Definition autisme
Définition autisme
In France, we describe the pathological personalities depending on the disease to which they resemble, they imitate in a minor or that they are implicitly supporting the field.
These classifications use different sets of traits that seek to define a particular group of individuals whose personality profile is observed with high frequency.
It’s a personality that is distinct from pathological paranoia. The paranoia is not systematized delusions chronic deficit in interpretive mechanism, it belongs to the realm of psychosis, which is not the case of paranoid personality.
The most paranoid and delusional never become individuals through their social and relationship difficulties without going to see the doctor by simply bully their family and professional.
For many psychiatrists, the schizoid personality pathology shows a plot and a predisposition to schizophrenic psychosis. For others, it is already a minor form of psychosis.
Schizoid personality combines coldness and emotional poverty, avoidance of social relations and contacts with the outside environment, isolation, a nonchalance, a header
– The histrionics and theatricality: the hysterical woman trying to attract attention to herself. Emotional expressions are dramatized. The arousal, the intensity of emotional reactions are constant. The thinking is an imaginary role. Emotional dependence, the puerile, disorders of sexuality are part of the table.
Phobic personality is characterized by hyperactivity, avoidance of interpersonal situations (shyness, inhibition, trac), forward flight and hyperactivity.
It is a scrupulous moralist experiencing crises of conscience and guilt. He is tired in the morning. Traits anal (Freud) are the order, parsimony and obstinacy.
They amount to the existence of instability, impulsivity and conduct disorder without these traits are related to a psychotic structure or neurotic personality or a mental illness.
The cause of mental disturbance is unknown. Genetic factors and family involved as well as environmental factors (family separated, repeated investment in children, chronic alcoholism family …). The difficulties of adapting the unbalanced and often start very early in childhood, the entourage noticed a motor instability, aggression toward peers, tantrums, fights, running away.
The emotional disturbances, coupled with defects in attention, quickly lead to problems of special education while intelligence is normal.
The imbalance is evident in adolescence: running away, vagrancy, breach of toxic anarchic sexual activity, delinquency minor repetitive.
The medico-legal (theft, fraud, fights …) Are repeated impulsive, reckless, regardless of previous experience.
This concept refers to patients who oscillate constantly with the limits of neurosis and psychosis without symptoms of neurotic be durable and without delusional decompensation.
The symptoms are very varied. The general tendency to impulsivity, instability, dependency, sexual disorders and eating behavior, the behavior of dependence vis-à-vis the toxic antisocial behavior are constants. Anxiety, depression are common.
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Definition of psychotic children: The child is suffering from psychosis that result in behavioral disorders, delayed mental development
It was around the age of 3, the child begins to exhibit psychotic disorders: impulsivity, aggression are the main symptoms. The child is delayed at the mental level, and can not seem to fit in a social environment.Psychosis that affects children hinders normal development and learning. If psychotic disorders are often dominated by infantile autism, schizophrenia, paranoia are also included.
Supervised by an educator, psychotic children receive care at an educational level (autonomy of the child), but also educational (intellectual development) and therapeutic (relational development).
What is psychosis?
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These criteria were first highlighted by Lorna Wing. They were then taken to the medical classification of the WHO ICD-10.This classification puts autism in the category of pervasive developmental disorders (PDD).
The term is also used more or less independently of the diagnostic criteria for qualifying TEDs in general or to identify a symptom or psychological attitude theorized on the basis of so-called ‘autistic withdrawal’ (eg in the case of the Hospital).
It seems that currently, in the state of research, you can link autism to a ‘neurological disorder of early brain development.’ The investigations which would induce this state have not produced any firm conclusions, although combinations of genetic factors are presented as a possible cause of hereditary character.
In terms of clinical diagnosis, for historical reasons linked to the spread of knowledge on these disorders, autism is the term often used for childhood autism from the definition of Leo Kanner, but others separate diagnostic qualified autism, atypical autism as such, and in general Asperger syndrome.
To overcome this ambiguity of terminology, autism and other pervasive development today tend to be grouped under the generic name of autism spectrum disorder (ASD short), even if there are distinctions within this spectrum. According to a July 2009 publication of the Association Autism-Europe:
The word autism is also associated with many considerations that do not fit the clinical disorder. Since the 1990s, authors autism (who had a diagnosis of infantile autism in their childhood) described their view their singularities. Highlighting aspects that are not deficient in particular has been greatly expanded through the Internet.
On the other hand, the current language or journalism tends to use the term autism based on these etymological bases to describe the conduct of someone falling back on itself, refusing to listen to see the others: ‘Autism government ‘for example. If this is common sense, yet it is absolutely not representative of autism in the clinical sense, because ‘the problem of autism is not lack of desire to interact and communicate, but a lack of opportunity to do so. ‘
Screening and diagnosis
There is so far no biological test to detect autism. The diagnosis of autism and other pervasive developmental disorders is clinical and based on development and behavior of children between 0 and 3 years (or beyond in some cases such as Asperger syndrome).
Early detection can then be performed at 18 months of fairly reliable test with the M-CHAT, a pediatrician (or parents if applicable). This test has been validated internationally and is currently being tested in France. In suspicious cases after this test it is recommended that in the months after a detailed diagnosis.
In case of doubt it is very important to seek an early diagnosis.Indeed, all studies on the development of people with autism show that early detection allows the implementation of appropriate care at the earliest, thereby significantly increasing the chances of further progression of the child.
The diagnosis must be supervised by a medical specialist (neurologist or psychiatrist) and must include (see the recommendations of the HAS):
The specialist (neurologist or psychiatrist) performs the synthesis of these elements and his own clinical observations to deliver the diagnosis, which must be made according to the nomenclature of ICD-10, as recommended by the HAS.
Overview
Meaning of Autism Spectrum
In 1982, Lorna Wing highlights three features by showing their prevalence in the developmental disorders:
But if this triad tends to be applied to the definition of autism as it demonstrated by Kanner, it remains representative of a wider spectrum than the first definition.The concept of autism spectrum disorder introduced in 1988, allowing inclusion of other disorders representing these criteria without confusing them with infantile autism. It says for instance in 2008 as part of neuropsychiatry:
Categorization of disorders related to autism
The use of classifications used to categorize the various forms of autism, as well as differentiate them from other disorders. However, a classification is a representation of reality, not reality itself, ie it does not create an order of reality, but it categorizes those found in reality it is external. If the criteria seem about to change significantly, ICD-10 the World Health Organization remains the reference in 2009 to distinguish the different disorders autism and compare the criteria of national identification:
The DSM IV classification is the benchmark U.S. and French CFTMEA a reference.However, in France, according to the recommendations of the High Authority of health diagnosis must be made now based on international classifications. When a diagnosis is made using the French classification CFTMEA, equivalence ICD-10 should be explicitly mentioned (the use of international classifications is to enable all stakeholders, professionals and parents to have better communication with the Using the same terminology).
Infantile autism
Infantile autism is also called early childhood autism (also translated early infantile autism), childhood psychosis, Kanner’s syndrome or autism. The term autism, without any additional returns most often to this identification, but often by extending more or less (as seen in the criteria used in epidemiological studies are supposed to count with autism).
Identification criteria are discussed since we saw people diagnosed with autism grow out qualification criteria for autism.The concept of high-functioning autism then appeared, but the trend is towards the opening of the primary criteria to create a further distinction.
Rett Syndrome
Rett syndrome is a genetic disease. There is a high prevalence of autistic disorder in nature as part of this disease, but talking with autism in this case remains very controversial. And accounts for epidemiological this syndrome is sometimes included and sometimes excluded from counts.
Asperger Syndrome
First called autistic psychopathy (in 1943) this syndrome is considered a form of autism. It is included in the counts epidemiology of autism, but the diagnostic criteria are very different from infantile autism, and a little less of autism called high level, even if limits were raised in comparison of verbal IQ and performance.
Epidemiology
Several publications report a prevalence rate of over 60 children in 10 000 affected by a form of autism, 1 in 166 children.In the United States in 2000 in England in 2001 in France in 2002.
This figure would increase according to recent epidemiological studies in the U.S. since 2000 by the CDC (Center for Disease Control and Prevention), hundreds of thousands of children: the prevalence of autism now reach 150 children, a boy of 94. This raised the question of the reason for the changing prevalence of autism diagnosed. The answers provided are improved diagnosis, broader inclusion of children previously treated in another way, that is to say otherwise diagnosed, or an increase in the number of autism.
By Country
Notice No. 102 of the National Advisory Committee on Ethics (CCNE) indicates that France is lagging behind compared to countries of Northern Europe or Anglo-Saxon, as regards the diagnosis and access to support adapted education.The report criticizes the plight of families in France, the succession of reports and legislation ineffective for over ten years and the continued application of psychoanalytic theories, theories that other developed countries have abandoned in the 1980s .
In France, autism concerns over a hundred thousand people, children and adults, three cases involving four men .. This figure underestimates the reality. Their support is currently too often inadequate, much to the chagrin of their parents and relatives who may live a real nightmare because of the lack of adequate facilities to support academic, educational, social and therapeutic aspects of children .
Families can contact the Autism Resource Centre in their area to obtain a diagnosis according to international criteria. Associations of parents and professionals have been created to accompany autism and their families with educational support individuals with autism and support for families.
The proportion of people with autism in Morocco is estimated at about 60000, of which most is supported exclusively by the family. There were centers in major cities such as Casablanca and Rabat, which are also closed so far. The schooling of children with autism depends essentially private initiatives.
Theorization of autism
The psychoanalytic approach
Among psychoanalysts, the question of autism has always been debate as that under the guise of psychoanalysis, the approach of Bruno Bettelheim sociogenetic or ideological Maud Mannoni threw confusion. Lustin for JJ (psychoanalyst) who speaks of autistic states: ‘It always appeared to me necessary to exclude autism from the strict framework of infantile psychoses because their appearance and their extreme gravity does not seem to result from a real process. We can consider them as ‘states’ more or less early in the etiology very mysterious and probably multi-factorial. .The confusion on the theories and practice of psychoanalysis claiming generated excesses which have been heavily criticized, especially causal claims and interference to other modes of care. Major controversies occur, especially in France where many complaints of parents’ associations are successful and other reports to the National Advisory Committee on Ethics:
These controversies also arise largely from the hyper-mediated dissemination of the work and theories of Bruno Bettelheim, especially those concerning children with autism who fall back on himself because he was ‘traumatized’ by his environment, parents in particular and especially the mother. This type of assumption has already been mentioned by Leo Kanner was not a psychoanalyst, but had found that parents of ‘autistic’ were cold or distant.Today this vision is no longer valid, psychoanalysis is more likely referring to the writings of Margaret Mahler, Frances Tustin or Donald Meltzer and others to theorize or autism (s). It speaks also more likely to autistic states, the term nominal leaving room for the word in the phrase.
The fact remains that sometimes irreconcilable differences exist between the psychoanalytic approach to autism and supported who claim it, and cognitive-behavioral approach used today mostly in the world to understand autism and develop best practices of care. In addition many professionals trained at the time of Bettelheim expression of autism was considered a reference to remain attached, causing still difficult situations for some families.
Theory of mind
The theory of mind is set in 1978 by Premack and Woodruff as the ability to infer mental states (beliefs, desires, intentions …) to represent the behavior of others.It would explain and understand the social environment, and the ability to understand and predict the behavior of others and thereby to adapt to his social situation experienced.
Origin, and Sally Anne test
This formalization has been implemented in the context of autism through several sets of experiments. The first is carried out by Baron-Cohen, Leslie and Frith in 1985 with autistic children, children with Down syndrome and control children (taking approximately the principle of the test established by Wimmer and Perner 1983), but in the form of experiment called ‘Sally and Anne ‘
The experimenter played the following situation with dolls: Sally lays a ball into a basket and then leaves the room. Anne leaves the ball in the basket and places it in a box. Sally comes into the room. The experimenter then asked the child: ‘Where will Sally does get the log? ‘
If the answer is ‘in the basket’The experimenter believes that the child was able to get’ in the skin of the character of Sally as they are asked to do, and understand that in the history represented in the child it can be aware of the maneuver Anne.
Children with Down Syndrome as ordinary children give the expected response to more than 80%. Conversely, in twenty autistic children tested, sixteen have failed that question, so that everyone knew where the ball was.
The authors conclude that the experience of autism is that a specific deficit independent of overall general mental retardation. The idea of a ‘lack of theory of mind’ is the working hypothesis, based on the fact that only a small minority of children with autism pass the test of ‘representation of the second order,’ they state that their hypothesis that autistic children generally ‘fail to use the theory of mind’ is strengthened.
Challenging and changing concept
In this experiment, and even more in the following (call with a banana, a box of Smarties …) the problem of the role of the experimenter is raised by critics. What is questioned is the link made between the side of a failure of understanding of a situation created by the experimenter and the other at the conclusion of the overall failure mechanism understanding of the other in general.
Simon Baron-Cohen, one of the protagonists of the first experiment, the difficulty in forming metarepresentations and therefore difficult to infer mental states to oneself and others, has an important impact on behavior. A person immersed in an environment populated with people he barely understand and predict the actions, which he does not have any language, will present avoidance behaviors or aggression, motivated by misunderstanding.Therefore the structuring of the environment, making it predictable and understandable, enabling the person with autism to better manage its deficit in theory of mind and improves behavior problems.
According to Christiane Riboni, doctor of linguistics, ‘the analysis of interviews with patients with autism shows that the lack of theory of mind is not clear, however in some cases.’ It describes an intentional but ‘use the language more marked on the side that representational communicative.’ It also refers to Tager-Flusberg to offer an explanation of a ‘marked failure to master a causal explanatory framework.’
Temporomandibular disorder treatment spatial sensory information
This theory has been developed over the past fifteen years by Bruno Gepner et al, on the basis of several clinical and psychophysical studies conducted among children and adolescents with autism or Asperger syndrome.
These studies show that sensory information dynamics (movements of the environment, human body or facial movements, speech) are too fast to be perceived in real time by people with autism spectrum disorder. This problem of temporal processing of dynamic information cascade explain their understanding of language disorders and emotions, their imitative disorders, their executive function disorders, including delays in their motor responses, and ultimately their social interaction disorders . If dynamic information poses major problems for people with autism spectrum disorders, however they may show off and increased attention to the static spatial information, spatial details or sound, and develop greater skills in the field visuo-spatial (puzzles, spatial memory, graphics), or the calculation (the brain pathways dedicated to the calculation are partly the same as those that address spatial information).These features of temporal-spatial processing of sensory information is probably correlated with abnormalities in brain functional connectivity and neuronal synchronization, that is to say the alignment of different brain areas and neuronal groups, whether at rest or during cognitive tasks simple or complex. It is clear from studies using fMRI (functional magnetic resonance imaging) or coherence EEG (electroencephalographic) that the brains of autistic people would rather be less connected and less synchronized in tasks involving visual or auditory dynamic, and unlike most connected and more synchronized during focused attention tasks or involving static stimuli, relative to the brains of control subjects. Gepner and colleagues refer to these mechanisms of hypo-or hyper-syncing, or under-or over-connectivity among multiple brain regions: the cerebral disconnectivité-dissynchronisation multi-system (DDCM).
Still in the working hypothesis, this theory offers the opportunity to make connections with other problems often associated with autism spectrum disorders such as epilepsy (considered as a pathological hyper-syncing), and miscellaneous disorders development (dysphasia, dyslexia, dyspraxia, …), and suggests ways to better distinguish the different disorders, including within the autism spectrum. Finally, this theory opens new therapeutic avenues. Indeed, studies of Gepner and colleagues show that the slowdown of visual and auditory signals can improve the recognition of emotional facial expressions and non-emotional, improve the imitation of gestures, and improve understanding of language in autistic children, especially those with the most severe disorders or whose development levels are low. These results could in future lead to reeducation tracks using software slow and audible.
Treatment
There is no cure for autism.Nevertheless, and in a practical, scientific studies have now demonstrated the efficacy of early treatment using educational methods behavioral (ABA), cognitive (TEACCH) or developmental. The scientific literature is unanimous on this point: we need the intervention is early, massive and structured.
Guides to good practices exist: a French guide to 1996 (but the results of an ‘Autism Plan 2008-2010’ are expected), a guide to the Spanish Ministry of Health newest, SIGN for Scotland in 2007 or guide the State of New York. All references to converge and what is expressed in France in 2008 (CCNE)
Beyond childhood, monitoring lines are proposed by the report of Autism Europe 2009: ‘The treatment plan’ adult ‘should focus on: