Indiana University-Purdue University Indianapolis (IUPUI) / Little is known regarding the psychosocial outcomes of adult siblings of adults with autism. Accordingly, the current study sought to: (1) illuminate factors that predict health-related quality of life, caregiver burden, and reported benefits in adult siblings of adults with autism, using a stress and coping framework and (2) compare outcomes of siblings of adults with autism (n = 31) to siblings of adults with Down syndrome (DS) (n = 54). For the within subject hypotheses, analyses were repeated within the DS group and an overall Disability group (n = 97). The Disability group consisted of participants in the Autism and Down syndrome groups plus twelve individuals in a mixed group of adult siblings of adults with DS who presented with co-morbid symptoms of autism. Variables were organized using The Adult Sibling Caregiver Conceptual Model (ASCCM) into three categories: antecedents (e.g., sibling relationship quality, problem behaviors of the disabled sibling), mediators (e.g., coping strategies, cognitive appraisal types), and psychosocial outcome variables (i.e., mental and physical health-related quality of life, caregiver burden, and reported benefits). For the within subject primary hypotheses, I posited a series of relationships between the antecedents and outcomes based on prior literature on demographic and individual difference predictors (e.g., siblings of adults with autism with fewer problem behaviors would have increased health-related quality of life [HRQOL], decreased caregiver burden, and increased reported benefits) and on stress and coping factors related to the burden of providing care for an individual with autism (e.g., greater use of avoidant coping strategies would be related to lower HRQOL, increased caregiver burden, and decreased reports of benefits). Exploratory hypotheses also were examined (e.g., being married would be associated with increased HRQOL, decreased burden, and increased reported benefits). The within-subject results indicated support for eight of the ten primary hypotheses and five of the six exploratory hypotheses when examined within at least one of the study groups: Autism, DS, or Disability. Overall, sibling caregivers, regardless of their sibling’s disability, reported more favorable psychosocial outcomes when demands were lower (e.g., less severe levels of problem behaviors, fewer autism symptoms exhibited by their disabled sibling, decreased additional pile-up stress), when resources were available to cope with stress (e.g., social support, respite care), and when healthy responses to stress were reported (e.g., use of emotion focused vs. avoidant coping strategies, use of challenge vs. threat appraisal types). Of note, reported benefits, which have rarely been examined in the autism literature, were strongly related to the quality of a sibling relationship across all study groups, and with the helpfulness of received services and perceived social support within the Autism group. The between subject hypotheses also were largely supported. As expected, compared to siblings of those with Down syndrome, siblings of those with autism demonstrated greater levels of caregiver burden and lower mental HRQOL. Moreover, there was a rank ordering in levels of caregiver burden across disability groups; siblings of adults with DS reported the lowest burden, siblings of adults with DS with symptoms of autism reported significantly higher levels of burden, and siblings of those with autism reported the most burden. The results imply that autism, either alone or co-morbid with another diagnosis, presents an increased risk of stress and caregiver burden, not only in parent caregivers, but also in sibling caregivers. Interestingly, there was also evidence for higher levels of stress related growth within the Autism group compared to the DS group. Future research will be needed to generalize the results of this study to broader samples of adult siblings while taking a life course perspective to assess changes in non-disabled siblings’ outcomes over time.

Thesis (MEdPsych)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The study was undertaken to identify internal and external assets of a ten year- old girl with Down Syndrome. The assets include those of the individual and the broader community. The learner’s assets, in her immediate environment, was difficult to identify because of minimal exposure to community activities. A list of assets were compiled and the 40 Developmental Assets as researched by the “Searched Institute of Minneapolis” (Roehlkepartain & Leffert, 2000), served as key elements for the cartographic listing of the assets of the learner with Down Syndrome. In this research, the asset-based approach was used as a framework. A qualitative research design was used for the research where the learner was observed in her natural environment. The learner was observed at school and at home with the aim to identify assets. During the research the parents as well as the school was empowered by shifting their focus from the learner’s needs and shortcomings to the learner’s strengths, abilities and talents. The identifying of the new assets will enable the learner to improve her socialising skills and allow her to improve her self-care. The results of the research show that the parents and the school developed a more positive attitude with regard to the identification and mobilization of assets of learners with disabilities. / AFRIKAANSE OPSOMMING: Die studie is onderneem om interne en eksterne bates by 'n leerder met Downsindroom te identifiseer. Die bates sluit nie net diè van die individu in nie, maar neem ook die bates wat in die breër gemeenskap bestaan, in ag. Die leerder se eksterne bates in haar onmiddellike omgewing was moeilik identifiseerbaar, omdat sy weinig blootgestel word aan gemeenskapsaktiwiteite. 'n Lys van bates is saamgestel en die 40 Ontwikkelingsbates soos deur die "Search Institute of Minneapolis" (Roehlkepartain & Leffert, 2000) nagevors, is as sleutelelemente gebruik vir die kartografering van die bates vir die leerder met Downsindroom. In hierdie navorsing is die bate-gebaseerde benadering as 'n raamwerk gebruik. 'n Kwalitatiewe navorsingsontwerp is vir hierdie navorsing gebruik waar die leerder in haar natuurlike omgewing waargeneem is. Die leerder is by die skool en by die huis waargeneem met die doel om bates te identifiseer. Tydens die navorsing is die ouers en die skool bemagtig deur hul fokus te verskuif vanaf die leerder se behoeftes en tekorte na die leerder se sterkpunte, vermoëns en talente. Die identifisering van die nuwe bates by die leerder sal haar sosialiseringsvaardighede verbeter en haar in staat stel om veral haar selfversorging te verbeter. Die resultate van die navorsing dui daarop dat die ouers en die skool 'n meer positiewe houding ontwikkel het ten opsigte van die identifisering en mobilisering van bates by leerders met gestremdhede.

Thesis (MEd)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: This study was undertaken to identify key aspects related to the promotion of the effective inclusion of a learner with Down Syndrome in a mainstream school and at the same time to give close attention to the implementation of the principles of inclusive education. The study was done over a period of four years in an Afrikaans medium primary school in a large rural town. The Educational Management and Development Centre (EMDC) in the region in which the school is situated is currently promoting and implementing inclusive education and the proposals set out in the Education White Paper 6. The findings of this study will be used to support and encourage this process (also at grassroots level) as well as the inclusion of learners with Down Syndrome. The study takes the form of a single case study and falls within an interprevistlconstructivist paradigm. Qualitative research methods were used to develop an understanding and an insight into the key aspects in order to promote the successful inclusion of learners with Down Syndrome. The primary methods of investigation were four individual interviews and one focus group interview with educators. The data generated in this manner was verified by means of recent literature, observations and available documents. During the process of data analysis the data were reduced to four themes relating to the inclusion of learners with Down Syndrome: attitudes and views with regard to inclusion, the address of specific challenges with which mainstream education is presented, specific strategies for promoting inclusion and the value that inclusion holds for mainstream education. The findings show that the principles of inclusive education and the educational practice associated with it do take into account the barriers to learning and development that learners with Down Syndrome experience: these barriers can be addressed within mainstream education. The key aspects attached to this depend mainly on the attitudes and views of the school and parent community, the address of the challenges such a learner presents, the use of specific educational and teaching strategies to promote inclusion and the acknowledgment of the value that inclusion holds for mainstream education. / AFRIKAANSE OPSOMMING: Hierdie studie is onderneem om die kernaspekte ter bevordering van effektiewe insluiting van 'n leerder met Downsindroom in 'n hoofstroomskool te identifiseer en terselfdertyd die implementering van die beginsels van inklusiewe onderwys onder die loep te neem. Die studie is oor 'n tydperk van vier jaar in 'n Afrikaansmedium laerskool op 'n groot plattelandse dorp onderneem. Die Onderwysbestuur- en Ontwikkelingsentrum (OBOS) van die streek waarbinne die betrokke skool geleë is, is besig om inklusiewe onderwys en die voorstelle soos in Onderwys Witskrif 6 uiteengesit aktief te bevorder en te implementeer. Die bevindinge van die studie sal aangewend word ter ondersteuning en bevordering van hierdie proses (ook op voetsoolvlak), sowel as die insluiting van ander leerders met Downsindroom. Die studie het die vorm van 'n indiwiduele gevallestudie aangeneem en is vanuit 'n interpretatiewe/konstruktiwistiese paradigma benader. Kwalitatiewe navorsingsmetodes is aangewend ten einde begrip en insig te ontwikkelomtrent die kernaspekte ter bevordering van effektiewe insluiting van leerders met Downsindroom. Die primêre metode van ondersoek was vier indiwiduele onderhoude en een fokusgroep onderhoud met opvoeders. Die data wat op hierdie wyse gegenereer is, is aan die hand van resente literatuur, observasies en beskikbare dokumente geverifieer. Die proses van data-analise het die data tot vier temas met betrekking tot die insluiting van 'n leerder met Downsindroom gereduseer, naamlik houdings en sieninge ten opsigte van sodanige insluiting, die aanspreek van spesifieke uitdagings wat aan hoofstroomonderwys gestel word, spesifieke strategieë om insluiting te bevorder en die waarde wat insluiting tot hoofstroomonderwys toevoeg. Die bevindinge dui daarop dat die beginsels van inklusiewe onderwys en onderwyspraktyk daaraan verbonde, voorsiening maak dat die algemene hindernisse tot leer en onwikkeling wat leerders met Downsindroom ondervind effektief binne hoofstroomonderwys aangespreek kan word. Die kernaspekte hieraan verbonde berus hoofsaaklik op die houdings en sieninge van die skool- en ouergemeenskap, die aanspreek van die uitdagings wat so In leerder stel, die benutting van spesifieke onderwys- en onderrigstrategieë ter bevordering van insluiting en die erkenning van die waarde wat die insluiting van In leerder met Downsindroom tot hoofstroomonderwys toevoeg.

La trisomie 21 (t21) est l'anomalie génétique la plus fréquente à l'origine d'une déficience intellectuelle. Bien que la recherche concernant le stéréotype social de la t21 soit limitée, les personnes porteuses de t21, et particulièrement les enfants, semblent être associées à des traits de personnalité tels que « affectueux » et « heureux », les caractéristiques positives l'emportant sur les négatives comme « retardé ». Cependant, ce stéréotype positif coexiste avec des attitudes ambivalentes notamment à propos de l'intégration scolaire de ces enfants. L'objectif principal de cette thèse est d'étudier ce stéréotype au niveau implicite ainsi que l'impact des caractéristiques faciales sur le stéréotype au niveau explicite et implicite. Nos résultats confirment d'une part, un stéréotype social positif explicite dans des échantillons d'étudiants, d'adultes non étudiant et de professionnels du handicap intellectuel. Les visages d'enfants présentant plus de traits faciaux associés à la t21 sont associés à un stéréotype moins positif que ceux en présentant moins. D'autre part, nous mettons en évidence un stéréotype négatif au niveau implicite, même chez les professionnels du handicap. Nous étudions l'influence des variables individuelles sexe, familiarité avec la t21 et théories implicites de l'intelligence sur le stéréotype explicite et implicite. Puis, nous montrons une relation négative entre la typicalité des visages et le jugement sur l'intelligence alors que nous n'observons pas de relation significative entre la typicalité des visages et le niveau cognitif. Nous discutons l'implication de ces résultats sur l'étude du stéréotype et sur les personnes stigmatisées. / Trisomy 21 (t21) or Down syndrome is the most frequent genetic disorder associated with intellectual disability. Although research on the social stereotype toward t21 is very limited, it seems that persons with t21 are typically viewed as “affectionate” and “happy”; with positive personality traits prevailing over the negative ones (e.g., “mentally retarded”). However, this positive stereotype coexists with ambivalent attitudes. The main objective of this study was to investigate the stereotype at the implicit level and the impact of t21 facial features on the stereotype of t21 at the both explicit and implicit levels. Our results confirm, on one hand, a positive social stereotype explicit in samples of young adult students, non-student adults and professional caregivers working with intellectually disabled persons. The positive bias typically found in explicit judgments of children with t21 is smaller for those whose facial features are highly characteristic of this disorder, compared to their counterparts with less distinctive features and to typically developing children. On the other hand, we also show that this bias can coexist with negative evaluations at the implicit level, even among professional caregivers but to a lesser extent. We study the influence of individual variables sex, familiarity with the t21 and implicit theories of intelligence on explicit and implicit stereotypes. Finally, we show a negative relationship between t21 typicality of faces and the judgment of the intelligence as we do not observe a significant relationship between typicality and the cognitive level. We discuss the implications of these results.

Para o estudo da emergência da linguagem expressiva na síndrome de Down (SD), foi realizado estudo qualitativo, segundo o método dialético-didático, com 12 crianças, acompanhadas durante três semestres consecutivos: oito com SD, com idades entre 33 e 52 meses no início, e quatro com desenvolvimento típico (DT), entre 14 e 16 meses, todas localizadas na transição do quinto para o sexto estágio do período sensório-motor. Ao final da pesquisa, os dados obtidos confirmaram a evolução do gesto para a expressão oral e indicaram que algumas crianças com SD apresentaram a predominância da comunicação gestual, enquanto outras apresentaram linguagem oral e comunicação gestual simultâneas / Aiming to study the emergence of expressive language in Down Syndrome (DS), a qualitative study was carried out, based on the dialetic-didactic method, with 12 children, who were followed for three consecutive semesters: eight with DS, with ages between 33 and 52 months at the beginning, and four in typical development (TD), with 14 to 16 months old, all of them, cognitively, in the transition from the fifth to the sixth stage of the sensorimotor period. At the end of the study, data confirmed the evolution from gesture to oral expression and showed that, in some children with DS, gestural communication was predominant, while others had both oral and gestural communication simultaneously

A síndrome de Down (SD) é a alteração cromossômica mais comum nos seres humanos e traz consigo algumas co-morbidades como: hipotonia muscular, baixo condicionamento cardiorrespiratório e obesidade. A prática de exercícios físicos diminui o risco desses fatores, o que pode contribuir para melhora da qualidade de vida e autonomia dessas pessoas. Este estudo teve por objetivo avaliar o impacto de um programa de exercícios físicos para pessoas com síndrome de Down. Participaram desse estudo 21 pessoas com SD com idades entre 18 e 32 anos. Foram avaliados: adesão ao programa, condicionamento cardiorrespiratório, força muscular, composição corporal, equilíbrio postural, nível de atividade física diário dos participantes da pesquisa e de seus principais cuidadores e a correlação entre estes, o risco para Síndrome da Apneia Obstrutiva do Sono (SAOS) e as principais barreiras que influenciavam essas famílias a adotarem a prática de exercício físico. Houve boa adesão ao programa. Os resultados mostraram aumento da força muscular, melhora no condicionamento cardiorrespiratório e equilíbrio postural. Não houve diferença para composição corporal e no nível de atividade física dos participantes e de seus principais cuidadores no pós-programa. Houve correlação moderada em atividade física moderada e vigorosa (AFMV) e correlação forte em passos diários entre os participantes e seus principais cuidadores. A falta de tempo disponível, de condições financeiras, falta de incentivo e de interesse em praticar exercício foram fatores mencionados pelos principais cuidadores como os mais impeditivos para inclusão do exercício físico em seu cotidiano. Conclui-se que a prática de exercícios traz benefícios à saúde das pessoas com SD, e que há correlação positiva no nível de atividade física das pessoas com SD e de seus principais cuidadores / The Down syndrome (DS) is the most common chromosomal alteration in humans and brings some comorbidities such as muscle hypotonia, low physical conditioning and obesity. Physical exercise reduces these risk factors, which can contribute to the improvement of quality of life and autonomy of DS individuals. This study aim evaluate the impact of physical exercise program in individuals with DS. Twenty one DS individuals with 18-32 years old were evaluated in: adherence to the program, cardiorespiratory fitness, muscle strength, body composition, balance, level of physical activity, the risk for sleep apnea syndrome and the information about the obstacles that influenced these caregivers and the DS to adhere to regular exercise in their daily. After physical exercise program, were observed increase in muscle strength, cardiorespiratory fitness and balance. The body composition and physical activity level of the participants and their caregivers not changed, and there was a moderate correlation between in the moderate vigorous physical activity (MVPA) and strong correlation steps day between the participants and the carevigers. The lack of available time, financial conditions, lack of incentive and interest in practicing exercise was factors impeding to include exercise in their daily. It was concluded that the practice of exercise brings benefits to the health of people with DS, and that there is a correlation of physical activity and people of their caregivers

INTRODUÇÃO: A prevalência dos fatores de risco clássicos para a doença cardiovascular (DCV), maior causa de morbimortalidade no Brasil e no mundo, encontra-se razoavelmente estabelecida na população geral. Entretanto, pouco se conhece sobre sua incidência em populações especiais, entre elas, a com síndrome de Down. O objetivo do presente estudo foi avaliar a incidência de fatores de risco para a DCV em indivíduos jovens com trissomia do cromossomo 21. MÉTODOS: Estudo transversal que inclui 45 crianças e 44 adultos jovens com síndrome de Down, matriculados em uma instituição de ensino não governamental. Parâmetros antropométricos, como peso, altura e circunferência abdominal (CA), foram avaliados em conjunto com parâmetros clínicos, como pressões sistólica (PAS) e diastólica (PAD). Também foram obtidas de todos os indivíduos, amostras de sangue para dosagens de glicemia, índice HOMA-ir, proteína C reativa de alta sensibilidade (PCRas) e perfil lipídico. Todas as variáveis foram consideradas como fatores de risco cardiovascular. RESULTADOS: As alterações encontradas com maior frequência no grupo pediátrico foram o índice de massa corpórea (IMC): 60,0% e as alterações nos níveis de PCRas: 69,4%. Para o grupo adulto, as taxas foram ainda mais elevadas, IMC: 65,9% e PCRas 77,2%. Valores de IMC elevados correlacionaram-se com uma maior prevalência de obesidade central, representada pela CA ( < 0,001), PAS (p < 0,02), PAD (p=0,007), e níveis elevados de insulina basal (p=0,003) e de HOMA-ir (p=0.01). O achado mais relevante foi uma forte associação com níveis de PCRas alterados, presentes em três quartos (76,8%) dos indivíduos com excesso de peso. CONCLUSÃO: Obesidade central e a alta prevalência de fatores de risco para a doença cardiovascular sugerem a necessidade de um maior monitoramento desses parâmetros, em conjunto com alterações de estilo de vida / BACKGROUND: Down syndrome patients are subject to highly deleterious conditions such as obesity and sedentarism. DESIGN: Transverse study including 45 children and 44 young adults with Down syndrome from a healthcare center. METHODS: Weight, height, waist (WC) and blood pressure [systolic (SBP) and diastolic (DBP)] were recorded according to the international criteria. Blood samples for fasting glucose, insulin, HOMA-ir, high-sensitivity C-reactive protein (hsCRP), and lipid profile were obtained of all individuals. RESULTS: The most frequently found alterations in the pediatric group were BMI (60.0%,) and hsCRP (69.4%). For the adult group, BMI (65.9%) and hsCRP (77.2%) rates were even higher. Body mass index (BMI) elevations from individuals correlated with a higher prevalence of central obesity, represented by WC ( < 0.001), SBP (p < 0.02), DBP (p=0.007), basal insulin (p=0.003) and HOMA-ir (p=0.01). The major characteristic was the hsCRP elevation, present in three quarters (76.8%) of the individuals with excess weight. CONCLUSION: Central obesity and a high frequency of cardiovascular risk markers in individuals with Down syndrome urge to a careful monitoring and better lifestyle habits

O conhecimento das características funcionais da Síndrome de Down (SD) é importante para a ciência odontológica, pois indivíduos com SD apresentam alterações craniofaciais e dentárias que alteram o desempenho do sistema estomatognático. O objetivo deste estudo foi determinar padrões de referência da força de mordida molar direita (FMMD) e esquerda (FMME) máximas de indivíduos com SD analisando a influência da idade, além de compará-los com indivíduos sem síndrome de Down. A abertura bucal, estalo na ATM, ranger dos dentes (sono e vigília) foram avaliados nos indivíduos com SD. Participaram 100 indivíduos com SD que foram distribuídos em quatro grupos: crianças entre 8 e 12 anos (GSDI, n=28); adolescentes entre 13 e 20 anos (GSDII, n=30); adultos jovens entre 21 e 40 anos (GSDIII, n=29) e adultos entre 41 e 60 anos (GSDIV, n=13). Os GSD (I, II, III e IV) foram pareados sujeito a sujeito com seus respectivos controles sem síndrome (GCI, GCII, GCIII e GCIV) por idade, gênero e IMC. Os registros da FMMD e FMME foram captados pelo dinamômetro digital. O estalo sem dor (ESD), ranger dos dentes no sono (RS) e na vigília (RV) foram analisados por meio de questionário anamnésico. A abertura sem auxílio e sem dor (A), abertura máxima sem auxílio (MSA) e abertura máxima com auxílio (MCA) foram mensuradas por régua milimétrica. Os dados de FMM máximas, abertura bucal foram tabulados e submetidos à análise estatística (SPSS 22.0, p &le;0,05). Os dados de ESD, RS e RV em indivíduos com SD foram demonstrados em valores percentuais. Houve diferença estatística significante (ANOVA, p &le; 0,05) para FMME no GSD ao longo dos anos (p=0,00) registrando maior força para o GSDII. Na comparação dos Grupos etários com os Grupos controles houve diferença estatística significante (teste t de student, p &le; 0,05) para FMMD: GSDII X GCII (p=0,00), GSDIII X GCIII (p=0,00), GSDIV X GCIV (p=0,00) e FMME: GSDI X GCI (p=0,00), GSDII X GCII (p=0,00), GSDIII X GCIII (p=0,00) e GSDIV X GCIV (p=0,00). As FMMD e FMME dos Grupos etários com SD foram menores quando comparados aos GC (I, II, III e IV). Na abertura bucal ocorreu diferença estatística significante (ANOVA, p &le; 0,05) ao longo dos anos: A (p=0,00), MSA (p=0,00) e MCA (p=0,00) com maior A no GSDII e maior MSA e MCA no GSDIII. O GSDIII apresentou maior valor percentual de ESD e RDV e o GSDI maior de RDS. Os resultados deste estudo determinaram padrões referenciais de FMM ao longo dos anos em indivíduos com SD, com maior força para os adolescentes, diminuição gradual durante o envelhecimento, menor força máxima quando comparado aos indivíduos sem síndrome, influência da idade na abertura bucal e presença de ESD, RS e RV. / Knowledge of the functional characteristics of Down Syndrome (DS) is important for dental science, since individuals with DS present craniofacial and dental alterations that alter the performance of the stomatognathic system. The aim of this study was to determine reference patterns of maximal right (RMBF) and left (LMBF) molar bite force of SD individuals by analyzing the influence of age, as well as comparing them with healthy individuals. The mouth opening, clicking in the TMJ, teeth grinding (sleep and wakefulness) were evaluated in individuals with DS. A total of 100 individuals with DS were divided into four groups: children aged 8 to 12 years (DSGI, n = 28); Adolescents between 13 and 20 years old (DSGII, n = 30); Young adults aged between 21 and 40 years (DSGIII, n = 29) and adults between 41 and 60 years (DSGIV, n = 13). GDSs (I, II, III and IV) were paired subject to their respective healthy controls (CGI, CGII, CGIII and CGIV) by age, gender and BMI. RMBF and LMBF records were captured by the digital dynamometer. The painless popping (PP), teeth grinding in sleep (GS) and wakefulness (W) were analyzed by means of an anamnestic questionnaire. The pain free opening (PFO), maximum unassisted opening (MUO), maximum assisted opening (MAO) mouth opening were measured by millimeter rule. Maximum MBF data, mouth opening were tabulated and submitted to statistical analysis (SPSS 22.0, P&le;0.05). The PP, GS and W data in individuals with SD were demonstrated in percentage values. There was a statistically significant difference (ANOVA, P &le; 0.05) for LMBF in GDS over the years (P = 0.00), registering the highest force for DSGII. In the comparison between age groups and control groups without SD, there was a significant statistical difference (Student t test, P &le; 0.05) for RMBF: DSGII X CGII (P = 0.00), DSGIII X CGIII (P = 0.00), DSGIV X CGIV (P = 0.00) and LMBF: DSGI X CGI (P = 0.00), DSG II X CGII (P = 0.00), DSGIII X CGIII (P = 0.00) and DSGIV X CGIV (P = 0.00). The RMBF and LMBF of the age groups with SD were smaller when compared to the CG (I, II, III and IV). In the mouth opening, there was a significant statistical difference (ANOVA, P &le; 0.05) over the years: PFO (p = 0.00), MUO (P = 0.00) and MAO (P = 0.00) In DSGII and higher MUO and MAO in DSGIII. The DSGIII had the highest percentage of PP and W and the highest DSGI of GS. The results of this study determined reference patterns of MBF over the years in individuals with DS, with greater strength in adolescents, gradual decrease during aging, lower maximum strength when compared to healthy individuals, influence of age on mouth opening and presence of PP,GS and W.

Estudos publicados a partir da década de 60 evidenciam o potencial terapêutico da participação de animais de estimação em situações clínicas. Desde então, as pesquisas e as práticas das denominadas Terapia Assistida por Animais (TAA) e Atividade Assistida por Animais (AAA) estão em amplo crescimento. A presente pesquisa analisa 12 registros filmados dos encontros realizados a partir da parceria entre uma escola de educação especial e um canil. Os encontros aconteciam num sítio, a freqüência era semanal e os horários eram fixos. Participaram quatro adolescentes com síndrome de Down. A narrativa dos encontros entre esses adolescentes e cães numa situação estabelecida tem por objetivo a elaboração de uma reflexão teórica cujo propósito é considerar o uso de um enquadre diferenciado que inclui a presença do cão como recurso. A lente sob a qual tais fenômenos são analisados e compreendidos é a psicanálise de D. W. Winnicott. A investigação psicológica dos encontros evidencia a necessidade de levar em consideração o contexto humano oferecido pelos profissionais e as relações interpessoais estabelecidas. Pode-se observar que a maneira de se relacionar com o animal apresenta-se qualitativamente diferente das relações essencialmente humanas e das com objetos inanimados. Destacando a complexidade dos fenômenos observados entre as pessoas e os animais, percebeu-se que os cachorros interagiam com as pessoas não a partir das intenções ou sentimentos destas, ou ainda por meio de um discurso representativo: o cão reagia ao fato, ao comportamento humano, a comunicação ocorria de forma não-verbal. Outra possível função dos cachorros foi a de despertar diferentes aspectos do self, manifestados pelos adolescentes em suas atitudes, ações e verbalizações, facilitando a expressão de sentimentos. A análise também revela que a maneira de ser do cachorro – através de suas ações de atender ou não aos comandos, de se deixar manipular ou não, de ser uma presença constante e segura, de ter uma inteireza e continuidade de ser – sugere a emergência de maior espontaneidade por parte dos adolescentes. Por fim, são tecidas reflexões teóricas que sustentam a possibilidade de uma clínica winnicottiana com enquadre diferenciado que inclui o cachorro como recurso. / Studies that have been published since the 1960s suggest the therapeutical potential of the use of pets in clinical situations. The research on and the practice of the called Animal Assisted Therapy (AAT) and Animal Assisted Activity (AAA) have become more and more popular ever since. The present research analyses 12 filmed meetings that aim at promoting such interaction between dogs and four adolescents with Down Syndrome, carried out by a special education school and a kennel. These weekly meetings took place in a small farm and had been previously scheduled, always at the same time. The description of these meetings between the adolescents and the dogs in an arranged situation aims at elaborating a theoretical reflection which has the objective of taking into account the use of a differentiated setting that involves the presence of the dog as a resource. The lens under which such phenomena are analysed and understood is the W.D.Winnicott psychoanalysis. The psychological investigation of the meetings explicits the need to take the human context offered by the professionals and the interpersonal relationships that take place into account. It is clear to notice that the way the adolescents relate to the animals is qualitatively different from the way they do in exclusively human relationships or even in their relationships with inanimate objects. It’s important to highlight that, among other complex phenomena that we observe in the relationship between people and animals, the communication between them is non-verbal: the dogs react to the human behaviour and not to their intentions, feelings or discourse. Also, the dogs have an important role in awakening different aspects of the self, acted out by the adolescents in their attitudes and speech, which makes the expression of their feelings easier. The analysis also shows that the dog’s behaviour– – whether or not responding to the commands of the adolescents, permitting or not being handled by them, of being a constant and safe presence, as well as its wholeness and continuity of being - suggests the emergence of more room for the adolescents’ spontaneity. Finally, some reflections that support the possibility of a winnicottian clinic with a differentiated setting that have the dog as a resource are presented.

Angesichts der wachsenden Zahl an Patienten, die sich im Internet über medizinische Fragen informieren, untersuchten wir Informationen auf Webseiten zum Down-Syndrom. Im Anschluss an eine Suche nach "Down-Syndrom" mit den Suchmaschinen Altavista und Yahoo (in deutsch und in englisch), untersuchten wir medizinische und psychosoziale Informationen auf den ersten 100 Suchergebnissen, die jede Suchmaschine ergab. Ein vordefinierter Katalog an gesundheitsbezogenen Daten wurde zur Beurteilung der Webseiten verwendet. Grundlegende (geforderte) und zusätzliche (fakultative) Informationen wurde getrennt ausgewertet. Deutsch- und englischsprachige Webseiten wurden miteinander verglichen. Die Stichprobengröße betrug 324 Suchergebnisse (200 englische, 124 deutsche), von denen nur 77 (24%) medizinische Webseiten waren. Unter ihnen befanden sich 34 relevante deutschsprachige Webseiten (27% von 124 Treffern) und 43 relevante englischsprachige Webseiten (22% von 200 Treffern). In beiden Sprachen wurden sämtliche Informationsgrade (von schlecht bis hervorragend) gefunden. Nur 24% der deutschsprachigen Webseiten und 35% der englischsprachigen Webseiten enthielten mehr als 50% der grundlegenden medizinischen Informationen. Bei den zusätzlichen Informationen gab es nur eine deutschsprachige und fünf englischsprachige Webseiten, die mehr als 50% des erwarteten Inhalts enthielten. Ein Einfluss der Sprache und des Verfassers (von Universitäten bis hin zu privaten Homepages) auf den Inhalt konnte festgestellt werden. Englische Webseiten enthielten mehr Material als deutschsprachige. Da viele Homepages die meisten der geforderten Fakten weder behandelten noch dafür bestimmt waren, dies zu tun, ist der Nutzen sowohl der deutschsprachigen als auch der englischsprachigen Webseiten als Informationsquelle über das DS eingeschränkt. Sorgfältige Anstrengungen sind erforderlich um zu gewährleisten, dass das Internet eine Gestalt annimmt, in der den Bedürfnisse der Nutzer bezüglich Gesundheitsinformationen Rechnung getragen wird. Allerdings zeigen einige Beispiele auch das Potential des Internets, auch wenn die Möglichkeiten, über das DS zu informieren, nicht voll ausgeschöpft werden. / Considering the increasing number of people using the internet as an source of knowledge about medical issues, we analysed the information of websites on Down Syndrome (DS). After a search for "Down syndrome" with the search engines Altavista and Yahoo (in German and in English), we examined medical and/or psycho-social information of web-sites within the first 100 hits yielded by each search engine. A predefined catalogue of health related data was used for ranking of web-sites. Basic (required) and additional (facultative) information were evaluated separately.English and German web-sites were compared. The sample size was 324 hits (200 English, 124 German) of which only 77 (24%) were medical web-sites. Among these were 34 relevant German web-sites (27% of 124 hits) and 43 relevant English web-sites (22% of 200 hits). In both languages all levels of information (poor/excellent) were found. Only 24% of the German web-sites and 35% of the English web-sites gave more than 50% of the basic medical information. Looking at the additional information, there were 1 German and 5 English web-sites communicating more than 50% of the expected content. An impact of language and authorship (universities/personal homepage) on the substance could be established. English websites contained more material than Germans. Since many homepages don`t cover and are not intended to present most of the required facts, the usefullness of both German and English web-sites as a source of information on DS is limited. Careful work is essential to ensure that the Internet takes shape in ways that support customers needs of health information. However, some examples show the potential of the Internet, although the possibilities to educate people about DS are not completly realised.