Submitted by Aelson Maciera (aelsoncm@terra.com.br) on 2017-06-05T17:11:25Z No. of bitstreams: 1 Autorização.pdf: 127395 bytes, checksum: a332f9735c0ea41c73872df294e95d20 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-05T17:56:44Z (GMT) No. of bitstreams: 1 Autorização.pdf: 127395 bytes, checksum: a332f9735c0ea41c73872df294e95d20 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-05T17:56:51Z (GMT) No. of bitstreams: 1 Autorização.pdf: 127395 bytes, checksum: a332f9735c0ea41c73872df294e95d20 (MD5) / Made available in DSpace on 2017-06-05T18:00:55Z (GMT). No. of bitstreams: 1 Autorização.pdf: 127395 bytes, checksum: a332f9735c0ea41c73872df294e95d20 (MD5) Previous issue date: 2017-02-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Early Intervention is constituted as an important tool for prevention, identification and intervention in conditions that offer risks to child development. Since the emergence of the first programs dating back to the 1960s, there were a number of conceptual and theoretical developments which culminated in the recognition of the systemic, ecological and family-centered model, as it produces better effects. In Brazil, the Early Intervention practices appear to develop highly focused on the needs of children, prioritizing interventions guided in their problems and developed from a rehabilitative model. It also observes that, despite the relevance of the theme, the scientific literature is scarce, which points to the need for further investigation. In this context, this study aimed to identify the practices developed by the Early Intervention services for children from zero to five years, in the state of São Paulo. This is a cross-sectional, descriptive and exploratory study with a qualitative approach. Participants were selected through non-probability sampling for convenience, in the case of professional staff working in services for children between zero and five years, located in the area covered by the Programa São Paulo pela Primeiríssima Infância. The study was developed in two stages, the first identification and characterization of early intervention services and the second identification of early intervention practices developed for services previously selected from the first stage. Data were collected through questionnaires (first stage) and interview (second stage). For the analysis of data from the questionnaires was used the methodology of descriptive statistics and analysis of the interviews content analysis methodology, the thematic analysis mode. The results of this study corroborate with the descriptions in the national scientific literature showing that Early Intervention practices remain being developed within the rehabilitation model, geared to the deficits presented by the children. In this context, the participation of families in the services proved to be limited because of the hegemonic role played by professionals in relation to the intervention process. It also revealed the existence of differences between the recommended practices in the child care networks and those that, in fact, are developed by the services. Regarding the existence of practices implemented in the natural context of the child, the results showed that these have been limited to observations and guidelines. Finally, the study identified a number of gaps in the process of training and continuing education of professionals that working in Early Intervention, a factor that can directly impact on the quality and the implemented practice model. From these results, the possibilities and challenges for the approximation between current practices and those recommended internationally are discussed, based on IP literature and national child care policies. / A Intervenção Precoce constitui-se como uma importante ferramenta para prevenção, identificação e intervenção sobre condições que ofereçam riscos ao desenvolvimento infantil. Desde o surgimento dos primeiros programas, datados da década de 1960, ocorreram uma série de transformações conceituais e teóricas, que culminaram no reconhecimento do modelo sistêmico, ecológico e centrado na família, como o que produz melhores efeitos. No Brasil, as práticas de Intervenção Precoce parecem desenvolver-se eminentemente centradas nas necessidades das crianças, priorizando intervenções pautadas em suas problemáticas e desenvolvidas a partir de um modelo reabilitativo. Observa-se ainda que, apesar da relevância da temática, a literatura científica é escassa, o que aponta para a necessidade de maiores investigações. Nesse contexto, o presente estudo teve por objetivo identificar as práticas desenvolvidas pelos serviços de Intervenção Precoce destinados a crianças de zero a cinco anos, no estado de São Paulo. Trata-se de um estudo transversal, descritivo e exploratório, com abordagem quali-quantitativa. Os participantes foram selecionados por meio de amostragem não-probabilística por conveniência, tratando-se de equipes de profissionais que atuam em serviços destinados a crianças entre zero e cinco anos, localizados na área de abrangência do Programa São Paulo pela Primeiríssima Infância. O estudo desenvolveu-se em duas etapas, sendo a primeira de identificação e caracterização dos serviços de Intervenção Precoce e a segunda de identificação das práticas de Intervenção Precoce desenvolvidas por serviços previamente selecionados a partir da primeira etapa. Os dados foram coletados por meio de questionários (primeira etapa) e entrevista (segunda etapa). Para a análise dos dados dos questionários foi empregada a metodologia de estatística descritiva e para análise das entrevistas a metodologia de análise de conteúdo, na modalidade análise temática. Os resultados desse estudo corroboram com as descrições apresentadas na literatura científica nacional, evidenciando que as práticas de Intervenção Precoce permanecem sendo desenvolvidas dentro do modelo de reabilitação, mais claramente voltado aos déficits/diagnósticos apresentados pelas crianças. Nesse contexto, a participação das famílias nos serviços mostrou-se limitada em virtude do papel hegemônico assumido pelos profissionais em relação ao processo de intervenção. Evidenciou-se ainda a existência de divergências entre as práticas preconizadas no âmbito das redes de atenção à criança e aquelas que, de fato, são desenvolvidas pelos serviços. Em relação à existência de práticas implementadas nos contextos naturais da criança, os resultados demonstraram que essas têm se limitado à observações e orientações. Finalmente, o estudo identificou algumas lacunas existentes no processo de formação e formação continuada dos profissionais que atuam em Intervenção Precoce, fator que pode impactar diretamente sobre a qualidade e o modelo de prática implementado. A partir desses resultados, discute-se, com base na literatura da IP e nas políticas nacionais de atenção à criança, as possibilidades e desafios para a aproximação entre as práticas atualmente desenvolvidas e aquelas recomendadas internacionalmente.

Made available in DSpace on 2014-12-17T14:36:46Z (GMT). No. of bitstreams: 1 ElianaRA_DISSERT_noPW.pdf: 5125022 bytes, checksum: 73f55cf802af39eb44b559aad107292f (MD5) Previous issue date: 2012-09-28 / In the last decades, studies on early intervention involving children with autism have suggested that there is no single intervention model capable of addressing the needs of all individuals in the spectrum. The role of parents as active intervention agents is, however, highly recommended. The More Than Words-HANEN Program has been specifically created for parents of children, under five years of age, who are in the autism spectrum. This intervention aims at improving the social competence and language comprehension of the child, as well as their parents empowerment. Until now only three studies have been performed in order to evaluate the effectiveness of the HMTW program. The purpose of this investigation is to evaluate the effects of an early intervention program inspired on HMTW model on the level of caregiver responsiveness and child communication skills. The present study adds to the existing research literature on family-centered early intervention that uses a developmental paradigm. A two year boy in risk for autism, his mother and nanny took part in this investigation, which was carried out in the child?s home in Mossor?, Rio Grande do Norte. The caretakers were given one fifty-two hours of training, divided into thirteen weekly meetings. A quasi-experimental A-B-C design (baselineintervention- follow-up) showed improvement in the caretakers level of responsiveness and meaningful social-communicative gains in the child?s response / Nas ?ltimas d?cadas, estudos em interven??o precoce realizados com crian?as com risco de autismo concluem n?o haver uma abordagem ?nica que possa ser aplicada a todas as crian?as com essa s?ndrome. Recomenda-se, no entanto, que os pais sejam envolvidos como agentes ativos nas interven??es de tratamento. O More Than Words-HANEN (HMTW) ? um programa de capacita??o criado especificamente para pais de crian?as menores de cinco anos de idade, as quais apresentam caracter?sticas de Transtornos do Espectro do Autismo TEA. A interven??o tem como objetivo a melhoria da compet?ncia social e da compreens?o da linguagem da crian?a, bem como a responsividade das cuidadoras. At? a atualidade, foram produzidos apenas tr?s estudos com o objetivo de avaliar a efic?cia da capacita??o HMTW. A presente pesquisa visa ampliar o campo de investiga??o em interven??o precoce focada na fam?lia sob a abordagem desenvolvimentista, avaliando os efeitos da implementa??o de um programa de interven??o precoce, inspirado na capacita??o do modelo HMTW. Participaram do estudo um menino de dois anos, com risco de autismo, sua m?e e sua bab?. A pesquisa, conduzida na resid?ncia da crian?a, localizada na cidade de Mossor?/RN, utilizou delineamento quase experimental do tipo A-B-C (linha de base, tratamento e acompanhamento). As cuidadoras participaram de cinquenta duas horas de capacita??o, distribu?das em treze encontros semanais. Os resultados do estudo evidenciaram ganhos nos n?veis de responsividade das cuidadoras durante a intera??o social com o menino, e indicaram aumento na frequ?ncia de turnos comunicativos

No description available.

A experiência de sentir fome e ser saciado é uma das mais intensas na vida inicial de um bebê. Ao lado de seu papel nutricional, o encontro mãe-bebê proporcionado pela alimentação ao seio materno pode representar os primeiros sinais de qualidade de vínculo dessa relação primordial. O desencontro, por sua vez, atravessa e dificulta o conhecimento mútuo, complicando não apenas a dinâmica mãe-bebê, mas todo o relacionamento familiar. Eventuais transtornos em início de vida com os objetos que são constitutivos no desenvolvimento psíquico do indivíduo atrapalham esse percurso e contribuem para dificuldades emocionais ao longo da vida. Este estudo teve por objetivo oferecer uma escuta do nível simbólico da amamentação por meio de um modelo de intervenção psicanalítica pais-bebê, e dos conteúdos latentes na dinâmica de oito famílias, cujas duplas mãe-bebê apresentaram dificuldades na amamentação. Além disso, buscou verificar os efeitos desse tipo de atendimento como auxiliar para a circulação das angústias e elaboração dos conflitos subjacentes, a partir da continência e nomeação das fantasias implícitas. O atendimento consistiu em visitas domiciliares a essas famílias, com frequência semanal pelo período de quatro a seis semanas, por indicação do pediatra que os acompanhava. O estudo revelou que o modelo de intervenção apresentado contribuiu para a circulação desses afetos, permitindo uma maior fluidez emocional observável no casal parental e que se acredita repercutir no bebê. Em alguns casos mostrou facilitar a amamentação concretamente, ao lado das possibilidades afetivas que podem acompanhá-la além do aspecto nutricional. O uso que as famílias faziam do atendimento, assim como a possibilidade de amamentar, dependeu das condições adquiridas anteriormente por seus integrantes, ao longo de seu desenvolvimento psíquico. Com essas constatações espera-se, além de propor um modelo de intervenção, contribuir para a interface psicanálise pediatria, oferecendo aos pediatras uma melhor compreensão das angústias desencadeadas pela amamentação e uma parceria nos cuidados com essas famílias nesse momento primordial. / One of the most intense experiences in the infants initial life is to feel hungry and then to be satisfied. Besides the nutritional value of a mother-baby relationship, established by maternal breast-feeding, this same relationship can also indicate early signs of the quality of this primordial link. It can also show a possible difficulty in this relationship that hinders the mother and infant to get to know each other, disturbing the dynamics of this relation as well as the whole familys relationship. Disturbances in early life with the objects that constitute the psychic development of the individual may contribute to emotional difficulties throughout life. The aim of this study was to provide a symbolic listening of the relation established by breast-feeding and of the family dynamics, using for this purpose a parent-infant psychoanalytical intervention model. This intervention was carried out in eight families, whose mother-infant relations showed difficulties in breast-feeding. It was also tried to verify the effects of this intervention, such as a possible help in handling the anxiety and in working through the underlying conflicts, by offering continence and naming the latent fantasies. The intervention consisted of weekly home visits to these families, during four to six weeks. These families were sent for this care by their pediatrician. The study revealed that this intervention model contributed to put the affects in movement, resulting also in a greater emotional fluidity observed in the parental couple, and which is also believed to affect the baby. In some cases, it turned out that this intervention also helped at breast-feeding itself, besides the emotional aspects that come together with the nutritional ones. The way the families could make some use of this intervention, as well as the possibility they had to achieve breast-feeding, depended on the conditions previously acquired by the family members during their own psychological development. Besides proposing an intervention model, these findings are expected to be a contribution in the interface psychoanalysis-pediatrics, providing pediatricians with a better understanding of anxieties triggered by breast-feeding, and also a partnership in the care of families in this primordial moment.

L’augmentation du nombre d’enfants avec un trouble du spectre de l’autisme (TSA) accroît les demandes sur le réseau de la santé et des services sociaux du Québec. Les programmes d’accompagnement parental semblent une alternative intéressante pour répondre aux besoins des familles ayant un jeune enfant avec un diagnostic ou une suspicion de TSA. Par contre, peu de chercheurs se sont intéressés à l’expérience des parents qui sont pourtant les acteurs-clés de ce type d’intervention. Cette étude mixte séquentielle explicative vise à évaluer un programme d’accompagnement parental de 12 semaines pour des enfants de 12 à 30 mois avec une suspicion de TSA en considérant autant les effets sur l’enfant que son parent. Méthodologie : Pour le volet quantitatif (essai clinique randomisé croisé), les 19 dyades parent-enfant ont été randomisées dans le groupe Intervention (immédiatement) ou le groupe Liste d’attente qui devait attendre trois mois avant de recevoir l’intervention. Les données collectées via des questionnaires et par observation directe réalisés trois à quatre fois en fonction du groupe de randomisation ont été analysées à l’aide de statistiques descriptives, de comparaisons inter- et intra-groupe. Pour le volet qualitatif (exploratoire), une analyse thématique a été complétée pour le contenu des entrevues semi-dirigées effectuées auprès d’un sous-échantillon de 6 parents. Résultats : Globalement, le programme a été fortement apprécié (score médian = 3,625/4). Plus spécifiquement, le programme met en évidence un effet positif significatif de l’intervention sur l’engagement dyadique (p = 0,012; taille d’effet = 0,51). De plus, les habiletés cognitives (p = 0,010; taille d’effet = 0,57) et motrices (p = 0,071; taille d’effet = 0,38) des enfants se normalisent suite à la participation au programme. La quasi-absence d’effet sur le bien-être parental pourrait être améliorée en offrant davantage de soutien directement aux parents pendant les interventions plutôt que de se concentrer uniquement sur le développement des habiletés nécessaires à la stimulation de leur enfant. Conclusion : L’intervention d’accompagnement parental a eu des effets bénéfiques prometteurs sur la variable proximale (interactions parent-enfant) et, dans une moindre mesure, sur les variables distales (développement de l’enfant, bien-être parental et validité sociale). L’intervention gagnerait toutefois à être bonifiée afin de mieux répondre aux besoins de soutien des parents. / Abstract: The increase in the prevalence of autism spectrum disorder (ASD) puts pressure on the healthcare system. Parent-mediated interventions are an interesting alternative to answer the needs of families having a toddler with a diagnosis or a suspicion of ASD. However, few researchers have looked at parents’ experience during parent-mediated interventions even though parents are the main actors of these interventions. This sequential explanatory mixed study aims to evaluate a 12-week parent-mediated intervention for young children with a suspicion of ASD aged between 12 and 30 months by considering both parents’ and children’s outcomes. Methods: For the quantitative part (crossover randomized controlled trial), the 19 parent-child dyads were randomized either in the Intervention group or the Waitlist group (participants in this group had to wait three months before getting access to the intervention). Data were collected through questionnaires and direct observation three to four times depending on the group allocation. Quantitative data were analyzed using descriptive statistics as well as between and within group comparisons. For the qualitative part (exploratory), semi-directed interviews conducted with a subsample of six participants were analyzed thematically. Results: The program was globally highly appreciated (median score = 3.625/4). Specifically, there was a significant positive effect of the intervention on parent-child dyadic engagement (p = .012; effect size = .51). Furthermore, there was a normalization of children’s cognitive (p = .010; effect size = .57) and motor abilities (p = .071; effect size = .38) after the 12-week program. The near absence of effect on parental well-being could be fixed by targeting specifically parental support rather than focusing on their skills development. Conclusion: The parent-mediated intervention brings promising benefits on the proximal outcome (parent-child interactions) and, to a lesser extent, on distal outcomes (children development, parental well-being and social validity). Still, the intervention should be adapted to better answer parental needs.

This research analyzes the play of sixteen children between 21 and 26 months showed risk of developing detected between 1 and 18 months by Child Development Risk Inventory proposed research Kupfer (2008 ). To this aime, children were filmed with their relatives in play activities for twenty minutes. The analysis of play was done from three different procedures: a protocol that analyzes the play and communication in a Piagetian cognitive vision ( ZORZI and HAGE , 2004) , another compound by categories proposals from reading transitional object Winnicott (Graña, 2008) and a descriptive analysis of three therapists from different professions, experts in childhood. The results of these analyzes were compared with historical risk children and with each other to check that these distinct analyzes provide data about the necessity of early intervention or another types of intervention indicated by the professionals. The descriptive results from protocols demonstrated that four of the sixteen children were playing, on the cognitive point of view; below expectations for their age group and that, this result was correlated with lower scores on items of the communication protocol, and indicating for language therapy by speech therapists. Two of the four children showed abnormalities in the object relation indicating greater risk of structuring mental disorder. The others children showed no significant changes in the protocols. When, however, analyzed the filming of sixteen children by three experienced professionals (a speech therapist, a psychologist and an occupational therapist), despite the coincident concern with language and psychological development of the four cases indicated by the protocols and the speech therapists, there were also eight other children indicated for early or brief intervention, based on more subtle qualitative changes in playful interaction with the mother. Only four cases were not referred to any intervention. These results demonstrate that the levels of risk for development fulfill the function of early detection of development or psychic risk, since most of the sample developed some kind of trouble, but should not be taken with a diagnostic value. This course can be modified by new spontaneous or even encouraged by occasional interventions familiar postures. Also, suggest that protocols that examine the play from a unique categorical look at the child do not capture the necessary subtleties on play for a more natural reflection to think clinical intervention. They can even detect disturbances in the course of installation, but they do not in all cases. The analysis that favors child - family intersubjectivity in spontaneous play activity, possible from filming, it was a common and preferred shape by the three professionals who analyzed sixteen filming. . They demonstrated that the interface between cognitive, linguistic and psych affective factors was constant and inseparable aspects when asked to analyze the play development. This fact demonstrated that early clinical intervention has to consider these three estrutuctural factors and instrumental one for diagnostic purposes, that is possible from the analysis of play between partners , whether the child and family , or the child and therapist. The three professionals who reviewed the plays sessions highlighted that undergraduate focus on playing is most commonly a cognitive one, and the psycho face became present in postgraduate training. The analyzes performed by therapists, and even the relationships between cognitive and psycho dimensions of play, are well esplanades by Winnicott theory, which enables us to sustain the need to establish a working hypothesis of playing for an every single case. / Esta pesquisa analisa o brincar de dezesseis crianças entre 21 e 26 meses que apresentaram risco ao desenvolvimento, detectado entre 1 e 18 meses, por meio dos Índices de Risco ao Desenvolvimento propostos na pesquisa de Kupfer (2008). Para tanto, as crianças foram filmadas com seus familiares em atividades lúdicas por vinte minutos. A análise se deu a partir de três procedimentos distintos de análise do brincar: um protocolo que analisa o brincar e a comunicação a partir da visão cognitivista piagetiana (ZORZI e HAGE, 2004), outro composto por categorias propostas a partir da leitura de objeto transicional de Winnicott (GRAÑA, 2008) e uma análise descritiva realizada por três terapeutas, de distintas profissões, experientes na clínica infantil. Os resultados dessas análises foram confrontados com o histórico de risco das crianças e também entre si para verificação de que dados essas distintas análises forneceram acerca da necessidade ou não de intervenção precoce do tipo de intervenção indicado pelos profissionais. Os resultados descritivos a partir dos protocolos demonstraram que quatro das dezesseis crianças apresentaram um brincar, do ponto de vista cognitivo, aquém do esperado para sua faixa etária e que tal resultado estava correlacionado a menor pontuação nos itens de comunicação do protocolo e também com a indicação de profissionais fonoaudiólogas, de presença de necessidade de intervenção fonoaudiológica. Duas dessas quatro crianças apresentaram alteração na relação objetal indicando risco maior de estruturação de transtorno mental. As demais crianças não apresentaram alterações significativas nos protocolos. Quando analisadas, porém, as filmagens das dezesseis crianças pelos três profissionais experientes (uma fonoaudióloga, uma psicóloga e uma terapeuta ocupacional), apesar da coincidente preocupação com a linguagem e desenvolvimento psíquico dos quatro casos indicados pelos protocolos e pelas fonoaudiólogas, houve também outras oito crianças indicadas para intervenção precoce ou breve, tendo como base alterações qualitativas mais sutis na interação lúdica com a mãe. Apenas quatro casos não foram indicados para nenhuma intervenção. Tais resultados demonstraram que os índices de risco ao desenvolvimento cumprem a função de detecção precoce de casos de risco, tanto ao desenvolvimento, quanto psíquico, pois a maior parte da amostra desenvolveu algum tipo de dificuldade, mas que não devem ser tomados com valor diagnóstico, pois o curso de instalação de sintomas pode ser modificado por novas posturas familiares, sejam elas espontâneas ou instigadas por uma intervenção. Também sugerem que os protocolos, que analisam o brincar a partir de um olhar categorial exclusivo sobre o brincar da criança, não captam as sutilizas necessárias para uma reflexão clínica mais singular para pensar a intervenção. A análise que privilegie a intersubjetividade criança-familiar em atividade lúdica espontânea, possível a partir das filmagens, apresentou-se como forma comum e preferida pelas três profissionais que analisaram as dezesseis filmagens. Eles demonstraram que a interface entre aspectos cognitivos, linguísticos e psicoafetivos foi constante e indissociável, quando solicitados a analisar o brincar. Esse fato demonstra que a clínica de intervenção precoce demanda considerar esse tripé estrutural e possíveis desdobramentos instrumentais para efeitos diagnósticos, e que isso é possível a partir da análise do brincar entre os parceiros, sejam eles a criança e familiar, ou a criança e terapeuta. As três profissionais que analisaram as filmagens ressaltaram que na graduação o enfoque sobre o brincar é mais comumente cognitivista e que a face psicoafetiva se fez mais presente na formação de pós-graduação. As análises realizadas pelas terapeutas, e mesmo as relações entre as dimensões cognitiva e psicoafetiva do brincar são bem explanadas pela teoria winnicottiana, que permite sustentar a necessidade de se estabelecer uma hipótese do funcionamento do brincar singular a cada caso.

The thesis is focused on the development of visual qualities of children in the early and preschool age. The aim is to analyze current trends and research in the sphere of the early intervention for children with severe visual impairments with a focus on developing their visual qualities. The first three chapters deal with the theoretical knowledge about the development of children at the early and preschool age and the development of children with visual impairments, about the diagnosis of visual impairments at the early age and about the methods of visual training and visual stimulation. The fourth chapter consists of the analysis of current trends and research in the sphere of intervention for visually impaired children at the early and preschool age in selected countries. The analysis is realized by analyzing foreign professional publications, articles and research in journals or websites of the organizations that deal with support and assistance to people, or to children with visual impairments. The analysis shows that the system of the initiation of the early intervention for children with severe visual impairments in those countries is not the same. They differ in the level of provided services. In some states the early intervention is still badly available or expensive. They also differ in...

The study identifies the increase in populations at risk for communication disorders world-wide and in South Africa as one the reasons for research to develop early communication intervention (ECI) services as a societal responsibility in South Africa. Since ECI is largely an unknown entity in the South African health system, but shares several mutual objectives, the dire need for data of populations at-risk validates the development of a computer-based relational data system as a 21st century research tool for ECI. Underpinnings for the development of a research database for ECI were obtained from the use of database management systems for early intervention in the USA, identified as leaders in the application of database technology in the field of Speech-Language Pathology. The aim of the study was to develop and establish a computerized database system to describe the characteristics of young children at risk for communication disorders enrolled in an existing ECI programme. Using a descriptive survey as research design, a rich description of 153 subjects and their families was obtained. The findings relating to the multiple risk profiles of the subjects revealed results not extensively described or emphasized in the literature, indicating the in-depth analysis of results that is possible when utilizing a database approach to research. The complex risk profile found in the subgroup of subjects with cleft lip and palate is an example of a need for further investigation. The results also indicated the critical importance of early identification of risk events throughout a child’s life to improve the efficacy of ECI services. Further results emphasized the important role of parents to identify the early signs of risks for communication disorders in their children, provided they are equipped with the necessary knowledge. A conceptual framework for the early identification of risks for communication disorders is proposed for best practice in ECI in South Africa. The study concluded that the CHRIB database system was successfully applied in the empirical research and is now established as a versatile 21st century research tool to be utilized in second generation research in ECI in South Africa. / Thesis (DPhil(Communication Pathology))--University of Pretoria, 2005. / Speech-Language Pathology and Audiology / Unrestricted

The purpose of this analysis was to present a systematic review of the effectiveness of child and adolescent PTSD early intervention programs implemented within 3 months following a potentially traumatic event (PTE). The mean weighted effect sizes of the early interventions were calculated, and study variables were encoded for potential moderator variables. A statistically significant mean weighted effect size of -.26 was calculated at final follow up measures, indicating that children receiving early interventions reported lower scores on PTSD outcome measures. The individual studies’ effect sizes at follow-up showed mixed results, thus CBT-based interventions were used as a moderator variable which showed to be a significant moderator in the effectiveness of early interventions. Early interventions programs also seemed to be effective in reducing anxiety outcomes measures, but not depression. Study implications and directions for future research are presented, explaining the need for more long-term follow-up, more early interventions for different types of trauma, and more research in general so that additional potential moderator variables can be identified, allowing experts and researchers valuable information needed to develop effective early interventions following potentially traumatic events.

Introdução: O aperfeiçoamento da assistência pré-natal e dos cuidados intensivos neonatais contribuiu para a redução da mortalidade dos recémnascidos (RN) com riscos para alterações do desenvolvimento neuromotor. Apesar destes avanços, a difícil previsão e prevenção de danos neurológicos está associada ao aumento de crianças com problemas graves como a Paralisia Cerebral (PC). Das avaliações disponíveis atualmente, a que possui melhor valor preditivo de danos neurológicos em bebês até os cinco meses de idade é a \"Avaliação Qualitativa dos Movimentos Generalizados (MGs)\" de Prechtl. No entanto, apresenta pouca aderência na prática clínica devido à sua subjetividade e necessidade de treinamento prévio para aplicação. Objetivos: Desenvolver e analisar a confiabilidade de uma escala de avaliação baseada nos MGs caracterizados a partir da avaliação qualitativa de Prechtl em recémnascidos e lactentes com riscos para alterações no desenvolvimento neuromotor. Método: Estudo observacional transversal com a participação de 30 RNs e lactentes com idade compreendida entre 31 semanas pós-menstrual e 17 semanas pós-termo avaliados no Hospital Universitário da USP. Os MGs normais e anormais foram avaliados segundo a análise qualitativa dos MGs de Prechtl seguindo as três fases: pré-termo (n=7), writhing movements (n=13) e fidgety movements (n=10). A escala foi construída baseando-se nestas fases e foram elaboradas duas versões, sendo analisadas as confiabilidades inter e intra-examinador por meio do ICC e do índice de Kappa. A consistência interna da versão final foi analisada através do alfa de Cronbach. Resultados: Foram analisadas duas versões da escala com três diferentes sistemas de pontuação: respostas do tipo \"SIM ou NÃO\"; do tipo \"SEMPRE, ALGUMAS VEZES e NUNCA\"; e \"SEMPRE, QUASE SEMPRE, ALGUMAS VEZES, QUASE NUNCA E NUNCA\". Os resultados mais significativos foram obtidos com as respostas binárias (SIM ou NÃO), sendo que nas fases pré-termo e writhing movements a pontuação máxima é de 32 pontos e na fase dos fidgety movements é de 12 pontos. A análise da confiabilidade da versão final da escala evidenciou concordância excelente tanto para a confiabilidade intra-avaliador (ICCs: 0.914 a 0.999; Kappa: 0.6 a 1 e 0.606 a 1, considerando a escala binária), como para confiabilidade inter-avaliadores (ICCs: 0.871 a 0.966 para avaliação 1; Kappa: 0.682 a 0.775 para avaliação 1, considerando novamente a escala binária). Apenas o índice Kappa neste caso apresentou concordância boa. Os valores de alfa de Cronbach se mostraram de bons a excelentes (0.866 a 0.980). Verificou-se também que os bebês com MGs anormais apresentaram pontuação abaixo de valores entre 20 e 25 na fase pré-termo e dos writhing movements, e abaixo de valores entre 8 e 12 na fase dos fidgety movements. Conclusão: Foi possível desenvolver uma escala capaz de quantificar os MGs, com pontuação capaz de diferenciar MGs normais de anormais, com excelente confiabilidade inter e intra-avaliador e alta consistência interna. A escala apresenta grande relevância clínica e, aliada ao treinamento no método qualitativo, torna-se um instrumento promissor para a detecção precoce de riscos para atraso do desenvolvimento neuromotor e seleção dos RNs e lactentes para acompanhamento e intervenção precoce / Introduction: The technological improvement of neonatal care and intensive care contributed to reduction of preterm newborn (PTNB) mortality. Despite these improvements, is still difficult to predict and prevent neural damage and neurobehavioral impairments, which are associated to higher proportion of children with severe neurological problems, such as Cerebral Palsy (CP). Between all the available methods of babies\' assessment and examination, the Prechtl´s Method of Qualitative Assessment of General Movements (GMs) shows the higher predictive value to neurological damage. Nevertheless, this assessment is not widely used because of its subjectivity and the necessity of training of the examiners. Objective: To develop a quantitative scale based on GMs in the newborn and infant, and to verify its reliability. Method: Crosssectional observational study involving 30 newborns and infants aged between 31 weeks postmenstrual age and 17 weeks post term age assessed at university hospital of University of São Paulo. The normal and abnormal GMs were evaluated based on the Prechtl´s Method of Qualitative Assessment of GMs following the three phases: preterm GMs (n=7), writhing movements (n=13) and fidgety movements (n=10). The scale was developed based on these phases and Kappa and ICC statistics were applied in the reliability analysis (inter- and intra-observer agreement). Cronbach alpha was applied in the internal consistency analysis. Results: Two versions of the scale were analyzed with three different scoring systems: \"YES or NO\"; \"ALWAYS, SOMETIMES and NEVER; \"ALWAYS, OFTEN, SOMETIMES, ALMOST NEVER and NEVER\". The most significant results were obtained with \"YES or NO\" answers. The total score obtained in preterm and writhing movements phases was 32 points and in the fidgety movements phase was 12 points. Considering the assessment with the final version of the scale, high to very high inter- (ICCs 0.871-0.966; Kappa 0.682-0.775 for the first evaluation, considering \"YES or NO\" answers) and intra-observer reliability (ICCs: 0.914-0.999; Kappa: 0.6-1, considering \"YES or NO\" answers) was found. High to very high Cronbach alpha values was also found (0.866-0.980). The infants showed abnormal GMs score below values between 20 and 25 in preterm phase and writhing movements, and below values between 8 and 12 at fidgety movements age. Conclusion: It was possible to develop a scale able to quantify GMs, with scores that can differentiate normal from abnormal GMs, with excellent inter- and intra-observer reliability and internal consistency. The scale has great clinical relevance and, combined with training in qualitative method, it is a promising tool for early detection of risks for delayed neuromotor development and screening of newborns and infants for monitoring and early intervention