O Distúrbio do Espectro do Autismo caracteriza-se como uma síndrome comportamental complexa, que compromete o processo do desenvolvimento ao longo da vida, ocorrendo uma grande variabilidade na intensidade e forma de expressão da sintomatologia, nas áreas que definem o seu diagnóstico. Pessoas com autismo necessitam de atenção especial durante toda a vida e é necessário voltar a atenção também para cuidador. O estresse parental da família de uma criança com autismo é significantemente maior do que o observado em famílias de crianças com desenvolvimento típico ou outras deficiências. A comunicação é um aspecto especialmente afetado nos quadros de autismo e pode ser potencializadora do estresse, sendo uma das primeiras preocupações dos pais. Assim foi indagado se, com relação à comunicação, o fato do filho com autismo não usar alguma fala para se comunicar teria relação com o aumento do nível de estresse dos pais. O Objetivo deste estudo foi investigar o nível de estresse de pais de crianças com autismo, verificando sua associação com a ausência de oralidade na comunicação de seus filhos. Participaram dessa pesquisa os pais de 75 crianças com autismo e pais de 100 crianças sem nenhuma queixa quanto ao desenvolvimento, que foram divididos em três grupos, sendo o grupo 1 formado por pais de crianças autistas que não apresentam comunicação oral; o grupo 2 por pais de crianças autistas que apresentam comunicação oral e o grupo 3, por pais de crianças sem nenhuma queixa. Todos os participantes responderam ao questionário sócio-demográfico, ao questionário de nível de estresse (formulado pela própria autora) e ao questionário de qualidade de vida. Os resultados mostraram que a maioria dos pais dos três grupos apresentaram médio nível de estresse e que não houve diferença significativa entre os pais de crianças com autismo, com e sem comunicação verbal. Quando os pais de crianças com autismo foram comparados aos pais do grupo controle, foi verificada diferença significativa, sendo que mais pais de crianças com autismo apresentaram alto nível de estresse. Foi constatada existência de associações entre o nível de estresse identificado e a qualidade de vida relatada pelos pais, mostrando que quanto maior o estresse apresentado pelos pais, menor é a qualidade de vida. Conclui-se, portanto, que o nível de estresse de pais de crianças com autismo não é influenciado pela ausência de oralidade na comunicação de seus filhos / Autism spectrum disorders are described as a complex behavioral syndrome. It impairs the development throughout life and has great variability in symptoms and intensity in the various areas that define the diagnosis. Persons with autism need special care during all life and therefore the caretakers need attention too. Parental stress in families with children with autism is significantly higher than the observed in families with children with other disorders or with typical development. Communication is specially affected in autism, is one of parent\'s first concerns and may increase stress. This study asked if parents of non-verbal children with autism have higher levels of stress than parents of verbal children with autism. The purpose of this study was to assess the stress levels of parents of children with autism and to verify its association with the abscess of verbal communication. Participants were parents of 75 children with autism and 100 parents with no complaints about their children development. They were divided in 3 groups: Group 1 comprised by parents by children with autism and no verbal communication; Group 2 comprised by parents by verbal children with autism and Group 3 with parents with no complaints about their children development. All participants responded to a socio-demographic questionnaire, to a stress level questionnaire (proposed by the author) and the questionnaire about quality of life. Results show that most parents from the three groups presented medium level of stress and that there was no significant difference between parents of children with autism with and without verbal communication. When parents of children with autism were compared with parents from the control group a significant difference was observed, with more parents of children with autism with high levels of stress. Associations between the stress level and the quality of life were also observed, showing that when higher stress levels were reported, lower quality of life was verified. It can be concluded that the stress level of parents of children with autism not influenced by their lack of verbal communication

Σκοπός της εργασίας αυτής ήταν η μελέτη της ενασχόλησης των πατέρων παιδιών με ειδικές ανάγκες με τη φροντίδα των παιδιών τους. Ιδιαίτερα μελετήθηκαν οι εξής παράγοντες που σύμφωνα με το θεωρητικό μοντέλο του Belsky (1984) φαίνεται ότι επηρεάζουν την ενασχόληση τους: ο τύπος της αναπηρίας, το φύλο και το ταμπεραμέντο του παιδιού, οι αντιλήψεις των πατέρων για τον πατρικό ρόλο, το επίπεδο του άγχους τους, η συζυγική τους ικανοποίηση και η υποστήριξη που λαμβάνουν από το οικογενειακό και κοινωνικό τους περιβάλλον. Για τις ανάγκες της έρευνας χρησιμοποιήθηκαν ποσοτικές μέθοδοι σε ένα δείγμα 172 πατέρων παιδιών προσχολικής ηλικίας εκ των οποίων οι 78 είχαν παιδιά με ειδικές ανάγκες και οι υπόλοιποι 94 πατέρες αποτέλεσαν την ομάδα ελέγχου. Οι πατέρες συμπλήρωσαν ερωτηματολόγια αναφορικά με την ενασχόληση τους με τη φροντίδα του παιδιού τους, το ταμπεραμέντο του παιδιού τους, τις αντιλήψεις τους για τον πατρικό ρόλο, το άγχος που βιώνουν σε σχέση με το παιδί τους, την ικανοποίηση που έχουν από τη συζυγική τους σχέση και την οικογενειακή και κοινωνική υποστήριξη που λαμβάνουν. Τα αποτελέσματα έδειξαν ότι οι πατέρες παιδιών με ειδικές ανάγκες δεν παρουσιάζουν σημαντικές διαφορές από τους πατέρες «τυπικών» παιδιών στο επίπεδο της συνολικής ενασχόλησης με τα παιδιά τους. Ακόμα, τα αποτελέσματα έδειξαν ότι οι παράγοντες που επιδρούν άμεσα στην ενασχόληση των πατέρων με τα παιδιά τους είναι οι αντιλήψεις των πατέρων για τον πατρικό ρόλο και η συζυγική ικανοποίηση. Αντίθετα, ο τύπος της αναπηρίας - αυτισμός, νοητική καθυστέρηση, κώφωση - το φύλο και ταμπεραμέντο του παιδιού επηρεάζουν ελάχιστα την πατρική ενασχόληση. Το άγχος των πατέρων δε φαίνεται να επιδρά άμεσα στην ενασχόλησή τους με τα παιδιά τους. Παρόλα αυτά, οι πατέρες παιδιών με ειδικές ανάγκες έχουν περισσότερο άγχος σε σύγκριση με αυτό των πατέρων «τυπικών» παιδιών ενώ ρυθμιστές του άγχους τους είναι η σχέση τους με τη σύντροφό τους και η υποστήριξη που έχουν από το κοινωνικό τους περιβάλλον. Τα παραπάνω αποτελέσματα είναι βοηθητικά για την καλύτερη κατανόηση των παραγόντων που ενισχύουν την ενασχόληση των πατέρων και για το σχεδιασμό και την υλοποίηση προγραμμάτων στήριξης για τους ίδιους και τις οικογένειες τους. / The aim of this study was to examine fathers’ involvement with their children with special needs. The factors that, according to Belsky’s model of parenting, influence fathers’ involvement were examined: the disability type, the gender and the temperament of child, fathers’ beliefs concerning the parental role, the parental stress, the satisfaction fathers receive from their marital relationship and the social support they receive. For the research needs quantitative methods were used in a sample of 172 fathers of preschool-age children from whom the 78 had children with special needs and the 94 were the control group. Fathers completed questionnaires measuring their child-care involvement, their child’s temperament, their beliefs concerning the parental role, their parental stress, their marital satisfaction and the social support they receive. Results revealed no difference in the overall level of childcare involvement between fathers of children with special needs and fathers of “typical” children. Additionally, it was found that the factors that influence directly fathers’ involvement are fathers’ beliefs concerning the parental role as well as their marital satisfaction. By contrast, the disability type – autism, mental retardation and deafness – the gender and the temperament of children have a minor affect in paternal involvement. Paternal stress does not influence directly fathers’ involvement with their children. Moreover, fathers of children with special needs experience more stress than fathers of “typical” children while moderators of stress are their relationship with their spouse and the support they receive from environment. The results are useful for the better understanding of the factors that enhance fathers’ involvement and for the design and the implementation of support programs for them and their families.

Le torticolis postural est une affection courante dans le milieu pédiatrique en particulier depuis que les parents ont adopté les lignes directrices de la campagne « Back to Sleep ». Habituellement, un programme d’exercices à domicile est présenté aux parents afin de promouvoir une récupération optimale toutefois, peu d’outils existent pour les accompagner dans la réalisation de ces exercices. L'objectif de cette étude était d'évaluer l'impact de l'addition du nouveau livret d’intervention pour le torticolis (LIT) sur la résolution du torticolis (restitution de l’amplitude passive du cou), le stress parental et la satisfaction à l’égard du traitement reçu et sur l'observance des parents au traitement à domicile. Cinquante-huit nourrissons référés en physiothérapie pour un torticolis postural ont été recrutés et randomisés au cours de leur première visite à l’un ou l’autre de ces 2 groupes: Physiothérapie + LIT (n = 29) ou Physiothérapie + traitement standard (n = 29). Des évaluateurs ont évalué à l’aveugle les patients 1 et 3 mois après leur visite initiale, 30 minutes avant leur consultation en physiothérapie. L’amplitude articulaire passive du cou en rotation était mesurée à l’aide d’un goniomètre arthrodial. Le niveau de stress parental a été évalué en utilisant l’Indice de Stress Parental (ISP). Les parents ont reçu l’ISP à la fin de la visite initiale et ont été invités à le compléter à la maison et le retourner à la visite suivante en physiothérapie ou à la visite de 1 mois. La satisfaction des parents à l’égard du traitement reçu a été évaluée en utilisant la Mesure du Processus de Soins (MPOC-56) à 3 mois. L'observance au traitement a été estimée en demandant aux parents de rapporter la durée quotidienne de positionnement des nourrissons sur le ventre pendant la semaine dernière à l’évaluation. L’analyse de nos données consista à d’abord décrire les performances des 2 groupes à l’aide de statistiques descriptives. Ensuite, des tests de t ont permis de comparer le changement à la rotation passive cervicale, entre la visite de 1 mois et la visite initiale ainsi qu’entre la visite de 3 mois et la visite initiale. Des tests de t ont aussi été calculés pour comparer les scores de chaque sous-échelle du ISP (stress parental) et du MPOC-56 (satisfaction des soins) entre les groupes. Le test du chi carré a été réalisé pour comparer l'adhérence entre les deux groupes à 1 et 3-mois. Les résultats ont montré une tendance à un plus grand changement de la rotation passive du cou à 1-mois dans le groupe LIT (Intervalle de Confiance à 95% = 95% IC= 1,97-8,77 ; p = 0, 17) mais pas à 3 mois. Les parents du groupe LIT ont obtenu des scores de stress plus faibles après avoir reçu l'outil d'intervention (95%IC= 49,20-57,94 ; p = 0, 01) et ont déclaré être plus satisfaits que les parents du groupe témoin pour le traitement reçu (95%IC= 6,7-6,8 ; p=0,03) e o partenariat avec les thérapeutes (95%IC= 6,3-6,9 ; p<0,001). Enfin, l'observance au traitement a été plus élevée dans le groupe LIT que dans le groupe contrôle en particulier à 3-mois (p = 0.01). Le nouveau livret d'intervention pour le torticolis accompagné d'un traitement de physiothérapie a tendance à contribuer à une restitution plus rapide de l’amplitude passive du cou en rotation, peut aider à diminuer le niveau de stress parental, contribuer à une plus grande satisfaction à l’égard du traitement et améliorer l’observance au traitement à domicile. / Postural Torticollis is a common condition in pediatric practices especially since parents have adopted “Back to Sleep” campaign’s guidelines. Parents are often instructed to carry out a home program of exercises; however there are few educational tools with comprehensive information about postural torticollis exercises. The main objective of this study was to evaluate the impact of the addition of the new Torticollis Intervention Booklet (TIB) on torticollis resolution (attainment of full passive neck range of motion), parental stress level, parental satisfaction and adherence to treatment received. Fifty-eight infants referred to physiotherapy for a postural torticollis were recruited and randomized during their initial visit to two groups: Physiotherapy + TIB (n=29) or Physiotherapy + Standard Care (n=29). Blinded evaluators assessed the patients at 1 and 3 months after their initial visit, thirty minutes before their physiotherapy consultation. Passive neck rotation range of motion (ROM) was measured by an arthrodial goniometer. Parental stress level was evaluated using the Parenting Stress Index- Short Form (PSI-SF). Parents received the PSI-SF at the end of the baseline visit and were requested to complete it at home and return it at their subsequent physical therapy appointment or at the second scheduled study assessment time. Parental satisfaction was evaluated using the Measure of Processes of Care (MPOC-56) at 3-months. Adherence to treatment was evaluated as the length of time per day parents reported having their children in the prone awake position in the week before follow-up visits. Analysis consisted of descriptive analyses for each group; t-tests to compare passive neck rotation ROM change scores between the baseline and 1-month visits and baseline and 3-month visits; and to compare subscale scores for PSI-SF (parental stress) and MPOC-56 (satisfaction with care) between the two groups. The Chi-square test was performed to compare adherence between the two groups at 1 and 3-months. The results showed a tendency to greater passive neck rotation (ROM) change at 1-month in the TIB group (95% Confidence Interval = 95%CI = 1.97- 8.77; p=0.17) but not at 3-months. Parents in the the TIB group showed lower global stress scores after receiving the intervention tool (95%CI= 49.20- 57.94; p = 0.01) and reported greater satisfaction than controls in the “coordinated and comprehensive care” (95%CI= 6.7-6.8; p=0.03) and « enabling and partnership » subscales (95%CI= 6.3-6.9; p<0.001). Finally, adherence was higher in the TIB group than controls especially at 3-months (p=0.01). The new Torticollis Intervention Booklet accompanied by physical therapy treatment has a tendency to lead to an earlier restitution of passive neck rotation ROM, may help decrease stress levels, increase satisfaction with treatment, and improve adherence.

Fundação de Apoio a Pesquisa e à Inovação Tecnológica do Estado de Sergipe - FAPITEC/SE / This dissertation consists of three studies related to the theme of parental stress. In Study 1, described the characteristics of national publications on stress due to parenting and/or parentchild relationship, indexed in two Brazilian electronic bases data (SciELO and PePSIC). The full text of eleven empirical articles were analyzed in terms of their methods (participants and instruments), objectives and main results. In Study 2, we conducted the cross-cultural adaptation and investigation of psychometric properties of the Parental Stress Scale (PSS) for Brazilian-Portuguese. Participants were 304 parents, distributed in the same proportion by gender (mothers and fathers). In Study 3, examined the associations between the level of parental stress and parental socio-educational practices in 135 fathers/mothers of children without chronic disease (control group) and with type 1 diabetes mellitus (T1DM; clinical group). Results from Study 1 provided an overview of the state of the art regarding parental stress in the national literature and highlight the need for further research in the area. Results from Study 2 presented an adapted version of PSS for Brazilian-Portuguese with adequate psychometric properties, as a measure of parental stress in parents of children in general. Results from Study 3 indicated associations between the level of parental stress and parenting practices, and lead to a discussion on the impact of the stressor "child’s chronic disease", specifically T1DM, the stress and parental practices. In the end, the results discussed assist in the creation of intervention strategies for fathers/mothers aimed at minimizing parental stress and child behavior problems and promote health via satisfactory family relationships. / Esta dissertação é composta por três estudos relacionados à temática do estresse parental. No Estudo 1, descreveu-se as características de publicações nacionais sobre o estresse decorrente e/ou da relação pais-filho indexadas em duas bases de dados eletrônicas brasileiras (SciELO e PePSIC). Foram analisados 11 artigos empíricos na íntegra a partir de seus métodos (participantes e instrumentos), objetivos e principais resultados encontrados. No Estudo 2, foi realizada a adaptação e investigação de evidências de validade da Escala de Estresse Parental – EEPa (Parental Stress Scale – PSS) para o português brasileiro. Participaram 304 pais, distribuídos na mesma proporção por sexo (pais/mães). No Estudo 3, examinou-se as associações entre o nível de estresse parental e as práticas socioeducativas parentais em 135 pais/mães de filhos sem doença crônica (grupo controle) e com diabetes mellitus tipo 1 (DM1; grupo clínico). Os resultados do Estudo 1 forneceram um panorama do estado da arte em relação ao tema estresse parental na literatura nacional e evidenciam a necessidade de novos estudos na área. Os resultados do Estudo 2 apresentaram uma versão adaptada e com boas evidências de validade da EEPa em português brasileiro, como uma medida de estresse parental de pais e mães de crianças em geral. Os resultados do Estudo 3 indicaram associações entre o nível de estresse parental as práticas parentais, e levaram a discussões acerca do impacto do estressor “doença crônica do filho”, especificamente o DM1, no estresse e práticas parentais. Ao final, os resultados discutidos auxiliam na criação de estratégias de intervenção para pais/mães que visem minimizar o estresse parental e os problemas de comportamento infantil e promover saúde via relações familiares satisfatórias.

Introduction Numerous preventive programmes have emerged, and need to be investigated to determine their effects on the normal population. Earlier studies have shown a decrease in depressive symptoms, positive effects on children’s disruptive behaviour problems, and an improvement in parental competence. About a fifth of the parents in previous studies had problem-oriented (targeted) reasons for enrolment, whereas the rest of the parents had general (universal) reasons. The results of those studies suggest that the programmes are cost effective in terms of Quality-Adjusted Life Years. Aim Four sub-studies were performed, and their aims were to investigate the effect of parental training programmes (PTPs) in a naturalistic setting on parents’ mental health in the general population, to investigate how PTPs affect parents’ sense of parental competence, to investigate how PTPs affect parental stress and analyse the parents open questions about the PTPs, and to investigate the feasibility and to measure the effect on depression, anxiety, and social problems of two preventive school programmes for pupils in grade 7. Method In a longitudinal quantitative study in a real-world setting, 279 parents from the general population in northern Sweden participated in five PTPs. A comparison group of 702 parents without intervention was included. Simultaneously, a community sample of 59 pupils in grade 7 participated in two preventive school programmes. Both studies were conducted from 2010 to 2013. Parents were assigned to professionally supported interventions that included 5-10 two-hour sessions. Respondents filled in a web-based questionnaire with the General Health Questionnaire (GHQ), the Parents Sense of Competence (PSOC) for parents who had children aged 0-17 years, and the Swedish Parenthood Stress Questionnaire (SPSQ) for parents who had children aged 0-10 years. The intervention groups’ results were compared to comparison group of 702 parents from northern Sweden that had not participated in any parental training programme. In the school study, one of the preventive programmes was an ongoing programme called “Life-Skills”, and the other was an implemented Canadian programme called “Choosing Healthy Actions and Thoughts” (CHAT). The pupils completed a test battery including the Sense of Coherence (SOC), the Children’s Depression Inventory (CDI), and the Youth Self-Report (YSR) instruments. Follow up of the parental programme study was done six months after the post-intervention measure, and follow up of the school study was at one year. Results The improvements in GHQ were statistically significant for the mean of the 279 parents in the intervention group compared to the mean of a comparison group of the 702 parents who did not receive any intervention. This suggests that evidence-based PTPs enhance parental well-being even for parents without problems. The intervention group showed a statistically significant improvement in parental competence compared to the comparison group over time. The intervention itself had a significant effect on parental satisfaction, but the efficacy effect was not sustained when taking into account potential confounders. In the SPSQ, the intervention group was smaller due to the fact that the instrument was not validated for children over the age of 10 and one of the parental training groups was only for parents of teenagers. A reduction of stress in the sub-scale of health problems was detected, but no other subscale showed the intervention to have a significant effect when controlling for confounding variables. In the school study, both programmes had good feasibility according to the stake- holders and had several positive mental health outcomes over time. Compared to Life-Skills, CHAT had more significant positive effects on reducing anxious/depressive symptoms and girls experienced significant positive effects on reduced anxious/depressive behaviour, while boys reduced their aggressive behaviours. Conclusions Earlier studies indicate that PTPs enhance perceived parental competence among referred parents. The present study shows that PTPs applied in the general population might also enhance perceived parental benefits such as improved health and satisfaction, suggesting that PTPs can be an important preventive strategy to enhance parenthood. The results suggest that parents who feel a need to increase their parenting competence might participate in PTPs based on lower scores than the comparison control group both before and after the intervention. The school-based programme shows that schools may be a suitable arena for preventive programmes because there was a significant short-term improvement in depression symptoms. Further studies need to explore how parents’ participation in PTPs affects children’s mental health in the general population in quantitative longitudinal studies in real-word settings. There is also a need for bigger studies and RCTs on school preventions and on how children’s health develops naturally in the population.

Les enfants ayant un trouble du spectre de l’autisme (TSA) présentent parfois des comportements problématiques, comme des comportements agressifs ou stéréotypés. L’émission de tels comportements peut avoir des conséquences néfastes, tant pour l’enfant que pour son entourage. Ainsi, l’enfant peut être limité dans ses apprentissages et vivre de l’isolement social. Leurs parents peuvent quant à eux vivre un niveau élevé de stress parental. Afin de répondre à ces besoins, cette thèse doctorale vise l’évaluation d’une adaptation parentale du Prevent-Teach-Reinforce (PTR, Dunlap et al., 2010), un programme initialement conçu pour diminuer les comportements problématiques et augmenter les comportements désirables des enfants en milieu scolaire. Basé sur les principes du soutien comportemental positif, ce programme prévoit l’atteinte des objectifs suite à la mise en place d’une intervention comportementale qui tient compte de la fonction du comportement problématique. L’intervention comprend des stratégies d’intervention pour modifier les antécédents, pour enseigner des comportements désirables et pour modifier les conséquences. Une étude randomisée a montré l’efficacité du PTR auprès d’enfants en milieu scolaire et deux études l’ont évalué à l’aide de devis expérimentaux à cas uniques en milieu familial pour des enfants ayant des troubles développementaux. Cette thèse, comprenant trois articles, constitue la première évaluation randomisée du PTR en contexte familial pour diminuer les comportements problématiques d’enfants ayant un TSA. Le premier article décrit les adaptations apportées au programme initial en prévision d’une implantation en contexte d’intervention comportementale précoce et en milieu familial, pour les enfants ayant un TSA. De plus, un parallèle est fait entre le programme et les principes clés de l’intervention psychoéducative. Le deuxième article présente les principaux résultats du projet de thèse, dans lequel 24 familles ont reçu deux interventions distinctes : le PTR durant huit semaines ou une formation théorique d’environ trois heures. Des analyses de variance ont été menées afin de statuer sur l’efficacité du programme. En somme, les comportements problématiques des enfants appartenant aux deux groupes ont diminué et les comportements désirables ont augmenté. Il n’est donc pas possible de statuer sur l’efficacité unique du PTR à diminuer les comportements problématiques. Les parents ont implanté le PTR avec une grande fidélité et ont accordé un score élevé de validité sociale au programme. Le troisième article présente les résultats en lien avec le stress parental. Les scores initiaux de stress parental ont été associés à la sévérité des comportements problématiques, montrant une corrélation modérée entre les deux concepts. Par ailleurs, une analyse de variance a permis de montrer que le stress parental a diminué uniquement chez les parents qui ont implanté de PTR. En conclusion, cette thèse a montré que le PTR semble être efficace pour diminuer les comportements problématiques et augmenter les comportements désirables des enfants ayant un TSA lorsque leurs parents l’implantent, mais davantage d’études sont nécessaires pour confirmer cette hypothèse. Ces études devraient comporter davantage de sujets et comparer le PTR à un groupe ne recevant aucun type d’intervention pour diminuer les comportements problématiques. / Children with an Autism spectrum disorder (ASD) diagnosis sometimes show challenging behaviors such as aggressive or stereotyped behaviors. The presence of such behavior can have harmful consequences for both the children and the people living with them. For example, the child may be limited in his or her learning and experience social isolation. Parents may experience high levels of parental stress. In order to respond to these problems, this thesis evaluated a parental adaptation of the Prevent-Teach-Reinforce model (PTR; Dunlap et al., 2010), a program designed to reduce children’s challenging behaviors and increase their desirable behaviors in school settings. Based on the principles of positive behavioral support, this program aims to achieve its objectives by implementing a behavioral intervention taking into account the behavioral function of the challenging behavior. The intervention includes intervention strategies to modify the behavior’s antecedents, to teach desirable behaviors and to modify the behavior’s consequences. A randomized controlled study demonstrated the effectiveness of the PTR for school-aged children and two studies evaluated it in home settings for children with developmental disorders, using single case experimental designs. This thesis, comprising three articles, is the first randomized study evaluating the PTR in family settings to reduce challenging behaviors of children with ASD. The first article describes the adaptations made to the initial program in order to implement it with children with an ASD diagnosis receiving early intensive behavioral intervention or in family settings. In addition, a parallel was made between the PTR and the key principles from the psychoeducation field. The second article presents the main results of this thesis, with the 24 families which received two distinct interventions: the PTR for eight weeks or a theoretical training for about three hours. Analyzes of variance were conducted to evaluate the effectiveness of the PTR. In sum, children of both groups saw a reduction in challenging behaviors and an increase in desirable behaviors. It is therefore not possible to rule on the unique effectiveness of the PTR to reduce challenging behaviors. Parents implemented the PTR with great fidelity and rated the PTR with a very high level of social validity. The third article presents the results on parental stress. Initial parental stress scores were associated with the severity the child’s problem behaviors, showing a moderate correlation between the two concepts. On the other hand, an analysis of variance showed that parental stress only decreased for parents who implemented the PTR. In conclusion, this thesis has shown that PTR may be effective in decreasing problem behaviors and in increasing desirable behaviors of children with ASD. However, more studies are needed to confirm these hypotheses. These studies should include more subjects and compare the PTR to a group of children not receiving any type of intervention to reduce challenging behaviors.

O Distúrbio do Espectro do Autismo caracteriza-se como uma síndrome comportamental complexa, que compromete o processo do desenvolvimento ao longo da vida, ocorrendo uma grande variabilidade na intensidade e forma de expressão da sintomatologia, nas áreas que definem o seu diagnóstico. Pessoas com autismo necessitam de atenção especial durante toda a vida e é necessário voltar a atenção também para cuidador. O estresse parental da família de uma criança com autismo é significantemente maior do que o observado em famílias de crianças com desenvolvimento típico ou outras deficiências. A comunicação é um aspecto especialmente afetado nos quadros de autismo e pode ser potencializadora do estresse, sendo uma das primeiras preocupações dos pais. Assim foi indagado se, com relação à comunicação, o fato do filho com autismo não usar alguma fala para se comunicar teria relação com o aumento do nível de estresse dos pais. O Objetivo deste estudo foi investigar o nível de estresse de pais de crianças com autismo, verificando sua associação com a ausência de oralidade na comunicação de seus filhos. Participaram dessa pesquisa os pais de 75 crianças com autismo e pais de 100 crianças sem nenhuma queixa quanto ao desenvolvimento, que foram divididos em três grupos, sendo o grupo 1 formado por pais de crianças autistas que não apresentam comunicação oral; o grupo 2 por pais de crianças autistas que apresentam comunicação oral e o grupo 3, por pais de crianças sem nenhuma queixa. Todos os participantes responderam ao questionário sócio-demográfico, ao questionário de nível de estresse (formulado pela própria autora) e ao questionário de qualidade de vida. Os resultados mostraram que a maioria dos pais dos três grupos apresentaram médio nível de estresse e que não houve diferença significativa entre os pais de crianças com autismo, com e sem comunicação verbal. Quando os pais de crianças com autismo foram comparados aos pais do grupo controle, foi verificada diferença significativa, sendo que mais pais de crianças com autismo apresentaram alto nível de estresse. Foi constatada existência de associações entre o nível de estresse identificado e a qualidade de vida relatada pelos pais, mostrando que quanto maior o estresse apresentado pelos pais, menor é a qualidade de vida. Conclui-se, portanto, que o nível de estresse de pais de crianças com autismo não é influenciado pela ausência de oralidade na comunicação de seus filhos / Autism spectrum disorders are described as a complex behavioral syndrome. It impairs the development throughout life and has great variability in symptoms and intensity in the various areas that define the diagnosis. Persons with autism need special care during all life and therefore the caretakers need attention too. Parental stress in families with children with autism is significantly higher than the observed in families with children with other disorders or with typical development. Communication is specially affected in autism, is one of parent\'s first concerns and may increase stress. This study asked if parents of non-verbal children with autism have higher levels of stress than parents of verbal children with autism. The purpose of this study was to assess the stress levels of parents of children with autism and to verify its association with the abscess of verbal communication. Participants were parents of 75 children with autism and 100 parents with no complaints about their children development. They were divided in 3 groups: Group 1 comprised by parents by children with autism and no verbal communication; Group 2 comprised by parents by verbal children with autism and Group 3 with parents with no complaints about their children development. All participants responded to a socio-demographic questionnaire, to a stress level questionnaire (proposed by the author) and the questionnaire about quality of life. Results show that most parents from the three groups presented medium level of stress and that there was no significant difference between parents of children with autism with and without verbal communication. When parents of children with autism were compared with parents from the control group a significant difference was observed, with more parents of children with autism with high levels of stress. Associations between the stress level and the quality of life were also observed, showing that when higher stress levels were reported, lower quality of life was verified. It can be concluded that the stress level of parents of children with autism not influenced by their lack of verbal communication

Introduction: The shift from single- to dual-earner households means that, often, both parents have joined the paid labor force. The demands of work and family can conflict, and this conflict can be a major stressor to parents in today’s high-income countries. Parental stress has been connected to child anxiety and depression, known precursors for mental disorders later on in life. Aim: The aim of this study is to describe differences between convenience samples of Swedish and Swiss parents, exploring the relationship between parental stress (high and low stress parents) and perceived symptoms of anxiety and depression in their children. Methods: A cross-sectional comparative survey was conducted among convenience samples of n=45 Swedish and n=30 Swiss parents of children ages 7-10 years. Parents were categorized as having high (&gt; weekly) or low stress (&lt; weekly). Raw scores from the Revised Children's Anxiety and Depression Scale (RCADS) 25 parent version were calculated as the outcome. Data were analyzed using t-tests and Chi-square tests using SPSS-25. Results were considered significant at p&lt;0.05. Results: There was a significant correlation between high parental stress and RCADS-25-P scores. Swedish parents reported having to make priorities between activities in the family schedule more often than Swiss parents. Household chores correlated positively with parental stress. Conclusion: Families in both countries report stressors, and there was observed a relationship between parental stress and perceived symptoms of anxiety and depression among their 7-10 year old children. Social support, in the form of family-friendly workplace policies, may be useful in addressing these determinants of health. / Introduktion: Skiftet från enförsörjar- till tvåförsörjarhushåll innebär numera ofta att båda föräldrarna sysslar med förvärvsarbete. Det kan uppstå konflikt mellan kraven från arbete och familj, och den här konflikten kan utgöra en stor stressfaktor för föräldrar i dagens höginkomstländer. Föräldrastress har kopplats till ångest och depression bland barn, kända förelöpare till mental ohälsa senare i livet. Syfte: Syftet med den här studien är att beskriva skillnader mellan bekvämlighetsurval av svenska och schweiziska föräldrar, för att undersöka sambandet mellan föräldrastress (hög- och lågstressade föräldrar) och upplevda symptom av ångest och depression hos deras barn. Metod: En jämförande tvärsnitts-enkätstudie utfördes på ett bekvämlighetsurval av n=45 svenska och n=30 schweiziska föräldrar till barn i åldrarna 7-10 år. Föräldrar kategoriserades utefter om de upplevde hög (&gt; varje vecka), samt låg stress (&lt; varje vecka). En råpoäng räknades ut från Revised Children's Anxiety and Depression Scale (RCADS) 25 föräldraversion som utfall. Data analyserades genom t-tester och Chi2-tester i SPSS-25. Resultaten ansågs signifikanta vid p&lt;0,05. Resultat: Det fanns ett signifikant samband mellan föräldrars höga stressnivåer och förhöjda RADS-25-P råpoäng. Svenska föräldrar rapporterade att de oftare behövde prioritera i familjens schema än schweiziska föräldrar. Hushållssysslor korrelerade positivt med föräldrars förhöjda stressnivåer. Slutsats: Familjer från båda länderna rapporterade upplevda stressorer, och studien visar att det finns ett samband mellan föräldrastress och upplevda symptom av ångest och depression hos deras barn i åldrarna 7-10 år. Socialt stöd, i form av familjevänliga arbetsplatspolicyer, skulle kunna vara användbara för att adressera dessa bestämningsfaktorer för hälsa.

Bakgrund: Postpartum är en utmanande tidsperiod med ökad risk för psykisk ohälsa hos föräldrar. De flesta studier som har genomförts har undersökt inrikesfödda mödrar. Det saknas studier som undersöker postpartum-relaterad psykisk ohälsa hos utrikesfödda föräldrar i Sverige. Syftet med den aktuella studien var därför att undersöka välmående hos utrikes-och inrikesfödda mödrar och fäder i Sverige. Studien syftade också till att undersöka potentiella riskfaktorer för utveckling av psykisk ohälsa och om riskfaktorerna skiljde sig mellan utrikes och inrikesfödda föräldrar. Metod: 1847 mödrar och fäder inklusive 483 (26.2%) utrikesfödda och 1364 (73.8 %) inrikesfödda föräldrar besvarade skattningsskalorna the Swedish Parenthood Stress Questionnaire och Välmåendeskalan. Data analyserades med Student’s t-test, envägs-ANOVA, Pearson’s korrelationsanalys och Multipel regressionsanalys. Resultat: Utrikesfödda föräldrar rapporterade statistiskt signifikant lägre välmående jämfört med inrikesfödda föräldrar. Bland utrikesfödda föräldrar var social isolering, hälsoproblem, känsla av inkompetens och låg utbildningsnivå riskfaktorer för psykisk ohälsa. Bland inrikesfödda föräldrar var känsla av inkompetens, hälsoproblem, social isolering, relationsproblem och rollrestriktion samt låg utbildningsnivå, riskfaktorer för psykisk ohälsa. Slutsats: Resultatet i denna deskriptiva och explorativa studie indikerar att utrikesfödda föräldrar upplever sämre välmående och löper större risk för utveckling av psykisk ohälsa under postpartum-perioden. Studien visar också att riskfaktorerna skiljer sig åt beroende på födelse inom eller utanför riket. / Background: The postpartum is a challenging period with an increased risk for parental mental illness. Most studies conducted have been performed on Swedish-born mothers. At present, there are no studies examining postpartum related mental illness in foreign-born parents in Sweden. The purpose of this study was therefore to examine the mental wellbeing of foreign-born mothers and fathers in Sweden and whether it differs from Swedish-born parents. The aim of the study was also to investigate potential risk factors for the development of mental illness, and whether the risk factors differ between foreign- and Swedish-born parents. Method: 1847 mothers and fathers, including 483 (26.2%) foreign-born and 1364 (73.8%) Swedish-born parents, answered the Swedish Parenthood Stress Questionnaire and the Well–being scale. Data was analyzed using the Pearson’s correlation analysis, One-way-ANOVA and Standard Multiple Regression analysis. Results: Foreign-born parents reported statistically significant lower mental well-being compared to Swedish-born parents. The study shows that among foreign-born parents, social isolation was a significant risk factor for mental illness during the postpartum period followed by health problems, feeling incompetent as a parent, and a low level of education. Among Swedish-born parents, health problems, social isolation, low levels of education, feeling incompetent as a parent, role restriction and relationship problems were risk factors for mental illness. Conclusion: The results of this descriptive and exploratory study indicates that foreign-born parents experience poorer mental well-being and are at greater risk of developing mental illness during the postpartum period. The study also shows that the risk factors differ depending on birth within or outside the country.

El presente trabajo de investigación tuvo como objetivo realizar un estudio bibliométrico de las tesis de grado sobre el Estrés Parental y Estilos de Afrontamiento en padres de hijos con Trastorno del Espectro Autista (TEA) en la base de datos Alicia Concytec comprendidos del año 2012 a 2021. Para ello, se realizó la búsqueda de las variables de investigación en la base de datos mencionada, hallando así 18 estudios preliminarmente de los cuales se seleccionaron 11 de ellos debido a que cumplían con los criterios de inclusión. Posteriormente, se efectuó el análisis bibliométrico de la información obtenida. Los resultados resaltan una alta cantidad de estudios cuantitativos, de corte correlacional y con la utilización de una misma técnica de recolección de información. A su vez, hubo una escasa cantidad de estudios cualitativos de corte fenomenológico. Por otro lado, se observó que todos los estudios cuentan con introducción y resumen del mismo. No obstante, se hace énfasis en fomentar la adición del acápite de sugerencias y limitaciones para investigaciones futuras. Se concluye así que la bibliometría es una rama fundamental para observar el estado real de la actividad científica y evidenciar los fenómenos a estudiar. Tal como este estudio lo realizó mediante el recojo de información de manera sistemática ayudando a la mayor comprensión y difusión de investigaciones relacionadas a estilos afrontamiento y estrés parental en universidades del Perú. / The objective of this research work was to carry out a bibliometric study of the degree theses on Parental Stress and Coping Styles in parents of children with Autism Spectrum Disorder (ASD) in the Alicia Concytec database from 2012 to 2021 To do this, the research variables were searched in the aforementioned database, finding 18 preliminarily, of which 11 were selected because they met the inclusion criteria. Subsequently, the bibliometric analysis of the information obtained was carried out. The results highlight a high number of quantitative studies, of correlational cut and with the use of the same information collection technique. In turn, there was a limited number of qualitative studies of a phenomenological nature. On the other hand, it is believed that all studies have an introduction and summary thereof. However, emphasis is placed on encouraging the addition of the suggestions and limitations section for future research. It is thus concluded that bibliometrics is a fundamental branch to observe the real state of scientific activity and to show the phenomena to be studied. As this study carried out by collecting information in a systematic way, helping to better understand and disseminate research related to coping styles and parental stress in Peruvian universities. / Trabajo de investigación