Intervenção precoce no TEA

Dr. Clay Brites, PhD.

Neurologista Infantil

realização:
 Por que a intervenção deve ocorrer precocemente???
Prevenção de maiores déficits adaptativos a médio e longo prazos

Preservação do potencial intelectual e da linguagem

Redução de prejuízos sociais e acadêmicos em idades mais exigentes

Redução de custos públicos e privados

Reduzir a dependência de terceiros e aumentar qualidade de vida

Journal of Autism and Developmental Disorders
https://doi.org/10.1007/s10803-019-04014-z
Escalas de triagem
ORIGINALPAPER ORIGINAL RESEARCH
published: 17 July 2019
doi: 10.3389/fpsyt.2019.00488

The Economic Costs of Autism Spectrum Disorder: A Literature Review

Nicky Rogge1  · Juliette Janssen1

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Custos econômicos
Abstract
Autism is associated with a range of costs. This paper reviews the literature on estimating the economic costs of autism Validation of the Quantitative
spectrum disorder (ASD). More or less 50 papers covering multiple countries (US, UK, Australia, Canada, Sweden, the
Netherlands, etc.) were analysed. Six types of costs are discussed in depth: (i) medical and healthcare service costs, (ii) Checklist for Autism in Toddlers in
therapeutic costs, (iii) (special) education costs, (iv) costs of production loss for adults with ASD, (v) costs of informal care
and lost productivity for family/caregivers, and (vi) costs of accommodation, respite care, and out-of-pocket expenses. A an Italian Clinical Sample of Young
general finding is that individuals with ASD and families with children with ASD have higher costs. Education costs appear
to be a major cost component for parents with children with ASD. Children With Autism and Other
Atualizações
Keywords Autism · Autism spectrum disorder · Direct costs · Indirect costs · Financial burden Developmental Disorders
Liliana Ruta 1,2*, Flavia Chiarotti 3, Giuseppe Maurizio Arduino 4, Fabio Apicella 2,
Introduction Autism and Developmental Disabilities Monitoring Network Elisa Leonardi 1, Roberta Maggio 5, Cristina Carrozza 1, Natasha Chericoni 2,
(Centers for Disease Control and Prevention, US Depart- Valeria Costanzo 2, Nazarena Turco 4, Gennaro Tartarisco 1, Antonella Gagliano 5,
Autism spectrum disorder (ASD) is a range of neurodevelop- ment of Health and Human Services), for instance, yielded Carrie Allison 6, Simon Baron Cohen 6, Giovanni Pioggia 1 and Filippo Muratori 2,7
mental disorders that are characterized by the following core overall ASD prevalence estimates varying from 13.1 to 29.3 Edited by: Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy, 2 Department of
1

deficits: impairments in social interaction and communica-
tion, and restricted, repetitive behaviours (DSM-5, American
Psychiatric Association 2013). ASD affects people world-
wide, irrespective of race, ethnicity or socio-economic status
(Sharpe and Baker 2011; Durkin et al. 2010). Studies and
empirical evidence also show ASD is related to many poten-
tial comorbidities such as epilepsy, attention problems, gas-
tro-intestinal problems, oppositional behaviour, anxiety and
depression, sleeping disorder and feeding disorders (Hodg-
per 1000 children aged 8 years with an average prevalence
estimate of 16.8 per 1000 children aged 8 years (Baio et al.
2018). Based on the prevalence estimates of several stud-
ies across multiple countries, Lyall et al. (2017) estimated
the population prevalence to be around 1.5% in developed
Impacto da
countries around the world. As possible reasons for the dis-
crepancy in estimated prevalence figures, studies point out,
among other things, that for several countries (e.g., Belgium,
Scotland, most of the Arabic countries, etc.) there are no
Yuri Bozzi, Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy, 3 Center for Behavioral Sciences and Mental
University of Trento, ItalyHealth, National Institute of Health, Rome, Italy, 4 Centro Autismo e Sindrome di Asperger ASLCN1, Mondovì, Italy,
Open5 University
Access of Messina, Messina, Italy, 6 Autism Research Centre, Department of Psychiatry, University of Cambridge,Protocol
Reviewed by:
Preeti Jacob, Cambridge, United Kingdom, 7 University of Pisa, Pisa, Italy
National Institute of Mental Health Impact of the Early Start Denver Model
and Neurosciences, India
Background: The Quantitative Checklist for Autism in Toddlers (Q-CHAT) is parent-
Lin Sørensen, on the cognitive level of children with
report screening questionnaire for detecting threshold and sub-threshold autistic
University of Bergen, Norway
*Correspondence: autism spectrum disorder: study
features in toddlers. The Q-CHAT is a dimensional measure normally distributed in the
Liliana Ruta
protocol for a randomised controlled
general population sample and is able to differentiate between a group of children with a

precocidade
etts et al. 2015; Kogan et al., 2008; Vohra et al. 2017). As reliable and/or only limited statistics available regarding the
liliana.ruta@cnr.it
to the population prevalence of ASD, estimated figures vary prevalence of ASD and that diagnosis in ASD can be dif- diagnosis of autism and unselected toddlers.
depending on the country of study, the period studied, and ficult or complicated due to no or ineffective screening, and
Specialty section:
trial using a two-stage Zelen design
Objectives: We aim to investigate the psychometric properties, score distribution, and
the estimation method used. Recent estimates range from the interactions that occur between development and ASD This article was submitted to
1 per 160, 1 per 100, to 2 per 100 (Baird et al. 2006; Baio symptoms. Studies on the prevalence of ASD also show that Child and Adolescent Psychiatry,
external validity of the Q-CHAT in an Italian clinical sample of young children with autism
et al. 2018; Cidav et al. 2012; Hughes 2009; Knapp et al. there is an increasing trend in the percentage of the popula- a section of the journal versus childrenSandrine Touzet,1,2 Pauline
with developmental delay 1,2
and typically
Occelli, Schröder,3,4
developing
Carmen Sabine Manificat,5
children.
2009). Most recent estimates for the US as collected by the tion that is diagnosed with ASD (Lyall et al. 2017; Jacob Frontiers in Psychiatry Ludovic Gicquel,6,7 Razvana Stanciu,8 Marie Schaer,9 Marie-Joelle Oreve,10
Method: N =Mario
126 Speranza,
typically 10,11
developing
Angeliquechildren
Denis,1,2 (TD),
Amelien Zelmar,
= 1391,2children with autism,
Bruno Falissard, 12,13
et al. 2015; Sharpe and Baker 2007), with more recent stud- Received: 11 December 2018 14,15 11,16 14,15
ies showing higher estimates of prevalence rates compared Accepted: 21 June 2019
and n = 50 children presenting Stephane
Nicolas Georgieff, developmental
Bahrami,delay (DD) wereGeoffray,
Marie-Maude administered the
The IDEA Study Group
* Nicky Rogge to older studies. However, it is unclear whether this increase Published: 17 July 2019 Q-CHAT. Standardized measures of cognitive functions, language, and behaviors
Nicky.rogge@kuleuven.be
 Mas é possível identificar antes
dos 2 anos????

● Conhecer o neurodesenvolvimento infantil típico

● Conhecer os sinais mais significativos para o Autismo

● Desfazer-se dos antigos mitos

● Uso de vídeos e relatos de antes dos 2 anos

● “Red Flags”

● Rastreamento ativo durante consultas e triagens

RED FLAGS : SINAIS DE ALERTA PARA AUTISMO
Poucos sorrisos ou expressões de entusiasmo até 6 meses

Não compartilhar sons ou sorrisos até 9 meses

Ausência de balbucio até 1 ano

Irmã(o) com autismo

Ausência de atenção compartilhada no olhar e gestos

Nenhuma palavra até 16 meses de vida

Ausência na fala de sentenças acima de 2 palavras com intenção

Regressão de fala e habilidades sociais em qualquer idade

Comportamentos estranhos, atípicos e estereotipados

O QUE PODE REFORÇAR AINDA MAIS A SUSPEITA!!

PREMATUROS

PROBLEMAS NO
ALTERAÇÕES DO NASCIMENTO
DESENVOLVIMENTO

PAIS ACIMA DE PAIS COM ALTA

35-40 ANOS INTELECTUALIDADE

HISTÓRIA
FAMILIAR
 COMO PROCEDER ???

Desenvolvimento Uso de Atrasos de

Normal escalas DNPM

Escalas de Protocolos Escalas

triagem clínicos consolidadas

Como ela é
Dados
nos mais
Perfil clínico escolares e de
diversos
cuidadores
lugares
 ATENÇÃO
COMPARTILHADA

RECIPROCIDADE INICIATIVA DE
SOCIAL COMUNICAÇÃO
 O que mais observar???

• Sintomas sensoriais

• Problemas alimentares

• Alergias

• Irritabilidade e
medos excessivos

• Seletividades

• Pobreza ou atraso nas habilidades motoras e especiais

O que significam as intervenções precoces????

● Uso de estratégias que se iniciam antes dos 30 meses de vida;

● Modelo baseado em ABA com intervenção desenvolvimental, intensiva

e naturalística;

● Avaliação inicial e reavaliações dinâmicas e periódicas; e

● Alinhamentos com intervenções motoras/sensoriais

● Exige capacitação presencial, treinamento e atualização

(Dawson e cols., 2009)

 Bases da Intervenção Precoce

Atenção `as Alta Intensidade

comorbidades médicas
+

Problemas Uso do modelo

sensoriais/motores/espaciais ABA

Naturalística
AC + IC + RS
Modelos de ● RIT (Reciprocal Imitation Training)

intervenção ● ESDM (Early Start Denver Model)

precoce ● PRT (Pivotal Response Treatment)

● SCERTS (Social Communication

Emotional Regulation/Transactional
Dentro do ambiente
Support)
de consultório
● JASPER (Joint Attention Simbolic
Play Engagement and Regulation)
Modelos de ● ESDM

intervenção ● DIR-FLOORTIME
(Developmental Individual-
precoce Difference Relationship-
Based Model)

● ESI (Early Social Interaction)

Mediados por Pais
e/ou cuidadores ● PACT (Preeschool Autism
Communication Trish)

● JASPER

● PRT
 CONCLUSÕES

Identificar o TEA exige conhecer o desenvolvimento

neurotípico e atualização
Conhecer sinais precoces de TEA
Pais e cuidadores devem ser ativos
Modelos de intervenção com evidências
Observação criteriosa dos resultados
Convênios e setor público
 Referência bibliográfica

Brites C. (2020). Early Intervention on Autism: what do we need to know ?

Psychology, 11, 1081-1090. http://doi.org/10.4236/psych.2020.118071

Acesse pelo link acima e boa leitura!

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