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Todo proceso quirúrgico hospitalario genera ansiedad en el paciente. Especialmente si se trata de pacientes pediátricos. El caso que presentamos, fruto de un acuerdo entre el Hospital 12 de Octubre de Madrid, la Facultad de Psicología de la UNED, y los proyectos Innova-Docencia de la Universidad Complutense de Madrid, en colaboración con la Fundación Theodora y Medicina TV, muestra una experiencia de RSC en el citado Hospital, que pretende convertir la percepción de la situación traumática de una intervención quirúrgica en una vivencia positiva para las niñas, los niños y los adolescentes. Una experiencia en la cual la comunicación constituye la herramienta fundamental. Mediante la narración audiovisual de un cuento se trasforma la percepción que el niño tiene del proceso quirúrgico. Gracias a la visualización de un vídeo en el que unos payasos narran la historia de “Lucas y el hilo mágico”, y a la decoración de paredes y techos, enseres y puertas, en los pasillos y salas que dirigen al quirófano, se logra que el niño perciba todo el proceso como un viaje que realiza siempre acompañado por Lucas. Con todo ello se pretende disminuir la ansiedad del paciente pediátrico y de sus familiares, así como reducir la sensación de dolor del paciente. En definitiva, lograr que el proceso quirúrgico hospitalario sea percibido por el paciente pediátrico como una vivencia positiva.

In infant development, maternal sensitivity is a central construct in the study of the processes involved in the caregiver-infant relationship and child attachment. The relevance of these dyadic processes for infant and later child development requires the advancing in the measurement of maternal sensitivity. The measurement of this construct, that reveals its complexity through different ‘windows’ using different approaches and operational definitions, has brought researchers’ attention into the methodological arena. Mother–infant interaction has been mainly quantified through rating scales and sequential strategies using observational methodology. The present study is part of a research program whose purpose is to measure maternal sensitivity dimensions using sequential coding in real time, the free-play paradigm and the early mother–child interaction coding system (CITMI-R: by its Spanish initials) instrument. This study was designed to further the analysis of the quality of the data obtained by this coding system. For this purpose, six trained observers coded fifty-seven mother–infant free-play episodes. The reliability of their coding was estimated: firstly, examining the inter-coder agreement with the Alignment Kappa, thus, incorporating the temporal dimension of the measurement. Secondly, analyzing the inter-coder agreement on parameters that consider the sequential and temporal organization by applying variables derived from the State Space Grid methodology and the nonlinear dynamic system approach: Contingency, through dyadic events, visits to them, predictability and duration of event, visit and dyadic behavioral states. The results indicated acceptable inter-observer reliability values based on the standards for use on parameters of interest in the study of sensitivity.

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.

espanolEl presente estudio pretende analizar el perfil de los usuarios atendidos por el dispositivo especial de atencion psicologica en linea habilitado por el Servicio de Psicologia Aplicada (SPA) durante el primer periodo de alerta sanitaria COVID-19. La muestra, compuesta por 124 participantes (70.4% mujeres) con una edad promedio de 41.49 anos cumplimento las versiones abreviadas del Listado de sintomas SA-45, la medida de resultados clinicos CORE-OM, el Inventario de afrontamiento COPE-28 y la Escala de resiliencia de Connor-Davidson. Los resultados mostraron un perfil sociodemografico formado mayoritariamente por mujeres estudiantes o del sector servicios, solteras y de nacionalidad espanola, con problemas previos de salud mental. Congruentemente con los motivos de consulta, mostraron predominantemente sintomatologia de depresion, ansiedad y somatizacion, un deficiente uso de estrategias de afrontamiento y bajos niveles de resilencia. De las variables mencionadas puede extraerse un posible perfil de riesgo en poblacion clinica que perfila un grupo vulnerable sobre el que se precisan medidas de prevencion e intervencion psicologicas EnglishThisstudy aims to analyze the profile of users in an uni-versity clinic (SPA-UNED) during the first COVID-19 19 health alarm. The sample was composed of 124 partici-pants (70.4% women) with an average age of 41.49 years and four instruments were used: Symptom Assessment-45 Questionnaire (SA-45), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), Coping Ori-entation to Problems Experienced (COPE-28) and the Scale Connor-Davidson Resilience (CD-RISC). The re-sults showed a sociodemographic profile formed mainly by single Spanish women from the service sector. Con-sistent with the reasons for consultation, participants pre-dominantly showed symptoms of depression, anxiety, and somatization, poor use of coping strategies, and low levels of resilience. These variables may be a possible risk pro-file in the clinical population that outlines a vulnerable group for which psychological prevention and interven-tion measures are required.

espanolEste articulo presenta la intervencion terapeutica en un caso de fobia infantil, abordado en el dispositivo de Atencion a Emergencia por el estado de alerta sanitaria por Covid-19 en el Servicio de Psicologia Aplicada de la Facultad de Psicologia de la UNED. Se trata de un nino varon de 5 anos de edad, que presenta miedo a salir de casa y a fenomenos meteorologicos, tras la etapa de confinamiento. La intervencion terapeutica fue disenada desde la Terapia de Juego Cognitivo Conductual. Los objetivos principales de la intervencion fueron: la disminucion de la respuesta de ansiedad en el nino ante las actividades realizadas fuera de la vivienda y ante situaciones meteorologicas desfavorables, asi como generalizacion progresiva de dichas actividades tanto fuera del hogar como en situaciones meteorologicas adversas. Los resultados objetivos propuestos fueron conseguidos a lo largo de 6 sesiones de 1 hora de duracion con frecuencia semanal, en formato online, y mantenidos despues de un seguimiento de tres meses. EnglishThis article presents a therapeutic intervention in a case of childhood phobia addressed in the Applied Psychology Service of the Faculty of Psychology of the UNED. This case was studied in the frame of the Emergency Attention device due to thehealth alert status for COVID-19. The case presents a 5-year-old male child who is afraid of leaving home and of meteorological phenomena after the confinement stage. The therapeutic intervention was designed from the Cognitive Behavioral Game Therapy.The main objectives of the intervention were the reduction of the child's anxiety response to activities carried out outsidethe home and to unfavorable weather situations, as well as the progressive generalization of these activities both outside the home and in adverse weather situations. The proposed results were achieved over sixsessions of 1-hour duration with weekly frequency, in an online format, and maintained after a three-month follow-up.

Resumen: Introducción: Los trastornos del comportamiento y del aprendizaje se describen con frecuencia en

Introduction: Behavioural disorders and learning disabilities are often recognised in

Hasta la fecha se han realizado escasas investigaciones en España y Latinoamérica que aborden el ajuste psicológico de los prematuros. El presente trabajo examina el ajuste psicológico infantil y algunos factores relevantes para el mismo, en una muestra de niños prematuros españoles. Participantes: 29 menores (Media de edad=36.2 meses, DT=1.42)con antecedentes de prematuridad. El 51.7% fueron niñas. Instrumentos: Se utilizó una encuesta sociodemográfica, el Strengths and Difficulties Questionnaire (SDQ) y la Escala de estrés parental (PSS). Resultados: Entre el 71.4 y el 82.1% de los menores obtuvieron puntuaciones consideradas normales en el SDQ, en el 50% de ellos, sus progenitores indicaron la existencia de algún impacto negativo. No se encuentran relaciones estadísticamente significativas entre las escalas del SDQ y las variables neonatales. Ser español, tener estudios superiores y encontrarse en activo se relacionó con un mejor ajuste psicológico infantil. El estrés parental se relacionó con un peor ajuste. Conclusiones: El estudio de las fortalezas y del ajuste psicológico de padres e hijos en prematuridad es de especial importancia para poder conocer, prevenir e intervenir sobre el bienestar de esta población.

ResumenLa relación madre-hijo se ha estudiado tradicionalmente desde la perspectiva de la teoría del apego. Pero, además, es un fenómeno psicológico y social al que el niño dota de sentido y que trata de comprender. Para explorar la comprensión infantil de esta dimensión de la relación, hemos entrevistado a 85 niños de entre siete y nueve años me­diante una entrevista semiestructurada con cuatro histo­rias, en las que se relacionaban el Sistema de Apego y el Sistema de Cuidado. El análisis de las respuestas de los niños muestra que el 97 % atribuyen malestar en la ma­dre en relación con la vivencia de amenaza del hijo. Los niños de estas edades poseen ya una comprensión del Sistema de Cuidado de la madre en conexión con el Sis­tema de Apego del hijo. La responsabilidad y la empatía de la madre forman parte de las respuestas de los niños de estas edades como activadores de su comportamiento de cuidado y protección hacia el hijo. Las representacio­nes de los niños pueden organizarse en niveles de com­prensión cada vez más sofisticados y complejos. Conocer los sentimientos y motivaciones que los niños atribuyen a la madre en su rol de cuidadora principal y la visión in­fantil de las leyes emocionales que rigen las relaciones afectivas madre-hijo, puede ofrecernos nuevas perspecti­vas acerca de cómo se construyen las relaciones de apego y resultar útil en la detección e intervención en apegos no saludables, en ambos miembros de la díada. AbstractThe mother-child relationship has traditionally been stud­ied from the perspective of attachment theory. But in addition, they are a psychological and social phenome­non to which the child gives meaning and tries to under­stand. To explore the child's understanding of this dimen­sion of the relationship, we interviewed 85 children be­tween 7 and 9 years old through a semi-structured inter­view with four stories, in which the Attachment System and the System of Care were related. The analysis of the children's responses shows that 97 % attribute discomfort in the mother in relation to the experience of threat of the child. Children of these ages already have an understand­ing of the Mother's System of Care in connection with the child's attachment system. The responsibility and empathy of the mother are part of the responses of chil­dren of these ages as activators of their behavior of care and protection for the child. Children´s representations can be organized at increasingly sophisticated and com­plex levels of understanding. Knowing the feelings and motivations that children attribute to the mother in her role of primary caregiver and the child's vision of the emotional laws that govern affective mother-child rela­tionships, can offer us new perspectives on how attach­ment relationships are built and be useful in the detection and intervention in unhealthy attachments, in both mem­bers of the dyad.

Prematurity carries a high risk of mortality and sequelae, altering the bonding process and leading to repercussions in terms of attachment.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.Children1500g or32weeks 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.A total of 59% (117/199) of the children1500g or32weeks 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 children26weeks GA (p 0.003).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.

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.

Behavioural disorders and learning disabilities are often recognised in1,500g or32 weeks very low birth weight (VLBW) infants. There is very limited data in the Spanish population.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.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.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.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 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.

ResumenLa Entrevista de Apego para Niños (EAN) es un nuevo instrumento de evaluación del apego basado en un procedimiento de completar historias. El objetivo principal de este estudio se basa en el análisis de la estructura y las propiedades psicométricas del EAN a través de análisis factoriales exploratorios sobre una muestra constituida por 115 niños y niñas españoles de entre 8 y 13 años (63 % niños). Otras dos muestras procedentes de una población en situación de riesgo psicosocial y de una población clínica fueron comparadas con la muestra principal con el fin de obtener evidencias de validez criterial. Los resultados obtenidos revelan una estructura interna compuesta de 4 factores que se refieren a reacciones del niño (positiva, confiada, negativa y desconfiada) y cinco factores referidos a interacciones niño-figura de apego (empática, confiada, positiva, negativa y desconfiada). Las escalas han demostrada una adecuada consistencia interna. La comparación de las escalas entre el grupo general y los grupos criteriales, y las correlaciones con los constructos relacionados indicaron una buena validez de constructo.AbstractThe Children Attachment Interview (EAN) is a new instrument based on story telling reports. The main purpose of this study is to analyze the structure and basic psychometric properties of the EAN through exploratory factor analyses based on a sample of 115 Spanish children aged 8 to 13 years (63 % boys). Another two matched samples from the risk social population and clinical population were compared with the main sample in order to obtain criterial validity. Findings reveal a multi-internal structure composed of four factors that refer to children´s reactions (positive, trustful, negative and mistrustful) and five factors that refer to child-attachment figure interactions (empathic, trustful, positive, rivalry and pro-arousal). Scales demonstrated adequate internal consistency. The comparison of scales between general and criterial groups, and correlations with related constructs indicate good construct validity.

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.

This study analizes the psychometric properties of a new instrument about the working model of children´s attachment. The sample was composed of 60 subjects (30 from normal population and 30 from a social risk population). The age of children ranges from 3 to 7 years old. This instrument is an interview based on the completion story task, however it includes new contents as well as a new procedure in regarding to previous attachment measures. The findings show good validity and reliability. The found results are going to be the beginning of future studies.

Resumen Uno de los aspectos nucleares del desarrollo es la vinculacion afectiva de apego. El objetivo de este monografico es la presentacion de algunas aportaciones realizadas en nuestro pais en la investigacion del apego a lolargo de la vida. Se trata solo de una muestra ya que otros muchos profesionales en Espana tienen como objetivo y guia de sus trabajos, la vinculacion afectiva de apego como variable esencial para comprender e intervenir en el desarrollo tanto normativo como alterado

Mercedes Valle Traperoa, Purificacion Sierra Garciab, Idoia Palacios Agundezc, Rebeca Garcia Ormazabald y Manuel Moro Serranoe aUnidad de Psicologia y Atencion Temprana. Servicio de Neonatologia del Hospital Clinico San Carlos. Madrid. Espana bDepartamento de Psicologia Evolutiva y de la Educacion. Facultad de Psicologia (UNED). Madrid. Espana. cPrograma de Atencion Psicologica a Neonatos de Alto Riesgo y sus Familias. Hospital Universitario de Getafe. Madrid. Espana. dUnidad de Salud Mental Infanto-Juvenil (USMI-J). Hospital Universitario Reina Sofia. Cordoba. Espana. eServicio de Neonatologia. Hospital Clinico San Carlos. Madrid. Espana. mvalle.hcsc@salud.madrid.org; psierra@psi.uned.es; idoiapalaciosagundez@gmail.com; larisarebeca@hotmail.com; mmoro@ucm.es Puntos clave

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. 2012-13