Family and facility care variables attributing to postnatal depression among women in two tribal-dominated districts of Odisha: Log model analysis to suggest intervention.

Introduction: It is a proven fact that women are affected by poor mental health predominantly in the postnatal period. This is authenticated by the use of a validated and tested Edinburg Postnatal Depression scale (EPNS), which is a simple tool to measure depression among women after delivery by posing 10 questions and this is also validated in Odia language. Odisha has made laudable progress in delivering Maternal and Child Health care to women even in tribal-dominated districts through its robust Comprehensive Obstetrics care network restricting home delivery almost to a mere 4%-5% and reducing maternal deaths by 60%-70% as per the National Family Health Survey (NFHS-5). As a part of an Indian Council of Medical Research (ICMR) extramural project to enhance contraceptive acceptance among males in districts that had a total fertility rate (TFR) higher than 3, a qualitative objective to measure mean postnatal depression in the early postpartum period (who are also the target to advocate contraceptive acceptance) was undertaken. A secondary objective was to compare family care vs. facility care as greater attributing factors for higher EPNS scores. Materials and Methods: Due to time constraints, the study was done on a fast-track mode wherein two villages each from the sampled blocks of Koraput and Boudh (with one of the highest birth rates) were selected. All women in villages who had a baby aged between 1 and 6 months, were the sampling frame and only those were selected who consented. A questionnaire was used that elicited information on familial sociodemographic details and also facility-based antenatal care (ANC) and postdelivery services that were availed for the last-born child. General Health Questionnaire-12 (GHQ-12) scores were used as an independent variable and a proxy measure of cumulative familial stress. Descriptives and log regression were used to measure the odds of family vs. facility-based services. Results: A total of 98 women, 50 from Boudh and 48 from Koraput, participated in the study. Koraput's mean EPNS scores were 6 points higher than Boudh indicating much higher postnatal poor mental health. Log models showed that there was no difference between facility-based care in both districts as both reported 96%-97.3% institutional delivery, with out-of-pocket expenditure (OOP) being less than 520 Indian rupees on average and nearly 100% reported receipt of iron folic acid and calcium as well as streamlined Janani Suraksha Yojana (JSY) services. However, the odds of men's participation in Family planning was 2.77 times less in Koraput (SD = 2.582), fourth birth order 1.33 odds, and female gender 5.66 odds higher for the district as a result of which GHQ 12 score mean was 21.00 (CI: 19.18-22.82) hinting very high psychological stress as compared with Boudh where the mean was 17 (CI: 14.59-19.41). Conclusion: This clearly indicates that a robust healthcare delivery alone will not be able to address the holistic health of women in the childbearing age group. Familial stressors compound poor mental health and hence counseling of the family as a whole is necessary to achieve sound mental health in women in the postnatal period. The spousal role is emerging as a strong determinant, especially in terms of nonacceptance or casual approach to contraceptive use. Interestingly, a skewed gender bias is noted for the female child, which is also a contributor to postnatal depression (PND) in both districts, though a bigger sample would be needed to statistically prove it.

Family Counseling after the Diagnosis of Congenital Heart Disease in the Fetus: Scoping Review.

Congenital heart disease (CHD) is the leading cause of death from malformations in the first year of life and carries a significant burden to the family when the diagnosis is made in the prenatal period. We recognize the significance of family counseling following a fetal CHD diagnosis. However, we have observed that most research focuses on assessing the emotional state of family members rather than examining the counseling process itself. The objective of this study was to identify and summarize the findings in the literature on family counseling in cases of diagnosis of CHD during pregnancy, demonstrating gaps and suggesting future research on this topic. Eight databases were searched to review the literature on family counseling in cases of CHD diagnosis during pregnancy. A systematic search was conducted from September to October 2022. The descriptors were "congenital heart disease", "fetal heart", and "family counseling". The inclusion criteria were studies on counseling family members who received a diagnosis of CHD in the fetus (family counseling was defined as any health professional who advises mothers and fathers on the diagnosis of CHD during the gestational period), how the news is expressed to family members (including an explanation of CHD and questions about management and prognosis), empirical and qualitative studies, quantitative studies, no publication deadline, and any language. Out of the initial search of 3719 reports, 21 articles were included. Most were cross-sectional (11) and qualitative (9) studies, and all were from developed countries. The findings in the literature address the difficulties in effectively conducting family counseling, the strengths of family counseling to be effective, opportunities to generate effective counseling, and the main challenges in family counseling.

Planning and Setting Up of a Communication Program for Hospitalized COVID-19 Patients: Challenges and Potential Solutions in Resource Constrained Setting.

Background The recent onset of COVID-19 pandemic has necessitated many patients to be hospitalized in the COVID-19 treating centers. Owing to the need for isolation of these patients and minimizing the risk of transmission to healthy people, COVID-19-positive patients are completely restricted from meeting their friends and families. This gives rise to anxiety amongst the patients' relatives as they are not able to monitor the progress of the patients and have to depend entirely on the healthcare staff for any updates regarding the patient. In contrast, the treating doctors are undergoing severe stress due to the unknown nature of the virus and the risks involved in treating patients. They are thoroughly exhausted after the long hours donning the personal protection equipment (PPE). Objective To structure and form an interface for communication between the treating physician and the families, as a "communication team," to decrease the workload on the treating physicians and minimize their contact time in a COVID-19 setting. Results The addition of a communication team improved the physicians' efficiency of patient management and family satisfaction. Several challenges were faced during the setting up of this interface effectively. However, most of these were dealt with along the way. The communication team was instrumental in allaying the anxiety of the family with respect to their patients' clinical condition. This also ensured engagement of doctors from non-clinical and laboratory-based departments in the COVID-19 treatment process. Conclusion Adding up a communication team for communicating clinical updates to the family in a resource-limited scenario greatly improved communication and thus family satisfaction of the COVID-19-positive patients.

Combining Family Systems Approaches to Address BIPOC Families' Racial Trauma Amidst the Global Pandemic.

The ACE study (Felitti et al., 1998) led to the recognition of the prevalence and impact of trauma. However, since the ACE study sample was mostly white and middle class, the Philadelphia task force implemented their own study to account for trauma of a more diverse sample. A result of the study was a list of evidence-based treatments to be utilized with BIPOC populations. Of the evidence-based treatments was, ecosystemic structural family therapy (ESFT). A similar effective approach is the family resilience framework. When combined, the approaches can be effective with BIPOC families during the global pandemic and racial trauma, something not typically at the forefront of family counseling goals. In this article, I explain the four steps family counselors should follow when combining the approaches to better approach and treat racial trauma while also partaking in effective advocacy to enhance family resilience of BIPOC families. A case study is provided for family counselors to understand how to effectively utilize this combined approach.

Orientación a la familia del niño con necesidad educativa sensorial de tipo auditiva

RESUMEN En la orientación a la familia con niño de la primera infancia con necesidad educativa sensorial de tipo auditiva es vital prestar atención a la estimulación que debe recibir el menor y que propicia el desarrollo, con lo cual se previenen posibles retrasos y discapacidades. El objetivo del presente texto es exponer los resultados de la constatación del estado actual de la orientación que recibe la familia del niño con necesidad educativa sensorial de tipo auditiva durante sus dos primeros años de vida para que el proceso de atención temprana en el hogar sea eficiente desde la etapa prediagnóstica. Los resultados son parte del proyecto de investigación Perfeccionamiento del trabajo preventivo y comunitario en los diferentes niveles educativos de la provincia de Camagüey, que se desarrolló en la Universidad de Camagüey en el período comprendido entre diciembre de 2018 y marzo de 2020. Se aplicaron métodos y técnicas como análisis de documentos, observación, encuesta, entrevista y el Test de percepción del funcionamiento familiar. Los resultados del diagnóstico permiten disponer de datos cuantitativos y cualitativos que permiten mejorar la orientación familiar desde el programa Educa a Tu Hijo con la participación del médico y la enfermera de la familia.

ABSTRACT In the orientation of the family with a child of early childhood with an auditory sensory educational need, it is vital to pay special attention to the stimulation that the child should receive and that promotes development, thereby preventing possible delays or disabilities. Hence, the objective of this text is to present the results of the verification of the current state of the orientation that the child´s family receives with an auditory sensory educational need during the first two years of life so that the early care process at home is effective from the pre-diagnosis stage. The results are part of research project: Improvement of preventive and community work in the different educational levels of the province of Camagüey which takes place at the University of Camagüey in the period between December 2018 and March 2020. In carrying out this work, methods and techniques such as documents analysis, observation, survey, interview and the Family Performance Perception Test. The results of the diagnosis allow quantitative and qualitative data to be available to improve family orientation of the Educate Your Child Program with the participation of the family doctor and nurse.

Domestic Violence and Covid-19: Policy and Pattern Analysis of Reported Cases at the Family Counseling Center (FCC) in Alwar, India.

Introduction: The paper aims to assess the pattern of reporting complaints at the Family Counseling Centre (FCC), the nature and form of domestic violence (DV) during the lockdown, and the challenges addressed by the FCC, located in Alwar, India. Methods: The methodology is considered an event study methodology. The study was conducted using the records available with the FCC. Using monthly time series data for 33 months (from April 2019 to December 2021), the time series analysis was done to bring out the pattern of reporting, nature and form of DV. Interviews were conducted with the counselors to document the challenges faced by them. Results: The analysis shows that the reported DV-cases decreased by 23 percent during the lockdown. Challenges faced during the lockdown by the FCC in the existing policy guideline was that the lockdown disrupted the physical access of the routine complaint system. The COVID-19 lockdown and restrictions on mobility explain why only a portion of the women reach the center. The average decrease in reporting masked significant information about altered patterns and low reporting does not translate to a decline in violence at home. Conclusions: The average change in DV during lockdown can be very misleading when thinking about a reframing policy response in India. Therefore, these findings should not be restricted to lockdown but are viewed broadly in the explanation that can be extended in policy to include the role of chronic stressors in accentuating violence. Policy Implications: The study has significant implications for realigning and redesigning institutional strategies to overcome cultural barriers for seamless access to the FCC. This would enable a transition of counseling from event-based rescue to building resilience by adopting a lifelong learning and well-being approach.

Exploring Physicians' Perspectives on the Introduction of Complementary Foods to Infants and Toddlers.

Complementary feeding is the subject of many recommendations regarding the benefits of its use, illustrating its crucial impact on further health. However, it still poses a significant problem for caregivers, and thus for doctors. This survey focused on nutritional problems faced by the parents of infants and toddlers, as well as how physicians deal with these problems. Based on the responses from 303 doctors, it was determined that the time and sequence of introducing complementary foods raise the greatest doubts in parents. This study also found that at least one-third of pediatricians experience difficulties in providing effective nutritional counseling. Increasing the nutritional awareness of physicians can allow them to provide more appropriate support to parents.

How effective is family counselling on screen exposure of pre-school children?

BACKGROUND: Excessive screen viewing and background TV exposure are common problems all over the world. Therefore, intervention studies have gained importance. This study aims to investigate the effectiveness of family-based, developmental pediatrics clinic setting counseling in reducing screen time in typically developing children and to compare them with neurodevelopmental disorders. METHODS: Children (aged 24-62 months) who were exposed to screen viewing for at least 2 hours/day were included. Parents were given three counseling sessions to reduce excessive screen time. Parents reported daily screen time, co-viewing, background TV exposure, the duration of reading books and playing with their child. RESULTS: The study included 105 children (median age: 34 months IQR:28-41). Before counseling, the screen viewing time and the percentage of co-viewing among typically developing children (n=22) and children with a neurodevelopmental disorder (n=83) were similar. There was a statistically significant decrease in screen time in both groups after the intervention. A higher impact was shown in the neurodevelopmental disorder group. The increase in percentages of co-viewing, as well as the increase in the time spent playing with their children, were statistically significant in the neurodevelopmental disorder group. CONCLUSIONS: The study demonstrated that three pediatric office-setting counseling sessions including media use recommendations of the American Academy of Pediatrics are effective to decrease screen time for children who are either typically developing or with a neurodevelopmental disorder.

Role of older generations in the family's adjustment to Huntington disease.

Genetic diseases are a family matter, requiring adjustment and management from the family system, particularly when the diagnosis is recent. Literature has evidenced the importance of the role of older relatives in families dealing with some genetic diseases; however, knowledge is scarce regarding rare incurable genetic disorders, such as Huntington disease. Therefore, this exploratory qualitative study aims at describing how adjustment to Huntington disease occurs, from a family perspective, considering the roles performed by older generations, in the Portuguese context. It adopts the critical incidents technique, administered based on semi-structured interviews, and comprises 10 participants, aged 28 to 72 years (8 females), from seven families. Participants reported 130 critical incidents. The interviews were audiotaped, transcribed, and submitted to thematic analysis. Findings portray participants and their families as "beginners" in understanding and incorporating Huntington disease in their lives, due to recent diagnosis. In addition, data suggest that older relatives play two relevant roles in the creation of family narratives: (1) "shaping awareness about HD" (68 critical incidents) and (2) "influencing HD management" (62 critical incidents). Genetic counseling and family-centered interventions aimed at supporting families with a history of hereditary genetic diseases, should consider a narrative approach involving older relatives, since they have a great influence in sustaining family stories.

Predictors of family violence through the COVID-19 pandemic: Structural equation modeling.

There has been much talk, globally and locally, about family violence during the COVID-19 pandemic. Family violence has received increasing interest from the researchers in many different fields, while family violence during the COVID-19 pandemic outbreak still needs researchers' attention to investigate its predictors and detect the prevalence among family members through this health crisis. This study aimed to investigate the spread of family violence and detect the predictors of it with the applied advanced statistical procedure, structural equation modeling (SEM). The researchers prepared the family violence scale that consisted of 21 items, and applied it in a random sample that consisted of (312) individual. The finding indicated that there are high levels of family violence, violence between spouses, violence from parents to children, and sibling violence. As well as, the findings found that the years of marriage are statistically significant of violence between spouses, violence from parents to children, and sibling violence, and the total score of the family violence. As well as, sex is a statistically significant predictor of violence between spouses. While the educational level, age, and income level did not predict violence (total score or dimensions). Based on the results of the current study, counseling programs to reduce family violence and psychotherapy programs to reduce the negative effects of family violence on parents and children must be planned. Therefore, the role of traditional and online family counseling and psychotherapy must be activated in light of the outbreak of the COVID-19 pandemic.

Role of Social Support in Women facing Domestic Violence during Lockdown of Covid-19 while Cohabiting with the Abusers: Analysis of Cases Registered with the Family Counseling Centre, Alwar, India.

The present study aims to analyze the role of social support in the lives of women survivors of domestic violence who filed a complaint with the Mahila Salah and Suraksha Kendra (MSSK) Alwar, India, while residing with the abusive husband and his family during the lockdown period of COVID-19. The study explores the role of MSSK with extended vulnerability of women during the lockdown period at large. This study adopts an exploratory qualitative method. A total of 36 married women who had filed a complaint with MSSK before and during the lockdown were included. Interviews with the women were held through telephonic conversations on vulnerability, coping mechanism and extent and forms of social support. Thematic content analysis was done in a stepwise manner. Results show that degeneration of social support model is time -bound and the accuracy of applying this model wane under extended condition of vulnerability caused due to COVID-19. MSSK can expand support by creating and integrating virtual community networks to detect and deter violence during the lockdown. The study suggests that the government can ensure and empower bystanders with skills of modern communication. The existing physical institutional delivery mechanism need to evolve strategies that are resilient to emerging threats from the vulnerable ecosystem.

Interventions to Empower Adults with Eating Disorders and Their Partners around the Transition to Parenthood.

The transition to parenthood is perceived as a stressful life event, when parents experience an immense change of their psychological focus and a reorientation of roles and responsibilities in the family system. This process may be even more challenging in the presence of a parental eating disorder history. This paper reviews the impact of parental eating disorders on the parents, the couple relationship, and their child during the perinatal period. A parental eating disorder is associated with more negative expectations of parental efficacy as well as specific difficulties in couple communication over the child's feeding, shape, and weight. Providers who better understand the effects of an eating disorder on parental functioning can more effectively intervene early on. We also present couple- or parent-based, empirically supported interventions for adults with eating disorders and their partners in the prenatal and postnatal periods: Uniting Couples in the treatment of Anorexia Nervosa (UCAN) and Uniting couples In the Treatment of Eating disorders (UNITE) both enhance recovery from the eating disorder through a couple-based intervention; the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) incorporates the support of partners, when appropriate; Parent-Based Prevention (PBP) focuses on improving parental functioning and reducing risk of negative parental and child outcomes. Finally, we discuss the clinical implications of addressing parental eating disorders and encourage more research on these families.

La transición a la paternidad se percibe como una situación estresante de la vida, cuando los padres sufren un cambio inmenso en su foco de atención psicológico y una reorientación de los roles y las responsabilidades en el sistema familiar. Este proceso puede ser aun más difícil en presencia de antecedentes de trastornos alimentarios en los padres. Este artículo analiza el efecto de los trastornos alimentarios parentales en los padres, la relación de pareja y su hijo durante el periodo perinatal. Un trastorno alimentario parental está asociado con expectativas más negativas de la eficacia parental así como con dificultades específicas en la comunicación entre la pareja sobre la alimentación, la figura y el peso del niño. Los profesionales que mejor comprendan los efectos de un trastorno alimentario en el funcionamiento parental pueden intervenir más eficazmente en etapas tempranas. También presentamos intervenciones respaldadas empíricamente basadas en la pareja o en los padres para adultos con trastornos alimentarios y sus parejas en los periodos prenatales y posnatales: la "Unión de las parejas en el tratamiento de la anorexia nerviosa" (UCAN) y la "Unión de las parejas en el tratamiento de los trastornos alimentarios" (UNITE) mejoran la recuperación del trastorno alimentario mediante una intervención basada en la pareja; el modelo Maudsley de tratamiento para adultos con anorexia nerviosa (MANTRA) incorpora el apoyo de las parejas, cuando es adecuado; la prevención basada en los padres (PBP) se centra en mejorar el funcionamiento parental y en reducir el riesgo de consecuencias negativas para los padres y los niños. Finalmente, debatimos las implicancias clínicas de abordar los trastornos alimentarios parentales y de fomentar más investigaciones sobre estas familias.

[Low-threshold consulting services for dementia : Quality criteria from a provider's point of view]. / Niedrigschwellige Beratungsangebote bei Demenz : Qualitätskriterien aus Sicht der Leistungserbringer.

BACKGROUND: Low-threshold consulting services are becoming increasingly more important as an addition to outpatient and inpatient services. OBJECTIVE: What quality criteria do providers of low-threshold consulting services for family caregivers of people with dementia have? MATERIAL AND METHODS: Telephone interviews with 36 providers of family counseling, support groups, care course. Qualitative content analysis according to Mayring complemented by a literature search. RESULTS: The quality criteria of the providers are based on frequent, ongoing, daily life-oriented, family-oriented, relief-providing, professional, and cross-linked services. CONCLUSION: Increased cooperation and coordination of all involved stakeholders is necessary to improve the knowledge and utilization of the services and the qualitative orientation.

Characteristics of BRCA1/2 mutations carriers including large genomic rearrangements in high risk breast cancer patients.

PURPOSE: We investigated the prevalence of BRCA1/2 small mutations and large genomic rearrangements in high risk breast cancer patients who attended a genetic counseling clinic. METHODS: In total 478 patients were assessed for BRCA1/2 mutations by direct sequencing, of whom, 306 were identified as non-carriers of BRCA1/2 mutation and assessed for large rearrangement mutations by multiplex ligation-dependent probe amplification. Family history and clinicopathological characteristics of patients were evaluated. RESULTS: Sixty-three mutation carriers (13.2%) were identified with BRCA1 mutations (6.3%) and BRCA2 mutations (6.9%), respectively. Mutation frequency was affected by familial and personal factors. Breast cancer patients with family history of breast and ovarian cancer showed the highest prevalence of BRCA1/2 mutations (67%), and triple-negative breast cancer (TNBC) patients showed high BRCA1 mutation prevalence (25%). The three probands of BRCA1 deletion (1%) represented both familial risk and personal or clinicopathological risk factors as two with TNBC and one with bilateral ovarian cancer. DISCUSSION: This is the largest study assessing large genomic rearrangement prevalence in Korea and BRCA1 deletion frequency was low as 1% in patients without BRCA1/2 small mutations. For clinical utility of large genomic rearrangement testing needs further study.

[Psychotherapeutically-Systemic Acting in the Integrated Family Counseling Presented by the Example of Child-Centered Educational Counseling]. / Psychotherapeutisch-systemisches Handeln in der Integrierten Familienberatung am Beispiel der kindzentrierten Erziehungsberatung.

The article gives an insight into the practice of Integrated Family Counseling and identifies their interfaces with psychotherapeutic approaches. The example of the child-centered educational counseling shows how consultancy, systemic and psychotherapeutic interventions interact in order to meet the parents educational needs defined by the parents. The first part of the article explains the term of Integrated Family Counseling, differentiates the various substantive areas of work and outlines the systematic attitude. The second part describes the psychotherapy-systemic action in the child-centered educational counseling from the perspective of the practice. Main priorities in the course of counseling, including cause-related behavioral and developmental diagnostics, play therapy intervention and parental involvement are presented. Here the systemic approach, major methodological elements as well as their effects are pointed up. The third part is devoted to the reflection of the relationship between counseling and psychotherapy. It becomes clear that in particular the intended effectiveness of an intervention determines their methodological design to a large extent.

Implications for observant Jewish families in the provision of mother's own and donor milk for their very low birth weight infant.

Jewish law recognizes the importance of breast milk, and breastfeeding rates are high among religious mothers. Infants born at very low birth weight are medically fragile, and breast milk is of critical importance for their health protection and optimal growth and development. For observant Jewish infants and their families, there may be scenarios for special consideration in their health care. This report reviews briefly the relevant Jewish laws related to breast milk provision, both mother's own milk and donor milk, in the neonatal intensive care unit with background information for counseling such families.

[Development of a nurse-led family counseling program for families of the elderly: the first cycle of a Community-Based Action Research Project (CBPR)]. / Entwicklung einer pflegegeleiteten Familienberatung für Familien älterer Menschen: Der erste Zyklus eines gemeindebasierten Aktionsforschungsprojektes (CBPR).

BACKGROUND: With the support of family members many elderly people can live an independent life at home. Accepting support respectively providing support might be a challenge for both elder and family member. Families often have little professional support to manage those challenges. AIM: Therefore, a nurse-led counseling program for families of the elders has been established. METHOD: The counseling program was developed with community-based participatory research (CBPR) methodology using individual and focus group interviews, as well as a written survey and tested in a pilot study. RESULTS: Managing disease in everyday life, helpful means of support at home, changes in family relations, information about services as well as information how to navigate the healthcare system have been themes to discuss in the counseling sessions. Participants in the pilot study showed a statistically not significant increase in well-being, and preparedness for care and were highly satisfied with the counseling program. CONCLUSIONS: Families of the elderly could actively participate in developing and researching a nurse-led family counseling program. Several family members still engage as co-researcher in the program and participate to improve the new service.

Trastornos somatomorfos en la atención primaria: características psicosociales y resultados de una propuesta de consejería familiar / Somatoform disorder in primary health care: psycho-social characteristics and results of a familiar counseling proposal

The article describes the psychosocial characteristics of patients with somatization disorder and the results of a family counseling proposal, applied by the primary care health equipment. The objective of the counseling was that the patients recovered their personal skills, that allow them to take control or the solution of their problems, and they could act independently. Method: The sample was constituted by 128 patients from seven centers of primary attention health of the Bío-Bío Region. Results show that the main patient complaint is related to the family and the application was successful for 75 percent of the cases. Discussion: The results are discussed in relation to their limitations and future projections.

El presente artículo tiene como propósito, describir las características psicosociales de los pacientes con trastornos somatomorfos y los resultados de una propuesta de consejería familiar aplicada a estos por equipos de salud en la atención primaria. El objetivo de la consejería fue que los pacientes recuperaran sus competencias personales, a objeto de tener el control o resolución de sus problemas, y poder funcionar autónomamente. Método: La muestra, estuvo constituida por 128 pacientes, pertenecientes a 7 centros de Salud de atención primaria de la Región del Bío-Bío. Resultados: Muestran que la queja principal estaba relacionada con la familia y que la aplicación de la consejería fue exitosa en un 75 por ciento de los casos. Discusión: Los resultados son discutidos en relación a sus limitaciones y proyecciones futuras.

Contingências envolvidas na condução do desenvolvimento verbal de uma criança de 5 anos / Contingencies involved in driving riving the verbal development of a 5 years old child

Comportamento verbal é comportamento operante, sujeito a leis de reforçamento. Contingências de reforçamento podem produzir supressão ou baixa frequência de emissão de respostas verbais. O objetivo deste trabalho foi: levantar hipóteses de possíveis contingências de reforçamento que pudessem provocar supressão e/ou baixa frequência na emissão respostas verbais; observar interações familiares e identificar contingências que pudessem diminuir ou aumentar a frequência de emissão de respostas verbais e comportamentos inadequados; e, desenvolver procedimentos de intervenção através de orientações aos pais e verificar possíveis mudanças na frequência de emissão de respostas verbais de uma criança de cinco anos. Para isso, foram feitas: entrevista para levantamento da história de vida da criança e da queixa; observações semanais de uma hora na residência da criança por um período de sete meses; e, orientações aos pais ao final de cada sessão de observação para que usassem procedimentos tais como reforçamento diferencial de respostas alternativas, ensino de nomeação, reforçamento de mandos vocais, consequenciação de emissão de resposta verbal, alteração na frequência de assistir TV e jogar vídeo-game e extinção para comportamentos inadequados. As interações entre os membros da família durante as sessões de intervenção foram transcritas e categorizadas. Os resultados mostram que a criança em sua história de reforçamento e no início do estudo, foi exposta a contingências desfavoráveis ao desenvolvimento de respostas verbais, o que produziu supressão e/ou baixa frequência de emissão de respostas verbais. As orientações emitidas pela pesquisadora parecem ter produzido mudanças nos comportamentos dos pais e consequentemente, nos comportamentos da criança, provocando aumento na frequência de emissão de verbalizações e diminuição dos comportamentos inadequados. Além disso, os dados mostram que ocorreram mudanças na interação de todos os membros da família(AU)

Verbal behavior is operant behavior and, therefore, is ruled by the laws of reinforcement. Reinforcement contingencies may result in suppression or low frequency of verbal responses. The purpose of this study was threefold: To formulate hypotheses of possible reinforcement contingencies that might suppress or lower the frequency of verbal responses; to observe family interactions and identify the contingencies that could lower the frequency of verbal responses and raise the frequency of inappropriate behavior; to develop intervention procedures through parent counseling and to verify possible changes in the frequency of verbal responses emitted by a 5 yearold child. In order to accomplish this aim, an interview was conducted to assess the history of the child’s and the parents’ complaints; one hour observation sessions in the child’s home were held over 7 months and, at the end of each observation session, parent counseling took place. The purpose of counseling the parents was to instruct them to differentially reinforce alternative responses, teach naming, reinforce vocal mands, prompt the emission of verbal responses, alter the frequency of watching TV and playing video games, and perform the extinction of inappropriate behavior. The interactions of family members during the intervention sessions were noted and categorized. The results show that the child was exposed to unfavorable contingencies at the beginning of the experiment and in his earlier life, which had given rise to the suppression and/or low frequency of verbal responses. The instructions given by the researcher seem to have produced changes in the parents’ behavior and, consequently, in the child’s behavior, leading to an increased frequency of verbal responses and a decreased frequency of inappropriate behavior. In addition, the data show that changes occurred in the interactions of all members of the family, confirming that verbal behavior is shaped and maintained by reinforcement contingencies(AU)