Explorando a complexidade do comportamento autolesão no transtorno do espectro do autismo: uma revisão sistemática
DOI:
https://doi.org/10.34024/rnc.2025.v33.19952Palavras-chave:
Transtorno do Espectro Autista (TEA), Comportamentos autolesivos (SIB), Diagnóstico de TEA, Autolesão, Terapias para TEAResumo
Introdução. O Transtorno do Espectro Autista (TEA) é um dos transtornos do neurodesenvolvimento caracterizado por déficits de comunicação, comportamentos repetitivos, interesses restritos e dificuldades na interação social. Além dessas características, alguns indivíduos com TEA também apresentam comportamentos autolesivos (SIB), que podem ocorrer em diferentes graus de gravidade e são uma preocupação relevante para pais e cuidadores. Objetivo. Explorar a relação entre os comportamentos autolesivos em indivíduos com TEA, realizando uma revisão sistemática baseada em critérios de inclusão e exclusão estabelecidos. Foram analisados artigos que avaliaram comportamentos autolesivos em indivíduos com TEA, abrangendo diferentes faixas etárias e contextos geográficos. Método. Dos 823 artigos identificados, seis atenderam aos critérios de inclusão, com estudos realizados no Reino Unido, Estados Unidos, Canadá e França. Resultados. A pesquisa revelou que os SIB são comuns em indivíduos com TEA, com prevalência observada tanto em crianças quanto em adultos. Fatores como habilidades cognitivas, presença de condições dolorosas e controle comportamental foram associados à gravidade dos comportamentos autolesivos. Não foram encontradas diferenças significativas entre sexo e SIB, e a sensibilidade à dor parece variar entre os indivíduos. Conclusão. Os SIB são comuns no TEA, destacando a importância de intervenções precoces e abordagens terapêuticas para reduzir os impactos a longo prazo e melhorar a qualidade de vida.
Métricas
Referências
Assumpção Jr FB, Pimentel ACM. Autismo Infantil. Rev Bras Psiquiatr 2000;22:37-9. https://doi.org/10.1590/S1516-44462000000600010
Harris J. Leo Kanner and autism: a 75-year Perspective. Int Rev Psychiatry 2018;30:3-17. https://doi.org/10.1080/09540261.2018.1455646
McGlashan TH. Eugen Bleuler: Centennial Anniversary of His 1911 Publication of Dementia Praecox or the Group of Schizophrenias. Schizophr Bull 2011;37:1101-3. https://doi.org/10.1093/schbul/sbr130
Brodkin E. BALB/c mice: Low Sociability and Other Phenotypes That May Be Relevant to Autism. Behav Brain Res 2007;176:53-65. https://doi.org/10.1016/j.bbr.2006.06.025
Viana CDO, Felismino MFM, Dutra LLA, Bachur TPR, Aragão GF. Testes Comportamentais Para O Estudo Do Transtorno Do Espectro Autista. Infarma Ciênc Farmac 2021;33:106. https://doi.org/10.14450/2318-9312.v33.e2.a2021.pp106-116
Howlin P. Autism and Intellectual disability: Diagnostic and Treatment Issues. J R Soc Med 2000;93:351-5. https://doi.org/10.1177/014107680009300704
Capal JK, Jeste SS. Autism and Epilepsy. Pediatr Clin North Am 2024;71:241-52. https://doi.org/10.1016/j.pcl.2024.01.004
Crawford H, Karakatsani E, Singla G, Oliver C. The Persistence of Self-injurious and Aggressive Behavior in Males with Fragile X Syndrome over 8 Years: a Longitudinal Study of Prevalence and Predictive Risk Markers. J Autism Dev Disord 2019;49:2913-22. https://doi.org/10.1007/s10803-019-04002-3
Failla MD, Gerdes MB, Williams ZJ, Moore DJ, Cascio CJ. Increased Pain Sensitivity and pain-related Anxiety in Individuals with Autism. Pain Rep 2020;5:e861. https://doi.org/10.1097/PR9.0000000000000861
Oakley B, Loth E, Murphy DG. Autism and Mood Disorders. International Rev Psychiatr 2021;33:280-99. https://doi.org/10.1080/09540261.2021.1872506
Lai MC, Lombardo MV, Baron-Cohen S. Autism. Lancet 2014;383:896-910. https://doi.org/10.1016/S0140-6736(13)61539-1
Kirsten TB, Bernardi MM. Prenatal Lipopolysaccharide Induces Hypothalamic Dopaminergic Hypoactivity and autistic-like behaviors: Repetitive self-grooming and Stereotypies. Behav Brain Res 2017;331:25-9. https://doi.org/10.1016/j.bbr.2017.05.013
Fernandes LA, Silva A, Augusto VME, Nogueira NGHM, Ferreira BP, Junqueira C, et al. Análise Da Lateralidade E Destreza Manual Em Crianças Com Transtorno Do Espectro Autista. Rev Bras Edu Esp 2020;26:587-604. https://doi.org/10.1590/1980-54702020v26e0084
Paquet A, Golse B, Girard M, Olliac B, Vaivre-Douret L. Laterality and Lateralization in Autism Spectrum Disorder, Using a Standardized Neuro-Psychomotor Assessment. Dev Neuropsychol 2017;42:39-54. https://doi.org/10.1080/87565641.2016.1274317
Fombonne E. Epidemiology of Autistic Disorder and Other Pervasive Developmental Disorders. J Clin Psychiatry 2005;66(Suppl 10):3-8. https://pubmed.ncbi.nlm.nih.gov/16401144/
Rozance PJ, Limesand SW, Barry JS, Brown LD, Hay WW. Glucose Replacement to Euglycemia Causes Hypoxia, Acidosis, and Decreased Insulin Secretion in Fetal Sheep with Intrauterine Growth Restriction. Pediatr Res 2009;65:72-8. https://doi.org/10.1203/PDR.0b013e318189358c
Leow KQ, Tonta MA, Lu J, Coleman HA, Parkington HC. Towards Understanding Sex Differences in Autism Spectrum Disorders. Brain Res 2024;1833:148877. https://doi.org/10.1016/j.brainres.2024.148877
Ratto AB, Kenworthy L, Yerys BE, Bascom J, Wieckowski AT, White SW, et al. 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
Chaste P, Leboyer M. Autism Risk factors: genes, environment, and gene-environment Interactions. Dialogues Clin Neurosci 2012;14:281-92. https://doi.org/10.31887/DCNS.2012.14.3/pchaste
Lotter V. Epidemiology of Autistic Conditions in Young Children. Social Psychiatr 1966;1:124-35. https://doi.org/10.1007/BF00584048
Zeidan J, Fombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S, et al. Global Prevalence of autism: a Systematic Review Update. Autism Res 2022;15:778-90. https://doi.org/10.1002/aur.2696
Darwin C. A Origem das Espécies. São Paulo: Martin Claret; 2014.
Nock MK. Self-Injury. Annu Rev Clin Psychol 2010;6:339-63. https://doi.org/10.1146/annurev.clinpsy.121208.131258
Whitlock J, Muehlenkamp J, Purington A, Eckenrode J, Barreira P, Baral Abrams G, et al. Nonsuicidal self-injury in a College population: General Trends and Sex Differences. J Am Coll Health 2011;59:691-8. https://doi.org/10.1080/07448481.2010.529626
Summers J, Shahrami A, Cali S, D’Mello C, Kako M, Palikucin-Reljin A, et al. Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input. Brain Sci 2017;7:140. https://doi.org/10.3390/brainsci7110140
Maddox BB, Trubanova A, White SW. Untended wounds: Non-suicidal self-injury in Adults with Autism Spectrum Disorder. Autism 2016;21:412-22. https://doi.org/10.1177/1362361316644731
Richards C, Moss J, Nelson L, Oliver C. Persistence of self-injurious Behaviour in Autism Spectrum Disorder over 3 years: a Prospective Cohort Study of Risk Markers. J Neurodev Disord 2016;8:21. https://doi.org/10.1186/s11689-016-9153-x
Richards C, Davies L, Oliver C. Predictors of Self-Injurious Behavior and Self-Restraint in Autism Spectrum Disorder: Towards a Hypothesis of Impaired Behavioral Control. J Autism Dev Disord. 2017 Mar 9;47(3):701–13. https://doi.org/10.1007/s10803-016-3000-5
Edelson SM. Comparison of Autistic Individuals Who Engage in Self-Injurious Behavior, Aggression, and Both Behaviors. Pediatr Rep 2021;13:558-65. https://doi.org/10.3390/pediatric13040066
Courtemanche AB, Black WR, Reese RM. The Relationship between Pain, Self-Injury, and Other Problem Behaviors in Young Children with Autism and Other Developmental Disabilities. Am J Intellect Dev Disabil 2016;121:194-203. https://doi.org/10.1352/1944-7558-121.3.194
Duerden EG, Card D, Roberts SW, Mak-Fan KM, Chakravarty MM, Lerch JP, et al. Self-injurious behaviours are associated with alterations in the somatosensory system in children with autism spectrum disorder. Brain Struct Funct 2014;219:1251-61. https://doi.org/10.1007/s00429-013-0562-2
Rattaz C, Michelon C, Munir K, Baghdadli A. Challenging Behaviours at Early Adulthood in Autism Spectrum disorders: topography, Risk Factors and Evolution. J Intellec Disab Res 2018;62:637-49. https://doi.org/10.1111/jir.12503
Oliver C, Richards C. Practitioner review: Self-injurious behaviour in children with developmental delay. J Child Psychol Psychiatry. 2015;56(10):1042-54. https://doi.org/10.1111/jcpp.12425
Baghdadli A, Pascal C, Grisi S, Aussilloux C. Risk factors for self‐injurious behaviours among 222 young children with autistic disorders. J Intellec Disab Res 2003;47:622-7. https://doi.org/10.1046/j.1365-2788.2003.00507.x
Baghdadli A, Picot MC, Pry R, Michelon C, Burzstejn C, Lazartigues A, et al. What Factors are Related to a Negative Outcome of Self‐Injurious Behaviour During Childhood in Pervasive Developmental Disorders? J Appl Res Intellec Disab 2008;21:142-9. https://doi.org/10.1111/j.1468-3148.2007.00389.x
Shattuck PT, Seltzer MM, Greenberg JS, Orsmond GI, Bolt D, Kring S, et al. Change in Autism Symptoms and Maladaptive Behaviors in Adolescents and Adults with an Autism Spectrum Disorder. J Autism Dev Disord 2007;37:1735-47. https://doi.org/10.1007/s10803-006-0307-7
Richards C, Oliver C, Nelson L, Moss J. Self‐injurious behaviour in individuals with autism spectrum disorder and intellectual disability. J Intellec Disab Res 2012;56:476-89. https://doi.org/10.1111/j.1365-2788.2012.01537.x
MacLean WE, Tervo RC, Hoch J, Tervo M, Symons FJ. Self-Injury among a Community Cohort of Young Children at Risk for Intellectual and Developmental Disabilities. J Pediatr 2010;157:979-83. https://doi.org/10.1016/j.jpeds.2010.05.052
Esbensen AJ, Seltzer MM, Lam KSL, Bodfish JW. Age-Related Differences in Restricted Repetitive Behaviors in Autism Spectrum Disorders. J Autism Dev Disord 2009;39:57-66. https://doi.org/10.1007/s10803-008-0599-x
Taylor L, Oliver C, Murphy G. The Chronicity of Self-Injurious Behaviour: A Long-Term Follow-Up of a Total Population Study. J Appl Res Intellec Disab 2011;24:105-17. https://doi.org/10.1111/j.1468-3148.2010.00579.x
Emerson E, Kiernan C, Alborz A, Reeves D, Mason H, Swarbrick R, et al. Predicting the persistence of severe self-injurious behavior. Res Dev Disabil 2001;22:67-75. https://doi.org/10.1016/s0891-4222(00)00062-7
Baghdadli A, Assouline B, Sonié S, Pernon E, Darrou C, Michelon C, et al. Developmental Trajectories of Adaptive Behaviors from Early Childhood to Adolescence in a Cohort of 152 Children with Autism Spectrum Disorders. J Autism Dev Disord 2012;42:1314-25. https://doi.org/10.1007/s10803-011-1357-z
Smith RG, Iwata BA, Vollmer TR, Pace GM. On the relationship between self‐injurious behavior and self‐restraint. J Appl Behav Anal 1992;25:433-45. https://doi.org/10.1901/jaba.1992.25-433
Kerth DM, Progar PR, Morales S. The Effects of Non‐Contingent Self‐Restraint on Self‐Injury. J Appl Res Intellec Disab 2009;22:187-93. https://doi.org/10.1111/j.1468-3148.2008.00487.x
Forman D, Hall S, Oliver C. Descriptive Analysis of Self‐injurious Behaviour and Self‐restraint. J Appl Res Intellec Disab 2002;15:1-7. https://doi.org/10.1046/j.1360-2322.2001.00083.x
Matson JL, Wilkins J, Macken J. The Relationship of Challenging Behaviors to Severity and Symptoms of Autism Spectrum Disorders. J Ment Health Res Intellect Disabil 2008;2:29-44. https://doi.org/10.1080/19315860802611415
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2025 Lucas Maruchi Delapena Silva, Liebert Bernardes Carvalho, Eurides Nascimento Dias, Rodrigo Augusto Foganholi da Silva, Maria Martha Bernardi
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Como Citar
Aprovado 2025-03-13
Publicado 2025-03-28
