RESUMO
BACKGROUND: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental trouble which prevents the child from socio-communicative interaction, and learning from his environment. Non-medical early intervention attempts to improve prognosis. We will review the main current hypothesis, intervention models and scientific supports about early intervention. METHODS: We conducted a search of the literature published on Medline between 2010 and 2015 related to intervention models provided to children with ASD aged less than 3 years. Data were extracted from systematic reviews and recent randomized controlled trials with moderate to high GRADE quality of evidence. RESULTS: Early intervention refers to brain plasticity theory. With the epidemiological studies of infant "at risk" there is an attempt to intervene earlier before full syndrome is present. Interventions tend to follow more on a developmental hierarchy of socio-communicative skills and to focus on the dyadic relation between the child and the caregivers to improve the core autistic symptoms. Over the last 6 years, there's been news and fine-tuned ways about early intervention, and more and more systematic evaluation. CONCLUSION: However, there are only few interventions which were evaluated in trial with a strong GRADE recommendation and all of them have methodological concerns. It is important to be cautious in recommendations for mental health politic, even if it is important to improve access to services for all children and their families, hence finance and design rigorous project in research.
RESUMO
Born a little time after the death of his sister, our patient, Antoine, 13 years old, was suffering from severe obsessional compulsive disorders, which needed care in the hospital and adapted treatment. We tried to know if what we were led to observe by this adolescent could be explained by works and thoughts around the notion of substitute child. Building our thought on various theoretical approaches, including neurosciences, we tried to think the psychopathological signs of this patient by two ways. One is about the birth and the growth in the presence of depressed parents, and this since the pregnancy. The other one is about the necessity to deal with the traumatic story of the family, met by the parents, who are still facing it, that leads to the question of the transmission of the traumatism from the mother to the baby. Using the notion of maternal primary care, we proposed the term 'the child after', which appeared to us more able to represent the dynamic and the place really given to these children. This term could mean the question of an undone grief, a traumatism without temporality, and a relation between the mother and the child which seems to be uncertain because of the investment of the child as an impossible reparation of an unscarred loss.