G. E. Sukhareva's place in the history of autism research: Context, reception, translation

<p>Grunya Efimovna Sukhareva was a Soviet child psychiatrist and neurologist who described an autism-like condition closely resembling Asperger’s syndrome about 20 years before Hans Asperger and Leo Kanner published their descriptions of autistic psychopathy and early infantile autism, first naming it schizoid psychopathy (1925), later renaming it autistic psychopathy (1959). While autistic-like syndromes were repeatedly described independently in many countries in the first half of the 20th century, Sukhareva seems to have been the only person to give a detailed description of the syndrome’s presentation in girls and its sex differences. Considered the founder of child psychiatry in Russia, she is little known elsewhere, despite a significant portion of her work being written in German. Awareness of Sukhareva and her work has been slowly making its way into autistic history, largely as a result of the 1996 publication of Sula Wolff’s translation of the 1926 case studies on schizoid psychopathy in boys, but the large majority of her work remains untranslated from German and/or Russian and inaccessible to many people. Her 1927 paper of case studies on girls, describing sex differences similar to those being described now, are virtually unknown even in German texts. Including the translation of Sukhareva’s German-language paper on schizoid psychopathy in girls, summaries of her Russian-language texts on the syndrome, and what is hoped is a comprehensive bibliography of her published work, this thesis seeks to place Sukhareva’s work and its reception within the wider context of research into autistic-like syndromes in Anglo-European medical literature, and to understand the impact of domestic and international politics of the 20th century on child psychiatry and the international exchange of scientific knowledge. The thesis also corrects misinformation found in some recent popular histories of autism.</p>

G. E. Sukhareva's place in the history of autism research: Context, reception, translation

<p>Grunya Efimovna Sukhareva was a Soviet child psychiatrist and neurologist who described an autism-like condition closely resembling Asperger’s syndrome about 20 years before Hans Asperger and Leo Kanner published their descriptions of autistic psychopathy and early infantile autism, first naming it schizoid psychopathy (1925), later renaming it autistic psychopathy (1959). While autistic-like syndromes were repeatedly described independently in many countries in the first half of the 20th century, Sukhareva seems to have been the only person to give a detailed description of the syndrome’s presentation in girls and its sex differences. Considered the founder of child psychiatry in Russia, she is little known elsewhere, despite a significant portion of her work being written in German. Awareness of Sukhareva and her work has been slowly making its way into autistic history, largely as a result of the 1996 publication of Sula Wolff’s translation of the 1926 case studies on schizoid psychopathy in boys, but the large majority of her work remains untranslated from German and/or Russian and inaccessible to many people. Her 1927 paper of case studies on girls, describing sex differences similar to those being described now, are virtually unknown even in German texts. Including the translation of Sukhareva’s German-language paper on schizoid psychopathy in girls, summaries of her Russian-language texts on the syndrome, and what is hoped is a comprehensive bibliography of her published work, this thesis seeks to place Sukhareva’s work and its reception within the wider context of research into autistic-like syndromes in Anglo-European medical literature, and to understand the impact of domestic and international politics of the 20th century on child psychiatry and the international exchange of scientific knowledge. The thesis also corrects misinformation found in some recent popular histories of autism.</p>

Preschool Confusion Assessment Method for the Intensive Care Unit–Spanish (psCAM-ICU-S): Cross-Cultural Adaptation and Validation in Colombia

Objective: The goal of the present study was to perform a cross-cultural adaptation and clinical validation of the Preschool Confusion Assessment Method for the Intensive Care Unit–Spanish (psCAM-ICU-S) for its clinical use in the Colombian Population.Methods: We designed a Cross-cultural adaptation study followed by a cross-sectional validation study at a Single-center Pediatric Intensive Care Unit (PICU) at a University Hospital in Bogotá, Colombia. The study population was children aged from 6 months to 5 years and 11 months who had been treated in the PICU with a Richmond sedation-agitation scale score of−3 or higher. A three-phase study was carried out. The first phase comprised the application of psychometric tests on the tool. In the second phase, the psCAM-ICU-S was applied to the target population. Patients were evaluated by a nurse and a pediatric intensivist using the psCAM-ICU-S; additionally, a child psychiatrist evaluated each patient using the DSM-V criteria; the psychiatrist evaluation was chosen as the gold standard for the diagnosis of delirium. In the third phase, an evaluation of the tool's effectiveness was carried out by using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. Interrater agreement was also assessed by using the Fleiss' kappa.Results: Psychometric tests established the instrument's reliability and consistency as well as the clarity of its items. A total of 31 patients were evaluated. On average, the instrument presented a sensitivity of 93.3%, specificity of 94.8%, PPV 78%, NPV 99%, a positive likelihood ratio of 19.93, and a negative ratio of 0.07. The prevalence of delirium was 16.1% by the child psychiatrist and 25.8% using de psCAM-ICU-S. We confirmed high Interrater agreement, Kappa index (0.672–0.902).Conclusions: The psCAM-ICU-S was a valid and reliable instrument for the diagnosis of delirium in critically ill pediatric patients.

Lehetséges összefüggés egy autizmusspektrum-zavarban érintett gyermek metilfenidát-kezelése és az azt követően kialakult gynaecomastia között

Összefoglaló. Bár a figyelemhiányos hiperaktivitási zavar kezelése során alkalmazott metilfenidát-monoterápiával összefüggésben jelentkező gynaecomastiáról bizonyos nemkívánatos hatások adatbázisai beszámolnak, a szakirodalom áttekintése alapján ez idáig mindössze 5 esettanulmányt publikáltak a témában. Tanulmányunkban egy autizmusspektrum-zavarral és figyelemhiányos hiperaktivitási zavarral egyaránt diagnosztizált gyermek esetét mutatjuk be, akinél 6 hónapon át tartó, folyamatos metilfenidát-monoterápiájával összefüggésben kétoldali gynaecomastia kialakulását tapasztaltuk. A kezelés azonnali leállítása mellett 10 napos klomifénkezelés történt. A metilfenidát-terápia azonnali leállítását követően 14 nappal a gynaecomastia mindkét oldalon visszahúzódott. 3 hónapos, gyermekpszichiátriai szempontból gyógyszermentes időszakot követően a metilfenidát-terápia újraindítása történt, de 1 hónap elteltével a nem kívánt mellékhatás ismét jelentkezett. A metilfenidát-terápia és a gynaecomastia kialakulása közötti kapcsolat számos mechanizmussal kapcsolatban kérdéseket vet fel. Gyermekpszichiátriai szempontból érdekes kérdés, hogy releváns lehet-e a gyógyszeres terápia következményeként kialakuló nemkívánatos mellékhatás megjelenésében az autizmusspektrum-zavar és a figyelemhiányos hiperaktivitási zavar komorbid fennállása. A jelenség hátterében felmerül továbbá a neuroendokrin-immunológiai rendszer szabályozásának esetleges megváltozása. Esettanulmányunk felhívja a gyakorló orvoskollégák figyelmét a metilfenidát-terápia alkalmazása mellett potenciálisan kialakuló gynaecomastia monitorozására. Orv Hetil. 2021; 162(42): 1703–1708. Summary. Although gynecomastia associated with methylphenidate monotherapy in the treatment of attention deficit hyperactivity disorder has already been reported in some adverse event databases, based on a review of the literature it appears that only five case reports have been published. In our study, we present the case of a child diagnosed with both autism spectrum disorder and attention deficit/hyperactivity disorder, who developed bilateral gynecomastia in association with continuous methylphenidate monotherapy for 6 months. With immediate cessation of methylphenidate therapy, clomiphene treatment was given for 10 days. A total of 14 days after cessation of methylphenidate treatment gynecomastia receded on both sides. After a methylphenidate drug-free period of 3 months, methylphenidate therapy was restarted, but 1 month later the side effect reappeared. The relationship between methylphenidate and the development of gynecomastia raises questions about a number of mechanisms. From a child psychiatrist point of view, it is an interesting question whether the presence of comorbid autism spectrum disorder and attention deficit/hyperactivity disorder may be relevant in the onset of adverse events by medication. The phenomenon may also be caused by altered regulation of the neuroendocrine-immune system. Our case report draws the attention of practicing physicians to monitoring of potential gynecomastia during methylphenidate therapy. Orv Hetil. 2021; 162(42): 1703–1708.

Attachment Theory and Research

Attachment theory was founded by John Bowlby (1907–1990), a British child psychiatrist and psychoanalyst. The theory builds on an integration of evolutionary theory and ethology, cybernetics and cognitive science, as well as psychoanalytic object relations theory. The theory postulates that an attachment behavioral system evolved via natural selection processes. Bowlby conceived of the attachment system as a behavioral control system that continuously monitors the offspring’s proximity to caregivers, which has in turn been associated with protection from dangers and thus increased chances of survival and reproduction in humans’ and many other mammals’ ancestral environments. Attachment is a species-wide phenomenon denoting the strong bonds that children form to their caregiver(s), seeking to maintain proximity and communication, protesting separations, and using the caregiver(s) as a safe haven to return to for comfort and protection and as a secure base to explore the environment from. Attachments take time, maturation, and repeated sequences of interaction to form and are typically observed from the second half of children’s first year of life onward. According to the theory, attachment-related experiences with the caregiver(s) become internalized in the form of cognitive-affective representations of self and others (internal working models [IWMs]) that organize the child’s behavior and displays of affect in relation to the caregiver(s). Although malleable, such IWMs display a certain measure of continuity across time and situations and may generalize to affect the individual’s expectancies and behavioral inclinations in other and later interpersonal relationships. As pioneered by Mary Ainsworth and colleagues, attachments vary in quality, largely depending on the caregiver’s behaviors (e.g., responsivity and sensitivity to the child’s signals), whereas evidence for a direct influence of genetic heritability is limited. Variations in attachment are typically described using two dimensions (secure–insecure, organized–disorganized) subsuming four categories (secure, insecure–avoidant, insecure-resistant–ambivalent, disorganized–disoriented). Much of the empirical research regarding attachment has focused on these variations and their measurement. Ainsworth and colleagues’ Strange Situation Procedure (SSP), applicable for children aged 10–18 months, is often heralded as the “gold standard” attachment measurement tool. The concerted body of research indicates that secure attachment (or associated factors), marked by confidence in the caregiver’s availability, is generally a protective factor in socioemotional development. In contrast, insecure (avoidant and resistant) attachment, characterized by lack of confidence in the caregiver’s availability, is generally a vulnerability factor in development. Disorganized attachment, reflecting confused, conflicted, or apprehensive child behaviors in the presence of the caregiver (in the SSP), is a risk factor in development, most notably for externalizing behavior problems. Notably, the effect sizes observed have typically been small to moderate, and much is unknown about linking mechanisms and moderating influences. Although most readily observed in early childhood, humans form attachments throughout the lifespan. Accordingly, much research has also focused on adult (e.g., spousal) attachment and the intergenerational transmission of attachment from caregivers to their children.

Dr Bowlby: a psychiatrist for our times

Inspired by his experience as a teacher in a special school, John Bowlby became a doctor in order to give psychological treatment to children and their families. His debt to psychoanalysis is evident, while his determination to give external life events at least equal weight with mental states led him towards attachment theory. This pathway is well known, but Bowlby's parallel career as a child psychiatrist doggedly independent of psychoanalysis or medical practice, is not. His intelligent curiosity about human relationships took him beyond the prevailing scientific and clinical fixation with diagnosis, which persists to this day. Dr Bowlby's clinical approach is a model for modern child and adolescent psychiatrists.

STUDY OF THERAPEUTIC MANAGEMENT IN LOWER LIMB PEDIATRIC TRAUMA

Amputations of limbs, in terms of traumatic pediatric afflictions, are sparse, but severe indispositions that can become very uncomfortable for the ones involved. The role of the orthopedic or the plastic surgeon is crucial here, for she or he needs to preserve as much as possible from the viable physis in order for the bond development of the child to still happen. In following steps, a wound examination should be done to check for symptoms of ischemia or tissue non-viability. Some problems, such as neuromas, can be avoided by dividing the nerves proximally. A multidisciplinary approach involving physiotherapists, play therapists, and a child psychiatrist, in addition to the surgeon and primary care practitioners, may lead to a successful recovery.