De l’enfance à l’âge adulte : quelques effets d’un environnement postmoderne sur le processus de subjectivation

Postmodern world offers to children and to teenagers a new environment. The couple is make casual, and the families often multi-recomposed. Care-taking and education of children and teenagers are profoundly modified with the estompage of the big structuring marks of the difference of genders and that of the generations, the shrinkage of authority in education. Some families have given up education of their child as preparation for the grown-up life. There is a loss of the complicity between parents and school. The invasion of cultural and family world by screens adds a deep novelty in the exchanges of the young person with its environment, in particular by the interactivity and the opening without limit to the virtual world and the absence of real parental control. The construction of the personality of the child as that of the teenager in its architecture as in the balance between the various classic instances are modified there. What are the effects of these changes during the transition to adulthood, on the process of subjectivation so essential for adolescent process? Does-it ensue from it one organisation modified by the personality?     

L’évaluation du contexte familial dans l’examen psychologique de l’enfant

Family assessment is an essential component of the psychological evaluation of the child. The aim of this assessment is to determine risk and resiliency factor in the proximal relational environment of the child. Results of researches have indeed shown on the one hand that family-level variables explain a specific part of the variance in child development and psychopathology, and on the other hand that family intervention is efficient to treat several pathological conditions in child and adolescent such as conduct disorders, substance abuse, or eating disorders. In this paper, we present the specific dimensions of family functioning (e.g. cohesion and flexibility) and the different methods and instruments that can be used to assess them, with their respective benefits (e.g. direct observation with the Lausanne Trilogue Play, questionnaires such as the Family Adaptability and Cohesion Evaluation Scales). We present then different possible uses of family assessment: for therapeutic indication (to evaluate the relevance of a family intervention in a given situation), or to determine therapeutic goals (to specify which relational dimension may be targeted by the intervention), or as an intervention in itself (like in the joint assessment procedures developed by the family-centred approaches).     

Transmission dans la famille : transmission du nom,mythe familial et construction de l’identité

In this article, the authors have tried to describe some clinical elements, linked to the designation of identity to each individual by their very name. As the name is given to the individual by others, an essential element of the identity of each person is immediately written through transmission and human interactivity. The child, indeed, will gradually learn during its early development to recognise its name as a representation of its own identity. The transmission of a family name, in the past systematically the father's name, is today more open. In France, for instance, the law of 4th March 2002 concerning the application of a family name has given parents new possibilities of choice in the naming of their children. A clinical case is evoked regarding the use of this law to appease a family conflict. However, the surname plays a role in the transmission between generations but it is only one part of this process, amongst the ever-renewed construction, for each generation, of the family myths. These myths also contribute to the choice of the first names, even the nicknames of the child. The investment of one's name for each individual is influenced by the interweaving of the experiences of family life and the construction of the family myth. A clinical case shows the difficulty that can result, in adoption, from changing the myth references, one of which being the change in name.     

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.     

Attachement et handicap mental à l’adolescence : un regard rétrospectif sur la prime enfance

Assessing the representations of attachment of mentally handicapped adolescents still belongs to an exploratory approach because of the few works on attachment of mentally handicapped subjects. With an assessment tool, usually used with children, “the attachment story completion task” a rich clinical material could be gathered from mentally handicapped adolescents and a control group. In spite of the small size of the samples, it appeared that the mentally handicapped adolescents all had an unresolved attachment. The trauma experienced by their parents, at the beginning of their life, due to the announcement of the handicap, may be considered as the major explanatory factor of the specificities of the early environment of these subjects.     

Déficience sensorielle,utilisation de l’espace et constitution de l’espace psychique. Psychothérapie d’un enfant aveugle

Based on material from psychotherapy with sensory deficient patients (blind or deaf children and adults) this paper analyses subjects’ use of physical space in transference as well as in the elaboration of psychical spaces. Through the psychotherapy of Tom, a blind child, drawing upon Winnicott's work, we will show how this space, which is at first unapproachable, is progressively assimilated into a shared reality. This space is first experienced as suffering, before being ultimately used creatively and playfully as transitional space. This transformation occurs through the integration of aggressiveness induced by the occupation of this space. Any discontinuity is experienced by the patient as a rupture of the relationship. Furthermore, discontinuity is associated with the elaboration of separations and an increase in the patient's capacity to distinguish the self from the object. We thus hypothesize that differentiation from the object may pose a particular challenge for sensory deficient patients. The absence of the visual or vocal bond accentuates adhesive identifications (Bick, 1986 [6]). These pathological identifications can be repeated in transference, where they take the form of the patient's excessive need for continuous vocal tactile or visual contact. Supported by the therapist, these adhesive identifications can be overcome, and the patient's access to a three-dimensional world can be facilitated.     

Évaluation des connaissances et des pratiques d’hygiène des mains au niveau de l’unité de néonatologie et soins intensifs du service de médecine infantile et néonatologie de l’hôpital Nord, Marseille

Background

The hygiene of hands stays the basic measure to reduce the incidence of the hospital-borne infections. Its importance is major in a service of neonatology. Our work aimed at estimating the knowledge and the practices on the hygiene of hands.

Method

The study was realized at the level of the unit of neonatology and the intensive care of the service of infant medicine and neonatology of the north hospital of Marseille and took place from 1st till 15 August 2008.

Results

We questioned 55 persons of the staff, seek attendants and observed 30 persons. Near the quarter of the staff (23.6%) think that the solutions hydro-alcoholic are less effective than the simple wash of hands and more half (the 51%) than they are less effective than the hygienic wash. In respectively 20% and 36% of the cases, the staff underestimates the duration of the procedure of wash of hands and the hydro-alcoholic friction. In 58.1% of the cases, the staff ignores that the hydro-alcoholic solutions can be used in all the situations where hands are not soiled. Attendants seems to have a good knowledge of the hydro-alcoholic solutions. They know the indication about it in 56.2% of the cases and think that they are effective in 50% of the cases. The staff seems to have a good theoretical knowledge (87.2 in 96.4%) measures of hygiene of hands to be before adopted and after the most current gestures in the unit. There is an inobservance of the hygiene of hands in 33.3% of the cases. None of the persons outside the service practised a measure of hygiene of hands. A bad quality of the wash of hands concerning the contagion at the end of procedure was found in 64.7% of the cases and it in all the observed categories.

Conclusion

There is a real lack of information of the staff about the hygiene of hands. For the improvement of the quality of the care, the evaluation of the practices and the training of the staff turn out indispensable.     

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.     

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.     

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

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

Les nouvelles articulations entre l’école,les structures médicosociales et les secteurs de psychiatrie infantojuvénile induites par la loi du 11 février 2005. (Communication au colloque de la SFPEADA du 11 décembre 2009)

About the multimodal approach of care, pedagogy and education for a case of autistic child, the author proposes a reflection on the modifications of practices led by the law of February 11th, 2005. The discussion argues the differences between the approach in terms of space and time of the care and the administrative logic. In conclusion, the reflection is widened on the place which takes the law of 2005 in a set of regulatory measures aiming at the reform of the health system and in the mastery of the costs.     

Construction d’une cure : de la prise en compte de la place des différents intervenants comme nécessité fondamentale dans certaines prises en charge

The authors expose the particularity of the elaboration of a cure in child psychiatry, in certain situations where it is necessary to broaden the therapeutic system to include the third party who already takes care of the child and who has sent him for treatment. In the clinical cases presented here, the child is still being followed by an institution for the visually deficient. It was necessary to build a therapeutic framework, providing security, taking into account the different professionals and the members of the family, leading to several differentiated spaces in a larger framework that of the orientation of child psychiatric treatment.