Actualización en Trastornos Ansiosos en niños y adolescentes: Ansiedad de Separación-Ansiedad Social-Ansiedad Generalizada / Update on anxious disorders in children and adolescents: separation anxiety-social anxiety-generalized anxiety

Resumen: Los trastornos ansiosos en niños y adolescentes tienen una prevalencia de vida de un 15-20%, con una edad promedio de comienzo de 11 años (1). En Chile la prevalencia en la población general es de 8,3 %. Trastorno por Ansiedad de Separación (TAS) 4,8% Ansiedad social (TA social) 3,7% y Ansiedad Generalizada (TAG) 3,2% (2). Es así como TAS, TA social y TAG están dentro de las enfermedades de salud mental más frecuentes en este grupo etario, tienen una menor edad de comienzo que otros trastornos psiquiátricos internalizantes, están asociados con un gran impacto en la funcionalidad y tienden a persistir hacia la adultez (3). Si estos trastornos ocurren en la infancia y/o adolescencia predicen la ocurrencia de otros trastornos en la adultez, como: trastornos ansiosos, del ánimo, abuso de sustancias y conducta disruptiva.TAS, TASocial y TAG constituyen un grupo heterogéneo de trastornos con síntomas que se sobreponen (síntomas somáticos, dificultades para dormir, conductas evitativas), están frecuentemente en comorbilidad y tienen una respuesta positiva al tratamiento con terapia cognitivo conductual y fármacos antidepresivos (3). La detección temprana y el tratamiento de los trastornos ansiosos en niños y adolescentes puede prevenir el impacto sustancial en el desarrollo y la funcionalidad; el tratamiento precoz también puede prevenir el posterior desarrollo de trastornos psiquiátricos en el adulto (3). Palabras Clave: trastornos ansiosos, ansiedad de separación, ansiedad social, ansiedad generalizada, ansiedad infantil

Abstract: Anxiety disorders in children and adolescents have a life prevalence of 15-20%, with an average presentation age of 11 years (1). In Chile the prevalence in the general population is 8.3%; separation anxiety disorder (TAS) 4.8% social anxiety (social TA) 3.7% and generalized anxiety (TAG) 3.2%. (2). TAS, social TA and TAG are within the most common mental health disorders in this age group, have a younger age of onset than other psychiatric disorders, are internalizing disorders, are associated with a major impact on functionality and they tend to persist into adulthood (3). When these disorders appear in childhood or adolescence, they predict the occurrence of other disorders in adulthood, such as: anxiety, mood, substance abuse and disruptive behavior disorders. TAS, social TA and TAG constitute a heterogeneous group of disorders with symptoms that overlap (somatic symptoms, difficulty sleeping and avoidant behavior), they are frequently comorbid and have a positive response to treatment with cognitive behavioral therapy and antidepressant drugs (3). Early detection and treatment of anxious disorders in children and adolescents can prevent the substantial impact on development and functionality; early treatment can also prevent further development of psychiatric disorders in adults (3). Key Words: anxiety disorders, separation anxiety, social anxiety, generalized anxiety, childhood anxiety.

Comportamentos internalizantes: associações com habilidades sociais, práticas educativas, recursos do ambiente familiar e depressão materna / Internalizing behavior problems and associations with social skills, educative practices, familiar resources and maternal depression / Comportamientos internalizantes: asociaciones con habilidades sociales, prácticas educativas, recursos del ambiente familiar y depresión materna

Problemas de comportamento internalizantes são subidentificados e carecem de estudos que investiguem diversas variáveis simultaneamente. Os objetivos são comparar e correlacionar indicadores de práticas educativas, recursos do ambiente familiar, repertório comportamental infantil e depressão materna de crianças com e sem problemas internalizantes, diferenciadas por sexo e escolaridade. Participaram 32 mães de crianças com problemas internalizantes e 32 sem problemas, que foram pareadas por sexo e escolaridade. Foram utilizados instrumentos validados para mensurar as variáveis do estudo, cujos dados foram comparados e correlacionados. Os resultados são: (a) práticas negativas foram mais frequentes no grupo com problemas e, habilidades sociais, no grupo sem problemas; (b) práticas negativas correlacionaram-se a problemas e práticas positivas às habilidades sociais e recursos do ambiente; (c) quanto maior a depressão materna, menores as habilidades sociais infantis; (d) crianças escolares têm mais problemas de ansiedade que pré-escolares. Discute-se sobre as implicações das variáveis estudadas para os comportamentos internalizantes.

Internalizing behaviors are under-identified and scarcely studied in association with more than one variable simultaneously. The objectives are to compare and correlate indicators of parental practices, family resources, child behavior, and maternal depression, in children with or without internalizing problems, differentiated by gender and schooling. Participants were 32 mothers of children with internalizing problems and 32 mothers of children without problems, which were matched for gender and schooling. Validated instruments were used to measure variables of interest. Data were compared and correlated. The results are: (a) negative practices were more frequent in the problems group and social skills, in the group without problems; (b) negative practices correlated to complaints about problems and positive practices correlated to child social skills and environmental resources; (c) higher maternal depression was associated with less social skills; (d) school-aged children are more anxious than pre-schoolers. Implications of these results for understanding internalizing behaviors are discussed.

Problemas de comportamiento internalizantes son subidentificados y faltan estudios de diversas variables simultáneamente. Los objetivos son comparar y correlacionar indicadores de prácticas educativas, recursos del ambiente familiar, repertorio comportamental infantil y depresión materna de niños con y sin problemas internalizantes, diferenciadas por sexo y escolaridad. Participaron 32 madres de niños con y 32 sin problemas internalizantes, pareadas por sexo y escolaridad. Fueron utilizados instrumentos validados para mensurar las variables, cuyos datos fueron comparados y correlacionados. Los resultados son: (a) prácticas negativas fueron más frecuentes en el grupo con problemas, y habilidades sociales en el grupo sin problemas; (b) prácticas negativas se correlacionaron a problemas y prácticas positivas a las habilidades sociales y recursos del ambiente; (c) cuanto mayor la depresión materna, menor las habilidades sociales infantiles; (d) niños escolares tienen más problemas de ansiedad que pre-escolares. Se discute sobre las implicaciones de las variables estudiadas para los comportamientos internalizantes.

Identifying relation of anxiety and salivary cortisol among abused children / Шинэ санаа Шинэ нээлт

WHO informed that across world an average of 565 young people aged 10 to 29 die every day through interpersonal violence. Some studies mentioned that anxiety was most frequently occurred as one of the psychological consequences among victims of child abuse. Recent research on effects of adverse early life experiences on central nervous system as stress systems (hypothalamus-pituitary-adrenal axis-HPA) has provided a greater understanding of the link between childhood abuse and susceptibility to anxiety disorder. Therefore, this research was done to study anxiety among abused adolescents, some physical parameters and level of cortisol in saliva.There were selected 20 abused children and 40 non abused children aged between 11-16 years old and lived in Ulaanbaatar city. The Spence Children’s Anxiety Scale (SCAS; Spence, 1997) is a 38-item self-report questionnaire that assesses multiple symptoms of childhood anxiety disorders based on current diagnostic criteria. All participants were measured the cortisol in the saliva by Cortisol ELISA kit, Sigma, Average age of all subjects in the study was 13.52±1.57 and 59% of them were female and 41% were male. All anxiety symptoms of case group was statistically significance higher (p<0.01) than control group. The average amount of salivary cortisol of case group was (18.65±7.08) statistically significantly lower (p<0.01) than average amount of control group (32.15±20.99).Anxiety was more frequently occurred among abused children and blunted cortisol responses might indicate a level of impaired HPA functioning that could constitute a vulnerability to psychopathology with exposure to anxiety.

Identifying relation of anxiety and salivary cortisol among abused children / Шинэ санаа Шинэ нээлт

WHO informed that across world an average of 565 young people aged 10 to 29 die every day through interpersonal violence. Some studies mentioned that anxiety was most frequently occurred as one of the psychological consequences among victims of child abuse. Recent research on effects of adverse early life experiences on central nervous system as stress systems (hypothalamus-pituitary-adrenal axis-HPA) has provided a greater understanding of the link between childhood abuse and susceptibility to anxiety disorder. Therefore, this research was done to study anxiety among abused adolescents, some physical parameters and level of cortisol in saliva. There were selected 20 abused children and 40 non abused children aged between 11-16 years old and lived in Ulaanbaatar city. The Spence Children’s Anxiety Scale (SCAS; Spence, 1997) is a 38-item self-report questionnaire that assesses multiple symptoms of childhood anxiety disorders based on current diagnostic criteria. All participants were measured the cortisol in the saliva by Cortisol ELISA kit, Sigma, Average age of all subjects in the study was 13.52±1.57 and 59% of them were female and 41% were male. All anxiety symptoms of case group was statistically significance higher (p<0.01) than control group. The average amount of salivary cortisol of case group was (18.65±7.08) statistically significantly lower (p<0.01) than average amount of control group (32.15±20.99). Anxiety was more frequently occurred among abused children and blunted cortisol responses might indicate a level of impaired HPA functioning that could constitute a vulnerability to psychopathology with exposure to anxiety.