Sandra Regina B. Muzzolon

Learning disabilities: analysis of 69 children

With this article we intend to demonstrate the importance of evaluation and follow up of children with learning disabilities, through a multidisciplinary team. As well as to establish the need of intervention. We evaluate 69 children, from Aline Picheth Public School, in Curitiba, attending first or second grade of elementary school, through general and evolutionary neurological examination, pediatric checklist symptoms, and social, linguistic and psychological (WISC-III, Bender Infantile and WPPSI-figures) evaluation. The incidence was higher in boys (84,1%), familiar history of learning disabilities was found in 42%, and writing abnormalities in 56,5%. The most frequent diagnosis was attention deficit and hyperactivity disorder, in 39,1%. With this program, we aimed to reduce the retention taxes and stress the importance of this evaluation, and, if necessary, multidisciplinary intervention in the cases of learning disabilities.

Crescimento e antropometria em pacientes com paralisia cerebral hemiplégica

OBJECTIVE: To analyze the linear growth, the head circumference and the anthropometric differences between involved and non-involved sides of 24 children with hemiplegic cerebral palsy, comparing them to standard values for age. METHODS: This cross-sectional study enrolled 24 consecutive children with cerebral palsy clinically classified as spastic hemiplegia. The anthropometric measures included: weight, lenght, head circumference, total upper limb length, hand length, palm width, total lower limb length, foot length, and limb circumference of upper-arm, thigh and calf. The anthropometric differences between both sides were calculated in centimeters and a comparison of the involved and non-involved sides was made. Two different reference values were used to compare the measures of hand and foot length: growth charts and the software ABase® (a PalmOS-based software). The Spearmans correlation coefficient was estimated for the association between quantitative variables and the Wilcoxon non-parametric test was used for age comparisons between involved and noninvolved sides. RESULTS: The mean values of weight, length and head circumference were within the normal range for age and 21% of the children presented microcephaly. Discrepancy was noted between both sides in all cases, being the largest discrepancy in hand length and width. There was a positive correlation between the discrepancy observed in superior and inferior affected limbs (r=0.48), and discrepancy increases with age (r=0.44). CONCLUSION: Growth impairment in children with hemiplegic cerebral palsy was observed on the affected limbs and in smaller proportion in head circumference.

Evaluation of the Pediatric Symptom Checklist as a screening tool for the identification of emotional and psychosocial problems

OBJETIVO Investigar a Lista de Sintomas Pediatricos (LSP) como instrumento de triagem para identificar problemas emocionais e psicossociais em escolares de seis a 12 anos. METODOS Estudo do tipo teste diagnostico, realizado em uma escola publica de Curitiba, Parana, para avaliar a acuracia e a consistencia da LSP, considerando-se o Child Behavior Checklist (CBCL) como padrao-ouro. Dos 415 pais convidados a participar do estudo, 145 responderam a LSP e ao CBCL, constituindo a amostra. Os resultados dos dois instrumentos foram comparados. Considerou-se como positivo o escore da LSP ≥28 e o do CBCL >70 pontos. RESULTADOS Dos 145 questionarios, 49 (33,8%) tanto da LSP como do CBCL mostraram-se positivos. A curva ROC indicou 21 como o melhor ponto de corte para triagem de problemas emocionais e psicossociais, com sensibilidade de 96,8% e especificidade de 86,7%. No ponto de corte de referencia (≥28), observou-se sensibilidade de 64,5% e especificidade de 100,0%, similares as encontradas na versao americana do instrumento. CONCLUSOES A LSP mostrou-se eficaz para a identificao precoce de problemas emocionais e/ou psicossociais em um grupo de escolares, podendo ser uma ferramenta util ao pediatra.OBJECTIVE To investigate the Brazilian version of Pediatric Symptom Checklist (PSC) as a screening tool to identify psychosocial and emotional problems in schoolchildren from six to 12 years old. METHODS Diagnostic test conducted in a public school of Curitiba, Paraná (Southern Brazil), to evaluate the PSC accuracy and consistency, considering the Child Behavior Checklist (CBCL) as the gold standard. Among 415 parents invited for the study, 145 responded to both PSC and CBCL. The results of the two instruments were compared. PSC and CBCL were considered positive if scores ≥28 and >70 respectively. RESULTS Among the 145 cases, 49 (33.8%) were positive for both PSC and CBCL. The ROC curve showed the PSC score of 21 as the best cutoff point for screening psychosocial and emotional problems, with a sensitivity of 96.8% and a specificity of 86.7%. Regarding the reference cutoff (score ≥28 points), the sensitivity was 64.5% and the specificity, 100.0%, similar to those found in the original version of the tool. CONCLUSIONS The Portuguese version of PSC was effective for early identification of emotional and/or psychosocial problems in a schoolchildren group and may be useful for pediatricians.

Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study.

OBJECTIVE To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP). Only the study group (SG) received early treatment of spasticity with botulinum neurotoxin type A (BXT-A). METHODS Gross Motor Function Measure (GMFM), functional performance (Pediatric Evaluation of Disability Inventory - PEDI), range of movement, gait pattern (Physician Rating Scale - PRS) and the speed of hand movements were considered. RESULTS The SG, composed of 11 HCP (45.64±6.3 months), was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months). SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. CONCLUSION Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance.

Triagem cognitiva e comportamental de crianças com dificuldades de aprendizagem escolar: um estudo preliminar

Objective: To evaluate the applicability of the mini-men- tal state examination (mmse) and the Pediatric symptom Checklist (PsC) as a screening test for cognitive and psycho - social problems in children with learning disabilities. Methods: Descriptive and cross-sectional study involv - ing 103 children aged 6 to 9 years, with possible learning disabilities, referred from a public school in Curitiba, Brazil, from march 1, 2002 to June 30, 2009. Data were simultane - ously collected by a multidisciplinary team using the PsC, mmse, and Wechsler Intelligence scale for Children (WIsC- III). From 2007 on the Child Behavior Checklist (CBCL) and Teachers Report Form (TRF) were used and compared with the PsC. Correlation coefficients between the tests were calculated, with the significance level set at <0.05. Results: Among the studied children, 10% had some type of learning disability, 76% were male, and 24% were female. The most prevalent age group was 6 to 7 years. A positive fam - ily history was found in 45% of cases, and an adverse obstetric history in 18%, with low birth weight the most common issue. Correlations were detected between the mmse and WIsC-III (r=0.73) and between the CBCL and PsC (r=0.53). Conclusion: The mmse and PsC can be used by pediatricians as screening tools for detection of cogni - tive and psychosocial problems in children with learning disabilities.

Cognitive and behavioral screening of children with learning disabilities: a preliminary study

Objective: To evaluate the applicability of the mini-men- tal state examination (mmse) and the Pediatric symptom Checklist (PsC) as a screening test for cognitive and psycho - social problems in children with learning disabilities. Methods: Descriptive and cross-sectional study involv - ing 103 children aged 6 to 9 years, with possible learning disabilities, referred from a public school in Curitiba, Brazil, from march 1, 2002 to June 30, 2009. Data were simultane - ously collected by a multidisciplinary team using the PsC, mmse, and Wechsler Intelligence scale for Children (WIsC- III). From 2007 on the Child Behavior Checklist (CBCL) and Teachers Report Form (TRF) were used and compared with the PsC. Correlation coefficients between the tests were calculated, with the significance level set at <0.05. Results: Among the studied children, 10% had some type of learning disability, 76% were male, and 24% were female. The most prevalent age group was 6 to 7 years. A positive fam - ily history was found in 45% of cases, and an adverse obstetric history in 18%, with low birth weight the most common issue. Correlations were detected between the mmse and WIsC-III (r=0.73) and between the CBCL and PsC (r=0.53). Conclusion: The mmse and PsC can be used by pediatricians as screening tools for detection of cogni - tive and psychosocial problems in children with learning disabilities.

Evaluation of the use of the pediatric symptom checklist as screening for emotional and psychosocial problems in a public school in curitiba, Brazil

Introduction: The identification of emotional and psychosocial problems must be part of the pediatric practice. Studies have documented the increase in the prevalence of Mental Disorders in children and adolescents. Even so pediatricians still have not received adequate training on this subject. The routine use of emotional and psychosocial assessment tests has been proposed as a way to improve and thus increase the recognition of problems, enabling the early initiation of appropriate intervention. Objective: To investigate the effectiveness of the Brazilian version of the Pediatric Symptom Checklist (PSC) as a tool at screening for the identification of emotional and psychosocial problems and their prevalence in a population of children and/or adolescents aged between 6 and 12 years, attending the fundamental level in a public school in the city of Curitiba, PR. Method: In the first stage of study, the PSC was answered by 415 parents and/or responsible person for the students with an average age of 9.21 (±1.99), taking the elementary schools, of which, later, 145 responded to PSC and Child Behavior Checklist, CBCL questionnaires. Results: From the initial population of the study, 14% showed POSITIVE result for the PSC, indicating frequency of response to psychosocial problems, ie value ≥28. In the sample the prevalence of PSC POSITIVE was 34%. The consistency of the PSC Brazilian version was good (Cronbach alpha 0.89). The ROC curve showed the better cut-off at 21, with sensitivity of 96.8% and specificity of 86.7%. In the cut point (28 and above) it was observed sensitivity of 64.5% and specificity of 100%, similar to the results found in the American version indicating similarity between the Brazilian and American samples. The male gender prevailed in the group with indicative of psychosocial dysfunction. The PSC proved to be appropriate for the age group studied, with more sensitivity and specificity in children below 10 years of age. Conclusion: The Brazilian PSC version proved to be an effective tool in the early identification of emotional and/ or psychosocial problems in a group of children and/or adolescents at school age.

THE EFFECT OF ADAPTED SPORTS IN QUALITY OF LIFE AND BIOPSYCHOSOCIAL PROFILE OF CHILDREN AND ADOLESCENTS WITH CEREBRAL PALSY

ABSTRACT Objective: The participation in sports and recreational activities promotes inclusion and the quality of life (QOL) for people with some type of disability. This study aims to evaluate and describe the effect of adapted sports (AS) on the QOL and biopsychosocial profile of children/adolescents with cerebral palsy (CP). Methods: Forty-seven children/adolescents with CP were evaluated and referred to AS (soccer and swimming). The QOL was evaluated by the Pediatric Outcome Data Collection Instrument (PODCI) and the biopsychosocial profile by the Behavior Checklist for Children/Adolescents (CBCL). These instruments considered the influence of gender, age, race, social income, education and topography of spasticity. Results: Seventeen children/adolescents who practiced AS were re-evaluated after one year. There was significant improvement in the dimensions of transfers and mobility (p=0.009), upper extremity function (p=0.021) and global function (p=0.004) of IARRP. There was significant improvement considering the attention disorder syndrome (p=0.026), and the attention deficit hyperactivity disorders (p=0.008) in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented analysis (CBCL). Children/adolescents with diplegia obtained greater benefit than those with hemiplegia in relation to the comfort and pain (p=0.02) and global dimension (p=0.027) (PODCI). The boys had higher scores in total competence (p=0.048); the extremely poor group obtained higher levels in the breaking rules syndrome (p=0.008). Conclusions: The AS had a positive effect on the QOL and biopsychosocial profile of children/adolescents with CP in this sample, especially considering the global and upper extremity function, capacity for transfers and mobility, and benefits in the problems related to difficulties in attention.

Avaliação da Lista de Sintomas Pediátricos como instrumento de triagem para identificar problemas emocionais e psicossociais

OBJETIVO Investigar a Lista de Sintomas Pediatricos (LSP) como instrumento de triagem para identificar problemas emocionais e psicossociais em escolares de seis a 12 anos. METODOS Estudo do tipo teste diagnostico, realizado em uma escola publica de Curitiba, Parana, para avaliar a acuracia e a consistencia da LSP, considerando-se o Child Behavior Checklist (CBCL) como padrao-ouro. Dos 415 pais convidados a participar do estudo, 145 responderam a LSP e ao CBCL, constituindo a amostra. Os resultados dos dois instrumentos foram comparados. Considerou-se como positivo o escore da LSP ≥28 e o do CBCL >70 pontos. RESULTADOS Dos 145 questionarios, 49 (33,8%) tanto da LSP como do CBCL mostraram-se positivos. A curva ROC indicou 21 como o melhor ponto de corte para triagem de problemas emocionais e psicossociais, com sensibilidade de 96,8% e especificidade de 86,7%. No ponto de corte de referencia (≥28), observou-se sensibilidade de 64,5% e especificidade de 100,0%, similares as encontradas na versao americana do instrumento. CONCLUSOES A LSP mostrou-se eficaz para a identificao precoce de problemas emocionais e/ou psicossociais em um grupo de escolares, podendo ser uma ferramenta util ao pediatra.OBJECTIVE To investigate the Brazilian version of Pediatric Symptom Checklist (PSC) as a screening tool to identify psychosocial and emotional problems in schoolchildren from six to 12 years old. METHODS Diagnostic test conducted in a public school of Curitiba, Paraná (Southern Brazil), to evaluate the PSC accuracy and consistency, considering the Child Behavior Checklist (CBCL) as the gold standard. Among 415 parents invited for the study, 145 responded to both PSC and CBCL. The results of the two instruments were compared. PSC and CBCL were considered positive if scores ≥28 and >70 respectively. RESULTS Among the 145 cases, 49 (33.8%) were positive for both PSC and CBCL. The ROC curve showed the PSC score of 21 as the best cutoff point for screening psychosocial and emotional problems, with a sensitivity of 96.8% and a specificity of 86.7%. Regarding the reference cutoff (score ≥28 points), the sensitivity was 64.5% and the specificity, 100.0%, similar to those found in the original version of the tool. CONCLUSIONS The Portuguese version of PSC was effective for early identification of emotional and/or psychosocial problems in a schoolchildren group and may be useful for pediatricians.

Evaluación del uso de la Lista de Síntomas Pediátricos como instrumento de rastreo para identificar problemas emocionales y psicosociales

OBJETIVO Investigar a Lista de Sintomas Pediatricos (LSP) como instrumento de triagem para identificar problemas emocionais e psicossociais em escolares de seis a 12 anos. METODOS Estudo do tipo teste diagnostico, realizado em uma escola publica de Curitiba, Parana, para avaliar a acuracia e a consistencia da LSP, considerando-se o Child Behavior Checklist (CBCL) como padrao-ouro. Dos 415 pais convidados a participar do estudo, 145 responderam a LSP e ao CBCL, constituindo a amostra. Os resultados dos dois instrumentos foram comparados. Considerou-se como positivo o escore da LSP ≥28 e o do CBCL >70 pontos. RESULTADOS Dos 145 questionarios, 49 (33,8%) tanto da LSP como do CBCL mostraram-se positivos. A curva ROC indicou 21 como o melhor ponto de corte para triagem de problemas emocionais e psicossociais, com sensibilidade de 96,8% e especificidade de 86,7%. No ponto de corte de referencia (≥28), observou-se sensibilidade de 64,5% e especificidade de 100,0%, similares as encontradas na versao americana do instrumento. CONCLUSOES A LSP mostrou-se eficaz para a identificao precoce de problemas emocionais e/ou psicossociais em um grupo de escolares, podendo ser uma ferramenta util ao pediatra.OBJECTIVE To investigate the Brazilian version of Pediatric Symptom Checklist (PSC) as a screening tool to identify psychosocial and emotional problems in schoolchildren from six to 12 years old. METHODS Diagnostic test conducted in a public school of Curitiba, Paraná (Southern Brazil), to evaluate the PSC accuracy and consistency, considering the Child Behavior Checklist (CBCL) as the gold standard. Among 415 parents invited for the study, 145 responded to both PSC and CBCL. The results of the two instruments were compared. PSC and CBCL were considered positive if scores ≥28 and >70 respectively. RESULTS Among the 145 cases, 49 (33.8%) were positive for both PSC and CBCL. The ROC curve showed the PSC score of 21 as the best cutoff point for screening psychosocial and emotional problems, with a sensitivity of 96.8% and a specificity of 86.7%. Regarding the reference cutoff (score ≥28 points), the sensitivity was 64.5% and the specificity, 100.0%, similar to those found in the original version of the tool. CONCLUSIONS The Portuguese version of PSC was effective for early identification of emotional and/or psychosocial problems in a schoolchildren group and may be useful for pediatricians.