Approches psychothérapiques de l'autisme. Résultats préliminaires à partir de 50études intensives de cas

Background: Since the 2000s, the evaluative psychotherapy research has refocused on the questions "Why, how and under what conditions psychotherapy works?". These objectives involve giving prominence to pragmatic naturalistic case studies and practice research networks to achieve them. This article presents the first results of a multicenter longitudinal process-outcome study, during one year, of individual psychotherapies conducted under natural conditions with children with autism, in the context of the Inserm Psychotherapy Practice-Based Research Network. Methods: The general methodology is the intensive study of individual cases meeting the criteria for evidence of the American Psychological Association. The indicators include the one hand symptoms, the process of development and mental functioning and secondly the therapeutic action from the main characteristics of the patient, the therapist and their interactions during therapy. The analysis combines and connects the study of each case, the cases together and comparing similar cases. This article focuses on the results from the 50first aggregated cases (25psychotherapies of children under the age of 6. years and 25aged 7-15. years). Results: Analysis of aggregated cases show significant changes in the reduction of behavioural disorders (effect size. =. 2.1; P<. 0.0001), development (effect size. =. 1.2; P<. 0.0001), emotional experience and relationships to the world and others. The psychotherapeutic process is characterized by a generally active and animated child, and a responsive and sensitive therapist, adjusting to the child, encouraging him to express himself verbally, supporting its attempts to language, while having a great capacity for tolerance with emotions and violent impulses of the child and keeping him in countenance. This description leads to the hypothesis of 4main causes that may explain the evolution of children: the therapeutic setting, the adjustment of therapist to the child, his/her tolerance opening the possibility of affects' expression, and the parallel work of verbalization/symbolization. Conclusions: Our results support the notion that psychotherapy conducted under natural conditions by experienced and trained in the specificity of autism practitioners, is associated with significant changes. The results also suggest that underlining mechanisms might be favourable conditions for the initiatives of the child, expression and mutual understanding as a basis for enhancement of communication and language, and structuration of the Self. The limitations of these preliminary results are discussed and targets for reducing presented.