从使用母亲的角度评价初级卫生保健中注意缺陷多动儿童多模式治疗的积极效果

L. Araneda, Olga García Salazar, M. Alarcón-Espinoza
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引用次数: 0

摘要

注意缺陷多动障碍(ADHD)被定义为一种行为表现、慢性、症状进化和可能的遗传传递的神经精神病学图景(Aboitiz & Carrasco, 2009),影响儿童及其家庭的不同发展领域(Silver, 2010)。研究表明,患有多动症的学生有更高的教育风险,不仅因为学业和学习困难,还因为社交困难,同龄人的排斥和教学期望的降低(Valero, 2013)。在整个生命周期中,最臭名昭著的特征之一是多动症与其他精神疾病的频繁联系;焦虑、情感和对立障碍(Larson, Russ, Khan & Halfon, 2011),后者在儿童和青少年中最为普遍(Garrido, 2013)。与上述一致,世界卫生组织(世卫组织)已确定,始于儿童或青少年的精神疾病应成为公共卫生的优先事项(维森特、萨尔迪维亚、德拉巴拉、梅利皮兰、瓦尔迪维亚和科恩,2012年)。在智利,初级卫生保健从综合和跨学科的角度看待这一问题,其依据是其方法理想地建议采用多模式治疗,并将其理解为根据生物心理社会模式进行的多学科治疗,旨在补充精神药理学、心理治疗和精神病学的资源。目前的调查旨在了解在家庭健康中心对诊断为多动症的儿童的母亲进行多模式治疗的效果。使用描述性的定性设计,使用集中的个人访谈作为一种技术。样本由四位母亲组成,她们在正式签署知情同意书后参加了访谈。通过研究人员和专家的三角测量,对访谈的常规内容进行了分析。研究结果表明,对儿童个体发展、家庭动态和学校环境影响的认知。关于儿童的个人发展,已经确定了对治疗在情感、行为和社会领域的影响的看法。在家庭动力学中,人们认识到两个方面,一个与父母角色的表现有关,另一个与母亲和孩子之间的关系有关。关于父亲的角色,它们表明父亲更多地参与,家庭日常生活的组织、养育方式、对自己的行为管理发生了变化,对母亲的角色感到更满意。在这段关系中,母亲感受到更大程度的同理心,更多的自主权和情感表达的改善。关于在学校环境中治疗效果的感知,确定了学校适应、绩效、人际关系和学校行为的改善。我们主要讨论情感领域的感知进步,通过观察他们的孩子更快乐,表达能力更强,沟通能力更强,更自信,更好的社会关系,这对孩子和他的家庭的生活质量都有更好的影响,研究结果显示自尊和情感成熟度的提高。强调在干预过程中需要对儿童进行去病理性和整体的认识,强调他们的能力和家庭相互作用,其中重组过程、角色的改变和养育模式对儿童的需要更有作用。关于本研究的局限性,我们可以提到参与者人数较少,这可能会影响所研究现象经验的丰富性。同样,据估计,对于未来的研究,了解儿童和其他重要行为者(如父母和教师)的看法将是相关的。
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Evaluación de los efectos positivos de un tratamiento multimodal para niños con déficit atencional con hiperactividad en la atención primaria de salud desde la perspectiva de madres usuarias
Attention Deficit Hyperactivity Disorder (ADHD) is defined as a neuropsychiatric picture of behavioral manifestation, chronic, symptomatically evolutive and of probable genetic transmission (Aboitiz & Carrasco, 2009) that impacts the different areas of development, for the child and his family (Silver, 2010). Research has shown that students with ADHD have a higher educational risk, due not only to academic and learning difficulties, but also to social difficulties, rejection of their peers and a decrease in teaching expectations (Valero, 2013). One of the most notorious characteristics, throughout the life cycle, is the frequent association that ADHD presents with other psychiatric disorders; anxious, affective and oppositional disorders (Larson, Russ, Khan & Halfon, 2011), the latter being the most prevalent in children and adolescents (Garrido, 2013). In coherence with the above, the World Health Organization (WHO) has established that psychiatric disorders that begin in childhood or adolescence should be a priority for Public Health (Vicente, Saldivia, De la Barra, Melipillan, Valdivia & Kohn 2012). In Chile, it is approached from an integral and interdisciplinary perspective from Primary Health Care, based on the evidence that multimodal treatment is ideally recommended for its approach, understanding it as a multidisciplinary treatment according to the biopsychosocial model seeks to complement resources psychopharmacological, psychotherapeutic and psychopedagogical. The present investigation seeks to know what is the perception of the effects of a multimodal treatment in mothers with children diagnosed with ADHD, in a Family Health Center. A qualitative design of descriptive type was used, using the focused individual interview as a technique. The sample consisted of four maternal figures, who accessed the interviews after having duly signed an informed consent. An analysis of the conventional content of the interviews was carried out, with triangulation by researchers and experts. The results indicate the perception of the effects on: the individual development of the child, the family dynamics and the school environment. In relation to the individual development of the child, perceptions of the effects of treatment in the emotional, behavioral and social areas have been identified. In the family dynamics, two aspects are recognized, one related to the performance of the role of the parents and the other related to the relationship between mother and child. Regarding paternal roles, they indicate greater participation on the part of the father, changes in the organization of family daily life, in the parenting patterns, in the behavioral management of themselves and a greater satisfaction with their maternal role. Regarding the relationship, mothers perceive a greater level of empathy, the promotion of more autonomy and an improvement in the expression of affects. Regarding the perception of the effects of treatment in the school environment, improvements in school adaptation, performance, interpersonal relationships and school behavior are identified. We mainly discuss the perceived progress in the affective field, where the findings show improvements in self-esteem and emotional maturity, by observing their children more cheerful, expressive, communicative and with greater self-confidence, better quality social relationships that impact on a better quality of life for both the child and his family. The need for a depathologizing and integral vision of the child in the intervention processes is emphasized, with emphasis on their competences and family interaction, where reorganization processes, changes of roles and parenting patterns are more functional to the needs of the child. Regarding the limitations of this study, we can mention the small number of participants, which could affect the richness of the experiences of the phenomenon studied. Likewise, it is estimated that for future research it would be relevant to know the perception of the child and other significant actors, such as parents and teachers.
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