Dépistage de l’autisme : ne pas négliger les alertes parentales (Dr Roseline Péluchon, Journal International de Médecine)
Le dépistage précoce est un enjeu majeur dans la prise en charge des troubles du spectre autistique. Le praticien n’est pas démuni et dispose de plusieurs outils pour cela.
La première alerte provient souvent des parents. Le Pr David da Fonseca insiste sur l’attention que les praticiens doivent accorder aux signes d’alerte émis par les parents et à leurs inquiétudes. Les premiers signaux sont évoqués par les parents dans 38 % des cas dès la fin de la première année, dans 41 % des cas entre la 1ère et la 2ème année, dans 16 % des cas entre 2 et 3 ans et dans 5 % au-delà de 3 ans. C’est-à-dire que des signes sont repérables généralement avant 2 ans. Toutefois, l’on observe un décalage important, allant de 15 à 24 mois, entre le moment où les parents font part de leurs préoccupations et le premier avis spécialisé.
Différents travaux ont identifié 2 types de trajectoires des troubles du spectre autistique. La première est précoce, avec les premiers signes perçus vers l’âge d’un an, voire plus tôt. La seconde est tardive, avec les premiers signes apparaissant vers 18 mois. Mais, à 24 mois et à 36 mois, il n’existe plus de différence dans la symptomatologie entre ces 2 groupes.
L’inquiétude des parents est un signe majeur
Quel que soit l’âge, les signes d’alerte majeurs sont l’inquiétude des parents concernant le développement de l’enfant, particulièrement en termes de communication sociale et de langage, ou la survenue d’une régression des habiletés langagières ou relationnelles, alors que l’examen neurologique est normal. Chez le jeune enfant, l’absence de babillage ou de gestes sociaux de communication à 12 mois, l’absence de mots à 18 mois et l’absence d’associations de mots à 24 mois, doivent alerter. A 18 mois, 2 signes simples à détecter peuvent être considérés comme des indicateurs d’un trouble du développement : il s’agit de l’absence de pratique du jeu de « faire semblant » et la rareté, voire l’absence de l’attention conjointe.
Le M-CHAT, outil de dépistage dès 24 mois
Des tests permettent ensuite de préciser les premières constatations du dépistage. Le premier d’entre eux, le CHAT (CHecklist for Autism in Toddlers), utilisé à partir de 18 mois, a été remplacé par le M-CHAT (Modified CHecklist for Autism on Toddlers), questionnaire proposé à 24 mois, rempli par les parents, et comportant 23 items. Il explore le comportement de l’enfant envers son entourage, ses manifestations d’intérêt et l’attention qu’il porte aux autres. Ce test explore également d’autres domaines comme le comportement moteur, etc. Il s’agit bien d’un test de dépistage et non pas d’un test diagnostique. La conduite à tenir ensuite varie selon le score obtenu. Un score < 3 signale un risque faible, il est alors préconisé de renouveler le dépistage un peu plus tard. Un score moyen justifie un examen complémentaire pour rechercher d’autres signes d’alerte. Enfin un score élevé > 7 nécessite une évaluation diagnostique dans un centre spécialisé.
Un autre questionnaire, le SCQ (questionnaire de communication sociale) peut être utilisé après 4 ans. Il comporte 40 questions et doit être rempli par un parent ou une personne connaissant bien l’enfant.
Enfin, pour le dépistage des troubles du spectre autistique sans déficience intellectuelle (autisme de haut niveau ou syndrome d’Asperger), des tests utilisés au Royaume-Uni ont été traduits en langue française et sont actuellement à l’étude pour leur utilisation en France (Quotient du spectre de l’autisme, Quotient d’empathie, Quotient de systématisation).
Dr Roseline Péluchon
Références
Pr David da Fonseca : Dépistage de l’autisme : comment être efficace sans être excessif ? 21èmes Journées Interactives de Réalités Pédiatriques. Du 10-11 septembre 2020 (Bordeaux).
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