This thesis deals with orientation and mobility (O&M) of children with visual and multiple disabilities in early childhood years. It provides basic information about individuals with visual and multiple disabilities, about early childhood, about early intervention, about O&M, about importance of family and about possibilities of support in early learning. The main attention is focused on content areas of O&M in early childhood years and devices O&M for children. It also deals with the situation in the sphere of O&M for children in early childhood in the Czech Republic.

Introdução: O aperfeiçoamento da assistência pré-natal e neonatal contribuiu para maior sobrevida dos recém-nascidos com riscos para alterações do desenvolvimento. A detecção precoce e eficaz destes riscos é fundamental para a intervenção oportuna e minimização dos danos funcionais. A avaliação com melhor valor preditivo para anormalidades é pelos General Movements (GMs), porém a mais utilizada no Brasil é a Escala Motora Infantil de Alberta (EMIA). Objetivo: Verificar a validade dos GMs e da EMIA com um e três meses de idade para predizer o desfecho do desenvolvimento motor pela EMIA aos seis e 12 meses. Método: Estudo observacional longitudinal com 45 recém-nascidos e lactentes do Hospital Universitário da Universidade de São Paulo, avaliados do nascimento até os cinco meses de idade (corrigida, se prematuros) pelos GMs, e de um a 12 meses pela EMIA. Foi realizada análise descritiva e testes de kappa e curva roc para a comparação entre as avaliações. Resultados: Os participantes (masculino = 51,1%) apresentaram idade gestacional média de 34 semanas; 57,7% apresentaram alteração em pelo menos uma avaliação pelos GMs, com predomínio do repertório pobre (RP) e fidgety movements (FM) ausentes, enquanto 46,6% apresentaram alguma alteração na EMIA. A maioria (85,7%) apresentou avaliações normais aos 12 meses de idade pela EMIA; e os com avaliações anormais também tiveram GMs alterados em toda sua trajetória. Houve pobre confiabilidade entre os GMs e a EMIA no primeiro (kappa: 0,165) e no terceiro mês, ligeira confiabilidade (kappa: 0,259). Comparando os writhing movements (WM) com a EMIA com um mês, para prever desfecho aos seis meses de idade, foi encontrado uma sensibilidade dos WM de 78,6% e uma especificidade de 100%. Valores melhores de sensibilidade e especificidade também foram encontrados nos WM para desfecho com 12 meses de idade (sensibilidade de 75% e especificidade em 100%). Os lactentes que apresentavam alguma alteração nas avaliações eram encaminhados para fisioterapia. Conclusão: Foi possível observar um grande número de participantes com GMs alterados, porém com diminuição/normalização nas avaliações pela EMIA, podendo ser devido a intervenção fisioterapêutica nos casos mais graves. A avaliação com melhores valores para predição do desenvolvimento são os GMs na fase dos WMs. Não existe correlação entre a avaliação dos GMs com 1 mês e EMIA 1 com mês, nem entre estes dois métodos aos 3 meses / Introduction: Improvement of prenatal and neonatal care has contributed to a greater survival of newborns with risks for developmental disorders. Early and effective detection of these risks is essential for timely intervention and minimization of functional impairment. The most predictive value for abnormalities is the General Movements (GMs), but the most used in Brazil is the Alberta Infant Motor Scale (AIMS). Objective: To verify the validity of GMs and EMIA at one and three months of age to predict the outcome of motor development by EMIA at six and 12 months. Method: A longitudinal observational study with 45 newborns and infants of the University Hospital of the University of São Paulo, evaluated from birth to five months of age (corrected, if premature) by GMs, and from one to 12 months by EMIA. Descriptive analysis and kappa and roc curve tests were performed to compare the evaluations. Results: Participants (male = 51.1%) had a mean gestational age of 34 weeks; 57.7% presented alterations in at least one evaluation by GMs, with a predominance of poor repertoire (RP) and fidgety movements (FM) absent, while 46.6% had some alteration in EMIA. The majority (85.7%) presented normal evaluations at 12 months of age by EMIA; And those with abnormal ratings also had altered GMs throughout their trajectory. There was poor reliability between GMs and EMIA in the first (kappa: 0.165) and in the third month, slight reliability (kappa: 0.259). Comparing writhing movements (WM) with EMIA at one month, to predict outcome at six months of age, a WM sensitivity of 78.6% and a specificity of 100% was found. Better sensitivity and specificity values were also found in WM for 12-month-old outcome (75% sensitivity and 100% specificity). Infants who presented some alterations in the assessments were referred to physical therapy. Conclusion: It was possible to observe a large number of participants with altered GMs, but with a decrease / normalization in the evaluations by EMIA, and may be due to physiotherapeutic intervention in the most severe cases. The best predictive values for development prediction are GMs in the WM phase. There is no correlation between the evaluation of GMs at 1 month and EMIA 1 with month, nor between these two methods at 3 months

Bereits im frühen Kindesalter zeigen Kinder mit Spaltbildungen im Vergleich zu Kindern ohne Spaltbildungen eine veränderte Sprachentwicklung. Untersucht wurden die Möglichkeiten einer von Geburt ansetzenden Sprachförderung von Kindern mit Spaltbildung unter intensiver Zusammenarbeit mit den Eltern im Hinblick auf eine physiologische Sprachentwicklung. Innerhalb der Arbeit wurde ein sprachliches Frühförderkonzept für Kinder mit Lippen-, Kiefer-, Gaumenspalte (LKG) für die Zeit der ersten zwei Lebensjahre entwickelt und mit sieben Kindern mit LKG (Untersuchungsgruppe) in Form von Hausbesuchen erprobt. Im Alter von zwei Jahren wurde die Sprachentwicklung dieser Kinder mit sieben Kindern ohne Spaltbildung (Vergleichsgruppe) verglichen. Für die Auswertung der Untersuchungen kamen die Testverfahren ELFRA-1, ELFRA-2 und SETK-2 sowie eine informelle Prüfung des Lautbestandes zum Einsatz. Die Ergebnisse bestätigten bei fünf Kindern der Untersuchungsgruppe Unterschiede im sprachlichen Entwicklungsverlauf, die sich in Tendenzen zu Sprachentwicklungsrückständen bzw. Auffälligkeiten auf phonetisch-phonologischer Ebene niederschlugen. Deutlichere Hinweise auf Symptome der Gaumenspaltensprache gab es nur bei zwei Probanden. Zwei Kinder der Untersuchungsgruppe zeigten eine altersgerechte sprachliche Entwicklung. Möglicherweise sind diese positiven Ergebnisse auch auf die frühe sprachtherapeutische Förderung zurückzuführen. Zukünftig müsste die Wirksamkeit frühsprachlicher Förderkonzepte anhand von größeren Probandengruppen und längerem Förderzeitraum untersucht werden. / Even in the earliest stages of speech and language development children with cleft lip and palate show differences compared to children without clefts. This study focussed on encouraging early speech development of children with cleft lip and palate and investigated an intensive cooperation between speech pathologist and parents straight after birth up to the age of two years. An early intervention speech program was developed for the first two years of life and tried out on seven children with cleft lip and palate (research group). At the age of two the speech and language development of these children was compared to seven children without clefts (control group). For the time of the investigation the speech pathologist visited the families at home on a regular basis. Evaluation was done with the help of the following instruments: parent questionnaire ELFRA-1, ELFRA-2, language test SETK-2 and an informal screening of the childrens’ sound inventory. The results show differences in speech development in five children with clefts that are reflected in tendencies for delayed speech development and decreased phonological abilities. However, only two children of the research group showed distinctive signs of cleft palate speech. Two children of this group even had speech and language outcomes without pathological findings. Tentatively, these positive results may also be attributed to the effects of the early speech intervention. In future, the effectivity of such programs must be evaluated by researching larger groups of children over a longer period of time.

Made available in DSpace on 2016-04-28T20:40:11Z (GMT). No. of bitstreams: 1 Maria Ana Rita Souza Rocha.pdf: 1703484 bytes, checksum: f116e08134c09cd643b6a993da918bc1 (MD5) Previous issue date: 2009-11-12 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This paper discusses the conceptions and interventions proposed by the Parenthood Clinic as a health promoting basis. The disharmony between parents-baby revealed during the visits to the pediatrician can arise from conflicts of the parents´psychism and interfere in the emotional availability necessary to the practice of preventive parenthood against pathologies and global development disorders. The method used was the open interview with six pediatricians according to their different personal ways: allopathy, psychoanalysis, anthroposophy, acupuncture, family. We based ourselves on the hypothesis that by knowing better the pedriatrician´s experience, it is possible to put same, during the consultation, into interdisciplinary dialogue with the findings available in the literature about the Parenthood Clinic developed by psychologists and psychoanalysts. The discussion of the material was effected using the winnicottan concepts and the more debated subjects in papers already published on Parenthood. We concluded that the disharmony between parents-baby reveals itself under the form of dysfunctional symptoms in the child or the caregiver. The pediatricians´intervention includes advice and encouragement to the parents, however there is no symbolic elaboration of the symptom, leaving the baby or even the foetus defenseless against more complex parental conflicts but that affect its health, with possibilities of affective, social and cognitive limitations in the adult phase. Vulnerabilities in the building of parenthood, since gestation, can hinder the caregiver´s emotional availability to follow the doctor´s advice and the practice of a healthy parenting. The interviews with the pediatricians brought evidences that they cannot treat the dysfunctional symptoms like a psychoanalyst due to their formation, the time and frequency of the puericulture consultation, but can understand them as a psychoanalyst can, promoting more integrating interdisciplinary interventions for the human coming about / Este trabalho discute as concepções e intervenções propostas pela Clínica da Parentalidade como base promotora de saúde. As desarmonias entre paisbebê que se revelam nas consultas pediátricas, podem emergir de conflitos do psiquismo dos pais e interferir na disponibilidade emocional necessária para o exercício da parentalidade preventiva das patologias e dos distúrbios globais do desenvolvimento. O método utilizado foi a realização de entrevista aberta com seis pediatras segundo diferentes percursos pessoais: alopatia, psicanálise, antroposofia, acupuntura, família. Partiu-se da hipótese que conhecendo melhor a experiência do pediatra durante as consultas é possível colocá-la em diálogo interdisciplinar com os achados encontrados na literatura sobre a Clínica da Parentalidade desenvolvida por psicólogos e psicanalistas. A discussão do material foi feita utilizando os conceitos winnicottianos e os temas mais discutidos em trabalhos já publicados sobre a Parentalidade. Concluiu-se que as desarmonias entre pais-bebê revelam-se sob a forma de sintomas disfuncionais na criança ou no cuidador; a intervenção dos pediatras inclui orientação e encorajamento aos pais, porém não há elaboração simbólica do sintoma, deixando o bebê ou mesmo o feto desprotegido dos conflitos parentais que afetam sua saúde com possibilidades de limitações afetivas, sociais e cognitivas na fase adulta. Vulnerabilidades na construção da parentalidade, desde a gestação, podem impedir o cuidador da disponibilidade emocional necessária para seguir as orientações do médico e o exercício da maternagem saudável. As entrevistas com os pediatras trouxeram evidencias de que eles não podem tratar os sintomas disfuncionais como um psicanalista, em função da especialidade, da formação, do tempo e da freqüência que dispõe na consulta de puericultura, mas podem entendê-los como um psicanalista promovendo intervenções interdisciplinares mais integradoras para o acontecer humano

The effectiveness of psychoeducation and peer support programs for children of mentally ill parents is frequently measured by demonstrating children’s ability to meet program goals according to pre-defined categories determined by adults. Little is known about how children respond to these goals, whether they share them, and how, or if, their needs are met. I conducted an ethnographic study of one such group for school-aged children. I examined how specific discourses framed the content of the program manual designed to educate and support children and I observed how children responded to the program. My study is rooted in Goffman’s (1959) dramaturgical analyses of the reciprocal influence individuals have on one another in face-to-face encounters. From a critical dramaturgical perspective the participants were expected to conform to behavioural expectations of the setting, itself framed by broader arenas of interaction in which shared institutionalized meanings govern (often idealized) presentations of self. Data collection included: 1. a critical discourse analysis of the program manual; 2. participant observation of interactions during the eight-week program; and 3. children’s evaluations of the program in a separate group interview. Being identified as “as all in the same boat” was meaningful and consequential for children who were expected to learn mental health/illness information because, “knowledge is power”, and to express difficult feelings about being a child of a mentally ill parent. Children could be said to have achieved the goals of the program because they developed a mutual understanding about how to interpret and give meaning to their circumstances; “recognizing” unpredictable behaviours as signs of illness and becoming responsible for managing only how “their own story would go”. Children were not expected to care for ill parents, even when they wanted some responsibility, and were strongly discouraged from turning to friends for support. Children strategized to negotiate and resist group expectations and challenge assumptions about being “all in the same boat”. Suggestions are made for determining what constitutes “good” mental health literacy based on children’s preferences for explaining their circumstances in ways they find relevant and for supporting children’s competencies to manage relationships that are important to them.

The effectiveness of psychoeducation and peer support programs for children of mentally ill parents is frequently measured by demonstrating children’s ability to meet program goals according to pre-defined categories determined by adults. Little is known about how children respond to these goals, whether they share them, and how, or if, their needs are met. I conducted an ethnographic study of one such group for school-aged children. I examined how specific discourses framed the content of the program manual designed to educate and support children and I observed how children responded to the program. My study is rooted in Goffman’s (1959) dramaturgical analyses of the reciprocal influence individuals have on one another in face-to-face encounters. From a critical dramaturgical perspective the participants were expected to conform to behavioural expectations of the setting, itself framed by broader arenas of interaction in which shared institutionalized meanings govern (often idealized) presentations of self. Data collection included: 1. a critical discourse analysis of the program manual; 2. participant observation of interactions during the eight-week program; and 3. children’s evaluations of the program in a separate group interview. Being identified as “as all in the same boat” was meaningful and consequential for children who were expected to learn mental health/illness information because, “knowledge is power”, and to express difficult feelings about being a child of a mentally ill parent. Children could be said to have achieved the goals of the program because they developed a mutual understanding about how to interpret and give meaning to their circumstances; “recognizing” unpredictable behaviours as signs of illness and becoming responsible for managing only how “their own story would go”. Children were not expected to care for ill parents, even when they wanted some responsibility, and were strongly discouraged from turning to friends for support. Children strategized to negotiate and resist group expectations and challenge assumptions about being “all in the same boat”. Suggestions are made for determining what constitutes “good” mental health literacy based on children’s preferences for explaining their circumstances in ways they find relevant and for supporting children’s competencies to manage relationships that are important to them.

This thesis explores the applications of a drama-based intervention program for very young children with Autism Spectrum Disorder (ASD) and their parents. Drama-based pedagogy and practice is merged with behavioral principles from the world of Applied Behavior Analysis (ABA) to create an interdisciplinary program tailored specifically for the unique learning needs of children with ASD. This document offers a comprehensive overview of the history of diagnosis and treatment of ASD and the many factors that can influence relationships between children with ASD and their parents. A drama-based intervention program was designed specifically to address the communication and social skill deficits in children with ASD. In addition, the drama-based intervention program encouraged parents to use responsive teaching strategies to enhance and extend creative play with their child. The document concludes with recommendations for essential components of a drama-based intervention program for very young children with ASD and their parents. / text

Background: Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design: EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in- and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo)affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion: To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised.

Acompanha: Produção técnica / Percebe-se que uma orientação nutricional com as crianças com Síndrome de Down (SD) é o caminho para melhorar os distúrbios relacionados à alimentação, necessitando de ferramentas educacionais que os auxilie de forma prática, estimulando a aprendizagem significativa destas crianças. Contudo, a pirâmide dos alimentos demonstra de maneira generalizada, as proporções alimentares que a população deve seguir para ter uma alimentação equilibrada, neste sentido, ressaltar a importância de metodologias diferenciadas para o ensino da educação nutricional voltada às crianças com SD fazem-se necessário quando analisamos as pré-disposições genéticas destas crianças em desenvolverem doenças crônicas não transmissíveis (DCNT) como: diabetes mellitus, hipertensão arterial sistêmica, obesidade, colesterolemias, patologias estas que podem ser tratadas ou prevenidas com a mudança nos hábitos alimentares. A estimulação precoce é uma aliada na aprendizagem significativa sobre a educação nutricional, visto que, quanto mais precoce os alimentos saudáveis forem apresentados às crianças com SD, mais estimuladas elas serão em praticarem a mudança no comportamento alimentar melhorando a sua saúde. O processo de socialização e ensino aprendizado das crianças com deficiência no âmbito escolar necessita de um ensino diferenciado que as impulsionem o desenvolvimento psicomotor, potencializando as relações interpessoais. Fundamentados nesta evolução significativa da criança com SD os materiais interativos para o ensino da educação nutricional voltado as crianças com SD, promove a junção da aprendizagem significativa através da aprendizagem significativa focado na educação nutricional, consequentemente a mudança nos hábitos alimentares melhorando a saúde e prevenindo as DCNT. O presente trabalho teve como objetivo elaborar uma metodologia de materiais interativos para o ensino da educação nutricional voltado as crianças com SD. / Nutritional counseling with children with Down Syndrome (DS) is the way to improve eating disorders, requiring educational tools that help them in a practical way, stimulating the meaningful learning of these children. However, the food pyramid demonstrates in a generalized way the food proportions that the population must follow in order to have a balanced diet, in this sense, to emphasize the importance of differentiated methodologies for the teaching of nutritional education for children with DS are necessary when we analyzed the genetic pre-dispositions of these children in developing chronic noncommunicable diseases such as diabetes mellitus, systemic arterial hypertension, obesity, cholesterolemias, which can be treated or prevented by changing eating habits. Early stimulation is an ally in meaningful learning about nutrition education, since the earlier the healthy foods are presented to children with DS, the more stimulated they will be in practicing change in eating behavior, improving their health. The process of socialization and teaching learning of children with disabilities in the school environment requires a differentiated teaching that fosters psychomotor development, enhancing interpersonal relationships. Based on this significant evolution of the child with SD, the interactive materials for the teaching of nutritional education aimed at children with DS, promotes the joining of meaningful learning through meaningful learning focused on nutritional education, consequently changing eating habits, improving health and preventing DCNT. The present work had as objective to elaborate a methodology of interactive materials for the teaching of the nutritional education directed to the children with SD.

The main aim of this graduation thesis is to define the term of secondary prevention of drug addiction, which is sometime apprehended in different ways in The Czech Republic. I try to include this new definition to our drug policy and classify target groups and bring new methods to the secondary prevention of drug addiction. The thesis is focused on the terms drug, dependence syndrome and prevention and I use various definitions and opinions. I describe and briefly evaluate the system of drug policy and the place of secondary prevention. The occasional users and their families and friends are defined as a target group. The motivational interviewing is the main method in the secondary prevention. The thesis is structured into six parts and in the last part there are some practical examples from two low-thershold facilities for children and youth.