El neurodesarrollo en la infancia y la importancia de la comprensión nominal en el diagnóstico / Neurodevelopment in childhood. The importance of diagnostic names

The objective of this presentation is to review the denomination Neurodevelopmental Disorders contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by considering the latest paradigms on human development, which include the emerging neurobiological and intersubjective foundations required to understand and intervene in problems of the baby and the small child. The current denomination adopts a theoretical position that is exclusively biological (despite being defined as a-theoretical), and tends to make fundamental aspects of human development linked to inter-subjectivity invisible. The presentation also includes clinical experiences related to perinatal events in children with serious developmental problems and a revision of the underlying paradigms of the different concepts of Health and Mental Illness. Two relevant variables that intervene in human development are considered; firstly, epigenetics, underlining that its programming can be altered by diverse environmental conditions, thus revealing how certain acquired characters can be transmitted to offspring and that such modifications are potentially reversible; secondly, the recursive, visualized in the emergence of the mind from its biological bases, and the marks of inter-subjectivity in the body. New evidence is provided that mental phenomena begin as a mind shared with others and that early intersubjective experiences are mapped into the individual's brain performance. From the above, it follows that neurodevelopment requires intersubjectivity to enable the emergence of the mind as an eminently human phenomenon. Therefore, this should be reflected in the most commonly used diagnostic names.

El objetivo de esta presentación es la revisión de la denominación Trastornos del Neurodesarrollo del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5). Los paradigmas actuales sobre el desarrollo humano incluyen las bases neurobiológicas e intersubjetivas emergentes, requeridas para comprender e intervenir en problemáticas del recién nacido y del niño pequeño. Se advierte que la denominación vigente adopta una postura teórica exclusivamente biológica, no obstante definirse como ateórico, tendiendo a invisibilizar aspectos fundamentales del desarrollo humano vinculados con la intersubjetividad. Se incorporan, además, experiencias clínicas vinculadas con acontecimientos perinatales en niños con graves problemáticas del desarrollo. Se efectúa una revisión de distintos paradigmas que subyacen en los conceptos de salud y enfermedad mental. Se consideran dos relevantes variables que intervienen en el desarrollo humano; primero, la epigenética, subrayando que su programación puede ser alterada por diversas condiciones ambientales, evidenciando cómo ciertos caracteres adquiridos pueden trasmitirse a la descendencia y que tales modificaciones son potencialmente reversibles. Segundo, lo recursivo, visualizado en la emergencia de la mente desde sus bases biológicas y las marcas que imprime la intersubjetividad en el cuerpo. Se incorporan evidencias de que los fenómenos mentales comienzan como una mente compartida con otros y de que las experiencias intersubjetivas tempranas se mapean en el funcionamiento cerebral del individuo. Se deriva que el neurodesarrollo requiere la intersubjetividad para posibilitar la emergencia de la mente como fenómeno eminentemente humano y, por lo tanto, sería de gran utilidad que ello sea reflejado en las denominaciones diagnósticas más utilizadas.

Specific and social fears in children and adolescents: separating normative fears from problem indicators and phobias

Objective: To distinguish normative fears from problematic fears and phobias. Methods: We investigated 2,512 children and adolescents from a large community school-based study, the High Risk Study for Psychiatric Disorders. Parent reports of 18 fears and psychiatric diagnosis were investigated. We used two analytical approaches: confirmatory factor analysis (CFA)/item response theory (IRT) and nonparametric receiver operating characteristic (ROC) curve. Results: According to IRT and ROC analyses, social fears are more likely to indicate problems and phobias than specific fears. Most specific fears were normative when mild; all specific fears indicate problems when pervasive. In addition, the situational fear of toilets and people who look unusual were highly indicative of specific phobia. Among social fears, those not restricted to performance and fear of writing in front of others indicate problems when mild. All social fears indicate problems and are highly indicative of social phobia when pervasive. Conclusion: These preliminary findings provide guidance for clinicians and researchers to determine the boundaries that separate normative fears from problem indicators in children and adolescents, and indicate a differential severity threshold for specific and social fears.

Em busca das origens desenvolvimentais dos transtornos mentais / Searching for the developmental origins of mental disorders

INTRODUÇÃO: A psicopatologia desenvolvimental é uma disciplina que integra perspectivas epidemiológicas, sociais, genéticas, desenvolvimentais e de psicopatologia para entender as origens e o curso dos transtornos mentais. Neste artigo, são discutidos abordagens e conceitos utilizados para compreender as origens desenvolvimentais dos transtornos mentais. RESULTADOS: A psicopatologia desenvolvimental entende que os transtornos mentais são possíveis desfechos do processo de desenvolvimento e são dependentes de influências sociais, genéticas e ambientais. Esses diversos fatores estão inter-relacionados de diferentes formas e em diferentes níveis, exercendo um efeito dimensional. São discutidos: a) abordagens para determinar causalidade entre eventos ambientais e transtornos mentais; b) a importância de entendimento dos mecanismos biológicos através dos quais fatores ambientais e genéticos atuam; c) fatores genéticos predizendo a exposição a estressores ambientais; e d) fatores genéticos moderando o efeito de estressores ambientais. CONCLUSÕES: As origens dos transtornos mentais podem ser iluminadas por dados de estudos que utilizam enfoques e conceitos complementares e que integrem influências sociais, genéticas, ambientais e desenvolvimentais.

INTRODUCTION: Developmental psychopathology is a discipline that integrates epidemiological, social, genetic, developmental, and psychopathological perspectives to understand the origins and courses of mental disorders. In the present paper, theoretical concepts and approaches applied with the purpose of understanding the developmental origins of mental disorders are discussed. RESULTS: According to developmental psychopathology, mental disorders are possible outcomes of the developmental process that depend upon social, genetic, and environmental influences. These factors are linked in different ways and levels, exerting a dimensional effect. The following factors are addressed: a) approaches to determine a causal effect between environmental factors and mental disorders; b) the importance of understanding biological mechanisms by which environmental and genetic factors exert their effect; c) genetic factors predicting the exposure to environmental stressors; d) genetic factors moderating the effect of environmental stressors. CONCLUSIONS: The origins of mental disorders can be clarified by data from studies that use complementary approaches and concepts, integrating social, genetic, environmental and developmental influences.

Developmental Psychopathologies of Nine Preschool Children, Experiencing Single, Severe Trauma / 신경정신의학

OBJECTIVES: It has been known that children reved symptoms of Posttraumatic Stress Disorder (PTSD) after experiencing traumas similar to adults. But there are a few studies regarding the psychopathologies of PTSD in preschool children. Considering more active brain and psychological development in preschool children, it is expected that trauma of preschool children causes more serious psychopathologies than those of children with older ages or adults. This study aims to investigate psychopathologies of 9 preschool children experiencing a single, severe trauma, specifically in the respect of PTSD diagnosis. METHODS: Nine preschool children, 3-5 years old, experiencing physical injuries caused by attack from a psychotic patient during lunch time at kindergarten, were evaluated for clinical diagnoses through semi-structured interviews using Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and Research Diagnostic Criteria (RDC for Kiddies) of PTSD for preschool children. RESULTS: Five (56% by DSM-IV) and Six (67%, by RDC) out of 9 children were diagnosed as to have PTSD. Among those children with PTSD, four (44%) showed Separation Anxiety Disorder (SAD) and one (17%) showed Major Depressive disorder (MDD) as comorbid diagnoses. On subclinical level, two of 9 children (22%) suffered from separation anxiety, seven (78%) from aggressive behaviors, and two (22%) from depressive mood. Sleep disturbances (89%) and reexperiencing of trauma (89%) were the most prominent symptoms of PTSD in preschool children. CONCLUSION: While preschool children showed profiles of PTSD symptoms similar to those of adults, it was critical to use more developmentally sensitive diagnostic tools for a better detection of psychopathologies. Young children experiencing severe trauma showed other comorbid psychopathologies along with PTSD. For proper diagnosis and intervention, it is important to make an accurate clinical diagnosis based on developmentally appropriate diagnostic process and tools.