Perfil de habilidades de comunicação de dois irmãos com a Síndrome Alcoólica Fetal
Communicative profile in two siblings with Fetal Alcohol Syndrome
Roberta Garcia; Natalia Freitas Rossi; Célia Maria Giacheti
Resumo
Objetivo: caracterizar o perfil de habilidades de comunicação e o desempenho nos subtestes do Teste Illinois de Habilidades Psicolingüísticas (ITPA) de dois irmãos com diagnóstico da Síndrome Alcoólica Fetal (SAF): S1, sexo feminino, 16 anos e S2, sexo masculino, 8 anos, ambos matriculados em escola especial.
Métodos: foi realizada avaliação fonoaudiológica clínica das habilidades de linguagem complementada pela aplicação do ITPA.
Resultados: a avaliação clínica com S1 mostrou prejuízo de compreensão verbal, não sendo capaz de seguir instruções simples (verbais e gestuais), bem como não foi observado o uso de recursos comunicativos verbais e gestuais. Devido ao comprometimento apresentado, não foi possível obter dados referentes ao ITPA. Resultados bastante diferentes foram observados na avaliação clínica de S2, considerando que o mesmo foi capaz de realizar questionamentos, manter o tema abordado e seguir instruções verbais simples. Entretanto, observou-se baixo desempenho para a idade em situações que requeriam narrativas de fatos e acontecimentos que evidenciaram prejuízos sintáticos e semânticos. O escore escalar obtido por S2 nos subtestes do ITPA revelou baixo desempenho para as habilidades auditivas e visuais.
Conclusão: apesar de ambos terem o mesmo diagnóstico e viverem sob as mesmas condições ambientais, o perfil de comunicação diferiu significativamente entre os irmãos. Pode-se especular que prejuízos mais graves em habilidades comunicativas do S1 possam estar relacionados a níveis mais elevados de exposição ao álcool durante etapas críticas do desenvolvimento fetal.
Palavras-chave
Abstract
Purpose: to characterize the communication profile and the performance in the subtests of Illinois Test of Psycholinguistic Abilities (ITPA) of two siblings with Fetal Alcohol syndrome (FAS): S1, female 16 years and S2, male, 8 years and both of special school students.
Methods: clinical evaluation of language abilities was carried out and complemented by the ITPA test.
Results: data of clinical evaluation with S1 showed verbal understanding impairment. S1 was not capable to follow simple instructions (verbal and gestual) and the use of verbal and gestual resources communication was not also observed. Due to the compromising level, it was not possible to obtain relative data to the ITPA test. Quite different results was observed in the clinical evaluation of S2, considering that he was able to make questions, maintaining the theme and to follow simple verbal instructions. However, low performance was observed for age in situations that requested narrative of facts and events that shown syntactic and semantic impairments. Scale score obtained by S2 in the ITPA subtests revealed low performance in auditory and visual abilities.
Conclusions: although the siblings have the same diagnosis and live under the same environmental conditions, the communication profile was significantly different. It can be speculated that more serious impairments in communicative abilities of S1 can be related to higher levels of exposure to alcohol during critical stages of the fetal development.
Keywords
Referências
1. Lemoine P, Harousseau H, Borteyru PJ, Menuet CJ. Les enfants de parents alcooliques: anomalies observees a propos de 127 cas. Ouest Med. 1968; 21:476-82.
2. Jones KL, Smith DW, Ulleland CN, Streissguth P. Pattern of malformation in offspring of chronic alcoholic mothers. Lancet. 1973; 1(7815):1267-71.
3. Stratton K, Howe C, Battaglia F, editors. Fetal alcohol syndrome: diagnosis, epidemiology, prevention and treatment. Washington: National Academy Press; 1996. p.4-21.
4. Gardner J. Living with a child with fetal alcohol syndrome. Am J Matern Child Nurs. 2000; 25:252-7.
5. Roccella M, Testa D. Fetal alcohol syndrome in developmental age: neuropsychiatric aspects. Minerva Pediatr. 2003; 55(1):63-74.
6. May PA, Fiorentino D, Phillip Gossage J, Kalberg WO, Eugene Hoyme H, Robinson LK, et al. Epidemiology of FASD in a province in Italy: prevalence and characteristics of children in a random sample of schools. Alcohol Clin Exp Res. 2006; 30(9):1562-75.
7. Grinfeld H, Segre CAM, Chadi G, Goldenberg S. O alcoolismo na gravidez e os efeitos na prole. Rev Paul Pediatr. 2000; 18:41-9.
8. Burd L, Cotsonas-Hassler TM, Martsolf JT, Kerbeshian J. Recognition and management of fetal alcohol syndrome. Neurotoxicol Teratol. 2003; 25(6):681-8.
9. Merrick J, Merrick E, Morad M, Kandel I. Fetal alcohol syndrome and its long-term effects. Minerva Pediatr. 2006; 58(3):211-8.
10. Streissguth AP, Barr HM, Kogan J, Bookstein FL. Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) [thesis]. Seattle(USA): University of Washington Publication Services; 1996.
11. Shprintzen RJ. Genetics, syndromes, and communication disorders. San Diego: Singular; 1997. 315 p.
12. Mattson SN, Schoenfeld AM, Riley EP. Teratogenic effects of alcohol on brain and behavior. Alcohol Res Health. 2001; 25(3):185-91.
13. O'Malley KD, Nanson J. Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder. Can J Psychiatry. 2002; 47(4):349-54.
14. Suzuki K. Adult fetal alcohol syndrome (FAS) with various neuropsychiatric symptoms. Nihon Arukoru Yakubutsu Igakkai Zasshi. 2004; 39(5):474-81.
15. Swayze VW, Johnson VP, Hanson JW, Piven J, Sato Y, Giedd JN, et al. Magnetic resonance imaging of brain anomalies in fetal alcohol syndrome. Pediatrics. 1997; 99(2):232-40.
16. Sowell ER, Thompson PM, Mattson SN, Tessner KD, Jernigan TL, Riley EP, et al. Regional brain shape abnormalities persist into adolescence after heavy prenatal alcohol exposure. Cereb Cortex. 2002; 12(8):856-65.
17. Bookstein FL, Streissguth AP, Sampson PD, Connor PD, Barr HM. Corpus callosum shape and neuropsychological deficits in adult males with heavy fetal alcohol exposure. Neuroimage. 2002; 15(1):233-51.
18. Riley EP, McGee CL, Sowell ER. Teratogenic effects of alcohol: a decade of brain imaging. Am J Med Genet C Semin Med Genet. 2004; 127(1):35-41.
19. Roebuck-Spencer TM, Mattson SN, Marion SD, Brown WS, Riley EP. Bimanual coordination in alcohol-exposed children: role of the corpus callosum. J Int Neuropsychol Soc. 2004; 10(4):536-48.
20. Church MW, Abel EL. Fetal alcohol syndrome: hearing, speech, language, and vestibular disorders. Obstet Gynecol Clin North Am. 1998; 25(1):85-97.
21. Cone-Wesson B. Prenatal alcohol and cocaine exposure: influences on cognition, speech, language, and hearing. J Commun Disord. 2005; 38(4):279-302.
22. Becker M, Warr-Leeper GA, Leeper HA. Fetal alcohol syndrome: a description of oral motor, articulatory, short-term memory, grammatical, and semantic abilities. J Commun Disord. 1990; 23(2):97-124.
23. Carney LJ, Chermak GD. Performance of american indian children with fetal alcohol syndrome on the test of language development. J Commun Disord. 1991; 24(2):123-34.
24. Mattson SN, Roebuck TM. Acquisition and retention of verbal and nonverbal information in children with heavy prenatal alcohol exposure. Alcohol Clin Exp Res. 2002; 26(6):875-82.
25. Willford JA, Richardson GA, Leech SL, Day NL. Verbal and visuospatial and memory function in children with moderate prenatal alcohol exposure. Alcohol Clin Exp Res. 2004; 28(3):497-507.
26. Rasmussen C. Executive functioning and working memory in fetal alcohol spectrum disorder. Alcohol Clin Exp Res. 2005; 29(8):1359-67.
27. Schonfeld AM, Mattson SN, Riley EP. Moral maturity and delinquency after prenatal alcohol exposure. J Stud Alcohol. 2005; 66(4):545-54.
28. Howell KK, Lynch ME, Platzman KA, Smith GH, Coles CD. Prenatal alcohol exposure and ability, academic achievement, and school functioning in adolescence: a longitudinal follow-up. J Pediatr Psychol. 2006; 31(1):116-26.
29. Burden MJ, Jacobson SW, Jacobson JL. Relation of prenatal alcohol exposure to cognitive processing speed and efficiency in childhood. Alcohol Clin Exp Res. 2005; 29(8):1473-83.
30. Simmons RW, Thomas JD, Levy SS, Riley EP. Motor response selection in children with fetal alcohol spectrum disorders. Neurotoxicol Teratol. 2006; 28(2):278-85.
31. Kodituwakku P, Coriale G, Fiorentino D, Aragon AS, Kalberg WO, Buckley D, et al. Neurobehavioral characteristics of children with fetal alcohol spectrum disorders in communities from Italy: preliminary results. Alcohol Clin Exp Res. 2006; 30(9):1551-61.
32. Yavas M, Hernandorena CLM, Lamprecht RR. Avaliacao fonologica da crianca. Porto Alegre: Artes Medicas; 1992. 148 p.
33. Kirk SA, McCarthy JJ. The Illinois test of psycholinguistic abilities. Urbana: University Illinois Press; 1968. 136 p.
34. Bogossian MADS, Santos MJ. Manual do examinador: teste de habilidades psicolinguisticas. Rio de Janeiro: EMPSI; 1977. 64 p.
35. Sowell ER, Thompson PM, Mattson SN, Tessner KD, Jernigan TL, Riley EP, et al. Voxel-based morphometric analyses of the brain in children and adolescents prenatally exposed to alcohol. Neuroreport. 2001; 12(3):515-23.
Submetido em:
11/09/2007
Aceito em:
20/11/2007
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