The diagnosis of autism was made at the age of 3 years based on communication and social interaction impairments and restricted, repetitive patterns of behaviour and interests. Behavioural problems were reported early, before the age of 2 years, with intense and repeated mutilations of cheekbones and eyes, culminating in a bilateral blindness at the age of 4 years by intumescent white cataract after numerous surgical complications. Behavioural problems and self-injurious behaviours (SIB) compromised his school attendance. The parents separated when he was five years old.
The patient was hospitalized three times in a child psychiatry unit thereafter with inconclusive antipsychotic treatments. He remained without specialized care. He only received the occasional intervention of associative home help. A major developmental regression was reported at home after the loss of sight: increasingly important attachment to adults and grasping behaviour, loss of walking, increase in SIB, and a diet almost exclusively made up of dairy products.
At the age of 7 years and 7 months, he was admitted in a dedicated neurodevelopmental child psychiatric unit. He was initially prescribed tiapride hydrochloride 40 mg/d, cyamemazine 40 mg/d, paracetamol 600 mg/d, melatonin 6 mg in the evening, hydroxyzine dihydrochloride 25 mg/d when needed, and two ophthalmic eye drops. SIB were prominent and nearly permanent, preventing any interaction: knee blows on his face, punches against his cheekbones, and banging his head against the walls. He did not react to the sound of his name or to simple instructions. He had lost the ability to walk and moved on his back by jerking on the ground or requested to be carried, constantly clinging to adults. Eating at a table was unthinkable. He was spoon-fed, immobilized. Several episodes of regurgitation and vomiting, followed by rhinorrhoea, were observed. These episodes were marked by a refusal of solid oral intake (solid food, medicine), a marked resurgence of crying, irritability, grabbing, and SIB. His intestinal transit was altered, with episodes of diarrhoea (false constipation), encopresis, and coprophagia. He also showed mood fluctuation, alternating between emotional outbursts with bursts of self-stimulatory behaviours (stereotypies) and significant irritability, intolerance to frustration, opposition behaviours, tantrums, and sleeping troubles. The psychiatric evaluation found a severe autistic syndrome (Children Autism Rating Scale (CARS) = 38) and severe ID (Vineland-II development age equivalent to 12 months in areas of communication and social skills and 15 months in autonomy).