Programas de fortalecimiento de prácticas parentales: un aporte a la prevención de conductas externalizantes en preescolares / Training programs in parental skills: a contribution to the prevention of the development of externalizing behaviors in preschool children

Resumen: La presencia de conductas externalizantes en la infancia tiene importantes grados de continuidad temporal futura, y es un factor de riesgo de fracaso y abandono escolar, de conductas delictuales, abuso y dependencia de sustancias, de conductas suicidas y de otros trastornos psicopatológicos del desarrollo. En esta revisión se analizan los principales aspectos relacionados con los programas de fortalecimiento de prácticas parentales como dispositivos útiles en el marco de estrategias multicomponentes de trabajo preventivo. La evidencia ha demostrado que la intervención dirigida a madres y padres es crucial en la modificación de problemas de conducta en niños/as, siendo el entrenamiento en habilidades parentales una de las estrategias mejor estudiadas y consideradas de mayor calidad al momento de prevenir el desarrollo de conductas externalizantes.

Abstract: The presence of externalizing behaviors in childhood has significant degrees of future self-continuity and is a risk factor for school failure and drop-out, criminal behavior, substance abuse and depen dence, suicidal behaviors and other developmental psychopathological disorders. In this review, the main aspects related to parental practices strengthening programs are analyzed as useful instruments in the context of multi-component preventive work strategies. The evidence has shown that interven tion aimed at mothers and fathers is crucial in the modification of behavioral problems in children, where training in parental skills is one of the most studied strategies and considered of higher quality when preventing the development of externalizing behaviors.

Intimate partner violence during pregnancy and behavioral problems in children and adolescents: a meta-analysis / Violência por parceiro íntimo na gravidez e problemas comportamentais de crianças e adolescentes: uma metanálise

Abstract Objective: To evaluate the association of intimate partner violence during the gestational period and the development of externalizing and internalizing behavioral problems in children and adolescents. Source of data: A meta-analysis of cohort and case-control studies was performed, using studies selected from electronic databases. Eligible studies included women who experienced intimate partner violence during pregnancy and their children's behavioral problems. These problems encompass two groups: externalizing problems (expressed by hyperactivity, aggressive and challenging behavior, and delinquency) and internalizing problems (represented by depressive moods, anxiety, and somatic symptoms). The risk of bias was assessed by the Newcastle-Ottawa Quality Assessment Scale (NOS) and the quality of evidence by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RevMan 5.3 software was used for the meta-analysis. Data synthesis: Of the 687 eligible articles, only seven met all inclusion criteria and consisted of 12,250 mother/child pairs. The age range of the assessed children varied from 10 months to 16 years. The odds of internalizing problems in children exposed to prenatal violence were two-fold higher (OR = 2.10, 95% CI: 1.17-3.76) and that of externalizing problems were 1.9-fold higher (95% CI: 1.28-2.83), when compared to children of unexposed mothers. Conclusion: The results of this study are consistent with the hypothesis that women's exposure to intimate partner violence during pregnancy may be associated with behavioral problems of their children, emphasizing the need for greater understanding about the vulnerability of children to adversity in early ages.

Resumo Objetivo: Avaliar a associação da violência por parceiro íntimo durante o período gestacional e o desenvolvimento de problemas comportamentais externalizantes e internalizantes de crianças e adolescentes. Fontes dos dados: Foi realizada metanálise de estudos de coorte e caso‐controle, selecionados em bases de dados eletrônicas. Os estudos elegíveis incluíram: mulheres que sofreram violência pelo parceiro íntimo durante a gravidez e problemas comportamentais de seus filhos. Esses problemas englobam dois grupos: os problemas externalizantes (que se expressam por hiperatividade, comportamento agressivo e desafiante e delinquência) e os internalizantes (representados por humor depressivo, ansiedade e sintomas somáticos). O risco de viés foi avaliado pela Newcastle‐Ottawa Quality Assessment Scale (NOS) e a qualidade da evidência pelo "Grading of Recommendations, Assessment, Development and Evaluation (GRADE)". O software RevMan 5.3 foi usado para a metanálise. Síntese dos dados: Dos 687 artigos elegíveis, apenas sete apresentaram todos os critérios de inclusão e formaram 12.250 pares de mães e filhos. A faixa etária das crianças analisadas variou de 10 meses a 16 anos. A chance de problemas internalizantes das crianças, expostas à violência pré‐natal, foi duas vezes maior (OR = 2,10; IC 95%: 1,17‐3,76) e de problemas externalizantes, foi 1,90 vezes maior (IC 95%: 1,28‐2,83), quando comparada com filhos de mães não expostas. Conclusão: Os resultados deste estudo são consistentes com a hipótese que a exposição da mulher a violência por parceiro íntimo na gestação pode estar associada a problemas comportamentais dos filhos, destacando a necessidade de maior compreensão sobre vulnerabilidade das crianças a adversidades precoces.

Behavioral problems of school children: impact of social vulnerability, chronic adversity, and maternal depression

This study's objective was to identify the predictive effect of indicators concerning social vulnerability, chronic adversity, and maternal depression on behavioral problems among school-aged children, according to the perceptions of mothers and teachers, considering the presence or absence of difficulties in the contexts of family and school. A total of 85 pairs of mothers and school children were distributed into three groups according to the behavioral problems identified. A General Questionnaire, the PHQ-9, the Chronic Adversity Scale, and the (Strengths and Difficulties Questionnaire) SDQ were applied to the mothers; the Raven's Colored Progressive Matrices were applied to the children; and the SDQ was applied to the teachers. Data were analyzed with descriptive, predictive, and comparative statistical procedures (p ≤ 0.05). The results reveal the presence of cumulative risks for children with behavioral problems; mothers more frequently identified behavioral problems than teachers; and maternal depression was a predictor for behavioral problems. Such findings are relevant for devising mental health programs.

Influence of passive smoking on learning in elementary school / Influência do tabagismo passivo na aprendizagem de escolares

Abstract Objective To analyze the association between household smoking and the development of learning in elementary schoolchildren. Methods Cross-sectional study with 785 students from the 2nd to the 5th year of elementary school. Students were evaluated by the School Literacy Screening Protocol to identify the presence of learning disabilities. Mothers/guardians were interviewed at home through a validated questionnaire. Descriptive and bivariate analysis, as well as multivariate Poisson regression, were performed. Results In the final model, the variables associated with learning difficulties were current smoking at the household in the presence of the child (PR = 6.10, 95% CI: 4.56 to 8.16), maternal passive smoking during pregnancy (PR = 1.46, 95% CI: 1.07 to 2.01), students attending the 2nd and 3rd years of Elementary School (PR = 1.44, 95% CI: 1.10 to 1.90), and being children of mothers with only elementary level education (PR = 1.36, 95% CI: 1.04 to 1.79). Conclusion The study demonstrated an association between passive exposure to tobacco smoke and learning difficulties at school.

Resumo Objetivo Analisar a associação entre o tabagismo domiciliar e o desenvolvimento da aprendizagem em escolares do ensino fundamental. Métodos Estudo transversal, com 785 escolares do 2° ao 5° ano do ensino fundamental. Os alunos foram avaliados por meio do Protocolo de Triagem de Letramento Escolar, para identificar a presença de dificuldades de aprendizagem. As mães/responsáveis foram entrevistadas no domicílio por meio de questionário validado. Foram feitas análises descritiva, bivariada e regressão múltipla de Poisson. Resultado No modelo final, as variáveis associadas às dificuldades de aprendizagem foram tabagismo atual domiciliar na presença do filho (RP = 6,10; IC 95% 4,56-8,16), tabagismo passivo materno durante a gestação (RP = 1,46; IC 95% 1,07-2,01), alunos pertencerem ao 2° e 3° ano do ensino fundamental (RP = 1,44; IC 95% 1,10-1,90) e serem filhos de mães com apenas o nível fundamental de escolaridade (RP = 1,36; IC 95% 1,04-1,79). Conclusão O estudo evidenciou associação entre a exposição passiva ao tabaco e as dificuldades de aprendizagem nos escolares.

Dysfunctional family environments and childhood psychopathology: the role of psychiatric comorbidity / Ambientes de famílias disfuncionais e psicopatologia infantil: o papel da comorbidade psiquiátrica

Introduction: The study of the association between specific characteristics of family environments and different types of psychopathology may contribute to our understanding of these complex disorders and ultimately inform therapeutics. Objective: To compare the family characteristics of four groups: typically developing children; children with anxiety disorders only; children with externalizing disorders only; and children with both anxiety and externalizing disorders. Methods: This study enrolled 115 individuals from the community. Child psychiatrists made psychiatric diagnoses using a structured clinical interview. The Family Environment scale was used to evaluate six domains of family function. Results: The group with both anxiety and externalizing disorders had higher levels of conflict in family environment and lower levels of organization when compared with typically developing children. In addition, internalizing and externalizing symptoms were positively associated with conflict and negatively with organization. Maternal depressive and anxious symptoms were also associated with higher conflict and lower organization scores. Conclusion: An important between-group difference in comorbid cases of anxiety and behavioral disorders suggests that children with this comorbidity are potential candidates for family interventions to address family conflicts and organizational aspects (AU)

Introdução: O estudo da relação entre características específicas do ambiente familiar e os diferentes tipos de psicopatologias pode contribuir para o nosso entendimento desses complexos transtornos e possivelmente gerar informações para seu tratamento. Objetivo: Comparar as características familiares de quatro grupos: Crianças com desenvolvimento típico; crianças com transtornos de ansiedade apenas; crianças com transtornos de externalização apenas; e crianças com transtornos de ansiedade e de externalização. Métodos: Cento e quinze indivíduos foram recrutados na comunidade. Psiquiatras pediátricos usaram uma entrevista clínica estruturada para estabelecer os diagnósticos psiquiátricos. A Escala do Ambiente Familiar (Family Environment) foi usada para avaliar os seis domínios de funcionamento da família. Resultados: O grupo que apresentava tanto transtornos de ansiedade quanto de externalização apresentou níveis mais altos de conflito e níveis mais baixos de organização quando comparados com as crianças com desenvolvimento típico. Além disso, os sintomas de externalização e internalização estavam positivamente relacionados a conflitos e negativamente a organização. Sintomas depressivos e de ansiedade da mãe também se mostraram relacionados a resultados mais altos para conflito e mais baixos para organização. Conclusão: Uma importante diferença entre grupos em casos de comorbidades de transtornos de ansiedade e de comportamento sugerem que as crianças com esta comorbidades são candidatos em potencial para intervenções familiares que abordem conflitos familiares e aspectos organizacionais (AU)

Mental health of children and adolescents with epilepsy: analysis of clinical and neuropsichological aspects / Saúde mental de crianças e adolescentes com epilepsia: análise de fatores clínicos e neuropsicológicos

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. .

Factors affecting academic performance of primary school children

To determine the socio-economic, psychosocial, environmental and student related factors affecting academic performance of public and private primary school children. Descriptive cross-sectional survey of 600 students [300 each from public and private primary schools] using randomly selected children from Saddar town, Karachi. Using selected schools and children, information was collected on a questionnaire. The factors studied included socio-economic, psychosocial, school and home environment and student related factors. SPSS version 15 was used for data analysis and chi-sq at 0.05 alpha level for significance test. Univariate and multi variate analysis were used to find out the association of the variables. A total of 600 students filled the questionnaire of whom 300 were from private and 300 from public sector schools. The mean age of children was 11.37 +/- 1.52 with male to female ratio of 1:1.8 in public schools and 1:0.9 in private schools. Socio-economic status was classified as good, fair and poor using the parent's job and number of family members working. Almost 34% children belonging to public and 65% to private schools were categorized as good. Among the public school children 65% fathers and 58% mothers were literate while, these figures were 62% and 67% among private school children. Overall 25% school children did not regularly take breakfast. Almost 50% public and 20% private school children remained absent once a week. Overall 35% children did not have adequate sleep and 22% children of public and 14% of private schools were suffering from some kind of illness. Based on BMI overall 24% children were underweight while, obesity was seen in 3% public and 11% private school students. Parent's help in completing school homework was twice more in those studying in private school [11% public and 22% private] thus showing a better academic performance of students in private school [poor performance seen in 40% public and 16% private]. Cognitive behavior evaluated from learning habits and overall psychosocial condition was good in both types of school children and school environment of 43% public and 54% private school was also good. Majority of the schools had no sports or physical training facilities. Using univariate and multivariate analysis it was found that younger age, female gender, better socio-economic condition, habit of taking breakfast, better condition of school, and regular attendance were significantly associated with better academic performance. Academic performance of public school children was poor as compared to private schools. Socio-economic, psychosocial, school and home environment and student's own factors, affected their academic performance. School and out of school factors both need to be improved for achieving good school achievement of primary school children

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.

Quando a convivência com a violência aproxima a criança do comportamento depressivo / When living with violence brings a child close to depressive behavior

O estudo investiga a associação entre o comportamento retraído/depressivo de crianças escolares e a presença/ausência de violências vividas em casa, na escola e na comunidade. É um estudo descritivo com dados seccionais de 479 alunos entre 6 e 13 anos de idade, da 1ª série do ensino fundamental de escolas públicas de um município do Rio de Janeiro. O desenho amostral é do tipo conglomerado simples em três estágios de seleção, com proporção de 50 por cento, nível de confiança de 98 por cento e erro relativo de 5 por cento. Variáveis sociodemográficas da criança e da família, a subescala de retraimento/depressão (CBCL), a Escala de Conflitos e de violência na escola e na comunidade são investigadas. A análise de correspondência múltipla foi a principal técnica estatística empregada. Os resultados indicam que as diferentes vitimizações de violência tendem a estar mais próximas do comportamento de retraimento/depressão a nível clínico e limítrofe. Programas e políticas públicas necessitam abordar a conjuntura da vida infantil, com o foco na intervenção dos problemas de saúde mental, das violências e da condição de vitimização de crianças e adolescentes, com vistas a interromper as revitimizações pela violência, assim como as suas conseqüências.

The present study investigates the relation between withdrawn/depressive behavior of schoolchildren and presence/absence of violence experienced at home, at school and in the community. This descriptive cross-sectional study is based on data from a sample of 479 schoolchildren between 6-13 years of age, attending the first grade in the public elementary schools of a city of the state of Rio de Janeiro, Brazil, 2005. The multi-stage cluster sampling strategy involved three selection stages with 50 percent proportion, 98 percent confidence level and relative error of 5 percent. Socio-demographic variables of the child and the family, the withdrawal/depression sub-scale (CBCL), Conflict Tactics Scale and school and community violence scale are investigated. Multivariate Correspondence Analysis indicates that the different violence victimizations tend to be closer to clinical and borderline withdrawn/depressive behavior. Programs and public policies must address the life circumstances of the child, with focus on interventions in mental health problems, violence and victimization in order to interrupt the cycle of re-victimization through violence and its consequences.

Study of Behavioural Problems in Mentally Retarded Children.

Behaviour disorders are common in children with mental retardation and in addition to the subjective distress they cause the individual, they restrict opportunities to engage in many normal activities. Methods- 50 children from age group 6-14 years were randomly selected from a special school for mentally retarded children and assessed. Results- Analysis of the data reveled 66% the children to be above cut off score. Mean CBCL score was 56.42.There was significantly higher prevalence of behaviour problems in the younger age group. There was higher prevalence of behaviour problems in children with moderate mental retardation than in children with mild mental retardation. Common behaviour problems reported were ‘ impulsive or acts without thinking’, ‘can not concentrate’ & ‘sudden changes in mood or feelings’. Common behaviour problems in younger age group were ‘impulsive’, ‘can’t concentrate’, ‘ acts too young for her age ‘ etc. and in the older group it was ‘impulsive’, ‘can not concentrate’ and ‘acts too young for her age’. Common behaviour problems in children with mild mental retardation were impulsive’, ‘can’t concentrate’, ‘Gets hurt a lot, accident prone’ etc and in children with moderate retardation were ‘can’t concentrate’, ‘bites fingernails’, ‘Gets hurt a lot, accident prone’ etc. Discussion- Analysis of the data revealed a significantly higher prevalence of behaviour problem in mentally retarded children. Behaviour problems were more in the younger age group There was higher prevalence of behaviour problems in children with moderate mental retardation than in children with mild mental retardation. No specific trend could be observed in the types of behaviour problems as regards to sex, age, income of the parents and severity of mental retardation.

Epilepsy, antiepileptic drugs and educational problems.

Epilepsy is a chronic disorder that significantly affects learning and behavior. Children with epilepsy are particularly vulnerable to educational problems and resultant academic underachievement. Co-morbidities like cognitive and behavioral problems contribute significantly for the problems at school. Both epilepsy and neuropsychological deficits may occur as different clinical manifestations of a common etiological process. Ongoing seizures themselves adversely affect the developing brain. Furthermore, psychosocial issues also contribute significantly to the problems at school. The effect of antiepileptic drugs is double edged in this setting. They may reduce the seizure burden and thus improve the cognitive function. However, these drugs also significantly affect the learning process. The treating pediatrician should be equipped to comprehensively address all these factors for an optimal outcome. Recent onset of educational problems in a child with epilepsy deserves immediate and aggressive evaluation and management.

Behavioral problems in children with Down syndrome.

Forty consecutive children with Down syndrome were included as the Study Group (SG). The Control Group (CG) consisted of forty children attending the immunization clinic in pediatric OPD. Behavior Screening Questionnaire (BSQ) was used to screen the study groups as well as their siblings and control group for behavioral problems. The assessment of parental attitudes was done on Attitude Screening Questionnaire which includes 2 separate questionnaire for mother and father. Twenty two children (55%) with Down's syndrome showed behavioral problems as compared to 5 (12.5%) in control group. Children with Down's syndrome showed behavioral problems related to all the spheres (feeding, socialization, toilet training and sleep) as compared to control group. Mothers showed highly indulgent attitude as related to feeding to nearly total neglect as related to socialization and toilet training whereas in Paternal Attitude Screening Questionnaire, there was total neglect in all the spheres as compared to control group. There is higher prevalence of psychiatric disorders in children with Down's syndrome and their siblings.

Le syndrome de rett [a propos d'un cas]

Rett syndrome is a degenerative neurological disorder with onset between 6 and 18 months of age We report one case of Rett syndrome affecting a 2 years 6 months old girl. She had presented an early deterioration of higher brain function with dementia and autistic behavior, loss of purposeful use of the hands and deceleration of head growth. No specific laboratory test for Rett syndrome has been set up yet and there are many unanswered questions about this disease

O estresse materno e os fatores de risco em crianças com distúrbios psiquiátricos / Maternal stress and the risk factors for children with psychiatric disturbances disorders

Objetivo: Avaliar mäes de crianças com distúrbios emocionais em relaçäo a algumas variáveis pré e perinatais, correlacionando estes dados com o nível de estresse materno. Método: Aplicaçäo do inventário de sistemas de estresse (ISS) em 25 mäes e uma avó de crianças avaliadas previamente por neurologistas, psiquiatras infantis e psicólogos, complementado com dados obtidos nos prontuários. Resultado: A idade das entrevistadas variou dos 29 aos 65 anos, predominantemente casadas, com certo grau de ocupaçäo; 0,84 apresentou sintomas de estresse. A idade das crianças variou dos 7 aos 14 anos; 0,86 frequentou escola; 0,30 apresentou diagnóstico de transtorno hipercinético; 0,15 de transtornos mentais decorrentes de lesöes e disfunçöes cerebrais; 0,15 retardo mental; 0,11 depressäo. Conclusäo: O estresse materno é um fator importante na avaliaçäo de crianças com distúrbios emocionais. Profissionais de saúde devem estar atentos a esse fator, criando espaços para orientaçöes e cuidados para essas mäes