Desenvolvimento neuropsicomotor, linguagem e a qualidade do ambiente ecológico de crianças do município de Belém: Uma compreensão bioecológica

Abstract

The central aim of this doctoral thesis is to analyze the relationship between ecological quality of environment and the neuropsychomotor development and language of children enrolled in elementary school in Belém, based on bioecological theory. Two studies with similar methods were elaborated. The first study analyzed the relationship between the environment’s quality (family, school and neighborhood) and the neuropsychomotor development (NPMD) of children enrolled in elementary school in Belém. The study design is longitudinal, descriptive, correlational and quantitative. The elementary school involved in this study is located in the Batista Campos, Administrative District of Belém (DABEL), central region. 70 children participated in this study. To evaluate the NPMD, the Denver II was used in three times. The personal and contextual data were collected by the Child Characterization Questionnaire. The family environment quality was measured by the Home Environment Resources Scale (HERS) and the Family Poverty Level (IPF). The neighborhood environment quality was measured by the Neighborhood Quality Instrument (IQV) and the school environment quality by the Early Childhood Environment Rating Scale (ECERS-R). The collection of data occurs in the year 2016, the results showed an increase in the percentage of children with normal performance during the three evaluations by Denver II. The IPF (p=0.005), HERS (p<0.001) and IQV (p<0.001) scores were statistically significant associated with suspected delay. ECERS-R pointed to the school environment quality as basic or minimum, however there was no statistically significant association with the Denver II. The logistic regression model indicated that the probability of a child with suspected delay in DNPM is 80% lower when female (OR=0.20); 57% lower when married parents (OR=0.27); and 98% lower, the more joint activities the parents perform with the child in the family environment (OR=0.01), and it is 5.9 times higher the poorer the family (OR=5.98). In the second study, verified the relationship between ecological quality of environment, family and neighborhood and the child's language development. This study had a cross-sectional design, and a total of 64 participants who were evaluated by Denver II, ASQ-BR and Naming Test (TIN) and Phonological Discrimination Test (TDF). The majority of the children had a suspected delay by Denver II (56.3%) and below the cutoff point (51.6%) by ASQ-BR. In contrast, the mean scores (48.4%) for TDF and high (45.3%) for TIN were obtained. The personal variables that showed a statistically significant association were sex (p<0.007), time in school (p<0.04) and breastfeeding (p<0.01). Overall HERS scores (p<0.001) and IPF (p=0.01) were associated with the score. The logistic regression showed that the probability of a child presenting low language performance is 62% higher the lower the professional qualification of the mother (OR=0.39); 2.05 times higher, lower maternal schooling (OR=2.05), 1.97 times higher, lower family monthly income (OR=1.97); 4.91 times higher the lower the phonological discrimination of the child (OR=4.91); and 4.30 times higher the smaller the joint activities between parents and children (4.31). The data were analyzed by the Bioecological Theory and were coherent to analyze the results of the children as a function of the proximal processes, the characteristics of the person, the three microsystems investigated and the time interval of the research. Thus, the high prevalence of suspected delays in the development of the participating children highlights the importance of the emergence of policies and actions to stimulate children's development, besides alerting to the presence of risk factors that interfere with the quality of the environments.