En busca de la dimension clínica del apego a través de las narrativas infantiles / In search of the clinical dimension of attachment through children's narratives

La dimensión clínica de la Teoría del Apego permanece insuficientemente desarrollada, pero pueden encontrarse interesantes propuestas actuales en este ámbito. Abordamos los principios básicos que deben sostener un acercamiento clínico a la Teoría del Apego: situar el apego en el conjunto de sistemas motivacionales, atender a los distintos niveles de seguridad que comprende (físico, emocional, cognitivo) y considerar los procesos de autoregulación dañados por fallos en las relaciones de apego. Abordamos el papel de las narrativas en el desarrollo infantil, y su uso para evaluar las construcciones internas del apego; finalmente exponemos con detalle el uso de la Attachment Story Completion Test (ASCT) como instrumento útil para su evaluación

Clinical dimension of Attachment Theory is still illdeveloped, but interesting current proposals can be found. Basic principles necessary to bear a clinical approach to Attachment Theory are explained: placing attachment among other motivational systems, paying attention to the different safety levels included in attachment (physical, emotional, cognitive) and taking into account self-regulation processes which could be hampered by failures in attachment. The role of narratives in child development, and its utility to assess attachment internal models are considered; finally, a detailed account of the use of Attachment Story Completion Test (ASCT), as an useful assessment tool, is presented

Calidad de vida y sintomatología depresiva en mujeres adolescentes vulnerables / Quality of life and depressive symptoms in vulnerable adolescent women

En este trabajo se analizó la relación entre calidad de vida y sintomatología depresiva en 230 mujeres adolescentes vulnerables, con una edad media de 12,5 años (DT= 2,1). Las adolescentes fueron evaluadas con el KIDSCREEN-27 y el "Inventario de depresión en niños". La presencia de sintomatología depresiva fue 20% y en la calidad todos los dominios de KIDSCREEN fueron mayores a 50 puntos. La salud física fue menor en las adolescentes con mayor escolaridad y anhedonia; la dimensión psicológica de la calidad de vida disminuye con la anhedonia, la autoestima, el ánimo negativo y los problemas interpersonales; la esfera familiar se impacta negativamente con la anhedonia y la autoestima negativa; el apoyo social decrece con los problemas personales y la ineficacia, mientras que la dimensión escolar se afecta negativamente por la anhedonia e ineficacia. Se concluye que la alta prevalencia de sintomatología depresiva en esta población y sus efectos negativos sobre la calidad de vida constituyen un recurso valioso para direccionar acciones sanitarias, implementar programas de prevención de la depresión y promoción de la salud mental

This paper analyzes the relationship between quality of life and depressive symptomatology in 230 vulnerable adolescent women, with mean age of 12.5 (SD= 2.1). The adolescents were evaluated with KIDSCREEN-27 and Children Depression Inventory. The prevalence of depressive symptomatology was 20 percent, and in the quality of life all domains of KIDSCREEN were greater than 50. Physical health was lower in adolescents with higher schooling and anhedonia; the psychological dimension of quality of life diminishes with anhedonia, negative self-esteem, mood, and interpersonal problems; the family sphere is impacted negatively by anhedonia and negative self-esteem; social support decreases with personal problems and ineffectiveness, while the school dimension of quality of life affected negatively by the presence of anhedonia and ineffectiveness. It is concluded that the high prevalence of depressive symptomatology in this population and its negative effects on the quality of life constitute a valuable input for directing subsequent health actions, implementing programs for the prevention of depression and promoting mental health

A Pilot Study of Trauma-Focused Cognitive-Behavioral Therapy Delivered via Telehealth Technology.

Significant barriers exist in access to evidence-based, trauma-focused treatment among youth from economically disadvantaged backgrounds, those living in rural areas, and belonging to a racial and ethnic minority group, despite the high prevalence rates of trauma exposure among these underserved groups. The present study is proof-of-concept pilot of trauma-focused cognitive-behavioral therapy (TF-CBT) delivered to underserved trauma-exposed youth ( N = 15) via telehealth technology (i.e., via one-on-one videoconferencing), aimed at addressing barriers in access to TF treatment. This pilot study provides preliminary evidence of the ability to successfully deliver TF-CBT via a telehealth delivery format. Results demonstrated clinically meaningful symptom change posttreatment (large effect sizes for youth-reported ( d = 2.93) and caregiver-reported ( d = 1.38) reduction in posttraumatic stress disorder symptoms), with no treatment attrition (0% dropout). These findings are promising in showing treatment effects that are comparable with TF-CBT delivered in an in-person, office-based setting and an important first step in determining how to best address the mental health needs of trauma-exposed youth with barriers in access to care.

Apego y psicopatología en adolescentes y jóvenes que han sufrido maltrato: implicaciones clínicas / Attachment and psychopathology in formerly maltreated adolescents and young adults: Clinical implications

Se estudia la relación entre apego y psicopatología en una muestra de 40 adolescentes y jóvenes que han sufrido maltrato intrafamiliar. El apego se evalúa mediante el cuestionario RQ de Bartholomew, que distingue cuatro estilos de apego en función de la imagen positiva o negativa del self y de los demás: apego seguro, preocupado, temeroso y evitativo. Los resultados del estudio muestran que el apego inseguro, sobre todo el subtipo evitativo, es el más prevalente. Algo más de la mitad de la muestra (52.5%) presenta sintomatología clínicamente significativa (evaluada mediante el SCL-90-R), en especial hostilidad, obsesión-compulsión, ideación paranoide, psicoticismo y sensibilidad interpersonal. Los estilos de apego con una visión negativa del self (preocupado y temeroso) tienden a presentar más sintomatología psicopatológica. Se discuten las implicaciones clínicas de estos resultados

In this research, the relationship between attachment and psychopathology was studied in a sample of 40 adolescents and young adults who have suffered from intrafamily maltreatment. Attachment was assessed with Bartholomew’s RQ, which distinguishes four attachment styles depending on the positive or negative image of the self and others: secure, preoccupied, fearful and dismissive attachment. Results show that insecure attachment, particularly the dismissive subtype, is the most prevalent one. Slightly more than half of the sample (52.5%) shows clinically significant symptoms (as assessed with the SCL-90-R), particularly hostility, obsessive-compulsive, paranoid ideation, psychoticism, and interpersonal sensitivity. Attachment styles with a negative vision of the self (preoccupied and fearful) tend to show more psychopathological symptoms. The clinical implications of these results are also discussed

PTSD as a criminal defense: a review of case law.

Posttraumatic stress disorder (PTSD) has been offered as a basis for criminal defenses, including insanity, unconsciousness, self-defense, diminished capacity, and sentencing mitigation. Examination of case law (e.g., appellate decisions) involving PTSD reveals that when offered as a criminal defense, PTSD has received mixed treatment in the judicial system. Courts have often recognized testimony about PTSD as scientifically reliable. In addition, PTSD has been recognized by appellate courts in U.S. jurisdictions as a valid basis for insanity, unconsciousness, and self-defense. However, the courts have not always found the presentation of PTSD testimony to be relevant, admissible, or compelling in such cases, particularly when expert testimony failed to show how PTSD met the standard for the given defense. In cases that did not meet the standard for one of the complete defenses, PTSD has been presented as a partial defense or mitigating circumstance, again with mixed success.

Estimating present and future damages following child maltreatment.

The child psychiatric forensic evaluation of children and adolescents who are plaintiffs in civil lawsuits regarding their present and future damages from child maltreatment requires knowledge of current research findings on the short-term and long-term consequences of child maltreatment, evidence-based treatments for psychological trauma, and relevant professional guidelines, along with knowledge of the ethics and laws governing mental health expert practice and testimony in personal injury litigation. This article reviews current research and recommends an approach to these evaluations and expert testimony that is informed by current research findings, recently developed professional guidelines, and many years of professional experience.

A cross-national comparison of aggressors, victims and defenders in preschools in England, Spain and Italy

There is a small, but growing, body of research investigating peer-victimisation between preschoolers, an age which has been identified as being important both theoretically and practically for the development of interventions. This study compares aggressive and defending behaviour and victim status of preschoolers in three European countries; England, Spain and Italy. The results provide further confirmation that some children behave aggressively towards their peers during preschool in each of the countries studied. There are similarities between preschool children involved in peer-victimisation in the three countries in terms of the roles taken, sex differences and the types of aggressive behaviours used and experienced by the children. There were differences in the profiles of children identified as taking the roles by teachers and peers. Overall, it was found that those children identified by peers or teachers as being aggressive were more likely to be male, rated as physically strong and more likely to be rejected by classmates. Also, in general, the targets of peer-victimisation differed depending on the reporter. Peer-nominated victims were not identifiable in terms of gender, popularity or physical strength. Teacher-nominated victims were more likely to be socially rejected and physically weak. There are several subtle differences between the countries which deserve further investigation. The findings are discussed in relation to furthering our understanding of the development of peer-victimisation in preschools and the need for interventions which address this phenomenon (AU)

En la actualidad existe un pequeño, aunque creciente, cuerpo de investigación científica referida a la victimización entre preescolares, edad identificada como de gran importancia tanto teórica como práctica para el desarrollo. Este estudio compara las conductas de agresión y defensa con el estatus social de grupo en muestras de preescolares de tres países europeos: Inglaterra, España e Italia. Los resultados aportan evidencia de comportamiento agresivo de unos escolares hacia otros en cada uno de los países estudiados. Hay similitudes entre los preescolares victimizados por sus iguales en los tres países estudiados en términos de los roles adoptados, el sexo, el tipo de agresión ejecutada y padecida, así como en la identificación que realizan los compañeros sobre los roles jugados. Se encontraron diferencias en identificación y atribución de roles, realizada por los maestros y por los iguales. Y sobre todo, se ha encontrado que los preescolares identificados por sus iguales o por sus maestros como agresores tienden a ser varones, valorados como físicamente más fuertes y con mayor tendencia a ser rechazados por sus compañeros de aula. Pero en general, la elección del preescolar objeto de agresión por sus iguales, parece depender de quién haga la nominación. La nominación como víctimas de sus iguales no parece identificable en términos de género, popularidad y desarrollo físico. Los maestros tienden a nominar como víctimas de sus compañeros a preescolares a los que perciben como socialmente rechazados y físicamente débiles. Hemos encontrado diferencias entre países que requieren investigación confirmatoria. Los resultados se discuten en relación a la necesidad de una mayor comprensión de la victimización entre iguales en los años preescolares para una más idónea intervención del fenómeno (AU)

Maternal and paternal filicides: a retrospective review of filicides in Finland.

The purpose of this retrospective study was to illustrate the differences in maternal and paternal filicides in Finland during a 25-year period. In the sample of 200 filicides [neonaticides (n = 56), filicide-suicides (n = 75), other filicides (n = 69)], the incidence was 5.09 deaths per 100,000 live births: 59 percent of filicides were committed by mothers, 39 percent by fathers, and 2 percent by stepfathers. The mean age of the maternal victims (1.6 y) was significantly lower than that of the paternal victims (5.6 y), but no correlation between the sex of the victim and the sex of the perpetrator was found, and the number of female and male victims was equal. The sample of other filicides (n = 65) was studied more closely by forensic psychiatric examination and review of collateral files. Filicidal mothers showed mental distress and often had psychosocial stressors of marital discord and lack of support. They often killed for altruistic reasons and in association with suicide. Maternal perpetrators also dominated in filicide cases in which death was caused by a single episode or recurrent episodes of battering. Psychosis and psychotic depression were diagnosed in 51 percent of the maternal perpetrators, and 76 percent of the mothers were deemed not responsible for their actions by reason of insanity. Paternal perpetrators, on the other hand, were jealous of their mates, had a personality disorder (67%), abused alcohol (45%), or were violent toward their mates. In 18 percent of the cases, they were not held responsible for their actions by reason of insanity. During childhood, most of the perpetrators had endured emotional abuse from their parents or guardians, some of whom also engaged in alcohol abuse and domestic violence. The purpose of this study was to examine the differences between maternal and paternal filicides in a sample of 200 cases in Finland. This report also provides a psychosocial profile of the perpetrator and victim in 65 filicides and a discussion of the influence of diagnoses on decisions regarding criminal responsibility.

Piscoanálisis y la protección a la infancia / Psychoanalysis and child protection

Existe una importante distancia entre el psicoanálisis y los servicios que atienden a la infancia maltratada. Este trabajo reflexiona acerca de los motivos y presenta propuestas para favorecer el acercamiento. Se aporta una nueva lectura de las diferencias entre Freud y Ferenczy para ilustrar la necesidad de un cambio de actitud en relación al niño maltratado. Se analizan las aportaciones del grupo independiente desde la perspectiva de las necesidades del niño. Finalmente, se consideran los efectos negativos de una actitud parental patológica sobre el desarrollo del niño, en relación a las exigencias que esto pudiera plantear a los profesionales. Se concluye con la necesidad de sistematizar las aportaciones psicoanalíticas sobre el maltrato y de reconsiderar nuestra actitud ante la infancia maltratada (AU)

An important gap exists between Psychoanalysis and the Services designed to assist maltreated children. This paper reflects on the reasons and presents various proposals to bring them closer. A new understanding of the differences between Freud and Ferenczi is given to illustrate the necessity of a change of attitude in relation to abused children. The contributions of the Independent Group are examined from the perspective of the child´s needs. Finally, the negative effects of pathological parental attitudes on child development are considered in relation to the demands posed on professionals. The paper concludes that it is necessary to systematize psychoanalytic contributions on maltreatment and reconsider our attitude towards childhood abuse (AU)

[Risk assessment of neglect and maltreatment in infants and toddlers. Chances of early preventive intervention]. / Risikoeinschätzung bei Vernachlässigung und Kindeswohlgefährdung im Säuglings--und Kleinkindalter--Chancen früher beziehungsorientierter Diagnostik.

The German child protection system lacks of interdisciplinary and standardized procedures for screening and diagnosing child maltreatment as well as for service delivery. Evidence based assessments of risk-screening in combination with consensus-based models for risk-judgement seem to predict the best possible results. A central part of determining whether an infant is at risk is to evaluate various domains of parental competencies and skills. In particular assessment procedures based on attachment research have proven to be practically and methodologically relevant. These include interactive and video-based observational methods as well as parental representations as sources of information for risk assessment. Attachment based intervention and treatment programs are effective, especially with regard to enhancing paternal sensitive behavior. However, these programs need to be adapted to delivery for specific risk groups. Overall an interdisciplinary approach with regard to the programs as well as to the training of the professionals has to be taken into account.

Trauma infanto juvenil y psicopatología adulta: un estudio empírico / Child battering and adult psychopathology: an empiric study

Background: Childhood trauma and battering have been associated with adult psychopathology. Aim: To explore the relationship between childhood trauma, somatization, post traumatic stress disorder (PTSD), affective disorder and borderline personality disorder in hospitalized patients of four Chilean hospitals. Material and methods: Five hundred five patients were screened by a short seven item trauma recollection scale (70 from San Bernardo Hospital, 193 from Salvador Hospital, 97 from El Trabajador Hospital and 147 from Curico Hospital). A random sample of 85 cases was studied in depth using the CIDI 2.1, depression, PTSD and somatization scales, Inventory of Personality Organization (IPO) and the OQ 45.2 scale. Results: Forty five percent of patients did not report traumatic experiences, 38.4 percent recalled one or two events and 16.3 percent three or more traumatic experiences. The most remembered event was physical punishment (28.7 percent), followed by traumatic separation from parents (27.1 percent), alcohol and drug use by an adult at home (22 percent) and presence of family violence (22 percent). Thirty two percent of the 85 selected cases met CIDI criteria for affective disorder, 20 percent for post traumatic stress disorder and 11.8 percent for somatization disorder. There were statistically significant correlations between the frecuence of trauma and post traumatic stress disorder (p <0.001), as well as somatization and depressive disorder (p <0.007 and 0.008). Conclusions: This study supports the concept that traumatic psychosocial environments during chilhood are a risk factor for diverse psychiatric syndromes during adulthood.

Políticas e prioridades políticas: a experiência de Ribeirão Preto no atendimento à criança e ao adolescente vítimas de violência doméstica

Nesta investigação buscamos conhecer e analisar as representações sociais dos trabalhadores sociais em torno do atendimento à criança e ao adolescente vítimas de violência doméstica no Programa de Apoio e Orientação Familiar (PAOF) na Divisão da Criança e do Adolescente em Situação de Risco de Ribeirão Preto/SP, bem como levantamos dados para caracterizar o atendimento governamental nessa Divisão de Risco, com relação a: tipo da violência doméstica, aspectos relacionados à vítima e ao agressor, com o intuito de subsidiar ações futuras na consolidação do Estatuto da Criança e do Adolescente (Brasil, 1990). Os dados coletados apontam que nos meses de outubro, novembro e dezembro de 2001, estavam abertos 498 prontuários (CAB) de crianças e adolescentes que sofreram violência doméstica, dos quais 49% eram de violência física, 42% de negligência e 9% de violência sexual. No referencial teórico, fica explícito as categorias analíticas senso comum/bom senso com base no pensamento de Gramsci e a Política de Atendimento à Criança e ao Adolescente.O processo metodológico adotado é de natureza qualitativa, estudo de caso, sendo que o corpus da análise consistiu nas entrevistas semi-estruturadas com os sujeitos da pesquisa; na observação participante do serviço e no diário de campo....

[Child battering and adult psychopathology: an empiric study]. / Trauma infanto juvenil y psicopatología adulta: un estudio empírico.

BACKGROUND: Childhood trauma and battering have been associated with adult psychopathology. AIM: To explore the relationship between childhood trauma, somatization, post traumatic stress disorder (PTSD), affective disorder and borderline personality disorder in hospitalized patients of four Chilean hospitals. MATERIAL AND METHODS: Five hundred five patients were screened by a short seven item trauma recollection scale (70 from San Bernardo Hospital, 193 from Salvador Hospital, 97 from El Trabajador Hospital and 147 from Curico Hospital). A random sample of 85 cases was studied in depth using the CIDI 2.1, depression, PTSD and somatization scales, Inventory of Personality Organization (IPO) and the OQ 45.2 scale. RESULTS: Forty five percent of patients did not report traumatic experiences, 38.4% recalled one or two events and 16.3% three or more traumatic experiences. The most remembered event was physical punishment (28.7%), followed by traumatic separation from parents (27.1%), alcohol and drug use by an adult at home (22%) and presence of family violence (22%). Thirty two percent of the 85 selected cases met CIDI criteria for affective disorder, 20% for post traumatic stress disorder and 11.8% for somatization disorder. There were statistically significant correlations between the frequence of trauma and post traumatic stress disorder (p <0.001), as well as somatization and depressive disorder (p <0.007 and 0.008). CONCLUSIONS: This study supports the concept that traumatic psychosocial environments during childhood are a risk factor for diverse psychiatric syndromes during adulthood.

Possible influence of defenses and negative life events on patients with chronic fatigue syndrome: a pilot study.

13 patients with a diagnosis of chronic fatigue syndrome and two contrast groups of conversion disorder patients (n = 19) and healthy controls (n = 13) were assessed using the projective perceptual Defense Mechanism Test to investigate if specific defense patterns are associated with chronic fatigue syndrome. Another objective was to assess the possible influence of perceived negative life events prior the onset of the illness. The overall results showed significant differences in defensive strategies among groups represented by two significant dimensions in a Partial Least Squares analysis. Compared to the contrast groups the patients with chronic fatigue syndrome were distinguished by a defense pattern of different distortions of aggressive affect, induced by an interpersonal anxiety-provoking stimulus picture with short exposures. Their responses suggested the conversion group was characterized by a nonemotionally adapted pattern and specific constellations of defenses, associated with interior reality orientation compared to the patients with chronic fatigue syndrome and the healthy controls. Rated retrospectively, the group with chronic fatigue syndrome reported significantly more negative life events prior to the onset of their illness than healthy controls. For instance, 5 of the 13 patients reported sexual assault or physical battery as children or teenagers compared to none of the healthy controls. A significant association was found between defense pattern and frequency of reported negative life events. However, these retrospective reports might be confounded to some extent by the experience of the patients' illness; for example, the reports may be interpreted in terms of present negative affect.

Síndrome del niño maltratado: ¿cómo reconocerlo? / Child abuse syndrome: How inspect?

El objetivo del trabajo es detectar las características clínicas radiológicas del paciente que sufre síndrome de niño maltratado (SNM). La respuesta se obtuvo mediante el estudio de 47 pacientes, en el período que se extiende entre junio de 1996 y junio de 1999, que fueron asistidos en el Servicio de Guardia del Hospital de Niños Víctor J. Vilela de la ciudad de Rosario con Síndrome de Niño Maltratado. Este estudio se valió del análisis clínico y radiológico de los pacientes así como de la investigación de su entorno familiar y social. De la evaluación de los pacientes obtuvimos los siguientes datos: el motivo de consulta más frecuente fueron las lesiones de partes blandas (74,5 por ciento), el 25,5 por ciento ingresó por presentar uno o más sitios de fractura, en el 12,8 por ciento se presumió deshonesto, en 18 pacientes la consulta se produjo días o incluso semanas posteriores al trauma, el sitio de fractura más frecuente fue la diáfisis femoral, en contraste con algunos autores que describen el desprendimiento diafisarios como características del síndrome, en menores de 3 años predominaron las lesiones óseas y en los mayores a 3 años las lesiones de partes blandas, en todos los pacientes se descartó la presencia de metabolopatías u osteopatías, sin embargo su diagnóstico no descarta en sí mismo el SNM. Sabemos fehacientemente que la confirmación del maltrato infantil por parte del responsable será negado en forma sistemática. Pero ante la sospecha fundamentada de su existencia es nuestra responsabilidad profundizar en la búsqueda de un diagnóstico cierto para implementar un tratamiento integral físico psíquico que involucre el entorno de la víctima con la intención de evitar así futuras agresiones e incluso muerte