Abstract
ABSTRACT Purpose: to analyze the associations between speech-language-hearing diagnostic hypotheses in children and adolescents and the Environmental Factors in the International Classification of Functioning, Disability, and Health. Methods: an observational, analytical, cross-sectional study carried out between 2016 and 2019 in an outpatient center with 5- to 16-year-old children and adolescents undergoing speech-language-hearing assessment and their parents/guardians. The Brazilian Economic Classification Criteria was used, and sociodemographic data were collected, along with speech-language-hearing diagnostic hypotheses and information on the presence of categories of the Environmental Factors, qualified as either barriers or facilitators. Descriptive and association analyses were made, using Pearson’s chi-square and Fisher’s Exact tests, with the significance level set at 0.05. Results: most participants had changes in oral language acquisition/development, written language, and oral-motor function. The most prevalent facilitators were in the categories of Services, Systems, and Policies; Support and Relationships; and Products and Technology, whereas the barriers were in the categories of Attitudes; Products and Technology; and Services, Systems, and Policies. The diagnostic hypotheses of “Change in cognitive aspects of language”, “Change in speech”, and “Change in voice” had a significant association with the codes present in chapters 3 - Support and Relationships, and 4 - Attitudes. Conclusion: this association shows that patients with communication changes need a comprehensive approach encompassing the Contextual Factors.
Highlights
The need for including external and internal factors in a classification complementary to the International Classification of Diseases (ICD)[1] arose during the process of reviewing the old International Classification of Impairments, Disabilities, and Handicaps (ICIDH), which preceded the International Classification of Functioning, Disability, and Health (ICF)[2]
The data were collected between 2016 and 2019 in an outpatient center that is part of the Unified Health System (SUS, in Portuguese) and attends patients coming from various sectors of a hospital complex. It was carried out with 5- to 16-year-old children and adolescents who were in a speech-language-hearing assessment process and their parents/guardians
The descriptive analysis of the speech-languagehearing diagnostic hypotheses showed that most children and adolescents had “Changes in oral language acquisition/development” (85.4%), “Changes in written language” (74.4%), and “Changes in oralmotor functions” (63.4%)
Summary
The need for including external and internal factors in a classification complementary to the International Classification of Diseases (ICD)[1] arose during the process of reviewing the old International Classification of Impairments, Disabilities, and Handicaps (ICIDH), which preceded the International Classification of Functioning, Disability, and Health (ICF)[2]. Its organization starts on the individual level, encompassing the immediate environment with its physical and material characteristics and the contact with others, and reaches the social level, addressing the formal and informal structures, organizations and services, attitudes and ideologies, and so forth[2]. These factors interact with the components in Part 1 of the ICF and can have either a positive influence (as facilitators) or a negative influence (as barriers). The disabilities, Activity limitations, and Participation restrictions result from the interaction between the latent predisposition and the environmental barriers[3]
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