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.     

L’évaluation pluridisciplinaire : pour un partenariat à réinventer

The law which came out on February 11th 2005 has deeply modified the conception of handicap by proposing a situational definition of it. This common law rules nowadays and schooling in a regular setting should thus apply to all children being in a situation of handicap. But it is coupled with the setting up of a “personalized schooling project”, which requires a multidisciplinary assessment that includes contributions from the teams of child and adolescent psychiatry. Indeed, there is a risk of seeing children in a situation of being “included at school” only on a formal level because of the misappreciation of the psychopathological obstacles which limit the possibilities of learning. The ways of cooperating with and between the psychiatric teams must be thought anew and in the spirit of partnership and mutual exchange.     

Transmission des émotions entre mère et bébé : du normal au pathologique

There are a multitude of emotional expressions that play across a baby's face. The adult in front of him recognizes these expressions, identifies them and transfers the sense to the baby, which the author calls “trans-subjectivity”. The emotional freedom of the parent and the baby allows both to run the gamut of emotions and for the child to little by little understand them. On the other hand when the privileged relational partner of the baby is herself caught up in the freedom of her emotions, constantly fixed on a particular emotion, there is a risk of taking from this rich and varied gamut of emotions only those which more or less fit with her own problems. This privileged attention given to a specific expression risks giving it an overly important role. This in turn leads to the unconscious transmission of this type of emotion to the child, which is always fascinated by that, which interests the adult. Some clinical examples show how this pathological transmission of emotions could occur without either of the partners being aware of it.     

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.     

Différence culturelle dans la perception de l’image échographique : étude des représentations maternelles dans une perspective interculturelle

The authors from a research work conducted for 4 years on maternal representations through the dreamlike productions and ultrasound images, question the notions of image and maternal representations, and reshape the concepts commonly used in pregnancy including the cultural dimension. They propose to include dream productions to reflect the processes involved.     

De l’intégration à la scolarisation des handicapés : regards sur 30 années de collaboration école–psychiatrie

Thirty years have passed since the establishment of two French laws regarding the schooling of disabled children and adolescents (1975–2005). This article proposes a critical examination of the expressions used in the two texts since they reflect the mentality of each period; followed by an analysis of the progression and pitfalls of the laws from the angle of the users (parents and children) and the professionals. The author relies on her 30 years of experience in the public domain of pedopsychiatry to provide a diachronic analysis of the school–pedopsychiatric relationships since the instigation of the Regional Commission for Specialised Education (Commission départementale de l’éducation spécialisée [CDES]) and the setting up of Houses for the disabled (Maison de personnes handicapées [MDPH]).     

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.     

L’enfant au cœur de la transmission

Already before its birth, the child is the depositary of an infinite wealth of transmissions, biological, psychological, cultural, family, social or political. In order to grow, the child must learn of its elders what they themselves have learned from their elders. And the human being, who is aware that he is mortal, tries more or less consciously to bequeath to the other what he has received and what he has become himself, in order to survive a little. The question of the place given to this transmission was, of course, widely discussed by philosophers over the past centuries but it not obvious any longer in our western postmodern society. The importance given to the individual person and to the conquest of an individual freedom to conquer is imposed to the man of the 21st century. Indeed, the break-up with the very idea of tradition that characterizes our era, goes hand in hand with a profound crisis of acts of transmission which, often enough, do no longer play their role of awakening to the life of intellect and of sensitivity. However, this is far from being without importance to the psychological development of the child. Transmission sets limits between the self and the other, while establishing bonds at the same time, and places as such the human being in a relation to the world which surpasses his own existence and will. There are many transmissions, many types of transmission and very precise driving forces which facilitate transmission, hamper transmission and thus engage us in a different manner. The ethical obligation to relate to the other, which gives a particular incentive to the adult to assume the responsibility of supporting the human development of the child, stresses the essential character of the desire to transmit. This desire allows to prepare future generations, giving them the tools necessary to think, grow and create in their turn, helping them understand and share common values, a legacy, a memory, a culture, all serving as foundations on which to build a future that is not the simple repetition of the past or a building without foundation… We analyze in this text the conditions of the malaise related to transmission today, in an attempt to approach the subject from a historical, philosophical and sociological point of view, and to provide some ideas emphasizing the essential nature of transmission to all human life.     

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.     

Abord de la vie affective et sexuelle des déficients intellectuels

The sexual and emotional life of people with intellectual disability is linked to their personality, and inserted to their global psychological functioning. We have made a review of the literature on the subject, which focused on the social representations linked to the sexuality of the disabled, the way these persons perceived and lived their sexuality, and the sexual education that concerned them. The review included studies from 1980 to 2009. We have found that parents, educators and the community as a whole tend to recognize more and more the presence of a sexual and emotional life in the people with intellectual disability, which indicates a beginning of an evolution of the social representations concerning sexuality and intellectual disability. The question now is not weather people with intellectual deficiency have a sexual life or if they have the right to live it, but what are their specific needs in this field. All studies indicate the necessity of a sexual education to help these persons live better the expression of their sexuality.     

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.     

L’activité sportive chez un jeune en surpoids : une prescription ?

As far as taking care of obese people is concerned, advising young overweight children to do more exercise seems to be relevent. And yet some problems emerge. People associate sport with mockery and it often rhymes with physical and moral suffering. That's why it's necessary to pay attention to children's feelings about it. When they try to avoid sport, they think they protect themselves from the other, who has ultimately become the prosecution, blaming them for their difference. That can create a lot of frustration. As psychologists and teachers in the adapted physical activity area, we work as a group, especially during our therapy session. Then, the physical activities that we propose are talked about in therapy. They can look at it from the outside as they are expressing their difficulties, from previous or present experiences. Sport must be associated with game, pleasure, self-satisfaction and most of all with the communication with the other. They’re accompanied according to their need and we aim at integrating them progressively in a sports association. Besides, a psychological support often proves itself required and beneficial. Moreover, guilty parents feel like they are being judged. Their inability to encourage their child to do any sport echoes their own fear. So we must take their feelings into account so they don’t feel even less capable and more guilty. Offering to verbalise their problems and respecting everyone's feelings make them consider they have a choice, and it enables them to realize that sport can be a source of personal achievement.     

La MDPH : un paradigme de l’évolution sociétale. Comprendre sans se méprendre

The February 2005 white paper (Law) and the creation of Departmental Houses for Handicap (MDPH) had a wide-spanning effect on our practices and knowledge. The new law replaced the Departmental Commissions for Specialised Education, in which medical practitioners had a statutory (constitutional) role, with Commissions on Rights and Autonomy. The latter's constitution fundamentally changed our understanding of handicap and the role of users. In this reconfigured landscape, the medical practitioner occupies a subsidiary role of a rather technical kind. One no longer speaks of allocating funds. Rather, values such as recognising rights, ensuring the participation of handicapped persons, and redistributing according to principles of equity now organise a cooperative society inspired by Rawls’ political philosophy. There is a change in logic from one based on ‘caring for’ to one based on ‘accompanying’ the handicapped person. Clearly, one is witnessing a move towards a greater recognition of a person's autonomy, human dignity and place in society, in spite of their handicap. However, by stripping collective and institutional spaces of their vitality, it risks sidelining those who do not know how to ask. So too does it dispense with attending to the expression of the suffering and the scars that handicap leaves.     

Relations sociales entre pairs à l’adolescence et risque de désinvestissement scolaire

Objective

This paper emphasizes the variety of peer relationships and their impact on the psychological and social-emotional development of adolescents of their attachment to school. In greater detail, this study analyzes the impact of social status on school commitment/disengagement within suburban schools (socially disadvantaged areas). We define social status as the social position of a person in a group: popular, rejected, lonely profile, etc. We study it based on the integration of an adolescent to a peer group, on the acknowledgment than he gets back, on the quality of his relationships with the other members of the group and on the fact he is/is not able to curb the peer pressure.

Methods and population

We asked 186 adolescents, pupils of a suburban school (58% of them are girls and 42% are boys). Most families live on low (or medium) incomes with a low educational attainment. A Decreasing Hierarchical Classification (DHC, Alceste, a method which consists of providing clusters by bringing them together according to their similarity) was used to identify five adolescents’ profiles: “followers/aggressive”, “popular”, “rejected”, “lonely” and “estimates”. This approach allowed us to set up typical adolescent profiles based on their social status and illustrated with their school disengagement.

Results

It was revealed that adolescents with “extreme” relationships (profiles: famous, aggressive or rejected) are those experiencing more difficulties at school. Their relationships are based either on power, on research for conformity or on strong emotional dependence. This leads them to bad school behaviors (practicing other activities at school, inattention, or being passive during class) because of their values too far from school requirements. Adolescents who have balanced and satisfying relationships succeed better. The support and the security from peers make them more cognitively available during class. The adolescents who do not belong to any group are also good performers: this way, they avoid social pressure so that they can concentrate on school activities.

Conclusion

After all, these results underlie that the social status of a adolescents in his group of peers can generate individual problems affecting his personality, his self-esteem, his sociability, his values and, as a consequence, his whole school journey.     

Le devenir des idées en pédopsychiatrie, à travers l’histoire de l’autisme

The history of autism can serve as a model for the understanding of the history of child psychiatry. One can observe the controversies between the inborn or acquired nature of the child psychic troubles, between the primacy of psychiatric care or education, between handicap or disease and about the specificity of the child psychopathology. The 19th century was dominated by the educational model. The goals were, first, to civilize wild children, then to develop by education the mind of idiotics, imbeciles, mentally retarded children, ranged on a one-dimension scale of intellectuel level. At the turn of the century, under the influence of psychoanalysis but also of a more humanistic conception of psychiatry, psychopathology has developed as a new approach, against the pessimistic view of heredity, giving birth to the new concept of infantile autism included in the more general frame of infantile psychosis and fostering the development of various forms of psychotherapy articulated with educative methods. After World War II, in France, the movement of “sector public child psychiatry” has represented a major trend in favor of social and psychological reintegration of abnormal children. Nowadays, parents have received some of psychodynamic theories as a way of making them responsible of their child pathology. They ask for a turn towards mere education and fight against the therapeutic methods. This backward movement may, by neglecting the need for care and therapy, hinder a regard for the emotional life of the child and be detrimental for his/her evolution. Under the pressure of the families exaction, the influence of drug industry, the financial shortage due to economic conditions, child psychiatry is in need of more historical knowledge in order to insure its transmission and its ethics.     

Le programme TEACCH : des principes à la pratique

The TEACCH Program, created in North Carolina in 1964, was progressively disseminated in France during the 1990s. At first considered with suspicion by certain French psychiatrists, it gradually found its place in the palette of interventions for people with ASD. After a short history of the origin of this program, its theoretical basis is presented: personalized educational plans are designed around each person's individual characteristics, cognitive and sensory-motor functioning but also personality and interests, the goal being independence and social participation. Implementation of the program requires certain conditions that will be addressed in the light of the author's experience.