Felipe Alckmin-Carvalho

Identificação de Sinais Precoces de Autismo Segundo um Protocolo de Observação Estruturada: um Estudo de Seguimento

Early, intensive and long-term interventions are associated with a positive impact on the prognosis of children with Autism Spectrum Disorders-ASD. The objectives of this study were to follow children with 16-24 months until three years of age in order to confirm/refute the diagnosis of ASD and verify if a structured observation protocol developed in Brazil would be able to discriminate children at high/low risk for ASD. Instruments: Modified Checklist for Autism in Toddlers-M-CHAT, Autism Behavior Checklist-ABC, Structured Observation for Autism Screening-OERA, Bayley and Vineland Scales. Of the 11 participants, none confirmed ASD diagnosis according to DSM-IV. The OERA was able to discriminate all negative cases of ASD. Conclusion: it was verified that M-CHAT was sensitive to identify developmental delays, but not specific regarding to ASD, being necessary other assessments to confirm the diagnosis; OERA was considered low cost, well accepted and important to discriminate developmental delays from ASD.

Age and gender changes in children and adolescent patients of a Brazilian eating disorder program

ABSTRACT Background: International studies have demonstrated an increase in the prevalence of boys and a decrease of patients’ age at the beginning of outpatient treatment for eating disorders (ED). Objective: To evaluate if these changes are also present in the Brazilian population participating in the PROTAD, a Brazilian ED program, and to discuss its clinical implication for treatment. Methods: Cross-sectional study. We evaluated 150 medical records of patients under 18 years diagnosed with ED (DSM IV-TR). Patients were divided into two groups: G1 (2001-2007) (n = 77) and G2 (2008-2014) (n = 73). The girl/boy proportion and the mean age of patients were compared. Results: In G1, six boys (7.8%) were admitted (girl/boy proportion: 11.8:1), while in G2, 16 (22%) boys were admitted (girl/boy proportion: 3.5:1) (p 0.05). Discussion: The increase in the number of boys treated for EDs reported in international studies was also found at the PROTAD. Contrary to what has been reported in international studies, the mean age of patients at the PROTAD did not decrease significantly. Gender and sexual orientation issues, clinical presentation, prior overweight history and culture/media impact on boys should be addressed by the healthcare team to increase the therapeutic efficacy.

Development, applicability and effects of a pilot program of group cognitive-behavioral therapy in Brazilian adolescents with anorexia nervosa

Background: Most of the clinical trials involving cognitive-behavioral therapy (CBT) for the treatment of anorexia nervosa (AN) used the individual therapy format, and few have been dedicated to adapting and assessing the effects of the group format. Objectives: To assess the applicability and effects of a group CBT program for Brazilian adolescents with AN. Methods: Open clinical trial with 22 patients with AN divided into an intervention group – IG (n = 11; CBT, psychiatry, nutrition and family psychoeducation-6 months) and a control group – CG (n = 11; psychiatry, nutrition and family psychoeducation-6 months). Data collected at baseline, at the end of groups and six months after the completion were: weight, height, body mass index and Eating Disorder Examination Questionnaire (EDE-Q) used to assess the severity of AN symptoms. Results: Baseline homogeneous groups, with 91% adherence in the IG vs. 54% in the CG (p = 0.05). Participants in both groups regained weight and decreased symptoms of eating disorders at the end of groups. Comparing the EDE-Q scores IG presented a statistically significant difference in the restraint subscale of the EDE-Q between the end-of-group and the follow-up (p = 0.01). Discussion: Group CBT program produced positive effects and was applicable in Brazilian adolescents with AN as an adjuvant to multidisciplinary treatment. Pegado P et al. / Arch Clin Psychiatry. 2018;45(3):57-60

Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review

Background: Efficacy studies on the treatment of anorexia nervosa (AN) in childhood and adolescence are scarce and systematic reviews are almost non-existent. Objective: Systematic review of the literature regarding the modalities of psychological intervention based on evidence used in the treatment of AN in childhood and adolescence. Methods: The research was carried out in the databases: PubMed, PsycINFO and Cochrane, using the combined keywords: anorexia nervosa and evidence-based therapy. Articles published between 1990 and 2015 were assessed. Results: Of the 139 eligible articles, 14 were selected, of which 10 (71.4%) were conducted in the United States and England. The sample ranged from 9 to 167 participants. Randomized Clinical Trial represented the most frequent design (n = 9; 63.4%), with more than half of the interventions structured in 20 or more sessions (n = 9, 64.3%). Nine types of treatments were tested, with the most tested being Family-Based Treatment (FBT) (n = 7; 50%). Interventions involving the family seem to be more effective, however, the rates for complete remission are modest. Discussion: Although evidence of efficacy was verified in the treatments analyzed, the limited number of studies, the various methodological limitations and the methodological heterogeneity between studies make the findings inconclusive.

Similaridades e Diferenças de Crianças/Cuidadores Atendidos em Serviço-Escola de Psicologia e Psiquiatria

In order to provide the best care to children and adolescents referred for university-based psychology and psychiatry centers, this research describes and compares the profile of families who looked for treatment in these services. Forty mothers and children were assessed (20 participants in each group – Waiting list for psychological counseling or psychiatric care). The mothers completed the Child Behavior Checklist, Beck Depression Inventory, Marital Adjustment Scale and semi-structured interview. The children referred to psychiatry services had higher scores in the clinical range for somatic complaints, thought problems and externalizing problems. The comparison of the caregivers’ profiles indicated that the choice of the type of service for the child was related to maternal variables, since mothers with greater adversity levels and depression choose drug treatment. This highlights the importance of simultaneously care for mother and child and proposals to ensure demand and adherence to psychological treatment.

Semejanzas y Diferencias de Niños/Cuidadores Atendidos en Servicio-Escuela de Psicología y Psiquiatría

In order to provide the best care to children and adolescents referred for university-based psychology and psychiatry centers, this research describes and compares the profile of families who looked for treatment in these services. Forty mothers and children were assessed (20 participants in each group – Waiting list for psychological counseling or psychiatric care). The mothers completed the Child Behavior Checklist, Beck Depression Inventory, Marital Adjustment Scale and semi-structured interview. The children referred to psychiatry services had higher scores in the clinical range for somatic complaints, thought problems and externalizing problems. The comparison of the caregivers’ profiles indicated that the choice of the type of service for the child was related to maternal variables, since mothers with greater adversity levels and depression choose drug treatment. This highlights the importance of simultaneously care for mother and child and proposals to ensure demand and adherence to psychological treatment.

Similarities and Differences of Children/Caregivers at Traning-Clinic of Psychology and Psychiatry

In order to provide the best care to children and adolescents referred for university-based psychology and psychiatry centers, this research describes and compares the profile of families who looked for treatment in these services. Forty mothers and children were assessed (20 participants in each group – Waiting list for psychological counseling or psychiatric care). The mothers completed the Child Behavior Checklist, Beck Depression Inventory, Marital Adjustment Scale and semi-structured interview. The children referred to psychiatry services had higher scores in the clinical range for somatic complaints, thought problems and externalizing problems. The comparison of the caregivers’ profiles indicated that the choice of the type of service for the child was related to maternal variables, since mothers with greater adversity levels and depression choose drug treatment. This highlights the importance of simultaneously care for mother and child and proposals to ensure demand and adherence to psychological treatment.

Rejeição e vitimização por pares em crianças com Deficiência Intelectual e Transtorno do Espectro Autista

Children with special educational needs, such as Intellectual Disability (ID) and Autism Spectrum Disorders (ASD), are increasingly participating in regular classes. Despite the relevance of this inclusion, these children may face difficulties as rejection and victimization by peers. Through a literature review, this work aimed to identify the prevalence, impact and factors associated with rejection and victimization among children with DI and TEA. The search was conducted in the Web of Science, PubMed, Medline, Lilacs and Scielo, using the keywords: rejection by peers, peer victimization, intellectual disabilities, Autism Spectrum Disorder , children with disabilities and special needs. We identified 196 articles, of which 32 met the inclusion criteria. We verified high prevalence of victimization and rejection among children with special educational needs, regardless of age. Deficits in social skills and executive functions, inattentive and hyperactive behavior and internalizing problems were associated with difficulties in relationships with peers in this population. These indicators should be included in prevention and/or treatment programs to enable the proper inclusion of children with special educational needs in regular classrooms.