B.MilletJ.-M.VanelleJ.BenyayaPrescrire les psychotropes1994Elsevier-Masson, collection Abrégés de médecine448 pp.

Abstract

Dans la catégorie des troubles envahissants du développement sans déficience intellectuelle, le trouble des interactions sociales apparaît comme la principale source de handicap de l’enfance à l’âge adulte. Les propositions d’interventions dans cette catégorie sont à ce jour peu nombreuses en France et souvent non validées. Dans ce contexte, nous avons mis au point une prise en charge pro-sociale de groupe innovante basée sur l’analyse de séquences vidéo. Le choix de ce support nous semble très adapté à notre population. En effet, les connaissances théoriques concernant le fonctionnement intellectuel des sujets avec autisme soulignent leurs compétences d’analyse et de raisonnement à partir d’un support visuel. De plus, la vidéo constitue fréquemment un centre d’intérêt pour ces sujets. Cette prise en charge est proposée depuis quelques années au sein de notre service et depuis peu dans d’autres lieux de soins pour enfants et adolescents avec autisme. L’analyse qualitative suggère une progression des sujets dans leurs aptitudes conversationnelles ainsi que dans leur adaptation sociale. Nous souhaitons à présent objectiver nos constatations cliniques par une étude évaluant l’impact de notre prise en charge sur les habiletés de communication et le comportement socio-adaptatif.The category of pervasive developmental disorders (PDD) without intellectual disability (including Asperger syndrome and high-functioning autism) has increased steadily among individuals since the 1980s. Although some symptoms may decrease with age, functional disability persists and is largely related to abnormalities in social interaction. Within the framework of PDD without intellectual disability, improving social skills appears to be a primary target for intervention programs. Despite a recent increase in the number of studies on this topic, few validated programs are yet available for clinical settings.We have developed an intervention targeting the improvement of social skills from the analysis of video sequences. The goal of this intervention is to promote communication within the group through sharing their interests and emotions, and to enhance the understanding of social situations. In order to assess the efficiency of this intervention, we have conducted a prospective, open, and uncontrolled study. First, it aimed at assessing the immediate effect of our intervention on a single social skill (communication) in an experimental situation (in the group) and in an ecological situations (family and school). Second, this study aimed at assessing the effects of this intervention on the subjects’ social adjustment.This study included 16 individuals with high-functioning autism/Asperger syndrome. Participants were evaluated before and after a 6-month video-based training using measures of socio-communicative and adaptive skills.Results revealed a statistically significant increase in the communication skills not only in the group (15.5%), but also at home (13.7%) and at school (8.7%). The evaluation of socio-adaptive behavior indicates a statistically significant increase in communication (12%), family (7%) and social autonomy (8%), and leisure activities (8%).The communication and social adjustment scores obtained upon inclusion were low, despite low autistic intensity scores. However, the improvement at six months was significant for most studied variables. These results are consistent with our clinical findings and seem partly explained by the use of video supports as the mediator of exchanges within the group. However, because of some methodological limitations, the conclusions on the effects of the intervention should be nuanced.This type of intervention seems to be an interesting therapeutic indication for individuals with high-functioning autism/Asperger syndrome. The first results are encouraging, and all participants enjoyed attending the meetings. These conclusion elements encourage us to continue this intervention and to pursue further research by studying the impact on the individuals’ quality of life.