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).
- Effects of Maternal Psychopathology and Education Level on Neurocognitive Development in Infants of Adolescent Mothers Living in Poverty in Brazil(2019) SHEPHARD, Elizabeth; FATORI, Daniel; MAURO, Larissa Rezende; V, Mauro de Medeiros Filho; HOEXTER, Marcelo Q.; CHIESA, Anna M.; FRACOLLI, Lislaine A.; BRENTANI, Helena; FERRARO, Alexandre A.; III, Charles A. Nelson; MIGUEL, Euripedes C.; V, Guilherme PolanczykBACKGROUND: Adolescent motherhood remains common in developing countries and is associated with risk factors that adversely impact infant neurodevelopment, including poverty, low maternal education, and increased maternal psychopathology. Yet, no published work has assessed how these factors affect early brain development in developing countries. METHODS: This pilot study examined effects of maternal psychopathology and education on early neurocognitive development in a sample of adolescent mothers (N = 50, final n = 31) and their infants living in poverty in Sao Paulo, Brazil. Maternal symptoms of anxiety, depression, and attention-deficit/hyperactivity disorder and education level were assessed during pregnancy. Infant neurocognitive development was assessed at 6 months of age, with oscillatory power and functional connectivity in the theta (4-6 Hz), alpha (6-9 Hz), and gamma (30-50 Hz) frequencies derived from resting-state electroencephalography; temperament (negative affect, attention, and regulation); and cognitive, language, and motor skills. Cluster-based permutation testing and graph-theoretical methods were used to identify alterations in oscillatory power and connectivity that were associated with maternal psychopathology and education. Correlations between power and connectivity alterations were examined in relation to infants' overt cognitive behavioral abilities. RESULTS: Increased maternal anxiety and lower maternal education were associated with weaker oscillatory connectivity in alpha-range networks. Infants with the weakest connectivity in the alpha network associated with maternal anxiety also showed the lowest cognitive ability. Greater maternal anxiety and attention-deficit/hyperactivity disorder were associated with increased absolute and relative theta power. CONCLUSIONS: Our findings highlight the importance of addressing maternal psychopathology and improving education in poor adolescent mothers to prevent negative effects on infant neurodevelopment.
- 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.
- ADHD and autism symptoms in youth: a network analysis(2022) FARHAT, Luis C.; BRENTANI, Helena; TOLEDO, Victor Hugo Calegari de; SHEPHARD, Elizabeth; MATTOS, Paulo; BARON-COHEN, Simon; THAPAR, Anita; CASELLA, Erasmo; POLANCZYK, Guilherme V.Background Previous research investigating the overlap between attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (henceforth, autism) symptoms in population samples have relied on latent variable modeling in which averaged scores representing dimensions were derived from observed symptoms. There are no studies evaluating how ADHD and autism symptoms interact at the level of individual symptom items. Methods We aimed to address this gap by performing a network analysis on data from a school survey of children aged 6-17 years old (N = 7,405). ADHD and autism symptoms were measured via parent-report on the Swanson, Nolan, Pelham-IV questionnaire and the Childhood Autism Spectrum test, respectively. Results A relatively low interconnectivity between ADHD and autism symptoms was found with only 10.06% of possible connections (edges) between one ADHD and one autism symptoms different than zero. Associations between ADHD and autism symptoms were significantly weaker than those between two symptoms pertaining to the same construct. Select ADHD symptoms, particularly those presenting in social contexts (e.g. 'talks excessively', 'does not wait turn'), showed moderate-to-strong associations with autism symptoms, but some were considered redundant to autism symptoms. Conclusions The present findings indicate that individual ADHD and autism symptoms are largely segregated in accordance with diagnostic boundaries corresponding to these conditions in children and adolescents from the community. These findings could improve our clinical conceptualization of ADHD and autism and guide advancements in diagnosis and treatment.