Cultural adaptation of an intervention for caregivers of young autistic children: Community members' perspectives.

Caregivers of autistic children in low-to-middle-income countries experience many barriers to access resources to support their child's development. Caregiver training is considered an evidence-based practice and may be a cost-effective way to support caregivers of autistic children in such settings. This study focuses on the cultural adaptation of Parents Taking Action (PTA; Magaña et al., Family Process, 56, 57-74, 2017) to support caregivers of autistic children in Paraguay. We conducted focus groups and individual interviews with 28 caregivers, autistic individuals, and professionals in Paraguay to understand caregivers' needs and to explore needed cultural adaptations of PTA to achieve contextual fit. Participants identified caregivers' need for accurate and reliable information, strategies to support children's growth, and emotional support and strategies to manage stress. Additionally, participants provided recommendations for adapting PTA considering the dimensions within the Cultural Adaptation Checklist (Lee et al., International Journal of Developmental Disabilities, 2023). This study is the first step in the iterative process of culturally adapting an intervention and the process described in this study may be appropriate for culturally adapting other interventions.

A biomarker-based solution for the limited access to early diagnosis and assessment of autism.

With the upsurge of community uptake in population-based early screening for autism, the main obstacle to increasing access to early treatment and intervention services is the extremely limited access to high quality diagnosis, specifically the shortage of expert clinicians. Diagnostic evaluation models deployed by academic centers of excellence, which typically require the investment of 6-10 hours by specialized multidisciplinary teams, is not a viable solution to the vast needs of communities, resulting in parents' "diagnostic odysseys" and delays, often of several years, for treatment, interventions and supports. Biomarker-based objective procedures for early diagnosis and assessment of autism are now available, clinically validated, and cleared for broad implementation by the US Food and Drug Administration (FDA). They are intended to increase access while maintaining high quality. Such solutions, however, will require change in entrenched models of diagnostic care, and aggressive prioritization of the needs of the community at large. If these innovations are successful, the number of children diagnosed in the first three years of life will double or triple. This will, in turn, require much greater investments in resources for treatment, including massive workforce training of providers capable of delivering community-viable caregiver-mediated interventions, and of early educators capable of serving autistic children in therapeutic inclusive preschool settings.

Con el aumento de la aceptación comunitaria de la detección temprana del autismo basada en la población, el principal obstáculo para aumentar el acceso al tratamiento temprano y a los servicios de intervención es el acceso extremadamente limitado a un diagnóstico de alta calidad, específicamente la escasez de médicos expertos. Los modelos de evaluación diagnóstica implementados por centros académicos de excelencia, que normalmente requieren la inversión de 6 a 10 horas por parte de equipos multidisciplinarios especializados, no son una solución viable para las vastas necesidades de las comunidades, lo que resulta en "odiseas diagnósticas" y retrasos, a menudo de gran importancia, para los padres varios años, para tratamiento, intervenciones y apoyos. Los procedimientos objetivos basados en biomarcadores para el diagnóstico temprano y la evaluación del autismo ya están disponibles, clínicamente validados y aprobados para su amplia implementación por la Administración de Alimentos y Medicamentos de EE. UU. (FDA). Su objetivo es aumentar el acceso manteniendo una alta calidad. Sin embargo, tales soluciones requerirán cambios en los modelos arraigados de atención de diagnóstico y una priorización agresiva de las necesidades de la comunidad en general. Si estas innovaciones tienen éxito, el número de niños diagnosticados en los primeros tres años de vida se duplicará o triplicará. Esto, a su vez, requerirá inversiones mucho mayores en recursos para el tratamiento, incluida la capacitación masiva de la fuerza laboral de proveedores capaces de brindar intervenciones comunitarias viables mediadas por cuidadores, y de educadores tempranos capaces de atender a niños autistas en entornos preescolares terapéuticos inclusivos.

Acceptability and feasibility of a parent-mediated social-communication therapy for young autistic children in Brazil: A qualitative implementation study of Paediatric Autism Communication Therapy.

LAY ABSTRACT: Parents of autistic children and health professionals who work with autistic children in Brazil had positive views about introducing Paediatric Autism Communication Therapy as a therapy for autistic children in Brazil. The parents and clinicians also mentioned some difficulties about using Paediatric Autism Communication Therapy in Brazil. We made adaptations to Paediatric Autism Communication Therapy to address these difficulties. Paediatric Autism Communication Therapy is a therapy to support the development of social and communication skills for autistic children aged 2-10 years. The therapy is conducted with the autistic child's parent. Paediatric Autism Communication Therapy has not been used in Brazil before. There are few therapy options available for autistic children in Brazil and we believed that Paediatric Autism Communication Therapy may be useful. We asked three groups of people in Brazil about their views of Paediatric Autism Communication Therapy, after explaining how the therapy works. Group 1 included 18 parents of autistic children aged 2-10 years. Group 2 included 20 health professionals such as psychologists who work with autistic children. Group 3 included 15 parents of autistic children aged 2-7 years who received the Paediatric Autism Communication Therapy. We learned that parents and clinicians felt that Paediatric Autism Communication Therapy would be a beneficial therapy for autistic children in Brazil. We also found out about the challenges of using Paediatric Autism Communication Therapy in Brazil. We used these findings to make small cultural adaptations to Paediatric Autism Communication Therapy to make it more suitable for Brazil.

Assistance to families of children with Autism Spectrum Disorders: Perceptions of the multiprofessional team / Assistência às famílias de crianças com Transtornos do Espectro Autista: percepções da equipe multiprofissional / Asistencia a familias de niños con Trastornos del Espectro Autista: percepciones del equipo multidisciplinario

Abstract Objective: to synthesize the care provided by health professionals, at different care levels, to the families of children with Autism Spectrum Disorders. Method: a qualitative study, based on the Family-Centered Care philosophical theoretical framework and developed with 22 professionals from three multidisciplinary teams from the Health Care Network of a municipality in the state of Mato Grosso do Sul, Brazil. The data were collected through two focus groups with each team, organized with the support of the Atlas.ti 8 Qualitative Data Analysis® software and submitted to Thematic Content Analysis. Results: the findings show actions centered on specific situations, especially on the demands and needs arising from the child's care and atypical behavior. Influencing factors for family care, such as work overload and little professional experience, show the weakness of multiprofessional care and the invisibility of the family as a care unit. Conclusion: the need is highlighted to review functioning of the network for the multiprofessional care of children and their families and how such network is organized. It is recommended to offer permanent education actions that contribute to the qualification of multiprofessional teams in the care of families of children in the autism spectrum.

Resumo Objetivo: sintetizar o cuidado prestado por profissionais de saúde, nos diferentes níveis de atenção, às famílias de crianças com Transtornos do Espectro Autista. Método: estudo qualitativo, baseado no referencial teórico filosófico do Cuidado Centrado na Família, desenvolvido com 22 profissionais de três equipes multidisciplinares de serviços da Rede de Atenção à Saúde de um município do estado de Mato Grosso do Sul, Brasil. Os dados foram coletados por meio de dois grupos focais com cada equipe, organizados com apoio do software Atlas.ti 8 Qualitative Data Analysis e submetidos à Análise Temática de Conteúdo. Resultados: as descobertas mostram ações centradas em situações pontuais, principalmente nas demandas e necessidades advindas do cuidado da criança e de seu comportamento atípico. Fatores influenciadores para o cuidado à família, como a sobrecarga de trabalho e a pouca experiência profissional, evidenciam a fragilidade da assistência multiprofissional e a invisibilidade da família enquanto unidade de cuidado. Conclusão: destaca-se a necessidade de rever o funcionamento e modo como a rede para o cuidado multiprofissional da criança e sua família está organizada. Recomenda-se a oferta de ações de educação permanente que contribuam com a qualificação das equipes multiprofissionais no cuidado às famílias de crianças no espectro do autismo.

Resumen Objetivo: resumir la atención que brindan los profesionales de la salud, en los diferentes niveles de atención, a las familias de niños con Trastornos del Espectro Autista. Método: estudio cualitativo, basado en el marco teórico filosófico de la Atención Centrada en la Familia, desarrollado con 22 profesionales de tres equipos multidisciplinarios de servicios de la Red de Atención de la Salud en un municipio del estado de Mato Grosso do Sul, Brasil. Los datos fueron recolectados a través de dos grupos focales con cada equipo y organizados con la ayuda del software Atlas.ti 8 Qualitative Data Analysis ® y sometidos al Análisis de Contenido Temático. Resultados: los hallazgos muestran acciones enfocadas en situaciones específicas, principalmente en las demandas y necesidades que genera el cuidado del niño y su comportamiento atípico. Factores que influyen en la atención a la familia, como la sobrecarga de trabajo y la poca experiencia profesional, revelan las falencias que tiene la asistencia multidisciplinaria y la invisibilidad de la familia como unidad de atención. Conclusión: es necesario examinar el funcionamiento y la forma en que está organizada la red para la atención multidisciplinaria de los niños y sus familias. Se recomienda implementar acciones de educación continua que contribuyan a la capacitación de los equipos multidisciplinarios para la atención a las familias de niños con espectro autista.

Considerações sobre a direção de tratamento na Clínica de Linguagem com crianças que não falam / Consideraciones sobre la dirección del tratamiento en la Clínica del Lenguaje con niños que no hablan / Considerations on the direction of treatment in the Language Clinic with children who do not speak / Considérations sur l'orientation du traitement à la Clinique du Langage avec des enfants qui ne parlent pas

Neste artigo, após apresentar uma reflexão crítica sobre os efeitos da terapia ABA (Applied Behavior Analysis) - Análise Aplicada do Comportamento (verbal) no atendimento de uma criança com o diagnóstico de autismo, proponho indicar um outro entendimento de linguagem e, portanto, um outro modo de se posicionar diante da fala dessas crianças. Neste sentido, esse artigo tem como objetivo apresentar uma crítica, a partir da Clínica de Linguagem, solo teórico desse trabalho, a metodologia ABA, método amplamente difundido no tratamento dessas crianças

En este artículo, tras presentar una reflexión crítica sobre los efectos de la terapia ABA (sigla en inglés) Análisis Conductual Aplicado (conducta verbal) en la atención a un niño diagnosticado de autismo, me propongo indicar otra forma de entender el lenguaje y, por tanto, otra forma de posicionarse ante el habla de estos niños. En este sentido, este artículo tiene como objetivo presentar una crítica, basada en la Clínica del Lenguaje, base teórica de este trabajo, a la metodología ABA, método ampliamente difundido en el tratamiento de estos niños

In this article, after presenting a critical reflection on the effects of ABA therapy -Applied Behavior Analysis (verbal behavior) in the care of a child diagnosed with autism, I propose to indicate another understanding of language and, therefore, another way to position oneself in front of the speech of these children. In this sense, this article aims to present a critique, based on the Language Clinic, the theoretical basis of this work, the ABA methodology, a widely disseminated method in the treatment of these children

Dans cet article, après avoir présenté une réflexion critique sur les effets de la thérapie ABA -Analyse Comportementale Appliquée (verbale) dans la prise en charge d'un enfant diagnostiqué autiste, je propose d'indiquer une autre compréhension du langage et, par conséquent, une autre façon de se positionner face à la parole de ces enfants. En ce sens, cet article vise à présenter une critique, basée sur la Clinique du Langage, base théorique de ce travail, la méthodologie ABA, une méthode largement diffusée dans le traitement de ces enfants

Construção de um circuito no tratamento do autista / Construcción de un circuito en tratamiento del autista / Construction of a circuit in the treatment of autism / Construction d'un circuit dans le traitement de l'autiste

A partir da apresentação de fragmentos de um caso clínico de autismo infantil, busca-se discutir possibilidades de manejo da voz, do olhar e do corpo do analista no trabalho com sujeitos autistas. Com o referencial da psicanálise, analisam-se algumas estratégias utilizadas pelas analistas na condução do caso bem como seus efeitos na construção do corpo da criança. Assim, considera-se que o analista, ao se portar como um parceiro no trabalho de construção já realizado pelo autista, pode acolher suas dificuldades e reconhecer seus interesses particulares, a fim de estabelecer uma prática clínica que o ajude a se regular e a construir formas menos angustiantes de estar no mundo e de se relacionar

A partir de la presentación de fragmentos de un caso clínico de autismo infantil, se busca discutir posibilidades de manejo de la voz, de la mirada y del cuerpo del analista en el trabajo con sujetos autistas. Con el referencial del psicoanálisis, se analizan algunas estrategias utilizadas por las analistas en la conducción del caso así como sus efectos en la construcción del cuerpo infantil. Así, se considera que el analista, al portarse como un compañero en el trabajo de la construcción ya realizado por el autista, puede acoger sus dificultades y reconocer sus intereses particulares, a fin de establecer una práctica clínica, que lo ayude a regularse y construir formas menos angustiantes de estar en el mundo y relacionarse

Based on the presentation of fragments of a clinical case of infantile autism, the aim is to discuss possibilities for managing the analyst's voice, gaze and body when working with autistic subjects. Relied on the theoretical framework of psychoanalysis, some strategies used by the analysts in the conduction of the case are analyzed, as well as their effects in the construction of the child's body. Thus, it is considered that the analyst, by behaving as a partner in the work of construction which was already carried out by the autistic, can host his/her difficulties and recognize his/her particular interests, in order to establish a clinical practice that helps him/her to regulate himself/herself and to build less distressing ways of being in the world and relating

A partir de la présentation des fragments d'un cas clinique d'autisme infantile, on cherche à discuter les possibilités dans le maniement de la voix, du regard et du corps de l'analyste dans son travail avec les sujets autistes. D'après les références de la psychanalyse, on analyse certaines stratégies utilisées par les analystes pour bien conduire les cas ainsi que leurs effets dans la construction du corps de l'enfant. Alors, on considère que l'analyste, en se conduisant comme un compagnon de travail dans la construction déjà réalisé par l'autiste, peut accueillir ses difficultés et reconnaître ses intérêts particuliers, afin d'établir une pratique clinique qui puisse l'aider à se régir et à construire des modes moins angoissants d'être au monde et de se rapporter aux autres

Functionality of Apps for People with Autism: Comparison between Educators from Florence and Granada.

BACKGROUND: Studies on the potential of smartphone apps for people with autism are currently increasing in number, given the large digital supply available and the benefits they offer. We analyzed the opinion of educators from Florence (Italy) and Granada (Spain) regarding the benefits and applicability of apps, frequency of their use, and the type of apps used for people with autism. METHODS: The study involved 1261 professionals, of whom 286 worked with apps, using a non-experimental quantitative design, descriptive and frequency statistics, parametric inferential analyses (Student's t and one-factor ANOVA), and calculation of the effect size (Cohen's d and eta squared) and intrafactorial correlations. RESULTS: Statistically significant differences were observed in respect of city, sex, age, years of experience, place of work, and type of teacher. The teachers from Granada found more benefits and applicability in apps, and revealed a slightly higher usage than those from Florence. CONCLUSIONS: It is an arduous but worthy task for professionals from schools and associations that work with people with autism to acquire the necessary knowledge to apply methodologies based on information and communication technology (ICT), as this will help achieve the integrated development of people with different capabilities.

A systematic review of observational, naturalistic, and neurophysiological outcome measures of nonpharmacological interventions for autism.

OBJECTIVE: Naturalistic and neurophysiological assessments are relevant as outcome measures in autism intervention trials because they provide, respectively, ecologically valid information about functioning and underlying neurocognitive mechanisms. We conducted a systematic review to highlight which specific neurophysiological techniques, experimental tasks, and naturalistic protocols have been used to assess neural and behavioral functioning in autism intervention studies. METHODS: Studies were collected from four electronic databases between October 2019 and February 2020: MEDLINE (via PubMed), PsycINFO, LILACS, and Web of Science, and were included if they used structured observational, naturalistic, or neurophysiological measures to assess the efficacy of a nonpharmacological intervention for ASD. RESULTS: Fourteen different measures were used by 64 studies, with the Autism Diagnostic Observation Schedule the most frequently used instrument. Thirty-seven different coding systems of naturalistic measures were used across 51 studies, most of which used different protocols. Twentyfour neurophysiological measures were used in 16 studies, with different experimental paradigms and neurophysiological components used across studies. CONCLUSIONS: Cross-study variability in assessing the outcomes of autism interventions may obscure comparisons and conclusions about how different behavioral interventions affect autistic social communication and underlying neurophysiological mechanisms.

The influence of equine-assisted services on the balance of a participant with visual impairment and autism characteristics.

INTRODUCTION: Balance is the basis for all body movements, and is influenced by sensory systems: visual, vestibular and proprioceptive. Therefore, the loss of any of these systems, as in the case of visual impairment (VI), may carry important consequences for body balance and, thus, motor development. The objective of this study was to evaluate changes in the static and dynamic balance of a participant with VI and autism characteristics. METHODS: application of the Berg and Tinetti's Balance Scale, pre- and post-equine assisted services interventions. The study is a qualitative and descriptive case study. RESULTS: The data found showed improvement in the participant's static and dynamic balance, with performance enhancement on the two scales assessed after the equine assisted services program. CONCLUSION: The results proved that equine assisted services is an alternative and effective tool for balance stimulation and improvement of a visually impaired participant with autism characteristics.

Autism: an 'epidemic' of contemporary times?

The text discusses the growing incidence of autism in the world, presents an understanding of autism from the point of view of analytical psychology, and reflects on the treatment of autistic patients. Today, it is understood that autism is part of a continuum of characteristics on a spectrum with biological and congenital causes. It is a non-specific picture resulting from multiple causations of non-linear factors. Autism is a neuro-developmental disorder characterized by a triad of symptoms: persistent deficits in social communication and social interaction, and restricted and repetitive patterns of behaviours, interests, or activities. Autism spectrum disorder must be considered as a clinical entity, with current clearly defined characteristics. It is an extremely complex condition, which requires multidisciplinary approaches aiming at the possibility of prognosis and effective therapeutic approaches. This paper explores how a disturbance may occur from the intra-uterine phase, in which matriarchal experiences do not constellate. The structuring function of the patriarchal organization can then become dominant, and people with autism need understanding and help to organize their world and learn to live in it. As they don't have the capacity to structure consciousness through the matriarchal archetype, they rely entirely on the structuring and organizing capacity of the Father archetype.

Ce texte traite du taux croissant d'autisme dans le monde. Il présente une compréhension de l'autisme du point de vue de la psychologie analytique, et réfléchit au traitement des patients autistes. Au jour d'aujourd'hui il est accepté que l'autisme fait partie d'un continuum de caractéristiques sur un spectre qui inclut des causes biologiques et congénitales. Il s'agit d'un tableau non-spécifique qui est le résultat de causalités multiples concernant des facteurs non-linéaires. L'autisme est un trouble neuro-développemental caractérisé par une triade de symptômes: des déficits durables dans la communication et les interactions sociales, et des schémas de comportements, d'intérêts et d'activités restreints et répétitifs. Le spectre autistique doit être considéré comme une entité clinique, avec des traits caractéristiques actuels raisonnablement définis. C'est une condition extrêmement complexe, qui requiert des approches multidisciplinaires ayant pour but la possibilité d'un pronostic et d'approches thérapeutiques efficaces. Il est possible qu'un problème se produise durant la phase intra-utérine, dans laquelle les expériences matriarcales ne se constelleraient pas. La fonction structurante de l'organisation patriarcale peut devenir dominante et les personnes autistes ont besoin de compréhension et d'aide pour organiser leur monde et apprendre à vivre dedans. N'ayant pas la capacité de structurer la conscience à travers l'archétype matriarcal, elles s'appuient complètement sur la capacité structurante et organisatrice de l'archétype du Père.

El texto describe la incidencia en aumento de autismo en el mundo, presenta una comprensión sobre el autismo desde la perspectiva de la psicología analítica, y reflexiona acerca del tratamiento de pacientes autistas. Actualmente, se comprende que el autismo es parte de un continuum de características en un espectro con causas biológicas y congénitas. Es un cuadro no específico resultado de múltiples causalidades de factores no-lineales. El autismo es un trastorno del neuro-desarrollo caracterizado por una tríada de síntomas: un déficit persistente en la comunicación e interacción social; patrones de conducta, intereses o actividades restrictivas y repetitivas. El trastorno de espectro autista debe ser considerado como una entidad clínica, con características razonablemente definidas y vigentes. Es una condición extremadamente compleja, que requiere de abordajes multidisciplinarios tendientes a la posibilidad de una prognosis y de abordajes terapéuticos efectivos. Posiblemente, una alteración ocurre en la fase intrauterina, en la cual la experiencia matriarcal no se constela. La función estructurante de la organización patriarcal puede volverse dominante y las personas con autismo necesitan comprensión y ayuda para organizar su mundo y aprender a vivir en éste. Al no tener la capacidad de estructurar la consciencia a través del arquetipo matriarcal, dependen enteramente de la capacidad estructurante y organizadora del arquetipo del Padre.

O texto discute a crescente incidência de autismo no mundo, apresenta uma compreensão do autismo do ponto de vista da psicologia analítica e reflete sobre o tratamento de pacientes autistas. Hoje, entende-se que o autismo faz parte de um continuum de características em um espectro com causas biológicas e congênitas. É um quadro inespecífico resultante de múltiplas causas de fatores não lineares. O autismo é um transtorno do neurodesenvolvimento caracterizado por uma tríade de sintomas: déficits persistentes na comunicação social, na interação social; e padrões restritos e repetitivos de comportamentos, interesses ou atividades. O transtorno do espectro do autismo deve ser considerado como uma entidade clínica, com características atuais razoavelmente definidas. É uma condição extremamente complexa, que requer abordagens multidisciplinares visando a possibilidade de prognóstico e abordagens terapêuticas eficazes. Possivelmente, ocorre um distúrbio a partir da fase intrauterina, na qual as experiências matriarcais não se constelam. A função estruturante da organização patriarcal pode se tornar dominante e as pessoas com autismo precisam de compreensão e ajuda para organizar seu mundo e aprender a viver nele. Como eles não têm a capacidade de estruturar a consciência através do arquétipo matriarcal, eles dependem inteiramente da capacidade de estruturação e organização do arquétipo do Pai.

Perfil do atendimento fonoaudiológico voltado para a Comunicação Suplementar e Alternativa / Profile of speech-language pathology care focused on Augmentative and Alternative Communication

RESUMO Objetivo identificar os principais aspectos na tomada de decisão para indicar o uso da Comunicação Suplementar e Alternativa (CSA), bem como características de intervenção. Métodos trata-se de um estudo prospectivo. Foi elaborado um questionário eletrônico para envio a fonoaudiólogos com experiência clínica na área de CSA há cinco anos ou mais, objetivando o levantamento dos dados para esta pesquisa. Resultados verificou-se predomínio de atuação na clínica, com crianças pequenas, sobretudo para casos de transtorno do espectro do autismo e apraxia de fala na infância. Houve divergência de relato de tecnologia abordada e exemplificação de recurso utilizado. A maioria referiu dificuldades de adesão ao trabalho, atribuídas, principalmente, por dificuldades de compreensão do que é a CSA por parte dos familiares e de outros profissionais. Conclusão há escassez de pesquisas e de capacitação profissional para a área de CSA. O investimento nessas fragilidades faz-se necessário para ampliar o uso consciente da CSA e favorecer ações de conscientização de outros profissionais e de familiares.

ABSTRACT Purpose The aim of this study is to identify the main aspects of the decision-making process indicating the use of Augmentative Alternative Communication (AAC), as well as characteristics of the interventions. Methods This is a prospective study, which was submitted to and approved by the Ethics and Research Committee. An electronic questionnaire was created and sent to speech therapist professionals to collect data for this research, with a minimum of 5 years clinical experience in the AAC area. Results We found a predominance in the clinic, of work with young children, especially in cases of ASD and CAS. There is a divergence in the reporting of the addressed technology and the example of the used resource. Most report difficulties in adherence to AAC, mainly due to lack of understanding what AAC is all about and barriers from family members and other professionals. Conclusion There is a lack of research and professional training in the AAC area. Therefore, investing in these areas is necessary to expand the conscious use of AAC and to promote awareness of other professionals and family members.

Transitivismo e psicopatologia na infância / Transitivismo y psicopatologia em la infancia / Transitivism and psychopathology in childhood / Transitivisme et psychopathologie dans la enfance

No presente ensaio teórico, apresenta-se uma leitura da articulação do conceito de transitivismo com a psicopatologia do autismo na infância. Como objeto de pesquisa, utiliza-se um corpus textual composto por escritos de quatro autores que se dedicaram à discussão da psique infantil: Henri Wallon (1879-1962), Jacques Lacan (1901-81), Jean Bergès e Gabriel Balbo. Trabalha-se, ainda, a partir de recortes clínicos de acompanhamentos terapêuticos [AT] com crianças realizados com uma das autoras. A compilação dos recortes clínicos demarca a especificidade da intervenção no AT e aponta a importância de que o profissional psi considere o transitivismo na prática clínica e interrogue-se sobre os obstáculos que se interpõem na organização do transitivismo mãe-criança

En este ensayo teórico, se presenta una lectura de la articulación del concepto de transitivismo con la psicopatología del autismo en la infancia. Como objeto de investigación se utiliza un corpus textual elaborado por cuatro autores dedicados a la discusión de la psique infantil: Henri Wallon (1879-1962), Jacques Lacan (1901-81), Jean Bergès y Gabriel Balbo. También trabajamos a partir de recortes clínicos de acompañamientos terapéuticos [AT]con niños realizados con una de las autoras. La recopilación de recortes clínicos demarca la especificidad de la intervención en el AT y señala la importancia de que el profesional psi considere el transitivismo en la práctica clínica y pregunte por los obstáculos que se interponen en el camino de la organización del transitivismo madre-hijo

In this theoretical essay, the concept of transitivismis articulated with the psychopathology of autism in childhood. As a research object, we work with texts written by four authors who dedicated themselves to the discussion of the infantile psyche: Henri Wallon (1879-1962), Jacques Lacan (1901-81), Jean Bergès and Gabriel Balbo. We also work with clinical excerpts from therapeutic accompaniments [TA] with children that were conducted by one of the authors of this essay. The compilation of the clinical excerpts demarcates the specificity of the intervention in TA and points out how important it is for the psychologist to consider transitivism in the clinical practice and to consider the obstacles that stand in the way of the organization of the mother-child transitivism

Dans le présent essai théorique, nous présentons une lecture de l'articulation du concept de transitivisme avec la psychopathologie de l'autisme dans l'enfance. Comme objet de recherche, nous utilisons un corpus textuel composé pour les écrits de quatre auteurs que se dévoués à la discussion de la psyché infantile: Henri Wallon (1879-1962), Jacques Lacan (1901-81), Jean Bergès et Gabriel Balbo. Nous travaillons encore à partir de vignettes cliniques de les accompagnements thérapeutiques [AT] avec des enfants, réalisés par une de les autrices. La compilation des vignettes cliniques délimite la spécificité de l'interversion dans l'AT et indique l'importance de que le professionnel psy considère le transitivisme dans le pratique clinique et qu'il s'interroge sur les obstacles que s'interposent dans l'organisation du transitivisme mère-enfant

Effect of non-invasive brain stimulation on behavior and serum brain-derived neurotrophic factor and insulin-like growth factor-1 levels in autistic patients.

Aberrant neural connectivity and intra-cortical inhibitory dysfunction are key features of autism. Non-invasive brain stimulation (NIBS) protocols have been proposed that modulate this aberrant plasticity. However, additional investigations are needed to evaluate the impact of this intervention on biological biomarkers of the disease. We recently demonstrated alterations in serum insulin-like growth factor-1 (IGF-1) and brain-derived neurotrophic factor (BDNF) immunoreactivity in subjects with autism compared to controls. The aim of this pilot study was to explore the change in serum levels of the neurotrophic factors BDNF and IGF-1 in patients undergoing NIBS therapy. Sixteen subjects with autism spectrum disorder (ASD) were tested 1 week before and 1 week after NIBS to determine the short-term outcome on behavior using the total score on the autism behavior checklist, autism treatment evaluation checklist, clinical global impression severity and the autism diagnostic interview. ASD subjects younger than 11 years old (n = 11) were treated with transcranial direct current stimulation (tDCS), and those 11 years and older (n = 5) were treated with repetitive transcranial magnetic stimulation (rTMS). Serum levels of BDNF and IGF-1 were evaluated by Enzyme-Linked Immuno-Sorbent Assay before and after the intervention with NIBS. A significant reduction in scores on the clinical behavioral scales was observed in patients treated with NIBS (ABC-T p = .002, CGI-S p = .008, ADI-T and ATEC-T p < .0001). There was a trend towards reduced serum BDNF levels after NIBS (p = .061), while there was no change in IGF-1 levels. These data support further studies on the potential of BDNF as a biomarker to measure the effectiveness of NIBS in autism.

Um olhar psicanalítico acerca do autismo: revisão bibliográfica / Una mirada psicoanalítica sobre el autismo: revisión bibliográfica / A psychoanalytical view on autism: a literature review

O presente artigo é uma pesquisa de revisão de literatura, com o objetivo de identificar algumas das principais hipóteses explicativas sobre o autismo na psicanálise e as suas contribuições no que diz respeito ao seu tratamento. A busca foi realizada nas bibliotecas virtuais Pepsic e Scielo, sendo incluídos artigos escritos em língua portuguesa, publicados no período de 2012 a 2017. Vinte e três artigos foram selecionados e analisados, buscando- se identificar as hipóteses psicanalíticas sobre o autismo, propostas de tratamento, objetivos, métodos, principais resultados e conclusões. Constatamos que os autores mais citados foram Jacques Lacan, seguido por Jean-Claude Maleval, Marie Christine Laznik, Alfredo Jerusalinsky e Maria Cristina Kupfer, todos autores mais ou menos identificados ao referencial lacaniano. No que diz respeito às hipóteses explicativas, encontramos hipóteses sobre a existência de alguma falha ou de algo que não se completa na constituição psíquica do autista. Sobre o diagnóstico do autismo, destacamos os riscos dos diagnósticos precoces e normativos, considerando que a constituição psíquica da criança ainda está em formação. E, finalmente, sobre a possibilidade de tratamento, os artigos indicam a necessidade de respeitar a singularidade da pessoa autista e sua forma de estar no mundo, buscando uma aproximação delicada e não invasiva.

Este artículo es una investigación de revisión de literatura, con el objetivo de identificar algunas de las principales hipótesis explicativas sobre el autismo en psicoanálisis y sus contribuciones respecto a su tratamiento. La búsqueda fue realizada en las bibliotecas virtuales Pepsic y Scielo, incluyendo los artículos escritos en lengua portuguesa y publicados entre 2012 y 2017. Veintitrés artículos fueron seleccionados y analizados, buscando identificar las hipótesis psicoanalíticas sobre el autismo, propuestas de tratamiento, objetivos, métodos, principales resultados y conclusiones. Los resultados apuntan que los autores más citados fueron Jacques Lacan, seguido de Jean-Claude Maleval, Marie Christine Laznik, Alfredo Jerusalinsky y Maria Cristina Kupfer, todos ellos más o menos identificados con el referencial lacaniano. En lo que se refiere a las hipótesis explicativas, encontramos hipótesis sobre la existencia de alguna falla o algo incompleto en la constitución psíquica del autista. Sobre el diagnóstico de autismo, destacamos los riesgos de los diagnósticos tempranos y normativos, considerando que la constitución psíquica del niño todavía está en formación. Y, finalmente, sobre la posibilidad de tratamiento, los artículos indican la necesidad de respetar la singularidad de la persona autista y su forma de estar en el mundo, privilegiando un enfoque no invasivo.

This article is a research literature review aiming to identify some of the main explanatory hypotheses on autism in psychoanalysis and their contributions related to its treatment. The search was carried out in Pepsic and Scielo virtual libraries including articles written in Portuguese, published among 2012-2017 period. Twenty- three articles were selected and analyzed with the purpose of identifying the psychoanalytic hypotheses on autism, treatment proposals, objectives, methods, main results and conclusions. Results showed that the most cited authors were Jacques Lacan, followed by Jean-Claude Maleval, Marie Christine Laznik, Alfredo Jerusalinsky and Maria Cristina Kupfer, who are supported by the Lacanian framework. Regarding the explanatory hypotheses, assumptions about the existence of some failure or something that is not completed in the psychic constitution of the autistic were found, leading to highlight the risks of early and normative diagnoses. And, finally, about the possibility of treatment, the articles point out the need of respecting the uniqueness of the autistic person and his way of being in the world, in search of a delicate and non-invasive approach.

[Intolerance to uncertainty in autism]. / La intolerancia a la incertidumbre en el autismo.

We start from the evidence that confirms a greater vulnerability to anxiety in people with autism and to wonder to what extent the intolerance to the uncertainty mediates in that anxiety. In addition, the alterations of the predictive abilities in autism could explain the coherence between greater intolerance to uncertainty and some peculiarities inherent in autism such as patterns of restrictive and stereotyped behaviors, interests and activities, and particularities in the processing of sensory information. This information will allow us to develop interventions specifically focused on this construct for the prevention and improvement of anxiety symptoms in autism in cases that the severity of intolerance to uncertainty constitutes a significant risk factor.

Partimos de las evidencias que confirman una mayor vulnerabilidad a la ansiedad de las personas con autismo para preguntarnos en qué medida la intolerancia a la incertidumbre media en dicha ansiedad. Además, las alteraciones de las habilidades predictivas en el autismo podrían explicar la coherencia existente entre mayor intolerancia a la incertidumbre y algunas particularidades inherentes al autismo como los patrones de comportamientos, intereses y actividades restrictivos y estereotipados, y las particularidades en el procesamiento de la información sensorial. Esta información nos permitirá desarrollar intervenciones centradas específicamente en este constructo para la prevención y mejora de la sintomatología ansiosa en el autismo en los casos en los que la severidad de la intolerancia a la incer tidumbre constituya un factor de riesgo significativo.

La intolerancia a la incertidumbre en el autismo / Intolerance to uncertainty in autism

Partimos de las evidencias que confirman una mayor vulnerabilidad a la ansiedad de las personas con autismo para preguntarnos en qué medida la intolerancia a la incertidumbre media en dicha ansiedad. Además, las alteraciones de las habilidades predictivas en el autismo podrían explicar la coherencia existente entre mayor intolerancia a la incertidumbre y algunas particularidades inherentes al autismo como los patrones de comportamientos, intereses y actividades restrictivos y estereotipados, y las particularidades en el procesamiento de la información sensorial. Esta información nos permitirá desarrollar intervenciones centradas específicamente en este constructo para la prevención y mejora de la sintomatología ansiosa en el autismo en los casos en los que la severidad de la intolerancia a la incer tidumbre constituya un factor de riesgo significativo.

We start from the evidence that confirms a greater vulnerability to anxiety in people with autism and to wonder to what extent the intolerance to the uncertainty mediates in that anxiety. In addition, the alterations of the predictive abilities in autism could explain the coherence between greater intolerance to uncertainty and some peculiarities inherent in autism such as patterns of restrictive and stereotyped behaviors, interests and activities, and particularities in the processing of sensory information. This information will allow us to develop interventions specifically focused on this construct for the prevention and improvement of anxiety symptoms in autism in cases that the severity of intolerance to uncertainty constitutes a significant risk factor.

Praxias bucofonatorias con dispositivos bucales y realidad virtual inmersiva: un estudio piloto / Bucco-phonatory training practices with oral devices and immersive virtual reality: a pilot study

El presente trabajo evalúa la efectividad de una intervención utilizando Praxias bucofonatorias con dispositivos bucales en conjunto con realidad virtual inmersiva (RVI), mediante programas diseñados para estimular estados de relajación e interacción en diferentes ambientes virtuales. Para ello, se aplicó la terapia integrada de vibro estimulación bucal palatina, ejercitación lingual y la exposición a imágenes y sonidos empleando RVI en un grupo de 6 niños con el diagnóstico de dislalia. Se comparó los resultados de esta intervención con el de una intervención utilizando únicamente la vibro estimulación bucal palatina en un grupo de 20 niños con diagnóstico de dislalia. Finalmente, se aplicó la terapia integrada de vibro estimulación bucal palatina, ejercitación lingual y RVI en un grupo de niños con autismo. Los resultados observados mostraron que la terapia con dispositivos bucales combinadas con RVI tendía a producir mayores avances que la terapia sin RVI. Además, se observó diferentes grados de avances individuales y grupales en el dominio fonético dependiendo las habilidades de hablainicial, los niños con mejores habilidades presentaban mayores avances. El grupo de niños con autismo presentó menores avances respecto de los otros dos grupos. A pesar de las limitantes del presente estudio (diferente cantidad de sujetos por grupo y distintas edades) puede considerarse esta propuesta como prometedora para futuros estudios.

This study assesses the effectiveness of a therapy using Bucco-phonatory training practices with buccal devices and immersive virtual reality (RVI) through programs designed to stimulate states of relaxation and interaction in different virtual environments. In order to do so, an integrated therapy based on Intra buccal stimulation by means of vibrations in the palatal area, daily lingual exercises with a lingual exerciser device, and exposure to images and sounds using RVI was applied to a group of 6 children diagnosed with dyslalia. The results of this intervention were compared with those obtained in an intervention based only on intra buccal stimulation by means of vibrations in the palatal area (conducted on a a group of 20 children diagnosed with dyslalia). Finally, the integrated therapy of intra buccal stimulation by means of vibrations in the palatal area, lingual exercises, and RVI was applied to a group of children with autism. The results showed that therapy with oral devices combined with RVI tended to produce greater advances than therapy without RVI. In addition, individual differences in group advances in the phonetic domain were observed depending on the initial speech skills, children with better abilities presented greater advances. The group of children with autism progressed less than the other two groups. Even considering the limitations of this study, such as the heterogeneity in terms of group size and age, results can be considered as promising for future studies.

Direção de tratamento para um "corpo-espinho": considerações sobre o desejo de analista / Dirección de tratamiento para un "cuerpo-espín": consideraciones sobre el deseo del analista / Direction of the treatment for a "hedge-body": considerations on the desire of the analyst

O desejo de analista é uma questão fundamental à psicanálise e preciosa àqueles que se iniciam em sua prática. Este trabalho se debruça sobre o desejo de analista a fim de encontrar uma direção de tratamento para uma criança psicótica. Diante do imperativo ético de o analista se abster de seu desejo próprio frente ao analisante, haveria uma especificidade do desejo de analista na clínica com crianças e, particularmente, com crianças autistas e psicóticas?

El deseo de analista es una cuestión fundamental al psicoanálisis y valiosa para aquellos que se inician en su práctica. Este trabajo examina el deseo de analista con el objetivo de encontrar una forma de tratamiento a un niño psicótico. Ante el imperativo ético del analista abstenerse de su propio deseo frente al analizante, ¿habría una especificidad del deseo de analista en la clínica con niños, más específicamente con niños autistas y psicóticos?

The desire of the analyst is a fundamental issue to psychoanalysis and precious to those who are in the beginning of their practice. This paper explores this desire with the intent to find a direction of treatment for a psychotic child. Before the analyst ethical imperative to abstain their own desire vis-a-vis with the analysand, would there be certain specificity on the desire of the analyst in a clinic with children, particularly with autistic and psychotic children?

[Specialism, specificity and identity - the controversiessurrounding autism in the Brazilian Unified Health System (SUS)]. / Especialismo, especificidade e identidade - as controvérsias em torno do autismo no SUS.

The passing of federal law 12,764/2012 marked a victory for the political activism of parents of autistic individuals in Brazil, but it also drew attention to the serious antagonism between parents of autistic individuals and the mental health network. This article examines the perspectives of social actors involved in the controversy that took place after the enactment of this law and seeks to show why this controversy precedes the passing of the law and is not resolved by it. The argument is that the troubled relationship between the political movement of parents of autistic individuals and the mental health network can be better understood when the construction and consolidation of a network of expertise around autism spectrum disorders as being inseparable from the construction of a social and political identity for autistic people in Brazil is taken into consideration. The article draws inspiration from the Studies of Expertise and Experience, which discuss the new regime of relations between scientific research and civil society. Nevertheless, it is also seen that the consolidation of this expertise network has arisen despite the absence of a broad specialized treatment network and of a profound reconfiguration in the regime of scientific research and production of knowledge about autism in Brazil.

A aprovação da Lei no 12.764/2012 representou uma vitória do ativismo político de familiares de autistas no Brasil, mas também deu visibilidade a um enorme antagonismo entre uma parcela significativa de pais de autistas e a rede de saúde mental. Este artigo analisa o posicionamento dos diferentes atores envolvidos na controvérsia que se sucedeu à aprovação e regulamentação da lei, e procura demonstrar as razões pelas quais essa polêmica antecede à lei e não se resolve com ela. Argumenta-se que a conturbada relação entre o movimento político de pais de autistas e a rede de saúde mental pode ser mais bem entendida se tomarmos a construção e a legitimação de uma rede de "expertise" a respeito dos transtornos do espectro autista como indissociável da construção de uma identidade social e política para os autistas no Brasil. O artigo utiliza como referência teórica os Estudos sobre Expertise e Experiência, que têm como principal pano de fundo uma discussão acerca do novo regime de relações entre a pesquisa científica e a sociedade civil. Entretanto, demonstramos também que a consolidação dessa rede de expertise vem ocorrendo apesar da ausência de uma ampla rede de tratamentos especializados e de uma reconfiguração profunda no regime de pesquisa e de produção de conhecimento sobre autismo no Brasil.