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Este artigo se propõe a delinear, historicamente, o diagnóstico clínico do Transtorno Disruptivo da Desregulação do Humor (TDDH). Com base no método genealógico, essa categoria diagnóstica é desnaturalizada e recontextualizada em sua origem. Analisa-se o conceito de desregulação do humor a partir da escala CBCL (Childhood Behaviour Checklist), sua identificação como um transtorno bipolar da infância, posterior transformação no diagnóstico de TDDH e subsequente crítica deste, com a proposta de englobar os sintomas de desregulação do humor na infância, no diagnóstico de transtorno opositor-desafiante. Como alternativa, o artigo sugere que o humor irritadiço na infância é um estado afetivo primário, constituindo-se, assim, em uma predisposição orgânica primária. Já a regulação emocional é uma construção adaptativa, que se modela ao longo da vida, gerando apresentações subjetivas diversas.
Resumos This article historically outlines the clinical diagnosis of disruptive mood dysregulation disorder (DMDD). Based on the genealogical method, this diagnostic category is denaturalized and recontextualized in its origin. The concept of mood dysregulation is analyzed from the Childhood Behavior Checklist scale (CBCL), its identification as a childhood bipolar disorder, subsequent transformation in the diagnosis of DMDD and subsequent criticism of it, with the proposal of encompassing the symptoms of mood dysregulation humor in childhood into the diagnosis of oppositional defiant disorder. As an alternative, the article suggests that irritable mood in childhood is a primary affective state, thus, constituting a primary organic predisposition. Emotional regulation, on the other hand, is an adaptive construction, which is modeled throughout life, generating diverse subjective presentations.
Cet article retrace l'historique du diagnostic clinique du trouble disruptif avec dysrégulation émotionnelle (TDDE). Basée sur la méthode généalogique, cette catégorie diagnostique est dénaturalisée et recontextualisée dans ses origines. Le concept de dysrégulation émotionnelle est analysé à partir de l'échelle CBCL (Childhood Behavior Checklist), de son identification en tant que trouble bipolaire de l'enfance, de sa transformation ultérieure en diagnostic de TDDE et de sa critique ultérieure, avec la proposition d'inclure les symptômes de dysrégulation émotionnelle dans l'enfance dans le diagnostic du trouble oppositionnel avec provocation. Comme alternative, l'article suggère que l'humeur irritable dans l'enfance est un état affectif primaire, constituant ainsi une prédisposition organique primaire. La régulation émotionnelle, quant à elle, est une construction adaptative qui est modelée tout au long de la vie, générant diverses présentations subjectives.
Este artículo describe historicamente el diagnóstico clínico del trastorno de desregulación disruptiva del estado de ánimo (TDDEA). Con base en el método genealógico, esta categoria diagnostica se desnaturaliza y recontextualiza en su origen. Se analiza el concepto de desregulación del estado de ánimo a partir de la escala CBCL (Childhood Behavior Checklist), su identificación como trastorno bipolar pediátrico, posterior transformación en el diagnóstico de TDDEA y posterior crítica al mismo, con la propuesta de englobar los síntomas de desregulación del estado de ánimo en el diagnóstico de trastorno negativista desafiante. Como alternativa, se sugiere que el estado de ánimo de irritabilidad en la infancia es un estado afectivo primario, constituyendo una predisposición orgánica primaria. La regulación emocional, por su parte, es una construcción adaptativa, que se modela a lo largo de la vida, generando diversas presentaciones subjetivas.
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BACKGROUND: Local political discord together with isolation and fear marked the COVID-19 pandemic in Brazil. AIMS: To determine the prevalence of anxiety and depression symptoms and analyze adult quality of life (QoL) during the pandemic in four groups: "childless", "children without mental problems", "children with autism" and "children with other mental problems." METHODS AND PROCEDURES: A sample of 867 individuals recruited using social media in northeastern Brazil completed the following instruments: the Hospital Anxiety and Depression Scale (HADS, Brazilian version), the WHOQOL-Bref, and a sociodemographic form OUTCOMES AND RESULTS: The mean score for depression was significantly higher in the "children with autism" group compared to the other groups. The mean anxiety score was significantly higher in the "children with autism" and "childless" groups. Mean QoL scores were lower in the "children with autism" group compared to the other groups for all the domains, with this difference being statistically significant compared with the "children without mental problems" group for all the domains. CONCLUSIONS AND IMPLICATIONS: Anxiety and depression symptoms were greater and QoL scores were lower in parents of children with autism. All groups benefitted from logistic support during the pandemic, whereas having to care for others negatively impacted QoL.
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Autistic Disorder , Quality of Life , Child , Adult , Humans , Pandemics , Depression/epidemiology , Depression/diagnosis , Autistic Disorder/epidemiology , Surveys and Questionnaires , Parents , Anxiety/epidemiology , Anxiety/diagnosisABSTRACT
ABSTRACT Objective: Estimate the prevalence of anxiety and depression symptoms in parents of children with autism spectrum disorder (ASD) during the first wave of the Coronavirus Disease (COVID-19) pandemic, comparing them with parents of neurotypical children and with other mental disorders. Methods: Responses from 211 participants were collected from an online form about familial behavior during the pandemic, and the Portuguese version of the HADS scale (Hospital Anxiety and Depression Scale). Results: Anxiety symptoms were present in 51% of the sample and depression was present in 35.1%. The prevalence of depression and anxiety symptoms was 58% and 44.4% respectively in the group of parents of children from the ASD; 50.3% e 32.2% for parents of neurotypical children; and 40% and 35% in the group of parents of children with other mental disorders. Conclusions: The prevalence of anxiety and depression in parents during the pandemic was greater than that of before the pandemic period. The prevalence of anxiety symptoms, as well as the mean scores of anxiety and depression symptoms, were significantly higher for the group of parents of children with the ASD. The results point to the need for additional care for parents and caregivers of children with ASD, since the social isolation adopted as a measure to contain the pandemic seemed to pose as a risk factor for negative psychological effects especially in this group.
RESUMO Objetivo: Estimar a prevalência de sintomas de ansiedade e depressão em pais de crianças com transtorno do espectro autista (TEA), durante a primeira onda da pandemia da doença causada pelo coronavírus SARS-CoV-2 (COVID-19), comparando com pais de crianças típicas e com outros transtornos mentais. Métodos: Foram coletadas respostas de 211 participantes a partir de um questionário on-line sobre comportamento familiar durante a pandemia e da versão em português da escala HADS (Hospital Anxiety and Depression Scale). Resultados: Sintomas de ansiedade estiveram presentes em 51% da amostra e de depressão, em 35,1%. A prevalência de sintomas de ansiedade e depressão foi de 58% e 44,4%, respectivamente, no grupo de pais de crianças com TEA, 50,3% e 32,2% no grupo de pais de crianças típicas e 40% e 35% no grupo de pais de crianças com outros transtornos mentais. Conclusões: As prevalências de ansiedade e depressão em pais durante a quarentena foram superiores àquelas fora do período pandêmico. As prevalências de sintomas de ansiedade, bem como as médias dos escores de sintomas de ansiedade e depressão, foram maiores no grupo de pais de crianças com TEA. Os resultados indicam a necessidade de atenção aos pais e cuidadores das crianças com TEA, já que o isolamento social adotado como medida de contenção da pandemia se constituiu como um fator de risco para impactos psicológicos negativos especialmente nesse grupo.
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ABSTRACT Objective: To translate and validate the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) from English to Brazilian Portuguese, taking transcultural differences into account. Methods: Permission for the translation was obtained from the author of the scale. Translation and back-translation were performed, and the document was then assessed for reference and general equivalence. Specialists in childhood autism evaluated the scale. A preliminary version was prepared and pre-tested in a sample population, and a final version was validated with the target population. Results: Only one question had issues relating to referential equivalence. The 10 individuals questioned in the pre-test all understood most of the instrument, although some suggested substituting certain terms to improve comprehension. The final version was reached following inclusion of pertinent suggestions and was submitted to validation with the target population, indicating a sensitivity of 88.2% for a cutoff point greater than 2 points. Conclusions: A Brazilian version of the M-CHAT-R/F scale, approved by specialists and understandable by the target audience, is now available for use.
RESUMO Objetivo: Realizar a tradução e validação do inglês para o português do Brasil da escala Modified Checklist for Autism in Toddlers, Revised with Follow-Up para triagem precoce do autismo, respeitando a equivalência transcultural. Métodos: Foi obtida permissão da autora da escala e realizaram-se tradução, retrotradução, avaliação da equivalência referencial e geral, avaliação de especialistas em autismo infantil, elaboração da versão preliminar, pré-teste, elaboração da versão final e validação com população-alvo. Resultados: Apenas uma das questões não foi 100% semelhante na avaliação da equivalência referencial. Das 10 pessoas interrogadas no pré-teste, todas compreenderam a maior parte do instrumento, contudo houve algumas sugestões de substituição de termos e exemplos para facilitar a compreensão. Após a incorporação das sugestões pertinentes, foi elaborada a versão final, que, submetida à validação com a população-alvo, indicou sensibilidade de 88,2% para ponto de corte maior que 2 pontos. Conclusões: O estudo torna disponível a versão em português da escala Modified Checklist for Autism in Toddlers, Revised with Follow-Up, considerada adequada por especialistas e compreensível pela população.
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OBJECTIVE: To translate and validate the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) from English to Brazilian Portuguese, taking transcultural differences into account. METHODS: Permission for the translation was obtained from the author of the scale. Translation and back-translation were performed, and the document was then assessed for reference and general equivalence. Specialists in childhood autism evaluated the scale. A preliminary version was prepared and pre-tested in a sample population, and a final version was validated with the target population. RESULTS: Only one question had issues relating to referential equivalence. The 10 individuals questioned in the pre-test all understood most of the instrument, although some suggested substituting certain terms to improve comprehension. The final version was reached following inclusion of pertinent suggestions and was submitted to validation with the target population, indicating a sensitivity of 88.2% for a cutoff point greater than 2 points. CONCLUSIONS: A Brazilian version of the M-CHAT-R/F scale, approved by specialists and understandable by the target audience, is now available for use.
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Autism Spectrum Disorder , Autistic Disorder , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/epidemiology , Brazil , Checklist , Humans , Mass Screening , Surveys and QuestionnairesABSTRACT
INTRODUÇÃO: Em dezembro de 2019 surgiram, na China, os primeiros caso de COVID-19, uma doença infectocontagiosa que, em poucos meses, evoluiu para o estado de pandemia. Foram adotadas medidas de distanciamento social, que podem gerar impactos psicológicos negativos para a população. O impacto pode ser maior para os pais de indivíduos com TEA, já que as demandas de cuidados dos filhos passam para os genitores em tempo integral. Soma-se ainda o fato de o trabalho dos pais em home-office e as demandas de trabalho doméstico. OBJETIVO: Revisar estudos sobre a saúde mental e/ou qualidade de vida de pais durante a pandemia. METODOLOGIA: Tratase de uma revisão narrativa da literatura buscando-se artigos nas bases PubMed/Medline, Scielo (Scientific Electronic Library Online), Google Scholar, Portal BVS (Biblioteca Virtual em Saúde), Periódicos Capes (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior). Foram selecionados 12 artigos de estudos qualitativos transversais a partir das bases de dados. RESULTADOS: A avaliação dos artigos mostra que os pais de indivíduos com TEA tendem a estar mais ansiosos, estressados e depressivos nesse período devido a sobrecargas físicas e emocionais. Além disso, eles apresentaram pior qualidade de vida neste período quando comparado a pais de crianças com outros transtornos e com desenvolvimento típico. CONCLUSÃO: O desenvolvimento de mais estudos sobre o tema é necessário, pois com maior embasamento científico é possível planejar um cuidado mais direcionado. O apoio virtual de profissionais e outros pais podem minimizar o impacto da pandemia sobre essa população. Entretanto, a diversidade de fatores sociais, econômicos e culturais envolvidos nessa questão requer mobilização multisetorial.
INTRODUCTION: In December 2019, the first cases of COVID-19, an infectious-contagious disease that evolved into a pandemic state, emerged in China. Social distancing measures were adopted, which can generate negative psychological impacts for the population. The impact may be greater for the parents of individuals with ASD, as the demands of the children's care are passed on to the parents on a full-time basis. In addition, the fact that parents work from home and the demands of domestic work is added. OBJECTIVE: To review studies on the mental health and/or quality of life of parents during the pandemic. METHODOLOGY: This is a narrative review of the literature looking for articles based on PubMed/Medline, Scielo (Scientific Electronic Library Online), Google Scholar, BVS Portal (Virtual Health Library), Capes Journals (Coordination for the Improvement of Health Personnel Upper level). 12 articles from qualitative crosssectional studies were selected from the databases. RESULTS: The evaluation of the articles shows that the parents of individuals with ASD tend to be more anxious, stressed, and depressed in this period due to physical and emotional overload. In addition, they had a worse quality of life in this period when compared to parents of children with other disorders and with typical development. CONCLUSION: The development of more studies on the theme is necessary because it is possible to plan more targeted care with a greater scientific basis. The virtual support of professionals and other parents can minimize the impact of the pandemic on this population. However, the diversity of social, economic, and cultural factors involved in this issue requires multisectoral mobilization.
Subject(s)
Autism Spectrum Disorder , Mental Health , COVID-19ABSTRACT
OBJECTIVE: To find evidence of the content, construct, and criterion validity of the LABIRINTO scale for the diagnosis of autism spectrum disorder (ASD) in children aged 24-59 months. METHODS: The scale was constructed in four stages: 1) items were defined based on an extensive literature review and discussions with autism and child development specialists; 2) child development specialists evaluated each item; 3) a preliminary version of the scale was applied to children diagnosed with ASD to enable any necessary adjustments; 4) the scale was then applied to 27 children with typical development and no neurodevelopmental disorder and 48 children with ASD. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Childhood Autism Rating Scale (CARS), clinical diagnosis constitutes the gold standard. RESULTS: The scale's psychometric indexes were appropriate for construct validity, with Kaiser-Meyer-Olkin = 0.94 and root mean square error of approximation = 0.000. Only one factor on the scale had a Cronbach alpha of 0.97. The receiver operating characteristic curve indicated a cutoff of 12, with a sensitivity of 100% and specificity of 100% for distinguishing children with ASD from those with typical development. CONCLUSION: This study confirmed the validity of the LABIRINTO scale.
Subject(s)
Autism Spectrum Disorder , Autistic Disorder , Autism Spectrum Disorder/diagnosis , Child Development , Child, Preschool , Diagnostic and Statistical Manual of Mental Disorders , Humans , PsychometricsABSTRACT
Parents of children with autism spectrum disorder may be more likely to have a mental disorder, both due to genetic and environmental reasons. A cross-sectional study involving 161 children, 161 mothers and 108 fathers. Diagnosis followed the criteria established in DSM-5. Symptom severity was evaluated using the Childhood Autism Rating Scale. The Factorial Personality Inventory served to evaluate parents' personality traits. Several correlations were found between mothers and fathers personality traits and children symptoms. In both parents, personality traits associated with greater intransigence/less flexibility and fewer social skills were those associated with more severe autism symptoms in the children.
Os pais de crianças com transtorno do espectro do autismo podem ter maior probabilidade de ter um transtorno mental, devido a razões genéticas e ambientais. Estudo transversal envolvendo 161 crianças, 161 mães e 108 pais. O diagnóstico seguiu os critérios estabelecidos no DSM - 5. A gravidade dos sintomas foi avaliada usando a Escala de Classificação do Autismo na Infância. O Inventário Fatorial de Personalidade foi utilizado para avaliar os traços de personalidade dos pais. Várias correlações foram encontradas entre traços de personalidade de mães e pais e sintomas de crianças. Em ambos os pais, os traços de personalidade associados a maior intransigência / menor flexibilidade e menos habilidades sociais foram os associados a sintomas mais graves de autismo nas crianças.
Los padres de niños con trastorno del espectro autista pueden ser más propensos a tener un trastorno mental, tanto por razones genéticas como ambientales. Se trata de un estudio transversal con 161 niños, 161 madres y 108 padres. El diagnóstico siguió los criterios establecidos en el DSM-5. La gravedad de los síntomas se evaluó mediante la Escala de calificación de autismo infantil. El Inventario Factorial de Personalidad sirvió para evaluar los rasgos de personalidad de los padres. Se encontraron varias correlaciones entre los rasgos de personalidad de las madres y los padres y los síntomas de los niños. En ambos padres, los rasgos de personalidad asociados con una mayor intransigencia / menor flexibilidad y menos habilidades sociales fueron los asociados con síntomas de autismo más severos en los niños.
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ABSTRACT Objective To understand how parents react to the diagnosis of autism in their child, and the manner in which the diagnosis was revealed, as well as the method through which the researcher perceived this communication. Methods A qualitative, narrative approach was used. Semi-structured interviews were held with 21 mothers and 9 fathers of children with autism spectrum disorder (ASD) enrolled in a special needs school in Salvador, Bahia, Brazil. In another setting, a specialist university service for the diagnosis of autism located in the same city, data were collected from 11 mothers and 5 fathers receiving diagnosis using ethnographic participant observation. Analysis categories were established, and the data interpreted. Results The categories selected were: " in search of a diagnosis ", " impact of receiving the diagnosis ", " patterns of diagnosis communication ", and " coping strategies ". Conclusion The diagnosis of autism is often delayed due to doctors' unpreparedness. Awareness of their child's diagnosis exerts a negative emotional impact on parents, which can be softened using coping strategies and diagnosis communication that offers technical information, offers emotional support and provides hope regarding the child's development. Parents need to be cared for in order to provide for the needs of their children at the moment of diagnosis and throughout the entire process of caring for individuals with ASD.
RESUMO Objetivo Conhecer como os pais reagem ao diagnóstico de autismo em seu filho e ao modo em como esse foi revelado, bem como a forma que o pesquisador percebeu essa comunicação. Métodos Qualitativo, abordagem narrativa. Foram feitas entrevistas semiestruturadas com 21 mães e 9 pais com filhos com transtorno do espectro autista (TEA) de uma escola especial em Salvador, Bahia, Brasil, e utilizada técnica etnográfica de observação participante em um serviço universitário especializado em diagnóstico de autismo, na mesma cidade, com 11 mães e 5 pais. As categorias de análise foram elaboradas e os dados, interpretados. Resultados Foram selecionadas as categorias "em busca do diagnóstico", "impacto na recepção do diagnóstico", "padrões da comunicação diagnóstica" e "estratégias de enfrentamento". Conclusão O diagnóstico de autismo é tardio devido ao pouco conhecimento e/ou habilidade dos profissionais médicos. Saber do diagnóstico dos filhos produz impacto emocional negativo nos pais, o que pode ser amenizado com estratégias de enfrentamento e comunicação diagnóstica que passe informações técnicas, ofereça suporte emocional, além de esperança quanto ao desenvolvimento do filho. Os pais precisam ser cuidados, para cuidarem dos filhos, no momento do diagnóstico e em todo o percurso de assistência às pessoas com TEA.
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BACKGROUND: Human T-cell lymphotropic virus type 1 (HTLV-1) spreads silently in the world's population and causes several syndromes. Among these, HTLV-1 associated myelopathy, also called tropical spastic paraparesis (HAM/TSP), affects the nervous system. It causes sensorimotor losses, spasticity, muscle weakness, voiding and sexual dysfunction, pain, and balance disorders. There is limited knowledge of the feelings, experiences, and coping mechanisms associated with this neglected disease. The objective of the present qualitative study was to investigate the signs, meanings, and practices of people with HAM/TSP, through narratives obtained from focus groups and individual semi-structured face-to-face interviews. RESULTS: Thirty-eight individuals diagnosed with HAM/TSP participated in the study. The following categories and subcategories emerged from the participants: Signs-physical signs, symptoms, and discovery of the disease; Meanings-reaction to diagnosis and knowledge of disease, fears, and expectations; Practices-daily life, leisure, religious, and treatment activities. CONCLUSIONS: People with HAM/TSP suffer from symptoms that limit their social participation, and they are affected by complex and multidimensional feelings. This awareness can contribute to the implementation of public policies-focused on the real perspective of these patients-that provide more directed, empathic, and harmonious care for these individuals.
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OBJETIVOS: Descrever o perfil sociodemográfico das vítimas de suicídio no Brasil entre 2006- 2015. MÉTODOS E MATERIAIS: Utilizaram-se dados do SIM e DATASUS. Analisaram-se incidências por raça/cor, escolaridade, faixa etária, de 2006-2015. Compararam-se variações na mortalidade por suicídio com mudanças regionais nos indicadores de características socioeconômicas e demográficas. RESULTADOS: As maiores causas de suicídio foram enforcamento, lesão por armas de fogo, autointoxicação por pesticidas. Os mais acometidos foram os menos escolarizados, adultos jovens (entre 20-39 anos) ou maiores de 60 anos. As taxas entre homens são 3,7 vezes maiores em todas as regiões. A mortalidade mais elevada se encontra na região Sudeste e o maior crescimento percentual, no Norte. CONSIDERAÇÕES FINAIS: A mortalidade por suicídio continua a crescer no país, com importantes variações regionais. O Brasil ainda carece de programas governamentais que trabalhem efetivamente na prevenção do suicídio.
OBJECTIVES: To describe the sociodemographic profile of suicide victims in Brazil between 2006-2015. METHODS AND MATERIALS: Data from SIM and DATASUS were used. Incidences by race / color, education, age range, from 2006-2015 were analyzed. Variations in suicide mortality were compared with regional changes in indicators of socioeconomic and demographic characteristics. RESULTS: The main causes of suicide were hanging, firearms injuries, self-poisoning by pesticides. The most affected were the least educated, young adults (between 20-39 years old) or over 60 years old. Rates among men are 3.7 times higher in all regions. The highest mortality is found in the Southeast and the highest percentage growth in the North. FINAL CONSIDERATIONS: Death by suicide continues to increase in the country, with important regional variations. Brazil still lacks government programs that work effectively in preventing suicide.
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Suicide , Epidemiology , MortalityABSTRACT
RESUMO Objetivo O objetivo do estudo foi construir os itens e realizar a validade de conteúdo e construto da Escala de Comportamento Alimentar do Autismo. Métodos Uma equipe multidisciplinar analisou a validade do conteúdo. A escala foi aplicada de forma verbal e individualizada a pais de pessoas com transtorno do espectro autista (TEA) para ajuste semântico. Essa primeira versão da escala foi respondida por 298 pessoas, sendo feita uma análise dos componentes principais com uma rotação Varimax. Resultados Dos 53 itens inicialmente desenvolvidos para o estudo do construto, 33 mostraram-se válidos para a avaliação do atributo e três foram acrescentados, compondo a segunda versão da escala, que foi respondida por 130 pessoas. Dos 35 itens que permaneceram após a primeira análise fatorial, 26 mostraram-se válidos para a avaliação do atributo e foram distribuídos em sete dimensões: motricidade na mastigação, seletividade alimentar, habilidades nas refeições, comportamento inadequado relacionado às refeições, comportamentos rígidos relacionados à alimentação, comportamento opositor relacionado à alimentação, alergias e intolerância alimentar. A estrutura final da escala ficou composta por 26 itens, distribuídos em sete fatores, apresentando um valor geral de confiabilidade de 0,867. Conclusão A escala visa identificar as dimensões do comportamento alimentar que se encontram alteradas, proporcionando um direcionamento mais específico em relação à terapêutica, podendo também ser utilizada para mensurar a evolução do tratamento.
ABSTRACT Objective An evaluation instrument was developed to assess the eating behavior of individuals with autism spectrum disorder (ASD), both from the professional viewpoint and based on aspects identified as problematic by parents at semi-structured interviews. Methods A multidisciplinary team analyzed content validity. The scale was applied verbally and individually to parents of individuals with ASD for semantic adjustment. Overall, 298 individuals answered this preliminary version of the scale, with varimax rotation being used to analyze the principal components. Results Of the 53 items initially developed to assess the construct, 33 proved valid for evaluation of the attribute and three were added, thus obtaining the second version of the scale, which was then answered by 130 individuals. Of the 35 items that remained after the first factor analysis, 26 proved valid for evaluation of the attribute and were divided into seven domains: the motricity of chewing, food selectivity, mealtime skills, inappropriate mealtime behavior, inflexible eating-related behavior, hostility towards food, and food allergies and intolerance. The final structure of the scale was composed of 26 items, distributed in seven factors, presenting an overall reliability value of 0.867. Conclusion The scale aims to identify the areas of eating behavior that are altered in individuals with ASD, allowing more specific therapy to be implemented. The tool could also be used to measure the effectiveness of treatment.
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ABSTRACT Objective: This study analyzes subjective aspects associated with parents' perception of the changes that have affected their lives since the birth of their child with autism spectrum disorder (ASD). Methods: A qualitative study, using a narrative approach. Semi-structured interviews were conducted with 7 fathers and 16 mothers of children with ASD enrolled in a special needs school in Salvador, Bahia, Brazil. The interviews were transcribed, analytical categories were defined, and data interpreted. Results: Five categories were identified: "Emotional and Health-Related Effects", "Effects on Daily/Professional and Academic Life", "Effects on Marital and/or Affective/Sexual Life", "Effects on Social Life", "Adaptation Strategies". The analysis showed that, despite the impacts suffered, social support, professional help can facilitate parents' adjustment to life changes following the birth of a child with ASD. Conclusion: The physical and emotional demands of living with and parenting a child with ASD are enormous, include changes in social roles and in couples' social and affective/sexual lives, highlighting the need for parents to receive support from healthcare professionals, particularly mental health professionals. Care strategies need to be implemented for parents, in addition to the healthcare provided to their children, in order to improve the comprehensive care given to the child with ASD.
RESUMO Objetivo: Este estudo buscou analisar os aspectos subjetivos associados à percepção dos pais sobre as mudanças ocorridas em suas vidas após o nascimento de seu filho com transtorno do espectro autista (TEA). Métodos: Estudo qualitativo, com abordagem metodológica de narrativa. Foram feitas entrevistas semiestruturadas com 7 pais e 16 mães de crianças com TEA em escola especial, Salvador-Bahia. As entrevistas foram transcritas, as categorias de análise, elaboradas e os dados, interpretados. Resultados: Foram identificadas cinco categorias: "impacto emocional e na saúde", "impacto na vida diária/profissional e acadêmica", "impacto na vida do casal e/ou afetiva/sexual", "impacto na vida social" e "estratégias de adaptação". A análise revelou que, apesar dos impactos sofridos, apoio social e ajuda profissional podem facilitar uma adaptação às mudanças na vida dos pais, a partir do nascimento do filho com TEA. Conclusão: Conviver e ser mãe ou pai de criança com TEA produz grande demanda física e emocional, mudança de papéis sociais, da vida social e da vida do casal e/ou afetiva/sexual, o que demonstra necessidade de atenção aos pais por profissionais de saúde, especialmente os da saúde mental. Estratégias de cuidado precisam ser implantadas para os genitores, paralelamente à assistência à saúde dos seus filhos, buscando melhorar a atenção integral à criança.
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This article describes how autism spectrum disorder is experienced in the context of immigrant families and how the meaning of this condition, proposed by professionals in the host country, is negotiated between families and healthcare providers. The study sample consists of 44 parents of different nationalities and their 35 children with autism spectrum disorder (ASD) living in a socioeconomically deprived neighborhood of Montreal, Canada. Individual parent interviews were audiotaped and transcribed for subsequent analysis. Results suggest that - although they may sometimes be a source of anxiety - the uncertainties regarding the etiology of ASD, as well as the gap between the explanatory models (EMs) proposed by host country professionals and the impressions of parents, seem to increase the capacity of families to resist the imposition of what they perceive as external categories. Parents perceived the day-to-day difficulties associated with their child's condition as a form of social exclusion that compromised their child's future and independence. These day-to-day difficulties were also described as directly affecting the parents' social life, constituting an important emotional and physical burden. When talking about their children, parents described the painfulness of their experiences, but also discussed how their autistic child had transformed and shaped their lives. Overall, these results show how the disease is "enacted" in the day-to-day life of parents; and suggest that such an embodied understanding of ASD may sometimes represent a form of re-appropriation of power by families faced with adversity.
Subject(s)
Autism Spectrum Disorder/ethnology , Autism Spectrum Disorder/psychology , Emigrants and Immigrants/psychology , Negotiating/psychology , Parents/psychology , Canada , Cultural Diversity , Female , Humans , Interviews as Topic , Language , Male , Qualitative Research , Stress, PsychologicalABSTRACT
Autism Spectrum Disorder (ASD) is characterized by impaired social interaction, impaired verbal and nonverbal communication, and repetitive, stereotyped, and restricted patterns of behavior and interests. Mealtime behavioral problems related to food refusal and selectivity were found to affect the health of this population negatively. A systematic literature review was conducted regarding existing evaluation instruments by searching PubMed, Cochrane, SciELO, Lilacs, Science Direct, and Embase databases using combinations of the following Keywords: autism, autism spectrum disorder, eating disorders, selective eating, eating behavior, food selectivity, eating problems, sensory processing disorders, questionnaire, evaluation, scale, inventory, and screening tool. Fifty-two studies were found, five of which met the inclusion criteria. The review identified significant methodological limitations in the studies and revealed the need for a new instrument to take the parents' views and the severity of the disorder into consideration.
O transtorno do espectro autista (TEA) é caracterizado por déficits na interação social, comunicação verbal e não verbal, associados a padrões de comportamento repetitivos, estereotipados e interesses restritos nos comportamentos. Problemas comportamentais durante as refeições relacionados à recusa e seletividade alimentar são observados e impactam negativamente a saúde dessa população. Foi feita uma revisão sistemática dos instrumentos de avaliação disponíveis na literatura. Realizou-se busca no PubMed, Cochrane, SciELO, Lilacs, Science Direct e Embase com a combinação das palavras-chave: autismo, transtorno do espectro autista, distúrbios alimentares, comer seletivo, comportamento alimentar, seletividade alimentar, problemas de alimentação, distúrbios do processamento sensorial, questionário, avaliação, escala, inventário, ferramenta de rastreio. Foram encontrados 52 estudos, dos quais cinco satisfizeram os critérios de inclusão. Após a revisão, apontaram-se as limitações metodológicas nos trabalhos publicados e a necessidade de elaborar novo instrumento que contemple as impressões dos pais e a gravidade do transtorno.
El trastorno del espectro autista (TEA) se caracteriza por déficits en la interacción social, la comunicación verbal y no verbal, por un perfil de patrones de comportamiento repetitivos, estereotipados e intereses restringidos, y problemas de comportamiento durante las comidas, relacionados con la selectividad alimentaria. Para explorar el comportamiento alimentario en TEA se desarrolló una revisión sistemática de los instrumentos de evaluación en la literatura. Se realizó una búsqueda en PubMed, Cochrane, SciELO, Lilacs, Science Direct y Embase con la combinación de palabras clave: autismo, trastorno del espectro autista, trastornos de la alimentación, capricho para comer, comer, la selectividad de alimentos, problemas de alimentación, trastornos el procesamiento sensorial, cuestionario, la evaluación, la escala, la herramienta de seguimiento de inventario. Se encontraron 52 estudios de los cuales cinco satisfacían los criterios de inclusión, sin embargo, se encontraron limitaciones metodológicas en la obra publicada y la necesidad de desarrollar un nuevo instrumento.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Feeding Behavior , Autism Spectrum Disorder , Child , Child Development , Diet , Data Analysis , Social InteractionABSTRACT
Discute-se o caminho percorrido pela psiquiatria através dos manuais diagnósticos até o momento atual, com o projeto do Research Domain Criteria (RDoC), que busca, eliminando a subjetividade, alcançar uma excelência terapêutica na psiquiatria. São apresentadas quatro perspectivas para se pensar o diagnóstico das doenças psiquiátricas: as doenças que são descritas nos manuais de psiquiatria e que encontram correspondentes em pacientes na prática clínica; os transtornos que foram descritos nos manuais de psiquiatria e que geraram diagnósticos imprecisos; as síndromes culturais e o sofrimento psíquico que é estruturado de forma subjetiva e individual. Conclui-se que uma abordagem terapêutica deve levar em conta a natureza complexa do sofrimento psíquico, gerando mais cautela e individualização no que diz respeito às abordagens terapêuticas.
It discusses the path taken by psychiatry through diagnostic manuals up until now, with the Research Domain Criteria (RDoC) project, which seeks to achieve therapeutic excellence in psychiatry, by eliminating subjectivity. Four perspectives are presented to think about the diagnosis of psychiatric diseases: diseases that are described in the manuals of psychiatry and that have correspondence in patients in the clinical practice; disorders that are described in the manuals of psychiatry and that generated inaccurate diagnoses; the cultural syndromes and the psychic suffering that are structured subjectively and individually. It is concluded that a therapeutic approach should take into account the complex nature of psychic suffering, being more cautious and considering the individualization with respect to therapeutic approaches.
Cet article analyse le développement de la psychiatrie au moyen de manuels de diagnostic jusqu'à ce jour, prenant comme base le projet Research Domain Criteria (RDoC), qui cherche, en éliminant la subjectivité, à atteindre un niveau d'excellence thérapeutique en psychiatrie. Quatre perspectives sont présentées pour penser le diagnostic des maladies psychiatriques : les maladies décrites dans les manuels de psychiatrie qui correspondent aux patients en pratique clinique; les troubles décrits dans les manuels de psychiatrie qui ont produit des diagnostics inexacts; les syndromes culturels et la souffrance psychique structurée de façon subjective et individuelle. On conclut qu'une approche thérapeutique devrait tenir compte de la nature complexe de la souffrance psychique, générant un degré plus important de prudence et d'individualisation par rapport aux approches thérapeutiques.
A través de los manuales diagnósticos, se discute el camino recorrido por la psiquiatría hasta el momento actual, con el proyecto Research Domain Criteria (RDoC), que busca, eliminando la subjetividad, alcanzar una excelencia terapéutica en la psiquiatría. Se presentan cuatro perspectivas para pensar en el diagnóstico de las enfermedades psiquiátricas: las enfermedades que se describen en los manuales de psiquiatría y que encuentran coincidentes en pacientes en la práctica clínica; los trastornos que se describieron en los manuales de psiquiatría y que generaron diagnósticos imprecisos; los síndromes culturales y el sufrimiento psíquico que está estructurado de forma subjetiva e individual. Se concluye que un abordaje terapéutico debe tener en cuenta la naturaleza compleja del sufrimiento psíquico, generando más cautela e individualización en lo que se refiere a los abordajes terapéuticos.
Dieser Artikel diskutiert den Werdegang der Psychiatrie anhand von Diagnosehandbücher bis zur heutigen Zeit, unter Zuhilfenahme des Projekts Research Domain Criteria (RDoC), dessen Ziel es ist, Subjektivität zu beseitigen um therapeutische Exzellenz in der Psychiatrie zu erreichen. Es werden vier Perspektiven der Diagnose von psychiatrischen Erkrankungen vorgestellt: Krankheiten, die in den Handbüchern der Psychiatrie beschrieben sind und denen von Patienten in der klinischen Praxis entsprechen; Störungen, die in den Handbüchern der Psychiatrie beschrieben wurden und ungenaue Diagnosen erzeugten; kulturelle Syndrome und psychisches Leiden, das subjektiv und individuell strukturiert ist. Schlussfolgernd wird festgehalten, dass der therapeutische Ansatz die komplexe Natur des psychischen Leidens berücksichtigen und eine erhöhten Grad an Aufmerksamkeit und Individualisierung in Bezug auf therapeutische Ansätze aufbringen sollte.
ABSTRACT
INTRODUCTION: Few studies have dealt with the potential correlation between anxiety, depression, and cognitive impairment in community-dwelling older adults. METHOD: This longitudinal study was conducted in the city of Montreal, Canada, with 352 older adults aged 55 years or more. The participants were interviewed at baseline and again 2 years later. The Montreal Cognitive Assessment (MoCA) score was estimated and compared between the 2 time points, the Composite International Diagnostic Interview (CIDI) was used to assess major depression and anxiety, and the K10 measured high psychological distress. Likewise, major depression, anxiety disorders, and psychological distress were evaluated at the 2 study time points. RESULTS: In older adults with a diagnosis of depression or anxiety at baseline, no significant reduction in the MoCA score indicating deterioration in cognitive function was found 2 years later. Nevertheless, in individuals with a high level of psychological distress at baseline, there was a significant reduction in MoCA scores 2 years later, indicating deterioration in cognition. The findings of the present study suggest that a high level of psychological distress in addition to environmental factors may constitute important predictors for cognitive health.
Subject(s)
Anxiety Disorders/diagnosis , Cognitive Dysfunction/diagnosis , Depressive Disorder, Major/diagnosis , Disease Progression , Stress, Psychological/diagnosis , Aged , Aged, 80 and over , Anxiety Disorders/epidemiology , Cognitive Dysfunction/epidemiology , Comorbidity , Depressive Disorder, Major/epidemiology , Female , Follow-Up Studies , Humans , Interview, Psychological , Male , Mental Status and Dementia Tests , Middle Aged , Quebec , Stress, Psychological/epidemiologyABSTRACT
O Brasil tem 49.412 psicólogos atuando no Sistema Único de Saúde (SUS). Isso desafia o ensino a deslocar-se de suas tradicionais estruturas, que privilegiam a clínica, para formar promotores de saúde. Parte de uma tese que compreende a psicologia como profissão de saúde, este estudo descreve o Internato, uma prática pedagógica assistida, na qual o professor responde como mediador numa perspectiva psicopedagógica. Esse estudo apresenta a percepção dos estudantes sobre a experiência de aprendizagem no Internato. Estudo descritivo, qualitativo, que analisou o conteúdo de 51 questionários de estudantes do 8º ao 10º semestre, pelo Método de Interpretação de Sentido. Os resultados são indicativos de 100% de satisfação frente à experiência e desenvolvimento de competências como atitude interdisciplinar, capacidade de atuar em equipe, comunicação, autonomia e maturidade, reveladoras de uma aprendizagem que integra atitude, conceito e técnica, respondendo às demandas das Diretrizes Curriculares e do SUS.
There are about 49,412 Psychologists working on SUS that challenges the education system to move from its traditional position, which privileges clinics, to develop health promoters. This is part of a thesis that thinks Psychology as a health profession. This study describes the Internship, a pedagogic assisted practice, where the teacher is viewed as a mediator in a psychopedagogical perspective. It provides the perception of the students about the Internship experience. This is a descriptive study based on qualitative approach analyses of the content of 51 questionnaires of students enrolled between the 8th and 10th semester of a Psychology course in Bahia, Brazil. The data was analyzed using Sense Interpretation Method. The results indicate 100% of satisfaction facing the experience and development of competences as interdisciplinary attitude, capacity to work with teams, communication, autonomy and maturity. All the above reveals the learning that integrates attitude, concept and techniques, answering the demands of the DCN's and SUS.
ABSTRACT
Este artigo descreve o processo dialógico de constituição de uma reformulação curricular do Curso de Psicologia da Escola Baiana de Medicina e Saúde Pública. A fundamentação teórica concebe o currículo como campo político de produção de subjetividades, a Psicologia como uma profissão de saúde e o conceito de competência definido pela cubana González Maura (2000) que envolve a dimensão específica do fazer em Psicologia e a dimensão pessoal, atitudinal e motivacional. Trata-se de um relato de experiência que apresenta uma interpretação das DCN, destacando a subjetividade como central na formação em Psicologia, especialmente para o desenvolvimento da autonomia, capacidade de crítica e compromisso com valores sociais. O resultado do processo foi um modelo de currículo organizado em Módulos, a partir de Eixos Temáticos, com o uso de Metodologias Ativas e Práticas Interdisciplinares estruturados como sistemas abertos, de forma a contemplar diferenças e diversidades em permanente movimento de construção e desconstrução. Esses elementos estão sustentados por uma cultura de trabalho docente coletiva, pelo protagonismo discente e docente, pela comunicação com o mercado de trabalho e pela experiência do conjunto de subjetividades individuais que permitiram a emergência de um discurso formativo carregado de poder transformador que coloca a formação acadêmica em Psicologia articulada ao desenvolvimento de sujeitos, ultrapassando a perspectiva de construção de uma identidade ocupacional tecnicista.
This article describes the dialogic process of constitution of a new manner for the curriculum made on the Psychology Major from Escola Baiana de Medicina e Saúde Pública. In theory the curriculum is treated as a political field to product subjectivities, the Psychology as a Health profession and the concept of competence defined by González Maura (Cuban, 2000), involving the specific dimension to do Psychology, united to the personal, attitudinal and motivational dimensions. That idea is based on an experience passage that presents an interpretation of the DCN's, which highlights subjectivity as central on Psychology formation, especially for the progress of: autonomy, critical capacity and commitment with social values. The result of the process was a Showpiece curriculum, divided in modules, starting from the Thematic Axis, using the interdisciplinary practices and active methodologies, structured as opened systems to contemplate differences and diversity in constant movement between construction and deconstruction. These elements are based on a docent collective working culture, by teachers and students, as important part of the story, by the link between the job market and the set of individual subjectivities. Those changes connect the academic formation in Psychology with the development of people, overtaking the perspective of construction of a Technicistic occupational identity.
En este artículo se describe el proceso dialógico de formación de una reformulación del Curso de Psicología en la Escuela Bahiana de Medicina y Salud Pública. La fundamentación teórica concibe el currículo como un campo de subjetividades, y producción política, la Psicología como una profesión de la salud y el concepto de competencia definido por la cubana González Maura (2000), que involucra la dimensión específica del hacer en Psicología y la dimensión personal, actitudinal y motivacional. Presenta un relato de experiencia que trae una interpretación de las DCN que destaca la subjetividad como central en la formación en Psicología, sobre todo para el desarrollo de la autonomía, de la capacidad crítica y compromiso con los valores sociales. El resultado del proceso fue un modelo de plan de estudios organizado en Módulos, a partir de los ejes temáticos, con el uso de metodologías activas y prácticas interdisciplinares estructuradas como sistemas abiertos, para abarcar las diferencias, la diversidad en el movimiento permanente de construcción y deconstrucción. Estos elementos están apoyados en una cultura de trabajo docente colectivo, que tiene como protagonista el discente y el docente, la comunicación con el mercado laboral y la colección de experiencias subjetivas individuales que permitieron el surgimiento de un discurso formativo cargado de poder de transformación que pone la formación académica en Psicología articulada con en el desarrollo de los sujetos, superando la perspectiva de construcción de una identidad ocupacional técnica.
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This study aims to estimate the prevalence of symptoms of attention-deficit/hyperactivity disorder (ADHD) in parents of children with autism spectrum disorder (ASD). This is a cross-sectional study conducted with the parents of 89 children previously diagnosed with ASD. The research instrument used was the 18-item Adult ADHD Self-Report Scale (ASRS). Symptoms of ADHD were present in 10.4% of the mothers of children with a diagnosis of ASD and in 11.3% of the fathers. These results suggest that the prevalence of symptoms of ADHD in the parents of children with autism is higher than that found in the general adult population.
