[pt] Setenta anos após as primeiras descrições de autismo, os prejuízos sensoriais parecem finalmente ganhar um espaço no cenário do transtorno. Hoje já parece haver um consenso de que esses problemas realmente existem e possivelmente estão por trás de muitos dos sintomas encontrados nos autistas. Pesquisas científicas sugerem que até 95 porcento de crianças autistas apresentam problemas sensoriais. Diante da inclusão de critérios sensoriais no próximo DSM-5, torna-se fundamental um número cada vez maior de estudos a fim de esclarecer melhor a especificidade desses problemas no autismo, seus mecanismos de ação, sua prevalência e sua relação com sintomas oficiais do transtorno (prejuízos de interação e comunicação social com padrões restritos e repetitivos de comportamentos, interesses e atividades). Esse trabalho representa, portanto, um ponto de partida de estudos dessa natureza no Brasil. Seu objetivo foi investigar através do questionário Short Sensory Profile (SSP) os prejuízos sensoriais em uma amostra de 28 crianças autistas brasileiras e explorar a relação desses padrões sensoriais com o grau de severidade do transtorno, avaliado através do Childhood Autism Rating Scale, Second Edition (CARS2-ST). Apesar de questões metodológicas, os resultados foram consistentes com a literatura. A maioria das crianças autistas da pesquisa, 82,1 porcento apresentou algum grau de problema sensorial. No grupo de crianças com autismo severo, a incidência de problemas sensoriais foi de 94,4 porcento. Uma análise do perfil sensorial geral revelou que 85,7 porcento das crianças apresentaram dificuldades na categoria Auditory Filtering, 60,7 porcento na categoria Low Energy/Weak e 53,6 porcento na categoria Underresponsive/Seeks Sensation, sendo esta última a categoria que apresentou a maior correlação com o grau de severidade do autismo. Os resultados, assim como as limitações do estudo e orientações futuras são discutidos. / [en] Seventy years after the first descriptions of autism, sensory problems seem to finally have its place in the scenario of the disorder. There seems to be a consensus about the existence of these problems and their possible role behind many of the symptoms found in autism. Scientific research suggests that up to 95 percent of children with autism have sensory issues. Given the inclusion of a sensory criteria in the upcoming DSM-5, it becomes essential to have a growing number of studies to further clarify the specificity of these problems in autism, their mechanisms of action, its prevalence and its relationship with the official symptoms of the disorder (social communication and interaction impairments with restricted and repetitive patterns of behaviors, interests and activities). This work therefore represents a starting point for studies of this nature in Brazil. Its goal was to investigate, through the Short Sensory Profile (SSP), sensory problems in a sample of 28 Brazilian children with autism and explore the relationship of the sensory patterns with the severity of the disorder, measured by the Childhood Autism Rating Scale, Second Edition (CARS2-ST). Despite methodological issues, the results were consistent with the literature. Most of the children assessed, 82.1 percent had some degree of sensory impairment. In the group of children with severe autism, the incidence of sensory problems was 94.4 percent. A sensory profile analysis revealed that overall 85.7 percent of the children had difficulties in the Auditory Filtering category, 60.7 percent in the Low Energy / Weak category and 53.6 percent in the Underresponsive / Seeks Sensation, the latter being the only category that correlated the most with the severity of autism. The results, as well as the study s limitations and future directions are discussed.

Avec le vieillissement démographique, le nombre de personnes âgées dépendantes augmente et les proches (ou "tierces personnes") sont de plus en plus sollicités à leur côté. Dans une visée de santé publique, il importe d'étudier la place des tierces personnes dans le vieillissement et la relation entre dépendance et accumulation de facteurs de risque accessibles à la prévention.Le premier axe de cette thèse s'intéresse à l'intervention des tierces personnes dans les études de cohorte avançant en âge. Le deuxième axe consiste à analyser l'association entre la dépendance et l'accumulation de déficits sensoriels ou de comportements de santé.Cette thèse se base sur les données des femmes de la cohorte E3Nnées entre 1925 et 1930 : celles auto-rapportées et celles recueillies auprès d'une tierce personne. La dépendance est définie comme la présence d'une limitation dans au moins une des huit activités de l'échelle des activités instrumentales de la vie quotidienne (IADL).Les tierces personnes corroborent globalement la perception des personnes âgées concernant leur capacité à réaliser les IADL, étayant ainsi l'intérêt de leur implication dans les études épidémiologiques portant sur le vieillissement. Nous montrons également qu'un double déficit sensoriel est associé à un risque accru de survenue de la dépendance à court terme. De plus, le non-respect des recommandations concernant cinq comportements de santé était associé à une augmentation du risque de dépendance une dizaine d'année plus tard, selon un schéma cumulatif.Cette thèse contribue à valoriser la place des tierces personnes dans les études épidémiologiques et à améliorer les connaissances sur les facteurs de risque modifiables de la dépendance. Elle ouvre des pistes d'actions ciblées permettant d'améliorer la qualité de vie des personnes âgées tout en augmentant leur durée de vie sans incapacité. / The number of people living with disabilities is rising with the ageing of the population, leading to an increased need in proxy' help (or from "third partie"). Preventive approaches to delay disability or increase disability-free life expectancy are needed. In that respect, it is essential to study proxies'role in ageing, to identify risk factors of disability, and to analyze the effect of combinations of risk factors on risk of disability.The first aim of this PhD thesis was to study the contribution of proxies in cohorts of older people. The second aim was to analyze the association between disability and cumulative sensory impairments or health behaviours.The study population consisted in a subpopulation of the E3N cohort of women born between 1925 and 1930. Data were self-reported and/or reported by a proxy. Disability was defined as a limitation in at least one of the eight instrumental activities of daily living (IADL) scale.Results supported the interest of proxy involvement in epidemiological studies, particularly in those dealing with ageing. Indeed, most proxies corroborated the perception of the elderly women about their ability to perform IADL. In the study of risk factors of disability, having a dual sensory impairment was associated with higher short-term incidence of disability. Moreover, not adhering to the recommendations in the five studied health behaviours was associated with an increased risk of disability ten years later, in a dose-dependent manner.This work contributes to highlight the usefulness of proxies in large epidemiological studies, and to enhance knowledge about risk factors of disability. It suggests tracks of targeted actions to improve the quality of life of older people, and to increase their disability-free life duration.

[pt] O diagnóstico do autismo é feito com base na tríade de prejuízos que engloba problemas na comunicação, nos comportamentos sociais e padrões restritos e repetitivos de comportamentos, interesses e atividades. Embora esse critério diagnóstico não faça referência em momento algum a prejuízos sensoriais, crescem as evidências, advindas principalmente de relatos autobiográficos de autistas de alto funcionamento, de que o transtorno autista seja uma condição diretamente relacionada a um aparato sensorial imperfeito. Essas evidências são complementadas com pesquisas científicas que levam em consideração, em sua maioria, relatos retrospectivos de pais e cuidadores. Estudos indicam que problemas sensoriais já estão aparentes no primeiro ano de vida de uma criança autista, podendo inclusive ser úteis para um rastreamento precoce do transtorno. Considerando-se a importância do aparato sensorial para o desenvolvimento das relações interpessoais do bebê e o fato de 69% a 80% dos autistas apresentarem problemas sensoriais, o objetivo do trabalho é iniciar uma reflexão sobre a possível relação da tríade de prejuízos do autismo com um aparato sensorial imperfeito no bebê, começando a se pensar no autismo como, talvez, um transtorno de natureza sensorial. / [en] The diagnosis of autism is based on a triad of impairments that includes communication problems, social impairments and repetitive and restricted patterns of behaviors, interests and activities. Although this diagnosis criterion does not make reference to sensory impairments, evidence arising from autobiographical accounts of high-functioning individuals with autism, suggests that the autistic disorder is directly related to an impaired sensory apparatus. Such evidence is complemented with scientific research based mostly on retrospective accounts from parents and caretakers. Studies indicate that by the first year of an autistic child´s life, sensory impairments are already apparent, and may be useful to an early identification of the disorder. Considering the importance of the sensory apparatus to the development of a child´s interpersonal relations and the fact that approximately 69% to 80% of autistic individuals present sensory problems, the purpose of this work is to suggest a link between the triad of impairments associated with autism and an impaired sensory apparatus in babies, thus starting to approach autism as, perhaps, a disorder of sensory nature.