Effect of perceived discrimination on the psychological adaptation of children relocated to alleviate poverty: a longitudinal study / 中国学校卫生

Objective@#A longitudinal study design was used to explore the effect of perceived discrimination on the psychological adaptation of children relocated to alleviate poverty.@*Methods@#Four hundred twenty six children who were relocated to alleviate poverty were measured three times using a perceived discrimination questionnaire, childhood depression inventory, and the Illinois loneliness questionnaire, the data were analyzed using a cross lag model.@*Results@#Depression and loneliness of children relocated to alleviate poverty had an increasing trend during the three surveys( F=18.79, 8.69, P <0.01). Perceived discrimination was positively correlated with depression and loneliness at the time points for the three surveys( r=0.23~0.55, P <0.01). Cross lag analysis showed that perceived discrimination in the pretest (Tn) significantly predicted posttest (Tn+1) depression ( β=0.16, 0.20, P < 0.01 ) and perceived discrimination at time 2 significantly predicted loneliness ( β=0.25, P <0.01) at time 3.@*Conclusion@#Perceived discrimination was shown to be an important factor affecting the psychological adaptation of children relocated to alleviate poverty.

A Short Review on the Current Understanding of Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by a deficit in social behaviors and nonverbal interactions such as reduced eye contact, facial expression, and body gestures in the first 3 years of life. It is not a single disorder, and it is broadly considered to be a multi-factorial disorder resulting from genetic and non-genetic risk factors and their interaction. Genetic studies of ASD have identified mutations that interfere with typical neurodevelopment in utero through childhood. These complexes of genes have been involved in synaptogenesis and axon motility. Recent developments in neuroimaging studies have provided many important insights into the pathological changes that occur in the brain of patients with ASD in vivo. Especially, the role of amygdala, a major component of the limbic system and the affective loop of the cortico-striatothalamo-cortical circuit, in cognition and ASD has been proved in numerous neuropathological and neuroimaging studies. Besides the amygdala, the nucleus accumbens is also considered as the key structure which is related with the social reward response in ASD. Although educational and behavioral treatments have been the mainstay of the management of ASD, pharmacological and interventional treatments have also shown some benefit in subjects with ASD. Also, there have been reports about few patients who experienced improvement after deep brain stimulation, one of the interventional treatments. The key architecture of ASD development which could be a target for treatment is still an uncharted territory. Further work is needed to broaden the horizons on the understanding of ASD.

Gifted students with a coexisting disability: the twice exceptional / Estudantes com altas habilidades/superdotação com deficiência associada: a dupla excepcionalidade

The twice exceptional are students who have both high ability and a disability or disorder. The ability can be in any culturally-valued domain, including high intelligence, academics, the visual or performing arts, and athletics. The co-existing disability can be physical, medical, or psychological. There is a growing literature of scholarly opinion about twice exceptionality; however, there are few well-designed empirical investigations of gifted students with anxiety, depression, bipolar disorder, attention-deficit/hyperactivity disorder, eating disorders, conduct problems, or medical, physical or sensory disabilities. This article examines a few key issues about the twice exceptional student and then discusses what we know about the gifted students with attention-deficit hyperactivity disorder and gifted students with learning disabilities. The article also provides a brief discussion on suicide and the gifted student.

Estudantes com dupla excepcionalidade são aqueles que apresentam, concomitantemente, alta capacidade e uma deficiência ou doença. A capacidade pode ser expressa em qualquer domínio culturalmente valorizado, incluindo alta inteligência, rendimento acadêmico, artes visuais ou performativas e esporte. Por outro lado, a deficiência coexistente pode ser física, médica ou psicológica. Há uma literatura acadêmica crescente sobre a dupla excepcionalidade, sendo importante destacar, no entanto, um número reduzido de pesquisas empíricas desenvolvidas junto a alunos superdotados que apresentam ansiedade, depressão, transtorno bipolar, transtorno de deficit de atenção/hiperatividade, transtornos alimentares, problemas de conduta ou incapacidades físicas ou sensoriais. Este artigo examina algumas questões-chave sobre o discente duplamente excepcional e, em seguida, discute o que se sabe sobre os alunos superdotados com transtorno de deficit de atenção/hiperatividade e aqueles com dificuldades de aprendizagem. O artigo também fornece uma breve discussão sobre o suicídio e o aluno superdotado.

Do Homo ergaster ao Homo autisticus: aspectos filogenéticos e ontogenéticos do desenvolvimento da mente e seus desvios / From Homo ergaster to Homo autisticus: considerations about phylogenesis and ontogenesis of the development of the mind and its disorders / Del Homo ergaster al Homo autisticus: aspectos filogenéticos y ontogenéticos del desarrollo de la mente y sus desviaciones

O compartilhamento precoce das emoções é considerado, por alguns estudiosos do desenvolvimento, como uma característica que define o humano. Tal traço teria sido propiciado, segundo Sarah Hrdy, em Mothers and Others, pelo padrão de cuidado compartilhado das crianças que existiu a partir do Homo ergaster, descrito como tendo vivido há 1.800.000 anos. Nas últimas décadas, esta configuração sofreu transformações radicais nas sociedades ocidentalizadas. Os cuidados parentais agora são pouco compartilhados e intermediados, com frequência, por meios não humanos, como a televisão e computadores. O texto levanta a hipótese de que tais práticas possam estar ligadas, ainda que indiretamente, ao aumento marcante da prevalência dos transtornos autísticos.

Developmental psychologists consider early sharing of emotions as a trait unique to human beings. According to Sarah Hrdy, in Mothers and Others, such characteristic would have evolved from the practice of shared infant care, which can be traced back to Homo ergaster, around 1.8 million years ago. This practice has changed dramatically in the last decades in Westernized societies. Parental care is no longer shared, but rather intermediated by nonhuman means, such as video, television and computers. The author hypothesizes that such practices may be linked to the great increase in prevalence rates of autistic disorders.

El compartir precozmente las emociones es considerado por algunos estudiosos del desarrollo una característica que define lo humano. Este rasgo habría sido favorecido, según Sarah Hrdy, en Mothers and Others, por el padrón de cuidado compartido de los niños que existió a partir del Homo ergaster, que se según se describe, vivió hace 1,8 millones de años. En las últimas décadas, esta configuración ha sufrido transformaciones radicales en las sociedades occidentalizadas. La crianza de los hijos no es más compartida y es intermediada, a menudo, por medios no humanos, tales como la televisión y las computadoras. El texto plantea la hipótesis de que tales prácticas pueden estar vinculadas, tal vez indirectamente, al notable incremento en la prevalencia de los trastornos del espectro autista.

Compreensão de expressões idiomáticas em pessoas com síndrome de Asperger/autismo de alto funcionamento / Idiom understanding in people with Asperger syndrome/high functioning autism

OBJETIVO: Ampliar pesquisas anteriores a respeito do desenvolvimento da compreensão de expressões idiomáticas por meio da investigação dessa habilidade em crianças com síndrome de Asperger (AS) ou com autismo de alto funcionamento (HFA). MÉTODOS: Três grupos participaram do estudo. O primeiro grupo era composto por 27 crianças com AS/HFA (média de idade 11 anos e 3 meses) e os outros dois eram constituídos, respectivamente, por crianças em desenvolvimento típico e adultos. O Teste de Compreensão de Expressões Idiomáticas (CTIP) foi aplicado a todos os participantes. RESULTADOS: Crianças com AS/HFA tiveram desempenho inferior ao dos participantes dos outros dois grupos. Nenhuma diferença foi observada no desempenho dos dois grupos típicos. Também não houve correlação significativa entre o QI e o desempenho de crianças com AS/HFA, enquanto foram observadas correlações positivas entre a performance e a idade para nos dois grupos de crianças. CONCLUSÃO: Os resultados oferecem mais evidências de que crianças com AS/HFA tem dificuldades para compreender expressões idiomáticas e confirmam sua tendência a fazer interpretações literais. Essas dificuldades são irrelevantes para sua inteligência, mas afetam sua comunicação com outros. A compreensão dessas dificuldades é importante para a identificação de mecanismos para diminuir as confusões e mal entendidos observados nos atos comunicativos desse grupo.

PURPOSE: To extend previous research in the development of idiom comprehension by investigating this ability in children with Asperger Syndrome (AS) or with High Functioning Autism (HFA). METHODS: Three groups participated in the study. The first group consisted of 27 children with AS/HFA (mean age 11.3 years) and the other two consisted of typically developing children and adults, respectively. The Comprehension Test of Idiomatic Phrases (CTIP) was administered to all participants. RESULTS: Children with AS/HFA had lower performance compared to the other two groups. No difference was found in the performance between the two typically developing groups. Also, there was no significant correlation between the IQ and the performance for the children with AS/HFA, while positive correlations were revealed between performance and age for the two groups of children. CONCLUSION: The results provide further evidence that children with AS/HFA have difficulties in understanding idioms and they confirm their tendency to make literal interpretations. These impairments are irrelevant to their intelligence and they affect their communication with others. The understanding of these difficulties is important in order to find ways to limit the confusion and the misinterpretations which are observed during the communicative acts with this clinic group.

Autistic spectrum disorders: Diagnostic and therapeutic challenges in Mexico / Trastornos del espectro autista: retos diagnósticos y terapéuticos en el contexto de México

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.

A associação entre a suspeita inicial de perda auditiva e a ausência de comunicação verbal em crianças com transtornos do espectro autístico / The association between an initial suspicion of hearing loss and the absence of verbal communication in children with autism spectrum disorders

OBJETIVO: Averiguar a associação entre a suspeita inicial de deficiência auditiva e a ausência de comunicação verbal em crianças com diagnóstico de transtornos do espectro autístico. MÉTODOS: Por meio de estudo retrospectivo, analisamos 54 anamneses de indivíduos com diagnóstico de transtornos do espectro autístico. Inicialmente, obtivemos o registro da suspeita inicial de perda auditiva, mencionada pela família. O grau de associação entre a presença de suspeita inicial de perda auditiva e o tipo de desempenho comunicativo (não verbal e verbal) foi verificado. Posteriormente, as avaliações audiológicas foram rastreadas para confirmarmos a pertinência da queixa auditiva mencionada. Para tratamento estatístico dos resultados utilizamos os Testes Qui-quadrado e Exato de Fisher. Estabeleceu-se nível de significância de 0,05. RESULTADOS: Verificamos que 62,96 por cento dos pais de crianças autistas (verbais ou não) apresentaram a suspeita inicial de perda auditiva como primeira etiologia. A avaliação audiológica mostrou que somente 11,11 por cento dos indivíduos com comunicação não verbal e nenhum com comunicação verbal apresentaram algum tipo de deficiência auditiva. CONCLUSÕES: O número de crianças com suspeita inicial de perda auditiva mostrou-se significativo, independente destas serem verbais ou não. Na análise da associação entre desempenho comunicativo e suspeita de prejuízos na audição, os resultados foram estatisticamente significante maiores em crianças não verbais. Esses dados nos fazem refletir sobre a importância da sensibilização dos profissionais que atuam em clínica infantil quanto à busca pelo diagnóstico diferencial entre a deficiência auditiva e os transtornos do espectro autístico.

PURPOSE: To determine the association between the initial suspicion of hearing loss and the absence of verbal communication in children with diagnosis of autistic spectrum disorders. METHODS: A retrospective study was carried out analyzing 54 anamneses of individuals with diagnosis of autistic spectrum disorders. From each case history, it was obtained the records of the initial suspicion of hearing loss, mentioned by family members. The degree of association between the initial suspicion of hearing loss and the type of communicative performance (verbal and non-verbal) was verified. After that, hearing assessments were tracked down to confirm the pertinence of the hearing complaint mentioned. The data were statistically analysed using Chi-Square Test and Fisher's Exact Test. A significance level of 0.05 was adopted. RESULTS: It was verified that 62.96 percent of the parents of children with autism (both verbal and non-verbal) exhibited an initial suspicion of hearing loss as the first etiology. The hearing assessment demonstrated that only 11.11 percent of the individuals with non-verbal communication and none of those with verbal communication actually had some type of hearing impairment. CONCLUSIONS: The number of children with initial suspicion of hearing loss was significant, regardless whether these individuals had verbal or non-verbal communication. However, in the association analysis between communicative performance and suspicion of hearing impairments, the results were significantly greater for non-verbal children. This fact leads to a reflection on the importance of sensitization of the professionals who act in childcare clinic regarding the search for a differential diagnosis between hearing impairment and autistic spectrum disorders.

No Association Study of SLC6A4 Polymorphisms with Korean Autism Spectrum Disorder

OBJECTIVES : The serotonin transporter gene(SLC6A4) is one of the most widely studied candidate genes in autism spectrum disorder(ASD), but there have been conflicting results from studies into the association between SLC6A4 and ASD. The aim of this study was to evaluate the association between single nucleotide polymorphisms(SNPs) in the SLC6A4 gene and ASD in the Korean population. METHODS : We selected 12 SNPs in SLC6A4 and observed the genotype of 151 Korean ASD trios. We tested the family-based association for each individual polymorphism and haplotype by using the standard TDT method in Haploview(http : /www.broad.mit.edu/mpg/haploview/). RESULTS : Through transmission-disequilibrium testing and haplotype analysis, we could not find any statistically significant transmitted allele or haplotype. In addition, a case-control association test with Korean HapMap data did not reveal any statistical significance. CONCLUSION : Although serotonin-related genes must be considered candidate genes for ASD, we suggest that common SNPs of SLC6A4 are not important markers for associations with Korean ASD.

Well Baby Clinic: Developmental Guidance according to the Parent's Chief Complaints

Despite the relatively high prevalence (5~10%) of developmental disability, the early identification for such problems remains difficult. Doctors who care children with developmental delay tried to find out these disorders as early as possible in order to apply an early intervention and reduce the long-term disabilities among them. Identification of a delayed young child by routine out-patient's clinic mandates a careful search for an underlying etiology. This article discusses the available approaches for the infants and young children with various kinds of developmental disabilities, according to the parent's chief complaints including 'unable to walk', 'unable to speak', 'unable to control temper', and 'unable to contact his or her eyes'.

Convivendo com a criança autista: sentimentos da família / Living with an autistic child: feelings of the family / La convivencia con el niño autista: sentimientos de la familia

Os objetivos com este estudo consistiram em identificar o significado do autismo para familiares de crianças portadoras desse transtorno e o envolvimento deles no tratamento/acompanhamento dessas crianças. Para tanto, foi utilizada a metodologia qualitativa, sendo encontradas como unidades temáticas a dificuldade de comunicação e socialização da criança autista, referida como a dificuldade do portador de autismo em usar a linguagem para se comunicar ou de perceber as outras pessoas; sentimentos diversos da mãe em relação ao(à) filho(a) autista; bem como o envolvimento e a dependência da família em relação aos cuidados com a criança autista. Pôde-se perceber que é essencial que profissionais da área da saúde estejam cientes dos problemas mais comuns enfrentados pelos pais de crianças autistas, para que possam assisti-los em relação ao sofrimento que experimentam, bem como do sofrimento da criança e da família.

The present work had the objective of identifying the meaning of autism for family members, as well as the involvement of the family in the treatment/attendance of the child. To this end, a qualitative methodology was used, and the following subjects were found: difficulty in social interaction and communication, referred as difficulty in using language for communication, or in noticing other people; diverse feelings of the mother regarding the autistic child and involvement/dependence of the family in relation to the child care. We noticed that it is essential that health working professionals are aware of the most common problems faced by the autistic children's parents, so they are able to assist and minimize the family suffering.

El objetivo del presente trabajo ha sido identificar el significado del autismo para los familiares de niños autistas bien como el compromiso asumido por ellos con el tratamiento/seguimiento de tales niños. Fue utilizada la metodología cualitativa; las unidades temáticas encontradas fueron dificultad de comunicación y socialización, del niño autista, referidos como la dificultad para usar el lenguaje para comunicarse o de percibir las demás personas; distintos sentimientos de la madre hacia su hijo (a) autista y compromiso y dependencia de la familia con los cuidados del niño autista. Es esencial que los profesionales en el área de la salud estén conscientes de los problemas más comunes enfrentados por los padres de los niños autistas para poder ayudarlos en su sufrimiento, en el de sus hijos y de sus familias.