A depressão materna é reconhecida como uma adversidade ao comportamento infantil. O estudo se insere em lacunas apontadas pela literatura quanto à necessidade de abordar, de forma combinada, múltiplas condições contextuais de risco e proteção associadas à depressão materna. Objetivou-se identificar condições de risco e de proteção para problemas comportamentais de crianças que convivem com a depressão materna, em comparação a crianças que convivem com mães sem transtornos psiquiátricos, focalizando estressores, práticas parentais positivas e suporte social, e as possíveis associações entre essas variáveis. Avaliou-se 100 díades mães-crianças, distribuídas em dois grupos: G1 50 díades mães-crianças, cujas mães apresentaram história de depressão recorrente; e G2 50 díades mães-crianças, cujas mães não apresentaram transtornos psiquiátricos. A identificação das mães participantes foi feita junto a serviços de saúde de Ribeirão Preto - SP, e as crianças, de ambos os sexos, com idade entre sete e 12 anos, foram identificadas por meio de suas mães. Procedeu-se à coleta de dados com mães e crianças em situação individual face a face. As mães responderam aos seguintes instrumentos: (a) Entrevista Clínica Estruturada para o DSM-IV; (b) Questionário Geral; (c) Questionário de Capacidades e Dificuldades; (d) Inventário de Recursos do Ambiente Familiar; (e) Escala de Eventos Adversos; (f) Escala de Adversidade Crônica e (g) Entrevista com Roteiro Semi-Estruturado para a avaliação de estressores, práticas parentais positivas e suporte social. As crianças responderam ao teste das Matrizes Progressivas Coloridas de Raven e ao Teste do Desempenho Escolar. Os instrumentos foram codificados conforme as normas técnicas e as entrevistas foram transcritas e codificadas, tendo por referência categorias pré-definidas. Para a análise dos dados, utilizou-se: Teste Exato de Fisher, Teste t-Student, Análise de Regressão Logística Bivariada e Correlação de Pearson, adotando-se o nível de significância de p 0,05. Verificou-se nas comparações entre os grupos, que G1 apresentou significativamente mais indicadores de problemas comportamentais das crianças (x G1 = 15,12 e x G2 = 9,08), mais eventos adversos (x G1 = 14,08 e x G2 = 8,38), mais adversidades crônicas (x G1 = 3,92 e x G2 = 2,22), mais estressores no total (x G1 = 29,63 e x G2 = 17,91), menos recursos do ambiente familiar (x G1 = 57,76 e x G2 = 62,12), menos práticas parentais positivas envolvendo sensibilidade ao outro (x G1 = 70,00 e x G2 = 90,00) e menos suporte social no total (x G1 = 33,19 e x G2 = 37,14). Identificaram-se correlações moderadas e significativas dos problemas comportamentais das crianças de G1 com: estressores relacionados às crianças, suporte social total e proveniente da rede de apoio; e de G2 com: estressores total e referentes ao contexto geral, ao contexto familiar e relacionados às crianças, práticas parentais positivas total e envolvendo sensibilidade ao outro. Verificou-se a presença de múltiplas adversidades no ambiente familiar de convivência com a depressão materna, caracterizando um contexto com risco cumulativo, tendo o suporte social se caracterizado como uma condição de proteção para tais famílias. Considera-se que tais dados podem contribuir para o planejamento de estratégias de prevenção e intervenção em saúde mental materna e infantil. / Maternal depression is well-documented as a risk factor in the development of child behaviour. There is, however, a gap in the literature concerning multiple simultaneous influences of behavioural problems in children of depressed mothers. This study helps fill this gap by identifying multiple risk and protective factors with regards to behavioural problems in children of depressed mothers, relative to children of mentally healthy mothers. The study focused on stressors, positive parental practices, social support and possible correlations between these variables. One-hundred mother-child dyads took part in the study, divided in two groups: G1 50 child-mother dyads in which the mothers had a history of recurrent depression; and G2 50 child-mother dyads in which the mothers did not suffer from psychiatric disorders. Mothers, and by extension their children, were recruited from healthcare centres in the city of Ribeirao Preto SP. Children were aged between 6 and 12 years old. Mothers and children took part in individual face-to-face interviews. Mothers completed the following measures: (a) DSM-IV Structured Clinical Interview; (b) General Questionnaire; (c) Strengths and Difficulties Questionnaire; (d) Family Environment Resources Inventory; (e) Adverse Events Scale; (f) Chronic Adversity Scale; (g) Semi-structured interview to assess stress factors, positive parental practices, and social support. Children, in turn, completed the Ravens Colourful Progressive Matrices Scale and the School Performance Test. Scales were coded according to technical norms and interviews were transcribed and analysed in accord with previously defined codes. Data analysis was conducted using Fishers Exact Test, Students t- test, Bivariate Logistic Regression, and Pearson Correlation. Results revealed that, as compared to G2, G1 showed a higher frequency of childrens behavioural problems (x G1 = 15.12 and x G2 = 9.08), more adverse events (x G1 = 14.08 e x G2 = 8.38), greater frequency of chronic adversities (x G1 = 3.92 and x G2 = 2.22), more stress factors in general (x G1 = 29.63 and x G2 = 17.91), less resources in the family environment (x G1 = 57.76 and x G2 = 62.12), less positive parental practices concerning social sensitivity (x G1 = 70.00 and x G2 = 90.00), and generally less social support (x G1 = 33.19 and x G2 = 37.14). The frequency of behavioural problems in G1 was positively correlated with stressors concerning the children. Notably, both greater social support in general and support provided by the social network were correlated with fewer problem behaviours for the same group. Similarly, stressors were positively correlated with behavioural problems in G2. Finally, greater frequency of positive parental practices, in particular those reflecting sensitivity to others, were related to fewer behavioural problems in G2. These results point to the presence of multiple adversities in a family environment of maternal depression, which characterizes a context of cumulative risk. However, social support emerged as a protective factor for these families. These results can inform the design of intervention and prevention strategies in the context of maternal and infant mental health.

Conviver em família nuclear intacta tem sido considerado uma condição de proteção ao desenvolvimento infantil, sendo a convivência com a depressão materna e com práticas educativas parentais negativas reconhecidas como adversidades. Objetivou-se comparar e verificar as possíveis associações das práticas educativas parentais de mães e de pais de famílias nucleares intactas, diferenciadas em dois grupos, um com mães com indicadores de depressão e outro com mães sem indicadores de depressão, tendo como foco os aspectos comportamentais das crianças, em idade escolar. Avaliou-se 42 famílias nucleares intactas, compostas por pai, mãe e filho (a), distribuídas em: G1 17 famílias, cujas mães apresentaram indicadores atuais de depressão e G2 25 famílias, cujas mães não apresentaram indicadores atuais de depressão. As crianças, de ambos os sexos tinham idades entre oito e 10 anos, frequentavam o ensino fundamental em ano compatível com a idade, e por meio delas, nas escolas, identificou-se as famílias. Procedeu-se à coleta de dados em um único encontro com cada família, em sessões individuais, face a face, primeiro com o pai, seguida da mãe e criança. Com pais e mães aplicou-se o Inventário de Estilos Parentais e o Questionário de Capacidades e Dificuldades; com as mães, aplicou-se ainda o Questionário sobre a saúde do paciente e um Questionário Geral; e com as crianças aplicou-se o teste Matrizes Coloridas Progressivas de Raven. Os dados foram tratados por procedimentos estatísticos, adotando-se p0,05. Verificou-se com significância estatística que: 1. nas comparações mães e pais , as mães apresentaram mais práticas positivas que os pais ( mães = 21,60 e pais = 20,31) e mais monitoria positiva ( mães = 11,24 e pais = 10,10 ) ; 2. nas comparações de G1 em relação a G2, as mães de G1 avaliaram mais dificuldades comportamentais em suas crianças ( G1 = 15,35 e G2 = 10,20) , e apresentaram mais monitoria negativa ( G1 = 8,71 e G2 = 7,52) ; 3. nas comparações crianças com problemas de comportamento (CP) em relação as sem problemas (SP), as mães e pais apresentaram mais práticas negativas para as crianças com problema comportamentais (Mães- CP = 26,22 e SP =17,09; Pais- CP = 21,78 e SP = 17,18). Foram verificadas correlações significativas:1.nas avaliações das mães- entre problemas de comportamento das crianças e mais práticas educativas negativas (r=0,562) e menos prática educativa positiva (r=0,431), e ainda, a depressão materna apresentou correlação com Problema de Conduta (r=0,341); 2. nas avaliações dos pais- problemas de comportamento das crianças e mais disciplina relaxada (r=0,414) . Os dados evidenciaram que mesmo na condição de convivência em famílias nucleares intactas as crianças que convivem com a depressão materna estão expostas a mais práticas negativas, assim como as crianças com dificuldades comportamentais. Considera-se que tais dados podem contribuir para o planejamento de estratégias de prevenção e intervenção em saúde mental. / Living in an intact nuclear family has been regarded as a protective factor for child development, while living with maternal depression and negative parenting practices are considered adversities. The objective was to compare and verify potential associations of the parenting practices of mothers and fathers of intact nuclear families, assigned to two groups, one with mothers presenting depression and another with mothers with no indication of depression, focusing on the behavior of school-aged children. A total of 42 intact nuclear families composed of a father, mother and child were assessed according to: G1 17, families whose mothers presented current indicators of depression and G2 25, families whose mothers did not present current indicators of depression. Children, of both sexes were aged between eight and 10 years old and attended primary school in grades compatible to their ages. These families were recruited through their children at their schools. Data were collected in a single meeting with each family in individual sessions. A face-to-face interview was held, first with the father, followed by the mother and then, the child. The Parenting Style Inventory and Strengths and Difficulties Questionnaire were applied to both fathers and mothers; the Patient Health Questionnaire and a general questionnaire were also applied to the mothers, while the Ravens Coloured Progressive Matrices was applied to the children. Data were statistically analyzed, adopting p0.05. Differences with statistical significance were found in regard to: 1. Comparison between mothers and fathers, in which mothers more frequently than fathers presented positive practices ( mothers = 21.60 and fathers = 20.31) and positive monitoring ( mothers = 11.24 and fathers = 10.10); 2. Comparison between G1 and G2: G1 mothers more frequently reported their children presenting behavior problems ( G1 = 15.35 and G2 = 10.20), and also more frequently presented negative monitoring ( G1 = 8.71 and G2 = 7.52); 3. Comparison between the children with behavior problems (BP) and children without behavior problems (No BP) showed that mothers and fathers more frequently presented negative practices toward children with behavior problems (Mothers- BP = 26.22 and No BP =17.09; Fathers- BP=21.78 and No BP=17.18). Significant correlations were found in regard to: 1. Mothers assessment, between childrens behavior problems and more frequent negative parenting practices (r=0.562) and less frequent positive parenting practices (r=0.431), while maternal depression was correlated with Conduct Disorder (r=0.341); 2. Fathers assessment, between childrens behavior problems and more permissive parenting (r=0.414). Data show that even when living in intact nuclear families, children facing maternal depression are more frequently exposed to negative practices, as well as children with behavior problems. These findings can contribute to the planning of preventive and interventional strategies in mental health.

A depressão materna tem sido considerada uma condição de adversidade ao desenvolvimento infantil, observando-se quanto ao gênero peculiaridades e uma diversidade de achados em relação ao comportamento, à psicopatologia e ao perfil de socialização de crianças que convivem com a depressão materna. Objetivou-se: a) caracterizar o perfil de socialização de crianças em idade escolar que convivem com a depressão materna recorrente, identificando recursos e dificuldades relativos ao desempenho escolar e ao comportamento; b) comparar grupos separados pelo gênero; c) correlacionar desempenho escolar e comportamento. Foram avaliadas 40 díades mãe-filho, tendo as mães diagnóstico sistematicamente avaliado de Transtorno Depressivo Recorrente, e as crianças, com idades entre sete e 12 anos, foram distribuídas em dois grupos diferenciados pelo gênero: G1-20 meninos e G2-20 meninas. As crianças foram identificadas a partir da seleção das mães atendidas em serviços públicos de Saúde Mental da cidade de Ribeirão Preto - SP. Para a seleção dos participantes foram utilizados: a Entrevista Clínica e Estruturada para o DSM-IV (SCID), para confirmação diagnóstica das mães; e o teste das Matrizes Progressivas Coloridas de Raven - Escala Especial, para avaliação cognitiva das crianças e exclusão de déficit intelectual. Procedeu-se a avaliação do comportamento infantil por meio do Questionário de Capacidades de Dificuldades (SDQ) respondido pelas mães, e do desempenho escolar por meio do Teste de Desempenho Escolar (TDE) realizado pelas crianças. Os instrumentos foram aplicados segundo as recomendações técnicas e as avaliações foram realizadas em sessões individuais. Os dados foram codificados segundo as proposições dos instrumentos. Para a análise procedeu-se à comparação entre os grupos diferenciados pelo gênero em relação às variáveis desempenho escolar e comportamento e, na dependência da distribuição das variáveis, utilizaram-se os testes de Mann Whitney, do Qui-Quadrado, Exato do Qui-quadrado, Exato de Fisher, Análise de Regressão Logística Bivariada e Correlação de Spearman, adotando-se o nível de significância p 0,05 em todas as comparações. Em relação ao desempenho escolar, não foram observadas diferenças significativas entre meninos e meninas. Aproximadamente metade do total de crianças apresentou dificuldades, principalmente relacionadas às habilidades aritméticas, e apresentaram indicadores de recursos nos domínios escrita e leitura. No que se refere ao comportamento, 42,5% do total de crianças apresentou dificuldades comportamentais, observando-se diferença estatisticamente significativa entre os gêneros em relação aos sintomas emocionais, com 80% das meninas apresentando indicadores de prejuízos nesta escala em comparação a 50% dos meninos. Para o grupo das meninas foram identificadas correlações negativas entre desempenho escolar e comportamento. Conclui-se que as crianças expostas à depressão materna recorrente apresentam dificuldades escolares e comportamentais independentemente do gênero, sendo que as meninas mostraram-se mais vulneráveis do que os meninos em relação aos problemas emocionais relativos a queixas somáticas e de insegurança, próprias de comportamentos internalizantes, não diferindo dos meninos quanto aos comportamentos externalizantes, os quais apresentaram mais recursos para lidar com tal adversidade. Considera-se que tais dados podem contribuir para o planejamento de intervenções terapêuticas diferenciadas para meninos e meninas em idade escolar que convivem com a depressão materna, com especial atenção para as meninas. / Maternal depression has been considered a condition of adversity on child development, observing regarding gender peculiarities and diversity of findings in relation to behavior, psychopathology and the socialization profile of children living with maternal depression. This study aimed to: a) characterize the socialization profile of school-age children living with recurrent maternal depression, identifying resources and difficulties related to academic performance and behavior; b) compare groups separated by gender; c) correlate school performance and behavior. Were evaluated 40 mother-child dyads, with mothers diagnosis systematically assessed of recurrent depressive disorder, and children aged between seven and 12 years, were divided into two groups differentiated by gender: G1- 20 boys and G2-20 girls. Children were identified by the selection of mothers in treatment at public mental health services in Ribeirão Preto - SP. For the selection of participants were used: Structured and Clinical Interview for DSM-IV (SCID) for diagnostic confirmation of mothers, and the Matrizes Progressivas Coloridas de Raven - Escala Especial test, for cognitive assessment of children and exclusion of intellectual deficit. Proceeded with the evaluation of child behavior through Strenghts and Difficulties Questionnaire (SDQ) completed by the mothers, and school performance through the Teste de Desempenho Escolar (TDE) performed by children. The instruments were applied according to technical recommendations and evaluations were conducted in individual sessions. Data were coded according to the propositions of the instruments. For the analysis proceeded to compare the groups differentiated by gender for school performance and behavior and, depending on the distribution of variables, were used the tests Mann Whitney, Chi-square, Exact Chi-square, Fisher Exact, Bivariate Logistic Regression Analysis and Spearman Correlation, adopting a significance level p0.05 for all comparisons. In relation to school performance, there were no significant differences between the profile of boys and girls. Approximately half of all children had difficulties, especially those related to arithmetic skills, and presented resource indicators in writing and reading areas. With regard to behavior, 42.5% of children had behavioral difficulties, observing a statistically significant difference between genders in relation to emotional symptoms, with 80% of girls presenting indicators of losses on this scale compared to 50% boys. For the group of girls were identified negative correlations between school performance and behavior. Concludes that children exposed to recurrent maternal depression have difficulties on school performance and behavioral regardless of gender, and girls were more vulnerable than boys in relation to emotional problems related to somatic complains and insecurity, prevailing in internalizing behaviors, not differing from boys with regard to externalizing behaviors, which had more resources to deal with such adversity. It is considered that such data can contribute to the planning of different therapeutic interventions for school age boys and girls living with maternal depression, with special attention to girls.

Thesis advisor: Penny Hauser-Cram / Parents of children with developmental disabilities (DD) face greater caregiving demands than other parents, which may lead to heightened levels of stress. The problematic behavior and functional limitations of the child with DD have been found to contribute to parenting stress (Baker et al., 2002; Beckman, 1991). Despite heightened demands, many parents successfully adapt to raising a child with DD. A goal of recent research has been to identify resources and supports that explain the considerable variability in parental adjustment (Neece & Baker, 2008). This dissertation examined trajectories of parenting stress among mothers (N=147) and fathers (N=110) of children with diverse developmental disabilities, from their child's early years (age 3) through adolescence (age 15). Using hierarchical linear modeling, stress was found to increase from early to middle childhood and subsequently decrease from middle childhood to adolescence. Characteristics of the child with DD were found to contribute to parents' stress, with higher behavior problems and lower functional skills predicting greater stress. Parent resources and supports were also found to relate to parenting stress. Greater social support, use of adaptive coping strategies, and more positive perceptions of the family climate predicted lower stress. An additional model was conducted using a modified hierarchical linear modeling approach to examine the role of child stressors and family resources and supports within parenting dyads. The findings of this study contribute to the limited literature on patterns of change in stress among parents, particularly fathers, of children with DD. Following these results, interventions for families of children with DD should aim to reduce child-related stressors and promote parent resources and supports. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

Thesis advisor: Eric Dearing / Family educational involvement has been identified as a particularly beneficial practice for the achievement and behavioral outcomes of all students, including ethnic-minority students from families who have low levels of income, education, and English language proficiency. However, despite the associated benefits and education policymakers' emphasis on increasing family-school partnerships, not all families are involved and the explanation for differing involvement patterns has not been fully explored. In general, immigrant families engage in fewer educational involvement activities in comparison to their native-born counterparts. Although they want their children to excel in school, many face socio-cultural barriers to educational involvement. Moreover, most schools are not equipped to meet their non-academic needs. On the other hand, immigrant families tend to have close family and community ties, which have been linked to family and child well-being. As a result, social capital may be an asset of immigrant families that can be leveraged to promote their educational involvement. With a selective focus on immigrant children and families from the Child Development Supplement of the Panel Study of Income Dynamics (N = 189), this dissertation relied on path analyses to garner empirical support for a theoretically-based model linking social capital with family perceptions and attributions, home- and school-based family educational involvement, and student outcomes (i.e., achievement, behavior problems, positive behavior). Results demonstrated that social support was positively associated with immigrant families' self-efficacy and perceptions of opportunities for involvement. In turn, families with higher levels of self-efficacy engaged in more home-based involvement activities. Children in immigrant families with a role construction around education in alignment with the dominant culture of the U.S. demonstrated better child achievement but worse behavior outcomes than children from immigrant families with a role construction unaligned with dominant U.S. culture. Lastly, in contrast to extant literature, immigrant families' school-based educational involvement was not associated with any family perceptions or attributes or child outcomes. Implications of both significant and null findings are discussed for developmental science, practice, and policy. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

Thesis advisor: Penny Hauser-Cram / This study is a secondary data analysis of data from the Early Intervention Collaborative Study (EICS) (Hauser-Cram, Warfield, Shonkoff, & Krauss, 2001), a longitudinal investigation of families who have children with developmental disabilities (DD) (i.e. Down syndrome, motor impairment, and developmental delay). The study investigated a transactional relation between child problem behavior and parenting stress during the early (ages 3 to 5 years) and middle childhood (ages 5 to 10 years) years. Parental planful problem solving coping and positive reappraisal coping and the helpfulness of social support were examined as moderators of the relation between child problem behavior and parenting stress from the ages 3 to 5 years. Child problem behavior and parents' levels of stress, coping strategies, and ratings of social support were collected during home visits with the families when children were 3, 5, and 10 years. Using hierarchical regression techniques a transactional relation was found between child problem behavior and parenting stress from ages 3 to 5 years for both mother-child and father-child dyads. A transactional relation was again found between these constructs from ages 5 to 10 years for only mother-child dyads. Maternal positive reappraisal coping significantly moderated the relation between child problem behavior and maternal parenting stress. Maternal report of the helpfulness of social support significantly moderated the relation between child behavior and parenting stress at both the early and middle childhood levels. The findings support the design of familial interventions. Interventions that promote adaptive coping strategies may be particularly helpful for families of children with DD who exhibit high levels of problem behavior. Finally, improving the helpfulness of current support systems may positively impact parents' stress who have children with developmental disabilities. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

A Odontopediatria e a Psicologia se inter-relacionam e completam, principalmente quando existe necessidade de atendimento odontopediátrico. Quando o paciente é criança em idade pré-escolar, torna-se imperioso uma interação entre estas áreas, para que o resultado final traga benefícios para o paciente. A observação do comportamento das crianças em Odontopediatria é ferramenta importante para a elaboração do plano de tratamento. Levantamento bibliográfico sobre instrumentos para avaliação do comportamento de crianças em ambiente odontológico, mostrou que escalas eram o instrumento mais utilizado, porém, não se encontrou escalas aplicáveis às faixas etárias abaixo de 36 meses. Predominantemente, escalas para avaliação de comportamento estavam direcionadas a medir medo e ansiedade, pressupondo sua existência. Nesta pesquisa buscou-se elaborar e aplicar uma escala observacional para avaliação do comportamento, em primeira consulta odontológica, em crianças entre um e três anos de idade. A escala foi denominada EOCI – Escala de Observação do Comportamento Infantil. A finalidade era avaliar o comportamento em todas as etapas do primeiro atendimento, identificando o grau de cooperação e participação, e não quantificar ou classificar a presença de medo ou ansiedade. A escala foi aplicada em 398 sujeitos de ambos os sexos, oriundos de classes sociais e estruturas familiares diversas, freqüentando creches, pré-escolas ou no próprio lar. Os materiais utilizados foram: vestimenta seguindo as normas para profissionais de saúde; o ambiente foi sempre um consultório odontológico com o equipamento mínimo necessário para atendimento sem procedimento; como instrumental foi utilizado um espelho clínico e o material impresso constou de: convite aos pais, questionário de dados demográficos e sociais do paciente, termo de consentimento informado para pais ou responsáveis e folheto de orientação aos pais sobre como se comportar durante o atendimento. O procedimento consistiu em uma seqüência de atendimento simples, desde a entrada da criança na sala, apresentação aos equipamentos básicos, exame clínico e saída da criança, sempre acompanhada por um dos pais. A EOCI – Escala de Observação do Comportamento Infantil foi desenvolvida seguindo critérios de padronização e normatização. Consta de dez itens, com cinco possíveis respostas para cada um, relacionados ao ambiente, equipamentos, instrumentais e à própria pessoa do Odontopediatra e as respostas estão relacionadas a tipos de comportamentos que as crianças podem apresentar durante este primeiro contato. Após a avaliação da criança somaram-se as pontuações, obtendo-se um escore final. Com a análise estatística dos dados em quartis, chegou-se a uma classificação dividida em quatro níveis, correspondentes a quatro padrões de comportamentos de cooperação / não cooperação. Estes padrões são também apresentados em tabelas divididas por idade, sexo e comportamento, onde é possível localizar o escore individual e comparar com a classificação da amostra. Observou-se que a maioria das crianças sem experiência prévia com situação odontológica não apresenta medo. Também se pode afirmar que a maioria das crianças apresenta um comportamento cooperativo com o dentista durante seu atendimento, quando este é realizado nestas circunstâncias. Concluiu-se que a escala pode ser uma ferramenta útil para auxiliar o odontopediatra na realização de um exame clínico completo e como preditor do comportamento de cooperação futura. / Pedodontology and the Psychology are interrelated and complementary areas, mainly when the need of interventionist treatment exists. When the patient is a preschool age child, an interaction among these areas becomes imperious so that the final result brings benefits to the patient. The observation of the children's behavior in Pedodontics is an important tool for the elaboration of the treatment plan. Gathering of bibliographical data showed that the scales were the most commonly used instrument to evaluate children's behavior. However, it was not found any that could be applicable in the age groups below 36 months. Predominantly, the behavior evaluating scales were focused on measuring fear and anxiety, presupposing their existence. In this research, we elaborated and applied an observacional scale for evaluation of the behavior, in a first attendance, in children between one and three years. The scale was denominated CBOS – Children’s Behavior Observation Scale. The purpose was to evaluate the behavior in all the stages of the first attendance, identifying the cooperation degree and participation, and not to quantify or classify the presence of fear or anxiety. The scale was applied in 398 subjects of both sexes, with all sort of social and family backgrounds, frequenting day cares, pre-schools or at their own home. The materials used were: clothes following the rules for health professionals; the environment was always an odontological clinic with the minimum equipment necessary for the attendance without procedure; as the instrumental a clinical mirror was used and the printed paper material consisted of: invitation to the parents, questionnaire of the patient's demographic and social data, term of informed consent for the parents or the person responsible for the child and orientation pamphlet to the parents on how they should behave during the attendance. The procedure consisted of a sequence of simple attendance, from the child's entrance in the room, presentation to the basic equipments, clinical exam and the child's exit always together with one of the parents. The CBOS – Children’s Behavior Observation Scale was developed following criteria of standardization and normatization. It consists of ten items, with five possible answers for each one, related to the atmosphere, equipment, instrumental and to the own person of Pediatric Dentistry and the answers are related to types of behaviors that the children could present during this first contact. After the child's evaluation the obtained punctuations were added being obtained a final score. With the statistical analysis of the data in quartis, we came to a classification divided in four levels corresponding to four patterns of cooperation behaviors / no cooperation. These patterns are also presented in tables divided by age, sex and behavior, where it is possible to locate the individual score and to compare with the classification of the sample. It was observed that most of the children inexperienced with odontological situation don't present fear. We can also affirm that most of the children present a cooperative behavior with the dentist during his attendance, when this is done under these circumstances. As a conclusion it was observed that the scale can be a useful tool to aid pediatric dentistry to perform a complete clinical exam and as a predictor of the future cooperation behavior.

Como as dificuldades comportamentais e emocionais infantis, se não superadas neste período, podem estender-se ao longo do desenvolvimento, é de fundamental importância o investimento em estudos focados na avaliação e compreensão dos problemas de comportamento desta população, para, então, realizar um planejamento de intervenção adequado às suas necessidades. O presente trabalho tem como ponto de partida o reconhecimento da importância de múltiplas fontes de informações no processo de avaliação da criança, incluindo ela própria e o psicólogo clínico, para que haja o melhor atendimento psicológico. O objetivo desta pesquisa foi identificar a presença de problemas de comportamento em crianças a partir da avaliação de seus pais e do clínico, compreender os fatores de risco que possam estar associados a presença de tais dificuldades e analisar os níveis de concordância e discordância entre as avaliações realizadas pelas múltiplas fontes. Para tanto, foram realizadas entrevistas clínicas semiestruturadas (SCICA) com 25 crianças, de ambos os sexos e com idade entre sete e 11 anos, encaminhadas para atendimento em serviços de saúde mental, a fim de compará-las com as respostas dos pais/cuidador a um inventário de comportamentos infantis, o CBCL. Também foram coletadas informações sobre a presença de fatores de risco na família (Índice de Adversidade Familiar) e sobre os problemas de comportamento dos cuidadores que realizaram a avaliação (ASR). A SCICA mostrou-se um protocolo de entrevista válido para obtenção de observação comportamental e do relato da criança sobre seu funcionamento. A partir da análise dos resultados identificou-se que tanto os problemas observados pelos clínicos, quanto os reportados pela própria criança, apresentavam-se em taxas inferiores às relatadas pelos cuidadores. As dificuldades com agressividade e com ansiedade/depressão dos pais se mostraram um fator explicativo para as discrepâncias identificadas. As análises com os fatores de risco revelaram uma correlação positiva entre os escores no IAF e a presença de dificuldades internalizantes e total de problemas relatados pelas crianças. Considerando os fatores de risco isoladamente, observou-se que o fator presença de discórdia conjugal guardava relação com as dificuldades externalizantes e totais, enquanto o fator presença de psicopatologia na família estava relacionado às dificuldades internalizantes. Os dados sobre adversidade ambiental sugerem a importância de acompanhar os pais paralelamente ao trabalho da criança, dado que as condições de saúde mental na família e a presença de conflito marital apresentam uma relação intrínseca com as dificuldades infantis. A partir das análises de discordâncias observamos que a inclusão de forma sistematizada das diversas fontes mostrou-se relevante, pois, articuladamente ao relato dos pais, foi possível ir além da queixa declarada inicialmente e identificar outras áreas deficitárias do funcionamento das crianças avaliadas / The children\'s behavioral and emotional difficulties, if not overcome during childhood, may extend through the adult development, so it is extremely important to invest in studies focused on the evaluation and understanding of their behavioral problems to perform an intervention plan on these needs. One of the main concepts of this study is to recognize the importance of having multiple sources of information in the childs evaluation process (for instance, him/herself and the clinical psychologist) to have the best psychological care. The objective of this research was to identify the presence of behavioral problems in children based on their parents and clinical assessment, to analyze the risk factors that may be associated with these difficulties and to examine the levels of agreement and disagreement between the evaluations performed by multiple sources. To achieve that, we have compared the children\'s scores on a parentreport questionnaire, the CBCL, with semi-structured clinical interviews that were performed with 25 children referred for psychological care, of both genders and age range from 7 to 11 years old. We have also collected information about the presence of risk factors in the family (Rutter\'s Family Adversity Index) and about the presence of parents behavioral problems according to ASR. The SCICA proved to be a valid interview protocol to obtain behavioral observation and child\'s report about their functioning. From the analysis, we found that the problems noted by clinicians and reported by the child, were presented at rates lower than those reported by caregivers. An explanatory factor for the discrepancies found was parents´ aggression and anxiety/ depression problems. According to the analysis, Rutter\'s Family Adversity Index scores had a positive correlation with the presence of internalizing problems and total problems reported by children. Regarding the types of risk factors, it has been observed that the \"marital discordance\" factor was linked to the externalizing and total problems, while \"presence of psychopathology in the family\" factor was related to internalizing problems. Data on environmental adversity suggests the importance of instructing parents while the child´s treatment is being conducted, given that family mental health problems and the presence of marital conflict have a close relationship with the children\'s difficulties. From the identified discrepancies we can conclude that a systematic inclusion of the various sources is relevant, since the parental-report integrated with clinical psychologist perception and child\'s report allowed to go beyond the main complaint initially declared and identify other deficient areas of children functioning

by Sonya Y.W. Law. / Includes Chinese and English questionnaires. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 80-89). / ABSTRACT --- p.II / ACKNOWLEDGEMENTS --- p.III / TABLE OF CONTENTS --- p.IV / LIST OF TABLES --- p.V / LIST OF APPENDICES --- p.VII / Chapter CHAPTER I - --- INTRODUCTION / The phenomenon of informant discrepancy on child and adolescent psychopathology --- p.8 / Variables affecting the agreement of informants in rating child and adolescent psychopathology --- p.11 / Who is the reliable and valid informant? --- p.25 / Focuses of the present study --- p.30 / Chapter CHAPTER II - --- METHOD / Subjects --- p.33 / Instruments --- p.34 / Procedure --- p.38 / Statistical analyses --- p.38 / Chapter CHAPTER III - --- RESULTS / "Internal Consistency of the CBCL, YSR, TRF syndrome scales and interrelation among syndromes scales" --- p.40 / Informant concordance - on the severity of reported symptoms --- p.46 / "correlation between parent's, teacher's, and child's rating" --- p.53 / "Association between parent-, teacher-, child-rated internalizing and externalizing problems and the external correlates of psychopathology" --- p.61 / Predictive ability of ratings from different informants on the external correlates of psychopathology --- p.64 / Chapter CHAPTER IV - --- DISCUSSION / Informant agreement on the severity of symptoms --- p.68 / "Correlation between ratings of different informants in relation to adolescent's sex, age, clinical status, and type of psychopathology" --- p.72 / Association between ratings from different informants and the external correlates of psychopathology --- p.75 / "Predictive ability of parent's, teacher's and adolescent's rating on the external correlates of psychopathology" --- p.77 / REFERENCES / APPENDICES

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-26T09:52:02Z No. of bitstreams: 2 Dissertação - Larissa da Silva Moura - 2015.pdf: 2134342 bytes, checksum: 01ed98fe80185227f4ae4ac62f8c3caa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-26T09:52:35Z (GMT) No. of bitstreams: 2 Dissertação - Larissa da Silva Moura - 2015.pdf: 2134342 bytes, checksum: 01ed98fe80185227f4ae4ac62f8c3caa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-01-26T09:52:35Z (GMT). No. of bitstreams: 2 Dissertação - Larissa da Silva Moura - 2015.pdf: 2134342 bytes, checksum: 01ed98fe80185227f4ae4ac62f8c3caa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015-09-29 / The effectiveness of a sedative for pediatric dental treatment is commonly assessed through observational scales that assess the children behaviour. There is little information about the ability of a variety of scales in properly evaluate this behavior. The aim of this study was to analyze the characteristics of three scales,e,g,. Houpt Scale, Ohio State University Behavioral Rating Scale (OSUBRS) and Venham Behavior Rating Scale, to measure the behavior of preschool children during dental procedures under sedation. This study was an observational study nested to a randomized clinical trial (NCT02284204), which included 27 children between 4 and 6 years of age with early childhood caries and negative behavior in previous consultation. Participants underwent dental treatment under moderate sedation with midazolam and ketamine with or without addition of sevoflurane. The sessions were videotaped and five trained and calibrated observers watched the movies to record the behavior of children according to each scale. The data showed non-normal distribution (Shapiro-Wilk, P> 0.05); descriptive and correlation analyses were made (Spearman test). A total of 1,209 minutes of videos were observed and analyzed. Global scales (Houpt overall behavior and Venham) had closer scores of good behavior. The most frequent scores for Houpt were “no crying” and “no movement”, and for OSUBRS, “quiet”. Statistically significant correlations (P <0.05) occurred between Houpt overall behavior and Venham; Houpt overall behavior with Houpt categories movement (scores 2 and 4) and cry (scores 1, 2 and 4); Venham with Houpt movement (score 4) and cry (scores 2 and 4). OSUBRS scores 1 and 4 had high correlation coefficients with Houpt overall behavior and Venham. The Houpt overall behavior and the Venham Behavior Scale were highly correlated to measure behavior of children in dental treatment under sedation. OSUBRS showed better correlation with global scales compared to the categories of crying and movement of Houpt scale. / Para a avaliação da eficácia de um agente sedativo para tratamento odontológico de crianças, uma das medidas utilizadas é o comportamento, e isso é feito através de escalas observacionais. No entanto, há poucas informações sobre a capacidade de avaliar corretamente esse comportamento. O objetivo deste estudo foi analisar as características de três escalas - Escala comportamental de Houpt, Ohio State University Behavioral Rating Scale (OSUBRS) e Escala comportamental de Venham - em mensurar o comportamento de crianças pré-escolares durante procedimento odontológico sob sedação. Esse trabalho foi um estudo observacional aninhado a um ensaio clínico randomizado (NCT02284204) que incluiu 27 crianças entre 4 e 6 anos de idade com cárie dentária e comportamento resistente ao tratamento odontológico. Os participantes foram submetidos a tratamento odontológico sob sedação moderada com uso de midazolam e cetamina com adição ou não de sevoflurano. Os atendimentos foram gravados em vídeo e cinco observadores treinados e calibrados assistiram para registrar o comportamento das crianças segundo cada escala. Os dados apresentaram distribuição não-normal (Shapiro-Wilk, P>0,05); foram feitas análises descritivas e de correlação (teste de Spearman). Um total de 1.209 minutos de vídeos foram observados e analisados. Escalas globais (Houpt comportamento geral e Venham) apresentaram escores mais próximos de bom comportamento. Os escores mais frequentes para Houpt foram de pouco choro e movimento e, para OSUBRS, comportamento quieto. Correlações estatisticamente significantes (P<0,05) ocorreram entre Houpt comportamento geral e Venham (rho= -,87); Houpt comportamento geral com Houpt categorias movimento (escore 2 e 4) e choro (escores 1, 2 e 4); Venham com Houpt movimento (escore 4) e choro (escores 2 e 4). OSUBRS escores 1 e 4 tiveram altos coeficientes de correlação com Houpt comportamento geral e Venham. Concluiu-se que a escala de Comportamento Geral de Houpt e a Escala Comportamental de Venham foram altamente correlacionadas para aferir comportamento de crianças em tratamento odontológico sob sedação. OSUBRS apresentou melhor correlação com as escalas globais, se comparado com as categorias de choro e movimento de Houpt.