L’autisme : vers une nécessaire révolution culturelle

Abstract

L’autisme est défini comme un trouble du développement caractérisé par une perturbation des interactions sociales et par des altérations de la capacité à communiquer associées à des activités stéréotypées. Les différentes thérapeutiques mises en oeuvre n’obtiennent souvent que des résultats partiels et instables. Les corpus théoriques proposés par la psychanalyse, la psychologie cognitive, la neurophysiologie, la neuropharmacologie et la génétique n’offrent que des éclairages très focalisés, laissant de larges zones d’ombre. La psychanalyse, qui a pendant longtemps constitué l’approche privilégiée, est aujourd’hui décriée par certaines associations de parents qui préfèrent aux théories psychanalytiques les hypothèses organiques de l’autisme. Les problèmes liés à la définition, à la classification de l’autisme, à la compréhension étiopathogénique et aux thérapeutiques se trouvent au coeur des controverses. L’objectif de cet article est de détecter les clivages et de soulever les questions à approfondir pour tenter de mieux prendre en charge les personnes autistes.

Autism is a pervasive developmental disorder of childhood characterised by disturbances in both social interactions and communication as well as stereotyped patterns of activities and behaviour. The increase in estimates of the prevalence of autism has raised the question of an «epidemic» of autism. More active case assessment and changes in diagnostic criteria probably account in large part for such increase. Investigators have attempted to define the neural pathophysiology of autism ever since the hypothesis of «refrigerator mother»as its cause was replaced by the view that it is a developmental disorder of the immature brain. However consensus is yet to be reached concerning the brain regions implicated. Psychoanalysis, cognitive psychology, neurophysiology, neuropharmacology, and genetics propose restricted view of the major issues leaving extensive areas unexplored. Therapeutic approaches induce only partial and uncertain results. There is no cure for autism but substantial evidence indicates that early, intensive, individualised education is beneficial for children. All modern intervention programs for autism affected children share a high degree of environmental structuring and predictability and an extensive individual approach. Autism being a behaviourally defined syndrome, it gave rise to a number of controversies concerning definition, classification, etiopathogeny and therapeutics. In the 1990s a crisis has occured in France with a loss of confidence between parents and psychiatrists with a problem concerning the means and ways of care of the autist. The aim of this paper is to point out the different questions raised by autism in order to better understand this syndrome which touches upon essential behaviour-related aspects such as self consciousness, reality perception, the functioning of the thought and communication, as well as the role of hereditary and acquired influences in normal and pathological development.