O fenótipo ampliado do autismo em pais de indivíduos autistas: uma revisão sistemática da literatura

Cruz, Lídia Prata; Camargos-Júnior, Walter; Rocha, Fábio Lopes

doi:10.1590/2237-6089-2013-0019

Lídia Prata Cruz Correspondence: Lídia de Lima Prata Cruz Rua Pernambuco, 353/1010, Centro 30130-150 - Belo Horizonte, MG - Brazil Tel./Fax: +55 (31) 3281.5052/9606.5052 E-mail: lidiapratacruz@gmail.com

, Belo Horizonte, MG, Brazil

Walter Camargos-Júnior

Hospital Infantil João Paulo II, Belo Horizonte, MG, Brazil

Fábio Lopes Rocha

Instituto de Previdência dos Servidores do Estado de Minas Gerais , Belo Horizonte, MG, Brazil

Correspondence: Lídia de Lima Prata Cruz Rua Pernambuco, 353/1010, Centro 30130-150 - Belo Horizonte, MG - Brazil Tel./Fax: +55 (31) 3281.5052/9606.5052 E-mail: lidiapratacruz@gmail.com

Financial support: none.

No conflicts of interest declared concerning the publication of this article.

Database	Keywords used	Studies retrieved
LILACS	(Fenótip$ OR Endofenotip$ OR Phenotyp$ OR Endophenotyp$) AND (“Transtorno Autístico” OR Autism$ OR Autistic$) OR (“Núcleo Familiar” OR Pais OR Padres OR Parents OR Famil$).	04
IBECS		03
Web of Science	(Phenotype OR Endophenotype ) AND (“Autistic Disorder” Autism OR Autistic) AND (Parent OR father OR mother).	178
MEDLINE	(“Phenotype” OR “Endophenotypes” OR Phenotype OR Endophenotype) wAND (“Autistic Disorder/etiology” OR “Autistic Disorder/psychology” OR “Autistic Disorder” Autism OR Autistic) AND (“Parents” OR Parent OR father OR mother).	232

Scale	Psychometric features	Studies that used instrument
FHI¹⁷17. Bolton P, Macdonald H, Pickles A, Rios P, Goode S, Crowson M, et al. A case-control family history study of autism. J Child Psychol Psychiatry. 1994;35:877-900.	Categorical assessment instrument used with children and adults. Semistructured interview that assesses deficits in the three areas of autism.	Pickles et al. (2000)⁹9. Pickles A, Starr E, Kazak S, Bolton P, Papanikolaou K, Bailey A, et al. Variable expression of the autism broader phenotype: findings from extended pedigrees J Child Psychol Psychiatry. 2000;41:491-502.; Piven et al. (1997)²⁰20. Piven J, Palmer P, Jacobi D, Childress D, Arndt S. Broader autism phenotype: evidence from a family history study of multiple-incidence autism families. Am J Psychiatry. 1997;154:185-90.; Fombonne et al. (1997)²¹21. Fombonne E, Bolton P, Prior J, Jordan H, Rutter M. A family study of autism: cognitive patterns and levels in parents and siblings. J Child Psychol Psychiatry. 1997;38:667-83.; Folstein et al. (1999)²²22. Folstein SE, Santangelo SL, Gilman SE, Piven J, Landa R, Lainhart J, et al. Predictors of cognitive test patterns in autism families. J Child Psychol Psychiatry. 1999;40:1117-28.
AQ¹⁸18. Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001;31:5-17.	Self-report dimensional scale; 50 items divided into five domains: social skills, communication skills, attention to detail, attention switching and imagination It is used with children and adults.	Bishop et al. (2004)⁷7. Bishop DV, Maybery M, Maley A, Wong D, Hill W, Hallmayer J. Using self-report to identify the broad phenotype in parents of children with autistic spectrum disorders: a study using the Autism-Spectrum Quotient. J Child Psychol Psychiatry. 2004;45:1431-6.; Scheeren & Stauder (2008)¹⁰10. Scheeren AM, Stauder JE. Broader autism phenotype in parents of autistic children: reality or myth? J Autism Dev Disord. 2008;38:276-87.; Whitehouse et al. (2007)²³23. Whitehouse AJ, Barry JG, Bishop DV. The broader language phenotype of autism: a comparison with specific language impairment. J Child Psychol Psychiatry. 2007;48:822-30.; Wheelwright et al. (2010)¹¹11. Wheelwright S, Auyeung B, Allison C, Baron-Cohen S. Defining the broader, medium and narrow autism phenotype among parents using the Autism Spectrum Quotient (AQ). Mol Autism. 2010;1:2-9.
BPASS¹⁹19. Dawson G, Estes A, Munson J, Schellenberg G, Bernier R, Abbott R. Quantitative assessment of autism symptom-related traits in probands and parents: Broader Phenotype Autism Symptom Scale. J Autism Dev Disord. 2007;37:523-36.	Dimensional scale. It is divided into four domains: social motivation, flexibility and variety of interests, social expressiveness and conversational skills. It may be used to evaluate adults and children.	Bernier et al. (2012)²⁴24. Bernier R, Gerdts J, Munson J, Dawson G, Estes A. Evidence for the broader autism phenotype characteristics in parents from multiple-incidence families. Autism Res. 2012;5:13-20.
BAPQ⁸8. Hurley RS, Losh M, Parlier M, Reznick JS, Piven J. The broad autism phenotype questionnaire. J Autism Dev Disord. 2007;37:1679-90.	Likert-like dimensional scale with 36 items. It has three domains: social interests, pragmatic language, and rigid personality. It is used with adults.	Hurley et al. (2007)⁸8. Hurley RS, Losh M, Parlier M, Reznick JS, Piven J. The broad autism phenotype questionnaire. J Autism Dev Disord. 2007;37:1679-90.

Reference	Sample of parents	Behavioral characteristics	Instruments used	Results
Landa et al. (1992)²⁵25. Landa R, Piven J, Wzorek MM, Gayle JO, Chase GA, Folstein SE. Social language use in parents of autistic individuals. Psychol Med. 1992;22:245-54.	43 parents of children with autism spectrum disorder 21 parents of children with Down syndrome or adults without children with autism	Disinhibited social communication Inadequate expressions Odd verbal interactions	PRS	42% of the parents of individuals with autism had some pragmatic language deficit, compared with 2% of parents in the control group
Fombonne et al. (1997)²¹21. Fombonne E, Bolton P, Prior J, Jordan H, Rutter M. A family study of autism: cognitive patterns and levels in parents and siblings. J Child Psychol Psychiatry. 1997;38:667-83.	160 parents of individuals with autism 42 parents of individuals with Down syndrome	Reading and writing skills	FHS Form A of GORT Short version of ERT NART The Schonell Graded SST	No significant differences were found in reading and spelling
Piven et al. (1997)⁶6. Piven J, Palmer P, Landa R, Santangelo S, Jacobi D, Childress D. Personality and language characteristics in parents from multiple-incidence autism families. Am J Med Genet. 1997;74:398-411.	48 parents of individuals with autism (multiple-incidence autism families) 60 parents of individuals with Down syndrome	Pragmatic language Social interaction Personality traits	MPAS-R PRS FS	Parents of children with autism had more characteristics of rigidity, aloofness, hypersensitivity to criticism and anxiousness They had more speech and pragmatic language deficits Moreover, they had more limited friendships
Piven et al. (1997)²⁰20. Piven J, Palmer P, Jacobi D, Childress D, Arndt S. Broader autism phenotype: evidence from a family history study of multiple-incidence autism families. Am J Psychiatry. 1997;154:185-90.	48 parents of children with autism 60 parents of children with Down syndrome	Social interactions Communication Rigid and stereotyped interests and behaviors	FHI	Parents of children with autism had greater social and communication deficits and more rigid and stereotyped interests and behaviors
Baron-Cohen et al. (1998)²⁶26. Baron-Cohen S, Bolton P, Wheelwright S, Scahill V, Short L, Mead G, et al. Autism occurs more often in families of physicists, engineers, and mathematicians. Autism. 1998;2:296-301.	275 math students 266 engineering students 100 physics students 652 literature students	Work interests	Questionnaire about incidence of 6 conditions: autism, anorexia, schizophrenia, language delays, manic-depression and Down’s syndrome	Autism was significantly more frequent in families of physics, engineering and math students than in control group of literature students
Folstein et al. (1999)²²22. Folstein SE, Santangelo SL, Gilman SE, Piven J, Landa R, Lainhart J, et al. Predictors of cognitive test patterns in autism families. J Child Psychol Psychiatry. 1999;40:1117-28.	166 parents of individuals with autism 75 parents of children with Down syndrome	Pragmatic language Social interaction	FHI PRS FI PAS	Parents of individuals with autism had early language-related difficulties and more difficulties in reading, writing and pragmatic language use However, they did not have greater difficulties in evaluation of social-related component of BAP
Bishop et al. (2004)⁷7. Bishop DV, Maybery M, Maley A, Wong D, Hill W, Hallmayer J. Using self-report to identify the broad phenotype in parents of children with autistic spectrum disorders: a study using the Autism-Spectrum Quotient. J Child Psychol Psychiatry. 2004;45:1431-6.	69 parents of people with autism-spectrum disorder 59 parents of children without autism	Social skills Communication Imagination Attention to detail Attention switching	AQ	Parents in clinical group had more autism characteristics in communication and social skills than parents in control group There were no differences between groups in other factors
Bishop et al. (2004)³²32. Bishop DV, Maybery M, Wong D, Maley A, Hill W, Hallmayer J. Are phonological processing deficits part of the broad autism phenotype? Am J Med Genet B Neuropsychiatr Genet. 2004;128B:54-60.	145 parents of children with autism spectrum disorder 96 parents of children with typical development	Phonological processing Social skills Communication Imagination Attention to detail Attention switching	AQ Nonword repetition Nonsense passage reading	Parents with more BAP characteristics according to AQ reported history of more language and literacy problems However, they did not have poorer scores in phonological processing
Di Michele et al. (2007)¹⁶16. Di Michelle V, Mazza M, Cerbo R, Roncone R, Casacchia M. Deficits in pragmatic conversation as manifestation of genetic liability in autism. Clin Neuropsychiatry. 2007;4:144-51.	23 parents of children with autism 35 parents in control group (12 of children with Down syndrome and 23 of healthy children)	Pragmatic language	Experimental tasks of Gricean conversational maxims	Parents of people with autism had more pragmatic language errors than controls when evaluating taped conversations: difficulty in identifying relevant, redundant and non-informative information
Ruser et al. (2007)²⁷27. Ruser TF, Arin D, Dowd M, Putnam S, Winklosky B, Rosen-Sheidley B, et al. Communicative competence in parents of children with autism and parents of children with specific language impairment. J Autism Dev Disord. 2007;37:1323-36.	47 parents of children with autism 47 parents of children with specific language impairment 21 parents of children with Down syndrome	Emotional expressiveness and awareness of other Communicative performance Over-talkativeness Pragmatic language	Modified version of the FHI of Developmental Disorders of Cognition and Social Functioning PRS-M	Parents of people with autism and specific language impairment did not differ from each other according to PRS-M Both groups had a significantly poorer performance in communicative skills than parents of children with Down syndrome
Whitehouse et al. (2007)²³23. Whitehouse AJ, Barry JG, Bishop DV. The broader language phenotype of autism: a comparison with specific language impairment. J Child Psychol Psychiatry. 2007;48:822-30.	30 parents of children with autism 30 parents of children with specific language impairment 30 parents of typically-developing children	Reading and spelling Social skills Communication Imagination Attention to detail Attention switching	TROG-2 Test of Word Reading Efficiency Dictation task AQ	Parents of children with autism had similar scores to those of typically-developing children The two groups had scores higher than those of parents of children with specific language impairments However, parents of children with autism had communication deficits according to AQ
Losh et al. (2008)²⁸28. Losh M, Childress D, Lam K, Piven J. Defining key features of the broad autism phenotype: a comparison across parents of multiple- and single-incidence autism families. Am J Med Genet B Neuropsychiatr Genet. 2008;147B:424-33.	48 parents of individuals with autism (multiple-incidence autism families) 78 parents of individuals with autism (single-incidence autism families) 60 parents of individuals with Down syndrome	Aloofness and social behavior Rigid personality Pragmatic language Personality traits	MPAS-R FI The NEO- Personality Inventory PRS	BAP expression was gradual in the groups of families: parents of multiple-incidence autism families had more BAP characteristics than parents of single-incidence autism families, who, in turn, had more BAP characteristics than parents in the control group
Scheeren & Stauder (2008)¹⁰10. Scheeren AM, Stauder JE. Broader autism phenotype in parents of autistic children: reality or myth? J Autism Dev Disord. 2008;38:276-87.	25 parents of children with high-functioning autism 25 parents of typically-developing children	Social skills Attention switching Attention to detail Communication Imagination	AQ	Results did not reveal differences between groups
Schmidt et al. (2008)²⁹29. Schmidt GL, Kimel LK, Winterrowd E, Pennington BF, Hepburn SL, Rojas DC. Impairments in phonological processing and nonverbal intellectual function in parents of children with autism. J Clin Exp Neuropsychol. 2008;30:557-67.	22 parents of children with autism 22 individuals in control group	Phonological processing	PPVT-III EVT DK-EFS TOLC-E Nonword repetition subtest of CTOPP WAIS subtests (vocabulary, similarities, block design)	Parents of people with autism had a worse performance in repetition of nonword syllables (nonword repetition test) In other phonological tests, there were no differences between groups
Lindgren et al. (2009)³⁰30. Lindgren KA, Folstein SE, Tomblin JB, Tager-Flusberg H. Language and reading abilities of children with autism spectrum disorders and specific language impairment and their first-degree relatives. Autism Res. 2009;2:22-38.	62 parents of children with autism and language impairment 39 parents of children without autism and language impairment 70 parents of children with specific language impairment	Semantics Morphology Syntax Memory for language Lexical comprehension Reading abilities	Comprehensive Test of Phonological Processing Clinical Evaluation of Language Fundamentals - Third Edition The Peabody Picture Vocabulary Test - Third edition The Woodcock-Johnson Psycho Educational Battery - Revised	Parents of people with autism and language impairment had a better performance in language tests than parents of children with specific language impairment
Wheelwright et al. (2010)¹¹11. Wheelwright S, Auyeung B, Allison C, Baron-Cohen S. Defining the broader, medium and narrow autism phenotype among parents using the Autism Spectrum Quotient (AQ). Mol Autism. 2010;1:2-9.	2,000 parents of children with autism 1,007 parents of typically-developing children	Social skills Communication Imagination Attention to detail Attention switching	AQ	Parents of individuals with autism had higher AQ scores in 4 of 5 factors than parents of typically-developing children, which indicated that the first had more BAP characteristics Fathers had more characteristics than mothers
Whitehouse et al. (2010)³¹31. Whitehouse AJ, Coon H, Miller J, Salisbury B, Bishop DV. Narrowing the broader autism phenotype: a study using the Communication Checklist-Adult Version (CC-A). Autism. 2010;14:559-74.	238 parents of children with autism 187 typical individuals with no history of autism in the family	Language (speech, syntax and semantics) Pragmatic skills (active communication) Social engagement (passive communication style)	CC-A	There were no differences between groups in results of language subscale However, parents of individuals with autism had higher scores in the other two subscales, particularly in social engagement subscale
Bernier et al. (2012)²⁴24. Bernier R, Gerdts J, Munson J, Dawson G, Estes A. Evidence for the broader autism phenotype characteristics in parents from multiple-incidence families. Autism Res. 2012;5:13-20.	39 parents of multiple-incidence autism families 22 parents of single-incidence autism families 20 parents of children with developmental delay without ASD 20 parents of typically-developing children	Social motivation Social expressivity Conversational skills Flexibility/range of interests (restricted interests)	BPASS	Parents of multiple-incidence autism families had significantly more autism phenotype characteristics than parents in other groups Moreover, parents of single-incidence autism families did not differ from those of typically-developing children

Reference	Sample of parents	Cognitive models	Instruments used	Results
Szatmari et al. (1993)³³33. Szatmari P, Georgiades S, Duku E, Zwaigenbaum L, Goldberg J, Bennett T. Alexithymia in parents of children with autism spectrum disorder. J Autism Dev Disord. 2008;38:1859-65.	96 parents of individuals with autism 54 parents of children with Down syndrome or low birth weight	Executive functions Central coherence	Subtests of the Wechsler Adult Intelligence Scale (digits, blocks, vocabulary and comprehension)	There were no differences between groups
Piven & Palmer (1997)³⁴34. Piven J, Palmer P. Cognitive deficits in parents from multiple-incidence autism families. J Child Psychol Psychiatry. 1997;38:1011-21.	48 parents of multiple-incidence autism families 60 parents of individuals with Down syndrome	Executive functions (planning)	Tower of Hanoi	Parents of individuals with autism had more difficulties in planning tasks than parents in control group
Hughes et al. (1997)³⁵35. Hughes C, Leboyer M, Bouvard M. Executive function in parents of children with autism. Psychol Med. 1997;27:209-20.	40 parents of children with autism 40 parents of learning disabled children 36 adults of unaffected families	Executive functions (attentional-shifting skills, planning, working memory)	CANTAB Wisconsin Card Sorting Task Tower of London Spatial working memory task Short-term spatial working memory	Parents of children with autism had good memory skills, but impaired planning and attentional-shifting skills
Happe et al. (2001)³⁶36. Happé F, Briskman J, Frith U. Exploring the cognitive phenotype of autism: weak "central coherence" in parents and siblings of children with autism: I. Experimental tests. J Child Psychol Psychiatry. 2001;42:299-307.	43 parents of individuals with autism 30 parents of individuals with dyslexia 20 parents of typically-developing children	Central coherence	WRAT reading subtest EFT Sentence completion task Unsegmented block design task Visual illusions task	Parents of children with autism, particularly fathers, had weak central coherence This was seen in semantic tasks (sentence completion), perceptual judgment (illusions), visuospatial construction and problem solving
Bölte & Poustka (2003)³⁷37. Bölte S, Poustka F. The recognition of facial affect in autistic and schizophrenic subjects and their first-degree relatives. Psychol Med. 2003;33:907-15.	54 parents of individuals with autism (single incidence) 28 parents of multiple-incidence autism families 31 parents of individuals with schizophrenia (single incidence) 4 parents of multiple-incidence schizophrenia families 22 unaffected individuals	Facial expression (ToM)	Test to recognize facial affect	Results did not reveal significant differences between groups
Bölte & Poustka (2006)³⁸38. Bölte S, Poustka F. The broader cognitive phenotype of autism in parents: how specific is the tendency for local processing and executive dysfunction? J Child Psychol Psychiatry. 2006;47:639-45.	62 parents of children with autism 36 parents of children with schizophrenia 30 parents of children with mental retardation	Central coherence Executive functions	Embedded figures test Unsegmented block design task Wisconsin Card Sorting Task Tower of Hanoi Trail-making test	Parents of children with autism had a significantly faster performance in EFT than parents in other two groups There were no other differences between groups
Jonge et al. (2006)³⁹39. de Jonge MV, Kemner C, van Engeland H. Superior disembedding performance of high-functioning individuals with autism spectrum disorders and their parents: the need for subtle measures. J Autism Dev Disord. 2006;36:677-83.	51 parents of children with autism 54 parents of typically-developing children	Central coherence	EFT	Parents of children with autism were not different from matched controls in locating shapes However, they made fewer incorrect attempts before finding the right shape
Palermo et al. (2006)⁴⁰40. Palermo MT, Pasqualetti P, Barbati G, Intelligente F, Rossini PM. Recognition of schematic facial displays of emotion in parents of children with autism. Autism. 2006;10:353-64.	40 parents of children with classical autism 40 parents of typically-developing children	Facial expression (ToM)	HVOT Facial expression decoding test Experimental emotional labeling tasks in response to schematic human facial patterns	Parents of children with autism performed worse than control parents in reasoning facial patterns, particularly sadness and disgust In the other two tasks, there were no differences between groups
Wong et al. (2006)⁴¹41. Wong D, Maybery M, Bishop DV, Maley A, Hallmayer J. Profiles of executive function in parents and siblings of individuals with autism spectrum disorders. Genes Brain Behav. 2006;5:561-76.	145 parents of children with autism spectrum disorder 96 parents of typically-developing children	Executive functions (planning, set shifting, inhibition and generativity)	WAIS subtests (vocabulary, similarities, picture completion and object assembly) Tower of London IDED set-shifting task RIL task Pattern meanings	Parents of children with autism performed worse than controls in verbal and non-verbal generativity tests, but had no difficulties with planning or inhibition
Delorme et al. (2007)⁴²42. Delorme R, Goussé V, Roy I, Trandafir A, Mathieu F, Mouren-Siméoni MC, et al. Shared executive dysfunctions in unaffected relatives of patients with autism and obsessive-compulsive disorder. Eur Psychiatry. 2007;22:32-8.	39 parents of individuals with autism 53 parents of individuals with COD 47 healthy individuals	Executive functions (planning and working memory)	Family interview for genetic studies Tower of London Trail-making test Verbal fluency test Non-verbal fluency test	In the Tower of London test, parents of individuals with autism and with COD had lower scores and were slower than individuals in control group No difference was found between groups in the other four tasks
Di Michele et al. (2007)¹⁶16. Di Michelle V, Mazza M, Cerbo R, Roncone R, Casacchia M. Deficits in pragmatic conversation as manifestation of genetic liability in autism. Clin Neuropsychiatry. 2007;4:144-51.	46 parents of individuals with autism 23 parents of typically-developing children 12 parents of individuals with Down syndrome	ToM	False belief task (smarties task; Sally-Anne task)	Parents of individuals with autism performed worse than controls in false belief tasks
Losh & Piven (2007)⁴³43. Losh M, Piven J. Social-cognition and the broad autism phenotype: identifying genetically meaningful phenotypes. J Child Psychol Psychiatry. 2007;48:105-12.	48 parents of children with autism 16 parents of typically-developing children 6 parents of children with Down syndrome	ToM	Eyes test MPAS-R	There were no differences between groups However, parents defined as aloof had social-cognitive deficits
Scheeren & Stauder (2008)¹⁰10. Scheeren AM, Stauder JE. Broader autism phenotype in parents of autistic children: reality or myth? J Autism Dev Disord. 2008;38:276-87.	25 parents of children with high-functioning autism 25 parents of typically-developing children	Central coherence	WAIS block design subtest	Groups had similar scores in the block design test
Gokcen et al. (2009)⁴⁴44. Gokcen S, Bora E, Erermis S, Kesikci H, Aydin C. Theory of mind and verbal working memory deficits in parents of autistic children. Psychiatry Res. 2009;166:46-53.	76 parents of children with autism 41 parents of typically-developing children	Executive functions ToM	WAIS subscales (comprehension, block design, similarities and figure completion) Benton Face Recognition Test – Short Form Stroop test ACT UOT Hinting task	Parents of children with autism had verbal working memory deficits and difficulty in reasoning about other’s emotions They also performed poorly in mental state reasoning task
Jonge et al. (2009)⁴⁵45. de Jonge M, Kemner C, Naber F, van Engeland H. Block design reconstruction skills: not a good candidate for an endophenotypic marker in autism research. Eur Child Adolesc Psychiatry. 2009;18:197-205.	25 parents of children with autism 30 parents of children with Down syndrome	Central coherence	WAIS block design subtest	Groups had similar scores in the block design test
Losh et al. (2009)⁴⁶46. Losh M, Adolphs R, Poe MD, Couture S, Penn D, Baranek GT, et al. Neuropsychological profile of autism and the broad autism phenotype. Arch Gen Psychiatry. 2009;66:518-26.	41 typical individuals with no history of autism in the family 83 parents of individuals with autism 32 typical parents with no history of autism in the family 24 parents that participated without their children 15 single fathers and mothers of a child with autism	ToM Executive functions Central coherence	Eyes test Morphed faces task Trustworthiness of faces Movie stills task Point light task Tower of Hanoi EFT Sentence completion task Trail-making test Block design test	Parents with BAP differed from controls in social cognition measures There were no differences between groups in measures of central coherence or executive functions
Wallace et al. (2010)⁴⁷47. Wallace S, Sebastian C, Pellicano E, Parr J, Bailey A. Face processing abilities in relatives of individuals with ASD. Autism Res. 2010;3:345-9.	22 parents of children with autism spectrum disorder 26 typically-developing adults	Facial expression (ToM)	Computer-assisted face processing tasks (unfamiliar face and object discrimination, facial expression recognition, judgment of eye-gaze direction)	Parents of individuals with autism were less capable of discriminating subtle differences between faces and had more difficulties in identifying expressions of fear and disgust than typically-developing individuals
Neves et al. (2011)⁴⁸48. Neves Mde C, Tremeau F, Nicolato R, Lauar H, Romano-Silva MA, Correa H. Facial emotion recognition deficits in relatives of children with autism are not associated with 5HTTLPR. Rev Psiquiatr Rio Gd Sul. 2011;33:261-7.	40 parents of individuals with autism 41 healthy controls	Facial expression (ToM)	ER-40 PFMT	Parents of children with autism performed worse than controls in facial emotion recognition tasks, particularly anger, fear and happiness

[1] Correspondence: Lídia de Lima Prata Cruz Rua Pernambuco, 353/1010, Centro 30130-150 - Belo Horizonte, MG - Brazil Tel./Fax: +55 (31) 3281.5052/9606.5052 E-mail: lidiapratacruz@gmail.com

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O fenótipo ampliado do autismo em pais de indivíduos autistas: uma revisão sistemática da literatura