Continuité historique entre autisme et idiotisme : exploration d'une correspondance sémiologique.

Certains spécialistes de l'autisme font de l'idiotisme l'origine historique du trouble. En résonance avec cette hypothèse, l'augmentation de la prévalence du trouble du spectre autistique est expliquée par différentes hypothèses, impliquant ou non une continuité historique. L'objectif de cet article est d'explorer la validité de ces hypothèses, en nous appuyant sur une comparaison historique des descriptions cliniques de l'idiotisme et de l'autisme. Afin d'établir cette correspondance sémiologique, nous relèverons les descriptions cliniques de l'époque de l'idiotisme et les comparerons à celles de l'autisme du DSM-5. Puis, nous regarderons les autres maladies pouvant être responsables d'un retard mental et associées potentiellement à l'idiotisme. La correspondance est frappante, notamment en ce qui concerne la communication, l'absence de contact visuel, les caractéristiques psychomotrices, l'attachement aux routines, les réactions extrêmes à la sensorialité et les compétences hors-normes. Cette correspondance pourrait bien être le fruit d'un biais d'interprétation. Aujourd'hui, certaines maladies responsables du retard mental ont disparu ou leur origine biologique a été identifiée. Il apparaît que la population atteinte d'idiotisme au 19ème siècle ne correspond pas à la population observée actuellement dans l'autisme. Il se pourrait que cette correspondance soit en partie vraie, mais elle semble biaisée par l'omission de certaines maladies sorties depuis du champ psychiatrique, du fait de la découverte de leur étiologie biologique. Some autism specialists locate idiocy as the historical origin of the disorder, implying that it would be a phenomenon present throughout the ages, but only correctly diagnosed today. In resonance with this hypothesis, the increase in the prevalence of Autism Spectrum Disorder is explained by different theories. It could be linked either to an improvement in the diagnostic approach and better identification of the disorder, or to a bio-psycho-social context favoring its appearance, or to an extension of the diagnostic criteria and a modification of the classifications. The purpose of this article is to explore the validity of these different hypotheses, drawing on a historical comparison of clinical descriptions of idiocy and autism. In order to establish this semiological correspondence, we will identify the clinical descriptions from the era of idiocy written by Edouard Séguin, "l'instituteur des idiots" (the schoolmaster of idiots), and will compare them with those of the autism in the DSM-5. Then, we will look at the historical process of other diseases that may be responsible for mental retardation and potentially associated with idiocy. The overlap between idiocy and autism is striking, especially with lack of communication skills, lack of eye contact, psychomotor characteristics, attachment to routines, extreme sensory reactions, and non-standard skills. This correspondence could demonstrate the continuity of the diagnostic entity over time between idiocy and autism, but could just as well be the result of a bias in interpretation. Some diseases responsible for mental retardation observed by the alienists of Séguin's time have been identified as having a biological and genetic origin. For some of them, treatments have been found and have led to their disappearance. It appears that the population identified with idiocy in the 19th century does not correspond to the population currently diagnosed with autism. This correspondence may be partly valid, but it seems mainly biased by the omission of some diseases that have been forgotten or removed from the psychiatric field, by the fact that their biological etiology has been identified. [ABSTRACT FROM AUTHOR]