ELIZABETH SHEPHARD
Projetos de Pesquisa
Unidades Organizacionais
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents(2021) FATORI, Daniel; ZUCCOLO, Pedro Fonseca; SHEPHARD, Elizabeth; BRENTANI, Helena; MATIJASEVICH, Alicia; FERRARO, Alexandre Archanjo; FRACOLLI, Lislaine Aparecida; CHIESA, Anna Maria; LECKMAN, James; MIGUEL, Euripedes Constantino; POLANCZYK, Guilherme V.To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life. We conducted a randomized controlled trial to test the efficacy of Primeiros Lacos, a nurse HVP for adolescent mothers living in a poor urban area of SAo Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Lacos (intervention group, n=40) or healthcare as usual (control group, n=40). Primeiros Lacos is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child's age of 24 months. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and 3, 6, 12, and 24 months of child's age. We assessed oscillatory power in the mid-range alpha frequency via electroencephalography when the children were aged 6 months. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment. Generalized estimating equation models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen's d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818. Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient=0.89, 95% CI [0.18, 1.61], p=0.014), maternal emotional/verbal responsivity (coefficient=0.97, 95% CI [0.37, 1.58], p=0.002), and opportunities for variety in daily stimulation (coefficient=0.37, 95% CI [0.09, 0.66], p=0.009). Standardized effect sizes of the intervention were small to moderate. Primeiros Lacos is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers. However, considering the limitations of our study, future studies should be conducted to assess Primeiros Lacos potential to benefit this population.Clinical Trial Registration: The study was registered at clinicaltrial.gov (Registration date: 21/06/2016 and Registration number: NCT02807818).
- Promoting mother-infant relationships and underlying neural correlates: Results from a randomized controlled trial of a home-visiting program for adolescent mothers in Brazil(2021) ALARCAO, Fernanda Speggiorin Pereira; SHEPHARD, Elizabeth; FATORI, Daniel; AMAVEL, Renata; CHIESA, Anna; FRACOLLI, Lislaine; MATIJASEVICH, Alicia; BRENTANI, Helena; NELSON, Charles A.; LECKMAN, James; MIGUEL, Euripedes Constantino; V, Guilherme PolanczykPoverty and teenage pregnancy are common in low-and-middle-income countries and can impede the development of healthy parent-child relationships. This study aimed to test whether a home-visiting intervention could improve early attachment relationships between adolescent mothers and their infants living in poverty in Brazil. Analyses were conducted on secondary outcomes from a randomized controlled trial (NCT0280718) testing the efficacy of a home-visiting program, Primeiros Lacos, on adolescent mothers' health and parenting skills and their infants' development. Pregnant youth were randomized to intervention (n = 40) or care-as-usual (CAU, n = 40) from the first trimester of pregnancy until infants were aged 24 months. Mother-infant attachment was coded during a mother-infant interaction when the infants were aged 12 months. Electrophysiological correlates of social processing (mean amplitude of the Nc component) were measured while infants viewed facial images of the mother and a stranger at age 6 months. Infants in the intervention group were more securely attached and more involved with their mothers than those receiving CAU at 12 months. Smaller Nc amplitudes to the mother's face at 6 months were associated with better social behavior at 12 months. Our findings indicate that the Primeiros Lacos Program is effective in enhancing the development of mother-infant attachment.
- Social communication therapy for children at risk for neurodevelopmental difficulties: Protocol for a clinical trial(2022) GODOY, Priscilla B. G.; SHEPHARD, Elizabeth; ARGEU, Adriana; SILVEIRA, Leticia R.; SALOMONE, Erica; ALDRED, Catherine; GREEN, Jonathan; V, Guilherme Polanczyk; MATIJASEVICH, AliciaExposure to adverse environments are risk factors for neurodevelopmental problems in childhood. Children exposed to such environments may benefit from interventions that target social communication abilities, since these are protective factors for healthy neurodevelopment. This randomized controlled trial will test the efficacy of Paediatric Autism Communication Therapy (PACT) in improving social communication development in young children at risk for neurodevelopmental difficulties living in poverty in Brazil. Participants will be 160 children aged 2-4 years with lower-than-average social communication abilities and their primary caregivers. Child-caregiver dyads will be recruited from public childhood education centers in impoverished urban regions of the city of Sao Paulo, Brazil. Lower-than-average social communication abilities will be defined by standard scores (<= 84) on the socialization and/or communication domains of the Vineland Adaptive Behavior Scales. Child-caregiver dyads will be randomized to receive 12 sessions of the PACT intervention (n = 80) or 5 months of community support as usual plus psychoeducation (n = 80). The primary outcome (parent-child interaction) and secondary outcomes (parent-reported social communication abilities and neurophysiological activity during a live social interaction) will be measured pre- and postintervention. This study may lead to new interventions for vulnerable young children in Brazil and better understanding of the neural mechanisms of PACT.
- Inattention symptoms in early pregnancy predict parenting skills and infant maltreatment during the first year of life(2022) OLIVEIRA, Jordana Verano de; FATORI, Daniel; SHEPHARD, Elizabeth; NETO, Mauro Xavier; MATIJASEVICH, Alicia; FERRARO, Alexandre Archanjo; ROHDE, Luis Augusto; CHIESA, Anna Maria; MIGUEL, Euripedes Constantino; POLANCZYK, Guilherme V.Objective: Maternal attention-deficit/hyperactivity disorder has not been investigated in relation to parent-ing skills in adolescent mothers. This study investigated whether maternal inattention and hyperactivity/ impulsivity symptoms early in pregnancy predict poorer parenting skills and infant maltreatment during the first year of life in adolescent mothers living in adverse environmental conditions.Methods: The participants in this study were 80 adolescent mothers aged 14-19 years and their babies who were taking part in a randomized controlled trial on the effects of a home-visiting program on infant development. Symptoms of maternal attention-deficit/hyperactivity disorder were assessed in the first trimester of pregnancy. Parenting skills (maternal competence, attachment to the baby, home environment) and child maltreatment were assessed when the infants were aged 6 and 12 months. Multilevel linear regression models were constructed to test the extent to which prenatal maternal inattention and hyperactivity/impulsivity symptoms predicted these parenting variables during the first year of the infant's life.Results: Prenatal inattention symptoms significantly predicted lower maternal competence and attachment, a poorer home environment, and greater maltreatment during the first year of life. Hyperactivity did not significantly predict parenting skills or maltreatment.Conclusions: Our findings suggest that inattention symptoms may interfere with parenting abilities in adolescent mothers and should be considered in early intervention programs.