1 Archives of Online version: ipad edition: APPSTORE/categoria MEDICINA/Psiquiatria Clinica IMPACT FACTORS 0.89 ISI (Thomson Reuters) 1.23 SCImago Revista de Psiquiatria Clínica VOLUME 42 SUPPLEMENT International Conference of Autism in Adult Life: Science, Society and Reality April 16-18, 2015
2 Editors Editor-in-Chief: Wagner F. Gattaz Assistant Editor: Ines Hungerbühler Regional Editor USA: Regional Editor Europe: Rodrigo Machado Vieira (Bethesda, USA) Wulf Rössler (Zürich, Switzerland) Human Sciences Editor: Francisco Lotufo Neto Psychology and Humanities Assistant Editors: Paulo Clemente Sallet Psychotherapy Felipe D Alessandro F. Corchs Transcultural Psychiatry Neurosciences Editor: Orestes Forlenza Neurobiology Assistant Editors: Breno Satler de Oliveira Diniz (Belo Horizonte, Brazil) Geriatric Psychiatry Basic Research Neuropsychology Clinical Psychiatry Editor: Geraldo Busatto Epidemiology Assistant Editors: Marcus V. Zanetti Psychopathology Tânia Correa de Toledo Ferraz Alves Neuroimaging Biological Therapy Instruments and Scales Editor: Clarice Gorenstein Assistant Editors : Elaine Henna Juliana Teixeira Fiquer Child and Adolescent Psychiatry Editor: Guilherme Vanoni Polanczyk Assistant Editors: Ana Soledade Graeff-Martins Tais Moriyama Former Editors Antonio Carlos Pacheco e Silva ( ) Fernando de Oliveira Bastos ( ) João Carvalhal Ribas ( ) José Roberto de Albuquerque Fortes ( ) Valentim Gentil Filho ( ) Editorial Board Alexander Moreira-Almeida ( Juiz de Fora, Brazil) Almir Ribeiro Tavares Jr. (Belo Horizonte, Brazil) André Malbergier Andrea Schmitt (Göttingen, Germany) Andréa H. Marques Benedicto Crepo-Facorro (Santander, Spain) Carmita Helena Najjar Abdo Christian Costa Kieling (Porto Alegre, Brazil) Daniel Martins de Souza Doris Hupfeld Moreno Eduardo Iacoponi (London, UK) Elida Paula Benquique Ojopi Emmanuel Dias Neto Ênio Roberto de Andrade Ester Nakamura Palacios (Vitória, Brazil) Frederico Navas Demetrio Fulvio Alexandre Scorza Gunter Eckert (Frankfurt, Germany) Helena Paula Brentani Samaia Helena Maria Calil Hélio Elkis Homero Pinto Vallada Filho Irismar Reis de Oliveira (Salvador, Brazil) Jair Constante Soares (Texas, USA) Jerson Laks (Rio de Janeiro, Brazil) João Quevedo (Criciúma, Brazil) Jorge Ospina Duque (Medellín, Colombia) José Alexandre de Souza Crippa (Ribeirão Preto, Brazil) Ligia Ito Liliana Rendón (Assunção, Paraguai) Marco Aurélio Romano Silva (Belo Horizonte, Brazil) Mônica Yassuda Osvaldo Pereira de Almeida (Crawley, Australia) Paulo Belmonte Abreu (Porto Alegre, Brazil) Paulo Canineu Paulo Rossi Menezes Paulo Mattos (Rio de Janeiro, Brazil) Renato Teodoro Ramos Renério Fraguás Junior Ronaldo Ramos Laranjeira Sandra Scivoletto Táki Athanassios Cordás Teng Chei Tung Zacaria Borge Ali Ramadam INSTRUCTIONS FOR AUTHORS Available on the journals website (www.hcnet.usp.br/ipq/revista) and published in the last issue every year (number 6).
3 We would like to thank the artist Laila Gattaz, who gently allowed, for exclusive use on the covers of the Archives of Clinical Psychiatry, the series of art works named Imagens de São Paulo. This journal is printed on acid-free paper. Cataloguing in Publication (CIP) Data archives of Clinical Psychiatry / University of São Paulo Medical School. Institute of Psychiatry - vol. 42, n. 1 (2015). São Paulo: / IPq-USP, From volume 29 (2001), the articles of this journal are available in electronic form in the SciELO (Scientific Electronic Library Online) database Clinical Psychiatry. University of São Paulo Medical School. Institute of Psychiatry. ISSN : printed version ISSN : X online version CDD Indexing Sources ISI (Institute for Scientific Information) - Science Citation Index Expanded (SciSearch ) - Journal Citation Reports/Science Edition EMBASE - Excerpta Medica Database LILACS - Literatura Latino-Americana e do Caribe de Informação em Ciências da Saúde PERIODICA - Índice de Revistas Latino-Americanas em Ciências SciELO - Scientific Eletronic Library Online SIIC - Sociedad Iberamericana de Información Científica Scopus (www.scopus.com) Gale Cengage Learning DOAJ - Directory of Open Access Journals HINARI - World Health Organization Advertisers bear full responsibility for the content of their advertisements. There is no commercial involvement by advertisers in the development of the content or in the editorial decision-making process for the Revista de Psiquiatria Clínica. Rua Anseriz, 27, Campo Belo São Paulo, SP. Fone: Diretor-geral: Idelcio D. Patricio Diretor executivo: Jorge Rangel Gerente financeira: Andréa Rangel Comunicações médicas: Cristiana Bravo Coordenadora comercial: Izabela Teodoro Gerente editorial: Cristiane Mezzari Coordenadora editorial: Sandra Regina Santana Imagem da Capa: Laila Gattaz Revisora: Glair Picolo Coimbra Produtor gráfico: Fabio Rangel Periodicidade: Bimestral Tiragem: exemplares Cód. da publicação:
4 INDEX Editorial Autism spectrum disorders: prevalence and service use in four Brazilian regions... 3 Beatriz Parasmo Sánchez, Rosane Lowenthal, Cristiane Silvestre de Paula Barriers for early identification of autism in Brazil... 3 Sabrina Helena Bandini Ribeiro, Cristiane Silvestre Paula, Daniela Bordini, Jair J. Mari, Sheila C. Caetano Assistive technologies as a resource to facilitate the interaction of autistic person and the family coping strategies... 4 Priscila Pires Alves, Vera Lúcia Prudência dos Santos Caminha, Adriano de Oliveira Caminha Contributions of family orientation of adolescents with autism in the Amazonian context... 4 Adenilda Teixeira Arruda, Maria Gleny Barbosa Soares, Antonia Egley Nascimento da Silva Psychomotricity, sensory processing and autism: a multidisciplinary approach... 5 Rana Malva Medeiros dos Santos, Angélica Cristiane Ovando, César Augusto Fritz Bueno, Antônio de Pádua Amorin, Vilson Rodrigues da Silva A review of adaptive behavior on Williams-Beuren, Down syndromes and autistic spectrum disorder: the search for an unique profile for each diagnostic group... 5 Carolina Grego Del Cole, Beatriz Lobo Araripe, Ivaldo Silva, Cristiane Silvestre de Paula, Sheila Cavalcante Caetano, Andrea Parolin Jackowski A trace scale of autistic spectrum disorder in young adults... 6 José Fausto de Morais, Victor Lawrence Bernardes Santana Adaptation and validation of SPST Social problem solving test for adults with intellectual deficiency... 6 Natália Costa, Elizabeth Nascimento, Gustavo Gauer, Virginia Viana Use of PECS in dentistry for autistic patients... 7 Adriana Gledys Zink, Renata de Oliveira Guaré, Renata de Oliveira Guaré Translation and cultural adaptation to Brazilian Portuguese of the autism dysmorphology measure... 7 Thais Arbocese Zanolla, Rodrigo Ambrosio Fock, Eduardo Perrone, Ana Beatriz Alvarez Perez, Decio Brunoni Training psychiatrists to evaluate minor congenital anomalies in patients with autism spectrum disorder... 8 Rodrigo Ambrosio Fock, Thais Arbocese Zanolla, Eduardo Perrone, Ana Beatriz Alvarez Perez, Decio Brunoni Functionality evaluation instrument for daily-life activities for adults with autism spectrum disorders... 8 Cristiano Pedrosos, Emília Rossi, Carina Eretzky Muriel, Vivian Renne Gerber Lederman
5 36491 Interface between language and behavior functionalities in autism spectrum disorders adults... 9 Giliana Maria da Rocha, Vivian R. G. Lederman, Carina Eretzky Muriel, Emília Rossi, Cristiano Pedroso Is there an adaptive behavior profile for Williams and Down syndromes and autism spectrum disorders?... 9 Carolina Del Cole, Wagner Ribeiro, Sheila C. Caetano, Andrea Parolin Jackowski Multicentric study: acquisition of social skills in children with autism using video modeling in parental training Leila Bagaiolo, Daniela Bordini, Tatiane Ribeiro, Maria Carolina Martone, Graccielle Rodrigues da Cunha Asevedo, Cristiane Silvestre de Paula Adenylosuccinate lyase deficiency and autism spectrum disorders (asd): a literature review Eduardo Perrone, Thais Arbocese Zanolla, Rodrigo Ambrosio Fock, Mirlene Cecilia Soares Pinho Cernach, Ana Beatriz Alvarez Perez, Decio Brunoni Are clustering by functioning associated to IQ and severity of the clinical picture in patients with ASD? Joana Portolese, Elaine Zachi, Paola Lourenço da Rocha, Helena Brentani Assisted living for adults with ASD: articulations in Rio Grande do Sul Marilice Costi, Renata Costa de Sá Bonotto Changes in daily life of an autistic A case report Silvia Mitie Kanawa, Claudiane Salles Daltio Clinical and genetic profile of adult patients with autism spectrum disorder (asd) diagnostic hypotesis: retrospective study of calls on genetic service at Hospital Regional of Sorocaba-sp, Brazil from 2003 to Gabriela Tizianel Carvalho, Luana Ajala Christiano, Elisa Varella Branco, Marta Wey Vieira, Débora Aparecida Rodrigueiro Daily living activities: intervention and orientation meetings to caregivers Camilla Lima Zugman, Graccielle Rodrigues da Cunha, Dinara Souza, Daniela Bordini Early diagnosis in children with autistic spectrum disorder: correlation with the language Maiara Cristine Oliveira de Almeida, Laise Carla Lira de Jesus, Karine Lopes Pinheiro, Laís Leandro de Souza Early predictors of asd in high-risk infants: joint attention, language and atypical behaviors Elisangela dos Anjos Paula Vieira, Ana Alexandra Caldas Osório Eating and learning: strategy for autonomy of autistic children Mariane de Almeida Flores, Catia Cristiane Purnhagen, Ezequiel Leopoldo da Silva, Morgana Pavan, Juliana Cristina Peres, Mariana Bernardes Antunes External clinic: therapy outside the offices for autism Mariane de Almeida Flores, Ezequiel Leopoldo da Silva, Morgana Pavan, Catia Cristiane Purnhagen, Mariana Bernardes Antunes, Juliana Cristina Peres
6 36552 First Expertise Rehabilitation Centre (erc) in Santa Catarina/Brazil: demand survey Lilianna Bianchini Dallanhol Rivero, Michele Gindri Vieira, Camille Macedo Nunes Weiser, Ana Virginia Nion Rizzi May, Melissa Watzko Eskelsen, Pedro Henrique de Campos Albino, Carla Dadalt, Daniela Ana Dunzer Multiprofessional call for students with autism spectrum disorder in Manaus Maria Gleny Barbosa Soares, Adenilda Teixeira Arruda, Antonia Egley Nascimento da Silva Parents perspectives of adolescents and adults with autism classics about the need of institutionalization as the main intervention strategy Eliane Agustinho da Costa, Elís Amanda A. Silva, Aldenívia dos Santos Silva Physical education as a means of intervention in low-functioning autistic adolescents and its ability to provide a better quality of life in adulthood. Case report from apae Taquaritinga-sp Rafael Miranda Oliveira Profile of patients with autistic spectrum disorder whose parents requested therapeutic residence or institutionalization evaluated in Unidade de Referência em Autismo Marcos T. Mercadante da Santa Casa de Misericórdia de São Paulo caism in Eliete Chiconelli Faria Buratto, Juliana Harumi Arita, Quirino Cordeiro Junior, Rosane Lowenthal Autism spectrum disorders in adulthood: psychosocial context in the Brazilian reality Fernanda Duarte Rosa, Thelma Simões Matsukura Rainbow game technique: changing of behavior through reorganization of feeding routine Viviane da Silva Machado Study of ten autism in age group of seven to ten years: clinical signs frequently and age diagnostic Katia Semeghini Caputo Taking care of adolescents and adults with asd: difficulties and concerns of the parents Regina Basso Zanon, Simone Steyer Lampert, Cleonice Alves Bosa The process of building autonomy in a group of pre teen with autistic spectrum disorder Adriana Balaguer, Priscila Fernandes, Ana Marta Vieira Ponte The sensory aspect of adults with autism spectrum disorder under the view of formal caregivers Andrea Schäfers Delgado, Maria Inês Rubo de Souza Nobre Using functional language through visual cues in patients with autistic spectrum disorder Maiara Cristine Oliveira de Almeida, Laise Carla Lira de Jesus, Karine Lopes Pinheiro, Laís Leandro de Souza Working memory in autism spectrum disorder: a literature review Suelen Bordignon, Renata Giuliani Endres, Simone Steyer Lampert, Clarissa Trentini, Cleonice Alves Bosa
7 37019 Using videos in the field of autism spectrum disorders: guidelines for treatment and training models Victor Amoroso, Luciana Coltri e Silva Assessment of nutrition status in children and adolescents with autism spectrum disorders Caroline Casarin-Reis, Monica Campos, Bianca Rebouças, Camila Leocadio, Myrella Acensos, Daniela Bordini, Sheila C. Caetano, Maria Conceição do Rosário, Michelle Caetano
8 Editorial This Supplement of the Archives of Clinical Psychiatry (ACP) presents the best abstracts submitted to the Conference Autism in adult life: Science, Society and Reality that is being organized by the partnership between the Department of Psychiatry of the Universidade Federal de São Paulo (UNIFESP) and the Brazilian NGO Autismo e Realidade. This conference will be held in São Paulo from April 16 th to 18 th, Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects 1% of the general population. ASD is characterized by abnormal social interaction and communication, and restricted and repetitive repertoire of activities and interests. ASD may be caused by a variety of genetic and environmental factors. Although the course of ASD varies among individuals, it is a condition that affects patients autonomy and caregivers quality of life. ASD requires multiple interventions that aim to improve their potential and limitations. Although increasing numbers of ASD children and adolescents are entering adulthood, there is scarce literature on outcomes in adult life. Our conference is the first International meeting on Autism in Adulthood and it will allow a fruitful dialogue among health and education professionals, national and international researchers of the field, Government representatives and patients and family members, about central issues that permeate the lives of people with autism, specifically in adult life. The main topics will address the possibilities of social, educational and occupational reintegration of people with ASD, their sexuality and marital adjustment, their families economic planning, and the stigma in family and society. We hope to generate suggestions and proposals that could be more effective to help people with Autism and their families. The Organizing Committee Sheila C. Caetano Assistant Professor, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP) Jair J. Mari Associate Professor, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP)
10 37007 Autism spectrum disorders: prevalence and service use in four Brazilian regions Beatriz Parasmo Sánchez, Rosane Lowenthal, Cristiane Silvestre de Paula Universidade Presbiteriana Mackenzie (UPM) Supplement Introduction: Several studies, conducted mainly in Europe, US and Japan, pointed an Autism Spectrum Disorders (ASD) prevalence ranging between 0.6 and 1%. In Brazil, only one study has been concluded, at the surroundings of Atibaia-SP, and it has estimated the prevalence in 0.3%. This rate presents the importance of further studies covering more Brazilian regions in order to enlarge the comprehension about ASD in Brazil. ASD identification is important to help with earlier diagnosis and with the reduction of treatment barriers. Objectives: (1) Estimating the prevalence of ASD among students from four Brazilian regions, (2) determining the frequency of health and educational service uses. Method: Design: Cross-sectional Pilot Study; Sample/Setting: 1,715 public schools students from 2 nd to 6 th grade (6-16 years) from four satellite towns located in the edges of four capitals: (i) Goianira-GO, (ii) Itaitinga-CE (iii) Caeté-MG and (iv) Rio Preto da Eva-AM. Measurement/ Instruments: (i) ASD Screening: Schedule subscale for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL); (ii) Demographics and service use (health and educational): a questionnaire developed by the research team; (iii) IQ: two subtests (Vocabulary and Blocks) from the Wechsler Intelligence Scale for Children-WISC-III; (iv), Psychiatric disorders in childhood/adolescence: K-SADS-PL. Results: The prevalence rates of ASD in this sample were similar to the majority of studies produced around the world. Among the positive cases, (a) 62.5% were male; (b) 75% had medium-inferior IQ, 12.5% borderline IQ and 12.5% average/normal IQ; (c) 63% presented at least one type of psychiatric disorder, mainly anxiety and depression. Services use: a smaller number of students had received (a) specialized health care (psychological/neurological/psychiatric) in the last 12 months or (b) special education support at the same time. Conclusions: The high ASD prevalence identified in this study is in accordance with the international data, revealing a significant number of children/adolescents in need of assistance. However, most of them are still not having access to specialized services neither in health nor in educational systems. These results should guide the development of new policies among the ASD field Barriers for early identification of autism in Brazil Sabrina Helena Bandini Ribeiro, Cristiane Silvestre Paula, Daniela Bordini, Jair J. Mari, Sheila C. Caetano Department of Psychiatry at Universidade Federal de São Paulo (UNIFESP) Introduction: The communication of mother s suspicions about her child s atypical development to the pediatrician is not only the first step but most of the time the only way possible for Autism Spectrum Disorder (ASD) early detection. We intended to study the pathway between first noticeable signs of ASD and diagnosis. Methods: We conducted in depth interviews of 13 mothers (mean age = 35.8) whose children were diagnosed with ASD and attended our Autism Program at the Federal University of São Paulo (UNIFESP). This patient group consisted of 2 girls and 11 boys, and their mean age at the time of the interview was 7.5 years. Results: Mothers had their first concerns that their child s development was atypical when children had a mean age of 1.1 years but these children had a formal diagnosis of ASD only at a mean age of 5.3 years, resulting in an average of 4.2 years of delay in diagnosis. The vast majority of the mothers mentioned their concerns firstly to pediatricians (76.9%), but 23.1% of them sought for specialists (neuropediatrician or child psychiatrist). Pediatricians further evaluated or referred for suspicion of atypical development only one third of these children. Mothers who had their complains dismissed were told by their pediatricians children should not be compared to each other, boys have a slower development rate or were more agitated than girls. These mothers described their relation with the pediatrician as negative experiences, feeling discouraged to address their concerns again and as a result they attributed this experience as an important impact on delay in diagnosis. The most frequent complaint about the 1-2 year old child recalled by mothers was agitation (6 out of 13). Conclusion: The pediatrician-mother interactions may lead to the delay of ASD formal diagnosis by 3 main mechanisms: 1) by disregarding spontaneously reported symptoms, the pediatricians may prevent forthcoming concerns later that are more specific to ASD diagnosis; 2) by not investigating symptoms that have low specificity but high sensibility to child psychopathology (agitation); and 3) by not asking about the child s development and specific symptoms related to ASD.
11 4 Arch Clin Psychiatry. 2015; Suppl. 42(1): Assistive technologies as a resource to facilitate the interaction of autistic person and the family coping strategies Priscila Pires Alves, Vera Lúcia Prudência dos Santos Caminha, Adriano de Oliveira Caminha Universidade Federal Fluminense (UFF) This paper presents considerations about the features of ICT (Information and Communication Technologies) to interact with the autistic person and devices designed to promote, through this auxiliary mode of interaction, coping strategies for the family. The advent of ICT has influenced more and more forms of relationship between people, producing new spaces of values, social and cultural representations, supporting consequently new settings between the person and its world. The break of geographical barriers, the acceleration in the ways to communicate, the Internet, social networking, etc., currently compose the resources that this revolution produced in our lives. And so, when thinking about digital environments and ICT that currently permeate our existence, from birth, it is important to reflect on the potential of these resources, especially as mediators that promote the communication and expression of the people with some kind of disorder that reduces the functionality in relation to the world. Produce Assistive Technology favorable to the improvement of the interaction is the goal of the project, which has been producing systems, games and software that can mediate a person s relationship with ASD and encourage the construction of new roads, providing opportunities for new discoveries of communication and expression. The work is developed concomitantly to the host person with ASD and its family, using the methodology of focus groups and conversation wheel, favoring the exchange of experiences and providing opportunities for the development of coping strategies to improve the relationship between the family with person with ASD. Assistive technologies, in this context, produce a knowledge aimed at the totality of being, considering a dialogical perspective, the idiosyncratic experiences of each person in building your relationship with the world. This approach finds support in the socio-interactionist theories of Vygotsky (2009), and in the Merleau Ponty, who moved the working method to approach, intervention and approaching families. We conclude that the device of information and communication technologies, coupled with the reception and understanding of the life history of each person, is a powerful resource to promote and expand the possibilities of contact with the person with ASD Contributions of family orientation of adolescents with autism in the Amazonian context Adenilda Teixeira Arruda, Maria Gleny Barbosa Soares, Antonia Egley Nascimento da Silva Secretaria Municipal de Educação de Manaus, Amazonas Introduction: The Special Education Complex of the Municipal Education, Manaus, Amazonas, performs various activities with students with autism spectrum disorder. Among these actions there is the family orientation since studies show that families with an autistic person face an overload of tasks and special requirements that can evoke situations of stress and emotional strain. The family orientation is performed by the group of psychologists and educators to parents and guardians of people with autism spectrum disorder, particularly in adolescence, seeking Special Education service in the city. Objective: Our objective is to report on the experience of family counseling to guardians of people with autism. The family guidance aims to clarify the clinical picture, clarify doubts about how to deal with teenagers, particularly with regard to sexuality, and strengthen family and social relationships. Method: Parents and caregivers of children with autism attend a listening space on their anxieties and fears, and are allowed to express their particular difficulties and receive the necessary clarifications on how to deal with autistic teenager. The family orientation occurs when requested by family members or by teachers of students with autism. Results: Family counseling helps in overcoming feelings commonly experienced by family members as anger, fear and distress facing the challenge of living and educating the autistic teenager, particularly those with higher cognitive and affective commitment. The orientation functions as a support in order to facilitate family compliance by building coping strategies both to reduce the burden on parents and guardians, as in the sense of teaching to alleviate the symptoms of autistic disorder, clarifying the possibilities and limits of the teenager. Conclusion: The orientation for the family can function as a key element of an integral practice and priority of preventive public policies in mental health. It can be added in educational and clinical programs of the institutions for the family to be guided on alternative strategies for learning and follow-upia of a teenager with autism, to accrue him/her better quality of life and social integration.
12 Arch Clin Psychiatry. 2015; Suppl. 42(1): Psychomotricity, sensory processing and autism: a multidisciplinary approach Rana Malva Medeiros dos Santos, Angélica Cristiane Ovando, César Augusto Fritz Bueno, Antônio de Pádua Amorin, Vilson Rodrigues da Silva Fundação Catarinense de Educação Especial People with Autism Spectrum Disorder (ASD) usually manifest problems in sensory processing, meaning their brains is wired differently. For a long time, therapists used only behavioral theories to explain adaptive problems in people with ASD. However, due to breakthroughs in tools to measure sensory processing, it is now known that a great portion of deficits seen in that population are connected to difficulties in dealing with stimuli. The concept of psychomotricity represents a close connection between the psyche and motor activities. It focuses on the close link between psychological and motor experience. It s vital to work with different body experiences in a safe and adequate environment. Due to exceedingly repetitive behavior, people with ASD have limited motor repertoire. They have trouble using their bodies to express their needs and emotions adequately. Psychomotricity aims to help them learn about their bodies and others, so they can work with people to express themselves more accurately. Therefore, the purpose of this study is to describe an intervention developed by a group of professionals with Relational Psychomotricity in adults with ASD. A group of 22 adults with ASD was included. We examined their ability to commit to therapy and made qualitative observations related to the way one perceived and experienced one s body. That included how it was represented mentally, how one interacted with the therapist verbally or not, how emotions and intention were expressed though the body, how time and room space were used and how problem solving happened. Interventions took place once a week for one hour. Subjects were assisted in groups by a physical therapist, a psychologist and a physical educator during each session. Sessions occurred in a special room where they had the opportunity to interact using their bodies and objects of their choice. Games, tasks and other activities were at the groups disposal, evoking awareness of sensations and perceptions, mobilization and expressions through body, which used their feelings; relationships and interaction with the environment. As a result, the groups manifested different motor behavior and managed to use their bodies to solve problems more effectively and express their feelings. Their relationship with therapists gained depth, and tolerance to many stimuli was developed. Thus it seems clear that psychomotricity is a valuable tool to help adults with ASD develop adaptive routines and relationships A review of adaptive behavior on Williams-Beuren, Down syndromes and autistic spectrum disorder: the search for an unique profile for each diagnostic group Carolina Grego Del Cole, Beatriz Lobo Araripe, Ivaldo Silva, Cristiane Silvestre de Paula, Sheila Cavalcante Caetano, Andrea Parolin Jackowski Departament of Psychiatry at the Universidade Federal de São Paulo (UNIFESP) Adaptive behavior (AB) is characterized by the skills response to daily life demands. AB profiles of genetic syndromes have been proposed, but literature is still controverse. The aim of the present study was to analyze the different results of AB on subjects with Williams-Beuren Syndrome (WBS), Down Syndrome (DS) and Autism Spectrum Disorder (ASD) through literature review using the PubMed database. The results demonstrated that WBS patients present better socialization whereas daily life activities are more impaired. DS presented better performance abilities in Socialization and Daily Living in relation to Communication. ASD group presented better results in communication and worst performance in socialization domain. Although the reviewed studies seem to demonstrate controversial results related to AB in each group, the main skills and shortages remained similar to each correspondent diagnostic behavioral characteristic.
13 6 Arch Clin Psychiatry. 2015; Suppl. 42(1): A trace scale of autistic spectrum disorder in young adults José Fausto de Morais, Victor Lawrence Bernardes Santana Universidade Federal de Uberlândia (UFU) Introduction: The expression Autistic Spectrum Disorder (ASD) includes the Autism, the Asperger s Syndrome (AS) and developmental disorders not specified. The AS (a more mild autism type) is often confused with other syndromes due to the fact that their diagnosis is not made by laboratory or test images, and there are no biological markers that characterize his specific morphological aspects. The diagnosis of AS should be performed by a qualified professional who will base their evaluation on behavior, medical history and clinical observation of the patient. At this stage, instruments that assess the trait of the syndrome are very important. Objective: The absence of instruments in Portuguese (Brazil) to evaluate the trace of ASD in adults (more than 18 years) motivated this study with the objective of proposing the Trace Scale of Autistic Spectrum Disorder (TSASD30). The scale is adjusted to Brazilian social context. Methods: To build the TSASD30 we adopted the technique of content analysis on the textual corpus formed by the 50 items of Autism Quotient Scale; 40 items of the Autism Screening Questionnaire; 57 items of the Autism Behavior Checklist; 15 items of the Childhood Autism Rating Scale, and 23 items of the Scale of Autistic Traits. Results: The TSASD30 is composed of 30 questions divided into six conceptual domains: Sociability, Communicability, Empathic Imagination, Attention to Detail, Resistance to Switching, and Non Conventional Physical Reactions. Conclusion: In our scale, each item has a value from 0 to 1 and the overall score of TSASD30 assumes a continuous value from 0 to 30 corresponding to the sum of the 30 items. Our scale is under validation process Adaptation and validation of SPST Social problem solving test for adults with intellectual deficiency Natália Costa, Elizabeth Nascimento, Gustavo Gauer, Virginia Viana Universidade Federal do Rio Grande do Sul (UFRGS) The present paper aimed to adapt and validate Castles & Glass s Social Problem Solving Test SPST (1986) for adults with mental retardation. The adaptation process of the SPST for the Brazilian context was made in accord with the International Test Commission (ITC, 2001) and the definitions of the Resolution 002/2003 of the Federal Psychology Council. The procedures were based on Pasquali s methodology (2010) for the use of instruments developed in different social, linguistic and cultural contexts. Two independent and complementary studies were conducted. The first study covers the initial procedures of the adaptation process of the SPST, which involves: the identification and systematization of the parameters evaluated by the test, the translation of instructions and items, the inclusion of visual stimuli corresponding to the verbal stimuli and the theoretical analysis of the items through evaluations from expert judges and representatives of the target population. The second study describes the empirical investigation of the psychometric properties of the adapted version of the SPST, the estimate of the precision of the test and survey of the validity evidences. Statistic procedures were used to explored the dimensional structure of the SPST through the Classical Test Theory. The first study findings helped establish the classes and subclasses covered by the SPST, identify and systematize the instrument dimension. Furthermore there was a high degree of agreement among the expert judges concerning appropriateness, relevance and intelligibility of the test items. The effectiveness scoring criteria for SPST (MEPS-MR) has also suffered modifications in its scoring system according to Brazilian reality. The second study was conducted on two separate groups, constituting independent samples, one with individuals diagnosed with mental retardation with 50 participants and other nonclinical with 30 participants. Because of the predominance of non-normality in the distribution of sample data, we used nonparametric statistics: Mann-Whitney U for comparisons between groups and Spearman s Rho correlation, adopting for both p < The results indicated (p < ) that the items were highly discriminating. The internal consistency indices were calculated using Cronbach Alpha and the Guttman and had values of and respectively. The exploratory factor analysis (EFA) revealed that the internal structure of SPST is one-dimensional.
14 Arch Clin Psychiatry. 2015; Suppl. 42(1): Use of PECS in dentistry for autistic patients Adriana Gledys Zink, Renata de Oliveira Guaré, Renata de Oliveira Guaré Universidade Cruzeiro do Sul The health professional-patient relationship can be limited when patients ability to communicate is compromised, as in the case of some patients with autism. This research aimed to condition patients with autism to use the Picture Exchange Communication System adapted for dentistry, through figures that demonstrate the stages of treatment. Twenty-six patients, were divided into 2 groups G1 (no previous experience in dental treatment) and G2 (with previous experience). The patient s initial approach was accomplished by applying principles of Son-Rise Method, which consists mainly to seek eye contact. Sequentially figures fixed on paper that showed the phases of dental treatment were presented. Each image/picture presented was used up to 3 times in order to observe results with record questionnaire: acquired, non-acquired and emerging. Seven variables corresponding to the pictures presented were used: dentist, mouth, equipment, chair, waiting room, water, triple syringe. Data were tabulated and statistical significance was considered for levels of p < The variables were the figures presented to patients before the dental treatment. The multivariate test for two samples was used to test Cramér. The Cramér test confirms that we could reject the null hypothesis that the two groups had the same distributions for the seven variables with a p-value of Observed difficulty in accepting the PECS adapted to Dentistry in G2 during the 1 st attempt to even approach this attempt was similar for the 2 groups and had a playful manner, regardless of their previous experience or manifestations of aggression during the procedure. Almost most of PECS was accepted even in 1 st attempt for the G1 showing the ease acceptance by the group without previous experience with dental treatment. For the G2 more sessions were required and even the need to resume conditioning using the device step-back, restarting the presentation of the figures that were accepted. The groups are statistically different. Our study confirmed that autistic patients with no previous dental treatment experience can be conditioned with dental images in a short time to accept dental treatment use of images for. Patients with previous dental treatment experience took longer to accept treatment. This suggests that using PECS adapted for dentistry for autistic patients should occur prior to any dental treatments Translation and cultural adaptation to Brazilian Portuguese of the autism dysmorphology measure Thais Arbocese Zanolla, Rodrigo Ambrosio Fock, Eduardo Perrone, Ana Beatriz Alvarez Perez, Decio Brunoni Universidade Federal de São Paulo (UNIFESP) Autism was first described by Leo Kanner in 1943, who defined the disorder based observating children with peculiar behavior and without major defects or malformations. Smaller congenital abnormalities, or simply minor anomalies are markers of abnormal development. It is well established that the greater the number of minor abnormalities, the greater the risk of having a malformative syndrome. Contrary to what was observed by Kanner, several authors since the 70s, suggested an increase number of minor anomalies in autistic population. Miles and Hillman, in 2000, suggested a classification based on the number of minor anomalies in patients with autism and classified them in subgroups: patients with complex autism or essential autism. A complex autism patient must have dysmorphic features, microcephaly or a combination of both. The two subgroups differs in the presence of syndrome, intelligence quotient, presence of minor abnormalities, magnetic resonance imaging abnormalities and recurrence risks, suggesting that they could have different etiologies. It was proposed to evaluate the morphological phenotype as a step towards the identification of syndromic autism and, in 2008, Miles proposed the Autism Dysmorphology Measure, to assist the dysmorphology education for non-medical geneticists, allowing them to classify patients in one of the two subgroups. In order to bring a new tool to Brazil to assist in the etiologic diagnosis of patients with autism spectrum disorder, the translation and cultural adaptation of ADM is of utmost importance. Based on the model proposed by Reichenheim and Moraes (2007), the translation and adaptation of Autism Dysmorphology Measure was performed for the Portuguese of Brazil. This method consists of obtaining the permission of the authors, completing the translation and back-translation, reference equivalence assessment, doing the first pre-test evaluation of general equivalence, experts review, preparation of a draft, a second pre-test and the final version. The final version of the Brazilian version of Autism Dysmorphology Measure is in national publication stage, and its knowledge is extremely important for professionals working with this group of patients.
15 8 Arch Clin Psychiatry. 2015; Suppl. 42(1): Training psychiatrists to evaluate minor congenital anomalies in patients with autism spectrum disorder Rodrigo Ambrosio Fock, Thais Arbocese Zanolla, Eduardo Perrone, Ana Beatriz Alvarez Perez, Decio Brunoni Universidade Federal de São Paulo (UNIFESP) The autism spectrum disorders (ASD) are neuropsychiatric/neurodevelopmental disorders characterized by impaired social interaction, communication, and a restricted repertoire of activities and interests. The autism behavioral phenotype may originate from a variety of genetic and environmental causes. Identified genetic causes of autism can be classified as the cytogenetically visible chromosomal abnormalities, submicroscopic deletions and duplications, and single-gene disorders. Miles, 2000, proposed a classification for ASD patients in two subgroups: the complex autism subgroup and the essencial autism subgroup. The complex autism had poorer outcomes with lower IQs, more seizures, abnormal EEGs and brain abnormalities on MRI. The remainder had essential autism, which was the more heritable group, with a higher sib recurrence, relatives with autism and a higher male to female ratio. To assist in the identification of minor anomalies, Miles proposed The Autism Dysmorphology Measure (ADM) whose goal was to produce a dysmorphology measure that could be completed by clinicians who are not extensively trained in dysmorphology, and teaching them to recognize minor congenital anomalies. Our goal is to prove that ADM can be a dysmorphology teaching guide, and in order to do so we realized the training of medical psychiatrists based on the ADM and compared with the knowledge of medical geneticists. We proposed a pre training test, lessons based on ADM and other test after the training with ADM. The scores of pre and post training of the psychiatrists were compared with the scores of medical geneticists (the medical geneticists completed the same test). As a result we observed an improvement in knowledge of the psychiatrists, both in identification of dysmorphic structures as well as in the description of the minor anomalies. Medical geneticists had higher grades than psychiatrists in identifying dysmorphic structures and description of minor anomalies. The ADM is not intended to replace the geneticist medical examination. However, for clinicians, the ADM will help to distinguish truly abnormal structures from normal, including recognition of normal variants. We intend that this measure provides to clinicians a practical way to distinguish individuals with complex autism from essential autism, which in turn will lead to more accurate prognoses, recurrence risk assessment, and treatment direction Functionality evaluation instrument for daily-life activities for adults with autism spectrum disorders Cristiano Pedrosos, Emília Rossi, Carina Eretzky Muriel, Vivian Renne Gerber Lederman Universidade Presbiteriana Mackenzie (UPM) Introduction: The functionality or the incapacity that certain people exhibit on their life development, are aspects directly conditioned by the environment where they live in. The International Classification of Functioning, Disability and Health (ICF) embodies an important instrument for their daily living conditions evaluation. In a supportive home model, it is essential to understand the functionality of the residents in order to promote autonomy. Objective: Employ the ICF as a functioning measurement instrument of the daily living activities of ASD (Autism Spectrum Disorders) adults living in a supportive home model, to evaluate their capabilities and functionalities, develop an individual supportive program and promote increasingly greater levels of independence. Method: The daily living activities related to the home management of the ASD, adults living at the supportive home Aldeia da Esperança, were listed. We used the ICF, fields of activity and participation, to measure the abilities and develop an action plan in self-care, domestic life, interaction/relationship and community/social life. With this instrument, we expected to measure qualitative and quantitative functionality, development and losses. Results: The instrument evaluated 11 ASD adults. As a group, the results were as follows: 1) functionality for self-care was 83% (SD 14%); 2) domestic life 45% (SD 19%); 3) interaction/relationship 50% (SD 20%); 4) community/social life 54% (SD 23%). The individual action plan focused in the home-living management. Conclusion: The develop measure instrument was efficient for the daily living functionality evaluation of the residents of the Supportive Home Aldeia da Esperança. Through the instrument s results it was possible to create individual plan actions, aiming to develop the autonomy of the Home residents.
16 Arch Clin Psychiatry. 2015; Suppl. 42(1): Interface between language and behavior functionalities in autism spectrum disorders adults Giliana Maria da Rocha, Vivian R. G. Lederman, Carina Eretzky Muriel, Emília Rossi, Cristiano Pedroso Universidade Presbiteriana Mackenzie (UPM) Introduction: The empiric observation of adults living in a supportive house points to correlation between language comprehension and expression and less need of help for daily activity management. The correlation between language competences and the management of adult life is this research hypothesis. Objective: Using the International Classification of Functioning, Disability and Health (ICF) and the ABFW language evaluations as algorithms to answer the question: Is it possible to identify disproportion between language capabilities and the management of adult life among the ASD group studied at Aldeia da Esperança? Method: Daily life activities related to home organization and routine performed by 10 ASD adults living at the supportive house Aldeia da Esperança were observed. The I.C.F. was employed in order to measure the competences regarding their home management capabilities. An evaluation of their receptive, expressive, lexical and semantic vocabulary was also made. The results were compared connecting the binomial: Language/behavior functionality. Results: The following percentage scores were found in language competences: receptive incipient vocabulary (expected in children up to 6 years old): 81% (SD 14%); expressive vocabulary: 75% (SD 19%). Regarding the house management-organization the results found were: self-care 83% (SD 14%); domestic-practical life 45% (SD 19%); interactions 50% (SD 20%); social 54% (SD 23%). Conclusion: As per the results, the percentage of the verbal designation collected at the investigation of the expressive and receptive vocabularies, is below the expected for adults or even children up to 6 years old. These adults presented disadvantage and/or a gap regarding their communication functional aspects. The results were the same in relation to their homes organization; poor communication capabilities lead to greater socializing and interaction difficulties Is there an adaptive behavior profile for Williams and Down syndromes and autism spectrum disorders? Carolina Del Cole, Wagner Ribeiro, Sheila C. Caetano, Andrea Parolin Jackowski Universidade Federal de São Paulo (UNIFESP) Activities related to daily life demands are the scope of adaptive behavior (AB). AB might be similar to the behavioral clinical characteristics of the different types of neurodevelopmental syndromes. The aims of the present study were: a) compare AB domains (socialization, communication and daily living) between Williams-Beuren Syndrome (WBS), Down Syndrome (DS), Autism Spectrum Disorder (ASD) to between Healthy Control (HC), in order to determine an AB profile for each group and; b) evaluate the effect of possible confounders such as IQ and Socioeconomic Status on AB performance. One hundred and eleven adolescents between years-old and residents of the State of Sao Paulo, Brazil were included in the study as follows: 24 adolescents with WBS, 25 with DS, 38 with ASD, and 24 HC subjects. All groups underwent the following evaluations: the Vineland Adaptive Behavior Scale (VABS), the Wechsler Intelligence Scale for Children Intelligence Quotient (IQ), and the Brazilian Economic Classification Criteria Socioeconomic Status (SES). All the diagnostic groups performance (WBS, DS, and ASD) was inferior to HC in all AB domains. Moreover, WBS group performed better than DS group in the communication domain (β = 10.6; p = 0.044); and better than that of the ASD group in the socialization domain (β = 9.0; p = 0.013). DS group also performed better than ASD group in the socialization domain (β = 17.0; p = 0.024). IQ presented as an important confounding factor and SES has an important effect on the AB in WBS, DS, and ASD. The different behavioral profiles on each syndrome AB performance still warrant investigation in order to establishing an AB profile for each syndrome.
17 10 Arch Clin Psychiatry. 2015; Suppl. 42(1): Multicentric study: acquisition of social skills in children with autism using video modeling in parental training Leila Bagaiolo, Daniela Bordini, Tatiane Ribeiro, Maria Carolina Martone, Graccielle Rodrigues da Cunha Asevedo, Cristiane Silvestre de Paula Department of Psychiatry at the Universidade Federal de São Paulo (UNIFESP) Applied Behavior Analysis (ABA) is an intervention with proven efficacy in treating impairments on social functioning and daily-life activities of individuals with Autism Spectrum Disorder (ASD). In Brazil we have a limited number of qualified professionals and an increasing demand of families non-served in the public health system. Our main objective is to describe the implemented intervention model for teaching eye contact and joint attention behaviors in children with ASD and also the evaluation system applied. Eye contact and joint attention are essential to develop adequate social interaction, the core impaired domain in autistic disorders. Video modeling is one of the most efficient teaching procedures among those used in ABA and is a mode of teaching that uses video recording and display equipment to provide a visual model of the target behavior or skill. It is a multicentric study to be carried out by Universidade Federal de São Paulo, Universidade de São Paulo and Universidade Presbiteriana Mackenzie. The sample was composed of 65 children divided in control and intervention groups that were randomly chosen. The intervention was carried out in 28 weeks and the primary outcome is the acquisition of new behaviors (eye contact and joint attention) checked through taped interactions between child and a family member before and after intervention. As secondary outcomes we will assess the improvement in patient s quality of life and reduction in family burden. The further development and evaluation of the efficacy of the present intervention can result in a major impact on ASD treatment in Brazil, as it will allow training of a much larger number of professionals and families, considering the need for low cost interventions that can reach locations with difficult access in our country Adenylosuccinate lyase deficiency and autism spectrum disorders (asd): a literature review Eduardo Perrone, Thais Arbocese Zanolla, Rodrigo Ambrosio Fock, Mirlene Cecilia Soares Pinho Cernach, Ana Beatriz Alvarez Perez, Decio Brunoni Universidade Federal de São Paulo (UNIFESP) Autism spectrum disorder (ASD) is a neurodevelopmental disease characterized by impairments in social interaction and communication and by repetitive behavior. The prevalence of this disease is about 1%. Two categories for ASD patients were proposed recently essential and complex. Each of these categories were different regarding morphologic status, presence/ absence of abormalities in central nervous system (CNS), microcephaly and epilepsy. Cromossomal microarray gives the best overall yields during autism investigation (10-20%) mainly in complex autism, so it s one of the first steps when searching an etiology for autism. Although hereditary metabolic diseases (HMD) can be responsible for about 3% of ASD, sometimes they are neglected during etiologic research because the correct diagnosis requires clinical and technological expertise. Adenylosuccinate lyase deficiency (ASLD) a disease of purine metabolism is one of HMD related to ASD. ASLD is diagnosed by quantitative analysis of SAICAr (succinylaminoimidazole carboxamide riboside) and S-Ado (succinyladenosine) in body fluids using HPLC method. Few medical departments around the world are able to diagnose this disorder. To date, about 50 patients, have been diagnosed worldwide. Although there is no specific treatment, the diagnosis is important to genetic counseling. We review data published of 43 patients with ASLD. Our purpose was to better delineate the clinical phenotype of this disease. In our review, all patients had global neurodevelopmental delay (GDD) against 9% in ASD general population; 93.1% had autism features; 79.1% had convulsions (clinical or diagnosed in EEG) against 11% in general ASD patients and 75.8% had hypotonia against 51% in general ASD. Related to the occipital frontal circunference (OFC), 36.7% showed absolute or relative microcephaly. With respect to CNS abnormalities, the most commom was white matter abnormality (65.4%), followed by cortical atrophy (55.6%) and cerebelar abnormalities (40.7%). Regarding to morphologic status from the patients, we had few informations from studies, but about 40% from patients described were dysmorphic. We conclude that ASLD is a possible diagnosis for complex ASD patients with GDD, mainly when convulsions and microcephaly are associated, after chromosomal imbalances and other inborn errors of metabolism were ruled out. More studies focusing on morphology of these patients are necessary to better delineate a phenotype.
18 Arch Clin Psychiatry. 2015; Suppl. 42(1): Are clustering by functioning associated to IQ and severity of the clinical picture in patients with ASD? Joana Portolese, Elaine Zachi, Paola Lourenço da Rocha, Helena Brentani Programa dos Transtornos do Espectro Autista (PROTEA); Departamento de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo (FMUSP) Autism Spectrum Disorder (ASD) is a complex, polygenic, and multifactorial disease. It has a huge heterogeneity in phenotypic expression and in severity of behavioral symptoms (Jeste, 2014). Intellectual quotient (IQ) is commonly described as a primary issue in its heterogeneity (Munson, 2008). The purpose of the study was to find ASD subgroups based on patients adaptive functioning, and to verify its relation to IQ and to the severity of symptoms. Thirty nine individuals with ASD (diagnosis based on DSM-V, CID-10, and CARS) were selected from the PROTEA (Programa do Transtorno do Espectro Autista) from the Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina USP. The patients were submitted to cognitivebehavioral assessment using the SON-R 2½-7 Nonverbal Intelligence Test, the Wechsler intelligence scales (WISC-III and WAIS-III), and the Vineland Adaptive Behavior Scales II. Statistical analyses were performed using the TMEV and the SPSS softwares, and included cluster analysis (hierarchical clusterization by Pearson correlation and complete linkage), and analysis of variance (ANOVA). The results showed the composition of 2 clusters combining Vineland domains (Communication+Motor Skills and Socialization+Daily Living Skills), and 2 clusters of patients (unsupervised analysis). Bootstrap simulation revealed validation of the clusters. Analysis of variance showed significant differences between groups (p < 0.05) in terms of age, IQ, CARS score, and in Communication. Group 1 was composed by patients with 7 years old in average, mean IQ 57 (mild intellectual disability), and mean CARS score 39 (severe autism). Group 2 was characterized by mean age of 12 years, mean IQ 73 (borderline), and mean CARS score 33 (mild to moderate autism). Age was negatively correlated to Vineland scores in both groups, and IQ was positively correlated to Communication and Daily Living Skills in group 2 (Pearson correlation, p < 0.05). The results corroborate previous findings indicating pronounced deficits in adaptive behavior with increasing age, and provide evidence that this pattern extends to adulthood. It also corroborate previous data indicating that Communication is the main domain associated to IQ in mild autism and that the development of Socialization is not related to IQ. The results highlight the importance of identifying outstanding developmental influences on adaptive behavior in autism Assisted living for adults with ASD: articulations in Rio Grande do Sul Marilice Costi, Renata Costa de Sá Bonotto Universidade Federal do Rio Grande do Sul (UFRGS), Instituto Autismo & Vida There is no report of reduced life expectancy for people with Autism Spectrum Disorders (ASDs). Many have associated disorders and experience important deficits such as limited or no verbal language, severe behavioral changes, difficulties regarding autonomy and performance of daily activities, socialization and maturity. Assistance to the people with ASD in face of the possibility of parents or other caregivers absence, stress, burnout, illness or death is an issue requiring attention and articulation in the context of public policies. Such discussion falls within the scope the Mental Health, Welfare and Social Security and relates to young people and adults with ASD as well as their family and caregivers. Programs in Brazil such as Therapeutic Home Services under the Ministry of Health and Inclusive Residency under the Ministry of Social Development show potential to aid in such respect, but currently reveal several limitations. This paper aims to address the actions and actual results of the Movimento Pró-Vida Assistida (MPVA Pro Assisted Living Movement). It started in 2011 as an social movement on the part of family members and friends and today encompasses several organizations from civil society from the state of Rio Grande do Sul. The movement has (1) highlighted the need for public and private initiatives more aligned with the specificities of the person with developmental and mental disorders; (2) identified the need for further discussions in the health and assistance sectors in order to expand the supply and qualify such services in the public or private sphere; (3) urged public control and supervision of existing initiatives to ensure care and health to people with ASD while providing them with increasing opportunities to exercise their autonomy and citizenship; and (4) advocate for improving quality of life and stress management for the whole family as family members and caregivers are likely to be overwhelmed if they may not resort to a network of supporters in face of the intense care load posed by adults with ASD. This discussion develops with considerations on aging of people with developmental and mental disorders as well as poor health brought about the absence of a network of support to caregivers.
19 12 Arch Clin Psychiatry. 2015; Suppl. 42(1): Changes in daily life of an autistic A case report Silvia Mitie Kanawa, Claudiane Salles Daltio Programa de Esquizofrenia (Proesq) da Universidade Federal de São Paulo (Unifesp) This paper aims to describe the clinical experience in a process of occupational therapy through care provided to a patient diagnosed with ASD (Autism Spectrum Disorder). The 41 year old patient begun medical treatment at 9, but until 34, when he had his first hospitalization, irregular treatments were made with use of different drugs: haloperidol, levomepromazine, risperidone and olanzapine. After hospitalization, motivated by an aggressive and disorganized behaviour, he began regular medical monitoring, currently in use of olanzapine 20 mg. The patient was referred to occupational therapy at age 35, due to the difficulty of social interaction, poor daily life and for presenting monosyllabic words. Since the admission, his social life was restricted only to family members. Initially, the patient went into consultation room with his mother, with whom he had a relationship of extreme dependence. After six meetings, he requested his mother remained outside the room. During the week, he performed drawings at his home and brought them to show to the therapist. Gradually he was leaving some of his productions in the setting, to the point of letting them all. In the meetings, rather do drawings to try another technique activity. After observing the therapist performing cut and collages, the patient became interested in learning to handle the scissors and glue the tube, thereby improving their fine and gross motor coordination. He began to conduct this activity at your home. The patient communication was made through nods; now and again voiced a word, always difficult to understand. He was stimulated by the therapist to sustain his gaze for a longer period and to verbalize their will within the setting. Alongside these events, the patient and mother were oriented to circulate more by collective spaces. In his routine it was included biblical passages and/ or biographies of painters like Salvador Dali, Vincent Van Gogh, Matisse, and others. Gradually, he began to bathe alone and do the housekeeping of the bed. Now he is helping his mother at housework. In conclusion, the patient showed significant gains in his autonomy and independence and conducting daily life activities as well as the acquisition of social skills. There is a continuity of this process in order to increase their vocabulary and encourage him in the development of sentences Clinical and genetic profile of adult patients with autism spectrum disorder (asd) diagnostic hypotesis: retrospective study of calls on genetic service at Hospital Regional of Sorocaba-sp, Brazil from 2003 to 2013 Gabriela Tizianel Carvalho, Luana Ajala Christiano, Elisa Varella Branco, Marta Wey Vieira, Débora Aparecida Rodrigueiro Pontifícia Universidade Católica de São Paulo (PUC-SP) Introduction: When considered as a single entity, autism does not fit known inheritance patterns, and could be just a product of unrecognized etiologic heterogeneity. From the genetic point of view the change of autism to a group of disorders called ASD, according to the DSM-5, brings together previously distinct diseases. Early diagnosis of ASD can help promoting nonpharmacological treatment strategies especially in workers suffering from ASD with comorbid depressive state. Less attention to these supports may sometimes mislead prolonged depressive episodes or development of further comorbidities like anxiety disorders. In particular, fatigue and psychomotor retardation associated with depression can mask such symptoms. Therefore, it is important for clinicians for possible diagnosis of ASD when seeing depressed adult outpatients. In Brazil, epidemiological studies are few. Objectives: This work aimed to quantify and describe patients seen in the genetic clinic of Hospital Regional de Sorocaba (CHS) from 2003 to 2013, over the age of 10 years, who complain clinical manifestations suggestive of ASD. Methods: In this period we treated 1,569 patients. The genetic and clinical data of 113 patients who reported clinical manifestations suggestive of ASD were analyzed. Results: Among the possible ASD cases, we studied 57 (35 males and 22 females), 13 had more than 16 years. The main complaints consisted of learning difficulties (25), mental delay (24), aggression (17), agitation (14), insulation (12), depression (5), hyperactivity (3), seizures (3). Regarding laboratory tests, changes were observed in 24 imaging, 8 ophthalmologic and 2 hearing evaluation. As for drugs, 24 patients were using at least one of the follow: antipsychotics (21), anticonvulsants (15), antidepressants (7). Only 11 cases had a final diagnosis, being genetic (3) and environmental causes (3) identified, besides 5 cases of unspecified mental. The remaining 27 were inconclusive, 14 did not return and 5 are still in research. Conclusion: There are a considerable number of adult patients without an accurate diagnosis. On the basis of the high-heritability index, we realize the importance of a referral these patients to a genetics center. Genetics counselling, psychiatry and neurology are able to offer together an accurate diagnosis making possible a range of treatments, special dishes, and thus a better quality of life for these patients.
20 Arch Clin Psychiatry. 2015; Suppl. 42(1): Daily living activities: intervention and orientation meetings to caregivers Camilla Lima Zugman, Graccielle Rodrigues da Cunha, Dinara Souza, Daniela Bordini Department of Psychiatry at Universidade Federal de São Paulo (UNIFESP) Autism spectrum disorder (ASD) is a pervasive developmental disability associated with high social and economic costs and increasing prevalence rates. Taking care of children with ASD impacts family life in several aspects. Previous studies have shown that caregivers of children with ASD have lower quality of life, related to several variables, including caregiver burden. Our aim is to test the effectiveness of a group-based intervention to reduce caregiver burden and improve their quality of life, focused on training caregivers to improve their children abilities in daily living activities Meetings will take place weekly with caregivers of children diagnosed with low-functioning autistic spectrum disorder aged between 3 and 8 years old, who have not received this kind of intervention in the last 6 months. The meetings will approach 6 daily living activities: toilet use, dressing, bath, oral hygiene and withdrawal diaper. ASD diagnosis will be made by child psychiatrists according to the criteria of DSM 5 and the quantification of autistic symptoms will be made through the Autism Behavior Checklist (ABC). Canadian Occupational Performance Measure (COPM) will be used to measure which daily living activity is more important to caregiver. Vineland Adaptive Behavior Scales II (VINELAND II Daily Living part) will be used to identify the child s dependency level on performing daily life activities. Zarit Burden Inventory (ZBI) will be used to measure the burden on caregiver and the WHOQOL-BREF to measure the Quality of Life. We expect to find an increase in the quality of life and decrease in the burden of caregivers after 3 months intervention Early diagnosis in children with autistic spectrum disorder: correlation with the language Maiara Cristine Oliveira de Almeida, Laise Carla Lira de Jesus, Karine Lopes Pinheiro, Laís Leandro de Souza Associação Pestalozzi de Arapiraca Language changes in autistic disorder are often characterized by significant delays or total absence of development of this skill. It is necessary to reduce or eliminate this difficulty with an early assessment in this population, making an overall assessment of the child by a multidisciplinary team, thereby generating an evaluation of all possible aspects changed in this population. Early identification of children with autism contribute to a more effective development, being minimized or remedied possible difficulties that may arise, taking advantage of the neural plasticity of the child to develop language and social skills. If this diagnosis is delayed the development will be more difficult in some activities as well as changes in skills already ingramadas in the child s brain. The objective of this study was to quantify children early diagnosed with autism in a philanthropic institution and correlate the development of language in children with early and late diagnosis. For its implementation the records were analyzed of all children admitted and evaluated the overall assessment service from a philanthropic institution. The selection criteria were children with confirmed or questioned medical diagnosis of the autistic spectrum disorder. Speech therapy evaluations and developments of children were analyzed included in customer service to autism. Overall assessments in service were conducted in 307 children between 0 and 18 years. Among these, 32 children were identified with autism or within the autistic spectrum, and 5 were younger than 3 years, 26 children were between 3 years and 10 years and only three were more than 10 years. After review of speech, it was observed that all the children had been outstanding in some or many aspects of language. After six months of therapy, we observed, the oral language, children who were framed in the group over three years had better performance and progress compared to other older children. It is possible to demonstrate the importance of stimulation and diagnosis early in a child with autism to minimize language difficulties, and the presence of communication reflects the quality of life and evolution in behavioral and social aspects of the child. There was a low rate of children diagnosed with autism since the implementation of the comprehensive assessment service, and that children who were diagnosed early have shown improvements in a shorter time correlated with children of late diagnosis.