Acceso usuarios
Tatiana Zuluaga Arroyave, Juan Bernardo Zuluaga Valencia, Jorge Mauricio Cuartas Arias
El trastorno del espectro autista (TEA) es un trastorno del neurodesarrollo, cuyas dificultades radican en las esferas social y comportamental. Al presente se ha estimado que aproximadamente uno entre 59 niños presentó esta condición, que es más frecuente en hombres. El nivel depende de la severidad de las alteraciones; el nivel 1 corresponde a lo que anteriormente se conocía como síndrome de Asperger. El objetivo de este trabajo es determinar la relación entre cognición social (CS) y el funcionamiento ejecutivo (FE) en una muestra de niños con trastorno del espectro autista nivel 1. Para esto, se desarrolló una metodología observacional, transversal, analítico-correlacional con diseño de dos grupos independientes, TEA (n = 39) y control (n = 39) de entre 8 y 16 años, todos escolarizados. Para la evaluación de las FE se utilizaron los test de clasificación de tarjetas, fluidez verbal y dígitos en regresión de la Evaluación Neuropsicológica Infantil (ENI), y para la evaluación de la CS se usaron el test de falsas creencias de primer y segundo orden, el test de expresiones faciales, las historias extrañas de Happé, el test de metidas de pata (faux pas) y el test de la mirada para niños. Este estudio encontró que los test de CS –las historias extrañas de Happé y el test de las miradas– logran discriminar a ambos grupos y confirman que los sujetos TEA tienen alteración en la teoría de la mente (ToM) emocional y, asimismo, sugiere revisar la evaluación del funcionamiento ejecutivo para delinear mejor la interacción entre FE y CS en el TEA. Para ello, se recomienda ampliar la medición de las FE de dominio más emocional y delinear nuevas estrategias para comprender la interacción entre los dominios cognitivo y social, y avanzar en la intervención neurocognitiva y en el pronóstico en este síndrome.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent challenges in social interaction, speech and nonverbal communication, and restricted/repetitive behaviors. The level varies depending on the impact and persistence of the symptoms in the person’s daily life. Some level 3 cases have a full dependence on their caregivers, while level 1, the other side of the spectrum, includes what used to be known as Asperger’s Syndrome (AS), who usually have a normal IQ and high language skills. The prevalence varies depending on the country and type of methodology for the estimation; at present it has been estimated that approximately 1 in 59 children presented this condition according to the study of the Centers for Disease Control and Prevention (CDC). In Colombia, a high prevalence of the disorder has been found: from 1/87 to 1/91 according to the screening instrument. The objective of this work is to determine the relationship between social cognition (SC), that focuses on how people process, store, and apply information about other people and social situations, and executive functioning (EF), that are skills we use every day to learn, work and manage daily life, in a sample of children with level 1 Autism Spectrum Disorder. An observational, cross-sectional, correlational analytical methodology was designed with two independent groups, ASD (n = 39) and control (n = 39) between 8 and 16 years of age, all of them enrolled in school. Both groups were assessed by neurodevelopmental experts to determine the presence or absence of ASD symptoms. For the components of the EF, the card classification subtests, regression digit span and phonological fluency of the Infant Neuropsychological Assessment (ENI) were used to evaluate the capacity for abstraction, the formation of concepts and the change of cognitive strategies in response to the changes that occur in environmental contingencies, as well as the initiation, efficient organization of verbal recovery, inhibition and self-monitoring. For the SC, the first and second order false beliefs were used to evaluate the ability of subjects to infer that someone has a belief that is different from their own and a third party; the Facial Expressions Test, to assess facial emotional recognition; and advanced tests such as Happé’s Strange Stories, the Faux Pas test and Reading the mind in the eyes test to assess understanding of covert language, detection of lies or deception, and attribution of cognitive emotions through inference from beliefs or intentions of others. This study found that the SC test, Happé’s strange stories and Reading the mind in the eyes test were able to discriminate both groups and confirm that ASD subjects have an alteration in emotional Theory of Mind. Although no differences were found in EF between the two groups, the hypothesis that there are alterations in EF in ASD is not rejected; on the contrary, the importance of carrying out a complete evaluation with sensitive instruments is emphasized, it suggests reviewing the evaluation of executive functioning to better delineate the interaction between EF and SC in ASD, expanding the measurement of EF of more emotional domain including some “hot” EF measures; outlining new strategies to understand the interaction between the cognitive and social domains, advancing neurocognitive intervention and prognosis in this syndrome. In future phases of this line of research, a better choice of instruments should be considered, including the Theory of Mind Inventory-2 (ToMi-2), a questionnaire filled out by caregivers that allows obtaining information on factors and domains evaluated by the applied tests that also has a pragmatic subscale.
