Appunti di Neuropsichiatria
Uno sguardo al neurosviluppo raggiunto ai 2 anni di età
A look at neurodevelopmental status at 2 years of age
Giulia Segre1, Ilaria Costantino2, Francesca Scarpellini1, Valeria Tessarollo2, Antonio Clavenna1, Maurizio Bonati1
1Laboratorio per la Salute Materno Infantile, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milano
1Unità di Neuropsichiatria Infantile, Ospedale Santi Paolo e Carlo, Milano
Maggio 2022 - pagg. 313 -323 | DOI: 10.53126/MEB41313
Abstract
When a child develops a psychological disorder, even a mild one, early diagnosis is essential to provide a timely and appropriate intervention that can improve the child’s symptoms and development. Early identification can prevent consequences of differing levels, in the short and long term, in the individual, in their family and in society as a whole. Hence the importance of the paediatrician’s point of view and clinical knowhow in identifying potential disorders early, but also of the parents’ views. It is therefore important to actively involve parents in initial diagnosis. In this regard, within the NASCITA Project, a study branch aimed to build a shared, active approach between parents, paediatricians and neuropsychiatrists/psychologists was activated for the 2-year health assessments (well-child visits) phase. Three tests were used: the M-CHAT-R (Modified Checklist for Autism in Toddlers, Revised) to evaluate language, social skills, behaviour, sensory areas; the PSI-SF (Parenting Stress Index - Short Form) to verify the degree of discrepancy perceived by the parent between the child’s requests and their ability to deal with them properly; the DERS (Difficulties in Emotion Regulation Scale) to highlight the difficulties of each parent in recognising, interpreting, and managing their emotions. The tests were given to 380 parents (142 couples, 215 mothers and 23 fathers) by 45 family paediatricians during the well-child visit held at two years of age. In all, 33 children (9%) resulted at risk, with a score of ≥ 3, 1 of whom was found to be at high risk. For 64 children (16.8%) at least one of the parents tested positive for PSI-SF and for 19 (5%) children at least one parent tested positive with the DERS. After combining the results obtained from the three tests and the clinical evaluation and by assessing the child’s condition with respect to those results, the paediatrician can provide the parents with a concise description of what emerged and the specialist with a summarised report. Such an effort leads to timely, shared communication within the parent-paediatrician-neuropsychiatrist triad that includes specificity of intervention and that can contribute to the effectiveness of the response.
Riassunto
Alla comparsa di un disturbo psicologico nel bambino, anche lieve, una diagnosi precoce è fondamentale per dar seguito ad un intervento tempestivo e appropriato finalizzato ad un miglioramento sia del quadro sintomatologico che dello sviluppo del bambino. Un’identificazione precoce consente di prevenire le conseguenze di varia entità, a breve e lungo termine, sia sull’individuo che sulla famiglia e sull’intera società. Da qui l’importanza dell’”occhio” e della pratica clinica del pediatra nell’individuare precocemente potenziali disturbi, ma anche quello dei genitori. È quindi importante coinvolgere attivamente i genitori sin dalla fase della diagnosi. A tale proposito, nell’ambito dell’albero-progetto NASCITA è stato attivato un ramo mirato a costruire un approccio condiviso e attivo tra genitori, pediatri e neuropsichiatri/psicologi in occasione dei bilanci di salute dei due anni d’età. Sono stati utilizzati tre test: l’M-CHAT-R (Modified Checklist for Autism in Toddlers, Revised) per valutare il linguaggio, le competenze sociali, il comportamento, l’area sensoriale; il PSI-SF (Parenting Stress Index –Short Form) per verificare il grado di discrepanza percepita dal genitore tra le richieste del figlio e le proprie capacità di farvi fronte adeguatamente; la DERS (Difficulties in Emotion Regulatory Scale) per evidenziare difficoltà di ciascun genitore nel riconoscere, interpretare e regolare le proprie emozioni. I test sono stati sottoposti a 380 genitori (142 coppie, 215 madri e 23 padri) da parte di 45 pediatri di famiglia in occasione della visita per il bilancio di salute ai due anni d’età. 33 bambini (9%) sono risultati a rischio riportando un punteggio ≥3 e 1 di questi è risultato essere ad elevato rischio. Per 64 bambini (16,8%) almeno uno dei genitori è risultato positivo al PSI-SF e per 19 (5%) bambini per quanto concerne i risultati positivi della compilazione della DERS. Combinando i risultati ottenuti dai tre test e la valutazione clinica, accertatosi delle condizioni del bambino rispetto ai risultati emersi, il pediatra può restituire ai genitori una sintetica descrizione di quanto emerso e sintetizzare una relazione strutturata per lo specialista. Una comunicazione condivisa all’interno della triade genitore-pediatra-neuropsichiatra in termini di tempestività e specificità di intervento che può contribuire anche all’efficacia della risposta.
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Corrispondenza: maurizio.bonati@marionegri.it