Archives of
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Revista de Psiquiatria Clínica
VOLUME 42 • SUPPLEMENT 1 • 2015
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International Conference of Autism in Adult Life:
Science, Society and Reality
April 16-18, 2015
Editors
Editor-in-Chief: Assistant Editor:
Wagner F. Gattaz (São Paulo, Brazil)
Rodrigo Machado Vieira (Bethesda, USA)
Wulf Rössler (Zürich, Switzerland)
Regional Editor USA:
Regional Editor Europe:
Human Sciences Editor:
Psychology and Humanities
Assistant Editors:
Psychotherapy Transcultural Psychiatry
Editor:
Neurosciences Neurobiology
Geriatric Psychiatry
Basic Research
Neuropsychology
Assistant Editors:
Ines Hungerbühler (São Paulo, Brazil)
Francisco Lotufo Neto (São Paulo, Brazil)
Paulo Clemente Sallet (São Paulo, Brazil)
Felipe D’Alessandro F. Corchs (São Paulo, Brazil)
Orestes Forlenza (São Paulo, Brazil)
Breno Satler de Oliveira Diniz (Belo Horizonte, Brazil)
Clinical Psychiatry
Editor: Epidemiology Assistant Editors:
Psychopathology Neuroimaging
Biological Therapy
Geraldo Busatto (São Paulo, Brazil)
Marcus V. Zanetti (São Paulo, Brazil)
Tânia Correa de Toledo Ferraz Alves (São Paulo, Brazil)
Editor:
Instruments and Scales Assistant Editors :
Clarice Gorenstein (São Paulo, Brazil)
Elaine Henna (São Paulo, Brazil)
Juliana Teixeira Fiquer (São Paulo, Brazil)
Child and Adolescent Psychiatry Editor:
Assistant Editors:
Former Editors
Antonio Carlos Pacheco e Silva (1972-1985)
Fernando de Oliveira Bastos (1972-1985)
João Carvalhal Ribas (1980-1985)
José Roberto de Albuquerque Fortes (1985-1996)
Valentim Gentil Filho (1996-2010)
Guilherme Vanoni Polanczyk (São Paulo, Brazil)
Ana Soledade Graeff-Martins (São Paulo, Brazil)
Tais Moriyama (São Paulo, Brazil)
Editorial Board
Alexander Moreira-Almeida
( Juiz de Fora, Brazil)
Almir Ribeiro Tavares Jr.
(Belo Horizonte, Brazil)
André Malbergier
(São Paulo, Brazil)
Andrea Schmitt
(Göttingen, Germany)
Andréa H. Marques
(São Paulo, Brazil)
Benedicto Crepo-Facorro
(Santander, Spain)
Carmita Helena Najjar Abdo
(São Paulo, Brazil)
Christian Costa Kieling
(Porto Alegre, Brazil)
Daniel Martins de Souza
(São Paulo, Brazil)
Doris Hupfeld Moreno
(São Paulo, Brazil)
Eduardo Iacoponi
(London, UK)
Elida Paula Benquique Ojopi
(São Paulo, Brazil)
Emmanuel Dias Neto
(São Paulo, Brazil)
Ênio Roberto de Andrade
(São Paulo, Brazil)
Ester Nakamura Palacios
(Vitória, Brazil)
Frederico Navas Demetrio
(São Paulo, Brazil)
Fulvio Alexandre Scorza
(São Paulo, Brazil)
Gunter Eckert
(Frankfurt, Germany)
Helena Paula Brentani Samaia
(São Paulo, Brazil)
Helena Maria Calil
(São Paulo, Brazil)
Hélio Elkis
(São Paulo, Brazil)
Homero Pinto Vallada Filho
(São Paulo, Brazil)
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
(São Paulo, Brazil)
Liliana Rendón
(Assunção, Paraguai)
Marco Aurélio Romano Silva
(Belo Horizonte, Brazil)
Mônica Yassuda
(São Paulo, Brazil)
Osvaldo Pereira de Almeida
(Crawley, Australia)
Paulo Belmonte Abreu
(Porto Alegre, Brazil)
Paulo Canineu
(São Paulo, Brazil)
Paulo Rossi Menezes
(São Paulo, Brazil)
Paulo Mattos
(Rio de Janeiro, Brazil)
Renato Teodoro Ramos
(São Paulo, Brazil)
Renério Fraguás Junior
(São Paulo, Brazil)
Ronaldo Ramos Laranjeira
(São Paulo, Brazil)
Sandra Scivoletto
(São Paulo, Brazil)
Táki Athanassios Cordás
(São Paulo, Brazil)
Teng Chei Tung
(São Paulo, Brazil)
Zacaria Borge Ali Ramadam
(São Paulo, Brazil)
INSTRUCTIONS FOR AUTHORS
Available on the journals website (www.hcnet.usp.br/ipq/revista) and published in the last issue every year (number 6).
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, 2011
From volume 29 (2001), the articles of this journal are available in electronic form in the SciELO (Scientific Electronic Library Online)
database.
1.1. Clinical Psychiatry. University of São Paulo Medical School. Institute of Psychiatry.
ISSN : 0101-6083 printed version
ISSN : 1806-938X online version
CDD 616.89
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Cristiane Mezzari Coordenadora editorial: Sandra Regina Santana Imagem da Capa: Laila Gattaz Revisora: Glair Picolo Coimbra Produtor gráfico: Fabio Rangel Periodicidade: Bimestral Tiragem: 2.000
exemplares Cód. da publicação: 16767.3.15
INDEX
Editorial........................................................................................................................................................................................................................ 1
37007
Autism spectrum disorders: prevalence and service use in four Brazilian regions..................................................................................... 3
Beatriz Parasmo Sánchez, Rosane Lowenthal, Cristiane Silvestre de Paula
37141
Barriers for early identification of autism in Brazil............................................................................................................................................. 3
Sabrina Helena Bandini Ribeiro, Cristiane Silvestre Paula, Daniela Bordini, Jair J. Mari, Sheila C. Caetano
36563
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
37015
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
36541
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
36996
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
35662
A trace scale of autistic spectrum disorder in young adults............................................................................................................................. 6
José Fausto de Morais, Victor Lawrence Bernardes Santana
37078
Adaptation and validation of SPST – Social problem solving test for adults with intellectual deficiency ............................................ 6
Natália Costa, Elizabeth Nascimento, Gustavo Gauer, Virginia Viana
37012
Use of PECS in dentistry for autistic patients....................................................................................................................................................... 7
Adriana Gledys Zink, Renata de Oliveira Guaré, Renata de Oliveira Guaré
37001
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
37002
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
35993
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
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
36995
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
37213
Multicentric study: acquisition of social skills in children with autism using video modeling in parental training.......................... 10
Leila Bagaiolo, Daniela Bordini, Tatiane Ribeiro, Maria Carolina Martone, Graccielle Rodrigues da Cunha Asevedo, Cristiane Silvestre de Paula
37010
Adenylosuccinate lyase deficiency and autism spectrum disorders (asd): a literature review............................................................. 10
Eduardo Perrone, Thais Arbocese Zanolla, Rodrigo Ambrosio Fock, Mirlene Cecilia Soares Pinho Cernach,
Ana Beatriz Alvarez Perez, Decio Brunoni
37020
Are clustering by functioning associated to IQ and severity of the clinical picture in patients with ASD?.......................................... 11
Joana Portolese, Elaine Zachi, Paola Lourenço da Rocha, Helena Brentani
36560
Assisted living for adults with ASD: articulations in Rio Grande do Sul...................................................................................................... 11
Marilice Costi, Renata Costa de Sá Bonotto
36548
Changes in daily life of an autistic – A case report........................................................................................................................................... 12
Silvia Mitie Kanawa, Claudiane Salles Daltio
36565
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.......................................................... 12
Gabriela Tizianel Carvalho, Luana Ajala Christiano, Elisa Varella Branco, Marta Wey Vieira, Débora Aparecida Rodrigueiro
36570
Daily living activities: intervention and orientation meetings to caregivers............................................................................................... 13
Camilla Lima Zugman, Graccielle Rodrigues da Cunha, Dinara Souza, Daniela Bordini
37051
Early diagnosis in children with autistic spectrum disorder: correlation with the language.................................................................. 13
Maiara Cristine Oliveira de Almeida, Laise Carla Lira de Jesus, Karine Lopes Pinheiro, Laís Leandro de Souza
36545
Early predictors of asd in high-risk infants: joint attention, language and atypical behaviors.............................................................. 14
Elisangela dos Anjos Paula Vieira, Ana Alexandra Caldas Osório
36557
Eating and learning: strategy for autonomy of autistic children..................................................................................................................... 14
Mariane de Almeida Flores, Catia Cristiane Purnhagen, Ezequiel Leopoldo da Silva, Morgana Pavan, Juliana Cristina Peres,
Mariana Bernardes Antunes
36558
External clinic: therapy outside the offices for autism..................................................................................................................................... 15
Mariane de Almeida Flores, Ezequiel Leopoldo da Silva, Morgana Pavan, Catia Cristiane Purnhagen, Mariana Bernardes Antunes,
Juliana Cristina Peres
36552
First Expertise Rehabilitation Centre (erc) in Santa Catarina/Brazil: demand survey............................................................................... 15
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
37026
Multiprofessional call for students with autism spectrum disorder in Manaus......................................................................................... 16
Maria Gleny Barbosa Soares, Adenilda Teixeira Arruda, Antonia Egley Nascimento da Silva
37030
Parents’ perspectives of adolescents and adults with autism classics about the need of institutionalization as the main
intervention strategy................................................................................................................................................................................................ 16
Eliane Agustinho da Costa, Elís Amanda A. Silva, Aldenívia dos Santos Silva
36553
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................................................................................................ 17
Rafael Miranda Oliveira
37038
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 2014.................................................................................................................................................................................... 17
Eliete Chiconelli Faria Buratto, Juliana Harumi Arita, Quirino Cordeiro Junior, Rosane Lowenthal
36192
Autism spectrum disorders in adulthood: psychosocial context in the Brazilian reality.......................................................................... 18
Fernanda Duarte Rosa, Thelma Simões Matsukura
37072
Rainbow game technique: changing of behavior through reorganization of feeding routine................................................................... 18
Viviane da Silva Machado
36128
Study of ten autism in age group of seven to ten years: clinical signs frequently and age diagnostic.................................................. 19
Katia Semeghini Caputo
36509
Taking care of adolescents and adults with asd: difficulties and concerns of the parents..................................................................... 19
Regina Basso Zanon, Simone Steyer Lampert, Cleonice Alves Bosa
36518
The process of building autonomy in a group of pre teen with autistic spectrum disorder...................................................................... 20
Adriana Balaguer, Priscila Fernandes, Ana Marta Vieira Ponte
36506
The sensory aspect of adults with autism spectrum disorder under the view of formal caregivers....................................................... 20
Andrea Schäfers Delgado, Maria Inês Rubo de Souza Nobre
37062
Using functional language through visual cues in patients with autistic spectrum disorder.................................................................. 21
Maiara Cristine Oliveira de Almeida, Laise Carla Lira de Jesus, Karine Lopes Pinheiro, Laís Leandro de Souza
37075
Working memory in autism spectrum disorder: a literature review.............................................................................................................. 21
Suelen Bordignon, Renata Giuliani Endres, Simone Steyer Lampert, Clarissa Trentini, Cleonice Alves Bosa
37019
Using videos in the field of autism spectrum disorders: guidelines for treatment and training models................................................. 22
Victor Amoroso, Luciana Coltri e Silva
37068
Assessment of nutrition status in children and adolescents with autism spectrum disorders................................................................ 22
Caroline Casarin-Reis, Monica Campos, Bianca Rebouças, Camila Leocadio, Myrella Acensos, Daniela Bordini, Sheila C. Caetano, Maria
Conceição do Rosário, Michelle Caetano
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 16th to 18th, 2015.
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)
Supplement
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)
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 2nd to 6th 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.
37141
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.
4
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
36563
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.
37015
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.
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
5
36541
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.
36996
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.
6
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
35662
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.
37078
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 < 0.05. The results indicated (p < 0.0001) that the items were highly discriminating. The internal
consistency indices were calculated using Cronbach Alpha and the Guttman and had values of 0.876 and 0.884 respectively.
The exploratory factor analysis (EFA) revealed that the internal structure of SPST is one-dimensional.
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
7
37012
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 < 0.05. 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 0.006. Observed difficulty
in accepting the PECS adapted to Dentistry in G2 during the 1st 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 1st 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.
37001
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.
8
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
37002
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.
35993
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.
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
9
36491
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.
36995
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 11-16 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.
10
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
37213
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.
37010
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.
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
11
37020
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.
36560
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.
12
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
36548
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.
36565
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.
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
13
36570
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.
37051
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.
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Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
36545
Early predictors of asd in high-risk infants: joint attention, language and atypical
behaviors
Elisangela dos Anjos Paula Vieira, Ana Alexandra Caldas Osório
Universidade Presbiteriana Mackenzie (UPM)
Autism Spectrum Disorder (ASD) occurs in an estimated proportion of 1% of the child population, significantly affecting
individuals, families and society, with important implications for social relations. However, siblings of children with ASD are
at higher risk – 10-19% – to be diagnosed with the disorder when compared to the general population (Ozonoff et al., 2014;
Sandin et al., 2014). Guidelines suggest ASD screenings from age 18 months, but it is common for children with this disorder
to reach older ages without a diagnosis, diminishing the efficacy of intervention strategies. We posit that differences in socialcommunication (expressive and receptive language), social-interaction (joint attention) and behaviors (atypical behavior) in
the first year of life are longitudinal predictors of symptoms in the autistic spectrum. We will outline the design of a study
which main goal is to verify the predictive signs of ASD symptoms in high-risk infants (with older siblings diagnosed with
ASD) compared to low-risk infants. This longitudinal study, still under development, is divided into Phase A (12 months) and
Phase B (18 months). Phase A: The Early Social Communication Scales (Mundy et al., 2003) – evaluation of joint attention;
Aberrant Behavior Scale (Aman et al., 1985) – parental report atypical behaviors; The Bayley Scales of Infant Development –
III (Bayley, 2005) – assessment of language development. Phase B: Second administration of the previous instruments, plus
the Autism Observation Scale for Infants – AOSI (Bryson et al., 2008) and the Modified Checklist for Autism in Toddlers –
MCHAT (Kleinman et al., 2008) – to assess the level of autistic symptoms. Main scientific contribution: deficits in joint attention
and language and the presence of abnormal behaviors have been thoroughly reported in older children with ASD, however
knowledge is still lacking on the developmental progression of these abilities in young infants at risk for the disorder. We argue
that comparisons between a sample of infants with siblings with ASD and a low-risk sample at two decisive time-points – 12 and
18 months – will allow a better understanding of the early changes in this high-risk group, elucidating the atypical trajectories
of individuals who develop ASD.
36557
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
Associação de Pais e Amigos do Autista, AMA, Litoral, SC
This intervention was carried out in the AMA Litoral institution, specializing in autism medical treatment. There were
psychologist multidisciplinary care, educator, physical therapist, occupational therapist, speech therapist, social worker and
therapist musician. The paid-intervention project aimed to develop the autonomy of skill in the feeding process. The specific
objectives were: to develop independence when making meals; arouse interest in manipulating, experimenting and designing
new foods; encourage interaction with the group through activity. Twenty-four patients who were between three and eleven
years, were encouraged to respect the thematic construction of a pizza. As a method, activities were conducted in therapy;
shopping trip to search for and purchase of ingredients; manipulation of the ingredients, activities in the pizza making group;
preparation of the meal as a group, collective power. The result of the intervention was positive because it showed the difficulties
that remained to autonomy of people with autism, also showed the potential of children for learning aimed at independence in
adulthood. This strategy involved all areas of professional institution, which provided a comprehensive development of the patient.
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
15
36558
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
Associação de Pais e Amigos do Autista, AMA, Litoral, SC
The intervention was carried out in the AMA Coast institution, specializing in autism medical treatment. There were
psychologist multidisciplinary care, educator, physical therapist, occupational therapist, speech therapist, social worker and
therapist musician. The paid-intervention project aimed to show different environments for patients. The specific objectives
were to explore places public leisure, of learning and work; allow interaction with other children; work behaviors on different
places, grant professional spaces to work in their areas outside the private clinical setting. As a method, visits were made to
the beach, sights of the city, zoo, farm school, cinema, restaurants, etc. In these places there were professionals for assistance
within its area, providing opportunities for exploration environments. The result of this intervention was positive, as children
provided an opportunity to socialize and meet other locations. This strategy involved all areas of professional institution, which
provided service in all areas.
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
Centro Catarinense de Reabilitação (CCR), CERII SES/SC
Introduction: In Santa Catarina (Brazil) the Centro Catarinense de Reabilitação (CCR) provides services to Unified Health
System (UHS) users for 40 years. In 2013 it was qualified to Expertise Rehabilitation Centre in physical and intellectual disabilities
(ERC II), following the National Plan of Persons with Disabilities Rights. To structure the care for people with intellectual
disabilities, CCR created the Intellectual Rehabilitation and Autism Spectrum Disorder Service (RIA). The service is consisted
of interprofessional team (neurologist, nursing, occupational therapy, psychology, psychomotor, physical therapy, social worker,
speech therapy) and structured that way: admission evaluation (neurologist and psychologist); interprofessional evaluation
(occupational therapist, physical therapist and speech therapist); individual and group rehabilitation care, guided by the unique
treatment plan; and revaluations. Provides services to 23 Santa Catarina’s cities, at Grande Florianópolis region. In admission
evaluating we see if the patient is indicated for service, ie, if has an intellectual disability (ID) or Autism Spectrum Disorder
(ASD). Objective: This study aims to demonstrate the demand survey evaluated at RIA service, within one year and three
months of operation, with emphasis on ASD’s cases. Results: It was found that, from November 2013 to January 2015, there
were 100 admission evaluations. Of these, 25 people were found to be ineligible to RIA service and 75 joined for rehabilitation.
Of those enrolled, 21 (28%) were diagnosed with ASD and 54 (72%), intellectual disability. Analyzing inflows of people with
ASD, we found 18 children (85.7%), two adults (9.5%) and only a teenager (4.8%). Conclusion: We concluded that in the RIA
service there was a greater demand for cases with DI compared to ASD, among they the majority were children. Indicating the
importance of early diagnosis and intervention.
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Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
37026
Multiprofessional call for students with autism spectrum disorder in Manaus
Maria Gleny Barbosa Soares, Adenilda Teixeira Arruda, Antonia Egley Nascimento da Silva
Secretaria Municipal de Educação
Introduction: The Municipal Education of Manaus disposes of the Special Education Municipal Complex André Vidal de
Araújo that aims to address the students of public schools that have learning difficulties, disabilities and Autism Spectrum
Disorder. Among the various aspects of care we highlight the Multidisciplinary Specialist Education Program (PEMULTI),
which was implemented in 2010 to track students for the last 10 years with Autism Spectrum Disorder (ASD) that did not show
satisfactory progress in the classroom or who have not had a school experience. The group was organized according to the skills
and difficulties in monitoring that took place twice a week with activities integrated into school routine, by a multidisciplinary
team (psychologist, physiotherapist, educational psychologist and pedagogue) and the presence of parents. Objective: To report
the experience of the multidisciplinary team as a mediator in the educational process between the school and the family, raising
new reflections from the creation of “the potential space” for the awakening of new skills facilitators in the learning process.
Method: The activities in group prioritized aspects: social, affective, psychomotor and affective, as well as develop activities
based on Functional Natural Resume to arouse independence in activities of daily and social life (ADLs). The program performs
as assessment procedure for students/parents: multidisciplinary assessment, individual quarterly report, meetings with parents
and teachers and even the inclusion of school space. Results: Research indicates the importance of accompaniment of the
multidisciplinary team as part of the support to students who have difficulties which forbid the progression to learning or even
integrate the school environment. Thus, the work performed on a multidisciplinary way adds new learning to be applied by
students and parents in their daily lives and also the exchange of experiences that are experienced by the group as a significant
unit for its development. Conclusions: The multidisciplinary effort brings a new perspective on educational issues for students
with autism, reverberating in the possibilities that may arise before the group experience and the emerging needs of each
person, to better responsiveness to the educational process as a priority for well-being of the student in their social context.
37030
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
Universidade Federal da Paraíba (UFPB)
Introduction: The discussions that permeate the autism are evolving over the years into a transformer and contingent of
significant coverage. In this context, we glimpse a current dilemma that pervades the autistic individual’s condition in the
early stages of its development, giving way to a wide discussion on the ethical, political, social setting and psychology, it is
the possibility of intervention of these in the short or long term. This proposal is already being applied in several countries
and Brazil presents its first results still lined in a series of difficulties. Based on these assumptions, this study aimed to analyze
the prospects for parents of adolescents and adults with classic autism about the need of institutionalization of these as the
main intervention strategy. In methodological terms, parents, residents in different regions of Brazil, were evaluated through
qualitative questionnaires and the age of their autistic children ranging from 16 to 35 years. Of these, 02 are verbal, non-verbal
and 02 1:0 pm oral language development phase. Results: When parents asked about the need to adopt the practice of the
institutionalization of autistics, were unanimous in stating that this device is one of the most accessible resources today to
ensure a decent future for their children, but must be performed in accordance to a multidisciplinary planning press, above all,
well-being and respect these people. However, still hovers insecurity and a certain feeling of guilt by parents, for they consider
that proposal extremely inconsistent and challenging, specifically in the context of Brazil, where the institutions work, often
based on the old model hospitalocentric. Despite the fears, it is important to point out how these parents are optimistic about
the effectiveness of laws that make possible the availability of therapeutic residential spaces suitable for the care of their autistic
children full and how are sustained by idiosyncrasy of high religiosity. Conclusion: As described, it is clear that Brazil needs
to move towards developing an effective policy, which takes into account the needs of persons with autism, in order to ensure
respect and protection of integrity of these as well as to his family, who needs to be assisted within the context of the treatment
of such individuals. Despite advances in modern achievements, there is still much to be done.
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
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36553
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
Associação de Pais e Amigos dos Excepcionais (APAE), Taquaritinga
The word autism comes from the Greek, meaning himself, as someone retracted to himself or herself, who have no interest in the
outside world. It is not just a simple disability, but a set of variations titled as “Autism Spectrum” and relates to several syndromes,
affecting communication, social interaction, imagination and behavior, usually accompanied by mental retardation in levels ranging
from severe to profound. High-functioning autistic people may accept social interaction but they do not seek it. Low-functioning
autistic people are entirely mute, isolated from social interaction and suffer from impaired motor coordination. Their movements
are poor, slow or delayed in their achievements. Motor coordination difficulties are noticed, such as balance and fine movement
difficulties. Physical education is an area that interacts with the human being in its entirety, so it plays an important role in the
overall development of students, especially those with motor and intellectual, social and emotional disabilities. Physical education
has been one of the main ways to reduce stereotyped behaviors characteristic to this disease. The objective of this study was to
report the importance and the results obtained by the intervention of physical education in a low-functioning autistic student
with mental retardation. Before the intervention, the student showed lack of motor coordination and muscle strength. The lack
of such skills did not allow them to perform simple tasks such as climbing stairs, walking without falling, opening a door, taking
a piece of cutlery to their mouth to feed, they could not manipulate or simply hold light objects, reconcile movements etc. The
student used containment splints due to self-harm. The activities occurred during the period of the first semester, five times a
week. After the period of interventions, the teenager developed capacity to hold and manipulate objects of different shapes, sizes
and weight, combine movements such as walking while carrying objects in their hands, perform the act of opening the door and
eating without help. They developed motor coordination, including the refined one, it the removal of the containment plates was
possible as they no longer self-harmed. Physical education is a great ally in the development process of autistic adolescents, since
it improves the social, emotional and motor coordination skills, contributing to a better quality of life in adulthood.
37038
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 2014
Eliete Chiconelli Faria Buratto, Juliana Harumi Arita, Quirino Cordeiro Junior, Rosane Lowenthal
Santa Casa de Misericórdia de São Paulo
Introduction: There are few data on progress of ASD patients who have required institutionalization or therapeutic residence.
Literature so far shows that the evolution of children with ASD in adulthood is worst in most cases. Often we observe comorbidities
that are associated with more severe cases. Studies show that the separation of the individual with ASD from his family life
brings multiple impacts to the these relatives. Objectives: To characterize the profile of patients whose legal guardian requested
admission to therapeutic residence or other institution to the Secretaria da Saúde do Estado de São Paulo that were evaluated in
the Unidade de Referência em Transtornos do Espectro Autista da Santa Casa de Misericórdia de São Paulo – CAISM, in 2014.
Method: The study included all patients with application for admission to therapeutic residence or institution who were referred
for evaluation in Unidade de Referência em Transtornos do Espectro Autista in 2014. All patients underwent evaluation according
to the Protocolo do Estado de São Paulo de Diagnóstico, Tratamento e Encaminhamento de Pacientes com TEA. The variables
were recorded age, gender, parental age, parents’ marital status, number of responsible caregivers, diagnosis of chronic disease
in the principal sponsor, existence of brother(s), age at diagnosis, school records and early intervention. In addition, presence of
intellectual deficit (ID) and epilepsy, aggressive behavior and difficulties in performing activities of daily living (ADL), presence
of oral language and use of medications. Statistical analysis of frequency and mean used the SPSS 20.0. Results: Eleven patients
were included. All patients were male with living parents, did not receive early intervention, had associated ID and were on
medications. Ages ranged from 12 to 33 years. 90.9% received diagnosis after the age of 24 months and 81.8% have aggressiveness.
None of them attended regular school, 81.8% studied in a special school and 18.2% had never attended school. In 54.5% we
found alteration of ADL, and 54.5% had oral communication. Conclusion: The profile of the patients was homogeneous in
general. This kind of work can help to guide the understanding of the characteristics involved in the bad evolution that many
experience, seeking to establish preventive measures and thus offer a better evolution for these patients.
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Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
36192
Autism spectrum disorders in adulthood: psychosocial context in the Brazilian reality
Fernanda Duarte Rosa, Thelma Simões Matsukura
Universidade Federal de São Carlos (UFSCar)
International studies focused on people with ASD in adulthood indicate the permanence of impairments of language and
social interaction at this stage of life and that these adults tend not present good levels of independence and social inclusion.
In addition, surveys indicate a shortage of specialized services and lack of formal social support for these people and their
families. This study aimed to identify the reality and demands of individuals diagnosed with Autism Spectrum Disorders
and their families. To meet the objectives we conducted 2 studies. The first study aimed to survey of institutions and/or nongovernmental organizations (NGOs) focused on people with ASD in adulthood and their families in Brazilian territory, for
both tools we used online pages. We found 101 institutions and NGOs. Study 2 aimed to identify the reality and demands of
individuals diagnosed with ASD and their families, three instruments were used for data collection, an identification form for
general data of the participating families, a questionnaire to collect data on the course of life of individuals with autism and their
families and WHOQOL – abbreviated. Most of the 67 participants were mothers of people with ASD in adulthood, living in the
State of São Paulo. Data were analyzed using descriptive statistics and using the technique of the Collective Subject Discourse.
Among the key findings is that the majority of autistic adults live with their parents and never received any preparation for
entering the job market or the possibility of housing outside the family. It was found that most adults with autism also attends
educational institutions and more specifically, special schools. Participants reported demands related to institutions dedicated
to people with ASD, the existence of multidisciplinary teams with qualified professionals with comprehensive care and which
were also offered support services to families. Among the major sources of support mentioned by participants were their own
families and institutions, however participants stated that there were institutions that offered appropriate support service to
adults with ASD, as the family and everyday life, participants reported that their lives revolved around care activities related to
the person with ASD, we presented also the positives of having a family member with ASD, challenges, fears and future prospects.
37072
Rainbow game technique: changing of behavior through reorganization of feeding
routine
Viviane da Silva Machado
Núcleo de Estudos e Atendimentos em Psicoterapias Cognitivas (NEAPC)
Autism Spectrum studies report that most children, especially in the first phase of childhood, tend to go through food phases
that vary in style and duration from child to child. In these phases they eat just one kind of food, e.g. of the same consistency
and color. This causes tension in the family and at school, due to being limited to only one type of food, the child refusing to
eat, increasing irritability, excitement and they can develop gastric and vitamin problems. The author often finds these issues
in her practice as an Occupational Therapist. From these contexts, in order to expand cognitive and behavioral resources, as
well as to improve quality of life for people with autism, she developed this technology based on the approach of Cognitive
Behavioral Therapy. Objective: Increasing of food diversity, contingency and frustation management in contrast with the
limitation of everyday food and relative issues, and some organization that favors the child in situations that change his or her
routine. Method: The Rainbow Game Technique (title registered by the author); Stage 1: Feeding behavior investigation: a)
ask the parents information about routine, b) eating habits, c) favorite and rejected foods. Stage 2: elaboration with the child
of a drawing of a rainbow in which at least four colors will be chosen. At the left end of the sheet we will put a picture of the
child and at the right end of the sheet an image of an object that the child wants very much (challenge element/search). Stage 3:
every X days, the child will choose and eat a food of a certain color and after the child goes through all the rainbow colors, he
or she will get the object at the end of the rainbow. The family must use their creativity to vary the foods and their consistency,
and preferably not to change its consistency on the first day. The directions of the activity (proposition, drawing and rules)
are performed during clinical appointment together with the family. This is an important feature, because it aims at a unique
communication among the therapist, family and child. Result: The sequence of this technique shows good results, such as
healthier eating, impulse control of food refusal, less irritability, variety in food choice and greater adherence to the rules of
everyday eating. Conclusion: The author will perform empirical studies through scientific and clinical partnership in order
to expand the data observed by her.
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
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36128
Study of ten autism in age group of seven to ten years: clinical signs frequently and
age diagnostic
Katia Semeghini Caputo
Associação dos Familiares, Pais e Amigos dos Autistas de Bauru (Afapab)
The overall objective of this study was to analyze ten children aged between seven and ten with Autism, through an instrument
Assessment Differential Diagnosis. The study included ten children (8 boys and 2 girls) aged between seven and ten years old,
attended at the Special School of Autistic Prof. Adolpho Menezes de Mello, in the municipality of Bauru-SP. The Differential
Diagnosis Evaluation was administered to parents or guardians. This questionnaire is a session that deals with general information
about the development, also the most common characteristics of three specific areas: Disability in Social interaction; Inability
to Communicate and Imagine; Activities and Interests Limited and Uncommon. The results demonstrated that the inability of
Interaction Social – the most frequent sign was ‘Laughing for no apparent reason’. In the second area – Inability to Commnicate
and Imagine, there were three characteristics cited: ‘Delayed speech after 03 years’, ‘It looks like or acts like deaf ’ and ‘Absence
of make-believe’, and finally the last area – Activities and Interests Limited and Unusual, was the most frequent feature ‘seems to
be afraid of harmless situations”. Additionally, if contacted that the age of diagnosis of children was delayed, occurring between
seven and eight years. Thus, it is concluded that autism is a disorder that has biological marker and wide clinical variability as
observed in the Differential Diagnosis Assessment, so often the diagnosis turns out be late.
36509
Taking care of adolescents and adults with asd: difficulties and concerns of the
parents
Regina Basso Zanon, Simone Steyer Lampert, Cleonice Alves Bosa
Universidade Federal do Rio Grande do Sul (UFRGS)
The Autism Spectrum Disorder (ASD) is characterized by socio communicative development deficits and repetitive behaviors
and restricted interests. Recent studies shows emotional, physical and financial suffering in parents of individuals with ASD,
being reported even higher levels of caregiver stress, especially in mothers. In the case of a chronic disease evolution, it is
recognized that care demands are modified over time according to each individual’s development phase. This study aimed
to investigate the main difficulties and concerns of parents of adolescents and adults with ASD in relation to care. Data were
collected from a survey of 40 parents. The instruments used were the Sociodemographic Questionnaire about the individual
with ASD and their families and the Self Report Questionnaire (SRQ). The average age of participants was 43.9 years (SD = 7.6)
and the age of children diagnosed with ASD was 17.6 years (SD = 79.94). Most participants were mothers (97.5 %, N = 39) and
were living with a partner (52.5%, N = 21). The main difficulties and concerns with regard to the care of son with ASD were
accounted for in accordance with the quantitative content analysis. In total, 8 categories and 16 subcategories were created.
Most parents reported difficulties with regard to the category “Son behaviors” (42.5%, N = 17), followed by “Relations with
Professional/Institutions/Society” (20%; n = 8). On the other hand, the subcategories “Socio communicative Deficits” (15%,
N = 6) and “Extreme dependency care” (15%, N = 6) were the most prevalent. In addition, 17 (42.5%) participants had risk of
mental disorder as a SRQ results. The implications of the results and limitations of the study were discussed.
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Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
36518
The process of building autonomy in a group of pre teen with autistic spectrum
disorder
Adriana Balaguer, Priscila Fernandes, Ana Marta Vieira Ponte
Escola Bahiana de Medicina e Saúde Pública (EBMSP)
This paper presents the therapeutic intervention performed in a group of pre teen with an autistic spectrum disorder during
two years. It was hold in a therapeutic space called Ciranda, in the city of Salvador, Bahia, during 9 hours a week. During
this period the group went through different phases that structured its evolution. In spite of these different phases, including
periods of crises and restructuring, this work has been based upon three basic axes that have made up its evolution. They are
independence favoring on the daily and practical life activities, social abilities and reading/writing. Inside these axes we can
list subthemes that have also been worked daily, like: executive functions, logical math, expressing feelings and others. On this
paper we show the way how the group arrived, how it has been structured and how it is today.
36506
The sensory aspect of adults with autism spectrum disorder under the view of formal
caregivers
Andrea Schäfers Delgado, Maria Inês Rubo de Souza Nobre
Núcleo de Integração Luz do Sol
The symptoms of autism spectrum disorder (ASD) include changes related to the sensory aspect, which may develop a dysfunction
of sensory integration. There are few references regarding adults with ASD, as well as specific material on sensory integration
therapy as a possible intervention for occupational therapy. This study aims to describe the sensory profile of adults with ASD
from the point of view of formal caregivers and it describes their social/demographic profile. This is a descriptive case study
and the subjects involved are formal caregivers of institutionalized adults with ASD. This project was approved by the Ethics
Committee at Unicamp Search under the report number 724568 (22.07.2014) and Conep number 748308 (12.08.2014). The
data collection took place in the residence for adults with disability where an interview with each of the caregivers was made.
After that they were subjected to the protocol Adolescent/Adult Sensory Profile – AASP during the month of August 2014. The
population of seven formal caregivers, with ages between 20-27 years, works in the institution from 1 to 4 years. Most of them
worked previously in manual, autonomous and human resources functions, have between 0 and 2 children and live in Atibaia,
São Paulo. In terms of their educational background there is middle school and high school. Regarding marital status most
of them have wifes. The sensory profile’s results that six of them showed abnormalities of the low registration and only one of
these brought change to “much more than most people”; five of “sensation seeking”, and only one had change to “much less than
most people”; two of “sensory sensitivity”, while only one with change to “much less” and two of “sensation avoiding” avoids
feeling, and none with change to “much more” or “much less”. It is possible to notice that, if there is a change in the sensory
profile of all adults with ASD in this study, this refers to an unusual sensory processing of them. The results are in agreement
with studies relating atypical sensory responses to ASD, even in adulthood. These data indicate the need for intervention of
sensory integration therapy to encourage the proper integration of sensory stimuli and concomitantly the guidance to formal
aspects of caregivers to promote sensory integration of adults with ASD in routine of this residence.
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
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37062
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
Associação Pestalozzi de Arapiraca
In some children with autism oral language is not only late, but often it does not develop. Sometimes this communication
disability affects social and behavioral skills. Children with autism do not see role in communication, and often make use of
inappropriate behaviors such as screaming, tantrums and aggression to express themselves. The initial focus of the intervention
of these children is the use of a functional communication, thereby express themselves and be understood by others. The aim
of this study was to analyze the benefits and changes in the behavior of children with autism through the use of functional
language through selected visual. Six patients with no oral language were included for research, and 3 presented difficulties in
routine changes and follow-up and 3 had difficulty understanding the completion of some episodes and did not finished. Those
with difficulties in routine conversations were held with those responsible for routine structure and the same made of cardboard
with pictures of the patient in his every day. In the group with the patient who had difficulty finishing some activity was carried
out a panel in which the time activity was divided into 4 parts and each end of a part was awarded a star on the panel and at the
end of 4 stars the patient know that the activity is over. It was observed that the 3 patients who had structured routine managed
to better understand their daily lives and their routine through the use of visual cues and did not need often the insistence of
those responsible for the daily activity of implementation. He noted widespread use of the panel to demonstrate activities that
it would like to accomplish at that time thereby improving interaction and communicative intent. The group was conducted
using visual cues for activity completion of understanding provided to all patients greater therapist-patient relationship, joint
attention, improved eye contact and better understanding for simple commands and orders generalizing the pick and place the
star on Panel object requested by family and therapists verbally. In both groups we observed reduced inappropriate behaviors
that occurred as a form of communication. We concluded that the use of functional language with significantly aid in visual
cues and functional expression generalization of skills in subjects with absence of oral language. Helping even the generalization
of other skills and behavior and social interaction.
37075
Working memory in autism spectrum disorder: a literature review
Suelen Bordignon, Renata Giuliani Endres, Simone Steyer Lampert, Clarissa Trentini, Cleonice Alves Bosa
Universidade Federal do Rio Grande do Sul (UFRGS)
People with Autism Spectrum Disorder (ASD) are part of a heterogeneous group with great variability in terms of the severity
of autistic symptoms, cognitive skills, and adaptive functioning. Studies have been conducted to better understand the profile
of these individuals with regard to aspects related to neuropsychological functions, such as memory. This concept has been
characterized as a cognitive domain that is widely responsible for the clinical manifestations of ASD and the more generalized
secondary cognitive deficits that comprise executive dysfunction. Specifically in terms of working memory, impairments among
individuals with autism are more complex. The heterogeneity of samples has led to differences in the findings relevant to working
memory in autism. The aim of this study was to systematically review the literature to investigate the presence or absence of
impairment and mnemonic skills in children and adolescents with ASD. The Banco Virtual da Saúde (BVS) and Web of Science
databases were searched using the following search terms (keywords) between 2003 and 2013: (asd OR asperger OR autism
OR pervasive developmental disorders OR pdd) AND (child* OR adol*) AND memory. The results reported here addressed
the data related to working memory specifically and were drawn from a larger study on memory in people with ASD. Sixteen
studies on working memory in children and adolescents with ASD were selected. Among these, six assessed working memory
as the main component and five assessed visuospatial working memory. Four assessed both of these and two assessed working
memory in everyday activities through parents’ reports. No consensus was reached with regard to the existence of impairment of
this function in this population. Some of the 10 articles that presented measures for the assessment of verbal working memory,
in addition to impaired performance, reported preserved aspects of verbal working memory in the ASD sample. Seven articles
found some impairment in this function in some of the aspects that were assessed and seven mentioned aspects of preserved
verbal working memory in ASD. The findings with regard to working memory in the present review partially oppose some
authors who advocate the notion that memory deficits are present to some extent in several individuals with ASD. Unclear are
the differences that might exist in the extension and severity of memory impairments along the spectrum of autism.
22
Arch Clin Psychiatry. 2015; Suppl. 42(1):3-22
37019
Using videos in the field of autism spectrum disorders: guidelines for treatment and
training models
Victor Amoroso, Luciana Coltri e Silva
Instituto Lucas Amoroso
Introduction: Autism Spectrum Disorder (ASD) is considered a developmental disorder of neurobiological causes and is
defined by clinical criteria that covers areas of social interaction forms, communication and behavior. Its diagnose is mainly
based on the clinical overview of the patient, and there is still no biomarker that characterizes it. Therefore it is important that
professionals get to know the symptoms, the phenotype and the topography of the most common behaviors well. One way to
train professionals to this knowledge is through the use of audiovisual material showing these characteristics, and allowing the
view of better details, which permits a greater description of the studied object. All these factors contribute to the evaluation
of ASD and the definition of treatment strategies and their maintenance. Videos can also be used by the trainees filming their
own performance and getting feedback from experienced professionals. Objective: To describe clinical cases of a behavior
analyst therapist of São Paulo, who works with patients with ASD, demonstrating the applicability of the videos in situations of
training and intervention. Methodology: In order to explain parents’ training, it will be described a case of a 3 year old male
diagnosed with ASD whose parents were trained through videos, with two strategies: first watching videos of other parents
who acted correctly, and secondly filming themselves to have further feedback from the therapist. On the staff training, it will
be described the case of a paid consultant in the city of Mossoró/RN, where the team was first trained with the use of videos
used as a model, and later to continue the case, the staff had their own videos analyzed by the consultant therapist who gave the
respective feedback. About the intervention with the child, it will be described a case of an eight years boy, diagnosed with ASD,
whose team of therapists met periodically with the videos of their sessions to define the next steps of therapy. Data Analysis/
Results: The description of the cases will be compared with the literature on the use of videos in interventions with ASD and
training of professionals. A qualitative analysis will be performed to attempt to demonstrate the applicability of audiovisual
resources in the intervention of ASD patients and training of professionals who work with them.
37068
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
Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP)
Background: Children with Autism Spectrum Disorders (ASD) may be particularly vulnerable to be overweight due to food
selectivity, little physical activity and psychosocial difficulties. Even though there is a vast literature on childhood obesity in
the general population, little is known about this problem in Brazilian children with ASD. The study of nutritional status is a
very important part of nutritional planning and intervention, specifically in the prevention and control of chronic disturbances
associated to obesity as lipid abnormalities and cardiovascular diseases. Objectives: To evaluate the nutritional status of children
and adolescents with ASD at the Unidade de Psiquiatria da Infância e Adolescência/Unifesp. Methods: In a cross-sectional
study we evaluated 37 patients diagnosed with ASD according to International Classification of Diseases (ICD-10) criteria.
Weight and height were assessed according to World Health Organization (WHO) guidelines. For the assessment of nutritional
status, body mass (ZBMI) and height-for-age (ZH) indices were expressed as z-scores using the WHO AnthroPlus statistical
software. Patients were categorized as overweight when the ZBMI was between 1 and 2; obese when ZBMI was > 2; and having
short stature when the ZH was < -2. Results: Patient’s age median was 8 years (3.5-14.5). The frequency of overweight/obesity
was 50%. The mean ZBMI was 1.27 (-1;3.9). Short stature was not observed (ZH: 0.68; -1.84; 2.57). Conclusion: We observed
elevated frequency of overweight/obesity (50%) in children and adolescents with ASD, measured by ZBMI. Our results highlight
the importance of nutritional follow up for ASD children and adolescents.