Impacto de la pandemia por COVID-19 en la conducta alimentaria de niñas, niños y adolescentes con trastorno del espectro autista / Impact of the COVID-19 pandemic on the eating behaviors of children and adolescents with autism spectrum disorder

Introducción. Los niños con trastorno del espectro autista (TEA) presentan dificultades de adaptación a situaciones estresantes, como la pandemia por COVID-19. Objetivo. Evaluar el impacto del primer año de pandemia en las dificultades alimentarias de niños con TEA. Población y métodos. Se invitó a participar a cuidadores de niños con TEA no sindromático (edad: 2-18 años) de una unidad de neurodesarrollo. Los participantes respondieron en línea un cuestionario y la escala de evaluación de problemas de conducta alimentaria (BPFAS por su sigla en inglés) antes y durante el primer año de pandemia. Se calculó un puntaje de prioridad (producto entre promedio de frecuencia y problema) para cada ítem del BPFAS. Resultados. El 56,6 % (86/152) de los cuidadores contestó la encuesta (madre 74,4 %), mediana de edad 6,3 años (p25-p75: 4,7-8,2); el 80,2 % de los niños eran de sexo masculino; el 58,1 % mantuvo terapia durante la pandemia y el 61,6 % presentaba problemas de comportamiento previo a esta. Durante el primer año de pandemia, los niños presentaron mayor intensidad en dificultades conductuales (34,9 %) y de alimentación (61,6 %); sin embargo, el 31,4 % refirió mejoría en la alimentación. No existieron diferencias significativas entre puntajes BPFAS antes y durante la pandemia. Los ítems con mayor puntaje de prioridad fueron "se levanta de la mesa durante la hora de comer", "no probar alimentos nuevos", "no come verduras", "no come frutas". Conclusiones. Hubo alta frecuencia de dificultades en las conductas alimentarias durante el primer año de pandemia. No se presentaron diferencias en las características de estas conductas antes y durante la pandemia.

Introduction. Children with autism spectrum disorder (ASD) have difficulties adapting to stressful situations, such as the COVID-19 pandemic. Objective. To assess the impact of the first year of the pandemic on feeding difficulties in children with ASD. Population and methods. The caregivers of children and adolescents with non-syndromic ASD (age: 2­18 years) from a neurodevelopment unit were invited to participate. Participants completed a questionnaire and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) online before and during the first year of the pandemic. A priority score (product between the average frequency and the problem) for each BPFAS item was estimated. Results. Among the caregivers, 56.6% (86/152) completed the survey (mother: 74.4%); children's median age was 6.3 years (p25­p75: 4.7­8.2); 80.2% of children were males; 58.1% continued with their therapy during the pandemic; and 61.6% had behavioral problems before the pandemic. During the first year of the pandemic, children had greater behavioral problems (34.9%) and feeding difficulties (61.6%); however, 31.4% of caregivers referred improvements in feeding. There were no significant differences in the BPFAS scores before and during the pandemic. The following items obtained the highest priority scores: gets up from table during meal, does not try new food, does not eat vegetables, does not eat fruits. Conclusions. A high frequency of feeding difficulties was noted during the first year of the pandemic. No differences were observed in feeding characteristics before and during the pandemic.

Early diagnosis of autism and other developmental disorders, Brazil, 2013-2019 / Diagnóstico precoce do autismo e outros transtornos do desenvolvimento, Brasil, 2013-2019

ABSTRACT OBJECTIVE To investigate the factors associated with the early diagnosis of autism and other types of pervasive developmental disorder (PDD) in children treated at the Psychosocial Care Center for Children and Adolescents of the Unified Health System, from 2013 to 2019,in Brazil. METHODS An exploratory cross-sectional study, based on data from the Record of Outpatient Health Actions (RAAS) of the first appointment of children aged 1 to 12 years. The gross (RRg) and adjusted (RRa) relative risks and respective 95% confidence intervals (95%CI) were estimated using the Poisson regression model with robust variance estimation. RESULTS Of the 22,483 children included in the study, the majority were male (81.9%), lived in the same municipality where they were diagnosed (96.8%) and in the Southeast region (57.7%). Early diagnosis was higher for childhood autism (RRg = 1.48; 95%CI 1.27-1.71) , PDD without subtype designation (RRg = 1.55; 95%CI 1.34-1.80), other PDD (RRg = 1.48; 95%CI 1.21-1.81) and PDD not otherwise specified (RRg = 1.44; 95%CI 1.22-1.69) than for atypical autism. Children residing in the same municipality where the diagnosis was made had a higher rate of early diagnosis (RRg = 1.31; 95%CI 1.10-1.55) than the others; as well as those referred by primary care (RRg = 1.51; 95%CI 1.37-1.68) and by spontaneous demand (RRg = 1.45; 95%CI 1.31-1.61) than those from other types of referral. Early diagnosis was higher from 2014 and lower in the North region than in the other regions. In the multiple analysis, the magnitude of RRa was similar to that of RRg. CONCLUSIONS Early identification of autism and other PDD has improved in Brazil, but it still represents about 30% of the diagnoses made. The variables included in the model were significant, but still explain little of the early diagnosis of children with autism and other PDD.

RESUMO OBJETIVO Investigar os fatores associados ao diagnóstico precoce do autismo e de outros tipos de transtorno global do desenvolvimento (TGD) de crianças atendidas no Centro de Atenção Psicossocial Infantojuvenil do Sistema Único de Saúde, no período de 2013 a 2019, no Brasil. MÉTODOS Estudo transversal exploratório, com base nos dados do Registro das Ações Ambulatoriais de Saúde (RAAS) do primeiro atendimento de crianças de 1 a 12 anos. Foram estimados o risco relativo bruto (RRb) e ajustado (RRa), e respectivo intervalo de confiança de 95% (IC95%), utilizando o modelo de regressão de Poisson com estimativa de variância robusta. RESULTADOS Das 22.483 crianças incluídas no estudo, a maioria era do sexo masculino (81,9%), residia no mesmo município em que foi diagnosticada (96,8%) e na região Sudeste (57,7%). O diagnóstico precoce foi maior para autismo infantil (RRb= 1,48; IC95% 1,27-1,71), TGD sem designação de subtipo (RRb= 1,55; IC95% 1,34-1,80), outros TGD (RRb= 1,48; IC95% 1,21-1,81) e TGD não especificado (RRb= 1,44; IC95% 1,22-1,69) do que para autismo atípico. As crianças que residiam no mesmo município onde foi realizado o diagnóstico tiveram maior índice de diagnóstico precoce (RRb= 1,31; IC95% 1,10-1,55) do que as demais; bem como aquelas encaminhadas pela atenção básica (RRb= 1,51; IC95% 1,37-1,68) e por demanda espontânea (RRb= 1,45; IC95% 1,31-1,61) do que as oriundas de outros tipos de encaminhamento. O diagnóstico precoce foi maior a partir de 2014 e menor na região Norte quando comparada às demais. Na análise múltipla, a magnitude do RRafoi similar ao do RRb. CONCLUSÕES A identificação precoce de autismo e outros TGD tem melhorado no país, mas ainda representa cerca de 30% dos diagnósticos realizados. As variáveis incluídas no modelo foram significativas, mas ainda explicam pouco do diagnóstico precoce de crianças com autismo e outros TGD.

Incongruencia de género en adolescentes con trastorno del espectro autista: Evaluación e intervención transafirmativa / Gender incongruence in adolescents within the autism spectrum disorder: Transaffirmative evaluation and intervention

En la población con incongruencia de género (IG) hay un alto número de personas con Trastornos del Espectro Autista (TEA). Existe reciente y escaso conocimiento respecto de la co-ocurrencia de estas entidades, por lo que los objetivos de este estudio son, en primer lugar, realizar una revisión bibliográfica en relación a la prevalencia, etiología, desarrollo, salud mental en la población adolescente con esta co-ocurrencia IG, TEA y género diverso y a partir de esta descripción poder, en segundo lugar, entregar sugerencias para profesionales respecto del apoyo en evaluación e intervención de estas condiciones. Método: Se realizó una búsqueda en PUBMED, Scielo y Google académico, artículos en inglés y español, desde el año 2005 a 2021. Resultados: Se informa de una prevalencia de 5,0 a 26% aproximadamente de personas TEA en población IG, sobre todo en mujeres asignadas al nacer. En la evaluación se requiere profesionales que conozcan tanto el área de IG y TEA. No debe excluirse a las personas con TEA de las intervenciones médicas y se debe realizar seguimiento de las dificultades sensoriales. Conclusiones: Es importante apoyar a estas (os, es) adolescentes en la afirmación de sus necesidades de género de manera individual y/o grupal, al igual que a sus familias.

Abstract. Introduction: In the population with gender incongruence (GI), there is a high prevalence of people with autism spectrum disorder (ASD). However, there is scarce and fairly recent knowledge about its co-occurrence. As a result, the purpose of this study is, first, to make a bibliographic review regarding the prevalence, etiology, development, mental health of the adolescent population with a co-occurrence of GI, ASD, and gender diversity, and from this description, to provide suggestions to professionals to support assessments and interventions when facing these conditions. Methods: A search was made in PUBMED, Scielo, and Google Scholar, for articles in English and Spanish, from 2005 to 2021. Results: A prevalence of approximately 5.0 to 26% is reported, of people with ASD in the GI population, especially among women assigned at birth. In the assessment, professionals that know both areas are required. People with ASD must not be excluded from medical interventions, and a follow-up must be made on sensory issues. Conclusions: It is important to support these adolescents, as well as their families, in the affirmation of their gender needs, whether individually and/or in groups.

Implementación de un Programa Multidisciplinario de Evaluación para pacientes con Trastorno del Espectro Autista. Experiencia chilena en un hospital público; resultados preliminares / plementation of a Multidisciplinary Evaluation Program for Patients with Autism Spectrum Disorder. Chilean Experience in a Public Hospital; Preliminary Results.

El aumento en la prevalencia de los Trastornos del Espectro Autista (TEA) ha influido en la necesidad de contar con equipos de experiencia formada para su evaluación. En este esfuerzo es que en la unidad de salud mental ambulatoria del Hospital Exequiel González Cortés se implementó un programa de evaluación multidisciplinario para pacientes con sospecha de TEA. Entre los meses de abril y julio del presente año han sido evaluados 15 pacientes, en su mayoría varones con una edad media entre 6 a 10 años, encontrando que un 30% correspondía a un TEA y un 57% a otros diagnósticos como Retraso Global del Desarrollo y Trastornos Emocionales, entre otros. Los resultados confirman la importancia de contar con profesionales competentes con las habilidades para realizar el diagnóstico de estos pacientes.

The increase in the prevalence of the Autism Spectrum Disorders (ASD) influenced the need of having trained experienced teams for its evaluation. In this effort a multidisciplinary evaluation program for patients with suspected ASD was implemented in the Ambulatory Mental Health Unit of the Exequiel González Cortés Hospital. Between the months of april and july of 2020, 15 patients have been evaluated, mostly male, with an range of 6 to 10 years of age. We found that 30% corresponded to an ASD and 57% to other diagnoses such as Global Development Delay and Emotional Disorders, among others. The results confirm the importance of counting with trained teams with the skills to make the diagnosis in these patients.

Prevalencia de factores de riesgo ambientales prenatales en niños con trastorno del espectro autista controlados en un hospital de niños / Prevalence of prenatal environmental risk factors in children with autism spectrum disorder monitored in a children's hospital

INTRODUCCIÓN: El Trastorno del Espectro Autista (TEA) afecta al 1% de los niños y se ha demostrado que una de sus principales causas se debe a factores ambientales prenatales que afectan al feto durante el periodo gestacional. El objetivo fue estimar la prevalencia de factores de riesgo (FR) prenatales en niños con TEA menores de 8 años que se controlan en un Hospital de niños. MÉTODOS: Se realizó un estudio transversal descriptivo. Se aplicó una encuesta a los padres o tutores de los niños durante la espera a su control. Se realizó un análisis descriptivo de los datos. RESULTADOS: Participaron 76 madres de niños con TEA. Entre los niños predominó el sexo masculino, mediana de edad de 5,4 años, la mayoría puede hablar sin dificultad (78%) y un 28% tenía diagnóstico de alguna enfermedad crónica. La prevalencia de FR prenatales encontrados en este estudio es similar a las reportadas en otros estudios especialmente la edad de los padres, los años de educación materna, los abortos previos y el diagnóstico de enfermedades en el embarazo. Sin embargo, la prevalencia de factores como el embarazo de alto riesgo, el consumo materno de fármacos durante el embarazo, el parto prematuro y el consumo de tabaco y drogas durante el embarazo, fueron muy superiores en este estudio comparado con otros estudios, y podrían estar relacionadas con el diagnóstico de TEA en la infancia. CONCLUSIÓN: A partir de estos hallazgos, se establece una base para realizar estudios comparativos en el futuro.

INTRODUCTION: Autistic Spectrum Disorder (ASD) affects 1% of children and it has been shown that one of its main causes is due to prenatal factors that affect the fetus during the gestational period. The objective was to estimate the prevalence of prenatal risk factors (RF) in children with ASD under 8 years of age who are monitored in a Children's Hospital. METHODS: A descriptive cross-sectional study was carried out. A survey was applied to the parents or guardians of the children during the wait for their control. A descriptive analysis of the data was carried out. RESULTS: 76 mothers of children with ASD participated. The male sex predominated, the average age was 5.4 years, the majority could speak without difficulty (78%) and 28% had a diagnosis of a chronic disease. The prevalence of prenatal RF found in this study is similar to that reported in other studies, especially the age of the parents, the years of maternal education, previous abortions and the diagnosis of diseases in pregnancy. However, the prevalence of factors such as high-risk pregnancy, maternal consumption of medicines during pregnancy, preterm delivery and tobacco and drug use during pregnancy were much higher in this study compared to other studies, and could be related to the diagnosis of ASD in childhood. CONCLUSION: Based on these findings, a basis for comparative studies in the future is established.

Antenatal exposure to antidepressant drugs and the risk of neurodevelopmental and psychiatric disorders: a systematic review / Exposição intrauterina a antidepressivos e risco de transtornos de neurodesenvolvimento e psiquiátricos: uma revisão sistemática / Exposición prenatal a medicamentos antidepresivos y riesgo de trastornos psiquiátricos y en el desarrollo neurológico: una revisión sistemática

Abstract: This study investigated whether antenatal exposure to antidepressants (ADs) increases the risks of autism spectrum disorders (ASD), attention deficit/hyperactivity disorders (ADHD), schizophrenia and other mental illnesses, and cognitive and developmental deficits in infants or preschool children. PubMed, EMBASE, BIREME/BVS databases were searched to identify studies examining associations of ADs in pregnancy with neurodevelopmental and psychiatric disorders. Twenty studies addressed ASD and/or ADHD risks while 30 focused on developmental and cognitive deficits in infants or preschool children. Most studies detected no association of antenatal AD with ASD after adjustment of risk ratios for maternal depression or psychiatric disorders. Some studies showed that maternal depression, regardless of whether it is treated or untreated, increased ASD risks. Seven out of 8 studies found no increase in ADHD risk associated with antenatal exposure to selective serotonin reuptake inhibitors, the most commonly used AD. No consistent evidence was found linking AD in pregnancy to neurocognitive developmental deficits in infants or preschool children. A residual confounding by indication (depression severity) remained in almost all studies. This systematic review found no consistent evidence suggesting that ADs in pregnancy increase risks of ASD, ADHD, and neurocognitive development deficits. Some studies, however, found evidence that maternal depression increases ASD risks.

Resumo: O estudo teve como objetivo investigar se a exposição intrauterina a antidepressivos (ADs) aumenta o risco de transtornos do espectro autista (TEA), transtorno de déficit de atenção e hiperatividade (TDAH), esquizofrenia e outros transtornos mentais e déficits cognitivos e de desenvolvimento em lactentes e pré-escolares. Foram realizadas buscas nas bases PubMed, EMBASE e BIREME/BVS para identificar estudos sobre associações entre o uso de ADs durante a gestação e transtornos de neurodesenvolvimento e psiquiátricos. Vinte estudos trataram de riscos de TEA e/ou TDAH, enquanto 30 focaram em déficits cognitivos e de desenvolvimento em lactentes ou pré-escolares. A maioria dos estudos não detectou associação entre AD na gestação e TEA, depois de ajustar as razões de risco para depressão ou outros transtornos psiquiátricos maternos. Alguns estudos mostraram que a depressão materna, quer tratada ou não, aumenta o risco de TEA. Sete entre oito estudos não detectaram aumento de risco de TDAH associado à exposição intrauterina a inibidores seletivos da recaptação da serotonina, o AD mais comumente utilizado. Não foram encontradas evidências consistentes entre o uso de AD na gestação e déficits de desenvolvimento neurocognitivo em lactentes ou pré-escolares. Em quase todos os estudos, permaneceu um confundimento residual por indicação (gravidade da depressão). A revisão sistemática não encontrou evidências consistentes de que os ADs na gestação aumentassem o risco de TEA, TDAH ou déficits de desenvolvimento neurocognitivo. Entretanto, alguns estudos evidenciaram que a depressão materna aumenta o risco de TEA.

Resumen: Este estudio investigó si la exposición prenatal a antidepresivos (ADs) incrementa los riesgos de trastornos del espectro autista (TEA), trastornos de déficit de atención/hiperactividad (TDAH), esquizofrenia, así como otras enfermedades mentales, cognitivas, y déficits en el desarrollo de niños de primaria o preescolares. Se consultaron las bases de datos PubMed, EMBASE, BIREME/BVS para identificar estudios de asociaciones de ADs durante el embarazo con trastornos de desarrollo neurológico y psiquiátricos. Veinte estudios estaban centrados en riesgos de TEA y/o TDAH, mientras que 30 se centraron en déficits de desarrollo y cognitivos en niños de primaria o preescolares. La mayor parte de los estudios no detectaron asociación de AD, durante la etapa prenatal, con TDA tras el ajuste de las ratios de riesgo para depresión materna o trastornos psiquiátricos. Algunos estudios mostraron que la depresión materna, independientemente de si es tratada o no, incrementó los riesgos de TEA. Siete de los 8 estudios no encontraron un incremento en el riesgo de TDAH, asociado con la exposición prenatal a inhibidores selectivos de la recaptación de serotonina, el antidepresivo más usado habitualmente durante el período prenatal. No se encontraron evidencias consistentes relacionando AD durante el embarazo y déficits en el desarrollo neurocognitivo de niños de primaria o preescolares. En casi todos los estudios hubo una desviación residual señalada como gravedad de la depresión. Esta revisión sistemática no halló evidencias consistentes, sugiriendo que el consumo de ADs durante el embarazo incremente el riesgo de TEA, TDAH, y déficits en el desarrollo neurocognitivo. Algunos estudios, no obstante, encontraron evidencias de que la depresión materna incrementa riesgos de TEA.

Prevalencia de los trastornos del espectro autista en niños en Estados Unidos, Europa y España: coincidencias y discrepancias / Prevalence of autism spectrum disorders in USA, Europe and Spain: coincidences and discrepancies

Los trastornos del espectro autista (TEA) engloban a un grupo heterogéneo de trastornos del neurodesarrollo que tienen en común la presencia de problemas para la interacción/comunicación social y la tendencia a mostrar intereses restringidos o conductas repetitivas. Diversos estudios epidemiológicos realizados en diferentes países en los últimos años han mostrado de forma consistente dos características: el incremento progresivo en la prevalencia de los TEA a nivel mundial y la existencia de una gran variabilidad geográfica entre territorios y dentro de un mismo territorio. En el presente artículo analizamos los datos de prevalencia más recientemente publicados en EE.UU. y en diversos países de Europa (incluyendo España), que muestran tasas de prevalencia muy variables, con un rango que abarca desde 1/59 niños con trastornos del espectro autista en EE. UU., hasta 1/806 en Portugal. En un segundo tiempo describimos brevemente algunas de las principales hipótesis que intentan explicar esta variabilidad.

Autism spectrum disorders are a heterogeneous group of disorders that share the presence of two core symptoms: problems in social interaction / communication and the tendency to present restricted interests and repetitive behavior. Over the last years, several epidemiologic studies have been published by different authors in diverse countries, having all of them shown two common characteristics: a global increase in the prevalence rates of autism spectrum disorders, and the existence of a great geographical variability no only between geographical areas, but also within the same geographical areas. At the present manuscript, we analyze some of the most recent prevalence data published in USA and some European countries (including Spain). All of them show different prevalence rates, ranging from 1/59 children with autism spectrum disorders in the USA to 1/806 in Portugal. In a second part, we briefly describe some of the current scientific hypotheses that try to explain this variability.

O perfil da população infantil com suspeita de diagnóstico de transtorno do espectro autista atendida por um Centro Especializado em Reabilitação de uma cidade do Sul do Brasil / The profile of the child population with suspected diagnosis of autism spectrum disorder attended by a Specialized Rehabilitation Center in a southern Brazilian city

Resumo O Centro Especializado em Reabilitação (CER-II) é um serviço do SUS que trabalha interdisciplinarmente na avaliação e reabilitação de pessoas com deficiência, incluindo a população com autismo. O objetivo desta pesquisa foi caracterizar o perfil da população infantil com suspeita de transtorno do espectro autista atendida por um CER-II do Sul do Brasil, levantar fontes, motivos de encaminhamentos, características sociodemográficas, instrumentos psicométricos utilizados nas avaliações e os níveis de diagnóstico recebido. Neste estudo documental retrospectivo, descritivo e exploratório-quantitativo, foram analisados 685 prontuários de usuários com idade de zero a 12 anos, que fizeram avaliação entre 2014 até dezembro de 2017. Os resultados mostraram que a média de idade da amostra é de 5,47 anos, sendo 83,8% do sexo masculino, 42% encontram-se na educação infantil e 59,7% fazem parte de uma família nuclear. Os sinais que mais motivaram encaminhamentos foram os déficits de linguagem (58,8%) e comportamentos externalizantes (56,9%); 30,1% da amostra obtiveram diagnóstico de TEA confirmado e o instrumento mais utilizado foi o ABC (70,5%). Observa-se a efetividade da aplicação do serviço proposto por essa política pública, destacando-se a necessidade de instrumentos qualificados para avaliação do diagnóstico e capacitação continuada para profissionais que nela atuam.

Abstract The CER-II Specialized Rehabilitation Center is a SUS service that works interdisciplinarly in the assessment and rehabilitation of people with disabilities, including the population with autism. This research aimed to characterize the profile of children with suspected autistic spectrum disorder treated by a CER-II from southern Brazil, to survey sources, referral reasons, socio-demographic characteristics, psychometric instruments used in the assessments and the levels of diagnosis received. This retrospective, descriptive and exploratory-quantitative documentary study assessed 685 medical records of users aged 0 to 12 years old who were evaluated between 2014 and December 2017. The results showed that the average age of the sample is 5.47 years; 83.8% are male, 42% are in kindergarten and 59.7% are part of a nuclear family. The signs that most motivated referrals were language deficits (58.8%) and externalizing behaviors (56.9%); 30.1% of the sample had a confirmed ASD diagnosis and the most used instrument was the ABC (70.5%). It is observed the effectiveness of the application of the service proposed by this public policy, highlighting the need for qualified instruments for diagnostic evaluation and continuing training for professionals who work in it.

Retraso del desarrollo del lenguaje en niños de 24 meses en un centro de salud en la Ciudad de Buenos Aires / Language development delay in 24-month-old children at a health care center of the City of Buenos Aires

Introducción. El retraso del desarrollo del lenguaje representa un desafío frecuente para pediatras y otros profesionales. El objetivo principal fue establecer su prevalencia en niñas y niños usuarios de un centro de salud. Población y métodos. Se evaluó el vocabulario expresivo de niñas y niños de 24 meses en un centro de salud utilizando el Inventario de Desarrollo de Habilidades Comunicativas MacArthur-Bates, versión breve (adaptación argentina). Se investigó la asociación entre el retraso del lenguaje y las características demográficas, socioeconómicas, conductuales/emocionales y de estrés parental. En aquellos con retraso expresivo, se evaluó el vocabulario receptivo y se investigaron posibles causas subyacentes (retraso cognitivo no verbal, trastornos del espectro autista, patología del oído medio e hipoacusia). Resultados. Se observó un retraso del desarrollo del lenguaje en 16 de 138 participantes (11,6%; intervalo de confianza -IC- 95%: 6,2-17%), asociado significativamente con antecedentes familiares de retraso del lenguaje, estrés parental y comportamiento problemático. El compromiso del vocabulario receptivo se identificó en 13 de 16 casos con retraso del desarrollo del lenguaje, y 7 presentaron sospecha de trastorno del espectro autista, de retraso global del desarrollo o ambas. Se observó la patología del oído medio en 5 de 9 estudiados. Los 9 participantes a los que se realizó una audiometría no presentaron resultados patológicos de acuerdo con los criterios adoptados en el presente trabajo. Conclusiones. El retraso del desarrollo del lenguaje representa un problema prevalente en nuestra población y se asoció principalmente con problemas de comportamiento y antecedentes familiares de retraso del lenguaje.

Introduction. Language development delay is a frequent challenge for pediatricians and other health care providers. The main objective of this study was to establish its prevalence among children attending a health care center. Population and methods. The expressive vocabulary of 24-month-old children attending a health care center was assessed using the Spanish-language MacArthur-Bates Communicative Development Inventories, short form (Argentine version). The association between language delay and demographic, socioeconomic, behavioral/emotional, and parental stress characteristics was analyzed. In children with expressive language delay, receptive vocabulary was assessed and possible underlying causes were studied (non-verbal cognitive delay, autistic spectrum disorders, middle ear pathology, and hearing impairment). Results. Language development delay was observed in 16 out of 138 participants (11.6%; 95% confidence interval: 6.2-17%), significantly associated with a family history of language delay, parental stress, and problem behavior. Receptive vocabulary compromise was identified in 13 out of 16 children with language development delay, and 7 were suspected of autistic spectrum disorder, overall developmental delay, or both. A middle ear pathology was observed in 5 out of 9 studied children. The 9 participants who had an audiometry did not have pathological results based on this study's criteria. Conclusions. Language development delay is a prevalent condition in our population and has been mainly associated with behavioral problems and a family history of language delay.

Características perinatais de crianças com transtorno do espectro autista / Perinatal features of children with autism spectrum disorder

RESUMO Objetivo: Analisar características perinatais de crianças com transtorno do espectro autista (TEA). Métodos: Revisão retrospectiva dos prontuários medicos de 75 crianças com TEA, entre janeiro de 2008 e janeiro de 2015. Os critérios de inclusão foram o diagnóstico de TEA baseado no DSM-5 e o termo de consentimento assinado pelo responsável legal. O critério de exclusão foi ausência de todos os dados no prontuário médico. As variáveis analisadas foram: idade materna, prematuridade (idade gestacional menor que 37 semanas), baixo peso ao nascer (<2.500 g) e asfixia perinatal (Apgar menor que 7 no quinto minuto). Os dados foram avaliados por meio do teste de diferença entre as proporções (nível de significância de p<0,05). Resultados: Setenta e cinco pacientes foram incluídos no estudo. A idade materna variou de 21,4 a 38,6 anos (29,8±4,1 anos). O parto prematuro ocorreu em 14 (18,7%) pacientes, asfixia perinatal em 6 (8,0%) e baixo peso ao nascer em 32 (42,6%). As prevalências de prematuridade, asfixia perinatal e baixo peso ao nascer entre as crianças com TEA neste estudo foram maiores do que as prevalências gerais dessas condições entre todos os nascidos vivos em nosso país, região e estado, as quais são, respectivamente, 11,5, 2,3 e 8,5% no Brasil, 11,0; 2,2 e 8,5% na região Sul e 10,5, 2,0 e 8,4% no estado do Paraná. Conclusões: Nossos achados mostraram maior prevalência de prematuridade, baixo peso ao nascer e asfixia perinatal em crianças com TEA. Algumas limitações são o desenho retrospectivo do estudo e a amostra de pequeno tamanho. Grandes estudos prospectivos são necessários para esclarecer a possível associação entre intercorrências perinatais e TEA.

ABSTRACT Objective: To analyze perinatal features of children with autism spectrum disorder (ASD). Methods: Retrospective review of the medical records of 75 children with ASD, between January 2008 and January 2015. Inclusion criteria were diagnosis of ASD based on DSM-5 criteria, and the informed consent form signed by the person who is legally responsible. The exclusion criterion was missing on the medical record. The variables analyzed were maternal age, prematurity (gestational age under 37 weeks), low birth weight (<2,500 g), and perinatal asphyxia (5th minute Apgar score <7). Data were analyzed using the difference between proportions test, being significant p<0.05. Results: Seventy-five patients were included. Maternal age ranged from 21.4 to 38.6 years (29.8±4.1 years). Premature birth occurred in 14 (18.7%) patients, perinatal asphyxia in 6 (8.0%), and low birth weight in 32 (42.6%) patients. The prevalence of prematurity, low birth weight, and perinatal asphyxia among the children in our study was higher than the general prevalence of these conditions among all live births in our country, region, and state, which are, respectively, 11.5, 2.3, and 8.5% in Brazil; 11.0, 2.2, and 8.5% in Southern Brazil; and 10.5, 2.0, and 8.4% in the state of Paraná. Conclusions: Our findings show a higher prevalence of prematurity, low birth weight, and perinatal asphyxia among children with ASD. Some limitations are the retrospective study design, and the small sample size. Large prospective studies are needed to clarify the possible association between perinatal complications and ASD.

Aspectos sociodemográficos, clínicos e familiares de pacientes com o transtorno do espectro autista no sul de Santa Catarina / Sociodemographic, clinical and familial aspects of patients with autism spectrum disorder in southern Santa Catarina

O transtorno do espectro autista (TEA) é considerado um distúrbio global do desenvolvimento que atinge a linguagem, a cognição e a interação social. OBJETIVO: Descrever o perfil diagnóstico de pacientes com o transtorno do espectro autista atendidos no Ambulatório de Neurogenética da Universidade do Sul de Santa Catarina. MÉTODOS: Foram analisados 122 prontuários de pacientes diagnosticados com Transtorno do Espectro Autista em acompanhamento regular no ambulatório de neurogenética da UNISUL entre os anos de 2010 e 2013. RESULTADOS: Foi encontrada a razão de 3 meninos para cada menina com TEA. O sexo feminino foi fator de risco para outros problemas de saúde. Problemas do sono e pais com problemas psiquiátricos estiveram associados a outras patologias clínicas e psiquiátricas. CONCLUSÃO: Entre os pacientes com TEA, o sexo feminino, história de pais com problemas psiquiátricos, e distúrbios do sono apresentaram associação estatística com comorbidades neurológicas, respiratórias e genéticas.

The Autism Spectrum Disorder (ASD) is considered a global disorder of the human development and it involves language, cognition and social interaction. AIM: To describe the diagnosis profile of patients living with ASD and attending the Neurogenetics Ambulatory of the Santa Catarina Southern University (UNISUL). METHODS: There have been analyzed 122 medical records of patients diagnosed with ASD in regular follow-up in the UNISUL's Neurogenetics Ambulatory between 2010 and 2013. RESULTS: The gender ratio of three boys to each girl in the sample have been found. Female gender was a risk factor for the occurrence of other medical conditions. Sleeping issues and parents with mental disorders were associated to other diseases. CONCLUSION: Among the patients with ASD, female gender, having parents with mental disorders and presenting sleeping problems were associated with neurological, respiratory and genetic comorbidities.

Alteraciones en la salud mental materna como factor de riesgo para trastorno del espectro autista / Maternal mental health disorders as a risk factor for autism spectrum disorder

El trastorno del espectro autista (TEA) es un síndrome multifactorial difícil de determinar. Se diagnostica a los 36 meses y está caracterizado por dificultades a nivel comunicacional, interacción social y conductas o actividades restringidas, repetidas y estereotipadas. Evidencias neuroanátomicas, exposición a teratógenos y diferencias de comportamiento en etapas tempranas sugieren que la neurobiología del TEA comienza durante el periodo intrauterino. Su desarrollo presenta componentes biológicos y ambientales. Estos últimos han sido menos estudiados, debido a los múltiples factores de gestación a que puede estar expuesto el feto, tal como diabetes gestacional materna, hipertensión, proteinuria, preclampsia, estado nutricional y exposición a contaminantes. Adicionalmente, existen estudios que han relacionado la salud mental de la madre con el diagnóstico de TEA ­hipótesis abordada en este trabajo­, puesto a que es un factor ambiental modificable en etapas tempranas su debida intervención podría prevenir el trastorno de desarrollo en las futuras generaciones o entregar evidencia para un diagnóstico temprano y, por ende, intervención. A pesar de los intentos por corroborar dicha conjetura, las inconsistencias de los resultados y las diferentes metodologías para estudiar los factores ambientales del TEA son un desafío para llegar a soluciones sólidas. Aún así, determinar factores de riesgo prenatal o en etapas tempranas sería crítico para la prevención o incluso mitigación del TEA.

The autism spectrum disorders (ASD) is a multifactorial syndrome hard to determinate. It is diagnosed at 36 months and is characterized by communication difficulties, social interaction and restricted, repeated and stereotyped behaviors or activities. Neuroanatomical evidence, exposure to teratogens, and behavioral differences in early stages suggest that neurobiology of ASD begins during the intrauterine period. Its development has biological and environmental components. The last component have been less studied because of the multiple gestational factors that the fetus may be exposed, for example maternal gestational diabetes, hypertension, proteinuria, pre-eclampsia, nutritional status and exposure to contaminants. Additionally, there are studies that have related the maternal mental health with the diagnosis of ASD -hypothesis of this work- as a modifiable environmental factor in the early stages. Their appropriate intervention could prevent the developmental disorder in the future generations or could provide evidence for an early diagnosis, and therefore, intervention. In spite of attempts to corroborate this conjecture, the inconsistencies of the results and the different methodologies that studying the environmental factors of the ASD have become into a challenge to reach solid solutions. Even so, determining prenatal or early risk factors could be critical for the prevention or even mitigation of ASD