Signes cliniques précoces chez les enfants porteurs d’un TSA léger : description et effet de genre (Early clinical signs in children with mild ASD: Description and gender effect)

Demulier, Donatienne Mousset, Estelle Kurzeja, Nastasia Evrard, Salomé Wintgens, Anne [UCL]

Background: In our Autism Spectrum Disorders Reference Center, we meet young people with mild autism spectrum disorder (ASD) with normal intellectual and language skills. The objective of this article was to characterize this population by analyzing the specific profile of these young people: first signs of concern, age of diagnosis in relation to more severe disorders, previous diagnoses, and reason for the assessment. In addition, we wanted to pay particular attention to the profiles of girls with mild ASD. Method: We carried out a retrospective study based on the analysis of the clinical records of patients with a diagnosis of autism spectrum disorder of mild intensity according to the DSM-5, having benefited from a diagnostic assessment in our service. From the patient clinical files, we compared several elements: reason for the request, requesting persons, possible previous diagnoses, common early clinical signs. We have for each element distinguished girls and boys. Results: We studied a population of 33 young people with mild ASD. The assessment is most often requested by parents in the context of social interaction disorders. The average age of diagnosis is higher than in children with moderate or severe ASD, and young people have sometimes received other past diagnoses. We were able to highlight certain early signs in terms of language, sleep, food, sensory sensitivities, emotional regulation and socialization, signs that are, however, not very specific. No significant difference but rather tendencies were highlighted between girls and boys, probably related to the small size of the sample. Discussion: The retrospective nature of this study, the sample size and the absence of a control group are limitations. However, a certain camouflage, early non-specific signs as well as sometimes less suitable diagnostic tools can explain a later diagnosis in young carriers of mild ASD, some of whom have also received another diagnosis in the past. An attitude of denial of the difficulties on the part of the parents is sometimes also mentioned. As far as girls are concerned, we found them in a higher proportion than expected, given the literature which describes a sex ratio quite different from ours. Conclusion: If the early and late clinical signs concerning mild ASD are better and better known from a theoretical point of view, the diagnosis does not seem to be facilitated for all that. Also, raising the awareness of parents and first-line caregivers is required to detect children with mild ASD early in order to refer them to specialists in this disorder. Given the number of girls in our sample, it seems that they likely benefited from effective screening. A future study could relate to a comparison of our population with a control group, in order to refine the specificity of any early symptoms.