Aplicação da classificação internacional de funcionalidade, incapacidade e saúde na prática fonoaudiológica

Abstract

Purpose: To examine the association between speech-language pathology diagnosis, functionality, and sociodemographic factors in children with language disorders or speech sound disorders. Methods: This was an analytical observational study with a cross-sectional design, conducted with children aged 1 year and 6 months to 6 years and 11 months, presenting with complaints or diagnoses of language and/or speech disorders. The sample was non-probabilistic. The tools used included the Child Language Test (ABFW), the Language Development Assessment (ADL 2), the Childhood Apraxia of Speech Checklist, the Brazilian Economic Classification Criteria (CCEB), and the International Classification of Functioning (ICF). Evaluations were conducted in two 50-minute sessions. Data analysis was carried out using descriptive statistics, bivariate analysis, and multiple linear regression with R language, which also included structural equation modeling. Results: The sample consisted of 100 children, 64% of whom were male, with a mean age of 47 months. Diagnoses of speech-language pathology revealed that 42% had language disorders associated with other conditions, 34% had speech sound disorders, 13% had language delay, 8% had no diagnosis, and 3% had language development disorders. Bivariate analysis revealed significant associations between language variables and the Apraxia Checklist. The final regression model explained 20.6% of the variance in the results, with comprehensive language being associated with better motor performance (p = 0.028) and expressive language showing a negative effect (p < 0.001). In the second manuscript, analysis of the CCEB_PON score by gender showed that among the 36 female children, the mean score was 31.3 (± 10.08) with a median of 31.0. Among the 64 male children, the mean was 33.7 (± 9.53) with a median of 31.5. Factor loadings were evaluated to determine the contribution of each variable to its respective factor. Internal consistency of the factors was assessed using Cronbach's alpha (⍺), with values above 0.70 indicating good consistency. For the Body Functions (FC) factor, Cronbach's alpha was 0.877, with most factor loadings considered adequate, ranging from 0.316 (Alternative Vocalization Functions, b340) to 0.992 (Temperament and Personality Functions, b126). For the Activities and Participation (AP) factor, Cronbach's alpha was 0.922, with factor loadings ranging from 0.351 (Eating, d550) to 0.988 (Informal Social Relationships, d750). While both factors demonstrated satisfactory internal consistency, some items had factor loadings below the expected threshold. However, when the hierarchical ICF model was tested to predict the behavior of the latent variables of FC and AP, the model failed to converge, possibly due to the high number of estimated parameters. Conclusion: This study demonstrates the potential of the International Classification of Functioning, Disability, and Health (ICF) to model the Body Functions (FC) and Activities and Participation (AP) dimensions in children. However, its viability depends on larger samples and adjustments to factor items. The results highlight the need to refine the model to ensure greater representativeness of items with lower factor loadings. Furthermore, the study underscores the influence of socioeconomic context on the performance of children with childhood apraxia of speech, with lower socioeconomic status being associated with poorer outcomes. Linguistic variables also play a significant role, with language comprehension positively correlated with motor performance and expressive language negatively affecting performance. These findings emphasize the importance of therapeutic approaches that integrate both socioeconomic and linguistic factors in the management of speech-language pathology interventions.