Toxic stress in childhood starts the trajectory toward complex health and social health needs in adulthood. In this breakout, a long-standing team (social work, behavioral health, and medicine) describe their efforts to systematically address toxic stress in pediatric primary care.

The primary study aim was to evaluate the latent biological effect of childhood sexual abuse (CSA) on adults by quantifying acquired cytogenetic changes and cortisol levels in identical twins who were discordant (N=22) or concordant (N=2) for a history of CSA. Although the difference scores for cortisol values between discordant identical co-twins were not significantly different from zero, a trend was observed for the twins exposed to intercourse, the most severe form of CSA, to have a blunted cortisol awakening response. Acquired cytogenetic changes were assessed by scoring telomere lengths and somatic cell abnormality frequencies via a cytokinesis-block micronucleus (MN) assay. No significant difference in overall telomere intensity values was observed between co-twins, but chromosome-specific telomere differences were observed in the individuals exposed to intercourse compared to their unabused co-twins ([χ2(45)= 62.88; p= 0.040 and χ2(45)= 73.72; p= 0.004). Specifically, shortened telomeres were observed on the short arms of chromosomes 3, 5, & 6, and long arms of chromosomes 11 & 13. A significant increase in MN frequencies was observed in the abused twins compared to unabused twins (t=2.65; df=16; p=0.009). A significant interaction between micronuclei frequencies and age was also observed, suggesting that the biological effects of stress are cumulative (coefficient [SE] = 0.030 [0.009]; p=0.0006). However, the pattern of chromatin present in MN, which was assessed using spectral karyotyping methodologies, was not limited to the subset of chromosomes with telomeric attrition. In summary, this is the first assessment of acquired chromosomal abnormalities, chromosome-specific telomere lengths and cortisol levels in identical adult twins discordant for exposure to CSA. Given that a portion of biological changes were most pronounced in the intercourse discordant twins, these findings support a possible dose-response relationship with CSA severity. Our data also suggest that the MN assay is a superior tool in assessing the latent effects of stress compared to either cortisol profiling or the measurement of telomere lengths. Collectively, application of the information gained from these studies may allow for novel screening techniques to identify individuals who are most at risk for developing stress-associated disease states.

O ingresso no Ensino Fundamental - EF tem sido visto como um momento de transição devido às novas demandas que apresenta para a criança. Neste contexto, parece haver um aumento da vulnerabilidade das crianças ao estresse, principalmente daquelas com maior dificuldade de adaptação a estas demandas. Esse estudo teve como objetivo amplo investigar o estresse da transição no contexto do EF de nove anos, partindo de uma visão desenvolvimentista aliada a uma perspectiva de exposição a estressores cotidianos. Especificamente, o estudo investigou a relação entre competências e sintomas de estresse no 1º ano do EF, o curso desenvolvimental dos sintomas e das percepções de estresse nos dois anos inicias do EF, suas associações com as tarefas adaptativas da transição e a influência da escola nos indicadores de estresse. Finalmente, exploraram-se modelos explicativos para indicadores de estresse apresentados no 2º ano. Seguindo metodologia prospectiva, avaliaram-se indicadores de ajustamento e competências relacionadas ao desempenho acadêmico, social e comportamental das crianças no 1º ano, estresse nos dois primeiros anos e características da escola (localização e IDEB). Participaram da pesquisa 157 alunos do 1º ano do EF, sendo 85 meninos e 72 meninas, com idade média de 6 anos e 10 meses no início da pesquisa. Todos tinham experiência de dois anos na Educação Infantil e estavam matriculados em escolas municipais de diferentes regiões de uma cidade do interior de São Paulo. Também participaram do estudo, como informantes, seus respectivos professores do 1º ano, num total de 25. As crianças responderam à Escala de Stress Infantil, ao Inventário de Estressores Escolares e a uma avaliação objetiva de desempenho acadêmico (Provinha Brasil). Os professores avaliaram as habilidades sociais, os problemas de comportamento externalizantes e internalizantes e a competência acadêmica dos seus alunos por meio do Social Skills Rating System Professores. A análise dos dados compreendeu estatísticas descritivas, comparações, correlações e regressões. Nos resultados, 57% dos alunos no 1º ano e 72% no 2º ano relataram sintomas de estresse pelo menos na fase de alerta. Crianças com estresse no 1º ano apresentaram menores índices de ajustamento e competência e perceberam suas escolas como mais estressantes em relação ao seu papel de estudante e nas relações interpessoais. Correlações moderadas entre medidas de indicadores de estresse tomadas no 1º e no 2º ano sugerem estabilidade. A presença de sintomas de estresse aumentou do 1º para o 2º ano, enquanto a percepção de estressores escolares não variou. Crianças com maiores médias de estresse são provenientes de escolas situadas em regiões periféricas e com classificação mais baixa no IDEB. As análises de predição evidenciaram a habilidade social de responsabilidade e cooperação avaliada no 1º ano como importante fator de proteção contra sintomas de estresse no 2º ano, ao passo que a percepção da criança de tensões nas relações interpessoais no 1º ano foi o principal fator de risco para futura sintomatologia de estresse. Nesse sentido, intervenções com ênfase na promoção de habilidades sociais das crianças podem ser profícuas na prevenção do estresse. / The entrance to the elementary school - ES has been considered as a transition time due to the new demands it presents for the child. In this context, some children may become more vulnerable to stress, especially those with greater difficulty in adapting to these demands. This study investigates the stress of transition to ES (nine years long), from a developmental perspective combined with the theoretical approach of exposure to daily hassles. Specifically, the study investigated (a) the relationship between competences and symptoms of stress in the 1st year of the ES; (b) the developmental course of symptoms and stress perceptions in the two initial years of the ES; (c) their associations with adaptive transition tasks; (d) the school influence on stress indicators. Explanatory models for stress indicators presented in 2nd year were also explored up. Following a prospective design, competence and adjustment indicators related to academic performance, social skills, behavior, and stress were evaluated in the 1st year, as well as school characteristics (location and IDEB). Stress measures were repeated in the 2nd year. The participants were 157 ES students, 85 boys and 72 girls, with an average age of 6 years and 10 months at baseline in 1st year. They had two years experience in kindergarten and were enrolled in public schools in different regions of a city of São Paulo State. Their teachers of the 1st year, a total of 25, also participated in the study, as informants. The children answered the Child Stress Scale, the Inventory of School Stressors and an objective evaluation of academic performance (Provinha Brazil). Teachers rated social skills, externalizing and internalizing behavior problems and academic competence of their students through the Social Skills Rating System - Teachers. Data analysis comprised descriptive statistics, comparisons, correlations and regressions. In the results, 57% of students in the 1st year and 72% in the 2nd reported stress symptoms at least in the alert phase. Children with stress symptoms at 1st year had lower levels of adjustment and competence. They also perceived their schools as more stressful concerning both academic demands and interpersonal relationships. Moderate correlations between stress indicators measures in the 1st and 2nd year suggest stability. The presence of stress symptoms increased from the 1st to the 2nd year, while the perception of school stressors did not change. Children with higher average stress come from schools in remote urban areas and lower IDEB index. The prediction analysis showed the social skill of responsibility and cooperation assessed at 1st year as an important protection factor against stress symptoms in the 2nd year, while the child\'s perception of tensions in interpersonal relationships in the 1st year was the main risk factor for future symptoms of stress. In this sense, interventions emphasizing the promotion of social skills of children can be fruitful in preventing stress.

O ingresso no Ensino Fundamental - EF tem sido visto como um momento de transição devido às novas demandas que apresenta para a criança. Neste contexto, parece haver um aumento da vulnerabilidade das crianças ao estresse, principalmente daquelas com maior dificuldade de adaptação a estas demandas. Esse estudo teve como objetivo amplo investigar o estresse da transição no contexto do EF de nove anos, partindo de uma visão desenvolvimentista aliada a uma perspectiva de exposição a estressores cotidianos. Especificamente, o estudo investigou a relação entre competências e sintomas de estresse no 1º ano do EF, o curso desenvolvimental dos sintomas e das percepções de estresse nos dois anos inicias do EF, suas associações com as tarefas adaptativas da transição e a influência da escola nos indicadores de estresse. Finalmente, exploraram-se modelos explicativos para indicadores de estresse apresentados no 2º ano. Seguindo metodologia prospectiva, avaliaram-se indicadores de ajustamento e competências relacionadas ao desempenho acadêmico, social e comportamental das crianças no 1º ano, estresse nos dois primeiros anos e características da escola (localização e IDEB). Participaram da pesquisa 157 alunos do 1º ano do EF, sendo 85 meninos e 72 meninas, com idade média de 6 anos e 10 meses no início da pesquisa. Todos tinham experiência de dois anos na Educação Infantil e estavam matriculados em escolas municipais de diferentes regiões de uma cidade do interior de São Paulo. Também participaram do estudo, como informantes, seus respectivos professores do 1º ano, num total de 25. As crianças responderam à Escala de Stress Infantil, ao Inventário de Estressores Escolares e a uma avaliação objetiva de desempenho acadêmico (Provinha Brasil). Os professores avaliaram as habilidades sociais, os problemas de comportamento externalizantes e internalizantes e a competência acadêmica dos seus alunos por meio do Social Skills Rating System Professores. A análise dos dados compreendeu estatísticas descritivas, comparações, correlações e regressões. Nos resultados, 57% dos alunos no 1º ano e 72% no 2º ano relataram sintomas de estresse pelo menos na fase de alerta. Crianças com estresse no 1º ano apresentaram menores índices de ajustamento e competência e perceberam suas escolas como mais estressantes em relação ao seu papel de estudante e nas relações interpessoais. Correlações moderadas entre medidas de indicadores de estresse tomadas no 1º e no 2º ano sugerem estabilidade. A presença de sintomas de estresse aumentou do 1º para o 2º ano, enquanto a percepção de estressores escolares não variou. Crianças com maiores médias de estresse são provenientes de escolas situadas em regiões periféricas e com classificação mais baixa no IDEB. As análises de predição evidenciaram a habilidade social de responsabilidade e cooperação avaliada no 1º ano como importante fator de proteção contra sintomas de estresse no 2º ano, ao passo que a percepção da criança de tensões nas relações interpessoais no 1º ano foi o principal fator de risco para futura sintomatologia de estresse. Nesse sentido, intervenções com ênfase na promoção de habilidades sociais das crianças podem ser profícuas na prevenção do estresse. / The entrance to the elementary school - ES has been considered as a transition time due to the new demands it presents for the child. In this context, some children may become more vulnerable to stress, especially those with greater difficulty in adapting to these demands. This study investigates the stress of transition to ES (nine years long), from a developmental perspective combined with the theoretical approach of exposure to daily hassles. Specifically, the study investigated (a) the relationship between competences and symptoms of stress in the 1st year of the ES; (b) the developmental course of symptoms and stress perceptions in the two initial years of the ES; (c) their associations with adaptive transition tasks; (d) the school influence on stress indicators. Explanatory models for stress indicators presented in 2nd year were also explored up. Following a prospective design, competence and adjustment indicators related to academic performance, social skills, behavior, and stress were evaluated in the 1st year, as well as school characteristics (location and IDEB). Stress measures were repeated in the 2nd year. The participants were 157 ES students, 85 boys and 72 girls, with an average age of 6 years and 10 months at baseline in 1st year. They had two years experience in kindergarten and were enrolled in public schools in different regions of a city of São Paulo State. Their teachers of the 1st year, a total of 25, also participated in the study, as informants. The children answered the Child Stress Scale, the Inventory of School Stressors and an objective evaluation of academic performance (Provinha Brazil). Teachers rated social skills, externalizing and internalizing behavior problems and academic competence of their students through the Social Skills Rating System - Teachers. Data analysis comprised descriptive statistics, comparisons, correlations and regressions. In the results, 57% of students in the 1st year and 72% in the 2nd reported stress symptoms at least in the alert phase. Children with stress symptoms at 1st year had lower levels of adjustment and competence. They also perceived their schools as more stressful concerning both academic demands and interpersonal relationships. Moderate correlations between stress indicators measures in the 1st and 2nd year suggest stability. The presence of stress symptoms increased from the 1st to the 2nd year, while the perception of school stressors did not change. Children with higher average stress come from schools in remote urban areas and lower IDEB index. The prediction analysis showed the social skill of responsibility and cooperation assessed at 1st year as an important protection factor against stress symptoms in the 2nd year, while the child\'s perception of tensions in interpersonal relationships in the 1st year was the main risk factor for future symptoms of stress. In this sense, interventions emphasizing the promotion of social skills of children can be fruitful in preventing stress.

The present study was designed to examine the etiology of suicidal behavior from cognitive and developmental perspectives. Given empirical evidence suggesting links between early negative life events and suicidal behavior, between early negative life events and cognitive factors, and between cognitive factors and suicidal behavior, it was hypothesized that early negative life events may impact individuals' suicidal behavior by affecting these individuals' cognitive functioning. That is, cognitive functioning may serve as a mediator in the relationship between early life events and suicidal behavior. The present study examined child maltreatment, family instability, and poor general family environment as early negative life events, and examined self-esteem, locus of control, hopelessness, and problem-solving deficits as cognitive factors. In addition, individuals' perceived social support before age 18 and current social support and life stress were also examined in relation to the above variables. The subject sample was comprised of 181 college students, including 51 suicidal, 60 depressed, and 70 normal-control individuals. Results from the study indicated that these three groups could be discriminated at highly satisfactory levels by using the above variables. A series of structural equation analyses also indicated that, even though early negative life events have mild direct impact on suicidal behavior, these events seem to have stronger direct impact on cognitive deficits which in turn seem to have stronger direct impact on suicidal behavior. / Ph. D.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-03-30T13:25:17Z No. of bitstreams: 1 thaiscostadetoledo.pdf: 853526 bytes, checksum: 8ab2266b6b3465f6d63f51aa6dedac20 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-04-24T02:52:12Z (GMT) No. of bitstreams: 1 thaiscostadetoledo.pdf: 853526 bytes, checksum: 8ab2266b6b3465f6d63f51aa6dedac20 (MD5) / Made available in DSpace on 2016-04-24T02:52:12Z (GMT). No. of bitstreams: 1 thaiscostadetoledo.pdf: 853526 bytes, checksum: 8ab2266b6b3465f6d63f51aa6dedac20 (MD5) Previous issue date: 2013-03-22 / A literatura vem demonstrando que o estresse, um dos problemas mais comuns que o homem moderno enfrenta na atualidade, tem alcançado grande relevância no Brasil e no mundo, sobretudo no que tange a sua sintomatologia na infância. O estresse pode causar danos ao desenvolvimento humano ao acarretar dificuldades ou desvantagens para a qualidade física e emocional da criança. Ainda, variáveis presentes nos contextos escolar e familiar podem atuar como desencadeadoras do estresse infantil ou como suporte promotor de desenvolvimento saudável. Diante disso, objetivou-se investigar o estresse infantil em alunos do ensino fundamental, bem como avaliar, em um subgrupo desses, possíveis aspectos familiares e escolares que poderiam estar atuando como fatores de risco e/ou proteção. Participaram da primeira etapa da pesquisa 103 alunos do 2º e 3º anos do ensino fundamental de uma escola pública federal mineira (idade média de 7 e 8 anos), seus pais e professores. Para o rastreio de alunos com indícios significativos de estresse, foi aplicada, coletivamente, a Escala de Stress Infantil – ESI. A correção padronizada da escala apontou 63 crianças com índices expressivos de estresse (61,2%). Deste total, 28 crianças (44,5%) foram identificadas como estando nas duas últimas fases do estresse – quase-exaustão e exaustão. Delimitou-se, a partir destes dados, um subgrupo com os 20 participantes que apresentaram os maiores índices de estresse. Nesta etapa da pesquisa pais e professores foram entrevistados com roteiros que abordaram três temáticas, envolvendo 16 perguntas no caso das entrevistas com os pais e 14 questões, no caso das professoras. As entrevistas foram gravadas, transcritas e submetidas à análise de conteúdo. Os resultados demonstraram que tanto pais como professores acreditam na ocorrência de sintomas de estresse na infância, associados a alterações comportamentais e reações fisiológicas. Na perspectiva dos pais, além da dificuldade de implementação de estratégias preventivas ao estresse, fatores familiares, como relacionamento conflituoso no âmbito familiar, irregularidade da rotina infantil, dificuldade das crianças em lidar com regras e limites, foram apontados como significativos estressores infantis. Em relação ao discurso das docentes, alterações comportamentais e a ocorrência de sintomas somáticos foram associadas aos fatores familiares e àqueles intrínsecos à criança e a sua rotina. Indica, ainda que, a maioria das crianças manifesta comportamentos preocupantes que exigem atenção individual, incluindo o comportamento desafiador, além de um relacionamento conflituoso com suas professoras. Ressalta-se, portanto, a necessidade de implementação de novos estudos que possam oferecer subsídios para a geração de ações promotoras de desenvolvimento emocional e social dessas crianças a partir da delimitação das potenciais fontes geradoras do estresse nesses contextos. / The literature has demonstrated that stress, one of the most common problems that modern man faces today, has achieved great importance in Brazil and worldwide, especially regarding their symptoms in childhood. Stress can cause damage to human development to lead to difficulties or disadvantages for the physical and emotional child. Still, variables present in the school and family can act as precipitating stress or child support as promoter of healthy development. The research objective was to investigate the children's stress on elementary students, and to evaluate, in a subset of these, family and school possible aspects that could be acting as risk factors and / or protection. Participated in the first stage of the study included 103 students from the 2nd and 3rd years of primary education in a public school federal from Minas Gerais - Brazil (mean age 7 and 8 years), their parents and teachers. For the screening of students with significant indications of stress was applied collectively to Escala de Stress Infantil - ESI. The correction standardized scale showed 63 children with expressive indices of stress (61.2%). Of this total, 28 children (44.5%) were identified as being in the last two stages of stress - near-exhaustion and exhaustion. Was delimited, from these data, a subset of the 20 participants who showed the highest levels of stress. At this stage of the research were interviewed parents and teachers with scripts that addressed three themes involving sixteen questions in the case of interviews with parents and fourteen questions in the case of teachers. The interviews were recorded, transcribed and subjected to content analysis. The results showed that both parents and teachers believe in the occurrence of stress symptoms in childhood associated with behavioral and physiological reactions. From the perspective of parents, besides the difficulty of implementing preventive strategies to stress, family factors, as conflicted relationship within the family, irregularity of routine infant, children's difficulty in dealing with rules and boundaries, were identified as significant stressors for children. Regarding the speech of teachers, behavioral changes and the occurrence of somatic symptoms were associated with the family and those factors intrinsic to the child and his routine. Also indicates that most children manifest behaviors of concern that require individual attention, including challenging behavior, and a conflicted relationship with their teachers. It is noteworthy, therefore, the need for implementation of new studies that may provide insight to the generation of actions that promote social and emotional development of these children from the delimitation of potential generating sources of stress in these contexts.

Educational Studies / M. Ed. (Guidance & Counselling)

Educational Studies / M. Ed. (Guidance & Counselling)

This study examines stresses experienced by primary school learners with learning problems in inclusive classrooms in an Independent School. Literature suggests that learners with learning problems experience more academic, emotional and social difficulties at school than do their peers without learning problems. The Transactional Model of stress was used as a point of departure for the qualitative empirical study to understand stress as it is experienced by three Grade 4 learners. Several school stresses were identified which contributed to unmet emotional and social needs. The three central sources of stress were classified as S1 (Inability to meet perceived/anticipated demand), S2 (Overload – too much expected) and S3 (Selfexpectations not met). The learners’ own suggestions regarding the relief of these stresses were examined and contributed to guidelines to assist teachers in relieving these stresses experienced by learners with learning problems in the inclusive classroom. / Psychology of Education / M. Ed. (Guidance and Counselling)

This study examines stresses experienced by primary school learners with learning problems in inclusive classrooms in an Independent School. Literature suggests that learners with learning problems experience more academic, emotional and social difficulties at school than do their peers without learning problems. The Transactional Model of stress was used as a point of departure for the qualitative empirical study to understand stress as it is experienced by three Grade 4 learners. Several school stresses were identified which contributed to unmet emotional and social needs. The three central sources of stress were classified as S1 (Inability to meet perceived/anticipated demand), S2 (Overload – too much expected) and S3 (Selfexpectations not met). The learners’ own suggestions regarding the relief of these stresses were examined and contributed to guidelines to assist teachers in relieving these stresses experienced by learners with learning problems in the inclusive classroom. / Psychology of Education / M. Ed. (Guidance and Counselling)