Des comportements alimentaires inhabituels chez les enfants autistes (Dr Jean-Marc Retbi, Journal International de M2édecine)
Les Comportements Alimentaires Inhabituels [CAI] ne font pas partie des critères de diagnostic des Troubles du Spectre Autistique [TSA]. Cependant, ils sont fréquemment rapportés par les parents et constatés par les éducateurs. Une étude, parue récemment dans une revue spécialisée, en fournit une description détaillée chez les enfants autistes.
Cette étude compare les CAI de 1 462 enfants avec TSA (âge moyen : 6,5 ans ; extrêmes : 1-18 ans) à ceux de 240 enfants avec des Troubles Déficit de l’Attention/Hyperactivité [TDA/H] et 313 enfants « neurotypiques » (normaux). Presque tous les enfants avec TSA et ceux avec TDA/H font partie du recrutement d’une Clinique de diagnostic pédo-psychiatrique nord-américaine alors que tous les enfants neurotypiques font partie de l’échantillon de standardisation de la CASD (Checklist for Autism Spectrum Disorder), un entretien semi-directif avec les parents à visée diagnostique. Les données sont tirées d’un item de la CASD sur les difficultés d’alimentation, et parfois de notes complémentaires des cliniciens.
Quatre fois plus fréquents que dans le TDAH
Les CAI ont une prévalence de 70 % dans les TSA. Ils sont 4,2 fois plus fréquents que dans les TDA/H dans le recrutement de la clinique (70,4 % versus 16,6 % ; p <0,0001), et 14,2 fois plus fréquents que chez les enfants neurotypiques dans l’échantillon de standardisation (68,4 % vs 4,8 % ; p < 0,0001).
Dans un sous-groupe de 253 TSA deux CAI sont prédominants : la sélectivité alimentaire (88,5 %) et l’hypersensibilité à certaines textures (46 %). En général les enfants autistes résistent à l’introduction de nouveaux aliments. Leur éventail d’aliments est restreint et s’élargit peu avec l’âge. Ils préfèrent les aliments uniformes et fades, et ont une prédilection pour les produits céréaliers et les nuggets de poulet. Certains refusent les aliments écrasés, d’autres les morceaux… Ces CAI sont aussi rapportés dans les TDA/H et, transitoirement, chez des enfants neurotypiques.
Les autres CAI comprennent, par ordre de fréquence décroissant, le stockage d’aliments dans le vestibule buccal (19,2 %), le pica (11,6 %), la consommation d’une seule marque d’un aliment, ainsi que des rituels autour de la présentation des aliments… Ces CAI ne sont pas rapportés dans les TDA/H ni chez les enfants neurotypiques.
Sélectivité alimentaire et hypersensibilité à certaines textures sont souvent combinés
Près de 60 % des enfants autistes présentent simultanément deux CAI ou plus, la combinaison la plus fréquente étant celle de la sélectivité alimentaire et de l’hypersensibilité à certaines textures.
Les CAI des autistes apparaissent précocement, dès la 2e année de vie. Ils n’empêchent pas la prise de poids. Leur prévalence diminue avec l’âge (de 78,5 % à 0-2 ans à 67,1 % à ≥ 6 ans ; p < 0,01), mais on les observe encore chez les adolescents et les adultes.
La sélectivité alimentaire et l’hypersensibilité à certaines textures des autistes se différencient des troubles des comportements alimentaires au sens du DSM-V, principalement l’anorexie mentale et les évitements/restrictions alimentaires dont l’acronyme anglais est ARFID. Dans les TSA, les CAI n’ont pas d’impact sur le poids, les ingesta ne sont pas réduits et les sujets ne sont pas préoccupés par leur poids ou l’image de leur corps.
Cette étude confirme la fréquence élevée des CAI dans les TSA. Leurs types, spécifiques ou non, et un nombre supérieur à 2 doivent éveiller l’attention des professionnels de santé quand ils sont signalés chez un jeune enfant, et les conduire à conseiller aux parents un bilan dans un centre de diagnostic et d’évaluation des TSA si cela n’a pas déjà été fait. Il est prouvé qu’une prise en charge précoce par une méthode comportementale améliore le pronostic des TSA, y compris les CAI.
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