Évaluation de la prise en charge institutionnelle d’enfants atteints d’un trouble envahissant du développement

Objective. – Starting from a review of the basic principles for the treatment of autism according to Lacanian psychoanalysis, we present a prospective study of the evolution of 24 children with pervasive developmental disorder who received institutional therapy oriented by Lacanian psychoanalysis. The efficacy of this therapy was evaluated on scales assessing socialization, communication, autonomy, motor functioning and intellec- tual and developmental quotients. Then, to describe the therapeutic process, to specify the prerequisites and to assess the beneficial effects, the study is completed by a clinical case. Method. – Twenty-four children took part in our study. All received a diagnosis of infantile autism (n = 14) or atypical autism (n = 10). Their mean age was 7 years and 5 months. Standardized evaluations were carried out using the Vineland Social Maturity Scale (for socio-adaptive behaviours) and the Harvey and Columbia scales (intelligence and developmental quotients), at two distinct moments: at admission and after 2 years of treatment. Results. – The results attest a statistically significant progression in all socio-adaptive domains on the Vine- land scale (communication, autonomy, motor functioning and socialization). A statistically significant improvement in the developmental quotient was also observed for the 11 children who were evaluated both at admission and after two years of treatment. The clinical study shows that by respecting certain preconditions, it is possible for clinicians to form a partnership with the child with autism and to provide support enabling a subjective dynamic to develop. This helps the child with autism to tolerate the introduc- tion of small changes in the repetitive and rigid constructions she or he adheres to. This openness to change makes it possible to widen and complexify the circuits established around the objects to which the child is attached. Discussion.–Evaluating the efficacy of a treatment on the basis of statistical criteria is not the same as making an evaluation using clinical criteria. Our statistical evaluation made it clear that significant changes could be observed in all the domains assessed on standardised scales. Our clinical study, in turn, enabled the question of the subject to be addressed. In this way, it is possible to observe speci- fic elements around which a child has constructed his own solutions, and has been able to open up to others.

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