Abstract: Objective: To identify positive qualities and mental health problems in adolescents that are clients of a mental health specialized service. Materials and methods: The sample consisted of 145 patients of both sexes. The Mexican validated official international Hispanic version of the Youth Self Report/11-18 (YSR/11-18) was used; it measures psychopathology and individual characteristics associated with positive adaptation, called Positive Qualities. Results: The positive quality most commonly reported was related to the positive social behavior, without mean differences between girls and boys. Girls showed the highest level of internalizing and externalizing problems. Conclusions: Adolescents with psychopathology in clinical settings also show positive qualities. It is important to identify and enhance these characteristics as protective factors in adolescents living in high-risk contexts. Girls showed higher psychopathology levels, implying gender differences in preventive intervention.

Resumen: Objetivo: Identificar la presencia de cualidades positivas y los problemas de salud mental en adolescentes que acuden a atención especializada. Material y métodos: Se evaluaron 145 pacientes de ambos sexos. Se utilizó la versión oficial internacional validada en español del Youth Self Report/11-18 (YSR/11-18) del ASEBA, que mide psicopatología y cualidades positivas, que son características personales asociadas con la adaptación positiva. Resultados: Las cualidades positivas más comúnmente reportadas fueron las relacionadas con el comportamiento social positivo, sin diferencias en las medias entre hombres y mujeres. Las mujeres presentaron niveles más altos de problemas internalizados y externalizados en comparación con los hombres. Conclusiones: Los adolescentes en escenarios clínicos muestran cualidades positivas tanto como psicopatología. Es importante identificar y fortalecer estas características como factores de protección en los adolescentes en contextos de riesgo. Las mujeres presentan mayor nivel de psicopatología por lo que la intervención preventiva implicaría un enfoque de género.

Abstract: Objective: To identify positive qualities and mental health problems in adolescents that are clients of a mental health specialized service. Materials and methods: The sample consisted of 145 patients of both sexes. The Mexican validated official international Hispanic version of the Youth Self Report/11-18 (YSR/11-18) was used; it measures psychopathology and individual characteristics associated with positive adaptation, called Positive Qualities. Results: The positive quality most commonly reported was related to the positive social behavior, without mean differences between girls and boys. Girls showed the highest level of internalizing and externalizing problems. Conclusions: Adolescents with psychopathology in clinical settings also show positive qualities. It is important to identify and enhance these characteristics as protective factors in adolescents living in high-risk contexts. Girls showed higher psychopathology levels, implying gender differences in preventive intervention.

Resumen: Objetivo: Identificar la presencia de cualidades positivas y los problemas de salud mental en adolescentes que acuden a atención especializada. Material y métodos: Se evaluaron 145 pacientes de ambos sexos. Se utilizó la versión oficial internacional validada en español del Youth Self Report/11-18 (YSR/11-18) del ASEBA, que mide psicopatología y cualidades positivas, que son características personales asociadas con la adaptación positiva. Resultados: Las cualidades positivas más comúnmente reportadas fueron las relacionadas con el comportamiento social positivo, sin diferencias en las medias entre hombres y mujeres. Las mujeres presentaron niveles más altos de problemas internalizados y externalizados en comparación con los hombres. Conclusiones: Los adolescentes en escenarios clínicos muestran cualidades positivas tanto como psicopatología. Es importante identificar y fortalecer estas características como factores de protección en los adolescentes en contextos de riesgo. Las mujeres presentan mayor nivel de psicopatología por lo que la intervención preventiva implicaría un enfoque de género.

Abstract: The activities concerning mental health care of psychiatric disorders during more than 50 years of service (1966-2016) at the Children’s Psychiatric Hospital “Dr. Juan N. Navarro” (HPI), as well as the progressive development of teaching and research, have contributed to its positioning as a leading institution in medical care of high specialization. This has been possible through the training of human resources that focus the quality of care to the children and their families. The hospital has progressed towards diagnostic and therapeutic care of outpatients through the creation of specialized clinics (emotions, behavior, development, adolescence, among others) and the development of more actualized and integral therapeutic programs (behavioral psychotherapy, cognitive behavioral, psychodynamic; individual, group, family, etc.). In the field of education, the hospital has been the most important institution in the training of child psychiatrists in Mexico and its recognition as a research interdisciplinary center has grown.

Resumen: La atención de la salud mental y de los trastornos psiquiátricos de niños y adolescentes a lo largo de 50 años de servicio (1966-2016) en el Hospital Psiquiátrico Infantil Dr. Juan N. Navarro (HPI), y el desarrollo progresivo de la enseñanza y la investigación han contribuido al posicionamiento de éste como institución líder en la atención médica de alta especialidad. El hospital ha evolucionado en la atención diagnóstica y terapéutica de pacientes ambulatorios a través de la creación de clínicas especializadas y del desarrollo de programas terapéuticos cada vez más actualizados e integrales (psicoterapia conductual, psicoterapia cognitivo-conductual, y psicodinámica en modalidad individual, grupal y familiar, etc). En el ámbito de la enseñanza, el hospital ha sido la sede más importante en la formación de psiquiatras infantiles en México, con un progresivo reconocimiento como un centro de investigación interdisciplinaria.

Abstract: Today, there is evidence that shows that children and adolescents can experience developmental problems and psychiatric disorders. This was possible because of two main reasons, the evolution of the concept of infancy and the progress made in medical and psychiatric diagnostic classification. This manuscript offers a glance to early psychiatric attention in Mexico, particularly the care processes provided to 36 children and adolescents under twenty, admitted in the mental asylum La Castañeda, during the first half of the XX century. Admission causes, length of stay, diagnosis, treatment and discharge motives, are some of the aspects described in this study. Finally, it also reflects about the challenge it is for a child psychiatric hospital nowadays, with such a history, to become an innovative institution able to claim a place in the medical field in favor of those minors that can barely defend themselves.

Resumen: Existe evidencia de que los niños y adolescentes pueden presentar problemas del desarrollo y trastornos psiquiátricos. Lo anterior es consecuencia del concepto de infancia y del refinamiento de las clasificaciones diagnósticas médico-psiquiátricas. Este artículo ofrece una mirada sobre los procesos de atención psiquiátrica brindados a 36 niños y adolescentes admitidos en el Manicomio La Castañeda en la primera mitad del siglo XX. Motivo de ingreso, tiempo de estancia, diagnósticos establecidos, tratamiento y motivo de egreso son algunos de los aspectos que se describen. Finalmente, se reflexiona sobre la existencia de un hospital psiquiátrico infantil, que siendo testimonio del pasado, tiene al mismo tiempo el desafío de convertirse en una institución innovadora; sitio que en el ámbito de las especialidades médicas reclama la psiquiatría infantil a favor de los menores que difícilmente pueden abogar por sí mismos.

Abstract: Today, there is evidence that shows that children and adolescents can experience developmental problems and psychiatric disorders. This was possible because of two main reasons, the evolution of the concept of infancy and the progress made in medical and psychiatric diagnostic classification. This manuscript offers a glance to early psychiatric attention in Mexico, particularly the care processes provided to 36 children and adolescents under twenty, admitted in the mental asylum La Castañeda, during the first half of the XX century. Admission causes, length of stay, diagnosis, treatment and discharge motives, are some of the aspects described in this study. Finally, it also reflects about the challenge it is for a child psychiatric hospital nowadays, with such a history, to become an innovative institution able to claim a place in the medical field in favor of those minors that can barely defend themselves.

Resumen: Existe evidencia de que los niños y adolescentes pueden presentar problemas del desarrollo y trastornos psiquiátricos. Lo anterior es consecuencia del concepto de infancia y del refinamiento de las clasificaciones diagnósticas médico-psiquiátricas. Este artículo ofrece una mirada sobre los procesos de atención psiquiátrica brindados a 36 niños y adolescentes admitidos en el Manicomio La Castañeda en la primera mitad del siglo XX. Motivo de ingreso, tiempo de estancia, diagnósticos establecidos, tratamiento y motivo de egreso son algunos de los aspectos que se describen. Finalmente, se reflexiona sobre la existencia de un hospital psiquiátrico infantil, que siendo testimonio del pasado, tiene al mismo tiempo el desafío de convertirse en una institución innovadora; sitio que en el ámbito de las especialidades médicas reclama la psiquiatría infantil a favor de los menores que difícilmente pueden abogar por sí mismos.

Abstract: The activities concerning mental health care of psychiatric disorders during more than 50 years of service (1966-2016) at the Children’s Psychiatric Hospital “Dr. Juan N. Navarro” (HPI), as well as the progressive development of teaching and research, have contributed to its positioning as a leading institution in medical care of high specialization. This has been possible through the training of human resources that focus the quality of care to the children and their families. The hospital has progressed towards diagnostic and therapeutic care of outpatients through the creation of specialized clinics (emotions, behavior, development, adolescence, among others) and the development of more actualized and integral therapeutic programs (behavioral psychotherapy, cognitive behavioral, psychodynamic; individual, group, family, etc.). In the field of education, the hospital has been the most important institution in the training of child psychiatrists in Mexico and its recognition as a research interdisciplinary center has grown.

Resumen: La atención de la salud mental y de los trastornos psiquiátricos de niños y adolescentes a lo largo de 50 años de servicio (1966-2016) en el Hospital Psiquiátrico Infantil Dr. Juan N. Navarro (HPI), y el desarrollo progresivo de la enseñanza y la investigación han contribuido al posicionamiento de éste como institución líder en la atención médica de alta especialidad. El hospital ha evolucionado en la atención diagnóstica y terapéutica de pacientes ambulatorios a través de la creación de clínicas especializadas y del desarrollo de programas terapéuticos cada vez más actualizados e integrales (psicoterapia conductual, psicoterapia cognitivo-conductual, y psicodinámica en modalidad individual, grupal y familiar, etc). En el ámbito de la enseñanza, el hospital ha sido la sede más importante en la formación de psiquiatras infantiles en México, con un progresivo reconocimiento como un centro de investigación interdisciplinaria.

Abstract: Objective: This study aims to generate evidence on intellectual development disorders (IDD) in Mexico. Materials and methods: IDD disease burden will be estimated with a probabilistic model, using population-based surveys. Direct and indirect costs of catastrophic expenses of families with a member with an IDD will be evaluated. Genomic characterization of IDD will include: sequencing participant exomes and performing bioinformatics analyses to identify de novo or inherited variants through trio analysis; identifying genetic variants associated with IDD, and validating randomly selected variants by polymerase chain reaction (PCR) and sequencing or real-time quantitative PCR (qPCR). Delphi surveys will be done on best practices for IDD diagnosis and management. An external evaluation will employ qualitative case studies of two social and labor inclusion programs for people with IDD. Conclusions: The results will constitute scientific evidence for the design, promotion and evaluation of public policies, which are currently absent on IDD.

Resumen: Objetivo: Esta investigación busca generar evidencia sobre trastornos del desarrollo intelectual (TDI) en México. Material y métodos: La carga de la enfermedad por TDI se estimará con un modelo probabilístico usando encuestas poblacionales. Se estimarán costos directos e indirectos de gastos catastróficos de familias con un integrante conTDI. La caracterización genómica deTDI incluirá secuenciar exomas, realizar análisis bioinformático para identificar variantes de novo o heredadas a través de análisis de tríos, identificar variantes genéticas asociadas con TDI, y validar variantes aleatoriamente seleccionadas con reacción en cadena de polimerasa y secuenciación o qPCR. Se harán encuestas Delphi sobre mejores prácticas de diagnóstico y manejo de TDI. Una evaluación externa empleará estudios cualitativos de caso de dos programas de inclusión social y laboral para personas con TDI. Conclusiones: Los resultados serán evidencia científica que podrá ser la base para el diseño, promoción y evaluación de políticas públicas, actualmente ausentes para TDI.

Abstract: Objective: This study aims to generate evidence on intellectual development disorders (IDD) in Mexico. Materials and methods: IDD disease burden will be estimated with a probabilistic model, using population-based surveys. Direct and indirect costs of catastrophic expenses of families with a member with an IDD will be evaluated. Genomic characterization of IDD will include: sequencing participant exomes and performing bioinformatics analyses to identify de novo or inherited variants through trio analysis; identifying genetic variants associated with IDD, and validating randomly selected variants by polymerase chain reaction (PCR) and sequencing or real-time quantitative PCR (qPCR). Delphi surveys will be done on best practices for IDD diagnosis and management. An external evaluation will employ qualitative case studies of two social and labor inclusion programs for people with IDD. Conclusions: The results will constitute scientific evidence for the design, promotion and evaluation of public policies, which are currently absent on IDD.

Resumen: Objetivo: Esta investigación busca generar evidencia sobre trastornos del desarrollo intelectual (TDI) en México. Material y métodos: La carga de la enfermedad por TDI se estimará con un modelo probabilístico usando encuestas poblacionales. Se estimarán costos directos e indirectos de gastos catastróficos de familias con un integrante conTDI. La caracterización genómica deTDI incluirá secuenciar exomas, realizar análisis bioinformático para identificar variantes de novo o heredadas a través de análisis de tríos, identificar variantes genéticas asociadas con TDI, y validar variantes aleatoriamente seleccionadas con reacción en cadena de polimerasa y secuenciación o qPCR. Se harán encuestas Delphi sobre mejores prácticas de diagnóstico y manejo de TDI. Una evaluación externa empleará estudios cualitativos de caso de dos programas de inclusión social y laboral para personas con TDI. Conclusiones: Los resultados serán evidencia científica que podrá ser la base para el diseño, promoción y evaluación de políticas públicas, actualmente ausentes para TDI.

The Joint Committee on Health at Work make up by: ILO/WHO (International Labour Organization and the World Health Organization) in 1992, recognized that inappropriate management, affects people's health through physiological and psychological mechanisms known as stress. The aim of this study was to evaluate the risks associated to toxic management, and to certain psychological demands; as contributors to mental distress, lack of stress and job dissatisfaction of psychiatrists, vitality psychologists and medical residents of a Child Psychiatric Hospital (CHPH). Material and methods The study design was a cross-sectional survey, descriptive and observational. Instrument: The Copenhagen Psychosocial Questionnaire (The Copenhagen Psychosocial Questionnaire COPSOQ). Originally developed in Denmark, was adapted and validated in Spain. The internal consistency of the scales was Cronbach's a (0.66 to 0.92) and Kappa indices (0.69 to 0.77). Statistical analysis. Descriptive analysis was expressed by means, percentages and standard deviations. Bivariate analysis was calculated between psychosocial factors and dimensions of health. The comparisons between categorical variables were analized through chi square tests, and Fisher's exact test was used when the number of observations in the cells of the contingency table was less than 5. The results were expressed by prevalence ratios and their respective confidence intervals were calculated. Statistical analysis was performed using JMP statistical package version 7 and SPSS version 17. Results A total of 111 clinicians were surveyed: 30 psychiatrists, 46 psychologists and 35 medical residents. The response rate was 97%. The age range of the clinical staff was, from 26 to 65 years, with M=40, SD=6.5 years. Association between psychosocial demands and dimensions of health. Major problems presented by clinical staff, were explained from 3 axes. First axis, about psychological demands. We evaluated five types of psychological demands, but those that emerged as predictors of mental distress, loss of energy and cognitive behavioral stress symptoms, were the emotional demands. Emotional demands had statistically significant associations with mental distress (OR 3.67, 95% CI 1.28-10.01), behavioral symptoms (OR 3.59, 95% CI 1.28-10.06) and cognitive stress (RP 2.15, 95% CI 1.00-5.12) as well as lack of vitality (OR 1.78, 95% CI 1.01-3.13) (table4). Second axis: about quality of leadership, this concept showed statistically significant association with: mental distress (OR 2.83, 95% CI 1.19-6.76), with cognitive symptoms (OR 2.33, 95% CI 1.00-5.60) and behavioral stress (RP 2.24, 95% CI 1.06-4.75) and lack of vitality (OR 1.65, 95% CI 1.06-4.75). Other high-risk concept was: Managers' low social support, that showed statistically significant association with job dissatisfaction (OR 3.08, 95% CI 1.41-6.73), lack of vitality (OR 1.41, 95% CI 1.12-1.78) and mental distress (OR 1.39, 95% CI 1.07-1.81). Within the same second axis of analysis, lack of predictability was significantly associated with: mental distress (OR 2.33, 95% CI 1.40-3.88), behavioral symptoms (OR 2.11, 95% CI 1.31-3.41) cognitive stress symptoms (OR 2.07, 95% CI 1.19-3.61), and lack of vitality (OR 1.63, 95% CI 1.17-2.29). Third axis: the effort-reward imbalance; had a statistically significant association between job insecurity and all dimensions of health such as behavioral symptoms of stress (RP 1.97, 95% CI 1.14-3.41), lack of vitality (RP 1.94, 95% CI 1.23 -3.07), mental distress (RP 1.73, 95% CI 1.04-2.88), and cognitive symptoms of stress (RP 1.39, 95% CI 1.12-1.72). But stronger association was found between insecurity and job dissatisfaction (OR 7.65, 95% CI 1.09-53.75). Hence, the lack of esteem was significantly related to mental distress (OR 2.11, 95% CI 1.12-3.95), with behavioral symptoms of stress (OR 1.82, 95% CI 1.03-3.23), and lack of vitality (OR 1.42, 95% CI 1.00-2.11). Discussion According to Karasek-Theorell's theoretical model, high demands, low control and low social support (the combination of these factors brought together the work of psychiatrists, psychologists and residents) this condition represents the greatest risk to health. Clinical professionals are treated disrespectfully, have no appreciation; causing an effort/reward imbalance in their work. Our results are consistent with research conducted with the same instrument in Sweden, Denmark, Serbia, Germany and Spain. These articles found that psychiatrists and psychologists are exposed to high emotional demands. In contrast a high quality management shows clear relationship to mental well-being, with high vitality and acceptable levels of stress. Our findings show that low social support from managers, increase psychosocial risks and stress findings which are consistent with a Chilean study. Although most participants (except residents) have an acceptable job safety almost eight of every ten respondents claimed to be quite concerned about possible changes or delays in salary, or requiring a second job. Security at work is a fundamental aspect of the model of effort-reward-balance. Lack of this characteristic has a negative impact on human health. The human rights organization in Latin America (HR), found that 33% of latino workers expressed "anxiety" because of job insecurity, furthermore recognized the relationship between job insecurity and an increase in cancer and depression. Latino workers seem to be the most affected by new global order, where employment is based on the informal economy. A poll by the Washington Post, Kaiser Family Foundation and Harvard University affirmed that 33% of latinos expressed "anxiety" by job insecurity, compared with 22% of Afro-American and 20% of white people. Complications in health and life prognosis for these workers and their productivity, affects directly the quality care of the patients, beyond production costs. The Chilean analysis concluded that is necessary to give special attention to health sector working population due to the importance of their work. In conclusion, our results suggest that high emotional demands coupled with a poor quality of leadership, characterized by a highly hierarchical power structure, with low esteem, lack of support and unfair treatment was associated with mental distress, and behavioral symptoms of stress and lack of vitality. The total of these deficiencies and their interaction could potentially cause an effort / reward imbalance in clinician work. From the standpoint of prevention, it is about working there; where the exposures have been identified. The risk factors such as stress need to be controlled from its source: toxic management. It seems relevant to include our proposals, in order to improve organization culture and create healthier environments for the staff, so we recommend: 1) A strategic program to protect health of the hospital staff. 2) To assess and reward the efforts, accomplishments, contributions, results and not permanence. 3) Assign a fair wage according to their preparation and the functions performed. 4) It is necessary that managers and middle managers solve conflict well, plan their job correctly and be able to establish proper communication channels with their subordinates. 5) Promote labor stability. 6) Flexible hours, according to the needs of people and not just production. 7) Working conditions should provide development opportunities and the tasks must be varied and meaningful. 8) Promote teamwork, encourage social support and avoid competition. 9) Strengthen the esteem and recognition, including a promotion plan in terms of expectations of each employee. 10) Eliminate highly hierarchical power structures.

El objetivo de esta investigación fue evaluar los riesgos asociados a las formas nocivas de la organización del trabajo, que unidas a ciertas exigencias psicosociales coadyuvan en la génesis del malestar mental, la falta de vitalidad, el estrés y la insatisfacción laboral de los psiquiatras, psicólogos y residentes del Hospital Psiquiátrico Infantil (HPI). Material y métodos El diseño del estudio fue observacional, transversal y descriptivo. Instrumento. El Cuestionario Psicosocial de Copenhague (The Copenhagen Psychosocial Questionnaire CoPsoQ). El instrumento original de origen danés fue adaptado y validado en España, mostrando tener validez y fiabilidad contrastada, con a de Cronbach (0.66 a 0.92) e índices de Kappa (0.69 a 0.77). Resultados Participaron 111 profesionistas, de los cuales 30 son psiquiatras, 46 psicólogos y 35 médicos residentes. Se obtuvo una respuesta del 97%. La edad mínima del personal clínico se ubicó entre 26 a 35 y la máxima de 56 a 65 años, con una M= 40, DE=6.5 años. Asociación entre las exigencias psicosociales y las dimensiones de salud. Los problemas más apremiantes que presentó el personal clínico se explican a partir de tres ejes. Primer eje, de las exigencias psicológicas: las de tipo emocional tuvieron asociaciones estadísticamente significativas con el malestar mental (RP 3.67, IC95% 1.2810.01), con los síntomas conductuales (RP 3.59, IC95% 1.28-10.06) y cognitivos del estrés (RP 2.15, IC95% 1.00-5.12) así como con la falta de vitalidad (RP 1.78, IC95% 1.01-3.13). El segundo eje, de la calidad de liderazgo: mostró asociación estadísticamente significativa con: el malestar mental (RP 2.83, IC95% 1.19-6.76), con los síntomas cognitivos (RP 2.33, IC95% 1.00-5.60) y los conductuales del estrés (RP 2.24, IC95% 1.06-4.75) y con la falta de vitalidad (RP 1.65, IC95% 1.06-4.75). El escaso apoyo social por parte de los jefes, mostró asociación estadísticamente significativa con la insatisfacción laboral (RP 3.08, IC95% 1.41-6.73), la falta de vitalidad (RP 1.41, IC95% 1.12-1.78) y el malestar mental (RP 1.39, IC95% 1.071.81). Dentro del segundo eje de análisis, la falta de previsibilidad mostró asociación estadísticamente significativa con: el malestar mental (RP 2.33, IC95% 1.40-3.88), con los síntomas conductuales (RP 2.11, IC95% 1.31-3.41) y con los síntomas cognitivos del estrés (RP 2.07, IC95% 1.19-3.61), así como con la falta de vitalidad (RP 1.63, IC95% 1.17-2.29). Tercer eje, del equilibrio esfuerzo-recompensa: se observó asociación estadísticamente significativa entre la inseguridad laboral y todas las dimensiones de salud (síntomas conductuales del estrés (RP 1.97, IC95% 1.14-3.41); falta de vitalidad (RP 1.94, IC95% 1.23-3.07); malestar mental (RP 1.73, IC95% 1.04-2.88) y síntomas cognitivos del estrés (RP 1.39, IC 95% 1.12-1.72). Sin embargo, la asociación de mayor fuerza se observó entre la inseguridad y la insatisfacción laboral (RP 7.65, IC95% 1.09-53.75). Por lo que se refiere a la falta de estima, ésta se asoció en forma significativa con el malestar mental (RP 2.11, IC 95% 1.12-3.95), con los síntomas conductuales del estrés (RP 1.82, IC95% 1.03-3.23) y con la falta de vitalidad (RP 1.42, IC95% 1.00-2.11). Discusión La existencia de la organización nociva en el hospital se explica por medio del modelo demanda-control-apoyo social, en donde los clínicos se exponen a una alta demanda emocional, falta de control y autonomía en el trabajo, aunado a un bajo apoyo social. Esta condición representa la situación de mayor riesgo para su salud. La carencia de respeto, la falta de reconocimiento y el trato injusto podrían ser el origen de un desequilibrio en el esfuerzo-recompensa del trabajo clínico. La pobre calidad de liderazgo, caracterizada por una estructura organizacional y de poder altamente jerarquizada, sumada a la falta de apoyo social, a la inseguridad laboral y a la falta de previsibilidad están afectando de forma muy importante la salud mental de los clínicos del HPI al crear un clima organizacional negativo que contribuye al ausentismo, a la baja productividad y muy probablemente perturba la calidad de la atención a los pacientes. Es necesario, por esto, proteger la integridad mental del personal del hospital.

Autistic Spectrum Disorders (ASD) are developmental disorders with impairments in three broad domains: social interaction, communication and stereotypic movements and repetitive behavior. Their symptoms are complex, bizarre and most of them persistent, causing maladaptive and poor psychosocial adjustment. Early detection and diagnosis is a priority in ASD, parents are the first to notice early autism symptoms: 50% observe signs in the first 12 months of age. Despite initial observations of atypical development, there are significant delays in seeking proper medical attention and correct diagnosis; less than 38% of families receive their diagnosis through health services. Educational and health primary care providers need training in developmental milestones with focus on language and socio-communicative domains. Health policy planners should facilitate rationale referral when key symptoms such as language alterations are detected. The use of valid instruments and surveillance approaches versus awareness through red flag symptoms is discussed. Psychosocial interventions are the most important treatment, with ABA and TEACHH techniques recommended; pharmacological treatment (atypical antipsychotics, antidepressants, drugs for hyperactivity, sleep problems and anxiety) must be directed to treat comorbid conditions and combined with behavioral interventions.

Los trastornos del espectro autista (TEA) son trastornos del desarrollo con alteración en tres dominios: interacción social, comunicación y conductas repetitivas o movimientos estereotipados. Los síntomas son complejos, bizarros y la mayoría persistentes y causan un pobre ajuste psicosocial. La detección y diagnóstico tempranos son prioridad en los TEA; los padres son los primeros en advertir los síntomas tempranos del autismo: 50% observan manifestaciones en los primeros doce meses de edad. A pesar de las observaciones tempranas del desarrollo atípico, existen atrasos en la búsqueda de atención médica apropiada. Los proveedores de servicios educativos y cuidados primarios en salud necesitan adiestramiento en los hitos del desarrollo enfocados en el lenguaje y dominios sociocomunicativos. Se discute el uso de instrumentos y protocolos de abordaje frente a programas sobre advertencia de los síntomas de alarma. Las intervenciones médicas y psicosociales se describen de acuerdo con un abordaje de manejo integral. Las intervenciones psicosociales son las más importantes, en particular el empleo de los programas conocidos como ABA y TEACHH. El tratamiento farmacológico debe combinarse con intervenciones conductuales y utilizarse para el manejo de la comorbilidad.

Summary As the environment is a crucial source in an infant’s development, it is important to assess the proximal environment where a variety of social relationships take place. Experiences derived from the home environment allow the specific activities that a child builds actively. These opportunities have an outstanding impact on an infant’s development. The home concept and its influence on development led to the discovery and interrelations of several dimensions and today’s emphasis relies on identifying the mechanisms of the variability of environment that exert an influence on the variability of development. Under this perspective, at the end of the 1960’s the Infant/Toddler HOME Inventory was developed by Caldwell and Bradley. Very soon, Cravioto adapted it for its use in a Mexican population according to the characteristics of typical families and cultural aspects. The purpose of this investigation was to establish the internal consistency of the Infant/Toddler HOME Inventory in the version adapted by Cravioto through the assessment of the precision of its scoring in terms of internal consistency. Cohort: 62 infants and their mothers were contacted in the first 72 hours after delivery through a Research Program from the Child Psychiatry Hospital Dr. Juan N. Navarro (Environmental Modulation of Infancy Development). They were born in two Mexico City hospitals: a state public hospital, Hospital de la Mujer (Women’s Hospital) and in the Mother-infant Research Center from the Birth Study Group (CIMIGEN). All of them were low-risk infants who met the criteria for a one year follow up and whose parents gave their informed consent and accepted to be visited at their homes. The distribution of the infants group by sex was: 30 infants (48%) were female and 32 (52%) were male. Families were classified as follows: 72.5% were nuclear and 27.5% were extended. According to their socioeconomic profile, a high relationship was found between income and housing: seven (11.3%) of the highest income families lived in houses or apartments of their own or rented, where there were more rooms than inhabitants, whereas all others were living as follows: crowded houses or apartments (23 families, 37.1%), houses with of only one room (4 families, 6.5%) and the poorest houses with collective bathroom (28 families, 45.2%). All households had electrical lighting and most of them had also drinkable water inside their homes (98.4%); one shared water from a deep pond with their community. Bathrooms were: 35.5% with running water, 59.7% used a bucket for carrying water and 4.8% had latrine. Instrument: The Infant/Toddler HOME Inventory, version adapted by Cravioto, with 62 items in a binary format response was used. Subscale VII, Play Materials, asked about color, size, consistency or texture and type of toys. The instrument is administered by having a person calling the home at a time when the infant is awake and can be observed interacting with the mother or principal caregiver. The internal consistency of the Infant/Toddler HOME Inventory was monthly assessed for each of its subscales and the total scale, until the child’s first year of life (12 months), applying Cronbach’s alpha. Results showed that alpha coefficient’s values higher than 0.60 throughout the 12 months were observed in the VII Play Materials shoed a range of 0.64 and 0.84, and 0.60 and 0.83 for the Total Scale. On the other hand, subscale VI, Physical Environment, showed a less than 0.60 value with an internal consistency coefficient of 0.56 in the first month of life; nevertheless the remaining months had values between 0.60 and 0.70. This was also observed with subscale II, Mental Development and Vocal Stimulation, with a 0.58 value for the first month of life and alpha values between 0.63 and 0.74 for the remaining eleven assessments. Subscale III, Emotional Climate, exhibited seven evaluations in a range between 0.61 and 0.76; this is the second with a 0.61, fourth with 0.69, sixth with 0.76, seventh with 0.67, ninth with 0.63, tenth with 0.69 and eleventh 0.63. Non-acceptable internal consistency, it is less than 0.60 in most of their scorings were observed for the following scales: I. Adult Contact, V. Breadth of Experience. Only in the sixth month’s a value of 0.64 was observed, and the rest of scales exhibited a range within a 0.38 as inferior limit and 0.56 superior limit in the former and a 0.65 value in the tenth month and 0.60 in the eleventh. Subscale IV, Avoidance of Restriction, showed the lowest coefficient with values between 0.24 and 0.49. These results suggest that most of the subscales had adequate reliabilities, except for subscales I, Adult Contact; IV, Avoidance of Restriction; and V, Breadth of Experience. The purpose of this study was to evaluate the internal consistency of an instrument which measures the home environment quality in infants during their first year of life. Results showed the Infant/Toddler HOME Inventory had high internal consistency values in the Total Scale. These results are similar to those obtained by Banard, Bee & Hammond with a group of 179 children in Seattle, where they found 0.77 values at fourth months, 0.81 at eight and 0.86 at twelve. Our findings were within a rank of 0.68 and 0.83. Cronbach’s alpha value obtained for the different subscales showed intersubscale differences. Subscales II, III, VI and VII showed internal consistency values equal or higher than 0.60 in most of the assessments during the 12 months of life. This implies measurements are precise and reliable when using them in low risk Mexican infants. Lower values found in subscales I, Adult Contact, IV, Avoidance of Restriction and V, Breadth of the Experience, may be due to the low number of items. According to Nunnally and Bernstein, it is recommended that measurements with a low internal consistency should be used with initial, non-crucial decisions, and with temporary and reversible effects susceptible to replication and rectification. It is very important to stress the fact that this Infant/Toddler HOME Inventory version is not comparable with other in the literature because the structure was notably modified. Limitations in this study are not only this modification, but the size sample, and future research efforts should overcome this fact by trying to sample infants from different Mexican regions. This study points out the need to adapt, develop and evaluate psychometrically instruments that measure specific aspects of the environment of infant’s homes. Our results may be an initial step for those interested in measurements of Mexican families homes, or in those interested in the Infant/Toddler HOME Inventory as an indicator of the environmental aspects in early infancy.

resumen está disponible en el texto completo