L’objectif de cette étude était de décrire le parcours de soins des enfants de 18 à 30 mois à risque élevé de troubles du spectre de l’autisme (TSA) suivis en protection maternelle et infantile (PMI) dans les Bouches du-Rhône. L’objectif secondaire était d’évaluer la faisabilité du dépistage systématique des TSA en consultation de PMI.

Les enfants inclus dans l’étude descriptive du parcours de soins avaient 18 à 30 mois et un risque élevé de TSA au M-CHAT-R. Les données de la consultation de dépistage, 6, 12 et 24 mois après leur consultation ont été recueillies rétrospectivement. Pour l’étude qualitative transversale, des entretiens ont été menés auprès de médecins de PMI.

Parmi les 2458 enfants dépistés entre septembre 2015 et décembre 2018, 76 enfants (3,1 %) avaient un risque élevé de TSA (M-CHAT-R ≥ 8). Ils ont bénéficié rapidement de mesures de socialisation, pour atteindre une importante intégration en école ordinaire. Le délai médian de consultation d’un médecin spécialiste à partir du dépistage était de 81jours [40 ; 145]. Les principaux freins au dépistage systématique des TSA exprimés par les médecins de PMI étaient : le temps nécessaire au dépistage, la barrière de la langue, les difficultés de compréhension, l’offre de diagnostic et de soins limitée. Des leviers spécifiques au contexte de consultation de PMI ont été rapportés.

De nombreuses actions peuvent être entreprises entre les âges de deux et trois ans pour ces enfants dépistés à risque élevé de TSA en PMI.

The objective of this study was to describe the care pathway, socialization, and the modalities of scholarization of children aged 18 to 30 months at high risk of Autism Spectrum Disorders (ASD) followed in Maternal-Child Health Services (PMI) in the Bouches du-Rhône area in France. The secondary objective was to evaluate the feasibility of systematic screening for ASDs in PMI consultations.

A mixed observational (quantitative-qualitative) study was carried out in the Bouches-du-Rhône department in France. The children included in the care pathway descriptive study were 18 to 30 months of age and at high risk for ASD at the M-CHAT-R (M-CHAT-R≥8). Data from the screening visit, and 6, 12 and 24 months thereafter were collected retrospectively. For the cross-sectional qualitative study, interviews were conducted with PMI medical practitioners.

From September 2015 to December 2018, of the 2458 children screened, 76 children (3.1%) were at high risk for ASD (M-CHAT-R≥8) and the socialization of these children was initially poor since it was done only within the family (69% at the time of screening). These children quickly benefited from socialization measures, achieving a significant integration into regular school. Indeed, the schooling rate was very high at 24 months after the screening since 89% of the children were enrolled in school, most in regular schools, with human support. The care provided by a speech therapist, a psychomotrician or a psychologist increased over time. However, the speech therapist's follow-up was a little later than that of the psychomotrician. The median time to see a child psychiatrist or neuropaediatrician or pediatrician from screening was 81 days [40; 145]. Nine interviews were conducted with the referring PMI medical practitioners in the Bouches-du-Rhône department. The main barriers to routine screening for ASDs expressed by PMI medical practitioners were: the time required for screening, language and comprehension barriers, and limited diagnostic and care options. Levers specific to the PMI consultation setting were reported.

This study provides a glimpse of certain characteristics of the care, socialization and schooling pathway of these very young children, which is little documented to date in France. In view of the elements resulting from the interviews, as well as the large number of children having been screened over three years (n=2458), the feasibility of systematic screening for ASD at 18–30 months in the context of consultations with PMIs in the department seems to be established. Although specialized care management is confronted with structures, and the time frames described and studied were long, many actions can be undertaken between the ages of two and three years for these children.