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.     

Fonctionnement et originalité du dispositif « Maison des adolescents (MDA) du Tarn-et-Garonne »

It deals with show specificities of the teenagers house of Tarn-et-Garonne: (1) put in synergy partners network already involved in the responsibility of the teenagers and the families, and to associate with the partners up to there isolated from the network (generalist physicians, lawyers…); (2) belong to La Raison des ados including one network for “hard teenagers”, a group of mutual aid and the Teenagers house; (3) be located by the adolescent and the professional like a place resource can intervene for diverse situations (questionnement about the adolescence, prevention, pathologies…), with possible and facilitated passthroughs in internal to the bosom even of the association or in external. The device is clarified through two situations.     

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.     

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.     

La thérapie d’échange et de développement,une rééducation neurofonctionnelle de la communication sociale

Exchange and development therapy (EDT) is based on a neurofunctional and developmental conception of autism. It aims to rehabilitate, through structured sequences of “social play”, functions subtended by the brain systems of social communication: attention to others, intention, imitation, etc. The neurophysiological basic principles developed involved are “physiological curiosity” and “free acquisition”. Serenity conditions, availability and reciprocity facilitate mutual adjustments between the child and the adult and synchronizations. This rehabilitation therapy is carried out in the context of play and exchange adapted to all the areas of the profile of development of the child. Changes induced by EDT (behaviour, development and functioning) are measured at follow-up by standardized behavioural and psychological assessments. For example, a study of 35 children with autism followed for 9 months shows improvement in the capacity of exchange and communication in children with a severe autism associated with a developmental delay. This rehabilitation therapy is particularly indicated in young children before 4 years, period of maximum brain plasticity. The EDT is one of the major elements of the therapeutic and educational project global multidisciplinary built for the child in close relationship with the family.     

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.     

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.     

La formulation de cas : un modèle d’évaluation psychologique de l’enfant et de l’adolescent

This article presents the case formulation approach to child and adolescent clinical psychology assessment. Case formulation was developed as a response to psychiatric diagnosis, which was seen as a reductionist approach to complex mental health issues. Clinical psychologists embraced this model, mainly developed by cognitive behavioural therapists, and adapted it. Nowadays, case formulation is widely used by child clinical psychologists in their everyday practice. It consists of adopting different theoretical lenses to understand a child's psychological difficulties and integrate current theoretical and research findings that can enhance the understanding of the case. It is both an evidence based approach and a type of reflexive practice. The aim of case formulation is to make suggestions and propose the treatment of choice. However, its collaborative nature means that families are part of the decision making process, which reinforces the therapeutic relationship. The present article presents the three major theoretical lenses that are used in a case formulation: cognitive-behavioural, psychodynamic and systemic. The same vignette is used throughout to show the relevance and complementary aspects of each clinical model.     

Difficultés et intérêt de l’autopsie dans le cas de décès d’enfant hors établissement de santé : à propos de 2 observations

In France, the number of deaths remains high in the pediatric population. These deaths are rarely subject to a scientific or forensic autopsy. However, this medical act appears necessary to answer the many private and public questions (public health, prevention, judicial, or even institutional) that can arise. Two pediatric clinical observations raising these questions in the context of a household accident are presented. In the first one, the death led to the establishment of a forensic obstacle to the burial and a forensic autopsy. The autopsy results provided answers, both to the relatives and to the court. The second concerns a deceased child managed within the protocol for sudden infant death syndrome. The autopsy was not authorized by the parents and no answer on the causes of death could be determined. These 2 observations underline the importance and utility of this medical act.     

L’examen psychologique de l’enfant : pratique et déontologie

Psychological assessment of children is a difficult task and is sometimes underestimated by clinicians who fear to be used as technicians rather than psychologists. The aim of this article is to show the relevance and beneficial aspects of a psychological assessment when performed in a scientific and ethical framework. Psychological assessment is viewed as a privileged encounter between a child presenting problems and an expert in child development, psychopathology and assessment. Distinct parts of assessment are described: preliminary interview with the parents and the child, choice of test battery, feedback. Feedback to the child and parents, often neglected because time-consuming, is a key element of assessing. It enables the child (and parents) to feel directly concerned and taken seriously, to understand the outcome of the procedure, to reflect on personal difficulties and assets, to find hope in future development. When the feedback is performed before the final report is written, it enables psychologists to adjust their interpretations, their language and their recommendations.     

Symptomatologie dépressive à l’adolescence : rôle de la personnalité et de la conscience émotionnelle

Aim of the study

The aim of the study was to analyze the relating contribution of personality dimensions referring to Cloninger's model and emotional awareness to depressive symptoms intensity, in a community sample of adolescents. Our purpose was also to investigate the mediating role of the emotional awareness on the personality-depression relationship.

Method

A sample of 372 school students completed the following questionnaires: the Tridimensional Personality Questionnaire (TPQ), the Level of Emotional Awareness Scale (LEAS), and the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

Correlationnal and multiple hierarchical regressions analysis confirmed the existence of direct links between each personality dimensions and depression, and the partial mediating effect of emotional awareness, but only for the novelty seeking and the harm avoidance dimensions.

Conclusion

Our results confirm the relationships observed in previous research between emotion awareness and depression on one hand, and between personality and depression on the other hand. They highlight the major role played by personality and emotional processing in the vulnerability to present depressive symptoms. The importance of taking in account and assess the emotional processing in the adolescent's depression clinical support is discussed.     

Traumatisme de l’enfance et risque de démence dans le grand âge

This is the text of a conference that has attempted to show the importance of childhood in the construction of the being and the deleterious role that life's events or traumatic situations can play during this period. It was well known in psychopathology that childhood trauma can generate during adult life different psychiatric disorders. It is here to present arguments for linking the risk of developing dementia in old age and the occurrence of childhood trauma. Alzheimer's disease, a neurodegenerative dementia is questioned as to its definition and because of its diverse etiopathogenic mechanisms. We now speak of unsuccessful aging and the psychopathologic track in relation to stress takes again an important relevance. Psychotraumatisms occurring in the infantile period would have a deleterious effect on the establishment of the HPA axis that would eventually deregulated and not allowing to cope with subsequent stress that will cause every time excess cortisol which is aggressive on neurons, particularly hippocampal ones. This exaggerated biological reactivity is combined with a fragility of the adaptive mechanisms of personality, which was also built in part during childhood. This does not question a genetic underlying vulnerability, but it underscores the importance to give in the pathogenesis of Alzheimer's disease and related syndromes to psychopathological risk factors such as personality, biography and habits of life that result. Data on the dimensions of personality that make vulnerable to develop dementia are exposed and recommendations for screening strategy are proposed.     

Les pères adolescents : le versant oublié des grossesses à l’adolescence

Background

Whereas adolescent motherhood has been the object of significant research over the past decades, much less studies have dealt with adolescent fatherhood. Every year approximately 14 million of female teenagers aged 15 to 19 years give birth to a child in the world (WHO, 2009), which corresponds to 11% of annual births. Statistics concerning adolescent fathers are very scarce, and even non-existent in the majority of the countries. Fathers seem to be the forgotten face of adolescent pregnancy. In this article, we propose a synthesis of the recent literature on adolescent fathers, their transition to parenthood and their marital relationships.

Main results

Most studies have been carried out with Afro-American populations whose psychosociological profile of poverty, family deprivation and social exclusion is meant to explain the pregnancy as a result of a series of risk behaviors. These populations are exposed to many risk factors other than their young age, and this precludes any generalization of their results to other groups. Although adolescent couples seem to be subjected to a greater marital instability, most studies show that adolescent fathers have positive expectancies towards parenthood and wish to keep a relation with their child and his mother, whether they maintain or not a romantic relationship with her. Some forms of coparenting can be sustained even when the parental couple does not maintain anymore a marital relationship. In case of noncohabitation, it is important to support the parental alliance and coparenting in order to maintain the father's contact and involvement with his child. The presence and the involvement of the father since pregnancy, or the early postpartum, are pointed as significant predictors for both the quality of couple and father–child relationships in the postpartum and later. However, from pregnancy, adolescent fathers are often excluded from programs of financial, social and psychological support offered to teenager mothers.

Conclusions

Studies on adolescent fathers are still very few and often affected by a negative vision, which does not account for the diversity of situations. More research is needed on this topic, including a longitudinal design and populations of multiple socio-economic and cultural background. Lastly, it appears imperative to offer them the same programs of prevention and material and psychological support that those proposed to teenager mothers, in order to encourage their involvement since the antenatal period, as recommended by WHO.