Autism in Brazil

Priscila B. Borges
Priscila B Borges
Some statistics
USA (Zablotsky et al., 2015):
● Prevalence: 222/10 000
○ Finland: 54/10 000
(Hinkka-Yli-Salomäki et al.,
2014)
● Male-female ratio: 4:1
● Median age of diagnosis: 3.7
years
Brazil - southern region (Beck, 2017):
● Prevalence: 3.85/10 000
○ National census 2010:
27/10 000
● Male-female ratio: 2:1
● Median age of diagnosis: 4 years
Legislation

● Bill 12.764 - “National Policy of Protection of the Rights of Persons with

ASD” (Brasil, 2012)
○ Grants people with ASD the same rights as people with disabilities.
■ Financial assistance, rights to education, work, transportation,
home assistance.
● Adheres to the UN Convention on the Rights of Persons with Disabilities
Mental health care in Brazil

● Municipal jurisdiction
● CAPS - Psychosocial Health Center
○ 1987; nurses and psychologists, but no physicians
● CAPSi - Psychosocial Health Center for children and young adults
○ 2001, may include neurologist/pediatrician
● NGOs
○ Since 1983
● Centros de atendimento especializados - specialized health centers for
ASD
○ Future
Some ASD support organizations:

● Associação de Amigos dos Autistas (AMAs)

○ NGO since 1983 - specific; free
● Associação de Pais e Amigos de Excepcionais (APAE)
○ 1954 - general intelectual disabilities; free
● Associação Brasileira de Autismo (ABRA)
○ 1988 - representative entity for public policies
● Fundação Mundo Azul
○ 2013 - family group
Two official guidelines:

● "Diretrizes de Atenção à Reabilitação da Pessoa com Transtorno do

Espectro Autista (TEA)" (Brasil, 2014)
○ “Disability”, “neurodiversity” - focus on rehabilitation
● Linha de Cuidado para a Atenção às Pessoas com Transtornos do
Espectro do Autismo e suas Famílias na Rede de Atenção Psicossocial do
Sistema Único de Saúde" (BR ASIL, 2015)
○ “Mental illness” - psychodynamic approach - CAPSi
○ More public participation and representativeness in its elaboration
○ More comprehensive
Diagnosis (Brasil, 2014)

● Observation of child’s behavior and interview with the caregivers

● Standardized assessment tools
○ Detect warning signs; not for diagnosis
○ Irdi and M-Chat
● Check if symptoms allow classification according to International
Classification of Diseases (ICD-11), considering differential diagnoses
Indicadores Clínicos de Risco para o
Desenvolvimento Infantil (Irdi) (Lerner, 2011)

● Brazilian instrument that can be applied by any health professional

● 31 indicators of child’s development and bonding quality with caregivers
● Caregiver answers the questions
● 0-18-month infants
● Risk in development: absence of characteristics described in the items
● Free and widespread use in the public health system
Lerner, 2011
Modified Checklist for Autism in Toddlers
(M-Chat) (Losapio & Pondé, 2008)

● Only free instrument that has been adapted and validated for use in Brazil
● Questionnaire with 23 items
● 16 to 30-month old children
● Applied by any health professional
● Yes or no answers that point to the presence of early signs of ASD
Losapio & Pondé, 2008
Treatment (Brasil, 2014, 2015)

● Multidisciplinary team: psychiatrist, neurologist, psychologist and

phonoaudiologist
● Singular Therapeutic Project (PTS)
○ Specific to each individual and family’s situation
● School/work adaptations
● Pharmacological intervention when needed

Continue ->
Treatment (Brasil, 2015)

● Psychoanalysis
○ Goal: through transference open the child to the world, favoring
socialization and self-expression.
● Applied Behavioral Analysis
○ Learn and practice specific skills and then generalize them.
● Supplementary and Alternative Communication
○ Gestures, symbols and figures.
● Sensory integration
○ Decrease “aggressive” behavior, improve attention, motor planning,
etc.
Autism in Brazil: a systematic review of family
challenges and coping strategies (Gomes et al., 2014)

Most common sources of familial ASD-related stress in Brazilian population:

● Symptoms of the disorder, especially problems with communication

● Deficient access to health care and social support
● Scarce social and leisure activities
● Financial situation - higher workload for parents
● Concerns about the future of the child - esp. financial
ASD treatment at CAPSi in Caxias, Maranhão.
References

Beck, R. G. (2017). Estimativa do número de casos de transtorno do espectro autista no sul do Brasil. Pós-Graduação em Ciência da Saúde.

BRASIL. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. (2015). Linha de Cuidado para a Atenção
às Pessoas com Transtornos do Espectro do Autismo e suas Famílias na Rede de Atenção Psicossocial do Sistema Único de Saúde.

BRASIL. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. (2014). Diretrizes de Atenção à
Reabilitação da Pessoa com Transtorno do Espectro Autista (TEA).

Couto, M. C. V., & Lima, R. C. (2017). 707 Políticas para o autismo no Brasil: entre. Physis Revista de Saúde Coletiva, 27(3), 707-726.

Hinkka-Yli-Salomäki, S., Banerjee, P. N., Gissler, M., Lampi, K. M., Vanhala, R., Brown, A. S., & Sourander, A. (2014). The incidence of diagnosed autism
spectrum disorders in Finland. Nordic journal of psychiatry, 68(7), 472-480.

Lerner, R. (2011). Indicadores clínicos de risco para o desenvolvimento infantil-IRDI: verificação da capacidade discriminativa entre autismo, retardo mental
e normalidade.

Losapio, M. F., & Pondé, M. P. (2008). Tradução para o português da escala M-CHAT para rastreamento precoce de autismo. Rev Psiquiatr Rio Gd Sul, 30(3),
221-9.

Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., & Blumberg, S. J. (2015). Estimated prevalence of autism and other developmental disabilities
following questionnaire changes in the 2014 National Health Interview Survey.
Thank you!

Obrigada!