Características de personalidade de mães de crianças com diagnóstico de autismo infantil: um estudo comparativo
Data
2000
Autores
Duarte, Cristiane Seixas 
Orientadores
Yazigi, Latife
Yazigi, Latife
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A descrição da personalidade das mães das crianças autistas, iniciada por
KANNER (1943) e desenvolvida por autores da área psicanalítica, sugeria o comprometimento
da capacidade afetiva e relacional. Nas últimas duas décadas, estudos sistemáticos têm referido
níveis elevados de estresse em mães de crianças autistas e há intenso trabalho de investigação
sobre que fatores estariam associados ao estresse experienciado. Mais recentemente, tem sido
investiga a hipótese de que a vulnerabilidade genética no autismo poderia se parentes não-
autistas das crianças autistas, por alterações leves, mas qualitativamente semelhantes àquelas das crianças. São identificadas alterações sociais, na comunicação e padrões repetitivos de
comportamento em mães de crianças autistas.
Objetivos: Verificar se as mães de crianças autistas possuem características específicas de
personalidade nas áreas afetiva, de relacionamentos interpessoais e estresse; identificar quais
fatores estão associados a essa(s) característica(s); e se essas mães apresentam um padrão próprio de representação objetal.
Desenho do Estudo: Caso-controle.
Local: Três ambulatórios de psiquiatria infantil, um Centro de Saúde e duas escolas da rede
pública (cidade de São Paulo).
Participantes: trinta e uma mães de crianças autistas pareadas por idade/gênero da criança e
idade da mãe com 31 mães de crianças sem problemas de saúde mental (escore T < 60 no
Inventário de Comportamentos da Infância e Adolescência – CBCL).
Metodologia: O Método de Rorschach, aplicado e avaliado conforme instruções do Sistema
Compreensivo foi utilizado para avaliar dez características de personalidade relacionadas com as
hipóteses do estudo e mais três variáveis confundidoras. Além das características de
personalidade, na avaliação dos fatores associados foram consideradas cinco características
sócio-demográficas e sete características relacionadas ao quadro clínico de autismo,
escolarização e tratamento. Para investigação do padrão de representações objetais das mães foi
aplicada às respostas humanas a Escala de Relações Objetais (BLATT et al., 1976) e efetuado
um estudo das temáticas recorrentes nessas respostas. A concordância entre examinadores no
Método de Rorschach (aferida através dos coeficientes Kappa e Coeficiente de Correlação
Intraclasses) variou de substancial (0,61-0,81) a excelente (>0,81) em todas as variáveis do
Sistema Compreensivo e em todas as categorias da Escala de Relações Objetais, exceto duas.
Resultados: A análise de regressão logística mostra que as mães das crianças autistas têm
probabilidade duas vezes maior do que as mães do grupo controle de experienciar estresse, parte
do qual determinado por elementos situacionais (OR=2,01; IC95%:1,18–3,69). A análise de três
modelos de regressão logística indica que esse estresse está associado a ter um filho autista
(OR=13,27; IC95%:2,83–62,17); baixa propensão a demonstração de afetos (OR=1,46;
IC95%:1,04-2,05); pouco interesse por pessoas (OR=1,39; IC95%:1,09–1,78); maior idade
materna (OR=0,86; IC95%:0,74–0,89); e menor idade da criança (OR=1,53; IC95%:1,08–2,17).
O nível de desenvolvimento estrutural da representação de objeto das mães de crianças autistas é
semelhante ao de controles em respostas adequadas à realidade (7,94 e 8,95; p = 0,131,
respectivamente na Escala OR+) mas menor em respostas distorcidas (4,97 e 7,0; p = 0,04
respectivamente na Escala OR-). A abordagem temática das representações objetais revela
figuras humanas bem construídas e coerentes embora desvalorizadas com componentes
relacionados à sexualidade não devidamente integrados. Observa-se também a representação de
temas relacionados à infância de modo indefinido e passivo.
Conclusões: As mães de crianças autistas experimentam maiores níveis de estresse ao menos
parcialmente determinado por elementos circunstanciais o que sugere que ao menos parte desse
estresse seja uma consequência do contato com a criança autista do que associada às causas do
quadro. Não foi identificado um padrão particular de demonstração e expressão afetiva (área do
afeto) ou de interesse por relacionamentos interpessoais. O principal fator responsável pelo
estresse das mães estudadas é o fato de ter um filho autista, mas a presença de outros fatores
(como expressão afetiva e interesse por pessoas diminuídos, maior idade materna e menor idade
da criança) podem aumentar ainda mais esse estresse, o que sugere a existência de subgrupos de mães de crianças autistas que merecem especial atenção por parte dos profissionais de saúde
mental. Fatores associados à gravidade do autismo, seu tratamento e escolarização da criança
autista parecem não ter influência sobre a experiência de estresse das mães de crianças autistas.
O padrão estrutural de representação objetal de mães de crianças autistas é semelhante ao de
mães de crianças sem problemas de saúde mental quando é empregada a Escala OR+ ou quando
um escore único, contínuo de representação estrutural de objeto é utilizado (RORSCORE).
Quando são consideradas separadamente as situações de distorção perceptiva da realidade
(Escala OR-), mães de crianças autistas apresentam níveis de desenvolvimento das
representações estruturais de objeto menores do que as mães do grupo controle. Esse resultado,
considerado em conjunto com elementos observados na análise temática podem ser interpretados
como indicadores do emprego de estratégias defensivas rígidas por parte das mães de crianças
autistas que podem estar associadas a uma estrutura neurótica de personalidade. Algumas mães
de crianças autistas apresentam uma visão de si mesma e de seus filhos associada a elementos
primitivos, mas parece que esse fato não caracteriza o grupo de mães de autistas.
Introduction: The description of autistic children's mothers personality, first considered by Kanner (1943) and further developed by psychoanalysts, suggested the existence of affective and interpersonal difficulties. In the last two decades, systematic studies have detected high levels of stress in autistic children's mothers and intense investigation has been performed on factors associated with such stress. More recently, the hypothesis that genetic liability for autism may be expressed in nonautistic relatives in milder but qualitatively similar features has been investigated. It has been found repetitive behavior patterns and social and communication problems in mothers of autistic children. Objectives: Verify if mothers of autistic children have specific personality characteristics in affect, interpersonal relationships and stress; identify which factors would be associated to these characteristics; and verify if these mothers have a particular object representation pattern. Design: Case-control study. Setting: Three psychiatric outpatient clinics, a primary care unit, and two public schools (São Paulo-Brazil). Participants: Thirty-one mothers of autistic children and 31 mothers of children without mental health problems (T score < 60 in the Child Behavior Checklist - CBCL) matched by child age/gender and mother age. Method: The Rorschach Method (applied and interpreted according to the Comprehensive System instructions) was used to assess 10 personality characteristics linked to the study hypothesis plus three confounds. In the evaluation of the associated factors, besides the personality characteristics, five demographic characteristics and seven characteristics related to the clinical picture of autism, schooling and treatment were considered. The Scale of Object Representation (OR Scale) formulated by Blatt et al. (1976), and the study of the thematic content of human responses were used to investigate mother’s object representations. Rorschach’s Method inter examiners agreement (assessed through Kappa and Intraclass Correlation Coefficient) varied from substantial (0.61-0.81) to excellent (>0.81) in all variables of the Comprehensive System and in all, except two, categories of the OR Scale. Results: Logistic regression analysis showed that mothers of autistic children were two times more likely to experience stress than mothers of children without behavior problems at least partially determined by situational elements (OR=2.01; IC95%:1.18–3.69). The analysis of three models of logistic regression indicated that stress was associated with having an autistic child (OR=11.85; IC95%:2.68-52.49); poor affective expression (OR=1.45; IC95%:1.03-2.03); little interest in people (OR=1.34; IC95%:1.06-1.70); being an older mother (OR=0.86; IC95%:0.75- 0.99); and having a younger child (OR=1.51; IC95%:1.1-2.12). The autistic children's mothers presented a level of structural development of object representation similar to the control group in answers adapted to reality (7.94 and 8.95; p = 0.131, respectively in OR+ Scale), but a smaller level in distorted answers (4.97 and 7.0; p = 0,04 respectively in OR- Scale). Although thematic content analysis of object representation revealed good and coherent human representations, the mechanism of devaluation was used sometimes and sexuality components were not properly integrated. It was also seen more indefinite and passive childhood representations. Conclusions: Mothers of autistic children presented higher levels of stress to some extent determined by situational experiences, suggesting that at least part of such stress should be a consequence of the contact with the autistic children. No peculiar personality pattern of affective demonstration and expression or of interpersonal relationships was identified. Having an autistic son was the main factor responsible for mothers' stress but other factors (e.g. decreased affective expression and interest in people, older mother, younger child) may increase that stress, suggesting that there is a subgroup of mothers that deserves special attention of mental health professionals. Clinical characteristics of the autistic picture do not seem to influence the stress experienced by the mothers. The pattern of structural object representation of the autistic children’s mothers is similar to the pattern of control mothers when measured by OR+ Scale, or when a single, continuous structural object representation score (RORSCORE) is used. Considering reality distortion situations independently (OR-), autistic children’s mothers present lower levels of structural object representation scores than control mothers do. This result, taking together with those of the thematic analysis can be interpreted as indicating that mothers of autistic children use rigid defense strategies, which might be associated with a neurotic personality structure. Some autistic children's mothers see themselves and their children in a primitive and passive way but that does not seem to characterize mothers of autistic children as a group. According to the structural and thematic analyses of object representation, mothers of autistic children seem to have rigid defense mechanisms usually found in neurotic personality organizations.
Introduction: The description of autistic children's mothers personality, first considered by Kanner (1943) and further developed by psychoanalysts, suggested the existence of affective and interpersonal difficulties. In the last two decades, systematic studies have detected high levels of stress in autistic children's mothers and intense investigation has been performed on factors associated with such stress. More recently, the hypothesis that genetic liability for autism may be expressed in nonautistic relatives in milder but qualitatively similar features has been investigated. It has been found repetitive behavior patterns and social and communication problems in mothers of autistic children. Objectives: Verify if mothers of autistic children have specific personality characteristics in affect, interpersonal relationships and stress; identify which factors would be associated to these characteristics; and verify if these mothers have a particular object representation pattern. Design: Case-control study. Setting: Three psychiatric outpatient clinics, a primary care unit, and two public schools (São Paulo-Brazil). Participants: Thirty-one mothers of autistic children and 31 mothers of children without mental health problems (T score < 60 in the Child Behavior Checklist - CBCL) matched by child age/gender and mother age. Method: The Rorschach Method (applied and interpreted according to the Comprehensive System instructions) was used to assess 10 personality characteristics linked to the study hypothesis plus three confounds. In the evaluation of the associated factors, besides the personality characteristics, five demographic characteristics and seven characteristics related to the clinical picture of autism, schooling and treatment were considered. The Scale of Object Representation (OR Scale) formulated by Blatt et al. (1976), and the study of the thematic content of human responses were used to investigate mother’s object representations. Rorschach’s Method inter examiners agreement (assessed through Kappa and Intraclass Correlation Coefficient) varied from substantial (0.61-0.81) to excellent (>0.81) in all variables of the Comprehensive System and in all, except two, categories of the OR Scale. Results: Logistic regression analysis showed that mothers of autistic children were two times more likely to experience stress than mothers of children without behavior problems at least partially determined by situational elements (OR=2.01; IC95%:1.18–3.69). The analysis of three models of logistic regression indicated that stress was associated with having an autistic child (OR=11.85; IC95%:2.68-52.49); poor affective expression (OR=1.45; IC95%:1.03-2.03); little interest in people (OR=1.34; IC95%:1.06-1.70); being an older mother (OR=0.86; IC95%:0.75- 0.99); and having a younger child (OR=1.51; IC95%:1.1-2.12). The autistic children's mothers presented a level of structural development of object representation similar to the control group in answers adapted to reality (7.94 and 8.95; p = 0.131, respectively in OR+ Scale), but a smaller level in distorted answers (4.97 and 7.0; p = 0,04 respectively in OR- Scale). Although thematic content analysis of object representation revealed good and coherent human representations, the mechanism of devaluation was used sometimes and sexuality components were not properly integrated. It was also seen more indefinite and passive childhood representations. Conclusions: Mothers of autistic children presented higher levels of stress to some extent determined by situational experiences, suggesting that at least part of such stress should be a consequence of the contact with the autistic children. No peculiar personality pattern of affective demonstration and expression or of interpersonal relationships was identified. Having an autistic son was the main factor responsible for mothers' stress but other factors (e.g. decreased affective expression and interest in people, older mother, younger child) may increase that stress, suggesting that there is a subgroup of mothers that deserves special attention of mental health professionals. Clinical characteristics of the autistic picture do not seem to influence the stress experienced by the mothers. The pattern of structural object representation of the autistic children’s mothers is similar to the pattern of control mothers when measured by OR+ Scale, or when a single, continuous structural object representation score (RORSCORE) is used. Considering reality distortion situations independently (OR-), autistic children’s mothers present lower levels of structural object representation scores than control mothers do. This result, taking together with those of the thematic analysis can be interpreted as indicating that mothers of autistic children use rigid defense strategies, which might be associated with a neurotic personality structure. Some autistic children's mothers see themselves and their children in a primitive and passive way but that does not seem to characterize mothers of autistic children as a group. According to the structural and thematic analyses of object representation, mothers of autistic children seem to have rigid defense mechanisms usually found in neurotic personality organizations.
Descrição
Citação
DUARTE, Cristiane Seixas. Características de personalidade de mães de crianças com diagnóstico de autismo infantil: um estudo comparativo. 2000. 280 f. Tese (Doutorado em
Psiquiatria, Psicologia Médica e Saúde Mental) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2000.