Littérature scientifique sur le sujet « Identificazione precoce difficoltà »

Una presa in carico non uniforme, tardiva o inappropriata dei bambini con deficit uditivo aumenta il rischio di sviluppare difficoltà comunicative-comportamentali e psicosociali che possono persistere fino all’adolescenza o all’età adulta. Nel Marzo 2014 il Centro di Controllo Malattie (CCM) del Ministero della Salute Italiano ha finanziato il progetto “Programma regionale di identificazione, intervento e presa in carico precoci per la prevenzione dei disturbi comunicativi nei bambini con deficit di udito”. Il progetto coinvolge 5 centri di III livello in cui il programma di screening uditivo neonatale è stato approvato dalla regione di appartenenza. Lo scopo principale del progetto è quello di definire e proporre un modello di salute pubblica su base regionale per l’identificazione delle ipoacusie infantili permanenti, la diagnosi e l’intervento. La prima fase del progetto prevede di indagare lo stato dell’arte e di produrre raccomandazioni che possano portare a cambiamenti positivi nell’identificazione, nella diagnosi, nella terapia e nella presa in carico dei bambini con deficit uditivo, tenendo presenti le innovazioni diagnostiche-riabilitative, il sostegno e l’alleanza terapeutica con la famiglia, un approccio interdisciplinare. Le raccomandazioni emerse da questa prima fase rappresenteranno le basi per un sistema regionale di intervento precoce che sia valido, integrato e condiviso da tutte le cinque regioni coinvolte.

Nelle più recenti linee guida internazionali sull’intervento precoce in audiologia pediatrica emerge l’importanza del coinvolgimento della famiglia nel percorso diagnostico- riabilitativo del bambino con deficit uditivo permanente. Questa modalità di approccio costituisce una ricchezza per lo sviluppo dei bambini con deficit uditivo. Vi sono ad oggi poche evidenze del panorama italiano rispetto a questo ambito e rimangono aperte perplessità e difficoltà di gestione pratica. L’obiettivo di questo articolo è presentare i risultati di un’analisi strategica che prende in considerazione i punti di forza, i punti di debolezza, le opportunità e i rischi di una presa in carico precoce che renda competente la famiglia. Le iniziali fasi della presa in carico devono fornire alle famiglie di bambini con recente diagnosi di ipoacusia permanente le informazioni e/o il sostegno necessario al fine di indurle a compiere la scelta del dispositivo protesico uditivo più idoneo, entro tre mesi dalla diagnosi audiologica. Nell’ambito del progetto del Ministero della Salute CCM 2013 “Programma regionale di identificazione, intervento e presa in carico precoci per la prevenzione dei disturbi comunicativi nei bambini con deficit uditivo” un gruppo di esperti ha identificato tre principali raccomandazioni utili per migliorare lo sviluppo comunicativo del bambino attraverso il coinvolgimento della famiglia e il rafforzamento dell’alleanza terapeutica. Queste considerazioni costituiranno il punto di partenza per riflessioni e analisi più dettagliate che potranno dare luce a linee guida e indicazioni specifiche su come buone prassi di presa in carico di bambino con deficit uditivo e famiglia possano inserirsi e concretizzarsi nel reale panorama italiano.

Lo studio presentato ha voluto esplorare la possibile presenza in bambini di etŕ prescolare, nati moderatamente pretermine, di precursori del disturbo da deficit dell'attenzione e iperattivitŕ. La ricerca ha coinvolto un gruppo di 50 bambini (etŕ media = 5 anni e 2 mesi, ds = 4 mesi) nati moderatamente pretermine (etŕ gestazionale media = 34 settimane, ds = 2) senza complicanze mediche neonatali e con basso peso alla nascita (media = 2100 g., ds = 350 g.) e 50 bambini nati a ter - mine in assenza di complicanze pre e perinatali (etŕ gestazionale media = 40 settimane). Ai genitori e agli insegnanti delle scuole di riferimento dei bambini sono stati somministrati specifici questionari (Identificazione Precoce Disturbo da Deficit dell'Attenzione/Iperattivitŕ per insegnanti - IPDDAI, Identificazione Precoce Disturbo da Deficit dell'Attenzione/Iperattivitŕ per Genitori - IPDDAG) per individuare difficoltŕ legate a disattenzione e iperattivitŕ nei bambini del gruppo della ricerca. I risultati mostrano un profilo dei bambini moderatamente pretermine in etŕ prescolare "a rischio" di precursori di deficit dell'attenzione e di disturbi di iperattivitŕ.

Alla nascita di un bambino, la solidità delle basi narcisistiche e l'infantile dei genitori sono messi alla prova fin dentro le ramificazioni delle loro appartenenze culturali. L'incontro tra il bambino e i suoi genitori è occasione di fantasie nostalgiche e fonte di stupore e meraviglia, ma inciampa sulla storia singolare di ciascuno, sulla costruzione della coppia con i suoi numerosi effetti in après-coup. Le proiezioni riguardo al bambino ostacolano talvolta la costruzione dei legami precoci e la costruzione del narcisismo primario del bambino. Il gioco delle identificazioni si trova in difficoltà e il bebè viene dolorosamente identificato a un elemento perturbante ed estraneo. Quando è a sua volta contenuta da una presenza attenta la madre può talvolta ritrovare una capacità calmante e sensuale; l'analista propone delle rappresentazioni delle poste in gioco in cui sono presi i partner della diade sotto l'influenza dell'angoscia. Questo lavoro di trasformazione in parole favorisce il posto del terzo e cerca di permettere al bambino come alla madre di ritrovare una capacità di gioco rappresentativo associato al piacere.

UNIVERSITA’ DEGLI STUDI DI MILANO BICOCCA Facoltà di Scienze della Formazione Dipartimento di Scienze Umane per la Formazione ”R. Massa” Dottorato di Ricerca In Scienze Umane, XXII Ciclo Curriculum “Benessere della Persona, Salute e Comunicazione Interculturale” LEARNING DISABILITIES AND DIFFICULTIES AN OBSERVATIONAL QUESTIONNAIRE FOR ANALYSIS OF BASIC SKILLS AND EARLY RISK IDENTIFICATION ABSTRACT Coordinatore: Chiar.ma Prof.ssa Ottavia ALBANESE Tesi di Dottorato di Palma Roberta CORCELLA Matricola N.708042 Anno Accademico 2009/2010 INTRODUCTION This work is part of a research field which over the past twenty years had an important trend. Learning disabilities and difficulties are frequent and important issues in the medical-pediatric field. Recent research suggests that the incidence of specific learning disabilities (LD) is about 4%. Law in Italy has just reached an important milestone that we had been waiting for about 10 years. Law 170, the first law about dyslexia in our country, appears in the October 2010 issue of “La Gazzetta Ufficiale” with the title “New rules about specific learning disorders at school". In their school-learning journey children with specific learning disabilities may have difficulties in the process of reading, writing or calculation automation, which can be very often connected one to the other. In addition to these difficulties concerning only learning, students develop a feeling of emotional and motivational failure with important implications. Therefore the presence of a LD does not affect only the child's learning process but also his general wellness: the child with LD often tends to develop styles of impractical or even harmful attribution to structure a good idea of himself and his self-esteem (De Beni R., Moè A. 2000, Dweck C.S. 2000). An important protective factor for children with LD is early diagnosis. Therefore, considering that the “time” factor plays an important role, it is interesting to hypothesize a program of observation and screening from the last year of kinder garten (Stella G. 2008; AID 2009). According to many longitudinal studies, early identification and intervention play a positive role in determining the evolution of specific learning disabilities and the overall cognitive and emotional development of children with these problems (Baker e Smith, 1999; Jackson et al., 1999; Byrne et al., 2000; Morris et al., 2000; Schneider et. al, 2000; Vadasy et al., 2000). The work of early identification of subjects who can be considered "at risk” has the objective of limiting the likelihood of their school failure by planning targeted and specific educational interventions. The effectiveness of a centered intervention has been shown by longitudinal studies in literature, such as studies of meta-phonological training goal with pre-school children who get significantly better results in reading and writing than the control group (Bryant e Bradley, 1985; Pinto, 1993; Kozminsky e Kozminsky, 1995). This study starts from these premises: we chose to perform a screening during the last year of kinder garten using an Italian instrument, the IPDA Observing Questionnaire (Early Identification of Learning Difficulties), born from a fruitful collaboration with the University of Padua. Peculiarity of this research is first of all the choice to investigate the prerequisites of school education through a questionnaire specifically created to bring to light slight situations of immaturity and potential risk to have difficulties in school learning. Secondly, the analysis of the responses is aimed at strengthening the prerequisites for academic learning through a targeted intervention. This work is structured into four chapters. The first deals with the theoretical definition, etiology, prognosis and characteristics of the specific school learning disability. The second chapter focuses on learning difficulties at school by analysing the differences between them and the LD. The third chapter is about prevention and early identification through the analysis of early risk signs of learning difficulties. The first three chapters can be seen as a theoretical introduction to the fourth chapter which is focused on the research. OBJECTIVES AND PURPOSES OF THE RESEARCH The objectives of my research are: 1. to establish that there are different ways of developing prerequisite skills of learning among children 2. to evaluate the effectiveness of treatment RESEARCH HYPOTHESIS The first hypothesis is that the group of children who undergo a specific work to strengthen their prerequisites of learning will show a better evolution than those who don’t. The second hypothesis is that, in a group of children who work to develop their prerequisites for academic learning, the children who have less structured basic skills will benefit more than those with a better level. METHOD PARTICIPANTS The group consists of 659 5 year-old children , 351 males (53%) and 308 females (47%) in the final year of kinder garten. These children come from five different kinder garten: two in the province of Milan and 3 in the province of Varese. According to the Handbook of Questionnaire Observing IPDA (Terreni et al, 2002), children with disabilities and immigrant children with little or no knowledge of Italian were excluded from this group. The whole group was divided into an experimental group, that followed the treatment, and a control group that followed the traditional educational program. The experimental group was composed of 384 children, 198 males (52%) and 186 females (48%) with an average age of 64 months, in the month of October, corresponding to five years and four months. The control group consisted of 275 children, 153 males (55%) and 122 females (45%) with an average age of 62 months, in the month of October, corresponding to five years and two months. MEASURES Twelve years ago a working group (which I still belong to) of the University of Padova, led by Professor Cesare Cornoldi, following the request of the Department of Education of Bergamo, decided to start a project for the prevention of learning school difficulties. The instrument which was created to perform the screening was the Observing Questionnaire IPDA (Terreni et al 2002). The Observing Questionnaire IPDA allows us to detect in an agile and quick way subjects potentially "at risk" to have learning difficulty at school using the teachers’ observations, whose prediction is confirmed by several works (Stevenson et al. 1976; Feshbach et al., 1977; Cornoldi e Pra Baldi, 1979; Archer e Edwards, 1982; Camerini et al., 1996; Alvidrez e Weinstein, 1999; Panter, 1999; Taylor et al., 2000; Teisl et al., 2001). The IPDA is composed of 43 items divided into two main sections. The first concerns the "general skills" related to general learning ability (behavioral, motor skills, language comprehension, oral expression, metacognition and other cognitive abilities (memory, praxis, orientation); the second refers to "specific skills" that are the prerequisites of reading- writing and mathematics. The total score of each child is calculated by adding the scores (1, 2, 3 or 4) assigned to any individual items. PROCEDURE First step of the research was the training of the teaching staff, who were introduced to the method of observation and the use of the tool; the training was attended by the teachers of the experimental and control groups. Then the teachers of the experimental group were taught about the treatment and they applied it in their class. The IPDA Materials were used in this second phase. At the end the children of both groups, experimental and control ones, underwent a re-test using the IPDA Questionnaire Observing again. TREATMENT IPDA Materials include educational activities that enhance the prerequisites of each specific basic school learning. Metacognition (in its aspects of awareness and control of their cognitive activity) and visual concentration are considered transversal skills. We examined the following basic school learning abilities: • reading-writing as instrumental skills: reading as decoding, spelling and writing as graphics; • reading as the ability of text understanding; • writing as presenting competence, ability to produce a text; • calculation. RESULTS The analysis of the results demonstrate that, after the treatment, children in the experimental group have significantly improved their level of prerequisites compared to the children belonging to the control group. In relation to the experimental group, the children belonging to the subgroups with high and low risk of having learning difficulties showed a higher improvement than the children belonging to the risk-free subgroup, who followed a typical evolution. The qualitative analysis of change is based on comparing the scores obtained at IPDA in pre and post-test; according to the results of the pre-test, 20 of the 35 children of the experimental group were included in the high-risk group; after treatment, the 20 children underwent the post-test and 13 of them were placed into the low-risk level and 7 into the risk-free one. After pre-test, 31 children of the control group were considered at high-risk level; after post-test, 16 of them were included into the low-risk group. No child "migrated" into the risk-free band. The first hypothesis was that the group of children who, in addition to teaching school curriculum program, undergo a specific work to strengthen their learning prerequisites will show a better evolution in relation to “natural” development of children. The data analysis confirms the first hypothesis for the subgroups of children at high and low risk. The second hypothesis was that children with lower performances (considered at risk) in a group of children who undergo this strengthening work on learning prerequisites are those who will benefit more from this work than those with a good level of development of prerequisites. The results confirm the second hypothesis, considering that the improvement of the high-risk group is significant if compared to the risk-free group, which highlighted an evolution similar to the one expected without treatment. DISCUSSION The results show that the treatment brings important benefits to children at high and low risk of scholastic difficulties, but does not bring significant benefits to risk-free children. However, it is important to notice that the treatment gave all the children the opportunity to work together, taking advantage from this collaboration. Working in small groups allowed them to practice communication and social skills that are useful for their personal growth. This experience has demonstrated the potentiality of this work led at school. It should be noticed that the success is also based on the sharing activity among the teachers about the objectives and the proposed methods, as well as their ability to adjust and adapt daily activities to the specific needs and characteristics of their class. From a more theoretical point of view, it is important to consider this improvement as related, besides to the effectiveness of the treatment, also to a wider change, given by the modification of the context. All teachers included in the research have completed a training course aimed not only at providing information and knowledge on the use of instruments and materials, but also at creating a good learning environment. This type of work is consistent with the assertion "Neither knowledge nor learning exist independently from the way the participants make them actual in their context” (Pontecorvo, 1999, p24). It is also important to consider that "the relationships between individual and context form a unique and indivisible unit, because the individual can never be understood outside his/her social dimension" (B. Ligorio, C. Pontecorvo, 2010). Stetsenko and Arievitch (2004) argue that there is a substantial ontological similarity between interindividual and the intraindividual development, because they are two interdependent processes. The events in the life of a class become observable only within a contextual perspective in which learning is understood as a collective co-construction of meanings. This definition goes beyond the cognitivist conceptions of learning that, as well as other cognitive processes, deals only with the mind of the learner. Defining learning in social-constructivist terms means, therefore, considering learning as a result of attribution of meaning and direction to activities, products and processes that relate to the working group, the instruments and the place where learning takes place.