Intérêt des unités neurocomportementales multidisciplinaires dans la prise en charge des décompensations aiguës des patients présentant un trouble du spectre autistique

Background: During adolescence, some individuals with autism spectrum disorder (ASD) engage in severe challenging behaviors, such as aggression, self-injury, disruption, agitation and tantrums. To better help patients and families with such conditions, the Agence Régionale de Santé (ARS) d'Île-de-France recently opened a multidisciplinary neurobehavioral unit connected with three mobile units. This paper summarizes our first two years of activities. Methods: Based on two previous studies assessing risks factors associated with very acute behavioral crises in adolescents with ASD admitted to a dedicated multidisciplinary neurobehavioral unit (Perisse et al., 2010; Guinchat et al., 2015), we aim to summarize our clinical experience of this complex situation and compare it to the available literature. To illustrate the clinical relevance of this approach, we report three paradigmatic clinical observations with their outcomes. Results: Most common etiologies for acute behavioral crises in patients with ASD are organic causes (including epilepsy and painful medical conditions), environmental causes (including lack of treatment and adjustment disorder), and non-ASD psychiatric condition (including catatonia, major depressive episode, bipolar disorder, schizophrenia). Diagnosis making is challenging given the frequent poor communication skills and comorbid intellectual disability. When diagnosed, treating seizures, painful medical conditions, non-ASD psychiatric diagnoses and environmental issues was particularly helpful. Also, longer hospitalization was correlated with higher Global Assessment Scale (GAS) score at discharge even after adjustment for confounding factors. The three case reports summarize how diagnosis and treatment were conducted in the case of an organic cause (case 1), of a non-ASD acute psychiatric comorbidity (case 2) and of environmental dysfunctional communication with developmental consequences (case 3). Conclusion: Challenging behaviors among adolescents with ASD may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic illness. The clinical relevance of the management of these behavioral challenges in specific neurobehavioral units is supported by the first evidence gathered after two years.