Résumé
Les reconfigurations actuelles de la clinique de l’autisme, caractérisées par l’injonction au diagnostic précoce, la promotion des tests standardisés comme supports de la procédure diagnostique et l’apparition concomitante de centres spécialisés en autisme, transforment les pratiques des services de pédopsychiatrie. En étudiant le cas de la Suisse romande, nous interrogeons dans un premier temps la façon dont les outils d’évaluation standardisés sont l’objet d’une intégration contextuelle dans les différents cantons, qui les éloigne parfois de leur but initial, en fonction notamment de la présence ou non d’un centre spécialisé. Dans un deuxième temps, nous décrivons comment l’injonction à la précocité du diagnostic accroît l’incertitude avec laquelle les cliniciens doivent travailler, et tend à inscrire le dépistage de l’autisme dans une logique de gestion du risque et de normalisation de l’enfance. Enfin, nous questionnons l’articulation du diagnostic et de la prise en charge, dans le contexte d’une valorisation des thérapies précoces et intensives qui, à ce jour, sont insuffisamment implantées pour répondre à l’augmentation du nombre de cas diagnostiqués.
The current reconfigurations of the autism clinic, characterized by the emphasis on early diagnosis, the promotion of standardized tests as a support for the diagnostic procedure, and the concomitant emergence of specialized autism centers, are transforming the practices of child psychiatry services. By studying the case of French-speaking Switzerland, we first examine the way in which standardized assessment tools have been the subject of a contextual integration in the various cantons, which sometimes distances them from their initial purpose, depending in particular on the presence or absence of a specialized center. Second, we describe how the emphasis on early diagnosis increases the uncertainty with which clinicians must work and tends to push the screening of autism toward a logic of risk management and normalization of childhood. Finally, we examine the link between diagnosis and management, in the context of the promotion of early and intensive therapies that, to date, have been insufficiently established to respond to the increasing number of diagnosed cases.
The current reconfigurations of the autism clinic, characterized by the emphasis on early diagnosis, the promotion of standardized tests as a support for the diagnostic procedure, and the concomitant emergence of specialized autism centers, are transforming the practices of child psychiatry services. By studying the case of French-speaking Switzerland, we first examine the way in which standardized assessment tools have been the subject of a contextual integration in the various cantons, which sometimes distances them from their initial purpose, depending in particular on the presence or absence of a specialized center. Second, we describe how the emphasis on early diagnosis increases the uncertainty with which clinicians must work and tends to push the screening of autism toward a logic of risk management and normalization of childhood. Finally, we examine the link between diagnosis and management, in the context of the promotion of early and intensive therapies that, to date, have been insufficiently established to respond to the increasing number of diagnosed cases.