Desenvolvimento de escolares com diagnóstico de atraso do desenvolvimento neuropsicomotor

Abstract

Neuropsychomotor developmental (NPMD) delay is a term frequently used in the area of child health, being used often, both in Brazil and abroad, as a final diagnosis. One problem, however, is that this term does not define the true picture of the situation of the child, not fulfilling the role of diagnosis. Literature review on the topic revealed that, besides the contradictions associated with the term, there are few studies on the natural history of the delay. The frequent use, and the conceptual confusion related to the use of the delay term NPMD and to contribute to Brazilian data on the development and outcome of these children, the general aim of this thesis was to seek information through literature search on the term delay NPMD aiming to recover its conceptual origin and evolution over time and to determine the outcome of development in school age children who were diagnosed with delay at the Associação de Assistência à Criança Deficiente of the city of Uberlândia, Minas Gerais. To achieve the objective, 45 children aged seven to eight years old, diagnosed with NPMD delay, were evaluated using the instruments Wechsler Intelligence Scale for Children - WISCIII, Swanson, Nolan and Pelham - IV - SNAP - IV, Pediatric Evaluation of Disability Inventory - PEDI, Movement Assessment Battery for Children - MABC -2, Resources from family environment (Recursos do Ambiente Familiar) - RAF, School Function Assessment - SFA, and teachers information about the child's school performance were collected. In addition, typically developing children, matched by sex, age and family income were recruited for purposes of comparing the motor development outcome (MABC - 2), school participation (SFA), academic performance (teacher´s information) and the quality of family environment (RAF). ANOVA and Binomial tests for two proportions were used to examine whether there were significant differences in the investigated variables between children with and without a history of delayed NPMD and, among the children with a history of delayed NPMD, between those with and without "not normal" diagnosis received as outcome at school age. Logistic regression analysis was performed to predict the likelihood of the child having the "not normal" diagnosis. For all analyzes, significance level was set at 0.05. It was found that school age children diagnosed with delayed NPMD have persistent motor limitations and functional difficulties. In addition, these children had more motor problems, lower school participation and lower academic achievement compared to children without delay. Biological factors seem to be more decisive to the outcome of the children with NPMD delay evaluated, as evidences of the influence of economic and environmental resources in promoting the development were not found. A variety of possible outcomes for children with delay were found, either normal or not normal, and the mother´s age at birth (p=0.03, OR=1.47 and CI=1.04-2.09), motor performance - equilibrium (p=0.04, OR=1.33 and CI=1.01-1.75 ) and the need for support in cognitive and behavioral tasks in the academic context (p =0.048, OR=1.08 and CI=1.00-1.17) were shown to be useful to signal not normal outcome among children diagnosed with NPMD delay. The results of this research suggest that it is possible to make specific diagnosis in children with NPMD delay and the use of interdisciplinary assessment of multiple domains of the development, with the participation of parents, contributes both to define the specific diagnosis and to identify the need for specialized support. It should be emphasized that, since the term NPMD delay works only as a temporary diagnosis, developmental follow up is a strategy that can help professionals and parents to understand what is happening and give support to the child, until the definition of a final diagnosis.