Controverses actuelles dans le champ de l'autisme

Autism is a clinical syndrome whose description so characteristic participated in the foundation of child psychiatry. Yet, it remains the syndrome of all mysteries and all controversies. The first controversy was taken up by the working group of DSM-V, for precisely the clinical definition and broadening of the spectrum of autism. Motivations of various kinds appear to justify the spectrum view. We will question them from research on Multiplex Developmental Disorder or disharmonies, since these are concepts at the border of the spectrum. A second controversy regards its origin, recognizing that current research emphasizes and revisits the genetic causes from paper to paper. Without ignoring the importance of genetic factors, we will explore the environmental factors involved and propose a developmental model based on probabilistic multifactor perspective better able to explain the possible increase in prevalence. This is the third a controversy. Are we confronted to a real increase in the prevalence of autism spectrum disorders? Is it only a broader definition and a more systematic tracking of cases? Yet, another controversy regards the age at which the diagnosis of autism can be performed early. We will discuss this point from research focusing on the parent-infant early interaction and show that parents of infants, who will later develop autism, are significantly more often actively seeking answers from their baby, as young as 6. months. Finally, we will conclude with the controversy regarding therapeutic approaches and the methods to be recommended. If we recognize that only behavioral or educational methods have been assessed in controlled studies, it appears a consensus to promote intensive care at the earliest possible age, in a report for one to one, with maximum integration mainstream and involving parents actively.