Vinculação aos pais, adversidade na infância e desenvolvimento de psicopatologia / Attachment to parents, adverse childhood experiences and psychopathology / Vinculación a los padres, adversidad en la infancia y desarrollo de psicopatología

O presente estudo teve como principal objetivo analisar o papel da qualidade da vinculação aos pais na associação entre experiências adversas na infância e sintomatologia psicopatológica em adultos. A amostra foi constituída por 511 indivíduos com idades entre os 25 e os 50 anos de idade (M = 34,69; DP = 7,82). Para a recolha dos dados recorreu-se a questionários de autorrelato. Os resultados sugerem que a qualidade da vinculação aos pais e as experiências adversas na infância são relevantes na predição de sintomatologia psicopatológica (depressão, somatização e ansiedade). Os resultados serão analisados à luz da teoria da vinculação, considerando a importância das experiências adversas na infância na compreensão dos processos psicopatológicos na adultícia

The present study aims to analyze the role of quality of attachment to parents in the association between adverse childhood experiences and the psychopathological symptoms in adulthood. The sample was composed by 511 adults, aged 25 to 50 (M = 34.69; DP = 7.82). For data collection we resorted to the self-report questionnaires. Results suggest that the quality of attachment to parents and adverse childhood experiences are relevant in predicting psychopathological symptoms (depression, somatization and anxiety). The results will be discussed according to attachment theory, considering the importance of adverse childhood experiences in understanding the psychopathological processes in adulthood

Este estudio tuvo como objetivo analizar el papel de la calidad del apego a los padres en la relación entre las experiencias infantiles adversas y síntomas psicopatológicos en adultos. La muestra consistió en 511 individuos con edades comprendidas entre 25 y 50 años de edad (M = 34,69; DP = 7,82). Para la recolección de datos se utilizaron cuestionarios de autoinformes. El presente estudio tuvo como objetivo analizar el papel de la calidad de la vinculación a los padres en la asociación entre experiencias adversas en la infancia y sintomatología psicopatológica en adultos. La muestra fue constituida por 511 individuos con edades entre los 25 y los 50 años de edad (M = 34.69, DP = 7.82). Para la recogida de los datos se recurrió a cuestionarios de autoinformes. Los resultados sugieren que la calidad de la vinculación a los padres y las experiencias adversas en la infancia son relevantes en la predicción de sintomatología psicopatológica (depresión, somatización y ansiedad). Los resultados serán analizados a la luz de la teoría de la vinculación, teniendo en cuenta la importancia de las experiencias adversas en la infancia en la comprensión de los procesos psicopatológicos en la edad adulta

Incidence and Comorbidity of Reactive Attachment Disorder: Based on National Health Insurance Claims Data, 2010–2012 in Korea

OBJECTIVE: We aimed to investigate the current diagnostic incidence, and medical and psychiatric comorbidities of reactive attachment disorder (RAD) using the National Health Insurance Review and Assessment (HIRA) claims data. METHODS: To examine the diagnostic incidence, we selected patients who were under 10-year-old and who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for RAD (F94.1 and F94.2) and who had not been diagnosed in the previous 360 days, from 2010 to 2012. In this study, we used the term ‘reactive attachment disorder’ representing for both RAD per se and Disinhibited social engagement disorder. Comorbid disorders were categorized according to ICD-10. RESULTS: Among 14,029,571, the total population under 10-year-old during 2010–2012, incident cases of RAD were 736. The mean diagnostic incidence of RAD was 5.25 per 100,000 annually. Language disorders (F80-84) were the most common psychiatric comorbidities in both boys and girls in age groups 0–3 years and 4–6 years, and attention deficit hyperactivity disorder was the most common in both sex aged 7–9 years. In non-psychiatric comorbidities, diseases of the respiratory system (J00–99) were the commonest in both sex in all age groups, and diseases of the digestive system (K00–99) were the next. CONCLUSION: RAD was very rare in practice and would be disguised as other psychiatric disorders. Children with RAD might have more medical comorbidities than typically developed children.

Aliança terapêutica, vinculação parental e sintomatologia de pacientes adultos que iniciam psicoterapia / Associations between therapeutic alliance, parental bonding and symptomatology in adult patients beginning psychotherapy / Allianza Terapéutica, vinculación parental y sintomatología del pacientes adultos que comienzan la psicoterapia

A aliança terapêutica (AT) é uma variável chave para o processo de mudança, sendo afetada por fatores do terapeuta e do paciente. Este estudo investigou a relação entre AT, vinculação parental e sintomatologia de pacientes em Psicoterapia Psicanalítica. Foram examinados 57 pacientes adultos entre a 4ª e a 5ª sessão de tratamento com medidas de avaliação da AT, da vinculação com os pais na infância e adolescência e de sintomas psicopatológicos. Associações positivas entre AT e cuidados da mãe e associações negativas entre AT e controle da mãe foram encontradas. Além disso, foram constatadas diferenças na AT entre os estilos parentais "cuidado ótimo" e "controle sem afeto" da mãe. Não houve associação entre AT e sintomas. Por outro lado, diversos sintomas mostraram associação positiva com o controle do pai. Os resultados indicam que a AT está relacionada com a história pregressa de vinculação do paciente e esta história tem relação com seu quadro clínico atual, evidenciando a complexidade dos processos que ocorrem na psicoterapia. (AU)

The Therapeutic Alliance (TA) is a key-variable for the process change, and it's affected by therapist's and patients' factors. This study investigated the relationship between TA, parental bonding and symptomatology in patients in psychoanalytic psychotherapy. Fifty-seven adult participants were examined between the 4th and the 5th session of the treatment with assessments of TA, child and adolescence parental bonding and psychopathological symptoms. Positive associations between TA and "mother care" and negative associations between "mother overprotection" and TA were found. Also, significant differences were found in TA and the mother's parenting styles "optimal parenting" and "affectionless control". TA and symptoms were not associated. However, several symptoms had positive associations with father overprotection. Results indicate that TA is related with the parental bonding history and that this history is related with patients' current clinical condition, showing the complexity of the processes that occur in psychotherapy. (AU)

La Alianza Terapéutica (AT) es una variable clave para el proceso de cambio y es afectada por factores del terapeuta y del paciente. Este estudio examinó la relación entre la AT, la vinculación parental y la sintomatología en pacientes en psicoterapia psicoanalítica. Se examinaron cincuenta y siete participantes adultos entre la cuarta y la quinta sesión del tratamiento con instrumentos de evaluación de la alianza terapéutica, de la vinculación parental en la infancia y adolescencia, y de los síntomas psicopatológicos. Se encontraron asociaciones positivas entre la AT y el cuidado de la madre, y asociaciones negativas entre la AT e la protección de la madre. También se constató diferencias significativas en la AT y los estilos parentales de la madre "cuidado óptimo" y "control sin afecto". No hubo asociación entre AT y síntomas. Sin embargo, varios síntomas mostraran asociación positiva con el control del padre. Los resultados indican que la AT se relaciona con la historia anterior de vinculación del paciente y que esta historia tiene que ver con su cuadro clínico actual, mostrando la complejidad de los procesos que ocurren en la psicoterapia. (AU)

Experiencias contradictorias y demandantes: la infancia y la adultez en la perspectiva de niños y niñas de Santiago de Chile / Childhood and adulthood in Chile today: A discursive study with boys and girls from Santiago / Infância e idade adulta no Chile atual: Um estudo discursivo com meninos e meninas de Santiago

En este artículo, se presentan los resultados de un estudio que exploró los discursos acerca de la infancia y la adultez de niños y niñas de distintos estratos socioeconómicos de Santiago, a partir de entrevistas abiertas realizadas a grupos mixtos y de un sólo sexo (niñas y niños varones). Se da cuenta, en este marco, de discursos que, para hablar de infancia y adultez, construyen oposiciones: juego versus trabajo, libertad versus sometimiento, inocencia versus conciencia e infancias ricas versus infancias pobres. Además, se identifican algunas diferencias de clase social y de género y se analiza cómo se expresan, en los complejos discursos de los niños y las niñas, contradicciones y ambivalencias culturales respecto a la infancia y adultez, en el marco de un contexto de neoliberalización creciente.

In this article, the results of a study exploring the discourses on childhood and adulthood of boys and girls from different socioeconomic strata of Santiago are discussed, achieved through open group interviews carried out in mixed gender and single sex settings. Within this framework, children tended to construct discursive antonyms to represent their notions of childhood and adulthood, such as play vs. work, freedom vs. compliance, innocence vs. conscience and poor vs. wealthy childhoods. In addition, class and gender differences are also analyzed, as well as complex and contradictory conceptions of childhood and adulthood present in these discourses, which express cultural ambivalence within a context of increasing neo–liberalization.

Neste artigo, apresentam–se os resultados de um estudo que explorou os discursos a respeito da infância e da fase adulta de meninos e meninas de diferentes setores socioeconômicos de Santiago, a partir de entrevistas grupais abertas realizadas em contextos mistos (meninos e meninas) e em grupos separados por gênero. Neste marco, pode–se perceber por meio dos discursos que, para falar da infância e da idade adulta, são construídas oposições como: jogo versus trabalho, liberdade versus submissão, inocência versus consciência e crianças ricas versus crianças pobres. Além disso, identificam–se algumas diferenças de classe social e de gênero. Também são analisados, nos complexos discursos das crianças, como se expressam as contradições e ambivalências culturais com relação à infância e à fase adulta, dentro de um contexto de crescente neo–liberalização

Trastornos del vínculo: detección y tratamiento / Attachment disorders: detection and treatment

El presente artículo describe una revisión panorámica y breve de la variedad de programas dirigidos a la promoción e intervención en apego y sensibilidad, desde un enfoque promocional, preventivo y de tratamiento. En primer lugar se revisan las conceptualizaciones dominantes que definen los trastornos del apego y a continuación se resumen los diferentes focos de trabajo de una muestra representativa de programas de intervención en apego. La mayoría de las intervenciones se focalizan en la interacción madre-hijo, en general están diseñadas para infantes y niños menores de tres años y se centran en mejorar las capacidades de sensibilidad parental así como los esquemas representativos de los padres en relación al hijo. Se concluye una creciente cantidad de propuestas con un enfoque de tipo universal e indicado, para díadas con problemas precoces de interacciones poco sensibles y condiciones psicosociales de cierto riesgo para apego inseguro. A su vez se describen intervenciones selectivas para poblaciones con presencia de maltrato y trastornos graves del apego. Se describen brevemente tres modalidades de intervención y sus rasgos, que representan diferentes focos y objetivos. Se discute finalmente sobre el tópico de la evidencia de efectividad y los factores asociados.

This article describes a panoramic review of the variety of programs aimed at the promotion and intervention in attachment and sensitivity from a promotional, preventive approach and treatment. First, the dominant conceptualizations of attachment disorders are reviewed, and then the different foci of work of a representative sample of attachment intervention programs are summarized. Most interventions are located in the mother-child interaction, are generally designed for infants and children under three years, and focus on improving the capabilities of parental sensitivity and representational schemes of parents regarding the child. We conclude that there are a growing number of proposals with a universal preventive approach for dyads with early attachment problems and insensitive interactions and psychosocial conditions that are risk factors for insecure attachment. At the same time we describe interventions for populations with severe abuse and attachment disorders. Three modes of intervention and their features are briefly described, representing different foci and objectives. We finally discuss the topic of evidence of effectiveness and associated factors.

Introduction of the Concept of Social Dysfunction Spectrum

Along with language, socialization is a unique feature of the human being. There is a continuous debate regarding whether the development of socialization is innate, and conducted by the environment in the growing process, or the result of the interaction of both aspects. If socialization is the result of the interaction with the environment or is an acquired developmental process, the following question rises. "Is there a 'critical period' for the development of socialization?" Although there are a huge number of studies seeking for treatment and solutions for developmental delay or deficits of socialization, it is very complicated question to answer. Historical figures such as 'Hugh Blair' of Borgue in England, and 'the wild boy of Aveyron' in France, seem to have innate socialization deficits. Nowadays patients with non-verbal learning disorder, social communication disorder, or autism spectrum disorder seem to have genetic defects. On the other hand, Harry Harlow's monkey experiments, hikikomori of Japan, Romanian orphans and patients with reactive attachment disorder seem to display social deficits due to environmental factors. However, it is not easy to clearly draw a line between innate or acquired factors. Therefore, rather than subdividing the diseases for etiological and pathophysiological approach to heterogenous groups with the common denominator of social deficit, and for the research of pathophysiology and treatment development, the authors suggest a comprehensive concept of "social dysfunction spectrum."

Childhood Hearing Impairment: How do Parents Feel about it?

"Hearing impairment or deafness is a major disabling condition worldwide. The etiology of hearing loss range from congenital to acquired; and includes common and preventable childhood infections like otitis media and meningoencephalitis. The morbidity and burden of hearing impairment on the children and their parents is enormous. This is because affected children have developmental delay in many domains including speech; cognition as well as behavioural and other aspects of psychosocial development. Early identification and effective treatment of hearing loss improves language; other forms of communication; and cognitive skills. This study was carried out to evaluate and ascertain the perception and attitude of parents of children with hearing impairment.Material and Method: This was a questionnaire based study of parents' perception and attitude about children with hearing impairment in the Port-Harcourt metropolis from 1st June 2011 to 31st May 2012.Results: Thirty seven parents of children with hearing impairment were studied. The parents demonstrated different attitudes towards the children. Majority; 34(94.59) of them felt sad; others expressed anger. Twenty seven (72.97) felt hearing loss was due to punishment from the ""gods"" for an evil deed by a family member. The attitude and feelings of parents included sadness; self-blame and anger. Parents also believe that immediate cause is spiritual.Conclusion: The public should be enlightened about common preventable causes so as to correct all negative attitudes about hearing loss/ impairment."

Apego & psicopatología: una revisión actualizada sobre los modelos etiológicos parentales del apego desorganizado / Attachment & psychopathology: an update review of parental etiological models of disorganized attachment

Una de las actuales tendencias dentro de la Teoría del Apego consiste en la comprensión de las trayectorias desviadas en el desarrollo del vínculo, a saber, lo que se conoce como apego desorganizado (apego D). Dos décadas de investigación sobre los antecedentes y consecuentes de este tipo de apego han generado un importante acopio de conocimiento empírico y teórico. Sin embargo, en relación a los modelos etiológicos parentales que buscan explicar los procesos y mecanismos que generan que los niños desarrollen el apego D, la evidencia es contradictoria e incompleta. Dada la enorme relevancia que tiene para la elaboración de estrategias de intervención infantil poseer un conocimiento específico y empíricamente validado sobre los procesos y mecanismos parentales predisponentes al desarrollo de la desorganización del vínculo, es que el presente artículo establece una revisión de los modelos disponibles con miras a aclarar el estado actual del conocimiento en esta temática.

One of the actual tendencies within Attachment Theory is about the understanding of atypical trajectories in development of attachment, specifically referred to Disorganized Attachment (D attachment). Two decades of research about antecedents and consequents of this pattern of attachment have spawned a huge amount of empirical and theoretical knowledge. However, parental etiological models who seek to explain processes and mechanisms of D attachment have shown contradictory and incomplete evidence. Due to the important contribution that this kind of models can have for infant and child interventions, this paper seek to review existing model in order to clarify the state of the art of this important research and clinical subject.

Cerebral Perfusion Assessed with 99m-Tc-ECD-SPECT in Childrens with Attachment Disorder / 신경정신의학

OBJECTIVES: This study aimed to reveal that severe disturbance of attachment relationship with primary care-giver can affect functional brain development by measuring with technetium-99m ethyl cysteinate dimer brain single-photon emission tomography. METHODS: Subjects were 12 children aged 2-6 years who met the diagnostic criteria of reactive attachment disorder. Diagnostic tools were DSM-IV, ICD-10, Strange Situation Procedure(SSP), Vineland Social Maturity Sclae(SMS), and Childhood Autism Rating Scale(CARS). Brain SPECT was performed in all sbjects and each SPECT scan was visually assessed by two nuclear medicine specilalists. RESULTS: Eleven of 12 children had abnormal brain perfusion on SPECT scans, revealing focal areas of decreased perfusions. Perfusion of thalamus was decreased in 10 subjects decreased perfusion of left thalamus(6/10), right thalamus(1/10), and both thalami(3/10). Perfusion of basal ganglia was decreased in 5 children. Four children had decreased perfusion of thalamus as well as of basal ganglia. Decreased perfusion of parietal area was noted in only one child on SPECT scan. All subjets had normal perfusion of frontal, temporal, occipital, cerebellar areas on SPECT scan. CONCLUSIONS: Perfusion abnormalities involving thalamus, basal ganglia in most children with attachment disorder were found in this study. These results suggest that brain development of infant could be impeded by severe pathologic care and early nurturing environment would be important for normal brain development.