De la mère à l’environnement, les causes suspectées de l’autisme (Dr. Alain Cohen, Journal International de Médecine)
Depuis plusieurs décennies, la recherche sur les causes de l’autisme s’est orientée surtout vers des hypothèses mono-factorielles. Avec Leo Kanner et surtout Bruno Bettelheim, la théorie prédominante des années 1960 supposait que des réponses parentales inadaptées en matière de communication conduisaient les enfants autistes à se replier sur leur propre monde et à rechercher dans des comportements répétitifs et stéréotypés une réassurance qu’ils ne trouvaient pas lors de liens inconsistants avec leurs parents. Et plus particulièrement avec leur mère : l’expression « mère-réfrigérateur »[1] contribua ainsi à la stigmatisation et à la culpabilisation des « mères de psychotiques » (car on parlait alors plus volontiers de « psychose infantile » que de « troubles envahissants du développement » ou de « troubles du spectre autistique », comme par la suite).
Responsabilité génétique
Si ces idées réductrices et contestables n’ont plus cours, le risque de culpabilisation maternelle demeure pourtant, car les progrès de la génétique associés à la transparence dans l’information renvoient paradoxalement ce risque en boomerang, quand la mère apprend par exemple qu’elle est « responsable » d’avoir transmis un « mauvais ADN mitochondrial » (une hérédité exclusivement maternelle) ou « un mauvais gène » (comme dans le syndrome de l’X fragile)[2], des problématiques associées parfois à des troubles de type autistique. Avec l’avènement des recherches génétiques et, parallèlement, l’essor de la neuro-imagerie, les conceptions psychanalytiques (et plus largement psychogénétiques) sur le déterminisme de l’autisme ont été supplantées par une approche où il s’enracine dans des dysfonctionnements du neuro-développement, lesquels expliqueraient aussi ses liens avec certains syndromes génétiques.
Pesticides, métaux lourds, perturbateurs endocriniens… désormais suspectés
Cependant, ces pistes génétiques n’épuisent probablement pas toutes les causes des troubles autistiques, considérés désormais comme les effets de contextes étiologiques poly-factoriels. Des éléments de l’environnement sont aussi incriminés, surtout à titre de facteurs de risques prénatals.
Épidémiologiste spécialisée sur ce thème, la Pr. Irva Hertz-Picciotto[3] (qui exerce à l’Université de Californie, à Davis) rappelle ainsi le rôle nocif de certains polluants comme des métaux lourds (plomb, mercure) ou les PCB[4], démontré notamment par les suites d’accidents industriels, telle la contamination d’huile de cuisine par des PCB (au Japon et à Taïwan) où les sujets exposés in utero ont été « les plus sévèrement atteints. » Et en raison d’une persistance prolongée (leur demi-vie s’évaluant en années chez les humains), ces polluants peuvent altérer le neuro-développement in utero d’un enfant, « même plusieurs années après l’exposition de la mère au produit toxique, et ils seraient suffisamment répandus dans l’environnement pour contribuer à expliquer une partie de « l’épidémie » actuelle de troubles autistiques ou/et cognitifs… »
Mais quels que soient ces facteurs d’environnement (pesticides, métaux lourds, ozone, perturbateurs endocriniens, microbiote, etc.), les auteurs rappellent que, contrairement aux facteurs génétiques, ils peuvent être modifiés : ouvrant alors des perspectives de prévention pour réduire leur part de responsabilité dans le déterminisme des troubles autistiques, cette possibilité intéressante justifie d’intensifier les recherches sur tous les facteurs d’environnement, au sens large : facteurs écologiques, microbiologiques, immunologiques, psychosociaux…
[1] https://fr.wikipedia.org/wiki/M%C3%A8re_r%C3%A9frig%C3%A9rateur
[2] https://www.orpha.net/data/patho/Pub/fr/XFragile-FRfrPub120.pdf
[3] https://en.wikipedia.org/wiki/Irva_Hertz-Picciotto
[4] https://fr.wikipedia.org/wiki/Polychlorobiph%C3%A9nyle
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