Camuflagem social e diagnóstico tardio de autismo em mulheres: uma revisão integrativa
DOI:
https://doi.org/10.34024/rnc.2024.v32.16553Palavras-chave:
Diagnóstico Tardio, Estereotipagem de Gênero, Mulheres, Transtorno do Espectro AutistaResumo
Introdução. O transtorno do espectro autista (TEA) é um transtorno do neurodesenvolvimento caracterizado por comportamentos repetitivos e déficits na comunicação e na interação social. Apesar de o diagnóstico ocorrer, comumente, aos 4 a 5 anos de idade, por meio sobretudo de questionários, apenas 1/5 das mulheres têm seu diagnóstico anterior aos 11 anos, fato que, somado à menor proporção de mulheres com o transtorno suscita a busca pelo porquê dessa discrepância, cuja resposta pode permear o predomínio do fenômeno da camuflagem nesse grupo. Objetivo. essa revisão objetiva discutir a influência da camuflagem social da mulher sobre o diagnóstico tardio do quadro de transtorno do espectro autista. Método. Foi realizada uma revisão integrativa nas bases de dados BVS e PUBMED, resultando em 36 artigos selecionados após aplicação dos critérios de inclusão e de exclusão definidos. Resultados. A camuflagem se pauta no mascaramento de determinadas características, sendo mais praticada por portadores de TEA, implicando consequências severas aos praticantes, como exaustão e ansiedade. O fenômeno teve suas características básicas associadas ao fenótipo feminino do autismo já em 1992 para explicar o fenótipo e o subdiagnóstico nesse grupo. Trata-se de uma prática mais realizada por mulheres autistas, conforme estudos, devido, dentre outros fatores, às maiores demandas sociais impostas diante da estereotipagem de gênero inerente. Conclusão. Assim, além do fenótipo autista feminino ser diferente do masculino, a camuflagem ameniza esse, dificultando a identificação do transtorno tanto por especialistas, quanto pelas ferramentas de diagnóstico e por aqueles que convivem com o indivíduo.
Métricas
Referências
Sociedade Brasileira de Pediatria (SBP). Departamento Científico de Pediatria do Desenvolvimento e Comportamento. Transtorno do Espectro do Autismo. 5 ed. 2019. https://www.sbp.com.br/fileadmin/user_upload/21775c-MO_-_Transtorno_do_Espectro_do_Autismo.pdf
Belcher H, Morein-Zamir S, Mandy W, Ford RM. Camouflaging Intent, First Impressions, and Age of ASC Diagnosis in Autistic Men and Women. J Autism Dev Disord 2021;52:3413-26. https://doi.org/10.1007/s10803-021-05221-3
Rynkiewicz A, Janas-Kozik M, Slopien A. Girls and women with autismo. Psychiatr Polska 2019;53:737-52. https://doi.org/10.12740/PP/OnlineFirst/95098
Tubío-Fungeiriño M, Cruz S, Sampaio A, Carracedo A, Fernández-Prieto M. Social Camouflaging in Females with Autism Spectrum Disorder: A Systematic Review. J Autism Dev Disord 2021;51:2190-9. https://doi.org/10.1007/s10803-020-04695-x
Corbett B, Schwartzman JM, Libsack EJ, Muscatello RA, Lerner MD, Simmons GL, et al. Camouflaging in Autism: Examining Sex-Based and Compensatory Models in Social Cognition and Communication. Autism Res 2021;14:127-42. https://doi.org/10.1002/aur.2440
Halsall J, Clarke C, Crane L. “Camouflaging” by adolescent autistic girls who attend both mainstream and specialist resource classes: Perspectives of girls, their mothers and their educators. Autism 2021;25:2074-86. https://doi.org/10.1177/13623613211012819
Schuck R, Flores R, Fung L. Brief Report: Sex/Gender Differences in Symptomology and Camouflaging in Adults with Autism Spectrum Disorder. J Autism Dev Disord 2019;49:2597-2604. https://doi.org/10.1007/s10803-019-03998-y
Gil AC. Como Elaborar Projetos de Pesquisa. 4. ed. São Paulo: Editora Atlas AS; 2002. https://bit.ly/3BYOexF
Souza MT, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer. Einstein 2010;8:102-6. https://doi.org/10.1590/S1679-45082010RW1134
Page MJ, McKenzie JE, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;71:372. https://doi.org/10.1136/bmj.n71
American Psychiatric Association. DSM-V: Manual de Diagnóstico de Distúrbios Mentais. Porto Alegre: Artmed; 2014. https://www.institutopebioetica.com.br/documentos/manual-diagnostico-e-estatistico-de-transtornos-mentais-dsm-5.pdf
Ratto A, Kenworthy L, Anthony LG. What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills. J Autism Dev Disord 2018;48:1698-711. https://doi.org/10.1007/s10803-017-3413-9
Mcfayden T, Albright J, Muskett AE, Scarpa A. Brief Report: Sex Differences in ASD Diagnosis—A Brief Report on Restricted Interests and Repetitive Behaviors. J Autism Dev Disord 2019;49:1693-9. https://doi.org/10.1007/s10803018-3838-9
Lai M, Szatmari P. Sex and gender impacts on the behavioural presentation and recognition of autismo. Curr Opin Psychiatr 2020;33:117-23. https://doi.org/10.1097/YCO.0000000000000575
Rujeedawa T, Zaman S. The Diagnosis and Management of Autism Spectrum Disorder (ASD) in Adult Females in the Presence or Absence of an Intellectual Disability. Inter J Environ Res Pub Health 2022;19:1315. https://doi.org/0.3390/ijerph19031315
Murray A, Booth T, Auyeung B, McKenzie K, Kuenssberg R. Investigating Sex Bias in the AQ-10: A Replication Study. Assessment 2019;26:1474-9. https://doi.org/10.1177/1073191117733548
Cook J, Crane L, Bourne L, Hull L, Mandy W. Camouflaging in an everyday social context: An interpersonal recall study. Autism 2021;25:1444-56. https://doi.org/10.1177/1362361321992641
Bernardin CJ, Mason E, Lewis T, Kanne S. “You Must Become a Chameleon to Survive”: Adolescent Experiences of Camouflaging. J Autism Dev Disord 2021;51:4422-35. https://doi.org/10.1007/s10803-021-04912-1
Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, et al. “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. J Autism Dev Disord 2017;47:2519-34. https://doi.org/10.1007/s10803-017-3166-5
Schneid I, Raz A. The mask of autism: Social camouflaging and impression management as coping/normalization from the perspectives of autistic adults. Soc Sci Med 2020;248:112826. https://doi.org/10.1016/j.socscimed.2020.112826
Perry E, Mandy W, Hull L, Cage E. Understanding Camouflaging as a Response to Autism - Related Stigma: A Social Identity Theory Approach. J Autism Dev Disord 2022;52:800-10. https://doi.gov/10.1007/s10803-021-04987-w
Cook J, Crane L, Hull L, Bourne L, Mandy W. Self-reported camouflaging behaviours used by autistic adults during everyday social interactions. Autism 2022;26:406-21. https://doi.org/10.1177/13623613211026754
Hull L, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides KV, et al. Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism 2020;24:352-63. https://doi.org/10.1177/1362361319864804
Beck J, Lundwall RA, Gabrielsen T, Cox JC, South M. Looking good but feeling bad: “Camouflaging” behaviors and mental health in women with autistic traits. Autism 2020;21:809-21. https://doi.gov/10.1177/1362361320912147
Jorgenson C, Lewis T, Chad R, Kanne S. Social Camouflaging in Autistic and Neurotypical Adolescents: A Pilot Study of Differences by Sex and Diagnosis. J Autism Dev Disord 2020;50:4344-55. https://doi.org/10.1007/s10803020-04491-7
Livingston L, Happé F. Conceptualising compensation in neurodevelopmental disorders: Reflections from autism spectrum disorder. Neurosci Biobehav Rev 2017;80:729-42. https://doi.org/10.1016/j.neubiorev.2017.06.005
Cook J, Hull L, Crane L, Mandy W. Camouflaging in autism: A systematic review. Clin Psychol Rev 2021;89:102080. https://doi.org/10.1016/j.cpr.2021.102080
Livingston L, Shah P, Milner V, Happé F. Quantifying compensatory strategies in adults with and without diagnosed autismo. Mol Autism 2020;11:1-10. https://doi.org/10.1186/s13229-019-0308-y
Dell’osso L, Cremone, IM, Chiarantinu I, Arone A, Massimetti, G, Carmassi C, et al. Autistic traits and camouflaging behaviours: A cross-sectional investigation in a University student population. CNS Spectrum 2021;27:740-6. https://doi.org/10.1017/S1092852921000808
Mcquaid G, Lee N, Wallace G. Camouflaging in autism spectrum disorder: Examining the roles of sex, gender identity, and diagnostic timing. Autism 2022;26:552-9. https://doi.org/10.1177/13623613211042131
Cage E, Troxell-Whitman Z. Understanding the Reasons, Contexts and Costs of Camouflaging for Autistic Adults. J Autism Dev Disord 2019;49:1899-911. https://doi.org/10.1007/s10803-018-03878-x
Wood-Downie H, Wong B, Kovshoff H, Mandy W, Hull L, Hadwin JA. Sex/Gender Differences in Camouflaging in Children and Adolescents with Autism. J Autism Dev Disord 2021;51:1353-64. https://doi.org/10.1007/s10803-020-04615-z
Lai M, Lombardo MV, Ruigrok ANV, Chakrabarti B, Auyeung B, Szatmari P, et al. Quantifying and exploring camouflaging in men and women with autismo. Autism 2017;21:690-702. https://doi.org/10.1177/1362361316671012
Green R, Travers AM, Howe Y, McDougle CJ. Women and Autism Spectrum Disorder: Diagnosis and Implications for Treatment of Adolescents and Adults. Curr Psychiatr Rep 2019;21:22. https://doi.org/10.1007/s11920-019-1006-3
Beauvoir S. O segundo sexo: fatos e mitos. 4. ed. São Paulo: Difusão Europeia do Livro; 1970.
Lundin K, Mahdi S, Isaksson J, Bolte S. Functional gender differences in autism: An international, multidisciplinary expert survey using the International Classification of Functioning, Disability, and Health model. Autism 2021;25:1020-35. https://doi.org/10.1177/1362361320975311
Whitlock A, Fulton K, Lai MC, Pellicano E, Mandy W. Recognition of Girls on the Autism Spectrum by Primary School Educators: An Experimental Study. Autism Res 2020;13:1358-72. https://doi.org/10.1002/aur.2316
Cola M, Plate S, Yankowitz L, Petrulla V, Bateman L, Zampella CJ, et al. Sex differences in the first impressions made by girls and boys with autism. Mol Autism 2020;11:49. https://doi.org/10.1186/s13229-02000336-3
Young H, Oreve M, Speranza M. Clinical characteristics and problems diagnosing autism spectrum disorder in girls. Arc Ped 2018;25:399-403. https://doi.org/10.1016/j.arcped.2018.06.008
Hervás A. Género femenino y autismo: infra detección y mis diagnósticos. Medicina (B. Aires) 2022;82:37-42. https://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802022000200037
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2024 Érica Otoni Pereira Miranda, Lisandra Maria Maria Pereira Fontes Chagas

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Como Citar
Aprovado 2024-09-03
Publicado 2024-09-23
