Les troubles du Spectre Autistique (TSA) sont des troubles neuro-développementaux, d’apparition précoce et qui affectent le développement de l’individu tout au long de sa vie. La prévalence des TSA est estimée aux alentours de 1% de la population générale. Des interventions précoces peuvent minimiser le handicap résultant de ce trouble et améliorer la qualité de vie et l’insertion sociale des enfants. L’opportunité de bénéficier d’une intervention précoce dépend de l’âge du diagnostic. Aujourd’hui, l’âge moyen du diagnostic des TSA en France est de 5 ans en moyenne. Un diagnostic précoce est pourtant possible dès l’âge de 24 mois. Un dépistage précoce des TSA permettrait de diminuer l’âge du diagnostic et par conséquent l’âge du début de l’intervention, maximisant ainsi les bénéfices. L'objectif général de ce travail, organisé autour de 3 études, est de participer à l’amélioration des pratiques de dépistage et de diagnostic précoce des TSA en évaluant la pertinence de différents outils pour aider les professionnels à repérer et orienter les enfants à risque de TSA. La première étude a pour objectif d’évaluer la faisabilité d’un dépistage systématique des TSA chez les enfants âgés de 24 mois. Un dispositif de dépistage a été développé avec pour préalables la formation des professionnels de première ligne et la validation d’outils de dépistage spécifiques aux TSA : le CHAT et le M-CHAT. La seconde étude a pour objectif d’améliorer l’orientation diagnostique des enfants repérés pour une suspicion de TSA. Dans cette optique, cette étude vise à évaluer la pertinence de l’utilisation du module 1 de l’ADOS-G pour confirmer ou infirmer la présence d’un risque de TSA chez les enfants de moins de 3 ans. Enfin, l’objectif de la dernière étude est d’évaluer l’apport éventuel des données issues de l’évaluation développementale dans le dispositif. L’évaluation développementale des enfants permet de mettre en évidence leur profil et ainsi de proposer un plan d’intervention dans l’attente de la confirmation diagnostique. Les résultats de ces études témoignent de la possibilité de repérer les enfants à risque de TSA à 24 mois. Les professionnels impliqués dans la pratique de dépistage ont aujourd’hui à leur disposition deux outils validés sur un échantillon français: le CHAT et le M-CHAT. Ces outils présentent des propriétés psychométriques satisfaisantes pour une utilisation en population générale. L’utilisation du module 1 de l’ADOS-G permet de différencier les enfants de moins de 3 ans présentant un TSA des enfants avec une autre problématique développementale. Cet outil apparaît donc important pour améliorer la spécificité du dépistage précoce. L’évaluation développementale apporte quant à elle des informations sur les profils des enfants avec un TSA, marqués notamment par des déficits dans les domaines de l’imitation et du jeu. Les implications cliniques de ces études sont discutées et de nouvelles pistes de recherche sont proposées. / Autism Spectrum Disorder (ASD) is a neuro-developmental disorder with early onset affecting the development of person throughout their life. The prevalence of ASD is estimated approximately 1% of the general population. Early intervention can minimize disabilities resulting from the disorder and improve the quality of life and social inclusion of affected children. The opportunity to profit early interventions depends on the age of diagnosis. At the moment, the average age of diagnosis of ASD in France is 5 years. However, an early diagnosis is possible at the age of 24 months. Since early detection of ASD would reduce the age of diagnosis and the age of commence of the intervention as well, it concludes that it may maximize profits. The overall aim of this dissertation, organized in three studies, is to improve practice of screening and early diagnosis of ASD by evaluating the relevance of different tools employed by professionals to identify and refer children at risk ASD. The aim of first study is to evaluate the feasibility of ASD screening for 24 months old children. A screening program was developed with priority given to the training of frontline professionals and validation of two specific screening tools for ASD: CHAT and M-CHAT. The second study aims to improve the orientation of diagnostic practice for children with potential ASD. In this context, the objective is to assess the relevance of using Module 1of the ADOS-G in order to confirm or disprove the presence of a risk of ASD in children less than 3 years. Finally, the aim of the last study is to examine the developmental aspect of data obtained from the screening program and to find their potential implications. The assessment of at risk children may highlight their developmental profile; also it may help proposing an intervention plan before the confirmation of diagnostic. The results of these studies demonstrate that it is possible to identify children at risk for ASD at 24 months. Today, professionals involved in the practice of screening have at their disposal two screening tools validated in a French sample: CHAT and M-CHAT. These tools show satisfactory psychometric properties for the use in the general population. Children less than 3 years with ASD may be distinguished from other young children with developmental disorders by using the Module 1 of the ADOS-G. The use of this tool seems to be important to improve the specificity of early screening. The developmental assessment provides some information concerning the profiles of children with ASD, particularly has been marked by deficits in the areas of imitation and play. At last, the clinical implications of these studies are discussed and new lines for future research are proposed.

Background – People with functional impairments have unmet needs and they are not given the support and service they are entitled to. According to international studies, early measures and treatment may slow down the outbreak of mental illness and relieve its course. Aims - To elucidate and compare both somatic poor health and social needs of people with either physical or mental functional impairments in a rural district, and to explore and compare how different personnel in the primary health care service and psychiatric services are able to detect early signs of psychosis. Moreover, to find out how early signs of psychosis are detected in primary health services, and to explore the patients’ pathways to the GPs. Methods – In studies I and II, people with severe functional impairments were offered a screening health examination followed by an interview. Three vignettes were presented to personnel in the primary health care service and the psychiatric services in study III. The participants were asked to detect any signs and symptoms of psychosis in the vignettes. In studies IV and V, notes in primary health care records were studied during a period of two years and six months, respectively, before a diagnosis of psychosis was made by the general psychiatric services. Results – People with severe functional impairments had poorer health and more problems with their ADL (Activities of Daily Life), economy/work and Quality of Life than people in general. Among the groups studied, people with mental impairments had the poorest living conditions. There were no differences between the participants in study III regarding sex, age and occupation; and the participants detected the signs and symptoms in the vignettes to a high degree (75% of all signs and symptoms). In all, 152 patients (22 with schizophrenia/ schizoaffective disorders, 41 with schizophrenia preceded by other psychotic disorders and 89 with persisting psychiatric disorders) with the diagnosis of psychosis made by the general psychiatric services were included in study IV and V. There were notes in 77% of the primary health records during the two-year study period, and 70% of these notes were about psychiatric signs and symptoms, which means that the GPs detected signs and symptoms of psychosis in 2/3 of the cases. The analysis of the patients’ visiting patterns to GPs showed that many patients did not visit their “own” primary health care centre or their “own” GP. Furthermore, many patients had no contact with the primary health care service at all, and the subgroup with schizophrenia/schizoaffective disorders visited the primary health care service less frequently than the other groups. Main conclusion – People with severe functional impairments must be granted regular contacts with a GP, whose role must be: to identify and motivate the patients; to detect when there are needs for care and social needs; to function as a representative for the patients; to inform the patients about their rights and to guide them to other social or health authorities. The GPs detected early signs and symptoms of an emerging psychosis to a high degree, which would make early intervention possible. The more visits to the GPs, the more symptoms were detected, and out of all signs and symptoms with psychiatric content noted, the GPs would have suspected an emerging psychosis in almost every second patient who visited them. To detect early signs and symptoms of psychosis is difficult, and whenever in doubt, primary health care personnel must be able to consult psychiatric professionals. Otherwise we may miss the opportunity to intervene in an early phase of the illness. Additional training could also mean better understanding and earlier detection of people at risk of an emerging psychosis.

No description available.

Este estudo originou-se do interesse em investigar a sensibilidade do IRDI-Questionário, adaptação do instrumento IRDI, para detecção de sinais iniciais de TEA (Transtorno de espectro de autismo). O autismo ou TEA caracteriza-se por severos déficits na interação social recíproca, na comunicação e na atividade imaginativa, assim como por padrões repetitivos e limitados de interesses e de comportamentos. Nesse sentido, deve-se ressaltar a indefinição de sua etiologia, pois, se trata de um distúrbio complexo e heterogêneo com graus variados de severidade, resultado provável de uma combinação de fatores ambientais e genéticos. Soma-se à ausência de um marcador biológico a acentuada heterogeneidade das manifestações clínicas do transtorno, daí o conceito de espectro que lhe foi atribuído. Tais condições terão como consequências dificuldades no próprio processo diagnóstico. Isso significa que o diagnóstico do autismo e as condições associadas ainda estão baseados em observações de confluência de anormalidades comportamentais nos campos social, de comunicação, do jogo e da imaginação. É importante pensar que a heterogeneidade do quadro implica que os sintomas podem não se expressar do mesmo modo em todas as crianças, apesar de apresentarem certa regularidade que permite a construção de um diagnóstico. Além disso, algumas crianças vão apresentar sinais de risco desde os primeiros meses de vida e, outras, apresentarão sintomas mais tardios. Nesse contexto, os instrumentos de avaliação são importantes ferramentas de auxílio na avaliação clínica da criança com TEA, sendo que vários pesquisadores ressaltam a importância de se realizarem triagens de crianças de até três anos de idade a fim de propiciar o diagnóstico e a intervenção ainda nos primeiros meses de vida. Com o intuito de instrumentalizar a detecção de sinais iniciais de TEA, diversos pesquisadores têm formulado protocolos com foco em diferentes formas de expressão de tais sinais e os instrumentos especializados para fins de rastreamento/ triagem têm se mostrado eficientes na detecção de sinais iniciais de TEA, além disso, são de fácil e rápida aplicação. Esta pesquisa, portanto, se propôs a investigar a sensibilidade de um instrumento para sinais iniciais de TEA, sendo que, para a investigação, participaram 72 pais de crianças/crianças divididos em 2 (dois) grupos: grupo pesquisa-TEA (32 pais) e grupo controle-típico (40 pais). Para ambos os grupos, foram utilizados o IRDI-Questionário e a CARS-BR, os quais tiverem seus resultados comparados. Utilizou-se o teste de inteligência não verbal SON-R 2½-7 no grupo pesquisa-TEA para controlar a variável DI (deficiência intelectual). Os dados foram submetidos a tratamento estatístico e as análises estatísticas demonstraram que as médias descritas pelo IRDI-Questionário foram diferentes, sendo que os IRDI do grupo TEA (85,09) são, em média, menores que os IRDI do grupo típico (129,32). Os grupos juntos mostraram alta correlação negativa entre os valores do IRDI-Questionário e da CARS-BR. Para o estudo de sensibilidade foi realizada uma análise através da curva ROC, que definiu um ponto de corte do escore gerado pelo instrumento IRDI-Questionário. A sensibilidade do IRDI-Questionário para sinais iniciais de TEA foi de 96,9%, resultado este que também indicou que o instrumento pode ser interessante para um instrumento para o rastreamento da condição estudada. Além do estudo de sensibilidade, apresentou-se, ainda, um breve estudo sobre o conceito de Intersubjetividade e suas rupturas, assim como algumas pesquisas atuais a ele referentes, relacionando-o aos indicadores IRDI e ao TEA. O conceito de intersubjetividade tem sido investigado por vários campos de conhecimento. A Psicologia do desenvolvimento é um desses campos, sendo que diversos autores nos apresentam diferentes interpretações sobre o conceito. Neste trabalho, destacou-se a importância de apresentar o conceito, pois, este guarda uma estreita relação com o autismo / This study originated from the interest in investigating the sensitivity of the IRDI - Questionnaire, adaptation of the IRDI instrument to detect early signs of ASD (autism spectrum disorder). Autism or ASD is characterized by severe deficits in reciprocal social interaction, communication and imaginative activity, as well as repetitive and restricted patterns of interest and behavior. His early appearance, profile and chronicity of symptoms are strong arguments for a biological causality, however, not defined a biological indicator present in all cases. In this sense, it should be noted the vagueness of its etiology, because it is a complex and heterogeneous disorder with varying degrees of severity, likely the result of a combination of environmental and genetic factors. Added to the absence of a biomarker a marked heterogeneity of clinical manifestations of the disorder, hence the concept of spectrum allocated to it. Such conditions will have as consequences difficulties in itself diagnostic process. This means that the diagnosis of autism and associated conditions are still based on observations of confluence of behavioral abnormalities in the social, communication, play and imagination. It is important to think that the heterogeneity of the picture implies that the symptoms can not express themselves in the same way in all children, despite having certain regularity that allows the construction of a diagnosis. In addition, some children will show signs of risk in the first months of life, and others, will present the later symptoms. In this context, the assessment tools are important aid tools in the clinical evaluation of children with ASD, and several researchers emphasize the importance of conducting trials of children under three years of age in order to provide diagnosis and intervention still in first months of life. In order to manipulate the detection of initial signs of TEA, many researchers have made agreements with focus on different ways of expressing such signals and specialized tools for tracking / sorting have been shown to be effective in detecting early signs of TEA, moreover, they are quick and easy application. This research therefore aims to investigate the sensitivity of an instrument for early signs of ASD, and for research, participated 72 parents of children / children divided into two (2) groups: research - TEA group ( 32 parents ) and control group - typical (40 parents). For both groups, we used the IRDI - Questionnaire and the CARS-BR, which have their results compared. We used the non-verbal intelligence test SON- R 2½ -7 in the search -TEA group to control the variable DI (intellectual disability). The data were subjected to statistical analysis and statistical analyzes showed that the average described by IRDI - Questionnaire were different, and the IRDI TEA group (85.09) are on average smaller than the typical group IRDI (129, 32). Groups together showed high negative correlation between the values of the IRDI - Questionnaire and the CARS- BR. For the sensitivity study was carried out through an analysis of the ROC curve, it defined a cutoff score generated by IRDI - Questionnaire tool. The sensitivity of the IRDI - Questionnaire for early signs of ASD was 96.9 %, a result which also indicated that the instrument may be interesting to a tool for tracking the condition studied. In addition to the sensitivity analysis presented is also a brief study on the concept of Intersubjectivity and their breaks, as well as some current research relating thereto, relating it to IRDI indicators and TEA. The concept of intersubjectivity has been investigated by several fields of knowledge. Developmental Psychology is one of those fields, and several authors present us with different interpretations of the concept. In this work, we stressed the importance of presenting the concept, because this is closely related to autism

As inovações, motores do desenvolvimento global, viabilizam-se nas organizações por meio dos projetos. Quanto maior for o nível de inovação nesses projetos, maior é a probabilidade de existirem incertezas imprevisíveis. A identificação dos sinais precoces de uma mudança permitiria perceber essas incertezas, porém, para o reconhecimento antecipado desses sinais, é preciso também dar sentido ao que está ocorrendo, pela criação de sentido (sensemaking). Assim, este estudo tem como objetivo principal entender qual é o fator gerador da incerteza imprevisível, quais são os fatores motivadores de sua identificação e quais práticas contribuem para a criação de sentido dessas incertezas em projetos inovadores. Para tal, foi feito um levantamento de campo, de maio a dezembro de 2011, no qual foram utilizados: um questionário para se obterem informações iniciais sobre os projetos que poderiam ser considerados inovadores e, posteriormente, uma entrevista aprofundada, direcionada por um roteiro com perguntas abertas, com um dos participantes do projeto. Foram enviados 152 convites para gestores de projetos, dos quais apenas 16 projetos atenderam aos requisitos exigidos, transformando-se em unidade de análise. A cada uma dessas unidades foram solicitados, também, pelo menos dois eventos imprevistos, materialização da incerteza imprevisível, obtendo-se a quantidade de 35. Esses eventos imprevistos foram considerados unidade de análise incorporada. A análise dos dados foi inicialmente qualitativa, com a geração de variáveis e categorias avaliadas estatisticamente; posteriormente, por meio de provas não paramétricas. Com base nas análises efetuadas, foi possível observar que o nível mais alto de eficiência na identificação da incerteza imprevisível - perceber a incerteza imprevisível previamente e ter menos impacto - ocorre preferencialmente em eventos com a percepção do sinal precoce feita pelo gerente do projeto ou pelo sponsor, no início do projeto; com a existência de um fator facilitador organizacional; com a utilização de um processo de criação coletiva de sentido. O nível mais baixo de eficiência - percepção tardia do evento imprevisto e existência de mais impacto - associa-se, porém, à causa externa da incerteza imprevisível, à ausência da percepção de um sinal precoce, à presença de um fator bloqueador à identificação com origem nas características pessoais, baixo número de atividades coletivas, entre outras. Recomenda-se incorporar o diagnóstico da incerteza na gestão de riscos dos projetos, buscar informações sobre as áreas incertas do projeto e interagir para socializar o conhecimento. Futuros estudos ampliados, para se obter um número maior de eventos e projetos, poderão permitir novas associações, assim como gerar um modelo multivariado. O uso de métodos alternativos de gestão de projetos inovadores também se mostra como um relevante tema de pesquisa. / The organizations enable innovations, engines of global development, through the projects. The more innovative a project, the greater is the probability of occurrence of unforeseeable uncertainties. The identification of early signs of a change would realize this kind of uncertainty, but for the early recognition of these early signs is necessary to give sense to them, sensemaking. Thus, this study aims to understand what the main factor that generates the unforeseeable uncertainty is, what the motivating factors for their identification are and what the practices that contribute to the creation of meaning of these uncertainties are on innovative projects. To this end, a field survey has been done, from May to December 2011, with: a questionnaire to obtain initial information about the projects that could be considered innovative, and subsequently an in-depth interview, guided by a script with open questions, with one of the project participants. 152 invitations were sent to project managers, of which only 16 projects met the requirements, becoming a unit of analysis. Each of these units was also requested at least two unforeseen events, materialization of unforeseeable uncertainty, thus obtaining 35 unanticipated events, which are considered the unit of analysis embedded. Data analysis was qualitative, the generation of categories and variables were evaluated statistically through non-parametric tests. Based on the analysis performed it was observed that the highest level of efficiency in identifying unforeseeable uncertainty - it was notice in advance and it had less impact - occurred preferentially when events have had the perception of early sign made by the project manager or the sponsor at the beginning of the project, with the existence of an organizational facilitator factor, and using a collective sensemaking process. Moreover, the lowest level of efficiency - late perception of the unforeseeable event and existence of more impact - were associated with the external cause of unforeseeable uncertainty, the lack of perception of an early signal, the presence of a blocking factor identification originated from the personal characteristics, low number of collective activities, among others. It is recommended to incorporate the diagnosis of unforseeable in risk management of projects, seeking information about the uncertain areas of the project and interacting to share the knowledge. Further studies extended to obtain a larger number of events and projects may allow new associations as well as generate a multivariate statistical model. The use of alternative methods of management of innovative projects to identify unforeseeable uncertainty also appears as a relevant research topic.

The purpose of the study is to investigate how active teachers in grades k–3 can work actively to prevent reading difficulties. The purpose is also to investigate what early signs teachers can be observant of in terms of early reading learning associated with reading difficulties. My theoretical point of departure is based on the socio-cultural perspective in which learning takes place in a community with others based on the individual's conditions. I have also assumed the concept of literacy, which means that individuals can read, write, understand and draw conclusions in such an acceptable way that everyday situations work. The informants are active teachers in grades k–3. The study shows what signs the teachers are observant of, for example that students do not hear syllables, cannot rhyme, nor see word pictures. They write letters backwards, pronounce the sounds wrong and change or remove endings. Furthermore, the study shows how the respondents identify students with difficulties in early years by personalizing the teaching according to the student`s needs. Additional findings include the importance of having a good background knowledge of different reading difficulties and the importance of preventive work. The results also show other factors that counteract reading difficulties such as the classroom climate, the importance of getting the right information at handover from the teacher in preschool class and the importance of reading aloud. / Syftet med studien är att undersöka hur verksamma lärare i årskurs f–3 kan arbeta aktivt med att förebygga lässvårigheter. Syftet är även att undersöka vilka tidiga tecken som lärare kan vara observanta på när det gäller den tidiga läsinlärningen kopplat till lässvårigheter. Mina teoretiska utgångspunkter grundar sig i det sociokulturella perspektivet där lärande sker i gemenskap med andra utifrån individernas förutsättningar. Jag har även utgått ifrån begreppet literacy vilket innebär att individer ska kunna, läsa, skriva, förstå och dra slutsatser på ett så pass godtagbart sätt att vardagssituationer fungerar. Urvalsgruppen är verksamma lärare i årskurs f–3. Studiens resultat visar vilka tecken respondenterna är observanta på, så som att eleverna inte hör stavelser, inte kan rimma eller se ordbilder, att de vänder på bokstäver, säger fel ljud och ändrar eller utelämnar ändelser. Vidare visar resultatet hur respondenterna fångar upp elever med lässvårigheter i tidig ålder genom att individanpassa undervisningen utefter elevens behov. Studien visar även på vikten av att ha en bra bakgrundskunskap till olika lässvårigheter och hur viktigt det förebyggande läsinlärningsarbetet är. Resultatet visar även andra faktorer som motverkar lässvårigheter så som klassrumsklimat och vikten av att få rätt information vid överlämningen från förskoleklassen samt högläsningens betydelse.

Este estudo originou-se do interesse em investigar a sensibilidade do IRDI-Questionário, adaptação do instrumento IRDI, para detecção de sinais iniciais de TEA (Transtorno de espectro de autismo). O autismo ou TEA caracteriza-se por severos déficits na interação social recíproca, na comunicação e na atividade imaginativa, assim como por padrões repetitivos e limitados de interesses e de comportamentos. Nesse sentido, deve-se ressaltar a indefinição de sua etiologia, pois, se trata de um distúrbio complexo e heterogêneo com graus variados de severidade, resultado provável de uma combinação de fatores ambientais e genéticos. Soma-se à ausência de um marcador biológico a acentuada heterogeneidade das manifestações clínicas do transtorno, daí o conceito de espectro que lhe foi atribuído. Tais condições terão como consequências dificuldades no próprio processo diagnóstico. Isso significa que o diagnóstico do autismo e as condições associadas ainda estão baseados em observações de confluência de anormalidades comportamentais nos campos social, de comunicação, do jogo e da imaginação. É importante pensar que a heterogeneidade do quadro implica que os sintomas podem não se expressar do mesmo modo em todas as crianças, apesar de apresentarem certa regularidade que permite a construção de um diagnóstico. Além disso, algumas crianças vão apresentar sinais de risco desde os primeiros meses de vida e, outras, apresentarão sintomas mais tardios. Nesse contexto, os instrumentos de avaliação são importantes ferramentas de auxílio na avaliação clínica da criança com TEA, sendo que vários pesquisadores ressaltam a importância de se realizarem triagens de crianças de até três anos de idade a fim de propiciar o diagnóstico e a intervenção ainda nos primeiros meses de vida. Com o intuito de instrumentalizar a detecção de sinais iniciais de TEA, diversos pesquisadores têm formulado protocolos com foco em diferentes formas de expressão de tais sinais e os instrumentos especializados para fins de rastreamento/ triagem têm se mostrado eficientes na detecção de sinais iniciais de TEA, além disso, são de fácil e rápida aplicação. Esta pesquisa, portanto, se propôs a investigar a sensibilidade de um instrumento para sinais iniciais de TEA, sendo que, para a investigação, participaram 72 pais de crianças/crianças divididos em 2 (dois) grupos: grupo pesquisa-TEA (32 pais) e grupo controle-típico (40 pais). Para ambos os grupos, foram utilizados o IRDI-Questionário e a CARS-BR, os quais tiverem seus resultados comparados. Utilizou-se o teste de inteligência não verbal SON-R 2½-7 no grupo pesquisa-TEA para controlar a variável DI (deficiência intelectual). Os dados foram submetidos a tratamento estatístico e as análises estatísticas demonstraram que as médias descritas pelo IRDI-Questionário foram diferentes, sendo que os IRDI do grupo TEA (85,09) são, em média, menores que os IRDI do grupo típico (129,32). Os grupos juntos mostraram alta correlação negativa entre os valores do IRDI-Questionário e da CARS-BR. Para o estudo de sensibilidade foi realizada uma análise através da curva ROC, que definiu um ponto de corte do escore gerado pelo instrumento IRDI-Questionário. A sensibilidade do IRDI-Questionário para sinais iniciais de TEA foi de 96,9%, resultado este que também indicou que o instrumento pode ser interessante para um instrumento para o rastreamento da condição estudada. Além do estudo de sensibilidade, apresentou-se, ainda, um breve estudo sobre o conceito de Intersubjetividade e suas rupturas, assim como algumas pesquisas atuais a ele referentes, relacionando-o aos indicadores IRDI e ao TEA. O conceito de intersubjetividade tem sido investigado por vários campos de conhecimento. A Psicologia do desenvolvimento é um desses campos, sendo que diversos autores nos apresentam diferentes interpretações sobre o conceito. Neste trabalho, destacou-se a importância de apresentar o conceito, pois, este guarda uma estreita relação com o autismo / This study originated from the interest in investigating the sensitivity of the IRDI - Questionnaire, adaptation of the IRDI instrument to detect early signs of ASD (autism spectrum disorder). Autism or ASD is characterized by severe deficits in reciprocal social interaction, communication and imaginative activity, as well as repetitive and restricted patterns of interest and behavior. His early appearance, profile and chronicity of symptoms are strong arguments for a biological causality, however, not defined a biological indicator present in all cases. In this sense, it should be noted the vagueness of its etiology, because it is a complex and heterogeneous disorder with varying degrees of severity, likely the result of a combination of environmental and genetic factors. Added to the absence of a biomarker a marked heterogeneity of clinical manifestations of the disorder, hence the concept of spectrum allocated to it. Such conditions will have as consequences difficulties in itself diagnostic process. This means that the diagnosis of autism and associated conditions are still based on observations of confluence of behavioral abnormalities in the social, communication, play and imagination. It is important to think that the heterogeneity of the picture implies that the symptoms can not express themselves in the same way in all children, despite having certain regularity that allows the construction of a diagnosis. In addition, some children will show signs of risk in the first months of life, and others, will present the later symptoms. In this context, the assessment tools are important aid tools in the clinical evaluation of children with ASD, and several researchers emphasize the importance of conducting trials of children under three years of age in order to provide diagnosis and intervention still in first months of life. In order to manipulate the detection of initial signs of TEA, many researchers have made agreements with focus on different ways of expressing such signals and specialized tools for tracking / sorting have been shown to be effective in detecting early signs of TEA, moreover, they are quick and easy application. This research therefore aims to investigate the sensitivity of an instrument for early signs of ASD, and for research, participated 72 parents of children / children divided into two (2) groups: research - TEA group ( 32 parents ) and control group - typical (40 parents). For both groups, we used the IRDI - Questionnaire and the CARS-BR, which have their results compared. We used the non-verbal intelligence test SON- R 2½ -7 in the search -TEA group to control the variable DI (intellectual disability). The data were subjected to statistical analysis and statistical analyzes showed that the average described by IRDI - Questionnaire were different, and the IRDI TEA group (85.09) are on average smaller than the typical group IRDI (129, 32). Groups together showed high negative correlation between the values of the IRDI - Questionnaire and the CARS- BR. For the sensitivity study was carried out through an analysis of the ROC curve, it defined a cutoff score generated by IRDI - Questionnaire tool. The sensitivity of the IRDI - Questionnaire for early signs of ASD was 96.9 %, a result which also indicated that the instrument may be interesting to a tool for tracking the condition studied. In addition to the sensitivity analysis presented is also a brief study on the concept of Intersubjectivity and their breaks, as well as some current research relating thereto, relating it to IRDI indicators and TEA. The concept of intersubjectivity has been investigated by several fields of knowledge. Developmental Psychology is one of those fields, and several authors present us with different interpretations of the concept. In this work, we stressed the importance of presenting the concept, because this is closely related to autism

As inovações, motores do desenvolvimento global, viabilizam-se nas organizações por meio dos projetos. Quanto maior for o nível de inovação nesses projetos, maior é a probabilidade de existirem incertezas imprevisíveis. A identificação dos sinais precoces de uma mudança permitiria perceber essas incertezas, porém, para o reconhecimento antecipado desses sinais, é preciso também dar sentido ao que está ocorrendo, pela criação de sentido (sensemaking). Assim, este estudo tem como objetivo principal entender qual é o fator gerador da incerteza imprevisível, quais são os fatores motivadores de sua identificação e quais práticas contribuem para a criação de sentido dessas incertezas em projetos inovadores. Para tal, foi feito um levantamento de campo, de maio a dezembro de 2011, no qual foram utilizados: um questionário para se obterem informações iniciais sobre os projetos que poderiam ser considerados inovadores e, posteriormente, uma entrevista aprofundada, direcionada por um roteiro com perguntas abertas, com um dos participantes do projeto. Foram enviados 152 convites para gestores de projetos, dos quais apenas 16 projetos atenderam aos requisitos exigidos, transformando-se em unidade de análise. A cada uma dessas unidades foram solicitados, também, pelo menos dois eventos imprevistos, materialização da incerteza imprevisível, obtendo-se a quantidade de 35. Esses eventos imprevistos foram considerados unidade de análise incorporada. A análise dos dados foi inicialmente qualitativa, com a geração de variáveis e categorias avaliadas estatisticamente; posteriormente, por meio de provas não paramétricas. Com base nas análises efetuadas, foi possível observar que o nível mais alto de eficiência na identificação da incerteza imprevisível - perceber a incerteza imprevisível previamente e ter menos impacto - ocorre preferencialmente em eventos com a percepção do sinal precoce feita pelo gerente do projeto ou pelo sponsor, no início do projeto; com a existência de um fator facilitador organizacional; com a utilização de um processo de criação coletiva de sentido. O nível mais baixo de eficiência - percepção tardia do evento imprevisto e existência de mais impacto - associa-se, porém, à causa externa da incerteza imprevisível, à ausência da percepção de um sinal precoce, à presença de um fator bloqueador à identificação com origem nas características pessoais, baixo número de atividades coletivas, entre outras. Recomenda-se incorporar o diagnóstico da incerteza na gestão de riscos dos projetos, buscar informações sobre as áreas incertas do projeto e interagir para socializar o conhecimento. Futuros estudos ampliados, para se obter um número maior de eventos e projetos, poderão permitir novas associações, assim como gerar um modelo multivariado. O uso de métodos alternativos de gestão de projetos inovadores também se mostra como um relevante tema de pesquisa. / The organizations enable innovations, engines of global development, through the projects. The more innovative a project, the greater is the probability of occurrence of unforeseeable uncertainties. The identification of early signs of a change would realize this kind of uncertainty, but for the early recognition of these early signs is necessary to give sense to them, sensemaking. Thus, this study aims to understand what the main factor that generates the unforeseeable uncertainty is, what the motivating factors for their identification are and what the practices that contribute to the creation of meaning of these uncertainties are on innovative projects. To this end, a field survey has been done, from May to December 2011, with: a questionnaire to obtain initial information about the projects that could be considered innovative, and subsequently an in-depth interview, guided by a script with open questions, with one of the project participants. 152 invitations were sent to project managers, of which only 16 projects met the requirements, becoming a unit of analysis. Each of these units was also requested at least two unforeseen events, materialization of unforeseeable uncertainty, thus obtaining 35 unanticipated events, which are considered the unit of analysis embedded. Data analysis was qualitative, the generation of categories and variables were evaluated statistically through non-parametric tests. Based on the analysis performed it was observed that the highest level of efficiency in identifying unforeseeable uncertainty - it was notice in advance and it had less impact - occurred preferentially when events have had the perception of early sign made by the project manager or the sponsor at the beginning of the project, with the existence of an organizational facilitator factor, and using a collective sensemaking process. Moreover, the lowest level of efficiency - late perception of the unforeseeable event and existence of more impact - were associated with the external cause of unforeseeable uncertainty, the lack of perception of an early signal, the presence of a blocking factor identification originated from the personal characteristics, low number of collective activities, among others. It is recommended to incorporate the diagnosis of unforseeable in risk management of projects, seeking information about the uncertain areas of the project and interacting to share the knowledge. Further studies extended to obtain a larger number of events and projects may allow new associations as well as generate a multivariate statistical model. The use of alternative methods of management of innovative projects to identify unforeseeable uncertainty also appears as a relevant research topic.