Tag: tsa

Autisme et TDAH (Marie Schaer) [en]

Symposium TDAH, mes petites notes comme je peux, lacunaires et sans doute avec des erreurs et approximations.

Spécialiste de l’autisme.

Résumé des recouvrements

Autisme: vraiment un trouble du développement des compétences sociales. Communication sociale et interactions. Autre symptôme clé: intérêts spécifiques (atypiques possiblement), comportements moteurs répétitifs.

Recoupements: DE, aussi difficultés sociales, impulsivité. Comportements d’auto-stimulation, toucher des objets pour canaliser son hyperactivité vs stimming, parfois difficile à différencier.

Quel est le niveau de commodité? comment distinguer les deux?

TDAH 1/9 TSA 1/36 si on prend DSM strict.

1 TDAH/7 a tous les critières pour TSA.

Avant le DSM-5, on pouvait pas avoir les deux!! Beaucoup de discussions qui sont des relents de ça.

1 TSA sur 2 ou 3 a les critères pour TDAH.

Deux TND, partagent des facteurs de risque => même voie dévelopmentale.

Neurobio: processus le même ou pas?

Sans rentrer dans le détail: similitudes dans le développement neurobiologique mais aussi/surtout différences. Bien regarder ces différences.

Double diag? Impact sur le fonctionnement.

Les trois groupes se retrouvent pour la qualité de santé, mais pour des choses plus fonctionnelles, comme être en emploi ou aux études, la comorbidité triple le risque. Donc important de chercher TDAH quand on a un patient TSA.

On va pas traiter différemment la personne TDAH avec ou sans TSA. Mêmes recommandations!

TDAH: on pose pas forcément le diag avant 6 ans, alors qu’autisme oui.

Autisme: utile de diagnostiquer tôt car on peut mettre en place les mesures avant l’école déjà. TDAH: les compétences exécutives sont en pleine maturation donc difficile de déterminer avant 6 ans. Phases de développement différentes.

Autisme: facteur de vulnérabilité pour le TDAH?

Généralement enfants viennent à 18-24 mois chez le clinicien pour question diag autisme. Faire bilan diagnostic complet! 5-8 séances pour confirmer le diagnostic. Souvent la première question des parents c’est: que va-t-il devenir? Ecole, parler, amis…

Nous on lit ça: y a-t-il des comorbidités? déficience intellectuelle, TDAH… Quelles sont les difficultés les plus importantes que l’enfant va pouvoir présenter? Aujourd’hui on peut pas prévoir le reste au-delà du retard. Ne jamais dire à 2 ans “votre enfant va jamais parler” (souvent pas vrai), gros impact sur parents ce qui se dit à ce moment-là.

Inquiétant avec le TSA: retard dans les acquisitions => écart qui va s’agrandir avec l’âge. Donc enjeu du diagnostic précoce. Eviter une déficience intellectuelle secondaire au fait de ne pas avoir les codes sociaux.

Cohorte à GE

Que peut-on en apprendre sur les signes émergeants du TDAH. Dans 10 ans on en saura bien plus vu l’âge de la cohorte!

Enfant typique pré-scolaire: passe son temps à regarder les visages (extrait de dessin animé). Enfant TSA 5 ans: son regard se balade partout sans trop de distinction, pas du tout attiré sur les stimulus sociaux plus que le toboggan, le soleil, les grains de sable…

=> jour après jour, heure après heure, il n’apprend pas ses interactions sociales. Perte d’opportunité d’apprentissage.

Comment les accompagner?

Interventions comportementales. Demande beaucoup d’énergie et de ressources. Fonctionne hyper bien.

Permet par ex d’éviter la déficience intellectuelle. On veut faire ça entre 2 et 4 ans!

Ecole: ordinaire pour la plupart. Mais redirigés en cours de route vers l’école spécialisée.

Qu’est-ce qui fait qu’on “perd” ces enfants?

  • difficulté avec apprentissages abstraits nécessitant flexibilité mentale (typiquement pensée autistique)
  • difficulté d’attention/planification
  • hyperactivité associée

Les deux derniers points font penser au TDAH, et ça se traite!

Différence pour leur inclusion scolaire? TDAH => sortent du public.

Donc on cherche le TDAH dès que possible pour le prendre en charge. Enjeu: scolarisation en système ordinaire!

Pouvait-on repérer ces enfants TDAH à 2 ans? Non, pas de différence.

Pas de développement cognitif différent. Par contre activités du quotidien, oui.

Aurait-on pu repérer ces enfants TDAH durant l’intervention précoce? que 1/3 dans le pool “intervention”. L’intervention aurait-elle évité des TDAH?

TDAH semblent moins gagner de QI avec l’intervention.

Caveat: petits échantillons…

Effet assez fort, protecteur de l’intervention?

Travail encore en cours avec cette cohorte!

On n’a pas une bonne manière de mesurer si les enfants ont un TDAH ou pas.

Travail là-dessus.

Indispensable d’identifier éventuel TDAH lors de TSA.

Et:

Intervention précoce fait diminuer le stress parental.

Dépression de l’enfant en lien avec environnement hypo-stimulant. Ecrans coupent enfants des interactions => tableaux qui font penser à l’autisme mais ne sont pas de l’autisme. Facteurs de l’environnement peuvent faire rater des opportunités d’apprentissage. Quand on change l’environnement on voit les symptômes disparaître.

Cohorte, 6 ans, batterie complète neuropsy. Symptômes inattention augmentent avec l’âge tels que rapportés par les parents.

Wrong Place, Wrong Time [en]

[fr] Un autre récit de rêve -- double, celui-ci. Je suis navrée, mais ça sort toujours en anglais...

A dream.

I have a gift for ending up at the wrong place at the wrong time. For example, think of the day Obama broke our beautiful lake in half by blowing up a huge bomb under it. I was in Saint-Tryphon, the lovely town at the end of the lake, and watched as the water ran out of it through the crack, as swimmers tried to reach the shore, and as the first rows of buildings in Saint-Tryphon toppled over in slow motion under the afternoon sun to come and lie down in the receding water.

We spent the rest of the afternoon checking out our boats, which were moored in mid-air, lowering them so that they would be back in the water again.

At some point I fled. I ran through Saint-Tryphon, watching the wobbly buildings by the shore and praying that the people would get out before they fell. I climbed into the mountains, found an abandoned village, and spread the word. “The lake is draining itself!” Nobody really believed me.

Obama had smilingly assured me that the lake would stop bleeding out sometime in the evening, and that everything would be back to normal in a few days. He didn’t seem to think there was anything wrong with what he had done. I was just horrified.

Or another time, shortly after that, I had taken a trip to some middle-eastern country just in time to witness the explosion of a nuclear device under the sea near the coast. I saw birds fall out of the sky as they feebly tried to fly away. Why I was alive, I just couldn’t understand. A car with two military stopped and picked me up. We went to the command centre where for some reason, most of my luggage was waiting for me. There were some nice people there, but it was out of question to let me go back home.

I swallowed an iodine pill, and wondered why on earth we all had to be exposed to so much radiation. My life doesn’t always make sense to me, as you can see.

I was relieved to meet Cecil in the command centre. He was a friend of mine, and we plotted our escape together. Julie, one of the assistants, would come with us — she was a nice girl and also felt that she had nothing to do there, that her life was supposed to take another path. The trouble was packing (we had many belongings) and finding a way out of the country (that was Cecil’s job, being in a position of authority).

Amongst my most precious belongings was some jewellery, and a set of teeth (I know this sounds funny, but they were ivory and polished, and worth quite a lot in those days), as well as some pearls. Trying to get everything to fit in bags and boxes was a nightmare, especially as we couldn’t afford to have the other people in the command centre figuring out that we were going to make a run for it. They must have, because we even got comments on the size of our boxes, but they pretended nothing was wrong. Maybe they hoped it would go away if they didn’t confront it.

So we packed, and repacked, and repacked, and as days went by I became more and more anxious about leaving. We almost managed, once. Robert took us out to his helicopter. There were four of us, but Cecil was nowhere to be found. I was a bit worried, because Robert was completely loyal to those in charge, and I really wondered what the deal was with him taking us away. Maybe he was actually going to take us to a reeducation camp or a prison, and all our precious belongings would be taken away from us.

We never knew, because as he was fuelling up, he never passed the DUI test — and the helicopter was not up to standards either. I heaved a sigh of relief as we returned to the base, but went to bed certain that we had been found out and absolutely had to leave the very next day.

It didn’t happen the next day, or the one after that. It was agonizing. Cecil disappeared, after a long phone call to his family where I heard him tell his son he loved him very much. The day after that, Simon came up to me and gruffly told me that I was leaving, that Cecil had left instructions, and that he was my driver. Simon was not happy about it, but followed orders. I initially expressed surprise but decided to go along with it.

He scowled at me while I put my big box and bag in the boot of his tiny car. I climbed in, and we drove off. I didn’t need a Geiger counter to tell me how radioactive we were, and I hoped that we would not set off any alarms at the airport. I already had too much luggage and getting on board without attracting attention was going to be a tight squeeze.

As you can see, I made it out in one piece. I had to leave some of my things behind, but the precious teeth and pearls travelled in my jeans pocket (you know how TSA are with precious items in checked-in luggage: they just tend to disappear). I went through long and painful anti-radiation treatment, and thankfully today’s medical technology is keeping at bay all the cancers I should have developed as a result of such important exposure.

What was going through the minds of those people at the time, it really beats me.