Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A tese tem o objetivo de apresentar a Pedagogia Cemiterial como proposta de ação a ser desenvolvida no ensino básico. A metodologia escolhida fundamenta-se na metanálise de dados do Censo de 2010, referentes ao perfil religioso dos/das adolescentes brasileiros e na pesquisa etnográfica virtual, através do monitoramento de Páginas Comunitárias do Facebook ligadas ao incentivo e extinção do comportamento autolesivo e suicidário entre adolescentes brasileiros (as) de 13-17 anos de idade. A estrutura foi dividida em quatro capítulos distintos. O primeiro apresenta o indivíduo, na fase da adolescência, a partir do modelo bioecológico de Bronfenbrenner e como este se insere nos estágios da fé e o Deus Google. O segundo verifica a percepção de morte e morrer do/da adolescente virtualizado (a), bem como sua interação com as Páginas Comunitárias do Facebook associadas ao incentivo e extinção do comportamento autolesivo. O terceiro analisa a importância do Ensino Religioso como componente curricular compatível ao desenvolvimento do tema da morte e do morrer no espaço escolar através da Pedagogia Cemiterial. Por fim, o último capítulo propõe um modelo de ação para a aplicação da Pedagogia Cemiterial com adolescentes no espaço escolar. / The goal of this dissertation is to present the Cemeterial Pedagogy as a proposal for action to be developed in primary education. The methodology chosen is founded on the meta-analysis of data from the 2010 Census, regarding the religious profile of Brazilian adolescents and on the virtual ethnographic research, through the monitoring of Community Facebook pages connected to the encouragement and extinction of self-injurious and suicidal behavior among Brazilian adolescents ages 13 to 17. The structure was divided into four distinct chapters. The first presents the individual, in the adolescent phase, based on the bio-ecological model of Bronfenbrenner and how this adolescent inserts him/herself in the faith stages and the Google God. The second verifies the perception of death and dying of the virtualized adolescent as well as his or her interaction with Community Facebook pages associated to the encouragement and extinction of self-injurious behavior. The third analyzes the importance of Religious Education as a curricular component that is compatible to the development of the theme of death and dying in the school space through the Cemeterial Pedagogy. Finally, the last chapter proposes a model of action for the application of the Cemeterial Pedagogy with adolescents in the school space.

Contexto: Pouco se sabe a respeito da prevalência e correlatos de autolesão deliberada em jovens de países em desenvolvimento. Além disso, existe uma escassez de estudos avaliando associações clínicas e com psicopatologia familiar ajustando-se para outras comorbidades, especialmente numa faixa etária mais jovem da população (dos 6 aos 14 anos). Objetivos: Nós investigamos a prevalência e as associações de autolesão deliberada em jo- vens desta faixa etária com fatores de risco demográficos (idade, gênero, status socioeconô- mico e etnicidade), clínico (diagnóstico psiquiátrico das crianças) e familiar (diagnóstico psiquiátrico materno) em um grande estudo comunitário no Brasil. Métodos: Participantes (n=2.508) e suas mães (n=2,295) da Coorte de Alto-Risco para Transtornos Psiquiátricos foram avaliados através da Development and Well Being Assess- ment (DAWBA) e Mini International Neuropsychiatric Interview (MINI) respectivamente. Autolesão atual (no último mês) e ao longo da vida foram estimadas, incluindo análises estratificadas por faixa etária. Regressões logísticas foram realizadas investigando o papel do diagnóstico clínico de crianças e adolescentes e da psicopatologia materna sobre as estimativas de autolesão, ajustando-se para potenciais fatores confundidores. Resultados: A prevalência de autolesão deliberada atual foi de 0,8% (0,6% para crianças e 1% para adolescentes) e ao longo da vida foi de 1,6% (1,8% e 1,5% respectivamente). Estas estimativas não variaram de acordo com a idade, sexo e etnicidade. No entanto, pertencer à classe média esteve associado a uma diminuição de 70% na probabilidade de se relatar um episódio de autolesão ao longo da vida comparando-se com a classe mais favorecida. Autolesão atual e ao longo da vida foram mais frequentes em jovens com Depressão Maior, Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e Transtorno Opositor Desafiante (TOD), mesmo em modelos múltiplos ajustado para variáveis demográficas e co- ocorrência de transtornos psiquiátricos. Além disso, a presença de transtorno de ansiedade nas mães esteve fortemente associada com autolesão deliberada recente e ao longo da vida em seus descendentes. Ao estratificar-se a análise por faixa etária, esta associação tornou- se não significativa para crianças com autolesão recente e adolescentes com autolesão ao longo da vida; ao passo que, especificamente em crianças, autolesão recente foi associada com transtorno de humor materno. Conclusão: A autolesão deliberada é um problema importante em crianças e adolescen- tes. Os diagnósticos de Depressão Maior, TDAH e TOD estão consistentemente associados com este comportamento, bem como ter uma mãe com um transtorno de ansiedade. Nos- sos resultados salientam a importância de se perguntar a respeito de comportamentos suicidas em jovens com comportamentos disruptivos, independentemente da comorbidade com depressão, e também realçam a necessidade de estratégias preventivas com um en- volvimento familiar. / Background: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in youngsters from low and middle-income countries. In addition, there is a shortage of studies evaluating clinical associations and family psychopathology adjusting for other comorbidities, especially in a younger age-group (from 6 to 14 years). Objectives: We investigated prevalence and associations of DSH in youngsters of that age range with demographic (age, gender, socioeconomic status and ethnicity), clinical (children psychiatric diagnosis) and familial risk factors (maternal psychiatric diagnosis) from a community-based study from Brazil. Methods: Participants (n=2,508) and their mothers (n=2,295) from the High Risk Co- hort for Psychiatric Disorders (HRC) were assessed through the Development andWell Be- ing Assessment (DAWBA) and the Mini International Neuropsychiatric Interview (MINI) respectively. Current (last month) and lifetime DSH were estimated, including analysis stratified by age-groups. Logistic regressions were performed investigating the role of youths’ clinical diagnoses and maternal psychopathology on prevalence estimates of DSH adjusting for potential confounding factors. Results: Prevalence of current DSH was 0.8% (0.6% for children and 1% for adolescents) and life-time DSH was 1.6% (1.8% and 1.5% respectively). These estimatives did not vary with age, gender and ethnicity. However, being from middle class was associated with a 70% decrease in the odds of reporting a lifetime episode of DSH comparing to the wealthiest class. Current and life-time DSH was more frequent in youth with Major Depression, Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), even in multiple models accounting for demographic variables and co- occurring psychiatric disorders. Anxiety in mothers was strongly associated with current and life-time DSH in the offspring but when stratifying by age-group this association becomes non-significant for children with current DSH and for adolescents with lifetime DSH, whereas current DSH was associated with maternal mood disorder specifically in young children. Conclusion: Diagnoses of Major Depression, ADHD and ODD are consistently associated with DSH as well as having a mother with anxiety disorder. Our results emphasize the necessity to ask about suicidal behavior in young people with disruptive behaviors, regard- less of comorbidity with depression, and also highlight the need for preventive strategies with a family component.

Many children diagnosed with autism spectrum disorder (ASD) engage in problem behaviors (e.g., aggression and self-injurious behavior) that present safety concerns for both the children themselves and others around them. Previous research has shown that treating precursor behaviors that precede problem behavior may prove to be an alternative, safer method for preventing and treating problem behavior. The present study used a multiple baseline design across subjects (n = 4) to assess the efficacy of relaxation interventions on reducing precursor behavior and preventing problem behavior in children with ASD. Researchers first identified precursor behaviors for all participants through observation. During the intervention phase, all four children were taught deep breathing relaxation exercises. After participants received relaxation training, researchers cued relaxation exercises when precursors occurred, and the frequency of precursor, problem, and on-task behavior was observed. Results showed that problem behavior decreased in all participants following the relaxation intervention. Additionally, for the majority of participants, precursor behavior decreased and on-task behavior increased post-intervention. Implications for practice and future research on interventions that target precursor behaviors are discussed.

Contexto: Pouco se sabe a respeito da prevalência e correlatos de autolesão deliberada em jovens de países em desenvolvimento. Além disso, existe uma escassez de estudos avaliando associações clínicas e com psicopatologia familiar ajustando-se para outras comorbidades, especialmente numa faixa etária mais jovem da população (dos 6 aos 14 anos). Objetivos: Nós investigamos a prevalência e as associações de autolesão deliberada em jo- vens desta faixa etária com fatores de risco demográficos (idade, gênero, status socioeconô- mico e etnicidade), clínico (diagnóstico psiquiátrico das crianças) e familiar (diagnóstico psiquiátrico materno) em um grande estudo comunitário no Brasil. Métodos: Participantes (n=2.508) e suas mães (n=2,295) da Coorte de Alto-Risco para Transtornos Psiquiátricos foram avaliados através da Development and Well Being Assess- ment (DAWBA) e Mini International Neuropsychiatric Interview (MINI) respectivamente. Autolesão atual (no último mês) e ao longo da vida foram estimadas, incluindo análises estratificadas por faixa etária. Regressões logísticas foram realizadas investigando o papel do diagnóstico clínico de crianças e adolescentes e da psicopatologia materna sobre as estimativas de autolesão, ajustando-se para potenciais fatores confundidores. Resultados: A prevalência de autolesão deliberada atual foi de 0,8% (0,6% para crianças e 1% para adolescentes) e ao longo da vida foi de 1,6% (1,8% e 1,5% respectivamente). Estas estimativas não variaram de acordo com a idade, sexo e etnicidade. No entanto, pertencer à classe média esteve associado a uma diminuição de 70% na probabilidade de se relatar um episódio de autolesão ao longo da vida comparando-se com a classe mais favorecida. Autolesão atual e ao longo da vida foram mais frequentes em jovens com Depressão Maior, Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e Transtorno Opositor Desafiante (TOD), mesmo em modelos múltiplos ajustado para variáveis demográficas e co- ocorrência de transtornos psiquiátricos. Além disso, a presença de transtorno de ansiedade nas mães esteve fortemente associada com autolesão deliberada recente e ao longo da vida em seus descendentes. Ao estratificar-se a análise por faixa etária, esta associação tornou- se não significativa para crianças com autolesão recente e adolescentes com autolesão ao longo da vida; ao passo que, especificamente em crianças, autolesão recente foi associada com transtorno de humor materno. Conclusão: A autolesão deliberada é um problema importante em crianças e adolescen- tes. Os diagnósticos de Depressão Maior, TDAH e TOD estão consistentemente associados com este comportamento, bem como ter uma mãe com um transtorno de ansiedade. Nos- sos resultados salientam a importância de se perguntar a respeito de comportamentos suicidas em jovens com comportamentos disruptivos, independentemente da comorbidade com depressão, e também realçam a necessidade de estratégias preventivas com um en- volvimento familiar. / Background: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in youngsters from low and middle-income countries. In addition, there is a shortage of studies evaluating clinical associations and family psychopathology adjusting for other comorbidities, especially in a younger age-group (from 6 to 14 years). Objectives: We investigated prevalence and associations of DSH in youngsters of that age range with demographic (age, gender, socioeconomic status and ethnicity), clinical (children psychiatric diagnosis) and familial risk factors (maternal psychiatric diagnosis) from a community-based study from Brazil. Methods: Participants (n=2,508) and their mothers (n=2,295) from the High Risk Co- hort for Psychiatric Disorders (HRC) were assessed through the Development andWell Be- ing Assessment (DAWBA) and the Mini International Neuropsychiatric Interview (MINI) respectively. Current (last month) and lifetime DSH were estimated, including analysis stratified by age-groups. Logistic regressions were performed investigating the role of youths’ clinical diagnoses and maternal psychopathology on prevalence estimates of DSH adjusting for potential confounding factors. Results: Prevalence of current DSH was 0.8% (0.6% for children and 1% for adolescents) and life-time DSH was 1.6% (1.8% and 1.5% respectively). These estimatives did not vary with age, gender and ethnicity. However, being from middle class was associated with a 70% decrease in the odds of reporting a lifetime episode of DSH comparing to the wealthiest class. Current and life-time DSH was more frequent in youth with Major Depression, Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), even in multiple models accounting for demographic variables and co- occurring psychiatric disorders. Anxiety in mothers was strongly associated with current and life-time DSH in the offspring but when stratifying by age-group this association becomes non-significant for children with current DSH and for adolescents with lifetime DSH, whereas current DSH was associated with maternal mood disorder specifically in young children. Conclusion: Diagnoses of Major Depression, ADHD and ODD are consistently associated with DSH as well as having a mother with anxiety disorder. Our results emphasize the necessity to ask about suicidal behavior in young people with disruptive behaviors, regard- less of comorbidity with depression, and also highlight the need for preventive strategies with a family component.

The human intruder test (HIT) is a noninvasive tool widely used for assessing anxiety in rhesus macaques (Macaca mulatta). This thesis explores the HIT procedure and applies it to a population of monkeys with a self-injurious behavioral pathology. Individual variation on this test can be used to assess anxiety and temperament. The first experiment of this thesis applied two different procedures of the HIT to 17 monkeys at UMass. Monkeys displayed little response to the intruder, and no significant differences were detected for the two procedures. To determine whether these responses were unique to the UMass monkeys, their behavior was then compared to the behavior of monkeys at three other primate facilities. UMass monkeys showed less of a reaction compared to monkeys at other facilities. They came to the front of the cage when the intruder entered the room whereas the monkeys at other facilities moved to the back and showed virtually no threats to the intruder. One possible explanation is the increased exposure to humans that UMass monkeys experience. Even though the human running the HIT was a stranger, monkeys at UMass may not perceive a new human in front of their cage to be a threat. The second experiment tested the hypothesis that monkeys with a record of self-injurious behavior (SIB) would be more anxious in response to the HIT. The cage-side version of the HIT was applied to 41 monkeys with a record of self-injurious behavior and 36 matched controls. In contrast to our prediction, SIB subjects spent significantly less time showing anxious behavior and aggressive behavior toward the intruder as well as spent more time in the front of the cage. SIB subjects showed the same range of behaviors as controls, but significantly less behavioral change overall. These data add to the evidence from experiment one that the HIT may not be a sufficient novelty test to elicit a response in monkeys who are more often exposed to different people. An alternative explanation is that SIB is associated with a depressive like syndrome based on reduced overall activity and possibly lowered affect during the stare phase.

Prior research suggests a greater degree of suicidality and self-harm behavior in those involved with criminal justice and forensic mental health systems. Such individuals also evidence increased exposure to early childhood adversity, which is often associated with suicide risk. Other significant predictors of suicidality have been noted within forensic populations, however, including indicators of specific psychopathology and situational and demographic factors. These populations present with overlapping risk factors that remain underexamined. In the current study, 182 persons residing in secure forensic psychiatric care following incidents of illegal and aggressive behavior were evaluated. Adverse childhood experiences and other empirically derived potential predictors of suicide attempts and self-harm were examined via binomial logistic regression. Findings indicate frequent experiences of early adversity across participants, and that a combination of race, individual adverse childhood experiences, number of biological children, and diagnoses of either posttraumatic stress disorder or borderline personality disorder were significant predictors of suicide attempts, self-harm behavior, and first hospitalization resulting from a suicide attempt. Clinical and research implications are discussed.

The present study was designed to investigate the role of sensory extinction and sensory reinforcement in the moti- vation of self-injurious behavior. The intervention was based on the assumption that each subject's SIB behavior was motivated by the sensory consequences of the behavior. A pre- assessment phase was used to select appropriate sensory ex- tinction devices and sensory reinforcing toys, although no appropriate sensory toys could be identified. Thus, treat- ment consisted solely of sensory extinction using a reversal design. Results showed that the sensory extinction devices reduced tactile stimulation of face slapping and pica for two developmentally disabled adults. Maintenance of treat- ment gains was programmed by fading the device both on the unit and in the experimental setting. This procedure was minimally successful in achieving long term reduction in SIB.

Självskadebeteende är relativt vanligt förekommande bland personer med psykisk ohälsa. Återhämtning är ett begrepp som beskriver hur en person kan återerövra och finna kvalitet i sitt liv trots svår sjukdom. Självskadebeteende innebär ett stort lidande för individen och påverkar närstående i personens omgivning negativt. Syftet med denna litteraturstudie var att utifrån egenerfarnas perspektiv sammanställa kunskap om vad som främjar återhämtning vid självskadebeteende. Metoden för studien var en integrerad litteraturöversikt, vilken utgick från 15 vetenskapliga artiklar och resulterade i 6 kategorier. I resultatet framkom att återhämtning hos personer med självskadebeteende kunde främjas av att komma till en vändpunkt, att vara i gemenskap med andra med liknande erfarenheter, att få stöd av närstående, att få professionellt stöd, att förstå och kunna hantera svåra känslor och handlingar, och av att finna inre styrka. Forskning visade även att det bland vårdpersonal florerade negativa attityder och brister i förhållningssättet mot personer med självskadebeteende, vilket motverkade deras återhämtning. Vår slutsats är att etiska reflektioner i arbetsgruppen, handledning, stöd, samt utbildningsinsatser till vårdpersonal är angeläget för att öka förståelsen och höja kompetensen angående självskadebeteende; samt för att minska negativa attityder och förbättra omvårdnaden av personer med självskadebeteende på ett sätt som främjar deras återhämtning.

Self-injurious behaviour (SIB) is recognised as a difficult behaviour to work/deal with and Community Support Workers (CSW‟s) who work with this behaviour may not have any formal training in the field of SIB. This study was therefore aimed at assessing the needs of CSW‟s working in the field of self-injurious behaviour amongst adolescents. A qualitative approach was used, the study was of an explorative nature and the researcher made use of purposive non-probability sampling to select respondents who were willing to participate in one-on-one semi-structured interviews with the researcher. This data was then analysed by the researcher making use of Creswell‟s spiral of analysis. The data collected was sorted into themes, sub-themes and categories and interpreted according to literature. The study identified that there are specific needs amongst CSW‟s who work with adolescent SIB in the specific areas of support and education/training. / Social Work / M. Diac. (Play Therapy)

本研究旨在探索自我傷害行為的動機、相關現象與情緒調節功能，並以此為基礎釐清該行為的情緒內涵，包括正向情緒強度特質、負向情緒強度特質、平靜滿足、經驗迴避程度及情緒調節能力。此外，本研究以因素分析探索自傷動機的分類，並以此分類結果為基礎，探討不同自傷動機所引發的情緒種類、情緒強度是否有所不同，在自傷行為的進行方式、次數上是否有顯著差異，並瞭解其無法適當應用的情緒調節能力為何。研究採用問卷調查的方式，研究對象為839位私立高中職生，包括日間部與夜間部，調查所得資料以描述統計分析、卡方檢定、相關分析、獨立樣本t檢定、相依樣本t檢定、因素分析、邏輯迴歸分析和階層迴歸分析進行處理。 本研究主要結果如下：首先支持自傷行為具有負向情緒調節的功能，而經驗迴避對於自傷行為的影響有限。其次，將自傷動機進行因素分析的結果發現可以將其分為四類：人際影響、負向感受的因應、避免失控和負向自我評價。在區分是否有自傷行為部分，情緒調節困難的不接納與無助能夠有效解釋自傷行為的有無；在影響自傷行為的頻率部分，自傷動機的強度與情緒調節困難的衝動失控能夠有效解釋自傷頻率的多寡。此外，本研究發現不同的自傷方式與不同的動機、所處的自傷前情緒有關，且不同的自我傷害動機在情緒強度特質、情緒調節困難、負向情緒和自傷方式上會呈現出不同的樣貌。 / The purpose of this study was to explore the motivations, the phenomenon, and the function of deliberate self-harm behaviors(DSH), and based on these, to clarify emotional contents behind DSH, including positive affect intensity, negative affect intensity, serenity, experiential avoidance and the emotional regulation ability. Besides, the study investigated the classification of the motivations of DSH by exploratory factor analysis, and accordingly discussed whether the affect categories and the affect intensity resulted from the motivations of DSH were different, and whether the motivations of DSH resulted in significantly different using of methods and frequencies, moreover, the emotional dysregulation. The study was based on questionnaires, and the participants were 839 students from a private senior high school , including vocational schools. Data obtained were analyzed by descriptive statistics, correlation analysis, t-test, factor analysis (FA), logistic regression, and hierarchical regression analysis. The main results were as follows: First, the results supported that DSH has regulative function on negative affect, and experiential avoidance influenced DSH limitedly. Second, according to factor analysis, the motivations of DSH were classified into four categories: interpersonal influence, negative affect modulation, control, and negative self-evaluation. Moreover, nonacceptance of the emotion dysregulation could successfully distinguish students with DSH from students with no history of DSH in the past 1 year. Both intensity of motivations and impulse of the emotion dysregulation could reliably predict DSH’s frequency. Finally, different methods of DSH correlated to different motivations and different emotions before DSH, and there were various representations of affect intensity, emotion dysregulation, and methods depends on different motivations.