Factores protectores, cualidades positivas y psicopatología adolescente en contextos clínicos / Protective factors, positive qualities and psychopathology in adolescents in clinical settings

Resumen: Objetivo: Identificar la presencia de cualidades positivas y los problemas de salud mental en adolescentes que acuden a atención especializada. Material y métodos: Se evaluaron 145 pacientes de ambos sexos. Se utilizó la versión oficial internacional validada en español del Youth Self Report/11-18 (YSR/11-18) del ASEBA, que mide psicopatología y cualidades positivas, que son características personales asociadas con la adaptación positiva. Resultados: Las cualidades positivas más comúnmente reportadas fueron las relacionadas con el comportamiento social positivo, sin diferencias en las medias entre hombres y mujeres. Las mujeres presentaron niveles más altos de problemas internalizados y externalizados en comparación con los hombres. Conclusiones: Los adolescentes en escenarios clínicos muestran cualidades positivas tanto como psicopatología. Es importante identificar y fortalecer estas características como factores de protección en los adolescentes en contextos de riesgo. Las mujeres presentan mayor nivel de psicopatología por lo que la intervención preventiva implicaría un enfoque de género.

Abstract: Objective: To identify positive qualities and mental health problems in adolescents that are clients of a mental health specialized service. Materials and methods: The sample consisted of 145 patients of both sexes. The Mexican validated official international Hispanic version of the Youth Self Report/11-18 (YSR/11-18) was used; it measures psychopathology and individual characteristics associated with positive adaptation, called Positive Qualities. Results: The positive quality most commonly reported was related to the positive social behavior, without mean differences between girls and boys. Girls showed the highest level of internalizing and externalizing problems. Conclusions: Adolescents with psychopathology in clinical settings also show positive qualities. It is important to identify and enhance these characteristics as protective factors in adolescents living in high-risk contexts. Girls showed higher psychopathology levels, implying gender differences in preventive intervention.

Epidemiología y manejo integral de la discapacidad intelectual / Epidemiology and the overall management of the intellectual disability

Intellectual disability (ID) is a condition of limited intellectual and adaptive functioning that occurs before the age of 18 years. For varied reasons, ID is the most forgotten of public health programs. Exact prevalence is unknown, due to the absence of epidemiological research in children and adolescents, which is essential to know the needs of this population. Detection involves identifying children at risk for any type of atypical development with emphasis on language probes and dysmorphic searching, optimally combined with developmental screening tools with proven psychometric properties; training psychologists and health providers such as general practitioners or pediatricians in the first level of attention is needed. The goal of second-level intervention is to diagnose ID with an emphasis on accurate measurement of intellectural coeficcient (IC) and adaptive level, including expanded genetic medical evaluation and assessment of the personal, familiar, and community resources of children with suspected ID. We also recommend the use of existing classifications, employing the World Health Organization (WHO) International Classification of Functioning, Disability and Health, to identify individual and environmental barriers and facilitators and the application of appropriate tests. The overall treatment includes specific medical, psychological and educative & social interventions. Medical intervention also includes pharmacological treatments, especially psychotropic medication, including risperidone, methylphenidate and melatonin. Developing evidence for the use of this medication is provided for challenging behaviors such as aggression, hyperactivity, sleep problems and depression. Psychological help includes psychoeducation and techniques evidence based, such as those derived from applied behavior analysis and cognitive behavior. Its chronic use is discouraged and medication is recommended to be combined with proper behavior management. Early and appropriate education for ID is lacking; which also requires improving access to health services, limiting social exclusion. Enhancing advocacy and promoting the human rights for this population is also needed.

La discapacidad intelectual (DI) alude a una condición limitada del funcionamiento intelectual y adaptativo, que ocurre antes de los 18 años de edad. Por varias razones, la atención a la DI es uno de los programas de salud pública más olvidada. Se desconoce la prevalencia exacta debido a la ausencia de investigación epidemiológica de la discapacidad en niños y adolescentes, la cual es esencial para conocer las necesidades de esta población. La detección consiste en la identificación de niños en riesgo de algún tipo de desarrollo anormal, con énfasis en el sondeo del lenguaje y la búsqueda de dismorfias, combinado con herramientas como los instrumentos de tamizaje del desarrollo psicométricamente fiables. La meta de la intervención en el segundo nivel es diagnosticar la DI con énfasis en una medición precisa del coeficiente intelectual (CI) y el nivel adaptativo, incluyendo una evaluación genética extendida y una valoración personal, familiar y de recursos comunitarios del niño. También se recomienda el uso de las clasificaciones existentes, incluyendo la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF), por ser un sistema que identifica barreras y facilitadores individuales y ambientales. El tratamiento de la DI incluye intervenciones de tipo médico, psicológico, educativo y social. La intervención médica incluye el uso de psicofármacos que pueden ser de gran utilidad en el tratamiento de conductas problemáticas (agresión, hiperactividad, problemas de sueño, depresión). Se aconseja combinarlo con técnicas conductuales y desalentar el uso crónico de los mismos. La intervención psicológica incluye técnicas con base científica como las que derivan del análisis conductual aplicado y las de tipo cognitivo conductual. Las intervenciones de tipo educativo tales como la educación temprana y apropiada para niños con DI es un tema pendiente. También es necesario mejorar el acceso a los servicios de salud con el fin de limitar la exclusión social.

Datos psicométricos del EMBU-I "Mis memorias de crianza" como indicador de la percepción de crianza en una muestra de adolescentes de la Ciudad de México

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SUMMARY Introduction: Childrearing or parenting is the assumption of responsibility for the emotional, social and physical growth and development of a child. Research literature has identified three related components commonly associated to rearing or parenting: a) spontaneous emotions and attitudes that are non-goal directed parental behaviors such as gestures, changes in the tone of voice, temperamental bursts, body language; b) specific goal-directed parental practices, which are better understood in the context of a socialization domain (academic achievement, peer cooperation), and c) the value system and beliefs of parents related to socialization goals of their children. Based on sound empirical data, there is no doubt about the impact of child-rearing environments on a wide variety of outcomes, ranging from normal variations of adaptive functioning and school success to an array of psychopathological results such as drug abuse, aggressive behavior, and anxiety in children and adolescents. During adolescence, parenting implies the transformation of the relationships between parents and children. This is a critical transition period in which the emerging social demands turn it into a particularly vulnerable period of life. Psychological distress that arises in adolescents may threaten their mental health on a medium and long term-basis. Based on an exhaustive literature study related to the parentchild relationship and the shared family environment, Repetti et al. suggest that conflict, lack of cohesion and organization, as well as unsupportive, cold and neglectful environments, were characteristic of families in risk of developing physical and mental problems. Adolescent studies provided evidence related to alcohol and drugs abuse, involvement in pregnancy, aggressive behaviour and delinquency as outcomes for children from families lacking cohesion and orderliness, as well as emotional warmth, support and involvement in parenting. Thus, it is important to rely on instruments that measure parenting and whose dimensions have proven to be relevant to the outcomes evaluated. One empirically evaluated instrument, in terms of internal consistency, construct validity, and convergent and divergent validity in transcultural context, is the Egna Minnen Betraffande Uppfostran-My memories of upbringing (EMBU). It has been extensively used and adapted in more than 25 countries, including Spanish-speaking populations from Guatemala, Venezuela and Spain. Factor analyses have revealed four factors (emotional warmth, rejection, control/overprotection and favouring subject), and multiple studies have documented the validity, reliability and cross-national transferability of the EMBU. Criticism regarding the retrospective nature of the EMBU has been overcome by designs with younger samples confirming its cross-stability for all scales except favouritism scale. There is a lack of instruments measuring parenting in Spanishspeaking countries. It is imperative to evaluate parental perceptions with adolescents as the source of information. There is, therefore, a need to empirically evaluate a reliable and valid parenting measurement, whose relational nature dimensions (warmth/rejection, control) can also be compared with those found in other countries. The purpose of the present study was to explore the psychometric properties of the EMBU-I in a sample of Mexican adolescents. In particular, its aim was to test the reliability (internal consistency), the congruency of the dimensions for fathers and mothers and within the scales comprising the EMBU, and its convergent and divergent validity. Method: Seven hundred seventy five adolescents, with a mean age of 13.81 years, from two secondary schools, one public and one private, participated in the study. Instruments: EMBU-C, parental involvement in studies scale, and the cohesion, conflict and organization scales from the FES. All of them showed reliability values above .50. Results: Emotional warmth, rejection, and control showed evidence of good internal consistency (Cronbach's alphas above or equal .65), except favoritism, in agreement with previous studies. Correlation between both scales, for father and mother (emotional warmth, rejection and control) was positive and high. Negative correlations were found between emotional warmth and rejection, as expect. Interestingly, perception of father control positively correlated with warmth, whereas perception of mother control was higher loaded on rejection than in warmth. The multiple correlation analysis of each scale of the EMBU and the other instruments were as follows: warmth in both parents correlated positively with organization and cohesion in family and rejection, again in both parents, also correlated with conflict. Warmth and control for father, as well as for mother, correlated with parental involvement in studies, but stronger correlations were documented in the case of perception of father's involvement. For mothers, cohesion and organization showed a tendency to correlate higher with involvement in studies. Results support the convergent validity of the scales. Evidence for the divergent validation was provided through the negative correlations found between warmth and conflict. This was also true for cohesion and organization, with regard to rejection. As expected, rejection also showed a negative correlation with parental involvement in studies. In agreement with other studies, the present study corroborates internal consistency in Mexican adolescents, as well as convergent and divergent validity of the EMBU-C scales of emotional warmth, rejection and control. A finding of this study was the different correlation tendency found between the dimension of control for fathers and mothers, suggesting that control in fathers is perceived more as warmth than rejection, in contrast to other studies. Also warmth and control, again in the fathers' case, correlated higher with involvement in studies. This finding is in agreement with Youniss and Smollar, whose findings suggest a differential perception of fathers and mothers, especially in early adolescence. Mexican boys and girls tend to perceive fathers with more deference and as advisors or instructors. Although the risky families' construct has a wider perspective, it is also important to evaluate separately the family unit with regard to the adolescent-parent relationship because intervention strategies are different. According to adolescent perception, parenting dimensions related to emotional climate are notably related to other parental components, such as parental involvement in school or family cohesion and organization. Psychometric properties of EMBU-C were acceptable in terms of reliability and validity. It proved to be a useful tool for future studies, purported to evaluate adolescent perception of parental childrearing. Future studies should provide further data on test-retest reliability, confirmatory factor analyses testing the three factor resolution found in previous studies and on its convergent validity. Limitations of the present study arise from the sample of students and its socioeconomic or demographic restrictions. Future studies could overcome the fact that data come only from one source, i.e., children. Concurrent validity comparing EMBU-C with other parenting indicators is also needed.