Étude des facteurs de risque des comportements agressifs dans les troubles du spectre autistique

Abstract

BackgroundWhen coping with auto- and hetero-aggressive behavior in children with autism spectrum disorders, the child psychiatrist has a double role: treating these behaviors as well as identifying at risk persons and situations. ObjectivesIn this perspective, our work aimed to study the risk factors of auto- and hetero-agressivity in behavioral self-hetero-aggressive. MethodsWe conducted a transversal study of 50 children with autism spectrum disorder (DSM-5 criteria). The diagnosis was confirmed by the Autism Diagnostic Interview-Revised (ADI-R). The severity of autism was determined by the Childhood Autism Rating Scale (CARS). Aggressive behaviors were assessed by the Behavior Problems Inventory (BPI-01) translated and validated in Arabic. The psycho-educational profile revised (PEP-R) evaluated, through the seven domains of development, the developmental age of each child. A predetermined plug collected information on the epidemiological and clinical characteristics. To determine the risk factors associated with aggressive behaviors, we conducted a univariate followed by a multivariate analysis. ResultsOur sample consisted of 50 children with ASD in accordance to DSM-5 criteria. The sex ratio was 4.5. Patients had an average age of 6 years (SD: 2) with extremes ranging from 2 to 12 years. Mean CARS score was 37.1 (SD: 7). Twenty percent of the children had a high functioning form of autism while the rest of the sample presented mild to moderate intellectual disability. The prevalence of auto-aggressive behavior was 46% and that of hetero-aggressiveness was of 60%. The univariate analysis found the following results. A statistically significant association was found between self-harm and the following factors: a higher age (P=0.007), a later age of diagnosis (P=0.006), digestive disorders (P=0.026; OR=4.28; 95% CI=1.1–16), high pain threshold (P=0.007; OR=5.8; 95% CI=1.5–21.8), intellectual disability (P=0.004), a lower score of perception at the PEP-R (P=0.045), and a higher score on the ADI-D (P=0.001). A statistically significant association was found between hetero-aggressive behavior and the following factors: a higher age (P=0.042) and the absence of the “no” opposition (P=0.017; OR=0. 1; 95% CI=0.1–0.9). The multivariate analysis isolated three independent factors for self-harm: a higher age (P=0.011; adjusted OR=1.05; 95% CI=1.01–1.09), digestive disorders (P=0.016; adjusted OR=17.5; 95% CI=1.7–1.80), intellectual disabilities (P=0.008; adjusted OR=0.9; 95% CI=0.8–0.9); and two independent factors for hetero-aggressiveness: a higher age (P=0.039; adjusted OR=1.03; 95% CI=1–1.06) and the absence of the “no” opposition (P=0.008; adjusted OR=0.1; 95% CI=0.02–0.56). ConclusionThese data invite us to consider the aggressiveness as a multifactorial behavior and to analyze aggressive behavior in light of the complex set of interactions between an individual and his environment.