Made available in DSpace on 2016-04-04T18:30:04Z (GMT). No. of bitstreams: 1 Ana Paula Justo.pdf: 4567415 bytes, checksum: 5b01c60ab6a86faef9dd5007e70dd6b9 (MD5) Previous issue date: 2015-02-27 / Pontif?cia Universidade Cat?lica de Campinas / Adolescence is a period of life when individuals are vulnerable to stress and the development of emotional and behavioral problems, but which can be changed with coping strategies and a temperament based on self-regulation. This dissertation was based on a developmental perspective and analyzed the role of temperament and coping as mediator and moderator variables in the relationships among stressors/stress and emotional and behavioral problems (BP), as well as internalizing (IP) and externalizing (EP) problems experienced by adolescents. The study s participants were 83 adolescents (67.47% girls), aged between 12 and 15 years old (M = 13.65); 38.55% were attending the 7th grade and 61.45% were in the 8th grade of a public school in a medium-sized city in the state of S?o Paulo, Brazil. Brazil Criterion, an economic classification developed by ABEP, was applied together with the Youth Self-Report (YSR), the Adolescent Perceived Events Scale (APES); Escala de Estresse para Adolescentes [the Stress Scale for Adolescents]; Escala de Enfrentamento [the Coping Scale]; and the Early Adolescent Temperament Questionnaire - Revised (EATQ-R). The multivariate logistic regression analysis indicated that adolescents with a higher a) number of stressors, b) level of stress, and c) level of extroversion were more likely to experience BP. Adolescents with a higher a) number of stressors and b) level of extroversion, and c) lower effortful control were those more likely to experience EP, while adolescents with a higher level of stress were more likely to experience IP. The structural equation analysis revealed that adolescents experiencing BP were a) male, b) with higher levels of stress, c) a greater number of stressors, d) higher levels of extroversion, and e) lower levels of affiliation. Adolescents with EP were those with a) higher levels of extroversion, b) lower effortful control, and c) a greater number of stressors, while those experiencing IP were male adolescents facing higher levels of stress. The analysis of structural equation indicated a mediation effect for control with effort and negative affect.Linear regression analysis indicated that the relationship between stress and BP was significant (moderation effect) among adolescents with lower effortful control, while the relationship between stress and EP was significant (moderation) for those with a smaller repertoire of coping strategies. It also showed that the relationship between stressors and BP was significant (moderation) among adolescents with low levels of extroversion. Understanding the processes involved in the development of psychopathologies among adolescents favors their prevention and the development of more efficacious interventions. / A adolesc?ncia ? um per?odo do ciclo vital vulner?vel ao estresse e ao desenvolvimento de problemas emocionais e de comportamento, os quais podem ser alterados pelos processos de enfrentamento (coping) e pelo temperamento, com base na autorregula??o. Com uma perspectiva desenvolvimentista, esta Tese analisou a fun??o do temperamento e do enfrentamento como vari?veis mediadoras e moderadoras na rela??o entre os estressores/estresse e os problemas emocionais e de comportamento [PC] e os problemas do tipo internalizante [PI] e externalizante [PE] nos adolescentes. Participaram 83 adolescentes (67,47% meninas), entre os 12 e os 15 anos de idade (M = 13,65), sendo que 38,55% cursavam o 8? Ano e 61,45% o 9? Ano do Ensino Fundamental, em uma escola p?blica de uma cidade de m?dio porte do Estado de S?o Paulo. Foram aplicados, em grupo, os Crit?rios de Classifica??o Econ?mica Brasil da ABEP; o Invent?rio de Autoavalia??o para Adolescentes (Youth Self-Report YSR); a Escala de Eventos Percebidos para Adolescentes (Adolescent Perceived Events Scale APES); a Escala de Estresse para Adolescentes; a Escala de Enfrentamento; e o Question?rio de Temperamento Adolescente Revisado Forma Completa (Early Adolescent Temperament Questionnaire Revised - EATQ-R). A an?lise de regress?o log?stica multivariada indicou que os adolescentes com um maior risco para a ocorr?ncia dos PC foram aqueles com maior: a) n?mero de estressores, b) n?vel de estresse, e c) n?vel de extrovers?o. J? os adolescentes com um maior risco para os PE foram aqueles com: a) maior n?mero de estressores, b) maior n?vel de extrovers?o, e c) menor n?vel de controle com esfor?o; e os adolescentes com maior risco para os PI foram aqueles com maior n?vel de estresse. As an?lises de equa??es estruturais indicaram que os adolescentes com PC foram aqueles com: a) maior n?vel de estresse, b) do sexo masculino, c) maior n?mero de estressores, d) maior n?vel de extrovers?o, e e) menor n?vel de afilia??o. J? os adolescentes com PE foram aqueles com: a) maior n?vel de extrovers?o, b) menor n?vel de controle com esfor?o, e c) maior n?mero de estressores, e os adolescentes com PI foram aqueles com maior n?vel de estresse e do sexo masculino. As an?lises de equa??es estruturais indicaram um efeito de media??o para o controle com esfor?o e para o afeto negativo. A an?lise de regress?o linear indicou que a rela??o entre o estresse e os PC foi mais significativa (efeito de modera??o) para os adolescentes com menor n?vel de controle com esfor?o, e a rela??o entre o estresse e os PE foi mais significativa (efeito de modera??o) para os adolescentes com menor repert?rio de fam?lias de enfrentamento. Tamb?m indicou que a rela??o entre os estressores e os PC foi mais significativa (efeito de modera??o) para os adolescentes com baixo n?vel de extrovers?o. A compreens?o dos processos envolvidos no desenvolvimento da psicopatologia, nos adolescentes, favorece a preven??o e a elabora??o de interven??es mais eficazes para esta popula??o.

Doctor of Philosophy (Phd) / Despite general agreement that severely emotionally disturbed children and adolescents are an "at risk" group, and that ongoing evaluation and research into the effectiveness of services provided for them is important, very little outcome evaluation actually takes place. The absence of well-conducted and appropriately interpreted studies is particularly notable for day or residential treatment programs, which cater for the most severely emotionally disturbed youths. This thesis outlines the main areas of conceptual, pragmatic and methodological confusion and neglect which impede progress in research in this area. It argues for plurality of data analytic strategies and research designs. It then critically reviews the reported findings about the effectiveness of day and residential treatment in specialist facilities, and the predictors of good outcomes for this treatment type. This review confirms that there is very little to guide practice. Having argued for the legitimacy of its methods and the necessity to address basic questions, the thesis reports the results of a naturalistic study based on data accumulated during a decade-long evaluative research program taking place at Arndell Child and Adolescent Unit, Sydney. The study addresses the question of what child, family and treatment variables predict outcome for 159 children and adolescents treated at this facility from 1990 to 1999. Statistically significant results with large effect size were obtained. Among the most disturbed subgroup of forty three children, (a) psychodynamic milieu-based treatment was shown to be more effective than the “empirically-validated” cognitive-behavioural treatment which superseded it in 1996, and (b) children from step-families showed better outcome than those from other family structures. Furthermore, it was found for the study sample as a whole that severe school-based problem behaviours were associated with a limited trajectory of improvement in home-based problem behaviour. These results are discussed with regard to implications for treatment, research methodology, policy and further studies.

Doctor of Philosophy (Phd) / Despite general agreement that severely emotionally disturbed children and adolescents are an "at risk" group, and that ongoing evaluation and research into the effectiveness of services provided for them is important, very little outcome evaluation actually takes place. The absence of well-conducted and appropriately interpreted studies is particularly notable for day or residential treatment programs, which cater for the most severely emotionally disturbed youths. This thesis outlines the main areas of conceptual, pragmatic and methodological confusion and neglect which impede progress in research in this area. It argues for plurality of data analytic strategies and research designs. It then critically reviews the reported findings about the effectiveness of day and residential treatment in specialist facilities, and the predictors of good outcomes for this treatment type. This review confirms that there is very little to guide practice. Having argued for the legitimacy of its methods and the necessity to address basic questions, the thesis reports the results of a naturalistic study based on data accumulated during a decade-long evaluative research program taking place at Arndell Child and Adolescent Unit, Sydney. The study addresses the question of what child, family and treatment variables predict outcome for 159 children and adolescents treated at this facility from 1990 to 1999. Statistically significant results with large effect size were obtained. Among the most disturbed subgroup of forty three children, (a) psychodynamic milieu-based treatment was shown to be more effective than the “empirically-validated” cognitive-behavioural treatment which superseded it in 1996, and (b) children from step-families showed better outcome than those from other family structures. Furthermore, it was found for the study sample as a whole that severe school-based problem behaviours were associated with a limited trajectory of improvement in home-based problem behaviour. These results are discussed with regard to implications for treatment, research methodology, policy and further studies.

Made available in DSpace on 2016-03-15T19:40:15Z (GMT). No. of bitstreams: 1 Mayra Fernanda Ferreira Seraceni.pdf: 1029710 bytes, checksum: b57c57f730492d7ba5b3d3710294cb41 (MD5) Previous issue date: 2013-12-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Schools are appropriate contexts for the investigation of mental health, emotional and behavioral problems in children and adolescents. In Brazil there are few studies that compare behavioral problems in students of mainstraim public and private schools associated with the use of educational and mental health facilities. The present study had the objective of investigating emotional and behavioral problems, as well as its associated risk and protection factors, in Elementary Schools students from private and public mainstream schools. A cross-sectional study was made and based on the proposed objectives the sample attended convenience criteria. The sample was composed of 357 students, age range 6 to 12 years old, from public and private schools and their respective parents (176 are students from three public schools in Barueri and 181 students from one private school in Sao Paulo downtown). Data collection instruments were: a) questionnaire with social-demographic data and information on the use of health services; b) Child Behavior Checklist for ages 6 to 18 (CBCL/6-18); c) recording of academic performance through the identification of annual average grades in Portuguese and Mathematics. Descriptive analysis were carried out through the use of simple frequency tables and crossed tables; analyses of variance for the comparison of average scores in CBCL/6-18 between groups; correlation analysis for the verification of possible associations among variables of sample characterization with scores of emotional and behavioral problems, social and academic competences indicators, as well as indicators of social-demographic characterization and use of educational and health services and a technique of logistic regression to determine the probability or result of a child to be classified as border-line/clinical in the scales of externalizing, internalizing or total behavioral problems on CBCL/6-18 based on predictive factors: gender, age, school (public or private), caretaker s age, socioeconomic classification, average grade in Mathematics and Portuguese and scores in the scales of competences for performing activities, socialization and academic performance on CBCL/6-18. The main results indicate emotional and behavioral problems in both groups. Observa-se de modo geral que os pais cuidadores de crianças das escolas públicas perceberam um maior número de problemas de comportamento em seus filhos quando comparados aos informantes da escola particular. It was observed that parents of children enrolled in public schools perceive a greater number of behavioral problems in their children compared to parents of children enrolled in private schools. In terms of academic variables, both groups achieved similar results in average grade in Portuguese and Mathematics and academic performance assessed by CBCL/6-18, what indicates that participants do not present problems in this area. It was observed that according to parental perception concerning the existence internalizing behavioral problems (Private=38,10%; Public=30,70%) was greater if compared to externalizing (Private=15,50%; Public=15,30%). Data show that children that do not present emotional and behavioral difficulties according to the caretaker s report use more psychological services compared to the group that present borderline/clinic scores in the total scale of emotional and behavioral problems of CBCL/6-18. In both groups logistic regression model has allowed the verification of concomitant associations among academic and social competences and the caretaker s age with the result of emotional and behavioral problems of children. We concluded that the identification of these concomitant association enhance the need of mental health strategies focused on the promotion of social abilities and monitoring and management of academic difficulties of these children. Thus, such actions can be developed in the school locus though workshops and lectures with orientations on the management of emotional and behavioral problems or intervention strategies and necessary follow-up. / As escolas são contextos adequados para o levantamento de problemas de saúde mental e di-ficuldades emocionais e comportamentais em crianças e adolescentes. No Brasil são escassos os estudos que comparam problemas de comportamento de alunos que frequentam escolas públicas e privadas associado ao uso de serviços educacionais e de saúde mental. O estudo teve como objetivo geral realizar em alunos do Ensino Fundamental I de escolas públicas e particular um levantamento de problemas emocionais e comportamentais e fatores potenciais de risco e proteção associados aos mesmos. Foi realizado um estudo de corte transversal e baseado nos objetivos propostos a amostra seguiu critérios de conveniência. A amostra foi composta por 357 alunos na faixa etária de 6 a 12 anos de escolas públicas e particular e seus respectivos pais (176 escolares estavam regularmente matriculados em três escolas públicas do Ensino Fundamental I -EF I do município de Barueri e 181 alunos eram de uma única escola particular da região central da cidade de São Paulo). Os instrumentos de coleta de dados foram: a) Questionário para caracterização sociodemográfica e uso de serviços de saúde; b) Inventário de Comportamentos para Crianças e Adolescentes entre 6 e 18 anos (CBCL/6-18); c) Registro de desempenho acadêmico dos participantes mediante a identificação da média escolar anual nas disciplinas de português e matemática. Para as análises de dados foram realizadas análises descritivas mediante uso de tabelas de frequências simples e tabelas cruzadas; análises de variância para comparação de médias de escores brutos das escalas do CBCL/6-18 entre os grupos; análises de correlação para verificação de possíveis associações entre variáveis de caracterização da amostra com os escores brutos de problemas emocionais e comportamentais, indicadores de competências sociais e escolares, assim como, os indicadores de caracterização sociodemográfica e o uso de serviços educacionais e de saúde e uma técnica de regressão logística para determinar a probabilidade ou desfecho de uma criança ser classificada como limítrofe/clínica nas escalas de problemas de comportamento externalizantes, internalizantes e totais do CBCL/6-18 a partir dos fatores preditores: gênero da criança, idade da criança, tipo de escola, idade do cuidador informante, classificação socioeconômica familiar, médias em matemática e português e escores brutos das escalas de competências para realização de atividades, socialização e desempenho escolar do CBCL/6-18. Os principais resultados indicam problemas emocionais e comportamentais em ambos os grupos de participantes. Observa-se de modo geral que os pais cuidadores de crianças das escolas públicas perceberam um maior número de problemas de comportamento em seus filhos quando comparados aos informantes da escola particular. Quanto as variáveis escolares média de desempenho acadêmico nas disciplinas de matemática e português e o desempenho escolar avaliado pelo CBCL/6-18 houve entre os grupos resultados similares indicando que os participantes parecem não apresentar problemas de aproveitamento escolar. Observa-se que de acordo com percepção dos pais em relação à existência de problemas de comportamento internalizantes (Particular=38,10%; Pública=30,70%) foi maior se comparada aos externalizantes (Particular=15,50%; Pública=15,30%). Os dados mostram que crianças que não apresentam dificuldades emocionais e comportamentais fazem maior uso de serviços de psicologia quando comparadas ao grupo que apresenta escores limítrofe/clínico na escala total de problemas emocionais e comportamentais do CBCL/6-18. Em ambos os grupos o modelo de regressão logística que foi gerado permitiu verificar associações concomitantes entre competências nas áreas escolar e social e idade do cuidador com o desfecho problemas emocionais e comportamentais das crianças. Conclui-se que a identificação dessas associações concomitantes evidenciam a necessidade de ações de saúde mental que sejam focadas na promoção de habilidades sociais e no monitoramento e remediação de dificuldades de desempenho escolar destas crianças. Sendo assim, são ações que poderão ser desenvolvidas nos próprios lócus escolares mediante palestras de orientação sobre o manejo de problemas emocionais e comportamentais ou estratégias de intervenções e acompanhamentos necessários aos escolares.

Hintergrund: Psychische Auffälligkeiten beginnen häufig im Kindesalter und können in psychische Störungen münden. Vorhandene Präventionsangebote werden trotz Wirksamkeit nur spärlich in Anspruch genommen. Ziel war zu prüfen, inwiefern durch die Etablierung einer Versorgungskette Risikokinder frühzeitig identifiziert und Präventionsmaßnahmen zugewiesen werden können, sowie inwieweit indikative Präventionsprogramme schlussendlich in Anspruch genommen werden. - Methoden: In einer prospektiven Implementationsstudie wurde während der regulären U9- bis U11-Gesundheitsuntersuchungen (Altersbereich: 5–10 Jahre) der „Strengths and Difficulties Questionnaire“ als Screeninginstrument an Familien ausgegeben. Diese erhielten von ihren Kinderärzt*innen unmittelbar eine Ergebnisrückmeldung und im Falle von grenzwertig auffälligen emotionalen oder Verhaltensproblemen eine Empfehlung für ein indikatives Präventionsprogramm. Vor Programmteilnahme fand im Vorgespräch eine Indikationsprüfung statt. - Ergebnisse: Im Raum Dresden beteiligten sich n = 46 (38,7 %) Kinderärzt*innen am Projekt. In n = 28 Kinderarztpraxen nahmen n = 3231 (86,4 %) Familien am Screening teil, n = 864 (26,7 %) Kinder, deren Familien eine Ergebnisrückmeldung erhielten, bekamen eine Präventionsempfehlung. Zur Präventionsprogrammteilnahme meldeten sich n = 118/864 (13,7 %) Familien selbstständig. n = 215/624 (35,5 %) zeigten Interesse nach projektinitiierter Kontaktaufnahme. Über andere Zugangswege kamen n = 139 Teilnahmeanfragen. n = 337 (n = 461; über alle Zugangswege) Vorgespräche wurden geführt. Schließlich nahmen n = 237 (n = 337) Kinder ein indikatives Präventionsprogramm in Anspruch. - Schlussfolgerung: Eine Ausweitung der Vorsorgeuntersuchung auf psychische Auffälligkeiten ist umsetzbar, nützlich und erfährt breite Akzeptanz. Um eine Versorgungskette einzurichten, sollte eine Angebotsstruktur etabliert werden, um damit die Zuweisung zu und Inanspruchnahme von Präventionsmaßnahmen zu ermöglichen. / Background: Mental health problems usually have their onset in childhood. Undiagnosed, they may progress into mental disorders. Despite their effectiveness, existing preventive programs have been rarely used. We aimed to examine to what extent the establishment of a care chain can identify children at high risk at an early stage and assign them to preventive interventions. In addition, prevention program participation was assessed. - Methods: In a prospective implementation study, the Strengths and Difficulties Questionnaire was administered as a screening instrument to families during regular pediatric health examinations (U9–U11, child age 5–10 years). Families received feedback directly from the pediatrician, and in the case of borderline abnormal emotional or behavioral problems, a recommendation for an indicative prevention program. Program indication was additionally determined in an entry examination prior to program participation. - Results: In the area of Dresden (Germany), n = 46 (38.7%) pediatricians participated in the project. In n = 28 pediatric practices, n = 3231 (86.4%) families participated in the screening and n = 864 (26.7%) children received a prevention recommendation. Of the families, n = 118/864 (13.7%) self-registered for the prevention programs, n = 215/624 (35.5%) showed interest after being contacted by the study teamn. Through other pathways, n = 139 families requested participation. Clinical evaluation interviews to assess prevention indication were conducted in n = 337 children (n = 461; via all entry pathways). Finally, n = 237 (n = 337) children participated in an indicated prevention program. - Conclusion: Expanding screening to mental health problems during regular health checkups is feasible, useful, and widely accepted. In order to implement a care chain, a supply structure should be established to enable referral to and uptake of preventive interventions.