Rogério Lerner

Predictive value of clinical risk indicators in child development: final results of a study based on psychoanalytic theory

No presente artigo, apresentam-se os resultados finais da Pesquisa IRDI. A partir da psicanalise, 31 indicadores clinicos de risco para o desenvolvimento infantil (IRDI) foram construidos e aplicados em 726 criancas entre 0 e 18 meses. Uma sub-amostra foi avaliada com a idade de 3 anos. Os resultados apontaram a capacidade dos IRDI para predizer problemas de desenvolvimento e destacaram ainda 15 indicadores do IRDI com capacidade para predizer risco psiquico para a constituicao subjetiva.We present the final results of a study using the IRDI (Clinical Risk Indicators in Child Development). Based on a psychoanalytic approach, 31 risk signs for child development were constructed and applied to 726 children between the ages of 0 and 18 months. One sub-sample was evaluated at the age of three. The results showed a predictive capacity of IRDIs to indicate developmental problems; 15 indicators for the IRDI were also highlighted that predict psychic risk for the constitution of the subject.

Questionário de indicadores clínicos de risco para o desenvolvimento infantil: avaliação da sensibilidade para transtornos do espectro do autismo

Purpose To assess the sensitivity of the Clinical Risk Indicators for Early Childhood Development (IRDI) questionnaire for parents in identifying autism spectrum disorders. Methods Seventy-two subjects, which comprised parents of children aged 2 years 11 months to 7 years 7 months, participated in the study divided into two groups, namely the study and control groups. The IRDI questionnaire was administered in both groups, and the CARS-BR was applied in the study group. The data were subjected to statistical analysis, and the Pearson correlation coefficient between the IRDI questionnaire and CARS-BR was performed only for the study group to calculate validity. In defining the cutoff score generated by the IRDI questionnaire, the receiver-operating characteristic (ROC) curve was used, and sensitivity, specificity, and positive predictive value were calculated. In the reliability analysis for the IRDI questionnaire, the Kappa coefficient and overall concordance was used. Results The IRDI questionnaire was easy to use, quick to complete, and inexpensive. Analysis of the internal consistency of the questions of the instruments presented good content. The IRDI questionnaire was positively correlated with the CARS-BR. The ROC curve analysis revealed good performance. Conclusion The evaluation of the sensitivity of the instrument for purposes of identifying autism spectrum disorders showed good performance according to the established cutoff point in the study.

Effects of Pediatric Training for Detecting Signs of Developmental Problems

A multicenter study (2004-2008) of clinical Risk Indicators for Child Development (IRDI) created and validated 31 indicators that can be observed in the initial 18 months post birth, with a statistically significant ability to predict developmental problems and psychic risk. Pediatricians were trained to collect data using the instrument. We discuss what remained for the pediatricians by interviewing a pediatrician who attended the course. The interview was analyzed from an institutional discourse perspective, revealing an objective/subjective duality and a split between prior and acquired knowledge. The ward emergency scenario does not provide enough time for a guided look at the indicators; indicators associated with parental function had a greater impact. The course increased his pleasure in his clinical practice, although his prior knowledge was limited. We suggest investigating the extent and limits of the effects of IRDI-oriented training for medical practice.

Contribuições da clínica da parentalidade no atendimento de um caso de obesidade infantil

Estudios con respeto a la obesidad indican que, ademas de cuestiones geneticas, su surgimiento puede estar asociado a las primeras relaciones interpersonales. El presente articulo tiene por objetivo discutir las contribuciones que la clinica de la parentalidad puede traer para el tratamiento de la obesidad infantil, a partir de recortes de un caso clinico. Para tanto, sera presentado el concepto de parentalidad, su derivacion clinica y cuestiones de la contemporaneidad que interfieren en el proceso de tornarse padre y madre. La interpretacion del material clinico revelo que el comportamiento de comer compulsivo del nino estaba relacionado a la fragilidad parental, de acuerdo con los datos de la literatura. Asi, trabajar en el contexto de la clinica de la parentalidad puede favorecer la mejora del sintoma en la medida en que liberta el nino de un legado inenarrable y fortalece tanto el lugar subjetivo del nino como las funciones parentales. Ademas, en los casos en que es necesario, pueden contribuir para la construccion de una demanda para terapia familiar.

A Psicologia na articulação entre os âmbitos coletivo e psíquico: construção de uma política pública em saúde de cuidado com o desenvolvimento

Nowadays, psychology has been demanded to contribute with health public polices articulating collective and psychic stances. The Clinical Indicators of Risk for the Infantile Development - IRDI can achieve it in the context of primary attention for considering development as derived of the interaction between organism and relationships experienced by the baby. Its items are everyday circumstances in with underpin psychic operations that are core for development. The reality of the Brazilian Unique System of Health imposes to psychology the ethic imperative of questioning itself in regard to the version of the mind built in every consultation, psychological or otherwise, which receives the contribution of a psychologist. This demand depends on the articulation between the collective and psychic fields in building a public health policy of development care. The experience of primary care professionals who get to know the items of the protocol and their fundaments increases the overture for the singularity of the people involved in the assessments and orientation provided.

Efeitos de Formação Pediátrica para Detecção de Sinais de Problemas de Desenvolvimento

A multicenter study (2004-2008) of clinical Risk Indicators for Child Development (IRDI) created and validated 31 indicators that can be observed in the initial 18 months post birth, with a statistically significant ability to predict developmental problems and psychic risk. Pediatricians were trained to collect data using the instrument. We discuss what remained for the pediatricians by interviewing a pediatrician who attended the course. The interview was analyzed from an institutional discourse perspective, revealing an objective/subjective duality and a split between prior and acquired knowledge. The ward emergency scenario does not provide enough time for a guided look at the indicators; indicators associated with parental function had a greater impact. The course increased his pleasure in his clinical practice, although his prior knowledge was limited. We suggest investigating the extent and limits of the effects of IRDI-oriented training for medical practice.

Efectos de la Formación Pediátrica en la Detección de Señales de Problemas de Desarrollo

A multicenter study (2004-2008) of clinical Risk Indicators for Child Development (IRDI) created and validated 31 indicators that can be observed in the initial 18 months post birth, with a statistically significant ability to predict developmental problems and psychic risk. Pediatricians were trained to collect data using the instrument. We discuss what remained for the pediatricians by interviewing a pediatrician who attended the course. The interview was analyzed from an institutional discourse perspective, revealing an objective/subjective duality and a split between prior and acquired knowledge. The ward emergency scenario does not provide enough time for a guided look at the indicators; indicators associated with parental function had a greater impact. The course increased his pleasure in his clinical practice, although his prior knowledge was limited. We suggest investigating the extent and limits of the effects of IRDI-oriented training for medical practice.

Associação entre sinais de sofrimento psíquico até dezoito meses e rebaixamento da qualidade de vida aos seis anos de idade

A pedido do Ministerio da Saude foi desenvolvido e validado um protocolo de Indicadores clinicos de Risco para o Desenvolvimento Infantil (IRDI) para detectar riscos para transtornos psiquicos de desenvolvimento em bebes de 0 a 18 meses. Este trabalho teve como objetivo verificar a validade preditiva do IRDI, a partir de sua relacao com dois instrumentos: o Autoquestionnaire Qualite de Vie Enfant Image (AUQUEI) e o Child Health Questionnaire (CHQ), ambos ja validados no Brasil e aplicados aos seis anos de vida. A amostra foi composta por 46 criancas de tres centros de saude de Sao Paulo. Os resultados indicaram que o IRDI nao se mostrou sensivel a avaliacao de qualidade de vida obtida com o uso do AUQUEI. No entanto, a associacao estatisticamente significante encontrada entre resultados obtidos no IRDI e no CHQ mostrou maior capacidade do IRDI para predizer qualidade de vida relacionada ao indice psicossocial do que ao indice fisico do mesmo instrumento.

IRDI en la Evaluación de Bebés con Problemas de Desarrollo Asociados al Autismo

This exploratory study investigates the contributions the Clinical Risk Indicators in Child Development (CDRI) may bring for the evaluation of infants who might be considered in autistic development. To do so, results of the evaluation – using CDRI and the Modified Checklist for Autism (M-CHAT) – of 43 babies who were 18 months old were compared. The present study showed that autism is amongst the risks the CDRI detects. The statistical analysis highlights that the axis Subject Assumption (SA) may not differentiate infants who present developmental problems associated with autism from typically developing ones. The Alternate Presence/Absence (PA) axis seems to be the one that most distinguishes these groups of infants. The clinical vignette demonstrates that CDRI can be used as a guide that helps to understand the family dynamics and can guide the interventions made in public health services.Esta pesquisa e um estudo exploratorio com o objetivo de investigar contribuicoes que o protocolo Indicadores Clinicos de Risco para o Desenvolvimento Infantil (IRDI) pode trazer para avaliacao de bebes que estejam se desenvolvendo em um percurso autistico. Para tanto, foram comparados resultados do IRDI e do Modified Checklist for Autism in Toddlers (M-CHAT) em 43 bebes de 18 meses de vida. O estudo demonstrou que dentre os riscos detectados pelo IRDI tambem esta o autismo. A analise estatistica aponta para a possibilidade de o eixo Suposicao de Sujeito (SS) nao diferenciar bebes com problemas de desenvolvimento associados ao autismo daqueles que apresentam um desenvolvimento tipico. O eixo Alternância Presenca/Ausencia (PA) parece ser aquele que mais distingue os dois grupos de bebes. A vinheta clinica demonstra que o IRDI pode ser utilizado como um operador de leitura que auxilia a compreensao de dinâmicas familiares com potencial para orientar intervencoes no contexto da saude publica.

IRDI na Avaliação de Bebês com Problemas de Desenvolvimento Associados ao Autismo

This exploratory study investigates the contributions the Clinical Risk Indicators in Child Development (CDRI) may bring for the evaluation of infants who might be considered in autistic development. To do so, results of the evaluation – using CDRI and the Modified Checklist for Autism (M-CHAT) – of 43 babies who were 18 months old were compared. The present study showed that autism is amongst the risks the CDRI detects. The statistical analysis highlights that the axis Subject Assumption (SA) may not differentiate infants who present developmental problems associated with autism from typically developing ones. The Alternate Presence/Absence (PA) axis seems to be the one that most distinguishes these groups of infants. The clinical vignette demonstrates that CDRI can be used as a guide that helps to understand the family dynamics and can guide the interventions made in public health services.Esta pesquisa e um estudo exploratorio com o objetivo de investigar contribuicoes que o protocolo Indicadores Clinicos de Risco para o Desenvolvimento Infantil (IRDI) pode trazer para avaliacao de bebes que estejam se desenvolvendo em um percurso autistico. Para tanto, foram comparados resultados do IRDI e do Modified Checklist for Autism in Toddlers (M-CHAT) em 43 bebes de 18 meses de vida. O estudo demonstrou que dentre os riscos detectados pelo IRDI tambem esta o autismo. A analise estatistica aponta para a possibilidade de o eixo Suposicao de Sujeito (SS) nao diferenciar bebes com problemas de desenvolvimento associados ao autismo daqueles que apresentam um desenvolvimento tipico. O eixo Alternância Presenca/Ausencia (PA) parece ser aquele que mais distingue os dois grupos de bebes. A vinheta clinica demonstra que o IRDI pode ser utilizado como um operador de leitura que auxilia a compreensao de dinâmicas familiares com potencial para orientar intervencoes no contexto da saude publica.