Efeito de instruções e de treino parental sobre comportamentos observados em cuidadores e em crianças com câncer durante sessão de punção venosa para quimioterapia ambulatorial

Os procedimentos invasivos recorrentes no tratamento do câncer na criança têm-se mostrado o momento de maior sofrimento tanto para o paciente quanto para o cuidador. Durante estes procedimentos, como no caso da punção venosa, grande parte das crianças apresenta reações caracterizadas como distresse comportamental. Intervenções comportamentais têm sido desenvolvidas com o objetivo de diminuir este distresse, podendo utilizar como agentes os próprios cuidadores das crianças. Esta pesquisa teve como objetivo analisar os efeitos de instrução e de treino parental sobre comportamentos observados em cuidadores e em crianças com diagnóstico de câncer durante procedimento de punção venosa em ambulatório. Foram selecionados nove cuidadores de crianças em tratamento quimioterápico em um hospital especializado em Belém-PA. Para a coleta de dados foram utilizados: Roteiro de entrevista, Questionário Sociodemográfico, Instrumento de Avaliação das Relações Familiares (Parental Bonding Instrument [PBI]), Child Behavior Checklist (CBLC), Protocolo de observação direta dos comportamentos da criança e do cuidador, Escala de Avaliação Comportamental, Manual de orientação para cuidadores sobre punção venosa em crianças e Protocolo de treino parental. Os participantes foram submetidos a uma dentre três condições: (1) Rotina, (2) Manual de Orientação ou (3) Treino Parental. A coleta de dados foi realizada por meio de entrevista e de quatro sessões de observação direta do comportamento. Os comportamentos das crianças foram classificados como concorrentes e não concorrentes. Os comportamentos dos cuidadores foram classificados como monitoria positiva, monitoria negativa e negligência. Os resultados sugerem que, na Condição Rotina, os participantes (cuidadores) não variaram seus comportamentos ao longo das sessões, com dois participantes mantendo alta frequência de comportamentos negligentes e um participante mantendo monitoria positiva. Na Condição Manual, observou-se mudança de comportamento em dois cuidadores como efeito imediato à utilização do manual, mas não em longo prazo. Na Condição 3, na qual os cuidadores foram submetidos ao Protocolo de treino parental, observou-se aumento na frequência de monitoria positiva em curto e longo prazo. Com relação às crianças, os resultados indicaram maior frequência de comportamentos não concorrentes, independente da condição a que o cuidador foi submetido. A maioria dos cuidadores foi classificada no PBI com estilo parental permissivo, confirmando a literatura sobre cuidadores de crianças com doenças crônicas. Ocorreram relatos de generalização das habilidades treinadas para contextos fora do hospital. Conclui-se que o uso do manual aumentou a aquisição de conhecimentos sobre punção venosa mas não foi suficiente para a manutenção de mudança de comportamentos. Por outro lado, o uso de treino parental mostrou-se eficaz na mudança de comportamentos (a longo prazo), assim como no desenvolvimento de novas habilidades sociais. Discute-se a importância do estilo parental como fator de proteção à criança com câncer.

Efeitos de instruções, treino de relato verbal e treino de automonitoração sobre o seguimento de regras nutricionais em crianças com obesidade ou sobrepeso

A obesidade é uma doença crônica definida como o acúmulo de gordura anormal ou excessiva que pode prejudicar a saúde. Torna-se necessário intervir no seu combate e prevenção, especialmente entre as crianças. A literatura da área indica que, em geral, intervenções apenas com crianças ou com cuidadores, ou com ambos, apresentam resultados favoráveis. Neste estudo foram avaliados os efeitos de instruções, do treino de relato verbal (TRV) e do treino de automonitoração (TA), aplicados com e sem a participação do cuidador principal, sobre o seguimento de regras nutricionais em crianças com obesidade ou sobrepeso. Participaram duas crianças (9 e 11 anos) e suas cuidadoras primárias. O ambiente foi um consultório do ambulatório de psicologia de um hospital universitário. Foram utilizados: Prontuário dos pacientes, Roteiro de entrevista inicial, Inventário de estilos parentais (IEP), Roteiro de entrevista 2, Recordatório 24 horas, Manual informativo sobre obesidade e alimentação saudável, Teste de conhecimentos, Protocolo de orientação nutricional para crianças, Protocolo de automonitoração, Roteiro para análise do protocolo de automonitoração, jogos e brinquedos e Roteiro de entrevista final. O procedimento de coleta ocorreu em 10 sessões distribuídas em aproximadamente 15 semanas e consistiu de análise dos prontuários; entrevista no ambulatório com o cuidador e com a criança para assinatura do Termo de Consentimento Livre e Esclarecido, aplicação do roteiro de entrevista inicial e do IEP; inserção dos participantes em uma de duas condições (Condição 1, apenas a criança [P1] presente; Condição 2, tanto a criança [P2] quanto seu cuidador primário [C2] estavam presentes); aplicação do Roteiro de entrevista 2 seguido da aplicação do Recordatório 24 horas (Linha de Base 1 [LB1]); aplicação do Manual informativo sobre obesidade e alimentação saudável e do Teste de conhecimentos; TRV (Linha de Base 2 [LB2]); TA; entrevista de acompanhamento e entrevista de encerramento. Quanto aos efeitos das instruções, os resultados indicam que P1 manteve a mesma classificação em todos os itens, enquanto P2 melhorou seu desempenho nos itens conhecimento e seguimento das orientações nutricionais e C2 apresentou melhora no conhecimento sobre obesidade ao final do estudo. Os Índices de adesão à dieta obtidos por P2 foram mais elevados do que os obtidos por P1 em todas as fases da pesquisa. Comparando-se a média obtida pelos dois participantes em LB1 e LB2, observou-se aumento de 39,77% indicando mudança com significância clínica após intervenção. A combinação de variáveis nesta pesquisa mostrou-se favorável a ampliação do repertório dos participantes em relação ao comportamento alimentar, tendo como referência o próprio sujeito ao longo do estudo. Os resultados sugerem que há maior eficácia quando crianças e cuidadores são alvo de intervenção.

Práticas parentais de mães de bebês: a influência de variáveis maternas e do bebê

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Práticas educativas de mães de bebês: efeitos de um programa de intervenção

This research aims to describe the effects of an intervention program focusing on parenting practices of mothers of babies by comparing pre- and post -test (intragroup comparison) performed with groups of adolescent mothers and adult mothers (intergroup comparison). Participants were 40 mothers, 20 adolescents and 20 adults. To collect data we used the Parenting Styles Inventory for Mothers of Babies (IEPMB), applied before and after the intervention, which is characterized for ten weekly meetings on topics related to the cycle of human development and parenting practices. The results showed significantly better educational practices for adolescent mothers compared to adult mothers especially in the first evaluation conducted. The intervention group was effective for most participants, adults and adolescents, who improved their parenting practices or remained appropriate. It discusses the importance of interventional groups to improve parenting practices of mothers of babies.

História de vida, concepções sobre a família, maternidade e práticas parentais de mães atendidas pelo judiciário por denúncia de negligência materna

Pós-graduação em Saúde Coletiva - FMB

Laços de afeto: as homoparentalidades pela via da adoção

Pós-graduação em Psicologia - FCLAS

Relações entre os estilos parentais e juízo moral de adolescentes

Pós-graduação em Psicologia - FCLAS

Os efeitos da matriz bioparental nos processos de adoção de crianças e adolescentes

This paper is the result of a homonymous scientific research, funded by CNPq-PIBIC where we understand the adoption process as a process of dissidence in relation to the bio-parental matrix. Founded on a heteronormative naturalization of human sexuality - which presupposes a continuum and naturalized organization among sex / gender / desire – this bioparental matrix sets the binary relation of distinction between the legitimate/illegitimate child as their origin or not arising from “blood ties”. Considering our experience in the Project developed at the Department of Clinical Psychology at UNESP, Assis, SP called “Ties of love: Adoption, Gender, Citizenship and Rights”, we prepared a content analysis - as proposed by Bardin (1977) -, of transcripts of psychological sessions that were made from 2005 to 2012 in the "Center for Research and Applied Psychology “Dra. Betti Katzenstein. Our general objective was to analyze the effects of the bioparental matrix and its impact on children/adolescents and their families as well as estimate the possibilities of escape to the subjection to this bioparental matrix. The results showed us several aspects that may be significant for understanding the discursive crossings related to the practice of adoption. It was observed that there is still a great ambivalence pervading this theme, revealing that there is a discrepancy between what we say and what we do in relation to practices of caring among the adopted children. On the one hand, it was noticed that relatives rationally seek to enhance the bonding of the “emotional ties”, but their practices and beliefs, are still supported in modes of subjectivation that prioritize the biological discourse. This fact reveals a strained and conflictive field that probably weaknesses those families seeking to prioritize the ties of affection. However, as can be seen in this study, it is comforting and motivating to realize the power of resistance of individuals to absolute truths that govern their ways of feeling, affiliating and/ or exert their parenting.

Relação entre os estilos parentais e o desempenho intelectual de crianças com pumblemia

This study investigated the children s intellectual development with high and low blood lead level with the parenting styles in the respective interactions with these children. The WISC-III and IEP (Parenting Styles Inventory) were used. Were studied 40 children, with ages among 7 to 13 years old, and 40 parents, who lived in a risk spot near the contamination area. The children were divided into two groups: G1 – 20 children with blood lead level above 10µg/dl; and G2 – 20 children with blood lead level lower than 10µg/dl. The results indicated damages on WISC-III for the children with Pb-S than10µg/dl and prevalence of practices educational negatives were found in both groups, with statistical difference (5%). The environmental stimulation can minimize the damages caused by the lead poisoning, and the parent s positive educative practice can contribute as modulator of the lead s effect.

Práticas parentais maternas e a influência de variáveis familiares e do bebê

Parenting practices can be understood as the behaviors emitted by parents to educate and socialize their children. The present study investigates the influence of the parenting practices according to the baby sex and age, family configuration and number of children. For this, 50 adult mothers were questioned according to the Parental Styles Inventory for Mothers with Babies (IEPMB). An analysis with the results indicates that mothers with baby girls normally uses a more Positive Monitoring practice when compared with mothers with boy babies. A positive correlation (r = +0.54, p <0.001) was found, between the age of the baby and the practice of negligence, meaning that there is an increase of the usage in the practical as the baby age increases. Also a significant difference (p = 0.04) in the Inconsistent Punishment practice pointed out to the fact that mothers from nuclear families seem to use this practice more than mothers from other family configurations. And multiparous mothers use more Physical Abuse practical than primiparous mothers (p = 0.02). Concerning this analysis, we support a discussion in the present work about the importance of interventions that focus on the effect of specific positive practices, the reduction of negative practices and the role of the network support on the children development.

Estilos e práticas parentais de mães adolescentes: um programa de intervenção

The aim of this study was to describe the styles and parenting practices of adolescent mothers to evaluate the influence of participation in an intervention program of parental practices. 14 adolescent mothers contributed with this research. For the evaluation was used the Inventory of Parenting Styles of Babies Mothers (IEPMB). The results showed that the participants before beginning the group had an average of Parental Style Good, after participating in the group participants had an average of Parenting Style Great. The intervention group presented effectively promoting the acquisition and/or maintenance of positive parenting practices and the reduction in negative practices.

Práticas parentais e repertório infantil: caracterização da demanda por atendimento e predição de abandono

The objective of this paper is: (a) to characterize behaviors of the 47 primary caregivers and their children who sought for psychological services, (b) to compare groups: abandonment x participants; boy x girl. The participants answered the interview inventory (RE-HSE-P), inventory (IHS-Del Prette) and scales (Rathus Assertiveness Scale and CBCL). For the results, 60% of the children presented behavior problems at clinical level. There is correlation between negative parenting practices and behavior problems and social skills among caregivers (HSE-P) and children. People who drop out psychological services, present lower frequence and quality of HSE-P and more behavior problems. There are not differences in comparisons between boys and girls. The results highlight the importance of evaluating clinical context, the contingent behaviors of parents and children employing different instruments in order to describe the relationship between behavior problem and potentialities of both interlocutors socially interacting.

Assessment of the effects of a parental intervention with mothers of children with internalizing problems

The present study assesses the effects of a semi-structured intervention held exclusively with mothers and its effects on internalizing problems, social skills of children, and positive and negative parenting practices. The single subject experimental design with three participants was adopted. The three mothers had, in baseline, children diagnosed with internalizing and externalizing problems. The instruments used were CBCL, RE-HSE-P, QRSH-Pais and PHQ-9, they were performed in baseline, pre-test, post-test, and follow-up assessments. The intervention held is characterized as semi-structured for it promotes the development of parental practices that are considered positive by the literature on behavior problems, however, contingently to the difficulties and demands of each case. The number of sessions performed for each case was 14, 15 and 17, which lasted about two hours each. The data were analyzed according to the instruments' norms and under the perspective of each singular case. The results found include remission of internalizing problems, increase in frequency of the children's social skills, increase in frequency of positive parental practices, and decrease in variability of negative parental practices. All the improvements were maintained on the six months follow-up, with the exception of variability on the negative parental practices of one client. Results are discussed in a context of mental health promotion and indicate the need for strategies to prevent internalizing problems in children.

Efeitos de instrução e de treino parental em cuidadores de crianças com câncer

Esta pesquisa teve como objetivo analisar os efeitos de instrução e de treino parental sobre comportamentos observados em cuidadores e em crianças com diagnóstico de câncer durante procedimento de punção venosa em ambulatório. Participaram nove cuidadores em três condições (Rotina, Manual e Treino). Fez-se análise de características familiares, estilo parental, efeitos de um manual de instruções e de treino parental, com sessões de observação direta do comportamento durante punção venosa. Os resultados apontam efeito positivo do manual para mudança de comportamento em curto prazo. Após treino parental, observou-se aumento nas taxas de monitoria positiva do cuidador, com relatos de generalização desses comportamentos para outros contextos. Discute-se a importância do estilo parental como fator de proteção à criança com câncer.

Parental Ethnotheories of Child Development: Looking Beyond Independence and Individualism in American Belief Systems

Over the past several decades, the topic of child development in a cultural context has received a great deal of theoretical and empirical investigation. Investigators from the fields of indigenous and cultural psychology have argued that childhood is socially and historically constructed, rather than a universal process with a standard sequence of developmental stages or descriptions. As a result, many psychologists have become doubtful that any stage theory of cognitive or socialemotional development can be found to be valid for all times and places. In placing more theoretical emphasis on contextual processes, they define culture as a complex system of common symbolic action patterns (or scripts) built up through everyday human social interaction by means of which individuals create common meanings and in terms of which they organize experience. Researchers understand culture to be organized and coherent, but not homogenous or static, and realize that the complex dynamic system of culture constantly undergoes transformation as participants (adults and children) negotiate and re-negotiate meanings through social interaction. These negotiations and transactions give rise to unceasing heterogeneity and variability in how different individuals and groups of individuals interpret values and meanings. However, while many psychologists—both inside and outside the fields of indigenous and cultural psychology–are now willing to give up the idea of a universal path of child development and a universal story of parenting, they have not necessarily foreclosed on the possibility of discovering and describing some universal processes that underlie socialization and development-in-context. The roots of such universalities would lie in the biological aspects of child development, in the evolutionary processes of adaptation, and in the unique symbolic and problem-solving capacities of the human organism as a culture-bearing species. For instance, according to functionalist psychological anthropologists, shared (cultural) processes surround the developing child and promote in the long view the survival of families and groups if they are to demonstrate continuity in the face of ecological change and resource competition, (e.g. Edwards & Whiting, 2004; Gallimore, Goldenberg, & Weisner, 1993; LeVine, Dixon, LeVine, Richman, Leiderman, Keefer, & Brazelton, 1994; LeVine, Miller, & West, 1988; Weisner, 1996, 2002; Whiting & Edwards, 1988; Whiting & Whiting, 1980). As LeVine and colleagues (1994) state: A population tends to share an environment, symbol systems for encoding it, and organizations and codes of conduct for adapting to it (emphasis added). It is through the enactment of these population-specific codes of conduct in locally organized practices that human adaptation occurs. Human adaptation, in other words, is largely attributable to the operation of specific social organizations (e.g. families, communities, empires) following culturally prescribed scripts (normative models) in subsistence, reproduction, and other domains [communication and social regulation]. (p. 12) It follows, then, that in seeking to understand child development in a cultural context, psychologists need to support collaborative and interdisciplinary developmental science that crosses international borders. Such research can advance cross-cultural psychology, cultural psychology, and indigenous psychology, understood as three sub-disciplines composed of scientists who frequently communicate and debate with one another and mutually inform one another’s research programs. For example, to turn to parental belief systems, the particular topic of this chapter, it is clear that collaborative international studies are needed to support the goal of crosscultural psychologists for findings that go beyond simply describing cultural differences in parental beliefs. Comparative researchers need to shed light on whether parental beliefs are (or are not) systematically related to differences in child outcomes; and they need meta-analyses and reviews to explore between- and within-culture variations in parental beliefs, with a focus on issues of social change (Saraswathi, 2000). Likewise, collaborative research programs can foster the goals of indigenous psychology and cultural psychology and lay out valid descriptions of individual development in their particular cultural contexts and the processes, principles, and critical concepts needed for defining, analyzing, and predicting outcomes of child development-in-context. The project described in this chapter is based on an approach that integrates elements of comparative methodology to serve the aim of describing particular scenarios of child development in unique contexts. The research team of cultural insiders and outsiders allows for a look at American belief systems based on a dialogue of multiple perspectives.