Autism

Epidemiology

The Prévalence estimated on an English population is of almost 4 cases for 1000 of the same children age.

In France, the autism would concern more than one hundred thousand people, confused children and adults. This figure would underestimate however reality.

Several publications give a report on a rate of prevalence of more than 60 children out of 10.000 touched by a form of autism is 1 child out of 166

This figure would have further increased. It is what the last epidemiological studies carried out in the USA since 2000 by the CDC show (Center for Disease Control and Prevention), on hundreds of thousands of children: the prevalence of the autism would reach from now on a child on 150.

Diagnosis

The clinical picture of this disease was defined in 1943 by the psychiatrist Léo Kanner, which took again the term of autism (of the Greek car , oneself) created in 1911 by Eugen Bleuler in order to name the behavior of fold on oneself that it observed at certain subjects within the framework of his studies on the Schizophrénie (Dementia praecox). Bleuler had condensed the word autoerotism of Freud to evacuate of it the sexual concept which it contained. The symptoms appear during the first three years of the life of the child. They are varied and vary from one patient to another, their intensity being able to evolve/move, in particular with the age:

indifference with the others or reactions odd;
repetitive behaviors and stereotyped activities (agitation of the hands, swinging of the body…) ;
disinterest for the objects of its environment or nonconventional and stereotyped use;
dumbness or unusual language (for example echolalia: repetition in echo of the sentences or words heard);
fear of the change.

None them is sufficient individually to establish a diagnosis. In the same way, the absence of a criterion does not disqualify therefore the diagnosis of autism. Thus, a child can be verbal and to have autism.

Criteria of diagnosis

The descriptive criteria of diagnosis of the Manual off Psychiatric Diseases , 4th edition (DSM-IV) of American Psychiatric Association are the following (Diagnosis Criteria for 299.00 Autistic Disorder).

Critère has
# the qualitative of the reciprocal interactions social, severe and durable deterioration;
# Deterioration of the communication, marked and durable, which affects the verbal and nonverbal capacities;
# Character restricted, repetitive and stereotyped behaviors, interests and activities.
Criterion B
# Beginning before the 3 years age.
Critère C
# the disturbance is not explained better by the diagnosis of Syndrome of Rett or désintégratif Trouble of childhood.

The use of international classifications allows all the speakers (professional and parents) a better communication, by the use of the same terminology.

Diagnostic tools

Tracking

International classifications (CIM-10, DSM-IV) insist on the dysfunctions relating to the communication and the social interactions in the autism, and these anomalies are not easily detectable in very the young child.

In answer to these difficulties of tracking, S. Baron-Cohen and Al worked out in 1992 a tool allowing to locate the early signs of the TED in the children at the autistic risk as of 18 months.

This test, composed of a series of nine questions to pose to the parents and of a series of seven observations to be carried out by a professional is simple and fast to manage. It can completely be used by non-specialists in autism, the such general doctors. It consists of observations which relate to two central points. Initially, concept “to make seeming”, present in the normal development towards the 12-15 month age, and which is disturbed in the autism. In the second place, the behavior of joint attention, present in the normal development towards the 9-14 month age, and which is absent or rare in the autism. Studies of validity (16 000 subjects) revealed that the 18 month old children detected as high-risk from diagnosis of autism received this diagnosis at 3 years thereafter.

The test CAT makes it possible to locate deteriorations of development of the child in the following fields:

play “to make seeming”;
protodéclaratif pointing (to draw the attention of the entourage towards a center of interest by pointing finger);
social interest;
social play;
joint attention.

The diagnosis

The disorders are rather stable at the three years age so that one can pose a reliable diagnosis. For a strong majority of case, the diagnosis can be posed as of two years. Before this age, the reliability of the diagnosis is not guaranteed.

The diagnosis must be posed on the basis of international classification.

Causes

Cerebral anomalies and defects of the placenta

Cerebral anomalies

The review of the expert of April 1999 gives a report on anomalies of cytoarchitectonic limbic system and cerebellum. One observes an increased size of certain cells and a reduction in intercellular connections. " The absence of anomalies in other areas suggests that the lesions occur before the 23e week of gestation".

Defects of the placenta

Researchers of the medical school of Yale highlighted the presence of defective cells in the placenta of children developing with T.E.D. These results could lead to an early diagnosis of a disorder développemental which roughly assigns a child on 200 and who has like consequence of the difficulties of communication, socialization and interaction with others.

Kliman and its team examined under the microscope of the fabric samples coming from the placenta recovered by various hospitals of research. Thirteen of the samples came children diagnosed later on Asperger and sixty and one came not diagnosed children. The comparison of various fabrics highlights the presence, in the placentas of the children who are in the spectrum of the autistic disorders, of abnormal microscopic wells, three times more than those of the reference group.

Research could lead to analyzes of routine of the placenta of newborns at the risk, in particular those which have an older brother or sister who develops with autism.

Genetics causes

In synthesis m/s (medicine/sciences) of 2003, the authors think that a quarter of the cases of autism is associated with known affections. The three remaining quarters remain of unknown origin.

The development of the novel methods of analysis as well as the studies undertaken as of the Seventies on the couples of twins made it possible to highlight a strong influence of heredity in the appearance of the autistic syndrome.

The elements in favor of the genetic cause of the autism are:

the proportion girls/boys is identical in all the countries, whatever the sociocultural level
the probability of developing with autism increases with the genetic proximity:
* lower than 1 % for the general population
* 3 % (autism) and 10 % (T.E.D.) in the brothers and sisters of children with autism
* 60 with 90 % at identical twin
the “agreement” of the autism is higher at identical twin than among fraternal twins (approximately 3 %,)
Several genetic diseases, malformations chromosomal or infectious illness are in bond with the autism in a statistically significant way.

Chromosomal causes

Half of these autists of chromosomal origin is:

either a Syndrome of Prader-Willy
or a Syndrome of Angelman

An international study on the autism, in which take part, since 2002,120 researchers of 9 countries, is in hand. DNA of 1.200 families whose member is autistic were collected and are studied. The first results made it possible to identify an area of susceptibility in the Chromosome 11 and the description of the defect of expression of a gene in the Chromosome 2.

Genetic causes

The autism is observed in the following monogenetic diseases:

A recent study shows that the majority of the cases of autism could be explained by spontaneous genetic mutations and not by a genetic predisposition transmitted on many generations.

Psychogenic

Approaches

There does not exist curative treatment of the autism, which does not prevent that the people with autism can profit from treatments psychotherapeutic S simultaneously with an institutional assumption of responsibility, educational and teaching.

The scientific literature is however unanimous on this point: is needed that the educational intervention is early, massive and structured. The best results are obtained when the child profits from an educational and behavioral assumption of responsibility as of his 2 years.

Behavioral approach

Any intervention starts with a good evaluation. Once the profile développemental of the determined child, one works out an individualized project that the team which follows it and the parents will apply within the structure and in the daily life of the child. Every year, one evaluates the development of the child and one rehabilitates the personalized project of the child at the meetings of synthesis.

The behavioral intervention is very effective to treat the behavioral problems, which are very often present in the autism. The intervention usually consists in replacing an inadequate behavior by another, adequate. One intervenes on the behavior itself and/or the causes of the behavior. It is proven today that the people reached of autism having profited from a structured education more autonomous, are médicamentées and more integrated in the company than those which were private.

Method PECS

When the child does not acquire the verbal language, it is necessary to propose to him alternative and augmentative means of the communication. In the autism, in fact the facets of the communication are reached.

Andrew Bondy and Lori Frost (Delaware US) developed communications tools called PECS. Method PECS consists in for the child giving to his interlocutor the image of the object which it wishes to obtain in exchange.

The difference in the other methods of alternative communication, the PECS makes it possible the child to learn how to initiate itself a communication with others. The time necessary with this training is extremely short. Moreover, the cost is extremely low, because of the possibility of creating oneself the material, made up of photographs or pictograms, according to the comprehension of the subject.

The PECS was validated as of 18 months, and can be started at any age of the life.

Program A.B.A

A.B.A ( Applied Behavioral Analysis , or analyzes applied behavior) is an educational approach inspired of the Béhaviorisme and created by Ivar Lovaas with the the United States in the years 1960. It consists of an analysis of the behavior, associated with an intensive intervention aiming at obtaining best integration in the company by the increase in the behaviors considered adapted, and the reduction in the behaviors considered to be unsuited (see operative Conditionnement).

The results obtained initially by Lovaas, and then confirmed by other studies, report that 50% of the children - which had less than 3 years at the beginning - having followed the program lasting 2 to 3 years, then could continue their school course without assistance, by having an indistinguishable operation of the normal children (see the scientific references on ABA in the external bond below, in particular the article of Sallows & Graupner).

So that a program A.B.A is effective, its promoters give the two following conditions. Initially, it must be intensive, at a rate of 30 to 40 hours per week. Then, it must be carried out by an educative team (of which the parents are integral part) trained and intervening in the same way, within the framework of a well defined individualized program. Moreover, the forecast is of as much better than program A.B.A is started early.

This type of intervention is on the other hand very constraining. In addition to its procedure, it has a cost which the families cannot only support. In France, A.B.A is not recognized by the Social security. On the other hand, in Holland or with the Canada (Ontario) this approach is dealt with by the State.

The detractors of A.B.A criticize this method because it takes its source in research on conditioning (Pavlov, Skinner). Its promoters consider, on the contrary, that conditioning belongs to any education, and that A.B.A is only one adaptation of this aspect for a population which has particular difficulties of training. They insist on the concrete results which they obtain.

Futuroschool

The Futuroschool is a school of a new kind, of which the educational methods for autists are imported of the United States. The basic principle consists in opening the autistic children in the “ordinary” world. A project to answer the deficiency of the current devices which leave choice only the hospital of day or the institution, sometimes some medical-social work departments in residence or many classes of integration in school.

Program TEACCH

The heart of teaching structured TEACCH - Treatment and Education off Autistic and related Communication handicapped CHildren - is the development of autonomy in the following topics: skills of work, autonomy with the daily life, leisures, social skills and managements of the behaviors. This technique is derived from the Béhaviorisme and rests on the idea that the autism is the expression of a neurological deficit. The means to apply it are the structure and the communication. The four shutters structured in approach TEACCH are

space;
time;
the system;
the task.

The goal of the structure is to adapt teaching to make up the specific deficits of each person, of miser on the forces, to reduce useless and perturbing stimulations, to stress relevant information, to make it possible the person to give a direction to its environment, to make it possible the person to include/understand what one awaits from it, to better manage the behaviors and to reach a greater autonomy. All these elements belong to program TEACCH and are individualized for each person as well on the level of the objectives as of the means. The purpose of this is to meet the specific needs of each autist and its family.

Program TEACCH was the object of many studies:

Schopler, E. (1997a). Birth of the program TEACCH Principles, put into practice and evaluation.
In R. Misès and pH. Large (Eds.), Parents and professionals in front of the autism (pp. 191-207).
Paris: C.T.N.E.R.H.I and Sally Ozonoff and Kristina Cathcart, 1998, Effectiveness off have Home Program Intervention for Young Children with Autism , Journal off Autism and Developmental Disorders , Volume 28, Number 1 )

; Advantages: The application of this program makes it possible clearly to restrict the number of placements of the adult people reached of autism in restrictive institutional mediums. The parents also testify to the assistance brought by this program, which made it possible largely to decrease their level of stress at the house. The program is very well documented, also in French. While integrating them into the follow-up of their child, TEACCH does not require so that the parents become the teachers of their child.
; Disadvantages: It is a rather environmental approach, which means that one works less directly on the person, whereas the current trend is intrusive because one does not live on a planet " ". The relative tolerance of the deviating behaviors can pose problem if one lets the behavior crystallize until the adulthood.

Program IDDEES

The program IDDEES (Intervention, Development, Residence, School, Company, Supervision) was created in 2000 in Paris by Doctor Gattegno. Program IDDEES is a programme of assumption of responsibility total for people with disorders of the development which takes into account:

the development of the person
particular cognitive style
capacity of regulation of the activities and the behaviors

The assumption of responsibility is based on the assumptions of responsibility educational, behavioral and cognitive. The technique of assumption of responsibility is based in particular on the concepts of Regulation Modifiabilité Développement (RMD):

To control the cognitive and social trainings
To modify the cognitive and emotional structure for a suitable social integration
To develop the cognitive potential by taking account of the level of development, the forces and the weaknesses of cognitive operation

The original device of program IDDEES comprises two aspects:

weekly individualized accompaniment or intensive of the people reached of TED by students in psychology and/or psychologists
the intensive supervision of the individualized programs, speakers and families by the psychologists of network ESPAS (Evaluation - Support - Individual Programs - Accompaniment - Supervision)

See: Cabinet ESPAS - IDDEES

Contact with the animals

To take care of a pet can help the child with autism to develop his direction of the responsibilities and certain social aptitudes, but there exists very little of research being able to show the positive impact of the contact with the animals. Actually, several specialized educators specialize now in zoothérapie and one supports that since the autism is a problem of communication, the animal contact would be easier for the people reached by this syndrome.

Équithérapie

Dr. Bill Benda, researcher of Université of Arizona, made studies on the influence of horsemanship on various forms of handicap, of which autism.

Obviously, the lessons of horsemanship for the autists require a heavy structure of framing, and the monitors all are not formed in the field of the autism. This is why the adapted teaching of traditional horsemanship tends to being replaced by activities strictly speaking therapeutic associating the horse, suggested by looking after having received a specific training in équithérapie, and practiced into individual as in the majority of the more traditional therapies.

The équithérapie is an activity which can take an active part in the development of social competences and influence the communication notably. The contact with the horse does not require of verbal capacities but an aptitude for the expression of the body (isopraxic communication) and for the expression of the emotions (isoesthesic communication) which is usually relatively preserved in the autism, and more rapids to make emerge that the verbal language. It is thus a true dialog which can be set up between the animal and the child, which constitutes a first stage towards a language more structured.

The contact between the child and the horse, that it is by the grooming, displacements with foot (in longe, in halter, with long the reindeers) or possibly assembles it (which is not obligatory in équithérapie, contrary to the courses of horsemanship), supports also the autonomisation, the catch of responsibility, the regulation of the activity, the tonico-postural adjustment, the construction of space and the body structuring. The emotional aspect related to felt can also be put in direction, by words, charts or the mediatization of a drawing, because of the presence of the thérapeute.
• Source: French company of Equithérapie

Tomatis method

This original Method relates to the relations existing between the ear and the voice, and by extension between listening and the communication: it is acted in fact of a pedagogy of listening insofar as it allows about finding the desire to communicate while learning how as well as possible to use the auditive system it has.

The Tomatis Method also works on the improvement of the perception of the frequencies of the human voice (which can be disinvested with the profit of other frequencies).

She works finally on auditive lateralization. By making right ear the directing ear, one allows a faster and more effective decoding of the language, because the right ear leads the sound to the left hemisphere where the decoding of the language is, whereas a direct left ear brings the sound to the right hemisphere, which does not have any linguistic capacity.

The relevance of the approach of Tomatis Method seems confirmed by the recent discoveries, in particular the article published in the monthly magazine Nature Neuroscience in 2004 (cfr " Surface of perception of the voix" below).

Psychoanalytical approach

Research

Surface of perception of the voice

According to a research team Franco-Canadian, published in Natural monthly magazine Neuroscience and which was very médiatisée in 2004, the “perception of the active voice” at the normal subject a specific cerebral surface on the external face of the left higher temporal furrow, whereas at the autistic subject, the voice does not cause any activation of this zone. This handicap thus includes/understands an anomaly of the recognition of the human voice.

This discovery whose conclusions remain to be confirmed brings a new lighting to the comprehension of the major disorders of the communication from which the autists suffer. Behavioral studies had already made it possible to observe the deficit of the perception of the voice in the autism, and in 2000, other teams had already shown anomalies on the level of what one thinks of being able to regard as the surface specialized in the recognition of the faces.

This work thus supports the assumption according to which the autism would be related to a certain number of deficits of the perception of the social stimuli (voice, intonations, mimicry…), and could allow the development of new educational strategies of early assumption of responsibility of the very young patients, if the next studies confirm that such anomalies can already be noted among very young patients from 12 to 18 months. That could confirm that these very young children test difficulties of locating and of answering elementary social signals, like answering the smile of their mom or tightening the arms to him, and it could be set up of the therapies of the communication, intended to activate the disturbed cerebral systems.

More recent experiments however showed than, far from not showing any reaction (deficit) to the human voice, the “perception of the voice” at subjects presenting of the autistic disorders activates a zone located in the cerebral hemisphere right corresponding to a surface of treatment of the emotions (in particular caused by the listening of the music) at the ordinary subjects.

The research field which remainder is thus vast.

Bond with the text of Monica Zilbovicius, researcher with the C.E.A.

Particular food modes

It was empirically discovered that a Régime without casein nor gluten can significantly improve the quality of the life of certain patients. The products necessary to this mode are however difficult to reach and are expensive.

In addition, this announced improvement is not confirmed by the professionals implied in the accompaniment of people presenting of the autistic disorders. It leaves thoughtful all the specialists.

Two points of view exposed in an article of the INSERM

Theory of the spirit

In France

In France, the autism would concern more than one hundred thousand people, confused children and adults. This figure would underestimate however reality. Their assumption of responsibility is currently too often insufficient, with the great despair of their parents and their close relations who live sometimes a true martyrdom because of insufficiency of structures adapted to the school assumption of responsibility, educational, social and therapeutic their children. The families can address themselves to the center of resource autism of their area to obtain a diagnosis according to the international criteria. Associations of parents and professionals were created to accompany the autists and their families with an educational assumption of responsibility by the autistic subjects and a support for the family.

In Morocco

The share of the population suffering from autism to the Morocco is estimated at approximately 60.000, of which the greatest part is dealt with exclusively by the family. There exist reception centres in the large metropolises such as Casablanca and Rabat. Elsewhere, the schooling of the autistic children depends primarily on private initiatives.

Autism and cinema

The autism knows a mediatization largely varying from one country to another. Certain films put it in scene:

Rain Man of Barry Levinson (1989), this work of fiction recalls the meeting again then the peregrinations of two brothers who had lived in way separate because of the autism of Raymond, older brother played by masterly Dustin Hoffman. The film exploits much the sensitivity of the spectators, the autist which is represented there in an impressive way by the actor is a kind of genius which misses to be recognized. This aspect of its personality is however far from being representative of the ordinary life of an autist.

Silent Fall of Bruce Beresford (1994) traditional police film where an autistic child is the witness of the double murder of his parents.

of Harold Becker (1997) is an action film with Bruce Willis which puts in scene a high level autistic child (syndrome To sprinkle?) able to decipher any method of Encoding. A passage of this film could be an allusion to method PECS (see): to use images to try to communicate with an autist.

Cube (1997) of Vincenzo Natali is a film with suspense where a group of people is wedged in systems of cubes of which only an autist, thanks to its capacities of calculation except standards, will manage to find the exit.

the Devils (2002) film of Ruggia

Marathon of Jeong Yun-Cheol (2005) which recalls us accurately the life of an autistic young man who prepares for the marathon of Seoul.

Mozart and the Whale (film, 2005) of Petter Naess (2005) It is the history of a genius of mathematics which falls in love with expert in art in and music. Their love is compromised by their syndromes To sprinkle.

Snow Cake , a film of Marc Evans of 2006: In full winter, in Wawa in lOntario, Alex, a rather introverted British quinquagénaire, striking with the door of Linda, an autistic woman.

to note that the scenario writer François Truffaut had approached the case of a child whose behavior evoked the autism through its film entitled: the wild Child (1969).

to also note that, although the autism does not constitute the central theme of it, the disc of Pink Floyd " The Wall " (1979) and the film of Alan Parker which of it was drawn (1982) contain very clear allusions to the autistic universe: emmurement psychic, tyranny of the handicap, obsessions various…

Like documentary, one can quote:

It is called Sabine , turned in 2007 by Sandrine Bonnaire on one of his/her sisters.

See too

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