A Perturbação do Espetro do Autismo na Primeira Infância: O Modelo do Centro de Estudos do Bebé e da Criança de Avaliação Diagnóstica e Intervenção Terapêutica

Abstract

Introduction: The Centro de Estudos do Bebé e da Criança in Hospital Dona Estefânia has organized a multidisciplinary model for children under three with suspected autism spectrum disorder, thus implementing the recent guidelines established by the Directorate General for Health. The aim of this study is to describe this model and case series.Material and Methods: A retrospective descriptive study of observed children with suspected ASD. They were observed according to the model of the Centro de Estudos do Bebé e da Criança and DC:0-5TM classification, between January 2018 and September 2019.Results: The study included 178 children. The average age at the initial assessment was 27 months. From the total sample, 116 children concluded the diagnostic sessions (axis I): Autism Spectrum Disorder/Early Atypical (36%), Developmental Language Disorder (18%), Other (19%). Factors of axes II, III, IV and V of DC:0-5TM were determinant for clinical diagnosis in 26%.Discussion: Of 116 children, 36% were diagnosed with Autism Spectrum Disorder. This highlights the diagnostic challenge posed by neurodevelopmental disorders in early infancy. The sample shows that the characteristics of the relationship with the caregiver (axis II), presence of physical conditions (axis III), psycho-social stressors (axis IV) and developmental trajectory (axis V) have a significant clinical impact. In the future, the initial assessment should take place well before the age of 27 months because of the impact on prognosis.Conclusion: This model is a pioneering approach in Portugal. It promotes a common approach of Child and Adolescent Psychiatry and Neuropediatrics/Developmental Pediatrics in early infancy. Moreover, it increases the diagnostic acuity of Autism Spectrum Disorders and early therapeutic intervention.

Raising Awareness about Adult Autism Spectrum Disorder

“…There is no maximum validity foreseen for vaccination certificates. 1 What is the evidence behind this decision? Previously infected individuals have very low risk for reinfection at least six to eight months after the primary infection, as observed both in healthcare workers (HCW) and in the general population.…”

“…Dear Editor, Martins Halpern et al 1 presented the experience of their specialized center while highlighting the challenges of diagnosing and treating autism spectrum disorders in early infancy. However, problems in the approach of these and other neurodevelopmental disorders are not limited to the early stages of life.…”

“…3 Overall, available national clinical recommendations provide general advice suggesting the assessment of adults presenting with inadequate social interaction, cognitive and behavioural rigidity, restricted interests and previous medi-cal history of neurodevelopmental disorders. 1,5 Although it is useful, the translation of these general principles in everyday clinical practice is not as straightforward as it may seem. Challenges include the clinical heterogeneity of ASD, ranging from complex genetic conditions with learning disability to high functioning individuals who adapted and developed strategies to overcome autistic deficits.…”

Seguimento de Doentes com Carcinoma Diferenciado da Tiróide nos Cuidados de Saúde Primário: Estamos a Postos?

“…Ana Catarina OLIVEIRA 1 , Patrícia FINO 2 , Vera FERNANDES 3 , Ana Margarida MONTEIRO Como é descrito pelos autores do artigo, a maioria das referenciações para consulta hospitalar especializada são feitas através dos cuidados de saúde primários que, ao identificarem crianças com suspeita de perturbação do espetro do autismo (PEA), permitem um diagnóstico e inter-venção terapêutica precoces, o que terá um impacto considerável no prognóstico e evolução da PEA. 1 O diagnóstico desta perturbação é clínico, 1,2 pelo que a proximidade entre médico de família e utente é crucial na identificação de sinais de alarme.…”

“…O número de sobreviventes de CDT tem vindo a crescer, em resultado do aumento da incidência da doença, elevada taxa de sobrevivência a cinco anos, e idade jovem ao diagnóstico. 1 Em Portugal, os dados do Registo Oncológico Regional do Norte confirmam-no: o número de novos casos de cancro da tiróide foi de 696 e 753, em 2013 e 2018 respetivamente, com 992 previstos para 2020. 2 Em dezembro de 2020, encontravam-se codificados com 'Neoplasia Maligna da Tiróide' 14 610 utentes no Norte e 32 510 no país.…”