MİNE ŞAHİNGÖZ, CEM GÖKÇEN, Ikbal INANLI CIVI

Çocuk psikiyatri kliniğine öfke patlaması yakınmalarıyla başvuran çocukların annelerinde psikiyatrik bozukluklar ve aile işlevselliği

Amaç: Bu çalışmanın amacı çocuk psikiyatri polikliniğine sinirlilik, öfke patlamaları, söz dinlememe ve yaramazlık yakınmaları ile başvuran ve herhangi bir ruhsal bozukluk saptanmayan okul öncesi çağdaki (2-6 yaşları arasındaki) çocukların annelerinde psikiyatrik bozuklukların sıklığını ve aile işlevselliğini araştırmaktır. Yöntem: Çalışmaya 2-6 yaşları arasındaki 62 çocuk ve anneleri alınmıştır. Çocuk psikiyatri polikliniğine başvuru öyküsü olmayan ve herhangi bir psikiyatrik bozukluğu olmayan 55 çocuk ve annesi ise kontrol grubunu oluşturmuştur. Tanı görüşmeleri Structured Clinical Interview for DSM Axis-I Disorders (SCID-I) Türkçe örneği ile yapılmıştır. Aile işlevselliği ise Aile Değerlendirme Ölçeği (ADÖ) ile değerlendirilmiştir. Sonuçlar: Sinirlilik, öfke patlamaları, söz dinlememe ve yaramazlık yakınmalarıyla polikliniğe başvuran çocukların annelerinde psikopatoloji sıklığı kontrol grubundan daha yüksekti. Çalışma grubu annelerin %51.6'sında en az bir psikiyatrik bozukluk saptanırken, kontrol grubunda bu oran %26.8'di. En sık konulan psikiyatrik tanılar majör depresyon (%27.4), yaygın anksiyete bozukluğu (%19.4) ve obsesif kompulsif bozukluktu (%17.7). Benzer şekilde, çalışma grubu annelerinin kontrol grubuna göre algıladıkları aile işlevlerinin daha sağlıksız olduğu saptanmıştır. Tartışma: Çalışmamızın bulguları çocuk psikiyatri polikliniğine bazı sorunlu davranışlarla başvuran annelerin yarısında psikiyatrik bir bozukluk bulunduğunu göstermektedir. Bu yakınmalarla polikliniğe başvuran çocuklarla birlikte annelerin de değerlendirilmesi ve gerektiğinde psikiyatrik

Psychiatric disorders and family functioning in mothers of children admitting to the child psychiatry clinic with temper tantrum

Objective: The aim of this study is to investigate the family functioning and frequency of psychiatric disorders in mothers of pre-school children (between ages 2 and 6) who referred to child and adolescent psychiatry outpatient clinic for anger, mischievousness, unruliness, temper tantrum complaints and who were not diagnosed any psychiatric disorder. Methods: Sixty-two children aged between 2 and 6 years and their mothers were included in the study. The control group consisted of 55 mothers of children who were not admitted to psychiatry clinic and without any psychiatric disorders. Diagnostic interviews of the parents were conducted with Structured Clinical Interview for Axis-I Disorders (SCID-I). Family functioning was evaluated with McMaster Family Assessment Device. Results: The frequency of psychopathology was higher in the mothers of children referred to child psychiatry outpatient clinic with anger, mischievousness, unruliness, and temper tantrum complaints than the controls. At least one psychiatric disorder was diagnosed in 51.6% of mothers of study group, meanwhile this ratio was 26.8% in the control group. More frequent psychiatric disorders were major depressive disorder (27.4%), generalized anxiety disorder (19.4%), and obsessive compulsive disorder (17.7%). Similarly, family functioning perceived by mothers in the study group was poorer than the controls. Conclusion: The results of this study suggested that half of the mothers who brought their children for the behavioral problems to the outpatient clinic were suffering from a psychiatric disorder. The mothers of children, who referred to the child psychiatry outpatient clinic with these complaints, need to be screened for psychiatric symptoms and guide for a psychiatric assistance if necessary.

PDF

___

1. Zeanah Jr CH, Zeanah PD. The scope of infant mental health. CH Zeanah (Ed.), Handbook of Infant Mental Health, third ed., The Guilford Press, 2009.
2. Görker I. Sosyal ve duygusal gelişim. K Karabekir (Ed.) Bebek Ruh Sağlığı Temel Kitabı, Türkiye Çocuk ve Genç Psikiyatrisi Derneği, Ankara, 2012.
3. Mayes LC, Gilliam WS, Sosinsky LS. The infant and toddler. A Martin, FR Volkmar (Eds.), Lewis's Child and Adolescent Psychiatry A Comprehensive Textbook, Philedelphia, Lippincott Williams & Wilkins, 2007, p.252-261.
4. Squires J, Bricker D. Conceptual principles and framework. An activity based approach to developing young children's social emotional competence. Baltimore, Maryland; 2007, p.25-37.
5. Lamb ME, Teti DM, Bornstein MH, Nash A. Infancy. M Lewis (Ed.), Child and Adolescent Psychiatry: A Comprehensive Textbook, third ed., New York, NY: Lippincott Williams and Wilkins, 2002, p.293-323.
6. Ölçer S, Perdahlı Fiş N, Berkem M, Karadağ B. The relationship in between self-esteem levels and the mothers' expressed emotion in children with asthma. Türk Ped Arş 2010; 45:144-149.
7. Keenan K, Wakschlag L. Are oppositional defiant and conduct disorder symptoms normative behaviors in preschoolers? A comparison of referred and non referred children. Am J Psychiatry 2004; 161:356-358.
8. Lewis, M. Child and Adolescent Psychiatry, third ed., Philadelphia: Lippincott Williams & Wilkins, 2002, p.1320-1335.
9. Luangrath A, Hiscock H. Problem behaviour in children - an approach for general practice. Aust Fam Physician 2011; 40:678-681.
10. Thompson RA, Meyer S, Jochem R. Social and emotional development in infancy and early childhood. JB Bneson, MM Haith (Eds.) Emotional Regulation, first ed., Oxford, UK: Academic Press (Elsevier), 2009, p.119-128.
11. Campbell SB. Behavior problems in preschool children: Clinical and developmental issues. New York: Guilford Press, 2002.
12. Demirkaya SK, Abalı O. Annelerin çocuk yetiştirme tutumlarının okul öncesi dönem davranış sorunları ile ilişkisi. Anadolu Psikiyatri Derg 2012; 13:67-74.
13. Campbell SB, Spieker S, Vandergrift N, Belsky J, Burchinal M. Predictors and sequelae of trajectories of physical aggression in school age boys and girls. Dev Psychopathol 2010; 22:133-150.
14. Rhoades KA, Leve LD, Harold GT, Neiderhiser JM, Shaw DS, Reiss D. Longitudinal pathways from marital hostility to child anger during toddlerhood: Genetic susceptibility and indirect effects via harsh parenting. J Fam Psychol 2011; 25:282- 291.
15. van der Waerden J, Galera C, Larroque B, Saurel Cubizolles MJ, Sutter Dallay AL, Melchior M. Maternal depression trajectories and children's behavior at age 5 years. J Pediatr 2015; 166:1440-1448.
16. Akdemir D, Gökler B. Psychopathology in the children of parents with bipolar mood disorder. Turk Psikiyatri Derg 2008; 19:133-140.
17. Degnan KA, Calkins SD, Keane SP, HillSoderlund AL. Profiles of disruptive behavior across early childhood: contributions of frustration reactivity, physiological regulation, and maternal behavior. Child Dev 2008; 79:1357-1376.
18. Büküşoğlu N, Aysan F, Erermiş S. The study of school fobic children with respect to their behavioral characteristics psychological symptoms of their mothers and family functions. Ege Tıp Dergisi 2001; 40:99-104.
19. Civic D, Holt VL. Maternal depressive symptoms and child behavior problems in a nationally representative normal birth weight sample. Matern Child Health J 2000; 4:215-221.
20. Wakschlag LS, Choi SW, Carter AS, Hullsiek H, Burns J, McCarthy K, et al. Defining developmental parameters of temper loss in early childhood: implications for developmental psychopathology. J Child Psychol Psychiatry 2012; 53:1099-1108.
21. Çorapçıoğlu A, Aydemir Ö, Yıldız M, Esen A, Köroğlu E. DSM-IV eksen I ruhsal bozukluklarına göre Türkçe yapılandırılmış klinik değerlendirmenin güvenirliği. İlaç ve Tedavi Dergisi 1999; 12:33-36.
22. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV clinical version (SCID-I/CV). Washington DC: American Psychiatric Press, 1997.
23. Bulut I. Aile Değerlendirme Ölçeği El Kitabı. Ankara: Özgüzeliş Matbaası, 1990.
24. Epstein NB, Bolwin LM, Bishop DS. The Mc Master Family Assesment Device. J Marital Fam Ther 1983; 9:171-180.
25. Swanston HY, Tebbutt JS, O'Toole BI, Oates RK. Sexually abused children 5 years after presentation: A case-control study. Pediatrics 1997; 100:600-608.
26. Yöntem FT. Assessment of mental symptoms and risk factors in children and adolescents who admitted to the child- adolescent psychiatry clinic. Konuralp Tıp Dergisi 2011; 3:1-8.
27. Durukan İ, Karaman D, Kara K, Türker T, Tufan AE, Yalçın Ö, ve ark. Çocuk ve ergen psikiyatrisi polikliniğine başvuran hastalarda tanı dağılımı. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 2011; 24:113-120.
28. Ticehurst RL, Henry RL. Stage-related behavioural problems in the 1-4 year old child: parental expectations in a child development unit referral group compared with a control group. Aust Pediatr 1989; 25:39-42.
29. Janicke DM, Finney JW, Riley AW. Children's health care use: a prospective investigation of factors related to care-seeking. Med Care 2001; 39:990-1001.
30. Fergusson DM, Lynskey MT, Horwood LJ. The effect of maternal depression on maternal ratings of child behavior. J Abnorm Child Psychol 1993; 21:245-269.
31. Briggs-Gowan MJ, Carter AS, Schwab-Stone M. Discrepancies among mother, child, and teacher reports: examining the contributions of maternal depression and anxiety. J Abnorm Child Psychol 1996; 24:749-765.
32. Richers JE. Depressed mothers as informants about their children: A critical review of the evidence for distortion. Psychol Bull 1992; 112:485-499.
33. Spann CA, Gagne JR. Aggressive behaviors in young siblings: Associations with executive functions and maternal characteristics. J Abnorm Child Psychol 2016; 44:523-533.
34. Needlman R, Stevenson J, Zuckerman B. Psychosocial correlates of severe temper tantrums. Dev Behav Pediatr 1991; 12:77-83.
35. Cummings EM, Davies PT. Maternal depression and child development. J Child Psychol Psychiatry 1994; 35:73-112.
36. Beck CT. Maternal depression and child behavior problems: A meta-analysis. J Adv Nurs 1999; 29:623-629.
37. Swartz HA, Shear MK, Wren FJ, Greeno CG, Sales E, Sullivan BK, et al. Depression and anxiety among mothers who bring their children to a pediatric mental health clinic. Psychiatr Serv 2005; 56:1077-1083.
38. Hirshfeld DR, Biederman J, Brody L, Faraone SV, Rosenbaum JF. Expressed emotion toward children with behavioral inhibition: Associations with maternal anxiety disorder. J Am Acad Child Adolesc Psychiatry 1997; 36:911- 924.
39. Campbell SB, Ewing W, Breaux AM, Szumowski EK. Parent identified problem three year-old: Follow-up at school entry. J Child Psychol Psychiatry 1986; 27:473-488.
40. Campbell SB, Ewing W. Hard-to-manage preschoolers: adjustment at age nine and predictors of continuing symptoms. J Child Psychol Psychiatry 1990; 31:871-889.
41. Campbell SB, Pierce EW, Moore G, Marakovitz S, Newby K. Boys' externalizing problems at elementary school age: pathways from early behavior problems, maternal control and family stress. Dev Psychopathol 1996; 8:701-720.
42. Lavigne JV, Arend R, Rosenbaum D, Binns HJ, Christoffel KK, Gibbons RD. Psychiatric disorders with onset in the preschool years: II: correlates and predictors of stable case status. J Am Acad Child Adolesc Psychiatry 1998; 37:1255-1261.