Transtorno do Espectro do Autismo em crianças e adolescentes: revisão sistemática de literatura, estudo de caso-controle e uma intervenção

Abstract

Autism spectrum disorder (ASD) affects the way information is processed in the brain, leading to symptoms such as impaired social interaction and communication, restricted interest and repetitive behavior, and it has become a serious public health problem with major family, social and economic impacts. This thesis aimed to investigate issues related to Autism Spectrum Disorder (ASD) in children and adolescents and three studies were conducted. Study 1 aimed to identify, in the literature, the perinatal factors that could be associated with ASD. An integrative literature review was conducted, and articles on ASD and perinatal factors were identified in the Scielo, Lilacs, MedLine and PubMed databases, published between 2000 and 2014. Seventeen of the 619 articles analyzed were included. The main risk factors associated with ASD were male gender, maternal emotional state, psychiatric disorders/neurological diseases, duration of labor, Apgar score, type of delivery, gestational age, maternal/paternal age, maternal smoking, birth weight, and prematurity. Study 2 aimed to estimate the association between ASD and parental age at childbirth. A case-control study was conducted consisting of individuals with ASD (case) and neurotypical individuals (control). A semi-structured questionnaire was applied to the mothers and multiple logistic regression was performed. Paternal and maternal ages were categorized at 10-year intervals and into parental age-matched groups. The data were analyzed using the statistical software SPSS version 23.0. The final sample consisted of 248 children and adolescents with ASD diagnosis (case group) and 886 neurotypical individuals with no signs of ASD (control group). Associations between ASD and paternal and maternal ages were significant when evaluated using independent models. However, when included in the same model, only maternal age remained associated. The magnitude of the association was higher when both parents were older. Study 3 aimed to develop and evaluate the results of a training offered to the members of a support team for parents whose child had a diagnosis of ASD. The training comprised three modules (Module I: What is ASD?; Module II: Feelings experienced at the time of diagnosis; Module III: Frequently asked questions at the moment of diagnosis). A questionnaire containing two questions, one closed and one open, applied before and after the training was used as a data collection instrument and a formative assessment instrument was applied after the training. A change in perception was noticed, i.e. before the training, the participants showed emotional involvement when supporting parents, and after they highlighted the importance of advising the parents to seek qualified professionals and have their child followed up by a multiprofessional team. Conclusion: There is still not enough evidence to assert that the perinatal factors mentioned above are considered as etiologic agents, although the exposure to these factors may increase the risk for developing ASD. Associations between ASD and paternal and maternal age were significant when evaluated in independent models. However, when included in the same model only maternal age remained associated. The magnitude of the association was higher when both parents were older. These findings can have important implications for clinical psychiatry and public health. The training raised the participants’ awareness about their need to develop in the cognitive, psychomotor and attitudinal aspects when supporting parents whose child had a diagnosis of ASD.