Mood disorders in children following neonatal hypoxic-ischemic encephalopathy.

BACKGROUND: Few studies on the consequences following newborn hypoxic-ischemic encephalopathy (NHIE) assess the risk of mood disorders (MD), although these are prevalent after ischemic brain injury in adults. OBJECTIVE: To study the presence of MD in children survivors of NHIE. METHODS: 14 children survivors of NHIE treated with hypothermia and without cerebral palsy and 15 healthy children without perinatal complications were studied aged three to six years for developmental status (Ages and Stages Questionnaire 3 [ASQ-3]) and for socio-emotional status (Preschool Symptom Self-Report [PRESS] and Child Behavior Checklist [CBCL] 1.5-5 tests). Maternal depression was assessed using Montgomery-Asberg Depression Rating Scale (MADRS). Socio-economic factors such as parental educational level or monthly income were also studied. RESULTS: NHIE children did not present delay but scored worse than healthy children for all ASQ3 items. NHIE children showed higher scores than healthy children for PRESS as well as for anxious/depressive symptoms and aggressive behavior items of CBCL. In addition, in three NHIE children the CBCL anxious/depressive symptoms item score exceeded the cutoff value for frank pathology (P = 0.04 vs healthy children). There were no differences in the other CBCL items as well as in maternal MADRS or parental educational level or monthly income. Neither ASQ3 scores nor MADRS score or socio-economic factors correlated with PRESS or CBCL scores. CONCLUSIONS: In this exploratory study children survivors of NHIE showed increased risk of developing mood disturbances, in accordance with that reported for adults after brain ischemic insults. Considering the potential consequences, such a possibility warrants further research.

Uso del Strength and Difficulties Questionnaire en prematuros para su evaluación psicosocial y cribado del trastorno por déficit de atención e hiperactividad / The use of strength and difficulties questionnaire in psychosocial evaluation and attention deficit hyperactivity disorder screening in preterm infants

Introducción: Los trastornos del comportamiento y del aprendizaje se describen con frecuencia en < 1.500 g o < 32 semanas (RNMBP/MP). Se dispone de muy poca información en población española. Objetivo: Identificar los problemas psicosociales de los RNMBP/MP mediante la aplicación del test Strength and Difficulties Questionnaire (SDQ) a los 6 años y comparar los resultados con los de una población de referencia. Establecer los puntos de corte para el uso del SDQ como cribado del trastorno por déficit de atención e hiperactividad (TDAH) en RNMBP/MP. Participantes y métodos: Estudio prospectivo observacional en RNMBP/MP evaluados a los 6 años con SDQ. Se recogen variables perinatales, neurodesarrollo y diagnóstico de TDAH mediante DSM-5. Resultados: Se incluyeron 214 niños con el total de las valoraciones. Comparados con la población de referencia obtuvieron puntuaciones significativamente mayores en síntomas emocionales, relaciones con compañeros y en el total del test. La escala de hiperactividad y la puntuación total se identifican como buenos predictores del diagnóstico de TDAH, con un área bajo la curva ROC de 0,83 y 0,87, respectivamente. Las puntuaciones que consiguen una adecuada sensibilidad para el cribado de TDAH son ≥ 6 para la escala de hiperactividad y ≥ 13 para la puntuación total del test, y una puntuación combinada ≥ 5 en hiperactividad junto con un total ≥ 12. Conclusiones: Los RNMBP/MP presentan más frecuentemente problemas emocionales y de relación que sus compañeros nacidos a término. El test SDQ podría utilizarse como una prueba de cribado para el TDAH

Introduction: Behavioural disorders and learning disabilities are often recognised in < 1,500g or < 32 weeks very low birth weight (VLBW) infants. There is very limited data in the Spanish population. Objective: To determine the presence of psychosocial disorders in preterm infants at 6 years of age, as assessed by the strength and difficulties (SDQ) questionnaire, in comparison to a reference population. To set a cut-off value to use SDQ as a screening tool for attention deficit hyperactivity disorder (ADHD) in the preterm child. Participants and methods: A prospective observational study was conducted on premature children assessed at 6 years of age using the SDQ. Perinatal variables, neurodevelopment, and diagnosis of ADHD, according to the DSM-5, were collected. Results: A total of 214 children who met all the requirements, were included. When compared with the reference population they had significantly higher scores in emotional symptoms, in peer relationships, and in the total score of the test. The hyperactivity scale and the total test score are good predictors of a diagnosis of ADHD, with an area under the ROC curve of 0.83 (95% CI: 0.76-0.90) for hyperactivity, and 0.87 (95% CI: 0.80-0.93) for the total score. The scores for hyperactivity and the total test, from which the screening for ADHD could be considered positive would be ≥ 6 and ≥ 13 respectively, and a combination of hyperactivity ≥ 5 and total score ≥ 12. Conclusions: Preterm children are at higher risk of emotional and peer relationship problems than those born full term. The SDQ test could be used for ADHD screening

[The use of strength and difficulties questionnaire in psychosocial evaluation and attention deficit hyperactivity disorder screening in preterm infants]. / Uso del Strength and Difficulties Questionnaire en prematuros para su evaluación psicosocial y cribado del trastorno por déficit de atención e hiperactividad.

INTRODUCTION: Behavioural disorders and learning disabilities are often recognised in<1,500g or<32 weeks very low birth weight (VLBW) infants. There is very limited data in the Spanish population. OBJECTIVE: To determine the presence of psychosocial disorders in preterm infants at 6 years of age, as assessed by the strength and difficulties (SDQ) questionnaire, in comparison to a reference population. To set a cut-off value to use SDQ as a screening tool for attention deficit hyperactivity disorder (ADHD) in the preterm child. PARTICIPANTS AND METHODS: A prospective observational study was conducted on premature children assessed at 6 years of age using the SDQ. Perinatal variables, neurodevelopment, and diagnosis of ADHD, according to the DSM-5, were collected. RESULTS: A total of 214 children who met all the requirements, were included. When compared with the reference population they had significantly higher scores in emotional symptoms, in peer relationships, and in the total score of the test. The hyperactivity scale and the total test score are good predictors of a diagnosis of ADHD, with an area under the ROC curve of 0.83 (95% CI: 0.76-0.90) for hyperactivity, and 0.87 (95% CI: 0.80-0.93) for the total score. The scores for hyperactivity and the total test, from which the screening for ADHD could be considered positive would be≥6 and≥13 respectively, and a combination of hyperactivity≥5 and total score≥12. CONCLUSIONS: Preterm children are at higher risk of emotional and peer relationship problems than those born full term. The SDQ test could be used for ADHD screening.

The Temporal Dimension in Maternal Sensitivity Predicting Organized Attachment in Children.

This study analyzed Maternal Sensitivity in the interaction of mother-infant dyads to distinguish different dynamics associated with their attachment group membership - Insecure-Avoidant (A), Secure (B), or Insecure-Resistant (C), with no Disorganized traits - that they developed at 15 months. Participants were 26 eight-month old infants interacting with their mothers in a free-play setting. The analyses used sequential streams of infant actions and maternal responses, and state-space grids to study the temporal organization of the sequences. We examined appropriateness and promptness of the maternal response to infant behavior and a dynamic analysis of the interactive process. In Group B, when the antecedent behavior was infant social approach, the appropriateness of the maternal profile (sensitive vs. intrusive responses) was related to their children's subsequent security. However, how promptly mothers responded was not predictive. Conversely, when the antecedent behavior was infant play, how promptly the mothers responded was associated with securely attached children while mothers' profile of appropriate responses did not distinguish the subsequent quality of attachment. The indices derived from state-space grids were associated with attachment type and distinguished Group C from Groups B and A. However, results from analysis of a specific region of states, 'maternal interfering response to infant social approach,' showed significant discriminant function that correctly classified 78% of Group B, 73% of Group A, and 83% of Group C. Group B infants received less intrusive behavior than their counterparts, and when they did, it involved positive affection or playfulness. Finally, regarding attractors, although more Group B dyads showed multi-stability of coexisting attractors, than Groups A or C, the differences were not statistically significant.

Model that predicted death or disabilities in premature infants was valid at seven years of age.

AIM: Validated a model that used bronchopulmonary dysplasia (BPD), brain injuries measured using ultrasound and retinopathy of prematurity (ROP) to predict late death or disability in premature infants at seven years of age. METHODS: A retrospective study was performed at the 12 de Octubre Hospital neonatal unit in Madrid. A logistic model was applied to estimate the independent prognostic contribution of each morbidity, and the effect that the combination of morbidities had on the seven-year outcomes. The analysis was performed on the total cohort from 1991 to 2008 and on two subcohorts from 1991 to 1998 and 1999 to 2008. RESULTS: A total of 1001 children were included with a mean birth weight of 922 ± 208 g. Severe ROP was strongly associated with poor neurodevelopment, with an odds ratio (OR) 3.17 and 95% confidence interval (CI) of 1.56-6.50, and so was BPD (OR 1.52, 95% CI: 1.03-2.2). The combination of two neonatal morbidities increased the risk of a poor outcome (OR 4.44, 95% CI: 1.51-7.86). The model behaved differently in the two subcohorts. CONCLUSION: The prognostic model predicted a poor outcome at seven years of age when the subjects had at least two of the three morbidities.

Developmental Outcomes, Attachment and Parenting: Study of a Sample of Spanish Premature Children.

The aim of this study is to provide an overview of the development of premature children, including attachment, child psychological adjustment and parental variables. 130 children < 1,500 g or < 32 weeks at birth from two public hospitals, assessed at two years corrected age, together with their parents. Parental socio-demographic data was collected. Infant development, attachment and child psychological adjustment were evaluated, as was parental stress. The percentage of preterm children with developmental delays ranged from 5% to 21%. Girls tend to show higher levels of development than boys with effect sizes ranging from small, η2p = .02, to medium, η2p = .07. Secure attachment was the most frequent pattern in the sample. No significant differences, p < .05, between preterm children and the normative population were found on children´s behavioral problems and maternal stress levels. Despite the fact prematurity is considered to be a risk factor for a child´s development, a significant proportion of these children do not show problems in terms of developmental levels, attachment pattern and maternal stress. However, socio-emotional and affective domains, as well as psychological support programs for parenthood, should be followed up from a multidisciplinary perspective.

Developmental outcomes, attachment and parenting: study of a sample of Spanish premature children

The aim of this study is to provide an overview of the development of premature children, including attachment, child psychological adjustment and parental variables. 130 children < 1,500 g or < 32 weeks at birth from two public hospitals, assessed at two years corrected age, together with their parents. Parental socio-demographic data was collected. Infant development, attachment and child psychological adjustment were evaluated, as was parental stress. The percentage of preterm children with developmental delays ranged from 5% to 21%. Girls tend to show higher levels of development than boys with effect sizes ranging from small, η2p = .02, to medium, η2p = .07. Secure attachment was the most frequent pattern in the sample. No significant differences, p < .05, between preterm children and the normative population were found on children's behavioral problems and maternal stress levels. Despite the fact prematurity is considered to be a risk factor for a child's development, a significant proportion of these children do not show problems in terms of developmental levels, attachment pattern and maternal stress. However, socio-emotional and affective domains, as well as psychological support programs for parenthood, should be followed up from a multidisciplinary perspective

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Parental and Infant Gender Factors in Parent-Infant Interaction: State-Space Dynamic Analysis.

This study aimed to investigate the influence of parental gender on their interaction with their infants, considering, as well, the role of the infant's gender. The State Space Grid (SSG) method, a graphical tool based on the non-linear dynamic system (NDS) approach was used to analyze the interaction, in Free-Play setting, of 52 infants, aged 6 to 10 months, divided into two groups: half of the infants interacted with their fathers and half with their mothers. There were 50% boys in each group. MANOVA results showed no differential parenting of boys and girls. Additionally, mothers and fathers showed no differences in the Diversity of behavioral dyadic states nor in Predictability. However, differences associated with parent's gender were found in that the paternal dyads were more "active" than the maternal dyads: they were faster in the rates per second of behavioral events and transitions or change of state. In contrast, maternal dyads were more repetitive because, once they visited a certain dyadic state, they tend to be involved in more events. Results showed a significant discriminant function on the parental groups, fathers and mothers. Specifically, the content analyses carried out for the three NDS variables, that previously showed differences between groups, showed particular dyadic behavioral states associated with the rate of Transitions and the Events per Visit ratio. Thus, the transitions involving 'in-out' of 'Child Social Approach neutral - Sensitive Approach neutral' state and the repetitions of events in the dyadic state 'Child Play-Sensitive Approach neutral' distinguished fathers from mothers. The classification of dyads (with fathers and mothers) based on this discriminant function identified 73.10% (19/26) of the father-infant dyads and 88.5% (23/26) of the mother-infant dyads. The study of father-infant interaction using the SSG approach offers interesting possibilities because it characterizes and quantifies the actual moment-to-moment flow of parent-infant interactive dynamics. Our findings showed how observational methods applied to natural contexts offer new facets in father vs. mother interactive behavior with their infants that can inform further developments in this field.

Quality of attachment in infants less than 1500g or less than 32weeks. Related factors.

BACKGROUND: Prematurity carries a high risk of mortality and sequelae, altering the bonding process and leading to repercussions in terms of attachment. OBJECTIVE: To assess the type of attachment in children under 32weeks' gestational age (GA) or below 1500g, in hospitals where development-centred care has been implemented and to study the association between various types of attachment and certain neonatal and family characteristics. METHOD: Children <1500g or <32weeks GA who were born or admitted before 48h of life to one of two hospitals in Madrid between January and December 2012 were candidates for the study. The type of attachment was assessed through the strange situation procedure (SSP). Attachment was classified according to three types: secure (B), avoidant (A), or resistant/ambivalent (C). Insecure attachment was considered to be A+C. Children were assessed at a corrected age of 2years using the Bayley III Scales and SSP. Data on the characteristics of the parents and children were collected. RESULTS: A total of 59% (117/199) of the children <1500g or <32weeks GA born in 2012 in the two study hospitals were able to be evaluated. Secure attachment was found in 64% (75/117), avoidant attachment in 12.8% (15/117), and resistant/ambivalent in 23.1% (27/117). The children with secure attachment had a score of 107.6±16 in the cognitive area of the Bayley's Scale versus 98.8±18.8 in those with insecure attachment (p 0.007). Frequency of secure attachment at ≤26weeks GA was 23% (3/13) versus 69% (72/104) in children >26weeks GA (p 0.003). CONCLUSIONS: Nearly two-thirds of the children studied presented secure attachment, which was associated with better cognitive development. The frequency of secure attachment is lower in the children born more preterm.

Introducción. Atención Temprana: Desarrollo y Educación / Introduction. Early attention: Development and Education

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El Apego en la Escuela Infantil: Algunas Claves de Detección e Intervención / Attachment and Preeschool: Keys to Detection and Intervention

Uno de los aspectos clave del desarrollo es la vinculación afectiva de apego. Ya que el desarrollo es un fenómeno integrado la naturaleza del apego tiene repercusiones en todas las demás áreas del desarrollo. El vínculo de apego ha de interpretarse como un factor de primer orden en el desarrollo y su alteración, por tanto, no puede ser vista únicamente como subsidiaria de otras alteraciones. Las alteraciones infantiles de la vinculación afectiva tienen un entorno privilegiado de expresión en la Escuela Infantil, con la maestra, las tareas y los iguales ya que, es en este contexto donde los niños (fundamentalmente desde los tres años) pasan la mayor parte del tiempo. Es esencial conocer y reivindicar el papel del maestro como figura de apego y el compromiso de toda la comunidad educativa en su implicación en esta tarea(AU)

One of the most important aspects in the development of a child is the emotional bonding of attachment. Because this development is considered to be an integrated phenomenon, the type of attachment developed affects all other areas of development. The bond of attachment must be considered to be the main factor in the child’s development and change. Therefore, it cannot be seen as subsidiary to other alterations. The main context of disorders of emotional attachment in children is that of the nursery school (with teacher, homework and classmates). This is because at the age of 3, this is the place where children spend most time. Therefore, it is very important to point out and emphasize the teacher's role as an attachment figure and encourage the whole of the school's staff to become involved in this task(AU)