Changes in behavioral and cognitive abilities after rapid maxillary expansion in children affected by persistent snoring after long-term adenotonsillectomy: A noncontrolled study.

INTRODUCTION: The objective of this study was to verify changes in behavioral abilities and cognitive functions after rapid maxillary expansion (RME) in children with refractory sleep-disordered breathing (SDB) in the long term after adenotonsillectomy. METHODS: A prospective clinical trial study using RME therapy was conducted. Participant inclusion criteria were children who had adenotonsillectomy with maxillary transverse deficiency and persistent SDB (obstructive apnea-hypopnea index ≥1). The study included 24 children aged 5-12 years, and of these 24 children, 13 had primary snoring and 11 had obstructive sleep apnea. The patients underwent laryngeal nasofibroscopy and a complete polysomnography. In addition, patients completed the Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire. Behavioral and neurocognitive tests were also completed before and after RME. RESULTS: The Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life scores showed a statistically significant decrease in both groups (P <0.001) after RME. The results showed that neurocognitive and behavioral parameters (Child Behavior Checklist scale) were similar in primary snoring and obstructive sleep apnea (OSA) groups before RME. In the OSA group, the mean scores of the "Somatic" and "Aggressiveness" domains decreased significantly (P <0.05). The cognitive functions did not register significant differences pre- and post-RME in any of the cognitive functions, except for visuospatial function in the OSA group. CONCLUSIONS: The noncontrolled design was a major limitation of our study. The need for treatment for SDB should consider the association of symptoms and behavioral disturbances with the child's obstructive apnea-hypopnea index. RME might prove to be an alternative treatment for children with SDB refractory to adenotonsillectomy, improving quality of life and behavioral aspects. However, a larger sample size with a control group is needed to substantiate these claims.

Response to intervention as an identification strategy of the risk for dyslexia. / Resposta à intervenção como estratégia de identificação do risco para dislexia.

PURPOSE: To develop on intervention process to identify children at risk of dyslexia, based on the Response to Intervention model. Specifically, to identify the pattern of changes in post-intervention performance in tasks of phonological awareness, working memory, lexical access, reading and writing; and to analyze which cognitive functions had a significant effect on the discriminating students at risk of dyslexia. METHOD: Sample of 30 participants with Reading and writing difficulties, aged 8-11, from public/private schools, students from 3rd to 5th grade. Participants were submitted to a battery of cognitive-linguistic tests, before and after 12 intervention sessions. To monitor their performance, five reading and writing lists of words and pseudowords were applied. We qualitatively and quantitatively analyzed the differences in pre- and post-intervention performance of each participant; and among participants in the post-assessment, to understand the patterns of dyslexia vs non-dyslexia groups. RESULTS: There were statistically significant changes in: rapid automatized naming, narrative text comprehension, phonological awareness, rate and typology of hits/misses in reading and writing, and reading speed. Being the last three variables the most sensitive to discriminate the two groups, all with less post-intervention gains for the dyslexia group. CONCLUSIONS: The intervention focused on the stimulation of phonological skills and explicit and systematic teaching of graphophonemic correspondences contributed positively to the evolution of the group's participants. The intervention response approach favored the identification of children with a profile at risk for dyslexia, as distinct from children with other learning difficulties.

OBJETIVO: desenvolver um processo de intervenção para identificação de crianças em risco para dislexia, baseado no modelo de resposta à intervenção. Especificamente, identificar o perfil de mudança no desempenho pós-intervenção em tarefas de consciência fonológica, memória operacional, acesso lexical, leitura, escrita; e analisar quais funções cognitivas tiveram efeito significativo para discriminação de estudantes em risco para dislexia. MÉTODO: amostra composta por 30 participantes com dificuldades na leitura e escrita, entre 8 e 11 anos, de escola pública ou particular, estudantes do 3º ao 5º ano. Todos foram submetidos a uma bateria de testes cognitivo-linguísticos, antes e após a realização de 12 sessões de intervenção. Para monitoramento do desempenho foram aplicadas cinco listas de leitura e escrita de palavras/pseudopalavras. Foram realizadas análises, qualitativas e quantitativas, das diferenças de desempenho pré e pós-intervenção; e entre os participantes na pós avaliação, para compreensão de grupos perfil em risco para dislexia vs não-dislexia. RESULTADOS: ocorreram mudanças estatisticamente significativas em nomeação automática rápida, compreensão de texto, consciência fonológica, taxa e tipologia de acertos/erros na leitura/escrita e velocidade de leitura. Sendo essas três últimas variáveis as que se mostraram mais discriminativas dos grupos, todas com menos ganhos na pós-intervenção para o grupo com perfil em risco de dislexia. CONCLUSÃO: a intervenção com foco na estimulação das habilidades fonológicas e ensino explícito das correspondências grafofonêmicas contribuiu para a evolução dos participantes. A abordagem de resposta à intervenção favoreceu a identificação de crianças com perfil em risco para dislexia, as diferenciando de crianças com outras dificuldades de aprendizagem.

Resposta à intervenção como estratégia de identificação do risco para dislexia / Response to intervention as an identification strategy of the risk for dyslexia

Resumo Objetivo desenvolver um processo de intervenção para identificação de crianças em risco para dislexia, baseado no modelo de resposta à intervenção. Especificamente, identificar o perfil de mudança no desempenho pós-intervenção em tarefas de consciência fonológica, memória operacional, acesso lexical, leitura, escrita; e analisar quais funções cognitivas tiveram efeito significativo para discriminação de estudantes em risco para dislexia. Método amostra composta por 30 participantes com dificuldades na leitura e escrita, entre 8 e 11 anos, de escola pública ou particular, estudantes do 3º ao 5º ano. Todos foram submetidos a uma bateria de testes cognitivo-linguísticos, antes e após a realização de 12 sessões de intervenção. Para monitoramento do desempenho foram aplicadas cinco listas de leitura e escrita de palavras/pseudopalavras. Foram realizadas análises, qualitativas e quantitativas, das diferenças de desempenho pré e pós-intervenção; e entre os participantes na pós avaliação, para compreensão de grupos perfil em risco para dislexia vs não-dislexia. Resultados ocorreram mudanças estatisticamente significativas em nomeação automática rápida, compreensão de texto, consciência fonológica, taxa e tipologia de acertos/erros na leitura/escrita e velocidade de leitura. Sendo essas três últimas variáveis as que se mostraram mais discriminativas dos grupos, todas com menos ganhos na pós-intervenção para o grupo com perfil em risco de dislexia. Conclusão a intervenção com foco na estimulação das habilidades fonológicas e ensino explícito das correspondências grafofonêmicas contribuiu para a evolução dos participantes. A abordagem de resposta à intervenção favoreceu a identificação de crianças com perfil em risco para dislexia, as diferenciando de crianças com outras dificuldades de aprendizagem.

ABSTRACT Purpose To develop on intervention process to identify children at risk of dyslexia, based on the Response to Intervention model. Specifically, to identify the pattern of changes in post-intervention performance in tasks of phonological awareness, working memory, lexical access, reading and writing; and to analyze which cognitive functions had a significant effect on the discriminating students at risk of dyslexia. Method Sample of 30 participants with Reading and writing difficulties, aged 8-11, from public/private schools, students from 3rd to 5th grade. Participants were submitted to a battery of cognitive-linguistic tests, before and after 12 intervention sessions. To monitor their performance, five reading and writing lists of words and pseudowords were applied. We qualitatively and quantitatively analyzed the differences in pre- and post-intervention performance of each participant; and among participants in the post-assessment, to understand the patterns of dyslexia vs non-dyslexia groups. Results There were statistically significant changes in: rapid automatized naming, narrative text comprehension, phonological awareness, rate and typology of hits/misses in reading and writing, and reading speed. Being the last three variables the most sensitive to discriminate the two groups, all with less post-intervention gains for the dyslexia group. Conclusions The intervention focused on the stimulation of phonological skills and explicit and systematic teaching of graphophonemic correspondences contributed positively to the evolution of the group's participants. The intervention response approach favored the identification of children with a profile at risk for dyslexia, as distinct from children with other learning difficulties.