TDAH et TED-NAS (non autrement spécifique)

À la frontière du TDAH, face aux colères explosives, sans motif apparent, devant des comportements souvent hermétiques, à une fabulation extrême avec personnages hétéroclites qui se parlent peu, il y a une exploration digne de mention, celle des troubles envahissants du développement, dits TED-NAS (non autrement spécifiques).

Dans le manuel du DSM IV, il existe à peine 7 lignes (sur 850 pages) sur le sujet, dans ce chapitre complexe, comme pour manifester l'intérêt d'un lieu de passage, d'une pathologie réelle, même si discrète et toutefois bien présente et bien capable de causer des dégâts.

C'est dire qu'il faut s'éloigner des classifications rigides, des causalités fermées, comme supposer qu'il y a une génétique pour le TDAH, une autre pour l'autisme, une autre pour la dépression, l'anxiété.

Depuis quelques années, des professionnels ont développé une expertise qui tente au mieux de cerner la réciprocité affective, le besoin de l'autre, la pertinence des réponses, dans un contexte donné. L'ADOS (Autism Diagnostic Observation Schedule) permet une évaluation standardisée, à travers les âges, sur les niveaux de développement et les capacités de langage. À cet exercice périlleux, l'expert doit être bien formé, expérimenté, sans doute travaillé avec des pairs et à la fin, avoir un bon jugement clinique.

http://portal.wpspublish.com/portal/page?_pageid=53,70384&_dad=portal&_schema=PORTAL

Autism Diagnostic Observation Schedule (ADOS)
by Catherine Lord, Ph.D., Michael Rutter, M.D., FRS, Pamela C. DiLavore, Ph.D., and Susan Risi, Ph.D.

    This semi-structured assessment can be used to evaluate almost anyone suspected of having autism--from toddlers to adults, from children with no speech to adults who are verbally fluent.

    The ADOS consists of various activities that allow you to observe social and communication behaviors related to the diagnosis of pervasive developmental disorders. These activities provide interesting, standard contexts in which interaction can occur.

    The ADOS consists of four modules, each requiring just 35 to 40 minutes to administer. The individual being evaluated is given just one module, depending on his or her expressive language level and chronological age. Following guidance provided in the manual, you select the appropriate module for each person. Module 1 is used with children who do not consistently use phrase speech, Module 2 with those who use phrase speech but are not verbally fluent, Module 3 with fluent children, and Module 4 with fluent adolescents and adults. The one group within the autism spectrum that the ADOS does not address is nonverbal adolescents and adults.

    Modules 1 and 2 require you and the child to move around the room. Modules 3 and 4, both of which involve more conversation, can be administered at a table. Activities included in Modules 1 and 3 are listed below:

 

    Module 1

    Module 3

 

Free Play

 

Construction Task

Response to Name

Make-Believe Play

Response to Joint Attention

Joint Interactive Play

Bubble Play

Demonstration Task

Anticipation of a Routine With Objects

Description of a Picture

Responsive Social Smile

Telling a Story from a Book

Anticipation of Social Routine

Cartoons

Functional and Symbolic Imitation

Reporting a Non-Routine Event/Conversation

Birthday Party

Emotions

Snack

Social Difficulties/Annoyance

Break

Friends/Loneliness/Marriage

Creating a Story

 

    These activities provide a 30- to 45-minute observation period full of opportunities for the examinee to exhibit behaviors relevant to a diagnosis of autism or PDD. As you administer the ADOS, you record your observations, then code them later and formulate a diagnosis. Cut-off scores are provided for both the broader diagnosis of PDD/atypical autism/autism spectrum, as well as the traditional, narrower conceptualization of autism.

    Offering standardized materials and ratings, the ADOS gives you a measure of autism spectrum disorder that is unaffected by language. Because it can be used with a wide range of children and adults, it is a cost-effective addition to any hospital, clinic, or school that serves individuals with developmental disorders.
    The ADOS/ADI-R/SCQ unlimited-use scoring CD allows you to score all three of these important assessments using just one computer scoring program. The CD provides all of the algorithm scoring functions of the ADOS and ADI-R (use the standard paper-and-pencil administrations for the ADOS (W-365A) and ADI-R (W-382A), and then enter the responses into the computer program for rapid scoring). For the SCQ, use the CD to quickly score paper-and-pencil administrations using the PC Answer Sheet (W-381D or W-381E), or take advantage of convenient onscreen administration.

 

Claude Jolicoeur
2007, ®