Journal 16/22

1.The three little pigs

In our clinical practice of 242 patients (active file as of January 1, 2022,) we have 28 patients followed in our practice (11.6%) with Asperger's syndrome and we have evaluated until 2016 about 50 patients with this diagnosis. Often we noted in these patients symptoms of obsessive disorders, major compulsive disorders (OCD) and attention deficit disorder with or without hyperactivity (ADHD). In several patients who came to us for consultation, the presence of this symptomatological triad of Asperger's, ADHD and OCD was striking.

To make our speech easily understandable with the help of a well-known image, we let's talk about the «three little pigs»: the three little pigs being Asperger's syndrome, ADHD and OCD which, according to our experience, with a different priority depending on the case, are nevertheless always present at the same time. To avoid overly long formulations, we define the person with the Triple Diagnosis as a PTD person. The expression «the three little pigs» comes from the fact that the three little pigs are always together. It is easy to understand for patients as well as for colleagues that the three little pigs Asperger's Syndrome ADHD and TOC which, we have to recognize, are always present together.

3. Representations of professionals and parents about social inclusion of adults with intellectual disability according to an ecological approach

Despite literature and political framework about social inclusion of people with intellectual disabilities (ID), knowledge of social inclusion and concrete resources to deploy inclusive practices are still unclear and uncertain for professional and parents. The implementation of effective inclusive practices requires the development of an ecological approach. In this context, one reference model exists (Simplican et al., 2015) and develops different ecological pathways, through individual, interpersonal, organizational, community and socio-political, influencing social inclusion of people with ID. The present study aims to question knowledge and practices about social inclusion of adults with ID. To this end, 52 semi-structured interviews were conducted with professionals and parents which were then subjected to a deductive thematic analysis based on ecological factors from the model of Simplican et al. (2015). Results show that in overall, each ecological pathway of the model are considered both by professionals and parents as influencing positively or negatively social inclusion possibilities. By order of importance attributed by both samples, pathways are community, organization, individual, interpersonal and socio-political.

5. From diagnostic errancy to the relief of being among Asperger's

Patients who come to us often have two types of profile. Some have heard about Asperger's syndrome and find themselves in the description found on the Internet, in a book, a report or a testimony. Others are referred by their care network who wonder if this diagnosis might fit.

Patients report long follow-ups while exploring various leads. However, the diagnoses made did not cover all the difficulties or suffering perceived by the patients (Zecca, et al., 2021; Galli Carminati, et al, 2022). In fact, most of our assessment patients are over 30 years old and have a turbulent journey. Many people come to us to find answers to this feeling of weirdness, of being out of step with others and society. As soon as we start the history-taking interview, they can share their thoughts and reflections with a professional who understands what they are experiencing because of our specialization. It is then a mixture of relief, questioning about their newly revealed functioning and sometimes even anxiety that the patients can share with us.

Then comes the time of the group, once the discomfort of the novelty is overcome, there is a fluidity of sharing with peers who think or function like them, and with whom it is easy to express themselves without using thousand words. They can take off the social mask and share their experiences, stop forcing themselves to respect all the social codes to be « normal ». What a relief being among Asperger’s !

7. Complex cases...did you say complex ?

A sociological and historical view

In reality, complexity is everywhere; we live in an increasingly complex world. This is the reality.

Yet knowledge is separated and contingent on disciplines. Knowledge is distributed in watertight compartments.

If, for Aristotle, science was only one great subject, he admitted three great classes of sciences: poetic, practical and speculative. After him, we have few other visions proposed. But since the Lumières, there has been an acceleration of classifications and rankings in all fields.

While this practice can certainly be justified on rational grounds, we can see that it leads to a society of increasingly specialised specialists who are less and less in touch with human reality.

How then can we approach, help and care for these « complex cases », a kind of UFO in a world of carefully compartmentalized specialties ? 

Formation:en criminologie, psychologie des groupes et analyse transgénérationnelle.

Formatrice ASTRAG ASsociation TRavail Groupal thérapeutique et Social.

Expérience croisée des secteurs enseignement, aide à la jeunesse, handicap et santé mentale.

Approche globale et holistique des situations individuelles ou de groupe.

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Language: French