Dinâmica familiar de crianças autistas

The Relationship between Anxiety Symptoms and Perceived Quality of Life among Caregivers of Children with Autism Spectrum Disorder in the Amazon

The relationship between anxiety symptoms and perceived quality of life among caregivers of children with autism was verified. To assess perceived quality of life, the Short Form Healthy Survey Item was used; perception of anxiety symptoms was assessed using the Beck Anxiety Inventory. Eighty caregivers of children with autism participated, with 68.7% of caregivers being mothers. Of the total number of caregivers, 68.8% had a severe level of anxiety. Regarding perceived quality of life, they demonstrated greater impairment in limitation due to physical aspects, limitation due to emotional aspects, vitality, and pain. Caregivers with severe anxiety levels had a worse quality of life in the domains of pain (p = 0.012), social aspects (p < 0.001), limitation due to emotional aspects (p = 0.001), and mental health (p < 0.001). However, in the functional capacity domain, caregivers with a moderate level of anxiety had a better physical capacity score (p = 0.001). There was a negative correlation between the general anxiety score and the general physical (p = 0.029) and general emotional components of perceived quality of life (p < 0.001). It was found that caregivers of children with ASD have a high level of anxiety, which is a predictor of the perception of a worse quality of life.

Family Functioning and Emotional Aspects of Children with Autism Spectrum Disorder in Southern Brazil

Autism spectrum disorder (ASD) affects children and their families. We investigated the family environment of children with ASD in Brazil. Twenty-one families participated. Outcome measures administered to parents included the Strengths and Difficulties Questionnaire, Questionnaire on Resources and Stress—Short Form, and the Family Environment Scale. All families reported a number of difficulties, including social interactions and peer relationships, stress levels, and communication difficulties. Families also reported great concern for their child’s future. Brazil is a developing country, yet there are few national resources and studies related to ASD. The challenges continue from diagnosis through treatment. Our results emphasize the need to understand the family environment of children with autism and their parents’ apprehensions to develop effective coping programs.

Quality of Life in Caregivers of Children and Adolescents with Autistic Spectrum Disorder: Development and Validation of the Questionnaire

Studies have shown that children and adolescents with autism and their relatives present a high level of stress and more family problems, impacting parents' and caregivers' quality of life (QoL). Despite studies on this subject, there is no specific questionnaire to evaluate QoL in parents or caregivers of children and adolescents with an autistic spectrum disorder (ASD) in Brazil. Therefore, this study's primary purpose was to develop and validate a specific questionnaire to evaluate QoL in these individuals. The study was performed using the following steps: development of the ASD Parent/caregiver QoL questionnaire (autistic spectrum disorder parent/caregiver quality of life-ASDPC-QoL), subjective evaluation, validation of the questionnaire by the Delphi method, assessment of internal consistency, responsiveness, and reliability of the ASLPC-QoL, and administration of the questionnaire to 881 Brazilian ASD caregivers or parents. ASDPC-QoL comprises 28 questions divided into four domains (social, concerns, physical and mental health) with good psychometric properties (reproducibility, reliability, internal consistency, responsiveness, and validity). Our data showed that worries and physical health were the domains with the lowest scores in ASDPCA-QoL. ASDPCA-QoL did not differ among gender and age of child considering the total and all domains. Older participants (≥41 y/o) presented the best scores for social and worries domains but did not differ in other domains and the total. Parents or caregivers of ASD children diagnosed for more than three years have better mental and physical health domains than those recently diagnosed (up to 1 year) but did not differ in the total and other domains. Individuals with a partner and with the highest educational level present the best score for the social domain. Employed individuals showed better scores than unemployed ones for all domains and the total, except for worries, which did not differ. It also occurred comparing the individuals that do not use antidepressants and the ones that use them. Assessing and better understanding the QoL of caregivers is highly relevant. By understanding the social, worries, physical, and emotional health domains of caregivers, it is possible to track harmful aspects, prevent and treat pathologies, in addition to assisting in the implementation of effective public policies.

“Todo Mundo Quer Ter um Filho Perfeito”: Vivências de Mães de Crianças com Autismo

Resumo O objetivo deste artigo é compreender a vivência de mães de crianças com autismo, com base em entrevistas e estudos existentes, situando o debate teórico em torno desse processo. Trata-se de pesquisa qualitativa, realizada por meio de entrevistas semiestruturadas com seis mães de crianças com autismo. O tratamento do material deu-se por intermédio da análise de conteúdo, resultando em três temas - impacto do diagnóstico de autismo, suporte social e ser mulher e mãe de criança com autismo. Os resultados corroboram dados da literatura quanto ao impacto do autismo no cotidiano dessas mulheres, aos encargos enfrentados por elas e à importância da rede social de apoio. Destaca-se como achados deste estudo, a importância do diagnóstico como norteador das ações dessas mães e a resistência dos profissionais em fornecê-lo, além do pai da criança com dificuldades em aceitar a condição do filho, mas resgatando a identidade feminina dessa mãe.

[Impact of moderate intellectual disability on the dynamics and quality of family life: a qualitative clinical study]

This qualitative clinical study investigated the impact of moderate intellectual disability on family dynamics and quality of life. The data were collected using individual interviews with 15 mothers of children with intellectual disabilities, as a convenience sample, and examined with categorical thematic content analysis. The results were discussed using a comprehensive and interpretative approach. Analysis of the interviews showed that care for children with intellectual disabilities is centered on the mother, contributing to the change in family relations. Religious coping appeared as a common strategy for adjusting. Children with intellectual disabilities had less access to services and support than they needed in the areas of health, education, and leisure. Financial constraints and difficulties in community living had a negative impact on the quality of family life. Emotional and psychological support for all the family members, and practical and social support, including income distribution and access to adequate services, proved essential for the well-being of children with intellectual disabilities and their families.

Autism in Brazil: a systematic review of family challenges and coping strategies

OBJECTIVE

To describe the challenges faced by families caring for children with autism spectrum disorder (ASD) in Brazil and the coping strategies employed.

SOURCES

Systematic review of articles published until September of 2013, without language restrictions, using quality appraisal (AMSTAR and CASP/Oxford instruments).

SUMMARY OF THE FINDINGS

The literature shows parental emotional overload as one of the main challenges faced by families, especially mothers. The main stressors were diagnostic postponement, difficulty dealing with the diagnosis and associated symptoms, and poor access to health services and social support. The predominant coping strategies found included information exchange between affected families and integrated healthcare network for patient and family support.

CONCLUSION

ASD exerts strong influence on family dynamics, resulting in caregiver overload, especially in mothers. The Brazilian Unified Health System needs to provide comprehensive, continuous, and coordinated care to strengthen the patient-family dyad and promote the full development and societal inclusion of children with ASD.

Qualidade de vida dos cuidadores de crianças e adolescentes com alterações de fala e linguagem

OBJETIVO: Investigar a qualidade de vida dos cuidadores de crianças ou adolescentes com alterações de fala e linguagem de acordo com a perspectiva deles. MÉTODOS: Participaram dois grupos, totalizando 40 sujeitos. O Grupo 1 foi composto por 20 cuidadores de crianças ou adolescentes com alterações de fala e linguagem entre 4 e 17 anos, pareados por idade com o Grupo Controle ou 2, que incluiu 20 de crianças ou adolescentes sem queixas de fala e linguagem. Para a coleta de dados, foram aplicadas duas questões abertas e um instrumento da Organização Mundial de Saúde, traduzido e adaptado para o português - World Health Organization Quality of Life Scale (WHOQOL) Abreviado. Os resultados de tal instrumento foram submetidos à análise estatística, e as perguntas abertas estavam sendo analisadas qualitativamente. RESULTADOS: Na distribuição das mudanças de fala e linguagem, havia: gagueira (35%), alterações de linguagem oral sem (35%) e com causas neurológicas (30%). Na análise dos escores do WHOQOL-abreviado, encontraram-se diferenças da qualidade de vida nos domínios físico (1,1%), psicológico (0,5%) e relações sociais (1,8%). O Grupo 1 apresentou qualidade de vida mais insatisfatória; e nas abertas, boa e razoável. Já o Grupo 2 mostrou ótima e boa. A rotina clínica e os filhos foram mencionados como fatores que dificultam o autocuidado no Grupo 1. CONCLUSÕES: O menor escore do Grupo 1 no WHOQOL-abreviado foi compatível com achados das questões abertas, mostrando que aspectos como rotina de atendimentos clínicos e dificuldades de compreensão influenciam a qualidade de vida dos cuidadores. Os resultados reafirmam a necessidade de que, além de cuidadores, sejam cuidados, entendendo-os como um grupo digno de ações de saúde direcionadas aos mesmos.

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.

História de vida de adolescentes autistas: contribuições para a Fonoaudiologia e a Pediatria

OBJETIVO: Analisar os processos dialógicos de seis adolescentes autistas, durante terapia fonoaudiológica a respeito de suas histórias de vida, buscando subsídios para o pediatra e o fonoaudiólogo trabalharem com a família, a fim de impulsionar o desenvolvimento desses sujeitos. MÉTODOS: A coleta de dados foi realizada a partir da vídeogravação de duas sessões fonoaudiológicas com seis sujeitos diagnosticados como transtorno global do desenvolvimento, sendo três com transtorno autista e três com Asperger. As gravações foram transcritas e os dados, separados em eixos temáticos. As análises foram respaldadas na perspectiva qualitativa de pesquisa, sob a ótica da teoria histórico-cultural e o paradigma indiciário. RESULTADOS: Obtiveram-se as seguintes categorias a partir da coleta dos dados: lazer, escolaridade, grupo social, fatos da infância, vivências da adolescência e interesses. Tais categorias elucidaram as experiências vivenciadas pelos sujeitos e o modo como eles significam o mundo e são significados pelos outros, permitindo elencar dificuldades vivenciadas por esses sujeitos e seus familiares. CONCLUSÕES: Os apontamentos dos sujeitos mostram a necessidade de orientações contínuas sobre os aspectos destacados nas categorias, desde o momento da descoberta do diagnóstico, proporcionando ao indivíduo uma participação social e um desenvolvimento linguístico-cognitivo mais efetivo. O pediatra e o fonoaudiólogo são os profissionais indicados para tais orientações, uma vez que são os primeiros a atender as crianças autistas e os que participam diretamente do momento da descoberta do diagnóstico, acompanhando os pacientes até a adolescência.

Depression and quality of life in mothers of children with pervasive developmental disorders

The aim of this study was to evaluate the prevalence of dysphoria/depressive symptoms in mothers of autistic children and to identify correlations between quality of life and socio-demographic profile. An exploratory, descriptive and cross-sectional study was carried out, involving 20 mothers, by applying a socio-demographic profile questionnaire, the Brazilian version of the Beck Depression Inventory (BDI) and the WHOQOL-Bref quality of life scale. Dysphoria/depression criteria were found in 15% of the mothers. Overall quality of life was evaluated as positive in 70%, however only 40% were satisfied with their health. The Physical domain (mean=69.4) was perceived as the best, and environment domain as the worst (mean=60.8). Quality of life had a positive association with family income and level of education, and a negative association with depression. Considering the results, further research, especially on those variables that were not statistically relevant, is suggested.

Control of psychomotor agitation and aggressive behavior in patients with autistic disorder: a retrospective chart review

OBJECTIVE: To evaluate the efficacy of pharmacotherapy on the symptoms of psychomotor agitation and aggressive behavior in a sample of patients with autistic spectrum disorder. METHOD: The charts of all patients with a diagnosis of autistic spectrum disorder, receiving care for psychomotor agitation and/or aggressive behavior in two psychiatric outpatient departments between 2001 and 2006, were reviewed. The Clinical Global Impression-Severity and -Improvement scales (CGI-S and CGI-I) were applied to the data retrieved from the charts. RESULTS: The majority of the 26 patients included were treated with second-generation antipsychotics. A positive, statistically significant correlation was found between the implementation of pharmacotherapy and a reduction in CGI-S scores (p<0.05). Treatment response in patients with no mental retardation was better than in those mentally retarded (p<0.05). The majority of patients in whom clinical improvement was found following implementation of treatment had participated in at least one form of intervention therapy in addition to the principal treatment (p<0.05). CONCLUSION: Second-generation antipsychotics seem to reduce psychomotor agitation and aggressive behavior in patients with autistic spectrum disorder; however, further studies are required to evaluate the side effects of these drugs in relation to their beneficial effects.

[Quality of life and autism]

OBJECTIVE

To evaluate the index quality of life (QL) in bearers of including upset of the development.

METHOD

20 autistic children, between 4 and 12 years, submitted to the diagnostic evaluation by autistic traces scale-ATA and for the Vineland adaptive behavior scales, needing to obtain in this a quotient of superior development over 70. The data about QL were obtained by the scale of quality of life-AUQEI and compared from the application of Vineland and of AUQEI in a population of normal children, resembling in the sex and in the age.

RESULTS

In the evaluation of the ATA, average was 33.75 with 4.95 standard deviation. The indexes of Vineland suggest that normal children have larger probability to present level of appropriated adaptative behavior than autistic children (p=0.0196). Concerning QL, the general indexes are the same for both groups, indicating positive QL (p=0.744). In the sub domain autonomy, autistic children present higher index (p=0.0048).

CONCLUSION

Autistic children present similar indexes of QL than normal children.