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Doctoral Thesis
DOI
https://doi.org/10.11606/T.47.2018.tde-05022018-155845
Document
Author
Full name
Deisy Emerich Geraldo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2017
Supervisor
Committee
Silvares, Edwiges Ferreira de Mattos (President)
Assumpcao Junior, Francisco Baptista
Bosa, Cleonice Alves
Lotufo Neto, Francisco
Mecca, Tatiana Pontrelli
Title in Portuguese
Problemas de comportamento de crianças com necessidades educacionais especiais, saúde e práticas educativas do cuidador
Keywords in Portuguese
Cuidador
Necessidades educacionais especiais
Problemas de comportamento
Saúde mental
Transtornos do Neurodesenvolvimento
Abstract in Portuguese
As politicas de apoio a criancas com Transtornos do Neurodesenvolvimento precisam que seus cuidadores sejam responsaveis por prover o ensino especial necessario para o manejo dos problemas de comportamento e evitar que sejam objeto de rejeicao social em funcao de seus deficits comportamentais. Essa carga de trabalho pode acarretar impacto a saude mental e qualidade de vida dos cuidadores e justifica a importancia de estudos voltados para o mapeamento de tais dificuldades, afim de sustentar propostas de prevencao e intervencao destinadas a este publico. Este estudo, de corte transversal, teve como objetivo identificar associacoes entre os problemas de comportamento de criancas com Transtornos do Neurodesenvolvimento e a saude mental e qualidade de seus cuidadores, alem de descrever as praticas parentais educativas utilizadas. A amostra foi composta por 91 diades cuidadorescriancas. Todas as criancas (idade entre 3 e 18 anos) estavam matriculadas em escolas da rede publica do municipio de Barueri-SP como aluno com necessidade educacional especial e apresentavam laudo diagnostico de Deficiencia Intelectual (DI) idiopatica, Transtorno do Espectro Autista ou Sindrome de Down comorbido com DI. Para a avaliacao comportamental infantil foi empregada a Escala de Comportamentos Aberrantes, o Inventario de Problemas de Comportamento e o Inventario dos Comportamentos de Criancas e Adolescentes. Para a avaliacao dos cuidadores, aplicou-se o Inventario de Autoavaliacao para Adultos de 18 a 59 anos, o Instrumento abreviado de avaliacao de qualidade de vida (WHOQOL-Bref) e o World-Safe CORE para as praticas parentais. As analises demonstram nao haver diferenca na saude mental do cuidador em funcao do diagnostico de seu filho. A avaliacao comportamental dos cuidadores evidenciou que suas dificuldades internalizantes foram as areas mais impactadas pelos problemas de comportamento infantis. Entre 3,4% e 20% da variancia dos indicadores de saude mental dos cuidadores foi significativamente explicada pelas queixas externalizantes da crianca, especialmente hiperatividade e agressividade, e as dificuldades internalizantes infantis, principalmente o retraimento. As dificuldades comportamentais infantis nao foram preditores da qualidade de vida total dos cuidadores. Ja a frequencia de comportamento agressivo da crianca foi preditor do Dominio Psicologico do WHOQOLBref. Quanto as praticas parentais, muitos reportaram utilizar metodos coercitivos para tentar controlar o comportamento de seus filhos. As queixas internalizantes dos cuidadores, especialmente Ansiedade/ Depressao e Queixas Somaticas, devem ser alvo de atencao das iniciativas em saude. Assim propostas de intervencao para melhoria da saude mental poderiam ser destinadas a todos os cuidadores independente do diagnostico clinico de seus filhos, dado que muitos reportaram o uso de estrategias coercitivas e que seus problemas de comportamento sao similares
Title in English
Not informed by the author
Keywords in English
Behavior problems
Caregiver
Mental health
Neurodevelopmental Disorders
Special educational needs
Abstract in English
Policies to support children with Neurodevelopmental Disorders need their caregivers to be responsible for providing the special education in order to manage behavioral problems and avoid social rejection due to their child behavioral difficulties. This caregiver's workload can impact one's mental health and quality of life therefore supporting the importance of studies aimed to investigate this impact in order to support prevention and intervention programs for this specific public. This crosssectional study aimed to identify associations between the behavioral problems of children with Neurodevelopmental Disorders and the mental health and quality of life of their caregivers, as well as to describe their parental practices. The sample consisted of 91 caregiver and child. All children (Aged between 3 and 18 years) were enrolled in public schools in the city of Barueri-SP as students with special educational needs and diagnostic reports of Idiopathic Intellectual Disability (ID), Autism Spectrum Disorder and Down Syndrome comorbid with ID. For the child's behavioral assessment, the following questionnaires were used: Aberrant Behavior Checklist, Behavior Problems Inventory and Child Behavior Checklist. For the caregiver's evaluation were used the Adult Self-Report, the World Health Organization Quality of Life Instruments (WHOQOL-Bref) and the World-Safe CORE for parental practices. The analysis shows that there is no difference in the caregiver's mental health due to their child's diagnosis. The caregiver's behavioral evaluation demonstrated that their internalizing difficulties are the most impacted area due to their children's behavioral problems. Between 3.4% and 20% of the variance on the caregiver's assessment were significantly predicted by child's externalizing complaints, mainly hyperactivity and aggressiveness, and the child's internalizing difficulties, especially social withdrawal. Caregiver's overall quality of life were not predicted by child's behavioral difficulties, whereas the frequency of child's aggressive behavior predicts 4% of variance on the Psychological Domain of WHOQOL-Bref. Regarding parental practices, many caregivers reported the use of coercive methods to try to control their children's behavior. Caregiver's internalizing problems, especially Anxiety/ Depression and Somatic Complaints, should be addressed by health initiatives. Thus, interventions for improving mental health could be targeted to all caregivers regardless their child's clinical diagnosis, given that many of them have reported using coercive measures and the similarity of their behavioral problems
 
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Publishing Date
2018-02-20
 
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