L’influence d’Internet est profonde dans la vie personnelle et sociale, mais aussi dans le domaine éducatif. La révolution e-learning décrit la tendance de ces dernières années adoptée par le domaine de la formation. Le domaine de la santé doit s’adapter à cette nouvelle réalité en adoptant des outils numériques et en proposant la formation en ligne. Dans cette perspective, ce projet de recherche décrit le processus d’adaptation d’un programme de formation aux habiletés parentales destiné aux parents d’enfants avec autisme, dans une version en ligne. Ce projet de recherche est une monographie décrivant les étapes nécessaires pour la proposition de ce programme de formation parentale dans une version en ligne. En adoptant la méthode de la recherche design en éducation nous nous basons sur des théories et des concepts pertinents que nous utilisons pour notre contribution pratique ; celle de la conception pédagogique et de l’implantation d’un prototype mis à la disposition des utilisateurs. / The Internet has deeply influenced our personal and social life, as well as the educational field. The e-learning revolution refers to recent advances in the educational field and the usage of digital tools for teaching and the delivery of educational content. The field of health can profit by adapting to this new reality and by adopting digital tools suitable to offer online training. From this perspective, this research project describes the process of developing an online adaptation of a psycho-educational program targeted to parents of children with autism disorder. This thesis is a monograph describing the steps required to design and implement this training program in an online version. By adopting the method of Educational Design Research, we investigate relevant theories and concepts that are later used to guide our practical contribution : the instructional design and implementation of a prototype, that is implemented and tested with the first users.

A deficiência auditiva, definida como a perda total ou parcial da audição, vem sendo colocada pela literatura como uma variável que pode interferir na interação pais-filhos e, consequentemente, no desenvolvimento socioemocional da criança com perda auditiva. Neste sentido, estudos apontam a necessidade de se pensar em estratégias, aliadas à terapia fonoaudiológica, que contribuam para melhoria dessa interação. Neste contexto, propôs-se a realização de dois estudos, os quais ocorreram na clínica-escola de Fonoaudiologia da Faculdade de Odontologia campus de Bauru da Universidade de São Paulo. No estudo 1 o objetivo foi identificar, a partir da análise dos relatos dos participantes, se os cenários e personagens de uma ferramenta educacional denominada My World, a qual é utilizada durante a terapia fonoaudiológica de crianças com deficiência auditiva, podem ser utilizadas para o treinamento de habilidades sociais educativas cotidianas com mães de crianças e adolescentes com deficiência auditiva. Participaram deste estudo três mães de pré-adolescentes com perda auditiva com idade entre 10 e 11 anos. Os cenários e personagens da ferramenta foram apresentados às mães, que apontaram, por meio de um questionário, a contribuição da ferramenta para expressão dos comportamentos desempenhados em seu dia-adia. No estudo 2 desenvolveu-se um Programa de Treinamento de Habilidades Sociais Educativas no qual se fez uso da ferramenta educacional empregada no estudo anterior como um recurso de apoio para o desenvolvimento e/ou aprimoramento dessas habilidades. O objetivo geral deste estudo foi o de avaliar os efeitos do Programa no repertório de comportamentos das mães e dos filhos com deficiência auditiva. Para isso, utilizou-se do delineamento quase-experimental, no qual são formados dois grupos, controle (GC) e experimental (GE), e são realizados pré e pós-teste em ambos. Participaram quatro mães de pré-adolescentes com deficiência auditiva com idade entre 10 e 12 anos, sendo duas pertencentes ao GC e duas ao GE. Para avaliação do repertório de comportamento das mães e dos filhos no pré e no pós-teste foram aplicados o Roteiro de Entrevista de Habilidades Sociais Educativas Parentais (RE-HSE-P) e o Child Behavior Checklist (CBCL). As mães do GE responderam aos mesmos instrumentos quatro meses após o término do treinamento. O programa foi desenvolvido em 10 sessões, com duração de 1 hora e 30 minutos cada. Trabalhou-se temas relacionados à deficiência auditiva e às habilidades sociais (gerais e educativas) identificadas como em defasagem no préteste. Para análise dos dados do RE-HSE-P foi utilizado o método Jacobson Truax, que indicou mudanças confiáveis em relação ao incremento das habilidades sociais educativas positivas e das habilidades sociais infantis para o GE. Os dados do CBCL indicaram problemas de comportamento internalizantes no GE e em um participante do GC e problemas de comportamento externalizantes em um participante do GC na pré-intervenção. Tais dados mantiveram-se semelhantes na pós-intervenção e na avaliação follow up para o GE. Acredita-se que o desenvolvimento de Programas de Treinamento de Habilidades Sociais Educativas, tendo como suporte os cenários e personagens da ferramenta My World, pode se constituir em um importante aliado da terapia fonoaudiológica ao buscar contribuir para melhora do clima comunicacional no contexto familiar. / Hearing impairment, defined as the total or partial loss of hearing, has been described in various reports as one of the factors that can interfere in the interaction between parents and children and as a result, with the emotional and social development of children with hearing loss. In this case, studies showed the need of new strategies, combined with speech therapy, in order to improve this interaction. In this context, the development of two studies were proposed, which took place at the Clinical School of Speech and Hearing Therapy - Dental School of Bauru - Univesity of São Paulo. In study 1 the objective was to identify, by means of the speech of the participants, the scenarios and characters of an educational tool called My World, which is used in the speech therapy for children and adolescents with hearing loss, it is used to learn new ways to develop social skills as part of the daily routine between children and parents. Three mothers of pre-adolescents with hearing loss aged 10 to 11 years old participated. The tools scenaries and characters were presented to the mothers, who responded in a questionaire their opnions on how this tool had helped them interact with their childrens activities and behaviour on a daily basis. Study number 2 was developed using the skills and tools learnt in study number 1, which was used as a support resource to enhance and develop positive parental practices. The main aim of this study was to evaluate the effects of the intervention on the range of behaviors between mothers and sons with hearing loss. Therefore, this experimental design was tested by two groups, control (CG) and experimental (EG), and they were tested before and after the experiment took place. Four mothers of pre-adolescents with hearing loss aged 10 to 12 years old beloging to the groups GC and two to the group GE were used.To evaluate the range of behavior of mothers and their sons in the pre and post-test, the Roteiro de Entrevista de Habilidades Sociais Educativas Parentais (RE-HSE-P) and the Child Behavior Checklist (CBCL) were applied. The mothers of the EG responded to the tools four months after the end of the intervention. The program was developed in 10 sessions, each lasting 1 hour and 30 minutes each. The topics developed were hearing impairment and social skills and parental practices identified as inadequate in the pre-test. For this data analysis of RE-HSE-P, the Jacobson Truax method was used, which indicated reliable changes in relation to the incremental positive parental practice and infantile social skills for the EG. The CBCL data indicated internalizing behavior problems in the EG and a participant in the CG and externalizing behavior problems in a participant of the CG in the pre intervention stage. This data remained similar in the post-intervention data and in the follow-up evaluation for the EG. It is believed that the implementation of semi-structured interventions to develop positive parental practices, supported by scenarios and characters of the My World tool, can constitue an importante ally of speech-language therapy contributing to the climate of improved communications within the family context.

A deficiência auditiva, definida como a perda total ou parcial da audição, vem sendo colocada pela literatura como uma variável que pode interferir na interação pais-filhos e, consequentemente, no desenvolvimento socioemocional da criança com perda auditiva. Neste sentido, estudos apontam a necessidade de se pensar em estratégias, aliadas à terapia fonoaudiológica, que contribuam para melhoria dessa interação. Neste contexto, propôs-se a realização de dois estudos, os quais ocorreram na clínica-escola de Fonoaudiologia da Faculdade de Odontologia campus de Bauru da Universidade de São Paulo. No estudo 1 o objetivo foi identificar, a partir da análise dos relatos dos participantes, se os cenários e personagens de uma ferramenta educacional denominada My World, a qual é utilizada durante a terapia fonoaudiológica de crianças com deficiência auditiva, podem ser utilizadas para o treinamento de habilidades sociais educativas cotidianas com mães de crianças e adolescentes com deficiência auditiva. Participaram deste estudo três mães de pré-adolescentes com perda auditiva com idade entre 10 e 11 anos. Os cenários e personagens da ferramenta foram apresentados às mães, que apontaram, por meio de um questionário, a contribuição da ferramenta para expressão dos comportamentos desempenhados em seu dia-adia. No estudo 2 desenvolveu-se um Programa de Treinamento de Habilidades Sociais Educativas no qual se fez uso da ferramenta educacional empregada no estudo anterior como um recurso de apoio para o desenvolvimento e/ou aprimoramento dessas habilidades. O objetivo geral deste estudo foi o de avaliar os efeitos do Programa no repertório de comportamentos das mães e dos filhos com deficiência auditiva. Para isso, utilizou-se do delineamento quase-experimental, no qual são formados dois grupos, controle (GC) e experimental (GE), e são realizados pré e pós-teste em ambos. Participaram quatro mães de pré-adolescentes com deficiência auditiva com idade entre 10 e 12 anos, sendo duas pertencentes ao GC e duas ao GE. Para avaliação do repertório de comportamento das mães e dos filhos no pré e no pós-teste foram aplicados o Roteiro de Entrevista de Habilidades Sociais Educativas Parentais (RE-HSE-P) e o Child Behavior Checklist (CBCL). As mães do GE responderam aos mesmos instrumentos quatro meses após o término do treinamento. O programa foi desenvolvido em 10 sessões, com duração de 1 hora e 30 minutos cada. Trabalhou-se temas relacionados à deficiência auditiva e às habilidades sociais (gerais e educativas) identificadas como em defasagem no préteste. Para análise dos dados do RE-HSE-P foi utilizado o método Jacobson Truax, que indicou mudanças confiáveis em relação ao incremento das habilidades sociais educativas positivas e das habilidades sociais infantis para o GE. Os dados do CBCL indicaram problemas de comportamento internalizantes no GE e em um participante do GC e problemas de comportamento externalizantes em um participante do GC na pré-intervenção. Tais dados mantiveram-se semelhantes na pós-intervenção e na avaliação follow up para o GE. Acredita-se que o desenvolvimento de Programas de Treinamento de Habilidades Sociais Educativas, tendo como suporte os cenários e personagens da ferramenta My World, pode se constituir em um importante aliado da terapia fonoaudiológica ao buscar contribuir para melhora do clima comunicacional no contexto familiar. / Hearing impairment, defined as the total or partial loss of hearing, has been described in various reports as one of the factors that can interfere in the interaction between parents and children and as a result, with the emotional and social development of children with hearing loss. In this case, studies showed the need of new strategies, combined with speech therapy, in order to improve this interaction. In this context, the development of two studies were proposed, which took place at the Clinical School of Speech and Hearing Therapy - Dental School of Bauru - Univesity of São Paulo. In study 1 the objective was to identify, by means of the speech of the participants, the scenarios and characters of an educational tool called My World, which is used in the speech therapy for children and adolescents with hearing loss, it is used to learn new ways to develop social skills as part of the daily routine between children and parents. Three mothers of pre-adolescents with hearing loss aged 10 to 11 years old participated. The tools scenaries and characters were presented to the mothers, who responded in a questionaire their opnions on how this tool had helped them interact with their childrens activities and behaviour on a daily basis. Study number 2 was developed using the skills and tools learnt in study number 1, which was used as a support resource to enhance and develop positive parental practices. The main aim of this study was to evaluate the effects of the intervention on the range of behaviors between mothers and sons with hearing loss. Therefore, this experimental design was tested by two groups, control (CG) and experimental (EG), and they were tested before and after the experiment took place. Four mothers of pre-adolescents with hearing loss aged 10 to 12 years old beloging to the groups GC and two to the group GE were used.To evaluate the range of behavior of mothers and their sons in the pre and post-test, the Roteiro de Entrevista de Habilidades Sociais Educativas Parentais (RE-HSE-P) and the Child Behavior Checklist (CBCL) were applied. The mothers of the EG responded to the tools four months after the end of the intervention. The program was developed in 10 sessions, each lasting 1 hour and 30 minutes each. The topics developed were hearing impairment and social skills and parental practices identified as inadequate in the pre-test. For this data analysis of RE-HSE-P, the Jacobson Truax method was used, which indicated reliable changes in relation to the incremental positive parental practice and infantile social skills for the EG. The CBCL data indicated internalizing behavior problems in the EG and a participant in the CG and externalizing behavior problems in a participant of the CG in the pre intervention stage. This data remained similar in the post-intervention data and in the follow-up evaluation for the EG. It is believed that the implementation of semi-structured interventions to develop positive parental practices, supported by scenarios and characters of the My World tool, can constitue an importante ally of speech-language therapy contributing to the climate of improved communications within the family context.

Behavoral Parental Training, BPT, är en stödinsats där föräldrar till barn som ofta hamnar i konflikter lär sig strategier som minskar både föräldrars stress och barnens risk för sociala problem. Denna uppsats frågar vilka kvalitéer som kännetecknar föräldrarnas lärande genom BPT och vill därför studera, beskriva och förstå detta lärande. Lärande förstås här som en förändrad relation till en del av omvärlden. Utifrån forskningsansatsen och metodologin ”kontextuell analys” görs en fallbaserad studie där 2 kursledare och 4 deltagare delar sina erfarenheter i kvalitativa intervjuer. När fallen jämförs framträder en dominerande bild av föräldrar som förändrat beteende, tankar och känslor och fått en mer positiv syn på sig själva och färre konflikter i relation till sina barn. Dessa förändringar kommer ur samtal, instruktioner, praktiska läxor och andra aktiviteter. Ett fall avviker då det endast visar ett begränsat lärande och att variationen är större än vad som enkelt låter sig generaliseras.

Studien, en multicenterstudie, som genomfördes vid barnpsykiatriska mottagningar i mellansverige, med kvantitativ ansats och konsekutivt urval ämnade utforska om ett deltagande i föräldrautbildningen STRATEGI för omsorgspersoner till barn med ADHD påverkar synen på familjefunktionen. Den ämnade också undersöka om självskattningsskalan SCORE- 15 som ännu inte validerats för svenska förhållanden kan urskilja en klinisk population i Sverige och valideras med hjälp av instrumentet Familjeklimat. Datainsamling skedde via upprepade mätningar via standardiserade protokoll i samband med föräldrautbildningen STRATEGI. Resultaten visade att deltagande i föräldrautbildningen STRATEGI kan ha effekt på synen på familjefunktionen för de omsorgspersoner som rapporterar högst problemtyngd. Resultaten i studien korrelerar väl med mätningarna från tidigare studier av kliniska populationer av O'Hanrahan (2016). Validiteten hos SCORE-15 tycks vara hög. SCORE-15 tycks fungera för en svensk population och bedöms kunna urskilja en klinisk population. SCORE-15 visar sig vara ett användbart kliniskt instrument. / The study, a multicenter study, conducted at the child psychiatric clinics in central Sweden, with a quantitative approach and consecutively selection aimed to explore whether a participation in the parental training programme STRATEGI for caregivers to children with ADHD affects the perception of family function. It meant also to examine whether self-rating scale SCORE-15 can distinguish a clinical population in Sweden and be validated using the instrument Familjeklimat. Data collection was done through repeated measurements using standardized protocols in connection as the caregivers participated in the programme. The results showed that participation in the parental education programme STRATEGI could have an effect on the perception of family function for the caregivers who reported having the largest impact of problems. The results of the study correlates well with measurements from previous studies of clinical populations (O'Hanrahan (2016). The validity of the SCORE-15 appear to be high. SCORE-15 seems adapted to a Swedish population and is expected to distinguish a clinical population. SCORE-15 is therefore a useful clinical instrument.

Made available in DSpace on 2016-04-29T13:18:16Z (GMT). No. of bitstreams: 1 Eva Maria dos Reis Gomes.pdf: 2760302 bytes, checksum: b951ddba4704ea03302954d9dc409f9e (MD5) Previous issue date: 2009-08-07 / Severa1 studies have demonstrated that parenting works as contexts for 1eaming both pro-socia1 and inadequate chi1dren's behavior. Exercising these practices demands specific abi1ities, which are absent in the parents' repertoires that present difficulties in teaching, and maintaining the pro-socia1 behavior, controlling their chi1dren's behavior prob1ems. These abi1ities have been taught during training programs with parents enabling them to act efficient1y on the re1ationship with their chi1dren. The present study has ana1yzed the modalities of specific contingent arrangements between the caretaker's actions, and the 1eaming and maintenance of the chi1d's behavior. Through the manipu1ation of a certain category of classes of the caretakers' positiV'eresponses, it was tried to observe the co-variation possibi1ities in the other categories of answers of both invo1ved in the díade. Three pairs of caretaker-chi1d, that participated in the study were se1ected in a service of parents' orientation in an inner city of Minas Gerais. Three movie cameras,a mini tape recorder and a Standardized Observation Codes - SOC IlI, were used as instruments. The procedure was divided in three stages: base 1ine, intervention and post intervention. During the all the study, dai1y registration of home interactions between caretaker and child was take in audio and video, 24 hours a day, ranging from 12 to 18 days in accordance with each dyad design, due to a mu1tip1ebase 1ine among participants . The episodes of interaction that contaíned at 1east an uninterrupted hour of re1ationship between caretaker-chi1d were se1ected. In the base 1ine period notes were IDade, and they produced the data used during th,e iptervention. Right after the base tine, portions of interaction of each fami1y in whicll a positive interaction had happened between the son's behavior and the mother's subsNuent answer were se1ected. Those portions were reproduced in six sessions of individual intervention in which the researcher together with the caretaker ana1yzed the effects of the caretaker's positive actions on her child's answers. Then for three more days, data were collected without intervention (post-intervention period). Caretakers' and chi1dren's behaviors were registered during the who1e e1apsing time ofthe study. Th~se behaviors were classified as positive, aversive and neutral. The data indicate that in ~e three pairs the caretakers presented preponderance of aversive andneutra1 behaviors during the base 1ine. During and after the intervention, those types of behaviórs decreased in occurrence and they noted1y increased the caretakers' positive behaviors. The post-intervention data show the continuation of positive response of the caretakers and their chi1dren during the observed period. This study points out that trainings based on1y on the se1ection of caretakers' positive responses can be a good strategy for the improvement of their chi1dren's social behaviors / Vários estudos têm demonstrado que as práticas parentais funcionam como contextos para aprendizagem de comportamentos tanto pró-sociais quanto inadequados das crianças. O exercício destas práticas exige habilidades específicas, ausentes nos repertórios dos pais que apresentam dificuldades para ensinar e manter o comportamento pró-social e controlar os comportamentos problemas de suas crianças. Estas habilidades têm sido ensinadas em programas de treinamento com pais habilitando-os para atuar assertivamente na relação com os filhos. O presente estudo analisou as modalidades de arranjos contingentes específicos entre ações do cuidador e a aprendizagem e manutenção do comportamento da criança. Através da l1)anipulação de uma determinada categoria de classes de respostas positivas das cuidadoras, procurou-se observar as possibilidades de co-variação nas outras categorias de respostas de ambos os envolvidos na díade. Participaram do estudo três díades, cuidadoracriança, selecionadas em um serviço de orientação de pais de uma cidade do interior de Minas Gerais. Utilizou-se como instrumentos três câmaras filmadoras e um mini gravador. Os comportamentos das díades foram categorizados por meio do Standardized Observation Codes, soe 111,3a revisão. O procedimento foi dividido em três etapas: linha de base, intervenção e pós intervenção. Durante todo o estudo realizou-se registro diário em áudio e vídeo de interações domiciliares entre cuidadora e ,criança, 24 horas ao dia, variando no período de 12 a 18 dias de acordo com o delineamento determinado para cada díade, em linha de base múltipla. Selecionaram-se os episÓdios da inFeração que contivessem pelo menos uma hora ininterrupta de relação cuidadora-criança. No período de linha de base foram realizadas observações que deram origem aos dados utilizados durante a intervenção. Em seguida à linha de base, selecionavam-se trechos de interação de cada família nos qúais havia ocorrido uma interação positiva entre o comportamento do filho e a subseqüente resposta da mãe. Esses trechos eram reproduzidos em seis sessões de intervenção individuais nas quais a pesquisadora analisava com a cuidadora os efeitos das ações positivas da cuidadora sobre as respostas de sua criança. Em seguida, por mais três dias, foram coletados dados sem intervenção (período pós-intervenção). Foram registrados comportamentos das mães e das cri~nças durante todo o decorrer do experimento os quais foram classificados como positivos, aversivos e neutros. Os dados indicam que nas três díades as cuidadoras apresentaram preponderância de comportamentos aversivos e neutros durante a linha de base. Durante e depois da intervenção, essas categorias de comportamentos diminuíram em ocorrência e aumentaram notadamente os comportamentos positivos das cuidadoras Os dados de pós-intervenção mostram também uma manutenção do responder positivo da mãe e da criança durante o período observado. Este estudo aponta que treinamentos baseados apenas em seleção de respostas positivas dos cuidadores podem ser uma boa estratégia para a melhoria de comportamentos sociais das suas crianças

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.