Inter-relação entre duas teses de doutorado que incluíram em suas amostras de pesquisa crianças com transtorno do espectro autista (TEA) / Interrelationship between two doctoral thesis that included in their research samples children with autistic spectrum disorder (ASD)

Este artigo destaca a inter-relação entre duas teses de doutorado. Foram identificados e explorados, a partir da leitura minuciosa e da análise comparativa entre os dois trabalhos, quatro pontos de convergência entre as referidas teses. Além disso, foram apresentados sinteticamente os objetivos, os métodos, os resultados e as conclusões de cada um dos estudos. O objetivo deste relato é discorrer, por meio de quatro pontos convergentes (perfis, definição do quadro, diagnóstico precoce e instrumentos de rastreio), sobre a inter-relação entre duas teses de doutorado que incluíram em suas amostras de pesquisa crianças com o Transtorno do Espectro Autista (TEA). Tais pontos convergentes relacionam-se a questões com as quais os profissionais que atuam junto aos indivíduos com TEA deparam-se frequentemente. Algumas ações como: 1. Conhecer o indivíduo com TEA através do estabelecimento de seu perfil; 2. Manter-se atualizado sobre os critérios diagnósticos e dados de literatura que definem a multifatoriedade do transtorno; e 3. Compreender a importância e a necessidade do diagnóstico precoce e da aplicação de instrumentos de rastreio para a avaliação deste distúrbio do neurodesenvolvimento podem auxiliar os profissionais de diferentes áreas quanto ao trabalho com pessoas diagnosticadas com TEA. O cotejamento realizado entre as duas teses, assim como os dados presentes na exploração de cada ponto convergente entre elas, trazem ao leitor elementos fomentadores de reflexões que confirmam a complexidade do transtorno e a importância das três ações descritas acima.

This article highlights the interrelationship between two doctoral theses. Four points of convergence between these thesis were identified and explored from the detailed reading and comparative analysis between the two works. In addition, the objectives, methods, results, and conclusions of each study were presented briefly. The purpose of this report is to discuss from four converging points (profiles, definition of the condition, early diagnosis, and screening instruments), about the interrelationship between two doctoral theses that included children with ASD in their research samples. Such converging points are related to issues that professionals who work with individuals with ASD often face. Some actions such as: 1. Knowing the individual with ASD through the establishment of their profile; 2. Keeping up to date on the diagnostic criteria and literature data that define the multifactorial nature of the disorder; and 3. Understanding the importance and the need for early diagnosis and the application of screening instruments to assess this neurodevelopmental disorder can assist professionals in different areas, regarding work with people diagnosed with ASD. The comparison made between the two thesis, as well as the data present in the exploration of each converging point between them, bring to the reader elements that encourage reflections that confirm the complexity of the disorder and the importance of the three actions described above.

New trends in instruments for child development screening in Brazil: a systematic review / Novas tendências em instrumentos para triagem do desenvolvimento infantil no Brasil: uma revisão sistemática

INTRODUCTION: Screening instruments are widely used to monitor child development. The accurate use of standardized tools is an indispensable condition for clinical practice and research aimed at detecting developmental risks and other problems in childrenOBJECTIVE: The objective of this systematic review was to analyze the use of standardized tools for child development screening used in studies with Brazilian childrenMETHODS: Two independent researchers selected references in English and Portuguese from five databases through which they searched for studies that used screening tests to assess the development of Brazilian children. All articles were read to determine the main objective, design, target population, the type of screening test, and the purpose of using the test with Brazilian childrenRESULTS: Among the 27 papers analyzed, most of them was observational studies conducted with children up to six years of age, with the main objective to screen development delays and analyze associations between risks and child development. Four instruments were identified: Denver Developmental Screening Test II, Ages and Stages Questionnaire, Bayley Scales of Infant and Toddler Development Screening Test, and Battelle Developmental Inventory Screening Test. Three of these tests have been validated for use in BrazilCONCLUSION: This review suggests that the screening instruments have been used in research for different purposes, such as in the diagnosis of developmental problems, and sometimes inappropriately. Furthermore, studies to validate measures for screening and assessing the development of Brazilian children are still scarce and, therefore, deserve more attention

INTRODUÇÃO: Instrumentos de triagem são usados para monitoramento do desenvolvimento infantil. O uso acurado de ferramentas padronizadas é condição indispensável para a prática clínica e pesquisas que visam detectar risco de desenvolvimento e problemas em criançasOBJETIVO: O objetivo desta revisão sistemática foi analisar o uso de instrumentos padronizados de triagem do desenvolvimento infantil adotados em estudos com crianças brasileirasMÉTODO: Dois pesquisadores independentes selecionaram em cinco bases de dados referencias em Inglês e Português onde buscaram estudos que usaram testes de triagem para avaliação do desenvolvimento de crianças brasileiras. Todos os artigos foram lidos para analisar o objetivo principal, delineamento, população-alvo, o tipo de teste de triagem e o propósito de uso do teste com crianças brasileirasRESULTADOS: Dentre os 27 artigos analisados, a maioria deles eram estudos observacionais conduzidos com crianças até seis anos de idade com objetivo principal de rastrear atrasos e analisar associações entre riscos e desenvolvimento. Quatro instrumentos foram identificados: Teste de Triagem do Desenvolvimento de Denver II; Ages and Stages Questionnaire; Bayley Scales of Infant and Toddler Development, Screening Test; e Battelle Developmental Inventory Screening Test. Três testes estão sendo validados para uso no BrasilCONCLUSÃO: Esta revisão sugere que os instrumentos de triagem têm sido usados nas pesquisas com diferentes finalidades, por vezes de forma apropriada ou incorreta, como por exemplo para diagnosticar problemas de desenvolvimento. Além disso, os estudos de validação de medidas para triagem e avaliação do desenvolvimento de crianças brasileiras ainda são escassos e, por isso, merecem atenção

Screening Instruments for Autism Spectrum Disorder: Mini Review / 신경정신의학

Most screening instruments for autism spectrum disorder (ASD) have been developed and evaluated in western countries. Therefore, difficulties are often experienced when using these instruments because of the cultural differences in the symptoms of ASD. This paper reviews the screening instruments for ASD used in South Korea and explores a new direction in the screening of ASD in South Korea. Among the many published screening instruments for ASD, the screening instruments with a validated Korean version were chosen and reviewed. A total of nine autism-screening instruments met the criteria for the inclusion criteria. Nine screening instruments were summarized and the direction for the Korean version of screening instruments was discussed.

Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D) en México: análisis bibliométrico / Center of Epidemiological Studies of Depression Scale (CES-D) in Mexico: bibliometric analysis

The CES-D is a screening instrument to measure depressive symptoms during the last week. It is useful and easy to use because no trained staff is needed to administer and score it. Interest in depression has been consistent in Mexico in recent years, and the CES-D is one of the most used scales. The goal of this paper is to present a bibliometric analysis of scientific papers reporting data obtained with the scale; the papers had to be published in a scientific journal with a reviewing board, a group of peer reviewers and be ISNN registered. Materials were found in EBSCOhost and Google Scholar databases. 80 papers were published between 1986 and 2011. An average of three papers was published every year. Most of the studies were developed in Mexico City and nationwide; there was a bi-national study, a multinational one, and four in several states combined. The journals with the highest number of papers were: SALUD MENTAL, Salud Pública de México, and Revista Mexicana de Psicología. There were 17 institutions involved in coordinating the studies; six of them were international. 41% of the studies were conducted with adolescents, 32% with women, and 90% in urban contexts. There are some areas which need further study to build a more comprehensive understanding about the distribution and characteristics of depressive symptoms and hence new studies must be designed to include understudied groups and populations.

La Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D) es un instrumento de tamizaje para la detección de casos de depresión con base en su sintomatología durante la última semana. La CES-D ha demostrado ser una herramienta útil y económica en formato autoaplicable en virtud de que no requiere personal especializado para su calificación y es autoaplicable. Reconocida la importancia de la depresión, el interés por su investigación ha sido consistente en México durante las últimas décadas y la CES-D ha sido uno de los instrumentos más empleados. El objetivo de este trabajo es presentar un análisis bibliométrico de las publicaciones científicas sobre su uso en México. Los artículos seleccionados tenían que estar publicados en revistas científicas con comité editorial, cuerpo académico de dictaminadores e ISSN. Las búsquedas se hicieron en EBSCOhost y Google Académico. Se analizaron 80 artículos, desde 1986 hasta julio de 2011. El promedio por año fue de tres artículos; 2007 y 2008 fueron los años con más publicaciones. La mayor cantidad de investigaciones se ha realizado en el Distrito Federal y a nivel nacional; hay una investigación binacional, otra multinacional y cuatro en entidades federativas combinadas. Las revistas con mayor cantidad de publicaciones fueron: SALUD MENTAL (27 artículos), Salud Pública de México (11 artículos) y la Revista Mexicana de Psicología (cinco artículos). Diecisiete instituciones (con predominio del Instituto Nacional de Psiquiatría Ramón de la Fuente) han sido responsables de las investigaciones; seis de ellas, a nivel internacional. 41.25% con adolescentes, 32.5% con mujeres y 90% en contextos urbanos, con predominio en la población general y en adolescentes estudiantes. Existen áreas por explorar para contar con un panorama más completo sobre las características y distribución de la sintomatología depresiva, por lo que habría que diseñar estudios con grupos y poblaciones menos explorados.

Validez del Cuestionario Breve de Tamizaje y Diagnóstico (CBTD) para niños y adolescentes en escenarios clínicos

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SUMMARY Background: Psychopathology in children can be conceptualized as a normal development that has gone awry. That is, some conducts which are expectable at a certain age could turn to be inappropriate and pathological if they persist. When some traits, conducts or signs are very conspicuous and they are frequently present together, they are conventionally called syndromes. Studies registering children's observed conducts by the parents have been very useful to identify groups of symptoms, and several scales have been designed to elicit psychopathology such as the Children's Behavior Questionnaire (CBQ), Conner's scales, and the Child Behavior Checklist, CBCL-P. With the exception of the CBQ, the other two instruments, although frequently used as screening instruments in several studies, are too long or too specific to be systematically employed at the general practice services and in the community. More recently, Goodman designed the Strengths and Difficulties Questionnaire (SDQ), which is a 25-item instrument showing an acceptable predictive validity for three groups of disorders: conduct, emotional, hyperactivity and inattentive. In Mexico, our epidemiological work on children's mental health started at the end of the eighties using the Report Questionnaire for Children (RQC) which is a 10-item screening instrument developed at the end of the seventies for a WHO collaborative research with the aim of extending psychiatric services to primary care settings. In our population, the instrument showed good efficiency with a positive predictive value (PPV) of 76% and a negative predictive value (NPV) of 99%, and it has been useful in detecting mental health problems both in the general population, as well as in primary care services. However, the need to identify what kind of disorders are they and estimating their prevalence remains. The Brief Screening and Diagnostic Questionnaire (CBTD) was built based on previous experience using the RQC. Seventeen items which explored symptoms frequently reported as motives for seeking attention at the out-patient mental health services were added to the original 10 questions of the RQC. Most of them are items included in the CBCL-P, which explore hyperactivity, impulsivity, attention deficit, sadness, inhibition, oppositional and antisocial behaviors, and eating behaviors associated with low or high weight. The aim was to include cardinal symptoms that could lead to identify probable specific syndromes and disorders, based on the parent's report. The reliability of the instrument was measured using the Kuder- Richarson coefficient (KR-20), obtaining a 0.81 value. Based on responses obtained in a general population sample of 1686 children aged 4 to 16 years in Mexico City, the score at the 90th percentile, five symptoms, was established to define probable caseness. Also, using logistic regression analysis, the association between the cardinal symptoms for different disorders -as defined in the DSMIV and ICD-10 diagnostic criteria- and the rest of the items from the questionnaire was studied in order to obtain symptom profiles or syndromes signaling probable psychiatric disorders. The main objective of the present study was to evaluate the concurrent validity and the efficiency of the diagnostic algorithms of the CBTD, as compared with the psychiatric diagnoses of children attended at two out-patient mental health services in Mexico City. Method: A random sample of consecutive new out-patients aged 4 to 16 years was obtained. The CBTD was administered to the accompanying parent before the consultation. Clinical evaluation was done independently and blind to these results; the psychiatrists emitted diagnoses following the ICD-10 criteria. Diagnostic reliability between this initial evaluation and further diagnosis of hyperactivity and attention deficit disorder, depressive disorder, oppositional and conduct disorder and anxiety disorders, established at the different clinics of the children's psychiatric hospital showed good agreement with Kappa values ranging from 0.60 to 0.83. Concurrent validity between the diagnostic algorithms of the CBTD and the psychiatric diagnoses was measured using Kappa and Yule statistics. Efficiency measures: sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were also obtained. Results: A total of 530 children were included in the study; 73% were male and 27% female; mean-age was 9.35 (s.d. 3.12) year old. Only eight patients reported less than five symptoms in the CBTD. The 4/5 cut-off point showed a sensitivity of 98.7% and PPV of 99.8%. However, as very few children were below the cut-off point, specificity resulted in 50% and NPV was 12.5%. Also, as the children attended the psychiatric services, they showed a highly symptomatic profile (median= 11 symptoms), concurrent validity analyses were first carried out in a sub-sample including only those patients with three CBTD syndromes at the most (n= 102). Diagnostic algorithms for attention deficit and hyperactivity, depression, and conduct disorders showed fair agreement with the corresponding psychiatric diagnoses: Yule statistic range from 0.43 to 0.55. As it could be expected, sensitivity (range: 71% to 84%) and NPV (range: 85% to 97%) were higher for the most general algorithms, while specificity and PPV were higher for the most stringent definitions. Analyses including the whole sample showed a sensitivity ranging from 54% to 95%, and NPV from 70% to 98% for the different diagnostic algorithms, and thus indicating a high efficiency of this brief instrument. Conclusion: The CBTD seems to be a good and efficient screening instrument, useful for the detection of the most frequent psychiatric disorders in childhood and early adolescence. Results suggest that it should be tested and incorporated as a tool at primary health services for the systematic surveillance of mental health during childhood and adolescence.