O impacto da dor nas funções executivas e sua relação com as estratégias de enfrentamento em crianças com anemia falciforme

Abstract

Alterations in cognition are common in patients with chronic diseases, due to the disease itself, the pain it produces, and the type of treatment, which can lead to difficulty in the person's daily functioning. Despite the psychological and social onus, there are few studies in the country in the field of Pediatric Psychology assessing the impact of chronic diseases in the developmental trajectory. Considering the diseases that affect the circulatory system, the Sickle Cell Anemia (SCA) is the most common, which may lead to Cerebral Vascular Accident (CVA); and, due to vessel-occlusion, there are constant and intense pain crises, which are the leading cause of hospitalization. This disease can lead to losses in cognition, especially in executive functioning (EF) that are responsible to direct behavior toward goals, assessing its efficiency and adequacy, solving m problems through planning, inhibitory control and selfregulation of actions. Moreover, on the condition of chronic disease it is important to examine the coping strategies (coping) to deal with adverse situations. To this end, this research conducted in three studies had as the overall goal to assess whether the illness and pain cause some type of loss on cognitive performance in children with SCA, as well as to analyze the relationship between EFs and the types of coping employed in the context of the disease, assuming that most of these adaptive processes are related to cognitive tasks related to executive functioning. 12 children (8-10 years old) with SCA treated at the pediatric hematology ward of a public hospital in Vitória, ES, participated in the study. The following instruments were applied: The Faces Pain Scale-Revised - FPS-R; Colored Progressive Matrices (CPM) – Sets A, Ab, B – test; Wisconsin Card Sorting Test – WCST; and the Computerized Instrument for Evaluating Strategies Facing Hospitalization – AEHcomp-Pain. Data was analyzed descriptively, using statistical analysis (Spearman correlation coefficient) for the association of variables within each group. Study 1 showed that the sample had the intensity of painful crises reduced in the last year and deficits in executive functioning. Study 2 found that the most reported coping strategies were rumination and problem solving, followed by cognitive restructuring. The fact that the strategy rumination appeared as the most used, indicates that children, in their routine, are concentrated on the negative aspects imposed by the disease, which may constitute a risk factor for the development of internalizing disorders. However, the other strategies presented show an active search on the solution of problems in an attempt to redirect the thinking to positive aspects, despite the stressful situation. In study 3, the analysis of correlation among variables indicated that the children who had more deficits in EF also showed a greater number of maladaptive coping strategies, in accordance to studies that that link an impairment of EF to less effective coping processes. Further studies are needed to evaluate the strength of this hypothesis using a representative sample and other instruments to assess coping and EF, checking with a better precision the relationship between variables. Thus, the assessment of cognitive functions and the most commonly types of coping used can help in the organization of interventions more targeted to populations at risk, as is the case of children with Sickle Cell Anemia, reducing the negative impact of illness and pain in the emotional and cognitive spheres of its carriers.