mg/dL to 50mg/dL [mean: 18.88 mg/dL] at the time of diagnosis and from 0.4mg/dL to 18mg/dL [mean: 7.37mg/oL] at the time of evaluation. On the other hand, we observed abnormal behaviors in all EEC abnormalities and there was a significant relationship between EEC abnormality and behavioral disorders. In our study, the prevalence of seizure was less than EEC abnormality and there was a significant relationship between EEC abnormalities and behavioral disorders in patients with Phenylketonuria regardless of seizure.The authors believe that treatment of EEC abnormalities may lead to the correction of behavioral disorders in these patients

Fetal alcohol spectrum disorder(FASD).

Fetal alcohol syndrome (FAS)is the leading cause of mental retardation worldwide but is also the foremost preventable cause of neurobehavioral and developmental abnormalities. It is equally important to know spectrum of disorders due to maternal alcoholism during pregnancy such as Fetal alcohol spectrum disorder (FASD)in order to identify and treat affected child and family effectively.This article aims to create awareness among practising clinicians most of whom are only aware of phenotypical variant of FASD which is FAS.In this article we discuss those aspects of FASD relevant to the clinician such as: terminological ambiguity, assessment, diagnosis and prevention.

Preventing behaviour problems through a universal intervention in Jamaican basic schools: a pilot study / Prevención de los problemas de comportamiento a través de una intervención universal en las escuelas preescolares de Jamaica: un estudio piloto

OBJECTIVE: To evaluate the effect of a preventative intervention in Jamaican basic schools on child behaviour and parent-teacher contacts. DESIGN AND METHODS: Five basic schools in Kingston, Jamaica, were randomly assigned to an intervention (n = 3) or control (n = 2) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training Programme supplemented by fourteen lessons on social and emotional skills in each class. Within each classroom (n = 27), children were screened for behaviour difficulties through teacher report and children with the greatest difficulties were selected for evaluation of outcomes (135 children). Teachers' reports of child behaviour using the Strengths and Difficulties Questionnaire and of the quality of teacher-parent contacts were collected at the beginning and end of the school year. Multilevel regression analyses controlling for school and classroom were used to evaluate the effects of intervention on child behaviour. RESULTS: Significant benefits of intervention were found for children's conduct problems (regression coefficient (b) = -0.62, 95% confidence interval (CI): -0.01, -1.23), hyperactivity (b = -0.84, 95% CI: -1.57, -0.11) and peer problems (b = -1.24, 95% CI: -1.89, -0.59). The effect sizes were 0.26 for conduct problems, 0.36 for hyperactivity and 0.71 for peer problems. No significant benefits were found for the prosocial and emotional problems subscales. The intervention also resulted in increases in the number of positive teacher-parent contacts (p < 0.0001). No benefits were found for the number of negative teacher-parent contacts. CONCLUSION: This is a promising approach for reducing children's externalizing behaviour and peer problems and for improving the quality of teachers' contacts with parents of children with behaviour problems.

OBJETIVO: Evaluar el efecto de una intervención preventiva en el comportamiento de los niños y los contactos entre padres y maestros en las escuelas preescolares de Jamaica. DISEÑO Y MÉTODOS: Cinco escuelas preescolares en Kingston, Jamaica, fueron asignadas de manera aleatoria a una intervención (n = 3) o condición de control (n = 2). La intervención comprendió siete talleres de maestro el día entero, usando el Programa de Entrenamiento de Maestros "Años Increíbles", complementado por catorce lecciones sobre habilidades sociales y emocionales en cada clase. Dentro de cada aula (n = 27), se realizó un pesquisaje de niños en busca de dificultades en la conducta a través del informe del maestro, y los niños con las mayores dificultades fueron seleccionados para la evaluación de resultados (135 niños). Informes de los maestros sobre la conducta de los niños - realizados mediante el Cuestionario de fortalezas y dificultades, y sobre la calidad de los contactos entre maestros y padres - fueron recogidos al inicio y al final del año escolar. Análisis de regresión multinivel para el control de la escuela y el aula, fueron usados para evaluar los efectos de la intervención sobre el comportamiento de los niños. RESULTADOS: Se hallaron beneficios significativos para los problemas de la conducta de los niños (coeficiente de regresión (b) = -0.62, 95% intervalo de confianza (IC): -0.01, -1.23), hiperactividad (b = -0.84, 95% IC: -1.57, -0.11) y problemas con los iguales (b = -1.24, 95% IC: -1.89, -0.59). Los tamaños de efecto fueron 0.26 para los problemas de conducta, 0.36 para la hiperactividad y 0.71 para los problemas de iguales. No se hallaron beneficios significativos para las subescalas de problemas prosociales y emocionales. La intervención también trajo como resultado aumentos en el número de contactos positivos entre maestros y padres (p < .0001). No se hallaron beneficios para el número de contactos negativos maestros-padres. CONSLUSIÓN: Este trabajo representa un abordaje prometedor a la hora de reducir la conducta externalizadora de los niños y los problemas de iguales, así como para mejorar la calidad de los contactos entre los maestros y los padres de los niños con problemas de conducta.

The rutter children behaviour questionnaire fo teachers: from psyhometrics to norms, estimating caseness

To establish the psychometric properties of the RCBQ for completion by teachers and to determine behavioural and emotional problems in young children, as they occur in the classroom, we asked 45 elementary school teachers of the north of Portugal to rate classroom behaviour of their pupils based on Rutter Children's Behaviour Questionnaire for teachers. A total of 970 Portuguese mid class children (530 girls and 440 boys) aged between 8 to 11 years (M=8,47; SD=.771) were evaluated. A two factor structure was found to be suitable, exhibiting an acceptable reliability and test-retest values along a 3-month period. An average of 16,1% of the pupils exhibited some behavioural problems, where teachers described anxiety (3,1%), worry (5,1%) and unconcentration (14,1%) as the most prevalent symptoms. The findings suggest that the translated scale could serve as a rapid and useful screening instrument in clinical and in research settings.

Com o objetivo de estabelecer as propriedades psicométricas do Inventário do Comportamento de Rutter na sua forma completa para professores e, determinar os problemas comportamentais e emocionais em crianças, tal como eles ocorrem na sala de aula, foi pedido a 45 professores do 1º CEB do Norte de Portugal para classificarem os comportamentos de 970 alunos (530 meninas e 440 meninos), com idades comprendidadas entre os 8 e os 11 anos (M=8,47; DP=0,771). Foi encontrada uma estrutura fatorial de dois fatores, que exibiu uma fidelidade e valores de teste-reteste aceitáveis ao longo de um período de 3 meses. Verificou-se que 16,1% dos alunos apresentavam algum problema ao nível do comportamento, e foram descritos pelos professores como os sintomas mais prevalentes: ansiedade (3,1%), preocupação (5,1%) e dificuldades de concentração (1,1%). Os resultados mostram que o instrumento traduzido pode ser útil e simples tanto em contexto clínico como de investigação.

Prevalence of emotional and behavioural problems among primary school children in Karachi, Pakistan - Multi informant survey.

Objective. To determine emotional and behaviourable problem among school going children in Pakistan. Methods. A cross sectional survey of school children of certain towns within Karachi metropolitan area, aged 5 to 11 years during 1st half of 2006. SDQ was filled out by parents and school teachers for the same children. Demographic data of parents, teachers and children were also collected using a separate performa. Results. 7 private and 8 community schools agreed to participate. 1488 consent forms were sent to 700 parents of private school and 788 parents of community school children. A total of 675 parents agreed to participate in the study. The response rate was 45.3%. Assessment of children’s mental health was conducted using Strength and Difficulties Questionnaire (SDQ). Parents rated 34.4% of children as falling under the “abnormal category on SDQ, slightly higher estimates 35.8% were reported by the teacher. The findings suggest a striking difference between the informants’ ratings as well as gender wise difference in prevalence of common child mental health problems. Conclusion. In the present study prevalence of child mental health problems was higher than reported in studies from other countries. There was also a gender difference in prevalence; boys had higher estimates of behavior/externalizing problems, whereas emotional problems were more common amongst females. There is a need for developing programs to train, sensitise and mobilize teachers and parents regarding child’s psychological, emotional and behavioral problems.