Manejo comportamental e estimulação de funções executivas em crianças com sinais de desatenção e hiperatividade baseados no Modelo de Resposta à Intervenção (RTI)

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is among the most common neurodevelopmental disorders in school-age children. It is most easily identified after starting school due to increased academic and social demands. Factors, external to children, such as aversive school environment, poor teacher didactics, family problems, among others, may cause inattention and hyperactivity behaviors. Given the large number of challenges involving children's learning and well-being, this work aimed to propose and apply an intervention model with behavioral management and stimulation of executive functions in children with signs of inattention and hyperactivity, based on the Response to Intervention Model (RTI). The most common RTI model, originally used for Learning Disorder, is the 3 tiers model, ranging from the whole group (Level I) to individual (Level III) intervention. In this work only the first 2 tiers were performed. Level I was a screening of 116 children from the second year of the Elementary school, to detect those at risk for ADHD, followed by a classroom behavior management intervention and reassessment, and Level II was an intervention in EF and self-regulation, for the 22 children who did not show any improvement after the Level I intervention. The instruments used in the assessment were Questionnaire Based on DSM-5, Inventory of Difficulties in Executive Functions, Regulation and Aversion to Delay (IFERA-I) and Brief Problem Monitor - BPM-P and BPM-T. At Level II, a Guided Observation Instrument was used to observe the behavior of each child in each of the 12 intervention sessions of this level. There were no statistically significant results at Level I, which may be associated with teachers' difficulties in applying the behavior management intervention. At Level II, there was a significant trend of improvement in children. Qualitative data, obtained through the Guided Observation Instrument, after the performance of the Level II activities, showed an improvement in the behavior of 53% of children, compared to 47% that showed a worsening in the number of appropriate behaviors or had no changes. Conclusion: The RTI is a screening and early intervention model that can be adapted to different disorders and enables an early identification of children at risk. However, solid professional training is required for its use, as well as mastery in assessment tools and systematic interventions to ensure their correct application. It is also important to correctly identify children at risk for the disorder and to be able to solve the problem through early intervention to prevent the problem from worsening and compromising their educational path and well-being.