• Nenhum resultado encontrado

4. Discussão

4.6. Conclusão e considerações finais

Os resultados deste estudo permitiram alcançar os objetivos inicialmente propostos, tendo-se verificado valores equilibrados para as quatro dimensões avaliadas, o que era expectável tendo em conta se tratar de uma amostra comunitária.

Salientam-se as associações encontradas entre as dimensões emocionalidade negativa e controlo com esforço, tanto do temperamento da criança como do temperamento da mãe, quer com os problemas de sono mas também com as queixas somáticas. Verificou-se ainda que a emocionalidade negativa da criança foi o principal preditor de ambas as problemáticas estudadas.

Os resultados do estudo remetem-nos para a importância de avaliar o temperamento das crianças, pois pode constituir um importante instrumento de triagem para identificar crianças em risco de desenvolver problemas de sono e/ou queixas somáticas. Será importante ajudar os pais de crianças com mais emocionalidade negativa a conhecerem e desenvolverem práticas parentais adequadas e positivas, contrariando a suscetibilidade para utilizarem práticas parentais negativas com crianças com um temperamento mais “difícil”.

58 Relativamente ao temperamento das mães, são vários os estudos que têm demonstrado que as características parentais influenciam a qualidade da parentalidade, o que por sua vez pode ter impacto na autorregulação das crianças. No entanto, sabemos muito pouco acerca das características dos pais (nomeadamente acerca do seu temperamento) que influenciam a sua parentalidade e que têm impacto no desenvolvimento das crianças. Este estudo encontrou algumas associações, no entanto, são necessários mais estudos para que exista uma maior compreensão acerca do tema e para que seja possível comparar resultados.

Apesar dos resultados encontrados, este trabalho tem algumas limitações importantes que devem ser consideradas. A amostra foi de conveniência, pelo que a generalização dos resultados deve ser feita cautelosamente. Sendo uma amostra muito homogénea e bastante adaptada tornou-se menos provável encontrar associações fortes entre as dimensões do temperamento e os problemas de sono e queixas somáticas. Esta característica também terá contribuído para uma distribuição que não cumpre os pressupostos de normalidade, o que limitou os testes estatísticos possíveis de utilizar.

As medidas utilizadas foram de hétero-relato, respondidas pelo mesmo informante num único momento (estudo transversal). Em futuras investigações seria importante incluir não só a mãe mas também outros informantes, como por exemplo o pai ou as educadoras das crianças e utilizar um desenho longitudinal que permita recolher informação em diversos momentos. Será importante também pensar num alargamento da variabilidade da amostra, incluindo sujeitos de grupos clínicos, de forma a poder comparar resultados. Por último, seria importante utilizar outros instrumentos específicos para avaliar os problemas de sono e as queixas somáticas, uma vez que o instrumento utilizado possui poucos itens para avaliar ambas as problemáticas.

59 Este estudo permitiu reforçar a importância do temperamento nos problemas de sono e nas queixas somáticas das crianças pré-escolares. Serão necessários estudos futuros que tentem ultrapassar as limitações referidas e que possibilitem uma maior compreensão das relações encontradas uma vez que existe pouca literatura que aborde as dimensões estudadas.

60 Referências bibliográficas

Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms and profiles. Burlington: University of Vermont: Research Center for Children, Youth, and Families.

Achenbach, T. M., & Rescorla, L. A. (2007). Multicultural understanding of child and adolescent psychopathology: Implications for Mental Health Assessment. New York: Guilford Press.

American Academy of Sleep Medicine. (2005). International classification of sleep disorders: diagnostic and coding manual (2nd ed.). Chicago, Illinois: American Academy of Sleep Medicine. doi: 0965722023.

Atkinson, E., Vetere, A., & Grayson, K. (1995). Sleep disruption in young children. The influence of temperament on the sleep patterns of pre-school children. Child Care Health Development, 21(4), 233-246.

Banks, K., & Bevan, A. (2014). Predictors for somatic symptoms in children. Nursing children and young people, 26(1), 16-20.

Beck, J. E. (2008). A developmental perspective on functional somatic symptoms. Journal of Pediatric Psychology, 33(5), 547–562.

Brown, R. J. (2007). Introduction to the special issue on medically unexplained symptoms: background and future directions. Clinical Psychology Review, 27(7), 769–780.

Burnham, M. M., Goodlin-Jones, B. L., Gaylor, E. E., & Anders, T. F. (2002). Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study. Journal of child psychology, 43(6), 713-725.

61 Calkins, S. D., Hungerford, A., & Dedmon, S. E. (2004). Mothers’ interactions with

temperamentally frustrated infants. Infant Mental Health Journal, 25(3), 219– 239.

Campo, J.V. (2012). Annual Research Review: Functional somatic symptoms and associated anxiety and depression – developmental psychopathology in pediatric practice. Journal of Child Psychology and Psychiatry, 53, 575-592. doi: 10.1111/j.1469-7610.2012.02535.x.

Campo, J. V., & Fritsch, S. L. (1994). Somatization in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 33(9), 1223–1235.

Crockenberg, S. C., & Leerkes, E. M. (2004). Infant and maternal behaviors regulate infant reactivity to novelty at 6 months. Developmental Psychology, 40(6), 1123– 1132.

Cumberland-Li, A., Eisenberg, N., Champion, C., Gershoff, E., & Fabes, R. A. (2003). The relation of parental emotionality and related dispositional traits to parental expression of emotion and children’s social functioning. Motivation and Emotion, 27(1), 27–56.

DeGucht, V., Fischler, B. & Heiser, W. (2004) Neuroticism, alexithymia, negative affect, and positive affect as determinants of medically unexplained symptoms. Personality and Individual Differences, 36, 1655–1667.

Domènech-Llaberia, E., Jané, C., Canals, J., Ballespí, S., Esparó, G., & Garralda, E. (2004). Parental Reports of Somatic Symptoms in Preschool Children: Prevalence and Associations in a Spanish Sample. Journal of American Academy of Child and Adolescent Psychiatry, 43(5), 598-604.

62 doi: 10.1097/01.chi.0000117043.35450.bf.

Eminson, D. M. (2007). Medically unexplained symptoms in children and adolescents. Clinical Psychology Review, 27(7), 855–871.

Evans, D. E., & Rothbart, M. K. (2007). Developing a model for adult temperament. Journal of Research in Personality, 41(4), 868-888.

Ferreira, S. I. F. (2013). Adaptação portuguesa do Children’s Somatization Inventory: Inventário de Somatização para Crianças (ISC-24).(Mestrado em Psicologia).

Ferreira, S., Martins, M. J., Monteiro, S., & Pereira, A. (2014). Inventário de Somatização para crianças (ISC – 24). Psicologia, Saúde & Doenças, 15(3), 752-768. doi: http://dx.doi.org/10.15309/14psd150315.

Garber, J., Walker, L. S., & Zeman, J. (1991). Somatization symptoms in a community sample of children and adolescents: further validation of the children’s somatization inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3(4), 588–595.

Garber, J., Zeman, J., & Walker, L. S. (1990). Recurrent abdominal pain in children: psychiatric diagnoses and parental psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 29(4), 648–656.

Garralda, M. E. (1996). Somatisation in children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 37(1), 13–33.

Garralda, E. (2005). Somatization and somatoform disorders. Psychiatry, 4(8), 97-100.

Garstein, M. A., & Rothbart, M K. (2003). Studying infant temperament via the revised infant behavior questionnaire. Infant Behavior and Development, 26(1), 64-86.

63 Giacobo, R. A., Jané, M. C., Bonillo, A., Ballespí, S., & Díaz-Regañon, N. (2012). Somatic symptoms, severe mood dysregulation and aggressiveness in preschool children. European Journal of Pediatrics, 171, 111-119. doi: 10.1007/s00431- 011-1495-5.

Gilleland, J., Suveg, C., Jacob, M.L., & Thomassin, K. (2009). Understanding the medically unexplained: emotional and familial influences on children’s somatic functioning. Child: care, health and development, 35, 383-390. doi: 10.1111/j.1365-2214.2009.00950.x.

Goodnight, J., Bates, J., Staples, A., Pettit, G., & Dodge, K. (2007). Temperamental resistance to control increases the association between sleep problems and externalizing behavior development. Journal of Family Psychology, 21(1), 39–48. doi:10.1037/0893-3200.21.1.39.

Gregory, A. M., & Sadeh, A. (2012). Sleep, emotional and behavioral difficulties in children and adolescents. Sleep medicine reviews, 16(2), 129-136. doi: 10.1016/j.smrv.2011.03.007.

Grunau, R. V., Whitfield, M. F., Petrie, J. H., & Fryer, E. L. (1994). Early pain experience, child and family factors, as precursors of somatization: a prospective study of extremely premature and fullterm children. Pain, 56(3), 353–359.

Gudmundson, J. A., & Leerkes, E. M. (2012). Links between mothers’ coping styles, toddler reactivity, and sensitivity to toddler’s negative emotions. Infant Behavior & Development, 35(1), 158–166.

Hart, S. L., Hodgkinson, S. C., Belcher, H. M. E., Hyman, C., & Cooley-Strickland (2013). Somatic symptoms, peer and school stress, and family and community

64 violence exposure among urban elementary school children. Journal of Behavioral Medicine, 36, 454-465. doi: 10.1007/s10865-012-9440-2.

Hayes, M. J., McCoy, S. K., Fukumizu, M., Wellman, J. D., & DiPietro, J. A. (2011). Temperament and sleep-wake behaviors from infancy to toddlerhood. Infant and Child Development, 20(5), 495–508. doi:10.1002/icd.720.Temperament.

Hill-Soderlund, A. L., & Braungart-Rieker, J. M. (2008). Early individual differences in temperamental reactivity and regulation: Implications for effortful control in early childhood. Infant Behavior and Development, 31(3), 386-397.

Husain, K., Browne, T., & Chalder, T. (2007). A Review of Psychological Models and Interventions for Medically Unexplained Somatic Symptoms in Children. Child

and adolescent mental health, 12(1), 2-7. doi: 10.1111/j.1475-

3588.2006.00419.x.

Johnson, N., & McMahon, C. (2008). Preschoolers’ sleep behaviour: associations with parental hardiness, sleep‐related cognitions and bedtime interactions. Journal of Child Psychology and Psychiatry, 49(7), 765-773.

doi:10.1111/j.14697610.2007.01871.x.

Kagan, J., Reznick, J. S., Clarke, C., Snidman, N., & Garcia-Coll, C. (1984). Behavioral inibition to the unfamiliar. Child Development, 55, 2212-2225.

Karraker, K. (2008). The role of intrinsic and extrinsic factors in infant night waking. Journal of Early and Intensive Behavior Intervention, 5(3), 108–121.

Keener, M. A., Zeanah, C. H., & Anders, T. F. (1988). Infant temperament, sleep organization and nighttime parental interventions. Pediatrics, 81(6), 762-771.

65 Kerr, S., & Jowett, S. (1994). Sleep problems in pre-school children: a review of the

literature. Child: care, health and development, 20, 379-391.

Kim, S., & Kochanska, G. (2012). Child temperament moderates effects of parent–child mutuality on self-regulation: A relationship-based path for emotionally negative infants. Child Development, 83(4), 1275–1289.

Kiss, M., Fechete, G., Pop, M., & Susa, G. (2014). Early Childhood Self-Regulation in Context: Parental and Familial environmental Influences. Cognition, Brain, Behavior, 18, 55-85.

Klein, V. C., & Linhares, M. B. M. (2010). Temperamento e desenvolvimento da criança: revisão sistemática da literatura. Psicologia em Estudo, 15(4), 821-829.

Lam, P., Hiscock, H., & Wake, M. (2003). Outcomes of infant sleep problems: A longitudinal study of sleep, behavior, and maternal wellbeing. Pediatrics, 111, 203–207.

Lengua, L. J., Honorado, E., & Bush, N. R. (2007). Contextual risk and parenting as predictors of effortful control and social competence in preschool children. Journal of Applied Developmental Psychology, 28(1), 40–55.

Meesters, C., Muris, P., Ghys, A., Reumerman, T., & Rooijmans, M. (2003) The Children’s Somatization Inventory: Further Evidence for Its Reliability and Validity in a Pediatric and a Community Sample of Dutch Children and Adolescents. Journal of Pediatric Psychology, 28, 413-422. doi: 10.1093/jpepsy/jsgo31

66 Mindell, J. A., Kuhn, B., Lewin, D. S., Meltzer, L. J., Sadeh, A. (2006). Behavioral treatment of bedtime problems and night waking in infants and young children. Sleep medicine, 29(10), 1263-1276.

Morrell, J., & Steele, H. (2003). The role of attachment security, temperament, maternal perception, and care‐giving behavior in persistent infant sleeping problems. Infant mental health journal, 24(5), 447-468. doi: 10.1002/imhj.10072.

Owens, J. A. (2004). Sleep in children: Cross‐cultural perspectives. Sleep and Biological Rhythms, 2(3), 165-173.

Owens, J. A. (2007). Classification and epidemiology of childhood sleep disorders. Sleep Medicine Clinics, 2(3), 353-361.

Owens, J. (2008). Classification and epidemiology of childhood sleep disorders. Primary Care: Clinics in Office Practice, 35(3), 533–546. doi:10.1016/j.pop.2008.06.003.

Owens, J., Frank, N., Smith, A., Hagino, A. O., Arrigan, M., & Alario, A. J. (1997). Child temperament, parenting discipline style, and bedtime behavior in childhood sleep disorders. Journal of Developmental & Behavioral Pediatrics, 18(5), 314-321.

Owens, J., & Mindell, J. A. (2011). Pediatric insomnia. Pediatric Clinics of North America, 58(3), 555–69. doi:10.1016/j.pcl.2011.03.011.

Owens, J., & Witmans, M. (2004). Sleep problems. Current problems in pediatric and adolescent health care, 34(4), 154–79. doi:10.1016/j.cppeds.2003.10.003.

Petit, D., & Montplaisir, J. (2012). Consequences of short sleep duration or poor sleep in children. Encyclopedia on Early Childhood Development, 1-7. Retrieved from http://www.child-encyclopedia.com/documents/Petit-MontplaisirANGxp1 2012.pdf.

67 Pihlakoski, L., Sourander, A., Aromaa, M., Rautava, P., Helenius, H., & Sillanpaa, M. (2006). The continuity of psychopathology from early childhood to preadolescence: a prospective cohort study of 3-12-year-old children. European Child and Adolescent Psychiatry, 15(7), 409–417.

Posner, M. I., & Rothbart, M. K. (2000). Developing mechanisms of self-regulation. Development and Psychopathology, 12, 427-441.

Propper, C., & Moore, G. A. (2006). The influence of parenting on infant emotionality: A multi-level psychobiological perspective. Developmental Review, 26(4), 427– 460.

Putnam, S. P., Ellis, L. K., & Rothbart, M. (2001). The structure of temperament from infancy to adolescence. In A. Eliaz, & A. Angleitner (Eds.), Advances in research of temperament (pp.165-182). Lingerich: Pabst Scientific.

Putnam, S. P., & Rothbart, M. K. (2006). Development of Short and Very Short Forms of the Children’s Behavior Questionnaire. Journal of Personality Assessment, 87(1), 103-113.

Razza, R. A., Martin, A., & Brooks-Gunn, J. (2012). Anger and children’s socioemotional development: Can parenting elicit a positive side to a negative emotion? Journal of Child and Family Studies, 21(5), 845-856.

Reid, G. J., Hong, R. Y., & Wade, T. J. (2009). The relation between common sleep problems and emotional and behavioral problems among 2‐ and 3‐year‐olds in the context of known risk factors for psychopathology. Journal of sleep research, 18(1), 49-59. doi: 10.1111/j.1365-2869.2008.00692.x.

68 Rescorla, L. A., Achenbach, T. M., Ivanova, M. Y., Harder, V. S., Otten, L., Bilenberg, N., … & Verhulst, F. C. (2011). International comparisons of behavioral and emotional problems in preschool children: Parent’s reports from 24 societies. Journal of Clinical Child & Adolescent Psychology, 40(3), 456–467. doi: 10.1080/15374416.2011.563472.

Rieffe, C. (2007) Interaction between emotions and somatic complaints in children who did or did not seek medical care. Cognition & Emotion, 21, 1630–1646.

Rocha, E. M., & Prkachin, K. M. (2007). Temperament and pain reactivity predict health behavior seven years later. Journal of Pediatric Psychology, 32(4), 393–399.

Rocha, E. M., Prkachin, K. M., Beaumont, S. L., Hardy, C. L., & Zumbo, B. D. (2003). Pain reactivity and somatization in kindergarten-age children. Journal of Pediatric Psychology, 28(1), 47–57.

Rothbart, M K. (1989). Temperament in childhood: A framework. In G. Kohnstamm, J. Bates, & M. K. Rothbart (Eds.), Temperament in childhood (pp. 59-73). Chichester, England: Wiley.

Rothbart, M. K. (2004). Commentary: Differentiated measures of temperament and multiple pathways to childhood disorders. Journal of Clinical Child and Adolescence Psychology, 33(1), 82-87.

Rothbart, M. K. (2007). Temperament, Development and Personality. Association for Psychological Science, 16(4), 207-213.

Rothbart, M. K., & Ahadi, S. A. (1994). Temperament and the Development of Personality. Journal of Abnormal Psychology, 103(1), 55-66.

69 Rothbart, M. K., Ahadi, S. A., & Evans, D. E. (2000). Temperament and Personality: Origins and Outcomes. Journal of Personality and Social Psychology, 78(1), 122- 135.

Rothbart, M. K., Ahadi, S. A., Hershey, K. L., & Fisher, P. (2001). Investigations of temperament at three to seven years: The Children's Behavior Questionnaire. Child development, 72(5), 1394-1408.

Rothbart, M. K., & Bates, J. E. (2006). Temperament. In W. Damon, R. M. Lerner & N. Eisenberg (Eds.), Handbook of child psychology: social, emotional and personality development (6ª ed., Vol. 3, pp. 99-165), New York: John Wiley and Sons.

Rothbart, M. K., & Putnam, S. (2002). Temperament and socialization. In L. Pulkinnen & A. Caspi, (Eds.), Paths to successful development: Personality in the life course (pp. 19-45). Cambridge, UK: Cambridge University Press.

Sadeh, A. (2005). Cognitive-behavioral treatment for childhood sleep disorders. Clinical Psychology Review, 25(5), 612–28. doi:10.1016/j.cpr.2005.04.006.

Sadeh, A., & Anders, T. (1993). Infant sleep problems: origins, assessment, interventions. Infant Mental Health Journal, 14(1), 17-34.

Sadeh, A., Flint-Ofir, E., Tirosh, T., & Tikotzky, L. (2007). Infant sleep and parental sleep-related cognitions. Journal of family psychology, 21(1), 74. doi:10.1037/0893-3200.21.1.74.

Sadeh. A., Lavie, P., & Scher, A. (1994). Seep and Temperament: Maternal perceptions of temperament of sleep-disturbed toddlers. Early Education & Development, 5(4), 311-324.

70 Sadeh, A., Mindell, J. A., Luedtke, K., & Wiegand, B. (2009). Sleep and sleep ecology in the first 3 years: a web-based study. Journal sleep research, 18, 60-73. doi: 10.1111/j.1365-2869.2008.00699.x.

Sadeh, A., & Sivan, Y. (2009). Clinical practice, Sleep problems during infancy. European journal of pediatrics, 168(10), 1159-1164. doi: 10.1007/s00431-009- 0982-4.

Sadeh, A., Tikotzky, L., & Scher, A. (2010). Parenting and infant sleep. Sleep Medicine Reviews, 14, 89-96. doi:10.1016/j.smrv.2009.05.003.

Scher, A., Tirosh, E., & Lavie, P. (1998). The relationship between sleep and temperament revisited: evidence for 12-month-olds: a research note. Journal Child psychology and psychiatry, 39(5), 785-788.

Schulte, I. E., & Petermann, F. (2011). Familial Risk Factors for the Development of Somatoform Symptoms and Disorders in Children. Child Psychiatry & Human Development, 42, 569-583. doi: 10.1007/s10578-011-0233-6.

Shiner, R. L., Buss, K. A., McClowry, S. G., Putnam, S. P., Saudino, K. J., & Zentner, M. (2012). What Is Temperament Now? Assessing Progress in Temperament Research on the Twenty-Fifth Anniversary of Goldsmith et al. (1987). Child Development Perspectives, 6(4), 436-444.

Sneddon, P., Peacock, G. G., & Crowley, S. L. (2013). Assessment of sleep problems in preschool aged children: An adaptation of the Children’s Sleep Habits Questionnaire. Behavioral Sleep Medicine, 11, 283-296. doi:10.1080/15402002.2012.707158.

71 Spruyt, K., Aitken, R. J., So, K., Charlton, M., Adamson, T. M., & Horne, R. S. C. (2008). Relationship between sleep/wake patterns, temperament and overall development in term infants over the first year of life. Early Human Development, 84, 289-296. doi: 10.1016/j.earlhumdev.2007.07.002.

Tackett, J. (2006). Evaluating models of the personality-psychopathology relationship in children and adolescents. Clinical Psychology Review, 26, 584-599.

Tarabulsy, G. M., Provost, M. A., Deslandes, J., St-Laurent, D., Moss, E., Lemelin, J.-P., … Dassylva, J.F. (2003). Individual differences in infant still-face response at 6 months. Infant Behavior and Development, 26(3), 421–438.

Tavares, H. B., Ferreira, P. D., & Fonseca, H. (2010). Perturbação de somatização - uma patologia prevalente em adolescentes. Ata Pediátrica Portuguesa, 41(1), 33-7.

Thiedke, C. (2001). Sleep disorders and sleep problems in childhood. American Family Physician, 63(2), 227- 284.

Thomas, A., Chess, S., & Birch, H. G. (1970). The origin of the personality. Scientific American, 223(2), 102-109.

Touchette, E, (2011). Factors associated with sleep problems in Early Childhood. Encyclopedia on Early Childhood Development, 1-8. Retrieved from http://www.child-encyclopedia.com/pages/PDF/TouchetteANGxp1.pdf.

Touchette, É., Petit, D., Tremblay, R. E., & Montplaisir, J. Y. (2009). Risk factors and consequences of early childhood dyssomnias: New perspectives. Sleep Medicine Reviews, 13, 355-361. doi:10.1016/j.smrv.2008.12.001.

Troxel, W. M., Trentacosta, C. J., Forbes, E. E., & Campbell, S. B. (2013). Negative emotionality moderates associations among attachment, toddler sleep and later

72 problem behaviors. Journal of Family Psychology, 27(1), 127-136. doi: 10.1037/a0031149.

Walker, L. S., Garber, J., & Greene, J. W. (1994). Somatic complaints in pediatric patients: a prospective study of the role of negative life events, child social and academic competence, and parental somatic symptoms. Journal of Consulting and Clinical Psychology, 62(6), 1213–1221.

Walker, L., Garber, J., Smith, C., Slyke, D., & Claar, R. (2001). The Relation of Daily Stressors to Somatic and Emotional Symptoms in Children With and Without Recurrent Abdominal Pain. Journal of Consulting and Clinical Psychology, 69, 85-91. doi: org/10.1037/0022-006X.69.1.85.

Weinraub, M., Bender, R. H., Friedman, S. L., Susman, E. J., Knoke, B., Bradley, R., Houts, R., Williams, J. (2012). Patterns of developmental change in infants’ nighttime sleep awakenings from 6 throught 36 months of age. Developmental Psychology, 48(6), 1511-1528. doi: 10.1037/a0027680.

Weissbluth, M., & Liu, K. (1983). Sleep patterns attention span, and infant temperament. Journal of Developmental and Behavioral Pediatrics, 4, 34-36.

Wolff, N., Darlington, A.S., Hunfeld, J., Verhulst, F., Jaddoe, V., Hofman, A., Passchier, J., & Tiemeier, H. (2010). Determinants of Somatic Complains in 18-month-old children: The Generation R Study. Journal of Pediatric Psychology, 35(3), 306- 316. doi: 10.1093/jpepsy/jsp058.

Zeanah, C.H. & Zeanah, P.D. (2001). Towards a definition of infant mental health. Zero to Three, 22,13-20.

Documentos relacionados