Tessituras da adolescência na pandemia: demandas psicossociais de um CAPSi / Adolescence structures in the pandemic: psychosocial demands of a CAPSi Center / Tesituras de la adolescencia en la pandemia: demandas psicosociales de un CAPS

A pandemia da Covid-19 afetou, drasticamente, o campo social. O público adolescente, por apresentar um caráter específico do desenvolvimento, também é atravessado na pandemia. O objetivo desta pesquisa foi identificar e descrever quais as demandas de atenção psicossocial que emergiram nos acolhimentos em um CAPSi de um município do interior do estado do Rio Grande do Sul na pandemia no período da adolescência. O método utilizado foi o modelo quali-quantitativo, de caráter descritivo e exploratório. Os resultados das demandas psicossociais que mais apareceram foram: comportamento suicida, ansiedade, heteroagressividade, autoagressividade, conflitos familiares e dificuldades de aprendizagem. Através do estudo pode-se perceber os atravessamentos que a pandemia da Covid-19 reverberou no público adolescente acolhido neste CAPSi, e o que essas demandas mostram sobre as questões de saúde mental no cenário pandêmico. (AU)

The Covid-19 pandemic has drastically affected the social field. Adolescents, as they present a specific character of development, are also affected by the pandemic. The objective of this research was to identify and to describe the psychosocial care demands that emerged in the receptions at a CAPSi, a Child and Youth Psychosocial Care Center, in a municipality in the interior of the state of Rio Grande do Sul, in the pandemic, during the adolescence period. The method used was the qualitative-quantitative model, with a descriptive and exploratory character. The results of the psychosocial demands that appeared the most were: suicidal behavior, anxiety, heteroaggression, self-aggression, family conflicts and learning difficulties. Through the study, it is possible to perceive the crossings that the Covid-19 pandemic reverberated in the adolescent public hosted in this CAPSi, and what these demands show about mental health issues in the pandemic scenario. (AU)

La pandemia del Covid-19 afectó, drásticamente, al campo social. El público adolescente, por presentar un carácter específico del desarrollo, también se ve afectado en la pandemia. El objetivo de esta investigación fue identificar y describir cuales las demandas de atención psicosocial que surgieron en las acogidas en un CAPSi de un municipio del interior del estado de Rio Grande do Sul en la pandemia en el periodo de la adolescencia. El método utilizado fue el modelo cuali-cuantitativo, de carácter descriptivo y exploratorio. Los resultados de las demandas psicosociales que más aparecieron fueron: comportamiento suicida, ansiedad, heteroagresividad,auto agresividad,conflictos familiares y dificuldates de aprendizaje. A través del estudio se puede percibir los atravesamientos que la pandemia del Covid-19 reverberó en el público adolescente acogido en este CAPSi, y lo que esas demandas muestran sobre las cuestiones de salud mental en el escenario pandémico. (AU)

Prevalence of inter-hemispheric asymetry in children and adolescents with interdisciplinary diagnosis of non-verbal learning disorder / Prevalência de assimetria inter-hemisférica em crianças e adolescentes com diagnóstico interdisciplinar de transtorno da aprendizagem não verbal

ABSTRACT Objective To describe clinical and epidemiological features of children and adolescents with interdisciplinary diagnosis of non-verbal learning disorder and to investigate the prevalence of inter-hemispheric asymmetry in this population group. Methods Cross-sectional study including children and adolescents referred for interdisciplinary assessment with learning difficulty complaints, who were given an interdisciplinary diagnosis of non-verbal learning disorder. The following variables were included in the analysis: sex-related prevalence, educational system, initial presumptive diagnoses and respective prevalence, overall non-verbal learning disorder prevalence, prevalence according to school year, age range at the time of assessment, major family complaints, presence of inter-hemispheric asymmetry, arithmetic deficits, visuoconstruction impairments and major signs and symptoms of non-verbal learning disorder. Results Out of 810 medical records analyzed, 14 were from individuals who met the diagnostic criteria for non-verbal learning disorder, including the presence of inter-hemispheric asymmetry. Of these 14 patients, 8 were male. Conclusion The high prevalence of inter-hemispheric asymmetry suggests this parameter can be used to predict or support the diagnosis of non-verbal learning disorder.

RESUMO Objetivo Descrever as características clínicas e epidemiológicas de crianças e adolescentes com transtorno de aprendizagem não verbal, e investigar a prevalência de assimetria inter-hemisférica neste grupo populacional. Métodos Estudo transversal que incluiu crianças e adolescentes encaminhados para uma avaliação interdisciplinar, com queixas de dificuldades de aprendizagem e que receberam diagnóstico interdisciplinar de transtorno de aprendizagem não verbal. As variáveis avaliadas foram prevalência por sexo, sistema de ensino, hipóteses diagnósticas iniciais e respectivas prevalências, prevalência de condições em relação à amostra total, prevalência geral do transtorno de aprendizagem não verbal, prevalência de acordo com ano escolar, faixa etária no momento da avaliação, principais queixas familiares, presença assimetria inter-hemisférica, dificuldade em aritmética, alterações em visuoconstrução, e principais sinais e sintomas do transtorno de aprendizagem não verbal. Resultados Dos 810 prontuários médicos analisados, 14 eram de indivíduos que preencheram os critérios diagnósticos para transtorno de aprendizagem não verbal, incluindo a assimetria inter-hemisférica. Destes 14 pacientes, 8 eram do sexo masculino. Conclusão A alta prevalência de assimetria inter-hemisférica sugere que este parâmetro possa ser usado como preditor ou reforçador para diagnóstico de transtorno de aprendizagem não verbal.

Impacto do DSM-5 no diagnóstico de transtornos de aprendizagem em crianças e adolescentes com TDAH: um estudo de prevalência / The impact of DSM-5 on the diagnosis of learningdisorder in ADHD children and adolescents: a prevalence study

Estudos de prevalência de Transtornos de Aprendizagem (TA) em crianças e adolescentes com TDAH apresentam resultados não conclusivos, apesar da frequente comorbidade entre as síndromes. Esse artigo descreve e analisa a prevalência de TA em uma amostra referida de 270 crianças e adolescentes com TDAH atendidas no Programa de Transtornos de Déficit de Atenção/Hiperatividade/Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul (ProDAH/HCPA-UFRGS), de acordo com os critérios diagnósticos do Manual Diagnóstico e Estatístico de Transtornos Mentais IV - versão revisada (DSM-IV-TR). Verificou-se que 46,7% dos estudantes apresentam, pelo menos, um TA, sendo o Transtorno da Expressão Escrita o mais frequente (32,6%). Discutiu-se o potencial impacto das mudanças nos critérios diagnósticos para os TA, propostas pelo DSM-5 na prevalência desses transtornos. Embora seja possível afirmar que ocorrerão alterações nas taxas de prevalência de TA, o impacto do DSM-5 sobre a prevalência, especificidade e comorbidade do TA permanece incerto, já que há mudanças que ampliarão a abrangência dos critérios de inclusão e outras que a reduzirão. (AU)

Prevalence studies on learning disabilities (LD) in children and adolescents with Attention Deficit and Hyperactivity Disorder (ADHD) show inconclusive results, despite the frequent comorbidity between these syndromes. This article describes and analyzes the prevalence of LD in a referred sample of 270 children and adolescents with ADHD treated at Disorders Program of Attention Deficit / Hyperactivity / Hospital de Clínicas de Porto Alegre - Federal University of Rio Grande do Sul (PRODAH/HCPA-UFRGS), according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The prevalence of LD among the sample was of 46.7%. In that group, the most common LD was the Written Expression Disorder (32.6%). The impact of the changes in the diagnostic criteria for LD proposed by the DSM-5 in the prevalence of these disorders is discussed. Although changes will occur in the rates of LD prevalence, the impact of the DSM-5 on the prevalence, specificity and comorbidity of LD remains uncertain, as there are some proposed changes that will broaden the scope of the criteria and others that will reduce it. (AU)

Prevalência e características de escolares vítimas de bullying / Prevalence and characteristics of school age bullying victims

OBJETIVO: Descrever a prevalência de vítimas de bullying, suas características e os sintomas associados nas áreas emocionais, de conduta, hiperatividade e relacionamento. MÉTODO: Trata-se de um estudo transversal aninhado a uma coorte que avalia transtornos de leitura, escrita e aritmética em 1.075 alunos, da 1ª à 8ª série, de duas escolas públicas de ensino fundamental de um bairro de classe média baixa de Pelotas (RS). Foi utilizado o questionário KIDSCAPE para avaliar a prevalência de bullying e o Strengths and Difficulties Questionnaire para avaliar características comportamentais das vítimas. RESULTADOS: A prevalência de bullying foi de 17,6 por cento. O tipo de intimidação mais prevalente foi o verbal, seguido do físico, emocional, racial e sexual. Após o ajuste para os fatores de confusão, o bullying se manteve associado com sexo masculino (RP 1,49 IC95 por cento 1,14-1,96), com hiperatividade (RP 1,89 IC95 por cento 1,25-2,87) e problemas de relacionamento com os colegas (RP 1,85 IC95 por cento 1,24-2,76). Entre as vítimas, 47,1 por cento também provocavam bullying. CONCLUSÃO: Este estudo identificou as características comportamentais das vítimas de bullying que podem ser úteis para políticas locais de proteção aos alvos de bullying.

OBJECTIVE: To describe the prevalence of bullying victims, the characteristics of those victims and their associated symptoms in the domains of emotion, behavior, hyperactivity and peer relationships. METHOD: This was a cross-sectional study nested in a cohort that assesses disorders of reading, writing and arithmetic in 1,075 students enrolled in the first to eighth grades of two public schools in a lower-middle-class neighborhood of the city of Pelotas, RS, Brazil. The KIDSCAPE questionnaire was used to evaluate the prevalence of bullying and the Strengths and Difficulties Questionnaire was used to assess victims’ behavioral characteristics. RESULTS: The prevalence of bullying was 17.6 percent. The most prevalent type of intimidation was verbal, followed by physical, emotional, racial and sexual. After adjustment for confounding factors, bullying was still associated with male sex (PR 1.49 95 percentCI 1.14-1.96), hyperactivity (PR 1.89 95 percentCI 1.25-2.87) and peer relationship problems (PR 1.85 95 percentCI 1.24-2.76). Among the victims of bullying, 47.1 percent had also initiated bullying. CONCLUSION: This study has identified the behavioral characteristics of bullying victims which may prove useful for local policies designed to protect the targets of bullying.

Risk Factor Frequency for Learning Disabilities in Low Socioeconomic Level Preschool Children in Mexico City / Frequência de fatores de risco para dificuldade de aprendizagem em pré-escolares com baixo nível socioeconômico, na Cidade do México / Frecuencia de factores de riesgo para problemas de aprendizaje en preescolares de bajo nivel socioeconómico en la Ciudad de México

The objective was to identify the frequency of risk factors for Learning Disabilities (LD) in low socioeconomic level children in Mexico City. We studied children by means of: Wechsler, Bender-Gestalt, and Human drawing tests. Average age of male subjects was 5.6±0.9 years, while that of the female group was 5.4±0.5 years. In male subjects, average Total intelligence quotient (T-IQ) score was 98±12.2 while, in the female group, this was 99±12.2. On the Bender-Gestalt test, male subjects had a mental and visual-motor average age of <1 year under chronological age. Female subjects had a mental and visual-motor age 8-7 months under the norm. On the Human drawing test, in male and female subjects, the most frequent at-risk features comprised: self-isolation in 25 por cento of subjects, shyness in 22.4 por cento, and poor internal controls in 22 por cento. In conclusion, we found a high at-risk factor frequency for LD in children of low socioeconomic strata. We highlight the importance of screening children before they attain school age.

Este estudo objetivou identificar a frequência de fatores de risco para dificuldade de aprendizagem (DA) em crianças com baixo nível socioeconômico, na Cidade do México. A escala de inteligência Wechsler, desenho da figura humana e o teste gestáltico visomotor de Bender foram utilizados. A idade média do grupo masculino foi de 5,6±0,9 anos e do grupo feminino 5,4±0,5 anos. O quociente intelectual total (QI-T) foi de 98±12 no grupo masculino e 99±12,2 no grupo feminino. No teste de Bender, os meninos apresentaram idade mental e visomotora um ano abaixo da idade cronológica, enquanto que as meninas apresentaram idade mental e visomotora 7-8 meses abaixo do normal. As características de alto risco que apresentaram maior frequência, tanto nos meninos como nas meninas, no teste do desenho de figura humana, foram: autoisolamento 25 por cento, timidez 22,4 e controle interno deficiente 22 por cento. Concluindo, alta frequência de fatores de risco para DA foi encontrada em crianças de baixo nível socioeconômico. É importante destacar a importância de se identificar pré-escolares em risco de DA.

Nuestro objetivo fue identificar la frecuencia de factores de riesgo para problemas de aprendizaje (PA) en niños de bajo nivel socioeconómico de la Ciudad de México. Se utilizaron las pruebas de inteligencia de Wechsler, Gestáltica Visuomotora de Bender y del Dibujo de la figura humana. La edad promedio en el grupo masculino fue 5,6±0,9 años, del femenino fue 5,4±0,5. En los hombres, el cociente intelectual total (CI-T) fue 98±12,2, en mujeres fue 99±12,2. En la prueba de Bender, los hombres mostraron una edad mental y visuomotora un año menor que la cronológica, las mujeres tuvieron una edad mental y visuomotora 7-8 meses por debajo de la norma. En la Prueba de la figura humana, los hombres y mujeres mostraron mayor frecuencia de: auto-aislamiento 25 por ciento, timidez 22,4 por ciento y controles internos pobres 22 por ciento. En conclusión encontramos una alta frecuencia de factores de riesgo en preescolares de bajo nivel socioeconómico, destacamos la importancia de identificar a los preescolares propensos a tener problemas de aprendizaje (PA).

Rinite alérgica: indicadores de qualidade de vida / Allergic rhinitis: indicators of quality of life

O objetivo desta revisão foi apresentar evidências da relação entre rinite alérgica e redução da qualidade de vida. As fontes de dados foram artigos originais, revisões e consensos indexados nos bancos de dados Medline e LILACS entre 1997 e 2008. As palavras de busca foram "rinite alérgica", "qualidade de vida" e "distúrbios do sono". Os pacientes com rinite alérgica frequentemente têm redução na qualidade de vida causada pelos sintomas clássicos da doença (espirros, prurido, coriza e obstrução). Além disso, a fisiopatologia da rinite alérgica, com frequência, interrompe o sono, ocasionando fadiga, irritabilidade, déficits de memória, sonolência diurna e depressão. A carga total da doença recai não apenas no funcionamento social e físico prejudicados, mas também no impacto financeiro, que se torna maior quando se consideram as evidências de que a rinite alérgica é um possível fator casual de comorbidades, tais como a asma e a sinusite. A obstrução nasal, o mais proeminente dos sintomas, está associada a eventos respiratórios relacionados aos distúrbios do sono, uma condição que tem profundo efeito sobre a saúde mental, o aprendizado, o comportamento e a atenção. Finalmente, a rinite alérgica - doença crônica que afeta crianças, adolescentes e adultos - frequentemente é subdiagnosticada ou inadequadamente tratada. O impacto deletério dos distúrbios do sono associados à rinite alérgica sobre a habilidade para realizar as atividades de vida diária dos pacientes é um importante componente da morbidade da doença. Com um diagnóstico acurado, existem vários tratamentos disponíveis que podem reduzir a carga associada à rinite alérgica.

The objective of this review was to present evidence of the relationship between allergic rhinitis and impairment of quality of life. The data sources were original articles, reviews and consensus statements entered into the Medline and LILACS databases between 1997 and 2008. The following search terms were used: "allergic rhinitis"; "quality of life"; and "sleep disorders". Quality of life is often impaired in patients with allergic rhinitis, due to the classic symptoms of the disease (sneezing, pruritus, rhinorrhea and nasal obstruction). In addition, the pathophysiology of allergic rhinitis often disrupts sleep, leading to fatigue, irritability, memory deficits, daytime sleepiness and depression. The total burden of this disease goes beyond impairment of physical and social functioning. It has also a financial impact, which becomes greater when we consider the evidence that allergic rhinitis is a possible causal factor of comorbidities, such as asthma and sinusitis. Nasal obstruction, the most prominent symptom, is associated with sleep disorders, which can have a profound effect on mental health, learning, behavior and attention. Finally, allergic rhinitis-a chronic condition that affects adults, adolescents and children-is often underdiagnosed or inadequately treated. The deleterious impact that allergic rhinitis-related sleep disorders have on patient capacity to perform activities of daily living is an important component of the morbidity of the disease. With an accurate diagnosis, there are various available treatments that can reduce the burden of allergic rhinitis.

Enfrentamiento terapéutico del trastorno por déficit atencional en una población infantil escolar perteneciente a la Región Metropolitana de Chile / Attentional deficit disorder treatment at a school children population in Region Metropolitana of Chile

An evaluation was made of a retrospective evolution presented by the patients from to 14 years and 11 month old (average 9,2 years old), with a diagnostic of attentional hyperactive disorder (AHD), treated with metilfenidate in Huechuraba during the year 2007. A revision of every clinic history showed the principal results: a high positive response (higher than the 76 percent of the measured parameters). The evaluated parameters were, academic response, self report of subjective opinion from the patient, opinion from the tutor of the child in relationships with his/her conduct at home and teacher's evaluations of the child conduct at school. No differences were found between the evolution of the clinic parameters, in children with and without comorbilities. It was found a 52, 7 percent of comorbility. Specific learning disease, adaptative disorder, anxious disorder, and depression were more frequent diagnoses. This study concludes that the high percent of success in the treatment of the student group is similar to the one found in literature. The presence of comorbility won't cause to down of the treatment efficiency. This is conditioned by the presence of psychosocial factors like maternal psychopathology and familiar violence.

Se realizó una evaluación restrospectiva de la evolución presentada por los pacientes desde 6 a 14 años 11 meses de edad (edad media de 9,2 años) con diagnóstico de Trastorno por déficit atencional (TDA) bajo tratamiento con metilfenidato en la comuna de Huechuraba durante el año 2007. Se hizo la revisión y el análisis de cada ficha clínica, encontrándose como principales resultados el alto porcentaje de mejoría, igual o mayor al 76 por ciento de los parámetros medidos, consistentes en evolución del rendimiento académico; autoreporte de sensación subjetiva del niño; reporte del cuidador principal en relación a la conducta del niño (a) en el hogar y evaluación del profesor en cuanto su conducta en el colegio. No se encontraron diferencias entre la evolución de los parámetros clínicos entre los niños con comorbilidad y sin comorbilidad, se encontró un 52,7 por ciento de esta, siendo los diagnósticos más frecuentes Trastorno específico del aprendizaje, trastorno adaptativo, trastorno ansioso y del ánimo. Se concluye que el alto porcentaje de éxito del tratamiento en el grupo estudiado es similar al encontrado en la literatura; que la presencia de comorbilidad no condiciona la disminución de la eficiencia del tratamiento y que esta es condicionada por presencia de factores psicosociales como psicopatología materna y violencia intrafamiliar.

Behavioral problems of epileptic children at Queen Sirikit National Institute of Child Health.

BACKGROUND: Neurological diseases and psychiatric problems were cloudily related. Many patients with epilepsy had associated problems such as Learning disorders (LD) or Attention deficit hyperactivity disorder (ADHD). Evaluation and treatments of these behavioral and learning problems should be, therefore, included in management of patients with epilepsy in order to improve their quality of life. OBJECTIVE: To study behavioral, learning problems that indicate ADHD in epileptic children. MATERIAL AND METHOD: These was cross sectional study in 100 epileptic children, age 6- 11-years-old who visited Neurological Clinic at Queen Sirikit National Institute of Child Health. The patients were assessed with Thai Youth Checklist (TYC), IOWA screening test for ADHD and questionnaires concerning learning area. The data was analyzed in Chi-square, using SPSS program. RESULTS: The prevalence of behavioral problems in epileptic children was 57 percent. The prevalence of moderate to severe ones which should be treated and related to complex partial seizure was 32 percent. The prevalence of learning problems was 23 percent. Most were found in higher classes. The prevalence of behaviors that indicate ADHD was 23 percent from TYC and 58 percent from IOWA screening test for ADHD. There was relationship of behaviors that indicate ADHD and the severity of epilepsy. The prevalence of delinquent behavior was 24 percent and social problems were 32 percent respectively. Correlation of behavioral problems and social skills (p = 0.027), good manner toward parents (p = 0.015) and helping house chores (p = 0.016) were significantly different. However there was no significantly different between behavioral problems and age of onset as well as duration of epileptic symptom, frequency of seizures in the past 6 months, EEG results and combination of medication. CONCLUSION: The epileptic children had high risks of behavioral and learning problems; they may be prevented by intensive evaluation, proper interventions, adequate counseling, proper medication, parental training and proper rehabilitation.

Transtornos de aprendizagem e presença de respiração oral em indivíduos com diagnóstico de transtorno s de déficit de atenção / hiperatividade (TDAH) / Learning disabilities and mouth breathing in subjects with attention deficit hyperactivity disorder diagnosis

Objetivos: caracterizar a população com Transtornos de Déficit de Atenção/Hiperatividade (TDAH);levantar prevalência de Transtornos de Aprendizagem (TA) e presença de respiração oral e verificarpossíveis associações. Métodos: foram estudados 77 pacientes do Serviço Ambulatorial deNeurodificuldades da Faculdade de Medicina ABC com diagnósticos de TA. Protocolos adaptadosforam utilizados para avaliação respiratória. Os subtipos de TDAH foram classificados pelo DSM-IV,sendo os pacientes agrupados em tipos: 1 (desatento), 2 (hiperativo-impulsivo) e 3 (combinado), presença/ausência de TA e modos respiratórios nasal, oral e oronasal. Foram utilizados: Teste de Igualdadede Duas Proporções, ANOVA e Técnica de Intervalo de Confiança para Proporção/Média. Resultados:houve prevalência de TDAH no gênero masculino, subtipo combinado, faixa etária infantil e 1ºgrau escolar. Observou-se alta ocorrência de TA (62,3%) com queixa de dificuldade escolar (87%).Houve significância estatística para presença de TA, dificuldade escolar e nenhuma repetência (61%).Houve alta ocorrência de respiração alterada (71,4%), que em associação ao TA foi de 41,6%. Houvepredominância de TA e respiração oronasal para gêneros e tipos de TDAH. O tipo 1 foi mais velho emidade média (12,4 anos) do que Tipo 3 (10,63 anos). Conclusões: o TDAH acometeu preferencialmentemeninos entre 7 e 13 anos, tipo 3, com alta prevalência e comorbidade com TA em associação arespiração oronasal. Houve correlação entre queixa de dificuldade escolar e TA; houve associaçãoentre TDAH, baixo rendimento escolar e presença de respiração oronasal devido à alta presença decomorbidade com TA, independente do gênero, idade ou subtipo de TDAH.

Purpose: to characterize the population with ADHD diagnoses; bring up prevalence of learning disabilities(LD) and presence of mouth breathing and verify likely association. Methods: 77 subjects of theNeurological Outpatient Clinic at ABC Medicine University were evaluated with LD diagnoses. Adaptedprotocols were used for respiratory evaluation. Subtypes of ADHD were classified by DSM-IV. Thus,the subjects were grouped in ADHD subtypes 1 (inattentive), 2 (hyperactivity / impulsive) and 3 (combined);LD presence / absence; and nasal, mouth breathing and mixed respiratory modes. “Dual ProportionEquality Test”, “ANOVA” and “Confidence Interval Technique for Proportion / Average” were used. Results:ADHD prevalence was noted in men, ADHD combined subtype, children’s of elementary and intermediateschool. There was high occurrence of LD (62.3%) with complaint of school difficulties (87%). There wasstatistical difference for LD presence, school difficulties and not repeater (61%). There was high occurrenceof altered respiration (71.4%) which in association with LD, it was 41.6%. There was LD and mixedrespiratory advantage for gender and ADHD types. Type 1 was older in average age (12.4 years old)than type 3 (10.63). Conclusion: ADHD appeared rather in boys among 7 and 13-year old, type 3 withhigh prevalence and comorbidity with LD in association with mixed respiratory mode. Complaint aboutschool difficulties showed correlation with LD. There was association among ADHD, low school efficiencyand presence of mixed respiratory due to high appearance of comorbidity with LD, regardless of gender,age or ADHD subtype.

High frequencies of plexiform neurofibromas, mental retardation, learning difficulties, and scoliosis in Brazilian patients with neurofibromatosis type 1

A clinical study of Brazilian patients with neurofibromatosis type 1 (NF1) was performed in a multidisciplinary Neurofibromatosis Program called CEPAN (Center of Research and Service in Neurofibromatosis). Among 55 patients (60 percent females, 40 percent males) who met the NIH criteria for the diagnosis of NF1, 98 percent had more than six café-au-lait patches, 94.5 percent had axillary freckling, 45 percent had inguinal freckling, and 87.5 percent had Lisch nodules. Cutaneous neurofibromas were observed in 96 percent, and 40 percent presented plexiform neurofibromas. A positive family history of NF1 was found in 60 percent, and mental retardation occurred in 35 percent. Some degree of scoliosis was noted in 49 percent, 51 percent had macrocephaly, 40 percent had short stature, 76 percent had learning difficulties, and 2 percent had optic gliomas. Unexpectedly high frequencies of plexiform neurofibromas, mental retardation, learning difficulties, and scoliosis were observed, probably reflecting the detailed clinical analysis methods adopted by the Neurofibromatosis Program. These same patients were screened for mutations in the GAP-related domain/GRD (exons 20-27a) by single-strand conformation polymorphism. Four different mutations (Q1189X, 3525-3526delAA, E1356G, c.4111-1G>A) and four polymorphisms (c.3315-27G>A, V1146I, V1317A, c.4514+11C>G) were identified. These data were recently published.

Aquisição da linguagem oral: relação e risco para a linguagem escrita / Oral language acquisition: relation and risk for written language

Este estudo relaciona a aquisição da linguagem oral com o desenvolvimento da escrita em 236 crianças provenientes de escola particular, da cidade de Porto Alegre, RS, Brasil. O objetivo desta pesquisa foi identificar fatores não-lingüisticos envolvidos na aquisição fonológica e descrever a relação da aquisição fonológica com alterações de escrita. Aos 6 anos de idade, os estudantes do jardim de infância foram divididos em 2 grupos, com base no teste de Avaliação Fonológica da Criança. No seguimento, aos 9 anos de idade, foram avaliados através de Ditado Balanceado e produção textual. Ao comparar os resultados dos grupos casos e controles houve diferença estatisticamente significativa na quantidade de erros cometidos na avaliação da escrita, apontando para a aquisição da linguagem oral como fator preditivo para o desenvolvimento ortográfico.

Pune low birth weight study--cognitive abilities and educational performance at twelve years.

OBJECTIVE: To assess the intelligence, visuo-motor perception, motor competence and school performance of children with birth weight less than 2000 grams, at the age of 12 years. DESIGN: Prospective cohort study. SETTING: Infants discharged from a Neonatal Special Care Unit of a referral hospital with birth weight less than 2000 g between 1987-89 and followed up in the High Risk Clinic. METHODS: The children were assessed by the Weschler's Intelligence Scale, Bender Gestalt test for visuo-motor perception, Wide Range Achievement Test for specific learning disability, Draw-a-Person screening test for emotional problems and Movement Assessment Battery for motor competence. Academic achievement was also scrutinised. RESULTS: One hundred and eighty children weighing less than 2000 grams at birth and ninety control children were assessed. The mean IQ of the study group was normal (89.5 +/- 16.9), though significantly lower than that of controls (97.2 +/- 14.1; p<0.05). Pre term SGA children had the lowest mean IQ (85.4 +/- 17.7). In the 78 VLBW children, there were 12 (15.4%) mentally retarded children as compared to only 3 (3.3%) amongst controls (p<0.001). There were only 3 (3.8%) 'bright' children among the VLBW group, as compared to 20 (22.2%) in the control group (p<0.001). Visuo-motor perception and motor competence of the study group was poor, and they had writing and mathematics learning disability, especially the preterm SGA and VLBW group. Academic achievement was poor and the incidence of borderline intelligence was 24.4%, which has increased from 13.4% at 6 years. CONCLUSIONS: The intelligence and academic performance of the children weighing less than 2000 grams is significantly lower than that of controls, though within normal limits. They also have poor visuo-motor perception, motor incompetence, reading and mathematics learning disability. The preterm SGA and VLBW children had the poorest cognitive abilities.

Infant hearing loss: the necessity for early identification

There has been controversy in the health professions about the necessity for newborn infant hearing screening. It is well accepted that patient history or a birth that places the infant in the high-risk registry (HHR) can identify 50 of all infants born with permanent bilateral hearing loss. Two major factors which have been cited as reasons for not screening the well-baby nursery have been poor cost effectiveness and the lack of documentation as to the benefits derived from early identification and intervention. Recent technological developments and published data are presented which indicate that economical well-baby hearing screening can be done in any setting, and that the language acquisition of the infant is permanently affected if the intervention is not done in the first six months after birth

Learning disabled students

By using an operational definition of Learning Disability [L.D] as a 'situation where a student fails to obtain minimum percentage of marks in a school's annual examination, set by the institution for promoting to the next higher grade. The problem has been identified to exist. 18.6% of students area. Various factors contributing to the situation of learning disability have been discussed. Many modifiable and preventable situations have been identified and studies are recommended to understand the problem in Pakistan

Diagnostico de los trastornos neuropsiquicos ocultos / Diagnosis of occult neuropsychic disorders

Se realizo diagnostico epidemiologico y psicologico de trastornos por deficit de atencion a ninos de los cursos 1991-1992 y 1992'1993, respectivamente, los cuales asisten a escuelas del area de salud del policlinico "Marta Abreu" de Santa Clara. La muestra estuvo integrada por 441 ninos de primeroa acuarto grado, escogida por el metodo de muestra aleatorio estratificado de fijacion proporcional. Se aplico una encuesta a padres y maestros para investigar sexo, antecedentes, tanto prenatales como perinatales y posnatales, personales y patologicos familiares, asi como atencion voluntaria, irregularidades de conducta, y desarrollo escolar. Hubo 113 ninos que coincidieron en la categorizacion de "sanos" "sospechosos" y "danados" por las tecnicas estadisticas "Cluster" y "Discriminante", a los cuales se realizo estudio psicologico que investigo atencion, memoria, pensamiento, afectividad, organicidad (diagnostico neuropsicologico); con ello se determino la elevada prevalencia de trastornos neuropsiquicos ocultos y la correspondencia entre ambos diagnosticos

Epidemiological aspects of school dropouts in children between 7-15 years in rural Maharashtra.

A study on school dropouts from primary and secondary school children was undertaken in September '91 from 16 schools at the headquarters of 8 Primary Health Centres, where 172 school dropouts were identified. A home visit was paid and information about socio-economic and cultural aspects was collected and a psychological screening was undertaken. Although there was no significant difference in overall dropout rates for both sexes, it increased sharply at 11 years of age in girls. The majority of children dropped out due to financial problems or unsatisfactory scholastic performance, and 142 (82.5%) of the 172 children studied were poor performers in one or more function tests. Maximum difficulty was observed in concept formation 87 (50.5%), followed by numerical ability in 78 (45%). Identification of children with learning difficulties and intervention using special educational methods within the framework of existing network of primary and secondary schools in rural areas is suggested.

Potenciales provocados auditivamente del tallo cerebral y de latencia media en disléxicos y controles / Brainstem auditory evoked responses and middle latency responses in dyslexics and controls children

Se estudió la integridad de la vía auditiva mediante potenciales provocados auditivos del tallo cerebral y de latencia media en nuve sujetos con dislexia pura y nueve sujetos controles. No se observó diferencia alguna en cuanto a las latencias y amplitudes de los potenciales provocados; sólo se evidenció una amplitud mayor de la onda V derecha en los sujetos control y de la onda V izquierda en los disléxicos. Este resultado se comenta en relación a la lateralidad cerebral. Potenciales provocados auditivos del tallo cerebral; potenciales provocados auditivos de latencia media