https://iancommunity.org/ssc/recovery-losing-autism-diagnosis
Après la publication de notre article relayant l’alerte lancée par le Docteur Anne-Lise Ducanda au sujet des écrans et de l’autisme, deux sujets inflammables, voici la réaction de deux chercheurs en sciences cognitives, Franck Ramus (directeur de recherches au CNRS et professeur attaché à l’Ecole Normale Supérieure) et Hugo Peyre (Pédopsychiatre à l’Hôpital Robert Debré et chercheur à l’Ecole Normale Supérieure). Ces deux spécialistes des troubles neuro-développementaux contestent ce qu’ils considèrent comme une diabolisation trop générale et pas assez étayée des écrans.
Rappel des faits : dans une vidéo postée sur Youtube le 1er mars, Anne-Lise Ducanda, médecin de PMI en Ile de France explique qu’elle est de plus en plus sollicitée par les écoles maternelles pour des enfants qui souffrent non seulement d’un retard de développement mais aussi de troubles de la communication et de stéréotypies. Des symptômes similaires à ceux des troubles du spectre autistique. En cinq ans, assure-t-elle, l’augmentation est considérable, dossiers adressés à la Maison Départementale des Personnes Handicapées à l’appui. Elle affirme d’autre part qu’après entretien avec les parents, il s’avère que ces enfants ont tous été exposés de façon très massive aux écrans depuis la naissance. Elle en conclut donc qu’il existerait un lien entre cette exposition massive et précoce aux écrans et la survenue de troubles autistiques.
Cette analyse a suscité de nombreuses réactions, commentaires sur Youtube, sous notre article ou sur certaines pages Facebook. D’autres médecins de PMI et des orthophonistes disent constater les mêmes phénomènes (de plus en plus d’enfants très exposés aux écrans avec des retards de développement associés à des troubles de la communication). Des internautes concernés par l’autisme réfutent ce lien de cause à effet et se désolent notamment que les parents soient de nouveau rendus responsables du handicap de leur enfant. Autre critique formulée, plutôt par les représentants de la recherche : il peut notamment exister un biais social, les familles concernées n’étant pas forcément représentatives de la population générale.
Peut-on tirer des conclusions générales d’une observation locale?
Pour Franck Ramus, très dubitatif, « il est difficile de faire confiance à l’impression subjective d’un médecin. » « Les cliniciens peuvent remarquer des tendances chez leurs patients, mais sans faire de véritables statistiques, il ne sont pas à l’abri de se leurrer, en prêtant une attention sélective aux cas qui confirment leurs hypothèses et en négligeant les autres. Par exemple, on ne sait pas ici si les enfants sans problème n’ont pas eux aussi été exposés massivement. Les médias sont inondés d’alertes émises par des médecins de bonne foi. Souvent, après vérification, on constate qu’il n’y a en fait pas d’augmentation. Cela ne veut pas dire que ce médecin en particulier a tort mais pour le moment il s’agit d’une affirmation subjective.» Anne-Lise Ducanda le reconnaît : elle n’est pas chercheur, elle parle de données empiriques, de ce qu’elle constate sur le terrain.
Hugo Peyre note qu’ « il peut aussi y avoir une augmentation du phénomène dans sa patientèle sans que ce soit représentatif d’une augmentation en population générale.» Le point d’entrée de ce médecin, ce sont les enfants qui ont un problème, posent les deux chercheurs. Il faudrait s’interroger sur la possible évolution de la taille de la circonscription couverte sur les dernières années, celle du nombre d’enfants, du nombre de médecins amenés à intervenir (une réduction amènerait mécaniquement plus d’enfants dans l’escarcelle du Dr Ducanda). Elle nous l’a assuré : en cinq ans, le nombre d’écoles et d’élèves scolarisés est resté à peu près le même. Reste que la population suivie s’est peut-être davantage précarisée, ce qui pourrait expliquer l’augmentation des troubles. A vérifier.
Les familles concernées sont-elles vraiment représentatives ?
Car cette interrogation est au cœur du sujet. D’un côté Anne-Lise Ducanda affirme constater les mêmes phénomènes chez toutes les classes sociales. Mais elle exerce dans une ville plutôt pauvre, avec une forte concentration de population immigrée. Il peut donc malgré tout y avoir un biais social dans ses constatations. Pour Franck Ramus et Hugo Peyre, la littérature montre, d’une part, une plus forte prévalence de tous les troubles dans les milieux défavorisés, en raison de l’accumulation de facteurs de risque et il n’y a pas de raison que ce ne soit pas le cas pour l’autisme. Les études montrent, d’autre part, sans aucun doute, une corrélation entre le milieu socio-économique et la consommation d’écrans. « La quantité d’exposition est très liée à d’autres pratiques parentales, elles mêmes liées au niveau d’éducation des parents, pose Franck Ramus. Mais le problème de toutes les études sur les pratiques parentales néfastes est qu’elles ont du mal à contrôler tous les facteurs qui entrent en ligne de compte. A ce jour on n’a pas résolu la question des écrans : il n’est pas prouvé que c’est leur utilisation en elle-même qui est délétère pour les enfants.»
Il poursuit : « Il est évident que l’utilisation massive des écrans prend la place d’autres interactions essentielles. C’était déjà le cas avec la télévision. C’est aujourd’hui le cas avec la tablette. Mais avant ces écrans, les enfants de ces familles étaient tout simplement livrés à eux-mêmes, laissés dans un coin. Etait-ce mieux pour autant ? Il manque une base de comparaison.»
Quant à proposer la piste environnementale (en dehors des facteurs biologiques) pour expliquer une partie des cas d’autismes, «tout est potentiellement à creuser » pour les chercheurs. « Mais on n’a pas pu mettre en évidence le rôle causal d’un facteur social dans la survenue de l’autisme, assure Franck Ramus. Ca ne veut pas dire qu’il n’y en a pas mais aujourd’hui il n’existe aucune preuve. » Il pousse plus loin le raisonnement en évoquant une possible causalité inversée : dans quelle mesure l’autisme de ces enfants n’a-t-il pas amené les parents désemparés à se dire que les tablettes faisaient l’affaire ?
Un consensus: 6 à 12 heures d’écran par jour pour un enfant de moins de 3 ans, c’est stupéfiant
Irrités par « le caractère simpliste et péremptoire de certaines affirmations » du Dr Ducanda, mais néanmoins d’accord sur la plupart des recommandations au quotidien formulées dans sa vidéo, ces deux spécialistes plaident pour la prudence et des discours mesurés. « Nous sommes opposés à la diabolisation générale des écrans. Même le fait de dire « ce qui est grave c’est de les utiliser avec des bébés » n’est pas étayé puisqu’on n’a pas montré d’effets délétères. On peut dire en revanche que les écrans ne sont pas des nounous et ne peuvent pas remplacer l’être humain.» Et ils l’admettent : « une exposition de six à douze heures par jour, c’est colossal et ça pose question ». Il nous semble que c’est d’ailleurs l’une des informations fortes de cette vidéo : des parents assez démunis (désinvestis?) pour laisser tous les jours des heures durant un bébé devant une télévision ou avec un smartphone dans les mains ont assurément, et urgemment, besoin d’aide.
Franck Ramus et Hugo Peyre notent au passage que les écrans peuvent même aider les enfants autistes. « Tous les systèmes de communication augmentée utilisent des logiciels informatiques. Ils enrichissent par exemple les pictogrammes de type PECS. Mais tout dépend toujours de la façon dont on utilise ces technologies.»
Anne-Lise Ducanda, elle, ne demande pas mieux que de voir des équipes de recherche venir investiguer sur son secteur. Pas si simple. « Pour en avoir le cœur net, explique Franck Ramus, il faudrait faire une étude prospective qui observerait tous les enfants, leur taux d’exposition aux écrans, qui ensuite analyserait le développement de ces enfants, et identifierait ou pas d’éventuelles corrélations prédictives dans le temps. Il faudrait aussi décorréler ces résultats avec les autres facteurs sociaux et les autres pratiques parentales. C’est un énorme travail de recherche. » Certainement. Mais peut-être est-il urgent de lever ce doute-là.
sabineduflo.fr 
Children with autism spectrum disorders (ASD) are uniquely vulnerable to various brain-related impacts of screen time. These electronic “side effects” include hyperarousal and dysregulation—what I call Electronic Screen Syndrome—as well as technology addiction, to video games, internet, smartphones, social media, and so on.
Why? Because a brain with autism has inherent characteristics that screen time exacerbates. In truth, these impacts in occur in all of us, but children with autism will be both more prone to experiencing negative effects and less able to recover from them; their brains are more sensitive and less resilient.
As a framework for understanding these vulnerabilities, it’s helpful to know that screen time—particularly the interactive kind—acts like a stimulant, not unlike caffeine, amphetamines, or cocaine. Also know that children with autism are often sensitive to stimulants of all kinds, whether pharmaceutical or electronic. For example, children with autism and attention issues often can’t tolerate prescribed stimulants, a standard treatment for ADD/ADHD. Stimulants tend to make children with autism irritable, weepy, over-focused, more obsessive-compulsive, and unable to sleep. Stimulants can also exacerbate tics, self-injurious behaviors, aggression, and sensory issues.
Meanwhile, in families dealing with autism, there exist additional social and emotional factors that contribute to technology overuse. First, families are often dealing with highly disruptive behaviors that are quieted—at least in the short term—by handing the child a device. Second, parents are told that “playing video games is ‘normal.’ It’s something your son can do with other kids.” Third, parents are encouraged to introduce technology early and often—especially if “he’s good at computers.” Fourth, in-home and school behavior therapists often use video games or other apps as reinforcers: “It’s the only thing that works with her!” And lastly, parents and clinicians are routinely encouraged to try unproven screen-based software claiming to reduce autistic behaviors or to improve social, communication or reading skills.
Needless to say, education in this arena is sorely needed.
11 reasons children with autism are extra vulnerable to screen time effects and tech addiction
1. Children with autism tend to have low melatonin and sleep disturbances, [1] and screen time suppresses melatonin and disrupts sleep.[2] Aside from regulating sleep and the body clock, melatonin also helps modulate hormones and brain chemistry, balances the immune system, and keeps inflammation at bay.
2. Children with autism are prone to arousal regulation issues, manifesting in an exaggerated stress response, emotional dysregulation, or a tendency to be over or under-stimulated[3]; screen time increases acute and chronic stress, induces hyperarousal, causes emotional dysregulation, and produces overstimulation.[4]
3. Autism is associated with inflammation of the nervous system,[5] and screen time may increase inflammation by a variety of mechanisms including increased stress hormones, suppressed melatonin, and non-restorative sleep.[6] Light-at-night from screens also suppresses REM sleep, a phase during which the brain “cleans house.”[7]
4. The autistic brain tends to be underconnected—less integrated and more compartmentalized [8]—and screen time hinders whole-brain integration and healthy development of the frontal lobe.[9] In fact, in tech addiction brain scan studies reveal reduced connectivity (via reduced white matter) and atrophy of gray matter in the frontal lobe.[10]
5. Children with autism have social and communication deficits, such as impaired eye contact, difficulty reading facial expressions and body language, low empathy, and impaired communication[11]; screen time hinders development of these exact same skills—even in children and teens who don’t have autism.[12] Screen time appears to directly compete with social rewards, including eye contact—a factor essential for brain development.[13] Lastly, screen viewing and even background TV has been shown to delay language acquisition.[14]
6. Children with autism are prone to anxiety[15]—including obsessive-compulsive traits, social anxiety—and screen time is associated with increased risk for OCD and social anxiety,[16] while contributing to high arousal and poor coping skills.[17] Additionally, anxiety in autism has been linked to abnormalities in serotonin synthesis and amygdala activity,[18] and both serotonin regulation and amygdala changes have been implicated in screen time.[19]
7. Children with autism frequently have sensory and motor integration issues[20] as well as tics; screen time has been linked to sensori-motor delays and worsening of sensory processing[21], and can precipitate or worsen vocal and motor tics due to dopamine release.
8. Individuals with autism are typically highly attracted to screen-based technology and are not only at increased risk for developing video game and other technology addictions, but are more likely to exhibit symptoms with smaller amounts of exposure.[22] Male teens and young adults with ASD are also at high risk for porn addiction, due to a combination of social deficits, isolation, and excessive computer time, and may develop romantic delusions or obsessions fueled by being accustomed to immediate gratification and a lack of practicing in the real world. At the same time, dopamine released by screen interaction reinforces these obsessive “loops.”
9. Children with autism tend to have a fragile attention system, poor executive functioning, and “reduced bandwidth” when processing information [23]; screen time likewise fractures attention, depletes mental reserves, and impairs executive functioning.[24]
10. Children with autism may be more sensitive to EMFs (electromagnetic fields) emitted from wireless communications (e.g. WiFi and cell phone frequencies) as well as from the electronic devices themselves.[25] At the cellular, molecular, and atomic level, the pathology seen in autism mirrors the effects demonstrated in research on the biological impacts of EMFs. Heightened sensitivity to EMFs may be due to (and may worsen) immune abnormalities and problems with barrier integrity in the gut and/or the brain.
11. Children with autism are at higher risk for psychiatric disorders of all kinds, including mood and anxiety disorders, ADHD, tics and psychosis.[26] Likewise, higher amounts of total screen time are associated with higher levels of psychiatric disturbances, including mood and anxiety disorders, ADHD, tics and psychosis.[27] Regarding psychosis, young people with ASD who engage in daily screen time may experience hallucinations, paranoia, dissociation, and loss of reality-testing. More often than not, however, these scary symptoms resolve or greatly diminish once devices are removed and don’t require antipsychotic medication.
In addition to the above, screen time replaces the very things we know to be critical to brain development: bonding, movement, eye contact, face-to-face verbal interactions, loving touch, exercise, free play, and exposure to nature and the outdoors. Reduced exposure to these factors negatively impact brain integration, IQ, and resilience in all children.
In my own experience in working with children and adults with autism, screen time can precipitate regression (loss of language or of social or adaptive living skills), exacerbate repetitive behaviors, further restrict interests, and trigger aggressive and self-injurious behaviors. I’ve even seen regression occur when a communication device is introduced, often when the parents are told to encourage “play” on the device so the child can “get used to it.” The proliferation of the iPad and smartphones has produced more problems and setbacks in my practice than any other single factor.
As stressful and devastating as these experiences can be, so can methodical elimination of screens be exciting and inspiring. Being screen-free can enhance eye contact and language, increase flexibility in thinking and behavior, expand interests, improve emotional regulation and ability to stay on task, induce more restorative sleep, and reduce anxiety and meltdowns.
Because the idea of eliminating screens can seem overwhelming, I typically recommend parents do a four week “electronic fast” as an experiment so they can get a taste of what the intervention can do. Families track two to three problematic areas to provide objective evidence, and are encouraged to document behaviors (such as screen time tantrums and how the child plays). Even a few short weeks can produce improvements that can be significant enough for the family to decide to continue with screen elimination, in which case the benefits will continue to build on one another.
Will the child still have autism? Yes, but it’s practically guaranteed that he or she will feel, focus, sleep, behave, and function better. And intriguingly, anecdotal evidence suggests this simple intervention may be powerful enough to prevent, arrest or in some cases even reverse the autism process if caught early enough; pilot studies testing this intervention more formally are forthcoming. (Case studies illustrating these phenomena will be the subject of a future post.)
When parents really grasp the science of what happens in the brain when children interact with screen devices—and understand how these things specifically impact autism—they are much better able to restrict screens appropriately and are less swayed by social pressures. They “see” how screen time translates into certain symptoms in their child, they prioritize brain-health over being tech-savvy, and appreciate that every minute spent on a screen is a tradeoff.
For more help implementing a screen fast, see Reset Your Child’s Brain: A Four-Week Plan to End Meltdowns, Raise Grades, and Boost Social Skills by Reversing the Effects of Screen-Time.
References
[1] J Melke et al., “Abnormal Melatonin Synthesis in Autism Spectrum Disorders,” Mol Psychiatry 13, no. 1 (May 15, 2007): 90–98.
[2] Shigekazu Higuchi et al., “Effects of Vdt Tasks with a Bright Display at Night on Melatonin, Core Temperature, Heart Rate, and Sleepiness,” Journal of Applied Physiology (Bethesda, Md.: 1985) 94, no. 5 (May 2003): 1773–76.
[3] Matthew S. Goodwin et al., “Cardiovascular Arousal in Individuals with Autism,” Focus on Autism and Other Developmental Disabilities 21, no. 2 (2006): 100–123; BA Corbett and D Simon, “Adolescence, Stress and Cortisol in Autism Spectrum Disorders.,” OA Autism 1, no. 1 (March 1, 2013): 1–6.
[4] Marjut Wallenius, “Salivary Cortisol in Relation to the Use of Information and Communication Technology (ICT) in School-Aged Children,” Psychology 1, no. 2 (2010): 88–95; Amy E. Mark and Ian Janssen, “Relationship between Screen Time and Metabolic Syndrome in Adolescents,” Journal of Public Health 30, no. 2 (June 1, 2008): 153–60; Gary S. Goldfield et al., “Video Game Playing Is Independently Associated with Blood Pressure and Lipids in Overweight and Obese Adolescents,” ed. Philippe Rouet, PLoS ONE 6, no. 11 (November 1, 2011): e26643.
[5] Theoharis C. Theoharides, Shahrzad Asadi, and Arti B. Patel, “Focal Brain Inflammation and Autism,” Journal of Neuroinflammation 10, no. 1 (2013): 46.
[6] Z. Ranjbaran et al., “The Relevance of Sleep Abnormalities to Chronic Inflammatory Conditions,” Inflammation Research: Official Journal of the European Histamine Research Society … [et Al.] 56, no. 2 (February 2007): 51–57.
[7] Christian Cajochen et al., “Evening Exposure to a Light-Emitting Diodes (Led)-Backlit Computer Screen Affects Circadian Physiology and Cognitive Performance,” Journal of Applied Physiology (Bethesda, Md.: 1985) 110, no. 5 (May 2011): 1432–38.
[8] Marcel Adam Just, Timothy A. Keller, and Rajesh K. Kana, “A Theory of Autism Based on Frontal-Posterior Underconnectivity,” Development and Brain Systems in Autism, 2013, 35–63.
[9] Cris Rowan, “Unplug—Don’t Drug: A Critical Look at the Influence of Technology on Child Behavior With an Alternative Way of Responding Other Than Evaluation and Drugging,” Ethical Human Psychology and Psychiatry 12, no. 1 (April 1, 2010): 60–68; Victoria Dunckley, “Gray Matters: Too Much Screen Time Damages the Brain,” Psychology Today, Mental Wealth, (February 27, 2014), http://www.psychologytoday.com/blog/mental-wealth/201402/gray-matters-to….
[10] Chuan-Bo Weng et al., “Gray Matter and White Matter Abnormalities in Online Game Addiction,” European Journal of Radiology 82, no. 8 (August 2013): 1308–12.
[11] R. Adolphs, L. Sears, and J. Piven, “Abnormal Processing of Social Information from Faces in Autism,” Journal of Cognitive Neuroscience 13, no. 2 (February 15, 2001): 232–40.
[12] Yalda T. Uhls et al., “Five Days at Outdoor Education Camp without Screens Improves Preteen Skills with Nonverbal Emotion Cues,” Computers in Human Behavior 39, no. 0 (October 2014): 387–92; Roy Pea et al., “Media Use, Face-to-Face Communication, Media Multitasking, and Social Well-Being among 8- to 12-Year-Old Girls,” Developmental Psychology 48, no. 2 (March 2012): 327–36.
[13] Karen Frankel Heffler and Leonard M. Oestreicher, “Causation Model of Autism: Audiovisual Brain Specialization in Infancy Competes with Social Brain Networks,” Medical Hypotheses 91 (June 2016): 114–22.
[14] Weerasak Chonchaiya and Chandhita Pruksananonda, “Television Viewing Associates with Delayed Language Development,” Acta Pædiatrica 97, no. 7 (2008): 977–82.
[15] Susan W. White et al., “Anxiety in Children and Adolescents with Autism Spectrum Disorders,” Clinical Psychology Review 29, no. 3 (April 2009): 216–29.
[16] Jee Hyun Ha et al., “Depression and Internet Addiction in Adolescents,” Psychopathology 40, no. 6 (2007): 424–30; Pea et al., “Media Use, Face-to-Face Communication, Media Multitasking, and Social Well-Being among 8- to 12-Year-Old Girls.”
[17] Christopher Mulligan, “The Toxic Relationship: Technology and Autism,” 2012, http://www.teenvideogameaddiction.com/The_toxicrelationshipautismandtech….
[18] D. C. Chugani et al., “Developmental Changes in Brain Serotonin Synthesis Capacity in Autistic and Nonautistic Children,” Annals of Neurology 45, no. 3 (March 1999): 287–95; Adolphs, Sears, and Piven, “Abnormal Processing of Social Information from Faces in Autism.”
[19] Jun Kohyama, “Neurochemical and Neuropharmacological Aspects of Circadian Disruptions: An Introduction to Asynchronization,” Current Neuropharmacology 9, no. 2 (2011): 330; Klaus Mathiak and René Weber, “Toward Brain Correlates of Natural Behavior: fMRI during Violent Video Games,” Human Brain Mapping 27, no. 12 (December 2006): 948–56.
[20] Geraldine Dawson and Renee Watling, “Interventions to Facilitate Auditory, Visual, and Motor Integration in Autism: A Review of the Evidence,” Journal of Autism and Developmental Disorders 30, no. 5 (2000): 415–421.
[21] Cris Rowan, “The Impact of Technology on Child Sensory and Motor Development,” 2010, http://www.sensoryprocessinginfo/CrisRowan.pdf.
[22] Micah O. Mazurek and Christopher R. Engelhardt, “Video Game Use and Problem Behaviors in Boys with Autism Spectrum Disorders,” Research in Autism Spectrum Disorders 7, no. 2 (February 2013): 316–24; Micah O Mazurek and Colleen Wenstrup, “Television, Video Game and Social Media Use Among Children with Asd and Typically Developing Siblings,” Journal of Autism and Developmental Disorders 43, no. 6 (June 2013): 1258–71.
[23] Just, Keller, and Kana, “A Theory of Autism Based on Frontal-Posterior Underconnectivity.”
[24] Edward L Swing et al., “Television and Video Game Exposure and the Development of Attention Problems,” Pediatrics 126, no. 2 (August 2010): 214–21; Robert M. Pressman et al., “Examining the Interface of Family and Personal Traits, Media, and Academic Imperatives Using the Learning Habit Study,” The American Journal of Family Therapy 42, no. 5 (October 20, 2014): 347–63; Angeline S Lillard and Jennifer Peterson, “The Immediate Impact of Different Types of Television on Young Children’s Executive Function,” Pediatrics 128, no. 4 (October 2011): 644–49.
[25] Martha R. Herbert and Cindy Sage, “Autism and EMF? Plausibility of a Pathophysiological Link – Part I,” Pathophysiology: The Official Journal of the International Society for Pathophysiology / ISP 20, no. 3 (June 2013): 191–209.
[26] Cecilia Belardinelli and Mahreen Raza, “Comorbid Behavioral Problems and Psychiatric Disorders in Autism Spectrum Disorders,” Journal of Childhood & Developmental Disorders 2, no. 2 (2016).
[27] Goran Mihajlović et al., “Excessive Internet Use and Depressive Disorders,” Psychiatria Danubina 20, no. 1 (March 2008): 6–15; Ju-Yu Yen et al., “The Comorbid Psychiatric Symptoms of Internet Addiction: Attention Deficit and Hyperactivity Disorder (ADHD), Depression, Social Phobia, and Hostility,” The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine 41, no. 1 (July 2007): 93–98; J Lee, K Lee, and T Choi, “The Effects of Smartphone and Internet/Computer Addiction on Adolescent Psychopathology.” (166th Annual Meeting of the American Psychiatric Association, San Francisco, CA, 2013), http://www.psychcongress.com/article/smartphone-addiction-linked-increas….