ARTIGOS

 

Correlation between symptoms of autism in children and personality traits in parents

 

Correlação entre sintomas de autismo em crianças e traços de personalidade em pais

 

Correlación entre síntomas de autismo en niños y rasgos de personalidad en padres

 

 

Milena Pereira Pondé^I; Sabrina Calmon Oliveira^II; Saulo Leal Merelles^III; Gustavo Marcelino Siquara^IV

^IEscola Bahiana de Medicina e Saúde Pública. Email: milenaponde@bahiana.edu.br ORCID: https://orcid.org/0000-0002-1292-5487
^IILaboratório Interdisciplinar de Pesquisa em Autismo. Email: sabrinacalmon@gmail.com ORCID: https://orcid.org/0000-0001-8447-8172
^IIIObras Sociais Irmã Dulce. Email: saulomerelles@gmail.com ORCID: https://orcid.org/0000-0003-0278-0584
^IVEscola Bahiana de Medicina e Saúde Pública. Email: gustavosiquara@hotmail.com ORCID: https://orcid.org/0000-0002-4495-6835

Correspondence

 

 

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ABSTRACT

Parents of children with autism spectrum disorder may be more likely to have a mental disorder, both due to genetic and environmental reasons. A cross-sectional study involving 161 children, 161 mothers and 108 fathers. Diagnosis followed the criteria established in DSM-5. Symptom severity was evaluated using the Childhood Autism Rating Scale. The Factorial Personality Inventory served to evaluate parents' personality traits. Several correlations were found between mothers and fathers personality traits and children symptoms. In both parents, personality traits associated with greater intransigence/less flexibility and fewer social skills were those associated with more severe autism symptoms in the children.

Keywords: ASD; parents; personality traits, ADHD, Hyperactivity

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RESUMO

Os pais de crianças com transtorno do espectro do autismo podem ter maior probabilidade de ter um transtorno mental, devido a razões genéticas e ambientais. Estudo transversal envolvendo 161 crianças, 161 mães e 108 pais. O diagnóstico seguiu os critérios estabelecidos no DSM - 5. A gravidade dos sintomas foi avaliada usando a Escala de Classificação do Autismo na Infância. O Inventário Fatorial de Personalidade foi utilizado para avaliar os traços de personalidade dos pais. Várias correlações foram encontradas entre traços de personalidade de mães e pais e sintomas de crianças. Em ambos os pais, os traços de personalidade associados a maior intransigência / menor flexibilidade e menos habilidades sociais foram os associados a sintomas mais graves de autismo nas crianças.

Palavras-chaves: TEA; Pais; Traços de Personalidade; TDAH; Hiperatividade

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RESUMEN

Los padres de niños con trastorno del espectro autista pueden ser más propensos a tener un trastorno mental, tanto por razones genéticas como ambientales. Se trata de un estudio transversal con 161 niños, 161 madres y 108 padres. El diagnóstico siguió los criterios establecidos en el DSM-5. La gravedad de los síntomas se evaluó mediante la Escala de calificación de autismo infantil. El Inventario Factorial de Personalidad sirvió para evaluar los rasgos de personalidad de los padres. Se encontraron varias correlaciones entre los rasgos de personalidad de las madres y los padres y los síntomas de los niños. En ambos padres, los rasgos de personalidad asociados con una mayor intransigencia / menor flexibilidad y menos habilidades sociales fueron los asociados con síntomas de autismo más severos en los niños.

Palabras clave: Tea; Padres; Rasgos De Personalidad; Tdah; Hiperactividad

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The parents of children with ASD may be more likely to have some form of mental disorder, either due to genetic or environmental reasons (Machado Júnior, Celestino, Serra, Caron, & Pondé, 2016). Since this is a genetically inherited neurodevelopment disorder, the parents may have characteristics of their child's disorder, even if only mild traits, which are referred to as broader autism phenotype. Studies have suggested that some autism traits may be present in the form of personality traits in unaffected parents and siblings of individuals with ASD. Parents of autistic children were more likely to be socially withdrawn, more emotionally detached, demonstrated less reciprocity in friendships, showed greater personality rigidity or less flexibility, perfectionism, little interest in new situations, and paid greater attention to details (Bolton et al., 1994; Cannone et al., 2017; Murphy et al., 2000; Narayan, Moyes, & Wolff, 1990; Piven, Palmer, Jacobi, Childress, & Arndt, 1997). The personality trait exhibition was less likely to be present in mothers of more severely ASD children, thus revealing a greater tendency towards social withdrawal in this group (Cannone et al., 2017). The effect of genetics on variations in personality traits is around 40% to 55% (Bouchard & McGue, 2003). Studying parents' personality traits could help direct research into the genetic and biological bases of the etiology of autism, and may also provide guidance for parents on how best to stimulate their children, considering their own difficulties. The objective of the present study was to identify correlations between parents' personality traits and groups of symptoms of ASD in the children.

 

Methods

Study population

The target population consisted of children attending a specialist school for individuals with ASD, children who were on the waiting list for a place at that school, and patients attending selected private specialist clinics. The parents of the children enrolled at the school were personally invited to participate in the study, while those whose name was on the waiting list were invited by telephone. The parents identified at the private clinics selected for the study were invited to participate in person by the attending psychiatrist/neurologist. Any parents who refused to participate in the study, adoptive parents and those who answered the questionnaires inappropriately were excluded from the study. The final sample consisted of 161 children, 161 mothers and 108 fathers. The data were collected between April 2014 and April 2016. The internal review board of the BAHIANA School of Medicine and Public Health approved the study protocol on March 12, 2014 under reference 551.381.

Evaluation instruments

Psychiatrists and a pediatric neurologist with extensive experience in the diagnosis and treatment of disorders of neurodevelopment evaluated the children. To increase the reliability of the diagnoses, the study coordinator personally trained all the professionals involved in the study. The children's diagnoses were made in accordance with the criteria established in the Diagnostic and Statistical Manual of Mental Disorders - DSM5 (APA, 2013), with the Childhood Autism Rating Scale (CARS) being applied to provide a better characterization of the symptoms of ASD in the patients. CARS is an observational scale that can be used for children of two years of age or more. A trained observer evaluates the child's behavior in 15 domains affected by autism and attributes scores ranging from 1 to 4 for each item, with higher scores reflecting more inappropriate behavior (Schopler, Reichler, & Renner, 1988). The factorial personality inventory (FPI) was the instrument used to evaluate personality traits in the parents. This consists of a self-report, structured questionnaire that is based on an adaptation of a modified version of the Edwards Personal Preference Schedule (EPPS) (Araújo, 2008). This tool was elaborated and validated in Brazil with 3,399 subjects (33% men and 67% women), the majority (49.5%) consisting of university students from 11 states in Brazil (Pasquali, Azevedo, & Ghesti, 1997). The test consists of the evaluation of 15 personality traits, with each trait being evaluated through nine items. Possible responses range from 1 to 7, with 1 indicating that the item is considered "not at all characteristic" and 7 "completely characteristic". The result for each trait is divided into percentiles in accordance with the scores, with high, moderate and low scores corresponding, respectively, to ≥ 70^th percentile, between the 69^th and 31^st percentiles and ≤ the 30^th percentile. The 15 traits measured in the inventory are: Nurturance expresses desires and feelings of kindliness, compassion and tenderness in which the subject wishes to be sympathetic to and fulfill the requirements of someone in need; intraception describes individuals who are dominated by a search for happiness, by fantasy and by imagination; succorance represents a search for support and protection; deference is related to respect, admiration and reverence to others; affiliation signifies giving and receiving affection from friends; dominance refers to feelings of self-confidence and the desire to control others; abasement is the tendency to submit passively to an external force, to be resigned to fate; achievement refers to ambition and endeavor, the desire to do something difficult; exhibition refers to vanity, to the desire to impress, to be heard and to be seen; aggression reflects anger and hate, individuals that like to fight, argue and attack; order represents a tendency to keep things clean, organized, balanced and precise; endurance expresses the ability to continue to perform a task that has been started no matter how difficult it may seem; change reflects the enjoyment of new things, not fearing things outside the individual's normal routine; autonomy is independence, acting freely according to the individual's own impulses; and heterosexuality refers to the desire to have relationships, including romantic and sexual relationships, with individuals of the opposite sex (Pasquali et al., 1997). The trait heterosexuality was not taken into consideration in the analysis, since it was deemed inappropriate in the validation studies and removed from the subsequent version of the inventory (Araújo, 2008).

Data Analysis

The data collected using the evaluation instruments were entered into the SPSS statistical software package, version 22 and analyzed by descriptive and inferential analyses. For the analysis of the factorial personality inventory (FPI), the overall scores for each personality trait were added together. In the inferential analysis, bivariate Spearman's correlation was used to identify positive or negative correlations between the scores for the personality traits in the parents, based on the FPI, and the scores for the symptoms of the children diagnosed with ASD, as according to the CARS. In the CARS, the higher the score given by the evaluating physician, the higher the symptom score. In the FPI, the higher the score, the greater the expression of the personality trait reported by the parents.

 

Results

The 161 mothers in the sample ranged in age from 19 to 68 years, with a mean age of 36.2 ± 7.6 years (± SD). The 108 fathers in the sample were aged from 27 to 67 years, with a mean age of 40.9 ± 8.7 years. Family income ranged from 1 to 50 minimum salaries per month, with a mean of 4.8 ± 7.2 minimum salaries per month. Regarding the individuals with ASD, 128 were male and 33 were female. They ranged in age from 1 to 29 years, with a mean age of 6.01 ± 5.41 years.

Correlation between personality traits in the mothers and the children's symptoms

As shown in Table 1, a positive and statistically significant correlation was found between endurance as a personality trait in the mother and the symptom imitation in the child (r = 0.189*). A negative and statistically significant association was found between the personality trait succorance in the mother and the symptom adaptation to change in the child (r = -0.184*), the personality trait exhibition in the mother and the overall ASD severity in the child (r = -0.179*) and the personality trait aggression in the mother and the symptom verbal communication in the child (r = -0.192*).

Nurturance (Nur), dominance (Dom), order (O), abasement (Ab), intraception (I), achievement (Ach), exhibition (Ex), heterosexuality (Het), affiliation (Affl), change (C), endurance (End), aggression (Agg), deference (Def), autonomy (Aut) and succorance (Succ).

Correlations between personality traits in the fathers and symptoms in the children

As shown in Table 2, a negative correlation was found between the personality trait change in the fathers and the symptoms interpersonal relationship (r = -0.246*), imitation (r = -0.242*), inappropriate use of objects (r = -0.248*) and the overall ASD severity in the children (r = -0.217*). There was a negative correlation between the personality trait achievement in the fathers and the symptoms inappropriate use of objects (r = -0.231*) and sensorial symptoms in the children (r = -0.228*). A negative correlation was found between the personality trait affiliation in the fathers and the symptom adaptation to change in the children (r = -0.273*). There was a positive correlation between the personality trait aggression in the fathers and the symptom hyperactivity in the children (r = 0.232*) and between the personality trait succorance in the fathers and the symptom body use in the children (r = 0.256*).

Nurturance (Nur), dominance (Dom), order (O), abasement (Ab), intraception (I), achievement (Ach), exhibition (Ex), heterosexuality (Het), affiliation (Affl), change (C), endurance (End), aggression (Agg), deference (Def), autonomy (Aut) and succorance (Succ).

 

Discussion

Some of the personality traits in the parents, evaluated using the FPI, correlated significantly with symptoms of autism in the children, while others did not. For the mothers, there was a statistically significant and positive correlation between the personality trait endurance and the symptom difficulty with imitation in the children. Endurance is a personality trait that may be associated with perseverance and rigidity, thus revealing a trait associated with rigid behavior in the broader autism phenotype in the mothers. A greater prevalence of limited interests, more rigid personalities, perfectionism and little interest in new situations have already been described in the parents of children with ASD (Murphy et al., 2000). The new finding the present study brings to light is the positive correlation between children with ASD who are less able to imitate and mothers who are more persistent. This result may indicate a genetic approximation between endurance/rigidity in the mothers and the children's difficulty in imitating behaviors or learning by imitation, that is related with poor social ability (de Guzman, Bird, Banissy, & Catmur, 2016; Santiesteban et al., 2012).A negative correlation was found between some of the personality traits in the mothers and symptoms in the children: succorance and adaptation to changes; exhibition and the overall severity of ASD; aggression and verbal communication. Succorance and exhibition are personality traits related to sociability. Succorance refers to an active search for help and protection in another person, while exhibition refers to the desire to be seen socially. Other studies have reported altered social behavior in the parents of individuals with ASD (Yucel et al., 2014), as well as affective distancing and less reciprocity in friendships (Bolton et al., 1994; Piven et al., 1997). The novel finding in the present study refers to a possible genetic correlation between poor sociability in the mothers (lower score of succorance and lower score of exhibition) and less adaptations to changes in the child, wish is related to rigid behavior. The negative correlation between Aggression in the mothers and verbal communication in the children indicates that a low level of Aggression in the mothers is associated with worst linguistic development in the children, which is an unexpected finding. None of the nine items of the factorial personality inventory (FPI) included under the domain aggression refers to aggression against individuals, but rather to aggression in an attitude of verbal confrontation (I am not afraid to tell people that I don't like them; I like to confront points of view that oppose mine; I like to make fun of people who do things I consider stupid; I want to get my own back when someone insults me; I feel like telling people to shut up when I disagree with them; sometimes I get so irritated that I feel like throwing things and breaking them; I blame others when things go wrong for me; I'm not afraid to criticize someone in public when they deserve it; I like to read or watch news items about murders and other forms of violence). In this respect, in the FPI, low score of aggression in mothers reveals individuals who tend to be less verbally confrontational, and less verbal skilled correlates with children with worst verbal communication skills. To the best of our knowledge, there are no other references in the literature reporting this association.

 

Figure 1

 

A poorer expression of the trait change in the fathers, a proxy of rigidity, was correlated with child's worst sociability (symptoms of worst interpersonal relationship), poor social ability (symptoms difficulty with imitation), repetitive behavior (symptoms of inappropriate and stereotyped use of objects), and greater overall severity of ASD. Previous studies have also shown that the fathers of individuals with ASD tend to have problems with change, an indication of the broader autism phenotype in the fathers (Bishop et al., 2004; Ruta, Mazzone, Mazzone, Wheelwright, & Baron-Cohen, 2012; Wheelwright, Auyeung, Allison, & Baron-Cohen, 2010). The finding in the present study refers to a possible genetic correlation between rigidity/inability to change in the fathers (lower score of change) and worst sociability, and repetitive behavior in the child.

The correlation between a poor expression of achievement, a proxy of difficulty with socialization and social adaptation, and the inappropriate use of objects (related to repetitive behavior) and sensorial symptoms in the children may also point to a genetic association between these traits. The negative correlation between the personality trait affiliation, a proxy of difficulty with socialization, in the parents and adaptation to changes in the children suggests a genetic association between poorer social skills in the parents and greater rigidity in the children with ASD. These correlations may indicate the presence of traits associated with the broader autism phenotype in the parents, which is in agreement with other references in the literature (Kose et al, 2013).

The present study suggests that rigidity (low expression of the trait Change) in the fathers was associated with a greater severity of symptoms regarding sociability, repetitive behavior and the severity of the overall symptoms of ASD in the child, thus indicating rigidity (difficulty with Change) as a possible endophenotype of ASD in the fathers. Other authors have discussed the hypothesis that parents of individuals with ASD also have a rigid personality, with little interest in new situations and difficulties in dealing with routine changes (Bernier, Gerdts, Munson, Dawson, & Estes, 2012; Hurley, Losh, Parlier, Reznick, & Piven, 2007). Poor sociability in the parents is related with repetitive behavior, sensorial symptoms and rigidity in the child. Sung et al. (2005) also found that traits of sociability and rigidity in the parents are indicative of greater heritability in relation to ASD, with a greater genetic correlation compared to traits such as expressiveness in social communication, communicative skills and the start of verbal communication.

 

Figure 2

 

In summary, both for the mothers and for the fathers, personality traits associated with greater rigidity and less flexibility, and personality traits associated with fewer social skills, corresponding to symptoms of the broader autism phenotype, were the traits that correlated more closely with the more severe symptoms of autism in the children.

 

Reference

American Psychiatry Association (APA). (2013). Diagnostic and Statistical Manual of Mental disorders - DSM-5. 5th.ed.Washington: American Psychiatric Association.         [ Links ]

Araújo, R. M. (2008). Análise da estrutura fatorial do Inventário Fatorial de Personalidade - IFP. Universitas: Ciências da Saúde, 2(1), 1-151. Doi: 10.5102/UCS.V2I1.519        [ Links ]

Bernier, R., Gerdts, J., Munson, J., Dawson, G., & Estes, A. (2012). Evidence for broader autism phenotype characteristics in parents from multiple-incidence autism families. Autism Research, 5(1), 13-20. Doi: 10.1002/aur.226.         [ Links ]

Bishop, D. V, Maybery, M., Maley, A., Wong, D., Hill, W., & Hallmayer, J. (2004). Using self-report to identify the broad phenotype in parents of children with autistic spectrum disorders: a study using the Autism-Spectrum Quotient. Journal of Child Psychology and Psychiatry, 45(8), 1431-1436. Doi:10.1111/j.1469-7610.2004.00325.x        [ Links ]

Bolton, P., Macdonald, H., Pickles, A., Rios, P. A., Goode, S., Crowson, M., Bailey, A., & Rutter, M. (1994). A case‐control family history study of autism. Journal of Child Psychology and Psychiatry, 35(5), 877-900. doi: 10.1111/j.1469-7610.1994.tb02300.x.         [ Links ]

Bouchard, T. J. Jr., McGue, M. (2003). Genetic and environmental influences on human psychological differences. Journal of Neurobiology, 54(1), 4-45. doi: 10.1002/neu.10160. PMID: 12486697.         [ Links ]

Cannone, L. A, Menezes, A. E, Rocha, L. A, Merelles, S. L, Coelho, M. T, & Pondé, M. P. (2017). Mothers' personality and severity of autism spectrum disorder symptoms in children. Revista Psicologia, Diversidade e Saúde, 6(2), 66-73. Doi:10.17267/2317-3394rpds.v6i2.1197        [ Links ]

de Guzman, M., Bird, G., Banissy, M. J., & Catmur, C. (2016). Self-other control processes in social cognition: from imitation to empathy. Philosophical Transactions of the Royal Society B: Biological Sciences, 371(1686), 20150079. Doi: 10.1098/rstb.2015.0079        [ Links ]

Hurley, R. S, Losh, M., Parlier, M., Reznick, J. S, & Piven, J. (2007). The broad autism phenotype questionnaire. Journal of Autism and Developmental Disorders, 37(9), 1679-1690. Doi: 10.1007/s10803-006-0299-3.         [ Links ]

Kose, S., Bora, E., Erermiş, S., Özbaran, B., Bildik, T., & Aydın, C. (2013). Broader autistic phenotype in parents of children with autism: Autism Spectrum Quotient - Turkish version. Psychiatry and Clinical Neurosciences, 67(1), 20-27. Doi: 10.1111/pcn.12005. PMID: 23331285.         [ Links ]

Machado Junior, S. B, Celestino, M. I, Serra, J. P, Caron, J., & Pondé, M. P. (2016). Risk and protective factors for symptoms of anxiety and depression in parents of children with autism spectrum disorder. Developmental Neurorehabilitation, 19(3), 146-153. Doi:10.3109/17518423.2014.925519        [ Links ]

Murphy, M., Bolton, P. F, Pickles, A., Fombonne, E., Piven, J., & Rutter, M. (2000). Personality traits of the relatives of autistic probands. Psychological Medicine, 30(6), 1411-1424. Doi: 10.1017/S0033291799002949        [ Links ]

Narayan, S., Moyes, B., & Wolff, S. (1990). Family characteristics of autistic children: a further report. Journal of Autism and Developmental Disorders, 20, 523-535.         [ Links ]


Pasquali, L., Azevedo, M. M, & Ghesti, I. (1997). Inventário Fatorial de Personalidade: manual técnico e de aplicação. São Paulo: Casa do Psicólogo.         [ Links ]

Piven, J., Palmer, P., Jacobi, D., Childress, D., & Arndt, S. (1997). Broader autism phenotype: evidence from a family history study of multiple-incidence autism families. American Journal of Psychiatry, 154(2), 185-190. Doi: 10.1176/ajp.154.2.185.         [ Links ]

Ruta, L., Mazzone, D., Mazzone, L., Wheelwright, S., & Baron-Cohen, S. (2012). The Autism-Spectrum Quotient - Italian version: a cross-cultural confirmation of the broader autism phenotype. Journal of Autism and Developmental Disorders, 42(4), 625-633. Doi: 10.1007/s10803-011-1290-1.         [ Links ]

Santiesteban, I., White, S., Cook, J., Gilbert, S. J., Heyes, C., & Bird, G. (2012). Training social cognition: from imitation to theory of mind. Cognition, 122(2), 228-235. Doi: 10.1016/j.cognition.2011.11.004.         [ Links ]

Schopler, E., Reichler, R., & Renner, B. R. (1988). The Childhood Autism Rating Scale (CARS). 10th ed. Los Angeles: Western Psychological Services.         [ Links ]

Sung, Y. J, Dawson, G., Munson, J., Estes, A., Schellenberg, G. D, & Wijsman, E. M. (2005). Genetic investigation of quantitative traits related to autism: use of multivariate polygenic models with ascertainment adjustment. American Journal of Human Genetics, 76(1), 68-81. Doi: 10.1086/426951        [ Links ]

Wheelwright, S., Auyeung, B., Allison, C., & Baron-Cohen, S. (2010). Defining the broader, medium and narrow autism phenotype among parents using the Autism Spectrum Quotient (AQ). Molecular Autism, 17(1) 10. Doi: 10.1186/2040-2392-1-10.         [ Links ]

Yucel, G. H., Belger, A., Bizzell, J., Parlier, M., Adolphs, R., & Piven, J. (2014). Abnormal neural activation to faces in the parents of children with autism. Cerebral Cortex, 25(12), 4653-4666. Doi: 10.1093/cercor/bhu147        [ Links ]

 

 

Correspondence:
Gustavo Marcelino Siquara
gustavosiquara@hotmail.com

Recebido em: 15/01/2020
Aceito em: 08/05/2020