Early language weaknesses are associated with increased risk for behavior challenges (Yew & O’Kearney, 2013). Comorbid language and behavior challenges are common, although the directionality and mechanisms underlying this association are unclear (Bichay-Awadalla et al., 2020; Petersen & LeBeau, 2021). In this project we investigate the association between language and problem behavior within the context of early caregiver-child interactions. We examined the degree to which child problem behavior predicts conversational turn-taking with caregivers, controlling for child language. We also compared child participation across interaction contexts, and the degree to which this was shaped by problem behavior. Finally, we evaluated the association between caregiver use of communicative repairs and child language, controlling for problem behavior. To address our research questions, we used parent-report measures of child language and behavior, as well as recorded interactions with caregiver-child dyads (N = 32) between the ages of 16 and 48 months of age. Using linear regression modeling, we found that child problem behavior was negatively associated with conversational turn-taking after adjusting for expressive language. We used negative binomial mixed effect modeling to examine participation, and found that children’s participation was significantly greater during completion of a puzzle and free play compared to book reading. There was no association between language and problem behavior on participation across contexts. We used zero-inflated binomial regression modeling to examine caregiver repair use, and failed to find significant associations with variables of interest. We conclude that problem behavior uniquely shapes the quality of early language interactions, and discuss clinical implications. / Communication Sciences

Yes / Many interventions that are delivered within public health services have little evidence of effect. Evaluating interventions that are being delivered as a part of usual practice offers opportunities to improve the evidence base of public health. However, such evaluation is challenging and requires the integration of research into system-wide practice. The Born in Bradford’s Better Start experimental birth cohort offers an opportunity to efficiently evaluate multiple complex community interventions to improve the health, wellbeing and development of children aged 0–3 years. Based on the learning from this programme, this paper offers a pragmatic and practical guide to researchers, public health commissioners and service providers to enable them to integrate research into their everyday practice, thus enabling relevant and robust evaluations within a complex and changing system. Using the principles of co-production the key challenges of integrating research and practice were identified, and appropriate strategies to overcome these, developed across five key stages: 1) Community and stakeholder engagement; 2) Intervention design; 3) Optimising routinely collected data; 4) Monitoring implementation; and 5) Evaluation. As a result of our learning we have developed comprehensive toolkits (https://borninbradford.nhs.uk/whatwe-do/pregnancy-early-years/toolkit/) including: an operational guide through the service design process; an implementation and monitoring guide; and an evaluation framework. The evaluation framework incorporates implementation evaluations to enable understanding of intervention performance in practice, and quasi experimental approaches to infer causal effects in a timely manner. We also offer strategies to harness routinely collected data to enhance the efficiency and affordability of evaluations that are directly relevant to policy and practice. These strategies and tools will help researchers, commissioners and service providers to work together to evaluate interventions delivered in real-life settings. More importantly, however, we hope that they will support the development of a connected system that empowers practitioners and commissioners to embed innovation and improvement into their own practice, thus enabling them to learn, evaluate and improve their own services. / Big Lottery Fund as part of the A Better Start programme. The Big Lottery Fund. NIHR CLAHRC Yorkshire and Humber.

Yes / Evidence for early intervention and prevention-based approaches for im-proving social and emotional health in young children is robust. However, rates of participation in programmes are low. We explored the dynamics which affect levels of community readiness to address the issues of social and emotional health for preg-nant women, young children (0-4 years) and their mothers.Setting:A deprived inner‐city housing estate in the north of England. The estate falls within the catchment area of a project that has been awarded long-term funding to address social and emotional health during pregnancy and early childhood.Methods:We interviewed key respondents using the Community Readiness Model. This approach applies a mixed methodology, incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling the placement of the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework approach to generate con-textual information to augment the numerical scores.Results:An overall score consistent with vague awareness was achieved, indicating a low level of community readiness for social and emotional health interventions. This score suggests that there will be a low likelihood of participation in programmes that address these issues.Conclusion:Gauging community readiness offers a way of predicting how willing and prepared a community is to address an issue. Modifying implementation plans so that they first address community readiness may improve participation rates. / Better Start Bradford

Professionals in early intervention have little information about the levels of sibling involvement in intervention, factors that contribute to sibling involvement, or how sibling involvement is related to families’ perceptions of self-efficacy. Few studies have investigated siblings in early intervention, and none have focused on relationships between sibling involvement in early intervention and parent self-efficacy. Using quantitative survey research this study investigated factors related to sibling involvement in early intervention strategies. Respondents completing the survey consisted of 129 parents who had a child enrolled in Michigan’s early intervention program, and at least one sibling in the home. Results indicated a significant relationship between sibling use of early intervention strategies and 1) the region in which the family lives, and 2) the age difference between the siblings in each sibling dyad. Practical implications of the findings are discussed.

Background: Conduct problems (CPs), a persistent pattern of challenging, oppositional, defiant or aggressive behaviour are a significant concern to educators, families and other professionals. CPs in preschool children are related to poorer educational and social outcomes in addition to a range of behavioural and emotional difficulties. Although there is evidence for hereditary and temperamental influences, parental factors are widely considered to be significant in the development of CPs. Parents experiencing psychological or social distress are considered to be at risk for challenging behaviour in their children. Psychologists and other theorists have suggested several possible reasons for this association. Firstly, it is possible that parents in distress have difficulty managing stress and as a result use harsh, inconsistent or coercive approaches to parenting. Secondly, parents with children who have CPs may be low in parental self efficacy, a consistent belief in their capacity to parent, which leads them to parent ineffectively and inconsistently. A third possibility is that parents in distress struggle to form stable attachments with their children which can lead to later behavioural difficulties. Finally, it is possible that parent’s distress is influenced by external contextual factors which also influence children such as family or social conflict. Studies suggest that training programmes for the parents of preschool children are effective in reducing child behaviour problems. Training approaches are influenced by a combination of psychological theories including behaviourist, social-cognitive, attachment and ecosystemic approaches. There have been many quantitative evaluations supporting the use of parent training programmes (PTPs). However, there has been limited inquiry into the process of PTPs from the perspective of those who attend them. Aims: The first part of this study was designed to evaluate vulnerability factors related to conduct problems; parental self efficacy, stress and child behaviour problems over the course of a community parent training programme designed to help participants to understand and manage the behaviour of young children. The overall research aim was to evaluate the outcomes and process, using different methodologies to address several questions. A realist methodology was applied to evaluating: 1. was there an association between parental stress, parental self efficacy and child behaviour problems at the start of the programme consistent with the established theory? 2. Did the parents attending the course experience higher than expected levels of stress and child behaviour problems? 3. Did quantitative and qualitative data indicate that these vulnerability factors changed over the duration of the course? Finally, an interpretivist methodology was used to explore how parents of young children evaluated as at risk of challenging behaviour described the experience of learning in the programme. Methods: The study utilised a pragmatic approach to evaluation with mixed methods and differing methodologies. At the start of the programme, a cohort of 38 parents agreed to participate in the study prior to the programme and completed self report measures related to parental stress and parental self efficacy. Parents with concerns about the behaviour of a child aged over three also completed a questionnaire relating to child behaviour problems. Of the original cohort, 27 completed self report measures at the end of the programme. 17 parents completed the same measures at a follow up meeting at the Children’s Centre, five to six weeks after the programme was completed. At this meeting 16 parents were interviewed to discuss their experience of the programme and any subsequent changes which had occurred. Results The results of the first part of the evaluation suggested a significant relationship between parental self-efficacy and stress and between stress and child behaviour problems. However, there was no statistical association between self-efficacy and child behaviour problems, as expected. This tentatively indicates that parental self-efficacy is less important in the development of child behaviour problems than has been previously suggested. The analysis of stress data at the start of the programme indicated that the frequency of parents reporting moderate to extremely severe stress was 4.42 times that which would be expected in a typical British cohort. At the start of the programme, frequency of child behaviour problems in the cohort were 5.9 times higher with conduct problems being 9 times what would be expected based on British norms. This suggests that the programme is being accessed by parents whose children are evidencing behaviour problems and, in particular, conduct problems. However, methodological issues are likely to have led to a slight overestimate of relative prevalence of child CPs in the cohort. Results indicated that parents reported significantly increased self efficacy, significantly reduced stress and child behaviour problems, including conduct problems, between the start and end of the programme. Thematic analysis and subsequent content analysis of outcome themes from interviews suggested that the majority of parents interviewed identified changes in parenting behaviour, knowledge, confidence, reduced stress and improved child behaviour as outcomes from the programme. However, changes in the quantitative data were not observed as frequently, reliably or to the same extent in the interview subgroup as they were in the main cohort, suggesting a sampling bias or a discrepancy in findings between methods. The self report data and interviews for all interviewees were then reviewed and interviews with six parents evaluated as having moderate to high stress, social or psychological difficulties and possible child behaviour problems were sampled. These were then re-analysed using a rigorous inductive approach to Thematic Analysis to identify emergent themes relating to the experience of participating and learning through the programme. Six themes emerged from analysis including; Understanding Difficulties, Identifying and Connecting, New Knowledge, Stopping and Thinking, Approach and Interaction and Reconstructing. The Understanding Difficulties theme described the different ways in which parents understood of their difficulties relating to themselves, their children and others which motivated them to attend the programme. The Identifying and Connecting theme described the importance to parents of personal identification with several aspects of the programme in terms of “being understood” in addition to identifying connections with established support, learning objectives and personal development goals. New Knowledge was categorised into three sub-themes of theoretical, practical and contextual. Contextual knowledge was constructed as understanding the experience of other parents, for example, identifying that other parents had similar difficulties. Theoretical knowledge about child behaviour and development encouraged parents to “stop and think” about the reasons for their children’s behaviour. Practical knowledge was constructed as parenting strategies which, when used, helped parents to feel more confident in themselves, more relaxed and more in control. The Stopping and Thinking theme described parents withholding action and considering the motivations for their children’s behaviour or the best approach to interacting with them. Approach and Interaction described changes to the way parents interacted with their children. The parents in question described changed or reconstructed understandings of their children, themselves and their difficulties as a result of participating in the programme. The theoretical implications of analysing the learning experience are that it highlights the importance of personal identification with the course objectives and experience.

Au cours des dernières années, plusieurs programmes d’intervention ont été bâtis, afin de répondre aux besoins particuliers des enfants autistes. Une composante importante de ces interventions devrait être la guidance parentale. Ce volet permet aux parents de se sentir plus compétents et les enfants peuvent généraliser leurs acquis au quotidien. Ce mémoire a donc pour but d’évaluer un programme d’intervention pour les parents d’enfants autistes au cours duquel ils recevront des connaissances sur les particularités de leur enfant et seront appelés à participer à des activités spécifiques favorisant des interactions plus centrées sur les besoins de leur enfant. Le protocole quasi expérimental avec un pré et un post test avec un groupe de contrôle non équivalent a été utilisé pour évaluer les effets de ce programme. L’échantillon pour cette étude est constitué de 14 familles, lesquelles ont été distribuées dans les groupes en fonction de leur arrivée dans le programme. Les parents et l’enfant ont participé à une séance hebdomadaire individuelle pendant cinq semaines. Des outils standardisés ont été utilisés avant et après l’intervention pour mesurer l’atteinte des objectifs. Tant pour les parents que pour les enfants, les deux groupes ont montré une amélioration significative ou une tendance à l’amélioration lors du post test, mais cette amélioration n’était pas significativement différente entre les deux groupes. Plusieurs variables non contrôlées peuvent expliquer ces résultats, malgré tout ceux-ci sont assez intéressants pour encourager la poursuite d’études sur le sujet. / Over the years, several programs of intervention were built, in order to meet the particular needs of autistic children. An important component of these interventions should be the parent-mediated treatment; this guidance made it possible for the parents to feel more qualified and the children were able to generalize their gains throughout their daily living. The purpose of this program was to evaluate an intervention for the parents of autistic children. During the study the parents received knowledge of the characteristics of their child. They took part in specific activities that taught them to be more responsive to the needs of their child. The quasi-experimental design with pre and a post test with a non-equivalent control group was used to evaluate the effects of this program. The sample for this study consists of 14 families. They were distributed into groups according to their arrival in the program. The parents and the children of the experimental group took part in an individual weekly session during five weeks. The parents and the children, from the two groups showed a significant improvement or a tendency to improve at the time of the post test. This improvement was not significantly different between the two groups as there were several non-controlled variables that can explain these results. The results are promising enough to encourage the continuation of this study.

Early detection facilitates early intervention (EI), which optimizes outcomes in autism spectrum disorders (ASD) and other developmental delays. However, facilitating the transition between receiving a diagnosis of ASD and other delays and accessing care has received little attention. When families first receive a diagnosis, they often experience grief, confusion, heightened stress, and difficulty accessing appropriate and affordable services, further increasing the disadvantages and disparity experienced by underrepresented populations. This feasibility study will focus on ways providers can better facilitate access to EI services for families following an initial diagnosis. Forty-nine diverse parents with children (16-32 m) diagnosed with ASD and other developmental delays were recruited from a larger screening study. During feedback, all families were provided with a provider list (treatment as usual) of therapeutic services. Half of the families were randomly assigned to receive a DVD/ Youtube Link (treatment plus video) that describes the diagnosis as well as common therapeutic options for children with developmental delays. Parents were asked questions regarding their use of materials (video vs. provider list) following feedback and their ability to access EI services. Study retention, demand and satisfaction were assessed to evaluate the use of video recommendations and the provider list. Demand, satisfaction and completion rates were assessed to evaluate the use of video recommendations as a feasible intervention following diagnosis. Additionally, differences in post measures of parental sense of competence, parental stress and access to the EI system were used to assess the potential efficacy of the intervention. Seventy- five percent of parents (across both treatment groups) used the provider list, whereas only 29% of parents who were randomized to the video condition reported that they viewed the video recommendations. Qualitative reactions from parents in the current investigation suggest a need for interdisciplinary care and coordination between mothers. Challenges to delivering a brief intervention following diagnosis are explored.

Bipolare Störungen zählen zu den schwerwiegendsten psychiatrischen Erkrankungen, die sich bereits in der Adoleszenz und im frühen Erwachsenenalter manifestieren, jedoch aufgrund ihrer komplexen Symptomatologie oftmals erst mit deutlich zeitlicher Verzögerung korrekt diagnostiziert werden. Auf Patientenseite ist die Erkrankung mit schweren psychosozialen Beeinträchtigungen, Einbußen in der gesundheitsbezogenen Lebensqualität und einem deutlich erhöhten Suizidrisiko verbunden; eine bipolar-spezifische Behandlung setzt zumeist zu spät ein. Forschungsbemühungen auf dem Gebiet der Früherkennung Bipolarer Störungen zeigen, dass Personen in möglichen Vorstufen der Erkrankung bereits unter subsyndromalen Symptomen und Funktionseinschränkungen leiden. Der Bedarf nach frühzeitiger und adäquater Behandlung in Risikostadien kann in der klinischen Versorgung bis dato nicht abgedeckt werden, da spezifische Versorgungsstrukturen für junge Menschen vor Manifestation einer schweren psychischen Störung sowie evidenzbasierte Therapieprogramme nicht existieren. Frühe präventive Maßnahmen können hilfesuchenden Personen mit Risikokonstellation für eine bipolare Entwicklung aber die Chance bieten, die bestehende Symptomatik zu reduzieren, die Funktionsfähigkeit zu verbessern und Bewältigungsstrategien aufzubauen. Weitere Ziele einer frühen Intervention stellen die Verzögerung oder Abschwächung von drohenden Krankheitsphasen beziehungsweise bestenfalls die Verhinderung der Konversion in eine manifeste Bipolare Störung dar. Die Studienlage zur Effektivität von adäquaten Behandlungsansätzen für Personen mit erhöhtem Risiko für eine bipolare Entwicklung ist ausgesprochen begrenzt. Für psychotherapeutische Verfahren gibt es erste Hinweise auf die Wirksamkeit familienbasierter Verfahren, wobei die Aussagekraft der Befunde aufgrund methodischer Limitationen eingeschränkt ist. Trotz indirekter Evidenz, welche sich aus dem Wirksamkeitsnachweis von kognitiver Verhaltenstherapie bei bipolaren Patienten mit wenigen Krankheitsphasen ableiten lässt, wurden kognitiv-verhaltenstherapeutische Ansätze hinsichtlich der Effektivität bei jungen, noch nicht erkrankten Personen mit erhöhtem Bipolar-Risiko bislang nicht systematisch untersucht. Ziel der vorliegenden Arbeit war es, die beschriebene Forschungslücke zu schließen, indem die Wirksamkeit einer spezifischen kognitiv-verhaltenstherapeutischen Gruppenintervention bei Hochrisikopersonen für die Entwicklung einer Bipolaren Störung untersucht wurde. Aufgrund des bisherigen unzureichenden Kenntnisstands erfolgte zunächst eine Charakterisierung der untersuchten Hochrisikoklientel für die Entwicklung Bipolarer Störungen hinsichtlich des psychosozialen Funktionsniveaus, des Stresserlebens sowie Ressourcen und Selbstmanagementfähigkeiten. Ausgehend von ersten praktischen Erfahrungen aus spezialisierten Früherkennungszentren wurde postuliert, dass die teilnehmenden Hochrisikopersonen bereits Einschränkungen im psychosozialen Funktionsvermögen zeigen und ein hohes Ausmaß an chronischem Stress erleben, während ihre Bewältigungsmöglichkeiten begrenzt erscheinen. In der vorliegenden Arbeit wurde die zentrale Frage untersucht, inwieweit mittels einer spezifischen kognitiv-verhaltenstherapeutischen Intervention eine günstigere Beeinflussung des psychosozialen Funktionsvermögens, des Stresserlebens sowie von Ressourcen und Selbstmanagementfähigkeiten der Studienteilnehmer gelingen kann als bei einer unstrukturierten Kontrollbedingung. Wenngleich in der Interventionsbedingung eine stärkere Verbesserung in den untersuchten Outcome-Maßen erwartet wurde, sollte sich durch die Teilnahme an den unstrukturierten Sitzungen der Kontrollbedingung ebenfalls ein gewisser therapeutischer Nutzen ergeben, der sich in der Verbesserung der beschriebenen Parameter widerspiegeln sollte. Schließlich wurde die Hypothese geprüft, inwieweit sich die zu erwartenden positiven Effekte im psychosozialen Funktionsvermögen sowie in den stressassoziierten Parametern in beiden Versuchsgruppen auch als stabil über einen Verlauf von sechs Monaten erweisen. Die vorliegende Arbeit war eingebettet in die multizentrische, DFG-geförderte, randomisierte und kontrollierte klinische EarlyCBT-Studie, in der die Wirksamkeit eines innovativen Gruppentherapieprogramms für Hochrisikopersonen für die Entwicklung einer Bipolaren Störung im Vergleich zu unstrukturierten Sitzungen untersucht wird. Das Vorliegen einer positiven Familienanamnese für affektive und/oder schizoaffektive Störungen, gepaart mit zunehmenden Einschränkungen in der psychosozialen Funktionsfähigkeit und subsyndromaler affektiver Symptomatik, stellten die wesentlichen Einschlusskriterien zur Studienteilnahme dar. Die Stichprobe umfasste 74 hilfesuchende Probanden im Alter zwischen 15 und 30 Jahren, welche zu drei Erhebungszeitpunkten (Baseline, am Ende der Intervention und sechs Monate nach Beginn der Intervention) untersucht wurden. Das eigens für die Studie konzipierte Behandlungsmanual enthielt neben Elementen der kognitiven Verhaltenstherapie auch Achtsamkeits- und Entspannungsübungen sowie Interventionen zum Stressmanagement. Primäre Outcomes der vorliegenden Arbeit waren das psychosoziale Funktionsvermögen, das Erleben von chronischem Stress sowie die Ressourcen und Selbstmanagementfähigkeiten der Teilnehmer. Veränderungen im psychosozialen Funktionsniveau der Hochrisikopersonen wurden mittels eines semistrukturierten Interviews erhoben, während die Effektivität der therapeutischen Intervention in Bezug auf stressassoziierte Parameter anhand von Selbstreportfragebögen erfasst wurde. Die Auswertungen basierten auf dem intention-to-treat (ITT)-Ansatz; fehlende Werte wurden anhand des Expectation-Maximization (EM)-Algorithmus geschätzt. Als statistische Verfahren für die Prüfung der dargestellten Hypothesen kamen Varianzanalysen (einfaktoriell, mit und ohne Messwiederholung) zum Einsatz. Zur systematischen Analyse von Dropouts erfolgte eine Deskription der Zeitpunkte und Gründe für die Ausfälle sowie eine Prüfung von Unterschieden zwischen Probanden der Dropout-Gruppe und den vollständig an der Studie teilgenommenen Probanden mittels 2-Tests und einfaktoriellen Varianzanalysen. In der vorliegenden Studie konnte hypothesengemäß gezeigt werden, dass die untersuchten Hochrisikopersonen bereits deutliche psychosoziale Einschränkungen aufwiesen, chronischen Stress erlebten und nur über begrenzte Ressourcen und Strategien zum Umgang mit Stress und Belastungen verfügten. Am Ende der Intervention zeigten sich in der Gesamtstichprobe erwartungsgemäß signifikante Verbesserungen hinsichtlich des Stresserlebens sowie der Ressourcen und Selbstmanagementfähigkeiten. Entgegen der Hypothese erbrachten die Auswertungen zum psychosozialen Funktionsvermögen in der Gesamtstichprobe numerische, aber keine signifikanten Effekte am Ende der Intervention. Zwischen der Interventions- und Kontrollbedingung konnten entgegen den Hypothesen am Ende der Intervention keine bedeutsamen Unterschiede in den geprüften Zielgrößen psychosoziales Funktionsvermögen, Stresserleben und Ressourcen und Selbstmanagementfähigkeiten festgestellt werden. Sechs Monate nach Beginn der Gruppenteilnahme zeigten sich im Einklang mit den Hypothesen in beiden Versuchsgruppen signifikante Verbesserungen in den drei untersuchten Parametern. Die im Rahmen der vorliegenden Studie eingesetzte, spezifische kognitivverhaltenstherapeutische Gruppenintervention bietet Personen mit Hochrisikostatus für die Entwicklung einer Bipolaren Störung einen guten Einstieg in die psychotherapeutische Behandlung. Um der komplexen Symptomatologie, der häufigen Komorbidität sowie den individuellen Bedürfnissen der jungen, (noch) nicht bipolar erkrankten Hochrisikopersonen besser gerecht werden zu können, erscheint ein kombinierter, über einen längeren Zeitraum angelegter psychotherapeutischer Ansatz im Einzel- und Gruppensetting auch unter Einbeziehung der neuen Medien sinnvoll, dessen Entwicklung und Evidenzprüfung Ziel weiterer Forschungsbemühungen sein sollte. Eine zeitnahe Implementierung von präventiven, bedarfsgerechten Interventionsstrategien in die klinische Versorgung erscheint vor dem Hintergrund der bereits in Risikostadien Bipolarer Störungen existierenden erheblichen psychosozialen Belastungen, unter denen die Betroffenen leiden, erstrebenswert.

[pt] O nascimento de um bebê com síndrome de Down, sem diagnóstico prénatal, configura um momento potencialmente traumático para seus pais. Este acontecimento intervém no exercício da parentalidade, sobretudo quando esta se inaugura neste contexto. Investigamos a importância do preparo das equipes de saúde em lidar com esta experiência e, assim, propiciar a emergência do apego e dos vínculos entre o bebê e os pais. Para tal empreendimento estudamos as relações pais-bebê pelo prisma de diversas teorias, iniciando com a teoria do apego de John Bowlby, passando pelo eu-pele de Didier Anzieu e finalizando com Freud, Winnicott e Bion. Abordamos, ainda, o tema da construção da parentalidade com o bebê portador da síndrome de Down e as suas especificidades: o luto pelo bebê ideal, o narcisimo ferido dos pais e as vicissitudes do trauma. Exploramos o dispositivo de estimulação precoce e introduzimos possíveis contribuições do campo da psicanálise e da psicoterapia da relação pais-bebê. Pesquisamos este universo através de um estudo de campo, realizando entrevistas semi-estruturadas com pais e profissionais da área. Das análises do discurso dos sujeitos, cinco categorias emergiram: o momento da notícia, o luto, a formação dos laços afetivos, a síndrome de Down e a estimulação precoce. Estas categorias foram discutidas em profundidade, a partir dos capítulos teóricos. Constatamos que os profissionais dos centros obstétricos que comunicam aos pais o diagnóstico do filho e os terapeutas quando realizam a estimulação precoce do bebê, em geral, não consideram os aspectos relacionais entre os membros do conjunto pais-bebê-profissionais como parte do próprio trabalho, e isto, além de gerar diversos impasses nas maternidade e nos centros de estimulação precoce, não contribui para a elaboração do luto pelo bebê ideal por parte dos pais, nem para o acionamento do potencial maturativo do bebê e do seu advento como sujeito. Inovamos, ao propor, então, um deslocamento da estimulação precoce do bebê ao acolhimento precoce da família. / [en] The birth of a child with Down syndrome without a prenatal diagnosis configures a potentially traumatic moment for parents. This event affects the exercise of parenthood, especially when the later is inaugurated in this context. We researched the importance of the preparation of health teams in dealing with this experience and, therefore, in fostering attachment and bonds between infant and parents. For such project, we studied the parents-baby relationships trough the prism of several theories, starting with John Bowlby´s attachment theory, passing trough the skin ego from Didier Anzieu and finalizing with Freud, Winnicott and Bion. We approached also the theme of the parenthood construction with a baby with Down syndrome and its specificities: the mourning for the ideal baby, the parents´ hurt narcissism and the trauma vicissitudes. We explored the early intervention device and introduced possible contributions from the psychoanalysis field and from the infant-parent psychotherapy. We researched this universe through a field study, performing semi-structured interviews with parents and professionals from this sector. From the analysis of the speeches of these subjects five categories were raised: the moment of breaking the news, the mourning, the formation of affective bonds, the Down syndrome and the early intervention. These categories were discussed in depth at the theory chapters. We noted that the professionals from obstetrician centers that communicate the child diagnosis to the parents and the therapists when performing early intervention in the baby, in general, do not consider the relationships aspects of the parent-infant-professionals group as part of their own work, and this situation, besides generating several roadblocks at the maternity centers and at the early intervention centers, do not contribute to the elaboration of the parents´ mourning of the ideal baby, as well as to driving the maturational potential of the infant and its advent as subject. We innovated, when proposing a displacement of the early intervention of the infant to the early family welcome.

Estudo exploratório, transversal que objetivou identificar os fatores de risco para o desenvolvimento associados às alterações de linguagem em crianças aos 18 meses acompanhadas em um serviço especializado de um município paulista. Participaram crianças atendidas no Serviço de Estimulação Precoce entre 01 de janeiro de 2013 e 31 de dezembro de 2015. Os dados foram obtidos através dos prontuários do serviço. As variáveis estudadas foram: peso ao nascer, idade gestacional, índice de Apgar, ocorrências clínicas (pré-natal, parto e pós-parto) e anomalias congênitas. Na fase descritiva, caracterizou-se os participantes, a partir das variáveis de interesse, sendo calculadas frequências e porcentagens das variáveis. Na fase analítica, buscou-se associações entre a variável dependente (atraso no desenvolvimento) e as demais variáveis, utilizou-se ainda modelos de regressão logística multinomial para estimar a chance de ocorrência das variáveis categóricas. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (CAAE 61587916.0.0000.5393; Ofício CEP-EERP-USP nº373/2016), após anuência da Secretaria Municipal de Saúde. Nos três anos elencados para o estudo observou-se que 78 prontuários (56,9%) eram de crianças que deram entrada no serviço no ano de 2013, 49 (35,8%) em 2014, e 10 (7,3%) no ano de 2015. A maioria das crianças era do sexo masculino, com nascimentos distribuídos em sua maioria, entre os hospitais 1 e 2 e grande parte foi identificada com mais de um risco ao nascimento. A média da idade materna foi de 28 anos, com registros que indicavam, em sua maioria, mais de uma intercorrência durante a gestação, parto e pós-parto. Após a caracterização inicial das variáveis, as crianças foram divididas em três grupos: G1 - detectadas com atrasos no desenvolvimento da linguagem, encaminhadas para terapia fonoaudiológica aos 18 meses; G2 - crianças que passaram pelo retorno aos 18 meses e foram reagendadas para retorno aos dois anos, devido a dúvida quanto ao atraso ou não nas habilidades esperadas, recebendo alta neste; G3 - encaminhadas antes dos 18 meses para terapia, devido atraso significativo no desenvolvimento global. A partir dessa distribuição, buscou-se verificar associação entre os grupos e as variáveis mencionadas. O teste exato de Fisher indicou associação significante (p<0,001) entre os grupos em relação à variável anomalias congênitas. A análise de regressão logística indicou que crianças sem registros de intercorrências durante a gestação e no parto e nascimento, tiveram menores chances de evoluir com atrasos no desenvolvimento da linguagem. Aquelas nascidas prematuras apresentaram chance 8,51 vezes maior de terem, como desfecho, atraso na linguagem do que as crianças nascidas a termo e pós-termo. Crianças com valores de Apgar inferior a 4 no primeiro minuto e 7 no 5º minuto tiveram maior chance de apresentar atrasos; o baixo peso ao nascer também aumentou as chances deste desfecho. Os resultados deste estudo apontam para a necessidade da pronta detecção e encaminhamento precoce dessas crianças para serviços especializados, visando minimizar e/ou até evitar agravos futuros / This exploratory, cross-sectional study aimed at identifying the developmental risk factors associated with language changes in children at 18 months followed at a specialized service in a city of São Paulo. Participants were children attending the Early Stimulation Service between January 1, 2013 and December 31, 2015. Data were obtained from the service charts. The variables studied were birth weight, gestational age, Apgar score, clinical occurrences (prenatal, delivery and postpartum) and congenital anomalies. In the descriptive phase, the participants were characterized by the variables of interest, and the frequencies and percentages were calculated. In the analytical phase, we sought associations between the dependent variable (developmental delay) and the other variables, and multinomial logistic regression models were used to estimate the chance of occurrence of the categorical variables. The study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing (CAAE 61587916.0.0000.5393; CEP-EERP-USP no. 373/2016), after consent of the Municipal Health Department. In the three years listed for the study, it was observed that 78 medical records (56.9%) belonged to the children who entered the service in 2013, 49 (35.8%) in 2014, and 10 (7.3%), in the year 2015. Most of the children were male, with births mostly distributed between hospitals 1 and 2, and most of them were identified as having more than one birth risk. The mean of maternal age was 28 years, with records indicating, for the most part, more than one intercurrence during pregnancy, delivery and postpartum. After the initial characterization of the variables, children were divided into three groups: G1 - children who were detected with delays in language development, referred for speech therapy at 18 months. G2 was related to children who returned for appointment at 18 months of age, and were rescheduled for return with two years, due to doubts related to delay or due they had no expected abilities; those children received discharge at two years old; and G3 was for children who was referred before 18 months for therapy, due to significant delay in overall development. From this distribution, we sought to verify association between the groups and the mentioned variables. The Fisher exact test indicated a significant association (p<0.001) between the groups in relation to the variable congenital anomalies. Logistic regression analysis indicated that children with no records of intercurrences during gestation, delivery and childbirth were less likely to evolve with delays in language development. Those children born premature presented an 8.51 times greater chance of having, as an outcome, delay in language than children born at term and post-term. Children with Apgar values less than 4 in the first minute and 7 in the fifth minute had a greater chance of delays; low birth weight also increased the odds of this outcome. The results of this study point to the need for prompt detection and early referral of these children to specialized services, in order to minimize and / or avoid future disorders