Disability in children and adolescents: the extent of the impact on psychiatric disorders and educational deficits

Abstract Introduction Most children/adolescents with disability live in low and middle-income countries and, worldwide, they are more likely to have mental health problems and achieve worse academic performance compared to those with typical development. Objective To assess whether Brazilian children/adolescents with four types of disabilities are more likely to have psychiatric disorders and educational deficits than children/adolescents with typical development. Method A multicenter cross-sectional study involving a school-based probabilistic sample of second to sixth graders (N = 1,674) from public schools in four Brazilian regions. The four types of disabilities (intellectual, visual, hearing, and motor) were assessed using the Ten Questions Questionnaire. Psychiatric disorders were measured with the Schedule for Affective Disorders/Schizophrenia for School-Age Children (K-SADS-PL), and academic performance was evaluated using the Teste de Desempenho Acadêmico - TDE (the academic performance test). Results A logistic regression model with cluster-robust errors identified the following statistically significant associations with three of the four types of disability (the exception was hearing). Intellectual disability was associated with anxiety (p < 0.01), depression (p < 0.01), attention deficit hyperactivity disorder (ADHD) (p < 0.001), school failure (p < 0.01), and poor academic performance (p < 0.01). Visual disability was associated with depression (p < 0.01). Motor disability was marginally associated with ADHD (p = 0.08). Conclusions Presence of disabilities (intellectual, visual, and motor) in children/adolescents was associated with psychiatric disorders, school failure, and academic performance. It is therefore important to identify presence of disabilities and plan and deliver specific interventions and specialized educational care for the needs presented by these children/adolescents. This is particularly important in low and middle-income countries, where these disabilities are frequent among children/adolescents.

Associações entre Sinais Precoces de Autismo, Atenção Compartilhada e Atrasos no Desenvolvimento Infantil / Associations Among Early Signs of Autism, Joint Attention and Developmental Delays in Children

RESUMOOs Transtornos do Espectro do Autismo (TEA) costumam comprometer o funcionamento adaptativo e desenvolvimento psicossocial na infância. O objetivo deste estudo foi buscar associações entre: sinais precoces dos TEA, falhas na atenção compartilhada-AC e atrasos de desenvolvimento. Participaram do estudo 92 crianças (16-24 meses) de cinco creches de Barueri-SP. Instrumentos utilizados: Development Screening Test-DENVER-II (desenvolvimento neuropsicomotor), Modified Checklist for Autism in Toddlers-M-CHAT (sinais precoces de TEA), Pictorial Infant Communication Scales-PICS(comunicação social). Identificou-se 28,3% de atrasos no desenvolvimento neuropsicomotor. Cinco crianças apresentaram sinais precoces dos TEA; todas falharam nas provas de AC (PICS). Nas crianças que apresentaram sinais indicativos de TEA, os déficits mais comuns foram relacionados à atenção compartilhada, área que deve ser privilegiada em avaliações precoces.

ABSTRACTThe Autism Spectrum Disorders (ASD) usually impair adaptive functioning and psychosocial development in childhood. The purpose of this study was to investigate associations among early signs of ASD, failures in joint attention (JA) and developmental delays. Participants were 92 children (16-24 months of age) from five day-care centers in Barueri-SP. Assessment instruments used: Development Screening Test-DENVER-II (child development); Modified Checklist for Autism in Toddlers-M-CHAT (screening for ASD); Pictorial Infant Communication Scales-PICS (social communication). Developmental delays were observed in 28.3% of the children. Five children showed early signs of ASD, all with deficits in joint attention. Since among children with early signs of ASD, the most common deficits were related to joint attention, this field should be privileged in early evaluations.

Rastreamento de sinais precoces de transtorno do espectro do autismo em crianças de creches de um município de São Paulo / Screening of early signs of autism spectrum disorder in children of a day care center from the city of São Paulo / Seguimiento de señales tempranas de trastornos del espectro del autismo en guardería infantil de la ciudad de São Paulo

Os transtornos do espectro do autismo (TEA) são considerados um dos mais severos transtornos infantis e se caracterizam por comprometer as habilidades sociais iniciais, que surgem nos primeiros anos de vida da criança e, portanto, podem ser investigadas a partir desse período. O objetivo desta pesquisa foi descrever as habilidades de orientação social e atenção compartilhada de uma amostra aleatória de 104 crianças, com idades entre 16 e 24 meses, identificando possíveis sinais precoces dos TEA nessa população. Para o rastreamento, utilizaram-se a escala Pictorial Infant Communication Scales (Pics) e a Modified Checklist for Autism in Toddlers (M-Chat). Das crianças avaliadas, quatro (3,8%) apresentaram sinais precoces de TEA. As habilidades mais comprometidas foram iniciação da atenção compartilhada e iniciação do comportamento de solicitação. Dados desta e de outras pesquisas nesse campo são relevantes para o planejamento de intervenções, que podem levar ao melhor prognóstico dos casos.

Autism spectrum disorders (ASD) are considered one of the most severe childhood disorders are characterized by compromise and social skills initials, which appear early in a child's life, and therefore can be investigated from this period. The aim of the research was to describe the social orientation and joint attention skills in a random sample of 104 children, aged between 16 and 24 months, identifying possible early signs of ASD in this population. For the screening were used the Pictorial Infant Communication Scales (Pics) and the Modified Checklist for Autism in Toddlers (M-Chat). Among the children studied, four (3.8%) showed early signs of ASD. The skills most compromised in these children, according to the Pics were the abilities of initiation of joint attention and initiation of request behavior. Data from this and other research in this field are relevant for planning interventions that can lead to better prognosis of cases.

Los trastornos del espectro autista (TEA) son considerados uno de los trastornos infantiles más graves y se caracterizan por una afectación de habilidades sociales iniciales en la vida del niño, y por lo tanto se pueden detectar a partir de este período. El objetivo de esta pesquisa fue describir las habilidades de orientación social y atención compartida en una muestra aleatoria de 104 niños, con edades entre 16 y 24 meses, identificando posibles signos tempranos de TEA. Para el despistaje fueron utilizadas la escala Pictorial Infant Communication Scales y la escala Modified Checklist for Autism in Toddlers. De los niños estudiados, cuatro (3,8%) mostraron signos tempranos de TEA. Las habilidades más comprometidas fueron la iniciación de atención compartida e iniciación de comportamiento de solicitación. Los datos obtenidos así como los de otras investigaciones en este campo son relevantes para la planificación de intervenciones que puedan conducir a un mejor pronóstico de los casos.

Atuação de psicólogos e estruturação de serviços públicos na assistência à saúde mental de crianças e adolescentes / Pratice of psychologists and public services organization for child and adolescent mentak health care / Práctica de psicólogos y organización de los servicios públicos para el cuidado de la salud mental de los niños y adolescentes

Assistência à saúde mental na infância/adolescência (Smia) tem complexidades próprias, sendo um desafio para os psicólogos recentemente inseridos nas equipes de atenção primária (AP). Os principais objetivos deste trabalho foram descrever atendimentos, serviços e programas oferecidos pela Secretaria Municipal de Saúde a crianças e adolescentes da região da Sé-SP. Foram realizadas entrevistas estruturadas com profissionais-chave de todas as oito unidades de AP e com a coordenadora dessa região, além de buscas sistemáticas em dados públicos. Observou-se que a estrutura da AP da Sé segue preceitos do Sistema Único de Saúde (SUS), a atuação do psicólogo é focada prioritariamente no atendimento individual, e a maioria das unidades contava com um profissional dedicando parcialmente seu tempo à assistência a Smia. Profissionais-chave também relataram falta de: espaço para reflexão das equipes, capacitação continuada e supervisão institucional. Conclui-se que houve um progresso na assistência a Smia, mas a falta de tempo e capacitação especializada ainda são limitações importantes.

Provision of mental health care for children/adolescents (MHCCA) has its own complexities, being challenging for psychologists currently part of the Primary Health Care (PHC) teams. The main objectives of this study were to describe care, services and programs offered by the municipality's health office to children and adolescents living at the Sé district-SP. Structured interviews were conducted with key professionals and with the health coordinator of the Sé district; in addition to systematic searches in public record data. It was noted that structure of local PHC follows SUS principles; psychologist's assistance is focused on individual care and most of units had a part time professional dedicated to MHCCA provision. Professionals also reported lack of: time for reflection about team work, training and institutional supervision. It is concluded that there was a progress in the assistance to MHCCA, but lack of time and specialized training still are important limitations.

Asistencia a la salud mental en la infancia/adolescencia (Smia) tiene sus complejidades, sobre todo con la inclusión de los psicólogos en los equipos de atención primaria (AP). Los objetivos fueron describir la atención/servicios/programas ofrecidos por el Departamento Municipal de Salud a los niños/adolescentes de la región Sé-SP. Se realizaron entrevistas estructuradas con profesionales de las ocho unidades de AP y el coordinador de la región, bien como búsquedas sistemáticas en los datos públicos. Se observó que la estructura de la AP siegue los preceptos del SUS; los psicólogos se centran en la atención individual y en la mayoría de las unidades había un profesional a tiempo parcial dedicado a Smia. Profesionales informaran sobre la falta de: tiempo para reflexión de los equipos, formación continua, supervisión institucional. De ello se deduce que hubo algunos avances en la asistencia a Smia, pero la falta de tiempo y conocimientos especializados son limitaciones importantes.