La métaphore chez les enfants avec troubles envahissants du développement non spécifiés

Background

The authors describe the case of a child with pervasive developmental disorder not otherwise specified (PDS-NOS) by analyzing aspects of his language skills and communication, in particular the way he uses metaphorical language. As is known from literature, such use is quite problematic in autism.

Method

Samples of spontaneous speech of the child are analyzed and compared at two different stages of his development from a linguistic and a cognitive point of view. The first stage has been video-recorded at home and dates back to 3 years and 11 months, when the child received his first diagnosis of PDD-NOS, while the second stage has been documented by a complete new evaluation in a clinical setting, at the age of 9.

Results

At 3 years and 11 months the child displays forms of atypical language, which appear as metaphorical but in a way that differs from the usages of normally developing children. These atypical forms are still present and even emphasized at 9, and create specific troubles in communication with adults.

Conclusion

This case study underlines the importance of considering metaphorical competence in all its aspects, in comprehension as well as in production, as a privileged way for accessing core communicative deficits in PDD-NOS.     

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.     

Les effets thérapeutiques des groupes de parole auprès d’enfants victimes de catastrophes naturelles en Haïti

Introduction

This article focuses on groupal traumatic experiences of children during natural disasters in Haiti. The group played a very important role for psychic survival of these children and even allowed them to dream a future. The objective of this study is to identify the functions of the group that helped a therapeutic effect for children.

Method

The study focused on a sample of 217 children and adolescents aged 6–18 years, encountered in schools and churches in different cities who were severely affected by the earthquake of 12 January 2010. In focus groups set up, the children were invited to discuss their families and events in their lives.

Results

The research results show that the work of the group mobilizes groups within each participant by providing a space where the container can put into words. The group offers a bracing and a space where the process of subjectivation and symbolization can be put in place.

Discussion

We have shown how the group welcomes trauma, how intersubjective links that are established mobilize intrapsychic scene and how the game is installed, allows figurability conflict and paves the way to a narrative. It is therefore important to maintain these discussion groups essential to allow subjects to enroll in continuity and historicity needed to pick up the thread of their stories.     

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.     

Influences socioculturelles médiatiques et insatisfaction corporelle chez les adolescentes françaises

Objective

To explore the sociocultural and media influences regarding thinness on body dissatisfaction in adolescents. More specifically, to associate frequency of media exposure (television and magazine) with its relationship to body dissatisfaction through the identification of an “internalization” process of popular beliefs about thinness as a positive predictor of body dissatisfaction in adolescents.

Participants and method

The sample was composed of 797 female adolescents of which the average age was 1671 ± 1.13. The participants were recruited from different schools in Northern France. The average BMI of participants was 20.71 ± 2.91. The participants were asked to respond to three self-report inventories: questionnaire on media exposure, The Body Shape Questionnaire (BSQ, evaluating body dissatisfaction) and The Sociocultural Attitudes Towards Appearance Questionnaire-3 ([SATAQ-3], evaluating the sociocultural influence on appearance perpetuated by the media through four subscales: internalization, athletic internalization, pressure, and information).

Results

The frequency of television exposure was negatively correlated with the “athletic internalization” subscale and the “pressure” subscale of the SATAQ-3. No correlation was found between exposure to magazines and the four subscales of the SATAQ-3 or body dissatisfaction. The model composed of “pressure” and “internalization” aspects appeared to explain the majority of the variance associated with body dissatisfaction in adolescent females.

Conclusion

The results appear particularly pertinent to the development of intervention, treatment and prevention strategies for body image disorders and eating disorder diagnoses in adolescents.     

Tentatives de suicide chez les adolescents français de 17 ans : données de l’étude ESCAPAD 2008

Background

Suicide among children and adolescents is a major public health issue. It is one of the leading causes of death in youths. A previous suicide attempt is a well-established risk factor for completed suicide. Since 1998, hospitalisation has been recommended for all children or adolescents who have attempted suicide by the French sanitary agency. We aim to estimate the frequency of suicide attempts during childhood and adolescence and the frequency of hospitalisation after a suicide attempt.

Method

A cross-sectional sample of adolescents aged 17 years was recruited in 2008 (ESCAPAD Study). Analyses were conducted on 38,236 participants who responded to the question: “During your life, have you ever attempted suicide?”. Bivariate statistical analyses compared sociodemographics characteristics and perceived relationships in the family according to the presence of a history of suicide attempt.

Results

In our sample of French adolescents aged 17 years, 8.2% (n = 3146) reported at least one history of suicide attempt. Three out of four adolescents reporting a history of suicide attempt were women (sex-ratio 1:3). Adolescents who were out of school at 17 years old (Odds ratio = 2.24 [CI 95%: 1.83–2.75]; P < 0.001) and those who had repeated at least one grade in school (Odds ratio = 1.97 [CI 95%: 1.83–2.12]; P < 0.001) were more likely to report a history of suicide attempt. Those whom parents were unemployed (Odds ratio = 1.41 [CI 95%: 1.24–1.61]; P < 0.001) were also more likely to report a history of suicide attempt. Family discord and negative relationship with parents were also associated with an increased frequency of history of suicide attempt. Only 25% of adolescents reporting a history of suicide attempt were hospitalised after this suicide attempt.

Discussion

The results of this study have to be considered given some methodological limitations: data are retrospective and collected by questionnaires completed by the adolescents themselves. Similar results on the association between negative relationships in family and suicidal behaviours in depressed adolescents have been previously shown by Consoli et al. (2013) in the ESCAPAD study.     

État des lieux des pratiques d’accompagnement sanitaire et médico-social des personnes avec troubles envahissants du développement (TED) dans trois régions françaises

Aim

This study is a component of the “French Autism Plan 2008–2010”. Its objective is to describe intervention and care practices proposed to people with pervasive developmental disorders (PDD) in three French regions (Île-de-France, Franche-Comté, Nord-Pas-de-Calais).

Method

Data were collected by a questionnaire adapted mailed to special education and health care services in three regions (quantitative data) and semi-structured interviews from a sample of professionals (qualitative data). A total of 254 questionnaires (163 from services for children and adolescents, 91 from services for adults) and 48 interviews (21 for children and adolescents, 27 for adults) were analyzed.

Results

Intervention and care practices described often lack of specificity and are not enough adapted to people with PDD, particularly in adults’ services. An improvement of practices is nevertheless evidenced, with the development of interventions centered on the development of communication or daily living skills and procedures to manage challenging behaviors, yet not generalized. Important efforts are made regarding training and partnership with ordinary settings. Professionals also wish to better take into account the person's and his family's point of view in the individualized program.

Conclusion

This study emphasizes lacks and improvement in intervention and care practices for people with PDD in France, and those data might be a useful basis to study the practices’ evolution in the future.     

Anxiété sociale et satisfaction des besoins d’autonomie,de compétence et d’appartenance sociale chez les adolescents obèses

Objective

The objective of this study is to evaluate the relationship between social anxiety and satisfaction of needs for autonomy, competence and relatedness in obese adolescents. Literature review reports that obese children and adolescents have higher social anxiety that their normal weight peers. But relations between obesity and social anxiety are not clear. We explore the relationship between social anxiety and satisfaction of needs for autonomy, competence and relatedness, three basic psychological needs advanced by Self-Determination Theory (SDT). SDT predicts that satisfaction of these needs should result in well-being and mental health. Thereby, a low satisfaction of the needs for autonomy, competence and relatedness is associated with psychopathology. These psychological needs are not yet explored in obese adolescents. We expect that obese adolescents have higher social anxiety and lower satisfaction of the needs for autonomy, competence and relatedness as compared to controls. Furthermore, high social anxiety could be associated with low satisfaction of these needs.

Methods

The study sample consists of a clinical group of 17 obese adolescents and a control group of 67 normal weight adolescents. They completed self-report questionnaires. Social anxiety was assessed with the Fear of Negative Evaluation Scale (FNE). Satisfaction of the needs for autonomy, competence and relatedness was measured with the Perceived Autonomy in Life Domains Scale (PALDS), the Perception of Competence in Life Domains Scale (PCLDS) and the Interpersonal Relationship Quality Scale (EQRI).

Results

Obese adolescents have significantly lower satisfaction of needs for autonomy and competence in leisure domain as compared to controls. Social anxiety is negatively correlated with satisfaction of needs for autonomy and competence in interpersonal relationships domain, general competence and relatedness with friends.

Conclusions

Physical complications in obese adolescents could explain dissatisfaction of needs for autonomy and competence in leisure domain. This assumption could be explored in future research. Results should improve treatment of obese adolescents. Consistent with SDT, satisfaction of the needs for autonomy, competence and relatedness is linked with social anxiety. Impairment of satisfaction of these needs could contribute to understanding the social anxiety in adolescents.     

Handicap et troubles mentaux de l’enfant chez les ruraux au Sénégal

Background

Like the other African developing countries, in Senegal, disparities in health services between towns and the rest of the country are very important in, particularly, the main town. Only some populations have opportunities to get enough quality of care health services. A lot of children and adolescents endure chronic diseases or handicap without correct assistance. Only one modern unit gives the children and their family adequate mental health cares.

Objectives

The authors try to determine the sociodemographic characteristics of the children coming from rural areas and consulting in child-psychiatry unit of Fann Hospital (Ker Xaleyi). They examine the origins of their mental handicap and make also the analysis of the main elements. At the end, some tracks of solutions are proposed.

Methods

Retrospectives data are used by consulting files of the children who have consulted at the years from 2000 to 2006 in the child-psychiatry unit “Kër Xaleyi”. Starting from the whole, those concerning the areas outside the main town (Dakar) are particularly analyzed. Data are treated by the freeware Epi Info 6 which is a series of programs for use by public health professionals, general database and statistics applications. In this work, the frequencies are mostly calculated concerning gender, age, repartition by region, kinds of disorders and diseases related to handicap.

Results

Only one quarter of the patients comes from rural areas. Some regions are poorly represented like Tambacounda and Kolda. Repartition about gender is not so different whatever the region or the trouble considered. Intellectual deficiency is more frequent as handicap. Concerning the sources of the mental handicap presented by many children, a majority is related to organic affections.

Analyze/Discussion

The differences seem to be linked to geographic availability (more the region is far from main town, less the population is represented in the unit), traditional convictions (persons are more in contact with mystic and irrational considerations in rural areas unlike the metropolitan citizen who have more information and education) and the poverty level is a characteristic of our rural areas (health care services and the means of transport are more developed in the city). Malaria and purulent meningitis cause sequels, which are aggravated by deficiency of taking care and inefficiency of prevention.

Conclusion

Despite real difficulties in rural areas, a reduction of the gap in health services between the main town and the other cities can be realized by a better prevention policy, a better exchange of ideas between actors and new consideration of sociocultural realities.     

Représentations émotionnelles de la maladie chez 22 enfants drépanocytaires

Background

The emotional and psychological impact of chronical disease among children is considerable. The aim of this study was to explore the emotional representations of sickle cell children followed up at Bordeaux University Hospital in both qualitative and quantitative ways.

Methods

Prospective observational study, conducted from February to May 2010 among 22 sickle cell children (SS, SC and Sβ) followed at Bordeaux University Hospital and among their parents. A questionnaire evaluating depressive symptoms and emotional representations was proposed to children and to their parents separately, measuring their child's emotions. Children were asked to draw themselves during sickle cell crisis and without any painful episode, in order to illustrate their perception of their disease.

Results

Emotional and psychological impact on sickle cell children was important in this study. Eighty-six percent of children have commonly had negative feelings such as sadness, anger or fear. Thirty-six percent of them had depressive symptoms. Parents largely underestimated this impact. Drawings and answers to the questionnaire emphasized an important lack of disease understanding, social consequences, and depressive affects.

Conclusion

Psychological and emotional difficulties in sickle cell children should be identified and supported. Resources for psychological and educational support are necessary to improve the quality of life of sickle cell patients in France.     

Rôle du burnout scolaire dans les idées de suicide des adolescents

Background and study aim

Recent previous studies have highlighted the existence of burnout among high-school students. Burnout among high-school students has been described as a continuum between academic stress and severe burnout. Moreover, as for adults, burnout in school context is a three-dimensional concept that includes: exhausting concerning school demands, cynical attitudes towards school and sense of inadequacy as a student (Salmela-Aro et al., 2009). Previous research has shown that burnout can engender depression (Salmela-Aro et al., 2009), and that, depression in turn could lead to suicide ideas among adolescents (Garlow et al., 2008). Therefore, the aim of this study is to explore the determinisms of burnout among French high-school students and to evaluate the mediator effect of depression between burnout and suicidal ideations.

Method

Two hundred and fifty-six high-school students from 11th and 12th grades participated in this study. Among the participants, 135 were boys and 117 were girls, mean age was 16.9 years (SD = 0.88). The participants completed questionnaires about depression, suicidal ideations, burnout, academic stress, perceived pressure and perfectionism.

Results

Regression analyzes were performed in order to determine the predictor variables of school burnout. The results indicates that burnout was predicted by academic stress, perceived pressure provided by parents and provided by peers; perfectionism however appears as a protective factor. In a second step mediation analyses using multiple regressions were performed. As expected, depression was a mediator between burnout and suicidal ideations. Since burnout was a significant predictor of depression and of suicide ideas, when depression and burnout are both associated, depression is the principal predictor (β = 0.64; t = 11, P < 0.0001) and burnout is no longer a significant predictor (β = –0.09; t = –1.6; P = 0.11). The Sobel post-hoc test confirmed these results (z = 8.4, P < 0.0001).

Conclusion

Therefore it seems important to take into account academic stress and burnout for prevention of suicidality in adolescents. Psychotherapy interventions, focused on problem solving or improving feelings of self-efficacy, may be interesting to explore.     

Adolescents et urgences pédopsychiatriques : revue de la littérature et réflexion clinique

Objectives

While the reception arrangements for child psychiatric emergencies seem increasingly frequented by adolescents, we sought to identify clinical and sociodemographic characteristics of these patients, yet poorly explored and understood.

Methods

We conducted an analysis of the literature review listed from the major search engines.

Results

Attendance at child psychiatric emergencies is increasing for over 20 years, with a predominance of adolescents and accompaniment by an overrepresentation of social assistance to children (child welfare): 22,7% to 43% of patients. The first emergency department visit patterns are agitation and violence. The main diagnoses that are registered are mood disorders and conduct disorders, including oppositional defiant disorder. A significant proportion of these adolescents come back to emergencies procedures within the year: nearly one third of adolescents, including a history of child welfare monitoring as a risk factor.

Discussion

In the different studies, the same proportion of internalizing problems and externalizing problems are registered by clinician investigators. The most striking characteristics relate more to the environment of these teenagers, including a significant proportion who are followed by child welfare. For those teenagers consulting in an emergency service, a therapeutic issue is to reintegrate them into a sufficient long-term care, thanks to disponibility, accessibility and an essential preliminary work and partnership coordination between the various professionals who accompany them.

Conclusion

Based on literature data, knowledge about clinical and sociodemographic adolescents referred for “psychiatric emergency services” need to be developed in order to better understand an important issue and to propose care projects closer to the needs of this high-risk population.     

La régulation des émotions par le coping chez les enfants et adolescents de sept à 16 ans placés à l’Aide sociale à l’enfance

Objective

The aim of this paper was to compare foster care and typical children's and adolescent's use of emotion regulation processes through coping. Developmental shifts in coping strategies were expected to change coping profiles during the transition from childhood to adolescence and enhance a less adaptive coping style in foster adolescents.

Methods and population

One hundred and forty-two children and adolescents, from 7 to 16 years, participated to this study, 46 were in foster care and 96 were in typical families. Most families lived on medium incomes with a low to medium educational attainment. An Hierarchical Classification Ascendant (method consisting to build a partition of the population into homogeneous clusters [low within-variability] which are different one from another [high between-variability]) was used to identify three coping profiles in children and adolescents: “flexible”, “avoidant”, and “active”. This method allowed us to set up children and adolescent profiles as a function of their ages, their social status and their gender.

Results

It was revealed that 30% of foster care children and adolescents used a “flexible” coping profile in the same proportion as in the control population. In both populations, there was an increase of the adaptive “flexible” coping profile with age. However, a placement in foster families after 6 years old increased adolescents’ vulnerability since between 12 and 16, they used less the “active” coping profile and more the “avoidant” coping style when faced with a stressor. The coping profiles of foster care girls differ significantly from those of girls in typical families with a greater proportion of “avoidant” coping profiles.

Conclusion

These results suggest that the transition from childhood to adolescence alters emotion regulation in both populations. They are discussed within the framework of clinical intervention following the resilience perspective.     

La dépression chez les mères adolescentes : pour un repérage des situations de vulnérabilité

Introduction and objectives

Due to the high frequency and co-occurrence of vulnerabilities, mothers under 20 years are at higher risk of perinatal depression than adults mothers. We performed a review of the literature investigating the epidemiology of adolescents mothers’ depression, compared these data to adult mothers and listed associated factors, to develop a more preventive approach and specific follow-up.

Methods

The review is based on Pubmed and Sciencedirect research combining “adolescent” or “teenage” and “depression” as keywords.

Results

Seventeen international studies were included, evaluating both prenatal (6 studies) and postnatal (14 studies) depression with three different scales (CES-D, BDI, EPDS). Depression rate in adolescents mothers varies from 26 to 63% in the third trimester of pregnancy and from 26 to 61% in the first 3 months postpartum, with differences depending of studies designs, screening instruments and cut-offs. Depression rate declines with time, but still persists with a prevalence ranging from 21 to 32% at 4 to 5 years after delivery. Depression rate in adolescent mothers are globally twice higher than in adult mothers, both in prenatal and postnatal periods. Characteristics associated with adolescent mothers depression include sociodemographic factors (less education, low income), psychosocial factors (confidence, self-esteem), poor or inadequate social support and negative life events (violence exposure, history of abuse).

Conclusion

Perinatal depression in adolescent mothers is very high and can contribute negatively to child-mother interaction. It should be a priority to screen depression early during pregnancy and to offer appropriate support services during the first years of motherhood. Moreover, it could be of high interest to assess maternofoetal attachment during pregnancy using validated instruments combined with depression scales.     

À propos de la chambre d’isolement en pédopsychiatrie. Étude au sein d’une unité d’hospitalisation pour adolescents

Background

The aim of this study is to examine characteristics associated with the use of locked seclusion in an adolescent in-patient unit.

Methods

We studied the seclusion room records of an adolescent in-patient unit for a six-year period. The demographic and clinical data related to all seclusions that occurred between 2005 and 2010 at an adolescent psychiatric unit were analyzed. Characteristics of adolescents who were placed in seclusion were compared to characteristics of all other adolescents at the unit. Information was abstracted from their case records and seclusion logs.

Results

The study included 175 adolescent in-patients. The six-year prevalence of use of seclusion was 13% (23 seclusions), 57% of secluded patients were boys and the average length of stay was 59 days. Adolescents with conduct disorder diagnosis and who were admitted on an emergency basis were more likely to undergo seclusion. They consumed more drugs too (alcohol, tobacco). The most frequent behaviours leading to seclusion were agitation and hetero-aggressive behaviours. Seclusion was most frequent in the first days of hospitalization (26% occurred the first day). The average duration of seclusion (16 days) was much more than reported by other investigators. Medication was used in conjunction with the seclusion in 91% of cases and intramuscular injection was necessary in 35% of cases. A physical restraint was necessary in 22% of cases. For two adolescents, seclusion time was stopped due to the deterioration of their clinical condition.

Conclusion

The use of seclusion in child and adolescent psychiatry units is particularly poorly documented in France. The prevalence of conduct disorder diagnosis indicates a need for guidelines for seclusion which takes into account the adolescent's need for protection from his own impulsive, the psychopathologic context and possible traumatic history. In this in-patient unit, seclusion is not used as a method of behaviour control. The time spends in seclusion tends to create a need for an intensive therapeutic care. The implications of the findings for practice need to be completed by further studied.     

Le vécu des soins précoces par les familles d’enfants autistes

Background

The medical program of the JET (jardin d’enfants thérapeutique or Therapeutic Kindergarten) located in the University Hospital of Saint-Étienne offers early care to children suffering from pervasive development disorders, aged from three to six until they reach the age of a specialized orientation (medico-educational institute, class for scholar inclusion) in sector-specific healthcare structures. This institutional and multidisciplinary medical care is part of a varied and sometimes controversial healthcare supply, leaving professional caregivers in a state of uncertainty.

Objective

The aim of this work was to evaluate how parents experienced early care and which therapeutic path they chose.

Method

A qualitative study was lead from June 2011 to April 2012 on a judgmental sample of 15 families of children presenting a pervasive development disorder amongst the 91 who attended the JET between 1994 and 2010.

Results

The arrival at the JET was described by parents as a scary experience: affected by the recent confirmation of their child's disorder diagnosis, and also by family and social isolation (at the moment of the admission of the child), they were entering an unknown place-receiving children with heterogeneous symptomatology. Trust in the JET was usually established quickly, thanks to an area unanimously referred to as « safe and protective ». Other resorts were described in the different fields of healthcare (biomedical, popular or traditional) more or less initiated and controlled by the institution or, on the contrary, completely alternative or occult. All together, they helped families to build hybrid knowledge of « expert-parents ». A feeling of abandon was often observed when the children left the JET since the handover is constrained by a lack of medico-social services and because of the low engagement of professional resources within liberal practitioners.

Perspective

A networking organization between primary care and hospital could help homogenize resorts and extend support.     

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.     

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.