Avaliação intelectual de crianças contaminadas por chumbo: um estudo comparativo

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Small car driver inflatable restraint system evaluation. Volume III: investigation of potential crash survivability of a current production subcompact vehicle equipped with an advanced driver restraint system. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Classificação Internacional de Funcionalidade, Incapacidade e Saúde : uma dimensão do neurodesenvolvimento

RESUMO: Objetivo Principal • Determinar a consistência da utilização dos instrumentos de avaliação da capacidade intelectual – escalas de Griffiths e WISC III – no enquadramento dos domínios e dos qualificadores da CIF-CJ, restrita às funções mentais do corpo. Objetivo secundário: • Estudar a efetividade e concordância inter-observador da aplicação da CIF, com base na leitura dos dados obtidos em avaliação efetuada com os instrumentos referidos, por duas observadoras independentes, em contexto de articulação saúde, respetivamente educação e segurança social Métodos • Estudo observacional, descritivo, transversal e prospetivo. • Foi estudada uma amostra de conveniência 355 crianças, num período de três anos (Maio de 2010 a 30 de Abril de 2013), com patologia da área da pediatria do neurodesenvolvimento (total de 4000 consultas) no Centro de Desenvolvimento (CD) do Hospital de Dona Estefânia (HDE), Centro Hospitalar de Lisboa Central, EPE (CHLC, EPE). • Critérios de inclusão: crianças de ambos os sexos, observadas no CD do HDE, CHLC (primeiras consultas e consultas de reavaliação) com idade ≥12 meses e ≤17 anos e incapacidade intelectual definida de acordo com os critérios da DSM-IV-TR, DSM 5 e CID-10. • Critérios de exclusão: crianças com autismo, perturbações específicas da linguagem, hiperatividade, défice de atenção e concentração, défices sensoriais congénitos (baixa visão e ou audição), ou com outros diagnósticos de perturbações de neurodesenvolvimento. • O estudo teve duas fases: na primeira, a investigadora principal colheu ou atualizou a história clínica, observou clinicamente as crianças solicitando os exames complementares considerados necessários e foi efetuada avaliação psicológica com os instrumentos adiante descritos, pela mesma psicóloga clínica, devidamente credenciada, e com larga experiência nas escalas referidas. Com base nos dados colhidos, quer por observação direta, quer através dos resultados das escalas Griffiths e WISC – III, a investigadora aplicou a CIF-CJ, circunscrita aos domínios e funções (variáveis): 1. FUNÇÕESMENTAIS GLOBAIS (b110- Funções da consciência, b114- Funções da orientação no espaço e no tempo, b117 – Funções intelectuais, b122- Funções psicossociais globais, b125- Funções intrapessoais, b126- Funções do temperamento e da personalidade); 2.FUNÇÕES MENTAIS ESPECÌFICAS (b140- funções da atenção, b147- Funções psicomotoras, b152- Funções emocionais, b156- Funções da perceção, b163- Funções cognitivas básicas, b164- Funções cognitivas de nível superior, b167- Funções mentais da linguagem 3. FUNÇÕES DA VOZ E DA FALA (b320- Funções da articulação, b330- Funções da fluência e do ritmo da fala). Numa segunda fase, foi solicitada a colaboração de duas co-investigadoras, com formação específica nas escalas utilizadas e na CIF-CJ, a aplicação da CIF nos mesmos domínios e funções. Estas observadoras não efetuaram observações diretas das crianças envolvidas. • Para efetuar a análise estatística e analisar a relação entre os qualificadores (0 a 4) das variáveis da CIF em estudo (b117, b122, b147, b163, b164, b167, b320 e b330) e os instrumentos psicométricos (escalas de Griffiths e WISC III), que constitui a primeira parte do estudo, recorreu-se à técnica estatística não paramétrica do coeficiente de correlação de Spearman, que quantifica a intensidade e sinal da eventual correlação existente entre as variáveis em estudo. • Para determinar as correlações referentes à segunda parte do estudo, foram utilizados os programas SPSS®, (IBM SPSS Statistics) e Statistica® (StatSoft, Inc., 2011). STATISTICA (data analysis software system, version 10. www.statsoft.com.), tendo-se dado preferência aos gráficos deste último. Resultados 1. Observou-se um predomínio do sexo masculino (relação de 1:1,9); relativamente à idade no momento de avaliação, 242 crianças (68,1%) tinham entre zero e seis anos e, dentro destas, a maioria (189) situava-se entre os três e os seis anos. 2. De acordo com a DSM-IV e DSM-5, 261 (73,4%) crianças apresentavam incapacidade intelectual ligeira. 3. A avaliação da competência intelectual pelas escalas de Ruth Griffiths e WISC III (QI), revelaram correlação negativa predominantemente forte e muito forte (índice de Spearman) com os qualificadores das funções do corpo estudadas (funções mentais, mentais específicas e da voz). Os resultados obtidos pela co-investigadora A foram sobreponíveis aos da investigadora principal. Os resultados obtidos pela co-investigadora B revelaram correlação negativa moderada e forte, correlação inferior à da investigadora principal; Conclusões Os resultados permitem inferir que as escalas de Ruth Griffiths e WISC-III são instrumentos adequados para caracterizar a incapacidade intelectual na CIF-CJ; a concordância inter-observador, moderada, nos qualificadores atribuídos nas funções em análise pela investigadora e co-investigadoras, permite concluir que as escalas de Ruth Griffiths e WISC IIIl são bons instrumentos para caracterizar os qualificadores nos domínios e funções estudados, por diferentes grupos de profissionais ligados à infância. Subsistem dificuldades na diferenciação entre qualificadores, designadamente entre os qualificadores 1 e 2, o que tem necessariamente implicações na elegibilidade das crianças para os apoios preconizados pelo DL 3/2008. ------------------------ ABSTRACT: Main objective • To determine the consistency of the use of assessment tools for intellectual ability - Griffiths and WISC III scales - in the context of domains and qualifiers for the ICF-CY, restricted to the mental functions of the body. Secondary objective • Studying the effectiveness and inter-observer concordance concerning the application of the ICF, based on the data recovered from the assessment made with the mentioned instruments, carried out by two independent observers including their perspective on health, education and social security. Methods • Observational, descriptive, cross-sectional and prospective study. • A convenience sample of 355 children was studied over a period of three years (May 2010 to April 2013), with a pathology in the area of pediatric neurodevelopment – intellectual disability (total of 4000 consultations, including first consultations and revaluations) were observed in the Development Centre (CD) in Hospital de Dona Estefânia (HDE), Centro Hospitalar de Lisboa Central, EPE (CHLC). • Inclusion criteria: children of both sexes aged ≥12 months and years ≤17 and intellectual disability defined according to the criteria in the DSM-IV-TR, DSM 5 and ICD-10. • Exclusion criteria: children with autism; specific language impairment, hyperactivity; attention deficit disorder; severe birth sensory deficits (eg, impaired vision and hearing); amongst other diagnoses for neurodevelopmental disorders. • The study was conducted in two phases: in the first phase the principal investigator collected or updated medical history, clinically observed children requesting additional investigations if she deemed necessary. Psychological evaluation was performed by a single, duly licensed clinical psychologist with extensive experience in the referred scales using the instruments described below. Based on data collected, either by direct observation or through the results of Griffiths scales and WISC - III, the researcher applied the ICF-CY confined to the following fields and functions (variables): 1. GLOBAL MENTAL FUNCTIONS (b110- functions of consciousness, b114- Functions referring to space and time orientation , b117 - intellectual functions, b122- global psychosocial functions, b125- intrapersonal functions, b126- functions related to temperament and personality); 2. SPECIFIC MENTAL FUNCTIONS ( b140- attention functions, b147-psychomotor functions, b152- Emotional functions, b156- perception functions, b163- basic cognitive functions and cognitive functions b164- top level b167- language related mental functions. ) 3. VOICE AND SPEECH FUNCTIONS (b320-articulation functions, b330- fluency and rhythm of speech functions). • In the second phase, two co-investigators, with specific training on the scales used and the ICF-CY have applied the ICF in the domains and functions mentioned above, based on the scales results. These co-investigators did not make any direct observation of the studied children. • To perform the statistical analysis and analyze the relationship between the qualifiers (0-4) of the variables in the ICF study (b117, b122, b147, B163, B164, b167, b320 and B330) and psychometric instruments (Griffiths scale and WISC III), which is the first part of the study, the statistical technique of non-parametric Spearman correlation coefficient was used, which quantifies the strength and sign of the possible correlation between the variables under study. • For submission of correlations related to the second part of the study, SPSS (IBM SPSS) and Statistica (StatSoft, Inc., 2011) programs were used. STATISTICA (data analysis software system, version 10 www.statsoft.com.). Preference was given to graphs computed in Statistica. Results • Male predominated (ratio of 1: 1.9). 242 children (68.1% of the sample) were aged between zero and six years and, among these, the majority (189) was aged largest number between three and six years. • According to the DSM-IV and DSM-5, 261 (73.4%) children had mild intellectual disability. The correlation between the assessment of intellectual competence by Ruth Griffiths scales and WISC III (QI), was predominantly negative strong and very strong correlation with the qualifiers of body functions studied (specific mental functions, mental and voice functions using Spearman index). The levels of correlation obtained by the co-investigatores were in agreeance with the results from the principal investigator. The results obtained by co-investigator B showed moderate to strong negative correlation, levels that were lower to the those registered by the principal investigator; Conclusions These results indicate that Ruth Griffiths and WISC-III scales are adequate tools to characterize intellectual disability in the ICF-CY; moderate inter-observer agreement in the qualifiers assigned the functions under analysis by the researcher and co-researchers, shows that the scales are also good tools to measure CIF qualifyers by diferent technicians with different professional orientations, related to children. However, there are still difficulties in differentiating qualifiers, namely between qualifiers 1/2 and 3/4, which necessarily has implications for the eligibility of children for the state support advocated by the Portuguese Decret Law 3/2008.

Investigação da capacidade intelectiva de pacientes pediátricos diagnosticados com tumores de fossa posterior

Central Nervous System are the most common pediatric solid tumors. 60% of these tumors arise in posterior fossa, mainly in cerebellum. The first therapeutic approach is surgical resection. Malignant tumors require additional strategies - chemotherapy and radiotherapy. The increasing survival evidences that childhood brain tumors result in academic and social difficulties that compromise the quality of life of the patients. This study investigated the intellectual functioning of children between 7 to 15 years diagnosed with posterior fossa tumors and treated at CEHOPE - Recife / PE. 21 children were eligible - including 13 children with pilocytic astrocytoma (G1) who underwent only surgery resection, and eight children with medulloblastoma (G2) - submitted to surgical resection, chemotherapy and craniospinal radiotherapy. Participants were evaluated by the Wechsler Intelligence Scale for Children - WISC-III. Children of G1 scored better than children of G2. Inferential tools (Mann-Whitney Ü Test) identified significant diferences (p ≤ 0.05) between the Performance IQ (PIQ) and Processing Speed Index (PSI) as a function of treatment modality; Full Scale IQ (FSIQ), PIQ and PSI as a function of parental educational level; PIQ, FSIQ, IVP and Freedom from Distractibility (FDI) as a function of time between diagnosis and evaluation. These results showed the late and progressive impact of radiotherapy on white matter and information processing speed. Furthermore, children whose parents have higher educational level showed better intellectual performance, indicating the influence of xxii socio-cultural variables on cognitive development. The impact of cancer and its treatment on cognitive development and learning should not be underestimated. These results support the need to increase the understanding of such effects in order to propose therapeutic strategies which ensure that, in addition to the cure, the full development of children with this pathology

Estudo longitudinal da capacidade intelectual de crianças contaminadas por chumbo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Identificação de alunos com altas habilidades ou superdotação a partir de uma avaliação multimodal

Pós-graduação em Psicologia do Desenvolvimento e Aprendizagem - FC

Impact of pediatric epilepsy surgery on intellectual efficiency

Introduction. Epilepsy surgery may be a promising alternative therapy for seizure control in patients with refractory seizures, resistant to medication. Cognitive outcome is another important factor in favor of the surgical decision. Aim. To investigate the correlation between seizure outcome and cognitive outcome after epilepsy surgery in a pediatric population. Patients and methods. A total of 59 pediatric patients were retrospectively assessed with the WISC-III (Full Scale, Verbal Scale and Performance Scale) before and, at least, 6 months after surgery. Patients were divided into two groups according whether or not improvement of seizure control after surgery. Data collected for each child included: epileptic syndrome, etiology, age at epilepsy onset, duration of epilepsy and seizure frequency. Results. Comparison using a MANOVA test revealed significant differences across pre-operative Full Scale, Verbal Scale and Performance Scale (p = 0.01) with seizure reduction group performing better than no seizure reduction group. Seizure improvement group achieved significant Performance Scale improvement (p = 0.01) and no seizure improvement group showed significant Verbal Scale worsened after surgery (p = 0.01). Conclusions. Our results suggest that the success of the epilepsy surgery in childhood when the seizure control is achieved may also provide an improvement in the Performance Scale whereas the seizure maintenance may worsen the Verbal Scale.

Variable phenotype in 16p duplication within a family

Background More individuals are now being identified with very rare genetic syndromes. We present a family with an inherited duplication of 16p11.2 to 16q12.1 in ring formation. Three of the four children, (aged 15 months to 10 years), mother, uncle, and grandmother are affected. Our aim was to provide preliminary evidence of possible phenotypic patterns of learning and behaviour associated with this chromosome anomaly. Method Psychometric assessments were undertaken with all four children. The mother and uncle also agreed to participate in the study. Measures of development (Bayley or Mullen), intellectual ability (WISC-IV or WAIS-III), academic achievement (WIAT-II), adaptive behaviour (Vinelands), and other relevant aspects of functioning (e.g., Children’s Memory Scale) were administered. Results. The first-born child is the only one who is unaffected. Her intellectual ability was assessed as being within the superior range. The second child experienced early difficulties with speech and motor skills. Although his intelligence is average, he has learning difficulties and significant auditory memory problems. The third child’s speech and motor milestones were markedly delayed. He has a complex medical history that includes a vitamin B12 deficiency. On the Mullen Scales at age 4 his scores ranged from average to very low. The development of the youngest child (aged 15 months), who also had a B12 deficiency but was treated early, was assessed as being within typical limits. Conclusions There is considerable developmental variability among the three children with this inherited 16p duplication. We discuss the intriguing similarities and differences, considering common features that may reflect phenotypic patterns and speculating about possible explanations for the variable presentations.

Gêmeos monozigóticos com Síndrome de Asperger: sociabilidade e cognição

Os obstáculos encontrados por crianças e adolescentes com Síndrome de Asperger em termos de interação social, comunicação e imaginação são notórios e causam sentimentos de angústia nos pais que procuram escolas para inserir seus filhos e centros especializados para tratá-los. As pesquisas tem evoluído sobremaneira através dos anos, desde as primeiras descrições sobre o transtorno na primeira metade do século XX, apontando diferentes visões e modos de intervenção, alguns destes que pudessem ser levados à cabo por pais, professores e cuidadores. Entretanto, em termos de língua portuguesa em geral e da realidade brasileira especificamente, há uma carência de instrumentos que possam ser utilizados no ensino de habilidades sociais e cognitivas à esses indivíduos com Síndrome de Asperger. Aproveitando a experiência de pesquisadores ingleses, que na década de noventa elaboraram um guia prático para pais e professores intitulado Teaching children with autism to mind-read: a practical guide for teachers and parents, partindo da intervenção com tradução para a língua portuguesa, o presente estudo exploratório tem os objetivos de: verificar a efetividade de referido instrumento no ensino de habilidades sociais e cognitivas, identificar as estratégias de ensino utilizadas e comparar o desempenho de dois meninos de doze anos, gêmeos monozigóticos com Síndrome de Asperger, alunos de uma escola da rede pública do município do Rio de Janeiro. A metodologia utilizada implicou na análise comparativa dos escores obtidos na pré e pós intervenção, pela avaliação das habilidades sociais com o Inventário Multimídia de Habilidades Sociais para Crianças e das habilidades cognitivas, em especial as funções executivas, via alguns dos subtestes da Escala de Inteligência Wechsler para Crianças WISC-III; e a filmagem das sessões de intervenção e posterior análise dos vídeos para identificação das estratégias de ensino. A análise mostrou que o instrumento foi efetivo no ensino de habilidades sociais e cognitivas, merecendo novos estudos visando sua adaptação para nossa realidade cultural; que as estratégia de ensino mais utilizadas e que contribuíram para a modificação do comportamento dos sujeitos foram levantamento de questões para verificar a compreensão, explicação de conceitos pouco familiares e a ampliação da resposta verbal.

A memória de curto prazo e a síndrome de down: a relação entre contextos de desenvolvimento

Down syndrome (DS) is one of the most frequent causes of intellectual disability, affecting one in every 600 to 1000 live births. Studies have demonstrated that people with DS have a lower capacity for short-term memory (STM) and working memory (WM), which affects their capability to learn new words and to follow spoken instructions, specially when they involve multiple information or consecutive orders/orientations. It seems that the basis of the learning process, as it happens with language and mathematics comprehension and reasoning, relies in the STM and WM systems. Individuals with DS are increasingly included in mainstream education, and yet, very few researches have been conducted to investigate the influence of memory development and the type of enrollment (regular school and special school). This study investigated the relationship between the type of school enrollment with the performance on STM tests and also, the relationship of this performance with early stimulation (ES). The tests used in the first research were the digit span, free recall, word recognition and subtests of the Wechsler Intelligence Scale for Children Third Edition (WISC-III). Individuals enrolled in the regular schools group had higher scores on the digit span test and the subtests of the WISC-III. In the free recall and recognition tests, no differences were found. This study indicates that the type of enrollment might influence the memory development of individuals with DS and clearly points the need for future investigations. In the second research, the tests used were the digit span, free word recall and subtests of the WISC-III. The test results showed better performance by adults that received ES before six months of age. The studies showed improvement in STM both in people who attended or were attending regular school, as well as those who benefited from ES before six months of age. However, some issues still need to be better understood. What is the relation between this stimulation with the individual s education? Since ES may reflect a greater family involvement with the individual, what is the role of emotional components derived from this involvement in the cognitive improvement? These and other questions are part of the continuity of this study

Estudo comparativo entre estilos parentais e o desempenho intelectual de crianças com alta e baixa plumbemia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Correlações entre sono-vigília, memória e melatonina em Síndrome de Williams-Beuren

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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.

Os Efeitos da Avaliação Psicológica em Crianças com Dificuldades de Aprendizagem

O presente estudo de caso agregado teve como objetivo primordial avaliar em que medida os recursos terapêuticos utilizados durante o tempo de avaliação psicodiagnóstica (psicométrica e projetiva) das crianças encaminhadas para o serviço de psicologia escolar, tem impacto positivo na criança em processo de avaliação, no duplo plano comportamental e cognitivo. O protocolo da investigação foi composto por: desenho de família, WISC-III e CAT, com recurso a algumas sessões de ludoterapia. Os meios utilizados no processo de avaliação permitiram a superação de algumas dificuldades apresentadas pelas crianças, tendo sido, muito particularmente, identificados os contributos que a psicanálise e a psicologia psicodinâmica podem oferecer à psicopedagogia. / The main objective of this aggregated case study was the assessment of the impact of psycho-diagnostic evaluation (psychometric and projective testing) on the improvement of the school-aged children oriented to the cabinet of psychology of their school. The research protocol included: family picture test, WISC -III and CAT, plus some play therapy sessions. Some of the children overcame part of the learning and behavioral difficulties after the evaluation period. Such a result proves, most particularly, the contributions of psychoanalysis and psychodynamic psychology to psycho-pedagogy.

Assessment of iodine intake and related cognitive function impairments in elementary schoolchildren from Terceira Island, Azores (Portugal)

Dissertação de Mestrado, Ciências Biomédicas, 28 de Junho de 2016, Universidade dos Açores.