Identité et spécificité du « pédantisme » dans le syndrome d’Asperger

The purpose of this work is to better understand pedantic speech in Asperger syndrome as a pervasive developmental disorder. Often mentioned, unlike echolalia in studies on typical autism, this symptom questions the possible specificity of Asperger syndrome. From a review of literature and clinical examples, we propose an interpretation of this speech style as unified and coherent as possible. This clinical feature includes an overly precise vocabulary or overly favourite topic (which can be explained by a more general sameness) in the context of a one-side interaction (which can be explained by a more general impairment of influence). We suggest that the tendency to speak in a pedantic manner may be specific despite a generic disorder shared with typical autism.     

Les « maisons d’adolescents » : le défi de l’accueil et de l’écoute

Insidiously, the label “adolescent halfway house” evokes a lot of phantasms. Nevertheless, these new structures appear as an opportunity to reinforce the provision of accommodation and care for a population which, to all evidence, presents health requirements that have not always been satisfactorily met in the past. However, in order to be fully efficient and without substituting the existing proper health structures, these “halfway houses” must prove their methodological rigour, essential when replying to the obvious particularities of the relational contract that is characteristic of this age group. This article provides various thoughts on the requirements of training and supervision by professionals assigned to accommodate and listen to adolescents.     

Activités à médiation : de l’occupationnel au thérapeutique

This reports deals with reflections by the medical staff of the Child and Teenager Care Centre about the therapeutic interest of mediator-supervised activities. This Care Centre, which is set within the university department of Child and Adolescent Psychiatry of Brest Hospital, receives mainly difficult teenagers. This study is in line with a redevelopment, at constant means, of our care offer because of the gradual changes observed in the issues and requests we have to cope with. This clinical evolution marked by deep societal motions has imposed us to modify our analysis of psychic suffering expression. The difficult teenager shows us to which extent our therapeutic and institutional tools may sometimes prove to be inadequate: indeed, his/her difficult behaviour means that we have failed. This finding drove us led us to take an interest in mediator-supervised activities that we needed to rediscover prior to appropriating them. As they proved to be better suited to difficult teenagers than “classical” approaches, we will try to highlight the ins and outs while underlining how an efficient therapy can emerge from a thorough organisation of occupations. The experience we have acquired through sailing activities will be used as illustration of our reflection.     

Placements dans l’enfance et devenir à l’âge adulte : insertion générale et qualité de vie liée à la santé

Background

Child welfare literature underlines a higher prevalence of health problems and psychiatric disabilities in fostered young people than in the general population. Questions remain about their social integration and health in the long term: Which risk factors continue to alter their pathway? Which protective factors have minimized a problematic psychosocial adaptation over time?

Purpose

A follow-up study in the past was conducted on a SOS children's village on 123 young people who had been reared for more than 3 years and left care after the age of 14. A survey was mailed to these adults aged 23–50 years old, followed by face-to-face interviews. All relevant institutional files were analysed. Attrition rates were very low in this high-risk population. An overall score of social integration aggregates data regarding: occupational situation, family life, relationships, general psychosocial state. Health-related quality of life (Duke Profile) was analyzed by means of multiple dimensions including mental and social health, self-esteem, depression and disability. Multivariate analyses by logistic regression were used to examine the specific roles of decisive factors on social integration.

Key findings

At a mean age of 36.5 years, two thirds were well integrated socio-economically, only one out of five had psychosocial problems. Three factors increased the risk of poor socioeconomic integration: accumulation of parental risk factors, having been placed with two or more siblings’ groups and persisting mental health problems when leaving care. The quality of life was significantly associated with a better perception of social and mental health and with self-esteem. It varied positively, taken into account with professional integration, relationships and supportive environment, and negatively according to past adversities: parental domestic violence, maltreatment, and persisting mental health problems. Except from disabilities and to a lesser degree sociability, globally, these former fostered population did not seem different from counterparts in terms of health measures, anxiety and depression.

Implications

Results highlight the importance of continuity and stability in placement. For the professionals, it is necessary to give more attention to the question of rearing together several groups of siblings. Persisting mental health problems during placement and when leaving care would suggest a vital need for the staff to identify and to implement intensive, appropriate therapeutic care.     

Autisme du nourrisson : quoi de neuf dans le diagnostic et l'accompagnement ?

The field of knowledge on autism has deeply changed within a decade. We know more about the different kinds of pervasive developmental disorders, on their incidence, on the clinical aspects of onset of autism, on the possibility of early detection, as soon as 18 months of age, on the frequency of neurological and genetic disorders which may be associated with autism, and on the necessity of an early intervention. New media, as video, are useful to enhance assessment and therapeutic follow-up. Research allow for a therapeutic follow-up that goes further than the splitting between educative and psychodynamic trends of thoughts. However, prognosis in autism is still a difficult issue, and therapeutic efficiency is still globally low. This paper is not a literature review on pervasive disorders in general or particularly in autism, but aims at highlighting some new aspects which may be of interest for both clinicians and researchers on these several issues, about children up to 3 years of age.     

Psychopathologie du syndrome d’Asperger et « aspérigisation » de la société contemporaine

The author has attempted here to point out, just for a start, the characteristics of Asperger syndrome from the point of view of psychopathology through a rereading of Hans Asperger's original paper (1944). This thesis merits reevaluation, if for no other reason than to fill the gaps in operational diagnostics based on the DSM. It is found by rereading that Asperger's view of the principal disturbances of autistic psychopathy include a “disturbance of natural evidence” or a “crisis of common sense”. This question of natural evidence that he evokes with regard to autistic psychopathy corresponds to W. Blankenburg's natural evidence, which constitutes a key concept for comprehending schizophrenia in the form poor-symptom (“symptomarme Schizophrenie”) that he observes in the speech of his patient Anne Rau. One can deduce from this that in terms of fundamental disturbances, Asperger syndrome and this “symptom-poor” schizophrenia overlap at the level of loss of natural evidence. It is moreover possible to classify Asperger syndrome among the disturbances of spacing in the sense meant by the evolutionary psychiatry of A. Stevens and J. Price. The author then develops our comprehension of Asperger syndrome from the point of view of the perspective proposed by the notion of resilience in people with Asperger syndrome and of the possibility for them, through these mechanisms of adaptation, to find in the organization of the personality of the “as if” type a position of relative equilibrium. They concur or overlap in the creation of crutches, of borrowed personalities secondarily legitimated by the reaction of the socius. This will end up in the production of inventions and œuvres (works). Clearly, one rarely encounters several cases that one could consider pertinently to be “successful” Asperger syndrome. Finally, the author notes that one can find a sort of isomorphism between Asperger syndrome and contemporary society when he proposes the term “asperigisation” to characterize our society, given that the equilibrium between emotion and logic is strongly disturbed in these patients, in whom logic undergoes hypertrophy while emotion is impoverished. From this perspective, the author hopes to suggest reasons for the increase in the number of cases of Asperger syndrome in the clinical setting and in society in general in our contemporary era.     

Un « élève handicapé » peut-il encore relever de mesures thérapeutiques : les MDPH

The law of February 11th, 2005 in favour of the disabled persons was approved by members of child psychiatric teams, but, we notice it today, certain texts of application question the orientations of care, to the point that children and concerned teenagers are essentially envisaged under the angle of handicaps recovering from measures of compensation. The example of Therapeutic and educational institute (ITEP) does well to see how the priority henceforth given to the concept of disabled pupil and the procedures which ensue from it in Departmental house of the disabled persons (MDPH) can be in contradiction with the multidimensional approaches which were before led, by including the aim of a “psychic restructuring”. These orientations which modify the conceptions and the child psychiatry practices were able to be imperative, without preliminary dialogue, by means of the texts of application of law. Nevertheless, the announced objectives of this law had aroused a wide support.     

Évaluation des troubles autistiques avant trois ans : l’expérience de l’« UNIDEP » (Unité de dépistage et d’évaluation précoce des troubles envahissants du développement)

In this article we will present our early detection local program of autism and invasive developmental disorders. It is to detect and evaluate children under the age of three, in order to propose proper treatment as quickly as possible. First of all we will present the different aspects of the program working within a network. On one side the collaboration with different structures such as the maternal and infant protection (PMI) and on the other the collaboration with institutions that will specifically take care of these children. The proper evaluation will be then explained and our methods will be further detailed. Secondly, we will share our clinical studies stemmed from our experience and will then consider diagnosis announcement, alliance and therapeutic process. This will then be followed by case studies that will highlight the therapeutic dimension, which already seems to exist in this evaluation phase.