Treating strangeness: Medicine and human dignity at the time of COVID-19.

The concomitance of a migratory wave and the hospital crisis once again raises the question of the care that the French healthcare system is able to provide to migrants. On the occasion of SFFEM's 19th annual day, we present a synthesis of the research work that has been communicated at that time. Firstly, we will discuss how doctors have been able to overcome strangeness to revive the notion of hospitality according to Levinas; secondly, we will discuss how the hospital is departing from its mission of institutional hospitality because of administrative injunctions; thirdly, we will discuss how ethnomedicine gives us keys to open up to other cultural norms; fourthly, we will see the inadequacy that exists between rights of access to medical care and their effectiveness; finally, the conclusion of Xavier Emmanuelli, founder of the social ambulance service, will remind us how much the values of the French Republic call us to the notion of care and openness to otherness.

Laterality and Lateralization in Autism Spectrum Disorder, Using a Standardized Neuro-Psychomotor Assessment.

A detailed assessment of laterality in children with Autism Spectrum Disorder (ASD) was realized, including handedness and other measures (muscle tone, manual performance, dominant eye), using a standardized battery for the developmental assessment of neuro-psychomotor functions. The results of the laterality tests relating to cerebral hemisphere organization (spontaneous gestural laterality and tonic laterality) were different in ASD children, and indicate that the cerebral organization could be disrupted. These assessments, added to the observations of usual laterality most often reported in the literature, provide better understanding of the developmental organization from the pathophysiological point of view in children with ASD.

[Left temporal arachnoid cyst and specific learning disorders associated with Pervasive Developmental Disorders - Not Otherwise Specified (PDD-NOS): contributions of an integrative neuropsychomotor, neuropsychological, psychopathological and neurosurgical approach about a case report in a child (François)]. / Kyste arachnoïdien temporal gauche et troubles spécifiques des apprentissages associés à un trouble envahissant du développement non spécifié (TED-NoS) : apports d'une approche intégrative neuro-psychomotrice neuropsychologique, psychopathologique et neurochirurgicale à propos d'une observation chez un enfant (le cas François).

Left temporal arachnoid cyst and specific learning disorders associated with pervasive developmental disorders - not otherwise specified (PDD-NOS): contributions of an integrative neuro-psychomotor, neuropsychological, psychopathological and neurosurgical approach about a case report in a child (François). With DSM-IV and DSM-IV-TR, the terminology of pervasive developmental disorders (PDD) covers two main categories of infantile disorders: disorders of "strictly" autistic nature and pervasive developmental disorders - not otherwise specified (PDD-NOS). Under the terminology of multiple complex developmental disorder (MCDD), it is proposed to classify children presenting symptoms approaching the psychotic disharmonies and usually diagnosed as PDD-NOS. Such a category of developmental disorders is now included without nosographic distinction in the autistic spectrum in the Diagnostic and Statistical Manual of mental disorders (DSM-V). CASE REPORT: We are reporting a case report of a 6-year-old boy which shows a PDD-NoS/MCDD complex symptomatology type. This child presents multiple disorders: minor neurological signs (soft signs), neuro-psychomotor disorders, developmental coordination disorder (DCD), communication, thought, and regulation of emotions disorders, attention deficit disorders (ADD); in the presence of a high verbal intellectual potential, which makes it difficult to establish a clear diagnosis. A cerebral magnetic resonance imaging (MRI) was carried out due to the presence of minor neurological signs (soft signs) and of neurodevelopmental multiple disorders. The MRI revealed a voluminous arachnoid temporo-polar left cyst with a marked mass effect on the left temporal lobe. DISCUSSION: A neurosurgical intervention allowed to observe the gradual disappearance of the specific symptomatology (in particular soft signs, neuro-psychomotor functions and autistic symptoms) secondary to the interference of the cyst's pressure with intracranial areas involving neurological and psychopathological abnormalities, underlying at the same time the reversibility of the disorders after decompression as demonstrated in some studies. There are always, with a quantitative and qualitative decrease, an emotional dysregulation, a DCD, an ADD as well as impairments in the executive functions. CONCLUSION: This clinical case underlines the necessity of an evaluation in a transdisciplinary way and to follow the developmental evolution of the child in order to focus adapted therapeutics. Furthermore, with neurodevelopmental disorders not specified, it is important to examine the presence of soft signs with standardized neuro-psychomotor assessment, and then, to propose an MRI investigation. To our knowledge, this is the first report in the literature with a school age child of an unusual association between a temporal arachnoid cyst associated with PDD-NOS/MCDD.

[Information, transmission, secrecy: What kind of discourse for children born by gamete donation?]. / Information, transmission, secret : quel discours pour les enfants nés par don de gamètes ?

The number of children born through gamete donation grows by the conceptions made abroad. All the couples engaging in this process do not benefit from of the same support around the issues raised by the information to the child and its terms. Through a literature review, the authors explore the data on information intentions from parents to child and to entourage, the influence of the issue of anonymity, the effective rate information, the influences of the age of the child, the terms information and links with family dynamics. The quantitative findings underscore the complexity of this task, since 10-90 % of couples report an intention to inform their child from conception through donation, while 5-30 % actually inform them after birth. Fifty-nine to 93 % of the relatives are nevertheless informed. The authors will highlight the psychopathological tracks that support the possibility of narration for parents: the internalization of their infertility, the representation of the gift, the development of rivalry towards donors, the secrecy and privacy. The objective of this article is to enable carers to accompany this reflection among future parents, a better listening of the issues raise by the couples allowing shoring their process.

[Formula: see text]Current knowledge on motor disorders in children with autism spectrum disorder (ASD).

Motor symptomatology in autism is currently poorly understood, and still not included in the autism spectrum disorder (ASD) diagnostic criteria, although some studies suggest the presence of motor disturbances in this syndrome. We provide here a literature review on early motor symptoms in autism, focusing on studies on psychomotor issues (tone, postural control, manual dexterity, handedness, praxis). The approach adopted in research to study altered motor behaviors is generally global and there is no detailed semiology of the motor or neuromotor disorders observed in people with ASD. This global approach does not enable understanding of the neuro-developmental mechanisms involved in ASD. Identification of clinical neuro-psychomotor profiles in reference to a standard would help to better understand the origin and the nature of the disorders encountered in ASD, and would thus give new directions for treatment.

[Divorce and joint physical custody]. / Divorce : résidence alternée de l'enfant.

This work first recalls the definition of joint physical custody, as well as the current legal procedure for obtaining it, its practical implementation, the financial implications for parents, and finally some statistics. Some psychological and psychopathological reflections on the impact of divorce on children are then presented before considering the question of joint physically custody with regard to attachment theory and depending on the age of the child (a great caution seems to be required before three years). The article concludes with a brief discussion of parental alienation syndrome.

Subthreshold traits of the broad autistic spectrum are distributed across different subgroups in parents, but not siblings, of probands with autism.

Autism is a categorical developmental disorder characterized by impairment in socialization, communication, and by restricted and circumscribed interests. Several authors have described the presence of subthreshold autistic traits in the general population, pervasive developmental disorders representing the extreme end of their distribution. In this study, we explored the presence of autistic traits in siblings and parents of a proband with autism, and in siblings and parents of a normally developing child, using the previously validated self-report French Autism Quotient, an adaptation of the AQ developed by S. Baron-Cohen. Scores were distributed between two main factors, F1 corresponding to socialization and communication, F2 to imagination and rigidity. Here, we show that both parents and siblings of a child with autism have more symptomatic scores in the domains of communication and socialization. In addition, we show that in these families the parents, but not the siblings, are distributed across different subcategories, according to their scores for the F1 and F2 domains. We hypothesize that these different subgroups may correspond to different underlying genetic mechanisms.

[Abnormal electroencephalography results and specific language impairment: towards a theoretical neurodevelopmental model?]. / Anomalies électroencéphalographiques paroxystiques et troubles spécifiques du langage de l'enfant : vers un modèle neurodéveloppemental ?

BACKGROUND: Specific language impairment (SLI) is a primary developmental disorder in which language is significantly more impaired than other developmental domains. Abnormal electroencephalographic recordings without clinical seizures are often observed. The aim of this retrospective study was to characterize the frequency of these abnormalities, to describe them and to analyze their association with anamnestic, clinical, paraclinical and evolution characteristics. METHODS: The cases of 35 children with a diagnosis of SLI, who also underwent electroencephalography and MRI, were systematically reviewed retrospectively. RESULTS: In this population, aged between 4 and 7 years, 49% (n=17) of patients exhibited a specific expressive language disorder and 51% (n=18) a specific receptive disorder. Forty-nine percent of the children featured abnormal electroencephalography results. Abnormalities were essentially localized on the left side of the brain and in two specific regions: the temporo-occipital (60%) and the frontorolandic (30%) regions. The groups with and without abnormalities were compared statistically with each other in terms of clinical, paraclinical and evolution characteristics. Evolution data were available for 24 patients through a telephone interview and for nine patients through a new complete language evaluation. The comparison of the two groups showed significant differences in terms of severity of the phonological disorder, a higher number of delayed acquisition of walking and cleanliness and a higher range of non specific psychomotor difficulties. DISCUSSION: A large proportion of children suffering from SLI present abnormal electroencephalography recordings with no clinical seizures. This rate is much higher than in the general population and the abnormalities are essentially localized on the left side of the brain in regions known for their specific role in language development. These abnormalities are more frequent in children with a severe phonological disorder, suggesting that they may share common pathophysiological features with SLI. CONCLUSION: The presence of EEG abnormalities in a large group of patients suffering from SLI associated with minor neurological abnormalities suggests a possible theoretical neurodevelopmental model. Minor neurodevelopmental abnormalities, genetically transmitted or acquired during the pre- or perinatal period, may create vulnerability towards SLI. This vulnerability, in conjunction with environmental influences such as family environment, linguistic stimuli, exposure to multiple languages, or transitory hearing loss, might take the form of SLI. This hypothesis underlines the importance of prevention and early detection of SLI when identifying vulnerable subjects. Monitoring the family early through parental guidance and early school support would facilitate the acquisition of language.

[The FAQ self-report is a valid instrument to characterize endophenotypes of the autistic spectrum in parents of children with autism]. / L'autoquestionnaire FAQ : un outil valide pour le repérage des endophénotypes des parents d'enfants autistes.

BACKGROUND: We have previously developed the FAQ self-report, an adaptation of the Baron-Cohen's Autism Quotient self-report, in order to detect traits of the autistic spectrum in the parents and siblings of children with autism. We have previously shown that parents of children with autism show significant differences in their global scores and in their social functioning scores according to their answers to the FAQ self-report. OBJECTIVE: Our aim was to validate the FAQ self-report in a population of control parents, and to confirm our previous results concerning parents of children with autism. METHODOLOGY: Hundred and twenty-seven adults (67 female, 60 male), parents of children with normal development were recruited in the general population. They were asked to fulfill the 40 questions of the FAQ self-report at two different times. Sixty-six parents of children with autism were asked to fulfill the FAQ self-report, for group comparisons. Statistical factor analysis and test-retest reliability analysis was performed with the Matlab toolbox(©) software. RESULTS: Statistical factor analysis and test-retest reliability show that the FAQ is structured in two main factors, socialization and communication on one hand, rigidity and imagination on the other, with good test-retest reliability. Further comparison between parents of children with autism and control parents shows a significant difference between the two groups for the socialization and communication domain, and for the global score. We show for the first time that scores of the parents of children with autism remain unchanged from infancy to adulthood. CONCLUSION: The FAQ is the first French validated self-report focused on the detection of traits of the autistic spectrum in parents and siblings of children with autism. It is structured in two main factors, corresponding to imagination/rigidity, which are negatively correlated, and communication and socialization, which are positively correlated. The FAQ is therefore a reliable instrument to measure endophenotypes associated with the autistic spectrum in parents of children with autism, and may be useful in genetic studies.

[About international adoption: the double strangeness of the child from abroad]. / À propos de l'adoption internationale : la double étrangeté de l'enfant venu d'ailleurs.

The foster child through an intercountry adoption is a "foreigner" in two ways: as a support for parental unconscious projections (as any child, including biological children) on the one hand, and because of the strangeness ethnic often involved in this framework in the other hand. After recalling the main parental representations concerning the unborn child, the author then proposes to think the approval procedure as a kind of imaginary and symbolic equivalent of the usual psychic pregnancy.

[Psychometric properties of the French version of the prenatal attachment inventory in 112 pregnant women]. / Etude des propriétés psychométriques d'une échelle d'attachement prénatal. Version française de la Prenatal Attachment Inventory (PAI, Müller, 1993).

BACKGROUND: Maternal-foetal attachment is the term used to describe the relationship between a pregnant woman and her foetus. This concept, created in 1981 and based on maternal cognitive representations of the foetus, describes the degree to which a woman engages in attachment behaviours toward her unborn baby. Three scales have been developed to quantify maternofoetal attachment and only a few studies have been published (72 since 1981). None of theses three scales is available in French language. OBJECTIVES: The aim of the study is to provide psychometric data concerning the Prenatal Attachment Inventory when administered to healthy pregnant women. This scale was developed and revised by Müller in 1993 and consists of 21 items. The items describe the mother's troughs, feelings and relationship to the foetus. Each item has four Likert-type options: 4=almost always, 3=often, 2=sometimes, and 1=almost never. Examples of the PAI items are "I feel love for the baby", "I dream about the baby" and "I enjoy feeling the baby move". Furthermore, this present study explores the prenatal attachment for the first time in a French population. METHOD: The current study was based on 112 mothers and their babies. Pregnant women were recruited during the 34(th) and 38(th) weeks of gestation from the Port-Royal Maternity Hospital in Paris. Social and medical data were assessed by an auto-questionnaire. Prenatal attachment was measured by the Prenatal Attachment Inventory. The translation of the scale into French followed established guidelines, including appropriate use of independent back translation. RESULTS: The reliability of the instrument was tested using the Cronbach alpha coefficient of internal consistency. This proved to be satisfactory for the PAI total score, i.e. 0.86. Results of a confirmatory factor analysis confirmed that the data fitted well to the one factor model of the PAI. DISCUSSION: The results of this validation show that the French version of the PAI has psychometric characteristics similar to the original version. Major limitations of the study are the small size of the sample and the impossibility to compare this scale to another tool. Thanks to this validation, a tool measuring prenatal attachment is available in French language.

[Taking care of teenagers hospitalized after a suicidal gesture or a suicidal threat]. / Prise en charge des adolescents hospitalisés à la suite d'un geste suicidaire ou d'une menace suicidaire.

Teenagers' suicidal gestures are a major problem of public health and it is important to understand its meaning. A global taking care of teenagers hospitalized after a suicide attempt or a suicidal threat by the pediatric teams and by the team of child psychiatry, having links with each department, is essential in the Necker - Enfants Malades hospital in Paris. The protocole of care has been recently strengthened by the integration of a deep psychological checkup with the projective tests Rorschach and Thematic Apperception Test (TAT) during the hospitalization, a psychological follow-up from a distance of the suicidal gesture and a second psychological checkup one year later in order to observe the evolution of the psychic functioning. The projective tests offer a special way to express the own intimate problematic while respecting the subject's need to remain hidden. These tests, analyzed with a psychodynamic interpretation, help the clinician to precise the psychic diagnosis, which is very important for the future therapeutic orientation, and offer to the patient a medium to express the hidden meaning of his gesture. To consider suicidal gesture not only as a dead end of identificatory process but also as an attempt to start up again this process may favor a therapeutic mobilization of psychic resources. Self-attack may signify a struggle against melancholy, the prospect of death appearing less frightening than those of madness. Suicidal gesture may express a transitory developmental breakdown but identificatory process may be revived if the suffering of the teenager may be listened, contented, elaborated and linked to meaning.

[Investigation of the behavioural phenotype of parents of autistic children through the new FAQ self-report]. / Intérêt de l'autoquestionnaire FAQ dans le repérage d'un endophénotype chez les parents d'enfants autistes.

INTRODUCTION: Autism is characterized by impairments in communication and socialization and by the presence of circumscribed and stereotyped interest. Previous studies have shown that genetic mechanisms may enhance the vulnerability to autism. These mechanisms are complex and may involve the combination of several genes, in interaction with the environment. The genetic mechanism involved in the vulnerability to autism may also concern other disorders and some features, with enhanced prevalence in relatives of autistic patients. It has been shown, for example, that the frequency of language disorders or serial difficulties is increased in the siblings of autistic patients. Characterization and taking into account the presence of such phenotypic traits in the relations may help in understanding the results of genetic studies, in particular association studies in sibling pairs or trios. OBJECTIVE: In this study, we used a new self-report in order to identify endophenotype traits in socialization, communication, rigidity and imagination in parents of autistic children. This self-report is the French adaptation of the previous self-report created by Baron-Cohen et al., aimed at the identification of Asperger profiles in a population of students studying science. METHODOLOGY: Ten autistic children and their parents from a clinical setting were asked to participate in the study. Autistic children were characterized using the ADI-R and various psychometric tests, according to the possibilities of the child (PEP-R, WPPSI-R, WISC3). Twenty parents of normal children were recruited from three different professional settings. There were no differences between the two groups of parents in terms of age or social status. Parents of both groups were asked to fill in the FAQ self-report. RESULTS: We performed a post-hoc analysis comparing the scores of the parents in the two groups. We found a main group, but no sex effect [F (1,37)=5.46; p<0.05]. Scores of autistic parents were higher in all domains compared to the control parents (p<0.05). However, the score on the socialization subscale was the only one that significantly differed from the scores on the imagination, language and rigidity subscales [F (3,111)=20.75, p<0.001]. CONCLUSION: Our results show significant differences between the two groups of parents in the socialization domain. This is of interest both for the interpretation of the presence of allelic variants in the genetic association studies, and for the understanding of the interplay between genotype and phenotype in the development of the autistic disorder.

[Is the concept of resilience useful or suitable?]. / La résilience: concept utile ou concept valide?

Having reminded various models of the concept of resilience, the author investigates this concept towards the psychoanalysis (via the concepts of maternal dreaming capacity, psychic bisexuality and malleability), and the attachment theory. Whatever is the theory to which we refer, two questions raise: what is the genetic part of the part acquired in utero of resilience, and what is the part able to report interpersonal differences.

Validation of the Edinburgh postnatal depression scale (EPDS) in a sample of women with high-risk pregnancies in France.

UNLABELLED: This research is intended to validate the Edinburgh Postnatal Depression Scale (EPDS) in a high-risk pregnant population. METHOD: Sixty women attending antenatal consultations for pregnancy complication in a major Parisian maternity facility were included. They completed the EPDS and were then interviewed according to a standardised psychiatric interview. RESULTS: The study of its sensitivity, specificity and predictive values, with a DSM-IV diagnosis of major depression as the reference, found that 11.5 was the optimal cut-off score (Se 0.80; Sp 0.80). Its validity as an index of severity of depression was also good as well as internal consistency and reliability. Factor analysis showed that its internal structure is composed of two subscales (F2 "depression" and F1 with items reflecting depression and other disorders, including anxiety). CONCLUSION: The French version of the EPDS would be a valid instrument to identify pregnant women who are likely to have clinical major depression. The results may have to be confirmed on a community sample before clinical use.

[Hyperactivity in infants below the age of six]. / Enfant de moins de six ans: hyperactivité

"Attention deficit with hyperactivity disorder" is a syndrome very difficult to detect at the earlier age of the life,before 3 or 4 years. Early signs are aspecific and the impact of the syndrome on socio-scolar adaptation is only detectable later on. So, the proto-syndrome is still discussed. It seems really important to face this problem in a polyfactorial perspective and in the light of child's history, because the signification and the meaning of the troubles are the key of the therapeutical choice which is not reducible only to amphetamine-like treatment.

French classification for child and adolescent mental disorders.

This report presents the French Classification of Child and Adolescent Mental Disorders (CFTMEA), operational since 1983 and validated through a broad multicentric study. CFTMEA is now the classification of reference for French child psychiatrists, who appear to be comfortable with it because it fits their diagnostic and therapeutic work. It bases its clinical categories on a psychopathological approach which includes an appraisal of potentials and prognosis. CFTMEA is deliberately built on two quite distinct axes: Axis I: basic clinical categories, and Axis II: associated and possibly etiological factors. The CFTMEA favors a broad appraisal of the disorders that it classifies, seeking whenever possible to establish a structural diagnosis based on psychodynamic psychopathology. The CFTMEA does not claim to be atheoretical, but does not impose a theoretical allegiance, because it is compatible with any etiological concepts. The CFTMEA's last revision (R 2000) is in an advanced phase of validation.

The pediatric team and the consulting child psychiatrist and the hospitalized depressed infant.

The link between pediatricians and child mental health professionals is a complex, but fascinating issue. Based on our clinical experience, this paper will discuss the issue of depression in very young children hospitalized for serious illness in a general pediatric ward, and its theoretical implications. We begin with a clinical vignette, followed by a review of several clinical phenomena including anticipated bereavement (either by the parents or the medical team, or both), some high-tech medical conditions specific to neonatology and joint parents-infant hospitalization as well as relating the above to psychoanalytical concepts. The significance and importance of adopting a dual perspective, from both the pediatric and the psychopathological viewpoint, while treating the very sick hospitalized young child and his/her parents, is underlined.