Sintomas externalizantes numa amostra epidemiológica de pré-escolares
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Data
2023-11-24
Autores
Salviani, Débora Muszkat [UNIFESP]
Orientadores
Caetano, Sheila Cavalcante [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Estudos atuais sobre psicopatologia do neurodesenvolvimento apontam para a natureza dimensional para identificação dos sintomas mais prevalentes baseado em fatores latentes de internalização (e.g., ansiedade, depressão, retraimento) e externalização (e.g., agressividade, hiperatividade e violação de regras). Os sintomas externalizantes apresentam grave impacto funcional tanto para criança quanto para a família e escola, por isto a importância da avaliação e diagnóstico precoce para melhor compreensão da trajetória desenvolvimental e identificação de alvos de prevenção e tratamento. Os objetivos deste estudo foram: 1) investigar a relação entre sintomas externalizantes com a prontidão escolar (habilidades matemáticas, motoras e de linguagem); e 2) examinar os fatores subjacentes aos sintomas externalizantes por meio da Análise Fatorial Confirmatória (AFC) e análise de classes latentes (ACL) da seção de sintomas externalizantes da CBCL 1,5-5 (problemas de atenção e comportamento agressivo); e seus fatores associados, incluindo história familiar de depressão e ansiedade e nível socioeconômico. Para tanto, usamos a amostra epidemiológica de Embu das Artes, região metropolitana de São Paulo, constituída de 1.292 estudantes de 4-5 anos de pré-escolas públicas (Pre-K), avaliada pela Child Behavior Checklist for ages 1.5-5 (CBCL/1.5-5) para investigar sintomas externalizantes. Para o primeiro objetivo, participaram 722 da amostra do Pre-K, que tiveram a prontidão escolar avaliada pela Escala Inglesa de Desenvolvimento Infantil (ESCD), forma B. Os resultados mostraram uma associação negativa significativa entre sintomas externalizantes e prontidão escolar. No segundo objetivo, com 1.289 crianças, usamos AFC e LAC do CBCL para delinear sintomas externalizantes. Os resultados mostraram que o modelo multidimensional, distinguindo problemas de atenção e comportamento agressivo, apresentou ajuste superior. A depressão materna emergiu como fator significativo associado a maiores escores de sintomas externalizantes. A análise de classes latentes identificou três grupos para cada domínio (externalização total, problemas de atenção e comportamento agressivo) – clínico, subclínico e normal – destacando-se a prevalência de sintomas subclínicos (65,05% do total externalizante, 50% dos problemas atencionais e 65,54% do comportamento agressivo). Os resultados destacam a importância da identificação e intervenção precoces sobre sintomas externalizantes em pré escolares para melhorar os resultados acadêmicos. Também ressaltamos a importância de considerar traços latentes, saúde mental materna e técnicas de análise ao abordar sintomas externalizantes em pré-escolares, oferecendo insights precisos para intervenções direcionadas e apoio. Desta forma, nosso estudo tem relevância para saúde pública e pode contribuir com informações ainda escassas na literatura sobre a prevalência e mecanismos relacionados ao desenvolvimento de transtornos externalizantes em população brasileira pré-escolar.
Current research on the psychopathology of neurodevelopment points to the dimensional nature of identifying the most prevalent symptoms based on latent factors of internalization (e.g., anxiety, depression, withdrawal) and externalization (e.g., aggressiveness, hyperactivity, rule violation). Externalizing symptoms have a significant functional impact on both children and their families and schools, highlighting the importance of early assessment and diagnosis for a better understanding of developmental trajectories and the identification of targets for prevention and treatment. The objectives of this study were as follows: 1) to investigate the relationship between externalizing symptoms and school readiness (mathematical, motor, and language skills); and 2) to examine the underlying factors of externalizing symptoms through Confirmatory Factor Analysis (CFA) and Latent Class Analysis (LCA) of the externalizing symptoms section of the CBCL 1.5-5 (attention problems and aggressive behavior); and associated factors, including maternal history of depression and socioeconomic status. To accomplish this, we utilized the epidemiological sample from Embu das Artes, a metropolitan region of Sao Paulo, consisting of 1,292 students aged 4-5 from public preschools (Pre-K), assessed using the Child Behavior Checklist for ages 1.5-5 (CBCL/1.5-5) to investigate externalizing symptoms. For the first objective, 722 participants from the Pre-K sample had their school readiness assessed using the English Scale of Child Development (ESCD), form B. The results revealed a significant negative association between externalizing symptoms and school readiness. In the second objective, involving 1,289 children, we employed CFA and LCA of the CBCL to delineate externalizing symptoms. The results demonstrated that the multidimensional model, distinguishing attention problems and aggressive behavior, provided a superior fit. Maternal depression emerged as a significant factor associated with higher scores of externalizing symptoms. Latent class analysis identified three groups for each domain (total externalizing, attention problems, and aggressive behavior) – clinical, subclinical, and normal – with subclinical symptoms prevailing (65.05% of total externalizing, 50% of attention problems, and 65.54% of aggressive behavior). The findings underscore the importance of early identification and intervention for externalizing symptoms in preschoolers to enhance academic outcomes. Additionally, we emphasize the significance of considering latent traits, maternal mental health, and analytical techniques when addressing externalizing symptoms in preschoolers, providing precise insights for targeted interventions and support. Thus, our study holds relevance for public health and can contribute valuable information to the limited literature on the prevalence and mechanisms related to the development of externalizing disorders in the Brazilian preschool population.
Current research on the psychopathology of neurodevelopment points to the dimensional nature of identifying the most prevalent symptoms based on latent factors of internalization (e.g., anxiety, depression, withdrawal) and externalization (e.g., aggressiveness, hyperactivity, rule violation). Externalizing symptoms have a significant functional impact on both children and their families and schools, highlighting the importance of early assessment and diagnosis for a better understanding of developmental trajectories and the identification of targets for prevention and treatment. The objectives of this study were as follows: 1) to investigate the relationship between externalizing symptoms and school readiness (mathematical, motor, and language skills); and 2) to examine the underlying factors of externalizing symptoms through Confirmatory Factor Analysis (CFA) and Latent Class Analysis (LCA) of the externalizing symptoms section of the CBCL 1.5-5 (attention problems and aggressive behavior); and associated factors, including maternal history of depression and socioeconomic status. To accomplish this, we utilized the epidemiological sample from Embu das Artes, a metropolitan region of Sao Paulo, consisting of 1,292 students aged 4-5 from public preschools (Pre-K), assessed using the Child Behavior Checklist for ages 1.5-5 (CBCL/1.5-5) to investigate externalizing symptoms. For the first objective, 722 participants from the Pre-K sample had their school readiness assessed using the English Scale of Child Development (ESCD), form B. The results revealed a significant negative association between externalizing symptoms and school readiness. In the second objective, involving 1,289 children, we employed CFA and LCA of the CBCL to delineate externalizing symptoms. The results demonstrated that the multidimensional model, distinguishing attention problems and aggressive behavior, provided a superior fit. Maternal depression emerged as a significant factor associated with higher scores of externalizing symptoms. Latent class analysis identified three groups for each domain (total externalizing, attention problems, and aggressive behavior) – clinical, subclinical, and normal – with subclinical symptoms prevailing (65.05% of total externalizing, 50% of attention problems, and 65.54% of aggressive behavior). The findings underscore the importance of early identification and intervention for externalizing symptoms in preschoolers to enhance academic outcomes. Additionally, we emphasize the significance of considering latent traits, maternal mental health, and analytical techniques when addressing externalizing symptoms in preschoolers, providing precise insights for targeted interventions and support. Thus, our study holds relevance for public health and can contribute valuable information to the limited literature on the prevalence and mechanisms related to the development of externalizing disorders in the Brazilian preschool population.