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RESUMO: O brincar infantil é reconhecido como ocupação que favorece o desenvolvimento e a autonomia das crianças. Estudos realizados com crianças com Transtorno do Espectro Autista (TEA) evidenciaram comprometimentos na participação no brincar. Este estudo objetivou descrever a participação de crianças com desenvolvimento típico e com TEA em situações de brincadeiras no contexto da Educação Infantil. Tratou-se de um estudo de abordagem qualitativa do tipo exploratória e descritiva que empregou a observação do comportamento do brincar na escola como instrumento de coleta de dados. Participaram da pesquisa seis crianças entre 4 e 5 anos, sendo três com desenvolvimento típico e três diagnosticadas com TEA. Embora o estudo não tenha tido a intenção de estabelecer comparações, os principais resultados apontaram diferenças entre os dois grupos. Crianças com TEA evidenciaram desenvolvimento do comportamento lúdico não condizente com a idade e um brincar concreto e com interação social ausente ou rudimentar. Esses resultados apontam para reflexões no contexto da Terapia Ocupacional para o desenvolvimento de estratégias que visem a participação das crianças na Educação Infantil, indicando a necessidade de promoção de oportunidades mediadas e/ou com brinquedos adaptados de acordo com os interesses das crianças com TEA.
ABSTRACT: Children's play is recognized as an occupation that favors children's development and autonomy. Studies carried out with children with Autistic Spectrum Disorder (ASD) showed impairments in participation in playing. This study aimed to describe the participation of children with typical development and with ASD in play situations in the context of Early Childhood Education. It was an exploratory and descriptive qualitative study that used the observation of playing behavior in school as an instrument of data collection. Six children between 4 and 5 years old participated in the research, three with typical development and three diagnosed with ASD. Although the study was not intended to make comparisons, the main results showed differences between the two groups. Children with ASD showed development of playful behavior not consistent with age and concrete play with absent or rudimentary social interaction. These results point to reflections in the context of Occupational Therapy for the development of strategies aimed at the participation of children in Early Childhood Education, indicating the need to promote mediated opportunities and/or with toys adapted according to the interests of children with ASD.
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Resumen Los individuos con trastornos del espectro autista suelen describirse con deficiencias comunicativas, sociales, emocionales y de comportamiento. A menudo están aislados y son pasivos, con pocas oportunidades de interacción positiva y constructiva con el mundo exterior. Por otra parte, pueden mostrar comportamientos retraídos, estereotipados y disruptivos. Estas condiciones pueden dificultar seriamente sus habilidades adaptativas al ambiente, con consecuencias negativas en su calidad de vida. La heterogeneidad fenotípica y la manifestación, así como la gravedad de los síntomas, pueden variar considerablemente según el niño. Esos determinan la necesidad de intervenciones personalizadas y adaptivas según las necesidades específicas, incluyendo factores como la edad, las habilidades intelectuales y las áreas afectadas específicas. Una intervención temprana promovería las habilidades adaptativas, la autodeterminación y la autonomía hacia el entorno. No obstante, los tiempos de esperas y los costes no permiten una evaluación temprana y como consecuencia los tiempos de intervención se retrasan afectando la cualidad de vida de los niños y de los pa dres. Además, los programas tradicionales de intervención dependen de la experiencia de los terapeutas. Una posible forma de superar este problema es el uso de tecnología adaptativa objetiva según las necesidades. El objetivo de este artículo es proporcionar una visión general de las pruebas empíricas disponible en los últimos siete años. En total, se seleccionaron 8 estudios, con 132 participantes que utilizaron 4 sistemas tecnológicos. Por último, se discuten las implicaciones tecnológicas, clínicas, psicológicas y rehabilitadoras de los hallazgos. Se esbozaron directrices prácticas dentro de esta área temática como perspectivas de investigación futuras.
Abstract Individuals with autistic spectrum disorder are often described as having communication, social, emo tional, and behavioral impairments. They are often isolated and passive, with few opportunities for positive and constructive interaction with the outside world. Moreover, they may exhibit withdrawn, stereotyped and disruptive behaviors. The aforementioned conditions can seriously hamper their ability to adapt to the environment, with negative consequences on their quality of life. Phenotypic heterogeneity and manifestation, as well as symptom severity, can vary greatly from child to child. These determine the need for individualized and adaptive interventions according to specific needs, including factors such as age, intellectual ability, and specific affected areas. Early intervention would promote adaptive skills, self-determination, and autonomy towards the environment. However, wait times and costs do not allow for early assessment, and therefore intervention times are delayed, affecting the quality of life of children and parents. In addition, traditional intervention programs depend on the expertise of the therapists. One possible way to overcome this problem is by using objective adaptive technologies based on needs. This article aims to provide an overview of the empirical evidence available over the past seven years. Overall, 8 studies were selected, with 132 participants using 4 technological systems. Finally, the technological, clinical, psychological, and rehabilitative implications of the findings are discussed. Practical guidelines within this topic area are outlined as future research perspectives.
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Los trastornos del espectro autista (TEA) son trastornos del neurodesarrollo que afectan la comunicación social y que presentan patrones de conducta repetitiva, estereotipada o/y inflexible. Un tercio de los casos diagnosticados de TEA tienen discapacidad intelectual y 2/3 una capacidad intelectual dentro de la norma. Los síntomas nucleares de autismo y otros asociados pueden afectar el desarrollo afectivo-sexual. En este artículo se expone qué dificultades en el desarrollo afectivo-sexual pueden presentar las personas con TEA y cuáles son las más frecuentemente descritas. Se propone de una manera breve, guías dirigidas a la evaluación y a la ayuda para un desarrollo afectivo-sexual satisfactorio en las personas con autismo-TEA.
Autistic spectrum disorders (ASD) are neurodevelopmental disorders that affect social communication and present repetitive, stereotyped and inflexible behaviour. A third of the people with a diagnosis of ASD also have intellectual disability associated and two thirds present an intellectual capacity within the average range. The nuclear autistic and others associated symptoms can affect the affective and sexual development. This article exposes which are the problems people with ASD present in the affective and sexual development, the most frequently described and brief guides for evaluation and support for an adequate affective-sexual development in people with ASD.
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Humanos , Masculino , Feminino , Sintomas Afetivos/fisiopatologia , Desenvolvimento Sexual/fisiologia , Transtorno do Espectro Autista/fisiopatologia , Fatores Sexuais , Sintomas Afetivos/psicologia , Relações Interpessoais , Deficiência Intelectual/fisiopatologiaRESUMO
The pathogenesis of autistic spectrum disorders is complicated and the exact etiology and pathogenesis remain unclear. Major advances in spatial information technology have revealed the potential of spatial information technology as an effective tool in research and treatment for children with autistic spectrum disorders. However, there are too many fragmented research topics. According to recent reports on spatial information technology, there is no precedent for the application of spatial information technology in autistic spectrum disorders in China. Space information technology analysis for autistic spectrum disorders can be divided into the following steps: pre analysis, spatial clustering analysis, spatial model analysis, and interpretation of related results. It is hopeful that the space information technology can provide proposals for the future research on the pathogenesis of autistic spectrum disorders in our country.
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Criança , Humanos , Transtorno Autístico , China , Análise por Conglomerados , Tecnologia da Informação , Análise EspacialRESUMO
Objective To investigate the effects of acupoint injection of mouse nerve growth factor (mNGF) on treatment of children with autistic spectrum disorders in different age groups. Methods Totally 80 cases of children with autistic spectrum disorders were divided into control group and experiment group according to random number table method, with 40 cases in each group. The control group was given structured education, ABA behavioral training, sensory integration training, and language training, 30 min for each class, 4 h each day, 5 d a week, for 5 months. At the same time, the control group was also given head needling treatment, once every other day, 3 times a week, 30 times as one treatment course, 2 courses. On the basis of the treatment of the control group, experiment group was given mNGF through acupoint injection, once every other day, 3 times a week, 10 times as one treatment course, 10 d between each treatment course, 5 courses in total. The scores of autism behavior checklist (ABC), children autism and related developmental disorders psychological education rating scale-Chinese version (C-PEP), neuropsychological development scale among children aged 0–6 years in the two groups were compared. Results Compared with before treatment, ABC scores in both group after treatment decreased significantly (P<0.05); ABC scores after treatment in children aged 18–36 months and 37–54 months in the experiment group were lower than those of the control group (P<0.05). Neuropsychological development scale scores in children aged 18–36 months and 37–54 months were better than the control group (P<0.05). Compared with before treatment, C-PEP scores of both groups increased significantly (P<0.05). There was statistical difference in the C-PEP scores in children aged 18–36 months between the two groups after treatment (P<0.05). The C-PEP scores in children aged 18–36 months increased to the highest (P<0.05).Conclusion Acupoint injection of mNGF can improve the clinical symptoms and intelligence of ASD children of all ages, but children can receive better treatment effects at younger ages.
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Disability in children can be broadly classified into physical and mental disabilities and there are many conditions that result in this. Physical disability is often present in children with cerebral palsy or neuromuscular disorders. With mental disability, the children are not able to learn self help skills and remain dependent on their caregivers for most of the activities of daily living. An extension of this group would include those with moderate to severe autism. In paediatrics, many conditions result in both forms of disabilities with greater consequence and burden to their families. Thus, early rehabilitation incorporating motor learning, education and vocational training, which are inclusive of all aspects of health and neuro-development, is the new paradigm shift. The current emphasis is focused on health and function, and not the disability. Rehabilitation plans are made toward the goals of life in school and community; participation and if possible, contribution to the society in adulthood. Long term care if needed, remains a most challenging task for all involved in the management of children with severe disabilities.
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Este artigo apresenta sessões conjuntas com os pais e sua filha de três anos, com transtorno global do desenvolvimento (posteriormente definido como Síndrome de Rett), incluindo traços autísticos. A criança, apática e hipotônica, com movimentos estereotipados das mãos, respondia pouco às solicitações dos adultos. Nas intervenções, procurou-se estabelecer redes de sentido que pudessem significar seu estado isolado e que resgatassem as funções parentais. Destaca-se o investimento subjetivante do analista no trabalho com crianças com transtornos autísticos. O trabalho se desenvolve a partir do setting de intervenção nas relações iniciais pais-bebê, dos conceitos de estados autísticos, de reclamação, de subjetivação e de construção da parentalidade.
This paper presents joint sessions with parents and their three year-old daughter, who shows a Pervasive Developmental Disorder (later defined as Rett Syndrome) which includes autistic features. The apathetic and hypotonic child, with stereotyped hand movements, responded very poorly to requests from adults. During the interventions, there was an effort to establish networks of meaning capable of signifying her isolated condition and which could rescue parental functions. The analyst's subjectivating investment in the work with children who have autistic disorders is highlighted. The paper develops from the intervention setting in parent-infant initial relationships and from the concepts of autistic conditions, reclamation, subjectivation and parentality construction.
Este trabajo presenta sesiones conjuntas con dos padres y su hija de tres años, con trastorno global de desarrollo (posteriormente definido como Síndrome de Rett), incluyendo trazos autísticos. La niña, apática e hipotónica, con movimientos estereotipados de las manos, respondía poco a las solicitudes de los adultos. En las intervenciones se busca establecer redes de sentido que pudieran significar su estado de asilamiento y que rescaten las funciones parentales. Se destaca la inversión subjetivante del analista en el trabajo con niños con trastornos autísticos. El trabajo se desarrolla a partir del setting de intervención en las relaciones iniciales padres-bebé, de los conceptos de estados autísticos, de reclamación, de subjeti-vación y de construcción de la paternidad.
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Disability in children can be broadly classified into physical and mental disabilities, and there are many conditions that result in this. Physical disability is often present in children with cerebral palsy or neuromuscular disorders. With mental disability, the children are not able to learn self-help skills and remain dependent on their caregivers for most of the activities of daily living. An extension of this group would include those with moderate to severe autism. In paediatrics, many conditions result in both forms of disabilities, with greater consequence and burden to their families. Nevertheless, there had been some recent advances in the management of the spasticity in children with cerebral palsy and the beginning of pharmacological treatment for Duchenne muscular dystrophy. Long term care and rehabilitation remains the most challenging task for all involved in the care of disabled children.
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A Lista de Verificação em Comunicação e Linguagem aqui apresentada foi elaborada para avaliar as especificidades de dois grupos distintos: os transtornos do espectro autístico e outras alterações de desenvolvimento da linguagem. Com essa finalidade foi aplicada em 60 participantes, divididos em dois grupos: 20 portadores de transtornos do espectro autístico (M=7, 11) e 40 portadores de outras alterações de desenvolvimento da linguagem (M=4, 10). Foi utilizado o teste do Qui-Quadrado para avaliar a validade do conteúdo e determinar quais questões deveriam ser retiradas do instrumento por não serem significativas. Os outros testes utilizados foram o Índice de Concordância Kappa e o teste de Mann-Withney. A Lista também apresentou uma sensibilidade de 90 por cento e uma especificidade de 97,5 por cento, o que demonstra a viabilidade de sua utilização como instrumento auxiliar na detecção de transtornos do espectro autístico.
The Checklist in Communication and Language presented herein was elaborated to assess specificities of two distinct groups: the autistic spectrum disorders and other languages development alterations. With this objective, it was applied in 60 participants divided into two groups: 20 subjects with autistic spectrum disorders (M=7, 11) and 40 with language development alterations (M=4, 10). The statistical analysis held after application was the Chi-Square distribution test to assess the content validity and to determine what questions should be removed of the instrument for not being significant. The other tests used were the Kappa Index Agreement and Mann-Whitney test. The Checklist indicated sensibility of 90 percent and specificity of 97,5 percent, which demonstrates viability to be used as an auxiliary tool in detecting the autistic spectrum disorders.
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Humanos , Masculino , Feminino , Criança , Adolescente , Lista de Checagem , Desenvolvimento da Linguagem , Transtorno Autístico/psicologiaRESUMO
Das primeiras observações de Freud sobre a representação simbólica da vivência de separação do menino do carretel, seu netinho, ao longo de todos os inúmeros desdobramentos na compreensão do brincar infantil e do próprio desenvolvimento da técnica analítica com crianças, temos nos defrontado com expansões dos instrumentos psicanalíticos para acessar vários níveis de funcionamento mental. Este trabalho propõe um retrospecto e reflexão acerca do desenvolvimento do conceito de transferência, a partir das expansões impulsionadas pela clínica dos estados primitivos da mente. Discute-se a elasticidade do conceito de transferência, a partir de Freud, ao longo dos desenvolvimentos produzidos pela investigação psicanalítica de aspectos psicóticos da personalidade, dos estados primitivos da mente e da clínica psicanalítica de crianças com transtornos autísticos. Tais importantes desenvolvimentos da clínica, e consequentemente da teoria psicanalítica, nos permitem adentrar um campo, tido outrora, pelo próprio pioneiro, como inacessível. Vinhetas clínicas do trabalho psicanalítico com uma criança com transtorno autístico são utilizadas para ilustrar a discussão, sugerindo-se que um novo desafio para o desenvolvimento do conceito de transferência poderia consistir em incorporar (ou discriminar, suscitando formulações paralelas) aspectos primitivos do funcionamento mental que se presentificam no contato analítico.
De las primeras observaciones de Freud sobre la representación simbólica de la vivencia de separación del niño del carretel, su nieto, a lo largo de todos los innúmeros desdoblamientos en la comprensión del juego infantil y del propio desarrollo de la técnica analítica con niños, nos hemos enfrentado con expansiones de los instrumentos psicoanalíticos para acceder a varios niveles de funcionamiento mental. Este trabajo propone una retrospectiva y reflexión acerca del desarrollo del concepto de transferencia, a partir de las expansiones impulsadas por la clínica de los estados primitivos de la mente. Se discute la elasticidad del concepto de transferencia, a partir de Freud, a lo largo de los desarrollos producidos por la investigación psicoanalítica de aspectos psicóticos de la personalidad, de los estados primitivos de la mente y de la clínica psicoanalítica de niños con trastornos autísticos. Esos importantes desarrollos de la clínica y consecuentemente de la teoría psicoanalítica nos permiten abordar un campo, visto en otro momento, por el propio pionero, como inaccesible. Viñetas clínicas del trabajo psicoanalítico con un niño con trastorno autístico son utilizadas para ilustrar la discusión, sugiriéndose que un nuevo desafío para el desarrollo del concepto de transferencia podría consistir en incorporar (o discriminar, suscitando formulaciones paralelas) aspectos primitivos del funcionamiento mental que se presentan en el contacto analítico.
From Freud's initial observations about his grandson's symbolic representations of separation experiences, through playing with the reel, to significant conceptual and technical developments within the area of child analysis and play, we have been faced with expansions of psychoanalytic instruments in order to access different levels of mental functioning. This paper proposes a retrospect and reflection about the development of the concept of transference, considering expansions allowed by clinical practice with primitive states of mind. The scope and elasticity of the concept of transference are discussed, with Freud as a reference point, throughout the developments produced by psychoanalytic investigation of psychotic aspects of personality, primitive states of mind, and the psychoanalytic work with children with autistic disorders. These important developments in clinical practice, and consequently developments in psychoanalytic theory, allowed us access to this field, previously considered unreachable by the pioneer of Psychoanalysis himself. Clinical vignettes of psychoanalytic work with an autistic child are used to illustrate the discussion, suggesting that a new challenge to the development of the concept of transference could consist in incorporating (or discriminating, creating parallel formulations) primitive aspects of mental functioning which are present within analytic contact.
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Humanos , Criança , Psicanálise , Transtorno Autístico , Transferência PsicológicaRESUMO
Recent studies demonstrate that autistic spectrum disprders children have deficits in executive functiony, particularly the function referred response inhibition. The antisaccade task provides a new tool for direct evaluation of inhibitory function and a new way to explore the character of response inhibition in children with cognitive impairment. Researchers have used the technologies of eye movement to reveal the ability of oculomotor inhibition in children with autistic spectrum disprders, which is poorer than that of normal children.
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Developmental disabilities involve a delay in development based on that expected for a given age level or stage of development.1 These impairments which originate before age 18 are expected to continue indefinitely and constitute a substantial impairment that may create a burden to the family and society. In a developing country like the Philippines, it is a public health problem that remains largely undetected and neglected. Local attempts to organize more systematic diagnostic services are needed.Objectives. To review the referrals made to the Section of Developmental Pediatrics for evaluation and to describe the demographic and clinical patterns of the more common developmental disabilities identified.Methods. This was a retrospective study based on the clinical census of patients seen over a five-year period from January 2004 to December 2008 by the Section of Developmental Pediatrics.Results. Referrals made to the Section of Developmental Pediatrics were usually seen during the first decade of life, were mostly males and were usually referred for developmental delay. The three most common developmental disabilities identified were mental retardation or global developmental delay, autistic spectrum disorders and cerebral palsy.