Quelques jalons introductifs à la loi du 11 février 2005

The law of February 11th, 2005 for “The equality of rights and chances, the participation and the citizenship of disabled persons” has substantially modified society's perception of the disabled. A fundamentally “social” law, it does not establish its logic on the medical and clinical aspects of the handicap, but on its functional and social consequences for the person. The principles of nondiscrimination, accessibility, consideration of the environment, and the compensation of the consequences of the handicap are the key words. Some of its measures question the privileged, even exclusive, place that has been granted up till now to the medical and social establishments welcoming handicapped children, for the implementation of their schooling, their education and care. The services of the Ministry of Education and the personalized project of schooling, as well as the life in the family place of residence thus tend to become the pivots around which establishments and medical and social services and the project of care have to articulate.     

Les effets de la Loi de février 2005 vus par les équipes des secteurs sanitaire et médicosocial

Answers to the questionnaire dispatched to the staffs of sanitary and medicosocial institutions indicate how they feel the effects of February 2005's law on their practice. On the whole, feeling is rather unfavorable. Many staffs consider that new procedures disturbed their work. Their school's relationships were hindered. Meanwhile, some of them could maintain connection's quality they had before. Opinion about referent-teachers is strongly positive. Reserve came from staffs that can’t place them as a third person in their work with school. In spite of difficulties encountered, staffs made the best possible use of the instructions of the law and improved their relationships with the school and MDPH with a voluntary approach.     

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.     

Les changements institutionnels amenés par la loi de février 2005 pour l’égalité des droits et des chances,la participation et la citoyenneté des personnes handicapées

First, the author describes the changes produced by the 1975's law. A change of perspective on disability has been the source of the law of February 11, 2005. This has changed the relationship of children with disabilities with the school. In the MDPH, a personalized project of schooling is constructed. The articulation of the role of each stakeholder is taking place gradually. This leads to some important questions. The National Solidarity Fund for Autonomy supports activities that promote this articulation. Some of its actions are focused on assessing the needs of people.     

La loi de 2005 organisatrice des réponses entre la MDPH,l’école et le soin

Relationship between psychiatric care for children and adolescents and its management of disability have been for a long time a matter of debate. The law of February 11th 2005 “for equal opportunities and rights, participation and citizenship of handicapped people” introduced several points that guide missions of MDPH (the Office for persons with disabilities): it gives an innovative definition of the concept of handicap and introduces the notion of a psychic handicap. According to the principle of equal opportunities, the right to schooling for everybody (under the supervision of National Education) and the right for compensation of the handicap (under the supervision of the newly created “Commission of Rights and Autonomy”) call for social and individualized therapeutic management in a global approach. Decentralization reform increases heterogeneity of implementations of the law, triggers new interaction processes between health and social care organizations and lets emerge new practices. The consequences of this, in the therapeutic management of psychiatric care for children and adolescents, are not yet delineated.     

Place et fonction du psychologue dans la clinique de l’enfant : la construction d’une enveloppe soignante

The author proposes some reflections about clinical psychologist's place in pedopsychiatry. In this case, the articulation of different professional places allows a thought about psychological care. Based on an example of unstable children's psychological care, the author introduces the notion of care packing. This one will be able to give some meaning to care's thought. Clinical illustration is proposed to precise care's group organizers in the child's and family's links.     

Intérêts de la psychothérapie à médiation sensorielle dans le cadre de la prise en charge des troubles de la relation et de la communication chez des enfants autistes sévèrement déficitaires I : introduction aux applications cliniques

Background

Sensory and emotional disorders are typical in autism spectrum and were analyzed by psychological, neuropsychological and psychodynamic models of interpretation.

Objectives

In the current article, we aim: to analyze the theoretical models relating to the explanation of the autistic syndrome, with a particular focus on the place of its sensory features; to conceptualize an approach of psychotherapy with sensory mediation intended to formulate therapeutic proposals for remediation of relationship and communication disorders.

Method

We develop the framework of such an approach by combining the theoretical and practical foundations of: sensory integration therapies and Snoezelen approach for the matter of sensory and embodiment development (neuropsychological perspective); basal stimulation and psychomotor therapies for the stabilization of the corporeal image and body image; touch therapy and relaxation in relation to the “skin–ego” construction; and music therapy for the relational and communicative skills development. The following article will present a clinical illustration of this theoretical study. We will demonstrate our care devices and their application within the framework of a research program, and results obtained with five patients exposed during 18 months to individual and weekly sessions of psychotherapy with sensory mediation.     

Changement de nom,changement de paternité et de sexualité

The replacement of “patronymic” by “name”, in January 2005, is the result of a long process, which since the late 19th century, has gradually abolished the privileges reserved for the paternal function. It is interesting to note that, during this process, the most important laws that confirmed the division of parental responsibilities between spouses of a couple were enacted in the 1970s, at a time when, following the generalization of the contraceptive pill, other laws both granted young teens free access to condoms, and young women permission to voluntarily interrupt pregnancy. Equality of man and woman in marriage as well as the separation of procreation and sexuality were thus jointly ratified, allowing the question to arise: is there a link between change in paternity and change of sex? A comparison of patri- and matrilineal kinship systems studied by anthropologists tend to show that procreation and sexuality are indeed separated when the representative of the law of the filiation group (role of the maternal uncle) and the representative of the law of exchanges (role of the father) are different. This change of law was no stranger to a change in pedagogy, which from the beginning of the 1980s gave birth to support groups open to parents in educational associations. Integrating children into society was no longer just a question of relying on the group but also on networks of exchange.     

Représentations sociales du déni de grossesse chez des professionnels et futurs professionnels de maternité de la métropole lilloise

Objectives

Despite its longevity, the phenomenon of pregnancy denial remains without satisfactory explanation, and easily lends itself to building social imaginary. The aim of our study was to investigate on a population of professionals of maternity, the social representations of the denial of pregnancy and their relationship to professional practice.

Methods

A questionnaire was distributed by email to a population of professionals of maternity.

Results

Two hundred and forty professionals and future professionals replied to the questionnaire. Data showed differences in the representation of the denial of pregnancy, the central role of clinical experience towards the medical approach of the case and a discrepancy between the official statement and the subjective perception of this phenomenon. The participants of the study massively agreed to a systematic intervention of adult and child psychiatry for the mother-child dyad.

Conclusion

The results point the disparity of the representations of the pregnancy denial, the significance of the emotional content associated with this phenomenon and the need to develop training on the denial of pregnancy.     

Intérêts de la psychothérapie à médiation sensorielle dans le cadre de la prise en charge des troubles de la relation et de la communication chez des enfants autistes sévèrement déficitaires II : illustration clinique

Background

Sensory and emotional disorders are typical in autism spectrum and were analyzed by psychological, neuropsychological and psychodynamic models of interpretation. Our theoretical analysis revealed that sensory-based solicitation of the autistic patients with intellectual disabilities could allow the revival of the intersubjectivity development. Therefore, the emergence of a relational and communicative dynamic. We conceptualized an approach of psychotherapy with sensory mediation intended to formulate therapeutic proposals for remediation of relationship and communication disorders.

Objectives

In this study, we aim: to present our care devices and method and their application within the framework of a developmental, clinical and experimental research program; to report the main results obtained with five patients as a clinical illustration.

Method

During 18 months, we exposed five patients to individual weekly sessions of psychotherapy with sensory mediation. Our experimental group, constituted of three children presenting severe intellectual disability associated with autistic disorders. It was compared to a control group with two children showing the similar level of intellectual deficiency but without autistic disorders. Quantitative (i.e. statistical) and qualitative analyses of the therapeutic effects were performed in the following domains: sensory integration, social interaction, communication, stereotypies, “positive” behaviors and “negative” behaviors.

Results

The specificity of the sensory profile of children with autistic disorders was shown. Moreover, we calculated a Sensory Integration Index allowing observation of the improvement of the autistic children's sensory integration capacity along the continuous care. Both groups increased significantly their investment of the plurimodal stimulations (i.e. associated proximal and distal stimulations). In parallel, the psychotherapy sessions allowed an increased level of social interaction and communicative skills for both groups. Furthermore, the number of stereotypies decreased for the autistic children in the course of care.     

« Un Enfant en conflit avec la loi au Togo aux frontières du sacré et du sacrificiel ». Cas de Paulin : un enfant aux multiples statuts ou aux problématiques psychopathologiques multiples ?

The phenomenon of Children in Conflict with the Law in Togo commonly echoes transgression. However, this label, which can be qualified as a socio-legal label, questions and conceals the status shouldered by those children and adolescents. This article is an excerpt from a qualitative, doctoral research project whose data is drawn from life story collections (Bertaux, 1993 ; 2006), analyzed using the method of Interpretative Phenomenological Analysis (Smith, 1993) and Complementarism (Devereux, 1972). The objective of Paulin's case study is to explore its subjective experience by highlighting a child's status. A thematic content analysis of Paulin's study reveals a set of pre-existing and co-existing statuses to that of Children in Conflict with the Law, conducive to a process of repetition. Paulin's status of a sacred child, and therefore worthy of absolute protection, was marred by a combination of factors. The manifestations of its suffering have been perceived but biased by transgenerational factors making attempts to take care of them futile, even though they are multidisciplinary. Thus, the changes in family structures and social relations in Togo imply a readjustment of joint care and child protection interventions. A complementary approach would seem to be a line for reflection..     

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.     

Étude exploratoire du vécu de la prise en charge des parents et de la fratrie de jeunes filles anorexiques

Background

Anorexia nervosa (AN) is a serious psychiatric disorder, which affects 0.3% of young people, with a high mortality rate. The impacts of AN on both the patient and their family are severe, as AN decreases the quality of life of the whole family, and increases dysfunctional family interactions. Providing families affected by AN with support to limit the impact of the disorder on the family is therefore critical. Importantly, the lack of consensus regarding treatments for AN is particularly painful for the patients and their relatives. This exploratory study focuses on the impact of treatments for AN on families in France. The main aim is to explore the experience of parents and siblings of individuals suffering from AN to gain a better understanding of the impact of the disorder and its treatment on the whole family. The second purpose is to identify directions for improving the support provided to patient and their relatives.

Method

Twelve relatives of girls suffering from anorexia (6 mothers, 3 fathers and 3 siblings) were recruited within an association dedicated to the support of parents of individuals suffering from AN. Semi-structured interviews were conducted and thematic analysis was used to extract the meaningful themes.

Results

The results highlight five distinct categories: long and ineffective treatments, family support (of lack thereof), involvement of the siblings, the need of guidance and the benefits of support groups. Treatments are stressful for family members who are negatively impacted by both the length of treatment and the slow rates of improvement. Relatives of individuals suffering from AN, particularly siblings, require greater support as they are generally excluded from the treatment process. Parents clearly express a need of guidance concerning the appropriate behavior to adopt with their daughters. Plus they highlight the benefits of talking with other parents.

Conclusion

Our exploration of the experience of the families of individuals suffering from AN provides targets for the improvement of the support provided to families. Findings highlight the need for information, guidance and sharing with other families. Relatives need to be provided with more information throughout the treatment process, from diagnosis to recovery. In addition, families were particularly interested in obtaining practical advice on the appropriate behaviors to adopt with their anorexic daughter or/and sister. Finally, our results stress the helpfulness of sharing the experience of caring for someone with AN with other families facing eating disorders, in order to decrease isolation and social stigma. This study contributes to the evidence of how AN deeply affects the entire family, with major consequences for parents and siblings. This study emphasizes the need to improve the support for relatives and their involvement in the care process, in order to limit the impact of AN on other family members and to promote recovery.     

Diagnostic, évaluation et prise en charge du trouble déficitaire de l’attention avec/sans hyperactivité : le point de vue du neuropsychologue

Despite the advances made regarding both the characterization and classification of the disorder (e.g., DSM-IV), the diagnosis of the attention deficit and hyperactivity disorder (ADHD) in children remains very difficult. The principal aim of this paper is to present the interest of a integrative approach in the understanding, diagnosis and identification of difficulties in ADHD children. More particularly, it aims to underline the interest of the cognitive approach in the understanding of this disorder in the day-to-day life functioning, as well as the benefits of this approach when a specific remediation is planned.     

Place des soins palliatifs en salle de naissance dans la prise en charge des prématurés de moins de 24 semaines d’aménorrhée. Expérience de 2 maternités

Aims of the study

To describe the management of extremely preterm newborns at the threshold of viability before 24 weeks of gestation in the delivery room when the decision has been made not to provide intensive care; to assess the role of palliative care (PC); to report the problems encountered.

Method

A prospective qualitative study was conducted using semi-structured interviews from November 2009 to June 2010 in two level III French maternity hospitals (A and B). In each center, four midwives, two obstetricians, two pediatricians, two anesthetists, and one chief midwife were interviewed.

Results

In maternity hospital A, a protocol was in place that proposed PC derived from developmental care (noise limitation, drying, warming) provided by parents or staff. The problems reported were related to former euthanasia practices rather than new procedures. In maternity hospital B, no palliative care protocol had been set up. Euthanasia was practiced and accepted fatalistically because the only currently existing alternative (letting the infant die) was considered inhumane. Few problems were reported. The reluctance to carry out PC is conceptual and organizational (the ratio of births per midwife in maternity hospital B was twice that of maternity hospital A). Lexical analysis showed preferential use of the words “fetus” and “expulsion” versus “child” and “delivery” in maternity hospital B (p < 0.05) when speaking of the delivery of the extremely preterm infant. Our explanatory hypothesis is that the concept of “fetus ex utero” legitimates euthanasia by assimilating it to feticide.

Conclusion

At the time of this study, two very different approaches to the death of extremely preterm, non-resuscitated newborns in the delivery room coexisted in France. Palliative care is obviously possible, after group reflection, if a true motivation to change, a better understanding of the law, and a clear identification of the respective status of the fetus and the newborn exist in the maternity hospital.     

Validation de la version française du Coding Interactive Behavior sur une population d’enfants à la naissance et à 2 mois

Objective

This paper presents the psychometric properties of a French adaptation of the Coding Interactive Behavior (CIB), a scale developed by Ruth Feldman and largely used to study mother–infant interaction.

Methods

The original manual has been translated in French and adapted to French terminology of concepts. Then Ruth Feldman controlled the translation with the help of a bilingual psychologist. The scale was administered to 74 clinical and non-clinical dyads recruited in an obstetric clinic, at birth and 2 months postpartum. Confirmatory factor analyses were employed to assess factorial structure using Cronbach's alpha. Inter-rater reliability was estimated with Interclass Correlation Coefficients (ICC).

Results

Inter-rater reliability of the training was good with a median ICC equal to 0.88. Confirmatory factor analyses supported a comparable latent factor structure as reported in the original CIB with α ranging from 0.67 to 0.96 at birth and 0.63 to 0.95 at 2 months. Inter-rater reliabilities at birth and 2 months were good with ICC ranging from 0.85 to 1 for each item.

Conclusion

The results indicate that the French version of CIB shares the same latent factor structure as its original counterpart and is a useful tool to assess early mother–infant interaction.     

Adolescents obèses : évaluation de l’image du corps,de l’estime de soi,de l’anxiété et de la dépression

Background

Adolescence is identified as a critical period for obesity and its complications.

Objective

To evaluate body image, self-esteem, anxiety and depression in obese adolescents.

Methods

Hundred and six obese adolescents benefited from an exploration of body image (Body Prominence, BPQ; Figure Rating Scale, FRS; Questionnaire of Body Preoccupation, QPC), self-esteem (Self-Esteem Scale, SES), anxiety (Revised children Manifest Anxiety Scale, RCMA-S), depression (Center for Epidemiologic studies–Depression Scale, CES-D).

Results

Globally, body image is disturbed. The BPQ shows a level of body consciousness greater in girls. Concerning the choice of the perceived figure, boys position themselves more frequently than girls in plump figures. For wished figures, girls choose more slim figures. However, there is no sex difference concerning body dissatisfaction that is relatively important for both sexes. The QPC indicates that girls have higher body preoccupation level than boys with specific focus on certain body area according to sex. The SES indicates that one out of two adolescents shows a low self-esteem and according to the RCMA-S, one out of three shows a high anxiety level without sex difference. Moreover, from the CES-D, one out of five adolescents, more frequently girls, exhibits a moderate to severe depression.

Conclusion

These results, with a differential interpretation (statistical vs clinical), partly confirm the data from the literature, and underline the need to perform a comprehensive investigation of body image, self-esteem, anxiety and depression in obese adolescents. In order to optimize the quality of the management provided to these youths, we proposed to physicians a pragmatic guide as “the somato-psychic pyramid”. It is important to remind that while escaping from the rule of the body fat regulation, obese adolescents may demonstrate a transgression and an adaptative marginalization.