Distúrbio específico de linguagem: a relevância do diagnóstico inicial

Early Detection of Cognitive, Language, and Motor Delays for Low-Income Preterm Infants: A Brazilian Cohort Longitudinal Study on Infant Neurodevelopment and Maternal Practice

Aim: This study examined the neurodevelopment trajectories, the prevalence of delays, and the risks and protective factors (adverse outcomes, environment, and maternal factors) associated with cognitive, motor, and language development for preterm infants from 4– to 24-months.

Method: We assessed 186 preterm infants (24.7% extremely preterm; 54.8% very preterm; 20.4% moderate/late preterm) from 4– to 24-months using the Bayley Scales of Infant Development – III. Maternal practices and knowledge were assessed using the Daily Activities of Infant Scale and the Knowledge of Infant Development Inventory. Birth risks and adverse outcomes were obtained from infant medical profiles.

Results: A high prevalence of delays was found; red flags for delays at 24-months were detected at 4– and 8-months of age. The neurodevelopmental trajectories showed steady scores across time for cognitive composite scores for extremely- and very-preterm infants and for language composite scores for the extremely- and moderate/late-preterm; a similar trend was observed for the motor trajectories of moderate/late preterm. Changes over time were restricted to motor composite scores for extremely- and very-preterm infants and for cognitive composite scores for moderate/late preterm; declines, stabilization, and improvements were observed longitudinally. Positive, strong, and significant correlations were for the neurodevelopment scores at the first year of life and later neurodevelopment at 18 and 24 months. The cognitive, language, and motor composite scores of extremely and very preterm groups were associated with more risk factors (adverse outcomes, environment, and maternal factors). However, for moderate/late preterm infants, only APGAR and maternal practices significantly explained the variance in neurodevelopment.

Discussion: Although adverse outcomes were strongly associated with infant neurodevelopment, the environment and the parents’ engagement in play and breastfeeding were protective factors for most preterm infants. Intervention strategies for preterm infants should start at 4– to 8-months of age to prevent unwanted outcomes later in life.

Guidelines for child health: language development on focus

Language disorders impact on child overall development. Policy directives for the child guide on ways to follow up child development for greater efficiency and effectiveness. The aim of this paper was to identify the policies positions of the proposals on the attention to language problems in the child health field. From a documental research, national and international guidelines were reviewed in order to identify actors, objectives, contexts, motivations, arguments, justifications and proposals regarding the follow of child development and child language. We performed a critical analysis in order to explain these positions and place on discussion the arguments that support them. The results point out to consensual aspects that place the problems of child development as vulnerabilities producers. Language problems cross the boundaries of political, scientific and social matters. These issues are challenges to interdisciplinary and intersectoral work and guide the need to promote the most effective responses of public policy for people requiring language support. The link of this discussion with the concepts of life cycle and human development for achieving full citizenship requires further deepening.

Auditory maturation and psychological risk in the first year of life

PURPOSE

To assess the potential association between psychological risk and limited auditory pathway maturation.

METHODS

In this longitudinal cohort study, 54 infants (31 non-risk and 23 at-risk) were assessed from age 1 to 12 months. All had normal hearing and underwent assessment of auditory maturation through cortical auditory evoked potentials testing. Psychological risk was assessed with the Child Development Risk Indicators (CDRIs) and PREAUT signs. A variety of statistical methods were used for analysis of results.

RESULTS

Analysis of P1 and N1 latencies showed that responses were similar in the both groups. Statistically significant differences between-groups were observed only for the variables N1 latency and amplitude at 1 month. Significant maturation occurred in both groups (p<0.05). There was moderate correlation between P1 latency and Phase II CDRIs, which demonstrates that children with longer latencies at age 12 months were more likely to exhibit absence of these indicators in Phase II and, therefore, were at greater psychological risk. The Phase II CDRIs also correlated moderately with P1 and N1 latencies at 6 months and N1 latencies at 1 month; again, children with longer latency were at increased risk.

CONCLUSION

Less auditory pathway maturation correlated with presence of psychological risk. Problems in the mother-infant relationship during the first 6 months of life are detrimental not only to cognitive development, but also to hearing. A fragile relationship may reflect decreased auditory and linguistic stimulation.

Percepção da família e do terapeuta sobre a evolução de crianças em uma abordagem interdisciplinar de intervenção precoce

RESUMO Objetivo: analisar e comparar a percepção dos pais e dos terapeutas referente aos efeitos da intervenção precoce no desenvolvimento de seus filhos, bem como acerca da evolução da criança e perspectivas futuras. Métodos: participaram deste estudo nove sujeitos, incluídos na clínica de Intervenção Precoce. Para a coleta dos dados realizaram-se entrevistas com os pais e/ou responsáveis pelas crianças e com os terapeutas de referência, as quais foram gravadas em áudio e transcritas literalmente. As informações foram analisadas qualitativamente e confrontadas, considerando os aspectos do desenvolvimento linguístico, motor, social e psíquico das crianças. Resultados: dos nove sujeitos analisados, sete apresentaram percepção parental e terapêutica semelhante para as questões do desenvolvimento abordadas e em dois casos houve divergência entre a visão dos familiares e dos terapeutas acerca do desenvolvimento das crianças, em que os familiares demonstram expectativas muito distintas das dos terapeutas quanto ao futuro dos filhos. Em relação à comunicação, todos os pais percebem avanços como as terapeutas. Conclusão: a percepção das terapeutas e pais demonstrou efeitos positivos da intervenção precoce interdisciplinar, manifestada na concordância de pontos de vista em relação aos sete dos nove sujeitos analisados. O estudo reforçou, ainda, a importância de se realizar a escuta qualificada das dificuldades da família quanto à limitação de seus filhos e orientá-las adequadamente a depender da patologia e/ou distúrbio apresentado.

Atraso de linguagem e desvio fonológico: um continuum ou duas patologia distintas?

OBJETIVO: estudar e verificar se o desvio fonológico é um continuum do atraso de linguagem, ou seja, se crianças com desenvolvimento fonológico atípico possuíam anteriormente algum atraso no desenvolvimento de linguagem. MÉTODOS: os dados foram coletados e organizados em dois grupos, sendo o Grupo1 composto por 10 crianças com atraso de linguagem que realizaram terapia fonoaudiológica para estimulação e evoluíram após tratamento, sendo remanejados para o grupo de fala. Já o Grupo2 foi constituído por 554 sujeitos apresentando características de desvio fonológico e assim foram diagnosticados após realização das avaliações. RESULTADOS: os achados deste estudo não mostram associação significante entre sexo e hipótese diagnóstica, sendo que a distribuição entre meninos e meninas foi semelhante. Na análise realizada entre idade de surgimento das primeiras palavras também não foram encontrados resultados significantes. No entanto, na comparação realizada entre idade de surgimento das primeiras palavras e hipótese diagnóstica houve resultado significante, sendo a idade de surgimento no grupo com atraso de linguagem mais tardio do que nas demais hipóteses diagnósticas. CONCLUSÃO: os achados deste trabalho corroboram a literatura, no sentido de que o desvio fonológico se refere a uma alteração no nível fonológico apenas, não sendo considerado como um continuum do atraso de linguagem.