El enfoque dimensional del trastorno del espectro autista: redefiniendo las bases de la comprensión e intervención psiquiátrica
DOI:
https://doi.org/10.25118/2763-9037.2025.v15.1500Palabras clave:
trastorno del espectro autista, neurodesarrollo, enfoque dimensional, transdiagnóstico, TEAResumen
Introducción: Las limitaciones de los criterios diagnósticos del trastorno del espectro autista (TEA) han llevado a una revisión de las bases de conocimiento y la comprensión del neurodesarrollo desde una perspectiva dimensional. Objetivo: Destacar la contribución del enfoque dimensional del TEA al desarrollo de modelos transdiagnósticos que ofrecen nuevas alternativas y posibilidades de intervención psiquiátrica. Método: Revisión narrativa de la literatura basada en la revisión de artículos científicos disponibles en bases de datos electrónicas, que presentan teorías, investigaciones y modelos diagnósticos sobre el TEA. Discusión y resultados: El enfoque dimensional ofrece nuevas posibilidades diagnósticas y de comprensión del TEA, al integrar el conocimiento sobre la neurodiversidad, considerando factores individuales, sociales y culturales y su correlación con diferentes dimensiones funcionales. Conclusión: Mediante una comprensión dimensional del TEA, se amplía la capacidad de intervención psiquiátrica y la atención personalizada, lo que permite ampliar las bases diagnósticas y ofrecer una respuesta más eficaz y adaptada a las necesidades y singularidades individuales.
Descargas
Métricas
Citas
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5-TR. 5th ed. Washington: American Psychiatric Publishing; 2022. https://doi.org/10.1176/appi.books.9780890424841
2. Mohammed AA. A critique of autism spectrum disorder in DSM-V. Int J Autism Relat Disabil. 2022;5(1):154. https://doi.org/10.29011/2642-3227.000050
3. Kuhn TS. A estrutura das revoluções científicas. 9a ed. São Paulo: Perspectiva; 2006.
4. Timimi S. No more psychiatric labels: why formal psychiatric diagnostic systems should be abolished. Int J Clin Health Psychol. 2014;14(3):208-15. https://doi.org/10.1016/j.ijchp.2014.03.004
5. Diniz NLF, Parlato-Oliveira E, Pimenta PGA, Araújo LA, Valadares ER. Autism and Down syndrome: early identification and diagnosis. Arq Neuropsiquiatr. 2022;80(6):620-30. https://doi.org/10.1590/0004-282x-anp-2021-0156 PMid:35946706 PMCid:PMC9387185
6. Betancur C. Etiological heterogeneity in autism spectrum disorders: more than 100 genetic and genomic disorders and still counting. Brain Res. 2011;1380:42-77. https://doi.org/10.1016/j.brainres.2010.11.078 PMid:21129364
7. Persico AM, Napolioni V. Autism genetics. Behav Brain Res. 2013 Aug 15;251:95-112. https://doi.org/10.1016/j.bbr.2013.06.012 PMid:23769996
8. Yao F, Zhang K, Feng C, Gao Y, Shen L, Liu X, Ni J. Protein biomarkers of autism spectrum disorder identified by computational and experimental methods. Front Psychiatry. 2021;12:554621. https://doi.org/10.3389/fpsyt.2021.554621 PMid:33716802 PMCid:PMC7947305
9. Yenkoyan K, Mkhitaryan M, Bjørklund G. Environmental Risk factors in autism spectrum disorder: a narrative review. Curr Med Chem. 2024;31(17):2345-60. https://doi.org/10.2174/0109298673252471231121045529 PMid:38204225
10. Jung CR, Lin YT, Hwang BF. Air pollution and newly diagnostic autism spectrum disorders: a population-based cohort study in Taiwan. PloS One. 2013;8(9):e75510. https://doi.org/10.1371/journal.pone.0075510 PMid:24086549 PMCid:PMC3783370
11. Lizé M, Monfort C, Rouget F, Limon G, Durand G, Tillaut H, Chevrier C. Prenatal exposure to organophosphate pesticides and autism spectrum disorders in 11-year-old children in the French PELAGIE cohort. Environ Res. 2022;212:113348. https://doi.org/10.1016/j.envres.2022.113348 PMid:35500857
12. Xu Y, Yang X, Chen D, Xu Y, Lan L, Zhao S, Liu Q, Snijders AM, Xia Y. Maternal exposure to pesticides and autism or attention-deficit/hyperactivity disorders in offspring: a meta-analysis. Chemosphere. 2023;313:137459. https://doi.org/10.1016/j.chemosphere.2022.137459 PMid:36470360 PMCid:PMC9839607
13. Shaw KA, Bilder DA, McArthur D, Williams AR, Amoakohene E, Bakian AV, Durkin MS, Fitzgerald RT, Furnier SM, Hughes MM, Patrícia M, Pierce K, Salinas A, Shenouda J, Vehorn A, Warren Z, Zahorodny W, Constantino JN, DiRienzo M, Esler A, Grzybowski A, Hudson A, Spivey MH, Ali A, Andrews JG, Baroud T, Gutiérrez J, Hallas L, Hall-Lande J, Hewitt A, Lee L-C, López M, Mancilla KC, Pettygrove S, Poynter JN, Schwenk YD, Washington A, Williams S, Cogswell ME. Early identification of autism spectrum disorder among children aged 4 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2018. MMWR Surveill Summ. 2021;70(10):1-14. https://doi.org/10.15585/mmwr.ss7010a1 PMid:34855727
14. Kern JK, Geier DA, Sykes LK, Geier M. Relevance of neuroinflammation and encephalitis in autism. Front Cell Neurosci. 2016;9:519. https://doi.org/10.3389/fncel.2015.00519 PMid:26834565 PMCid:PMC4717322
15. Hossain MM, Liu J, Richardson JR. Pyrethroid insecticides directly activate microglia through interaction with voltage-gated sodium channels. Toxicol Sci. 2017;155:112-123. https://doi.org/10.1093/toxsci/kfw187 PMid:27655349 PMCid:PMC6080855
16. Li X, Chauhan A, Sheikh AM, Patil S, Chauhan V, Li XM, Ji L, Brown T, Malik M. Elevated immune response in the brain of autistic patients. J Neuroimmunol. 2009;207(1-2):111-6. https://doi.org/10.1016/j.jneuroim.2008.12.002 PMid:19157572 PMCid:PMC2770268
17. Al-Beltagi M. Autism medical comorbidities. World J Clin Pediatr. 2021;10(3):15-28. https://doi.org/10.5409/wjcp.v10.i3.15 PMid:33972922 PMCid:PMC8085719
18. Murgatroyd C, Spengler D. Epigenetics of early child development. Front Psychiatry. 2011;2:16. https://doi.org/10.3389/fpsyt.2011.00016 PMid:21647402 PMCid:PMC3102328
19. Guang S, Pang N, Deng X, Yang L, He F, Wu L, Chen C, Yin F, Peng J. Synaptopathology involved in autism spectrum disorder. Front Cell Neurosci. 2018;12:470. https://doi.org/10.3389/fncel.2018.00470 PMid:30627085 PMCid:PMC6309163
20. Manzini A, Jones EJH, Charman T, Elsabbagh M, Johnson MH, Singh I. Ethical dimensions of translational developmental neuroscience research in autism. J Child Psychol Psychiatry. 2021;62(11):1363-73. https://doi.org/10.1111/jcpp.13494 PMid:34405894 PMCid:PMC7611913
21. Chetcuti LC, Spackman EK, Frazier TW, Whitehouse AJO, Uljarević M. The autism phenotype and transdiagnostic dimensional frameworks. Dev Med Child Neurol. 2025;67(9):1130-36. https://doi.org/10.1111/dmcn.16303 PMid:40126448
22. Mottron L. A radical change in our autism research strategy is needed: back to prototypes. Autism Res. 2021;14(12):2213-20. https://doi.org/10.1002/aur.2494 PMid:34077611
23. Cortese S, Bellato A, Gabellone A, Marzulli L, Matera E, Parlatini V, Petruzzelli MG, Persico AM, Delorme R, Fusar-Poli P, Gosling CJ, Solmi M, Margari L. Latest clinical frontiers related to autism diagnostic strategies. Cell Rep Med. 2025;6(2):101916. https://doi.org/10.1016/j.xcrm.2024.101916 PMid:39879991 PMCid:PMC11866554
24. Kamp-Becker I. Autism spectrum disorder in ICD-11 - a critical reflection of its possible impact on clinical practice and research. Mol Psychiatry. 2024;29:633-38. https://doi.org/10.1038/s41380-023-02354-y PMid:38273107 PMCid:PMC11153155
25. Waterhouse L. A Heterogeneity thwarts autism explanatory power: a proposal for endophenotypes. Front Psychiatry. 2022;13:947653. https://doi.org/10.3389/fpsyt.2022.947653 PMid:36532199 PMCid:PMC9751779
26. Rabot J, Rødgaard EM, Joober R, Dumas G, Bzdok D, Bernhardt B, Jacquemont S, Mottron L. Genesis, modelling and methodological remedies to autism heterogeneity. Neurosci Biobehav Rev. 2023;150:105201. https://doi.org/10.1016/j.neubiorev.2023.105201 PMid:37116771
27. Jacquemont S, Coe B, Hersch M, Duyzend M, Krumm N, Bergmann S, Beckmann JS, Rosenfeld JA; Eichler EE. A higher mutational burden in females supports a "female protective model" in neurodevelopmental disorders. Am J Hum Genet. 2014;94:415-25. https://doi.org/10.1016/j.ajhg.2014.02.001 PMid:24581740 PMCid:PMC3951938
28. McCarthy MM, Wright CL. Convergence of sex differences and the neuroimmune system in autism spectrum disorder. Biol Psychiatry. 2017;81(5):402-10. https://doi.org/10.1016/j.biopsych.2016.10.004 PMid:27871670 PMCid:PMC5285451
29. Navarro-Pardo E, López-Ramón F, Alonso-Esteban Y, Alcantud-Marín F. Diagnostic tools for autism spectrum disorders by gender: analysis of current status and future lines. Children (Basel). 2021;8(4):262. https://doi.org/10.3390/children8040262 PMid:33805261 PMCid:PMC8066607
30. Lai MC, Lombardo MV, Auyeung B, Chakrabarti B, Baron-Cohen S. Sex/gender differences and autism: setting the scene for future research. J Am Acad Child Adolesc Psychiatry. 2015;54(1):11-24. https://doi.org/10.1016/j.jaac.2014.10.003 PMid:25524786 PMCid:PMC4284309
31. Duvekot J, van der Ende J, Verhulst FC, Slappendel G, van Daalen E, Maras A, Greaves-Lord K. Factors influencing the probability of a diagnosis of autism spectrum disorder in girls versus boys. Autism. 2017;21(6):646-58. https://doi.org/10.1177/1362361316672178 PMid:27940569
32. Ratto AB, Kenworthy L, Yerys BE, Bascom J, Wieckowski AT, White SW, Wallace GL, Pugliese C, Schultz RT, Ollendick TH, Scarpa A, Seese S, Register-Brown K, Martin A, Anthony LG. What About the Girls? Sex-based differences in autistic traits and adaptive skills. J Autism Dev Disord. 2018;48(5):1698-1711. https://doi.org/10.1007/s10803-017-3413-9 PMid:29204929 PMCid:PMC5925757
33. Lockwood EG, Milner V, Spain D, Happé F, Colvert E. Barriers to autism spectrum disorder diagnosis for young women and girls: a systematic review. Rev J Autism Dev Disord. 2021;8(4):454-70. https://doi.org/10.1007/s40489-020-00225-8 PMid:34868805 PMCid:PMC8604819
34. Astle DE, Holmes J, Kievit R, Gathercole SE. Annual research review: the transdiagnostic revolution in neurodevelopmental disorders. J Child Psychol Psychiatry. 2022;63(4):397-417. https://doi.org/10.1111/jcpp.13481 PMid:34296774
35. Hus Y, Segal O. Challenges surrounding the diagnosis of autism in children. Neuropsychiatr Dis Treat. 2021;17:3509-29. https://doi.org/10.2147/NDT.S282569 PMid:34898983 PMCid:PMC8654688
36. Meilleur AAS, Fombonne E. Regression of language and non-language skills in pervasive developmental disorders. J Intellect Disabil Res. 2009;53:115-24. https://doi.org/10.1111/j.1365-2788.2008.01134.x PMid:19054269
37. Charman T. Developmental approaches to understanding and treating autism. Folia Phoniatr Logop. 2010;62:1660-77. https://doi.org/10.1159/000314032 PMid:20460929
38. Fu N. How do the Big Five personality traits correlate with the symptoms of Autism Spectrum Disorder (ASD)? Dean & Francis. 2023;1(4):1-2. https://doi.org/10.61173/j8j2j340
39. Rinaldi C, Attanasio M, Valenti M, Mazza M, Keller R. Autism spectrum disorder and personality disorders: comorbidity and differential diagnosis. World J Psychiatry. 2021;11(12):1366-86. https://doi.org/10.5498/wjp.v11.i12.1366 PMid:35070783 PMCid:PMC8717043
40. Shirayama Y, Matsumoto K, Hamatani S, Muneoka K, Okada A, Sato K. Associations among autistic traits, cognitive and affective empathy, and personality traits in adults with autism spectrum disorder and no intellectual disability. Sci Rep. 2022;12(1):3125. https://doi.org/10.1038/s41598-022-07101-x PMid:35210528 PMCid:PMC8873508
41. Cremone IM, Carpita B, Nardi B, Casagrande D, Stagnari R, Amatori G, Dell'Osso L. Measuring social camouflaging in individuals with high functioning autism: a literature review. Brain Sci. 2023;13(3):469. https://doi.org/10.3390/brainsci13030469 PMid:36979279 PMCid:PMC10046375
42. Knott R, Johnson BP, Tiego J, Mellahn O, Finlay A, Kallady K, Kouspos M, Sindhu VPM, Hawi Z, Arnatkeviciute A, Chau T, Maron D, Mercieca E-C, Furley K, Harris K, Williams K, Ure A, Fornito K, Gray K, Coghill D, Nicholson A, Phung D, Loth E, Mason L, Murphy D, Buitelaar J, Bellgrove MA. The Monash Autism-ADHD genetics and neurodevelopment (MAGNET) Project design and methodologies: a dimensional approach to understanding neurobiological and genetic aetiology. Mol Autism. 2021;12:55. https://doi.org/10.1186/s13229-021-00457-3 PMid:34353377 PMCid:PMC8340366
43. Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby RM, Brown TA, Carpenter WT, Caspi A, Clark LA, Eaton NR, Forbes MK, Forbush KT, Goldberg D, Hasin D, Hyman SE, Ivanova MY, Lynam DR, Markon K, Miller JD, Moffitt TE, Morey LC, Mullins-Sweatt SN, Ormel J, Patrick CJ, Regier DA, Rescorla L, Ruggero CJ, Samuel DB, Sellbom M, Simms LJ, Skodol AE, Slade T, South SC, Tackett JL, Waldman ID, Waszczuk MA, Widiger TA, Wright AGC, Zimmerman M. The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. J Abnorm Psychol. 2017;126(4):454-77. https://doi.org/10.1037/abn0000258 PMid:28333488
44. Ruggero CJ, Kotov R, Hopwood CJ, First M, Clark LA, Skodol AE, Mullins-Sweatt SN, Patrick CJ, Bach B, Cicero DC, Docherty A, Simms LJ, Bagby RM, Krueger RF, Callahan JL, Chmielewski M, Conway CC, De Clercq B, Dornbach-Bender A, Eaton NR, Forbes MK, Forbush KT, Haltigan JD, Miller JD, Morey LC, Patalay P, Regier DA, Reininghaus U, Shackman AJ, Waszczuk MA, Watson D, Wright AGC, Zimmermann J. Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical practice. J Consult Clin Psychol. 2019;87(12):1069-84. https://doi.org/10.1037/ccp0000452 PMid:31724426 PMCid:PMC6859953
45. Green J. Autism as emergent and transactional. Front Psychiatry. 2022;13:988755. https://doi.org/10.3389/fpsyt.2022.988755 PMid:36304560 PMCid:PMC9595115
46. Pellicano E, den Houting J. Annual research review: shifting from 'normal science' to neurodiversity in autism science. J Child Psychol Psychiatry. 2022;63(4):381-96. https://doi.org/10.1111/jcpp.13534 PMid:34730840 PMCid:PMC9298391
47. Lord C, Rutter M, DiLavore PC, Risi S, Gotham K, Bishop SL. (ADOS‑2) Autism Diagnostic Observation Schedule. 2nd ed. Torrance: Western Psychological Services; 2012. p. 45‑78.
48. Bordin IAS, Silvares EFM, Rocha MM, Teixeira MCTV, Paula CS. Inventário de Comportamentos da Infância e Adolescência (CBCL/6 18). Porto Alegre: ArtMed; 2010.
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2025 Marilena Corrêa de Mello, João Rana Vieira Sarquis, Pablo Gnutzmann Pereira
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Debates em Psiquiatria permite que el (los) autor (es) mantenga(n) sus derechos de autor sin restricciones. Permite al (los) autor (es) conservar sus derechos de publicación sin restricciones. Los autores deben garantizar que el artículo es un trabajo original sin fabricación, fraude o plagio; no infringe ningún derecho de autor o derecho de propiedad de terceros. Los autores también deben garantizar que cada uno atendió a los requisitos de autoría conforme a la recomendación del ICMJE y entienden que, si el artículo o parte de él es fallido o fraudulento, cada autor comparte la responsabilidad.
Reconocimiento-NoComercial 4.0 internacional (CC BY-NC 4.0) - Debates em Psiquiatria es regida por la licencia CC-BY-NC
Usted es libre de:
- Compartir — copiar y redistribuir el material en cualquier medio o formato
- Adaptar — remezclar, transformar y crear a partir del material
El licenciador no puede revocar estas libertades mientras cumpla con los términos de la licencia. Bajo las condiciones siguientes:
- Reconocimiento — Debe reconocer adecuadamente la autoría, proporcionar un enlace a la licencia e indicar si se han realizado cambios<. Puede hacerlo de cualquier manera razonable, pero no de una manera que sugiera que tiene el apoyo del licenciador o lo recibe por el uso que hace.
- NoComercial — No puede utilizar el material para una finalidad comercial.
No hay restricciones adicionales — No puede aplicar términos legales o medidas tecnológicas que legalmente restrinjan realizar aquello que la licencia permite.
