Barriers and facilitators to achieving employment in mainstream settings in adults with autism spectrum disorder without intellectual developmental disorders: A scoping review.

Autistic people without Intellectual Developmental Disorders (IDD) have a significantly lower employment rate compared to the general population even though employment favors social integration and quality of life. AIMS: To examine the barriers and facilitators to employability in mainstream settings for autistic adults without intellectual disability. METHODS: Following the scoping review guidelines, we searched the Cochrane, PubMed and PsycINFO databases for references published between 01/01/2000 to 01/08/2023. RESULTS: A review of the 44 identified articles suggests the existence of multiple individual and environmental factors influencing job access and retention. CONCLUSIONS: This is the first review to assess the facilitators and barriers to employment support for autistic people without intellectual disability. The results underline the need for studying strategies to promote access to employment and job retention for autistic people. Future research should explore the mediating and moderating factors leading to the improvement of employability of autistic people WIDD.

Parental involvement and adjustment during the diagnostic evaluation of autism spectrum disorder at two diagnostic centers.

OBJECTIVES: The primary objective of this study was to determine the effects of permanent, mediated parental presence during all autism spectrum disorder diagnostic evaluations on parental adjustment (perceived parental stress and sense of parental competence) compared with procedures that traditionally only involve parents in pivotal periods of the diagnosis. The level of satisfaction with the diagnostic procedure and parents' needs were also evaluated to complete this first objective. The secondary objective was to assess the effects of psychosocial, individual, and contextual variables on perceived parental stress and sense of parental competence. METHODS: The total sample of 49 parents was divided (using simple randomization) into two subgroups, each for a different procedure. Participants were met with once before the first consultation and once after. They completed self-reported questionnaires on parental stress, sense of parental competence, satisfaction with the procedure, social support, locus of control, and appraisal of life events. Statistical analysis was conducted using SPAD and SPSS software. RESULTS: There was no difference between the two groups in the variables assessed. Satisfaction with the diagnostic procedure was high in both groups, but parents highlighted that they had important needs following the diagnosis. The child's level of autonomy, the presence of disruptive behaviors, and satisfaction with social support were found to be important for determining parental adjustment. CONCLUSIONS: Several hypotheses may explain the lack of differences between the two groups, including that parents may not yet have been in a position to benefit from the procedure aimed at integrating them. Our suggestion is that professional interventions should focus on improving the child's autonomy and helping the parent to develop a satisfactory support network. Finally, parents' needs for the post-diagnosis phase should be given greater consideration, particularly in future research.

Humor in autism spectrum disorders: A systematic review.

OBJECTIVES: Humor is essential to social relationships. Its use and understanding appear to be impaired in people with Autism Spectrum Disorder (ASD). The main objective was to review the existing literature on the detection, understanding and use of humor in persons with ASD. The secondary objective involved exploring assessment scales and specific intervention tools. METHODS: A systematic review of the literature was carried out on all available French and English scientific papers about humor - including irony - in persons with ASD up to November 2021. We extracted 552 references and included 43 articles from six databases. RESULTS: Studies suggest that those with ASD can detect audiovisual and written humor. Understanding humor was impaired in writing and when using pure auditory stimuli and non-verbal cartoons. For irony, the results indicated a lower detection of quality and less understanding in speaking but not in writing. Regarding its use, in terms of expression, people with ASD use benevolent humor less often and do not consider humor as a key source of satisfaction with life, as opposed to the control group. CONCLUSIONS: It appears that it would be worthwhile to develop standardized humor detection and assessment tools specific to persons with ASD. Practical strategies that focus on humor ability could be worth developing, either individually or in groups.

[Restraint in child psychiatry]. / La contention en pédopsychiatrie.

In child psychiatry, there are significant ethical challenges when patients put themselves at risk or refuse to cooperate in their care. This article illustrates two situations of violence and restraints and looks at how the vulnerability of caregivers can be acknowledged in order to find the best balance between the imperatives of protection and the respect of young inpatients in child psychiatry.

5Minutes4Myself: Development of a Wellness Program for Caregivers of Children with Autism.

Background. Many caregivers of autistic children experience increased stress, and diminished health often due to the caregiving demands. Purpose. The project aim was to design a feasible and sustainable wellness program tailored to these caregivers' lives. Methods. In this collaborative research-informed project, participants (N = 28) were mostly female, white, and well-educated. In focus groups, we delineated lifestyle issues, then designed, delivered and assessed an initial program with one cohort; and repeated this process with a second group. Findings. Focus group data were transcribed then coded qualitatively to inform following steps. Data analysis identified lifestyle issues key to program design, desired program elements, and after program delivery, affirmed elements and recommended changes. The team used meta-inferences to guide program revisions after each cohort. Implications. Caregivers viewed resulting 5Minutes4Myself program as filling a significant service gap; its hybrid design used in-person coaching and a habit-building app with mindfulness content to support lifestyle change.

Cultural Adaptation and Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up in Moroccan Arabic dialect.

BACKGROUND: The prevalence of autism spectrum disorder is increasing worldwide, making screening and early intervention necessary. Several screening instruments have been developed in recent years. The Modified Checklist for Autism in Toddlers Revised with Follow-up (M-CHAT-R/F) is considered to be one of the specific measures designed to identify toddlers at risk for autistic spectrum disorder. OBJECTIVE: The aim of the study was to translate and adapt the original version of M-CHAT-R/F from the English to the Moroccan Arabic language. STUDY DESIGN: Specialized translators and clinicians ensured forward and backward translation of the scale into Moroccan Arabic. Then, a two-stage screening of the M-CHAT-R/F-T was applied to a study sample comprised of 56 toddlers with autistic spectrum disorder (category I) and 96 toddlers with normal development (category II). "Kappa test", "Cronbach's alpha" test, the intra class correlation coefficient, and the area under the curve were determined. RESULT: The average score results of M-CHAT-R/F were 13.12 for category I, while it was 2.24 for category II. The Cronbach's alpha coefficient of the checklist was 0.929. The kappa values ranged from k=0.78 to k=0.97 with a confidence interval of 95% indicating good convergence. The intra-class correlation coefficient ranged from 0.97 to 0.99, which is excellent. The area under the curve in our study was 0.988, an excellent result. CONCLUSION: Efficiency of the Moroccan Arabic version of the MCHAT was demonstrated for screening in the general population.

[The BSE2 scale : A new clinical tool for the diagnostic of ASD within NDDs]. / L'échelle ECA2 : un nouvel outil clinique pour le diagnostic du TSA au sein des TND.

OBJECTIVES: The behavioral summarized evaluation scales, the BSE and its revised version the BSE-R, were developed and validated in the 1980-1990s. The BSE-R is still used daily by clinical teams in France and foreign countries, and it is recommended by the French Health Authority (2018). Having taken into account knowledge improvement in neurodevelopment and autism spectrum disorder (ASD) and the importance of observation by relatives in ecological context, the second version of the BSE was developed. This paper presents the construction and the validation study of the second version of the behavioral summarized evaluation scale, the BSE2 and the BSE2-P rated by parents. METHODS: Construct validity of the BSE2 scale has been studied in a population of 244 children and adolescents with ASD according to DSM-5 criteria, aged from 30 months to 18 years. Discriminant validity has been analyzed using a population of 86 patients of the same age, with neurodevelopmental disorder (NDD) without comorbidity of ASD. RESULTS: BSE2 comprises 30 items and is a two-dimensional scale as was BSE-R. Both dimensions, labelled "Interaction" (11 items) and "Modulation" (11 items), accounted for 41.7 % of the total variance. They describe autism severity and are in accordance with the two DSM-5 dimensions. Internal consistency (0.927 and 0.850 respectively) and inter-rater reliability (0.932 and 0.897 respectively) are good or excellent for both dimensions. Sensibility and specificity (0.758 and 0.767 respectively) range BSE2 among the tools with good psychometric properties. The parent version, BSE2-P, dedicated to ecological context is easily rated by parents. CONCLUSIONS: BSE2 scale for children and adolescents is a clinical tool with good psychometric properties. Its two-dimensional structure is in accordance with DSM-5 criteria. This scale covers all spectrum of ASD clinical forms in both children and adolescents. It can be used to identify ASD in complex neurodevelopmental disorders with several comorbidities and can help to distinguish autism symptomatology from other neurodevelopmental diagnoses. Furthermore, this scale allows to expand the rating context, involving parents to define and adjust the individualized therapeutic project. Thus the BSE2 is a valuable clinical tool for practitioners for both diagnosis and follow-up.

Fonctions de la sensorialité dans la prise en charge thérapeutique de l'autisme infantile / Funções da sensorialidade no manejo terapêutico do autismo infantil / Functions of sensoriality in the therapeutic management of infantile autism / Funciones de la sensorialidad en el manejo terapéutico del autismo infantil

La sensorialité tient plusieurs fonctions dans l'élaboration psychique de l'individu autiste et dans son évolution psychique au cours de sa prise en charge thérapeutique. Nous suivons dans cette recherche l'idée de la transformation d'un usage défensif de la sensorialité en un processus mutatif, d'une construction du moi corporel, ainsi qu'un travail de symbolisation primaire, d'inscription, de représentation et de figurabilité.Avec la psychothérapie d'un enfant autiste en institution, nous explorons les fonctions de la sensorialité sur la base de l'attention particulière portée aux éprouvés corporels dans la dimension transférentielle et contre-transférentielle. Celle-ci permet au thérapeute d'éprouver les angoisses en lien avec des expériences sensorielles primaires. En s'appuyant sur la résonnance contre-transférentielle des différentes angoisses du patient, une sensorialité partagée aide à la métabolisation des éprouvés de catastrophe primitive ayant entravé l'organisation d'un sentiment continu d'exister. Cette dynamique thérapeutique ouvre sur de nouvelles perspectives psychiques et relationnelles.

Resumos A sensorialidade assegura várias funções na elaboração psíquica do indivíduo autista e em seu desenvolvimento psíquico durante os seus cuidados terapêuticos. Nesta pesquisa perseguimos a ideia da transformação de um uso defensivo da sensorialidade em um processo mutativo, de uma construção do eu corporal, bem como de um trabalho de simbolização primária, de inscrição, representação e figurabilidade. Na psicoterapia de uma criança autista em instituição, exploramos as funções da sensorialidade se concentrando mais particularmente nas experiências corporais a partir da dimensão transferencial e contra-transferencial. Esse trabalho permite que o terapeuta experimente angústias ligadas a experiências sensoriais primárias. Com base na ressonância contra-transferencial das diferentes angústias do paciente, uma sensorialidade partilhada ajuda na metabolização das experiências de catástrofe primitiva que impedem a organização de um sentimento contínuo de existência. Esta dinâmica terapêutica abre novas perspectivas psíquicas e relacionais.

Sensoriality has several functions in the psychic elaboration of the autistic individual and in his psychic evolution during his therapeutic care. We follow in this research the idea of the transformation of a defensive use of sensoriality into a mutative process, of a construction of the bodily self, as well as a work of primary symbolization, inscription, representation and figurability. With the psychotherapy of an autistic child in an institution, we explore the functions of sensoriality based on the particular attention paid to bodily experiences in the transference and counter-transference dimension. This allows the therapist to experience anxieties related to primary sensory experiences. By relying on the counter-transferential resonance of the patient's various anxieties, a shared sensoriality helps to metabolize the experiences of primitive catastrophe that have hindered the organization of a continuous feeling of existing. This therapeutic dynamic opens up new psychic and relational perspectives.

La sensorialidad tiene varias funciones en la elaboración psíquica del individuo autista y en su evolución psíquica durante la asistencia terapéutica. Seguimos en esta investigación la idea de la transformación de un uso defensivo de la sensorialidad en un proceso mutativo, de una construcción del yo corporal, así como de un trabajo de simbolización primaria, inscripción, representación y figurabilidad. Con la psicoterapia de un niño autista en una institución, exploramos las funciones de la sensorialidad a partir de la particular atención prestada a las experiencias corporales en la dimensión transferencial y contratransferencial. Este trabajo le permite al terapeuta experimentar ansiedades relacionadas con las experiencias sensoriales primarias. Apoyándose en la resonancia contratransferencial de las diversas angustias del paciente, una sensorialidad compartida ayuda a metabolizar las experiencias de catástrofe primitiva que han impedido la organización de un sentimiento continuo de existir. Esta dinámica terapéutica abre nuevas perspectivas psíquicas y relacionales.

Do riscado à assinatura. Um exemplo de solução sinthomática numa pessoa autista / From scratch to signature. An example of symptomatic solution in the cure with an autistic person / De la rayure à la signature. Un exemple de solution sinthomatique chez une personne autiste / Desde la raya hasta la firma. Un ejemplo de solución sintomática en una persona autista

A partir da apresentação do atendimento de um jovem autista no âmbito de um dispositivo que utiliza seu interesse pela música e sons em geral, os autores se esforçam para mostrar como se pode orientar a cura a partir de noções de riscado (testemunho da recusa que a pessoa autista remete ao outro), arranhão (primeira inscrição da descontinuidade operada no real) e assinatura (transformação do arranhão permitindo uma apresentação do sujeito autista no mundo do Outro).

Resumos From the presentation of the care of a young autistic patient within the framework of a device using his interest in music and sounds in general, the authors endeavor to show how one can orient the cure from notions of scratch (witness of the refusal that person with autism sends back to the other), graze (first inscription of the discontinuity operated in the chaos) and signature (transformation of the scratch allowing a presentation of the autistic subject in the world of Other)

À partir de la présentation de la prise en charge d'un jeune patient autiste dans le cadre d'un dispositif qui utilise son intérêt pour la musique et les sons en général, les auteurs s'attachent à montrer comment on peut guider la cure à partir des notions de rayure (témoignage du refus que l'autiste remet à l'autre), d'égratignure (première inscription de la discontinuité opérée dans le réel) et de signature (transformation de l'égratignure permettant une présentation du sujet autiste dans le monde de l'Autre).

A partir de la presentación de la atención a un joven autista en el marco de un dispositivo que utiliza su interés por la música y los sonidos en general, los autores pretenden mostrar cómo se puede orientar la cura desde nociones de la raya (testigo de la negativa que el autista devuelve al otro), rasguño (primera inscripción de la discontinuidad operada en lo real) y firma (transformación del rasguño que permite una presentación del sujeto autista en el mundo del Otro).

El lugar vacante del concepto de sujeto en la clínica psicoanalítica del autismo / O lugar vago do conceito de sujeito na clínica psicanalítica do autismo / The vacant place of the concept of subject in the psychoanalytic clinic of Autism / La place vacante du concept de sujet dans la clinique psychanalytique de l'autisme

Frente a la hegemonía de abordajes behavioristas y cognitivistas en el acompañamiento precoz del autismo, muchos psicoanalistas tomaron la palabra para criticar dicha universalización, y defender el lugar que el psicoanálisis ocupa. Para ello, se utiliza a menudo el término "sujeto": estas prácticas, dicen los psicoanalistas, excluyen al sujeto, mientras que el psicoanálisis apuesta por su emergencia. Ahora bien, ¿Cuál es el estatuto del sujeto en la clínica psicoanalítica del autismo? A través de una revisión de textos, se puso de manifiesto que para muchos psicoanalistas el sujeto dividido, definido por Lacan, no operaría en el autismo. Al mismo tiempo, no contamos con muchas elaboraciones que propongan un estatuto especifico de sujeto para el autismo. Por consiguiente, se llegó a la conclusión que existe un lugar vacante de dicho concepto en la clínica psicoanalítica del autismo en la orientación lacaniana. En este artículo se proponen tres caminos para reducir la distancia entre una promoción del psicoanálisis como clínica del sujeto y nuestras elaboraciones teóricas sobre el sujeto en el autismo.

Resumos Diante da hegemonia das abordagens behavioristas e cognitivistas no acompanhamento precoce do autismo, muitos psicanalistas têm se manifestado para criticar essa universalização e defender o lugar ocupado pela psicanálise. Para isto, utiliza-se frequentemente o termo "sujeito": essas práticas, dizem os psicanalistas, excluem o sujeito, enquanto a psicanálise aposta em sua emergência. No entanto, qual é o estatuto do sujeito autista na clínica psicanalítica? Através de uma revisão da literatura, verificou-se que para muitos psicanalistas o sujeito dividido, definido por Lacan, não operaria no autismo. Ao mesmo tempo, não temos muitas elaborações que proponham um estatuto de sujeito específico para o autismo. Portanto, concluiu-se que há um lugar vago do conceito de sujeito na clínica psicanalítica do autismo de orientação lacaniana. Neste artigo, três caminhos são propostos para diminuir a distância entre a promoção da psicanálise como clínica do sujeito e nossas elaborações teóricas sobre o sujeito no autismo.

Given the hegemony of behavioral and cognitive approaches in the early accompaniment of autism, many psychoanalysts criticize this universalization and defend the place occupied by psychoanalysis. To do this, the term "subject" is often used: these practices, say psychoanalysts, exclude the subject, whereas psychoanalysis bets on its emergence. However, what is the autistic subject's status in the psychoanalytic clinic? From a texts' review, it appeared that for many psychoanalysts the divided subject, defined by Lacan, would not operate in autism. At the same time, we do not have many elaborations that propose a specific subject status for autism. Therefore, it was concluded that there is a vacant place of the concept of subject in the psychoanalytic clinic of autism of Lacanian orientation. In this article, three paths are proposed to reduce the distance between a promotion of psychoanalysis as a clinic of the subject and our theoretical elaborations on the subject in autism.

Face à l'hégémonie des approches comportementalistes et cognitivistes dans le suivi précoce de l'autisme, de nombreux psychanalystes se sont manifestés pour critiquer cette universalisation et défendre la place occupée par la psychanalyse. Pour cela, le terme « sujet ¼ est souvent utilisé : ces pratiques, disent les psychanalystes, excluent le sujet, alors que la psychanalyse fait le pari de son émergence. Mais quel est le statut du sujet autiste dans la clinique psychanalytique ? Une revue de la littérature a permis de constater que pour de nombreux psychanalystes, le sujet divisé, défini par Lacan, ne serait pas opérant dans l'autisme. En même temps, nous n'avons pas beaucoup d'élaborations qui proposent un statut de sujet spécifique pour l'autisme. On peut donc conclure que la place du concept de sujet dans la clinique psychanalytique de l'autisme d'orientation lacanienne est vacante. Dans cet article, trois pistes sont proposées pour combler le fossé entre la promotion de la psychanalyse comme clinique du sujet et nos élaborations théoriques sur le sujet dans l'autisme..

Considerações sobre a direção de tratamento na Clínica de Linguagem com crianças que não falam / Consideraciones sobre la dirección del tratamiento en la Clínica del Lenguaje con niños que no hablan / Considerations on the direction of treatment in the Language Clinic with children who do not speak / Considérations sur l'orientation du traitement à la Clinique du Langage avec des enfants qui ne parlent pas

Neste artigo, após apresentar uma reflexão crítica sobre os efeitos da terapia ABA (Applied Behavior Analysis) - Análise Aplicada do Comportamento (verbal) no atendimento de uma criança com o diagnóstico de autismo, proponho indicar um outro entendimento de linguagem e, portanto, um outro modo de se posicionar diante da fala dessas crianças. Neste sentido, esse artigo tem como objetivo apresentar uma crítica, a partir da Clínica de Linguagem, solo teórico desse trabalho, a metodologia ABA, método amplamente difundido no tratamento dessas crianças

En este artículo, tras presentar una reflexión crítica sobre los efectos de la terapia ABA (sigla en inglés) Análisis Conductual Aplicado (conducta verbal) en la atención a un niño diagnosticado de autismo, me propongo indicar otra forma de entender el lenguaje y, por tanto, otra forma de posicionarse ante el habla de estos niños. En este sentido, este artículo tiene como objetivo presentar una crítica, basada en la Clínica del Lenguaje, base teórica de este trabajo, a la metodología ABA, método ampliamente difundido en el tratamiento de estos niños

In this article, after presenting a critical reflection on the effects of ABA therapy -Applied Behavior Analysis (verbal behavior) in the care of a child diagnosed with autism, I propose to indicate another understanding of language and, therefore, another way to position oneself in front of the speech of these children. In this sense, this article aims to present a critique, based on the Language Clinic, the theoretical basis of this work, the ABA methodology, a widely disseminated method in the treatment of these children

Dans cet article, après avoir présenté une réflexion critique sur les effets de la thérapie ABA -Analyse Comportementale Appliquée (verbale) dans la prise en charge d'un enfant diagnostiqué autiste, je propose d'indiquer une autre compréhension du langage et, par conséquent, une autre façon de se positionner face à la parole de ces enfants. En ce sens, cet article vise à présenter une critique, basée sur la Clinique du Langage, base théorique de ce travail, la méthodologie ABA, une méthode largement diffusée dans le traitement de ces enfants

Construção de um circuito no tratamento do autista / Construcción de un circuito en tratamiento del autista / Construction of a circuit in the treatment of autism / Construction d'un circuit dans le traitement de l'autiste

A partir da apresentação de fragmentos de um caso clínico de autismo infantil, busca-se discutir possibilidades de manejo da voz, do olhar e do corpo do analista no trabalho com sujeitos autistas. Com o referencial da psicanálise, analisam-se algumas estratégias utilizadas pelas analistas na condução do caso bem como seus efeitos na construção do corpo da criança. Assim, considera-se que o analista, ao se portar como um parceiro no trabalho de construção já realizado pelo autista, pode acolher suas dificuldades e reconhecer seus interesses particulares, a fim de estabelecer uma prática clínica que o ajude a se regular e a construir formas menos angustiantes de estar no mundo e de se relacionar

A partir de la presentación de fragmentos de un caso clínico de autismo infantil, se busca discutir posibilidades de manejo de la voz, de la mirada y del cuerpo del analista en el trabajo con sujetos autistas. Con el referencial del psicoanálisis, se analizan algunas estrategias utilizadas por las analistas en la conducción del caso así como sus efectos en la construcción del cuerpo infantil. Así, se considera que el analista, al portarse como un compañero en el trabajo de la construcción ya realizado por el autista, puede acoger sus dificultades y reconocer sus intereses particulares, a fin de establecer una práctica clínica, que lo ayude a regularse y construir formas menos angustiantes de estar en el mundo y relacionarse

Based on the presentation of fragments of a clinical case of infantile autism, the aim is to discuss possibilities for managing the analyst's voice, gaze and body when working with autistic subjects. Relied on the theoretical framework of psychoanalysis, some strategies used by the analysts in the conduction of the case are analyzed, as well as their effects in the construction of the child's body. Thus, it is considered that the analyst, by behaving as a partner in the work of construction which was already carried out by the autistic, can host his/her difficulties and recognize his/her particular interests, in order to establish a clinical practice that helps him/her to regulate himself/herself and to build less distressing ways of being in the world and relating

A partir de la présentation des fragments d'un cas clinique d'autisme infantile, on cherche à discuter les possibilités dans le maniement de la voix, du regard et du corps de l'analyste dans son travail avec les sujets autistes. D'après les références de la psychanalyse, on analyse certaines stratégies utilisées par les analystes pour bien conduire les cas ainsi que leurs effets dans la construction du corps de l'enfant. Alors, on considère que l'analyste, en se conduisant comme un compagnon de travail dans la construction déjà réalisé par l'autiste, peut accueillir ses difficultés et reconnaître ses intérêts particuliers, afin d'établir une pratique clinique qui puisse l'aider à se régir et à construire des modes moins angoissants d'être au monde et de se rapporter aux autres

"Amanhã você estará aqui?" O trabalho com objetos em uma instituição para crianças com dificuldades no laço social / « Est-ce que demain tu seras là? ¼ Le travail à partir des objets dans une institution pour enfants en difficulté au niveau du ien social / "Will you be here tomorrow?" The work with objects in an institution for children with social bond difficulties / "¿Estarás aquí mañana?"El trabajo con los objetos en una institución para niños con dificultades en el lazo social

Este artigo trata de uma experiência institucional de estágio no Institut Médico Pédagogique Notre Dame de la Sagesse, também conhecido como Le Courtil. O Courtil é uma instituição belga que acolhe crianças e jovens com impasses no laço social. A partir do caso clínico de uma garota de oito anos, discute-se a importância dos objetos para a invenção e o tratamento que o sujeito dá ao real. Demonstra-se que o tratamento é um trabalho singular realizado pelo sujeito em parceria com os interventores. A prática entre vários e a transferência são colocadas em evidência como dispositivos que favorecem esse trabalho

Cet article est à propos d'une expérience institutionnel de stage à l'Institut Médico Pédagogique Notre Dame de la Sagesse, connu comme Le Courtil. Le Courtil est une institution belge qui accueille des enfants et des jeunes en difficultéau niveau du lien social. À partir d'un cas clinique d'une fille de huit ans, on discute l'importance des objets pour l'invention et pour le traitement du réel donné par le sujet. On démontre que le traitement est un travail singulier réalisé par le sujet en partenariat avec des intervenants. La pratique à plusieurs et le transfert sont mis en avant comme dispositifs qui favorisent ce travail

This article is about an internship experience that took place at the Institut Médico Pédagogique Notre Dame de la Sagesse, known as Le Courtil. Le Courtil is a Belgian institution dedicated to the reception and treatment ofchildren and young people with social bond difficulties. Based on a clinical case of an eight-year-old girl, the importance of objects for the invention and treatment of the real given by the subject is discussed. It is shown that the treatment is a singular work carried out by the subject in partnership with intervening parties. The multi-person practice and the transfer are put forward as devices that favour this work

Este artículo trata de una experiencia de pasantía institucional en el Institut Médico Pédagogique Notre Dame de la Sagesse, también conocido como Le Courtil. Le Courtil es una institución belga que acoge a niños y jóvenes con impasses en el lazo social. A partir del caso clínico de una niña de ocho años, se discute la importancia de los objetos para la invención y el tratamiento que el sujeto hace de lo real. Se demuestra que el tratamiento es un trabajo único realizado por el sujeto en compañía de los interventores. La práctica entre varios y la transferencia se destacan como dispositivos que favorecen este trabajo

[Changes in child and adolescent psychiatric care with respect to autism spectrum disorders]. / Évolution des soins en psychiatrie de l'enfant et de l'adolescent au regard des troubles du spectre de l'autisme.

The evaluation unit for pervasive developmental disorders and autism - diagnostic center of Seine-et-Marne "United" has been open for eleven years within the child and adolescent psychiatry department. At the beginning, it welcomed patients as a first intention, or not, at a time when the diagnosis verbalized to the families was not self-evident. It has gradually taken on the role of an evaluation center for complex situations, pushed in this by the political authorities who are trying to structure (to change) the life course of people with autism. The Canadian "SACCADE" model opens up avenues of reflection on the understanding of autism, thus reexamining the place of the caregiver in child psychiatry.

Trastornos generalizados del desarrollo: programa de seguimiento post-CDIAP / Trastorns generalitzats del desenvolupament: programa de seguiment post CDIAP / Pervasive developmental disorders: post-CDIAP follow-up programme

Desde el Centro de Desarrollo Infantil y Atención Precoz (CDIAP) del Maresme (Barcelona), organizamos un seguimiento longitudinal una vez finalizada nuestra intervención. En este seguimiento han participado niños con diagnósticos distintos, centrados en el abanico de los trastornos generalizados del desarrollo que se ubican en la órbita de los trastornos del espectro del autismo (TEA). Este seguimiento se realizó entre los años 2016 y 2020, y consistió en visitas presenciales anuales en nuestro servicio, y la aplicación de distintos cuestionarios para progenitores, maestros y terapeutas. En el presente artículo mostramos una parte de los resultados y las conclusiones obtenidas.(AU)

From the Child Development and Early Care Center (CDIAP) of Maresme (Barcelona), we organized a longitudinal follow-up once our intervention has finished. This follow-up has involved children with different diagnoses, focused on the range of pervasive developmental disorders that are located in the orbit of autism spectrum disorders (ASD). This follow-up was carried out between 2016 and 2020 and consisted of annual face-to-face visits to our service, and the application of different questionnaires for parents, teachers, and therapists. In this article, we show part of the results and the conclusions obtained.(AU)

Des del Centre de Desenvolupament Infantil i Atenció Precoç (CDIAP) del Maresme (Barcelona), vam organitzar un seguiment longitudinal un cop finalitzada la nostra intervenció. En aquest seguiment, hi van participar nens amb diagnòstics diferents, centrats en el ventall dels trastorns generalitzats del desenvolupament que s'ubiquen a l'òrbita dels trastorns de l'espectre de l'autisme (TEA). Aquest seguiment es va realitzar entre els anys 2016 i 2020, i va consistir en visites presencials anuals al nostre servei, i en l'aplicació de diferents qüestionaris per a progenitors, mestres i terapeutes. En aquest article, mostrem una part de dels resultats i les conclusions obtingudes.(AU)

Affinity therapy, Novidade no tratamento do autismo / Affinity therapy, Nouveauté dans le traitement de l'autisme / Affinity therapy, Novelty in the treatment of autism

Es constante en el autismo una fijación o una ritualización, una obsesión o una pasión, un interés específico o una aptitud, en resumen, una particularidad, una afinidad. Este punto permite construir una dinámica subjetiva autista: una relación al mundo, al cuerpo, a los otros y al conocimiento. La alienación significante se correlaciona con un apoyo alienante al objeto como una compensación. Para Laurent, es un "órgano suplementario" a partir del cual el sujeto articula y desglosa todo su mundo. La defensa autística es el "regreso del goce sobre un borde". El sujeto procura el apoyo de un doble, en las variadas formas clínicas y con la intervención que resultará, un tratamiento de pulsiones y dinámica vital. Considerando esta defensa: ¿qué tratamiento sería posible con el autismo? ¿Qué apoyo institucional se puede ofrecer? ¿Cómo se podría acompañar al autista? La Affinity therapy nombra lo que sería un tratamiento del autista orientado por los objetos, los intereses específicos, los dobles, las particularidades de cada autista. El artículo muestra el interés de la Affinity therapy, explica la importancia y el peso de esta práctica en el tratamiento del autismo en un trabajo interdisciplinar orientada por el discurso analítico

É frequente no autismo uma fixação ou uma ritualização, uma obsessão ou uma paixão, um interesse ou uma atitude, em resumo, uma particularidade, uma afinidade. Este ponto permite construir uma dinâmica subjetiva autista: uma relação com o mundo, com o corpo, com os outros e com o conhecimento. A alienação significante é correlata de um apoio alienante no objeto como uma compensação. Para Laurent, é um "órgão suplementar" a partir do qual o sujeito articula e separa o seu mundo. A defesa autística é o "retorno do gozo sobre uma borda". O sujeito procura o apoio de um duplo, nas variadas formas clínicas e com a intervenção [do analista?] da qual resultará um tratamento das pulsões e uma dinâmica vital. Considerando esta defesa: qual o tratamento possível do autismo? Qual apoio institucional se pode oferecer? Como acompanhar o autista? A Affinity therapy nomeia o que seria o tratamento do autista orientado pelos objetos, pelos interesses específicos, pelos duplos, pelas particularidades de cada autista. O artigo mostra o interesse da Affinity therapy, explica a importância e o peso desta prática no tratamento do autismo num trabalho interdisciplinar orientada pelo discurso analítico.

Une fixation ou une ritualisation, une obsession ou une passion, un intérêt ou une attitude, bref, une particularité, une affinité, est fréquente. Ce point permet la construction d'une dynamique subjective autistique : un rapport au monde, au corps, aux autres et au savoir. L'aliénation significative est corrélée avec le soutien aliénant sur l'objet comme compensation. Pour Laurent, c'est un « organe supplémentaire ¼ à partir duquel le sujet articule et sépare son monde. La défense autistique est le «retour de la jouissance par-dessus bord ¼. Le sujet cherche l'appui d'un double, dans les différentes formes cliniques et avec l'intervention [de l'analyste ?] qui va déboucher sur un traitement des pulsions et une dynamique vitale. Considérant cette défense : quel est le traitement possible de l'autisme ? Quel soutien institutionnel peut être proposé ? Comment accompagner l'autiste ? L'Affinity therapy nomme ce que serait le traitement des autistes orienté par les objets, par les intérêts spécifiques, par les doubles, par les particularités de chaque autiste. L'article montre l'intérêt de la thérapie par affinité, explique l'importance et le poids de cette pratique dans la prise en charge de l'autisme dans un travail interdisciplinaire guidé par le discours analytique.

A fixation or a ritualization, an obsession or a passion, an interest or an attitude, in short, a particularity, an affinity, is frequent. This point allows the construction of an autistic subjective dynamic: a relationship with the world, with the body, with others and with knowledge. Meaningful alienation is correlated with alienating support on the object as compensation. For Laurent, it is a "supplementary organ" from which the subject articulates and separates his world. The autistic defense is the "return of jouissance over the edge". The subject seeks the support of a double, in the various clinical forms and with the intervention [of the analyst?] which will result in a treatment of the drives and a vital dynamic. Considering this defense: what is the possible treatment of autism? What institutional support can be offered? How to accompany the autistic? Affinity therapy names what would be the treatment of autistic people oriented by objects, by specific interests, by doubles, for the particularities of each autistic person. The article shows the interest of Affinity therapy, explains the importance and weight of this practice in the treatment of autism in an interdisciplinary work guided by analytical discourse.

Le suivi de l'extrême prématuré après le congé des soins intensifs néonatals.

La survie des extrêmes prématurés (moins de 28 semaines d'âge gestationnel) s'est améliorée au fil du temps. Bon nombre s'en sortent bien et ont une bonne qualité de vie. Ils demeurent toutefois vulnérables à des problèmes de santé, y compris des difficultés neurosensorielles et neurodéveloppementales, que les médecins de première ligne, les pédiatres et les cliniques spécialisées doivent surveiller. Le présent document de principes passe en revue les conséquences médicales et neurodéveloppementales potentielles pour les extrêmes prématurés dans les deux ans suivant leur congé et fournit des stratégies de counseling, de dépistage précoce et d'intervention. Parce qu'ils sont tous liés à l'extrême prématurité, la dysplasie bronchopulmonaire ou les troubles respiratoires, les problèmes d'alimentation et de croissance, le développement neurosensoriel (vision et audition), la paralysie cérébrale et le trouble du spectre de l'autisme doivent faire rapidement l'objet d'une évaluation. Pour évaluer la croissance et le développement, il faut corriger l'âge chronologique en fonction de l'âge gestationnel jusqu'à 36 mois de vie. Par ailleurs, l'attention au bien-être émotionnel des parents et des proches fait partie intégrante des soins de qualité de l'extrême prématuré.

Transition from child and adolescent mental health care to adult services for young people with Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) in Europe: Barriers and recommendations.

Transition in mental health care is the process ensuring continuity of care of a young patient arriving at the CAMHS (Child and Adolescent Mental Health Service) age boundary within mental health services. Transition refers to a transfer to an adult mental health service (AMHS), to private care or other mental health community services. A transition plan can also lead to a managed end of specialized care with involvement of a general practitioner or social services. For young people with a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) or ASD (Autism Spectrum Disorder), two disorders that persist into adulthood, an optimal transition would ensure continuity of care or facilitate access to specialized care in the case of a discharge. Transition typically occurs during adolescence, a known sensitive period when young people may experience major changes at several levels: physiological, psychological and social. Any barrier in the transition process resulting in discontinuity of care may worsen the symptoms of ADHD or ASD and can ultimately adversely affect the global mental health of young people with such neurodevelopmental disorders. The objectives of this narrative review are: 1/to identify the barriers in the transition process in mental health services often faced by young people with these two disorders; 2/to highlight specific recommendations for strengthening the CAMHS-AMHS interface that have been proposed by various countries in Europe.

Is Repetitive Transcranial Magnetic Stimulation (rTMS) Ready for Clinical Use as a Treatment Tool for Mental Health Targets in Children and Youth?

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation tool with potential for broad application in individuals with neuropsychiatric conditions. As in adults, most rTMS research in youth has focused on treatment-resistant depression. A limited number of rTMS studies have also been conducted in children and youth with primary diagnoses of Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD) or Tourette's syndrome. Across the available rTMS literature, rTMS appears to be well tolerated with few adverse effects reported when applied to child and youth research samples. However, the potential efficacy of rTMS treatment for a variety of targets in children and youth remains unclear, due in part to limitations of the current literature, including studies using diverse protocols, potential for bias in existing clinical trial designs, variability in the research samples, and the use of heterogenous outcome measures. While rTMS is unlikely to take the place of more accessible treatments (e.g., psychopharmacological, psychosocial, psychotherapeutic), rTMS may provide a valuable alternative treatment option, particularly for those individuals where conventional treatments are inaccessible, poorly tolerated, or ineffective. A more robust body of well-designed, controlled trials, is needed in order to clarify rTMS treatment efficacy across relevant neuropsychiatric conditions, optimize treatment protocols, and meet the critical need for novel mental health interventions in children and youth.

La Stimulation magnétique transcrânienne répétitive (SMTr) est un instrument de stimulation du cerveau non invasif qui a le potentiel d'une application élargie chez les personnes souffrant de conditions neuropsychiatriques. Comme chez les adultes, la majorité de la recherche sur la SMTr chez les jeunes a porté sur la dépression réfractaire au traitement. Un nombre limité d'études sur la SMTr ont aussi été menées chez les enfants et les jeunes ayant des diagnostics primaires du trouble du spectre de l'autisme (TSA), du trouble de déficit de l'attention avec hyperactivité (TDAH) ou du syndrome de la Tourette. Dans la littérature disponible sur la SMTr, celle-ci semble bien tolérée et peu d'effets indésirables sont signalés lorsqu'elle est appliquée aux enfants et aux jeunes des échantillons de recherche. Cependant, l'efficacité potentielle d'un traitement par SMTr pour une variété d'objectifs chez les enfants et les jeunes demeure imprécise, partiellement en raison des limitations de la littérature actuelle, notamment des études utilisant divers protocoles, le potentiel de biais dans les méthodes d'essais cliniques existants, la variabilité des échantillons de recherche, et l'usage de mesures de résultats hétérogènes. Même si la SMTr ne prendra probablement pas la place de traitements plus accessibles (p. ex., psychopharmacologiques, psychosociaux, psychothérapeutiques), la SMTr peut procurer une option de traitement parallèle valable, chez les personnes pour qui les traitements conventionnels sont inaccessible, mal tolérés ou inefficaces. Un ensemble plus robuste d'essais contrôlés mieux conçus est nécessaire afin de clarifier l'efficacité du traitement par SMTr dans toutes les conditions neuropsychiatriques, optimiser les protocoles de traitement et répondre au besoin critique de nouvelles interventions de santé mentale chez les enfants et les jeunes.

Autism: an 'epidemic' of contemporary times?

The text discusses the growing incidence of autism in the world, presents an understanding of autism from the point of view of analytical psychology, and reflects on the treatment of autistic patients. Today, it is understood that autism is part of a continuum of characteristics on a spectrum with biological and congenital causes. It is a non-specific picture resulting from multiple causations of non-linear factors. Autism is a neuro-developmental disorder characterized by a triad of symptoms: persistent deficits in social communication and social interaction, and restricted and repetitive patterns of behaviours, interests, or activities. Autism spectrum disorder must be considered as a clinical entity, with current clearly defined characteristics. It is an extremely complex condition, which requires multidisciplinary approaches aiming at the possibility of prognosis and effective therapeutic approaches. This paper explores how a disturbance may occur from the intra-uterine phase, in which matriarchal experiences do not constellate. The structuring function of the patriarchal organization can then become dominant, and people with autism need understanding and help to organize their world and learn to live in it. As they don't have the capacity to structure consciousness through the matriarchal archetype, they rely entirely on the structuring and organizing capacity of the Father archetype.

Ce texte traite du taux croissant d'autisme dans le monde. Il présente une compréhension de l'autisme du point de vue de la psychologie analytique, et réfléchit au traitement des patients autistes. Au jour d'aujourd'hui il est accepté que l'autisme fait partie d'un continuum de caractéristiques sur un spectre qui inclut des causes biologiques et congénitales. Il s'agit d'un tableau non-spécifique qui est le résultat de causalités multiples concernant des facteurs non-linéaires. L'autisme est un trouble neuro-développemental caractérisé par une triade de symptômes: des déficits durables dans la communication et les interactions sociales, et des schémas de comportements, d'intérêts et d'activités restreints et répétitifs. Le spectre autistique doit être considéré comme une entité clinique, avec des traits caractéristiques actuels raisonnablement définis. C'est une condition extrêmement complexe, qui requiert des approches multidisciplinaires ayant pour but la possibilité d'un pronostic et d'approches thérapeutiques efficaces. Il est possible qu'un problème se produise durant la phase intra-utérine, dans laquelle les expériences matriarcales ne se constelleraient pas. La fonction structurante de l'organisation patriarcale peut devenir dominante et les personnes autistes ont besoin de compréhension et d'aide pour organiser leur monde et apprendre à vivre dedans. N'ayant pas la capacité de structurer la conscience à travers l'archétype matriarcal, elles s'appuient complètement sur la capacité structurante et organisatrice de l'archétype du Père.

El texto describe la incidencia en aumento de autismo en el mundo, presenta una comprensión sobre el autismo desde la perspectiva de la psicología analítica, y reflexiona acerca del tratamiento de pacientes autistas. Actualmente, se comprende que el autismo es parte de un continuum de características en un espectro con causas biológicas y congénitas. Es un cuadro no específico resultado de múltiples causalidades de factores no-lineales. El autismo es un trastorno del neuro-desarrollo caracterizado por una tríada de síntomas: un déficit persistente en la comunicación e interacción social; patrones de conducta, intereses o actividades restrictivas y repetitivas. El trastorno de espectro autista debe ser considerado como una entidad clínica, con características razonablemente definidas y vigentes. Es una condición extremadamente compleja, que requiere de abordajes multidisciplinarios tendientes a la posibilidad de una prognosis y de abordajes terapéuticos efectivos. Posiblemente, una alteración ocurre en la fase intrauterina, en la cual la experiencia matriarcal no se constela. La función estructurante de la organización patriarcal puede volverse dominante y las personas con autismo necesitan comprensión y ayuda para organizar su mundo y aprender a vivir en éste. Al no tener la capacidad de estructurar la consciencia a través del arquetipo matriarcal, dependen enteramente de la capacidad estructurante y organizadora del arquetipo del Padre.

O texto discute a crescente incidência de autismo no mundo, apresenta uma compreensão do autismo do ponto de vista da psicologia analítica e reflete sobre o tratamento de pacientes autistas. Hoje, entende-se que o autismo faz parte de um continuum de características em um espectro com causas biológicas e congênitas. É um quadro inespecífico resultante de múltiplas causas de fatores não lineares. O autismo é um transtorno do neurodesenvolvimento caracterizado por uma tríade de sintomas: déficits persistentes na comunicação social, na interação social; e padrões restritos e repetitivos de comportamentos, interesses ou atividades. O transtorno do espectro do autismo deve ser considerado como uma entidade clínica, com características atuais razoavelmente definidas. É uma condição extremamente complexa, que requer abordagens multidisciplinares visando a possibilidade de prognóstico e abordagens terapêuticas eficazes. Possivelmente, ocorre um distúrbio a partir da fase intrauterina, na qual as experiências matriarcais não se constelam. A função estruturante da organização patriarcal pode se tornar dominante e as pessoas com autismo precisam de compreensão e ajuda para organizar seu mundo e aprender a viver nele. Como eles não têm a capacidade de estruturar a consciência através do arquétipo matriarcal, eles dependem inteiramente da capacidade de estruturação e organização do arquétipo do Pai.