Des parents co-thérapeutes,une solution gagnante pour le traitement des enfants autistes

Objectives

This article aims to report on the effects of an intervention program carried out in a clinical context and destined to parents of autistic children. The program was part of a diagnostic evaluation process and sought to provide parents with essential support as soon as their child was diagnosed. It was also designed to increase their knowledge of autism's particular characteristics.

Method

Each of the fourteen families participating in this research had a child aged between two and six years old who had been diagnosed with autism. They were assessed with the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule Generic (ADOS-G) by a team from Rivière-des-Prairies Hospital, in the Montreal area, specialized in Pervasive Developmental Disorder. The specification identified for this study was a quasi-experimental protocol with a pre- and post-test and a non-equivalent control group. The first eight families registered with the clinic were part of the experimental group; the other six formed the control group. The experimental group was composed of six boys and two girls whose average age was 48 months (span: 34–72). The implemented program contained two intervention targets: communication and the child's learning. Five individual sessions of approximately 90 minutes each were provided to each family. A psycho-educator directed activities chosen according to the developmental level of each child. Because one of the objectives of the program was to help parents intervene with their child, they were involved in the intervention each in turn, either by observing or by practising those intervention techniques identified for their child. In order to measure the change in parental practices, the Maternal Behavior Rating Scale was used. This observation table is composed of 12 items assessed with a Likert-type five-point scale, one meaning very low, and five meaning very elevated, evaluating four scales of parental educational practices designed to improve children's development: the parent's response (three items), the parent's animation (five items), the parent's support with the task (two items) and his or her authority (two items). The program's impact with the child was assessed with the Child Behavior Rating Scale, an observation table comprised of two scales recognized as preconditions to children's development: attention (four items) and initiation (two items). These items were assessed by two observers with a Likert-type five-point scale, one meaning very low and five meaning very elevated. Inter-rater coefficients varied between 0.88 and 0.93.

Results

Variance analyses undertaken from the results obtained with the Maternal Behavior Rating Scales and the Child Behavior Rating Scales before and after the intervention showed that both groups improved but that this improvement did not vary significantly from one group to the other.

Conclusions

Four elements may help explain the absence of significant results. Firstly, all children except one were recipients of other services during the intervention. Secondly, with regards to the objective of helping parents better understand their child's diagnostic, five 90-minute individual sessions appeared to be sufficient, but obviously that was not the case. Thirdly, there were difficulties with the recruitment and the sample's non-homogeneity. Fourthly, over and above their good psychometric qualities, the two instruments used were not sufficiently attuned to more subtle changes. Finally, we must insist on the importance, especially in human and social sciences, of publishing results considered as negative in as much as those results form an integral part of the scientific process.     

Aliénation parentale,abus psychologique de l’enfant et DSM-5

Psychiatric experts find it is easier to deal with more horrible crimes than highly conflictual divorces. In the former, projections are impossible and “files” raise very interesting issues with regard to criminology; in contrast, in the latter the expert is confronted not just with a family but also and lest one forget, a couple that at one point in time had loved each other. However, the separation resembles a bloodbath. We will not detail the various psychiatric pathologies, which may further complicate a separation: they are well-known and, on a procedural level, do not raise any specific concerns. We will however address “pathological divorces” where although individuals, assessed on a case-by-case basis, are exempt from ascertainable or developing psychiatric pathologies, pathology permeates systemic relations, inextricably linked to hatred or disgust. In this light, fault-based divorces still remain rare: it is in this context, marked by defiance and doubt as to the parental competence of each member of the couple that the psychiatric expert intervenes, with a similar acknowledged mission to that of the court: recommendations to be offered regarding visitation and custody rights. Amongst the conflictual and inextricable situations the most often encountered in expert practice, the parental alienation syndrome (PAS) now known as parental alienation (PA) refers to all psychopathological manifestations observed in children subject to highly conflictual parental separations, and above all, the unjustified or inexplicable rejection of a parent by a child (or even by siblings). This recent entity has raised controversy: some even go so far as to deny the existence itself of this phenomenon claiming that it does not appear in the international classifications of psychiatric disorders. Consequently, it was not included in the last edition of the DSM and does not appear in the ICD classification of the OMS whose 11th edition is currently being prepared. The weaknesses in the scientific concept and its purely passionate dimension, including sexist controversies, must be carefully elucidated in the dismissal or denial of this pathology. The author raises various definitions of parental alienation of which the most recent is undoubtedly the least controversial. He discusses the reasons for the dismissal of the concept by the Scientific Committee of the DSM-5. This dismissal is however quite apparent as although the term “parental alienation” is not contained therein, we will show that the notion is clearly referred to in at least two chapters of the new American classification of mental disorders.     

Épigénétique et pseudohypoparathyroïdies

Parental imprinting and the type of the genetic alteration play a determinant role in the phenotype expression of GNAS locus associated to pseudohypoparathyroidism (PHP). This imprint is tissue-specific, mainly localized in the kidney and the thyroid. Only the maternal allele is expressed at this level. An alteration in the coding sequence of the gene leads to an haplo-insufficiency and a dysmorphic phenotype (Albright's syndrome). If the alteration is on the maternal allele, there is a hormonal resistance to the PTH at the kidney level and to the TSH at the thyroid level. The phenotype is known as a PHP1a. If the alteration is on the paternal allele, there are few clinical signs with no hormonal resistance and the phenotype is known as pseudo-pseudo-hypoparathyroidism (PPHP). Methylation anomalies of GNAS locus, in particular of exon 1A, are responsible for a lack of expression of Gαs at kidney and thyroid levels only. If these anomalies concern the maternal allele (the only one expressed) with a paternal pattern, there is no haplo-insufficiency and no dysmorphic syndrome. The hormonal resistance is yet again limited to PTH and TSH. The phenotype is known as PHP1b. In the familial forms, these methylation anomalies are associated with a deletion of the syntaxine 16 gene in the maternal allele. This gene contains probably the imprinting center of the locus.     

Stratégies de coping et sentiment de compétence parentale des parents d’enfants atteints de troubles autistiques

Introduction

Numerous studies have been done about the impact of the diagnosis of autism spectrum disorder on the parents’ quality of life and the family as a whole. Confronting child suffering, day-to-day disability management and difficulties in integrating the child have an impact on the physical and mental well-being of parents. Parenting with a child suffering from a disability requires significant cognitive, emotional and behavioral adjustments by the parents. New knowledge in this field would make possible to adjust as much as possible the therapeutic management, in particular in the accompaniment of parents experience and parenting role. The main objective of this study is to identify links between coping strategies of parents to deal with the stressful events induced by the child's disability and their sense of parental competence. The second objective is to observe whether the integration of parents into the therapeutic management of the child has an impact on well-being.

L’adaptation socio-affective d’enfants de quatre à 12 ans en résidence alternée : une approche écosystémique

Aim of study

This study is based on an exploratory and an ecosystemic theoretical approach (Bronfenbrenner, 2005). This research aims to understand how children in situation of joint physical custody evolve in terms of socioemotional adaptation and to analyze the contribution of individual (children's age and sex), family (parental alliance, income, current marital status of the parents, sibling) and temporal (time elapsed since separation and children age at the beginning of the joint physical custody) factors.

Population and methods

Thirteen mothers and 13 fathers of 38 children aged 4 to 12 years completed questionnaires. The socioemotional adjustment of children was examined through the Child Behavior Checklist 4/18 (Achenbach, 1991) and the parenting alliance was assessed with the Parenting Alliance Inventory (Abidin and Brunner, 1995).

Results

Among 38 children, 16% figure in the limit or pathological zone on the internalized adaptation, and 10% figure in the same zones assessed by the externalized adaptation scale. Among the factors taken into consideration, we note first, that there is a significant effect of children age: children between 4 to 5 years tend to show less personal internalizing problems than children between 6 to 12 years. Secondly, results reveal that the parent alliance influences only the anxiety/depressive symptoms. Finally, we show the influence of children age at the beginning of joint physical custody on their socioemotional adjustment. Children 4 to 5 years old have more internalizing problems than those aged 1 to 3 years old. However, results indicate that time elapsed since separation moderates the effect of this variable on externalized adaptation. Indeed, children in joint physical custody since the age of 1 to 3 years who have experienced parental separation more than 2 years ago have more externalizing problems than those who experienced this separation 2 years ago or less.     

Les fausses allégations d'abus sexuels sur mineurs d'âge : entre Munchausen par procuration et aliénation parentale

It is not simple today, for the professional of childhood, to identify himself in the complex forms where the under-aged person is mistreated or suspected to be, moreover when the mode of presentation bases on the allegation of sexual abuse. These tables become more and more complex, not only by the fact that the child pleads a mistreatment, but also because the adult who keeps it, is sure of the suffered sexual aggression. How to react? How “to make allowances”? The article proposes to question two syndromes whose names are increasingly used, on the side of the allegation of sexual abuse, abuse that the evaluation carried out by specialized clinicians will cancel. Syndrome of Munchausen by proxy and syndrome of parental alienation, these rare or recent entities are difficult to understand and to approach on the diagnostic and therapeutic plans. It is interesting to distinguish them while going through what is common and what differentiates them, while sticking to the relative who pleads the mistreatment.