Efeitos de um programa de intervenção precoce baseado no modelo mais que palavras - HANEN, para crianças menores de três anos com risco de autismo

In the last decades, studies on early intervention involving children with autism have suggested that there is no single intervention model capable of addressing the needs of all individuals in the spectrum. The role of parents as active intervention agents is, however, highly recommended. The More Than Words-HANEN Program has been specifically created for parents of children, under five years of age, who are in the autism spectrum. This intervention aims at improving the social competence and language comprehension of the child, as well as their parents empowerment. Until now only three studies have been performed in order to evaluate the effectiveness of the HMTW program. The purpose of this investigation is to evaluate the effects of an early intervention program inspired on HMTW model on the level of caregiver responsiveness and child communication skills. The present study adds to the existing research literature on family-centered early intervention that uses a developmental paradigm. A two year boy in risk for autism, his mother and nanny took part in this investigation, which was carried out in the child´s home in Mossoró, Rio Grande do Norte. The caretakers were given one fifty-two hours of training, divided into thirteen weekly meetings. A quasi-experimental A-B-C design (baselineintervention- follow-up) showed improvement in the caretakers level of responsiveness and meaningful social-communicative gains in the child´s response

Análise dos efeitos de um plano educacional individualizado no desenvolvimento acadêmico e funcional de um aluno com transtorno do espectro do autismo

Given the paradigm of inclusive education, the presence of students with autism spectrum disorder in regular schools has become more significant in recent years. Studies have revealed, however, deficits in academic participation of these students in these settings. Among the factors contributing to this phenomenon include poor teacher training and the lack of strategies to promote curriculum access. The aim of this study was to develop an instrument that would promote academic inclusion of a student with autism through procedures that could simultaneously empower the teacher. In this perspective, the study aimed to analyze the effects of an Individualized Educational Plan (IEP), developed collaboratively with teachers, on the academic and functional development of a student with autism in an early childhood education setting. Data were collected in a private school located in the city of Natal in Rio Grande do Norte, in the course of the academic year 2012. In addition to the student with autism, one teacher, a specialized educator, and four teacher aides participated in the study. The research used a single subject quasi-experimental design (AB) as well as qualitative methods of data analysis. The study was conducted in three phases: characterization, baseline and intervention. The first comprised interviews with the child´s parents and teachers, as well as the identification of two routines focus of intervention. In the second phase, the amount of time the student spent engaged in the selected routines during baseline was analyzed. In the third phase, the researcher prepared, collaboratively with the teachers, an individualized educational plan (IEP) for the student. Finally, the IEP was implemented by the teachers. The results indicated qualitative and quantitative changes in student´s participation in academic and functional tasks after the intervention program

Aplicabilidade do Rorshach na avaliação psicológica do autismo

This study investigates the applicability of the Rorschach Method for evaluating the personality of people with Autism Spectrum Disorder (ASD).The relevance of this study is justified by the limited number of investigations published in the research literature concerning the use of psychological tests used for evaluating the personality of individuals with ASD. The Rorschach Method was chosen as an appropriate instrument considering it reveals the personality s basic structure, including characteristics of the affectivity, sensuality, inner life, mental resources, psychic energy and general characteristics and intellectual state of the individual. The general objective of this investigation consisted of verifying the applicability of the use the Rorschach Method in the evaluation of the characteristics of people's personality with autism spectrum disorder (ASD).The study also sought to identify perceptive factors of the personality structure of individuals with ASD, provide contributions of the understanding of this syndrome, seeking the establishment of possible therapeutic interventions starting from diagnostic by Rorschach Method. In addition, this investigation aims at verifying the adequacy of using the Rorschach Method as an instrument for evaluating the personality characteristics of individuals with ASD and its possible use in Brazil, starting from preliminary normative results. Participants consisted of 44 youngsters and adults, both genders with age range 14 - 39 years-old (average: 23.5 years-old) distributed in 2 groups. Group 1: composed with 22 youngsters and adults with clinical diagnosis of autism spectrum disorder (communication impairments, social interaction deficits, restricted and repetitive interests and activities); Group 2: composed with 22 youngsters and adults with typical behavior. The participants were paired to gender and age, individually. The Mann-Whitney and Wilcoxon tests were applied to evaluate statistical differences between the groups, considering demographic and social data. The results indicate the presence of restricted interest or difficulty in the expression of the social and affective interaction of people with ASD. However, the need of broader normative studies concerning the use of personality evaluation instruments for people with ASD is warranted. These investigations could help understand the psychic dynamism of this population, offering subsidies that can be added to the current techniques of diagnosis. The Rorschach Method is susceptible to application but it is necessary to respect the individual limitations of these people and to establish more criterions about the spectrum

Terapia de linguagem no espectro autístico: a interferência do ambiente terapêutico

OBJETIVO: Analisar o perfil funcional da comunicação de crianças e adolescentes com distúrbios do espectro autístico em dois ambientes de terapia de linguagem, que se diferenciam quanto ao aspecto físico. MÉTODOS: Participaram dez sujeitos com distúrbios do espectro autístico, seis do gênero masculino e quatro do gênero feminino, com idades entre 4 e 13 anos. Na coleta de dados, foram realizadas filmagens de oito sessões de terapia de linguagem individual com duração de 30 minutos, sendo quatro sessões em uma sala comum e quatro em uma sala com ambientação específica (sala NIC), intercaladamente, durante um mês. Para a análise dos dados foi empregado o Protocolo de Pragmática, e os resultados receberam tratamento estatístico. RESULTADOS: Verificou-se que não houve diferença significativa entre o perfil pragmático apresentado pelos dez sujeitos na sala comum e na sala NIC. CONCLUSÃO: O contexto físico aqui estudado não influenciou significativamente no perfil funcional da comunicação de indivíduos do espectro autístico, ainda que se tenha verificado tendências individuais apresentando melhor desempenho em uma sala ou em outra.

Suicidality in Obsessive-Compulsive Disorder: Prevalence and Relation to Symptom Dimensions and Comorbid Conditions

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Clinical features of obsessive-compulsive disorder with hoarding symptoms: A multicenter study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Clinical correlates of social adjustment in patients with obsessive-compulsive disorder

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Social phobia in obsessive-compulsive disorder: Prevalence and correlates

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

BODY DYSMORPHIC DISORDER IN PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER: PREVALENCE and CLINICAL CORRELATES

Background The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessivecompulsive disorder (OCD) have been previously addressed in primarily relatively small samples. Methods We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories. Results The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking. Conclusions Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders. Depression and Anxiety 29: 966-975, 2012. (C) 2012 Wiley Periodicals, Inc.

Alunos com distúrbios do espectro autístico em interação com professores na educação inclusiva: descrição de habilidades pragmáticas

OBJETIVO: Investigar as habilidades pragmáticas de alunos com distúrbios do espectro autístico durante a interação com suas professoras em salas comuns de escolas públicas. MÉTODOS: Participaram 14 alunos com distúrbios do espectro autístico, de ambos os gêneros, com idade entre três e oito anos (média=5,9; DP=1,8). Como parte do procedimento, foram realizadas filmagens em situações de sala de aula e para análise dos aspectos pragmáticos da comunicação dos participantes, foi utilizado o Protocolo de Pragmática. Os resultados foram tratados estatisticamente (p<0,05 e em alguns casos p<0,01; foram utilizados os testes de Wilcoxon, Friedman, Kruskal-Wallis, Spearman). RESULTADOS: em média, o número de atos comunicativos expressos por minuto pelas professoras (3,4 atos/min) foi superior (p<0,05) ao apresentado pelos alunos com distúrbios do espectro autístico (2,7 atos/min). Os alunos demonstraram predomínio de utilização do meio gestual, com média de 36,2 ocorrências, e de funções comunicativas menos interativas, com média de 24,1 ocorrências. Além disso, ocorreu correlação positiva entre os atos/min de alunos e professoras (p=0,01). Observou-se, também, que a idade e a escolaridade dos alunos não apresentaram correlações com o estabelecimento da comunicação nas díades. CONCLUSÃO: Foi possível identificar os déficits e as habilidades dos alunos com distúrbios do espectro autístico em sala de aula comum e confirmar a influência exercida pelo professor no desempenho comunicativo de tais alunos. Estes dados podem contribuir para esclarecimentos de lacunas existentes na literatura e para subsidiar intervenções terapêuticas e educacionais nos distúrbios do espectro autístico.

Desenvolvimento de uma Lista de Verificação em Comunicação e Linguagem para os Transtornos do Espectro Autístico

A Lista de Verificação em Comunicação e Linguagem aqui apresentada foi elaborada para avaliar as especificidades de dois grupos distintos: os transtornos do espectro autístico e outras alterações de desenvolvimento da linguagem. Com essa finalidade foi aplicada em 60 participantes, divididos em dois grupos: 20 portadores de transtornos do espectro autístico (M=7, 11) e 40 portadores de outras alterações de desenvolvimento da linguagem (M=4, 10). Foi utilizado o teste do Qui-Quadrado para avaliar a validade do conteúdo e determinar quais questões deveriam ser retiradas do instrumento por não serem significativas. Os outros testes utilizados foram o Índice de Concordância Kappa e o teste de Mann-Withney. A Lista também apresentou uma sensibilidade de 90% e uma especificidade de 97,5%, o que demonstra a viabilidade de sua utilização como instrumento auxiliar na detecção de transtornos do espectro autístico.

Iniciativas de comunicação na interação entre crianças com distúrbios do espectro autístico e suas mães: análise pragmática

OBJETIVOS: investigar as iniciativas de comunicação na interação entre crianças com distúrbios do espectro autístico (DEA) e suas mães, por meio de uma análise pragmática. MÉTODO: cinco crianças com DEA, de ambos os gêneros, idades entre cinco e 12 anos juntamente com suas mães. O grupo controle constou de cinco crianças com desenvolvimento normal, pareadas com as crianças com DEA de acordo com gênero e idade e suas respectivas mães, totalizando 20 participantes. Para a caracterização da amostra foram utilizadas uma Ficha informativa e a Escala de Avaliação de Traços Autísticos. Cada díade foi filmada por 30 minutos durante as interações lúdicas, analisadas a partir do Protocolo de Pragmática. Este instrumento avalia as iniciativas de comunicação, meios e funções comunicativas expressas. Os dados foram tratados estatisticamente (p < 0,05; foram utilizados os testes não-paramétricos de Wilcoxon e de Mann-Whitney). RESULTADOS: foram observadas diferenças estatisticamente significantes entre as iniciativas comunicativas das crianças com DEA e suas mães, quando comparadas ao grupo controle. As díades que envolveram crianças com DEA iniciaram menos a comunicação e utilizaram predominantemente gestos e vocalizações menos interativas. CONCLUSÕES: estes dados possibilitaram descrever aspectos fundamentais para compreensão das manifestações clínicas da população estudada e para a elaboração de programas de intervenção que visem melhorar a qualidade de vida da criança e sua família.

Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder

The study aimed to compare male and female patients with obsessive-compulsive disorder (OCD) across symptom dimensions, clinical course and comorbidity. A cross-sectional study was undertaken with 858 adult OCD patients (DSM-IV) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were evaluated using structured interviews, including the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sample was composed of 504 women (58.7%) and 354 men (41.3%) with a mean age of 35.4 years-old (range: 18-77). Men were younger, more frequently single and presented more tics, social phobia and alcohol use disorders. Among men, symptom interference occurred earlier and symptoms of the sexual/religious dimension were more common and more severe. Conversely, women were more likely to present symptoms of the aggressive, contamination/cleaning and hoarding dimension and comorbidity with specific phobias, anorexia nervosa, bulimia, trichotillomania, skin picking and compulsive buying. In the logistic regression, female gender remained independently associated with the aggressive and contamination/cleaning dimensions. In both genders the aggressive dimension remained associated with comorbid post-traumatic stress disorder, the sexual/religious dimension with major depression and the hoarding dimension with tic disorders. Gender seems to be relevant in the determination of OCD clinical presentation and course and should be considered an important aspect when defining more homogeneous OCD subgroups. © 2012 Elsevier B.V.

Clinical features of pure obsessive-compulsive disorder

Objective Psychiatric comorbidity is the rule in obsessive-compulsive disorder (OCD); however, very few studies have evaluated the clinical characteristics of patients with no co-occurring disorders (non-comorbid or pure OCD). The aim of this study was to estimate the prevalence of pure cases in a large multicenter sample of OCD patients and compare the sociodemographic and clinical characteristics of individuals with and without any lifetime axis I comorbidity. Method A cross-sectional study with 955 adult patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Assessment instruments included the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, The USP-Sensory Phenomena Scale and the Brown Assessment of Beliefs Scale. Comorbidities were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses were followed by logistic regression. Results Only 74 patients (7.7%) presented pure OCD. Compared with those presenting at least one lifetime comorbidity (881, 92.3%), non-comorbid patients were more likely to be female and to be working, reported less traumatic experiences and presented lower scores in the Y-BOCS obsession subscale and in total DY-BOCS scores. All symptom dimensions except contamination-cleaning and hoarding were less severe in non-comorbid patients. They also presented less severe depression and anxiety, lower suicidality and less previous treatments. In the logistic regression, the following variables predicted pure OCD: sex, severity of depressive and anxious symptoms, previous suicidal thoughts and psychotherapy. Conclusions Pure OCD patients were the minority in this large sample and were characterized by female sex, less severe depressive and anxious symptoms, less suicidal thoughts and less use of psychotherapy as a treatment modality. The implications of these findings for clinical practice are discussed. © 2013 Elsevier Inc. All rights reserved.