Les investigations cliniques et biologiques. Au service du soin et des personnes présentant un syndrome autistique?

Translated title of the contribution: Clinical and biological investigations. At the service of treatment and of individuals with an autistic disorder?

Sylvie Tordjman, David Cohen, Bernard Golse

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

We are often confronted by the issue of clinical and biological heterogeneity of autistic disorder, suggesting the existence of «sub-types » (endophenotypes) or « sub-groups » of autism which probably cover heterogenous etiologies. In order to clarify this problem, some clinical and biological evaluations appear to be necessary from a diagnostic, a therapeutic and a research perspective. However, which evaluations should be performed at the first stage of a routine assessment, and how far we should go in the ever escalating clinical and paraclinical evaluations? This article deals precisely with the clinical and paraclinical evaluations which should be completed with regard to an autistic syndrome, and it attempts to set them in hierarchical order and to define what is involved in a routine evaluation as opposed to a research framework. So as to better understand certain elements of a routine evaluation and of research investigations, the first part of the paper will deal with a synthesis of the main results obtained from neuro-anatomical and functional cerebral studies as well as biochemical and genetic research. Afterwards, the routine evaluation will be presented (which includes a clinical and biological evaluation whose aim is diagnostic, and an evaluation of the severity of the autistic disorder which is necessary for the orientation and adaptation of therapeutic treatment), as well as research investigations, both updated to take into account current knowledge and findings in the field. Finally, we will discuss the interest of integrating a biological to a clinical approach, and also of reflecting on the ethical basis of clinical and biological investigations. Caregivers and parents are often at a loss facing autistic behaviors which they don't understand and which leed them to. Some disorders such as autistic withdrawal, avoiding eye contact, absence of language, affective and social non-attunement and apparent intemporality, sometimes confront us with the limits of humanity. Thus, it is essential that the child with an autistic disorder remains for all as an entirely human subject for whom clinical and biological evaluations can be proposed according to the signs present. It is essential that this child does not become an object upon which we will multiply invasive investigations in the search of concrete elements which serve mostly to reassure ourselves.

Translated title of the contributionClinical and biological investigations. At the service of treatment and of individuals with an autistic disorder?
Original languageFrench
Pages (from-to)199-244
Number of pages46
JournalPsychiatrie de l'Enfant
Volume48
Issue number1
DOIs
StatePublished - 2005
Externally publishedYes

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