Foster children exhibit a broad pattern of developmental problems and psychopathology. The etiology of these disorders is discussed in the context of multiple risk factors, especially that of persistent maltreatment.
Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonin reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to end point in Clinical Global Impression-Improvement scale (CGI-I). Secondary efficacy measures included the CGI-Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED)-Child and Parent version, and The Youth Quality of Life Instrument-Research Version (Y-QOL-R). On the CGI-I scale, 13 of 20 patients (65%) had a score < or =2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week 12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.001). Escitalopram was generally well-tolerated. These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future double-blind, placebo-controlled, randomized clinical trials are warranted.
Our findings suggest that programs combining universal primary preventive strategies and interventions focused on at-risk students can be implemented and useful in developing countries to reduce school dropout.
Hintergrund: Pflegekinder haben hÄufig traumatisierende Situationen erlebt, die ihre Fremdunterbringung erforderlich machten. Dennoch gibt es bislang kaum Untersuchungen zu TraumafolgestÖrungen in dieser Risikopopulation. Patienten und Methoden: Die traumatische Belastung bei 20 7-bis 16-jÄhrigen Pflegekindern (10 Jungen, 10 MÄdchen) aus der Inanspruchnahmepopulation einer kinder-und jugendpsychiatrischen Sprechstunde wurde mit einer hinsichtlich Alter und Geschlecht vergleichbaren klinischen Kontrollgruppe von 20 Patienten, die bei wenigstens einem biologischen Elternteil leben, verglichen. Die Diagnostik erfolgte anhand des UCLA PTSD Reaction Index fÜr DSM-IV und des semi-strukturierten Diagnostikinterviews K-SADS Present und Lifetime Version. Ergebnisse: Bei den Pflegekindern liegen hÄufig multiple und chronische Traumata durch Misshandlung und/oder VernachlÄssigung vor (n = 19); die Kinder der Kontrollgrupper hingegen weisen hÄufiger einmalige, umschriebene Traumata auf (n = 9). Die PrÄvalenz posttraumatischer Stresssymptome bei Pflegekindern ist signifikant hÖher als bei den Kindern der Kontrollgruppe. Schlussfolgerungen: Pflegekinder entwickeln vor dem Hintergrund ihrer Misshandlungs-und VernachlÄssigungsvorgeschichte gehÄuft TraumafolgestÖrungen. Werden Pflegekinder wegen psychischer AuffÄlligkeiten zur Diagnostik vorgestellt, sollte daher eine gezielte Traumadiagnostik und bei Bedarf eine traumafokussierte Psychotherapie erfolgen.
Summary
Attachment in Very low Birthweight Infants (< 1500 g) and Their MothersA long hospital stay, along with the worries about the survival and the possible disabilities the child might suffer from, mark the start into life of very low birth weight premature infants (VLBW). The goal of this trial was to study the stability of the attachment representations of very low birthweight infants (birthweight < 1500 g) and the accordance of the attachment representations of the children and their primary care givers. In continuation of the Kölner Frühgeborenen Studie, we measured the attachment patterns of 40 VLBW children at the age of seven and their mothers. For the children we used the Geschichtenergänzungsverfahrens zur Bindung (GEV-B) and for the mothers the Adult Attachment Projective (AAP) to determine the attachment representation. The attachment representations first corresponded to a normal distribution pattern and shifted over time to a more insecure attachment. We could not determine a significant link between the attachment patterns of the child and their mother.Prax. Kinderpsychol. Kinderpsychiat. 62/2013, 142-154
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