Desafios diagnósticos e terapêuticos dos transtornos de ansiedade em comorbilidade com o transtorno do espectro Autista: uma revisão integrativa
DOI:
https://doi.org/10.11606/issn.1679-9836.v103i5e-226699Palavras-chave:
Adolescência, Psicofarmacologia, Terapia cognitivo-comportamental, Ansiedade, AutismoResumo
Os Transtornos de Ansiedade são comuns em crianças e jovens com Transtorno do Espectro Autista (TEA), afetando 16-40% dos casos e exacerbando o comprometimento funcional, amplificando comportamentos problemáticos, como déficits nas competências sociais e comportamentos repetitivos. O artigo pretende explorar a interação entre TEA e Transtornos de Ansiedade, com foco na prevalência, diagnóstico e tratamento. Foi realizada uma revisão da literatura em bases de dados como Medline/PubMed, destacando as implicações clínicas para a gestão dessas comorbilidades. A avaliação de psicopatologia é complexa, tendo em conta as dificuldades de base presentes no TEA, incluindo respostas não verbais atípicas e limitações na expressão emocional, e da frequente sobreposição entre os sintomas de ansiedade e os sintomas do TEA. Para além disso, os sintomas de ansiedade podem variar dos critérios convencionais estabelecidos nos manuais de diagnóstico de psicopatologia. O diagnóstico diferencial entre TEA e Ansiedade Social é desafiador devido a sintomas semelhantes. Existe uma demanda por abordagens terapêuticas específicas, como a terapia cognitivo-comportamental modificada, incorporando reconhecimento emocional e treino de competências sociais. Intervenções farmacológicas requerem cuidado devido à escassez de estudos sobre ISRS e aos potenciais efeitos laterais em indivíduos com TEA.
Downloads
Referências
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.)2022. Doi: 10.1176/appi.books.9780890425787
Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, et al. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network. Morb Mortal Weekly Rep Surveil Sum. 2018;67(6):1-23. Doi: 10.15585/mmwr.ss6706a1
Lai M, Lombardo M, Baron-Cohen S. Autism. The Lancet. 2014;383(9920):896-910. Doi: 10.1016/S0140-6736(13)61539-1
Kerns CM, Winder-Patel B, Iosif AM, Nordahl CW, Heath B, Solomon M, et al. Clinically Significant Anxiety in Children with Autism Spectrum Disorder and Varied Intellectual Functioning. J Clin Child Adol Psychol. 2021;50(6):780-95. Doi: 10.1080/15374416.2019.1703712
Wood JJ, Gadow KD. Exploring the Nature and Function of Anxiety in Youth with Autism Spectrum Disorders. Clin Psychol Sci Pract. 2010;17(4):281-92. Doi: 10.1111/j.1468-2850.2010.01220.x
Kerns C.M, Rump K, Worley J, Kratz H, McVey A, Herrington J, et al. The Differential Diagnosis of Anxiety Disorders in Cognitively-Able Youth With Autism. Cogn Behav Pract. 2016;23(4):530-47. Doi: 10.1016/j.cbpra.2015.11.004
Ung D, Selles R, Small BJ, Storch EA. A Systematic Review and Meta-Analysis of Cognitive-Behavioral Therapy for Anxiety in Youth with High-Functioning Autism Spectrum Disorders. Child Psych Human Develop. 2015;46(4):533-47. Doi: 10.1007/s10578-014-0494-y
Rigles B. The Relationship Between Adverse Childhood Events, Resiliency and Health Among Children with Autism. J Autism Develop Disorders. 2017;47(1):187-202. Doi: 10.1007/s10803-016-2905-3
Wood J.J, Kendall P.C, Wood K.S, Kerns C.M, Seltzer M, Small B.J, et al. Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder: A Randomized Clinical Trial. JAMA Psych. 2020;77(5):474-83. Doi: 10.1007/978-1-4419-6975-0_7
Farrugia S, Hudson J. Anxiety in Adolescents With Asperger Syndrome: Negative Thoughts, Behavioral Problems, and Life Interference. Focus Autism Other Develop Disabil. 2006;21(1):25-35. Doi: 10.1177/10883576060210010401
Joshi G, Petty C, Wozniak J, Henin A, Fried R, Galdo M, et al. The Heavy Burden of Psychiatric Comorbidity in Youth with Autism Spectrum Disorders: A Large Comparative Study of a Psychiatrically Referred Population. J Autism Develop Disord. 2010;40(11):1361-70. Doi: 10.1007/s10803-010-0996-9
Chiang HL, Gau SS. Comorbid psychiatric conditions as mediators to predict later social adjustment in youths with autism spectrum disorder. J Child Psychol Psych. 2016;57(1):103-11. Doi: 10.1111/jcpp.12450
Postorino V, Scahill L, De Peppo L, Fatta LM, Zanna V, Castiglioni MC, et al. Investigation of Autism Spectrum Disorder and Autistic Traits in an Adolescent Sample with Anorexia Nervosa. J Autism Develop Disord. 2017;47(4):1051-61. Doi: 10.1007/s10803-016-3023-y
Spain D, Sin J, Linder K, McMahon J, Happe F. Social anxiety in autism spectrum disorder: A systematic review. Res Autism Spect Disord. 2018;52:51-68. Doi: 10.1016/j.rasd.2018.04.007
Hagopian LP, Jennett HK. Behavioral assessment and treatment for anxiety for those with autism spectrum disorder. In: Davis TE WS, Ollendick TH, editor. Handbook of Autism and Anxiety Basel, Switzerland.: Springer International Publishing; 2014. Doi: https://doi.org/10.1007/978-3-319-06796-4_11
Chang Y, Quan J, Wood J. Effects of Anxiety Disorder Severity on Social Functioning in Children with Autism Spectrum Disorders. J Develop Phys Disabil. 2012;24. Doi: 10.1007/s10882-012-9268-2
Kerns CM, Renno P, Kendall PC, Wood JJ, Storch EA. Anxiety Disorders Interview Schedule-Autism Addendum: Reliability and Validity in Children With Autism Spectrum Disorder. J Clin Child Adolesc Psychol. 2017;46(1):88-100. Doi: 10.1080/15374416.2016.1233501
van Steensel FJ, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Family Psychol Review. 2011;14(3):302-17. Doi: 10.1007/s10567-011-0097-0
Costello EJ, Egger HL, Angold A. The developmental epidemiology of anxiety disorders: phenomenology, prevalence, and comorbidity. Child Adolesc Psych Clin North Am. 2005;14(4):631-48, vii. Doi: 10.1016/j.chc.2005.06.003
Kent R, Simonoff E. Prevalence of Anxiety in Autism Spectrum Disorders. In: Press A, editor. Anxiety in Children and Adolescents with Autism Spectrum Disorder2017. p. 5-32. https://doi.org/10.1016/B978-0-12-805122-1.00002-8
Mukaddes NM, Fateh R. High rates of psychiatric co-morbidity in individuals with Asperger's disorder. World J Biol Psych. 2010;11(2 Pt 2):486-92. Doi: 10.1080/15622970902789130
Kerns CM, Kendall PC. The Presentation and Classification of Anxiety in Autism Spectrum Disorder. Clin Psychol Sci Pract. 2012;19(4):323-47. Doi: 10.1111/cpsp.12009
Anxiety in Autism Spectrum Disorder: Hearing before the Lurie Center For Autism(2022).
Kerns CM, Kendall PC, Zickgraf H, Franklin ME, Miller J, Herrington J. Not to be overshadowed or overlooked: functional impairments associated with comorbid anxiety disorders in youth with ASD. Behav Ther. 2015;46(1):29-39. Doi: 10.1016/j.beth.2014.03.005
Sukhodolsky DG, Scahill L, Gadow K.D, Arnold LE, Aman MG, McDougle CJ, et al. Parent-Rated Anxiety Symptoms in Children with Pervasive Developmental Disorders: Frequency and Association with Core Autism Symptoms and Cognitive Functioning. J Abnorm Child Psychol. 2008;36(1):117-28. Doi: 10.1007/s10802-007-9165-9
Kaat AJ, Gadow KD, Lecavalier L. Psychiatric symptom impairment in children with autism spectrum disorders. J Abnormal Child Psychol. 2013;41(6):959-69. Doi: 10.1007/s10802-013-9739-7
Vasa R.A, Mazurek MO, Mahajan R, Bennett AE, Bernal MP, Nozzolillo AA, et al. Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders. Pediatrics. 2016;137 Suppl 2:S115-23. Doi: 10.1542/peds.2015-2851J
Gotham K, Brunwasser SM, Lord C. Depressive and anxiety symptom trajectories from school age through young adulthood in samples with autism spectrum disorder and developmental delay. J Am Acad Child Adolesc Psych. 2015;54(5):369-76.e3. Doi: 10.1016/j.jaac.2015.02.005
Reaven J. The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: developmental considerations for parents. Brain Res. 2011;1380:255-63. Doi: 10.1016/j.brainres.2010.09.075
Johnco C, Storch EA. Anxiety in youth with autism spectrum disorders: implications for treatment. Expert review of neurotherapeutics. 2015;15(11):1343-52. Doi: 10.1586/14737175.2015.1111762
Tyson K, Cruess D. Differentiating high-functioning autism and social phobia. J Autism Develop Disord. 2012;42(7):1477-90. Doi: 10.1007/s10803-011-1386-7
Kleberg J, Högström J, Nord M, Bölte S, Serlachius E, Falck-Ytter T. Autistic Traits and Symptoms of Social Anxiety are Differentially Related to Attention to Others' Eyes in Social Anxiety Disorder. J Autism Develop Disorders. 2017;47(12):3814-21. doi: 10.1007/s10803-016-2978-z
Kuusikko S, Pollock-Wurman R, Jussila K, Carter AS, Mattila ML, Ebeling H, et al. Social anxiety in high-functioning children and adolescents with Autism and Asperger syndrome. Journal of autism and developmental Disord. 2008;38(9):1697-709. Doi: 10.1007/s10803-008-0555-9
Joosten AV, Bundy AC, Einfeld SL. Intrinsic and extrinsic motivation for stereotypic and repetitive behavior. J Autism Develop Disord. 2009;39(3):521-31. Doi: 10.1007/s10803-008-0654-7
Briot K, Jean F, Jouni A, Geoffray M, Ly-Le Moal M, Umbricht D, et al. Social Anxiety in Children and Adolescents With Autism Spectrum Disorders Contribute to Impairments in Social Communication and Social Motivation. Front Psych. 2020;11:710. Doi: 10.3389/fpsyt.2020.00710
Zablotsky B, Pringle BA, Colpe LJ, Kogan MD, Rice C, Blumberg SJ. Service and treatment use among children diagnosed with autism spectrum disorders. J Develop Behav Pediat. 2015;36(2):98-105. Doi: 10.1097/dbp.0000000000000127
Nacional Institute for Health and Care Excellence. Anxiety Disorders - Quality standard [QS53]. NICE; 2014.
McKay D, Storch EA. Cognitive-behavior therapy for children: Treating complex and refractory cases: Springer Publishing Company; 2009.
Reaven J, Blakeley-Smith A, Culhane-Shelburne K, Hepburn S. Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. J Child Psychol Psych. 2012;53(4):410-9. Doi: 10.1111/j.1469-7610.2011.02486.x
Storch EA, Lewin A.B, Collier AB, Arnold E, De Nadai AS, Dane BF, et al. A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. Depres Anxiety. 2015;32(3):174-81. Doi: 10.1002/da.22332
Wood J.J, Ehrenreich-May J, Alessandri M, Fujii C, Renno P, Laugeson E, et al. Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial. Behav Ther. 2015;46(1):7-19. Doi: 10.1016/j.beth.2014.01.002
National Institute for Health and Care Excellence: Clinical Guidelines. Autism spectrum disorder in under 19s: support and management London: National Institute for Health and Care Excellence (NICE) Copyright © NICE 2021.; 2021.
Puleo CM, Kendall PC. Anxiety disorders in typically developing youth: autism spectrum symptoms as a predictor of cognitive-behavioral treatment. J Autism Develop Disord. 2011;41(3):275-86. Doi: 10.1007/s10803-010-1047-2
Wood JJ, Klebanoff S, Renno P, Fujii C, Danial J. Individual CBT for Anxiety and Related Symptoms in Children With Autism Spectrum Disorders. In: Kerns CM, Renno P, Storch EA, Kendall PC, Wood JJ, editors. Anxiety in Children and Adolescents with Autism Spectrum Disorder: Academic Press; 2017. p. 123-41. doi: 10.1016/B978-0-12-805122-1.00007-7
Wood JJ, Fujii C, Renno P. Cognitive behavioral therapy in high-functioning autism: Review and recommendations for treatment development. Evidence-based practices and treatments for children with autism. New York, NY, US: Springer Science + Business Media; 2011. p. 197-230. Doi: 10.1007/978-1-4419-6975-0_7
Kenworthy L, Anthony L.G, Naiman DQ, Cannon L, Wills MC, Luong-Tran C, et al. Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. J Child Psychol Psych. 2014;55(4):374-83. Doi: 10.1111/jcpp.12161
Bruin EI, Blom R, Smit FM, van Steensel FJ, Bögels SM. MYmind: Mindfulness training for Youngsters with autism spectrum disorders and their parents. Autism: Intern J Res Pract. 2015;19(8):906-14. Doi: 10.1177/1362361314553279
Shekunov J, Wozniak J, Conroy K, Pinsky E, Fitzgerald M, de Leon MF, et al. Prescribing Patterns in a Psychiatrically Referred Sample of Youth With Autism Spectrum Disorder. J Clin Psych. 2017;78(9):e1276-e83. Doi: 10.4088/JCP.16m11406
Vasa RA, Carroll LM, Nozzolillo AA, Mahajan R, Mazurek MO, Bennett AE, et al. A Systematic Review of Treatments for Anxiety in Youth with Autism Spectrum Disorders. J Autism Develop Disord. 2014;44(12):3215-29. Doi: 10.1007/s10803-014-2184-9
Thorkelson G, Laughlin SF, Turner KS, Ober N, Handen BL. Selective Serotonin Reuptake Inhibitor Monotherapy for Anxiety Disorders in Children and Adolescents with Autism Spectrum Disorder: A Chart Review. J Child Adolesc Psychopharmacol. 2019;29(9):705-11. Doi: 10.1089/cap.2019.0001
Accordino RE, Kidd C, Politte LC, Henry CA, McDougle CJ. Psychopharmacological interventions in autism spectrum disorder. Exp Opin Pharmacother. 2016;17(7):937-52. Doi: 10.1517/14656566.2016.1154536
Reddihough DS, Marraffa C, Mouti A, O'Sullivan M, Lee KJ, Orsini F, et al. Effect of Fluoxetine on Obsessive-Compulsive Behaviors in Children and Adolescents With Autism Spectrum Disorders: A Randomized Clinical Trial. Jama. 2019;322(16):1561-9. Doi: 10.1001/jama.2019.14685
Taylor D, Barnes T, Young A. The Maudsley prescribing guidelines in psychiatry (14th ed.). Sons. JW, editor. New York, NY2018.
Chugani DC, Chugani HT, Wiznitzer M, Parikh S, Evans PA, Hansen RL. Efficacy of Low-Dose Buspirone for Restricted and Repetitive Behavior in Young Children with Autism Spectrum Disorder: A Randomized Trial. J Pediatr. 2016;170:45-53. Doi: 10.1016/j.jpeds.2015.11.033
Ceranoglu TA, Wozniak J, Fried R, Galdo M, Hoskova BFMD. A Retrospective Chart Review of Buspirone for the Treatment of Anxiety in Psychiatrically Referred Youth with High-Functioning Autism Spectrum Disorder. J Child Adolesc Psychopharmacol. 2019;29(1):28-33. Doi: 10.1089/cap.2018.0021
Wehry A, Beesdo-Baum K, Hennelly M, Connolly S, Strawn J. Assessment and treatment of anxiety disorders in children and adolescents. Curr Psychiatry Rep. 2015;17(7):52. Doi: 10.1007/s11920-015-0591-z
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2024 Manuela Araújo, Maria do Rosário Nascimento e Sousa de Bessa Monteiro
Este trabalho está licenciado sob uma licença Creative Commons Attribution-ShareAlike 4.0 International License.
