L’absence de marche à quatre pattes : un indicateur précoce de risque de trouble du spectre autistique ?

National audienceLe repérage précoce en matière d’autisme est un enjeu majeur qui fait aujourd’hui l’objet d’un consensus unanime (HAS, 2012). Différents instruments cliniques de dépistage précoce sont déjà utilisés, auxquels s’associent des travaux sur la recherche de bio-marqueurs (Walsh, et al., 2011) avec l’objectif d’approcher au plus près un risque d’autisme, lequel devra conduire à la mise en place rapide d’une prise en charge globale et intensive pour prévenir au mieux l’apparition de désordres secondaires, en capitalisant notamment sur l’importante capacité de neuroplasticité cérébrale qui caractérise le nourrisson. Peu de travaux portent sur la recherche de marqueurs précoces dans le domaine du développement moteur. Pourtant, l’analyse rétrospective des films familiaux d’enfants avec Troubles du Spectre de l’Autisme (TSA) met en évidence certaines anomalies présentes précocement témoignant de dysfonctionnements dans tous les secteurs d’activité corporelle (Teitelbaum et al.,1998). En pratique clinique, beaucoup de parents rapportent, lors de l’anamnèse développementale d’enfants avec TSA, l’apparition d’une marche tardive, parfois atypique et régulièrement non précédée de déplacement à quatre pattes. Ce passage par une marche à quatre pattes n’est pas systématique dans le développement de l’enfant typique, et son absence n’est bien entendu pas spécifique d’un TSA, il nous a néanmoins semblé qu’il apparaissait avec une fréquence significativement moindre chez les enfants avec TSA. Aussi, nous avons cherché à valider l’hypothèse d’une moindre fréquence du passage par le déplacement à quatre pattes dans le développement moteur de ces enfants. La perspective de cette étude est de pouvoir éventuellement s’appuyer, en complément d’autres instruments ou marqueurs suscités, sur ce pattern moteur dans le dépistage des enfants à risque de TSA. Pour ce faire, nous avons comparé la fréquence de marche à quatre pattes dans la population typique à une population d’enfants avec TSA, ainsi que d’autres facteurs et paramètres de développement moteur précoce. A l’aide d’un questionnaire parental et du carnet de santé, nous avons évalué rétrospectivement la fréquence (sous la forme présence ou absence) du déplacement à quatre pattes auprès d’un échantillon de 79 enfants avec autisme typique ou syndrome d’Asperger (diagnostiqués au CRA de Bretagne entre 2011 et 2014) et de 100 enfants au développement typique. Tous étaient âgés entre 18 mois à 15 ans au moment de la récolte de données. Les principaux résultats observés sont : (1) une moindre fréquence de marche à quatre pattes chez les enfants avec autisme typique (44.2 % vs 69 % des enfants typiques; p=0.005), tendance observée chez les enfants Asperger (52.8 % vs 69 %; p=0.08) ; (2) à 9 mois, une moindre fréquence d’acquisition de la position assise sans aide et du déplacement chez les enfants avec autisme typique ou Asperger (tous les p<0.05) ; (3) l’âge moyen de la marche plus tardif chez les enfants avec autisme typique (15.9±2.3 mois) ou Asperger (14.5±1.9 mois) par rapport aux enfants typiques (13.1±1.2 mois; p<0.05). Ainsi, cette étude pilote soutient notre hypothèse : les enfants avec TSA semblent présenter moins fréquemment dans leur développement précoce un passage par un déplacement à quatre pattes que les enfants au développement typique. L’absence de marche à quatre pattes pourrait ainsi constituer un nouvel indicateur de dépistage précoce dans le registre du développement moteur

Early Motor Skills in Children With Autism Spectrum Disorders Are Marked by Less Frequent Hand and Knees Crawling

International audienceOur aim in this study was to affirm or negate (quantitatively) our subjective impression of altered hands and knees crawling (HandK crawling) among children with Autism Spectrum Disorder (ASD). Through parental questionnaires and children's health records, we retrospectively compared early motor skills, including the frequency of HandK crawling in 79 children with Autistic Disorder or Asperger Syndrome versus 100 children with typical development (TD). We found HandK crawling to be significantly less frequent among children with ASD (44.2%) versus children with TD (69%). Children with ASD also showed a decreased frequency of acquiring a seating position without help and a later mean walking age compared to the TD children. These data suggest that early motor development delays may be a useful sign for detecting ASD at early ages

Association between Hpa Axis Functioning and Mental Health in Maltreated Children and Adolescents: A Systematic Literature Review

Background: Previous studies have demonstrated that children who experience maltreatment show a more elevated risk of psychopathological disorders than children from the general population. The HPA (hypothalamic–pituitary–adrenal) axis is not mature at birth and undergoes strong social regulation during the first years of life. Consequently, early exposure to stress could modify the usual adaptative response to stress. In stressful situations, perturbations in both cortisol response and cortisol circadian rhythm have been observed. Nevertheless, studies that have evaluated the links between child abuse, dysregulation of the HPA axis, and mental disorders have shown diverse results. Because of the variety of methods employed in the different studies, no formal comparisons have been made. In this systematic review, we have brought together these results. Methods: We conducted a systematic review of studies analyzing the correlation between child abuse, mental disorders, and HPA axis activity in patients aged between 6 and 16 years. PubMed, Scopus, Cochrane, and Google Scholar were searched using relevant keywords and inclusion/exclusion criteria (from 2000 to 2020). Results: Fifteen studies from the 351 identified were included. Most patients were children in the child welfare system. Children who had experienced child abuse presented with more severe mental disorders (particularly in the dimensional measure) than children who had not been abused. HPA axis activity was assessed by measuring basal cortisol for some studies and cortisol reactivity for other studies. For children experiencing child abuse, there was a possible association between abuse and a decrease in the reactivity of the HPA axis. In addition, early life stress could be associated with lower matinal cortisol. However, the association between mental disorders and cortisol secretion in maltreated children did not seem obvious. Conclusions: This systematic review demonstrates that mental disorders are more frequent and severe in cases where child abuse has occurred. Moreover, children who experienced child abuse seem to present changes in the reactivity of the HPA axis. Nevertheless, the potential correlation between these changes in the reactivity of the HPA axis and mental disorders in this population needs to be evaluated in further studies

Sympathy-Empathy and the Radicalization of Young People

Background: The sympathy-empathy (SE) system is commonly considered a key faculty implied in prosocial behaviors, and SE deficits (also called callous-unemotional traits, CUTs) are associated with nonprosocial and even violent behaviors. Thus, the first intuitive considerations considered a lack of SE among young people who undergo radicalization. Yet, their identification with a cause, their underlying feelings of injustice and grievance, and the other ways in which they may help communities, suggest that they may actually have a lot of empathy, even an excess of it. As a consequence, the links between SE and radicalization remain to be specified. This critical review aims to discuss whether and how SE is associated with developmental trajectories that lead young people to radicalization. Method: We first recall the most recent findings about SE development, based on an interdisciplinary perspective informed by social neuroscience. Then, we review sociological and psychological studies that address radicalization. We will critically examine the intersections between SE and radicalization, including neuroscientific bases and anthropologic modulation of SE by social factors involved in radicalization. Results: This critical review indicates that the SE model should clearly distinguish between sympathy and empathy within the SE system. Using this model, we identified three possible trajectories in young radicalized individuals. In individuals with SE deficit, the legitimization of violence is enough to engage in radicalization. Concerning individuals with normal SE, we hypothesize two trajectories. First, based on SE inhibition/desensitization, individuals can temporarily join youths who lack empathy. Second, based on an SE dissociation, combining emotional sympathy increases for the in-group and cognitive empathy decreases toward the out-group. Conclusions: While confirming that a lack of empathy can favor radicalization, the counterintuitive hypothesis of a favorable SE development trajectory also needs to be considered to better specify the cognitive and affective aspects of this complex phenomenon

Self/other distinction in adolescents with autism spectrum disorder (ASD) assessed with a double mirror paradigm.

BackgroundSelf/other distinction (SOD), which refers to the ability to distinguish one's own body, actions, and mental representations from those of others, is an essential skill for effective social interaction. A large body of clinical evidence suggests that disruptions in SOD may be key to social communication deficits in individuals with autism spectrum disorders (ASD). In particular, egocentric biases have been found in cognitive, affective, behavioural, and motor domains. However, research in this area is scarce and consists of recognition paradigms that have used only static images; these methods may be insufficient for assessing SOD, given the increasing role of embodiment in our understanding of the pathophysiology of ASD.MethodA single-centre, prospective pilot study was carried out to investigate, for the first time, self-recognition and SOD in seven adolescents with ASD compared with matched, typically developing controls (TDCs) using the "Alter Ego"TM double mirror paradigm. The participants viewed a double mirror in which their own face was gradually morphed into the face of an unfamiliar other (self-to-other sequence) or vice versa (other-to-self sequence); participants were instructed to indicate at which point the morph looked more like their own face than the other's face. Two judgement criteria were used: 1) M1: the threshold at which subjects started to recognize their own face during the other-to-self morphing sequence; 2) M2: the threshold at which subjects started to recognize the other's face during the self-to-other morphing sequence.ResultsConsistent with the predictions, the results showed that the participants with ASD exhibited earlier self-recognition in the other-to-self sequence and delayed other-recognition in the self-to-other sequence, suggesting an egocentric bias. SOD impairments were also marginally correlated with ASD severity, indicating earlier face recognition in more severely affected individuals. Furthermore, in contrast with that of TDCs, the critical threshold for switching between self and other varied with the direction of morphing in ASD participants. Finally, these differences in face recognition and SOD using mirrors, unlike previous research using static images, support the central place of bodily self-consciousness in SOD impairments.ConclusionsAlthough additional research is needed to replicate the results of this preliminary study, it revealed the first behavioural evidence of altered SOD in ASD individuals on an embodied, semiecological face-recognition paradigm. Implications for understanding ASD are discussed from a developmental perspective, and new research and therapeutic perspectives are presented

Psychosis Caused by a Somatic Condition: How to Make the Diagnosis? A Systematic Literature Review

Background: First episode of psychosis (FEP) is a clinical condition that usually occurs during adolescence or early adulthood and is often a sign of a future psychiatric disease. However, these symptoms are not specific, and psychosis can be caused by a physical disease in at least 5% of cases. Timely detection of these diseases, the first signs of which may appear in childhood, is of particular importance, as a curable treatment exists in most cases. However, there is no consensus in academic societies to offer recommendations for a comprehensive medical assessment to eliminate somatic causes. Methods: We conducted a systematic literature search using a two-fold research strategy to: (1) identify physical diseases that can be differentially diagnosed for psychosis; and (2) determine the paraclinical exams allowing us to exclude these pathologies. Results: We identified 85 articles describing the autoimmune, metabolic, neurologic, infectious, and genetic differential diagnoses of psychosis. Clinical presentations are described, and a complete list of laboratory and imaging features required to identify and confirm these diseases is provided. Conclusion: This systematic review shows that most differential diagnoses of psychosis should be considered in the case of a FEP and could be identified by providing a systematic checkup with a laboratory test that includes ammonemia, antinuclear and anti-NMDA antibodies, and HIV testing; brain magnetic resonance imaging and lumbar puncture should be considered according to the clinical presentation. Genetic research could be of interest to patients presenting with physical or developmental symptoms associated with psychiatric manifestations

Une implémentation de jeu d'imitation avec des enfants atteints de TSA pour apprendre des comptines

International audiencePrevious studies have suggested that being imitated by an adult is an effective intervention with children with autism and developmental delay. The purpose of this study is to investigate if an imitation game with a robot can arise interest from children and constitute an effective tool to be used in clinical activities. In this paper, we describe the design of our nursery rhyme imitation game, its implementation based on RGB image pose recognition and the preliminary tests we performed