Proposição de uma metodologia para avaliação padronizada da atenção

Abstract

Ability tests are fundamental tools for cognitive assessment. Its application allows collection and analysis of essential data for both clinical practice and scientific research. Among the various abilities measured through tests, attention is presented as a basic skill. Attention is a complex and multidimensional phenomenon that allows the effective interaction of the individual with his/her environment, subsidizing the organization of mental processes. Although the field of standardized evaluation had greatly evolved regarding the testing of attention, it is still possible to observe a lack of appropriate instruments for the evaluation of populations with special needs, especially in relation to the difficulties of command, such as people with intellectual disability (ID) or autism spectrum disorder (ASD). On the other hand, Music Therapy has developed attentional rehabilitation techniques that use music as a mediating element, in order to foment responses in people with command difficulties. Such resources could be transferred to a standardized assessment methodology that applies music as a tool for communicating commands, facilitating the engagement and cooperation of test takers, and offering a stimulus variability capable of mobilizing groups with heterogeneous levels of cognitive, motor and language functions. In this way, the present work proposes the elaboration of a methodology that uses music as stimulus in standardized evaluations, constructing a test of attention applicable to people with ID and / or ASD. The first study of this Thesis presents a systematic review of attention testing in people with ID or TEA in order in order to identify: (1) if there are any tests that are fit to assess these populations; (2) which adaptations would be necessary for such tests to become fit; and (3) what limits and needs are involved. The main strategies employed for the comprehension of tasks, to communicate instructions, to assure engagement during the procedure, and ways to emit answers are discussed. The second study of the Thesis presents a review in the areas of cognitive musicology, neuroscience and music therapy in the field of music and attention. The text is divided into three sections that group a review of related studies: (a) Theoretical foundations of attention and music; (b) Neuroscientific evidence on attention and music; (c) Therapeutic applications of music in attention. Studies of cognitive musicology show that perceptual groupings and expectations are determining factors for the recruitment of the various dimensions of attention. Neuroimaging exams, neuropsychological tests and studies on rhythmic synchronicity add neuroscientific evidence about the strong relationship between music and attention. The evidence reported in this study demonstrates that music can be used in a therapeutic context with beneficial effects for people with impaired attention or as a resource to distract attention from painful sensations or stressful situations. Finally, the third study of the Thesis describes a proposal to apply the knowledge acquired in previous studies to develop strategies that can be employed in a standardized assessment of attention methodology and featuring the Musical Test of Focused Attention (TMAF). The TMAF is a test that uses music stimulation to assess focused attention in children aged 4 to 18 years. Specially formulated to meet the needs of people with severe command and / or response difficulty, it comprises five interactive tasks that employ singing and manipulating musical instruments. TMAF content validity studies are also presented from two stages: a) theoretical analysis of tasks; (b) semantic analysis of tasks. The theoretical analysis was performed by 6 expert judges who evaluated the feasibility of the tasks and the validity content of the test. The semantic analysis was performed by interviewing 10 mothers of children and adolescents with neurodevelopmental disorders. This Thesis expect that the actions proposed could favor the application of music as a resource for the assessment of people with ID or ASD, contributing with clinical practice and evidence-based research with such populations.