C Aussilloux's research while affiliated with Institut de France and other places

Publications (35)

This study examines change in 152 children over an almost 10-year period (T1: 4.9 (± 1.3) years; T2: 8.1 (± 1.3) years; T3: 15(± 1.6) years) using a group-based, semi-parametric method in order to identify distinct developmental trajectories. Important deficits remain at adolescence in the adaptive abilities of children with Autism spectrum disorders, but changes in adaptive skills show two distinct growth rates. The univariate analysis reveals that low growth trajectories for both social and communication outcome are associated with the following characteristics at age 5: low cognitive and language skills, presence of epilepsy, and severity of autism. The multivariate analysis confirms that risk factors at age 5, were low language and severity of autism for both social and communication outcomes 10 years later, and that hours of early intervention was protective factor for communication.
The study aims were to identify developmental trajectories of young children with autism and investigate their prognostic factors. The participants were 208 children, assessed first at the age of 5 years, followed longitudinally, and reassessed 3 years later. The children's clinical characteristics and the interventions received were recorded. The results indicated two distinct outcome groups with more stability than change. When changes did occur, they pertained to symptom severity (which decreased) and speech level and adaptive behavior (which improved). A logistic regression analysis pointed out two main risk factors (symptom severity and speech level) and two main protection factors (communication skills and person-related cognition). Surprisingly, the amount of intervention (in terms of number of hours) was not related to outcome.
This study took place in the context of recent legislation enacted in several countries--including France--and aimed at promoting inclusion of children with intellectual disabilities. It focuses on young children with autism and examines the links between the children's characteristics and their weekly hours of regular-classroom inclusion and intervention in specialised setting. Standardised clinical and sociodemographic data were collected for 77 children with autism, along with data about their interventional programmes. The study showed that the number of hours of inclusion at school was influenced by the children's behavioural and adaptive characteristics, as well as by the socioprofessional category of their parents, although these factors did not affect the number of hours spent in specialised setting. Moreover, the total amount of time per week spent in interventional services of any kind was very small for some of the children. The time spent in special-intervention services and regular classrooms combined did not add up to an adequate number of weekly hours for these children, particularly those exhibiting at least one of the following characteristics: low adaptation level, major behavioural problems or low socioprofessional category of parents.
Although Asperger syndrome is described by international classifications as a category of pervasive developmental disorder (PDD), its validity as a specific entity distinct from autistic disorders remains controversial. The syndrome, first described by Hans Asperger, could not be distinguished from high functioning autism (onset, symptoms, outcome...). However, international classifications propose a distinction between the two syndromes based on a delayed onset, the absence of speech delay, the presence of motor disorders and a better outcome in Asperger syndrome. This categorical differentiation is not confirmed by current studies and in the absence of biological markers, no clinical, neuropsychological or epidemiological criteria makes it possible to distinguish high functioning autism from Asperger syndrome. From a clinical perspective, it is nevertheless of interest to isolate Asperger syndrome from other autistic disorders to propose specific assessment and therapy.
SummaryBackground: Very few studies have been conducted on the impact of autistic problems on family quality of life. There are only studies on the stress of these families, the results of which are used to estimate the impact of autism on their quality of life.Aim: Study the impact of the weekly treatment recommended to autistic children on their parents’ quality of life.Methods: Our sample was composed of 77 young autistic children without significant mental retardation. The weekly treatments were monitored for each child over a one-year period. At the beginning and end of the study, parents filled in a questionnaire on the impact of autism on their quality of life (Par-DD-Qol).Results: It was difficult to reveal a significant effect of the children’s treatment duration on the family’s quality of life, even if some differences were observed between fathers and mothers. It was also noted that improvement in how the quality of life was perceived was not linked to treatment changes.Conclusion: There is apparently a positive emotional effect from any extra-familial time spent in group treatment.Prat Organ Soins 2008;39(1):53-60
Aim To explore the factors related to the outcome of self-injurious behaviour (SIB) in children with pervasive developmental disorders (PDD). Method Children with PDD were assessed on individual and environmental variables at time 1 and 3 years later. A questionnaire about the presence or absence of SIB was also administered at both times in order to examine the early course of SIB. Results Our findings suggest an association between a negative outcome and several aspects of the children’s behaviour. Children with a negative outcome differed from the others in having greater speech impairment, more cognitive and adaptive deficits, and more severe signs of autism. When these variables were entered into a multivariate model for predicting the outcome of SIB, only speech deficits (ORa 3.5, CI 95% 1.13–13.4) and autism severity (ORa 1.1, CI 95% 1.03–1.18) were significant risk factors. Discussion The importance of these findings for improving our understanding of SIB is discussed.
To describe the psychological development of children with pervasive developmental disorders over a period of 3 years and to identify the factors linked to their developmental paths. The study was a collaborative and prospective follow-up study of 219 preschoolers. Retrospective data and enrollment data were collected at the beginning of the study and 3 years later. We observed high variability in the short-term outcomes of preschoolers. In line with previous research, our results showed that intellectual, linguistic and adaptive functioning were useful for predicting outcome. The severity of a child's autistic symptoms appears to be related to his or her future development. These variables can therefore be used as predictors of outcome for preschoolers with autism. Developmental and symptom changes in young children with autism should not be overlooked and need to be assessed regularly in view of choosing suitable servicing programs.
This longitudinal study assessed multidisciplinary data on 219 children with autistic spectrum disorders from the median age of 5 (Time 1) to 8 years old (Time 2). The evolution of psychological and adaptive data was subjected to cluster analysis. Four clinically meaningful clusters emerged. The first group (21%) demonstrated the most important psychological transformations between the two times of the research. The second group (24%) made progress but less than group 1. The third and biggest group (30%) kept the same developmental slope. The fourth group (25%) showed no significant evolution between the two times of the research. This study highlights important differences among children with autism and the necessity of using a developmental view when considering the autistic syndrome.
Historically, the relationship between psychiatry and the mental handicap were organized around intellectual disabilities which were first considered as an alienation, then like as a maladjustment having to be treated. Education and therapeutic were generally considered in reciprocal exclusion or subordination one compared to the other in a competing delimitation of the professional categories. These oppositions were underlain by theoretical concepts, but also by economic considerations in contradiction with the stated principles. The major changes between the Law of 1975 “in favor of the people with a handicap” and the Law of 2005 on “the Right and Equal opportunity”, translation of the evolution of our society, imply adaptations of the functions and roles of the professionals whose width is not measured yet.
Autism is the best defined category among PDD. Its high prevalence, its onset in very young children and its persistence in adulthood arise many questions about early screening and early diagnosis. The aim of the study was to identify professional best practices about screening and diagnosis of autism in order to propose clinical guidelines and actions for the future. Scientific experts and parents take part to this procedure. Literature and previous guidelines were analyzed, experts in various fields were interviewed, a national study about the medical practices of the diagnosis of autism was made and questionnaires were send to 1600 psychiatrists and pediatricians. Guidelines built around 2 levels were proposed about screening and diagnosis. CONCLUSION: Diagnosis needs a multidisciplinary approach, validated instruments and more communication between professionals and parents. Finally one of the more important aims of the diagnosis of autism is to facilitate intervention program.
Autism is the best defined category among PDD. Its high prevalence, its onset in very young children and its persistence in adulthood arise many questions about early screening and early diagnosis. The aim of the study was to identify professional best practices about screening and diagnosis of autism in order to propose clinical guidelines and actions for the future. Scientific experts and parents take part to this procedure. Literature and previous guidelines were analyzed, experts in various fields were interviewed, a national study about the medical practices of the diagnosis of autism was made and questionnaires were send to 1600 psychiatrists and pediatricians. Guidelines built around 2 levels were proposed about screening and diagnosis.Conclusion. – Diagnosis needs a multidisciplinary approach, validated instruments and more communication between professionals and parents. Finally one of the more important aims of the diagnosis of autism is to facilitate intervention program.
After a long experience of the evaluation of children with autism, the Autism Resource Center in Languedoc-Roussillon (CRA-LR) has been assessing in institutions taking care of children with autism. The assessments take place in the institutions in order to maintain the necessary environment for the children with autism who present behaviour disorders and who are extremely sensitive to the change in their environment. This also enables the socio-educational or medical staff in the institutions and the staff from the Resource Center to share their knowledge and their know-how.
The Pervasive Developmental Disorders complications can lead to an important life long handicap. There is an important literature about autism, but in most cases, specifically concerning children and adolescents problems. We wished to focus our attention on adults, in order to describe, on one hand their socio-adaptive profile, and on the other hand, the necessity to resort to a psycho-active treatment. The geographic zone chosen in order to carry out this, was Languedoc-Roussillon, and the applied method was a descriptive study of psychotropic use in the 20-35 age adults with autism. The instruments used were standardized and validated. The diagnosis was confirmed using ICD 10 criteria checklist and individual characteristics including adaptive profile estimated on the Vineland scale, were collected. Moreover the prescriber's global impressions were collected on the CGI scale. Out of 165 case files collected, the sex-ratio was 3 men for 2 women, 45 % showed associated somatic disorders (of which 24 % epileptic), 66 % benefited from a psycho-active treatment ; 85 % had been admitted in institutions during childhood or adolescence. The admittance framework being respectfully, MAS 21.8 %, community homes 35.2 %, CAT 17.6 % and psychiatric services 20.6 %. Mean equivalent age, in the three Vineland adaptive domains, were from 21 months in Communication to 43 months in Autonomy in daily life Skills and 17 months in Socialization. The development quotient showed adaptive retardation in 100 % of cases. The 110 persons benefiting from a medicinal treatment, were treated for aggressiveness in 62.7 % of cases, agitation in 43.6 % of cases and anxiety in 48.2 % of cases. The therapeutic categories used were, in majority, antipsychotics in 85 % of cases, anxiolitics in 40.2 % of cases ; hypnotics as well as anti-depressants or mood-regulators, each representing 10 % of prescriptions. Associations of several molecules representing 83 % of cases. The therapeutic effect was considered interesting in more than two-thirds of cases. Undesirable side-effects were reported in 50 % of the patients under treatment ; 50 % of the persons treated had been administered the same treatment for more than 5 years. The adaptive-profile significantly varied, depending on the accommodation structures and also the presence or absence of a psycho-active treatment. The results of this study portrayed the level of social adaptation and the types of psychoactive treatment in adults with autism, who are severely limited in their adaptive functioning due to their handicaps.
The Pervasive Developmental Disorders complications can lead to an important life long handicap. There is an important literature about autism, but in most cases, specifically concerning children and adolescents problems. We wished to focus our attention on adults, in order to describe, on one hand their socio-adaptive profile, and on the other hand, the necessity to resort to a psycho-active treatment. The geographic zone chosen in order to carry out this, was Languedoc-Roussillon, and the applied method was a descriptive study of psychotropic use in the 20-35 age adults with autism. The instruments used were standardized and validated. The diagnosis was confirmed using ICD 10 criteria checklist and individual characteristics including adaptive profile estimated on the Vineland scale, were collected. Moreover the prescriber's global impressions were collected on the CGI scale. Out of 165 case files collected, the sex-ratio was 3 men for 2 women, 45% showed associated somatic disorders (of which 24% epileptic), 66% -benefited from a psycho-active treatment; 85% had been admitted in institutions during childhood or adolescence. The admittance framework being respectfully, MAS 21.8%, community homes 35.2%, CAT 17.6% and psychiatric services 20.6%. Mean equivalent age, in the three Vineland adaptive domains, were from 21 months in Communication to 43 months in Autonomy in daily life Skills and 17 months in Socialization. The development quotient showed adaptive retardation in 100% of cases. The 110 persons benefiting from a medicinal treatment, were treated for aggressiveness in 62.7% of cases, agitation in 43.6% of cases and anxiety in 48.2% of cases. The therapeutic categories used were, in majority, antipsychotics in 85% of cases, anxiolitics in 40.2% of cases; hypnotics as well as anti-depressants or mood-regulators, each representing 10% of prescriptions. Associations of several molecules representing 83% of cases. The therapeutic effect was considered interesting in more than two-thirds of cases. Undesirable side-effects were reported in 50% of the patients under treatment; 50% of the persons treated had been administered the same treatment for more than 5 years. The adaptive-profile significantly varied, depending on the accommodation structures and also the presence or absence of a psycho-active treatment. The results of this study portrayed the level of social adaptation and the types of psychoactive treatment in adults with autism, who are severely limited in their adaptive functioning due to their handicaps.
This study focuses on the organization of the socio-cognitive skills and abilities of autistic children under 7 years of age. The psychological development of 193 children with autism was assessed in five functional areas: object-related cognitions, person-related cognitions, mastery of social communication tools, daily living skills, and degree of socialization. Two very contrasting groups of children were constituted by crossing three variables: developmental age, presence or lack of linguistic activity, and disorder severity. A “low severity autism” group (n = 44; CA = 60 months and DA = 39 months) and a “high severity autism” group (n = 36; CA = 63 months and DA = 15 months) were compared to two control groups of typical children. Control groups were assessed in the same functional areas as autistic children: a group with a CA of 40 months (n = 46) and a group with a CA of 15 months (n = 52). The autistic children of the “low severity” group and the typical children, aged 40 months are characterized by an “undifferentiated organization”. Factor analyses highlight for each of these two groups one general factor. The two other groups (autistic children of the “high severity” group and typical children, aged 15 months) are characterized by a differentiation of their skills; factor analyses highlight for each of these groups a bifactorial structure. These results allow a distinction to be made between a developmental differentiation and an autistic dissociation.
Autism is now thought to be present right from birth. Although usually not officially diagnosed until after the child’s second birthday, parents often report disturbances before then. The age of detection of disturbances varies and may be linked to differences in the severity of the autism and its associated retardation. This study evaluates the developmental characteristics of 193 children with pervasive developmental disorder, using the same standard procedures for all subjects. Our goal was to determine the relationship between age of parental recognition of disturbances and disorder severity. The results indicated mainly a link between early abnormalities, associated medical condition and severity measured on cognitive tests. They suggest systematic screening for signs of autism in very young children.
The aim of this study was to identify risk factors for self-injurious behaviours (SIBs) in children with autistic disorders. The occurrence of SIB was examined in comparison with the following variables: chronological age, sex, adaptive skills, speech level, associated medical condition, degree of autism and parental social class. The subjects were 222 children aged under 7 years and all of them fulfilled the ICD-10 criteria for infantile autism. Retrospective data were collected on demographic characteristics and medical condition. Children were assessed in terms of speech, degree of autism and adaptive skills in communication, socialization and daily living skills domains. Results indicated that 50% of the children experienced SIB and 14.6% had severe SIBs. Lower chronological age, associated perinatal condition, a higher degree of autism and a higher daily living skills delay were risk factors of SIBs but parental class, sex and epilepsy were not.
Autism is now thought to be present right from birth. Although usually not officially diagnosed until after the child's second birthday, parents often report disturbances before then. The age of detection of disturbances varies and may be linked to differences in the severity of the autism and its associated retardation. This study evaluates the developmental characteristics of 193 children with pervasive developmental disorder, using the same standard procedures for all subjects. Our goal was to determine the relationship between age of parental recognition of disturbances and disorder severity. The results indicated mainly a link between early abnormalities, associated medical condition and severity measured on cognitive tests. They suggest systematic screening for signs of autism in very young children.
Autism is an early developmental disorder. It leads to severe and durable disturbances. Given this problem, no treatment can be excluded a priori. Thus, many approaches are used to deal with autistic disorders. In France, pharmacological treatments are, for instance, largely and mostly used in adults. In the USA, these treatments concern 50% of persons with autism of any age. Nevertheless, they are rarely based on controlled studies. At the present, however, prescriptions and expected effects appear to be hard to localize. Furthermore, only few controlled studies validate their use. Aim - We offer a review of studies about medical treatments used in adolescents and adults with autism. They are classified in 3 categories: the first (category I) includes drugs used for their neurochemical effects focusing on autistic signs. The second (category II) covers drugs used for treatment of behavioural disorders frequently associated with autism. The third (category III) corresponds to a wide range of drugs or vitamins for wich only few case studies exist reporting irregular positive effects. The main hypothesis of this review is that autism involves a dysfunction of the neuromediation systems. This hypothesis opens new perspectives in the research of medical treatments in autism by focusing on molecules, which are supposed to have an effect on neuromediation systems. Method - Our review is based on studies, which have been published during the past twenty years. For many studies, data are limited to adolescents and adults. So we expanded our review to data available in children. The data bases that we have used are medline and psyclit. Keywords have been chosen according to: pharmacological considerations (psychotropic, psychoactive drugs, psychopharmacology) and clinical symptoms (autism, automutilations, aggressive behavior, and hyperactivity). Hypothesis of a dysfunction in the neuromediation systems in autism - Many studies exist about biochemical abnormalities in autism. As in schizophrenia and mental retardation, dysfunctions of the neuromediation systems are considered to be etiological factors. In 30% of people with autism the most regular dysfunction is the increase of serotonine. This led to the serotoninergic hypothesis in autism and to the use of active drugs in the serotonine system. However, the presence of other neurometabolic abnormalities also motivates the use of drugs, supposed to be active in other neuromediation systems. Pharmacological treatments in autism - Category I section sign 1 Active drugs in the dopamine system. Haloperidol (Dopamine antagonist): The effects of this molecule have been broadly studied in autism. Results indicate high efficiency in some symptoms of autism (lack in social behaviour, stereotypical behaviour) and in behavioural impairments that may be associated with autism (aggressive behaviour, hyperactivity). Its side effects, particulary the risk of late dyskinesy, make atypical antipsychotics preferable because of their lower risks. Risperidone (Dopamine and serotonine antagonist): Among several studies only few have been controlled. They indicate that Risperidone has positive effects on the behaviour and is quite well tolerated. section sign 2 Active drugs in the serotonine system. Clomipramine: after promising results, the medium-term efficiency has decreased and severe side effects have limited its use. Fluvoxamine, Fluoxétine, Sertraline (Specific serotonine drugs): Their efficiency has been mainly tested through open studies and their results are contrasted. In some cases, social behaviours have improved and aggressiveness and stereotyped behaviours have decreased. Fenfluramine: At present, this drug is removed from the market. Yet, some studies have suggested that it improves behavioural disturbances as well as performances in autism. section sign 3 Active drugs in the opiate system. Naltrexone: Several controlled studies have indicated an improvement in social and aggressive behaviours. Nevertheless, these studies have used small size sample and have not been replicated. Category II. This category correspond to drugs supposed to be active on neurochemical disturbances found in autism but their target symptoms are not autism specific signs as defined by the ICD 10. Buspirone: This serotonine agonist may have a good impact on emotional disorders and sleeping confusions. Methylphenidate: Most of the current studies about this noradrenergic drug concern children. The results are variable. Paradoxical effects may exist in children with severe mental retardation. Propanolol: Some isolated studies habe reported its efficiency on behavioural disturbances. Clonidine: This adrenergic drug treats efficiently some cases of aggressive behaviour and hyperactivity. Category III. This category contains a wide range of drugs, vitamins or method used in autism after sporadic observations of their positive effects. Secretine: An important improvement has been reported in isolated cases. However, controlled studies in children do not confirm these results. Vitamines B6, B12 and Magnesium: An improvement in socialization and in behavioural disorders have been reported in some cases, but these results are not yet confirmed. Lithium, Carbamazépine, Valproate: Results of some case studies have found it to be efficient in cyclic disorders. Gluten and casein free diet: An improvement of social behaviour have been reported by some parents after these diets. No controlled study has validated this observation. Conclusion - There is no consensus on the use of psychopharmacological treatments in autism. Although there exist many clinical observations, only few controlled studies have validated the efficiency and safety of these treatments. At the present time and until having sufficient studies, drugs are generally limited to severe disorders, for which usual psycho-educational approaches are insufficient.
Benefits and shortcomings of follow-up studies to measure developmental changes in children with autism This paper discusses the interests and the limits of the follow-up studies on the outcome of the children and adolescent with infantile autism until the adulthood. These studies not only seek to describe the changes of symptomatology but also to establish if the individual characteristics observed in childhood are correlated with those observed at the adulthood in order to establish if it exists, possible prognostic factors for whole or part of the disorders. They finally aim at evaluating the effects of environmental factors likely to intervene in the course of trajectory. These studies allow the report of the diversity of the evolutions in infantile autism but in the absence of sufficient cognitive or cerebral maps they do not make it possible to understand what explains the individual differences in the evolution and what could support it.
This paper discusses the interests and the limits of the follow-up studies on the outcome of the children and adolescent with infantile autism until the adulthood. These studies not only seek to describe the changes of symptomatology but also to establish if the individual characteristics observed in childhood are correlated with those observed at the adulthood in order to establish if it exists, possible prognostic factors for whole or part of the disorders. They finally aim at evaluating the effects of environmental factors likely to intervene in the course of trajectory. These studies allow the report of the diversity of the evolutions in infantile autism but in the absence of sufficient cognitive or cerebral maps they do not make it possible to understand what explains the individual differences in the evolution and what could support it.
Currently the diagnostis of autism takes place towards the 3rd year, however, when parents are questioned concerning the first signs, they had become concerned very much earlier. Paediatricians and general practitioners, who saw these children after the parents had observed problems, tended to reassure them, due to the fact that they lacked the necessary elements enabling them to give greater depth to their diagnostic questioning (decision tree lacked branches). The objective of this work is to specify age of the observation of the first signs by parents, age at initial paedopsychiatric consultation, age at the initial acceptance of care and the analyse factor wich influence those ages.
Les visées économiques des procédures d'évaluation ont fait passer au second plan leur principale utilité médicale: déterminer les effets des actions de soins pour en préciser les indications. Dans cette optique, l'évaluation en psychiatrie de l'enfant doit prendre en considération les caractéristiques individuelles, au plan de la maladie et des déficiences, incapacités et désavantages, mais aussi les ressources de l'environnement. La mise en pratique de cette évaluation multidimensionnelle s'est avérée possible lors d'une recherche multicentrique sur l'autisme actuellement en cours. Elle devrait pouvoir s'adapter aux conditions habituelles de l'exercice en pédopsychiatrie pour les hospitalisations et les consultations.
In autism, individual and environmental factors lead to heterogeneous outcomes. Some individual and environmental factors such as intellectual and speech level in childhood are well known. Others — gender, age of onset or association of medical disease — are controversial. The influence of environmental factors and of interventions is less known.The aim of this collaborative and prospective study is to identify the relationship between the individual and environmental factors.The relationship between the differences as regards the two assessments realised at intervals of three years and interventions will be studied.In this paper, we present, retrospective data, social features and assessment results (diagnosis, intensity of autistic behavior, cognitive and speech profiles) in 193 autistic children with a mean age of five years.

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Top co-authors (44)

Amaria Baghdadli
  • Centre Hospitalier Universitaire de Montpellier
René Pry
  • Centre Hospitalier Universitaire de Montpellier
Cecile Michelon
  • Centre Hospitalier Universitaire de Montpellier
Eric Pernon
  • Paul Valéry University, Montpellier 3
Marie-Christine Picot
  • Centre Hospitalier Universitaire de Montpellier
Brigitte Assouline
  • Centre Hospitalier Alpes Isère

Affiliations

Institut de France
Institut de France
Centre Hospitalier Universitaire de Montpellier
Department
  • Department of Epidemiology, Biostatistics and Medical Information

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567