Objectifs : Cette recherche vise une meilleure comprehension de la construction identitaire des freres et soeurs de personnes autistes. Elle porte sur l'evolution de la representation de soi de ces membres de fratries a l'adolescence, et l'analyse est centree sur l'image du corps, l'investissement narcissico-objectal et le processus de subjectivation. Une revue theorique et clinique des travaux francophones et anglo-saxons met a jour l'etat des connaissances dans ce domaine clinique encore peu etudie.
Methode : Nous procedons par approche comparative en constituant un groupe temoin de fratries sans condition de handicap en parallele au groupe d'etude clinique de fratries avec autisme, chacun constitue de 24 sujets âges de 13 a 18 ans. Nous adoptons une methode clinique et projective en utilisant lentretien clinique, deux tests projectifs (Rorschach et TAT), une activite d'ecriture originale creee pour la recherche, deux echelles standardisees (R-CMAS : anxiete ; SEI : estime de soi). Des analyses statistiques sont proposees en complement de l'analyse des donnees cliniques.
Resultats : Nous degageons une specificite des caracteristiques de la representation de soi chez les adolescents de fratrie avec autisme qui se traduit a un triple niveau : celui de l'integration psychique du corps en transformation ; celui de l'engagement en direction de l'autre sexue ; celui de l'elaboration de projets d'avenir personnels. Une constellation de traits particuliers apparait plus ou moins fortement selon les sujets et nous amene a proposer des perspectives preventives et therapeutiques tenant compte de la variabilite des fonctionnements psychiques individuels.

https://hal.univ-lorraine.fr/tel-01749248/document

Etude clinique et projective de la représentation de soi chez des adolescents ayant un frère/une soeur autiste

L’inclusion scolaire des enfants en situation de handicap devient une priorite des politiques educatives. Les enfants ayant un Trouble du Spectre de l’Autisme (TSA) sont donc concernes par ces transformations. Cette these qui s’inscrit dans le champ de la psychopathologie developpementale poursuit un double objectif. D’une part, il s’agit d’analyser les trajectoires developpementales d’enfants ayant un TSA scolarises dans le cadre d’un dispositif innovant d’inclusion (etude 1). D’autre part, il s’agit d’evaluer les effets de deux interventions de mediation par les pairs, appliquees dans le cadre de la theorie socio-constructiviste du developpement, et mises en œuvre en situation de jeu symbolique (etude 2) ou de travail sur une tablette numerique (etude 3). Au total, 18 enfants ayant un TSA et 26 au developpement typique ont pris part a cette these. Apres deux ans de suivi longitudinal, les resultats de l’etude 1 montrent que les enfants ayant un TSA progressent sur le plan du developpement cognitif et socio-communicatif, et ce malgre une importante variabilite interindividuelle. L’ampleur des progres realises par les enfants est associee a plusieurs facteurs tels que l’âge chronologique, le niveau de fonctionnement intellectuel non-verbal et le niveau de langage. Les resultats des etudes 2 et 3, quant a eux, montrent que d’entrainer les enfants typiques a interagir avec leurs camarades ayant un TSA peut avoir des effets benefiques sur les competences socio-communicatives de ces derniers. Chez tous les enfants typiques, une augmentation du nombre de conduites de tutelle est egalement observee suite a la mise en œuvre de l’intervention. Cela ouvre des perspectives prometteuses en termes de pratiques educatives susceptibles d’etre mises en œuvre en milieu scolaire pour favoriser l’inclusion des eleves ayant un TSA.

Inclusion scolaire et mise en place d’un accompagnement médico-psychologique précoce pour les enfants présentant un Trouble du Spectre de l’Autisme

The outcomes of psycho-educational interventions for Autism Spectrum Disorders (ASDs) comorbid with severe to moderate intellectual disability (ID) are insufficiently documented. In this prospective study, we examined a developmental individual, interactive and intensive approach, called the ‘3i method’, which is based on play therapy. Twenty DSM-IV-TR ASD subjects (mean chronological age 63.8 ± 37.8 months; mean developmental age 19.5 ± 6.6 months) were included and followed the 3i method for 24 months. Developmental and behavioural skills were assessed at baseline and after 24 months using the VABS, PEP-R and Nadel Imitation scale. Autism severity was evaluated using the Child Autism Rating Scale (CARS) and the Autism Diagnostic Interview (ADI-R). After 2 years of the 3i method, our 3 primary outcome variables significantly increased (VABS developmental age of socialization increased by 83%, age of communication by 34%, and Nadel Imitation score by 53%). Almost all VABS and PEP-R domains significantly improved. Additionally, increases in the VABS socialization score were positively correlated with the total number of treatment hours and CARS score; all ADI-R areas significantly decreased; and diagnoses had changed in 47.5% of the subjects (37% for PDD-NOS and even 10.5% for ID without PDD). Children who followed the 3i method for 2 years had significantly improved behavioural and developmental skills and showed a clear decrease in autism severity. These results suggest that the 3i method may be useful for autistic children by improving their daily interactions with their social environment. was retrospectively registered on May 20th, 2014 by the French Agency for drug and health (ANSM) under number ID-RCB 2014-A00542–45, reference: B148558–31.

/pdf/clinical-outcomes-of-interactive-intensive-and-individual-3i-4h6l5h5pye.pdf

Clinical outcomes of interactive, intensive and individual (3i) play therapy for children with ASD: a two-year follow-up study

Des les annees 1950-1960, des pedopsychiatres de service public ont propose pour les enfants ted, denommes alors psychotiques, des prises en charge multidimensionnelles articulant soins, education et pedagogie avec une optique psychopathologique. Ces approches se sont generalisees, avec la politique de secteur, en privilegiant les institutions a temps partiel. Malgre des inegalites, les dispositifs de soins et les techniques se sont, depuis, diversifies avec une attention renforcee a la prise en charge educative. Apres une periode de reserve, les techniques formalisees (teacch, aba) ne sont plus totalement exclues, mais les equipes pedopsychiatriques, fideles a une approche globale, restent majoritairement prudentes quant a leur utilisation exclusive. Depuis la loi de 2005, la scolarisation des enfants ted, initiee par certaines equipes, s’est developpee, en collaboration avec l’Education Nationale. Le partenariat avec les familles a ete marque par des moments de tensions lies a des incomprehensions mutuelles qui persistent malgre des efforts certains de part et d’autre. Les travaux francais marques par une intense reflexion sur la comprehension des troubles et des propositions pour y remedier sont restes faibles sur l’evaluation objective. Des comptes rendus de l’evolution a long terme d’enfants regulierement suivis (cas uniques) voisinent avec l’evaluation a posteriori de groupes d’enfants sur des criteres cliniques simples.

/pdf/troubles-envahissants-du-developpement-les-pratiques-de-50rjspy19w.pdf

Troubles envahissants du développement : les pratiques de soins en France

The present study examined the effectiveness of two interventions, Imitation Responding (IR) and Intensive Behavior Treatment (IBT) used as initial treatment programs for autistic children enrolled ...

https://nasenjournals.onlinelibrary.wiley.com/doi/pdf/10.1111/1471-3802.12468

Comparing Imitation Responding and IBT for children with ASD, a preschool intervention

Les auteurs proposent une reflexion epistemologique fondee sur des arguments cliniques et theoriques chez le bebe et le petit enfant. Ils etudient la part du corps experimente au cours de l’interaction et engage dans la capacite de penser. Il s’agit des premiers elements issus d’une recherche au long court menee au sein d’un Centre Ressources Autisme sur l’etude des fondements des capacites interactives et communicatives. Les discussions se centrent donc sur la situation des enfants autistes ou est considere le trouble severe d’intersubjectivite. Ce travail amene a une hypothese nouvelle ou l’emotion et le corps propre tiennent la plus grande place, elle s’inscrit dans le paradigme developpe en France par Bernard Golse. Cette hypothese discute chez le petit enfant, autiste ou typique, la necessite de constituer un « espace de contact » pour mettre en œuvre des capacites primaires de representation de soi et de l’objet, et ainsi permettre le developpement progressif ecologique de la relation intersubjective.

Étude chez l'enfant autiste d'un des fondements corporels de l'intersubjectivité : le corps propre comme partage émotionnel

EnglishA one-year pilot study was conducted with 8 children with autism aged 30 to 84 months. The children were proposed 25 individual sessions of reciprocal imitation throughout the school year. The content of the sessions was adapted to the imitation level of each child, as assessed by our imitation scale including spontaneous imitation and recognition of being imitated in addition to the classical evaluation of instructed imitation. Whatever the initial level, the aim of the program was to gently lead children to alternate the roles of imitator and model, so as to achieve an efficient non verbal communicative means, and to improve their imitation capacities. The Before-After comparison of scores shows a significant increase of PEP-R imitation scores after the training, altogether with a significant increase of positive behaviour at the after evaluation and at home. A significant correlation arises between the increase of communicative imitation and the increase of positive behaviour. The developmental patterns used "a la carte" depending of each child's initial level are reported, some of them in full details so as to describe as closely as possible the work elaborated step by step during the training. Results are presented child by child, given the heterogeneity of initial levels. They show for 6 of the 8 children an important increase of positive behaviour and a significant correlation between the increase of communicative imitation and the increase of positive behaviour. The increase of positive behaviour is also quoted by the parents, thus stressing a trend toward the generalization of the improvement. francaisUne etude pilote a ete menee durant un an avec 8 enfants de 30 a 84 mois ayant recu le diagnostic d'autisme. Les enfants ont beneficie de 25 seances individuelles d'imitation reciproque durant l'annee scolaire. Le contenu des seances etait adapte au niveau d'imitation de chaque enfant, prealablement evalue a l'aide d'un instrument ajoutant l'imitation spontanee et la reconnaissance d'etre imite a la classique evaluation de l'imitation induite. Quel que soit le niveau, l'objectif etait de conduire doucement l'enfant a alterner les roles d'imitateur et de modele, de facon a maitriser un moyen efficace de communication non verbale, tout en enrichissant le repertoire d'actions. La comparaison des scores avant-apres montre une augmentation significative de l'imitation au PEP-R et une augmentation des comportements positifs lors de l'evaluation finale et en famille. Une correlation significative se degage lors de l'evaluation apres entre les progres en imitation communicative et l'augmentation des comportements positifs. Les patrons developpementaux sont presentes enfant par enfant, etant donne l'heterogeneite des niveaux de depart, et certains sont abondamment detailles pour decrire le principe du travail elabore pas a pas durant les entrainements.

L’imitation au service de l’autisme: une étude pilote

OBJECTIVES
To describe the appearance and size of the ganglionic eminence (GE) in normal fetuses at mid trimester three-dimensional (3D) neurosonography and to report the association between GE alterations (cavitation or enlargement) and malformations of cortical development (MCD).


METHODS
This was a prospective multicenter cohort study, with retrospective analysis of pathological cases. From January to June 2022, patients attending our tertiary centers for expert fetal brain scan were recruited for the purpose of the study. A 3D volume of the fetal head, starting from the sagittal plane, was acquired in apparently normal fetuses transabdominally or transvaginally. Stored volume datasets were then independently evaluated by two expert operators. Two measurements (longitudinal diameter or D1 and transverse diameter or D2) of the GE in the coronal view were taken twice by each operator. Intra- and interobserver variation was calculated. Normal reference ranges for GE measurements were calculated in the normal population. Previously stored volume dataset of 60 cases with MCD were also independently analyzed by the two operators using the same method, in order to assess if GE abnormalities (cavitation or enlargement) were present. Postnatal follow-up was obtained in all cases.


RESULTS
In the study period, 160 normal fetuses between 19 and 22 weeks of gestation were included in the study. The GE was visible in the coronal plane at 3D ultrasound in 144 (90%) cases, not clearly visible in the remaining 16 cases. The intra- and interobserver agreement were almost perfect for D1, with an ICC of 0.90 (95% CI, 0.83-0.93) and an ICC of 0.90 (95% CI, 0.86-0.92), respectively, and substantial for D2, with an ICC of 0.80 (95% CI, 0.70-0.87) and an ICC of 0.64 (95% CI, 0.53-0.72), respectively. A retrospective analysis of 50 cases with MCD in the second trimester showed that GE enlargement was bilaterally present in 14 cases and GE cavitation in four cases.


CONCLUSIONS
A systematic assessment of the GE in fetuses at 19-22 weeks is feasible at 3D brain ultrasound with good reproducibility in normal cases. Cavitations or enlargement of the GE can be demonstrated in fetuses with MCD. This article is protected by copyright. All rights reserved.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/uog.26229

Normal and abnormal appearance of fetal ganglionic eminence at second-trimester three-dimensional ultrasound.

Ultrasound in Obstetrics & GynecologyAccepted Articles Letter to the Editor Association between uterine artery Doppler in early spontaneous labor and adverse peripartum outcome in relation to birth weight A. Dall'Asta, Corresponding Author A. Dall'Asta [email protected] orcid.org/0000-0001-7201-0206 Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UKCorrespondence to: Prof. A. Dall'Asta, Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Via Gramsci 14, 43126 Parma, Italy, E-mail: [email protected]Search for more papers by this authorR. Ramirez Zegarra, R. Ramirez Zegarra orcid.org/0000-0001-7706-3016 Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, ItalySearch for more papers by this authorF. Figueras, F. Figueras Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, SpainSearch for more papers by this authorG. Rizzo, G. Rizzo orcid.org/0000-0002-5525-4353 Department of Obstetrics and Gynecology, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, ItalySearch for more papers by this authorC. Lees, C. Lees Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UKSearch for more papers by this authorT. Frusca, T. Frusca Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, ItalySearch for more papers by this authorT. Ghi, T. Ghi orcid.org/0000-0003-1823-1096 Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, ItalySearch for more papers by this author A. Dall'Asta, Corresponding Author A. Dall'Asta [email protected] orcid.org/0000-0001-7201-0206 Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UKCorrespondence to: Prof. A. Dall'Asta, Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Via Gramsci 14, 43126 Parma, Italy, E-mail: [email protected]Search for more papers by this authorR. Ramirez Zegarra, R. Ramirez Zegarra orcid.org/0000-0001-7706-3016 Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, ItalySearch for more papers by this authorF. Figueras, F. Figueras Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, SpainSearch for more papers by this authorG. Rizzo, G. Rizzo orcid.org/0000-0002-5525-4353 Department of Obstetrics and Gynecology, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, ItalySearch for more papers by this authorC. Lees, C. Lees Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UKSearch for more papers by this authorT. Frusca, T. Frusca Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, ItalySearch for more papers by this authorT. Ghi, T. Ghi orcid.org/0000-0003-1823-1096 Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, ItalySearch for more papers by this author First published: 16 June 2023 https://doi.org/10.1002/uog.26287 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.26287. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation 

Association between uterine artery Doppler in early spontaneous labor and adverse peripartum outcome in relation to birth weight.

OBJECTIVE
The prediction of adverse perinatal outcomes in low-risk pregnancies is poor, mainly due to the lack of reliable biomarkers. Uterine artery Doppler is closely associated with placental function and could assist in the peripartum detection of subclinical placental insufficiency. The objective of this study was to evaluate the relationship between mean uterine artery pulsatility index (PI) measured in early labor with obstetric intervention for suspected intrapartum fetal compromise and adverse perinatal outcomes in uncomplicated singleton term pregnancies.


METHODS
This was a prospective multicenter observational study conducted across four tertiary Maternity Units. Low-risk term pregnancies with spontaneous onset of labor were included. The mean uterine artery PI was recorded in between uterine contractions in women admitted for early labor and converted into multiples of the median (MoM). The primary outcome of the study was the occurrence of obstetric intervention - i.e., cesarean section or instrumental delivery - due to suspected intrapartum fetal compromise. The secondary outcome was represented by the occurrence of composite adverse perinatal outcome, defined as one of the following: acidemia (umbilical artery pH<7.10 and/or base excess >12) at birth and/or 5-min Apgar score < 7 and/or neonatal intensive care unit (NICU) admission.


RESULTS
Overall, 804 women were included, of whom 40 (5%) had a mean uterine artery PI MoM ≥95th percentile. Women who had an obstetric intervention for suspected intrapartum fetal compromise were more frequently nulliparous (72.2% vs 53.6%, P=0.008), had a higher frequency of mean uterine artery PI MoM ≥95th percentile (13.0% vs 4.4%, P=0.005), and had a longer duration of labor (456±221 vs 371±192 minutes, p=0.01). Logistic regression only retained as independently associated with obstetric intervention for suspected intrapartum fetal compromise mean uterine artery PI MoM ≥95th percentile (adjusted odds ratio (aOR), 3.48 (95% CI, 1.43-8.47), P=0.006) and multiparity (aOR, 0.45 (95% CI, 0.24-0.86), P=0.015). Mean uterine artery PI MoM ≥95th percentile was associated with a 0.13 (95% CI, 0.05-0.25) sensitivity, 0.96 (95% CI, 0.94-0.97) specificity, 0.18 (95% CI, 0.07-0.33) positive predictive value, 0.94 (95% CI, 0.92-0.95) negative predictive value, 2.95 (95% CI, 1.37-6.35) positive likelihood ratio and 1.10 (95% CI, 0.99-1.22) negative likelihood ratio for obstetric intervention for suspected intrapartum fetal compromise. Pregnancies with mean uterine artery PI MoM ≥ 95th percentile also showed a higher incidence of birthweight <10th percentile (20% vs 6.7%, P=0.002), NICU admission (7.5% vs 1.2%, P=0.001) and composite adverse perinatal outcome (15.0% vs 5.1%, P=0.008).


CONCLUSION
Our study conducted on a cohort of low-risk term pregnancies enrolled in early spontaneous labor shows an independent association between increased mean uterine artery PI and obstetric intervention for suspected intrapartum fetal compromise, albeit with moderate capacity to rule in and poor capacity to rule out this condition. This article is protected by copyright. All rights reserved.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/uog.26199

Anne Dall’Asta

Papers

Étude chez l'enfant autiste d'un des fondements corporels de l'intersubjectivité : le corps propre comme partage émotionnel

L’imitation au service de l’autisme: une étude pilote

Normal and abnormal appearance of fetal ganglionic eminence at second-trimester three-dimensional ultrasound.

Association between uterine artery Doppler in early spontaneous labor and adverse peripartum outcome in relation to birth weight.

Uterine artery Doppler in early labor and perinatal outcome of low-risk term pregnancies: prospective multicenter study.