BackgroundThe need for early treatment of autism spectrum disorders (ASD) necessitates early screening. Very few tools have been prospectively tested with infants of less than 12 months of age. The PREAUT grid is based on dyadic assessment through interaction and shared emotion and showed good metrics for predicting ASD in very-high-risk infants with West syndrome.MethodsWe assessed the ability of the PREAUT grid to predict ASD in low-risk individuals by prospectively following and screening 12,179 infants with the PREAUT grid at four (PREAUT-4) and nine (PREAUT-9) months of age. A sample of 4,835 toddlers completed the Checklist for Autism in Toddlers (CHAT) at 24 months (CHAT-24) of age. Children who were positive at one screening (N = 100) were proposed a clinical assessment (including the Children Autism Rating Scale, a Developmental Quotient, and an ICD-10-based clinical diagnosis if appropriate) in the third year of life. A randomly selected sample of 1,100 individuals who were negative at all screenings was followed by the PMI team from three to five years of age to identify prospective false negative cases. The clinical outcome was available for 45% (N = 45) of positive children and 52.6% (N = 579) of negative children.ResultsOf the 100 children who screened positive, 45 received a diagnosis at follow-up. Among those receiving a diagnosis, 22 were healthy, 10 were diagnosed with ASD, seven with intellectual disability (ID), and six had another developmental disorder. Thus, 50% of infants positive at one screening subsequently received a neurodevelopmental diagnosis. The PREAUT grid scores were significantly associated with medium and high ASD risk status on the CHAT at 24 months (odds ratio of 12.1 (95%CI: 3.0–36.8), p < 0.001, at four months and 38.1 (95%CI: 3.65–220.3), p < 0.001, at nine months). Sensitivity (Se), specificity, negative predictive values, and positive predictive values (PPVs) for PREAUT at four or nine months, and CHAT at 24 months, were similar [PREAUT-4: Se = 16.0 to 20.6%, PPV = 25.4 to 26.3%; PREAUT-9: Se = 30.5 to 41.2%, PPV = 20.2 to 36.4%; and CHAT-24: Se = 33.9 to 41.5%, PPV = 27.3 to 25.9%]. The repeated use of the screening instruments increased the Se but not PPV estimates [PREAUT and CHAT combined: Se = 67.9 to 77.7%, PPV = 19.0 to 28.0%].ConclusionsThe PREAUT grid can contribute to very early detection of ASD and its combination with the CHAT may improve the early diagnosis of ASD and other neurodevelopmental disorders.

West syndrome (WS) is a rare epileptic encephalopathy with early onset and a high risk of autistic outcome. The PréAut grid assesses this risk following WS onset by taking into account synchrony and emotion in interactions and by evaluating the baby's active desire to engage in pleasant interactions (especially the infant's early active behaviors that encourage being gazed at or kissed by the mother or to share joy with her). We followed a sample of 25 WS patients prospectively from disease onset and assessed whether the PréAut grid before 9 months, and the checklist for autism in toddlers (CHAT) at 18 and 24 months predicted autism or intellectual disability (ID) outcomes at 4 years. We found that the PréAut grid at 9 months (sensitivity = 0.83; specificity = 1) had similar prediction parameters as the CHAT at 18 months (sensitivity = 0.90; specificity = 0.83) and 24 months (sensitivity = 0.92; specificity = 1). WS patients with a positive PréAut screening at 9 months had a risk of having autism or ID at 4 years, which is 38 times that of children with a negative PréAut grid [OR = 38.6 (95 % CI 2.2-2961); p = 0.006]. We conclude that the PréAut grid could be a useful tool for the early detection of autism or ID risk in the context of WS. Further research is needed to assess the PréAut grid in other contexts (e.g. infants at high-risk for non-syndromic autism).

A autora problematiza a tese freudiana segundo a qual o funcionamento psíquico e pulsional apoia -se sobre a experiência de satisfação das necessidades vitais do organismo, e em especial a fome. Segundo ela, aquilo que é alucinado pelo bebê no polo alucinatório desta experiência de satisfação é antes de tudo a voz materna, e mais especialmente seus picos prosó-dicos, que devem ser tomados como primeiros objetos da pulsão oral. Psicanálise de bebês -pulsão oral -voz materna THE VOICE AS THE FIRST OBJECT OF THE ORAL DRIVEThe author discusses the freudian thesis of the anaclisis of the psychic functions of the vital needs. She sustains that the first objects of the oral drive are not those related to the hunger, but the prosodic peaks of the maternal voice. Babies psychoanalysis; oral drive; maternal H ntitulei este artigo "A voz como primeiro objeto da pulsão oral", mas, após ter trabalhado com algumas pesquisas psicolingüísticas atuais, eu deveria propor "Os picos prosódicos como primeiros objetos da pulsão oral".Freud, no final de sua vida, dizia na "Introdução..." (1938): "O primeiro órgão que se manifesta enquanto zona erógena e que emite para o psiquismo uma reivindicação libidinal, é, desde o nascimento, a boca. Qualquer atividade psíquica é agenciada para proporcionar satisfação às necessidades dessa zona. Trata-se evidentemente em primeiro lugar de agir para a autoconservação pela alimentação. Todavia, cuidemos de não confundir fisiologia e psicologia. Muito cedo, a criança, sugando obstinadamente, mostra que existe uma necessidade de satisfação que, ainda que extraia sua origem da alimentação e seja excitada por ela, procura seu ganho de prazer, independentemente desta. Assim, esta necessidade pode e deve ser qualificada como sexual". Referindo-nos ao texto sobre a pulsão (1915), podemos acrescentar: "pulsional".Freud insistia em partir do orgânico, e portanto apoiou sua "psicologia científica" -como ele a denomina no Projeto

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