Abstracts
Résumé
Les jeunes autistes diagnostiqués avec une déficience intellectuelle (DI) associée représentent près d’1/3 de la population autistique. Or, la majorité des études sur la santé mentale en autisme portent sur des personnes autistes sans DI, donc les besoins en santé mentale chez ces jeunes sont conséquemment encore mal compris. Le présent rapport de cas porte sur le suivi en pédopsychiatrie de Nabil (nom fictif), un jeune autiste avec une DI, qui est suivi depuis près de 10 ans pour des symptômes variés, dont des comportements ritualisés s’inscrivant dans un profil diagnostique complexe et rare. Sur le plan neurodéveloppemental, en plus des symptômes associés à l’autisme et la DI, un diagnostic de trouble de déficit d’attention/hyperactivité (TDAH) et de syndrome Gilles de La Tourette (SGT) ont été posés, mais le TDAH n’a pas été maintenu. De la catatonie associée à l’autisme a également émergé et est présentement en rémission. Sur le plan de la santé mentale, un diagnostic de trouble obsessionnel-compulsif (TOC) a été posé et des problèmes de comportement ont été notés, sans être attribués aux diagnostics préalables. Le cas présenté vise 3 objectifs spécifiques : 1- illustrer les défis inhérents à l’évaluation du potentiel intellectuel chez les autistes avec un fonctionnement adaptatif très bas et l’impact sur la prise en charge de ces jeunes, 2- donner des pistes pour le diagnostic différentiel des rituels autistiques, des compulsions, des tics, des stéréotypies et du TDAH au sein de cette même population et 3- sensibiliser à la sous-identification de la catatonie chez les jeunes autistes.
Mots-clés :
- autisme,
- déficience intellectuelle,
- santé mentale,
- pédopsychiatrie,
- diagnostic différentiel,
- rituels
Abstract
Autistic youth diagnosed with an associated intellectual disability (ID) represent nearly one third of the autistic population. However, the majority of studies on mental health and autism focus on autistic individuals without ID. Therefore, the mental health needs of autistic youth with an ID are still poorly understood. This case report focuses on the psychiatry follow-up of Nabil (fictitious name), an autistic adolescent with ID who has been treated for nearly 10 years for various symptoms, including ritualized behaviors that are part of a complex and rare diagnostic profile. In terms of neurodevelopmental disorders, in addition to symptoms associated with autism and ID, a diagnosis of attention deficit/hyperactivity disorder (ADHD) and Tourette syndrome was made, but the ADHD diagnosis was not maintained. Catatonia associated with autism has also emerged and is currently in remission. In terms of mental health, a diagnosis of obsessive-compulsive disorder (OCD) was made and behavioral problems were noted, without being attributed to the previous diagnoses. The presented case has three specific objectives: 1-to illustrate the challenges inherent in assessing the intellectual potential of autistic individuals with very low adaptive functioning and the impact on the treatment; 2- to provide avenues for the differential diagnosis of autistic rituals, compulsions, tics, stereotypies, and ADHD within this population and 3- to raise awareness about the underdiagnosis of catatonia in autistic youth.
Keywords:
- autism,
- intellectual disability,
- mental health,
- child psychiatry,
- differential diagnosis,
- rituals
Appendices
Bibliographie
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