A esquizofrenia ao longo da infância

As pesquisas sobre os grupos “de alto risco” (filhos de pais esquizofrênicos), assim como os estudos prospectivos na população geral, mostram que os futuros esquizofrênicos apresentam, comparativamente aos sujeitos-controle, atrasos do desenvolvimento psicomotor, déficits cognitivos e algumas particularidades comportamentais. Tais dados parecem confirmar a idéia segundo a qual a esquizofrenia corresponderia a um distúrbio neurodesenvolvimental cuja expressão varia ao longo da vida. As especificidades clínicas e evolutivas dos raros casos de esquizofrenia iniciando-se na infância levam alguns autores a pensar que se trataria de uma entidade específica e cujo pertencimento ao “espectro autista” necessita ainda ser estudado

Les traitements pharmacologiques de l'autisme

Les données publiées sur la pharmacothérapie des troubles autistiques chez l'enfant restent peu cohérentes, ce qui reflète probablement l'hétérogénéité de ce syndrome. Les neuroleptiques restent les psychotropes pour lesquels les données sont le mieux établies. Il y a près de 20 ans que des études contrôlées ont montré des effets symptomatiques significatifs de l'halopéridol. Récemment, un essai contrôlé en double aveugle contre placebo a montré l'efficacité de la rispéridone sur l'hyperactivité, l'agressivité et les conduites répétitives d'enfants présentant des troubles autistiques ou appartenant au « spectre autistique ». Cependant, il reste à s'assurer de la sécurité à long terme de ce traitement. D'autres auteurs ont observé des effets positifs des inhibiteurs de la recapture de la sérotonine, ainsi que de la naltrexone - un inhibiteur des opiacés - mais des discussions persistent sur l'intérêt de ces médicaments. Il faut souligner que même pour les traitements dont l'efficacité paraît sérieusement établie, on ne peut attendre plus qu'une amélioration symptomatique partielle : ils ont peu d'action sur les troubles centraux de l'autisme (les troubles de la communication et des échanges sociaux). Les traitements pharmacologiques de l'autisme doivent donc s'intégrer dans une stratégie globale de prise en charge thérapeutique et éducative à long terme

Les pratiques de soins en psychiatrie infanto-juvénile dans la prise en charge des troubles envahissants du développement (implantation d'outils communs d'évaluation)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Structures familiales et adolescence

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Recommandations pour la pratique professionnelle du diagnostic de l’autisme

Autres production

Infant’s engagement and emotion as predictors of autism or intellectual disability in West syndrome

International audienc

Infant and dyadic assessment in early community-based screening for autism spectrum disorder with the PREAUT grid

<div><p>Background</p><p>The need for early treatment of autism spectrum disorders (ASD) necessitates early screening. Very few tools have been prospectively tested with infants of less than 12 months of age. The PREAUT grid is based on dyadic assessment through interaction and shared emotion and showed good metrics for predicting ASD in very-high-risk infants with West syndrome.</p><p>Methods</p><p>We assessed the ability of the PREAUT grid to predict ASD in low-risk individuals by prospectively following and screening 12,179 infants with the PREAUT grid at four (PREAUT-4) and nine (PREAUT-9) months of age. A sample of 4,835 toddlers completed the Checklist for Autism in Toddlers (CHAT) at 24 months (CHAT-24) of age. Children who were positive at one screening (N = 100) were proposed a clinical assessment (including the Children Autism Rating Scale, a Developmental Quotient, and an ICD-10-based clinical diagnosis if appropriate) in the third year of life. A randomly selected sample of 1,100 individuals who were negative at all screenings was followed by the PMI team from three to five years of age to identify prospective false negative cases. The clinical outcome was available for 45% (N = 45) of positive children and 52.6% (N = 579) of negative children.</p><p>Results</p><p>Of the 100 children who screened positive, 45 received a diagnosis at follow-up. Among those receiving a diagnosis, 22 were healthy, 10 were diagnosed with ASD, seven with intellectual disability (ID), and six had another developmental disorder. Thus, 50% of infants positive at one screening subsequently received a neurodevelopmental diagnosis. The PREAUT grid scores were significantly associated with medium and high ASD risk status on the CHAT at 24 months (odds ratio of 12.1 (95%CI: 3.0–36.8), p < 0.001, at four months and 38.1 (95%CI: 3.65–220.3), p < 0.001, at nine months). Sensitivity (Se), specificity, negative predictive values, and positive predictive values (PPVs) for PREAUT at four or nine months, and CHAT at 24 months, were similar [PREAUT-4: Se = 16.0 to 20.6%, PPV = 25.4 to 26.3%; PREAUT-9: Se = 30.5 to 41.2%, PPV = 20.2 to 36.4%; and CHAT-24: Se = 33.9 to 41.5%, PPV = 27.3 to 25.9%]. The repeated use of the screening instruments increased the Se but not PPV estimates [PREAUT and CHAT combined: Se = 67.9 to 77.7%, PPV = 19.0 to 28.0%].</p><p>Conclusions</p><p>The PREAUT grid can contribute to very early detection of ASD and its combination with the CHAT may improve the early diagnosis of ASD and other neurodevelopmental disorders.</p></div