As Disfunções do Trato Urinário Inferior (DTUI) é um termo amplo que descreve todo o espectro de distúrbios em qualquer uma das fases da micção, de causas neurogênicas, anatômicas e funcionais. A Terapia Comportamental é um método que permite acompanhar o desenvolvimento físico e emocional da criança e do adolescente. Objetivo: Analisar os resultados obtidos com a Terapia Comportamental em crianças e adolescentes portadores de disfunções do trato urinário inferior associada ao refluxo vesico- ureteral. Materiais e Métodos: A população foi composta por 109 crianças e adolescentes, 60% do sexo feminino e 40% do sexo masculino, entre 3 e 16 anos de idade. O tratamento aconteceu no período de 2007 a 2014, sendo realizado por 3 anos, com seguimento mensal por 1 ano. Foi realizada avaliação dos exames laboratoriais e de diagnóstico de imagem: Ultrassom Dinâmico da Micção e Uretrocistografia. A avaliação dos sintomas e o acompanhamento dos Hábitos por meio dos Diários da micção, das noites secas, do funcionamento intestinal, da Ingesta hídrica, dos alimentos, do café da manhã e do sono. A Identificação dos Transtornos de Comportamentos Externalizantes dos Pacientes com DTUI foi realizada por intermédio das Escala de Avaliação do Comportamento Infantil. A Terapia Comportamental baseou-se em: educação do corpo humano, conscientização do treinamento vesical, hidratação, dieta e organização do sono. Resultados: Quando a capacidade vesical atingiu a esperada, as crianças não apresentaram contrações do detrusor e a média de contrações do assoalho pélvico foi de 0,25. Apenas 0,005% das crianças apresentaram resíduo pós miccional. Entre 18 e 24 meses, os episódios de infecção do trato urinário desapareceram. A média da frequência miccional foi de 7 a 8x/dia e da ingesta hídrica de 1500ml/dia. 95% dos pacientes ingeriram média de 8 verduras e frutas/semana e apresentaram funcionamento intestinal >3x/semana. As perdas urinárias diurnas e noturnas desapareceram. Houve melhora da inatenção e socialização negativa que apresentou diferença estatisticamente significativa na avaliação inicial do tratamento. Conclusão: A Terapia Comportamental, por si só, é um método eficaz para melhorar e, até mesmo, curar os sintomas das Disfunções do Trato Urinário Inferior, prevenindo complicações futuras para o Trato Urinário Superior. / Lower urinary tract dysfunction (LUTD) is a broad term that describes the entire spectrum of disorders in any of the stages of urination with neurogenic, anatomical and functional causes. Behavioral Therapy is a method that allows monitoring the physical and emotional development of children and adolescents. Objective: To analyze the results obtained with Behavioral Therapy in children and adolescents with LUTD associated with vesicoureteral reflux. Materials and Methods: The study population consisted of 109 children and adolescents, 60% female and 40% male, aged 3 to 16 years old. The treatment occurred between 2007 and 2014, within a period of 3 years, with monthly follow-up for 1 year. Laboratory tests and diagnostic imaging by dynamic urinary ultrasound and urethrocystography were carried out. It was also performed evaluation of symptoms and monitoring of habits through diaries of urination, dry nights, intestinal functioning, water intake, food ingestion, breakfast and sleep. The identification of externalizing behavioral disorders of patients with LUTD was performed using the Child Behavior Assessment Scale. Behavioral Therapy was based on: education of the human body, awareness of bladder training, hydration, diet and sleep organization. Results: When the bladder capacity reached the expected level, the children did not present detrusor contractions and the mean number of contractions of the pelvic floor was 0.25. Only 0.005% of the children had post-urination residue. Urinary tract infection episodes disappeared between 18 and 24 months. The mean urination frequency was 7-8 times/day and the water intake was 1500 mL/day. As much as 95% of the patients ingested on average 8 vegetables and fruits per week and presented intestinal functioning >3x/week. Daytime and nighttime urine losses disappeared. There was an improvement of the inattention and negative socialization, with statistically significant difference from the initial evaluation of the treatment. Conclusion: Behavioral Therapy, by itself, is an effective method to improve and even resolve the LUTD symptoms, preventing future complications for the upper urinary tract.

Introdução: Entre as lesões traumáticas, a lesão axonal difusa (LAD) tem sido apontada como a que ocasiona os piores desfechos. Destacam-se entre as consequências dessa lesão as mudanças comportamentais das vítimas que frequentemente rompem o equilíbrio em sua vida social e de seus familiares. Logo, conhecer as mudanças de comportamento dessas vítimas e os fatores relacionados foi relevante para contribuir para uma reabilitação adequada que facilitasse a reintegração das vítimas de LAD à sociedade, além de fundamentar uma melhor assistência aos familiares. Objetivos: Descrever as mudanças comportamentais das vítimas após LAD segundo informações de familiares, nos períodos de 3, 6 e 12 meses após o trauma, e identificar fatores associados a essas mudanças e a sua evolução. Método: Foram incluídas no estudo vítimas de LAD de 18 a 60 anos de idade, atendidas em hospital referência para lesões traumáticas na cidade de São Paulo e incluídas em serviço ambulatorial específico para seu tratamento. Foi realizado um estudo de coorte prospectivo com três abordagens às vítimas e familiares: 3, 6 e 12 meses após LAD. Para avaliar as mudanças comportamentais foi aplicado um questionário elaborado para identificar tais mudanças segundo percepção de familiares. A diferença da pontuação na Escala Likert desse questionário, antes e após o trauma, permitiu identificar as mudanças comportamentais das vítimas. Foi aplicado o modelo de efeitos mistos para identificar as mudanças comportamentais significativas e o efeito do tempo na sua evolução. Esse modelo também foi utilizado para verificar associações entre variáveis sociodemográficas, gravidade da LAD e mudanças comportamentais. Resultados: Mudanças comportamentais desfavoráveis foram observadas na grande maioria dos participantes deste estudo (81,2% a 91,6%). Alterações favoráveis foram menos frequentes, apontadas em torno de 50% dos casos. Predominaram entre os comportamentos com mudanças desfavoráveis a irritabilidade, o esquecimento e a dependência, presentes em 54,6% dos casos, seguidos pela ansiedade (45,8%), depressão (39,6%) e oscilação de humor (31,2%). Quanto às mudanças favoráveis, foram mais frequentes a impulsividade (18,7%), a irritabilidade (16,7%), a oscilação de humor (16,7%) e o temperamento explosivo (14,6%). Entre antes e após o trauma, houve diferença estatisticamente significativa (p0,05) para ansiedade, dependência, depressão, irritabilidade, esquecimento e oscilação de humor. Para esses comportamentos, as médias da intensidade das alterações foram sempre negativas, evidenciando a tendência de mudança desfavorável após LAD. A análise da evolução desses comportamentos mostrou que as mudanças observadas após a lesão mantiveram-se na mesma intensidade até 12 meses após trauma. Na análise de fatores associados, observou-se relação entre depressão e renda per capita familiar mensal, bem como entre idade e irritabilidade. A gravidade da LAD se associou com dependência e com a evolução da ansiedade entre 3 e 12 meses após trauma. Conclusão: Mudanças comportamentais foram consequências muitíssimo frequentes para as vítimas de LAD e não foi notada melhora dessas alterações até 12 meses após lesão. A irritabilidade, o esquecimento e a dependência foram comportamentos alterados na maioria dos casos, gerando impacto negativo sobre a participação dos indivíduos na comunidade. A renda per capita familiar mensal, a idade e gravidade da LAD tiveram relação com as alterações comportamentais. / Introduction: Among traumatic injuries, diffuse axonal injury (DAI) has been reported as the one that causes the worst outcomes. Behavioral changes are consequences of this injury that frequently break the balance between victims social life and their families. Thus, learning about behavioral changes of these victims and the related factors was relevant to contribute to a suitable rehabilitation that facilitates the reintegration of the victims of DAI in the society besides providing a better assistance to relatives. Objectives: Describe behavioral changes of DAI victims according to relatives information in the periods of 3, 6 and 12 months after trauma and identify associated factors to these changes and its course. Method: The study included victims of DAI, aged between 18 and 60 years old, assisted in a referral hospital for traumatic injuries in Sao Paulo and included in specific ambulatory service for treatment. A prospective cohort study of three assessments was carried out with victims and relatives: 3, 6 and 12 months after DAI. To evaluate behavioral changes, a questionnaire was designed as per identify such changes according to the perception of family members. The difference in the Likert Scale Score based on this questionnaire, before and after trauma, lead to identify behavioral changes of the victims. The mixed effects model was used to identify significant behavioral changes and the effect of time on the evaluation. This model was also used to verify associations with sociodemographic variables, severity of DAI and behavior changes. Results: Unfavourable behavioral changes were observed in the majority of the participants of this study (81.2% to 91.6%). Favourable changes were less frequent, indicated in around 50% of the cases. Irritability, memory deficits and dependence were prevalent among the behaviours with unfavourable changes in 54.6% of the cases, followed by anxiety (45.8%), depression (39.6%) and liability of mood (31.2%). When it comes to favourable changes, impulsivity (18.7%), irritability (16.7%), liability of mood (16.7%) and explosive temperament (14.6%) were more frequent. Comparing before and after trauma, there was significant statistical difference (p0,05) in anxiety, dependence, depression, irritability, memory deficits and liability of mood. Regarding these behaviours the alterations in intensity means were always negative, demonstrating the tendency of unfavourable changes after DAI. The analysis of the evolution of these behaviours showed that the changes observed after injury remained at the same intensity up to 12 months post trauma. In the analysis of the associated factors, there was relationship between depression and monthly family per capita income, age and irritability, and the severity of DAI was associated to dependence and anxiety evolution between 3 and 12 months after trauma. Conclusion: Behavioral changes were frequent consequences for DAI victims and no improvement of these alterations was noticed until 12 months after injury. Irritability, memory deficits and dependence were changed behaviours in most cases, generating a negative impact on the participation of individuals in the community. Monthly per capita family income, age and severity of DAI were related to behavioral changes

This research study examined the psychometric properties of the Student Risk Screening Scale for Internalizing and Externalizing Behaviors (SRSS-IE) using Item Response Theory (IRT) methods among a sample of 2,122 middle school students. The SRSS-IE is a recently revised screening instrument aimed at identifying students who are potentially at risk for emotional and behavioral disorders (EBD). There are two studies included in this research. Study 1 utilized the Nominal Response and Generalized Partial Credit models of IRT to evaluate items from the SRSS-IE in terms of the degree to which the response options for each item functioned as intended by the scale developers and how well those response options discriminated among students who exhibited varying levels of EBD risk. Results from this first study indicated that the four response option configurations of the items on the SRSS-IE may not adequately discriminate among the frequency of externalizing and internalizing behaviors demonstrated by middle school students. Recommendations for item response option revisions or scale scoring revisions are discussed in this study. In study 2, differential item functioning (DIF) and differential step functioning (DSF) methods were used to examine differences in item and response option functioning according to student gender variables. Additionally, test information functions (TIFs) were used to determine whether preliminary recommendations for cut scores differ by gender. Results of this second study indicate that two of the items on the SRSS-IE systematically favor males over females and one item systematically favors females over males. Additionally, examination of TIFs demonstrated different degrees of measurement precision at various levels of theta for males and females on both the externalizing and internalizing constructs. Implications of these results are discussed in relation to possible revisions of the SRSS-IE items, cut scores, or scale scoring procedures.

Empathy is a construct that plays a pivotal role in the development of interpersonal relationships, and thus ones ability to function socially and often professionally. The development of empathy in children is therefore of particular interest to allow for further understanding of normative and atypical developmental trajectories. This thesis investigated the assessment of affective empathy in children aged 5-12, through the development and comparison of a multimethod assessment approach. Furthermore this thesis evaluated the differential relationships between affective empathy and global behavioural problems in children versus the presence of early psychopathic traits, such as callous-unemotional traits. The first component of this study incorporated; a measure of facial expression of affective empathy, and self-reported experience of affective empathy, as measured by the newly designed Griffith Empathy Measure - Video Observation (GEM-VO) and the Griffith Empathy Measure - Self Report (GEM-SR); the Bryant's Index of Empathy for Children and Adolescents (1982) which is a traditional child self-report measure; and a newly designed parent-report of child affective empathy (Griffith Empathy Measure - Parent Report; GEM-PR). Using a normative community sample of 211 children from grades 1, 3, 5, and 7 (aged 5-6, 7-8, 9-10, & 11-12, respectively), the GEM-PR and the Bryant were found to have moderate to strong internal consistency. As a measure of concurrent validity, strong positive correlations were found between the mother and father reports (GEM-PR) of their child's affective empathy, for grades 5 and 7, and for girls of all age groups. Using a convenience sample of 31 parents and children aged 5 to 12, the GEM-PR and the Bryant demonstrated strong test-retest reliability. The reliability of the GEM-VO and the GEM-SR were assessed using a convenience sample of 20 children aged 5 to 12. These measures involve the assessment of children's facial and verbal responses to emotionally evocative videotape vignettes. Children were unobtrusively videotaped while they watched the vignettes and their facial expressions were coded. Children were then interviewed to determine the emotions they attributed to stimulus persons and to themselves whilst viewing the material. Adequate to strong test-retest reliability was found for both measures. Using 30% from the larger sample of 211 participants (N=60), the GEM-VO also demonstrated robust inter-rater reliability. This multimethod approach to assessing child affective empathy produced differing age and gender trends. Facial affect as reported by the GEM-VO decreased with age. Similarly, the matching of child facial emotion to the vignette protagonist's facial emotion was higher in the younger grades. These findings suggest that measures that assess the matching of facial affect (i.e., GEM-VO) may be more appropriate for younger age groups who have not yet learnt to conceal their facial expression of emotion. Data from the GEM-SR suggests that older children are more verbally expressive of negative emotions then younger children, with older girls found to be the most verbally expressive of feeling the same emotion as the vignette character; a role more complimentary of the female gender socialization pressures. These findings are also indicative of the increase in emotional vocabulary and self-awareness in older children, supporting the validity of child self-report measures (based on observational stimuli) with older children. In comparing data from the GEM-VO and GEM-SR, this study found that for negative emotions the consistency between facial emotions coded and emotions verbally reported increased with age. This consistency across gender and amongst the older age groups provides encouraging concurrent validity, suggesting the results of one measure could be inferred through the exclusive use of the alternate measurement approach. In contrast, affective empathy as measured by the two measures; the accurate matching of the participant and vignette character's facial expression (GEM-VO), and the accurate matching of the self reported and vignette character's emotion (GEM-SR); were not found to converge. This finding is consistent with prior research and questions the assumption that facially expressed and self-appraised indexes of affective empathy are different aspects of a complex unified process. When evaluating the convergence of all four measures of affective empathy, negative correlations were found between the Bryant and the GEM-PR, these two measures were also found to not converge with the GEM-VO and GEM-SR in a consistent and predictable way. These findings pose the question of whether different aspects of the complex phenomena of affective empathy are being assessed. Furthermore, the validity of the exclusive use of a child self report measure such as the Bryant, which is the standard assessment in the literature, is questioned. The possibility that callous-unemotional traits (CU; a unique subgroup identified in the child psychopathy literature) may account for the mixed findings throughout research regarding the assumption that deficiencies in empathy underlie conduct problems in children, was examined using regression analysis. Using the previous sample of 211 children aged 5-12, conduct problems (CP) were measured using the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1999), and the CU subscale was used from the Antisocial Process Screening Device (APSD; Caputo, Frick, & Brodsky, 1999). Affective empathy when measured by the GEM-PR and the Bryant showed differing patterns in the relationship between affective empathy, CU traits and CP. While the GEM-Father reported that neither age, CU traits nor CP accounted for affective empathy variance, the GEM-Mother report supported that affective empathy was no longer associated with CP once CU traits had been partialled out. In contrast, the Bryant reported for girls, that CU traits were not found to have an underlying correlational relationship. It can be argued from the GEM-Mother data only that it was the unmeasured variance of CU traits that was accounting for the relationship between CP and affective empathy found in the literature. Furthermore, the comparison of an altered CU subscale with all possible empathy items removed, suggests that the constructs of CU traits and affective empathy are not synonymous or overlapping in nature, but rather are two independent constructs. This multimethod approach highlights the complexity of this research area, exemplifying the significant influence of the source of the reports, and suggesting that affective empathy consists of multiple components that are assessed to differing degrees by the different measurement approaches.

Students with emotional and behavioral disorders (E/BD) have academic deficits that affect their success in school; however, few researchers have investigated what strategies work best for this population, especially in the area of writing. One promising intervention to support the writing skills of students with and at-risk for E/BD is self-regulated strategy development (SRSD). SRSD is a six-stage, explicit strategy instruction model that includes procedures for goal setting, self-monitoring, self-instruction, and self-reinforcement and can be generalized to a variety of writing tasks. The purpose of this study was to determine the effects of an SRSD persuasive writing intervention on the writing achievement of 44 students in a residential school. Results of a piecewise hierarchical linear modeling growth curve analysis suggest statistically significant gains were made over the course of the intervention in writing (quality, correct word sequences, and essay elements) and academic engagement. Effects also generalized to writing achievement measures. In addition, teachers implemented the intervention with high fidelity, and both students and teachers rated the intervention as socially acceptable, with higher ratings postintervention.

Students with emotional and behavioral disorders (E/BD) have academic deficits that affect their success in school; however, few researchers have investigated what strategies work best for this population, especially in the area of writing. One promising intervention to support the writing skills of students with and at-risk for E/BD is self-regulated strategy development (SRSD). SRSD is a six-stage, explicit strategy instruction model that includes procedures for goal setting, self-monitoring, self-instruction, and self-reinforcement and can be generalized to a variety of writing tasks. The purpose of this study was to determine the effects of an SRSD persuasive writing intervention on the writing achievement of 44 students in a residential school. Results of a piecewise hierarchical linear modeling growth curve analysis suggest statistically significant gains were made over the course of the intervention in writing (quality, correct word sequences, and essay elements) and academic engagement. Effects also generalized to writing achievement measures. In addition, teachers implemented the intervention with high fidelity, and both students and teachers rated the intervention as socially acceptable, with higher ratings postintervention.

This diploma thesis deals with Conduct disorder among pupils at the secondary school. It consists of two parts - theoretical and practical one. The theoretical part will be explained in detail the issue of behavioral disorders in children at the secondary school. There are also included chapters dealing with under-age-limit alcohol drinking and smoking since the thesis is focused on such topics. Alcohol and smoking addiction is among others reflected in questionaire investi within the practical part. The aim of the thesis is to find out what type of alcohol is mostly consumed by lower secondary school learners, in which way the information about drugs are transmited by teachers and how much learners are interested in such information. Keywords:

Introduction: Patients with psychoactive substance (PAS) dependence may co-present other mental and behavioral disorders (MBD), and such comorbidities may alter the symptoms and interfere with proper diagnosis, treatment and prognosis of each disease. Objectives: We aimed to assess the frequency of MBD comorbidities in patients dependent on PAS attending Centers for Psychosocial Care alcohol and other drugs (CAPS-ad), and their feelings about their own use of these substances. Furthermore, we aimed to compare socio-demographic data, conditions related to childhood and clinical features between those patients with and without comorbidities. Method: We consecutively analyzed adult patients from April to September, 2010, in two CAPS-ad in Uberlândia MG, excluding those who were under the influence of PAS, with withdrawal symptoms or with dementia. Patients were divided according to the abstinence length: < 1 week (Group 1), 1 to 4 weeks (Group 2) and > 4 weeks (Group 3). For diagnosing comorbidities we used the symptoms checklist of ICD-10 and collected information from medical records. We used a structured questionnaire to collect the analyzed data. Results: Among the 188 evaluated patients, 62.8% were diagnosed with a MBD comorbidity, which were more frequent (p < 0.05) in Group 1 (72%) than in Group 3 (54.2%), and what differed them was the greater frequency of depressive disorders and other anxiety disorders in the first (61.3% and 34.6% respectively); both groups were similar to Group 2 (61.0%). Patients with comorbidities, more often than those without them, respectively, suffered abuse in childhood (67.8% and 42.8%), had perceived that presented another MBD (84.7% and 37.1%) and psychological disorders (79.7% and 44.3%) in addition to CD, made use of psychotropic medications (81.4% and 37.1%) and previous treatments for CD (88.1% and 70.0%), had injuries due to external causes (84.8% and 68.6%), were involved in fights or assaults (71.2% and 50.0%), attempted suicide (45.8% and 15.8%) and were in controlled environments throughout life (72.9% and 57.1%). Sociodemographic features were similar between patients with or without comorbidities, and also between those with different periods of abstinence. Most patients (59.4%) had negative feelings about their own use of PAS. Conclusion: Two thirds of the patients had a MBD comorbidity diagnosis, which was more frequent among those with shorter periods of abstinence, which shows that sometime of abstinence should be awaited before these diagnoses are given as final. Presence of comorbidities was associated with worse clinical conditions and no differences were found regarding socio-demographic data between the patients with or without comorbidities. Among all, there was a predominance of negative feelings over their own use of PAS. / Introdução: Pacientes com dependência de substâncias psicoativas (SPA) podem ter outros transtornos mentais e comportamentais (TMC) associados, e essas comorbidades podem alterar a sintomatologia e interferir no diagnóstico, tratamento e prognóstico de cada uma das doenças. Objetivos: Avaliar a frequência de comorbidades de TMC em pacientes dependentes de SPA atendidos em Centros de Atenção Psicossocial álcool e outras drogas (CAPS-ad), e os seus sentimentos em relação ao próprio uso dessas substâncias. Além disso, comparar dados sociodemográficos, condições relacionadas à infância e características clínicas entre aqueles com ou sem comorbidades. Método: Avaliamos consecutivamente, pacientes adultos no período de abril a setembro de 2010 nos dois CAPS-ad de Uberlândia MG, excluindo os que estavam sob o efeito de SPA, com crises de abstinência ou com demência. Eles foram divididos de acordo com o tempo de abstinência: < 1 semana (Grupo 1), de 1 a 4 semanas (Grupo 2) e > 4 semanas (Grupo 3). Para o diagnóstico de comorbidades utilizamos o Checklist de sintomas da CID-10 e coletamos informações em prontuários. Utilizamos um questionário estruturado para a coleta dos dados analisados. Resultados: Entre os 188 pacientes avaliados, 62,8% foram diagnosticados com alguma comorbidade de TMC, que foram mais frequentes (p < 0,05) no Grupo 1 (72%) do que no Grupo 3 (54,2%) e o que os diferenciou foi a maior frequência de transtornos depressivos e de outros transtornos de ansiedade no primeiro (61,3% e 34,6% respectivamente); ambos os grupos foram semelhantes ao Grupo 2 (61,0%). Pacientes com comorbidades mais frequentemente do que aqueles sem comorbidades, respectivamente, sofreram maus tratos na infância incluindo abuso sexual (67,8% e 42,8%), perceberam que apresentavam outro TMC (84,7% e 37,1%) e transtornos psicológicos (79,7% e 44,3%) além da DQ, fizeram uso de medicamentos psicotrópicos (81,4% e 37,1%) e tratamentos anteriores para DQ (88,1% e 70,0%), tiveram lesões por causas externas (84,7% e 68,6%), estiveram envolvidos em brigas ou agressões (71,2% e 50,0%), tentaram suicídios (45,8% e 15,7%) e estiveram em ambientes controlados ao longo da vida (72,9% e 57,1%). As características sociodemográficas foram semelhantes entre os pacientes com ou sem comorbidades, e também entre aqueles com diferentes períodos de abstinência. A maioria dos pacientes (59,4%) apresentava sentimentos negativos em relação ao próprio uso de SPA. Conclusão: Dois terços dos pacientes tiveram diagnóstico de comorbidade de TMC, sendo mais frequentes entre aqueles com menores períodos de abstinência, o que mostra que algum tempo de abstinência deve ser aguardado antes que esses diagnósticos sejam dados como definitivos. Presença de comorbidades associou-se a piores condições clínicas e não encontramos diferenças em relação aos dados sociodemográficos entre os pacientes com ou sem comorbidades. Entre todos, houve predomínio de sentimentos negativos em relação ao próprio uso de SPA. / Mestre em Ciências da Saúde

Introdução: Entre as lesões traumáticas, a lesão axonal difusa (LAD) tem sido apontada como a que ocasiona os piores desfechos. Destacam-se entre as consequências dessa lesão as mudanças comportamentais das vítimas que frequentemente rompem o equilíbrio em sua vida social e de seus familiares. Logo, conhecer as mudanças de comportamento dessas vítimas e os fatores relacionados foi relevante para contribuir para uma reabilitação adequada que facilitasse a reintegração das vítimas de LAD à sociedade, além de fundamentar uma melhor assistência aos familiares. Objetivos: Descrever as mudanças comportamentais das vítimas após LAD segundo informações de familiares, nos períodos de 3, 6 e 12 meses após o trauma, e identificar fatores associados a essas mudanças e a sua evolução. Método: Foram incluídas no estudo vítimas de LAD de 18 a 60 anos de idade, atendidas em hospital referência para lesões traumáticas na cidade de São Paulo e incluídas em serviço ambulatorial específico para seu tratamento. Foi realizado um estudo de coorte prospectivo com três abordagens às vítimas e familiares: 3, 6 e 12 meses após LAD. Para avaliar as mudanças comportamentais foi aplicado um questionário elaborado para identificar tais mudanças segundo percepção de familiares. A diferença da pontuação na Escala Likert desse questionário, antes e após o trauma, permitiu identificar as mudanças comportamentais das vítimas. Foi aplicado o modelo de efeitos mistos para identificar as mudanças comportamentais significativas e o efeito do tempo na sua evolução. Esse modelo também foi utilizado para verificar associações entre variáveis sociodemográficas, gravidade da LAD e mudanças comportamentais. Resultados: Mudanças comportamentais desfavoráveis foram observadas na grande maioria dos participantes deste estudo (81,2% a 91,6%). Alterações favoráveis foram menos frequentes, apontadas em torno de 50% dos casos. Predominaram entre os comportamentos com mudanças desfavoráveis a irritabilidade, o esquecimento e a dependência, presentes em 54,6% dos casos, seguidos pela ansiedade (45,8%), depressão (39,6%) e oscilação de humor (31,2%). Quanto às mudanças favoráveis, foram mais frequentes a impulsividade (18,7%), a irritabilidade (16,7%), a oscilação de humor (16,7%) e o temperamento explosivo (14,6%). Entre antes e após o trauma, houve diferença estatisticamente significativa (p0,05) para ansiedade, dependência, depressão, irritabilidade, esquecimento e oscilação de humor. Para esses comportamentos, as médias da intensidade das alterações foram sempre negativas, evidenciando a tendência de mudança desfavorável após LAD. A análise da evolução desses comportamentos mostrou que as mudanças observadas após a lesão mantiveram-se na mesma intensidade até 12 meses após trauma. Na análise de fatores associados, observou-se relação entre depressão e renda per capita familiar mensal, bem como entre idade e irritabilidade. A gravidade da LAD se associou com dependência e com a evolução da ansiedade entre 3 e 12 meses após trauma. Conclusão: Mudanças comportamentais foram consequências muitíssimo frequentes para as vítimas de LAD e não foi notada melhora dessas alterações até 12 meses após lesão. A irritabilidade, o esquecimento e a dependência foram comportamentos alterados na maioria dos casos, gerando impacto negativo sobre a participação dos indivíduos na comunidade. A renda per capita familiar mensal, a idade e gravidade da LAD tiveram relação com as alterações comportamentais. / Introduction: Among traumatic injuries, diffuse axonal injury (DAI) has been reported as the one that causes the worst outcomes. Behavioral changes are consequences of this injury that frequently break the balance between victims social life and their families. Thus, learning about behavioral changes of these victims and the related factors was relevant to contribute to a suitable rehabilitation that facilitates the reintegration of the victims of DAI in the society besides providing a better assistance to relatives. Objectives: Describe behavioral changes of DAI victims according to relatives information in the periods of 3, 6 and 12 months after trauma and identify associated factors to these changes and its course. Method: The study included victims of DAI, aged between 18 and 60 years old, assisted in a referral hospital for traumatic injuries in Sao Paulo and included in specific ambulatory service for treatment. A prospective cohort study of three assessments was carried out with victims and relatives: 3, 6 and 12 months after DAI. To evaluate behavioral changes, a questionnaire was designed as per identify such changes according to the perception of family members. The difference in the Likert Scale Score based on this questionnaire, before and after trauma, lead to identify behavioral changes of the victims. The mixed effects model was used to identify significant behavioral changes and the effect of time on the evaluation. This model was also used to verify associations with sociodemographic variables, severity of DAI and behavior changes. Results: Unfavourable behavioral changes were observed in the majority of the participants of this study (81.2% to 91.6%). Favourable changes were less frequent, indicated in around 50% of the cases. Irritability, memory deficits and dependence were prevalent among the behaviours with unfavourable changes in 54.6% of the cases, followed by anxiety (45.8%), depression (39.6%) and liability of mood (31.2%). When it comes to favourable changes, impulsivity (18.7%), irritability (16.7%), liability of mood (16.7%) and explosive temperament (14.6%) were more frequent. Comparing before and after trauma, there was significant statistical difference (p0,05) in anxiety, dependence, depression, irritability, memory deficits and liability of mood. Regarding these behaviours the alterations in intensity means were always negative, demonstrating the tendency of unfavourable changes after DAI. The analysis of the evolution of these behaviours showed that the changes observed after injury remained at the same intensity up to 12 months post trauma. In the analysis of the associated factors, there was relationship between depression and monthly family per capita income, age and irritability, and the severity of DAI was associated to dependence and anxiety evolution between 3 and 12 months after trauma. Conclusion: Behavioral changes were frequent consequences for DAI victims and no improvement of these alterations was noticed until 12 months after injury. Irritability, memory deficits and dependence were changed behaviours in most cases, generating a negative impact on the participation of individuals in the community. Monthly per capita family income, age and severity of DAI were related to behavioral changes

v anglickém jazyce In this thesis called "Perspective Orientation of Girls Situated in Diagnostic Institution" I deal with young people with behavioral disorders. In the first part I am trying to describe the meaning of term adolescence. I tried to describe the main problems of this phase of life and show to reader spectrum or variety of risk and delinquent behavior. I shortly introduced topic of perspective orientation and described function of Diagnostic Institution. In practical part I firstly described methods of research. Partially I used printed documents for part of my research. Second and the main part is based on personal written works of clients themselves. By form of open questions I tried to learn ideas of clients about the future. In the first part of research I tried to understand family background of respondents and socio-economic status of their families. I was also interested in region girls came from. Finally, I was interested in reasons why clients are in Diagnostic Institution. Is it because of drugs or something completely different? In the second part of my research I used technique of interview directly with clients. I tried to analyze and valuate results. I compare my findings with other studies on this subject and find and describe similarities and differences. Besides...